Surgical Education and Training: How Are They Likely to Change? Thomas H Cogbill,
MD, FACS
I have two connections to Samuel Jason Mixter. His great grandson, Chip Mixter, did a rotation at the Denver General Hospital when I was a second-year resident at the University of Colorado. He was a resident at the Mayo Clinic and wanted to get some trauma experience, so he rotated at Colorado and we became good friends. Chip Mixter is currently a plastic surgeon in Milwaukee, Wisconsin. I spoke with him before this talk because I wanted to know more about his family, and he sent me a photograph taken in 1907. The picture shows scrub nurse, Ms Curly on the left and William J Mixter and Charles G. Mixter standing on each side of their father, Samuel Jason Mixter, for whom this talk is named (Fig. 1). William J Mixter became the first Department Chair of Neurosurgery at Massachusetts General Hospital and Charles G Mixter was the head of General Surgery at Beth Israel Hospital. The family has a long history of excellence in surgery. The other connection I have is to the Mixter clamps. The baby Mixter is my favorite clamp and the one I frequently use to take autonomy away from my residents (Fig. 2). Here are my disclosures. I absolutely love general surgery. I would do it again in whatever smallest subdivision of a second there is. These opinions are mine and mine alone. They clearly reflect my experience of 8 years on the American Board of Surgery (ABS). The last disclosure is that I am not a seer; I cannot predict the future. The rationale for this talk is that I was the program director of a small surgery residency for 20 years and that was the activity that I enjoyed most about my practice. Teaching is the closest thing we have to surgical immortality. It goes on beyond us. We teach somebody, they take care of patients. We teach many trainees, they take care of many patients, and maybe they go on to teach other surgeons, and so on. Surgical education is currently at a crossroads and I am worried; who is going to take care of my family and me, and who are we going to leave behind? 30th Annual Samuel Jason Mixter Lecture. Presented at the 95th Annual Meeting of the New England Surgical Society, Stowe, VT, September 2014. Received October 10, 2014; Accepted November 13, 2014. From the Department of General and Vascular Surgery, Gundersen Health System, La Crosse, WI. Correspondence address: Thomas H Cogbill, MD, FACS, Department of General and Vascular Surgery, Gundersen Health System, 1900 South Ave C05-001, La Crosse, WI 54601. email: [email protected]
ª 2015 by the American College of Surgeons Published by Elsevier Inc.
CURRENT STATE OF SURGICAL EDUCATION Surgery residency today has de facto been shortened by about 1 year if you consider the difference in hours.1 Knowledge has really exploded, it has not contracted, and the number of procedures that a resident needs to learn is greater, not fewer. Recent studies of resident operative experience demonstrate stable total operations, increased laparoscopic procedures, a considerable decrease in total open operations, a substantial decrease in the number of emergency operations and cases in which the resident serves as an assistant, including as a teaching assistant. Mark Malangoni and colleagues2 at the ABS reported that the frequency of operations performed a mean of >10 times during residency remains at about 20 cases. Of the essential or common operations listed in the Surgical Council on Resident Education curriculum, 34% were performed a median of
MD, FACS
I have two connections to Samuel Jason Mixter. His great grandson, Chip Mixter, did a rotation at the Denver General Hospital when I was a second-year resident at the University of Colorado. He was a resident at the Mayo Clinic and wanted to get some trauma experience, so he rotated at Colorado and we became good friends. Chip Mixter is currently a plastic surgeon in Milwaukee, Wisconsin. I spoke with him before this talk because I wanted to know more about his family, and he sent me a photograph taken in 1907. The picture shows scrub nurse, Ms Curly on the left and William J Mixter and Charles G. Mixter standing on each side of their father, Samuel Jason Mixter, for whom this talk is named (Fig. 1). William J Mixter became the first Department Chair of Neurosurgery at Massachusetts General Hospital and Charles G Mixter was the head of General Surgery at Beth Israel Hospital. The family has a long history of excellence in surgery. The other connection I have is to the Mixter clamps. The baby Mixter is my favorite clamp and the one I frequently use to take autonomy away from my residents (Fig. 2). Here are my disclosures. I absolutely love general surgery. I would do it again in whatever smallest subdivision of a second there is. These opinions are mine and mine alone. They clearly reflect my experience of 8 years on the American Board of Surgery (ABS). The last disclosure is that I am not a seer; I cannot predict the future. The rationale for this talk is that I was the program director of a small surgery residency for 20 years and that was the activity that I enjoyed most about my practice. Teaching is the closest thing we have to surgical immortality. It goes on beyond us. We teach somebody, they take care of patients. We teach many trainees, they take care of many patients, and maybe they go on to teach other surgeons, and so on. Surgical education is currently at a crossroads and I am worried; who is going to take care of my family and me, and who are we going to leave behind? 30th Annual Samuel Jason Mixter Lecture. Presented at the 95th Annual Meeting of the New England Surgical Society, Stowe, VT, September 2014. Received October 10, 2014; Accepted November 13, 2014. From the Department of General and Vascular Surgery, Gundersen Health System, La Crosse, WI. Correspondence address: Thomas H Cogbill, MD, FACS, Department of General and Vascular Surgery, Gundersen Health System, 1900 South Ave C05-001, La Crosse, WI 54601. email: [email protected]
ª 2015 by the American College of Surgeons Published by Elsevier Inc.
CURRENT STATE OF SURGICAL EDUCATION Surgery residency today has de facto been shortened by about 1 year if you consider the difference in hours.1 Knowledge has really exploded, it has not contracted, and the number of procedures that a resident needs to learn is greater, not fewer. Recent studies of resident operative experience demonstrate stable total operations, increased laparoscopic procedures, a considerable decrease in total open operations, a substantial decrease in the number of emergency operations and cases in which the resident serves as an assistant, including as a teaching assistant. Mark Malangoni and colleagues2 at the ABS reported that the frequency of operations performed a mean of >10 times during residency remains at about 20 cases. Of the essential or common operations listed in the Surgical Council on Resident Education curriculum, 34% were performed a median of
