Changing Surgical Training shouldcouldwould

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Changing Surgical Trainingshould/could/would

• Timothy C. Flynn, MD, FACS

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Should We?

• Declining applicant pool
• Changing demographics
• Excessive workload
• Poor faculty attitude
• Questions about future of general surgery

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Should We?

• Pressure from specialties that have General
  Surgery as a prerequisite
• Concern about length of training cycle
• Financing GME
• Desire to investigate more efficient training
• Re-evaluation of the value of General Surgical
  certification

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Should We?

• Underlying possibility that other surgical
  specialties will adopt schemes like Plastic
  Surgery.
• Further fragmentation of Surgery
• Unpredictable manpower supply
• Unfair pressure on students to early commit

5
Should We?

• Maybe there is a better way
• Current system is rooted in tradition
• Healthcare delivery system has changed
• Technology is compelling and unpredictable
• Educational principles have advanced

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Could We?

• Preserve the integrity of Surgery as a unified
  discipline in the practice of medicine
• Preserve the common training experience of
  surgeons, maintaining and enhancing the core
  curriculum in surgery
• Improve the efficiency of subspecialty training
• Focus the distribution of index cases

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Could We?

• 5. Reinforce a competency-based educational model
  for surgery training
• 6. Facilitate the development of a national
  curriculum
• 7. Explore and promote advances in educational
  technology
• 8. Improve the educational experience for future
  surgeons

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Could We?

• This topic has been discussed for some time
• A number of options have been proposed
• Flexible, early tracking
• Integrated model
• 3/3 program
• 4 years to certification
• Some marginal changes have been implemented

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Could We?

• Proposal
• 4 years of general surgical training with 36-42
  months devoted to primary components
• 4th year that of senior responsibility
• QE at end of 4th year
• All need 5th year to be eligible to take CE, but
  that year could be devoted to specialty

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QE
CE
ABS Certification
Certification
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Would We?

• In addition to the time spent in training and
  certification issues, there is a need to examine
  the whole process of training
• Service vs education
• Faculty training
• National curriculum

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RRC
ABS
APDS
ABMS
ACS
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Should/Could/Would

• The group recognizes the significant implications
  of proposing changes in a system that has served
  the profession and the nation well for many
  years. Others (many) may disagree, but for a
  variety of reasons,the time seem opportune to
  enter in to a substantive discussion of surgical
  training. In the end, surgical training exists to
  provide the citizens of this country with a
  workforce capable of safe, efficient and quality
  health care. Our challenge is to give the young
  men and women who come to us for training the
  skills to provide that care.