The opportunities for hands-on experience and practice for trainees is decreasing for many reasons. Studies show the alarming consequence of a broken training system.
Surgical trainees, (i.e. interns, residents, and fellows), are responsible for taking care of patients and participating in their surgeries in an apprenticeship training model. The cases a resident participates in are typically dictated by the schedule of the attending they are assigned to be assisting. It is not uncommon for them to be relegated to holding retractors, or just watching, depending on their level of seniority, and from time to time, take the lead in certain key parts of a case. The opportunities for hands-on experience and practice for trainees is decreasing for many reasons:
- New work hour restrictions capping the work week at 80 hours, while completely reasonable, have lost residents around a year of hands-on training time.
- New technologies better assist surgeons, meaning the surgeon needs less help from residents and the medical team.
- 50 percent of a trainee’s time can be spent on entering information into Electronic Medical Records systems
Studies show the alarming consequence of a broken training system. A groundbreaking study measured the ability of residents to operate autonomously throughout their training up until graduation. At the time of graduation, about 30 percent of residents were still unable to operate independently. This phenomenon is leading to a vicious cycle in which these young, undertrained attending surgeons are still spending their time training themselves instead of operating at a level where they can train the next round of young residents counting on their coaching and education.
Another study examines the effectiveness of traditional training methods for new procedures like robotic surgery, and its findings support the notion that these new advancements offer limited engagement opportunities for learning surgeons. It found robotic surgery greatly limited the trainees’ role in the work, making approved methods of training ineffective. This leads to a lack of engagement and participation that results in residents graduating with very little if any, actual hands-on experience.