I had the great privilege and pleasure of spending six days in Rome, Italy, as a 2014 American College of Surgeons (ACS) International Exchange Scholar. I attended the 116th National Congress of the Italian Surgical Society and spoke about liver transplantation for hepatocellular carcinoma. This is especially apt because after performing their first liver transplant in 1982, Italy has been at the forefront of advances in transplantation, notably by pioneering transplantation criteria for hepatocellular carcinoma.
The landmark paper establishing these still widely accepted criteria—based on tumor number and size—was written by Dr. Vincenzo Mazzaferro with whom I had the opportunity to meet. We discussed at length the challenges of going beyond size/number criteria to incorporate tumor and patient biology, the difficulties of leveling the field for patients with liver failure versus liver cancer, and how to equitably allocate a limited resource for these disparate populations.
The theme of the National Congress was “The Future of Surgery: Utopia or Reality?” Issues discussed there—that we in the United States will no doubt find familiar—included surgeons feeling beleaguered by litigation while not being sufficiently protected by their institutions, a sense of responsibility and selfless sacrifice to support a system plagued by budget cuts, and a drive toward technical and technological evolution and innovation while never compromising the quality of care and safety of patients. To that end, Carlos Pellegrini, MD, FACS, FRCSI(Hon),spoke at the Congress on the topic of surgeons as the leaders in quality of care.
I also had the pleasure of spending much time with my host, Giuseppe Nigri, MD, PhD, FACS, FRCS, an assistant professor of surgery at Sapienza University of Rome and Treasurer and Chapter Administrator of the Italy Chapter of the ACS. Not only does he have an interest in surgical quality, but he is very involved in surgical education and mentors many residents, some of whom I met during the course of my visit.
European working-time restrictions affect resident work hours even more so than those in the United States, leading to great challenges in training residents adequately. With work being limited to 48 hours per week, many are seeking more and more fellowship training opportunities, both in other cities and abroad, further delaying their entry into independent practice.
All of these challenges seem at once universal and also unique; the innovations required solving these problems—to improve care delivery and allocation and technology—need to be spread as seamlessly as possible. The barriers, whether cultural, political, economic, and social, are diminished by programs such as international conferences and exchange programs such as the RAS-ACS International Exchange Program. I am grateful to the Resident and Associate Society Member Services Committee and Italian Chapter of the ACS whose generosity and kindness made this visit a truly memorable one.
