Looking forward – July 2021

David B. Hoyt, MD, FACSSurgical education and training have changed dramatically in recent years as the result of work-hour limits, the introduction of new technology and techniques, increased administrative burdens, workforce shortages, the movement toward value-based care, the ongoing trend toward subspecialization, and more. As a leader in surgical education, the American College Surgeons (ACS) consistently has been a leader in this arena throughout its 108-year history and has sought to develop standards for teaching institutions.

To respond to the changes occurring in graduate medical education, the ACS Division of Education and an array of leaders in surgical education have collaborated to develop a new guidebook—Optimal Resources for Surgery Residency Training—which will be released later this year. We believe this manual will serve surgical educators and training program directors in much the same way as Optimal Resources for Surgical Quality and Safety (the Red Book) has served surgeons who are seeking innovative ways to improve quality, outcomes, and patient safety.

What the manual does

The manual is intended largely for program directors (PDs) who are trying to navigate the complexities of modern-day general surgery training, although the contributors anticipate that all surgeon educators will find it to be a valuable resource. The “Gold Book” recognizes that many residents complete their general surgery training well prepared for independent practice, but, unfortunately, some trainees are ill-prepared or lack confidence in their ability to deliver high-quality care. The opportunity to improve this situation through modification of the residency training program is the reason the College has accepted the challenge of preparing this manual.

The Gold Book looks at the strengths and weaknesses of the current training paradigm and offers new models that may be more effective in preparing residents for the future.

The manual was written by leaders of the ACS, the American Board of Surgery (ABS), and past and present PDs and surgical chairs from throughout the U.S. and Canada. With their expertise, the College has defined the scope of practice and the areas for which board-certified general surgeons should have broad knowledge and experience and surgical conditions that can only be treated by individuals who have gone through fellowship training.

The Gold Book looks at the strengths and weaknesses of the current training paradigm and offers new models that may be more effective in preparing residents for the future. Many training programs continue to adhere to the model that William S. Halsted, MD, FACS, created more than a century ago, under which residents were pretty much available around the clock to provide emergency care and to observe, assist, and perform operations under the careful eye of their attendings. To educate and train today’s residents, it is imperative that residents have access to alternative training mechanisms, including time to perfect their technique through simulation and access to mentors who can counsel them when faced with difficult cases.

In addition, the Gold Book outlines the rules that the Accreditation Council for Graduate Medical Education (ACGME) and its review committees (RCs) have put in place to guide the structure of accredited training programs. This chapter of the book should be invaluable to PDs who are new to their roles and learning their oversight responsibilities and when and how to deal with residents who require remediation. This chapter also points PDs and institutional graduate medical education committees to the professional organizations that can help them establish and sustain accredited programs and achieve excellence.

The Gold Book further explores how surgical training programs can help residents develop their level of professionalism, particularly how they can and should interact with patients and their families. Another chapter describes the technical skills that residents should develop at each level of training, ranging from placement of drains and closure of simple wounds to completion of a Whipple procedure.

Other chapters focus on the nontechnical skills that surgeons will need to apply throughout their career. As the health care system moves toward value-based care, the manual describes how training programs can inculcate trainees in the principle of continuous quality improvement and patient safety. Furthermore, this manual helps PDs assist trainees—who often leave training with significant debt—plan for a financially secure future, advocate for health policy changes that will improve patient care, and much more.

Why this manual is needed

Surgical education, training, and practice have changed dramatically over the last 30 years or so. It is incumbent upon all of us to ensure that surgeons of the future are prepared to deliver excellent care that meets the demands of our nation’s aging population. We must prepare residents to fulfill these expectations using very different approaches than many of us were exposed to as trainees. Together, the ACS, ABS, and the RC for Surgery, along with other organizations with stakes in the development of resident education, can address these well-documented and significant issues in surgical education through shared oversight, responsibility, and decision-making. As part of that solution, this manual creates a common vision of the goals of surgical training and clarifies and improves the training process through broader and increased stakeholder engagement. If we are to continue to provide quality care for our patients, we can and must work together to better prepare surgeons.

We anticipate that Optimal Resources for Surgery Residency Training will be released by the end of this year. Stay tuned, and thank you for all of your efforts to ensure that surgical patients will continue to receive the best possible care now and in the future.

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