Comparison of Plastic Surgery Training Programs Between Hong Kong and Shanghai

The field of plastic surgery has developed rapidly in the last couple of decades in Hong Kong and Shanghai, China. Both cities have their own educational system for training plastic surgeons. Their training programs differ in many ways, including the surgical exposure of undergraduate studies, the structure, curriculum, and operative requirements of residency training. In general, Hong Kong has a single pathway of residency training with more early clinical exposure in an undergraduate study. On the contrary, Shanghai has multiple pathways of residency training that are heavily emphasized in academic research. Both Hong Kong and Shanghai should complement each other to modify their plastic surgery training programs that will eventually benefit the field of plastic surgery education.     

Surgical education and surgical board system from the view point of pediatric surgeons

It is necessary to give priority to training in problem-solving ability regarding pre- and postoperative care during undergraduate education and internship training. We do not need to give priority to instruction in the knowledge of a specialized surgical field before surgical residency. Moreover, education that emphasizes a subspecialty from the early stage of surgical residency does not answer the requirements of society, while training in general surgery is indispensable. Reevaluation from the viewpoints of a number of specialists and regional distribution is requested for the present board system, at least in pediatric surgery. In addition, major issues like the acquisition of corporate status of a related surgical society with specialists' advertising deregulation and the influence of the introduction of required two-year clinical training should be resolved.     

Der "neue" Facharzt für Unfallchirurgie und Orthopädie: Wer profitiert—wer verliert?

As long ago as in 1997 there were demands for the field of trauma surgery, regarded up to then as a focus point within surgery, to be upgraded to the status of a specialty in its own right. About the same time, payers initiated discussions about the borderlines between orthopaedics and surgery/trauma surgery. The commission on future developments made up of specialists representing orthopaedic specialists and trauma surgeons has stressed that its appointment has provided a unique opportunity of merging these specialties. Comparisons with analogous mergers in commerce and biology to check on how legitimate this might be suggest, however, that such a merger will require a complicated and cost-intensive period of transition lasting for some years and that it will be to the detriment of more people than it helps. The revised arrangements for continuing education will lead to the emergence of a new specialist, who may well have a better basic surgical training than has so far been the case for orthopaedic specialists but on the other hand is not competent to treat polytraumatized patients. The best solution would be to include orthopaedics as the ninth subject in the new ordinance on continuing education in operative subjects and to leave trauma surgery as it is—with a basic training in surgical techniques, or perhaps in orthopaedic surgery and a 3-year training in any of the various branches of surgery.     

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.     

Der Weg zum Unfallchirurgen

An increasing lack of young fellowship trainees in operative medicine, particularly in orthopaedics and traumatology and the various options to counteract this problem during the phases until the individual decision for residency and the fellowship program is made, were the focus of part I. The present part concentrates on residency and the fellowship phase including the individual perspectives after successful training. With respect to an attractive and highly qualified training in orthopaedics and traumatology, three essential points are to be made: a timely general framework, the establishment of a clinic-specific management of training and a general evaluation of training in the sense of a benchmarking system. A flexible work schedule including structural entities, such as an in-hospital day care facility for children, a structured and reliable curriculum of training according to a model curriculum to be adapted to the corresponding training unit including options of rotation to other facilities of training and the integration of nationwide education and mentoring programs represent further elements of an attractive training program. Thus the quality of training will become a decisive criterion of selection. The fellowship program for specialized traumatology inevitably leads to limitations of the whole spectrum of the field with an increasing specialization. In the future the contents of fellowship training will need a well-considered adaptation to the clinical needs and realities in the light of the emerging national trauma network program. A wide field of activity will open up to specialists in orthopaedics and traumatology with a focus on special traumatology considering the rapid changing field of hospital and outpatient care. Thus a systematic and creative reorganization of the residency and fellowship phases will overcome any problem of attractiveness.     

Fazit der Nachwuchsumfrage 2007: Weiterbildung verbessern – Zukunftsperspektiven schaffen!

The increasing shortage of surgical residents now also affects the field of cardiothoracic surgery. Relatively few medical students apply for a surgical residency. In order to identify the factors that contribute to the declining attractiveness of our specialty, a current survey was performed among all residents in cardiothoracic surgery in Germany. Compared to the previous surveys demographic data were more or less the same, so were the scientific activities of the participants. The major point of criticism was still the long and unstructured surgical training, despite several changes having already been made. In contrast, the number of surgical procedures per resident have even decreased. Another reason for the declining attractiveness of cardiothoracic surgery was the lack of career perspectives. In order to attract young and talented trainees fundamental improvements are required particularly with regard to surgical training.     

Do medical school surgical rotations influence subspecialty choice?

BACKGROUND: A comprehensive exposure to general surgery is essential for medical students pursuing careers in surgery. Occasionally, students applying for surgical residency positions must choose a subspecialty field prior to starting their residency training. Often, this decision is heavily based on their experience on various surgical clerkships. MATERIALS and METHODS: To determine if surgical clerkships influence subspecialty choice, we surveyed medical students who interviewed for general surgery training over a 2-year period at The Johns Hopkins Hospital. RESULTS: Of 211 surveys sent, 146 were returned (66%). The mean age of the students was 26 +/- 0 years with 21% being female. Students anticipating subspecialization in cardiothoracic, plastic, pediatric, and transplant surgery saw significantly more operations in their respective fields. Similar trends were seen in vascular surgery and surgical oncology. Despite the apparent differences in exposure to subspecialty operations, all students saw equal numbers of hernia repairs and laparoscopic cholecystectomies. CONCLUSIONS: While medical students pursuing careers in surgery have equal exposure to general surgery, their anticipated subspecialty field highly correlated with their operative exposure to that field. Thus, medical school surgical rotations appear to highly influence subspecialty choice.     

Adequacy of education in musculoskeletal medicine

BACKGROUND: Basic musculoskeletal knowledge is essential to the practice of medicine. A validated musculoskeletal cognitive examination was given to medical students, residents, and staff physicians in multiple disciplines of medicine to assess the adequacy of their musculoskeletal medicine training. METHODS: The examination was given to 334 volunteers consisting of medical students, residents, and staff physicians. Analysis of the data collected and comparisons across disciplines were performed. RESULTS: The average cognitive examination score was 57%. Sixty-nine participants (21%) obtained a score of >/=73.1%, the recommended mean passing score. Of the sixty-nine with a passing score, forty (58%) were orthopaedic residents and staff physicians with an overall average score of 94%. Differences in the average scores for the orthopaedic residents compared with all other specialties were significant (p < 0.001). The average score was 69% for the 124 participants who stated that they had taken a required or an elective course in orthopaedics during their training compared with an average score of 50% for the 210 who had not taken an orthopaedic course (p < 0.001). When the scores of those in orthopaedics were excluded, the average score for the participants who had taken an orthopaedic course was 59%; this difference remained significant (p < 0.001). CONCLUSIONS: Seventy-nine percent of the participants failed the basic musculoskeletal cognitive examination. This suggests that training in musculoskeletal medicine is inadequate in both medical school and nonorthopaedic residency training programs. Among the nonorthopaedists, scores were significantly better if they had taken a medical school course or residency rotation in orthopaedics, suggesting that a rotation in orthopaedics would improve the general level of musculoskeletal knowledge.     

The good ol' days is now: trends in operative experience of general surgical residents over 25 years

To define the changing trends in operative experience of general surgery residents, the records of all residents completing our training program from 1964-1987 were reviewed. Except for a slight decline in operative experience in head and neck and gastric surgery, the experience in other primary component procedures either remained stable (major breast, esophagus, intestine, colon, pancreas, spleen and endocrine) or increased (minor breast, anorectal, hernia, biliary, vascular and trauma). A rich experience in secondary component procedures was maintained in thoracic, pediatric and plastic surgery, all of which are services within the department of surgery. A relatively low but stable experience in gynecology, neurosurgery, orthopaedics and urology has been reported, which did not change when these disciplines became separate departments. Finally, there has been a dramatic increase in endoscopic procedures performed in the surgery department despite the presence of endoscopic services in other departments. It is believed that such an institutional review of surgical resident caseload over time will be of help not only to program directors but also to accrediting and certifying organizations concerned with surgical training programs and their graduates.     

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.     

MD-PhD students in a major training program show strong interest in becoming surgeon-scientists

A wide spectrum of individuals have discussed the importance of promoting research in orthopaedics and of developing clinician-scientists (physicians who also do significant research) in the field. Although orthopaedic research may benefit from recruitment of MD-PhD students as clinician-scientists, it is unclear to what extent MD-PhD students are interested in pursuing research and surgical specialties concurrently. To better understand their professional goals, all MD-PhD students enrolled in our institution's training program were invited to complete an online questionnaire concerning training satisfaction and future career goals. Twenty-four percent of respondents (57.5% response rate of 167 recruits) reported a primary clinical interest in a surgical field (3% interest in orthopaedics); interest was strongest late in training. The majority of surgical MD-PhD students, like nonsurgical students, were planning to make research a significant part of their careers. In addition, students identified the importance of factors such as family issues and faculty role models in determining their clinical interests. The study data indicate that MD-PhD students have strong interests in becoming surgical clinician-scientists. They also suggested that active recruitment (especially early in training) that is responsive to the personal and professional needs of students has the potential to increase the number of clinician-scientists in orthopaedics.     

Trauma/critical care surgery

The specialty of trauma/critical care is relatively new and is currently in a state of evolution as we now face not only a shortage of surgeons but also an alarmingly increasing number of well-trained surgeons who are unwilling to provide emergency care. Regionalization of both trauma and emergency surgical care nationwide is on the horizon and will require major changes in our surgical training programs. However, careers in trauma/critical care and emergency surgery can offer a controlled lifestyle, challenging cases that cross over many disciplines, and a rich field for scientific investigation.     

Altering the career choice: Can we attract more women to vascular surgery?

Vascular surgery has relied upon the pool of general surgical residents for candidates for residency. This has significantly limited the pool of applicants. With the advent of new primary certificate training paradigms, we investigated factors that might alter the career choices for women medical students. A Web-based survey was conducted of third-year and fourth-year medical students at three university-affiliated programs. A total of 140 students completed the survey, which identified the third year of medical school as the primary year when students committed to a final career choice. Lifestyle issues were the primary deterrents, with long work hours and lack of time to see family negatively influencing students' interest in surgery. Eliminating the need for 5 years of general surgery and the opportunity for part-time training were cited as factors that would alter students' decisions to pursue vascular surgery. Ultimately, a positive rotation experience, lifestyle issues, and mentors impacted on final career decisions. To attract the best applicants to the field, we need to continue to be active in mentoring students and exploring alternative training paths and eventual career practices.     

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.     

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.     

Factors affecting choice of surgical residency training program

BACKGROUND: A significant problem facing American surgery today is the lack of participation from women and minorities. In 1995 and 1996, 15.1 and 15.8% of United States general surgical residency graduates were women. Of our 71 graduates in the last 12 years, 38% were women. The aim of this study was to identify the factors influencing our residents' choice of training program and the reasons why our program has a high percentage of female graduates. METHODS: Between 1989 and 2000, 27 women and 44 men completed general surgical training at our university and 44/71 (59%) responded to our survey. The age at residency completion was 34 +/- 2.2 years for men and 33.9 +/- 2.8 years for women. Fifty-five percent of men and 30% of women went on to fellowship training; and 36% of men and 20% of women are in academia. RESULTS: Factors influencing our graduates' selection of training program are: Only 23% of men had a female faculty as their mentor, whereas 90% of women had a male faculty as their mentor during training. Only 59% of men but 80% of women (P < 0.05) agreed that female medical students need role models of successful female faculty members. Fifty-five percent of men and 45% of women would encourage a female medical student to choose surgery as a career, but 82% of men and 50% of women would encourage a male medical student to do so. Ninety-one percent of men and 85% of women would choose surgery as a career again. CONCLUSIONS: A surgical residency training program with strong leadership, good clinical experience, and high resident morale will equally attract both genders. Women may pay more attention to the program's gender mix and geographic location.     

Entwicklung der Thoraxchirurgie in den nächsten 20 Jahren

Thoracic surgery is one of the self-contained surgical disciplines with an above average large potential over the next 20 years. An increase in mortality due to pulmonary diseases is to be expected worldwide. Bronchial carcinoma is the most common diagnosis in thoracic surgery patients and will remain a relevant topic for health politics for many years. However, the adequate treatment of these patients demands a high degree of interdisciplinary cooperation. In the future thoracic surgery will therefore be carried out in centres with an organ-dependent and interdisciplinary structure. From a surgical technical perspective minimally invasive operation strategies will become established for standard interventions, which are indispensible components of the repertoire for thoracic surgery. Thoracic surgery is traditionally a clinically oriented discipline with low academic superstructure and a high backlog demand in nearly all areas of research. It offers a large field of activity for the next scientifically interested generation with excellent chances to become established and succeed in this discipline with a very promising future.     

Qualit?t und Objektivierbarkeit der Aus- und Weiterbildung in der Urologie

The attraction to study medicine has not changed, however we are facing a lack of trainees especially in surgical subspecialties like urology. Possible explanations are a 70% proportion of female students and different views on the work-life balance in the future. A high burden of theory and unrealistic multiple choice examinations support those who can learn but there are no objective and reproducible criteria to recognize the competence of a good physician early in the career. This problem continues during residency, especially in surgical subspecialities. The different medical boards in Germany responsible for the training programs have no concepts. Many attempts in other countries to objectively measure surgical skills have so far been ignored. If we do not want to lose our traditionally high competence in medicine we should join those who attempt to improve teaching and to use methods for selecting suitable candidates for surgery as soon and as objectively as possible.     

Medical students' view on thoracic surgery residency programs in a Japanese medical school

There has been a decline in the number of medical students applying for thoracic surgery training programs. We obtained knowledge of medical students' views on thoracic surgery residency programs. After completion of thoracic surgery clerkship, 17 students were asked to fill out questionnaires on first-year thoracic surgery residency programs. The majority of students considered thoracic surgery to be held in high regard by the general public, and felt that the salary was sufficient. However, only one student chose a thoracic surgery training program. The main reason for not applying for thoracic surgery residency was lifestyle issues. The factors in determining career choice included quality of education and work hours. Medical students are likely to select specialties other than thoracic surgery. Since the main factor influencing medical students' career is the quality of education in a residency program, efforts should be made to improve the quality of education.     

Allgemeinchirurgie in der Diskussion

The need for a general surgical cover, with a high quality standard, following economic principles and offered 24 hours in all regions of Switzerland is not doubted. The title of a "General and Trauma Surgeon" is an additional qualification certified after further successful 4 years post-qualification training following the 6 years specialist title of surgery ('common trunk'). The main field of work encompasses primary emergency surgery as well as 'surgery of the common pathologies' in visceral, vascular, thoracic and partly hand surgery. Due to political reasons the additional qualification in surgical traumatology was completely and exclusively integrated in this sub-speciality title.The post-graduate training to gain the title of a "General and Trauma Surgeon" is mostly completed within 8-10 years and results in the full surgical competence in the above named fields. A major problem is the lack of academic representation of general surgery in the university hospitals resulting in a neglect and increasing difficulties of academic training in this field. Furthermore, there are some recurrent controversies concerning limitations of general surgery in the face of other subspecialities or specialities (e.g. orthopaedics). However, the most important and urgent problem is the lack of the possibility to gain an acknowledged and separate (from general surgery) certification in surgical traumatology, competitive to the specification in orthopaedics.There is no doubt, that, at least in the mid term, there is still a need for general surgeons. At the present moment, the future and the further development of the traumatologist's training under the roof of surgery, at university and regional level is insufficient and is at risk. Therefore, there is an urgent need to address this matter and the Swiss Society of Surgery is taking care of this with priority.