"It’s hard to get cadavers these days,” said Dr. Gerald B. Healy in his talk “The Challenges Facing 21st Century Surgery.”
But that is just one problem facing surgeons today. Change in medicine is happening very quickly.
It is therefore imperative that physicians have the tools to be successful. Some of these changes include new requirements for training and practice; new technologies; new tools, and time constraints. Maintenance of certification will soon be required every 5 years instead of every 10 years.
Simulators are being used more than ever before as innovative educational models and to help surgeons with maintenance of certification. In fact, residency training programs that do not have access to a simulation training center will be put on probation by the Residency Review Committee. Likewise, if surgical residents do not have documentation proving that they have passed the Fundamentals of Laparoscopic Surgery skills course, their application for board certification will be rejected. The public too demands proof that physicians are keeping up with learning, and physicians need to assure patients of safety and comfort. This can all be done through the use of simulators to improve surgical skills.
Illness is the same in Pakistan as it is in the United States, said Healy. So there needs to be greater structure across international boundaries regarding patient care and physician training. Simulation can help standardize training across borders and can weed out those who should not be surgeons. Not all have the proper skills to be a surgeon.
The American College of Surgeons is making efforts to address surgical knowledge and skills through simulation by establishing simulation laboratories in the United States and abroad, thus improving surgeon training and patient safety. The goal of the simulation laboratories is to provide regional support for maintenance of certification.
To maintain certification, surgeons will have to master certain core competencies. These include medical knowledge, patient care, communication, professionalism, practice-based learning and improvement, and system-based practice. Physicians will have to provide evidence of professional standing, evidence of commitment to lifelong learning and self-assessment, and evidence of cognitive expertise.
Because the medical arena is changing so dramatically, fellows will be faced with issues regarding tort reform and liability, reimbursement and practice costs, hassle factors, and more paperwork. One approach to tort reform, said Healy, would be to try to get medical malpractice insurance companies to reduce insurance premiums for liability insurance. If surgeons use simulators to hone their skills, insurance companies might agree to reduce malpractice premiums by 40%.
Surgeons must become leaders in the effort to improve patient care and safety and to encourage surgical competency and its ongoing measurement; otherwise, they will be left on the sidelines as more jobs in healthcare management are being filled by business executives, politicians, and think tank experts.
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