Making Surgeons

By

Leonard Zwelling

https://www.nytimes.com/2019/05/30/well/live/surgeons-hobbies-dexterity.html?searchResultPosition=9

I learned early on in medical school that I was not going to be a surgeon. Now I know why.

The article above points out how surgeons are really made through rote practice of manual dexterity early in their lives followed by intense and prolonged training in the art of cutting, sewing and handling human tissue.

I was not good at the things surgeons need to be good at early in my schooling. I was a solid C in art and in shop. I could build models, but not really well and I was far more adept at catching a baseball than I ever was at any fine motor skill including playing the piano.

Once I got to medical school and was formally introduced to surgery, I learned quickly that this was not for me. I was way too in my head for that. It’s not that great surgeons are not great thinkers. In fact, they are. They are great visualizers and great planners. They see many steps ahead and understand what they know and know what they don’t know and try to prepare accordingly. I was far more a seat of the pants internist than a contemplative surgeon and fortunately my career mirrored that.

What was alarming about the article is that today surgeons are being chosen for residencies based on their intellectual prowess or skills in the laboratory which are not aspects of their resumes that presage great surgical ability. Many of the younger applicants are far more adept at video games (which may be perfectly great for robotic surgery) than they are at tying knots or seeing the details of tissue planes. And to compound the problem is the limits on residency hours making it likely that a graduate of a surgical training program now will have done far fewer operations than a graduate of a surgical program a generation ago.

All of this concerns me greatly as I have needed and may need again the skills of great surgeons to keep me going. I’ve been lucky and had experienced men and women caring for me when I was asleep at the behest of an anesthesiologist, but what will be the case in the future when this latest generation of newly trained surgeons become the senior surgeons of tomorrow?

So I am making a plea. Let’s get art, home ec, shop and music back in the elementary school curriculum so that we can find the next generation of great surgeons and train them to take up the mantle of operative excellence. Furthermore, let’s extend the number of years of surgical residencies if need be (because the 80-hour work week in surgical residencies may be here to stay) so that trainees get a full surgical experience at doing operations under the guidance of senior surgeons.

During my life as a doctor, I always felt that surgeons were necessary aspects of the health care system when internal medicine reached its limits. I no longer feel that way. Surgery must take its rightful place as a perfectly acceptable way to deal with a medical problem—even one with non-surgical options. The best surgeons know that. They will avoid surgery unless it is what is best for the patient. This is as it should be and I have been lucky for as a patient—long after I was a doctor—it has been surgery that has come to my rescue at least as often as non-surgical medicine.

My point in writing this is to illustrate that surgeons are made not born and we need to make sure the system is geared to making more, better surgeons. This will necessitate attention long before medical school. Surgical dexterity is an early skill. A great surgeon is every bit as much a prodigy as a great pianist. Let’s create more great surgeons. You may need one—soon.

Leonard Zwelling