Frazer Abigail, Tanzer Michael
Department of Orthopaedic Surgery, McGill University, Montreal H3G 1A4, QC, Canada.
World J Orthop. 2021 Apr 18;12(4):234-245. doi: 10.5312/wjo.v12.i4.234.
As the average age of surgeons continues to rise, determining when a surgeon should retire is an important public safety concern.
To investigate strategies used to determine competency in the industrial workplace that could be transferrable in the assessment of aging surgeons and to identify existing competency assessments of practicing surgeons.
We searched websites describing non-medical professions within the United States where cognitive and physical competency are necessary for public safety. The mandatory age and certification process, including cognitive and physical requirements, were reported for each profession. Methods for determining surgical competency currently in use, and those existing in the literature, were also identified.
Four non-medical professions requiring mental and physical aptitude that involve public safety and have mandatory testing and/or retirement were identified: Airline pilots, air traffic controllers, firefighters, and United States State Judges. Nine late career practitioner policies designed to evaluate the ageing physician, including surgeons, were described. Six of these policies included subjective performance testing, 4 using peer assessment and 2 using dexterity testing. Six objective testing methods for evaluation of surgeon technical skill were identified in the literature. All were validated for surgical trainees. Only Objective Structured Assessment of Technical Skills (OSATS) was capable of distinguishing between surgeons of different skill level and showing a relationship between skill level and post-operative outcomes.
A surgeon should not be forced to hang up his/her surgical cap at a predetermined age, but should be able to practice for as long as his/her surgical skills are objectively maintained at the appropriate level of competency. The strategy of using skill-based simulations in evaluating non-medical professionals can be similarly used as part of the assessment of the ageing surgeons' surgical competency, showing who may require remediation or retirement.
随着外科医生的平均年龄持续上升，确定外科医生何时应该退休成为一个重要的公共安全问题。
研究用于确定工业工作场所能力的策略，这些策略可移植到评估老年外科医生中，并识别执业外科医生现有的能力评估方法。
我们搜索了描述美国非医疗行业的网站，在这些行业中认知能力和身体能力对公共安全至关重要。报告了每个行业的强制退休年龄和认证过程，包括认知和身体要求。还确定了目前使用的以及文献中存在的确定手术能力的方法。
确定了四个需要智力和体力、涉及公共安全且有强制测试和/或退休规定的非医疗行业：航空公司飞行员、空中交通管制员、消防员和美国州法官。描述了九项旨在评估包括外科医生在内的老年医生的职业后期从业者政策。其中六项政策包括主观绩效测试，4项使用同行评估，2项使用灵巧性测试。在文献中确定了六种评估外科医生技术技能的客观测试方法。所有这些方法都在外科实习生中得到了验证。只有客观结构化技术技能评估（OSATS）能够区分不同技能水平的外科医生，并显示技能水平与术后结果之间的关系。
不应强迫外科医生在预定年龄退休，而应能够在其手术技能客观上保持在适当能力水平的情况下继续执业。在评估非医疗专业人员时使用基于技能的模拟策略，同样可以作为评估老年外科医生手术能力的一部分，以表明谁可能需要补救或退休。
