Amanda Xi, Medical Student, 08:46AM Nov 2, 2013
He held tension on the silk ties and waited for me to cut them free of the knot. I aligned my scissors perpendicular to the tie, moved them down against the knot then turned them 45 degrees before cutting. He proceeded to close another part of the fascial layer as I watched and waited for my next opportunity to cut.
Four weeks later, we were hunched over the neck of a patient whose thyroid my preceptor had just removed. As we started the hunt for bleeding vessels and notified the anesthesiologist that we were nearly done, we were told to slow down; a dose of muscle relaxant had just been given in anticipation of a longer surgery. The surgeon looked at me. "Let the medical student close her up then." My eyes widened in excitement as I was handed the equipment. The intern working with me held out the fascial layers and I started. After finishing the first layer, my intern joked, "That felt like it took you 2 hours!" I chuckled and started to carefully run a subcuticular stitch. When I finished, the anesthesiologist was ready to wake the patient up.
When we delivered the patient to the post-anesthesia care unit, I sat down and wondered if it had really taken me that much longer to close the patient. I knew that I was slow because I wanted to do it right and it had been my first full closure, but I thought that after practicing on the models and feeling comfortable with the instruments, it wouldn't take me that long.
At one point during my surgery clerkship, I was seriously considering going into general surgery and asked for advice from my senior resident. He laughed when I asked if he thought I had enough dexterity and skill. "Anyone can be a surgeon, as long as they practice," he said. With that advice, I felt confident that with time and practice, I could become a competent surgeon. But a recent study in the New England Journal of Medicine, Surgical Skill and Complication Rates after Bariatric Surgery, suggests otherwise. In this study, researchers watched videos of operations and ranked the surgeons on their operative skill. The post-operative complication rates then were compared with the rankings. The researchers found that the rankings were relatively accurate -- sugeons who were ranked lower had higher morbidity and mortality rates. Dr. Pauline Chen wrote about the study in the NY Times, A Vital Measure: Your Surgeon's Skill, which included two operative videos, one from a highly ranked surgeon and another from a lower-ranked surgeon (I encourage you to watch them -- they're really interesting to compare).
Although I probably won't pursue a career in general surgery, this was still an interesting paper that contradicts what many of us have been told. Although I don't believe that all highly ranked surgeons were just naturally talented, I do recognize that there may be a component of artistry that impacts surgical outcome.
What do you think? With basic dexterity, do you think anyone can learn to be a skilled surgeon?