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Takeaways from a hundred and fifty years of surgical education: A chief resident's perspective
Lecciones de ciento cincuenta años de educación en cirugía: perspectiva de un jefe de residentes
Mauricio Gonzalez-Urquijo
Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
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Adalbert Franz Seligmann. 1880. Österreichische Galerie Belvedere.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Nearly 150 years ago, <span class="elsevierStyleItalic">circa</span> 1870, Theodor Billroth (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), considered one of the greatest surgeons of all time, wrote a monograph entitled, “Teaching and Learning the Medical Sciences in German Universities”. This is one of the first manuscripts where the topic “surgical education” formally appeared.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> Billroth was known for being one of the first surgeons who surrounded himself with a close-knit group of disciples who, working together on new procedures, developed and transferred knowledge for a common approach.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> Almost twenty years later, in 1889, William Halsted developed the first formal surgical training program, attributing the idea of the European model of surgical training he gathered from Theodor Billroth.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> The manner in which Billroth selected young trainees highlighted the talents he reckoned indispensable for a good surgeon. Downplaying the importance of manual skill in favor of medical knowledge, clinical judgement, and patient management was characteristic for the rising surgeon from the eighteenth century; however, Billroth went beyond that, prioritizing an academic interest in scientific research.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A chief resident plays a significant role in residency programs, being positioned at the nexus between faculty and residents. The position is considered one of integrity and respect, which is selected by faculty members for its exceptional clinical and leadership skills. The chief resident works as a team to provide leadership, supporting the residency program's fundamental missions.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This viewpoint emphasizes ten attributes that for a chief resident are indispensable for becoming a successful surgical resident, and at the end of the surgical training, a well-rounded and technically competent surgeon who is grounded in the principles of general surgery.</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Be a leader.</span> Leadership and authority are gained by forging an example for those with less experience, and not by abusing seniority or acting with a misplaced sense of hierarchical authority. Advancing through the training program does not represent automatic leadership, as it is obtained by leading through example, as you perform actions and attitudes that help with the training of those with less experience.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Be disciplined.</span> A surgeon must have a high concentration capacity. Surgeries, rounds, and teaching sessions are interlocking pieces that must function together as a whole for it to work promptly. All team members should have one common attribute, which is knowing and exhibiting the importance of being in time. This also shows discipline and demonstrates that you are ready for any task you are given. If you show competence and responsibility when entrusted with little, you will exhibit to your superior that you can likely be entrusted with more. Self-discipline helps you to become an unstoppable tour-de-force that will help you grow and become the best version of yourself.</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Be presentable.</span> George Washington Crile (1864-1943), a co-founder of the Cleveland Clinic, visited Vienna in 1872. He described Dr. Billroth as “the most impressive of them all<span class="elsevierStyleBold">—</span><span class="elsevierStyleItalic">positively god-like in</span><span class="elsevierStyleItalic">demeanor</span>”. Billroth always performed his work with the utmost formality.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> Appearances matter. This is a part of non-verbal communication. Being neat and tidy expresses that you have your act together and demonstrates self-confidence.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Be an educator.</span> In Greek, <span class="elsevierStyleItalic">a mentor</span> means “to endure”—to last through the ages. The atmosphere generated by a good mentor endorses self-esteem and the importance of lifelong learning.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> Be a mentor for junior residents or medical students. Mentorship tends to occur over an extended timeframe and can include guidance in areas outside of medical knowledge or surgical skills, such as career advice, networking, and work-life balance. Teaching offers a structured approach that encourages self-reflection by using facilitated feedback, analysis, and debriefing. It can be tailored to each individual goal and can benefit surgeons in training at every level.</p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Be a scientist.</span> There are certainly crucial surgical science discoveries yet to be made, and surgical scientists should continue to be at the forefront of those efforts.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> Residents must be trained to conduct meaningful basic or clinical research. There are always unanswered questions, and residents should try to find those answers by conducting research. Research is the door to an academic career. Publishing a paper at the beginning of a surgeon's career is extremely important in order to stimulate a curious mind.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Be resilient.</span> Resilience is the ineffable quality that allows some people to be knocked down by life and come back stronger than ever; the capacity to recover quickly from difficulties, often equated with toughness.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> A surgeon must understand that not everything depends on their own action and that many times the disease decides to act on its own.</p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Be an athlete</span>. Surgeon must have manual skills and visual ability. Nowadays, there is a lot of technology that helps improve surgical dexterities. Surgery is like any sport, where techniques are perfected, the more you practice. Visit the skills lab as many times as possible and make it a habit. Enrolled in many cases as possible. Exposure is the key for discovering and learning new skills.</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Be an anatomist.</span> A mechanic has to learn all the intricacies of a motor design. The same is true for surgeons. Fall in love with the complex structures of the body's interior and their arcane nomenclature. There is no surgery without embryology, gross anatomy, and microscopic anatomy. Look at the big picture through the small lens, and at the small picture through the higher perspective.</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Be the attending's right hand</span>: Know each of your attendings thoroughly, from their surgical preferences for incisions, to his or her latest published article, or their favorite sports’ team. Having a bond with your mentor is the key to a successful career. There is no better form to learn than from the mentor–mentee dualism. A right mentor transmits more than principles of surgery; he teaches life lessons.</p><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Be a physician, above all:</span> Before being a surgeon, it's indispensable to be a respectful physician. The Hippocratic Oath states that in addition to medical knowledge, the physician is obligated to diffuse the ethical and moral basis of medical art. The Oath precludes the technocratic aspect of medicine and reinforces its humanistic elements. A physician must be empathetic, encompassing an attitude of caring for others, respecting life, with the disposition to always be of help.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Many other attributes can lead you to successfully complete your training program, however; I firmly believe practicing these ten principles can lead you to become a respectable mentor, a renowned scientist, an excellent surgeon, and an outstanding leader, all merged to embody the qualities of a Billroth and Halsted type of resident.</p><p id="par0075" class="elsevierStylePara elsevierViewall">This viewpoint is dedicated to all the professors and mentors of surgery, because simply without them, we wouldn’t become the surgeons we are meant to be, taking me to the last point:</p><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Be grateful:</span> Be grateful and humble with your mentors and professors. Becoming a surgeon is challenging by definition, but the mountain of training can be easier to climb when there is reciprocity and team responsibility among colleagues, mentors, and leaders.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> It is up to the mentees to find someone they respect and trust to help them reach their objectives. Look for mentors with specific characteristics that fit your purpose.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> The final goal must be to reimburse our gratitude to our mentors by practicing the science of surgery in the most ethical, humane, and scientific way possible, providing admirable patient care, and to evolve into successful role models ourselves for new generations. Guaranteeing them that the essential traditions of our noble profession will continue to transcend through time.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Financial support</span><p id="par0085" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres1605686" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1437042" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1605685" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1437041" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-08-17" "fechaAceptado" => "2020-11-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1437042" "palabras" => array:5 [ 0 => "Surgical education" 1 => "Residency" 2 => "Training" 3 => "Surgery" 4 => "Young surgeon" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1437041" "palabras" => array:5 [ 0 => "Educación en cirugía" 1 => "Residencia" 2 => "Entrenamiento" 3 => "Cirugía" 4 => "Cirujano joven" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nearly 150 years ago, <span class="elsevierStyleItalic">circa</span> 1870, Theodor Billroth, considered one of the greatest surgeons of all time, wrote a monograph entitled, “Teaching and Learning the Medical Sciences in German Universities”. Almost twenty years later, in 1889, William Halsted developed the first formal surgical training program, attributing the idea of the European model of surgical training he gathered from Theodor Billroth. The manner in which Billroth selected young trainees highlighted the talents he reckoned indispensable for a good surgeon. This viewpoint emphasizes ten attributes that for a chief resident are indispensable for becoming a successful surgical resident, and at the end of the surgical training, a well-rounded and technically competent surgeon who is grounded in the principles of general surgery.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hace casi 150 años, <span class="elsevierStyleItalic">circa</span> 1870, Theodor Billroth, considerado uno de los mejores cirujanos de todos los tiempos, escribió una monografía titulada <span class="elsevierStyleItalic">Teaching and Learning the Medical Sciences in German Universities.</span> Casi 20 años después, en 1889, William Halsted desarrolló el primer programa formal de entrenamiento en cirugía, atribuyendo la idea del modelo europeo de entrenamiento en cirugía de Theodor Billroth. La manera en que Billroth seleccionaba jóvenes aprendices destacaba en los talentos que él consideraba indispensable que debería tener un buen cirujano. Este artículo de opinión enfatiza diez atributos que son indispensables, desde la perspectiva de un jefe de residentes, para convertirse en un residente quirúrgico exitoso, y al final de su entrenamiento, sea un cirujano completo, técnicamente competente basándose en los principios de la cirugía general.</p></span>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1037 "Ancho" => 750 "Tamanyo" => 189431 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Theodor Billroth Operating. Adalbert Franz Seligmann. 1880. Österreichische Galerie Belvedere.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The medical sciences in the German Universities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. Billroth" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1924" "editorial" => "The Macmillan Co." "editorialLocalizacion" => "New York" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0070" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgery and national identity in late nineteenth-century Vienna" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 3 | 12 |
| 2024 October | 35 | 10 | 45 |
| 2024 September | 62 | 14 | 76 |
| 2024 August | 54 | 13 | 67 |
| 2024 July | 37 | 16 | 53 |
| 2024 June | 51 | 13 | 64 |
| 2024 May | 31 | 17 | 48 |
| 2024 April | 47 | 11 | 58 |
| 2024 March | 32 | 9 | 41 |
| 2024 February | 23 | 9 | 32 |
| 2024 January | 34 | 9 | 43 |
| 2023 December | 56 | 14 | 70 |
| 2023 November | 51 | 10 | 61 |
| 2023 October | 54 | 14 | 68 |
| 2023 September | 28 | 4 | 32 |
| 2023 August | 21 | 9 | 30 |
| 2023 July | 39 | 4 | 43 |
| 2023 June | 22 | 7 | 29 |
| 2023 May | 43 | 10 | 53 |
| 2023 April | 21 | 10 | 31 |
| 2023 March | 10 | 8 | 18 |
| 2023 February | 11 | 5 | 16 |
| 2023 January | 9 | 5 | 14 |
| 2022 December | 18 | 13 | 31 |
| 2022 November | 16 | 7 | 23 |
| 2022 October | 12 | 10 | 22 |
| 2022 September | 18 | 11 | 29 |
| 2022 August | 18 | 13 | 31 |
| 2022 July | 11 | 10 | 21 |
| 2022 June | 15 | 17 | 32 |
| 2022 May | 13 | 20 | 33 |
| 2022 April | 10 | 7 | 17 |
| 2022 March | 17 | 19 | 36 |
| 2022 February | 9 | 11 | 20 |
| 2022 January | 15 | 19 | 34 |
| 2021 December | 22 | 18 | 40 |
| 2021 November | 15 | 30 | 45 |
| 2021 October | 14 | 20 | 34 |
| 2021 September | 12 | 10 | 22 |
| 2021 August | 8 | 11 | 19 |
| 2021 July | 6 | 9 | 15 |
| 2021 June | 12 | 10 | 22 |
| 2021 May | 16 | 15 | 31 |
| 2021 April | 6 | 24 | 30 |
| 2021 March | 7 | 45 | 52 |
| 2021 February | 9 | 48 | 57 |
| 2021 January | 8 | 51 | 59 |
| 2020 December | 2 | 119 | 121 |
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