During Monday’s Charles G. Drake History of Surgery Lecture, The Shifting Sands of Surgical Education, John R. Potts, MD, FACS, will discuss present challenges and future considerations in the evolving landscape of surgical training.
“The system of education has really undergone some rapid evolution to get to the point where we are right now. We’re in the midst of some significant innovations, and different paradigms of educating surgical residents are being tested,” said Dr. Potts, senior vice-president of surgical accreditation, the Accreditation Council for Graduate Medical Education (ACGME), Chicago, IL.
One concept that is gathering steam is competency-based residency education, an approach that focuses on learner performance (learning outcomes) in reaching specific goals and objectives of the program curriculum. The curriculum is based on the ACGME’s six core competencies for residency training: medical knowledge, patient care, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal and communication skills.
“Competency-based residency education is very much a buzzword now in a number of circles,” Dr. Potts said. “It’s a great hypothetical construct and there are a number of initiatives under way that are trying to move the needle in that direction. But there are significant challenges for any program or any specialty to really achieve competency-based residency education.”
Other challenges facing medical education in general, and surgical training programs in particular, include the ongoing consolidation of hospital systems and other health care organizations and the uncertainty of future funding for graduate medical education programs. Dr. Potts said both issues are likely to have a significant impact on the number of training programs and the number of fellow and resident slots available.
“Right now, we’re dependent on Medicare for about 80 percent of the funding for graduate medical education,” Dr. Potts said. “What happens if that funding decreases or goes away completely? It’s been at risk for a long time, and while Congress circles around it every couple years or so, it’s something that really needs to be settled.”
Dr. Potts will also discuss trends in physician employment and workforce issues, as well as changes in surgical trainee demographics that have influenced the way surgery is taught and learned.
“Simulation technology, for example, is something that many see as a boon to medical education, and I predict that it will play a growing role in training the next generation of surgeons,” Dr. Potts said. “I believe that simulation is a good thing, to a point, but it can’t be a substitute for actual clinical situations. And, frankly, simulation technology is pretty expensive and out of the reach of a lot of training programs.”
While there are significant challenges and more on the horizon, Dr. Potts is optimistic about the future of surgical training because of two constants—the joy of teaching surgery and the joy of learning surgery.
“Against a backdrop of accelerating change and increasing challenges, we must never forget the importance of maintaining the professionalism of surgery, the joy of practicing surgery, the joy of teaching surgery, and—as an outgrowth of that—instilling the joy of learning surgery in our residents,” he said. “Things are changing—they always have and they always will. But we mustn’t lose sight of those core values.”
The Charles R. Drake History of Surgery Lecture is sponsored by the Advisory Council for Neurological Surgery. The lecture was established in 1992 to explore the historical development of surgery and to honor Dr. Drake, a leader in neurosurgery.