Success in Academic Surgery: Developing a Career in Surgical Education

By Carla M. Pugh

This updated volume provides a guide on how to maximize the career and research opportunities available within surgical education. The book includes new chapters on opportunities to develop training in new surgical techniques, utilizing surgical coaching and video review for practice improvement, and getting promoted as a surgical educator. How to develop a research program in surgical education as well as offering guidance on applying for research grants, leadership positions, and other career enhancing opportunities are also covered.

This book is relevant to medical students, surgical residents, young faculty, and others considering a career within surgical education.

• Language: English
• Publisher: Springer
• Release date: Jul 24, 2019
• ISBN: 9783030191795

Book preview

© Springer Nature Switzerland AG 2019

Carla M. Pugh and Rebecca S. Sippel (eds.)Success in Academic Surgery: Developing a Career in Surgical EducationSuccess in Academic Surgeryhttps://doi.org/10.1007/978-3-030-19179-5_1

1. An Overview of Opportunities in Surgical Education

Rebecca S. Sippel¹   and Carla M. Pugh²  

(1)

Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

(2)

Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA

Rebecca S. Sippel (Corresponding author)

Email: [e-mail]

Carla M. Pugh

Email: [e-mail]

Keywords

Leadership positionGraduate medical educationSurgical educationClerkship directorResidency program director

Background

Educational Challenges

Increasing regulations, work-hour restrictions, and an increase emphasis on outcomes have created a need within departments for faculty that are not only good teachers but understand the issues confronting surgical education. Departments of surgery need to develop and run a competency-based surgical curriculum that not only exposes students and residents to the field of surgery but ensures that they are learning the core knowledge and skills that they need to be competent physicians and surgeons. No longer is it acceptable to simply see one, do one, teach one.

The Evolving State of Surgical Education

Historically to be successful in surgery, each individual strived to be a triple threat: an outstanding clinician, researcher, and teacher. While the concept of a triple threat has not disappeared, increasingly department chairs are recognizing that these are three core missions of the department, not necessarily of individual surgeons. The department as a whole needs to excel in each of these areas. In order to excel in education, there is a need to set evidence-based goals and commit to important infrastructure that educators need (training, time, and resources). As such there is a growing need for surgeons with not only an interest in surgical education, but also the training and expertise to help develop and support the educational mission of the department.

Success in surgical education cannot be accomplished alone. Educational programs need adequate administrative support and protected time for its administrators. Research programs need collaborators with expertise in education research. Increasingly departments of surgery are recognizing the need for PhD educators within the department to help fulfill and support these roles.

The Path to Becoming a Surgical Educator

Surgical education is a rapidly growing field with a variety of opportunities available to get involved. Due to this growth there is a critical need for surgeons with an interest and expertise in surgical education. For those of you that are interested in potentially making education your career focus, our hope is that this book will help to open your mind to some of the many possibilities available within the field of surgical education.

The first step to developing a career in surgical education is to get the correct training. For some people that will include pursuing an advanced degree either during residency or in their early years on faculty (see Chap. 13). However, taking the time to get an additional degree may not be feasible, and there are many other training opportunities available both within your institution and nationally that can help you to develop the skills you will need to be successful (see Chap. 12). In addition to getting the training you need, it is essential to identify mentors that are supportive of your goal and can work with you to achieve them (see Chap. 11). For those of you that are interested in taking on leadership roles within your department in surgical education, it is essential to obtain skills in leadership (see Chap. 9) and gain an understanding of how the surgical education mission is financed (see Chap. 10).

Within the field of surgical education, there are a variety of opportunities to get involved. The two most common areas for involvement relate to medical student and resident teaching. In addition to exploring opportunities to become a clerkship director or a residency program director, there are a wealth of leadership positions available in both the medical school and the graduate medical education office. Taking advantage of opportunities outside of the department can be a great vehicle for growth as a surgical educator. In Chaps. 2 and 3, we highlight many of the unique opportunities available within these areas. Surgical simulation is a rapidly growing field, and surgeons are ideally suited to get involved in and to take on leadership roles within an institution’s simulation center (see Chap. 4). Looking beyond the training years, there is an ever-increasing need for people with an expertise in continuing medical education, helping to address the needs of practicing surgeons with both maintenance of skills and knowledge as well as the acquisition of new skills once in practice. This new edition includes chapters focused on developing curricula for new and novel surgical techniques (Chap. 5) and Surgical Coaching (Chap. 6).

To establish yourself as a surgical educator, it is important to get involved not only locally but also nationally in surgical education. There are many great opportunities to get involved at a national level which are highlighted in Chap. 7. Surgical education is an increasingly viable career path for promotion within academic surgery, but it is important that you understand the metrics for which you will be measured. Tips for how the process works and how to get promoted as a surgical educator are highlighted in Chap. 8.

Finding Your Niche and Succeeding at It

Once you have chosen your path, there must be a strategy involved in honing and defining your niche. Whether you choose to focus on undergraduate medical education, graduate medical education, or continuing professional development, additional work is necessary in defining your focus within these areas. Specific examples include a focus on curriculum development, program evaluation, performance assessment, or education related to a specific clinical procedure or specialty. The opportunities are broad. The formal process of goal setting has been well defined and there are several strategies and approaches. The SMART concept states that your goals should be (1) Specific, (2) Measureable, (3) Attainable, (4) Rewarding, and (5) Timely.

Using the SMART concept, if your passion is simulation-based curriculum development for residents, it is recommended that you go through the process of writing down the following: What you wish to develop and what technology, content, financial support, and personal time are needed (Specific); how you will measure the success of your new curricula (Measurable); do you have the infrastructure including departmental support and key collaborators (Attainable); will you enjoy the work after noting the pros and cons of the work process (Rewarding); and can the goal be achieved in a reasonable time period without significant loss of relevance (Timely). Similarly, the SMART concept can be used in setting goals for obtaining local and national leadership positions.

The last section of this book has four chapters dealing with research in surgical education. This topic deserves special attention as it is pertinent to success regardless of your niche area. Use of qualitative or quantitative research methods to evaluate your program or execute specific experimental protocols will help to better define your goals and your niche. Publishing your work will help to build collaborations, establish local and national presence, and serve as the groundwork for obtaining funding.

Special Considerations

Graduate Study

Obtaining a Master’s or PhD in education is a great step towards defining your career as educational leader however; it is uncommon for faculty in a school of education to understand the many nuances of surgical education, training and assessment. In addition, it is unlikely that faculty in a school of education will know which societies you should plan to be involved in or where to present and publish your work. As such, it is extremely important to have a successful surgeon scientist as part of your mentorship team. Lastly, if you are planning a research career in surgical education, it is critical to have an understanding of the balance that must be achieved when trying to succeed as a surgeon scientist with a focus on surgical education.

Ethics in Education Research

The worst outcome of any education research project is to leave the participants feeling that they were just a number and the exercise they participated in was not useful because there was no feedback. This phenomenon is not special to research in surgical education, and there is an extensive amount of historical and new research regarding this phenomenon in traditional education literature and peer-reviewed journals.

Bridging the Gap

In the process of achieving our professional goals in surgical education, we must be reminded of the gap that exists between actual practice and the results of our research. Feedback is one of the key elements that may facilitate bridging the gap. For example, if you studied the validity and reliability of a checklist for laparoscopic colectomy, this would require you to not only document correct and incorrect answers but also generate an understanding of how the incorrect answers should be built into focused learning or deliberate practice for the individual surgeon.

Quality and Patient Safety

While the ultimate goal is to develop educational systems and processes that benefit the patient, more work is required to develop and achieve goals that consistently drive a successful quality and patient safety agenda. Outcomes and health services research have many direct links to education and collaborative initiatives that will be the key to achieving high-quality care.

Summary

In summary, the goal of the book is to provide an overview of important topics that must be considered when planning a successful career in surgical education. The three main sections of this book include: (1) Local and National Leadership Opportunities, (2) Professional Development, and (3) Research. All of the chapters have been written or coauthored by members of the Association for Academic Surgery (AAS), a premier organization for surgeon scientists.

© Springer Nature Switzerland AG 2019

Carla M. Pugh and Rebecca S. Sippel (eds.)Success in Academic Surgery: Developing a Career in Surgical EducationSuccess in Academic Surgeryhttps://doi.org/10.1007/978-3-030-19179-5_2

2. Opportunities in Medical Student Education

Morgan L. Cox¹  , Brandon V. Henry¹   and Ranjan Sudan¹  

(1)

Department of Surgery, Duke University Medical Center, Durham, NC, USA

Morgan L. Cox

Email: [e-mail]

Brandon V. Henry

Email: [e-mail]

Ranjan Sudan (Corresponding author)

Email: [e-mail]

Keywords

Medical studentFormal curriculumInformal curriculumHidden curriculumSurgical educatorClerkship director

Abbreviations

AAMC

American Association of Medical Colleges

AAS

Association for Academic Surgery

ACS

American College of Surgeons

ASE

Association for Surgical Education

CD

Clerkship director

SERF

Surgical Education Research Fellowship

Introduction

Historically, medical education has been associated with a lengthy, intense, and demanding course of training that requires much sacrifice on the trainee’s part. Following medical school, the aspiring surgeon faces 5 years or more of residency training due to the pursuit of research and/or subspecialty training. It is imperative that surgical residents and faculty alike provide adequate teaching, positive mentorship, and memorable experiences to our young students to increase interest in the field and display that a surgical career is feasible. Given only 6% of graduating students pursue a surgical specialty, the surgery clerkship will likely be the only surgical experience they obtain in their career. Therefore, it is important to teach the basic concepts of surgery to those students who will be pursuing non-surgical careers.

It is important to understand the mindset and priorities of our learners in order to obtain their maximal effort and attention on surgical rotations. In the 2018 American Association of Medical Colleges (AAMC) survey of graduating medical students, 47.0% and 34.8% of students rated the quality of educational experiences on the surgical clerkship as excellent and good, respectively. This was fewer compared to those who ranked the medicine experience as excellent (61.6%) or good (29.5%).

Additionally, 87.6% of students said fit of personality, interests, and skills had a strong influence on their specialty of choice. This was followed by specialty content (83.8%), role models (50.8%), work-life balance (44.2%), and future family plans (27.7%). While surgeon educators may not be able to influence a personality fit, we definitely have the ability to improve the content and teach technical skills thereby increasing their self-confidence and interest in surgery. In fact, if we are to encourage the best and the brightest students to pursue surgical careers it is crucial that we show them the best side of surgery and prepare them for success.

The same 2018 AAMC survey allows us to recognize and understand the existing opportunities to interact and influence medical students in a positive manner. Only 37.7% of students strongly agreed that surgery faculty provided effective teaching during the clerkship. Residents provided effective teaching according to just 46.7% of students. Furthermore, only 74.9% of students reported they were observed taking a patient history, and 81.0% were observed performing a physical exam while on a surgical rotation. This was much lower than internal medicine at 93.9% and 94.8%, respectively, revealing very important areas for improvement and opportunities for surgical faculty to get involved in medical student education.

Due to the changing practice environment, time is precious for surgery faculty. The fact that surgery residents were rated higher than surgery faculty indicates the education of medical students on surgical clerkships has shifted from being the primary responsibility of faculty to residents. This is understandable given that in the team structure residents are typically in constant contact with the students on the wards and in the operating room. Recently, increasing literature shows residents play an integral role in medical students’ experience during their surgery clerkship and in their perception of surgery. Students exposed to positive role models and strong mentors in a given specialty are more likely to be interested and feel well-suited to participate in that specialty.

It is of utmost importance that we continue to have faculty involvement in medical student education, and this chapter is dedicated towards helping surgeon educators understand the wonderful opportunities that exist in medical education but, more importantly, to help every surgeon understand that each interaction with a student is an opportunity to impact their perception of the field of surgery. In fact, the absence of interaction is often viewed by students as mistreatment. Perceptions and interest in surgical careers can improve after exposure to surgical clerkships. Hence, the responsibility of portraying the field positively and teaching the basics of surgery rests on the shoulders of all those who have chosen surgery as their profession. The message is simple. As surgeon educators we need to spend more time interacting with students. This can be accomplished simply by interacting with students when they perform their day-to-day clinical work and providing immediate feedback on their performance.

This chapter outlines a framework that encompasses the medical student curriculum through all 4 years of medical school in order to help surgeons become knowledgeable about the myriad of opportunities that exist within medical student education.

The curriculum can be divided broadly into three types: formal, informal, and hidden. The formal curriculum has an organized structure and consists of activities such as lectures, group discussions, and the simulation laboratory. The formal curriculum may not be the best form of learning because it is non-contextual, but is necessary to cover certain subject material in a time-efficient manner. It also provides uniform instruction across multiple sites and lends itself to testing and evaluations. The American College of Surgeons (ACS) and Association for Surgical Education have developed a standardized formal curriculum for medical students consisting of goals, objectives, and content for 24 different surgical topics.

The informal curriculum refers to more opportunistic learning that is contextual. Teaching within this realm occurs on the wards, in the operating room, or when interesting clinical material presents itself. Finally, the hidden curriculum is the unwritten code of expectations by which members of a profession behave within their environment. The teaching within these domains is performed most often by surgical residents, but provides a rich opportunity for surgical faculty involvement. Faculty members can participate in all of these curricula at either the departmental level, within the medical school, or both. Opportunities to participate in education also exist at the national level through education societies (ASE), specialty societies that have dedicated sections for medical students at their annual meeting (ACS, AAS). In order to facilitate professional development either as an educator or researcher, a partial list of teaching opportunities and resources is included in Table 2.1.

Table 2.1

Opportunities for involvement in medical student education

Curricula Opportunities

Formal Curriculum

Years 1–2 (Basic Science/Classroom/Laboratory)

Multiple opportunities exist in surgical education of medical students during their first 2 years of medical school. Most medical school human anatomy courses begin early in the student coursework and are taught by anatomists. The importance of understanding surgical anatomy is essential for building a good foundation for case observation during the surgery clerkship. Faculty surgeons are uniquely suited to teach anatomy, given their hands-on experience with live human anatomy, on a daily basis. This experience cannot be offered by medical specialists or anatomists. Therefore, the anatomy laboratory setting can be used to assist students with cadaveric dissections and to teach basic anatomical concepts from a surgical standpoint. This adds relevance and gives students their first glimpse into how a surgeon identifies and isolates important structures. This early interaction can encourage the formation of mentoring relationships between faculty and each class of new students.

Presentations by surgeons that are adjunct to the basic science curriculum are an opportunity to creatively introduce the role of surgical management in various disease states. This adds relevance and interest to the dryness of the basic science topics and places the role of surgery in its proper perspective. Surgical educators should be involved in core curriculum development to ensure that these opportunities are not missed. Surgeons can seek these opportunities through the medical school curriculum office.

Years 3–4 (Clerkships/Sub-internships/Bootcamps)

The third- and fourth-year clinical rotations are critically important to the surgical education of medical students. Under the guidance of the surgical clerkship director, students will spend several weeks on inpatient units, operating rooms, and outpatient clinics. There are many opportunities for surgical educators to teach and influence students during this period. It is very important that preceptors actively engage the students in hands-on teaching on the clinical services including obtaining a surgery specific history and physical, concise patient presentations, and technical skills. Much can be learned simply by observation, but active involvement in patient care will create a much more enriching and memorable experience.

Surgical educators can teach basic surgical skills in multiple ways. Ideally, students can be taught basic suturing, knot tying, cutting, laparoscopic camera driving, and other technical skills in a low-intensity setting in the simulation laboratory rather than the more stressful, real-time experience under the bright lights of the operating room. Programs with appropriate resources may attempt to implement simulation sessions appropriate for both lower-level and upper-level medical students. Simulation based championships or Olympics have been shown to improve medical student technical skill and increase interest in surgical specialties. Actively engaging the students in closing skin incisions and assisting with simple portions of dissection under attending supervision will enhance skill development. Faculty providing this hands-on training for the students during the core clerkship increases their baseline level of skill heading into sub-internships allowing students to become increasingly involved in operative procedures.

In addition to clinical and operative instruction, surgical educators can participate in didactic teaching sessions and case presentation sessions with medical students. This can be accomplished either as part of the formal clerkship curriculum or during breaks in daily clinical duties. Individually engaging students in discussions or brief presentations on various key subjects further encourages teaching interaction and gives the educator an opportunity to provide direct, verbal feedback. Dedicated teaching rounds can be implemented on a weekly basis to provide the platform for students to present their patients and demonstrate their understanding of surgical diseases in a less rushed manner than morning rounds.

Some institutions have a dedicated surgery boot camp to prepare senior-level medical students for a surgery residency. Utilizing simulation materials, students can be introduced to more advanced skills such as complex suture techniques, placement of central lines, endotracheal tubes, and chest tubes. Basic laparoscopic techniques can be taught using virtual simulators and box trainers, when available. Common surgical ward patient care issues and emergencies can be reviewed to help prepare these students for their surgical internship. Dictating operative notes and computerized order entry are also frequently taught. Surgical educators should seek these opportunities for hands-on teaching of surgery-interested students as often as possible.

Informal Curriculum

Shadowing

Many first- and second-year students are interested in clinical shadowing experiences, and some medical schools even require students to spend time shadowing physicians in the clinical setting during the basic science years. This presents a great opportunity for surgical faculty to interact with students and introduce them to surgery before they have the pressure to choose a specialty. Observing surgical practice in the clinics and operating rooms early may increase interest in the field of surgery among younger students who have had little prior exposure.

A list of names can be provided to the medical school so that students can be made aware of the surgeons who are interested in having students shadow them. Students should also be encouraged to attend surgical