Core training in surgery: what does it need to include?

Abstract

Core training for surgeons in any surgical specialty should include education in the relevant basic science knowledge, training in fundamental diagnostic skills, the development of surgical technical skills and considerable experience in patient care. However, for a number of reasons it is no longer acceptable to guide such training based only on such broad goals, not the least of which is the advent of resident duty-hour limitations that make it unrealistic to expect residents to simply acquire, by random observation and participation, all of the important elements of their future practices. Rather, it is necessary to provide a curriculum of learning opportunities specifically structured to allow them to gain the requisite knowledge and skills. Thus, the curriculum for the core surgical training of future vascular surgeons should be based on a very specific learning objectives, stating what information is to be learned or what action is to be done, under what conditions they are to be performed, and what criteria will be used to ascertain the acquisition of the necessary knowledge or skill. Next, the best methods of instruction, including reading materials, lectures, and exposure to specific surgical procedures must be defined and the appropriate instructional materials identified, selecting the best of existing materials or, if necessary, creating them. Finally, the residents' acquisition of knowledge and skills must be assessed. Previously this occurred through a loose combination of performance evaluations from clinical rotations, faculty group discussions, and annual in-training exams culminated in the American Board of Surgery certification process. Now evaluation must relate to specific educational objectives. This is all a daunting task currently being undertaken by vascular surgery program directors, albeit with input from the Residency Review Committee and the Vascular Surgery Board of the American Board of Surgery. Eventually, overall surgical curriculum will evolve to satisfy these educational ground rules, but currently it is very much a work in progress in most programs.