As the representative to the American Board of Surgery from the AAS, I have a bidirectional responsibility to share information between our two organizations. One event at the ABS that has great implications for the Academic Surgeon and our field more broadly is the discussion underway at the ABS and in our field more broadly about the redesign of the 5 year surgical training paradigm as we have each experienced.
On this question, the Directors of the American Board of Surgery had a retreat to discuss this topic as part of our January 2015 meeting which is summarized as follows:
The meeting began with a retreat on Sunday morning involving all directors, as well as all advisory council and component board members, to discuss the subject of “Residency Redesign”. While problems have been identified with surgical residency training since the seminal paper of Dr. H. Brownell Wheeler in 1993, the technological and evolutionary changes which have occurred since that time, exacerbated by the reductions in resident work hours, have resulted in significantly less volume and breadth of open operative experience, and reduced opportunities for the development of independence and autonomy in patient management and clinical decision making. Residents have increasingly compensated for this by getting additional training in specialty areas via post-residency fellowships, such that 80% of graduating residents currently take such additional fellowships before entering practice. While a clear consensus did not emerge from the retreat, there was a general conclusion that it was desirable to increase autonomy earlier in training, particularly after 4 years. It was proposed that the Qualifying Examination be moved into the fourth year as an option, not a requirement, so that residents who took it then might be considered “in the examination process” and have more autonomy. Additional training would be required prior to taking the Certifying Examination or becoming certified. Two task forces were assigned, one to look further into residency training, chaired by Dr. David Mercer, and one to look into redesign of the examination process, chaired by Dr. John Hunter. It was ultimately agreed that resolution of this issue would require several years and that multiple issues needed to be addressed in order to do so.
I hope this summary of the retreat was helpful and if you have any questions or concerns, please feel free to reach out to me anytime. My email address is fa@jhmi.edu.
