Abstract
Emerging changes in health care delivery will have a significant impact on the structure of surgical education in academic departments of surgery. Based on some assumptions as to the probable nature of the final product of this reform, this article encourages a proactive stance by surgical educators to anticipate changes and move toward restructuring in areas of curricular content, the teaching process, performance evaluation strategies, and faculty infrastructure of the academic department. Curriculum changes must bridge the gap between public health and medicine and continue the aggressive trend toward teaching in the outpatient setting. Surgical educators must adapt to evolving computer and instructional technology that will make multimedia presentations, distance education, teleconferencing, hypermedia, and virtual reality commonplace in the teaching setting. Increased emphasis on accountability and accreditation will require stringent criteria in performance and program evaluation methodology. The academic infrastructure will need to adapt to the changing goal of training more general surgeons and fewer specialists and yet maintain the fundamental responsibility of an academic surgeon for mentoring the medical student and surgical resident.
Résumé
Les changements actuels dans l'administration des soins vont avoir un impact important sur l'enseignement de la chirurgie dans les services de Chirurgie Universitaire. Basé sur quelques présomptions sur la forme finale de la réforme en cours, cet article encourage les enseignants futurs à anticiper ces changements et à commencer dès à présent une restructuration du programme, de l'enseignement, des stratégies d'évaluation et de l'infrastructure des services Universitaires. Le programme doit combler l'écart actuel entre les services de Santé publique et de Médecine et continue d'enseigner la prise en charge des patients dès la consultation. Les enseignants doivent s'adapter à la technologie informatique qui permet entre outre de réaliser les présentations multimédiatiques, le télé-enseignement, la téléconférence, l'hypermédiatique et la réalité virtuelle. On insiste aussi sur l'accréditation qui demande une méthodologie stricte d'évaluation et de contrôle de réalisation. L'infrastructure académique a besoin d'orienter ces objectifs vers la formation de moins de spécialistes et de plus de chirurgiens généraux. Elle doit avoir maintenir le principe fondamental d'un chirurgien académique responsable de la formation des étudiants et des résidents en chirurgie.
Resumen
Los emergentes cambios en los sistemas de atención de la salud han tenido un significativo impacto sobre la estructura de la educación quirúrgica en los departamentos académicos de cirugía. Con base en algunas suposiciones en lo referente a la probable naturaleza final del producto de esta reforma, el presente artículo estimula a los educadores quirúrgicos a tomar una posición activa con miras a definir los cambios por venir y a iniciar la reestructuración de diversos aspectos del contenido curricular, del proceso de enseñanza, de las metodologías de evaluación del rendimiento y de la infraestructura académica de los departamentos ruirúrgicos. Los cambios curriculares deben eliminar la brecha entre la salud pública y la medicina y mantener una decidida tendencia hacia la enseñanza en los escenarios de consulta externa. Los educadores quirúrgicos deben adaptarse para asumir las teconologías de computación y los nuevos métodos de instrucción que comprenden sistemas multimedia, educación a distancia, teleconferencias, hipermedia y realidad virtual, en tal forma que se conviertan en lo usual en el contexto educativo. El mayor énfasis sobre responsabilidad auditada y acreditación demanda estrictos criterios en las metodologías de ejecución y de evaluación de programas. La infraestructura académica deberá adaptarse a los cambiantes objectivos de adiestrar un mayor número de cirujanos generales y menos especialistas, y, sin embargo, preservando la responsabilidad fundamental del cirujano académico en cuanto a la tutoría del estudiante de medicina y del residente quirúrgico.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Osborn, J.E.: The nature of public health after reform. Acad. Med. 68:237–243, 1993
Da Rosa, D.A., Dunnington, G.L., Sachdeva, A.K., et al.: A model for teaching medical students in an ambulatory surgery setting. Acad. Med. 67:545, 1992
Rothman, A.I., Cleve-Hogg, D.M.: A medical school learning environment: views from the trenches. Teaching Learning Med. 2:12, 1990
Dunnington, G., Reisner, E., Witzke, D., Fulginiti, J.: Teaching and evaluation of physical examination skills on the surgical clerkship. Teaching Learning Med. 4:110–114, 1992
Reisner, E., Dunnington, G., Beard, J., Witzke, D., Fulginiti, J., Rappaport, W.: A model for the assessment of studients' physicianpatient interaction skills on the surgical clerkship. Am. J. Surg. 162:271–273, 1991
Council on Long Range Planning and Development and Council on Medical Education: The Future of Graduate Medical Education. American Medical Association, Chicago, 1989
Green, D.: Health care reform and the generalist physician. AAMCC Reporter 2: 1, 1992
Sculley, J.: The relationship between business and highar education: a perspective on the twenty-first century. EDUCOM Bull. 23(1):20–25, 1988
Association for American Colleges Reporter 2:7, 1993
Shatzer, J.H., DaRosa, D.A., Colliver, J.A., Barkemerler, L.: Station length requirements for reliable performance-based examination scores. Acad. Med. 68:223, 1993
Brailovsky, C.A., Grand Maison, P., Lescop, J.: A large-scale multicenter objective structured clinical examination for licensure. Acad. Med. 67:S37, 1992
Ramsey, D., DaRosa, D.A., Finch, W.T., et al.: Evaluation of surgical residents using simulated patients. Int. J. Eval. Program Plann. 10:9, 1987
Sokolov, J.: The evolution of managed care. In Proceedings of the University of Southern California Managed Health Care Symposium, April 17, 1993
Karnell, L.H.: Longitudinal Study of Surgical Resident, 1990–1991. American College of Surgeons, Chicago, 1992
Folse, R.F.: Surgeons as educators. Bull. Am. Coll. Surg. 78:31, 1993
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Dunnington, G.L., DaRosa, D.A. Changing surgical education strategies in an environment of changing health care delivery systems. World J. Surg. 18, 734–737 (1994). https://doi.org/10.1007/BF00298919
Issue Date:
DOI: https://doi.org/10.1007/BF00298919