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Eur J Cardiothorac Surg 2007;31:960. doi:10.1016/j.ejcts.2007.01.051
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
Letters to the Editor |
a Department of Cardiovascular Surgery, Hospital Clínico, University of Barcelona, Barcelona, Spain
b Department of Cardiovascular Surgery, Hospital Universitario "Marqués de Valdecilla", University of Cantabria, Santander, Spain
c Deutsches Herzzentrum, Berlin, Germany
Received 23 January 2007; accepted 29 January 2007.
* Corresponding author. Address: Department of Cardiovascular Surgery, Hospital Clinico, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain. Tel.: +34 93 2275749; fax: +34 93 4514760. (Email: cmestres{at}clinic.ub.es).
Key Words: Surgical training • Education • Professional affairs
We have read with great interest the reply to our previously published editorial [1] by Sadaba et al. entitled ‘Adapt or die. The imperative for a culture of innovation in cardio-thoracic surgical training’ [2]. We obviously have produced a personal opinion based on the analysis of the work done by our Papworth colleagues [3] and this is what personalized comments are for. The point is to give different perspectives on a problem or situation that may stimulate or provoke public discussion considering the importance of a subject like the one we are discussing. Regarding what Sadaba et al. commented we agree with the statement that there is a need for adaptation in current times. But this is not a new message. This is what Cardiovascular and Thoracic surgeons have done for many years. We, as a surgical community, have been able to evolve by working hard and by implementing a number of policies trying to adapt to the needs of every time. If we have a quick look to the recent history of our Specialty since the early days, hard work and innovation has been and continues to be our motto. Fifty or more years of practice are more than enough to confirm this as rightly stated by Turina in a former EACTS presidential address [4]. Then, to insist on the need for innovation may not be the only issue in the current discussion. We do support this as we have also practiced in this way in the past three decades.
There are many issues to discuss; one is the definition of a ‘competent surgeon’ and the second is the need to change the conduct of cardio-thoracic surgery. It will be endless discussions to remind ourselves that motor skills or manual dexterity are just a minimal part of the problem. It is also true that willingness to work, taking responsibilities etc. are at least as important, if not more. However, the only way to learn is to spend time in the operating room, going through all the steps, from the phase of inexperienced assistant to the skilled surgeon. To look after the patients regularly is the only way to get used to all the steps needed in a competent decision-making process [5]. All these establish the profile of a competent surgeon. To focus strictly on surgical training without a comprehensive programme is to stress on the training of a simple technician. In surgery, each and every activity is a repetitive task throughout a lifetime career. Then, the role of apprenticeship cannot be neglected. The same applies to the difference between a competent surgeon and a technician.
Whatever happens we should not lose our compass to the North. It is doubtful that when hard work and tireless and judicious patient care are the underlying foundations of our daily practice extinction will be at the corner. Needless to say that research should not be forgotten.
References
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