At the 2019 Society of Gynecologic Surgeons (SGS) Annual Meeting, John Gebhart, MD, MS brought together a multi-disciplinary panel to talk about the challenges in Gynecologic Surgery. Issues such as the impact of resident duty hours, weaker preparedness of incoming fellows, expansion of surgical pedagogy, and reduced surgical volume were among the topics that were discussed. This year, it was my honor as the 45th president of SGS to continue the dialogue as we now look forward to shaping the future of Gynecologic Surgery.
It is clear that collaboration between all of the specialty societies that represent Gynecologic Surgery will be the most efficient way for us to evolve to meet the needs of this new era in surgery. To that end, it was my pleasure to host this dialogue and get the perspectives of the key leaders of each society:
- President of the Society of Gynecologic Oncology Warner Huh, MD
- President of the American Urogynecologic Society Geoff Cundiff, MD, FACOG, FRCSC
- Past President of the Society of Reproductive Surgeons Samantha Pfeiffer, MD
- President of the American Association of Gynecologic Laparoscopists (AAGL), Marie Fidela R. Paraiso, MD
- President-elect of the American College of Obstetricians and Gynecologists Ted Anderson, MD
Prior to the panel discussion, we all agreed on a few key tenants. First, pursuing excellence in surgery really should be directed at improving outcomes for patients as the primary goal.
Next, the value of the surgeon is a broad understanding of the complexities and range of disorders that procedures might be used for. Future surgeons may be identified less by their specialty knowledge and more by their insight, clinical judgment, experience, and unique technical skills.
Finally, the surgical literature has shown clear associations between surgical volume and quality in nearly all disciplines.
Each panelist presented some unique perspectives to better inform us about the current state of affairs. Huh surveyed his SGO colleagues and found to the surprise of many in the audience that over half of the surgical work that practicing gynecologic oncologists do is benign pathology that Ob/Gyn specialists were not comfortable performing on their own.
Pfeiffer mentioned that her group is advocating for enhanced surgical training in restorative pelvic surgery for subspecialists in reproductive endocrinology and infertility.
Paraiso discussed her experience with 2 initiatives she is working with both at her local institution (Cleveland Clinic) and at AAGL. Her residency program has successfully incorporated a tracking option during the last year of training for the last 10 years. In addition, AAGL has been working to field test and further validate their Essentials in Minimally Invasive Gynecology (EMIG) simulation training program.
Cundiff leads the Department of Obstetrics and Gynecology in British Columbia has had found that those providing primary maternity care do not maintain sufficient surgical volume to maintain a broad surgical repertoire despite a 5-year training experience. Thus, they have created a system that allows some to be primary maternity providers that offer minor Gynecologic Surgery while others focus on major Gynecologic Surgery with consultative OB/no OB practices. Their system requires as much focus on MOC and credentialing as it does on postgraduate education.
Finally, Anderson briefly discussed one of his ACOG presidential initiatives which will focus on establishing gynecologic levels of service mimicking the work that has been done by the college on the obstetric side. Getting to this point will potentially require some creative training changes, such as early differentiation after completion of a pre-defined core curriculum.
There were two recurrent themes of solutions that everyone agreed would be critical for us all to collaborate on to ensure that our graduates will be equipped to practice successfully through 2050: competency-based surgical training and post-graduate surgical coaching. Re-designing our surgical education program to begin by building a firm anatomical foundation and sequential cultivation of motor skills reinforced by purposeful surgical coaching will significantly speed up the pace of surgical learning. When applied to a competency-based program, residents have the ability to develop a broad repertoire of surgical skills. I am excited that SGS will be releasing our white paper on the current state of competency-based surgical education in Gynecologic Surgery later this summer. And we hope to initiate a pilot program looking at training expert gynecologic surgeons on the key principles of coaching and how to apply them to a group of mentees from around the country.
It is imperative that we get back to the basics: sound judgment, decisiveness, unambiguous communication abilities, and compassion. Surgical competence extends well beyond the technical skills and our societies have committed to working together to build the future our patients and learners demand.
Dr. Rajiv Gala is the current president of the Society for Gynecologic Surgeons.