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Surgical Education Week

Surgical Education Week. 15 April 2008 Toronto. “People need to be reminded more often than they need to be instructed.” Dr. Johnson. The Hopkins Years. Dick Kieffer. George Zuidema. Tom Gadacz. The Vanderbilt Years—the 1990s. John Sawyers. Walter Merrill.

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Surgical Education Week

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  1. Surgical Education Week 15 April 2008 Toronto

  2. “People need to be reminded more often than they need to be instructed.” Dr. Johnson

  3. The Hopkins Years Dick Kieffer George Zuidema Tom Gadacz

  4. The Vanderbilt Years—the 1990s John Sawyers Walter Merrill Wright Pinson Jim O’Neill, Jr.

  5. The Vanderbilt Years-2000s Naji Abumrad Jeff Dattilo Dan Beauchamp

  6. Disclaimers No commercial interests. No off-label uses recommended for pharmaceuticals or devices. No base pair substitutions or p values. Non-linear and a bit hyperkinetic.

  7. “What Business Are We In?” Surgical Education Week Wednesday 16 April 2008 Toronto

  8. Past APDS Presidential Addresses • 2007—Jim Valentine: The Neglected Specialty • 2006—Joe Cofer: This Is Not your Mother’s APDS • 2005—John Potts: Dawn—of a New Day in Surgical Education • 2004—Richard Welling: The Evolving Renaissance in Surgery Education • 2003—Tom Whalen: Forgive and Remember While Punching the Clock

  9. “The primary purpose of residency is the education of the resident, not service to the hospital.” Frank Spencer, NYU. 1992.

  10. Program Director Job Description Dickens: “The best of times, the worst of times.” Schizophrenia The PD job is a lot harder in 2008 than in 1995. Management vs. Labor

  11. PD ACGME RRC/ABS Resident as Ping Pong Ball Attendings & Chiefs

  12. Q: What is the biggest problem, challenge in your program?AAMC Chief Medical Officer-Group on Faculty Practice3 Nov 2007 Washington DC A: Increasing the professional behavior of our faculty.

  13. Universal Access to Health Care “The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little.” F. D. Roosevelt Memorial Washington DC

  14. IOM: Disparities of Care National Global Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care--2002

  15. Four Major “Surgical” Challenges Globally Safe airway and anesthesia management Trauma3: prevention; Rx of long bone fractures, spine and head trauma, burns Ante-natal and peri-natal care; women’s health issues Analgesia—peri-operative pain management; palliative care

  16. Chyrurgerie is an art, which teacheth the way by reason, how by the operation of the hand we may cure, prevent and mitigate diseases, which accidentally happen upon us. Ambroise Pare, 1582

  17. “Everybody, sick or well, is affected…by the material and spiritual forces that bear on his life… for the secret of the care of the patient is in caring for the patient.” Francis W. Peabody JAMA 88:877-882, 1927

  18. To heal a person,one must first be a person. Abraham Joshua Heschel“The Patient as a Person”The Insecurity of Freedom.Farrar, Strauss & Giroux. 1966.

  19. Three Points I. General Surgery II. Surgical Formation • Sociology and Surgery

  20. General Surgery and Its Iterations Important, Meaningful Workforce Projections = Job Security Remuneration

  21. A Longitudinal Analysis of the General Surgery Workforce in the United States, 1981-2005 Decline in # of general surgeons by 26% over the past 25 years 7.68 per 100K 1981 5.69 per 100K 2005 Lynge et al. Arch Surg 143:345-350, 2008.

  22. Income: Medicare 30-Year Impact Rothman, D.J. Money and Medicine: What Should Physicians Earn/Be Paid? Eli Ginzberg, The Economist as Public Intellectual, Horowitz, I.H. (ed), 2002, Transaction Publishers, New Brunswick, pp. 107-119 2005 General Surgeons ~$300k (ACS)

  23. II. Surgical Formation

  24. The growth and development of the whole person by an intentional focus on one’s (1) spiritual and interior life, (2) interactions with others in ordinary life, and (3) the spiritual practices (prayer, the study of scripture, fasting, simplicity, solitude, confession, worship, etc.). “Spiritual formation …includes educational endeavors as well as the more intimate and in-depth process of spiritual direction.”Gerald G. May, Care of Mind, Care of Spirit. HarperOne. 1992. Spiritual Formation

  25. Career vs. Vocation Carrera. Latin for racetrack. car, career Vocatio, from vocare, to call. “Calling, that whereunto God hath appointed us to serve the common good.” William Sloane Coffin A Passion for the Possible Westminster/John Knox Press. 1993.

  26. Prior Model of Education See one, do one, teach one. Learn by osmosis: “Follow me around for five years, watch me; you will learn something.” The curriculum is what walks in the ER door. Tim Flynn, UFla.

  27. New, Emerging Model Intentional Standardized Work hours compliant Out of OR technical skills acquisition: Skills Labs, Simulation Curriculum-based objectives Competency-based goals and expectations

  28. Surgical Formation:Intentional and Reflective Industrial Model Formation Model Show up on time Ongoing, continuous acquiring Pay attention Journey, not a destination Hierarchy Team sport Teacher > Student Co-learners Fixed Period Lifetime process Cantaloupe: Grape Process, not an event Aschenbrener

  29. “Education is not filling pails;it is lighting fires.”William Butler Yeats1865-1939, Irish Poet and Dramatist1923 Nobel Prize for Literature (Poetry)

  30. O Burns

  31. Head: Cognitive, Judgement Hands: Technical Heart: People Skills, Respect Health: Lifestyle

  32. III. Sociology and Surgery

  33. 100 Years of Surgical Education 1910 Flexner Report 1964 Medicare • ACGME Resident Work Restrictions 1960s Women’s Liberation Abraham Flexner

  34. 1964

  35. Vanderbilt Medical School 1966 54 Students entered in the class of 1970 3 women, one of whom changed to PhD after one semester and married 1 Black—Vanderbilt’s First 1 Sri Lankan 49 White Guys

  36. Surgery, Hopkins, July 1970 Pyramid No SICU No CT No Laparoscopy or MIS No Women One Black

  37. Baltimore, July, 1970

  38. Hopkins Surgery 1977

  39. 1976-1977 Surgery Interns JHH Alex Shepherd—PD, Henry Ford Jim Sitzman—Former Chair at Georgetown and Rochester, now at Indiana U Linda Reilly—First Woman ACS Halsted Resident in 1981-1982 Program Director, UCSF Chair, Surgical RRC

  40. Linda Reilly, MD

  41. Baptist Medical Centre Ogbomoso, Nigeria 1978-1993

  42. Nigerian Surgeons JK Ladipo Akin OlaOlorun Wole Adebo Layi Adeoti M T Shokunbi

  43. Proportion of Medical Students Who Are Women, 1965–2006. Data are from the Association of American Medical Colleges. Becoming a Doctor, Starting a Family — Leaves of Absence from Graduate Medical Education. R. Jagsi, N. J. Tarbell, and D. F. Weinstein. N Engl J Med 357:1889-1891,2007

  44. Women in General Surgery Residency 30 to 25%

  45. “Challenges confronting female surgical leaders: overcoming the barriers.” Perseverance Drive Good Communication Skills A Passion for Scholarship A Stable Home Life A Positive Outlook Souba, WW. J Surg Res 132:179-187, 2006

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