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The Isolated Surgeon: A Scoping Review.

Matthew D Nealeigh¹, Walter B Kucera¹, Anthony R Artino²

¹Department of Surgery, Walter Reed National Military Medical Center and the Uniformed Services University of the Health Sciences, Bethesda, Maryland.

The Journal of Surgical Research

|January 19, 2021

Summary

Isolated surgeons in resource-limited areas perform complex procedures beyond general surgery training. This review defines their role and identifies critical training gaps in specialties like orthopedics and obstetrics to improve patient care.

Keywords:

Isolated surgeon Medical education Military surgery Rural surgeon Surgical education Surgical training

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Area of Science:

Surgical Practice
Global Health
Medical Education

Background:

Surgeons in resource-limited settings often exceed general surgery training scope.
Geographically isolated patients face barriers to specialty care access.
These patients present with emergencies requiring broader surgical expertise.

Purpose of the Study:

Characterize the unique role of isolated surgeons.
Identify areas for focused professional development.
Ultimately improve patient care in isolated environments.

Main Methods:

Conducted a scoping review of literature on isolated surgeons (US civilian and military).
Analyzed 25 years of research focusing on definitions, practice scope, and training gaps.
Included 91 articles from an initial 904 identified.

Main Results:

No prior definition of an isolated surgeon exists; an initial definition is proposed.
Isolated surgeons consistently perform high volumes and identify training gaps in orthopedic, gynecologic, obstetric, and urologic surgery.
Life-threatening, rare cases occur across multiple surgical disciplines, including neurosurgery.

Conclusions:

This is the largest examination of the isolated surgeon to date.
Defining the isolated surgeon's identity, practice, and training needs is crucial.
Formalizing support for isolated surgeons and their patients is the next step.