Thread by @arghavan_salles

Morning! Time for an angry tweet thread about this article on training surgeons. As a surgical educator, I am appalled by the assertions put forth here. Let me tell you why.

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nytimes.com/2019/05/30/wel…

The article starts off with, “Medical schools are noticing a decline in students’ dexterity…” I am a on the surgical faculty at one of the country’s best medical schools. I have not noticed this, nor has there been discussion of this around me.

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I am also the co-chair of the Surgical Education Research Group for the Association for Surgical Education. Not once has this issue been brought up. You might wonder whether an article was written about this, inspiring this article in the NYTimes. No, there has not.

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The article goes on to say, “Faculty members at medical schools…have noticed a marked decline in the manual dexterity of students and residents.” There are no data to back up this assertion.

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They then go on to say that restricting work hours to 80 hours a week creates an additional challenge for today’s learners, who the article asserts are “all thumbs.” There are no data—in the article or otherwise—that show that today’s residents are not competent surgeons.

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They quote Thomas Scalea, a renowned trauma surgeon, saying, “When I trained, good or bad, I worked about 120 hours a week…”

The jury’s not out on this verdict—the verdict is that it was bad! That’s why it’s not like that anymore. Is the current system perfect? Likely not.

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The whole premise here is harmful. The article suggests today’s learners cannot become competent surgeons. Actually, it is our responsibility, as faculty, to train them. Let's not get distracted by whether people work inhumane hours a week (80) or ungodly hours a week (120).

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If (and this is a big if for which there is no evidence in the article) we can’t train surgeons because they swiped too much when they were young (this is what the article asserts), then the problem is us, not them!

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The article ends citing a paper from 2002 (yo-that’s almost 20 years ago!) showing that some complications after surgery are avoidable. And then leaps to the conclusion that the source of the complications was technical error rather than errors of judgment. Wow.

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Just like anyone trying to jump from one side of the Grand Canyon to the other, this argument falls flat.

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I love the @nytimes. I’m a subscriber. But if you’re going to put something about surgical education out into the world, maybe involve some surgical educators. There are many of us readily available:
@AmaliaCochranMD @rogerhkim @HPB_Surgeon @LillianErdahlMD @BrenessaL

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In the meantime, all our students and residents should know this: You can be a surgeon if you want to. We will work with you to make that happen, regardless of whether you played piano or crocheted in your youth!*

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*Disclosure: I played piano, cross-stitched, crocheted, and knit in my youth. I don’t think those activities made me a better surgeon.

Thanks for coming to my #MedThread #rant.

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Adding a couple more tweets. Several people have raised an important point: the first iPhone came out in 2007. A person who was a child then would, at best, be in college now. Unless there are a lot of ppl out there skipping college & med school, these folks aren’t residents.
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Our rudimentary understanding of how to measure skills, teach while knowledge is expanding exponentially, and teach decision-making are all real challenges in surgical education. They’re why I got a PhD in education. An article on any of these topics would be welcome.

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