Subspecialty of oncoplastic breast surgery is needed to meet demandBMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7400.1165 (Published 29 May 2003) Cite this as: BMJ 2003;326:1165
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When we review the experience of general surgery residency training
programs, you may be able to determine whether an adequate experience was
being provided, and at what level of training, to safely and effectively
perform basic surgical procedures in a small community hospital.
The challenges of surgical education vary considerably with the
academic setting. “academic residencies tend to produce residents who
remain in academia and who undergo subspecialty training and community
programs tend to graduate surgeons who are more likely to practice broad-
based general surgery in private practice settings” .
The current trainees are the practicing surgeons who will be working
in this environment of outcomes accountability . The core competencies
of residency training should incorporate: patient care, medical knowledge,
practice-based learning and improvement, interpersonal and communication
skills, professionalism, and system-based practice into the curricula of
training programs. To meet all of these educational challenges, a
combination of one or more training models is required. The ongoing
changes in surgical education are staggering. These alterations, however,
can provide an outstanding opportunity to improve the model and concept of
surgical resident training .
A change in the assessment and training culture requires regular
discussion at all resident and faculty venues over a prolonged interval
during the implementation phase. Resident acceptance can be aided by
emphasizing that the system is designed to increase the volume of
performance feedback that residents receive. The assessment of competence
in systems-based practice is one of the most challenging problems, because
very little work has been done on assessing the performance of individuals
working in groups . The American College of Surgeons has also appointed
four special education task forces to address the competencies of
interpersonal and communication skills, professionalism, practice-based
learning and improvement, and systems-based practice. The charge to these
task forces is to develop educational programs that may be used readily by
all surgical specialties .
A survey could be electronically submitted to and completed by
surgery program directors and of course trainee, measuring attitudes
toward the necessity and ideal components of a rural surgery. As a result
of the survey, the level of interest in the surgery program will be more
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Competing interests: No competing interests
The comments made by Professor Baum in his editorial for the journal
“Breast”, and which you report, calling for a "serious look at the
training needs of those who wish to specialise in the care of women with
breast cancer" are to be applauded(1). It is no accident that the word
"plastic" be included in the title of his putative subspecialty.
Reconstructive plastic surgeons have been successfully addressing and
progressing the technical challenge of post extirpative breast deformities
for many more than "the last fifteen years".
Recently developed level III training posts for both general and plastic
surgical trainees essentially to learn each other’s discipline are flawed
in concept and unpopular. Limiting and shortening training produces
surgeons with limited horizons and robs them of the experience required to
extricate patients from difficult oncological situations. Ability to
address all aspects of breast reconstruction, congenital as well as
oncologic, demands broad based training in the full range of implant-
related and soft tissue techniques, including microsurgical. This training
must encompass the aesthetic aspects of the discipline. Such training
already exists within reconstructive plastic surgery.
By their very nature, NHS plastic surgeons are all "oncoplastic".
Approximately 30% of a typical consultants' general workload is cancer or
cancer related. Many currently play an integral part in the
multidisciplinary management of breast cancer. Professor Baum is worried
by the response of his general surgical colleagues to his proposal. The
answer to his dilemma and to which he points, is that this is no longer a
general surgical disease.
That there is a supply and demand problem for this type of surgery merely
reflects the persistent chronic under-expansion of a reconstructive
specialty whose role is much misunderstood within the modern NHS, even by
our surgical colleagues. The constant innovation in reconstructive
techniques provided by plastic surgery is to the advantage of patients and
the broader NHS. There is no need for a new sub-specialty, merely
expansion of what already exists and co-operative practices.
1) Dobson, R. News Roundup. Subspecialty of Oncoplastic Breast
Surgery is needed to meet demand BMJ 2003;326:1165
Competing interests: No competing interests