Advancing Surgical Education Globally: Training NextGen Surgeons

摘要

Surgical education is focused on imparting the essential knowledge and skills required to diagnose the disease, decision-making regarding the need for surgery, performing the operative procedure, and providing perioperative care, including managing postoperative complications. However, the exponential growth of technology, the progressive decline in the doubling time of medical knowledge over the past three decades, and the need to train surgeons in multiple domains in addition to clinical and technical skills have posed new challenges in surgical education.[1] Disparities in the global economy, availability of skilled health-care workers, equipment, medical infrastructure, and access to technology have resulted in significant gaps in surgical education and care worldwide. Around 70% of the global population cannot access safe, timely surgical care, and an estimated 143 million essential operations are not performed yearly in low- and middle-income countries (LMICs).[2] To ensure standardization and quality assurance, advancing surgical education is required globally, as implementing standardized surgical education ensures that practitioners worldwide receive consistently high-quality training. This ensures that all communities have access to well-trained surgical professionals, reducing variations in surgical practices and enhancing patient safety. However, there are challenges in advancing surgical education worldwide, and surgeon leaders must focus on addressing them. HISTORY OF SURGICAL EDUCATION Understanding the evolution of surgical education is critical before looking ahead to the future. Early surgical training in the mid-16th century was based on the apprenticeship model that involved the surgical trainee observing the mentor without any structured training in a clinical environment for 5–7 years, followed by independent practice without any oversight.[3] Subsequently, William Halsted introduced the pyramidal model of surgical education.[3,4] In this model, 50% of the admitted residents have only a 1-year position. Of the remaining trainees who continue beyond 1 year, only 25% can become a house surgeon. The remaining trainees spend an indefinite period of observation and training with no guarantee of becoming staff surgeons. The pyramidal system produced excellent surgeons, and many of Halsted’s trainees became chairs or professors of surgery in leading universities. However, the pyramidal model also depleted the trained surgeons’ pool. The training in the pyramidal system is, to some extent, dependent on the relationship established between a dominant mentor and a docile trainee, which is not in accordance with scientific training principles. Hence, Edward Churchill introduced the “rectangular structure” model of surgical residency training.[3,4] As per the “rectangular structure” model, all the trainees who join the residency program would be trained for a fixed period, which is essential for surgical training. Subsequently, 50% of trainees who might choose to remain in the hospital or join as professors at other academic institutions will be retained. Surgical training in many countries is based on this model in which residents undergo training in core surgical principles for approximately 3 years, such as General Surgery in India, followed by another 3 years of specialized training in a particular field of surgery, such as urology or neurosurgery. The “rectangular structure” model precluded some of the limitations of the Halstedian pyramidal model. However, the time-based training model does not prepare surgeons for all the challenges in their careers. Hence, there was a gradual shift from time-based to competency-based surgical training. Competency-based training refers to an education model where trainees must demonstrate a required level of knowledge and skill (competency) on a task before advancing to the next task.[5] Competency-based training is not a novel concept, as it has been incorporated into the non