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My lessons are simple, because they are distilled from the lessons I This lesson was actually taught to me by a surgical intern, who at 2 a.m.
Table of contents
- Current Issue
- General Surgery Residency - Gundersen Health System
- What can we learn from other countries—lessons from the CAJC Happiness Report
- Vanderbilt University Medical Center
- Leave a comment
Current Issue
Surgeons are equipped to adapt and learn fast, all while juggling the mundane. The lesson I learned from these challenges was, never limit yourself to a niche. Keep stretching, keep adapting, keep learning. And so, on a beautiful degree sunshiny Houston day in December , I packed two suitcases, went to Bush International Airport and three hours later, stepped off the plane at Reagan National Airport into a frigid, degree winter reality.
I had no idea what to expect. I worked on a series of other different projects in DC, from improving the safety of sterilization of surgical equipment to serving as the first woman to be nominated and appointed as Deputy Under Secretary for Health for Community Care for the US Department of Veterans Affairs.
When I got off that plane at Reagan National Airport into the freezing December cold last year, I walked into an unknown. Embrace it. J Surg Res. Am J Med Qual. Improving staff perception of a safety climate with crew resource management training. Shreveport: A Success Story. August 26, Bulletin of the American College of Surgeons. December 6, November 10, For more information about working with Dr. Blackham, please read about her exclusive intensive marriage therapy retreats.
Will post a link to your blog from mine. My surgeon-and-RN parents have been married 40 years this year, and you wrote down the lessons that they have used all their life. Thank you for writing this must-read piece for surgeons-to-be and their partners. Privacy Policy Disclaimer.
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The last part addresses the non-operating room OR -related training opportunities such as simulation programs, theoretical knowledge, or surgical mentoring programs and consists of nine questions. The questionnaire also tests the contentment of the residents and contains a comment section to address which aspects they particularly like and dislike about their program. In the following, some of the different national programs are described in alphabetical order of the countries only if there are two or more replies to the questionnaire.
At the end of each description, the key aspects and contentment are described as well as the lessons learned so far. Note that these are only descriptive, early results used for this opinion paper as the study is still ongoing and will then be published with the final results. In Brazil, the residency to become a general surgeon lasts only 2 years.
The residency is only possible in large hospitals and ends with an oral exam.
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After this time, most physicians leave to practice as surgeons in smaller hospitals or private practices. No additional examination is needed.
General Surgery Residency - Gundersen Health System
Only very few surgeons continue their training in large hospitals to specialize even more, e. What can we learn: Focusing on surgical procedures with respect to skills needed later is useful. In Germany, every hospital can train surgical residents. In the beginning, 2 years of a so-called common trunk are required, which includes 6 months at an emergency department and 6 months in an intensive care unit.
After this, the more specialized part of residency follows, ending with an oral examination conducted by the state medical association Landesaerztekammer. During the second part, residents can specialize in general, visceral, vascular, thoracic, heart, plastic, trauma, or pediatric surgery. Every 6 months, the resident gets a feedback talk with the surgeon in charge of surgical education. Whether or not this takes place is largely dependent on each individual hospital.
Contentment seems to rise with regularly performed feedback talks. What can we learn: Feedback talks on a regular basis help the residents. Great Britain has a very structured and centrally organized residency program.
What can we learn from other countries—lessons from the CAJC Happiness Report
For the first 2 years, one serves as house officer as part of a consultant team. There are different rotations, each with internal further training possibilities at least once a week. During this time, a catalogue of surgeries has to be performed. To become a consultant, 6 years of training as specialist registrar have to be fulfilled thereafter, which consist of 3 basic years, 1—2 years of out-of-program experience, and 2 years of subspecialization.
Every year, a record-in-training assessment takes place, where the consultant gives structured feedback to the trainee and vice versa. Apart from surgical and clinical skills, communicational and scientific skills also are addressed. Due to this very structured program, residency is mainly possible in NHS hospitals that undertake surgery.
Despite the very structured program, there can be discrepancy between the time residents are allowed to work according to the European Working Time Directive and the time needed for patient safety. Also, the training of soft skills is considered very important and useful.
What can we learn: Structured residency programs that are transparent and not only focus on OR skills are highly appreciated. In Greece, after receiving a diploma at the university, one has to apply for a residency at a specific hospital. As the waiting lists are long, it takes up to 3 years to get a slot in general surgery. The quality of the residency seems to be dependent on the favor of the superiors. Nonetheless, there is a logbook with certain numbers of procedures that are required for the oral examination at the end of the residency.
What can we learn: Transparent assignment of surgical procedures and salary that appreciates the work done are important. To get a residency slot in Italy, one has to pass a written entrance examination. Also, an enrollment fee has to be paid. The residency in general surgery lasts 6 years. Weeks are very structured with 1 day of teaching, 2 days of working on the ward and the outpatient clinic, and 2 days in the operation theater.
An exam has to be passed every year, and at the end of the residency, a scientific paper has to be written. What can we learn: Structured work schedules several months in advance make it easier to also plan work as well as leisure time. In The Netherlands, the teaching hospital decides who gets a residency slot.
As places are scarce, the graduates from medical school often take a position as Ph.
Thereby, they get to know the staff better and hence have better chances of being successful in the interview to get a residency slot. Residency for surgery lasts 6 years, but often the residents specialize already in the last 2 years e. HPB surgery or colorectal surgery.
Vanderbilt University Medical Center
In the Dutch system, the residents get constant feedback, especially regarding their surgical skills. For each procedure performed, an Objective Structured Assessment of Technical Skills is filled out by the supervisor with positive and negative feedback as well as an evaluation of the competence level at which the procedure was performed i. Especially, the rather early subspecialization as well as the feedback on all procedures performed are much appreciated.
What can we learn: With constant feedback, the residents get to know their strengths and weaknesses and can improve accordingly. In Singapore, residency can only be done at the university hospitals. Besides the clinical training, this involves structured education as well as research opportunities that the residents are encouraged to do.
Leave a comment
The program is very structured with an exam at the end of each year. During the first 3 years, the junior residents learn a broad basis of general surgery and surrounding disciplines such as gynecology, plastic surgery, and otorhinolaryngology. During the following 2 years as a senior resident, there is the opportunity to develop a subspecialization besides having more responsibilities in the core general surgery rotations with a mentored surgical management of the patients together with the junior resident and the consultant.