Should We Expand Surgical Residency Training Programs?

A Physician’s Weekly post I wrote last December was on the subject of surgeons possible losing proficiency for doing open cases because of the ever-increasing popularity of laparoscopic and other minimally invasive techniques. This results in declining numbers of open operations for residents during their training. Although some suggested that knowing how to do open cases would be unnecessary in the future, to me that is wishful thinking. One commenter said, “We are seeing the result of this in one of our hospitals with a new surgeon. He frequently aborts cases when he cannot complete them laparoscopically because he does not know how to do the open procedure. Worse, instead of seeking the help of someone who does, he transfers the patient to a medical center.” A resident said, “Observing the big name academic center that I train at, it seems that the massive cadre of fellows has led to an extremely low and less interesting case load for the rest of the general surgery trainees. Overload of floor management onto the trainees seems to exacerbate the problem. Why not substitute some of the current residency training with more focused experience with mentors—maybe even community mentors outside of academic centers—who perform the cases they’re lacking?” The presence of fellows is a huge problem that academic centers that both the Residency Review Committee and the American Board of Surgery have glossed over for years. Fellows are usually not present in large numbers at community hospital programs; therefore, the residents get to do more surgery. Two years ago, I wrote about the fact that community hospital residents do more cases and...