Minimally invasive surgery

Minimally invasive surgery (MIS), or laparoscopic surgery, plays a vital role in residency training in a number of surgical disciplines including general surgery, surgical oncology, colorectal surgery, pediatric surgery, and thoracic surgery. The tremendous patient demand for MIS over the past 2 decades has resulted in surgeons rapidly embracing this technique. Many general surgery residencies cover basic laparoscopy within their residency program; however, the experience with more advanced cases is more variable. This career resource guides the interested medical student and physician to opportunities for fellowship training in MIS. It includes a discussion of the specialty, training requirements, grant funding, research fellowships, and pertinent societies.     

Postgraduate education in surgery]

During the past 100 years, specialization and differentiation in medicine have developed rapidly. As a field of culture, medical science has progressively been deprived of the philosophical and ethical elements that are the most important part of the practice of medicine. New technology has improved surgical techniques for curing diseases but often the patient as a whole human being has been lost sight. Before imparting super-specialized knowledge and techniques to postgraduate medical students, a global standard of primary care, understanding, and sympathy for the patient must be provided. No super-specialty that does not also fulfill the minimum requirements for general, fundamental medical and surgical knowledge and techniques will be accepted and respected by the majority of people. So-called straight residency training in super-specialties starting immediately after medical school must cease. A residency program of several years including primary-care training for general surgery is mandatory to educate well-balanced "surgical specialists." Such a curriculum must be developed and constantly revised in response to social needs.     

Surgical Education and Postgraduate Training in Japan

Japanese students must pass very competitive entrance examinations to enter medical school after graduating from high school at the relatively young age of 18. There are currently 80 medical schools in Japan, with approximately 7700 students graduating annually. Since 2004, after passing the National Medical Board Examination, all medical graduates are required to complete a 2-year period of clinical training to become medical practitioners. Surgical residency starts only at the third postgraduate year. The Japan Surgical Society initiated a new surgical board certification system in 2002, defining minimum requirements to qualify for the specialty. Four subspecialties are recognized along with general surgery: gastroenterological surgery, cardiovascular surgery, thoracic surgery, and pediatric surgery. General surgery board certification is a prerequisite for subspecialty board certification. Notwithstanding these revisions, the number of surgery candidates is steadily declining because work conditions in the surgical profession are viewed as unfavorable. To regain some level of the previous attractiveness and glory of this specialty, surgeons need to receive significant incentives that counteract some of the downsides of the life of a surgeon.     

The general surgery residency at Ochsner Clinic Foundation: training the 'surgeon's surgeon'

The general surgery residency at Ochsner is, to some extent, a hybrid, combining the amenities and resources of an excellent private hospital/clinic with the academic tone of a university program. Our primary mission is to educate and train outstanding young surgeons who are ready to either enter clinical practice or undertake advanced fellowship training. Although our mission is not primarily to train full-time academic surgeons, our alumni include a number of distinguished academic surgeons. The passage from medical student to accomplished surgeon is exciting, and the camaraderie that a surgical resident establishes with his/her peers and faculty lasts for a lifetime. As surgical educators, we are privileged to spend a major part of our lives with a talented, bright and passionate group of young physicians who have set their sights on entering what I believe to be the world's greatest profession: general surgery.     

Women in surgical residency training programs

BACKGROUND: Increasing numbers of women are entering surgical fields. The purpose of this study was to assess whether orthopaedic surgery is significantly different from other surgical fields in the recruitment of women to training programs. METHODS: We analyzed data from the American Association of Medical Colleges as reported in annual issues on medical education in the Journal of the American Medical Association for the years 1970 to 2001, excluding 1975. Using linear regression models, we analyzed two factors: changes in the percentage of women within orthopaedic residencies (i.e., the ratio of men to women) and changes in the percentage of all female residents who choose to enter orthopaedics compared with other types of surgical residencies. RESULTS: The percentage of women in the entering classes of medical school has increased from 11.1% in 1970 to 47.8% in 2001, while the percentage of women in orthopaedics has increased from 0.6% in 1970 to 9.0% in 2001. Orthopaedic residencies have the lowest percentage of women compared with all other primary surgical specialties. Only thoracic surgery, a field entered secondarily after the completion of general surgical training, has a lower percentage. The increases in the percentage of women in orthopaedics over the past thirty years have been significantly lower than those in every other primary surgical field (including general surgery, obstetrics and gynecology, ophthalmology, otolaryngology, and urology), except neurosurgery, and are markedly different from the percentages of women in the entering classes of medical school. The percentage of all female residents who choose an orthopaedic residency is 0.6%, a number that has not changed over the past twenty years. CONCLUSIONS: Orthopaedic surgery has not had the same success in recruiting female trainees that other surgical fields have had. Furthermore, there appears to be a leveling of the recruitment rate over the past two decades, indicating that the higher numbers of women entering medicine will not be sufficient to improve gender representation in orthopaedic surgery training.     

The new Japanese board of surgery for general surgery specialists

The postgraduate training and board certification system for general surgery has just reached a new era with the upgrading from the previous system for registered surgeons. The new system consists of first-step training of a minimum of 5 years (initially 4 years or more) covering general surgery, emergency medicine, and basic knowledge of subspecialties. The subspecialties programs are optional but combined as the second step, and 7 years of training including the first step are required. The new system of a general surgical training consists of a residency training program with registered hospitals and a minimum requirement of surgical experience. At this starting point, the Japan Surgical Society should take responsibility for this new training system, together with the related societies of subspecialties, in this new step for the official and adequate public qualification of surgeons.     

The relationship between surgical and its subspecialty boards in Japan

This article deals with a 7-year endeavor to reform the board certification system of the surgical specialty and its subspecialties. The most important lesson learned is that the societies running the board must work not for the societies but for trainees and patients. The new postgraduate surgical training program is an overlapping system composed of a general surgery program of 5 years and optional subspecialty program of 7 years. There are four types of subspecialty program: cardiovascular; respiratory; gastroenterological; and pediatric surgery. The written examination for general surgery is taken 4 years after the start of training. Those who pass it and experience 350 general surgery cases within 5 years are eligible for oral examination by the surgery board. Those who pass the written examination for general surgery and experience a certain number of subspecialty surgeries within 7 years after the start of training are eligible for the oral and/or written examinations for the subspecialty board. The surgical societies are responsible for constantly improving the quality of the surgical training programs and qualification systems so that board-certified surgeons are accepted and treated as true surgical specialists in this country.     

Career pathways of graduates of general surgery residency programs: an analysis of graduates from 1983 to 1990.

BACKGROUND: Approximately 1,000 individuals complete graduate surgical education in general surgery each year. Their subsequent career pathways have not been described but may have relevance to the supply of general surgeons available to provide a broad range of surgical care to the population of the USA. STUDY DESIGN: Data for this study were obtained from the American College of Surgeons's Surgery Resident Masterfile, developed for the annual Longitudinal Study of Surgery Residents, and the American Board of Medical Specialties's Official Directory of Board Certified Medical Specialists. For verification purposes, the American Medical Association's Physician Masterfile and the American Board of Surgery's certified database were searched. Yearly analyses of certified general surgery graduates from 1983 to 1990 were conducted, and rates of certification between US or Canadian medical school graduates and international medical school graduates (IMG) were compared. RESULTS: Ten to 18 years after completion of a residency program in general surgery, 93.6% of graduates had been certified in general surgery or by another American Board of Medical Specialties board. A total of 43.7% of the 8,068 graduates were certified, in addition, in a general surgery-based specialty. Overall, evidence of certification was not available for 6.4% of graduates. The certification rate for US or Canadian graduates was 95.8% of general surgeons and increased for IMG surgeons from 69.4% for 1983 graduates to 94.7% for 1990 graduates. The number of IMGs in general surgery residency programs declined from 19.7% of 1983 graduates to 7.8% of 1990 graduates. The rates of American Board of Surgery certification are 96.1% for male and 93.6% for female US or Canadian graduates; 79.2% of male IMG graduates and 83.7% of female IMG graduates became certified. CONCLUSIONS: Most surgeons who completed a general surgery residency program from 1983 to 1990 are certified and presumably have met high standards for knowledge and experience. More than half of the graduates specialize further.     

The generation gap in modern surgery: a new era in general surgery

General surgery remains one of the most respected residencies available to medical students today. At the same time, the number of medical school graduates applying for general surgery residencies continues to decline. Despite this decline, we still search for those individuals exhibiting qualities shared by general surgeons who excel. Although the field of general surgery is constantly evolving, these qualities remain the same. While intellect and good technical skills are essential, they alone do not ensure success as a surgery resident. Confidence, stamina, tenacity, and patience are imperative. Good leadership, motivational, and decision-making skills are also vital characteristics. Finally, the importance of dedication to patient care cannot be overstated. Because disease, injury, and pain are not scheduled events, general surgery residents regularly spend long hours, day and night, caring for and worrying about their patients. To ensure that we continue to add a sufficient number of general surgery residents each year without lowering our standards, those of us in general surgery must attempt to determine why fewer medical school graduates are applying for general surgery residencies. Then we must find ways in which we can improve the residency programs and, probably more important, emphasize to students the things about this field that led us to devote our lives to its practice.     

�ҹ���ͨ���ҽʦ����ģʽ����ѧ���ٵ����⼰�Բ�

??Problems and strategies faced by training model and education of general surgeon YANG Zhen. Department of Surgery, Tongji Hospital, Tongji Medical College,Huazhong University of Science and Technology,Wuhan430030,China
Abstract At present, chinese general surgery should improve residency and subspecialty residencies training utilized global standards which is consisted of 3 overlapping phases.Fundamentals of surgery curriculum and surgical skills curriculum are an effective way to enhance the students' basic surgical skills and would obtain the global standards for postgraduate medical education. Working-hour restrictions and a heightened awareness of patient safety has changed resident education and training. Specialization and the current practices of general surgeons are a important problem.Postgraduate medical students program should be combined with resident training.Interprofessional education and service learning is a model for the future of health professions education. Simulation-based surgical education and simulator center has completely revolutionized the training process,especially in the laparoscopic and robotic surgery curriculum for resident training. Virtual realicy is the application of the computer aid technique in recent years, which shows its dominant position in medical education. E-learning will play an important role in the near future.     

Is a Broadly Based Surgical Residency Program More Likely to Place Graduates in Rural Practice?

Background There is a shortage of general surgeons practicing in rural America. Rural surgical practices differ from those in urban settings encompassing a broader case mix with a larger percentage of time spent performing abdominal, alimentary, gynecological, genitourinary, and orthopedic procedures. Present graduates of many general surgical residencies do not obtain the range of experience necessary to practice effectively in this environment. We hypothesize that general surgical residents undergoing broadly based training are more likely to practice in a rural location. Methods and Materials We conducted a survey of graduates from the Mary Imogene Bassett Hospital’s (MIBH) broadly based surgical residency program in 2004. Additionally, the surgical resident logs from the Accreditation Council for Graduate Medical Education (ACGME) and the residency program were reviewed for years 2001–2004. Results Of the 56 surveys sent out, 42 (75%) were completed and used in the analysis. A majority of the general surgeons who were raised in a rural environment reported that they are residing and practicing in a rural setting. Graduates of the MIBH residency program, on average, performed more cases as residents in the following subspecialty areas: genitourinary, plastics/hand, gynecology, neurosurgery, and orthopedics than national residency graduates. Conclusions Based on our findings, surgical residents graduating from a broadly based training program appear more likely to practice in a rural setting.     

Medical student mentorship in a university setting as a strategy for a career in surgery

Gender balance in surgery is a respectable and necessary goal. At the University of Louisville (UL) School of Medicine, we have compared percentages of UL medical student applicants to general surgery or surgical subspecialty residency programs, surgical residents, and surgical faculty with the rest of the nation. Although UL has at times paralleled or exceeded the nation in many of these categories, there is room for improvement and the comparison data allow for strategic planning initiatives. To promote gender balance among future generations of surgeons at UL, we recently implemented a mentoring program that pairs medical students with residents and faculty in surgery. We plan to track the success over time and correct any shortcomings of this program. Virginia Commonwealth University's commitment to gender balance in surgery is exemplary. As part of a more comprehensive vision to create a mentorship program for female medical students at the UL School of Medicine, we have recently recruited female surgical residents and faculty, whom we hope will provide the type of inspiration and guidance that will increase the number of women from UL who decide to train in general surgery and the surgical specialties. To understand why women across the nation are not generally at numerical parity in these fields, it is important to consider the length and intensity of the surgical residency programs in the context of the other goals and objectives that a woman might have for her future. This article does not address this broad topic but provides a perspective of how a medical school can evaluate and perhaps intervene to mentor medical students more effectively about the satisfaction derived from a career in surgery. As part of this project, we have evaluated each step of the path through medical school and a surgical residency by comparing data for our students, residency programs, and faculty with national data.     

Effects of a laparoscopic course on student interest in surgical residency.

BACKGROUND: The number of surgical residency applicants has been declining. Early introduction of the discipline of surgery is thought to stimulate early interest in surgical residency. This study investigated the hypothesis that a laparoscopic skills course introduced in preclinical years would stimulate student interest in entering surgical residency. METHODS: Preclinical medical students participated in a laparoscopic skills training course. All students underwent an animate laboratory at the beginning and at the end of the course. Students were divided into 4 separate groups: virtual reality, box trainer, both trainers, and control group. Before and after the course, students were asked their residency interest. First- and second-year medical students participated in the course. RESULTS: Before the course, 56% of the students desired to go into general surgery or a surgical subspecialty. After the course, 49% of the students expressed interest in entering general surgery or a surgical subspecialty. A decrease occurred in students who desired to go into surgical subspecialty residency from 31% to 15% (P = NS), and an increase occurred in students who desired to go into general surgery residency from 25% to 34% (P = NS). No statistically significant difference was seen in the 4 individual training subgroup analyses. CONCLUSIONS: Participation in a laparoscopic skills course does not affect medical student interest in entering surgical residency. A trend was noted in students choosing general surgery over surgical subspecialty training after this course. Surgical educators need to investigate methods to encourage preclinical medical student interest in surgical residencies.     

我国普通外科医师培养模式及教学面临的问题及对策

当前,我国普通外科要以国际标准完善住院医师和专科培训,涵盖医学教育连续统一体的3个阶段。外科基础课程和外科技能课程能有效地提升学生的基本手术技术和能达到全球医学教育最基本要求。医师工作时间的限制和病人安全意识的加强改变了住院医师教育和培训的模式。普通外科医师的专业化与当前的临床实践是重要问题。研究生的教育应与专科医师培训相结合。跨专业教育和学习服务是对未来医疗卫生教育的一种模式。基于虚拟技术的外科培训和模拟中心完全改变了教育的程序,特别是住院医师培训的腹腔镜和机器人外科课程。虚拟现实技术是近年出现的计算机辅助应用技术,在医学教育领域展显优势。电子学习系统将发挥重要作用。     

JATS’ role in a new era

We face a vital turning point in the basic organization of thoracic surgery having a long history of very cooperative relations among three core subgroups—cardiac, general thoracic, and esophageal surgery. The time has come for timely, drastic changes in our mission as a medical professional organization to cope with increasing burdens of quality control and risk management in our practice and in ongoing education including the establishment of reliable residency programs. Because of strong public demands to open up academic data related to quality assessment of institutions and for thoracic surgery specialists, we must make decisions on these issues by exchanging opinions and ideas among members and the Board to decide how to reorganize and restart efforts in a new era. In doing so, we welcome medical graduates and young surgeons to thoracic surgery fields by changing social and medical circumstances surrounding them and our medical profession. As the Director of the Japanese Association for Thoracic Surgery Board, I look forward to the cooperation of all members to make a breakthrough and open an exciting new era for thoracic surgery and surgeons.     

The physician's assistant as resident on surgical service. An example of creative problem solving in surgical manpower

A residency program for physician assistants (PAs) on a surgical service was undertaken to develop health professionals who could serve in a capacity similar to that of junior surgical residents helping to deliver preoperative and postoperative care under the supervision of surgeons and assisting in operations. As the number of approved surgical residencies and the number of individuals available for residency has decreased, a manpower void is occurring in some institutions in providing in-house services to surgical patients. The use of medical or family practice residents or full-time in-house surgeons is not totally satisfactory. A PA with special training in surgical case management and operative assisting meets many needs previously provided by surgical residents. The surgical PA is, indeed, a surgeon extender and seems, from our three-year experience, to be a good solution to this problem of surgical care in community hospitals. This program also provides an educational mission for the institution and the surgical staff.     

JATS’ role in a new era

We face a vital turning point in the basic organization of thoracic surgery having a long history of very cooperative relations among three core subgroups—cardiac, general thoracic, and esophageal surgery. The time has come for timely, drastic changes in our mission as a medical professional organization to cope with increasing burdens of quality control and risk management in our practice and in ongoing education including the establishment of reliable residency programs. Because of strong public demands to open up academic data related to quality assessment of institutions and for thoracic surgery specialists, we must make decisions on these issues by exchanging opinions and ideas among members and the Board to decide how to reorganize and restart efforts in a new era. In doing so, we welcome medical graduates and young surgeons to thoracic surgery fields by changing social and medical circumstances surrounding them and our medical profession. As the Director of the Japanese Association for Thoracic Surgery Board, I look forward to the cooperation of all members to make a breakthrough and open an exciting new era for thoracic surgery and surgeons.     

Vascular surgical training of general and vascular surgery residents

Objective: The opinions of general surgery program directors (SPDs) and vascular surgery program directors (VPDs) regarding vascular surgery training of general surgery residents and the construct of the vascular surgery residency were compared.Methods: Questionnaires were mailed to 55 VPDs and 290 SPDs in 1987 and 1988, and to 80 VPDs and 277 SPDs in 1995. Both questionnaires included questions regarding attitudes about vascular surgical competence, operative experience, future vascular practice opportunities of general surgery residents, and the impact of a vascular surgery residency on general surgery resident education. In addition, the 1995 survey included questions regarding the duration, content, and prerequisite versus requisite experience for the vascular surgery residency.Results: Significant differences in opinions between SPDs and VPDs persisted regarding vascular surgery training of general surgery residents. SPDs were more likely to feel that general surgery graduates are fully competent in vascular surgery, should be exposed to more complex vascular surgery during training, and should be granted unlimited vascular surgical privileges on entering practice. Most VPDs felt that general surgery graduates lack competence in vascular surgery, should be exposed to less complex vascular surgery during training, and should have limited vascular surgery privileges in practice. Both groups of program directors agreed about the construct of vascular surgery residencies and that such residencies have had a favorable impact on general surgery resident education. Both SPDs and VPDs were willing to consider creative restructuring of vascular surgery residencies to accommodate governmental restrictions on funding of graduate medical education.Conclusions: External pressures forcing residency reform may provide an opportunity for SPDs and VPDs to creatively work with regulatory bodies to resolve differences in expectations of vascular surgery education and practice. (J Vasc Surg 1996;24;1057-63.)     

When surgeons decide to become surgeons: new opportunities for surgical education

Background

When surgeons decide to become surgeons has important implications. If the decision is made prior to or early in medical school, surgical education can be more focused on surgical diseases and resident skills.

Methods

To determine when surgeons – compared with their nonsurgical colleagues – decide on their medical path, residents in surgery, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, and emergency medicine were surveyed. Timing of residency choice, demographic data, personal goals, and reason for residency choice were queried.

Results

A total of 234 residents responded (53 surgical residents). Sixty-two percent of surgeons reported that they were “fairly certain” of surgery before medical school, 13% decided during their preclinical years, and 25% decided during their clerkship years. This compares with an aggregate 40%, 7%, and 54%, respectively, for the other 5 residency specialties. These differences were statistically significant (P = .001). When the 234 residents were asked about their primary motivation for choosing their field, 51% pointed to expected job satisfaction and 44% to intellectual curiosity, and only 3% mentioned lifestyle, prestige, or income.

Conclusions

General surgery residents decide on surgery earlier than residents in other programs. This may be advantageous, resulting in fast-tracking of these medical students in acquiring surgical knowledge, undertaking surgical research, and early identification for surgical residency programs. Surgical training in the era of the 80-hour work week could be enhanced if medical students bring much deeper knowledge of surgery to their first day of residency.     

Surgical Education in Brazil

Background

The surgical residency was implemented in Brazil in 1944. Gradually, several programs were created under the auspices of the National Committee of Medical Residency (Comissão Nacional de Residência). A candidate for a residency program is submitted to a selection process in various institutions. One of the greatest obstacles to medical education in Brazil is that the number of graduate students is much larger than the number of available vacancies. As a consequence, they end up looking for other alternatives to their professional training, and these cannot offer the same results as a formal residency. Regarding the current residency program in surgery, Brazil has roughly 200 general surgery programs, which offer 1,040 vacancies yearly.

Method and results

The surgical residency program lasts 2 years with rotation in various surgical specialties, which is a requirement for the following years in specific specialties. The 1,040 who are enrolled in the first 2 years of a residency in surgery take a new examination to continue their training. Here, there are only 573 vacancies; therefore, 45% of the newly trained surgeons start a practice or become apprentices. The 573 residents who move on to further education then pass 2 years in basic general surgery at an institution and continue in the same or are transferred to another department. The next training period should be 2 or 3 years, depending on the specialty. The General Surgery program lasts 4 years: two initial basic years and two more years of training in elective, emergency, and trauma surgery and intensive care. The objective is to become competent in the diagnosis and treatment of the most common diseases that affect the community.

Conclusions

Medical entities in specialties have their own selection process to grant the title of specialist. The Brazilian College of Surgeons (Colégio Brasileiro de Cirurgiões) is responsible for granting the title “general surgeon,” following the model of the American Board of Surgery.