Training of Future Surgeons is a Priority for All

Stacey Tutt Gray, MD, visiting professor from Harvard Medical School and director of the Sinus Center at Massachusetts Eye and Ear, told Houston area residents and otolaryngology faculty recently that society has a vested interest in the training of future surgeons. “We are training our surgeons not just for now but for 10 or 15 years from now as we need more and more surgeons, and we have more and more surgical innovations to incorporate successfully into practice. We are all dependent on the surgical training process remaining robust,” said Dr. Gray, who was a guest professor for the annual endoscopic sinus course at Houston Methodist. Her keynote lecture was entitled “Setting Yourself Up for Success in Endoscopic Sinus Surgery During Training.”

Certain sinus surgeries, like frontal sinus (forehead) procedures specifically are more challenging than others as are surgeries that are performed in combination with neurosurgery and ophthalmology. These more complex procedures require more extensive training to master.

“As soon as you graduate, the expectation is that you’re going to be able to operate independently and confidently just the same as someone who’s been in practice for many years,” she said. “That doesn’t happen automatically. It’s something that is acquired in a very graduated process.” Dr. Gray is an otolaryngologist with fellowship training in rhinology and endoscopic sino-nasal and skull base surgery. She helped develop the Sinus Center at Mass Eye and Ear, which she now directs. She also is the director of Harvard’s otolaryngology residency training program and vice chair of education for the department.

“A big part of my academic life is surgical education, and a lot of the research work I’ve done in the surgical education area is related to how residents gain autonomy in the OR as they are training,” she said. “Part of the way you learn surgery, of course, is repetition and practice. You have to be with the same attending over and over again and do the same types of cases in a graduated way, starting with simple cases and progressing to the most complex as you are close to finishing training. “You have to do some of the hard things to get the understanding of how to do it. You have to push yourself a little bit beyond your comfort zone to get to the next level. “There are practical ways that residents can show that they are prepared and ways that programs can support trainees. Certainly, doing courses like this one is a big part of it, allowing residents to practice in a low-stakes and safe environment,” she said. The all-day course held in September was tailored specifically to endoscopic sinus surgery. Several lectures took place before Dr. Gray’s keynote talk. Then, the residents and faculty spent five hours practicing their skills on cadavers. She pointed out that certain sinus surgeries, like frontal sinus (forehead) procedures specifically are more challenging than others as are surgeries that are performed in combination with neurosurgery and ophthalmology. These more complex procedures require more extensive training to master.

Part of the way you learn surgery, of course, is repetition and practice. You have to be with the same attending over and over again and do the same types of cases in a graduated way, starting with simple cases and progressing to the most complex as you are close to finishing training.

Stacey Tutt Gray, MD

Dr. Gray said she appreciates the experience of giving and discussing more global ideas about surgical education and how surgeons can do a better job of thinking about their fields programmatically, taking ownership of their own training. In the operating room, there are specific strategies for how a resident can interact with the faculty to optimize their learning. It is important to know the surgeon’s “motivational style,” she teaches. “When we face challenges, some of us play to win, and some play not to lose. Most surgeons fall into one of those categories. Some focus on advancement in the operating room and some focus on avoidance of risk,” she said.

Stacey Tutt Gray, MD

“If the trainee and the faculty don’t align in their motivational styles, they may have some challenges working together in surgical cases,” Dr. Gray said. If the resident understands where the faculty is coming from, they can present themselves or discuss the case in a way that makes the experienced surgeon more comfortable and that lets the resident move forward in the case and do things more independently. In past years, resident training did not have as many constraints as the learning now has. For instance, a resident cannot be in the hospital physically compared to trainees 20 years ago. “We have to be much more intentional with how residents attain surgical experience, so they have the repetition and practice needed to gain confidence and independence. For instance, residents can keep practicing on a cadaver or in a simulation lab without the time constraints of being in an operating room.” “It was wonderful to be in Houston and to meet all the Houston Methodist residents (in otolaryngology). We are really fortunate as a field because we have the best and brightest students, which ensures the future of otolaryngology is secure,” Dr. Gray said.