Surgical Education Should Begin Early

Martin McKneally

Our undergraduate surgery program is spotlighted in this issue of the newsletter. The expansion of the exposure of our surgical faculty to the preclerkship level is a welcome development, based on the accounts from our undergraduate students Nada Gawad and Michael Bond. When students are exposed to surgical tasks like suturing and coached by surgical role models, the drapes that separated them from the arcane and mysterious world of surgery are lowered.

Our students are deciding early about their future careers and they need early active learning in surgery to try on the technology, culture and values of the surgical profession. “I could imagine myself doing that, especially with some experience” requires seeing, experiencing and doing some of the fascinating work of surgery with the right role models and mentors. George Christakis and Shibu Thomas are providing just exactly that and doing it well. The suturing sessions with preclerkship students in the first and second years have exposed undergraduates to John Wedge, Jim Rutka and a superb cast of faculty surgeons who are accessible and interested in helping them develop their understanding and test their aptitude for surgery.

Delaying surgery until clerkship misses the opportunity to inspire, converse and present role models sufficiently early in medical school. I was inspired by the diagnostic skills of thoracic surgeons William Barnes and Eugene Cliffton at New York Hospital and Memorial Sloan Kettering when I was an undergraduate. My mentor Hollan Farr showed me surgical humanity and patience, when I called him unnecessarily at midnight. I was worried about crepitus in the laparotomy wound of the dog my classmates and I had operated upon with him in the laboratory that afternoon. “It’s just air trapped in the tissue planes. It’s too early for gas gangrene, but I’m glad you called to check it out.”

Surgical Skills and knowing surgeons enable future family doctors to provide basic surgical care in the emergency room and assist at operations in their later practice. Surgeons of the future who are drawn to train for the specialty now will need more facilities to enable importing patients who are attracted, and able to pay to support and expand Canada’s excellent public system. They will likely disperse after their formal training to distant parts of Canada and the rest of the world as part of their career development, adding richly to their experience. They will help the specialty evolve, as the recent exciting work with organ repair for transplantation, the development of bariatric surgery, and multi-modal stenting for vascular and cardiac disease will change surgery as we currently know it. They will also develop economical solutions to bend the cost curve down to more realistic levels. (see also: http://www.surgicalspotlight.ca/Article.asp x?ver=Fall_2011&f=BusinessNeurosurgery). Our training programs will be refined to a needs based economic model as disruptive innovations displace or modify the more elaborate, traditional technology of many contemporary operations, the way stenting, minimal access techniques, and off pump variants have modified vascular and cardiac surgery.

Bravo to George Christakis, Shibu Thomas, our students and our surgical educators for the excellent initiatives in undergraduate education described in this issue.

Correction:

The Editor’s Column in the Fall issue contained a misprint. The correct statement should read: This innovative direct entry program in Cardiac Surgery was established in Canada in 1994.