Student and resident training needs radical change

If you’ve followed my blog, you know that I have been concerned about the state of surgical residency programs and other issues involving medical education. For more on these topics, browse the labels “surgical residency training” and "medical education" in my blog.

Here is more food for thought.

While the impending shortage of general surgeons has prompted calls for increases in the number of general surgery training programs and expansion of existing programs, there are some questions about quality.

Here is a paragraph from the Residency Review Committee for Surgery program requirements:

V.C.3. The performance of program graduates on the certification examination
should be used as one measure of evaluating program effectiveness. At
minimum, for the most recent five-year period, 65% of the graduates must
pass each of the qualifying and certifying examinations on the first
attempt.

The American Board of Surgery publishes data on board passage rates by program. According to the 2011 figures, 82 (34.3%) of the 239 accredited general surgery residency programs in the US have first-attempt board passage rates of <65% for the most recent five years and 30 of those programs (12.6% of the 239 programs) have rates of 50% or less.

In the March, 2012 issue of Archives of Surgery, Dr. Leigh Neumayer cited a decline in the in the rate of individual residents passing their boards. In 2010, 75.1% passed the written and 76.8% passed the oral examinations. These percentages are remarkably consistent with the 25% of surveyed surgical residents who feel that they are not adequately prepared to practice independently. She mentioned the trend of graduating residents taking fellowships because they are not ready to practice by themselves.

She also discussed the need to change the way surgeons are trained, pointing out that the amount of knowledge to be acquired by trainees is increasing exponentially while the time available to learn is decreasing.

She said that every surgeon should not necessarily be trained to perform every procedure. This is actually sorting itself out with the volume and outcomes debate, which despite a few discrepancies, favors surgeons who perform large numbers of certain procedures.

She made some other interesting suggestions which, because they are sensible, are unlikely to be adopted by those in power. Others have called for reforms in medical education such as reducing the amount of useless material memorized in the first two years of medical school, also unlikely to change.

Now that a resident can carry a computer in her pocket and access everything there is to know instantly, why should she have to memorize formulas, chemical reactions and other minutia? With the exception of the rules limiting work hours, medical school and resident curricula have changed very little since I was a student and resident some 40 years ago.

To summarize: We are trying to cram much more information, which is also more complex, into less time using the same methods we did in the middle of the Twentieth Century.

My suggestion: Let’s teach them to think instead of memorize.

I wonder what it will take to get the people in charge of medical education [American Association of Medical Colleges, American Board of Medical Specialties, Accreditation Council for Graduate Medical Education (parent organization of the Residency Review Committee for Surgery) and others] to wake up and notice that the system is not working very well.