Ideals in Surgery

SURGERY GYNECOLOGY AND OBSTETRICS ~ THIRTY-THREE years ago a group in the past eight years, of the length and char- lI) of very wise men founded the Amer~ acter of the training required. Others felt, ~ ican College of Surgeons. It was however, that all those who proposed to spe- : their hope that by gathering to- cialize should be forced at an early stage in &: gether in such a College all the surgeons and their graduate training to demonstrate to a t..D surgical specialists who were known to be court of examiners that they were proficient in ~ morally and ethically fit and who had demon- the principles of surgery and in the allied basic ~ strated by their training and by their standing medical sciences. From this arose the Ameri- j in the professional world that they were prop- can Board of Surgery and the boards of the ~ erly qualified, the standard of surgical care various surgical specialties, to which the Col- might be raised to the level that a great people lege elects representatives. ':£ deserves. It was hoped, too, that with the The aim of both the College and the Boards r-4 lapse of a few years the diploma of Fello"wship has been the improving of the quality of in the College would become so desirable and American surgery and both have been success- so necessary that all who proposed to practice ful. The College insisted on minimum periods surgery would seek it and that by and by it of apprenticeship, evidence of high moral and would constitute a clear index whereby those ethical standing, and proof that the candidate who were qualified to do surgery could be dis- had shown ability in practice. It concerned it- tinguished from those \\·ho were not. self with the raising of the standards of the 1 Since the day of its foundation the College hospitals in which its Fellows would study and / has grown and prospered and it has done those work, it busied itself with advanced surgical !( things to a superlative degree for which its education, as indicated by this Congress today '- founders so fondly hoped. and it is now engaged in what may prove to be As time went on, hO\\'ever, and the future of its greatest effort on behalf of American sur- the College had been firmly established, there gery, the establishment of adequate graduate arose both within it and without, a demand for training. The Boards have outlined more a definite raising of the requirements for ad- sharply the periods of hospital training that mission to Fellowship, both in the form of are required and have made sure, by requiring longer and better practical training and of the candidates to pass searching examinations, proficiency not only in surgery but also in all that they have an adequate knowledge not "lJ.ebasic sciences related to it. The College only of the art of surgery but of the basic ~cognized this demand by two modifications, sciences, without which no man can be a true surgeon. Address of the retiring President, before the Clinical Congress otthe American College of Surgeons, Cleveland. Ohio, December Speaking now, not as President of the Col- IHo, 1946. lege, but as a Canadian and a most friendly 513 onlooker, I recognize the same high motive in one might suppose. While most hospitals are both the College and the Boards, and I see interested to a certain extent, because certifi- great virtue in what each has done. It seems cation by the College that a hospital is ap- to me, however, that it is a pity to have two proved for graduate training would ensure a separate roads to public recognition and that a constant supply of good internes, yet many of combination of the two, with adoption of what these hospitals balk at the radical staff reor- is best in each, would add great strength to the ganization involved and hesitate to put the crusade for higher standards and would ulti- time and effort into a teaching program thr • mately serve the people best. could be considered adequate. It is clear thaL But while the setting up of standards for to make a success of its graduate training plan qualification to practice surgery is a step in the College will require the good will of the the right direction it will prove quite futile if public and the whole medical profession and . conditions are such that these standards can- the strong support of all the Fellows. be achieved. What does it profit to tell a In support of the program of graduate oung graduate that he must serve a period of training I propose to discuss with you briefly / I~supervised training in an approved hospital, the plan which has .been in operation in the V f extending over a period of 3 or 4 years, if a University of Toronto for the past 18 years. I ( sufficient number of such hospitals do not have no thought that it is adaptable to all situ- \ exist? A survey of the hospitals of Canada has ations nor have I any notion that it is as good as shown that only a few can at present be ap- that in many of the great American universities, proved for graduate training and the same particularly those with sufficient endowments lamentable state of affairs obtains in the to enable them to grant numerous fellowships United States as well. Only in a few of the toward graduate training. It does illustrate, hospitals attached to medical schools is there however, what can be done by long term any attempt at the planned training of in- planning and by persistent effort at reform. ternes and residents and in very few of these, Twenty-five years ago the Toronto General any provision for instruction in the basic sci- Hospital (1,000 beds), staffed by the best sur- ences. How man'y hospitals do you know geons in the land, all members of the Medical where a three year assistant residency is of- Faculty, had never trained a surgeon. In- fered, or where regular ward rounds or con- ternes came for a year or two and departed, ferences are held, or where supervised courses usually into general practice. Those who of· study are provided in anatomy, applied aspired to become surgeons sometimes went to physiology, and applied pathological chemis- New York to see~ a further interneship, or try? And how many hospitals do you know more often, went to London or Edinburgh to where internes are encouraged to make use of study for the coveted diploma of Fellowship in the libraries or to take part ip surgical re- one of the Royal Colleges. These Fellowships search? The answer is, yery few. There are, of were won by passing the stiffest kind of ex- course, outstanding examples to the contrary, aminations in anatomy, physiology, pathology where the training of the interne is a major and surgery and they were a guarantee that interest of the stafi but when one adds up the the successful candidate at at least one stage in number of these hospitals and makes up the his career had been familiar with what the grand total of the graduates receiving such textbooks said about them. They did not, training it will be found that the number is however, guarantee that the Fellow had any very small. satisfactory apprenticeship or had become a This is the reason for the present activity of master of his craft. It was only when he re- the College in graduate training and for its turned to his home and had received a junior effort to induce hospitals to make the neces- hospital appointment that his practical trair - sary reorganization of their staffs and to adopt ing began. ' the resident system. Under this system a small group of surgeons Unfortunately the reformation that the Col- was developed from which the medical school lege has in mind is by no means so simple as and the hospitals selected their staffs. Then came the era of the building of small versity staff appointments here or elsewhere hospitals and with it the enormous increase are sele£ted to remain as Fellows in general in the number of surgical operations. These surgery or in one of the surgical specialties. operations, of necessity, were performed by During, this period they rank as junior mem- practitioners of very little training who had bers om the staff and are permitted to as- learned what they knew from books, from ob- sume DDl:dependentresponsibilities. servational tours, and from the hard experi- ThiS plan of graduate training is quite elas- "'nce of trial and error. I know one such hos- tic. _-\5 I have outlined it, it is a minimal pital serving a neighborhood of six or seven course which may not be shortened but which thousand people where the operating rooms may k lengthened as circumstances seem to are busy every day from nine to one and wpere require. Thus for the young man whose ob- not a single operator ever had more than a ject it tS to leave the university and go into rotating interneship. It "vas to try to force an pradlll«:ltat a distance, we suggest that he take elevation of the standards of education of in ~t!ion to his general surgical training, as these surgeons that the American College of many (!)f the surgical specialties as possible. Surgeons was founded. Six mnxruthsassistan t residencies in orthopedic Recognizing that the raising of standards su~, gynecology, urology, and the surgery was useless unless provision were made for ofdrillrdJl'lOodare of great value to him.

Load more