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Surgery. 2014 Sep;156(3):707-17. doi: 10.1016/j.surg.2014.04.047.

What is the future of training in surgery? Needs assessment of national stakeholders.

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Department of Surgery, Institute for Simulation and Interprofessional Studies (ISIS), University of Washington School of Medicine, Seattle, WA. Electronic address:
The Methodist Institute for Technology, Innovation and Education (MITIE), The Methodist Hospital System, Houston, TX.
LSU Health New Orleans School of Medicine Learning Center, New Orleans, LA.
LSU Health Shreveport School of Medicine, Shreveport, LA.
Fletcher Allen Health/University of Vermont Clinical Simulation Laboratory, University of Vermont, Burlington, VT.
Arnold and Blema Steinberg Medical Simulation Centre, McGill University, Montréal, Quebec, Canada.
VirtuOHSU (Oregon Health Sciences University), Portland, OR.
Scott and White Surgical Skills Program, Texas A&M University, Temple, TX.
Charles A. Andersen Simulation Center, Madigan Army Medical Center, Tacoma, WA.
Department of Surgery, Goodman Simulation Center, Stanford University, Stanford, CA.
Southwestern Center for Minimally Invasive Surgery, UT Southwestern Medical Center, Dallas, TX.



The Curriculum Committee of the American College of Surgeons-Accredited Educational Institutes conducted a need assessment to (1) identify gaps between ideal and actual practices in areas of surgical care, (2) explore educational solutions for addressing these gaps, and (3) shape a vision to advance the future of training in surgery.


National stakeholders were recruited from the committee members' professional network and interviewed via telephone. Interview questions targeted areas for improving surgical patient care, optimal educational solutions for training in surgery including simulation roles, and entities that should primarily bear training costs. We performed an iterative, qualitative analysis including member checking to identify key themes.


Twenty-two interviewees included state/national board representatives, risk managers, multispecialty faculty/program directors, nurses, trainees, an industry representative, and a patient. Surgeons' communication with patients, families, and team members was raised consistently by stakeholders as a way to establish clear expectations regarding pre-, peri-, and postoperative care. Other comments highlighted the surgeon's development and demonstration and maintenance of cognitive and technical skills, including surgical judgment. Stakeholders also reiterated the critical need for surgeons to engage in on-going self-assessment and professional development to identify and remediate recognized limitations. Recommended learning modalities for meeting surgeons' needs included active learning (deliberate practice, diverse patient experiences), experiential learning (simulation), and peer and mentored learning (preceptorship).


This first formal needs assessment of education for surgeons points to opportunities for educational programs in patient-centered communication, learning models that match preferences of new generations of trainees, and training in interprofessional/interdisciplinary team communication and teamwork.

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