CommentaryFrom OT Europe

Senior surgeons, committees must oversee trainee education, involvement in surgical approaches

In addition to ensuring our patients get the best, safest and most evidence-based treatment, senior orthopaedic surgeons have the duty to make sure the next generation of orthopaedic surgeons are sufficiently trained in surgery to take over when “we have left the podium and pass on the relay for them.” This transition must be focused on in all areas of an orthopaedic department. Basically, it comes down to a simple statement: Every time a trainee and a senior surgeon are together around a patient – in surgery or not – there is a great opportunity to train and educate the trainee to improve her or his skills and knowledge for the benefit of patients in the future.

Being a senior surgeon for nearly 3 decades, I know these are ideal, as well as complicated promises to make, because as there are always more dilemmas to deal with and overcome.

Per Kjaersgaard-Andersen, MD
Per Kjaersgaard-Andersen

From the patient’s perspective, there is the goal to have perfect and safe surgery without any complications. It makes sense to them that this outcome is most likely to occur if the experienced senior surgeon is the one doing the surgery. I regularly encounter this situation in the outpatient clinic. After agreeing to surgery, the patient’s next question will be, “Professor, are you the one who does the surgery?”

Changed approach was effective

In our department, we have determined that our answer to such a question will be: “Yes, madam, I will always be there in the theater during your surgery and most likely will also do it. But, in some cases, my younger colleagues do the surgery, which is always under my responsibility and supervision.”

We rarely have patients who, hearing that, demand that I or another senior surgeon do their surgery. We changed to this approach some years ago. Earlier we had the young colleague approach patients the morning before surgery and inform them that he or she would do the surgery, but certainly with the professor assisting and being responsible for the approach. Between that time and the surgery, patients became sad and some of them were mad because this was not what they expected. In cases that were complicated, this was a more serious discussion. But, since we changed our approach in these situations, there have not been any problems. Patients understand, they are informed in due time about how it works at our institution, and they all agree this approach is perfect.

From the trainee’s perspective, it is certainly mandatory that he or she has a structured approach to surgery and the opportunity to gradually get involved with different surgical approaches. Also, it is key that the trainee performs the procedures under strict supervision. No two trainees are the same nor do they possess the same skills at a given time in their career or have the same dedication for surgery. We must, as senior orthopaedic surgeons, follow the structured program that national, regional and hospital educational committees have established, taking the time needed to make the trainee feeling comfortable and relaxed, while ensuring the single surgical cases are done at the highest level of quality and safety for the patients. This may put a lot of demands on the senior orthopaedic surgeons — awareness and flexibility, as well as remembering to also support a young trainee when everything is not going exactly as was anticipated.

Role of senior orthopaedic surgeon

Finally, senior orthopaedic surgeons also have another and more complex duty: to approach younger trainees who do not show qualifications and progress in surgical skills. A surgical career is not for everyone, even someone who has achieved the basic skills to be a surgeon. Therefore, it is important that the national and regional educational committees have systems in place that keep the senior-level surgeon informed early on about a trainee’s goals and skills. A system is needed so these committees regularly receive feedback on the trainee’s skills, so pertinent information can be passed to the trainee in a sensible and structured manner. Ultimately, this type of approach to orthopaedic training is the best for all parties involved and especially for the safety of current and future patients.

Disclosure: Kjaersgaard-Andersen reports no relevant financial disclosures.

In addition to ensuring our patients get the best, safest and most evidence-based treatment, senior orthopaedic surgeons have the duty to make sure the next generation of orthopaedic surgeons are sufficiently trained in surgery to take over when “we have left the podium and pass on the relay for them.” This transition must be focused on in all areas of an orthopaedic department. Basically, it comes down to a simple statement: Every time a trainee and a senior surgeon are together around a patient – in surgery or not – there is a great opportunity to train and educate the trainee to improve her or his skills and knowledge for the benefit of patients in the future.

Being a senior surgeon for nearly 3 decades, I know these are ideal, as well as complicated promises to make, because as there are always more dilemmas to deal with and overcome.

Per Kjaersgaard-Andersen, MD
Per Kjaersgaard-Andersen

From the patient’s perspective, there is the goal to have perfect and safe surgery without any complications. It makes sense to them that this outcome is most likely to occur if the experienced senior surgeon is the one doing the surgery. I regularly encounter this situation in the outpatient clinic. After agreeing to surgery, the patient’s next question will be, “Professor, are you the one who does the surgery?”

Changed approach was effective

In our department, we have determined that our answer to such a question will be: “Yes, madam, I will always be there in the theater during your surgery and most likely will also do it. But, in some cases, my younger colleagues do the surgery, which is always under my responsibility and supervision.”

We rarely have patients who, hearing that, demand that I or another senior surgeon do their surgery. We changed to this approach some years ago. Earlier we had the young colleague approach patients the morning before surgery and inform them that he or she would do the surgery, but certainly with the professor assisting and being responsible for the approach. Between that time and the surgery, patients became sad and some of them were mad because this was not what they expected. In cases that were complicated, this was a more serious discussion. But, since we changed our approach in these situations, there have not been any problems. Patients understand, they are informed in due time about how it works at our institution, and they all agree this approach is perfect.

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From the trainee’s perspective, it is certainly mandatory that he or she has a structured approach to surgery and the opportunity to gradually get involved with different surgical approaches. Also, it is key that the trainee performs the procedures under strict supervision. No two trainees are the same nor do they possess the same skills at a given time in their career or have the same dedication for surgery. We must, as senior orthopaedic surgeons, follow the structured program that national, regional and hospital educational committees have established, taking the time needed to make the trainee feeling comfortable and relaxed, while ensuring the single surgical cases are done at the highest level of quality and safety for the patients. This may put a lot of demands on the senior orthopaedic surgeons — awareness and flexibility, as well as remembering to also support a young trainee when everything is not going exactly as was anticipated.

Role of senior orthopaedic surgeon

Finally, senior orthopaedic surgeons also have another and more complex duty: to approach younger trainees who do not show qualifications and progress in surgical skills. A surgical career is not for everyone, even someone who has achieved the basic skills to be a surgeon. Therefore, it is important that the national and regional educational committees have systems in place that keep the senior-level surgeon informed early on about a trainee’s goals and skills. A system is needed so these committees regularly receive feedback on the trainee’s skills, so pertinent information can be passed to the trainee in a sensible and structured manner. Ultimately, this type of approach to orthopaedic training is the best for all parties involved and especially for the safety of current and future patients.

Disclosure: Kjaersgaard-Andersen reports no relevant financial disclosures.