Thursday, May 27, 2010

Your Last MOAS blog post! Finish the book first!


The Final BLOG Question: After completing this book, do you think changes should be made in the way surgeons are trained? How important is it for surgeons to “practice” on real patients? Would you want to be operated on by the Intern, the Attending or the Chief Resident? Why? Why not? What challenges are faced by surgeons today?

28 comments:

  1. I think that it is vital for surgeons to practice on real patients in order for them to really know what they are doing before they go out on their own. I do think, however, that they should ALWAYS be overseen by a licensed and experienced surgeon. As a patient, I definitely would not feel comfortable having an intern operate on me, so that poses a tricky issue because it's hard to find people willing to let interns operate on them, but the interns need to operate in order to learn and become more experienced. Ultimately, I think that the way surgeons are being taught is successful because in the end they come out as experienced and talented surgeons.

    ReplyDelete
  2. I think that it is very important for surgeons to practice on real patients. I think that the Interns will only be able to become great surgeons from hands-on experience. That being said, I think that it is essential that the Intern has watched that exact type of surgery many times before they actually scrub in on it. It seemed like when Nolen was an intern he was "practicing" on real patients with surgeries that he hadn't seen done very many times before. An attending or chief resident should always be present when a less-skilled surgeon is "practicing" and they should be proactive about taking over the surgery. I noticed that their were multiple attending chiefs, such as Doctor Grove who would just scream at Nolen, but never take the surgery over for him. I would be open do the idea of being "practiced" on but only if it was for a smaller surgery that had very little potential to do wrong. This becomes tricky because I know many people would not want to be "practiced" on when it comes to heart surgery and so it begs the question how do upcoming heart surgeons get practice? Overall I think this question is one of the most challenging questions about training for surgery, but I think that as long as the "practicing" is closely monitored, it is a good way to train surgeons.

    ReplyDelete
  3. I believe training for becoming a surgeon can be a very challenging task. Ideally I think interns should merely watch the process of surgery for a period of time. Once a resident, I think they should be able to help out during sugery, but not allowed to make any incisions still. Finally, I would think the only people who should be able to operate on patients are chief residents. These are the kind of doctors who I would prefer to have operate one me. Though they could tend to work fast and make mistakes, chief residents are where they are because of their skill and success. Despite chief residents being confident and capable surgeons they still face issues regarding families and their beliefs. Sometimes these issues can be more challenging to deal with than the operation itself.

    ReplyDelete
  4. I think it is critical for medical students training to be surgeons to work in a real hospital and operate on real patients. All the theoretical information students learn at universities is valuable, but the real expertise and qualifications that make a great surgeon is practical elements - not only the ability to execute a successful surgery, but also the ability to remain calm in a operation mishap, and the ability to talk to patients and sooth and support them. All these skills are only attainable through real life practice which is why the years Dr. Nolen spent at Bellevue were so valuable.
    Although this sounds hypocritical, I would not feel too comfortable having an intern operate on me. Most of Dr. Nolen's early operations were well, but some complications did arise and this is why it is so important for an experienced surgeon to oversee the operation. I think this is why Bellevue was such an ideal location for Dr. Nolen to work in because the patients who came to Bellevue were able to be admitted even though they were not necessarily able to pay for their stay, they were happy to be taken care of and operated on even though Dr. Nolen was not an experienced and fancy surgeon.

    ReplyDelete
  5. I think that in general, the way in which Dr. Nolen learned to be a surgeon was effective. The training at Bellevue was, in my opinion, akin to teaching someone how to swim by throwing them into the deep end. Surgeons learned through hands on experience. Reading about surgical procedure in a textbook is learnedly a completely different experience from actually making the incisions and taking the responsibility in the OR. Consequently, it is extremely important for surgeons to be able “practice” on real patients, because that is the only way for them to learn. I think that I would only be okay with allowing an intern to operate on me is it was a low-risk surgery and if I was assured that the intern would be under strict supervision. I think that each of the day-to-day decisions that surgeons must make are the most important and difficult part about being a doctor. What sets the chief resident apart from the attending or the intern is his or her ability to make a judgment call efficiently and be confident in his or her decision/years of training.

    ReplyDelete
  6. This is somewhat of a tough question because I feel that surgeons in training should have the opportunity to practice on real patients, but I would never want an intern to practice on me. I know that interns will never become amazing chief surgeons unless they have an extensive amount of practice on real patients, but it would be difficult for me to trust them on a serious operation. If interns are practicing on real patients, I think it is crucial for there to be an overseeing chief surgeon who follows the intern every step of the way. As the intern grows more comfortable doing the surgeries, the chief surgeon can continue to oversee but let go of the reigns a bit.

    I would want to be operated on by the Chief Resident. Yes, all doctors make mistakes, but I would want the doctor with the most experience. I think that that surgeons today face this tough issue frequently. The operations and outcomes of surgeries can also be very tough.

    ReplyDelete
  7. I think it is very important for interns to be able to practice on patients so that they can someday become chief residents with a lot of practice which is what people expect of the top surgeons. Without practice the interns will never be able to work their way up, though it is often hard for interns to get that necessary practice because people only want the very top surgeons operating on them. I personally would not trust and intern to operate on me because they simply dont have as much practice. I think often interns end up practicing on the patients who cannot pay for the operations they need and therefore cant have a say in whether or not an intern operates on them. This doesnt seem like a very good solution but it seemed like this happened a lot in the book and probably happens a lot today as well. I think interns should gradually be given more and more control by their supervisors so that they are never thrown into a surgery without knowing what to do but are instead gradually given more autonomy little by little. The attending surgeon should always watch over the intern and make sure that if anything goes wrong they are able to step in immediately. Even though this seems like a safe procedure, I personally still would feel nervous having an intern operating on me and would much prefer the chief resident.

    ReplyDelete
  8. I think that it's really important for surgeons to "practice" operating on patients. This is a crucial part of their learning experience that no other type of training can replace. However, they should always be overseen by trained surgeons while they do so. Placing a patients life at risk for the sake of practice is not okay. I would only feel comfortable being operated on by an Intern if they are being overseen to ensure that they do not make any fatal errors. I would obviously feel most comfortable being operated on by someone with a lot of experience, but I do understand the necessity for people with less experience to get practice (otherwise, how would we get people with lots of experience?).

    ReplyDelete
  9. This is Connor Townsend.

    I think it's definetly incredibly important for surgeons in training to practice on real people, but not until they're really ready. Someone who became an intern a few months ago shouldn't go anywhere near a scapel. It suprised me that Nolen actually started doing surgery so soon, even though he was under supervision. And, as I'm sure you can tell by what I just wrote, there's no way that I'd want an intern or anything. There's no way I'd trust them to not cut something they shouldn't.

    ReplyDelete
  10. I think that the becoming a surgeon should be a culmination of visual learning as well as physical learning. It is very important for the interns to be well versed on the surgeries that they are going to perform, they should watch multiple surgeries and research them before their own attempt. I also think that it is very important for the surgeons to actually perform surgeries. The act of doing a surgery is completely separate from just watching and researching on, as we learned from Nolen. Interns should not perform complicated surgeries and they should always be supervised because they are very inexperienced. I would not want an intern to operate on me because just for personal preservation. I think that the system could be a little more improved because it seemed like Nolen kind of jumped into the rush of hospital life instead of easing his way in. Hospitals should help interns adjust because they have no previous experience. I think that hospitals are doing a good job though. Many amazing surgeons have come out of this process so clearly it works.

    ReplyDelete
  11. I think it is necessary that interns “practice” on real patients because only through real hands-on experience can an intern become a great surgeon. I do think it is also necessary that this interns are always supervised by a chief resident, experienced surgeon etc. The problem with this idea of practicing is that many people, including myself, don’t want to be “practiced on” by an intern. People want to know that they are in goods hands but interns do need to practice so they can be great surgeons one day.

    ReplyDelete
  12. Ꮠhere are a few changes that Ꭸ would imagine might improve surgeon training, but in general, I think that the system described in this book sounds reasonable (modernized, of course - MOS is way old). Surgeons are responsible for many peoples' lives every single day, so it seems logical that there training should be very intense. Additionally, this type of work is good because it weeds out people who aren't really cut out for the career. It is very important for surgeons to practice on real patients, but hypocritically, I'm not sure I'd want to be operated on by an intern! Ꮖ guess the decision really comes down to weather the patient is paying a specific surgeon to do the work, or not. A patient paying for an operation at a private hospital, I think, should definitely not have to have an intern operate on them, but at a public hospital - so long as there is good supervision - I'd say its ᎤᏦ (and very necessary) for aspiring surgeons to have some practice. Humans aren't made of colorful, easily identifiable parts, as seen in text books!

    ReplyDelete
  13. I'm not sure why my last post looks weird and the name says "The" I still can't change my name back - sorry.

    I'm Ben

    ReplyDelete
  14. I think current methods for training surgeons are pretty effective. Practicing surgery is definitely a critical aspect of a doctor's training because doctors need real practical experience to become better doctors. Performing surgery on living humans is not only qualitatively different from practicing on cadavers or models, but it also affects the nerves of the doctor differently. It's important for doctors to get used to operating on living patients in smaller, less risky situations with other doctors supervising. This way, doctors are far less likely to be nervous and make fatal mistakes in the future. For this reason, I'd prefer not to have an intern in a risky surgery. In basic, straightforward operations, I'd be ok with an intern operating on me (with the supervision of an attending or someone more experienced). However, the concerns of many patients about having new doctors can impede opportunities for increased experience, which is problematic in creating new generations of experienced doctors.

    ReplyDelete
  15. The process of the making of a surgeon clearly works; it produces plenty of excellent surgeons. And for all the horror stories Dr. Nolan tells about operating as an intern, it’s an important and necessary part of the process. Supervision and keeping rigorous safety standards are key, of course, but honestly interns’ doing surgery is not as crazy or dangerous as some of Dr. Nolan’s anecdotes can make it sound. First of all, Nolan acknowledges that for each nearly-botched surgery there were a hundred flawless ones. Secondly, interns perform operations constantly at teaching hospitals all over the country; if this caused problems, I assure you we would hear about it. Deaths from uncomplicated surgeries are legal nightmares for hospitals; if it were truly a risk they wouldn’t let their interns operate, ever. While I would rather be operated on by an experienced surgeon I would allow an intern or resident to do it in any legitimate hospital if that’s what was being offered.

    ReplyDelete
  16. It is important that surgeons be able to train on real patients in order to get a feel for what a 'real' surgery is like. Unless the interns actually get some surgical experience under their belts, they won't have same ability to perform a surgery as well as they otherwise would. I think anyone would rather be operated on by the chief resident, but I personally wouldn't mind being operated on by an intern. They need the practice, and after all, I'm in a hospital and am being monitored by multiple people so I figure I'd be safe enough.

    ReplyDelete
  17. After completing this book, I’m still not sure whether changes should be made in the way surgeons are trained or not. I have to remind myself that this book tells the story through the eyes of one surgeon; this perspective is not necessarily representative of the rest of them. I think it takes a real surgeon to answer that question. Also, each surgeon can be trained a little different from the others so everybody does not have the same experience. However, it definitely seems important for all surgeons to “practice” on real patients. I would want to be operated on by the Chief Resident because they are the most experienced.

    ReplyDelete
  18. I don't think there are many problems with the current way of training surgeons. I do, however, believe that it is important for surgeons to practice on real patients, only after they prove that they are capable of doing so, and only under supervision of an attendant or more experienced surgeons. As much as I think interns should operate on real patients, I definitely would prefer to be operated on by a Chief Resident. I would simply prefer the security of knowing how experienced and qualified the surgeon is. It is obviously necessary to practice on patients to become experienced, but I would rather not be "practiced on".

    ReplyDelete
  19. I don't know if changes should be made in the way surgeons are trained because there are many different ways of how surgeons are trained, some of them are more effective than others. I think it is crucial for surgeons to "practice" on real patients because part of being a surgeon is dealing with what actually happens in the OR and with patients. However it is *very* important that there is an attending in the room, just in case something goes horribly wrong. I would want to be operated on by an intern because I know how important it is to practice on real patients. However, I would also insist that there be an attending or the chief resident with them while they are operating.

    ReplyDelete
  20. I think that Nolen became a good surgeon after he underwent medical training. So, I wouldn’t change anything to the ways that surgeons are trained.
    I think it is very important for surgeons to practice on real patients because you cannot learn by just seeing and not doing. Studying out of a book will not help a surgeon get through an unusual situation or complication.
    I would want to be operated on by the Chief Resident because they have the most experience/operating time. Of course they would still make mistakes but probably less then an intern or attending resident.
    Today, I think that surgeons and other medical professionals are challenged the most by political issues such as abortion, “playing God”, and the Health Care Bill.

    ReplyDelete
  21. I think that as of now, surgeons are undergoing proper training. As Nolen noted, it is crucial that surgeons practice on real patients. It is not enough to simply "know" how to perform a surgery because every patient varies and knowing theoretically what to do is dramatically different from actually doing the procedure. If I were in relatively good operative health and were undergoing a rather common and simple surgery, I might allow an intern to perform so as to gain experience, but I would definitely want a more experienced surgeon to be supervising. If I were undergoing a more complicated or delicate surgery, I would only want the chief resident to perform it because they have more experience. In the book, Nolen mentioned a patient who suffered because as a younger surgeon, Nolen tried to show off/overcompensate. I would not want that kind of treatment. I think that today, some problems that surgeons face today include the fear of a malpractice lawsuit and balancing a personal life with their profession.

    ReplyDelete
  22. I feel like this question really tackles the biggest concern in training surgeons. I do think that the best way for surgeons to be trained is for them to practice on real patients. Having that hands on experience is really essential. It's kind of like how there is a difference between looking at how to dissect a fetal pig online and dissecting one yourself. Even though the two seem the same, they really are completely different experiences. Surgeons plays a very important role, as they are the ones whom have many people's lives at their hands. Thus, in order for them to hone their skill, they have to have real practice. Concepts are completely different from the experience that a hands on practice gives. This book should be a perfect example of the necessity for a surgeon to have that hands on experience. Imagine the Nolen from the beginning of the book becoming a surgeon right then. After all, he had all the concept down. However, the thought sends shivers down my spine because it is quite evident that he was in no way prepared to enter the surgical world then. Now think of the Nolen now who is a surgeon. This book shows the importance of an internship, how, after constant practice, Nolen becomes better and better at surgical tasks--and it's all because of practice.

    The reason I said earlier that this question really tackles the biggest concern in training surgeon is that while practicing on real people is really important, no one is really willing to have anyone less than the best operate on them. To this day I still think that this is a big issue. After all, people want to continue living and will not want to decrease that chance by allowing someone less experienced to operate on them. In reality, although I know that having an intern operate on me will give him/her a really good learning experience, I do not want to put my life on the line. I am fine with an intern operating on me if it's a extremely low risk surgury--if the success rate of the surgery is extremely high and if my life is not in danger.

    ReplyDelete
  23. I think that the current method for training surgeons is pretty effective, and it leads to the training of proficient surgeons. When training a surgeon, it is very important to find a good balance between carefully monitoring what a surgeon does and teaching them, and letting them have hands on experience by actually performing surgery on the patients. I believe that at first, the residents should learn by watching surgery be performed by more experienced surgeons, and gradually, they can learn to do surgery themselves. A very important part of the process for these residents is learning through practicing on real patients, but they need to be very careful with this and have someone more experienced overseeing the surgery if necessary. I personally would not feel comfortable if the person was operating on me was using me for practice, unless someone else was overseeing the process. I think that the most important part in training a surgeon is giving them "practice" and hands on experience and at the same time making sure that there is someone more experienced overseeing the surgery, so it will not be as dangerous and they can be taught more.

    ReplyDelete
  24. Personally, I think that the way surgeons are currently trained is the only effective way to train a surgeon. Practicing on cadavers is sufficient for a little while, but the only way to really become a surgeon is to assist on actual traumas. The living human body can be radically different from a cadaver, so in order to groom an excellent surgeon, they need practice on actual patients.
    Would I want to be operated on by an intern, a resident, and attending, or the chief of surgery? Well, honestly, it depends. If whatever I had was life-threatening, then of course I would want an attending. However, if it was something simpler -- like an appendectomy -- I wouldn't mind a first-year resident doing my operation, so long as they're supervised. I don't want to die, after all.
    I think the biggest challenge that surgeons face these days are lawsuits. If a surgeon is unable to save a life, the victim's family will occasionally accuse malpractice and take the surgeon to court. The job a surgeon does is difficult enough as it is, and the added stress of lawsuits can't make it any easier

    ReplyDelete
  25. I think that having hands on practice is the best way to train a surgeon - if interns are not given the opportunity to conduct real surgery, then when they become surgeons they will still be inexperienced and more likely to make costly mistakes.

    Although I understand the importance of interns operating on real patients, I do not know if I would be comfortable having somebody so inexperienced performing surgery on me because the consequences of a mistake are so costly. However, I think that I would allow it:1) if the procedure was small and not at all life threatening, and 2) if there was an extremely qualified and experienced attending surgeon supervising and ready to intervene before anything went wrong. In general, I would be more comfortable being operated on by an attending surgeon.

    I think that one of the challenges faced by surgeons is the precision that is required in their work - if they even make the smallest mistake or miscalculation, the patient can be crippled or die, and the surgeon can face a lawsuit for just making a human mistake. It is a very high - pressure job and I think that it would be hard to have to be so perfect in your work all the time.

    ReplyDelete
  26. I feel that it is very important for surgeons to practice on living patients, because there is no other way to make sure that they are ready to be surgeons if they aren't allowed to do real operations. As scientific as being a surgeon is, there are a lot of variables that may make a procedure not go according to plan, and a surgeon in training should have firsthand experience.

    I wouldn't particularly want an intern operating me unless the surgery were low risk or there was an attending senior surgeon. Residents usually have enough experience and I feel that they too should be supervised, but i would not have reservations.

    Surgeons are confronted with a lot of various issues, but i would say one of the main ones is dealing with some of the moral issues where patients might have reservations, for example, abortion. It might be difficult to get conservative patients at a private practice if it is known that the institution performs abortions. Also, surgeons seem to be very overworked and on call a lot of the time--maybe more efficient scheduling would get them the sleep and the breaks they need.

    ReplyDelete
  27. I can't say I've experienced enough surgical practice to say it should be changed. However, that does tie into one believe I am solidly behind: practical experience is essential.
    I think surgeons can't become surgeons if they don't operate on patients, suffer through a few mistakes, learn how to correct erros, and complete a case. An Intern only ceases to be an Intern when she knows how to do her job.
    From a patient's perspective, I would not mind having an attending or Chief resident do a non life-threatening operation. I hate saying this, and I sound like an elitist, but I will admit I would feel uneasy being operated on by a complete novice. Admittedly, even if she was backed up by an experienced surgeon, I would'nt want to run the risk of complications and end up sick for months.
    As for challenges surgeons face today, I think that my own prejuduice outlines the problem of getting practical experience. Interns need people to operate on, but so many patients demand quality care and so few are willing to risk mistakes that there are often few opportunities for training.

    ReplyDelete
  28. I mean, I can only possibly think as the patient. Unfortunately, I have no desire whatsoever to be a surgeon, but I do know that it is inevitable that either I or someone I love will be in surgery probably a few times in my life. Coming from that point of view, I think the Chief Resident should do every surgery. Do I know that thats impossible? Yes. But at the same time, I don't think it's elitist to not trust someone with very little experience with my life. I would rather have my life than try to be politically correct and try to understand that this intern might be good (because statistically speaking, he's not going to be and I'd much more likely die on his table than a Chief Resident's." ) So yes, i agree that there should be actual surgical training in medical school. Of course, this is coming from a child who's mother is in healthcare and has always learned that "hospitals are the most dangerous places on earth." I probably should've gone to the emergency room more times than I have in my life, but my mother's fear of exhausted interns and overworked nurses has resulted in more than a few home remedies. I still live. As a result, I have an inherent suspicion of doctors and basically anyone who is too eager to cut into someone. My mom began college as a pre-med and took basic anatomy classes etc, where she remembers her classmates naming the bodies to dissect things like "Abra Cadaver." So I'm a little hesitant to support more of that type of training in medical school, but it's better to "practice" on a dead person , than a person that's still alive.

    ReplyDelete