Surgical Education and Certification

The paradigm shift in surgical education is from time-based training (e.g., 5 years of surgical residency, and then graduate with a subjective agreement by experts of the surgeon's basic training) to the new objective, criterion-, or proficiency-based training. The earlier model of mentoring (supplemented by knowledge acquisition and testing: lectures followed by written tests) resulted in a subjective assessment of performance, especially of technical procedural skills. The 1980s and 1990s saw the emergence of clinical problem-based learning, standardized patients for the Objective Structured Clinical Exam (OSCE), and the Objective Structured Assessment of Technical Skills (OSATS) [6] and McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) [7]. Along with the recent validation studies on virtual reality surgical simulators such as the Minimally Invasive Surgical Training - Virtual Reality (MIST-VR) [8], a new benchmark in surgical training has been set: objective assessment based upon expert-derived criterion for proficiency. This is the paradigm shift. Following the lead of the Royal Colleges of Surgeons in establishing standardized curriculum in basic skills in training and evaluation, the American Council of Graduate Medical Education and the American Board of Medical Specialties in the United States have added the dimension of an increased rigor by defining the components of competency to be achieved through such structured curricula with objective performance metrics. Although still in transition, the training of a surgeon is on a path of objectively documented acquisition of skills to a predefined level of proficiency in formal laboratory setting (rather than on patients), complimented with continuous evaluation during training and throughout the clinical career.

To the practicing surgeon, the phrase life-long learning takes on greater significance—no longer is it exclusively a professional obligation internalized in every surgeon when the Hippocratic Oath is taken; it is now a regulation that will be continuously monitored and evaluated. It is necessary to adapt to this new environment of mandatory training for any (new) procedures, of continuous learning with assessment, and of auditing surgical practice performance for acceptable outcomes. Failure to adapt will result in loss of surgical practice privileges.

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