Skill Maintenance, Remediation, and Reentry

  • Marlin Wayne Causey
  • Robert M. RushJr.Email author
Part of the Comprehensive Healthcare Simulation book series (CHS)


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.


Remedial surgical training Surgery refresher training Low-volume surgery Mental skills Reentry into surgical practice Absence from surgical practice Skill decrement Crowdsourced assessments 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Vascular SurgerySan Antonio Military Medical CenterSan AntonioUSA
  2. 2.Department of SurgeryMadigan Healthcare SystemTacomaUSA
  3. 3.PeaceHealth St Joseph Medical CenterBellinghamUSA
  4. 4.Madigan Army Medical CenterTacomaUSA

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