Head and Neck Surgery: Meeting the Needs of the 21st Century

Competency-based surgical education. Noting that the long-established experience-based model of surgical education is shifting to a proficiency-based model, Dr. Medina said training in the future is likely to be based on the achievement of benchmarks of knowledge and skill.

A declining emphasis on the importance of surgical skills. He called for the Accreditation Council for Graduate Medical Education to adopt a new competency for residents-a skill and judgment competency covering the skill to perform procedures and judgment to assess situations or circumstances and draw sound conclusions.

A decrease in the number of cases of cancer of the upper aerodigestive tract available for training. The problem, Dr. Medina said, is that invaluable cases are being diluted by teaching residents who in the end will never do these operations in their practice.

It will become increasingly more difficult to teach surgical skills by practicing on patients. This creates a growing need for training opportunities outside the operating room using simulators, artificial body parts, and animal models, he said.

Research experience in residency and fellowship. Calling most of this experience unstructured with a poorly defined and often misguided purpose, Dr. Medina said future training program requirements should be clear about the purpose of the research experience and should expose trainees to the discipline of research so that they gain a working understanding of research methodology.

How we effectively incorporate these 10 factors in shaping the future of training of head and neck surgeons is obviously complex and multifactorial, Dr. Medina noted. What is clear, however, is that head and neck surgery should not act in a vacuum. We must act in tandem with the underpinning disciplines: otolaryngology and general surgery. It is also clear that the time to do so is now or we will soon wake up in a world that no longer exists.

Recommendations for Training

Finally, Dr. Medina suggested that the training of future head and neck surgeons might involve a four-pronged process:

• Require fourth-year medical students interested in surgery to take basic rotations that currently take place in the first year of residency.
• Change residency to an initial two-year period of core training in either otolaryngology or general surgery, followed by the trainee’s choice to pursue two additional years of training in general otolaryngology or general surgery.
• Alternately, after the initial two years, a trainee interested in head and neck surgery could pursue additional training for three years and then attain certification.
• An optional phase of training would allow the pursuit of an academic career with additional training in clinical research (1 to 2 years) or basic science research (3+ years) with an option of obtaining an MS or PhD.

Noting that it would be naïve to think that these changes would occur overnight, Dr. Medina said that head and neck specialists and educational institutions must begin somewhere. He urged audience members to take action soon in redefining the scope of knowledge and skills of a modern-day head and neck surgeon, noting that this should lead to the development of a comprehensive curriculum for training that is periodically updated and includes topics in pertinent basic sciences as well as fundamental knowledge of radiation biology and therapy and of medical oncology.