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

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Endocrine Surgery

SRGS Volume 45 Number 6 Endocrine Surgery CoverVol. 45, No. 6, 2019

Literature Overview
Editor: Lewis M. Flint, MD, FACS
Associate Editors:Rachel Kelz, MD, FACS; Mark Malangoni, MD, FACS; and Lauren Krumreich, MD

  • Thyroid Gland Disorders
  • Thyroid Cancer
  • Parathyroid Gland Disorders
  • Adrenal Gland Disorders

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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.

Ebeling PA, Dent DL, Kempenich JW. The millennials have arrived: What the surgeon educator needs to know to teach millennials. Surgery. 2020;167(2):265-268. doi:10.1016/j.surg.2019.05.028

Commentary by: Amy Halverson, MD, FACS

Ebeling and colleagues synthesize a scoping literature review regarding millennials' education and explore what pedagogical changes one should consider in dealing with the new generation of learners. This article's premise is that changes in attitudes among current medical students and residents warrant reshaping our instructional methods. The authors share three strategies used by the armed forces for engaging millennials: "recognize ambition and set expectations," "communicate on their level," and "give them room to innovate." 1 Given that a military leader articulated these strategies, it is no surprise that the approaches echo fundamental principles of Crew Resource Management, first introduced in the military and serving as the basis for current leadership practices in health care organizations.2 In other words, the strategies promoted to teach millennials are the same fundamental principles that define leadership and promote optimal teamwork.

Having ambition is not unique to millennials. Most "boomers," upon self-reflection, would recall their purpose when embarking on their careers. Just as a successful leader directs and coordinates team members' activities, an effective mentor or teacher harnesses a learner's ambition by providing guidance. A core principle of teamwork is having a shared cognition, also known as a "shared mental model." To set expectations, the teacher and learner must establish shared goals and a shared understanding of each other's responsibilities and expectations. An effective leader or teacher should engage in preparatory sessions to develop a shared mental model.2 Frequent and timely feedback allows learners to understand how well their performance matches the teacher's expectations and adjust accordingly.

The second strength in teamwork is communication. Communication is essential to maintain a shared understanding and to allow team members to supply additional information and adapt to changing situations. Communicating with millennials "on their level" may require educators to adapt to more frequent but brief communication expectations. Current technology can facilitate communication. For example, describing a procedure's steps may be reinforced by sharing a video of that procedure. Although changing technology affects how we communicate, the principles that communication must be timely, concise, and clear remain the same.3

The third principle of effective teamwork is a flattening of hierarchy. In a successful team, all team members should feel encouraged to suggest alternative solutions and introduce new perspectives. An effective teacher needs to establish a supportive atmosphere. Shared strategizing and participatory goal setting facilitates learner engagement.

Astronomer Frank Watson Dyson once said, "The effect of a concept-driven revolution is to explain old things in new ways." Ebeling and colleagues' "new" approaches will prove valuable to the extent that they revitalize our integration of classic teamwork principles into our pedagogy.


  1. How the U.S. Army Recruits and Retains Millennials. (2017). Retrieved November 19, 2020, from
  2. Burke CS, Salas E, Wilson-Donnelly K, Priest H. How to turn a team of experts into an expert medical team: guidance from the aviation and military communities. Qual Saf Health Care. 2004;13 Suppl 1(Suppl 1):i96-i104. doi:10.1136/qhc.13.suppl_1.i96
  3. TeamSTEPPS Fundamentals Course: Module 3. Communication. (2019). Retrieved March 1, 2020, from



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.