Modernizing Surgical Training: From Apprenticeship to Structured Education

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• Apprenticeship Model Limitations
• Systematic Surgical Education
• Millennial Generation Feedback
• Technology in Surgical Training
• Future of Simulation Training
• Medical Second Opinion
• Full Transcript

Apprenticeship Model Limitations in Modern Surgery

Dr. Philip Theodosopoulos, MD, identifies significant constraints in the traditional mentor-mentee surgical training paradigm. This old model, while foundational, is now limited by reduced resident work hours and less operating room exposure. Patients today are less inclined to be operated on by trainee surgeons, and hospitals closely monitor clinical outcomes. These factors collectively stifle surgical innovation and limit the hands-on practice essential for proficiency.

The Shift to Systematic Surgical Education

A core challenge is that surgeons are skilled practitioners but not formally trained as educators. Dr. Philip Theodosopoulos, MD, emphasizes the need to move beyond learning by osmosis. His work involved creating a more formalized and systematic educational structure for neurosurgical residents. This approach focuses on helping surgeon-educators develop effective teaching methodologies. Structured feedback is crucial for resident improvement and cannot be left to chance.

Dr. Anton Titov, MD, and Dr. Theodosopoulos discuss the importance of rigorous training, as exemplified by mentors like Dr. Arthur Day. The goal is to build educational frameworks that ensure consistent, high-quality training for every resident.

Adapting Feedback for the Millennial Generation

Dr. Philip Theodosopoulos, MD, notes that the type of feedback required by current surgical residents is fundamentally different. Research into the Millennial generation reveals they need constructive and frequent evaluation to improve. The old norm of primarily negative feedback is detrimental and ineffective for modern trainees. This societal shift necessitates a new, more supportive approach to surgical education that aligns with how younger surgeons learn and develop.

Leveraging Technology for Enhanced Surgical Training

Modern tools provide unprecedented opportunities for surgical education. Dr. Philip Theodosopoulos, MD, highlights the ease of recording procedures under the microscope for immediate review. This technology allows for observed surgical sessions where educators can provide precise, visual feedback. What was technologically difficult fifteen years ago is now instantaneous. Integrating these tools is essential for maximizing training within the limited time available.

The Future of Simulation in Surgical Training

Dr. Philip Theodosopoulos, MD, points to simulation as the next frontier in surgical education. While not yet fully proven, simulation training is almost certain to be used extensively in the future. This technologically advanced method will allow residents to practice and become proficient with tools and techniques in a risk-free environment. It represents an exciting development for educators aiming to produce highly skilled, leading surgeons.

The Role of Medical Second Opinion in Surgery

Dr. Anton Titov, MD, and Dr. Theodosopoulos confirm the critical importance of a medical second opinion when surgery is required. Seeking a second opinion helps patients choose the best possible treatment plan for neurosurgical conditions. This process ensures patients are confident that the proposed operation is the most appropriate course of action. It is a vital step for informed consent and optimal patient care.

Full Transcript

Dr. Anton Titov, MD: How to train leading surgeons? Surgical training followed a craftsman and apprentice educational model for many centuries. The young surgeon was an apprentice; the senior surgeon was the craftsman. Today, surgical training has to become more formally structured. Mentors have to provide better feedback.

A leading neurosurgeon from California shares his vast experience in mentoring young surgeons. How do you prepare the next generation of leading surgeons? How to train leading surgeons? Video interview with a leading expert in neurosurgery. How to train the best surgeons.

Dr. Philip Theodosopoulos, MD: Experienced academic surgeons in leadership positions have to help the surgeon educators become educators. Surgical residency program directors have to structure the feedback to trainee surgeons.

Dr. Anton Titov, MD: Millennial generation surgeons require a different approach to surgical education. Observed surgical sessions are helpful for young surgeons. Providing constructive and frequent feedback to young surgeons is important. Surgeons have to use modern tools of computer technology and simulation training to improve the education of young surgeons.

Dr. Philip Theodosopoulos, MD: A medical second opinion is important if surgery is required. A medical second opinion helps to choose the best treatment when a neurosurgical operation is needed. A medical second opinion will make the patient confident that the proposed treatment is the best.

Becoming a surgeon. How to train leading surgeons.

Dr. Anton Titov, MD: Let's talk about neurosurgical training.

Dr. Philip Theodosopoulos, MD: You have already touched a little bit on this subject. It is a very important one. You and I first met at Brigham and Women's Hospital in Boston. I was then a resident, and you were a cerebrovascular and skull base fellow with Dr. Arthur Day.

Dr. Arthur Day is one of the most prominent cerebrovascular and skull base surgeons in the world. I also think that Dr. Arthur Day is an outstanding educator.

Dr. Anton Titov, MD: He is willing to devote as much attention as required for his residents. Then he devotes some more time to each of his residents and fellows. We both appreciate the importance of high quality and rigorous training in medicine and in surgery.

You have done some outstanding work in neurosurgical education at the University of Cincinnati.

Dr. Philip Theodosopoulos, MD: There you were a director of the neurosurgery residency program for a long time. Then you came to San Francisco, UCSF. You made changes in the surgical training and achieved results that were commended at the national level.

Dr. Anton Titov, MD: What are the crucial educational structures in the training of neurosurgical residents? What were the results of changes in neurosurgical training?

Dr. Philip Theodosopoulos, MD: We are in many ways still stuck in the old paradigm of training, in surgery in particular and in all surgical disciplines. That gets you to a certain point but not further. Why is that important?

We all lived through a mentor-mentee paradigm of surgical training. We flourished through it. That is very important and very effective. But the old paradigm of surgical training has become very limited now because of limited hours we can use to train patients, because of limited exposure to diseases and conditions, and because of limited time in the operating room.

There is limited exposure in the relationship between the mentor and mentee. Traditionally, that was supplanted by practice. Then you went out into your own clinical practice. That opportunity has also become more limited now because clinical outcomes are very well looked at, because the hospitals care about all of these things.

Patients are less interested in pushing the envelope by being operated on by trainee surgeons. There is a potential risk that surgeons will be faulted for taking the risk of pushing the envelope in training, which is not to say that we ever put the patient's well-being at risk. But there is a point where surgical innovation can be stifled by overt supervision.

Surgeons are all educators, but surgeons were never really trained as educators. We were trained as apprentices. Some surgeons had better role models than others, but surgeons did not have an educational, formal method of surgical training.

This is what I had tried to do in a systematic method in Cincinnati. I was a neurosurgical residency program director. I tried to make education more formalized and more systematic. I tried also to help the educators become educators, not just mentors.

Because when it comes to evaluating patients, when it comes to giving feedback to patients, sometimes it comes to making somebody else better, we still rely overtly and to a detrimental degree on the apprenticeship method of surgical resident training. "Watch me and learn by osmosis." That doesn't mean that we have to have the residents do the surgeries and we are watching.

That's not exactly what I'm saying. But unless we can structure the feedback that we give to patients, we cannot succeed fully. Sometimes in training, the feedback was always negative.

Dr. Anton Titov, MD: You did not want any feedback. In the old days, that was the accepted method, the norm. But now we are dealing with the Millennial generation. We have done a lot of research about the Millennial Generation in my prior capacity as a focused educator.

I can tell you that the type of feedback that surgical residents now require and need to improve is very different from what we required or needed. That is societal, at least in the US and everywhere. The tools we use should be different, and frankly now we have the technology to do that.

We had instituted observed surgical sessions where we would evaluate somebody in that.

Dr. Philip Theodosopoulos, MD: Now it is so easy for me to record you operating under the microscope and show it to you on the computer. It is funny we say this to patients now. Then they look at you like you have two heads. But fifteen years ago, that was not even possible. Sometimes you wanted to, you could not do it. Now it is a little button you press, and you just throw the video into your computer in an instant.

Dr. Anton Titov, MD: Some of the changes in surgical training supervision and strategy are technological. Some changes are systematized because unless you do it, there are not enough hours in the day now to just train patients osmotically. Some of the changes in surgical training treatment are related to increased competition.

There's a lot more patients doing a lot more things now.

Dr. Philip Theodosopoulos, MD: Surgeons have to really shift through the good quality patients. You have to give them those tools. Surgeons cannot expect younger surgeons to get skilled by themselves. Young surgeons cannot practice and become proficient in using the tools immediately because they are not going to get that practice until quite late in their own experience.

It is a very interesting and exciting field of surgical education. We haven't even touched on the more technologically advanced ways that are not yet quite proven.

Almost for certain, in the future, simulation of surgical operations will be used extensively. But those are the kinds of ways that we are going to use to train patients in the future. It is exciting for all of us as educators.

Dr. Anton Titov, MD: How to train leading surgeons. Video interview with a leading expert in neurosurgery. How to mentor young surgeons properly? Apprenticeship or structured feedback?