Our expert answers 3 Questions
Many graduating general surgery residents are not competent to perform procedures deemed core to the practice of general surgery. This likely compromises patient safety. The underlying causes are likely multi-factorial yet are difficult to address without better methods to assess trainee performance. Existing methods of credentialing surgeons for independent practice lack validity evidence and do not ensure that all surgeons are competent. Furthermore, changes in the wider health care system increasingly threaten the educational mission of teaching hospitals while the educational system has been slow to adapt. To address these issues we must bridge the gap between surgical education and surgical outcomes in order to frame the debate in terms of patient safety and not just learning. Fortunately, emerging data sources now make it possible to establish these links and promise a better understanding of how training affects surgical performance in practice.
I worry for future surgical patients who may, without meaningful change, increasingly be operated on by inadequately trained surgeons.
If we can link educational outcomes to patient outcomes, we can determine what level of performance prior to graduation leads to the best health outcomes. We can then use that information to set standards of performance that must be met by graduating trainees. We can also use that information to reform how we train surgeons. I suspect that similar methods can also be applied to other specialty training systems.