… May I be moderate in everything except in the knowledge of this science; as far as it is concerned may I be insatiable; grant me strenghth and opportunity to always extend its domain…
- Competence and Compassion
The objective of the department of surgery is to produce a competent and compassionate surgeon. To achieve this goal, surgical house officers must be instilled with commitment to pursue and achieve excellence in three areas: knowledge, decision-making and technical dexterity. Knowledge is the foundation of competence. With knowledge the surgeon can begin to safely achieve desired goals, as it is the catalyst for decision-making. The greater the knowledge, the greater the capacity for options and choices. Decision–making is a combination of knowledge, observation, planning and deduction. Deduction is composed of three components: prior knowledge, present pertinent facts and logical reasoning. Surgical decisions are characterized by promptness and are by necessity, formulated in a contracted timeframe, with incomplete data and situations permeated by stress. As Dr. J. Englebert Dunphy emphasized, the process is imprecise and based upon a “balancing of probabilities.” Last. But not least, is technical dexterity, the implementation of the surgical decision. For surgeons, unlike all other physicians, must actively formulate their decisions. They are physicians of action, who incise, manipulate and correct the corporal maladies. Surgeons literally invade and blaze a trail within the body.
He is a man who will worry, and …feel most keenly the burden of his responsibility…. Gentleness, compassion, tenderness, do not exclude firmness. The bravest are the tenderest. The loving are the daring.
Rudolph Matas, The Soul of the Surgeon
Compassion may be defined as sympathetic consciousness of the others’ distress together with a desire to alleviate the distress. Today, it somehow seems to be overshadowed in our drive to achieve competence but it is equally as important as the surgeon’s skills. Compassion affects the way surgeons wield their skills and determines whether these skills will be used with lofty aims. The compassionate surgeon empathizes with the patient’s disease and suffering, for he understands its impact upon the psyche, regardless of the patient’s social, economic or cultural milieu. He identifies with the patient as a fellow human being.
Coupled with compassion is a sense of responsibility. This is a key concept in surgery. Net only must a surgeon choose a course of action-he must be willing to accept the consequences of that decision. The true surgeon realizes that ultimately responsibility rests upon his competence and compassion.
- Milestones of Progress
In order to achieve these goals the surgical resident must be taught by surgeons/teachers/mentors who personify these objectives.
The surgical program must have cases spanning the full spectrum of gastrointestinal diseases, musculoskeletal trauma, endocrine surgery, peripheral vascular conditions, and surgical oncology. From such exposure the surgical resident learns to understand the basic management principles of problems in cardiothoracic, Vascular, Transplant, Gynecological, Otolaryngological, Neurosurgical, Orthopedic, Pediatric, Plastic and Urological Surgery. The resident has the opportunity, under guidance and supervision, to grow and evolve into progressive stages of patient care responsibility.
The junior resident develops a broad experience. History-taking skills and physical examination are refined. Honesty and reliability are carefully assessed if he is to ascend to higher levels of greater responsibility. Finally, he must demonstrate the capability to interact meaningfully with patients, nurses, ancillary personnel and faculty.
The intermediate resident develops surgical techniques, refines judgment and demonstrates evidence of intellectual progress.
The senior resident demonstrates signs of growth and maturation in three areas, decision-making, technical dexterity, and organization. The decision-making must be mature and based on sound reasoning and judgment. Technical dexterity for the common surgical procedures and a method for addressing the more difficult problems should be readily evident. Finally, there should be ample evidence of self discipline and organizational abilities as demonstrated by the ability to organize a surgical service into a coherent team. This team should provide a sound environment for patient care and junior surgical colleague education.
Out of this broad surgical experience and assumption of progressive responsibility, the resident is prepared to successfully pass the qualifying examination for certification.
- Total Commitment
Medicine is not just another profession. Rather it is a mission. The expression, a calling, might me meaningful to some. A physician is more than a professional, he is watching over the life and health of mankind. These demands have an absolute quality. As such medicine requires not only skills but a love of the art.
William Danforth, M.D.
It is not easy to educate and produce competent and compassionate surgeons. The entire process is rigorous and requires surgical residents who are totally committed and dedicated to acquiring the surgeon’s skills. Upon entering training, many young residents believe surgery is just another craft of profession. Few realize that the whole process is a way of life. Total dedication and total immersion is required – everything else is secondary. Surgery is the most important pursuit and all others must be subservient.
Acquiring the attitude and skills of a surgeon requires a high level of continuous effort. Stress is the hallmark of this achievement. The surgical resident must be physically fit to cope with long hours of call, rounds and sleep deprivation. Despite this physical stress, he or she must be emotionally stable and compatible with both patients and colleagues. Intellectually, under trying conditions, the house officer must read voraciously, attend technical conference and glean from each patient the lessons and skills of modern surgery. Personality and character need not be stifled as long as they do not detract from dedication.
Some may argue that these requirements are too stringent. Much is required but much is given to those who truly aspire. Consider that the patient blindly places himself literally in the surgeon’s hands. This is the ultimate act of faith. Obviously, the standards must be commensurate with this faith. To achieve less would be a betrayal of the patient’s trust.
E. M. Myers MD FACS
Surgical Education Committee