Published 7/1/2012
Shepard R. Hurwitz, MD

A Different Viewpoint

In all aspects of professional life, change is inevitable—and not all bad. The residency experience will continue to change as medicine, technology, our understanding of how learning occurs, and life itself change. The experiences and challenges faced by those who went through residency before the ACGME was established are not better or worse than the experiences and challenges facing today’s residents, but they were very different.

Dr. Gross makes a very good point that change is often forced by external factors—in this case, the ACGME—and there is cause for concern when such an important institution as orthopaedic residency is asked to a be part of the New Accreditation System (NAS).

Milestones are not about counting cases; they are a way to have residents grow by virtue of the six core competencies—patient care and procedural skills, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. The minimum number of surgeries was adopted to help program directors create a uniform experience for orthopaedic residents across the country. Thus, the minimum case number reflects on the residency program, not the residents, and should not be confused with milestones. The same is true of resident duty hours; forced by government pressure, this is a change that does not create a great deal of improvement in resident learning and has not improved patient safety.

In my opinion, the goal of residency education is not ‘to train master surgeons.’ No one is a master surgeon after residency. The goal is to train adequate surgeons who have the insight and skill set to become master surgeons over time, with added experience and lifelong learning. Adapting to the NAS provides residency programs with the opportunity to help create well-trained surgeons who are adaptive to change. That, in turn, will improve patient care over time as these individuals progress in their careers from trainees to successful orthopaedic surgeons.

Shepard R. Hurwitz, MD, is the executive director of the American Board of Orthopaedic Surgery.