Teaching and Evaluating Surgical Skills

Surgical education is changing. Mandates that foster this change include increasing demands from the public for perfection without practice, decreasing trainee work hours, increasing minimally invasive therapies, and fewer surgical educators. In addition, rising health care costs have caused many experienced surgeons to focus on patient care rather than the mentoring of surgical trainees. A paradigm shift in surgical education is being forced by all these issues. This paradigm shift is important not only for new surgical trainees but also for established surgeons who need to learn new technical skills to keep pace with evolving medical technology and new procedures.

How can one ensure that the first time a trainee picks up a knife and makes an incision that he or she is as prepared to do so as possible? The apprenticeship model of surgical education, although time honored, falls short in proving competency and requires vast repetition to work. Animate and inanimate models, virtual reality, mental imagery, and the gold standard of attending teaching in the operating room will all likely play a role in surgical education of the future. Practice makes perfect and surgery, like any other technical skill, has to be practiced to become effortless. Few would argue that flight simulators are a sufficient proxy for flying an aircraft, but they are certainly better than no practice whatsoever. Technical skills, however, do not improve with practice without knowledgeable feedback, underlining the need for technical skills curricula that give trainees the opportunity to practice in a safe environment with adequate feedback. Adequate measures to determine trainee competency are needed to ensure that when trainees are on their own, both their patients and employers know that they have not only completed their training but are also competent.

The inspiration for this edition of Obstetrics and Gynecology Clinics of North America arose out of a desire by the Education Committee of the American Urogynecology Society to improve surgical education in gynecology. Limitations of the Halstedian model of surgical education are reviewed, as are the ethics of surgical education. Presented is the limited literature that exists regarding the use of models, imagery, and virtual reality, and suggestions for improving surgical teaching in the operating room. The use of validated measures to evaluate surgical competency are also presented. The desire was to build on the excellent education we received as trainees and discuss limitations of what we experienced, with an eye to the future of surgical education in a changing landscape. It is hoped that this edition proves useful to surgical educators as they teach.