Surgical Training

Definition
Purpose
Demographics
Description
Diagnosis/Preparation
Risks
Normal results
Morbidity and mortality rates
Alternatives

Definition

Surgical training encompasses the acquisition of knowledge and skills required for a physician to operate on people in a safe and therapeutically successful manner.

Purpose

The purpose of surgical training is to prepare a physician to specialize in surgery.

An individual’s first formal exposure to surgery occurs during the third year of medical school. Every medical student spends 12 weeks in a surgical clerkship. During this period, students are exposed to patients with conditions that can be addressed using surgery. Medical students accompany surgeons. Initially, they observe. Gradually, they are allowed to assist with simple activities such as changing bandages or wound dressings or holding instruments. Under constant direct supervision, they may be allowed to close wounds by placing sutures. During this period, students read about surgery and are taught and quizzed by the surgeons that they are accompanying.

The next phase surgical training occurs after a physician has graduated from medical school. This phase is called residency training and lasts for five years. The first year of residency training is often referred to as an internship year. During this time, surgical residents receive intensive training in the medical management of patients. Their surgical duties include additional observation of surgical procedures. As their skills improve and knowledge base grows, they are allowed to perform simple surgical procedures such as establishing a surgical field, making initial incisions, placing drains in wounds and closing wounds when surgical procedures have been completed.

During the second through fifth years, surgical residents continue to read, acquire additional skills and manage patients. Throughout the five years of surgical training, residents are constantly observed and evaluated. In the fifth year, each trainee serves as a Chief Resident. In this capacity, residents learn about leadership. They are responsible for assigning cases (patients) to other surgical residents, instructing other surgical residents and teaching medical students.

After completing the five years of resident training, trainees must pass an examination. The testing involves a written component that covers medical and surgical knowledge and an oral component that covers surgical skills and patient management. When they

pass this examination, they receive Fellowship status in the American College of Surgeons. With this, they are entitled to call themselves surgeons and use the letters FACS after their names. At this point, surgeons are also board certified.

Some surgeons begin regular work in a surgical practice or as employees in a hospital or other similar organization. Some surgeons opt for obtaining additional specialized training and enter fellowships. (This is not to be confused with their Fellowship status in the American College of Surgeons.) Fellowship training is focused on a particular aspect of surgery. Fellowship training lasts from one to two years. At the completion of fellowship training, surgeons take another round of examinations. When they successfully complete the written and oral components, they receive an additional board certification as specialists.

Examples of surgical fellowship training include cardiac surgery (specialize on the heart), thoracic surgery (specialize on the lungs), plastic surgery (specialize on reconstructive and cosmetic surgery ), orthopedicsurgery (specialize on bones and joints), trauma surgery (specialize on hands or other body parts), gynecological surgery (specialize on the female reproductive system), ophthalmic surgery (specialize on the eye), and transplant surgery (specialize on the kidneys, pancreas, liver and lungs), and neurosurgery (specialize on the brain and nervous system).

Demographics

As of 2008, there were 61,516 Fellows in the American College of Surgeons.

More males than females enter surgical training. This is a long-standing pattern. As a result, the great majority of surgeons in the United States are males.

Description

An individual’s first formal exposure to surgery occurs during the third year of medical school. Every medical student spends 12 weeks in a surgical clerkship. During this period, students are exposed to patients with conditions that can be addressed using surgery. Medical students accompany surgeons. Initially, they observe. Gradually, they are allowed to assist with simple activities such as changing bandages or wound dressings or holding instruments. Under constant direct supervision, they may be allowed to close wounds by placing sutures. During this period, students read about surgery and are taught and quizzed by the surgeons that they are accompanying.

The next phase surgical training occurs after a physician has graduated from medical school. This phase is called residency training and lasts for five years. The first year of residency training is often referred to as an internship year. During this time, surgical residents receive intensive training in the medical management of patients. Their surgical duties include additional observation of surgical procedures. As their skills improve and knowledge base grows, they are allowed to perform simple surgical procedures such as establishing a surgical field, making initial incisions, placing drains in wounds and closing wounds when surgical procedures have been completed.

During the second through fifth years, surgical residents continue to read, acquire additional skills and manage patients. Throughout the five years of surgical training, residents are constantly observed and evaluated. In the fifth year, each trainee serves as a Chief Resident. In this capacity, residents learn about leadership. They are responsible for assigning cases (patients) to other surgical residents, instructing other surgical residents and teaching medical students.

After completing the five years of resident training, trainees must pass an examination. The testing involves a written component that covers medical and surgical knowledge and an oral component that covers surgical skills and patient management. When they pass this examination, they receive Fellowship status in the American College of Surgeons. With this, they are entitled to call themselves surgeons and use the letters FACS after their names. At this point, surgeons are also board certified.

Some surgeons begin regular work in a surgical practice or as employees in a hospital or other similar organization. Some surgeons opt for obtaining additional specialized training and enter fellowships. (This is not to be confused with their Fellowship status in the American College of Surgeons.) Fellowship training is focused on a particular aspect of surgery. Fellowship training lasts from one to two years. At the completion of fellowship training, surgeons take another round of examinations. When they successfully complete the written and oral components, they receive an additional board certification as specialists.

Examples of surgical fellowship training include cardiac surgery (specialize on the heart), thoracic surgery (specialize on the lungs), plastic surgery (specialize

QUESTIONS TO ASK YOUR SURGEON

• Are you board certified?
• When did you complete your surgical training?
• What is your complication rate?
• How many times have you completed the surgical procedure that you are recommending for me?

on reconstructive and cosmetic surgery), orthopedic surgery (specialize on bones and joints), trauma surgery (specialize on hands or other body parts), gynecological surgery (specialize on the female reproductive system), ophthalmic surgery (specialize on the eye), and transplant surgery (specialize on the kidneys, pancreas, liver and lungs), and neurosurgery (specialize on the brain and nervous system).

Diagnosis/Preparation

Prior to entering medical school, individuals interested in becoming surgeons usually complete four years of undergraduate training in a college or university. During their premedical education, future physicians complete a core curriculum that includes a minimum of one year of biology, one year of physics, one year of mathematics (including a semester of calculus), and two years of chemistry (including a year of inorganic chemistry and a year of organic chemistry). So-called premeds often complete a bachelor degree in biology or chemistry although this is not now required. Medical schools seek persons that can think in a logical manner. Thus, persons with degrees in any undergraduate major are welcomed as long as they have completed the ten courses of a core currriculul already described.

Candidates must take and submit scores from the Medical College Admission Test (MCAT).

Risks

Risks associated with surgical training include diappointment for candidates that are unsuccessful in gaining admission to medical school. Risks associate with surgical training from medical school through fellowship training include fatigue and occupational injuries associated with surgerinclude accidental needle sticks, accidental cuts from scalpels or other instruments and exposure to pathogens acquired from patients. Risks associated with surgical training include fatigue, occupational injuries and malpractice suits

KEY TERMS

Fellowship training— Additional specialty training that follows completion of residency training; fellowships are one to two years in length.

Internship— The first year of residency training

Residency training— A five-year period of additional training that follows completion of medical school.

Surgeon— A physician that has completed surgical residency training, passed all examinations and is a Fellow of the American College of Surgeons.

Normal results

The normal result of surgical training is successfully mastering the knowledge presented in medical school and residency, learning the techniques of surgery, and becoming a productive surgeon.

Morbidity and mortality rates

Morbidity for surgeons includes occupational injuries on the job. They experience the same risks of life as do all individuals. In 2008, mortality from on-the-job related events includes exposure to AIDS through an accidental needle-stick or cut by a contaminated instrument.

Alternatives

To become a surgeon, there are no alternatives to receiving surgical training.

Resources

BOOKS

Brunicardi, F. C., D. K. Anderson, T. R. Billiar, D. L. Dunn, J.G. Hunter, and R. E. Pollock. Schwartz’s Manual of Surgery. 8th ed. New York: McGraw Hill, 2006.

Ellis, H., R. Caine, and C. Watson. General Surgery: Lecture Notes. 11th ed. New York: Wiley, 2006.

Lawrence, P. F. Essentials of General Surgery. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2005.

Townsend, C.M., R. D. Beauchamp, B. M. Evers, and K. Mattox. Sabiston Textbook of Surgery. 17th ed. Philadelphia: Saunders, 2004.

Toy, E. C., T. H. Liu, and A. R. Campbell. Case Files: Surgery. New York: McGraw Hill, 2006.

PERIODICALS

Allen, T. K., A. S. Habib, G. L. Dear, W. White, D. A. Lubarsky, and T. J. Gan. “How much are patients willing to pay to avoid postoperative muscle pain associated with succinylcholine?” Journal of Clinical Anesthesia 19, no. 8 (2007): 601–608.

Halpern, L. R., and S. Feldman. “Perioperative risk assessment in the surgical care of geriatric patients.” Oral and Maxillofacial Surgery Clinics of North America 18, no. 1 (2006): 19–34.

Siddiqui, T., A. MacDonald, P. S. Chong, and J. T. Jenkins. “Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials.” American Journal of Surgery 195, no. 1 (2008): 40–47.

Vergis, A., L. Gillman, S. Minor, M. Taylor, and J. Park. “Structured assessment format for evaluating operative reports in general surgery.” American Journal of Surgery 195, no. 1 (2008): 24–29.

ORGANIZATIONS

American Board of Surgery. 1617 John F. Kennedy Boulevard, Suite 860, Philadelphia, PA 19103. (215) 568-4000; Fax: (215) 563-5718. http://www.absurgery.org.

American College of Surgeons. 633 North St. Clair Street, Chicago, IL 60611-32311. (312) 202-5000; Fax: (312) 202-5001. Web site: http://www.facs.org. E-mail:<postmaster@facs.o

American Medical Association. 515 N. State Street, Chicago, IL 60610. (312) 464-5000. http://www.ama-assn.org.

American Society for Aesthetic Plastic Surgery. 11081 Winners Circle, Los Alamitos, CA 90720. (800) 364-2147 or (562) 799-2356. http://www.surgery.org.

American Society for Dermatologic Surgery. 5550 Meadowbrook Dr., Suite 120, Rolling Meadows, IL 60008. (847) 956-0900. http://www.asds.net.

American Society of Plastic Surgeons. 444 E. Algonquin Rd., Arlington Heights, IL 60005. (847) 228-9900. http://www.plasticsurgery.org.

OTHER

Archives of Surgery (American Medical Association) [cited December 23, 2007]. http://archsurg.ama-assn.org/.

MedScape General Surgery [cited December 23, 2007]. http://www.medscape.com/generalsurgery.

National Medical Society [cited December 23, 2007]. http://www.medical-library.org/j_surg.htm.

Wake Forest University School of Medicine [cited December 23, 2007]. http://www.bgsm.edu/surg-sci/atlas/atlas.html.

L. Fleming Fallon, Jr, MD, DrPH