Review Article

Surgical Competence Today: What Have We Gained? What Have We Lost?

Authors: David W. Page, MD, FACS

Abstract

The complexity of modern surgical practice and the cognitive and technical overload to which trainees are subjected places practitioners and residents alike in jeopardy of developing areas of incompetence. Inadequate exposure to essential operations during residency forces trainees to seek further expertise in fellowships. At the same time, practice burdens increase stress levels on academic and community surgeons, resulting in a 30 to 40% burnout rate. Solutions include modification of restricted duty hours for residents and the institution of a simulation-based national surgical curriculum.

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References

1. Bell RH Jr, Biester TW, Tabuenca A, et al. Operative experience of residents in us general surgery programs: a gap between expectation and experience. Ann Surg 2009;249:719–724.
 
2. Ritchie WP, Rhodes RS, Biester TW. Work loads and practice patterns of general surgeons in the United States, 1995–1997: a report from the American Board of Surgery. Ann Surg 1999;230:533–543.
 
3. Lynge DC, Larson EH, Thompson MJ, et al. A longitudinal analysis of the general surgery workforce in the United States, 1981–2005. Arch Surg 2008;143:345–350.
 
4. Williams TE Jr, Satiani B, Ellison EC. The Coming Shortage of Surgeons: Why They Are Disappearing and What That Means for Our Health. Santa Barbara, California, Praeger, 2009.
 
 
5. Griffen WO Jr, Schwartz RW. Controllable lifestyle as a factor in choosing a medical career. Am J Surg 1990;159:189–190.
 
6. Green A, Duthie HL, Young HL, et al. Stress in surgeons. Br J Surg 1990;77:1154–1158.
 
7. Balch CM, Freischlag JA, Shanafelt TD. Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences. Arch Surg 2009;144:371–376.
 
8. Golub JS, Weiss PS, Ramesh AK, et al. Burnout in residents of otolaryngology-head and neck surgery: a national inquiry into the health of residency training. Acad Med 2007;82:596–601.
 
9. Campbell DA Jr, Sonnad SS, Eckhauser FE, et al. Burnout among American surgeons. Surgery 2001;130:696–705.
 
10. Miller G. The Problem of Burnout in Surgery. New York, General Surgery News, 2009, pp 20–23.
 
 
11. Debas HT. Surgery: a noble profession in a changing world. Ann Surg 2002;236:263–269.
 
12. Bell RH Jr. Why Johnny cannot operate. Surgery 2009;146:533–542.
 
13. Everett CB, Helmer SD, Osland JS, et al. General surgery resident attrition and the 80-hour workweek. Am J Surg 2007;194:751–757.
 
14. Neumayer l, Giobbie-Hurder A, Jonasson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 2004;350:1819–1827.
 
15. Archer SB, Brown DW, Smith CD, et al. Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg 2001;234:549–558.
 
16. Ericsson KA, Krampe RT, Tesch-Romer C. The role of deliberate practice in the acquisition of expert performance. Psych Rev 1993;100:363–406.
 
 
17. Pugh CM, DaRosa DA, Glenn D, et al. A comparison of faculty and resident perception of resident learning needs in the operating room. J Surg Educ 2007;64:250–255.
 
 
18. Van Sickle KR, Ritter EM, Smith CD. The pretrained novice: using simulation-based training to improve learning in the operating room. Surg Innov 2006;13:198–204.