Making Master Surgeons Out of Trainees: Part I. Teaching Surgical Judgment

The training of competent and ethical plastic surgery residents has become more difficult, as surgeons face increasing clinical and research demands, concern for medicolegal liability, and pressure to increase efficiency to decrease health care expenditures. The resulting variation in operative experience among plastic surgery trainees exemplifies the need for educational reform to accommodate change. Although the Accreditation Council for Graduate Medical Education has mandated a transition to competency-based training, and state-of-the-art technologies in surgical simulation are being developed to improve operative skills, the construction of a system to teach and assess operative judgment is deficient and should be thoughtfully created and implemented. Established educational methods and curriculums can be used in this effort and include apprenticeship operative teaching, surgical simulation, morbidity and mortality conferences, and resident clinics. The first step in this effort is to require trainees to make decisions, communicating their judgments and recommendations using language that demonstrates clear thinking and thoughtful analysis. For faculty, this means carving out dedicated preoperative teaching time in addition to efficient use of intraoperative time and sharing of postoperative outcomes. For programs, this means developing metrics to evaluate progress and build procedure-specific simulations. The goal should be not just to settle for training safe and ethical surgeons but to produce masterful surgeons with mature judgment.