What is the most effective approach to become an outstanding surgeon?

Becoming an Outstanding Surgeon: Evidence-Based Approach

To become the best surgeon, you must engage in structured mentoring, develop technical skills through validated simulation and skills laboratories, pursue research training in basic scientific methods, and participate in continuous competency assessment throughout your career. 1

Core Educational Framework

Structured Mentoring is Essential

• All surgical trainees should have access to a formally trained mentor who provides guidance on career planning, academic development, working relationships, and pastoral issues 1
• Only 34-52% of surgical trainees currently have mentors, yet 72% of those without one recognize its importance 1
• Focused mentoring has been demonstrated to improve attainment of technical surgical endpoints, including in laparoscopic colorectal training 1
• Mentors should be chosen based on your specific developmental needs at each career stage, and it is normal to change mentors as needs evolve 1
• 83% of surgical trainees want formal coaching and mentoring training, yet only 8% have received it 1

Technical Skills Development Outside the Operating Room

• Surgery departments must develop surgical skills laboratories with validated evaluation systems before trainees operate on patients 1
• New teaching technologies including simulators and virtual reality should be introduced as they become validated 1
• A curriculum for surgical skills must be acquired by trainees outside the operating room before beginning patient operations 1
• The American College of Surgeons should set and monitor national standards for skills centers 1

Research Training Requirements

Fundamental Scientific Knowledge

• All surgeons must be exposed to thorough understanding of basic scientific methods, biostatistics, and appropriate evaluation of published material during residency 1
• Training in basic research methods and biostatistics should occur during residency for all residents 1
• Optional surgeon-scientist training pathways leading to Masters and/or PhD degrees should be available 1
• Advanced curriculum-based training in clinical research, public health, or policy should be accessible, ideally leading to a degree 1

Research Training Caveats

• Unstructured, obligatory 1-2 years of research required as prerequisite for some specialty programs should be assessed based on benefits to the individual and specialty, not done merely to meet requirements 1
• Research training in surgery currently lacks the structure, organization, and oversight that exists for clinical training 1

Faculty and Educational Leadership Development

Requirements for Educational Excellence

• All academic surgical chairs and division chiefs must acquire fundamental knowledge of education and demonstrate commitment to high educational standards 1
• Clerkship directors and residency program directors must have established standards for qualifications and training in both education and administration 1
• Program directors must participate in training in program development and evaluation before assuming responsibility 1
• Faculty development courses in teaching and the education process should be provided 1
• Surgical faculty with advanced training in education and educational research should be actively recruited 1

Competency-Based Advancement

Formal Competency Assessment

• Completion of training does not automatically equal competence to practice independently - neurosurgical trainers must formally assess competence and grant clinical privileges based on demonstrated technical skills and outcomes 2
• Assessment should be based on actual cognitive knowledge and technical skills rather than solely on training structure 2
• Evaluation should include review of performance on procedures similar to those for which privileges are requested 2
• Quality assurance programs should include periodic review of random procedure samples by independent experts to confirm continued competence 2

Critical Safeguard

• The responsibility for determining surgical competence rests with trainers and credentialing bodies at the hospital where privileges are requested, not with the fellow's previous training program 2

Modular Training Structure

Restructured Residency Approach

• Surgical residencies should ensure all trainees receive common grounding in basic principles of surgical disease and patient care 1
• A modular format should include a basic surgical core curriculum, followed by further training in either general surgery or surgical subspecialty leading to specific certification 1
• Earlier differentiation into goal-oriented specialty tracks should occur, recognizing that "one size no longer fits all" 1
• Competence-based advancement should replace time-in-service requirements 1

Professional Development Activities

Building Surgical Excellence

• Participate in surgical clubs, research opportunities, preceptorships, and mentorship programs 1
• Engage in social interactions to understand the lifestyle and professional satisfaction of surgeons 1
• Pursue high-quality surgical clerkship and resident preparedness courses that meet leading-edge teaching and evaluation standards 1

Common Pitfalls to Avoid

• Do not rely solely on time-in-service or number of procedures completed without proper assessment of outcomes and technique 2
• Avoid unstructured research experiences done merely to meet fellowship requirements rather than for genuine educational benefit 1
• Do not assume that completing a fellowship or residency automatically guarantees competence for independent practice 2
• Recognize that isolated recommendations or credentials alone are insufficient for judging overall competence 2