Teaching surgical skills: changes in the wind

surgeon.jpg  This article was published in the December 21 issue of the New England Journal of Medicine. Free full text is available.

Reznick RK, MacRae H. Teaching surgical skills: changes in the wind. N Engl J Med 2006; 355(25):2664-2669.   [editorial commentary]  [videos]

Excerpt: Sir William Halsted introduced a German-style residency training system with an emphasis on graded responsibility at Johns Hopkins Hospital in 1889. This system remains the cornerstone of surgical training in North America more than a century later. However, advances in educational theory, as well as mounting pressures in the clinical environment, have led to questions about the reliance on this approach to teaching technical skills.

Those pressures include a move toward a shorter workweek for residents and an emphasis on operating room efficiency, both of which diminish teaching time. Yet the patients in our teaching hospitals are generally much sicker and have more complex problems than in times past. The increasing complexity of cases and a greater emphasis on mitigating medical error limit a faculty’s latitude in assisting residents with technical procedures.


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