Christmas 2012: Evolution of Practice

Bringing surgical history to life

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8135 (Published 18 December 2012)
Cite this as: BMJ 2012;345:e8135

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  1. Roger Kneebone, professor of surgical education,
  2. Abigail Woods, reader in the history of human and animal health
  1. 1Imperial College London, London W2 1NY, UK
  1. Correspondence to: R Kneebone r.kneebone{at}imperial.ac.uk

Roger Kneebone and Abigail Woods describe how a surgeon and a medical historian set out to capture a disappearing world

Things change fast in surgery. Within a single generation, ways of operating that had been stable for decades have been overturned. New drugs have revolutionised what were once “surgical” conditions, and minimally invasive procedures have driven many “open” operations to the verge of extinction.

As surgical teams from an earlier generation retire or die, their collective memory of how things used to be done is being lost. Yet such experience may be of real practical value for today’s surgeons. This article investigates whether it is possible to preserve such expertise for future reference, using simulation to re-enact operations from the past.

Have a look behind the scenes at one of the surgical re-enactments

Video

The method

We start with open cholecystectomy—a standard operation 30 years ago, but now almost always performed laparoscopically. At first sight it may seem relatively simple to recapture such a procedure. Surely the surgical texts that trainees used at the time will provide step by step descriptions of the procedure. But the picture such sources paint can be highly misleading. Like medieval recipe books, surgical textbooks and journals assume a huge amount of contextual knowledge in their readers. “Take three quails and prepare as usual” spoke volumes in the 1500s, but such directions do not help today’s cook.

The same can be said for film, video, and even verbal descriptions of operations by those who used to perform them. Such sources privilege the surgeon’s viewpoint, while ignoring the contributions of assistants, scrub nurses, anaesthetists, and other members of the surgical team. To capture this unspoken context, we brought together retired surgical teams and invited them to re-enact operations that they used to carry out together—like the Rolling Stones coming …

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