PubMed · 10086249
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V S Kaprielian, H S Bell. 1999. Evaluating without fear.. https://pubmed.ncbi.nlm.nih.gov/10086249/
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BACKGROUND: Technical competence is the bedrock of surgery, yet it has only recently been viewed as a valid area for either critical evaluation or formal teaching. METHODS: This review examines the teaching of surgical skills. The core is derived from a literature search of the Medline computer database. RESULTS AND CONCLUSION: The impetus for surgical change has generally related to the introduction of new technology. Advances initially allowed for open operation within the main body cavities; more recently minimal access surgery has appeared. The latter was introduced in an inappropriate manner, which has led to the evolution of teaching of technical skills away from an apprenticeship-based activity towards more formal skill-based training programmes. There is now a need for a solid theoretical base for the teaching of manual skills that accommodates concepts of surgical competence.
As with all subspecialties, the endocrine surgeon offers more than just improved technical expertise in the treatment of endocrine surgical disease. An understanding of the disease, and an ability to interpret investigations and surgically intervene with minimal morbidity allow for better patient care. Outcomes of endocrine surgical diseases are measured by the success of the operation at relieving the endocrinopathy and the ability of the surgeon to find the tumor, while at the same time minimizing the postoperative morbidity. Each of these factors has been considered when assessing the role of specialized expertise in endocrine surgical disease. The recurrence and survival data for these tumors, however, are not forthcoming and, therefore, the limitations of the existing literature must be acknowledged.
The outcome following surgery for resection of a solid tumor depends on a number of factors including patient comorbidity, stage of the disease, and surgical expertise. Each of these aspects must be considered when outcome data are being assessed. This multifactorial concept makes the relative importance of volume and specialization difficult to assess for individual patients. This article investigates the role of volume and specialization in determining outcome following solid tumor resection.