Can your patients trust you as a rookie doctor?
Next time a patient doesn’t want you to operate on them because you’re still a little wet behind the ear, you may show them a study published in the Journal of the American Statistical Association that found no statistically meaningful differences in patient mortality between new and experienced surgeons. The 2-year study was conducted by team of doctors and statisticians and comprised data on 130,106 Medicare patients at 489 hospitals in the United States. The findings showed that the overall death rate among patients who underwent a surgical procedure with a more experienced doctor was 3.59%, compared to 3.71% for less experienced surgeons.
The study will reassure pre-op patients “that new surgeons were able to achieve similar mortality rates to experienced surgeons when caring for similar patients. However, mortality is a relatively rare event that may not expose the benefits of experience,” associate professor of surgery at the Hospital of the University of Pennsylvania and study author Dr. Rachel R. Kelz said in a news release. The study did encounter a few limitations. For example, the researchers did not examine surgical complications and other common risks where experience may indeed make a difference. “We know for a fact that some of the more complex operations are clearly correlated with experience,” chief of surgery at Massachusetts General Hospital Dr. Keith Lillemoe told CBS News. Moreover, the study was published in a statistics journal as opposed to a peer-reviewed medical journal.
Current O.R. training is 6-12 months shorter than ten years ago, which according to Lillemoe is what fellowship programs are for. “If I'm a trainee and I don't feel comfortable at the end of my five years of training, I will then go out and do a fellowship,” he said. However, even that may not be enough. A 2013 Annals of Surgery study surveyed top subspecialty program directors who supervised training in invasive surgery, bariatric, colorectal, hepatobiliary, and thoracic specialties among other areas. Twenty-one percent of the respondents felt that new fellows were unprepared; for instance, 30% were not able to operate for 30 minutes without supervision or manipulate tissue safely during a laparoscopy, and 24% were unable to identify early signs of complications. Also during a laparoscopy, 26% were viewed as not able to identify anatomical planes, and 56% could not suture a cut.