Peisah Carmelle, Wijeratne Chanaka, Waxman Bruce, Vonau Marianne
ANZ J Surg. 2014 May;84(5):311-5. doi: 10.1111/ans.12506.
The surgical workforce is ageing. This will impact on future workforce supply and planning, as well as the professional performance and welfare of surgeons themselves. This paper is a 'call to arms' to surgeons to consider the complex problem of advancing years and surgical performance. We aim to promote discussion about the issue of ageing as it relates to surgeons, while exploring ways in which successful ageing in surgeons may be promoted. The task-specific aspects of surgical practice suggest that it is a physically and cognitively demanding task, reliant on a range of fine motor, sensory, visuospatial, reasoning, memory and processing skills. Many of these skills potentially decline with age, although there is great inter-individual variation, particularly in cognitive performance. Nevertheless, there is some consensus in the literature that age-related cognitive changes exist in a proportion of surgeons, and there is an increase in operative mortality rates for certain surgical procedures performed by older and more experienced surgeons. In the absence of mandatory retirement, guidance is needed in regard to individualizing the timing of retirement and encouraging reflective and adaptive practice based on insight into how one's skills and performance may change with age. This may be best facilitated by some form of informed and guided self-monitoring or 'self-screening'. It should be emphasized that self-screening is not a form of self-treatment but aims to enhance insight, using a tool kit of resources to promote adaptive ageing. Moreover, self-screening should not be restricted to cognition, which is only part of the picture of ageing, but extended to emphasize the maintenance of mental and physical wellness, and the acceptance of independent professional treatment and support when required.
外科医生队伍正在老龄化。这将影响未来的劳动力供应和规划，以及外科医生自身的专业表现和福利。本文是向外科医生发出的“战斗号召”，促使他们思考年龄增长与手术表现这一复杂问题。我们旨在推动关于外科医生老龄化问题的讨论，同时探索促进外科医生成功老龄化的方法。外科手术实践的特定任务表明，这是一项对身体和认知要求很高的任务，依赖一系列精细运动、感官、视觉空间、推理、记忆和处理技能。尽管个体差异很大，尤其是在认知表现方面，但这些技能中的许多都会随着年龄增长而潜在下降。然而，文献中存在一些共识，即一定比例的外科医生存在与年龄相关的认知变化，并且由年长且经验更丰富的外科医生进行的某些外科手术的手术死亡率有所上升。在没有强制退休制度的情况下，需要在确定个性化退休时间以及鼓励基于对自身技能和表现如何随年龄变化的洞察进行反思性和适应性实践方面提供指导。这可能通过某种形式的明智且有指导的自我监测或“自我筛查”来最好地实现。应该强调的是，自我筛查不是一种自我治疗形式，而是旨在通过一套资源工具来增强洞察力，以促进适应性老龄化。此外，自我筛查不应仅限于认知，认知只是老龄化情况的一部分，而应扩展到强调保持身心健康，以及在需要时接受独立的专业治疗和支持。
