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2010 | 82 | 7 | 377-402
Tytuł artykułu

Overview of General Surgery Training in the USA: History and Present

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A brief history of the development of surgery and early surgical training and practice is presented, starting in colonial America in the 18th century and extending to modern times in the USA. An abridged, but comprehensive overview of the metamorphosis and transformation of training programs in the United States is described and discussed, together with some of the most relevant rationale and justifications for the changes mandated, established and in progress. The current status of the accreditation requirements, oversight, and governance of general surgery training programs, together with the incorporation of the multiple technical and technological advances in general surgical practice; and, therefore, the addition of the required training modules and systems concurrently to the training programs; and their secondary implications, consequences, and impact upon the programs, are discussed. These include financial and other resource impediments, the 80 hour work week constraints, the technological explosion, the demands of the required expanded general surgical curriculum and operative case experience, the continued erosion of general surgery by surgical and medical specialists, the increasing workload coupled with decreasing reimbursement for general surgeons and their services, together with the difficulties of amalgamating all of these confounding or conflicting factors into an effective general surgery program which will be successful in attracting, recruiting, and retaining the best and brightest surgical candidates in the future in order to ensure the continuation of optimal general surgical care. Finally, the insights, opinions, experiences, and philosophy of the author regarding general surgery training and practice, accumulated during the more than half century served as a student, resident, clinician, scientist, administrator and educator, are incorporated into the presentation.
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Opis fizyczny
  • Department of Surgery, Yale University School of Medicine
  • Cooper DY, Ledger MA: Stirrings of organized medical education. In: Cooper DY, Ledger MA, (eds.): Innovation and tradition at the University of Pennsylvania School of Medicine, an anecdotal journey. Philadelphia: University of Pennsylvania Press; 1990, pp. 5-10.
  • Halsted WS: The training of the surgeon. Am Med 1904; 9: 69-75.
  • O'Neill JA, Jr.: Surgical education: Foundations and values. J Am Coll Surg 2009; 208: 653-62.
  • Zollinger RM: The post war trends in the training of the general surgeon. Surgery 1948; 24: 161-69.
  • Scott HW: Basic surgical education. Surgery 1961; 50: 1-11.
  • Accreditation Council for Graduate Medical Education. 2009; Chicago.
  • Kerr B, O'Leary JP: The training of the surgeon: Dr. Halsted's greatest legacy. Am Surg 1999; 65: 1101-02.
  • Scott DJ, Bergen PC, Rege RV et al.: Laparoscopic training on bench models: Better and more cost effective than operating room experience? J Am Coll Surg 2000; 191: 272-83.
  • Lossing AG, Hatswell EM, Gilas T et al.: A technical-skills course for 1st-year residence in general surgery: A descriptive study. Can J Surg 1992; 35: 536-40.
  • Reznick R, Regehr G, MacRae H et al.: Testing technical skill via an innovative "Bench station" examination. Am J Surg 1997; 173: 226-30.
  • Martin JA, Regehr G, Reznick R et al.: Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 1997; 84: 273-78.
  • Tsuda S, Scott D, Doyle J et al.: Surgical skills training and simulation. Curr Probl Surg 2009; 46: 261-372.
  • Moore MJ, Bennet CL: The learning curve for laparoscopic cholecystectomy. Am J Surg 1995; 170: 55-59.
  • Dent TL: Training, credentialing, and evaluation in laparoscopic surgery. Surg Clin North Am 1992; 72: 1003-11.
  • Jones DB, Brewer JD, Soper NJ: The influence of three-dimensional video systems on laparoscopic task performance. Surg Laparosc Endosc 1996; 6: 191-97.[PubMed][Crossref]
  • Wolf BM, Szabo Z, Moran ME et al.: Training for minimally invasive surgery. Need for surgical skills. Surg Endosc 1993; 7: 93-95.[Crossref]
  • Hunter JG, Sackier JM, Berci G: Training in laparoscopic cholecystectomy. Quantifying the learning curve. Surg Endosc 1994; 8: 28-31.
  • Rosser JC, Rosser LE, Savalgi RS: Skill acquisition and assessment for laparoscopic surgery. Arch Surg 1997; 132: 200-04.
  • Derossis AM, Bothwell J, Sigman HH et al.: The effect of practice on performance in a laparoscopic simulator. Surg Endosc 1998; 12: 1117-20.[Crossref]
  • Kohn LT, Corrigan JM, Donaldson MS, (eds.): To err is human: Building a safer health system. Washington: National Academy Press; 1999.
  • Dimic JB, Chen SL, Taheri PA et al.: Hospital costs associated with surgical complications: A report form the private-sector national surgical quality improvement program. J Am Coll Surg 2004; 199: 531-37.
  • Scott DJ: Patient safety, competency, and the future of surgery simulation. Simul Healthcare 2006; 1: 164-70.
  • Bridges M, Diamond DL: The financial impact of teaching surgical residence in the operating room. Am J Surg 1999; 177: 28-32.
  • Babineau TJ, Becker J, Gibbons G et al.: The "cost" of operative training for surgical residents. Arch Surg 2004; 139: 366-69; discussion 369-70.
  • Fisher JE: Continuity of care: A casualty of the 80 hour work week. Acad Med 2004; 79: 381-83.
  • Sachdeva AK, Bell RH, Jr., Britt LD et al.: National efforts to reform residency education in surgery. Acad Med 2007; 82: 1200-10.
  • Callery MP: Expansion beyond compression. Surg Endosc 2003; 17: 677-78.
  • DaRosa DA, Bell RH, Jr., Dunnington GL: Residency program models, implications, and evaluation: Results of a think tank consortium on resident work hours. Surgery 2003; 133: 13-23.
  • Evans SR: From surgical resident to postdoctoral student in surgery. J Am Coll Surg 2004; 198: 422-23.
  • Schneider JR, Coyle JJ, Ryan ER et al.: Implementation and evaluation of a new surgical residency model. J Am Coll Surg 2007; 205: 393-404.
  • Ericsson KA: Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med 2004; 79: S70-81.[Crossref]
  • McGreevy JM: The aviation paradigm and surgical education. J Am Coll Surg 2005; 201: 110-17.
  • The Cambridge Handbook of Expertise and Expert Performance. New York: Cambridge University Press, 2006.
  • Baumgartener H: Link flight trainer is designated a historic mechanical engineering landmark. New York: 2008;
  • Trunkey DD, Botaney R: Assessing competency: A tail of two professions. J Am Coll Surg 2001; 192: 385-95.
  • Seymour NE, Gallagher AG, Roman SA et al.: Virtual reality training improves operating room performance: Results of a randomized double-blinded study. Ann Surg 2002; 236: 458-63: discussion 463-64.
  • Fried GM, Feldman LS, Vassiliou MC et al.: Proving the value of simulation in laparoscopic surgery. Ann Surg 2004; 240: 518-25: discussion 525-28.
  • Grantcharov TP, Kristiansen VB, Bendix J et al.: Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 2004; 91: 146-50.
  • Andreatta PB, Woodrum DT, Birkmeyer JD et al.: Laparoscopic skills are improved with lapmentor training: Results of a randomized, double-blinded study. Ann Surg 2006; 243: 854-60: discussion 860-63.
  • Hyltander A, Liljegren E, Rhodin PH et al.: The transfer of basic skills learned in a laparoscopic simulator to the operating room. Surg Endosc 2002; 16: 1324-28.[Crossref]
  • Ahlberg G, Enochsson L, Gallagher AG et al.: Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. Am J Surg 2007; 193: 797-804.
  • Korndorffer JR, Jr., Stefanidis D, Scott DJ: Laparoscopic skills laboratories: Current assessment and a call for resident training standards. Am J Surg 2006; 191: 17-22.
  • Kapadia MR, DaRosa DA, MacRae HM et al.: Current assessment and future directions of surgical skills laboratories. J Surg Educ 2007; 64: 260-65.[Crossref][PubMed]
  • Sachdeva AK, Pellegrini CA, Johnson KA: Support for simulation-based surgical education through American College of Surgeons-accredited education institutes. World J Surg 2008; 32: 196-207.[PubMed][Crossref]
  • American College of Surgeons (ACS) Program for the accreditation of education institutes. Chicago: 2008;
  • Scott DJ, Dunnington GL: The new ACS/APDS skills curriculum: Moving the learning curve out of the operating room. J Gastrointest Surg 2008; 12: 213-21.[Crossref][PubMed]
  • ACS/APDS National Surgical Skills Curriculum. Chicago: 2008;
  • Bell RH, Jr.: Surgical council on resident education: A new organization devoted to graduate surgical education. J Am Coll Surg 2007; 204: 341-46.
  • Bell RH, Jr.: Revamping general surgery training. Editorial in the American College of Surgeons "Surgery News" 2009; 5: 6.
  • MOC requirements. Philadelphia: 2008;
  • Gallagher AG, Cates CU: Approval of virtual reality training for carotid stenting: What this means for procedural-based medicine. JAMA 2004; 292: 3024-26.
  • Gettman MT, Kondraske GV, Traxer O et al.: Assessment of basic human performance resources predicts operative performance of laparoscopic surgery. J Am Coll Surg 2003; 197: 489-96.
  • Gettman MT, Box G, Averch T et al.: Consensus statement on natural orifice transluminal endoscopic surgery and single-incision laparoscopic surgery: Heralding a new era in urology? Eur Urol 2008; 53: 1117-20.
  • Sanders S: Strategies for effectively managing an intergenerational workforce. The Business of Caring 2008; April: pp 12-13;
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