Each year, the President of the ASCRS is invited to speak at the ESCP meeting. In Barcelona, Dr Terry Hicks discussed the past, present and future of training colorectal surgeons in the United States. We talked with him in advance of his presentation.
“I have been asked to talk about what it takes to educate a fellow in colorectal surgery in the United States,” said Dr Hicks from New Orleans, Louisiana, where he is Associate Chairman, Department of Colon and Rectal Surgery, Ochsner Clinic, and Clinical Professor of Surgery, LSU School of Medicine.
“I will give a brief history of surgical education in the United States, starting from the early 1600s, when there were no boards or licensures for physicians. They learned by apprenticeship. By the late 1800s, physician training began to undergo vast changes, as students were brought into hospitals to examine patients and receive formal didactic lectures. I will talk about the development of modern surgical education and how it has evolved to where we are today.”
In his presentation, he will also discuss how actions of the US government affected modern surgical education. By limiting the number of hours that residents could train and placing restrictions on the supervision of surgery, the government’s actions led to a loss of autonomy for surgical residents and a reduction in the number of surgical cases each fellow could perform.
“Many educators came to the conclusion that the way we are training our surgical fellows will not adequately prepare them for the challenges of practicing alone. The American College of Surgeons is now testing a postgraduate fellowship year, which would be a transition into surgical practice,” he explained.
According to Dr Hicks, the many reasons why there is an inadequate level of training include, but are not limited to:
- Reduced exposure to surgical procedures and experience in medical school;
- Highly variable teaching effectiveness at different institutions;
- The 80-hour work week;
- Lost opportunities for autonomy and independent decision-making in the senior years of residency.
“Every generation of surgeons takes time out and tries to evaluate where they are. We are no different in that respect, but some significant things have changed,” he said.
“Hurdles we now face include incorporating many new areas into surgical training, including education on ethical issues, communication skills, system based practice education, electronic medical records, and legal concerns. In addition, the new generation has to learn about new techniques and technologies from laparoscopic surgery to robotic surgery and genetics, which are rapidly changing the way surgery is performed,” he continued.
“Surgical fellows have more to learn and less time to do it. All of these things pile up, and we have to get more accomplished in a shorter time. We have to find better ways to teach—sometimes by using simulators, online teaching, and whatever works better to reach the young people known as Generation Y or the millennials,” Dr Hicks said.
There has been a shift to more and more specialisation, but he argues that before surgeons do specialise it is important to ensure that they have a good basic foundation in general surgery. In his presentation, he will discuss some of the issues and problems of how best to split up and divide foundation and specialist knowledge.
“It will be interesting to compare and contrast the situation in the United States with what our colleagues in Europe are seeing. I expect the discussions following my presentation will be very interesting,” he added.
Solutions
Dr Hicks believes medical educators will have to find ways to give this generation more autonomy in the education process.
“We have to find better ways to interact with Generation Y to produce high quality surgeons. We have to reach out to meet them somewhere in the middle,” he said.
“People born between 1980 and 2000 have been described as the ‘me’ generation. They are culturally and racially diverse. They text and use cell phones all the time, receiving constant influence of their friends. They believe they should be involved in the education process, not just given didactic information to learn. They want to take leadership roles, have a say in how things work. Many have been raised by ‘helicopter parents’ who hovered over them every minute. They see the world differently than the previous generation. They want more time off. They work to live, not live to work,” he explained.
“Ultimately, it is about a shared responsibility. It is about meeting our patients’ expectations and teaching our fellows from our experience, who in turn must learn from their own experience,” he concluded.