Intended for healthcare professionals

Rapid response to:

News Roundup [abridged Versions Appear In The Paper Journal]

Subspecialty of oncoplastic breast surgery is needed to meet demand

BMJ 2003; 326 doi: (Published 29 May 2003) Cite this as: BMJ 2003;326:1165

Rapid Response:

Re: A new subspecialty is not required


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” [1].

The current trainees are the practicing surgeons who will be working
in this environment of outcomes accountability [2]. 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 [3].

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 [4]. 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 [5].

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

[1]. Schroen AT, Brownstein MR, Sheldon GF. Comparison of private
versus academic practice for general surgeons: a guide for medical
students and residents. J Am Coll Surg. 2003;197:1000–1011.
[2]. Russell TR. From my perspective. Bull Am Coll Surg. 2003; 88(9):3–4.
[3]. Silen W. Surgical education: in need of a shift in paradigm. Surgery.
[4]. Murray E, Gruppen L, Catton P, Hays R, Woolliscroft JO. The
accountability of clinical education: its definition and assessment. Med
Educ. 2000;34(10):871–879.
[5]. Sachdeva AK. Invited commentary: educational interventions to address
the core competencies in surgery. Surgery. 2004;135(1):43–47.

Competing interests:
None declared

Competing interests: No competing interests

29 March 2008
General Surgeon
10 Woodland Hill, Perth ANdover, NB, Canada. E7H 5H5