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U.S. health care reform: Will it change postgraduate surgical education?

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Abstract

The principal goals of the pending health care reform initiatives in the United States are improving access to health care and controlling its costs. There are multiple proposals designed to reach these goals. Regardless of the final result, health care reform is likely to have significant implications for postgraduate surgical education. The teaching environment is already rapidly changing. Present environmental influences include the explosion of surgical knowledge, demographic changes, expansion of regulatory requirements from within the health care delivery system and within surgery as a discipline, societal and cultural changes, and economic pressures. Current and pending concerns prompt several questions: What should we teach? Where do we teach? How long should it take? Who are our learners? How do we evaluate our educational programs? Who should pay? A number of predictable changes affecting surgical education are proposed. New, more complex technologies will result in increased surgical specialization. Demands on surgical education will require that it be shorter, more relevant, more efficient, more effective, and more accountable. Surgical manpower requirements must be more clearly defined. Better and more relevant measures of clinical outcomes will be developed. Use of improved informational technology to manage clinical activity will expand. Solutions to the problem of foreign medical graduates will be clarified. The issue of who pays for surgical education will require resolution with some new and creative results. A proposal for shorter and more effective surgical residency is advocated.

Résumé

Les objectifs principaux des initiatives de réforme de la santé aux États-Unis sont d'améliorer l'accès aux unités de soins et d'en limiter les coûts. Il existe une multitude de propositions pour atteindre ces buts. Indépendamment des résultats finaux, cependant, la réforme risque d'avoir des implications graves en ce qui concerne l'enseignement postuniversitaire. Actuellement le milieu enseignant change rapidement. Les influences principales sur l'enseignement sont l'explosion des connaissances médicales, les changements démographiques, le durcíssement et la complexité des règlements à la fois à l'intérieur de la communauté chirurgicale et à l'intérieur du système des soins, les changements sociaux et culturels et les exigences économiques. Les problèmes actuels peuvent être resumés ainsi: Que faut-il enseigner? où faut-il enseigner? Quel est le temps nécessaire? Qui doit le faire? Comment évaluer nos programmes d'enseignement? Et qui doit les payer? Un certain nombre de changements prévisibles, influençant la chirurgie, sont proposés. De nouvelles technologies, de plus en plus complexes, vont avoir comme conséquence une augmentation de la spécialisation chirurgicale. Il s'en suit que la formation chirurgicale va être plus courte, plus spécifique, plus effective et efficace? Les demandes en myoens humains seront mieux définies. Il faut également mieux défìnir les critères d'efficacité clinique. La nouvelle technologie informatique progressant sans cesse, intervient sur l'activité clinique. Le problème des médecins diplômés à l'étranger va être clarifié. Le financement de la formation médicale va conna ître de nouvelles tournures. Une proposition pour une formation postinternat plus courte et plus spécifique est formulée.

Resumen

Los principales propósitos de las iniciativas sobre reforma de la salud que actualmente se encuentran en discusión son el mejoramiento de la atención y el control de costos. Existen múltiples propuestas para alcanzar tales objetivos. No importa cual sea el resultado final, la reforma de la atención de la salud muy probablemente tendrá significativas implicaciones sobre la educación quirúrgica de postgrado. El escenario educativo ya está en un franco proceso de cambio. Algunos factores determinantes son la explosión del conocimiento quirúrgico, cambios demográficos, la explosión de los requerimientos regulatorios tanto en lo referente a los sistemas de los servicios de salud como a la círugía misma como disciplína, los cambios sociales y culturales y las presiones de tipo económico. Algunos interrogantes pertinentes son: Qué debemos enseñar? Dónde debemos enseñar? Qué tan prolongado debe ser el programa? Quiénes son nuestros discípulos? Cómo debemos evaluar nuestros programas educativos? Quién debe asumir los costos?

Se visualizan algunos cambios que han de tener impacto sobre la educación quirúrgica. Nuevas y más complejas tecnologías habrán de resultar en creciente especialización quirúrgica. Las demandas sobre la educación quirúrgica harán necesario que el proceso sea menos largo, más pertinente, más eficiente, más efectivo y más responsable y explicable.

Los requerimientos en cuanto a recursos humanos tendrán que ser más claramente definidos. Se desarrollan mejores y más pertinentes métodos para determinar los resultados finales. Se incrementará la utilización de mejores tecnologías de la información para el manejo de la actividad clínica. Se definirán soluciones al problema de los médicos graduados en el exterior. El tema de quién debe pagar por la educación quirúrgica deberá resolverse mediante nuevas y creativas soluciones. Se plantea una propuesta para una residencia quirúrgica más corta y más efectiva.

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Authors and Affiliations

  1. Department of Surgery, East Carolina University School of Medicine, 27858-4354, Greenville, North Carolina, USA

    Walter J. Pories M.D., Jay C. Smout Ph.D., Alva Morris M.B.A. & Victoria E. Lewkow M.A.

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  1. Walter J. Pories M.D.
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  2. Jay C. Smout Ph.D.
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  3. Alva Morris M.B.A.
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  4. Victoria E. Lewkow M.A.
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Pories, W.J., Smout, J.C., Morris, A. et al. U.S. health care reform: Will it change postgraduate surgical education?. World J. Surg. 18, 745–752 (1994). https://doi.org/10.1007/BF00298921

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