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Eur J Cardiothorac Surg 2007;31:959. doi:10.1016/j.ejcts.2007.01.052
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Letters to the Editor

Adapt or die

The imperative for a culture of innovation in cardio-thoracic surgical training

^a Policlínica Gipuzkoa, San Sebastián, Spain
^b Leeds General Infirmary, Leeds, UK
^c Erasmus MC, Rotterdam, The Netherlands

Received 19 December 2006; accepted 29 January 2007.

^_* Corresponding author. Address: Cirugía Cardiovascular, Policlinica Gipuzkoa, Paseo Miramón 174, 20009 San Sebastián, Gipuzkoa, Spain. Tel.: +34 6696 02 855; fax: +34 943 00 2771. (Email: jrsadaba{at}med.policlinicagipuzkoa.com).

Key Words: Time directive • Training • Cardio-thoracic surgery

In a recent Editorial [1], Mestres et al., give a personal view of the possible impact of the full application of the European Working Time Directive (EWTD) on training in cardio-thoracic surgery. The authors go to the extreme of describing the directive as ‘a well planned and organized assassination of surgery’.

It has been claimed that under this directive the cardio-thoracic surgical trainees will have only a fraction of the time allowed to their predecessors to become competent surgeons.

The answer to this challenge must be that of adaptation to the new environment in order to survive. The way training in cardio-thoracic surgery is conducted must therefore change. Below we propose some alternatives to optimise time spent in hospital in order to streamline training and produce competent surgeons in a 48-h week environment.

Processes for the selection of trainees in cardio-thoracic surgery in Europe are heterogeneous. Commonly, the methods used for selecting cardiac-thoracic surgical trainees are inappropriate to identify the attributes and skills required in a trainee to be. These fail to measure qualities such as manual dexterity, complex problem solving ability, willingness to work in or lead a team, ability to take responsibility, commitment etc. Time and resources spent in these processes would ensure the selection of those candidates most likely to progress through a training programme effectively.

Models for teaching basic and advanced surgical techniques in the wet lab must be developed. Retention of motors skills appears to be most dependent on the degree to which the skill was perfected, rather than other variables. The amount of transference of skills between tasks depends on the similarity between the two tasks. This implies that appropriate skills learnt in the wet-lab can be carried out effectively in the operating theatre [2].

Structured models for transfer of knowledge have been shown to optimise surgical training [3]. When compared with traditional teaching strategies based in the traditional apprenticeship method, the former have been applied very scarcely, and its broader use would certainly speed up the learning process.

The rate of progress during the training period varies amongst trainees. Therefore, establishing fixed training periods can be considered as unrealistic. Competence based training ensures that training is tailored to the trainee needs and abilities [4]. In it, progress is made by achievement of predetermined competencies. For instance, once a trainee is deemed competent in saphenous vein harvesting, he/she can move on to learn a new procedure. From then onwards needlessly performing simple, repetitive tasks, such as vein harvesting, compromises the overall learning continuum and advancement of trainees.

Evolution's rules are simple: creatures that adapt to threats and master the evolutionary game thrive; those that don’t, become extinct. There are tools available to successfully train cardiothoracic surgeons in a 48 h week environment. Some have been discussed in the text; many others have been left in the inkpot. It is our obligation to make good use of all of them and continue the research in this field.

References

1. Mestres CA, Revuelta JM, Yankah AC. The European Working Time Directive: quo vadis? A well planned and organized assassination of surgery. Eur J Cardiothorac Surg 2006;30:571-573.[Free Full Text]
2. Hamdorf JM, Hall JC. Acquiring surgical skills. Br J Surg 2000;87:28-37.[Medline]
3. Albert A, Peck EA, Wouters P, Hemelrijck JV, Bert C, Sergeant P. Performance analysis of interactive multimodal CME retraining on attitude toward and application of OPCAB. J Thorac Cardiovasc Surg 2006;131:154-162.[Abstract/Free Full Text]
4. Long DM. Competency-based residency training: the next advance in graduate medical education. Acad Med 2000;75:1178-1183.[Medline]

This article has been cited by other articles:

				C.-A. Mestres, J. M. Revuelta, and A. C. Yankah Reply to Sadaba et al. Eur. J. Cardiothorac. Surg., May 1, 2007; 31(5): 960 - 960. [Full Text] [PDF]

				E. Lim Reply to West Eur. J. Cardiothorac. Surg., May 1, 2007; 31(5): 958 - 959. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): David J. O’Regan Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sádaba, J. R. Articles by Kappetein, A. P. Search for Related Content PubMed PubMed Citation Articles by Sádaba, J. R. Articles by Kappetein, A. P. Related Collections Education Cardiac - other