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

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Colon, Rectum, and Anus Part III

SRGS Colon, Rectum & Anus, Part III – V45N4 CoverVol. 45, No. 4, 2019

  • Hirschsprung Disease
  • Inflammatory Bowel Disease Involving the Colon
  • Clostridium Difficile Colitis
  • Colon Ischemia

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Featured Commentary

The online formats of SRGS include access to What You Should Know (WYSK): commentaries on articles published recently in top medical journals. These commentaries, written by practicing surgeons and other medical experts, focus on the strengths and weaknesses of the research, as well as on the articles' contributions in advancing the field of surgery.

Below is a sample of one of the commentaries published in the current edition of WYSK.

Berger DH, Goodall A, Tsai AY. The Importance of Increasing Surgeon Participation in Hospital Leadership. JAMA Surg. 2019 Apr 1;154(4):281-282.

Commentary by: James Fleshman, MD, FACS, FASCRS

The authors have correctly deduced from the literature that surgeons need leadership training before they can lead health care systems. The reasons there are so few surgeons in high-level health care leadership positions seem to reflect any of the following: surgeon disinterest due to lower compensation, lack of emphasis on leadership education and skills development, and limited time available in an extremely busy practice for most surgeons. Surgeons have been shown to be capable of quality improvement historically (Dr. Martin Codman), and more recently with American College of Surgeons- (ACS) supported quality improvement programs. The authors astutely recommend surgeon-specific leadership and management training through the ACS, local hospital programs, and academic institutions (both faculty and trainees).

While trained surgeons are capable of filling senior level “C-suite” positions, there are other contribution pathways for surgeons at all levels of hospital functions. Surgeons need to be aware of the meaning provided by hospital leadership positions after a long career driven by RVU production—this may be the answer to burnout for a number of surgeons. Positions such as the vice president of quality and safety in a hospital provide both an income and relief from the burnout track. Real contributions and improved hospital function are the result of surgeon participation at any level of hospital management.

Every hospital administrator is aware that the operating room is the engine that drives the ship. Who better to lead or manage a hospital operating room than a collaborative, self-aware surgeon committed to improving the environment for the staff and the patient, surgical outcomes, and the experience for all in the operating room? Such improvements depend on a culture of safety based on team function throughout the hospital, learned communication skills, and consensus-developed processes adhered to and supported by every member of the operating room team. The ACS has a program that helps hospital-employed surgeon champions develop high reliability organizations based on the program descriptions in the new book Optimal Resources for High Reliability Organizations by Hoyt et al.; this book is an outstanding compilation of methodology around quality, data analytics, peer review, professionalism, process improvement, and credentialing that can be driven by the motivated surgeon.

Surgeons already consider themselves leaders in the operating suite, but rarely have they been helped to develop a positive approach to functioning as “captain of the ship” using adaptive or transformational rather than authoritative or transactional leadership approaches. For example, none of the 11 surgical interns starting at our institution this summer have had any leadership or emotional intelligence training prior to their orientation. Emotional intelligence and empathy can be taught to surgical trainees as the basis of leadership training. A leadership curriculum, not just a pathway as mentioned by the authors, injects required exposure to communication skills, conflict management, personality style profiles, the four areas of emotional intelligence (self-awareness, social awareness, self-management, social management), and an understanding of empathy and neuropsychological principles (e.g., etiology of emotion, amygdala hijacking, emotional triggers, slow and fast thinking, and frontal-lobe function).

For culture to change and leadership training to occur, residents and faculty must begin to jointly incorporate basic skills into training curricula. A resident request for leadership training is more powerful than a faculty suggestion. The ACS has gone to great lengths to provide opportunities to expose surgeons to the basics of leadership. A steady curriculum on leadership skills should be integrated into each level of residency programs to provide practical experience and ongoing exposure throughout these future potential leaders’ training.


Recommended Reading

The editor has carefully selected a group of current, classic, and seminal articles for further study in certain formats of SRGS. The citations below are linked to their abstract on PubMed; free full-text is available where indicated.

SRGS has obtained permission from journal publishers to reprint these articles. Copying and distributing these reprints is a violation of our licensing agreement with these publishers and is strictly prohibited.

Friedmacher F, Puri P.Rectal Suction Biopsy for the Diagnosis of Hirschsprung's Disease: A Systematic Review of Diagnostic Accuracy and Complications. Pediatr Surg Int. 2015;31(9):821-830.

Moghadamyeghaneh Z, Sgroi MD, Chen SL, et al.Risk Factors and Outcomes of Postoperative Ischemic Colitis in Contemporary Open and Endovascular Abdominal Aortic Aneurysm Repair. J Vasc Surg. 2016;63(4):866-872.