Teaching, training, and clinical surgery: are we making a difference?

Excerpt

It is with great interest that I reviewed the articles in this issue and the February issue of Surgical Endoscopy that emphasize the long process of teaching and training, the continued improvement in surgical outcomes, and the further development of more complicated techniques. The Gentileschi et al. [2] article on bile duct injury demonstrated that the incidence of bile duct injury has remained constant in two successive four-year reviews from 1994–2001 (0.26 in the first four years and 0.22 in the second four-year period), but the learning curve from 1989–1994 was not discussed. It would be interesting data to compare the first few years during the learning curve to see how many cases were needed to reach this low level of bile duct injury that is comparable to open cholecystectomy (0–0.3%) Surgeons have learned to recognize abnormal anatomy and have adapted to various clinical conditions over the past 15 years in spite of 2-dimensional monitors, lack of depth perception and touch, and the many variations of the biliary anatomy. They have learned to recognize, avoid, and adapt to these challenges, which have resulted in improved case management and more efficient and effective surgical procedures with less patient morbidity. However, it has taken several years to develop this skill level. Because the learning curve for laparoscopic cholecystectomy has required more time than expected, it emphasizes the fact that our training methods need to improve in order to shorten the learning process, especially when new technology and new techniques develop. Although there has been some instrument improvement over the years, the real change has been our improved visio-perceptive skill along with psychomotor skills to perceive visually abnormal anatomy and thus identify potentially dangerous areas before the injury occurs. …