American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

ACS Scholar Learns of Ireland Training Tools on Technology and Burnout

Joshua GoldmanIt was truly an honor to be chosen as the 2019 Resident and Associate Society of the American College of Surgeons (RAS-ACS) International Exchange Fellow to the Royal College of Surgeons, Ireland (RCSI). The hospitality I encountered was unsurpassable, and the experience was eye-opening and will undoubtedly inform the path of my career going forward. Though perhaps not breaking news to most, the issues and concerns that plague the United States health care system, and consequently its workforce—the physicians and surgeons who serve it—are not uniquely American. The most striking conclusion of my week in Ireland was the degree to which our systems and challenges are similar, not different. Though this realization could be cause for concern, that common woes are a natural conclusion in developed nations, sharing of data and solutions between our colleges will ultimately prove the best path forward in achieving our common aims—to optimize education of future surgeons and sustainably provide care to patients. 

The RCSI uniquely embodies a professional association as well as a medical institution. Exploration of the ramifications and nuances of such connectivity contributed to my desire to attend this particular exchange fellowship. I immediately noticed the major benefit that concerns at the association level are directly throughput into the educational design and amended as seen fit. Despite being the oldest of the Royal Colleges of Surgery, RCSI remains at the forefront of research innovation, technology, and medical education. My trip began with a tour of the historic education building, a monument to the impressive and storied surgical developments made there, followed by the architecturally stunning, new college building. The juxtaposed edifices stand as reminders of how far surgery and the culture of medicine has come. Implicit to the design of the new school is an air of focus on diversity, equity, and trainee wellness. The beautiful auditoriums, comfortable, high-tech study spaces, gender-neutral bathrooms, and impressive exercise facilities, reflected a sustainable future for medical trainees, and highlighted areas lacking at many programs stateside. In June 2019, the college opened Europe’s most advanced health care education facility. The inclusion of a 12,000 sq. ft. simulation center demonstrates the organization’s emphasis on incorporating technology into a progressive medical curriculum. While some of these amenities are available at our training programs, they are certainly not ubiquitous, and the centralized educational system in Ireland affords all of the trainees these tools, many of which are aimed at avoidance of burnout.

The focus on interdisciplinary approaches to medicine, global health initiatives in volunteerism, and strategic international academic partnerships reflected my own interest in these enterprises, and I had the opportunity to meet with experts in these fields and others. I found RCSI’s efforts to improve tracking of surgical proficiency through apps, designed in-house, particularly elegant solutions to issues of case logging (and its questionable value in promotion of residents). It was also my great pleasure to meet with faculty at i360, a spin-off company from RCSI, where leaders in innovation are streamlining the process of taking physician ideas to concept, to design, and to market. Over the week, I was able to attend Beaumont Hospital and exchange ideas and opinions regarding complex, advanced head and neck reconstruction, and firsthand experience the life of trainees. Before the week concluded with the national meeting, I had the pleasure of sitting down with RCSI President, Dr. Kenneth Mealy. We had a lengthy discussion on gender equity, being a dual-physician couple, trainee burnout, the steps the college has taken to mitigate these challenges, and future steps. 

The week concluded with the 2019 Millin Meeting, focused on “De-Risking Surgery.” Presentations on quality improvement metrics, data analytics, and optimization of surgical safety were all directly applicable to my experiences as a U.S. surgical trainee. Though Ireland’s two-tier system differs slightly from our own, the concern of resource allocation is understandably the most pressing issue in considering the provision of optimized care to all patients, an obstacle experienced globally. Highlights of the meeting also included a nighttime talk by Samantha Power, former U.S. Ambassador to the U.N., and Professor Ian Robertson’s keynote presentation, “The Era of the Mind.” 

I sincerely appreciate the ACS for affording me the opportunity to take part in the exchange fellowship and the RCSI for developing a program specifically geared to my many interests and for their unwavering hospitality. Throughout the week I fostered new relationships for future research, QI, and innovations collaborations with passionate individuals dedicated to their institution and the practice of medicine. The RCSI exemplifies an emphasis on advancement, self-awareness, and willingness to develop educational paradigm shifts in keeping with the times, culturally and technologically. I plan to take the experience and follow that example in my own efforts to affect surgical education and provision of care back home.

Joshua J. Goldman, MD, is the 2019 ACS/RCSI International Exchange Scholar. He is an assistant professor, department of plastic and reconstructive surgery, at the Las Vegas School of Medicine, University of Nevada. He did his fellowship in integrated craniomaxillofacial and microsurgery.

Dr. Berazaluce pictured above Sydney Harbor
Photo of the Sydney convention center
Photo of the clouds from the airplane
Opening session of the RACS Annual Scientific Congress