Gawande A A
Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston MA 02115, USA.
Am J Surg. 2001 Jun;181(6):551-6. doi: 10.1016/s0002-9610(01)00638-9.
In this J. Roland Folse Invited Lecture in Surgical Education, given before the Association for Surgical Education, a resident considers two challenges for surgery and surgical training: the increasing importance of less invasive technologies, and the growing awareness of the importance of "systems" in care. As less invasive technologies evolve, the role of surgeons is being fundamentally challenged. Two alternative models of adaptation to technological change exist: the breast surgery model, in which surgeons restrict their role to providing open operative interventions, versus the neurosurgery model, in which surgeons adopt even noninvasive technologies in order to continue to manage diseases that might need open intervention. The neurosurgery model appears preferable but poses difficulties for the existing structure of surgical training. Evidence that surgical outcomes are critically dependent on entire teams of personnel, and not merely individual surgeons, may require changes in surgical training, as well.
在本次面向外科教育协会发表的J. 罗兰·福尔兹外科教育特邀讲座中，一名住院医师思考了外科学及外科培训面临的两项挑战：微创技术的重要性日益增加，以及人们越来越意识到“系统”在医疗护理中的重要性。随着微创技术的不断发展，外科医生的角色正受到根本性挑战。存在两种适应技术变革的替代模式：乳腺外科模式，即外科医生将其角色限制在提供开放性手术干预；以及神经外科模式，即外科医生采用甚至非侵入性技术，以便继续管理可能需要开放性干预的疾病。神经外科模式似乎更可取，但给现有的外科培训结构带来了困难。有证据表明手术结果严重依赖于整个医护团队，而不仅仅是个别外科医生，这可能也需要对外科培训做出改变。
