Proficiency and Depth of Surgical Education in Switzerland is Heading in the Wrong Direction

Abstract

Abstract Background In Switzerland, surgical resident training has become increasingly difficult over the past decades for numerous reasons. While the number of surgical residents has doubled over twenty years, the average workweek dropped from 70 to 50 hours. At the same time, the surgical caseload increased only marginally as opposed to the proportion of administrative responsibilities, resulting in a substantial decrease of intraoperative exposure in surgical residency training. Aims To assess the surgical exposure of our residents. Methods This study is a review of all performed surgical procedures in the field of general, abdominal, thoracic, vascular and trauma surgery at a category-A Cantonal hospital in Switzerland, performed from September 1st 2021 to August, 31st 2023. The primary outcome was surgical exposure of residents as primary, secondary, and assisting surgeons. Secondary outcomes were case-distribution during daytime workhours as opposed to on-call hours per resident. Results The surgical exposure of a surgical resident at our cantonal hospital as primary and secondary surgeon was 41.19 and 39.06 minutes respectively per week. This surgical exposure as was paired with a total of 127.46 minutes as assisting surgeons per week. On average this results in 1.34 operations per week and 60.3 cases per year per surgical resident. 73.51% of these cases are performed during daytime work hours and 26.49% during on-call hours. Conclusion To fulfill the minimal number of 510 cases in the mandatory FMH surgical catalogue of becoming a general surgeon, a total residency period of 8.46 years would become necessary to take the exam based on the average number of operative cases in this category-A teaching hospital which is considerably longer compared to residency training 20 years ago. While surgical procedures and techniques continue to become more complex, the need to exploit ways to maintain a sufficient level of surgical exposure inside and outside the OR is eminent.