We need to start a revolution in surgical education

A few months ago I read an essay by Dr. Herbert Fred of Houston, Texas. After reading his essay, “Medical Education on the Brink,” I was inspired to start a revolution in surgical education.

His essay ends with the following recommendation:

“…raise the bar of performance in all training programs to a distinctly higher level, with excellence as the perpetual goal.”

As the Fourth of July approached, I began to view his remarks as a call to arms for a revival of classic medical education.

Coming from Massachusetts, I felt that I could take some liberties in re-writing the original call to arms document – the Declaration of Independence.

I decided to rewrite it after reviewing Medical Education on the Brink as well as several articles bemoaning the increasing board failure rates in internal medicine, surgery and thoracic surgery.

To their credit, influential members of the American College of Surgeons reviewed the current state of surgical education and revealed that the exam failure rate had increased to almost 30 %.

Their assessment was:

1.”This is a scary situation.”

2. “We have a problem. I maintain that we have to stop being bullied by naive, public, politically driven agendas and by some of our own graybeard pundits – and I think we all know who those groups are – and once again take over the control of educating our successors.”

3. “During the past decade the failure rate on the American Board of Surgery’s oral exam has climbed steadily from 16% to 28%.”

After reading this I came across another article analyzing the increasing failure rate of my colleagues in internal medicine. I then read an article about the American Board of Thoracic Surgery’s oral board examination.

The failure rate of that exam has doubled between 2000 and 2011 (14.4% to 28.1%).

I believe that there has been an overall loosening of educational demand on resident physicians in all specialties.

Many of my colleagues share the same view. A rigorous knowledge of human pathology has been subordinated to a constant drumbeat of respect for resident self-esteem.

One must deliver every essential medical lesson in a warm and nurturing manner paying full attention to the psycho-social and ethno-cultural needs of the resident.

This kinder, gentler educational environment has resulted in many residents feeling better and better about knowing less and less.

The result may be a doctor who feels great about knowing nothing.

Unfortunately for future patients, human pathology did not get the hostile work environment memo.

After reviewing the shackles that have been placed on medical educators by various regulatory and governing committees, I began to think about my New England roots. I thought about the citizens of Boston in the 1700’s who were trying to forge a new existence in the Colonies.

Their progress was thwarted by shackles placed upon them by regulating bodies many miles away.

So what did they do?

They figured they could do it better on their own, so they declared their independence and put it in writing.

Thomas Jefferson wrote it and 56 patriots signed it. The rest, as they say, (and I am semantically correct here) is history!

So one Saturday afternoon, I carefully reviewed the Declaration of Independence.  I decided that classically educated surgeons (and all classically educated physicians) should do the same thing – declare their independence from a far removed governing body that was hindering their growth and prosperity.

My generation, classically educated, produced some weird and unusual people.  But they were great educators and marvelous surgeons.

They were characters with character!

Many of these physicians were politically incorrect. Some were tired and occasionally insensitive. But they could dig out a necrotic colon at 3am. They could control exsanguinating hemorrhage after leaving their anniversary party. They could crack a chest, save a gunshot wound victim then regale the resident with a few Halsted and Billroth anecdotes.

These physicians were, in a word, inspiring.

I suppose that most of my surgical heroes if they were in the current system would be referred to various well-being committees. They would have to undergo gender and cultural counseling. Many might have even been suspended or had their privileges amended.

But they had all passed their boards and they could all do their job.

So here it is – a Declaration of Surgical Independence:

I hope, in some small way, that this will “raise the bar of performance in all training programs to a distinctly higher level.”

Leo Gordon is a surgeon. This article originally appeared in General Surgery News. For a copy of the Declaration of Surgical Independence, contact Dr. Gordon at SurgicalIndependence@gmail.com.

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