NEWS

Leaders Look to Bolster Surgical Proficiency, Skills Verification

Laura Newman

New surgical cancer techniques are developing all the time, but are surgeons necessarily skilled in these advances? Some observers worry that this is the most problematic part of the puzzle in disseminating effective new surgical techniques.

Samuel A. Wells Jr., M.D., chair of the American College of Surgeons Oncology Group, referred to a sort of "vacuum" in training from the time a doctor finishes residency training. "That’s where surgeons get their most intensive type of training." From then on, it is a bit scattershot, according to Wells. "This is not a process where state or medical professional societies get involved and [continuing medical education] does not get to the heart of the matter."

Wells worried that "new technologies are going to come along while there is no process for evaluating the surgical skills."

Even though many surgeons take continuing medical education courses, some experts worry that continuing medical education alone, as it is presently structured, is inadequate to the task.

Among other strategies for addressing this issue, Wells and other leaders are using clinical trials as an avenue for improving surgical proficiency. In many ongoing surgical oncology trials, surgeons must be credentialed and must successfully perform a set minimum number of procedures.

In the laparoscopic colectomy trial headed by Heidi Nelson, M.D., surgeon at the Mayo Clinic in Rochester, Minn., "before surgeons are credentialed, they must submit a recorded video demonstrating how they did the surgery," said Nelson. "The video is reviewed for critical elements," she added. In addition, surgeons are not credentialed until they perform at least 20 laparoscopic colectomies, she explained.

ACOSOG’s sentinel node biopsy trial also requires that surgeons perform at least 20 procedures, according to Wells. Noting that "it used to be 30," he said that the figure had to go down because the mentoring manpower is lacking. A skills verification component is also built into the NSABP sentinel node biopsy trial, said Ted Trimble, M.D., head of NCI’s surgery section in the Cancer Therapy Evaluation Program.

Meanwhile, Wells plans to use some seed money given to ACOSOG to determine the best mechanisms for teaching surgeons new surgical techniques. Trimble said that he is pleased by the "expansion of training initiatives, particularly for performing laparoscopic and thorascopic surgery."

For some, it is difficult to understate the importance of surgical skills verification and ongoing training. "Right now, any surgeon in practice can perform any surgery that he or she wants," warned Wells.

"There is no FDA for surgery, no oversight, and this is a major challenge," he said. Unless the medical profession champions this tough issue, Wells fears that medicine risks "losing its stature. ... More than that, it is an obligation to society."



             
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