Hanging up the surgical cap: Assessing the competence of aging surgeons.
Aging surgeon
Competency
Surgeon retirement
Surgical skill
Journal
World journal of orthopedics
ISSN: 2218-5836
Titre abrégé: World J Orthop
Pays: United States
ID NLM: 101576349
Informations de publication
Date de publication:
18 Apr 2021
18 Apr 2021
Historique:
received:
24
12
2020
revised:
28
01
2021
accepted:
05
04
2021
entrez:
7
5
2021
pubmed:
8
5
2021
medline:
8
5
2021
Statut:
epublish
Résumé
As the average age of surgeons continues to rise, determining when a surgeon should retire is an important public safety concern. To investigate strategies used to determine competency in the industrial workplace that could be transferrable in the assessment of aging surgeons and to identify existing competency assessments of practicing surgeons. We searched websites describing non-medical professions within the United States where cognitive and physical competency are necessary for public safety. The mandatory age and certification process, including cognitive and physical requirements, were reported for each profession. Methods for determining surgical competency currently in use, and those existing in the literature, were also identified. Four non-medical professions requiring mental and physical aptitude that involve public safety and have mandatory testing and/or retirement were identified: Airline pilots, air traffic controllers, firefighters, and United States State Judges. Nine late career practitioner policies designed to evaluate the ageing physician, including surgeons, were described. Six of these policies included subjective performance testing, 4 using peer assessment and 2 using dexterity testing. Six objective testing methods for evaluation of surgeon technical skill were identified in the literature. All were validated for surgical trainees. Only Objective Structured Assessment of Technical Skills (OSATS) was capable of distinguishing between surgeons of different skill level and showing a relationship between skill level and post-operative outcomes. A surgeon should not be forced to hang up his/her surgical cap at a predetermined age, but should be able to practice for as long as his/her surgical skills are objectively maintained at the appropriate level of competency. The strategy of using skill-based simulations in evaluating non-medical professionals can be similarly used as part of the assessment of the ageing surgeons' surgical competency, showing who may require remediation or retirement.
Sections du résumé
BACKGROUND
BACKGROUND
As the average age of surgeons continues to rise, determining when a surgeon should retire is an important public safety concern.
AIM
OBJECTIVE
To investigate strategies used to determine competency in the industrial workplace that could be transferrable in the assessment of aging surgeons and to identify existing competency assessments of practicing surgeons.
METHODS
METHODS
We searched websites describing non-medical professions within the United States where cognitive and physical competency are necessary for public safety. The mandatory age and certification process, including cognitive and physical requirements, were reported for each profession. Methods for determining surgical competency currently in use, and those existing in the literature, were also identified.
RESULTS
RESULTS
Four non-medical professions requiring mental and physical aptitude that involve public safety and have mandatory testing and/or retirement were identified: Airline pilots, air traffic controllers, firefighters, and United States State Judges. Nine late career practitioner policies designed to evaluate the ageing physician, including surgeons, were described. Six of these policies included subjective performance testing, 4 using peer assessment and 2 using dexterity testing. Six objective testing methods for evaluation of surgeon technical skill were identified in the literature. All were validated for surgical trainees. Only Objective Structured Assessment of Technical Skills (OSATS) was capable of distinguishing between surgeons of different skill level and showing a relationship between skill level and post-operative outcomes.
CONCLUSION
CONCLUSIONS
A surgeon should not be forced to hang up his/her surgical cap at a predetermined age, but should be able to practice for as long as his/her surgical skills are objectively maintained at the appropriate level of competency. The strategy of using skill-based simulations in evaluating non-medical professionals can be similarly used as part of the assessment of the ageing surgeons' surgical competency, showing who may require remediation or retirement.
Identifiants
pubmed: 33959487
doi: 10.5312/wjo.v12.i4.234
pmc: PMC8082508
doi:
Types de publication
Journal Article
Langues
eng
Pagination
234-245Informations de copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflict-of-interest statement: There is no conflict to disclose.
Références
Cochrane Database Syst Rev. 2009 Apr 15;(2):CD003030
pubmed: 19370580
Ann Surg. 2006 Sep;244(3):353-62
pubmed: 16926561
JAMA. 1999 Sep 1;282(9):867-74
pubmed: 10478694
Ann Surg. 2014 Aug;260(2):199-201
pubmed: 24670863
J Surg Educ. 2015 May-Jun;72(3):458-70
pubmed: 25547465
J Robot Surg. 2016 Sep;10(3):227-31
pubmed: 27039189
Circ Cardiovasc Qual Outcomes. 2017 Jul;10(7):
pubmed: 28710297
N Engl J Med. 2013 Oct 10;369(15):1434-42
pubmed: 24106936
BMJ. 2018 Apr 25;361:k1343
pubmed: 29695473
Ann Surg. 2005 Sep;242(3):344-8; discussion 348-52
pubmed: 16135920
Ann Thorac Surg. 2020 Dec;110(6):1909-1916
pubmed: 32504601
Acad Med. 2009 Aug;84(8):1008-14
pubmed: 19638764
JAMA Surg. 2017 Oct 1;152(10):967-971
pubmed: 28724142
Surg Endosc. 2011 Aug;25(8):2555-63
pubmed: 21359893
Surg Endosc. 2017 Mar;31(3):1203-1212
pubmed: 27412125
Ann Surg. 2018 May;267(5):905-909
pubmed: 28486391
J Am Coll Surg. 2013 May;216(5):955-965.e8; quiz 1029-31, 1033
pubmed: 23490542
Surg Endosc. 2020 Apr;34(4):1492-1508
pubmed: 31953728
J Endourol. 2015 May;29(5):604-9
pubmed: 25356517
J Bone Joint Surg Am. 2019 Jan 16;101(2):e7
pubmed: 30653052
JAMA. 2020 Jan 14;323(2):179-180
pubmed: 31935030
J Arthroplasty. 2021 Feb;36(2):579-585
pubmed: 32948425
J Contin Educ Health Prof. 2006 Summer;26(3):199-208
pubmed: 16986145
Mayo Clin Proc. 2017 Dec;92(12):1746-1752
pubmed: 29153596
Teach Learn Med. 2019 Apr-May;31(2):146-153
pubmed: 30514128
J Am Coll Surg. 2004 Oct;199(4):603-6
pubmed: 15454146
Acad Med. 2005 Jun;80(6):533-40
pubmed: 15917355
Clin Orthop Relat Res. 2016 Apr;474(4):874-81
pubmed: 26502107
N Engl J Med. 2012 Dec 27;367(26):2543-9
pubmed: 23268670
Am J Med Qual. 2019 Nov/Dec;34(6):545-552
pubmed: 30654617
Hum Resour Health. 2016 Nov 15;14(1):67
pubmed: 27846852
Clin Orthop Relat Res. 2009 Feb;467(2):402-11
pubmed: 18975041
Mt Sinai J Med. 2012 Jan-Feb;79(1):140-53
pubmed: 22238047
Am J Surg. 2005 Jul;190(1):107-13
pubmed: 15972181
Arthroscopy. 2016 Dec;32(12):2572-2581.e3
pubmed: 27474104
J Contin Educ Health Prof. 2013 Fall;33 Suppl 1:S36-47
pubmed: 24347151
Teach Learn Med. 2016;28(1):72-9
pubmed: 26787087
J Endourol. 2015 Oct;29(10):1183-8
pubmed: 25867006
J Urol. 2012 Jan;187(1):247-52
pubmed: 22099993
Surg Clin North Am. 2015 Aug;95(4):893-905
pubmed: 26210979
CMAJ. 1995 Dec 15;153(12):1723-8
pubmed: 8529186