[HSF] Current Requirements for the ABTS

Tea Acuff tacuff at swbell.net
Tue Oct 24 20:20:16 EDT 2006 

An interesting line of logic. Change the focus a little more up and down and see what you get.
To whit go backwards in training: why bother with 4 years of medical school most of which one will never use and is half wrong anyway since it was 10 years ago, how about all that chemistry in college, or 12 years of math before college? Who uses calculus anyway?
The other direction: Why not just study cardiac or thoracic, but not both? Why not just pedi? 
Why not just train for the mitral valve or the hardest to do just the anterior leaflet? Let the generalist surgeon do the easy posterior leaflets. Surely we can all recognize the supreme excellence of an idiot savant.
 
I think it makes more sense for us all to study theology, the queen of the sciences by western standard, before we specialize in science. Not complete sense, mind you , just more sense.
Tea


----- Original Message ----
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, October 22, 2006 8:55:17 AM
Subject: Re: [HSF] Current Requirements for the ABTS


Michael

I agree with most you say except your suggestion that only a 5 yr general surgery program allows for skills of post-op care etc. Remember that most countries in the world do not require 5 year general surgery prior to CT surgery training - do you suggest that they are producing inferior surgeons, or surgeons incapable of looking after patients?

If you ask me the greater flaw is in a system where a trainee spends 5 yrs training in general surgery (doing operations he will never do again in his life) and then only 2 years (the duration of many US CT programs) learning cardiac, thoracic and congenital CT surgery. Considering most surgeons are specialized, for some CT surgeons coming out of training they would have spent only 6 to 12 months learning their chosen specialty (adult, kids or thoracic). 

Would it not make more sense to spend a greater part of the 7 years learning what one will practice for the rest of one's life? In Canada, for example, almost all of those years is spent in CT surgery - I have seen a few young Canadian surgeons and they ain't that bad. I think the traditional US training system worked well when there were no working hour limits and when residents were made of steel, but in this day of curtailed working hours and fragile residents that need to be handled with care, the US system needs to change (hence the supposed introduction of integrated programmes).

Ani
  ----- Original Message ----- 
  From: Michael Firstenberg<mailto:msfirst at gmail.com> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Sunday, October 22, 2006 9:04 AM
  Subject: Re: [HSF] Current Requirements for the ABTS


  Hal,
  I agree with you 110%.  Unless you are in a system where you have no  
  control of your patients post-op (which probably does not exist),  
  these patients need to be led (not followed) thru their hospital  
  stays and I think only a general surgery 5 year program allows for  
  those skills.  Not just how to set-up and perform complex operations,  
  but also how to manage a team - which no consists of RNs, NPs, PAs,  
  Nutrition, PharmD, RTs, not to mention residents and house staff.   
  Calling consults and dealing with problems is much easier if you know  
  what you are talking about.  Unfortunately, most of us (at least I  
  feel I do) often have more experience in neuro, renal, GI, and ID  
  than many of fellows/residents (even at times Attendings?) is those  
  areas.  It is a shame that probably the most important learning years  
  in terms of becoming a leader and "doctor" and true patient advocate  
  are getting lost.

  But CT surgery is getting too complicated for 2-3 years of training -  
  OPCAB, Maze, Valve repairs, VADs, transplant, aortic work, etc - not  
  to mention congential and thoracic - I may be slow, but just learning  
  the basics is a lifetime process and adding more and more years of  
  training doesn't sound like the answer either.

  I think part of the solution is for young trainees, such as myself,  
  to find groups (as I have) of senior people who take pride in not  
  just teaching fellows, but mentoring young surgeons.  Give them jobs,  
  nurture their careers and professional development.  Guide them thru  
  the early years of their careers as they mature.  Just dont dump on  
  them and walk away.   No jobs?  Make them - hard to imagine that each  
  major group/medical center cant find a role for a young hungry CT  
  surgeon?  Case volume decreasing?  As Lytle says - "did you really  
  think you would still be doing the same operation for 50 years?" -  
  find new opportunities.  If there is so little work, then why is the  
  training getting so long and why do we all spend so much time in the  
  hospital?  IMHO, that is what leadership is.

  Ok, rambling, but it is early Sunday....
  Just my 2 cents on the problem.

  Michael


  On Oct 22, 2006, at 8:36 AM, Hgrmd at aol.com<mailto:Hgrmd at aol.com> wrote:

  > Prasanna,
  >   Worse yet, how will a couple extra years less of cutting and  
  > sewing  impact
  > the CT surgery residents abilities?  As a 4th and 5th year general   
  > surgery
  > resident, I was the primary surgeon on a lot of huge cases.  Most   
  > of these I
  > don't currently do, but gaining the skills and maturity was   
  > invaluable.  In
  > addition, some of my current patients suffer postop GI   
  > complications.  I can
  > recognize a surgical abdomen, as well as make sure  that the  
  > general surgeon
  > handles it appropriately.  Alas, the U.S. CT  surgery programs have  
  > multiple huge
  > problems in even maintaining the quality of  trainee that we've become
  > accustomed to them producing.
  > Hal
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