March 1, 2020
Editor’s note: The following comments were received regarding recent articles published in the Bulletin.
Letters should be sent with the writer’s name, address, e-mail address, and daytime telephone number via e-mail to firstname.lastname@example.org, or via mail to Diane Schneidman, Editor-in-Chief, Bulletin, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611.
Letters may be edited for length or clarity. Permission to publish letters is assumed unless the author indicates otherwise.
The Bulletin often publishes articles about surgical training and practice in low- and middle-income countries. In this letter, I offer my perspective as a surgical resident in Mexico.
Every year, the different public and private institutions in Mexico receive applications from hundreds of enterprising physicians who want to train in surgery. Despite the differences in approaches, geography, culture, and economic resources, training hospitals provide trainees with the skills they need to help cure or address their patients’ diseases.
Mexico has a mix of public and private training institutions, so it is inevitable that patients will have access to different types of surgical procedures, such as open versus laparoscopic and, on rare occasions, robotic surgery. Most advances in biomedical technologies in the treatment of different pathologies occur in private institutions, and only some medical units have resources to ensure that surgical patients receive the “gold standard” procedure.
One might assume that the resident or surgeon who is at the best private hospital is the one who is closer to modern medicine, the one with access to high-power resolution imaging, to the boldest approaches, and to the most current literature, whereas surgeons at second-level, public hospitals might only be able to provide life-preserving care to the extent possible with the resources at hand.
The pragmatic model of the surgeon is that of a physician who can remove or control disease with any surgical approach by using the tools that are available in the various work environments—in the rural community or in the big city.
It seems surgical residents are exposed to the two alternative worlds of a single country and emerge different surgeons. This assumption proves incorrect when residents meet as part of their rotations and share experiences, compare their acquired skills, and describe what their teachers can do. When the resident of the public institution meets the resident of the private hospital, they exchange the innate wishes of all physicians in training—to be the best surgeons they can be, to innovate, and to go out and look for what it takes to perfect their technique.
When we are performing any operation, we think about what could go wrong and what we learned from reading the articles, watching videos, and attending congresses. We turn to all these tools of energy, technology, and new surgical techniques that we have learned from surgeons in high-income countries, but we also recognize the skills we acquire in the continuous care of all those thousands of patients who need to be treated in our own institutions. That same thirst for wanting to be better drives us to publish cases, attend international congresses, join excellent societies such as the American College of Surgeons (ACS), and feel a little emboldened by different societies to carry out refresher courses that lead us to be better surgeons.
Uniformity will continue to be a challenge for Mexico’s training institutions. We must promote the integration of knowledge and autonomous learning to produce surgeons with the cognitive abilities and skills needed to provide high-quality surgical care. The pragmatic model of the surgeon is that of a physician who can remove or control disease with any surgical approach by using the tools that are available in the various work environments—in the rural community or in the big city. Humanism is the banner in the decision making of our work, forged for years in our hands. When patient care is our guiding concern, we realize that we are not so far from what we think of as surgery in developed countries, always grateful to societies such as the ACS that allow us to update our skills and have great exposure to problem solving. True success, we realize, is reflected in the health of our patients.
Edwin Maldonado, MD Mexico City, Mexico