Surgical GME

From 1990 to 2006 I was the Program Director of a General Surgery residency. It was a passion of mine, and a fulfilling one. Yet the changes that we saw in general surgery training in particular, but in our overall philosophy and processes of graduate medical education were staggering. Those changes continue to this day. The most advertised of those changes was of course that which carries the label of the 80 hour work week. As most know, the rule that there is a cap of 80 hours averaged over a rolling four week measurement is just one of several such regulations promulgated by the ACGME. Now there is a strong possibility that there will be a further reduction in the maximum number of hours worked per week, and there may not be any allowed averaging. At the behest of Congress there is an IOM Panel that is investigating the matter and will be reporting back to Congress via AHRQ. There are very strong signals that this Panel will "optimize" GME by limiting the work week to no more than sixty hours, akin to the shrinking training week in the European Union.

Now without showing how long in the tooth I am, let me make one observation. Here it is: for decades the center piece of surgical education has been the morbidity and mortality conference. Here at one and the same time we can smooth out the competencies of knowledge, patient care, professionalism, communication, practice based learning, and systems based practice. The most vivid and useful lessons of my training years derive from the often foreboding lessons learned at M&M. As I go to M&M in my present institution, I groan inwardly when I hear the presentations each week. "Well I wasn't there at the subsequent operation." "The patient dehisced when I was post-call and I didn't see it." "He became septic and Fred was on night float taking care of him." So much for continuity of care. Can the lessons of surgical pathophysiology truly be learned by trying to put parts of different puzzles together at different times? I wish I knew the answer to that question, for at the age of 55 I am almost certain to be looking up one day at a product of our new uncontrolled educational experiment. I hope that it is a success.