Lest we forget the surgeon

Within the United States, the applications from medical graduates to general surgery residency programs declined by 30% since 1992, and it has been estimated that by 2005 only 5% of US medical graduates will opt for a professional career in surgery. Thus in the assessment of the projected needs for surgical practice for the new century, we must not overlook the surgical manpower issue. We have to ensure that the high-tech operating rooms of the future will be manned by surgeons with the right personality, attitudes, competence, and skills. Certain key issue have to be addressed if we are to achieve this essential objective. These include changes in health care systems, including the rapidly advancing technologically-dependent minimal access therapy procedures, changes in attitude and culture between doctors and patients, especially in relation to human error enacted during health care delivery with the abolition of the "shame and blame culture," changes in the selection and training of surgeons that have to take into account the reduced working week for residents, and appraisal systems that will ensure sustained competence of fully trained surgeons throughout their professional life. Since it is not possible to eliminate errors completely from clinical practice, we can improve the quality of medical and surgical care by adopting error-tolerant operating medical systems based on progress in cognitive psychology, human factors, and human reliability assessment. Error-tolerant operating medical systems should enable detection, reporting, and targeted reduction of errors.