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Editorial
The teaching of orthopedic surgery
La enseñanza de la Cirugía Ortopédica
M. Cabanela
Clínica Mayo, Rochester, MN, USA
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dr&#46; Forriol has asked me to write an editorial about training in orthopedic surgery&#46; However&#44; upon reflection&#44; I have realized that&#44; despite being in permanent contact with my country of birth and visiting it very often for professional reasons&#44; I am not really aware of how postgraduate training is currently imparted in Spain&#46; Therefore&#44; the following comments should be read whilst bearing in mind that I have been working in the US for the past 40 years&#46; Nevertheless&#44; considering the current trend toward globalization&#44; I am confident that they can be applied to most countries&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">There are three&#44; clearly distinguished&#44; periods in this process&#58; teaching during residency&#44; the transition from residency to practice and the maintenance and update of knowledge and new skills&#46; The latter takes place throughout the remainder of our professional lives&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The Accreditation Council for Graduate Medical Education &#40;ACGME&#41; has established that residency programs should focus on teaching six core competencies&#58; patient care and technical skills&#44; medical knowledge&#44; practice-based learning and improvement&#44; systems-based practice&#44; interpersonal and communication skills&#44; and professionalism&#46; These concepts may be complex&#44; but they key objective is to teach and assess three main aspects&#58; knowledge&#44; skill &#40;essential in surgical fields&#41; and professionalism &#40;ethics&#44; interpersonal relations&#44; etc&#46;&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The process of acquiring knowledge has not varied much&#46; It can only be absorbed through the eyes and ears&#44; which means that studying&#44; attending conferences and courses and acquiring knowledge individually through the various means available on the Internet continue to demand time and concentration&#46; It is interesting to observe how the immense majority of available courses follow traditional teaching methods&#46; There have been some attempts to adapt the teaching process to the needs of participants&#44; but there are no measurements of the results of these initial assessments&#46; Similarly&#44; assessments of the effectiveness of these methods through surveys analyzing the residual knowledge remaining after a certain period of time have not been successful&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The teaching of surgical or technical skills &#40;most medical specialties include &#8220;invasive&#8221; activities&#41; has been a source of discussion and concern&#46; One cannot learn how to operate without performing operations&#44; but the use of &#8220;human guinea pigs&#8221; is not justifiable&#46; Teaching how to operate in an environment that is safe for patients has been my greatest concern and I doubt that I have resolved this problem&#46; I believe that there have been notable advances in this field in recent years&#46; Firstly through remote broadcasting of highly complex procedures performed by experts&#44; secondly through courses at specialized centers where participants may operate on cadavers and thirdly through techniques derived from the aeronautical industry&#58; simulations&#46; It is clear that this last method helps to improve surgical times and performance&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> I believe that&#44; in the future&#44; surgical skills will be completely acquired in a fully or partially simulated environment&#44; with no risks for patients&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Teaching surgical skills entails a risk of turning the acquisition of such skills into the main focus of professional training&#46; Preparing super specialists&#44; experts on a specific technique or procedure&#44; produces individuals who are unable to the see the &#8220;full picture&#8221; and are often incapable of even talking to patients&#46; This is part of a change in the self-perception of orthopedic surgeons that has slowly taken place over the past 25 years&#46; The objective of many residents nowadays is to become experts in a technique or set of techniques&#46; I believe that this current trend is pernicious because it weakens human contact&#44; which is essential in the medical profession&#46; Perhaps&#44; this is partly responsible for the drop in our professional prestige in the US&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This leads us to the third field of training&#59; that of ethics&#44; interpersonal relations and professionalism&#44; all concepts which are difficult to teach and assess&#44; since even specialists find it difficult to define them&#46; ACGME has defined professionalism as the commitment toward compassionate&#44; sensitive&#44; responsible and ethical healthcare&#46; Since there are no parameters for measuring these characteristics&#44; assessments of professionalism are always subjective&#46; On the other hand&#44; it has been argued that ethics and professionalism are already established by the time individuals enroll in a residency program&#46; However&#44; there is some evidence which counters that hypothesis and argues that professionalism can be taught and assessed&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Some residency programs include conferences on ethics and professionalism&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> but most of the learning in this field takes place without conscious thought and is influenced by the institutional culture and&#44; frequently&#44; by mentors acting as role models&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The transition from residency to practicing a specialty has not been perfectly resolved in any country&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> The necessary tests evaluate knowledge&#44; but none of them assess the capacity&#44; or lack thereof&#44; for a surgical discipline&#46; How is it possible that residents are only allowed to operate under close supervision until the day they graduate&#44; but can perform surgery of any level of complexity by themselves on the following day&#63; At some centers&#44; &#8220;junior&#8221; surgeons go through a period of supervised practice&#44; but this is not common&#46; This situation indicates a certain lack of care at the institutional level which leaves young surgeons vulnerable to failures that can damage their self-confidence&#44; hinder their development and harm their patients&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Maintaining and updating knowledge and new techniques is the domain of continuous medical training&#46; Most developed countries&#44; although not all of them&#44; have a legal requirement to test this update of knowledge&#44; which seems logical&#59; if we must all renew our driving license&#44; if pilots must renew their flying license after a certain time&#44; then our profession&#44; which deals with human life&#44; should also be recertified periodically&#46; This &#8220;maintenance&#8221; of certification is managed through specialty associations&#44; like AAOS in the US and SECOT in Spain&#46; The range of opportunities available is very wide&#58; from update courses in specific techniques including surgery on cadavers or with simulators&#44; to intensive courses reviewing the entire specialty&#46; In general&#44; each of these courses offers X hours and a certain number of hours is required each year to maintain the certificate as specialist&#46; There are similar courses offered by industry&#44; but their objectives are often very different and&#44; at least in the US&#44; they are rarely valid toward recertification&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Considering that the average professional life of an orthopedic surgeon lasts around 30 years and looking at the changes which have taken place within the specialty in that time&#44; the need for continuous medical training becomes obvious&#46; I could say that&#44; in my current practice&#44; I do not do anything like I did when I completed my residency&#44; back in the 1970s&#46; Surgeons working in academic institutions are exposed to these changes and are constantly updated without even noticing&#44; but those whose work takes place in isolated centers require periodical updates&#46; In my view&#44; the primary task of the national association of each specialty is precisely that&#58; providing continuous training for its members&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the US&#44; the main function of AAOS is the training of its current and future members&#46; With a history of over 75 years and a considerable budget&#44; it seems logical that it has become the model institution of its type in the world&#46; Over the past 25 years&#44; its International Committee has extended this training mission to all five continents&#46; The <span class="elsevierStyleItalic">modus operandi</span> of this committee has consisted in establishing links with the orthopedic societies of different countries in order to join efforts and improve teaching of the specialty throughout the world&#46; SECOT and AAOS maintain a long and productive relationship&#44; including postgraduate courses taught by members of both societies and numerous works published by authors from both countries&#46; It is worth highlighting that the participation of members of both organizations in training activities is completely free of charge&#46; I believe that&#44; throughout my career&#44; these are the kind of activities that have provided the greatest satisfaction&#46;</p></span>"
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Article information
ISSN: 19888856
Original language: English
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2022 May 11 3 14
2022 April 9 8 17
2022 March 12 9 21
2022 February 8 5 13
2022 January 5 4 9
2021 December 13 11 24
2021 November 5 7 12
2021 October 8 10 18
2021 September 5 15 20
2021 August 5 10 15
2021 July 7 11 18
2021 June 13 5 18
2021 May 9 4 13
2021 April 29 25 54
2021 March 6 8 14
2021 February 13 15 28
2021 January 3 1 4
2020 December 0 1 1
2019 June 0 6 6
2018 February 4 5 9
2018 January 1 6 7
2017 December 14 5 19
2017 November 4 3 7
2017 October 7 5 12
2017 September 7 2 9
2017 August 6 4 10
2017 July 11 0 11
2017 June 15 4 19
2017 May 5 6 11
2017 April 8 25 33
2017 March 4 10 14
2016 December 0 1 1
2016 October 0 1 1
2016 July 0 1 1
2016 February 0 2 2
2015 November 0 3 3
2015 August 1 0 1
2015 May 1 0 1
2015 April 1 5 6
2015 March 0 8 8
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos