How to train best surgeons? Apprenticeship meets modern healthcare reality. Top neurosurgeon and educator. 6
How to train leading surgeons? Surgical training followed craftsman and apprentice educational model for many centuries. Young surgeon was an apprentice. Senior surgeon is a craftsman. Today surgical training has to become more formally structured. Mentors have to provide better feedback. Leading neurosurgeon from California shares his vast experience in mentoring young surgeons. How do you prepare the next generation of leading surgeons? How to train leading surgeons. Video interview with leading expert in neurosurgery. How to train best surgeons. Dr. Philip Theodosopoulos, MD. Experienced academic surgeons in leadership positions have to help the surgeon educators become educators. Surgical residency program directors have to structure the feedback to trainee surgeons. Dr. Anton Titov, MD. Millennial generation surgeons require different treatment to surgical education. Observed surgical sessions are helpful for young surgeons. Providing constructive and frequent feedback to young surgeons is important. Surgeons have to use modern tools of computer technology and simulation training to improve education of young surgeons. Dr. Philip Theodosopoulos, MD. Medical Second Opinion is important if surgery is required. Medical Second Opinion helps to choose the best treatment when neurosurgical operation is needed. Medical Second Opinion will make patient confident that proposed treatment is the best. Becoming a surgeon. How to train leading surgeons. Dr. Anton Titov, MD. Let’s talk about neurosurgical training. Dr. Philip Theodosopoulos, MD. You have already touched a little bit on this subject. It is a very important one. You and I first met at Brigham and Women’s Hospital in Boston. I was then a resident and you were a cerebrovascular and skull base fellow with Dr. Arthur Day. Dr. Arthur Day is one of the most prominent cerebrovascular and skull base surgeons in the world. I also think that Dr. Arthur Day is an outstanding educator. Dr. Anton Titov, MD. He is willing to devote as much attention as required for his residents. then he devotes some more time to each of his residents and fellows. we both appreciate the importance of the high quality and rigorous training in medicine and in surgery. You have done some outstanding work in neurosurgical education in the University of Cincinnati. Dr. Philip Theodosopoulos, MD. There you were a Director the neurosurgery residency program for a long time. Then you came to San Francisco, UCSF. You made changes in the surgical training and achieved the results that were commended at the national level. Dr. Anton Titov, MD. What are crucial educational structures in training of neurosurgical residents? What were the results of changes in neurosurgical training? Dr. Philip Theodosopoulos, MD (Neurosurgeon, Director of Skull Base Tumor Program, UCSF). We are in many ways still stuck in the old paradigm of training. In surgery in particular, and in all surgical disciplines. That gets you to a certain point but not further. why is that important? Dr. Philip Theodosopoulos, MD. We all lived through a mentor – mentee paradigm of surgical training. We flourished through it. That is very important, and very effective. But old paradigm to surgical training has become very limited now. Because of limited hours we can use to train patients. Because of limited exposure to diseases and conditions. Because of limited time in the operating room. There is limited exposure in the relationship between the mentor and mentee. Traditionally that was supplanted by practice. Then you went out into your own clinical practice. That opportunity has become also more limited now. Because clinical outcomes are very well looked at. Because the hospitals care about all of these things. Dr. Philip Theodosopoulos, MD. Patients are less interested in pushing the envelope by being operated on trainee surgeons. There is a potential risk that surgeons will be faulted for taking the risk of pushing the envelope in training. Which is not to say that we ever put the patient’s well-being at risk. But there is a point where surgical innovation can be stifled by overt supervision. Surgeons are all educators. Dr. Philip Theodosopoulos, MD. But surgeons were never really trained as educators. We were trained as apprentices. Some surgeons had better role models than others. But surgeons did not have an educational, formal method of surgical training. This is what I had tried to do in a systematic method in Cincinnati. I was a neurosurgical residency program director. I tried to make education more formalized, more systematic. I tried also to help the educators become educators. not just mentors. Because when it comes to evaluating patients, when it comes to giving feedback to patients. Sometimes it comes to making somebody else better. We still rely overtly and to a detrimental degree to apprenticeship method of surgical resident training. “Watch me and learn by osmosis”. That doesn’t mean that we have to have the residents do the surgeries and we are watching. Dr. Philip Theodosopoulos, MD. That’s not exactly what I’m saying. But unless we can structure the feedback that we give to patients, we cannot succeed fully. Sometimes I was training the feedback was always negative. Dr. Anton Titov, MD. You did not want any feedback. In the old days that was the accepted method, the norm. But now we are dealing with the Millennial generation. We have done a lot of research about Millennial Generation in my prior capacity as a focused educator. I can tell you that the type of feedback that surgical residents now require and need to improve is very different to what we required or needed. that is societal, at least in the US, and everywhere. The tools we use should be different, and frankly now we have the technology to do that. We had instituted observed surgical sessions, where we would evaluate somebody in that. Dr. Philip Theodosopoulos, MD. Now it is so easy for me to record you operating under the microscope and show it to you on the computer. It is funny we say this to patients now. Then look at you like you have two heads. But fifteen years ago that was not even possible. Sometimes you wanted to you could not do it. now it is a little button you press and you just throw the video into your computer in an instant. Dr. Anton Titov, MD. Some of changes in surgical training supervision and strategy is technological. Some changes are systematized, because unless you do it, there is not enough hours in the day now to just train patients osmotically. Some of changes in surgical training treatment is related to increased competition. There’s a lot more patients doing a lot more things now. Dr. Philip Theodosopoulos, MD. Surgeons have really shift through the good quality patients. You have to give them those tools. Surgeons cannot expect younger surgeons to get skilled by themselves. Young surgeons cannot practice and become proficient in using the tools immediately. Because they are not going to get that practice up until quite late in their own experience. Dr. Philip Theodosopoulos, MD. It is a very interesting and exciting field of surgical education. We haven’t even touched on the more technologically advanced ways that are not yet quite proven. Dr. Philip Theodosopoulos, MD. Almost for certain into the future simulation of surgical operations will be used extensively. But those are the kinds of ways that we are going to use to train patients in the future. It is exciting for all of us as educators. Dr. Anton Titov, MD. How to train leading surgeons. Video interview with leading expert in neurosurgery. How to mentor young surgeons properly? Apprenticeship or structured feedback?
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