Retired surgeons as peer teachers in resident medical education: An underused resource

In his Presidential Address to the American Surgical Association in 2013, Carlos A. Pellegrini, MD, FACS, FRCSI(Hon), FRCS(Hon), FRCSEd(Hon), discussed the evolution of surgical education over the previous 100 years.¹ Dr. Pellegrini highlighted the need to incorporate changes in the structure of surgical residency programs proactively by increasing the use of simulation training and by emphasizing the importance of professionalism, communication skills, and systems-based practice in improving the quality of care for surgical patients. He also emphasized that surgical educators, acting as role models, have a responsibility to participate actively in a resident-oriented, patient-centered educational paradigm.

Ideally, this paradigm should be adopted and implemented by surgical educators with great enthusiasm. Unfortunately, current trends in medicine, including the demand for increased clinical productivity, the growing pressure of nonclinical responsibilities, and the emphasis on using the electronic health record, may hinder the involvement of attending physicians in the education of surgery residents. In addition, restricted duty hours for residents often limit their opportunities to interact with attending surgeons. These forces may have a detrimental effect on the overall educational experience of surgical trainees.

Despite their best intentions and efforts, many clinically active surgeons often lack the time to devote to educational endeavors. Moreover, many medical institutions fail to acknowledge the importance of education. While making demands on attending physicians to increase clinical productivity, these institutions often fail to provide adequate compensation to faculty for time spent on educational activities.

The pool of general surgeons is finite and is contracting slowly over time in comparison with other medical disciplines. Early retirement of surgeons due to the increasing problem of burnout will tend to lead to educational deficiencies in training programs if alternative solutions cannot be identified.

The case for retired surgeons as educators

One solution to this workforce problem may lie in tapping into an underused resource, namely retired surgeons. According to David B. Hoyt, MD, FACS, Executive Director of the American College of Surgeons (ACS), the College has approximately 18,000 retired surgeon members.² Many retired surgeons live in proximity to hospitals with Accreditation Council for Graduate Medical Education-accredited surgical residency programs. Retired surgeons have the time and energy to participate in humanitarian efforts and other professional activities.

It is not surprising that many retired surgeons actively seek out teaching opportunities. Among its many rewards, involvement in teaching allows retired surgeons to interact with youthful learners at all levels of experience and proficiency. Retired surgeons can act as valuable educational resources, sharing skills acquired through years of active clinical practice. In addition, involvement in resident education activities provides continued productivity for retired surgeons and may enhance their sense of self-worth.

Many general surgeons who gravitate toward post-retirement teaching opportunities have been respected role models throughout their professional lives and can continue to serve residents and faculty members in this manner. Retired surgeons can help motivate surgery residents to excel and succeed in their careers. Many retirees have developed networks at the regional and national level that allow them to assist residents as they pursue fellowships and career opportunities. Perhaps the single most important reward for retired surgeons is the opportunity to help promote the success of residents and faculty members.

Retired surgeons have extensive clinical experience, pattern-recognition skills, and reasoning abilities. They often have a strong interest in resident education. In addition, retired surgeons are enthusiastic about the surgical profession and improving the care of patients. Over the course of their careers, retired surgeons have developed the emotional intelligence that enables them to teach residents valuable strategies for conflict resolution by remaining calm in stressful situations. Retired surgeons also understand the increasingly complex socioeconomic aspects of health care delivery.

Speaking from experience

Four general surgeon authors of this column recently retired to southeastern North Carolina and have had the opportunity and privilege to participate as voluntary faculty members at the New Hanover Regional Medical Center (NHRMC) in Wilmington. With encouragement from co-author Thomas Clancy, MD, FACS, trauma medical director and program director of the general surgery residency at NHRMC, these retired surgeons have participated in a variety of educational activities including tumor board, morbidity and mortality (M&M) conferences, simulation training, mock oral examinations, and problem-based learning sessions for surgery residents and medical students.

In the setting of the M&M conference, these retired surgeons have shared their extensive knowledge and clinical experience with residents and faculty. In addition, they have helped to lighten the burden of educational responsibilities for the full-time faculty, allowing them to focus on patient care and their administrative responsibilities. The retired surgeons have also contributed to resident-initiated research projects by acting as advisors and editors. They have assisted junior faculty members with career development and with advice on ways to develop new clinical programs. Incorporation of retired surgeons as voluntary faculty members in the surgery department at NHRMC has become a source of satisfaction to medical students, surgery residents, full-time faculty, and retired surgeons alike.^3-5

Retired surgeons constitute a valuable and often underused resource for surgical residency training programs. Surgery chairs and program directors should be encouraged to explore opportunities to integrate retired surgeons into their educational programs.

To paraphrase the message of Beyond Halftime—a motivational book written by Bob Buford, former chairman and chief executive officer of a U.S. cable television network system—when moving into retirement, one needs to “move from success to significance.”⁶ One way that retired surgeons can accomplish this goal is by sharing with younger colleagues the wisdom and lessons learned during their careers in general surgery.

References

1. Pellegrini CA. Presidential Address: The surgeon of the future: Anchoring innovation and science with moral values. Bull Am Coll Surg. 2013;98(12):8-14. Available at: bulletin.faorg/2013/12/presidential-address-the-surgeon-of-the-future-anchoring-innovation-and-science-with-moral-values/. Accessed February 13, 2018.
2. Hoyt D. Executive Director’s annual report: 2016–2017: A year of transformational growth. Bull Am Coll Surg. 2017;102(12):43-58. Available at: bulletin.facs.org/2017/12/executive-directors-annual-report-2016-2017-a-year-of-transformational-growth/. Accessed February 13, 2018.
3. Orlander JD, Barber TW, Fincke BG. The morbidity and mortality conference: The delicate nature of learning from error. Acad Med. 2002;77(10):1001-1006.
4. Yule S, Flin R, Paterson-Brown S, Maran N. Non-technical skills for surgeons in the operating room: A review of the literature. Surgery. 2006;139(2):140-149.
5. Flin R, Yule S, McKenzie L, Paterson-Brown S, Maran N. Attitudes to teamwork and safety in the operating theatre. Surgeon. 2006;4(3):145-151.
6. Buford B. Beyond Halftime: Practical Wisdom for Your Second Half. Grand Rapids, MI: Zondervan; 2008.