“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.