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Skill Maintenance, Remediation, and Reentry

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Comprehensive Healthcare Simulation: Surgery and Surgical Subspecialties

Part of the book series: Comprehensive Healthcare Simulation ((CHS))

Abstract

For practicing surgeons, maintaining surgical skills and/or acquiring new procedural ability depend on many factors and are accomplished in several ways. Maintenance of certification programs for the American Board of Medical Specialties lays out some of those requirements. None at this point involve demonstration of procedural or technical skill competency in the surgical specialties, though reporting of caseloads, maintaining good standing/privileges at a hospital or health system, and submitting surgical patient cases to an outcomes database are accepted surrogates. Acquiring and performing new procedures are hospital-dependent, based on medical staff bylaws and credentialing policies. Reentering a surgical practice and remediating surgical skills due to specific deficiencies are difficult based on a surgeon’s caseload, the duration of absences from the practice of surgery, and the experience and the circumstances related to absences. While continuing medical education (CME) programs/credit is used for knowledge and skill maintenance, as of 2018, high-stakes procedural skill assessment verifying that practicing surgeons meet minimum criteria to be safe is lacking. While FLS, FES, and the developing FRS and FUSE programs are required for graduating residents to show procedural competency prior to graduation from residency and initial board certification, none are required for maintenance of certification. Studies from military programmed absences, for example, demonstrated that a greater than 6-month absence leads to self-perceived skill decrement. Surgeons are significantly impacted based on the stage of their career development, with junior surgeons likely sustaining the most profound impact due to non-solidification of experience/practice, disruption of the cognitive to technical interface, and a need for surgical skills refinement. For a surgeon to reenter clinical practice, programs need to focus on simulation and mental skills curriculum to bring to baseline technical skills while also developing coping skills and determining the impact of potential external stressors. Programs designed for reentering the surgical workforce should seek to solidify the cognitive to technical skill interface, refine technical skills learned during formal training, and build upon existing surgical skills. A structured and surgeon-specific reentry program focusing on both cognitive and procedural-related skills is necessary, enhanced through inanimate simulation, specific live tissue/cadaveric skills practice/assessment, and cognitive/mental skill scenario training followed by or in parallel to supervised clinical reintegration.

None of the authors have any disclosures or conflicts of interest.

All the authors are employees of the Department of Defense, and this study does not represent the views of the Department of Defense or the US Army.

The authors jointly take responsibility for the overall content and integrity of this manuscript.

There was no funding source for this work.

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Author information

Authors and Affiliations

  1. Department of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX, USA

    Marlin Wayne Causey

  2. Department of Surgery, Madigan Healthcare System, Tacoma, WA, USA

    Robert M. Rush Jr.

  3. PeaceHealth St Joseph Medical Center, Bellingham, WA, USA

    Robert M. Rush Jr.

  4. Madigan Army Medical Center, Tacoma, WA, USA

    Robert M. Rush Jr.

Authors
  1. Marlin Wayne Causey
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  2. Robert M. Rush Jr.
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Corresponding author

Correspondence to Robert M. Rush Jr. .

Editor information

Editors and Affiliations

  1. Vice Chair of Education, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Dimitrios Stefanidis

  2. Vice Chair of Education, Department of Surgery, Stanford University, Stanford, CA, USA

    James R. Korndorffer Jr.

  3. Executive Director WISH and CREST, Department of Urology, University of Washington, Seattle, WA, USA

    Robert Sweet

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Causey, M.W., Rush, R.M. (2019). Skill Maintenance, Remediation, and Reentry. In: Stefanidis, D., Korndorffer Jr., J., Sweet, R. (eds) Comprehensive Healthcare Simulation: Surgery and Surgical Subspecialties. Comprehensive Healthcare Simulation. Springer, Cham. https://doi.org/10.1007/978-3-319-98276-2_8

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  • DOI: https://doi.org/10.1007/978-3-319-98276-2_8

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