APSA Presidential Address
The surgeon and the child

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Abstract

For many reasons pediatric surgeons have been asked to do all general and thoracic procedures in children. The profession has responded by training more, but the core of special cases requiring pediatric surgical expertise has not changed, and there is concern that the many surgeons now in training will not each do enough cases to attain and maintain operative expertise. This presentation examines the psychological, educational, and surgical literature on the development of expertise, especially operative expertise. From this I conclude that individual surgeon volume when gained in deliberate practice with a coach and with effort is essential, and that several technologies hold promise for allowing deliberate practice in simulation environments. I propose that in order to avoid a decline in pediatric surgical operative expertise we must reorganize pediatric surgical training and practice to align with Optimal Resources for Children's Surgery and the evolution of training in general surgery.

Section snippets

The surgeon and the child

“With no language but a cry children are asking for better surgical treatment of their ills and are begging for more thoughtful attention to the congenital deformities it was their misfortune to be born with.” Willis Potts wrote this sentence in the introduction to his 1959 book, whose title I have borrowed for the theme of this meeting and the title of this talk. He was demanding specialization in pediatric surgery.

Fig. 5 shows how we have answered the cry of children described by Willis Potts

Developing expertise

It is now time to look at what is known about the development of expertise. I will begin with what is known today about expertise in general and move on to medical expertise and then to operative expertise.

Any discussion of a theory of expertise today must begin, and some would say end, with the work of K. Anders Ericsson and his colleagues and disciples [7], [8]. Ericsson's theories are based on research and experiment. Perhaps his most important finding is that there is little or no evidence

Action items

So, let's consider. Have we achieved operative excellence? Not yet. Atul Gawande, in one of his very early studies on surgical adverse advents in Colorado and Utah, found that 66% of all adverse events were surgical, 54% of surgical adverse events were preventable, and half of all surgical adverse events were technique related [28].

What is APSA's role? By APSA I refer to the community of pediatric surgeons in the United States and Canada. Last August I called together a task force of 40

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    • The Canadian pediatric surgery workforce: A 5-year prospective study

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      Citation Excerpt :

      The meeting was convened by Dr. Michael Klein, then President of the American Pediatric Surgical Association. It included a number of pediatric surgeons from the United States and Canada and openly discussed issues pertaining to training, clinical volume, and maintenance of competence [11]. This meeting started a critical public conversation on the future of pediatric surgical practice in North America, which will most certainly continue [12].

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