APSA Presidential AddressThe surgeon and the child
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
References (31)
The vascularization of tumors
Sci Am
(1976)- et al.
The physiology of willpower: linking blood glucose to self-control
Personal Soc Psychol Rev
(2007) - et al.
Surgical task and skill classification from eye tracking and tool motion in minimally invasive surgery
Med Image Comput Comput Assist Interv
(2010) - et al.
The learning curve in laparoscopic liver resection: improved feasibility and reproducibility
Ann Surg
(2009) Medical records that guide and teach
N Engl J Med
(1968)Medical records that guide and teach
N Engl J Med
(1968)Surgical research: a contradiction in terms?
J Surg Res
(1984)- et al.
The need for pediatric surgeons as determined by the volume of work and the mode of delivery of surgical care
Surgery
(1974) The right stuff
J Pediatr Surg
(2014)
The road to excellence: the acquisition of expert performance in the arts and sciences, sports, and games
The Cambridge handbook of expertise and expert performance
The making of a surgeon: 10,000 hours?
J Pediatr Surg
Crowd-sourced assessment of technical skills: a novel method to evaluate surgical performance
J Surg Res
The use of cognitive task analysis to reveal the instructional limitations of experts in the teaching of procedural skills
Acad Med
Cited by (5)
The Canadian Pediatric Surgery Workforce: A 10-year Prospective Assessment
2024, Journal of Pediatric SurgeryThe Canadian pediatric surgery workforce: A 5-year prospective study
2019, Journal of Pediatric SurgeryCitation 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].
Workforce issues in pediatric surgery
2017, American Surgeon