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Surgeons should train like pilots

Richard Woodman London

Surgeons should train on simulators, as pilots and astronauts do, a conference on surgical competence heard in London last week.

"One cannot help but be struck by the comparison of surgical competence and the qualities required of flying crew," said Sir Rex Richards, chairman of the task force on clinical academic careers.

"Both professions require high intellectual and personal skills; both require dexterity and good hand-eye coordination."

He told the meeting, organised by the Royal College of Surgeons of England and the Smith and Nephew Foundation, that research suggested that even very simple simulators can provide data that correlate well with real surgical skill.

Simulators could be used to select surgical trainees, to teach basic skills, to help find out if someone was ready for a consultant's post, and regularly thereafter to maintain and revise skills.

The cost of developing the machines would be high, but the result could be considerable savings in training, better outcomes for patients, and greater public and professional confidence.

The meeting heard that greater emphasis on competence, rather than the traditional criteria of fixed time in training and passing examinations, might open a fast track path to a consultant's post for the most gifted surgeons.

The college's president, Barry Jackson, said: "At a time when tackling disease has to be the highest priority for the health service, we need to look urgently at how we can ensure that there will be enough qualified doctors to meet patient needs. This may mean taking a fresh look not only at the number of posts but at how trainees are prepared for them."

Dr Liam Donaldson, chief medical officer for England, said that the condemnation of the Bristol children's heart surgery service, which led to two doctors being struck off the medical register, was a watershed in the history of poor clinical performance in the NHS.

He emphasised , however, that good clinical performance depended not only on the skills and dedication of individual surgeons but also on the working environment.

"In my experience, when things go wrong, perhaps due to the actions of an individual, they occur in an environment where there are often weak management systems, poor internal communications, and no coherent strategy.

"They often occur in organisations where the culture is not one of education and research being valued and where there are factions between clinicians and managers. And often when services go wrong, the organisation is one which has a fortress mentality and has shown a tendency to be defensive to constructive criticism from outside.

"In other sectors, such as the airline industry, it has long been recognised that some environments are at risk of error which can lead to disaster. The healthcare sector has been slow to appreciate this but it is now being taken seriously," Dr Donaldson added.
 
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Rapid Responses:

Read all Rapid Responses

Horsefeathers

Massey Beveridge
bmj.com, 12 Nov 1999 [Full text]

Simulators can assess aptitude, not ''''real life competence''''

Nagappan Kumar
bmj.com, 13 Nov 1999 [Full text]

Simulators are only a platform for learning

Ross Kerridge
bmj.com, 13 Nov 1999 [Full text]

Pilots also have to demonstrate competence

Duncan Innes
bmj.com, 15 Nov 1999 [Full text]

Surgical Training with Simulator

Abd Hamid Mat Sain
bmj.com, 27 Jun 2002 [Full text]