A matrix for comprehensive surgical education

Abstract

From bench to bedside, and from the care of individuals to the health of populations, the scope of general surgery has exploded in recent years, as new scientific and technical insights have come to light and as greater focus on outcomes have identified new opportunities to improve patient care.1,2 Surgeons of the twentieth century could not have predicted how technology would fundamentally and immediately reshape surgical practice, how complex multimodal therapies would be coordinated with airline industry–level precision or how organized systems of care would transform access to treatment and surgical outcomes.1 As surgical progress accelerates, the next generation of surgeons will have exciting opportunities and will face unprecedented expectations and challenges.3,4 Remarkably, even in this era of rapid growth, the basic principles of surgical education outlined by William Halsted more than a century ago have endured and continue to produce surgeons with superb knowledge, technical skills and professionalism.5 Surgical residents still go through a fixed period of time for training, are expected to master structured educational content and face escalating operative and perioperative responsibility. But a strong foundation of knowledge and skill, while fundamentally important, is only one aspect of comprehensive surgical training and practice. Optimal surgical care increasingly depends on rigorous and continuous adaptation of the scientific literature into clinical practice; skillful communication with patients, families and colleagues; insightful and decisive leadership of multidisciplinary teams; and dedicated advocacy for patients as they attempt to navigate the complex health care environment. Effective physicians and surgeons instinctively possess many of these attributes. In fact, a formal survey of Fellows of the Royal College of Physicians and Surgeons of Canada identified 7 fundamental roles of medical specialists (the CanMEDS framework, Fig. 1).6,7 This deconstruction of clinical excellence brought the essential attributes of modern physicians and surgeons into sharp focus for the first time and opened new avenues to improve surgical education.7 Unfortunately, articulation of the CanMEDS roles also appeared to make surgical education much more complicated.8,9 Surgical training programs struggled to find time in their already brimming curricula to devote to specific training in the CanMEDS roles, and surgical residents questioned the relevance and urgency of these newly mandated priorities.10 Fig. 1 In 1990, the Royal College of Physicians and Surgeons of Canada polled its members to identify “a comprehensive definition of the competencies needed for medical education and practice.” This process ultimately led to the Canadian Medical ... However, as experience with the CanMEDS roles has grown in surgical programs and skepticism among surgeons and residents has receded, the inherent relevance and role of the CanMEDS framework in daily surgical education has become increasingly apparent. All teaching surgeons have caught glimpses of CanMEDS roles in action during routine duties, such as obtaining consent (Communicator), running a trauma resuscitation or operative slate (Manager), teaching a medical student how to write postoperative orders (Scholar) or even discharge planning (Collaborator, Health advocate). These are exciting insights because they begin to inform the process of seamless integration of teaching CanMEDS roles during surgical training, and they increase the awareness of trainees and surgeons to the educational richness of everyday interactions.