But, over the years, actual hands-on surgical training has been reduced, he said. “When otolaryngology residents were on the general surgery service, they were mostly on the floor doing post-operative care and not participating in the operating room learning general surgery skills,” he said. “They weren’t really learning to operate as a fundamental skill.”
Explore this issue:February 2016
The opportunities to practice open head and neck surgery aren’t as common as they used to be, due to a shift toward more non-surgical treatments of head and neck cancers and the emergence of robotic and endoscopic procedures as opposed to traditional open surgical approaches, said Dr. Weber. “Furthermore, many of our procedures today are salvage surgery, for patients who have failed primary treatments. These are some of our most challenging cases and require a greater level of surgical expertise and judgment. The treatment paradigms have changed in the last five to 10 years, he said.
Jesus Medina, MD, a professor of otolaryngology at the University of Oklahoma Health Sciences Center in Oklahoma City, a former chair of the otolaryngology department, and a former Triological Society president, also cited the changes in surgical practice as the impetus for the curriculum changes.
“General surgery has evolved in a way that it no longer provides our junior residents sufficient exposure to traditional basic skills such as suturing and tying,” he said. “The continuing development of endoscopic techniques has practically eliminated the core open procedures like large abdominal incisions and limb vascular procedures, appendectomies, and hernia repairs. They’re now done using scopes and small incisions.”
Performing fewer of these open procedures leads to fewer teaching opportunities for post-operative care, said Dr. Medina. “For instance, when a junior resident assisted in an operation requiring a large incision, it was usually [the resident] who was most junior who was allowed to close that, which was a great opportunity to practice suturing techniques. Nowadays, they seldom do that anymore.”
And, finally, the nature of the surgical care of trauma patients has evolved away from surgical interventions and toward more conservative medical care, Dr. Medina added. “Years ago, in some cases we would do an exploratory open operation, but today, more patients are evaluated with more sophisticated imaging techniques and aren’t operated on as often.” As a result, there’s been a decrease in the opportunity to develop and use traditional surgical skills, he said, particularly as compared with five to 10 years ago.
While those interviewed believe the new curricula will be implemented smoothly, there may be some administrative adjustments, such as having fewer otolaryngology residents available for non-otolaryngology rotations. “The program directors in some programs will need to revise the rotations to which they have assigned (otolaryngology) PGY-1 residents in the past,” said Dr. Potts.