After listening to a well-presented and well-illustrated paper on a technique of vascular pedicle grafting for scaphoid nonunion at the recent American Society for Surgery of the Hand annual meeting, a colleague leaned over to me bemoaning the fact that there seemed to be fewer and fewer papers emphasizing surgical techniques. With the paradigm shift toward evidence-based studies and evaluations of new technologies, the truth is that some of these are less inspiring or applicable to the practicing hand surgeon.
Although we will always be physicians first and foremost, we are progressively using allied health personnel such as physician's assistants, nurse practitioners in addition to hospitalists to provide at least some of our direct clinical care. The fact remains, however, that our patients will continue to look for us to provide the best possible technical care when they require a surgical procedure.
More and more surgical training programs are becoming sensitive to the need to provide trainees with a structured program of surgical skill training that can be documented, transparent, and use new technologies in addition to traditional operative room experience.
We can document our trainees' fund of knowledge with annual in-service training examinations and every effort should be made to do the same with surgical skills. How to do this? Technology exists in numerous occupations for hands-on training using sophisticated simulators, computer animations, and virtual reality programs. A number of studies have been published documenting the effectiveness of surgical simulators for procedures such as percutaneous visceral surgery and this surely can be adapted to arthroscopy. There is no reason that this cannot also be extended to minimally invasive procedures throughout the musculoskeletal system, to vessel, tendon, or nerve repair, or to understanding deformity corrections.
Currently much of hands-on surgical skills training is being done through specific industry-supported programs, in some instances requiring travel, expense, and not available to all. With the drastic decrease in industry involvement in surgical education programs, it will be incumbent on all training programs to both recognize the real need for hands-on skills education and the provision of new technological methods of achieving this goal.
Hopefully, journals such as this will always have a role in our specialty.
Jesse B. Jupiter, MD
Harvard Medical School, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA