Karen E. Deveney, MD, FACS

It shouldn’t be a surprise. Although we don’t necessarily welcome change, change is a constant in our world. Nothing new here – it has always been so. Most of us dread change, because of our natural apprehension of the unknown. New ideas and ways of functioning that disrupt the status quo require effort, adjustment, and learning with no guarantee of success.

In my lifetime alone, ways of communicating with one another have undergone so many changes that it’s dizzying to contemplate. When I was a child in rural Oregon, our means of communicating with friends and family was the “party line” (by which was meant, not the political party, but the community’s telephone connection). We didn’t have a separate phone number, but rather a ring that was specific to our family. Most people on the line knew each other’s ring and could surreptitiously listen in if curiosity got the best of them. Privacy was not a big consideration.

Fast forward just over a half-century, and our system of communication is barely recognizable: 24/7 connectivity on hand-held electronic devices to any part of the world, SMS, Skype, Facebook, texting. Instantaneous worldwide communication is a given from anywhere, even the golf course.

Yes, there are hazards in this convenience. Recent events have demonstrated the lack of privacy and security of our communications, and what you see is not necessarily what it appears to be. It has become abundantly clear just how fragile the process of exchanging valid information can be. And yet, who would wish to erase all of this convenience to go back to the old days before the Internet? I doubt seriously that many surgeons would exchange the old world of limited access to information and communication for our era of immersive connectivity.

A comparable progression has occurred in our methods of professional learning and moving our corpus of knowledge forward. For the past half-century and more, new techniques, knowledge, and ideas have been presented in meetings of established societies and published in peer-reviewed journals. Unfortunately, not all who might benefit from these new ideas have access to them. If you belong to the society, can afford the time and money to attend the meeting, and work in an institution that subscribes to online access to all of the major journals, you can read them. Surgeons in independent practice in rural, remote communities likely do not have that luxury. ACS Surgery News has had many functions but one of the most important has been to serve surgeons in those remote communities as well as for others who simply wanted the convenience of ready access to new information all in one place.

Unfortunately, print publications are becoming more expensive to produce and mail, and advertising dollars to subsidize them are shrinking. Thus, Tyler Hughes and I, the coeditors of ACS Surgery News, were informed that our publication will cease production after the December 2018 issue. We and the ACS leadership huddled to find a way to continue what we all believe is a benefit to our ACS Fellows, particularly those who practice in small rural hospitals. The answer was right in front of us: The ACS Communities, to which all Fellows have online access. So that is our plan: Tyler and I will continue to write our “homespun” commentaries, and our editorial board will contribute concise articles that summarize the “latest and greatest” presentations at meetings they attend or from recently published articles in major journals across the spectrum of general surgery and surgical specialties. If readers have questions or comments, they will be able to communicate with the authors for clarification. We hope that this structure and content will benefit our surgical colleagues. Look for our new ACS Communities presence in January 2019.

Dr. Deveney is professor of surgery emerita in the department of surgery at Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

It shouldn’t be a surprise. Although we don’t necessarily welcome change, change is a constant in our world. Nothing new here – it has always been so. Most of us dread change, because of our natural apprehension of the unknown. New ideas and ways of functioning that disrupt the status quo require effort, adjustment, and learning with no guarantee of success.

In my lifetime alone, ways of communicating with one another have undergone so many changes that it’s dizzying to contemplate. When I was a child in rural Oregon, our means of communicating with friends and family was the “party line” (by which was meant, not the political party, but the community’s telephone connection). We didn’t have a separate phone number, but rather a ring that was specific to our family. Most people on the line knew each other’s ring and could surreptitiously listen in if curiosity got the best of them. Privacy was not a big consideration.

Fast forward just over a half-century, and our system of communication is barely recognizable: 24/7 connectivity on hand-held electronic devices to any part of the world, SMS, Skype, Facebook, texting. Instantaneous worldwide communication is a given from anywhere, even the golf course.

Yes, there are hazards in this convenience. Recent events have demonstrated the lack of privacy and security of our communications, and what you see is not necessarily what it appears to be. It has become abundantly clear just how fragile the process of exchanging valid information can be. And yet, who would wish to erase all of this convenience to go back to the old days before the Internet? I doubt seriously that many surgeons would exchange the old world of limited access to information and communication for our era of immersive connectivity.

A comparable progression has occurred in our methods of professional learning and moving our corpus of knowledge forward. For the past half-century and more, new techniques, knowledge, and ideas have been presented in meetings of established societies and published in peer-reviewed journals. Unfortunately, not all who might benefit from these new ideas have access to them. If you belong to the society, can afford the time and money to attend the meeting, and work in an institution that subscribes to online access to all of the major journals, you can read them. Surgeons in independent practice in rural, remote communities likely do not have that luxury. ACS Surgery News has had many functions but one of the most important has been to serve surgeons in those remote communities as well as for others who simply wanted the convenience of ready access to new information all in one place.

Unfortunately, print publications are becoming more expensive to produce and mail, and advertising dollars to subsidize them are shrinking. Thus, Tyler Hughes and I, the coeditors of ACS Surgery News, were informed that our publication will cease production after the December 2018 issue. We and the ACS leadership huddled to find a way to continue what we all believe is a benefit to our ACS Fellows, particularly those who practice in small rural hospitals. The answer was right in front of us: The ACS Communities, to which all Fellows have online access. So that is our plan: Tyler and I will continue to write our “homespun” commentaries, and our editorial board will contribute concise articles that summarize the “latest and greatest” presentations at meetings they attend or from recently published articles in major journals across the spectrum of general surgery and surgical specialties. If readers have questions or comments, they will be able to communicate with the authors for clarification. We hope that this structure and content will benefit our surgical colleagues. Look for our new ACS Communities presence in January 2019.

Dr. Deveney is professor of surgery emerita in the department of surgery at Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

It shouldn’t be a surprise. Although we don’t necessarily welcome change, change is a constant in our world. Nothing new here – it has always been so. Most of us dread change, because of our natural apprehension of the unknown. New ideas and ways of functioning that disrupt the status quo require effort, adjustment, and learning with no guarantee of success.

In my lifetime alone, ways of communicating with one another have undergone so many changes that it’s dizzying to contemplate. When I was a child in rural Oregon, our means of communicating with friends and family was the “party line” (by which was meant, not the political party, but the community’s telephone connection). We didn’t have a separate phone number, but rather a ring that was specific to our family. Most people on the line knew each other’s ring and could surreptitiously listen in if curiosity got the best of them. Privacy was not a big consideration.

Fast forward just over a half-century, and our system of communication is barely recognizable: 24/7 connectivity on hand-held electronic devices to any part of the world, SMS, Skype, Facebook, texting. Instantaneous worldwide communication is a given from anywhere, even the golf course.

Yes, there are hazards in this convenience. Recent events have demonstrated the lack of privacy and security of our communications, and what you see is not necessarily what it appears to be. It has become abundantly clear just how fragile the process of exchanging valid information can be. And yet, who would wish to erase all of this convenience to go back to the old days before the Internet? I doubt seriously that many surgeons would exchange the old world of limited access to information and communication for our era of immersive connectivity.

A comparable progression has occurred in our methods of professional learning and moving our corpus of knowledge forward. For the past half-century and more, new techniques, knowledge, and ideas have been presented in meetings of established societies and published in peer-reviewed journals. Unfortunately, not all who might benefit from these new ideas have access to them. If you belong to the society, can afford the time and money to attend the meeting, and work in an institution that subscribes to online access to all of the major journals, you can read them. Surgeons in independent practice in rural, remote communities likely do not have that luxury. ACS Surgery News has had many functions but one of the most important has been to serve surgeons in those remote communities as well as for others who simply wanted the convenience of ready access to new information all in one place.

Unfortunately, print publications are becoming more expensive to produce and mail, and advertising dollars to subsidize them are shrinking. Thus, Tyler Hughes and I, the coeditors of ACS Surgery News, were informed that our publication will cease production after the December 2018 issue. We and the ACS leadership huddled to find a way to continue what we all believe is a benefit to our ACS Fellows, particularly those who practice in small rural hospitals. The answer was right in front of us: The ACS Communities, to which all Fellows have online access. So that is our plan: Tyler and I will continue to write our “homespun” commentaries, and our editorial board will contribute concise articles that summarize the “latest and greatest” presentations at meetings they attend or from recently published articles in major journals across the spectrum of general surgery and surgical specialties. If readers have questions or comments, they will be able to communicate with the authors for clarification. We hope that this structure and content will benefit our surgical colleagues. Look for our new ACS Communities presence in January 2019.

Dr. Deveney is professor of surgery emerita in the department of surgery at Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

Surgeons have a time-honored institution of reflection, learning, and responsibility in the Morbidity & Mortality conference. The M&M is unique in the medical profession and we should look critically at efforts by hospitals and bureaucracies to change its character and its purpose.

A story in this issue (“Little overlap between surgical M&M and AHRQ” on adverse events, p. xx) covers a published study (Anderson J et al. J Am Coll Surg. 2018 Jul 5. doi: 10.1016/j.jamcollsurg.2018.06.008) of the ways in which surgeon-reported M&M cases do (but mostly, do not) overlap with those captured in the ubiquitous Patient Safety Indicators (PSIs).

I am reminded once again of the long road we have traveled from the M&M conference of my student and resident days in the 1970s to today’s version of this event.

At our institution, the M&M has evolved over the years to serve not only an educational venue from which all in attendance learn from the misadventures of others and (hopefully) avoid similar errors in the future, but also as a component of the institution’s overall patient safety and quality improvement program. The authors point out the inherent difference between the clinician-generated M&M cases, which may possess selection bias in the cases they identify as complications, and the strictly defined PSIs that are captured from an administrative database and often include cases overlooked by the clinicians as not relevant to the surgical M&M process.

Both kinds of data are valuable, but for surgeons, the M&M is the one venue where they can focus in the company of their colleagues on those instances where the best intentions go off the rails: erroneous decisions, faulty assessments, and unanticipated complications.

The surgical M&M conference traces its origins to the admirable practice of early 20th century Boston surgeon Ernest Codman, who tracked the treatment outcome of all of his patients on “End Result Cards” for at least a year with the goal of identifying errors to improve the care of his future patients. He established the first M&M conference at Harvard and was one of the founders of the American College of Surgeons and the forerunner of the Joint Commission. His idea that surgeon and hospital outcomes should be made public so that patients could make an informed choice about where and from whom to seek care was, however, vigorously resisted by Harvard and Dr. Codman lost his privileges there.

I would offer that the M&M conference and the PSIs are apples and oranges: both good, but different. Each serves a different purpose. But too much integration of the PSI into the M&M format could end up creating a formulaic adverse events conference that answers to bureaucratic needs of the hospital, but loses some of its value as a forum for learning.

It is worth reflecting on how and why the traditional M&M has such value to surgeons.

To begin with, the quality of the leadership matters. A good leader knows how to avoid blaming, shaming, or embarrassing the presenter, who likely feels bad enough about the complication without being tortured about it. The goal is that all salient factors that contributed to the complication are elicited and that everyone present comes away from the conference armed with alternative ways to prevent a repeat of the same complication.

As a resident I learned more at the Saturday morning M&M than I did at any other conference. I was there every Saturday morning almost without fail for 15 years as a medical student, resident, and faculty member. There I learned not only how to avoid errors and benefit from the accumulated wisdom of many gray hairs in the audience, but also how to present an embarrassing complication both honestly and even with some self-deprecating humor.

Chief residents such as Don Trunkey, Brent Eastman, and Theodore Schrock were gifted in being accountable for mistakes while simultaneously deflecting ire with some well-chosen props. I remember one vivid example: Ted Schrock stepping up to the podium to present a “case gone bad” while holding a garbage-can lid in front of his chest like a shield, ready to defend himself. I don’t remember the case, but the picture is still etched in my mind 45 years later.

Our chairman, Dr. J. Englebert Dunphy, was a master at zeroing in on the critical errors in decision-making or operative conduct that had led to a poor outcome. When the presenter was honest and well-meaning but lacking in sophisticated insight, Dr. Dunphy would calmly ask probing questions that guided the resident to understand why a complication had occurred and how it might have been avoided. If the complication was exceptionally egregious, or the resident was not forthright or was evasive in his “mea culpa,” Dr. Dunphy would turn to one of his staunch faculty allies in the front row and inquire, “Brodie, what do you think about that?” to which Brodie Stephens would typically reply, “Bert, I thought we were here to CURE disease, not CAUSE it!” (To add some colorful football lore to the story, Howard Brodie Stephens was the All-American end who caught a 53-yard pass from “Brick” Muller in the 1921 Rose Bowl victory of Cal Berkeley over Ohio State, the Pacific Coast Conference’s last win against a Big Ten team until 1953.)

Certain resident shortcomings were sure to raise Dr. Dunphy’s ire. These included failing to take responsibility for your mistake and attempting to blame the error on someone else or on another discipline or not adequately supervising an intern or junior resident if you were the chief resident. The latter crime was the subject of one of the most clever and resourceful chief resident M&M presentations of all time, that of past ACS President Brent Eastman as his final presentation from his vascular surgery rotation, the last of his chief year. This one took some moxie, considerable preparation, and the involvement of colleagues near and far. Brent enlisted his good friend and later distinguished cardiac surgeon Dr. Larry Cohn, then junior faculty at Harvard, to find a list of Dr. Dunphy’s complications while he was a resident in Boston in the 1930s. Although records were no longer available, Dr. Cohn mentioned the issue to Dr. Hartwell Harrison, who had been chief resident at the Peter Bent Brigham Hospital when Dr. Dunphy was a junior resident. Dr. Harrison remembered a case that Dr. Dunphy had performed in the outpatient clinic without supervision in which he encountered uncontrolled bleeding.

Armed with the perfect case to present, Brent coached Dr. Edwin (Jack) Wylie to be his “plant” in the audience. At M&M, Brent sheepishly admitted that the case he had to present was that of an unsupervised junior resident who incurred uncontrolled bleeding in the outpatient setting. On cue, Dr. Wylie asked, “Who the hell WAS that resident?” Dr. Eastman then shuffled through his papers to find the correct sheet and announced, “Dr. John E. Dunphy, Peter Bent Brigham Hospital, 1937.” The room exploded in uproarious laughter, joined heartily by Dr. Dunphy.

That was then, and this is now. I can’t envision such a spectacle ever occurring these days. The M&M conference of 2018 has become far more standardized and endowed with greater scientific rigor. Its evolution has likely made M&M more precise and valuable as an educational tool for surgeons to learn from the mistakes of others, but of course, it has lost an element of surprise and hilarity that kept all of us sleep-deprived residents awake and alert. The lessons learned from the traditional M&M lasted this surgeon’s lifetime, and we should consider preserving some of the give-and-take, admission of failure, and reflection that made the M&M so unforgettable.
 

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery at Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

Surgeons have a time-honored institution of reflection, learning, and responsibility in the Morbidity & Mortality conference. The M&M is unique in the medical profession and we should look critically at efforts by hospitals and bureaucracies to change its character and its purpose.

A story in this issue (“Little overlap between surgical M&M and AHRQ” on adverse events, p. xx) covers a published study (Anderson J et al. J Am Coll Surg. 2018 Jul 5. doi: 10.1016/j.jamcollsurg.2018.06.008) of the ways in which surgeon-reported M&M cases do (but mostly, do not) overlap with those captured in the ubiquitous Patient Safety Indicators (PSIs).

I am reminded once again of the long road we have traveled from the M&M conference of my student and resident days in the 1970s to today’s version of this event.

At our institution, the M&M has evolved over the years to serve not only an educational venue from which all in attendance learn from the misadventures of others and (hopefully) avoid similar errors in the future, but also as a component of the institution’s overall patient safety and quality improvement program. The authors point out the inherent difference between the clinician-generated M&M cases, which may possess selection bias in the cases they identify as complications, and the strictly defined PSIs that are captured from an administrative database and often include cases overlooked by the clinicians as not relevant to the surgical M&M process.

Both kinds of data are valuable, but for surgeons, the M&M is the one venue where they can focus in the company of their colleagues on those instances where the best intentions go off the rails: erroneous decisions, faulty assessments, and unanticipated complications.

The surgical M&M conference traces its origins to the admirable practice of early 20th century Boston surgeon Ernest Codman, who tracked the treatment outcome of all of his patients on “End Result Cards” for at least a year with the goal of identifying errors to improve the care of his future patients. He established the first M&M conference at Harvard and was one of the founders of the American College of Surgeons and the forerunner of the Joint Commission. His idea that surgeon and hospital outcomes should be made public so that patients could make an informed choice about where and from whom to seek care was, however, vigorously resisted by Harvard and Dr. Codman lost his privileges there.

I would offer that the M&M conference and the PSIs are apples and oranges: both good, but different. Each serves a different purpose. But too much integration of the PSI into the M&M format could end up creating a formulaic adverse events conference that answers to bureaucratic needs of the hospital, but loses some of its value as a forum for learning.

It is worth reflecting on how and why the traditional M&M has such value to surgeons.

To begin with, the quality of the leadership matters. A good leader knows how to avoid blaming, shaming, or embarrassing the presenter, who likely feels bad enough about the complication without being tortured about it. The goal is that all salient factors that contributed to the complication are elicited and that everyone present comes away from the conference armed with alternative ways to prevent a repeat of the same complication.

As a resident I learned more at the Saturday morning M&M than I did at any other conference. I was there every Saturday morning almost without fail for 15 years as a medical student, resident, and faculty member. There I learned not only how to avoid errors and benefit from the accumulated wisdom of many gray hairs in the audience, but also how to present an embarrassing complication both honestly and even with some self-deprecating humor.

Chief residents such as Don Trunkey, Brent Eastman, and Theodore Schrock were gifted in being accountable for mistakes while simultaneously deflecting ire with some well-chosen props. I remember one vivid example: Ted Schrock stepping up to the podium to present a “case gone bad” while holding a garbage-can lid in front of his chest like a shield, ready to defend himself. I don’t remember the case, but the picture is still etched in my mind 45 years later.

Our chairman, Dr. J. Englebert Dunphy, was a master at zeroing in on the critical errors in decision-making or operative conduct that had led to a poor outcome. When the presenter was honest and well-meaning but lacking in sophisticated insight, Dr. Dunphy would calmly ask probing questions that guided the resident to understand why a complication had occurred and how it might have been avoided. If the complication was exceptionally egregious, or the resident was not forthright or was evasive in his “mea culpa,” Dr. Dunphy would turn to one of his staunch faculty allies in the front row and inquire, “Brodie, what do you think about that?” to which Brodie Stephens would typically reply, “Bert, I thought we were here to CURE disease, not CAUSE it!” (To add some colorful football lore to the story, Howard Brodie Stephens was the All-American end who caught a 53-yard pass from “Brick” Muller in the 1921 Rose Bowl victory of Cal Berkeley over Ohio State, the Pacific Coast Conference’s last win against a Big Ten team until 1953.)

Certain resident shortcomings were sure to raise Dr. Dunphy’s ire. These included failing to take responsibility for your mistake and attempting to blame the error on someone else or on another discipline or not adequately supervising an intern or junior resident if you were the chief resident. The latter crime was the subject of one of the most clever and resourceful chief resident M&M presentations of all time, that of past ACS President Brent Eastman as his final presentation from his vascular surgery rotation, the last of his chief year. This one took some moxie, considerable preparation, and the involvement of colleagues near and far. Brent enlisted his good friend and later distinguished cardiac surgeon Dr. Larry Cohn, then junior faculty at Harvard, to find a list of Dr. Dunphy’s complications while he was a resident in Boston in the 1930s. Although records were no longer available, Dr. Cohn mentioned the issue to Dr. Hartwell Harrison, who had been chief resident at the Peter Bent Brigham Hospital when Dr. Dunphy was a junior resident. Dr. Harrison remembered a case that Dr. Dunphy had performed in the outpatient clinic without supervision in which he encountered uncontrolled bleeding.

Armed with the perfect case to present, Brent coached Dr. Edwin (Jack) Wylie to be his “plant” in the audience. At M&M, Brent sheepishly admitted that the case he had to present was that of an unsupervised junior resident who incurred uncontrolled bleeding in the outpatient setting. On cue, Dr. Wylie asked, “Who the hell WAS that resident?” Dr. Eastman then shuffled through his papers to find the correct sheet and announced, “Dr. John E. Dunphy, Peter Bent Brigham Hospital, 1937.” The room exploded in uproarious laughter, joined heartily by Dr. Dunphy.

That was then, and this is now. I can’t envision such a spectacle ever occurring these days. The M&M conference of 2018 has become far more standardized and endowed with greater scientific rigor. Its evolution has likely made M&M more precise and valuable as an educational tool for surgeons to learn from the mistakes of others, but of course, it has lost an element of surprise and hilarity that kept all of us sleep-deprived residents awake and alert. The lessons learned from the traditional M&M lasted this surgeon’s lifetime, and we should consider preserving some of the give-and-take, admission of failure, and reflection that made the M&M so unforgettable.
 

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery at Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

Surgeons have a time-honored institution of reflection, learning, and responsibility in the Morbidity & Mortality conference. The M&M is unique in the medical profession and we should look critically at efforts by hospitals and bureaucracies to change its character and its purpose.

A story in this issue (“Little overlap between surgical M&M and AHRQ” on adverse events, p. xx) covers a published study (Anderson J et al. J Am Coll Surg. 2018 Jul 5. doi: 10.1016/j.jamcollsurg.2018.06.008) of the ways in which surgeon-reported M&M cases do (but mostly, do not) overlap with those captured in the ubiquitous Patient Safety Indicators (PSIs).

I am reminded once again of the long road we have traveled from the M&M conference of my student and resident days in the 1970s to today’s version of this event.

At our institution, the M&M has evolved over the years to serve not only an educational venue from which all in attendance learn from the misadventures of others and (hopefully) avoid similar errors in the future, but also as a component of the institution’s overall patient safety and quality improvement program. The authors point out the inherent difference between the clinician-generated M&M cases, which may possess selection bias in the cases they identify as complications, and the strictly defined PSIs that are captured from an administrative database and often include cases overlooked by the clinicians as not relevant to the surgical M&M process.

Both kinds of data are valuable, but for surgeons, the M&M is the one venue where they can focus in the company of their colleagues on those instances where the best intentions go off the rails: erroneous decisions, faulty assessments, and unanticipated complications.

The surgical M&M conference traces its origins to the admirable practice of early 20th century Boston surgeon Ernest Codman, who tracked the treatment outcome of all of his patients on “End Result Cards” for at least a year with the goal of identifying errors to improve the care of his future patients. He established the first M&M conference at Harvard and was one of the founders of the American College of Surgeons and the forerunner of the Joint Commission. His idea that surgeon and hospital outcomes should be made public so that patients could make an informed choice about where and from whom to seek care was, however, vigorously resisted by Harvard and Dr. Codman lost his privileges there.

I would offer that the M&M conference and the PSIs are apples and oranges: both good, but different. Each serves a different purpose. But too much integration of the PSI into the M&M format could end up creating a formulaic adverse events conference that answers to bureaucratic needs of the hospital, but loses some of its value as a forum for learning.

It is worth reflecting on how and why the traditional M&M has such value to surgeons.

To begin with, the quality of the leadership matters. A good leader knows how to avoid blaming, shaming, or embarrassing the presenter, who likely feels bad enough about the complication without being tortured about it. The goal is that all salient factors that contributed to the complication are elicited and that everyone present comes away from the conference armed with alternative ways to prevent a repeat of the same complication.

As a resident I learned more at the Saturday morning M&M than I did at any other conference. I was there every Saturday morning almost without fail for 15 years as a medical student, resident, and faculty member. There I learned not only how to avoid errors and benefit from the accumulated wisdom of many gray hairs in the audience, but also how to present an embarrassing complication both honestly and even with some self-deprecating humor.

Chief residents such as Don Trunkey, Brent Eastman, and Theodore Schrock were gifted in being accountable for mistakes while simultaneously deflecting ire with some well-chosen props. I remember one vivid example: Ted Schrock stepping up to the podium to present a “case gone bad” while holding a garbage-can lid in front of his chest like a shield, ready to defend himself. I don’t remember the case, but the picture is still etched in my mind 45 years later.

Our chairman, Dr. J. Englebert Dunphy, was a master at zeroing in on the critical errors in decision-making or operative conduct that had led to a poor outcome. When the presenter was honest and well-meaning but lacking in sophisticated insight, Dr. Dunphy would calmly ask probing questions that guided the resident to understand why a complication had occurred and how it might have been avoided. If the complication was exceptionally egregious, or the resident was not forthright or was evasive in his “mea culpa,” Dr. Dunphy would turn to one of his staunch faculty allies in the front row and inquire, “Brodie, what do you think about that?” to which Brodie Stephens would typically reply, “Bert, I thought we were here to CURE disease, not CAUSE it!” (To add some colorful football lore to the story, Howard Brodie Stephens was the All-American end who caught a 53-yard pass from “Brick” Muller in the 1921 Rose Bowl victory of Cal Berkeley over Ohio State, the Pacific Coast Conference’s last win against a Big Ten team until 1953.)

Certain resident shortcomings were sure to raise Dr. Dunphy’s ire. These included failing to take responsibility for your mistake and attempting to blame the error on someone else or on another discipline or not adequately supervising an intern or junior resident if you were the chief resident. The latter crime was the subject of one of the most clever and resourceful chief resident M&M presentations of all time, that of past ACS President Brent Eastman as his final presentation from his vascular surgery rotation, the last of his chief year. This one took some moxie, considerable preparation, and the involvement of colleagues near and far. Brent enlisted his good friend and later distinguished cardiac surgeon Dr. Larry Cohn, then junior faculty at Harvard, to find a list of Dr. Dunphy’s complications while he was a resident in Boston in the 1930s. Although records were no longer available, Dr. Cohn mentioned the issue to Dr. Hartwell Harrison, who had been chief resident at the Peter Bent Brigham Hospital when Dr. Dunphy was a junior resident. Dr. Harrison remembered a case that Dr. Dunphy had performed in the outpatient clinic without supervision in which he encountered uncontrolled bleeding.

Armed with the perfect case to present, Brent coached Dr. Edwin (Jack) Wylie to be his “plant” in the audience. At M&M, Brent sheepishly admitted that the case he had to present was that of an unsupervised junior resident who incurred uncontrolled bleeding in the outpatient setting. On cue, Dr. Wylie asked, “Who the hell WAS that resident?” Dr. Eastman then shuffled through his papers to find the correct sheet and announced, “Dr. John E. Dunphy, Peter Bent Brigham Hospital, 1937.” The room exploded in uproarious laughter, joined heartily by Dr. Dunphy.

That was then, and this is now. I can’t envision such a spectacle ever occurring these days. The M&M conference of 2018 has become far more standardized and endowed with greater scientific rigor. Its evolution has likely made M&M more precise and valuable as an educational tool for surgeons to learn from the mistakes of others, but of course, it has lost an element of surprise and hilarity that kept all of us sleep-deprived residents awake and alert. The lessons learned from the traditional M&M lasted this surgeon’s lifetime, and we should consider preserving some of the give-and-take, admission of failure, and reflection that made the M&M so unforgettable.
 

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery at Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

I was recently reminded of the importance of face-to-face meetings to gain understanding and to learn from the experiences of others. In this case, the lesson was delivered in the idyllic setting of Sunriver, Oregon, where the Oregon and Washington chapters of the American College of Surgeons held their annual meeting. I always come away from this meeting energized and inspired by the shared experiences of young and old, urban and rural. This meeting exceeded all expectations in the quality of the presentations but also, more importantly, in the quality of the exchange of ideas and viewpoints among surgeons across the full spectrum of practice types, geographical locations, and generations.

Community and rural surgeons were both well represented at this meeting, perhaps because our Oregon chapter president, Keith Thomas, is a rural surgeon; he had invited rural surgeon extraordinaire Tyler Hughes to be the keynote speaker; and the overarching theme of the meeting was “The Right Care in the Right Place.” The program featured controversial topics that were presented in a way that respected all views and shed more light than heat on the subject: a debate about whether (and which) cancers needed to be referred to tertiary centers, an exploration of how surgical care for all might be improved by regionalization in a matrix that could allow all patients to access timely and appropriate care, and even a discussion of a strategy through which we might build consensus for the prevention of firearm injuries and deaths while avoiding the “demonization of the enemy” that currently occurs whenever the subject is mentioned.

The residents’ and fellows’ presentations have evolved over the past few decades to include a broader range of research topics than those in prior meetings. This year, trainees gave papers not only on the treatment of specific surgical conditions or basic science studies but also on quality improvement, patient safety, ethics, end-of-life care, and cutting-edge technologies. Those who presented their research displayed the very best attributes of the millennial generation: creativity, altruism, and a commitment to make our shared future world a better, safer, more humane place. They fielded questions from the audience like “old pros,” demonstrating an impressive understanding of their subjects as well as a passion for their work.

Although the accelerating demands on our lives have led some to question whether the time required to attend a chapter meeting is worth the money and effort, I would argue that it is crucial to our future to do so. As surgical practice becomes more specialized and “siloed,” it is critical that we reaffirm what unites us rather than focus on what separates us. It is easy to attribute ill motives and malevolent characteristics to someone who sees things differently than you do. Is much more difficult to do so when you spend time with that person and learn about him or her as an individual. Local ACS chapter meetings accomplish that and more. Older surgeons nearing retirement and worried about the future of their communities can meet and mingle with residents and fellows who might become future partners. Former colleagues from medical school or residency who have pursued different practice paths can reacquaint themselves with one another, relive the good (and perhaps bad) old times, and share a chuckle or two. Surgeons who practice in the “ivory tower” can gain appreciation for the challenges of practicing in a resource-limited facility. Those from competing institutions or practices can learn that the “other” is facing the same issues and that common strategies for success might be found. We can all gain a greater understanding that the other person’s problems aren’t that different or less complex than ours.

In addition to providing a stimulating program, a successful chapter meeting requires skillful planning and execution by an experienced chapter manager. Our Oregon chapter is fortunate to have Harvey Gail, an outstanding manager who takes care of those essential tasks that make the meeting run smoothly so that we can focus on the substance of the meeting itself.

Attending a chapter meeting requires a relatively short time commitment of three days away from home – including a weekend – and a tank of gas. Some have suggested that holding the meeting in the largest city in the region would lessen travel time demands for many, but doing so would mean losing the low-key setting that creates the perfect atmosphere for developing professional and personal relationships and building a true community. The future survival of our profession depends on finding better, novel solutions to our common problems; we can accomplish that only by sharing our diverse perspectives and identifying solutions that meet all of our needs and those of our patients.

To those of you who rarely (or never) have attended a chapter meeting, you need to go. You’ll be surprised at how much you can learn from your fellow surgeons, who, I guarantee, are more like you than they are different.
 

Dr. Deveney is a professor of surgery and the vice chair of education in the department of surgery at Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

I was recently reminded of the importance of face-to-face meetings to gain understanding and to learn from the experiences of others. In this case, the lesson was delivered in the idyllic setting of Sunriver, Oregon, where the Oregon and Washington chapters of the American College of Surgeons held their annual meeting. I always come away from this meeting energized and inspired by the shared experiences of young and old, urban and rural. This meeting exceeded all expectations in the quality of the presentations but also, more importantly, in the quality of the exchange of ideas and viewpoints among surgeons across the full spectrum of practice types, geographical locations, and generations.

Community and rural surgeons were both well represented at this meeting, perhaps because our Oregon chapter president, Keith Thomas, is a rural surgeon; he had invited rural surgeon extraordinaire Tyler Hughes to be the keynote speaker; and the overarching theme of the meeting was “The Right Care in the Right Place.” The program featured controversial topics that were presented in a way that respected all views and shed more light than heat on the subject: a debate about whether (and which) cancers needed to be referred to tertiary centers, an exploration of how surgical care for all might be improved by regionalization in a matrix that could allow all patients to access timely and appropriate care, and even a discussion of a strategy through which we might build consensus for the prevention of firearm injuries and deaths while avoiding the “demonization of the enemy” that currently occurs whenever the subject is mentioned.

The residents’ and fellows’ presentations have evolved over the past few decades to include a broader range of research topics than those in prior meetings. This year, trainees gave papers not only on the treatment of specific surgical conditions or basic science studies but also on quality improvement, patient safety, ethics, end-of-life care, and cutting-edge technologies. Those who presented their research displayed the very best attributes of the millennial generation: creativity, altruism, and a commitment to make our shared future world a better, safer, more humane place. They fielded questions from the audience like “old pros,” demonstrating an impressive understanding of their subjects as well as a passion for their work.

Although the accelerating demands on our lives have led some to question whether the time required to attend a chapter meeting is worth the money and effort, I would argue that it is crucial to our future to do so. As surgical practice becomes more specialized and “siloed,” it is critical that we reaffirm what unites us rather than focus on what separates us. It is easy to attribute ill motives and malevolent characteristics to someone who sees things differently than you do. Is much more difficult to do so when you spend time with that person and learn about him or her as an individual. Local ACS chapter meetings accomplish that and more. Older surgeons nearing retirement and worried about the future of their communities can meet and mingle with residents and fellows who might become future partners. Former colleagues from medical school or residency who have pursued different practice paths can reacquaint themselves with one another, relive the good (and perhaps bad) old times, and share a chuckle or two. Surgeons who practice in the “ivory tower” can gain appreciation for the challenges of practicing in a resource-limited facility. Those from competing institutions or practices can learn that the “other” is facing the same issues and that common strategies for success might be found. We can all gain a greater understanding that the other person’s problems aren’t that different or less complex than ours.

In addition to providing a stimulating program, a successful chapter meeting requires skillful planning and execution by an experienced chapter manager. Our Oregon chapter is fortunate to have Harvey Gail, an outstanding manager who takes care of those essential tasks that make the meeting run smoothly so that we can focus on the substance of the meeting itself.

Attending a chapter meeting requires a relatively short time commitment of three days away from home – including a weekend – and a tank of gas. Some have suggested that holding the meeting in the largest city in the region would lessen travel time demands for many, but doing so would mean losing the low-key setting that creates the perfect atmosphere for developing professional and personal relationships and building a true community. The future survival of our profession depends on finding better, novel solutions to our common problems; we can accomplish that only by sharing our diverse perspectives and identifying solutions that meet all of our needs and those of our patients.

To those of you who rarely (or never) have attended a chapter meeting, you need to go. You’ll be surprised at how much you can learn from your fellow surgeons, who, I guarantee, are more like you than they are different.
 

Dr. Deveney is a professor of surgery and the vice chair of education in the department of surgery at Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

I was recently reminded of the importance of face-to-face meetings to gain understanding and to learn from the experiences of others. In this case, the lesson was delivered in the idyllic setting of Sunriver, Oregon, where the Oregon and Washington chapters of the American College of Surgeons held their annual meeting. I always come away from this meeting energized and inspired by the shared experiences of young and old, urban and rural. This meeting exceeded all expectations in the quality of the presentations but also, more importantly, in the quality of the exchange of ideas and viewpoints among surgeons across the full spectrum of practice types, geographical locations, and generations.

Community and rural surgeons were both well represented at this meeting, perhaps because our Oregon chapter president, Keith Thomas, is a rural surgeon; he had invited rural surgeon extraordinaire Tyler Hughes to be the keynote speaker; and the overarching theme of the meeting was “The Right Care in the Right Place.” The program featured controversial topics that were presented in a way that respected all views and shed more light than heat on the subject: a debate about whether (and which) cancers needed to be referred to tertiary centers, an exploration of how surgical care for all might be improved by regionalization in a matrix that could allow all patients to access timely and appropriate care, and even a discussion of a strategy through which we might build consensus for the prevention of firearm injuries and deaths while avoiding the “demonization of the enemy” that currently occurs whenever the subject is mentioned.

The residents’ and fellows’ presentations have evolved over the past few decades to include a broader range of research topics than those in prior meetings. This year, trainees gave papers not only on the treatment of specific surgical conditions or basic science studies but also on quality improvement, patient safety, ethics, end-of-life care, and cutting-edge technologies. Those who presented their research displayed the very best attributes of the millennial generation: creativity, altruism, and a commitment to make our shared future world a better, safer, more humane place. They fielded questions from the audience like “old pros,” demonstrating an impressive understanding of their subjects as well as a passion for their work.

Although the accelerating demands on our lives have led some to question whether the time required to attend a chapter meeting is worth the money and effort, I would argue that it is crucial to our future to do so. As surgical practice becomes more specialized and “siloed,” it is critical that we reaffirm what unites us rather than focus on what separates us. It is easy to attribute ill motives and malevolent characteristics to someone who sees things differently than you do. Is much more difficult to do so when you spend time with that person and learn about him or her as an individual. Local ACS chapter meetings accomplish that and more. Older surgeons nearing retirement and worried about the future of their communities can meet and mingle with residents and fellows who might become future partners. Former colleagues from medical school or residency who have pursued different practice paths can reacquaint themselves with one another, relive the good (and perhaps bad) old times, and share a chuckle or two. Surgeons who practice in the “ivory tower” can gain appreciation for the challenges of practicing in a resource-limited facility. Those from competing institutions or practices can learn that the “other” is facing the same issues and that common strategies for success might be found. We can all gain a greater understanding that the other person’s problems aren’t that different or less complex than ours.

In addition to providing a stimulating program, a successful chapter meeting requires skillful planning and execution by an experienced chapter manager. Our Oregon chapter is fortunate to have Harvey Gail, an outstanding manager who takes care of those essential tasks that make the meeting run smoothly so that we can focus on the substance of the meeting itself.

Attending a chapter meeting requires a relatively short time commitment of three days away from home – including a weekend – and a tank of gas. Some have suggested that holding the meeting in the largest city in the region would lessen travel time demands for many, but doing so would mean losing the low-key setting that creates the perfect atmosphere for developing professional and personal relationships and building a true community. The future survival of our profession depends on finding better, novel solutions to our common problems; we can accomplish that only by sharing our diverse perspectives and identifying solutions that meet all of our needs and those of our patients.

To those of you who rarely (or never) have attended a chapter meeting, you need to go. You’ll be surprised at how much you can learn from your fellow surgeons, who, I guarantee, are more like you than they are different.
 

Dr. Deveney is a professor of surgery and the vice chair of education in the department of surgery at Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

For most of my professional life I have avoided writing about gender inequity in the field of surgery – not because I believe it does not exist, but because the reasons it does exist are manifold and complicated.

To be sure, implicit and explicit bias remain important reasons why only a minority of female medical students still choose surgery as a career in 2018, why female surgeons still earn only 82% of the salary of their male counterparts, and why women occupy only 12% of the chairs in academic surgical departments in the United States. It has long been tempting to lay the blame for those inequities on a stereotypical macho surgical culture that prevailed as the 20th century came to a close. But the factors that perpetuate male/female imbalance in our profession are complicated and run deep in the psyches of both men and women. We are all products of our generations, our culture, upbringing, and environment – men as well as women. Correcting the imbalance requires much more than simply passing laws that require equitable pay or treatment.

I realized how deeply ingrained biases are in all of us while still in my surgical residency in the 1970s. On a rare occasion when neither my husband (also a surgical resident) nor I was on call, we had a dinner party with friends at our house. The telephone rang (no iPhones, just a land line), and I ran to answer our only telephone in another room. It was the hospital operator, who asked, “Is Dr. Deveney there?” Without thinking, I answered, “Just a moment, I’ll get him!” I had taken only three steps away from the phone when it occurred to me what I had just said. I turned back, picked up the phone, and asked, “Which Dr. Deveney were you looking for?”

If even I had been conditioned to think automatically of “doctor” being a man after all of my effort to earn a place in the ranks, was there any hope that equality could be achieved? When I finished my residency and was offered a surgery position at our VA, I asked no questions about salary or other particulars; I was simply grateful that I had been given a job.

That was 1978 – a different time, a different generation. Since then, women have made dramatic progress toward equity in our profession, as in many others. The support, mentoring, and consciousness-raising efforts of the Association of Women Surgeons (AWS) are responsible for much of this progress. The American College of Surgeons was very supportive of the AWS early on and continues to encourage female medical students to choose surgery as a career and to help the advancement of women into leadership roles in surgery. Many surgical residency programs have 50% women in their ranks; half of our residents in Oregon have been women for over a decade. Our program director is a woman, as are 28% of the faculty; not 50%, but definitely progress, since I was the lone woman on the faculty when I arrived in 1987.

Although women occupy only 12% of the surgical chairs in U.S. surgical departments, this number has soared in the past 2 years from 7 in 2016 to 21 this year after languishing in the low single digits since 1987, when the late Olga Jonasson, MD, FACS, became the first female chair at Ohio State University. And yet, women have not reached full equality with men across the United States in surgical training, leadership, or pay. Why not?

Multiple factors have played roles in impeding the progress of women in achieving equality in surgery. Traditional cultural expectations of male and female roles in society affect both genders as they grow up, even when their parents make deliberate efforts to raise their children in as “gender-neutral” a way as possible and encourage their daughters to strive for success to the same degree as their sons. Explicit bias against women remains easier to recognize and combat than implicit or unconscious bias, to which we are all subject.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

For most of my professional life I have avoided writing about gender inequity in the field of surgery – not because I believe it does not exist, but because the reasons it does exist are manifold and complicated.

To be sure, implicit and explicit bias remain important reasons why only a minority of female medical students still choose surgery as a career in 2018, why female surgeons still earn only 82% of the salary of their male counterparts, and why women occupy only 12% of the chairs in academic surgical departments in the United States. It has long been tempting to lay the blame for those inequities on a stereotypical macho surgical culture that prevailed as the 20th century came to a close. But the factors that perpetuate male/female imbalance in our profession are complicated and run deep in the psyches of both men and women. We are all products of our generations, our culture, upbringing, and environment – men as well as women. Correcting the imbalance requires much more than simply passing laws that require equitable pay or treatment.

I realized how deeply ingrained biases are in all of us while still in my surgical residency in the 1970s. On a rare occasion when neither my husband (also a surgical resident) nor I was on call, we had a dinner party with friends at our house. The telephone rang (no iPhones, just a land line), and I ran to answer our only telephone in another room. It was the hospital operator, who asked, “Is Dr. Deveney there?” Without thinking, I answered, “Just a moment, I’ll get him!” I had taken only three steps away from the phone when it occurred to me what I had just said. I turned back, picked up the phone, and asked, “Which Dr. Deveney were you looking for?”

If even I had been conditioned to think automatically of “doctor” being a man after all of my effort to earn a place in the ranks, was there any hope that equality could be achieved? When I finished my residency and was offered a surgery position at our VA, I asked no questions about salary or other particulars; I was simply grateful that I had been given a job.

That was 1978 – a different time, a different generation. Since then, women have made dramatic progress toward equity in our profession, as in many others. The support, mentoring, and consciousness-raising efforts of the Association of Women Surgeons (AWS) are responsible for much of this progress. The American College of Surgeons was very supportive of the AWS early on and continues to encourage female medical students to choose surgery as a career and to help the advancement of women into leadership roles in surgery. Many surgical residency programs have 50% women in their ranks; half of our residents in Oregon have been women for over a decade. Our program director is a woman, as are 28% of the faculty; not 50%, but definitely progress, since I was the lone woman on the faculty when I arrived in 1987.

Although women occupy only 12% of the surgical chairs in U.S. surgical departments, this number has soared in the past 2 years from 7 in 2016 to 21 this year after languishing in the low single digits since 1987, when the late Olga Jonasson, MD, FACS, became the first female chair at Ohio State University. And yet, women have not reached full equality with men across the United States in surgical training, leadership, or pay. Why not?

Multiple factors have played roles in impeding the progress of women in achieving equality in surgery. Traditional cultural expectations of male and female roles in society affect both genders as they grow up, even when their parents make deliberate efforts to raise their children in as “gender-neutral” a way as possible and encourage their daughters to strive for success to the same degree as their sons. Explicit bias against women remains easier to recognize and combat than implicit or unconscious bias, to which we are all subject.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

For most of my professional life I have avoided writing about gender inequity in the field of surgery – not because I believe it does not exist, but because the reasons it does exist are manifold and complicated.

To be sure, implicit and explicit bias remain important reasons why only a minority of female medical students still choose surgery as a career in 2018, why female surgeons still earn only 82% of the salary of their male counterparts, and why women occupy only 12% of the chairs in academic surgical departments in the United States. It has long been tempting to lay the blame for those inequities on a stereotypical macho surgical culture that prevailed as the 20th century came to a close. But the factors that perpetuate male/female imbalance in our profession are complicated and run deep in the psyches of both men and women. We are all products of our generations, our culture, upbringing, and environment – men as well as women. Correcting the imbalance requires much more than simply passing laws that require equitable pay or treatment.

I realized how deeply ingrained biases are in all of us while still in my surgical residency in the 1970s. On a rare occasion when neither my husband (also a surgical resident) nor I was on call, we had a dinner party with friends at our house. The telephone rang (no iPhones, just a land line), and I ran to answer our only telephone in another room. It was the hospital operator, who asked, “Is Dr. Deveney there?” Without thinking, I answered, “Just a moment, I’ll get him!” I had taken only three steps away from the phone when it occurred to me what I had just said. I turned back, picked up the phone, and asked, “Which Dr. Deveney were you looking for?”

If even I had been conditioned to think automatically of “doctor” being a man after all of my effort to earn a place in the ranks, was there any hope that equality could be achieved? When I finished my residency and was offered a surgery position at our VA, I asked no questions about salary or other particulars; I was simply grateful that I had been given a job.

That was 1978 – a different time, a different generation. Since then, women have made dramatic progress toward equity in our profession, as in many others. The support, mentoring, and consciousness-raising efforts of the Association of Women Surgeons (AWS) are responsible for much of this progress. The American College of Surgeons was very supportive of the AWS early on and continues to encourage female medical students to choose surgery as a career and to help the advancement of women into leadership roles in surgery. Many surgical residency programs have 50% women in their ranks; half of our residents in Oregon have been women for over a decade. Our program director is a woman, as are 28% of the faculty; not 50%, but definitely progress, since I was the lone woman on the faculty when I arrived in 1987.

Although women occupy only 12% of the surgical chairs in U.S. surgical departments, this number has soared in the past 2 years from 7 in 2016 to 21 this year after languishing in the low single digits since 1987, when the late Olga Jonasson, MD, FACS, became the first female chair at Ohio State University. And yet, women have not reached full equality with men across the United States in surgical training, leadership, or pay. Why not?

Multiple factors have played roles in impeding the progress of women in achieving equality in surgery. Traditional cultural expectations of male and female roles in society affect both genders as they grow up, even when their parents make deliberate efforts to raise their children in as “gender-neutral” a way as possible and encourage their daughters to strive for success to the same degree as their sons. Explicit bias against women remains easier to recognize and combat than implicit or unconscious bias, to which we are all subject.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

Keeping up with refinements in old procedures and adopting new procedures throughout one’s surgical career has always been a challenge.

That challenge has grown as advancements in technology have become ever more disruptive, requiring the learning of radically different skills. Surgeons are highly motivated to learn new procedures, lest they become extinct like professional “dodo birds.” But doing so requires a considerable expenditure of time and money to attend courses and then a period of being proctored in the new procedure once it has been learned.

Coaching by master surgeons should become a professional norm. It is only after surgical education and coaching are incorporated all along the training continuum – from novice to competent to master during residency training – that surgeons already in practice will accept it as a regular part of their work. Refinements in procedures and new procedures would be met by continued professional improvement that would be enhanced by master surgeon coaching. We owe it to ourselves and our patients to achieve excellence, not mere competence. “Okay” is not good enough.

Dr. Deveney is a professor of surgery and the vice chair of education in the department of surgery at Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News. 

Keeping up with refinements in old procedures and adopting new procedures throughout one’s surgical career has always been a challenge.

That challenge has grown as advancements in technology have become ever more disruptive, requiring the learning of radically different skills. Surgeons are highly motivated to learn new procedures, lest they become extinct like professional “dodo birds.” But doing so requires a considerable expenditure of time and money to attend courses and then a period of being proctored in the new procedure once it has been learned.

Coaching by master surgeons should become a professional norm. It is only after surgical education and coaching are incorporated all along the training continuum – from novice to competent to master during residency training – that surgeons already in practice will accept it as a regular part of their work. Refinements in procedures and new procedures would be met by continued professional improvement that would be enhanced by master surgeon coaching. We owe it to ourselves and our patients to achieve excellence, not mere competence. “Okay” is not good enough.

Dr. Deveney is a professor of surgery and the vice chair of education in the department of surgery at Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News. 

Keeping up with refinements in old procedures and adopting new procedures throughout one’s surgical career has always been a challenge.

That challenge has grown as advancements in technology have become ever more disruptive, requiring the learning of radically different skills. Surgeons are highly motivated to learn new procedures, lest they become extinct like professional “dodo birds.” But doing so requires a considerable expenditure of time and money to attend courses and then a period of being proctored in the new procedure once it has been learned.

Coaching by master surgeons should become a professional norm. It is only after surgical education and coaching are incorporated all along the training continuum – from novice to competent to master during residency training – that surgeons already in practice will accept it as a regular part of their work. Refinements in procedures and new procedures would be met by continued professional improvement that would be enhanced by master surgeon coaching. We owe it to ourselves and our patients to achieve excellence, not mere competence. “Okay” is not good enough.

Dr. Deveney is a professor of surgery and the vice chair of education in the department of surgery at Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News. 

In the waning weeks of 2017, still another disaster was added to the long list of natural and man-made tragedies of the year: the derailment of an Amtrak train near Tacoma, Washington. Although the cause of this event has not yet been determined and will not be for at least several months, we do know that safety equipment that has been recommended for years had not been installed in the train. I can only hope that this accident reminds our governmental leaders and institutional officials of the costs in lives and injury of ignoring deteriorating infrastructure and neglecting known safety measures.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

In the waning weeks of 2017, still another disaster was added to the long list of natural and man-made tragedies of the year: the derailment of an Amtrak train near Tacoma, Washington. Although the cause of this event has not yet been determined and will not be for at least several months, we do know that safety equipment that has been recommended for years had not been installed in the train. I can only hope that this accident reminds our governmental leaders and institutional officials of the costs in lives and injury of ignoring deteriorating infrastructure and neglecting known safety measures.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

In the waning weeks of 2017, still another disaster was added to the long list of natural and man-made tragedies of the year: the derailment of an Amtrak train near Tacoma, Washington. Although the cause of this event has not yet been determined and will not be for at least several months, we do know that safety equipment that has been recommended for years had not been installed in the train. I can only hope that this accident reminds our governmental leaders and institutional officials of the costs in lives and injury of ignoring deteriorating infrastructure and neglecting known safety measures.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

While basking in the fading glow of the holidays, I have been reflecting on the dynamic of stressful professional lives of surgeons combined with the negativity local and world events engender that can push us toward burnout.

The holiday season is a time when people tend to engage in activities that have been shown to improve mood and outlook: connecting with old friends, sharing memories of a happier time, spending time with children and grandchildren, sitting around a warm fire, enjoying the sights and smells of bright decorations and fragrant candles, attending traditional holiday plays, concerts, and ballets. The holiday traditions, no matter what your ethnic or religious background, create community and warm feelings. The workweek may be shortened, people take a little time out, smile a bit more. For many of us, these activities can be a tonic.

At the same time, the days become shorter, colder, and grayer in most of North America. The normal frustrations of our day-to-day professional lives may seem more profound during the winter, and some experience SAD (seasonal affective disorder) or even burnout.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

While basking in the fading glow of the holidays, I have been reflecting on the dynamic of stressful professional lives of surgeons combined with the negativity local and world events engender that can push us toward burnout.

The holiday season is a time when people tend to engage in activities that have been shown to improve mood and outlook: connecting with old friends, sharing memories of a happier time, spending time with children and grandchildren, sitting around a warm fire, enjoying the sights and smells of bright decorations and fragrant candles, attending traditional holiday plays, concerts, and ballets. The holiday traditions, no matter what your ethnic or religious background, create community and warm feelings. The workweek may be shortened, people take a little time out, smile a bit more. For many of us, these activities can be a tonic.

At the same time, the days become shorter, colder, and grayer in most of North America. The normal frustrations of our day-to-day professional lives may seem more profound during the winter, and some experience SAD (seasonal affective disorder) or even burnout.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

While basking in the fading glow of the holidays, I have been reflecting on the dynamic of stressful professional lives of surgeons combined with the negativity local and world events engender that can push us toward burnout.

The holiday season is a time when people tend to engage in activities that have been shown to improve mood and outlook: connecting with old friends, sharing memories of a happier time, spending time with children and grandchildren, sitting around a warm fire, enjoying the sights and smells of bright decorations and fragrant candles, attending traditional holiday plays, concerts, and ballets. The holiday traditions, no matter what your ethnic or religious background, create community and warm feelings. The workweek may be shortened, people take a little time out, smile a bit more. For many of us, these activities can be a tonic.

At the same time, the days become shorter, colder, and grayer in most of North America. The normal frustrations of our day-to-day professional lives may seem more profound during the winter, and some experience SAD (seasonal affective disorder) or even burnout.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

The decision to stop practicing surgery is a monumental one when you have been a surgeon for almost 40 years, have loved operating, and have defined yourself by the word “surgeon.”

The decision to cease operating should at best be a personal one that the surgeon makes, rather than one imposed by others. The “others” could be an institutional policy mandating retirement at a given age, the results of a series of psychomotor examinations, or even a kind department chair’s suggestion that you should stop operating because your complications have increased and it is in your patients’ best interests. As we approach “a certain age,” I suspect that most surgeons would prefer to decide their own fate and, especially, to avoid the last of the three above options.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

The decision to stop practicing surgery is a monumental one when you have been a surgeon for almost 40 years, have loved operating, and have defined yourself by the word “surgeon.”

The decision to cease operating should at best be a personal one that the surgeon makes, rather than one imposed by others. The “others” could be an institutional policy mandating retirement at a given age, the results of a series of psychomotor examinations, or even a kind department chair’s suggestion that you should stop operating because your complications have increased and it is in your patients’ best interests. As we approach “a certain age,” I suspect that most surgeons would prefer to decide their own fate and, especially, to avoid the last of the three above options.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

The decision to stop practicing surgery is a monumental one when you have been a surgeon for almost 40 years, have loved operating, and have defined yourself by the word “surgeon.”

The decision to cease operating should at best be a personal one that the surgeon makes, rather than one imposed by others. The “others” could be an institutional policy mandating retirement at a given age, the results of a series of psychomotor examinations, or even a kind department chair’s suggestion that you should stop operating because your complications have increased and it is in your patients’ best interests. As we approach “a certain age,” I suspect that most surgeons would prefer to decide their own fate and, especially, to avoid the last of the three above options.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

As today’s surgical residents complete their residencies and enter practice, we are compelled to ask, Is their level of confidence and independence different from that of, say, the class of 1978? Have circumstances of training changed to such a degree that graduating residents’ beliefs in their own judgment have been undermined?

The answer is yes: The conditions and circumstances of training have changed substantially. Our attendings were strong role models, but they were not as omnipresent as are today’s faculty, particularly in the operating room. We, therefore, felt a greater sense of autonomy than do today’s trainees.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

As today’s surgical residents complete their residencies and enter practice, we are compelled to ask, Is their level of confidence and independence different from that of, say, the class of 1978? Have circumstances of training changed to such a degree that graduating residents’ beliefs in their own judgment have been undermined?

The answer is yes: The conditions and circumstances of training have changed substantially. Our attendings were strong role models, but they were not as omnipresent as are today’s faculty, particularly in the operating room. We, therefore, felt a greater sense of autonomy than do today’s trainees.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

As today’s surgical residents complete their residencies and enter practice, we are compelled to ask, Is their level of confidence and independence different from that of, say, the class of 1978? Have circumstances of training changed to such a degree that graduating residents’ beliefs in their own judgment have been undermined?

The answer is yes: The conditions and circumstances of training have changed substantially. Our attendings were strong role models, but they were not as omnipresent as are today’s faculty, particularly in the operating room. We, therefore, felt a greater sense of autonomy than do today’s trainees.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

The more we think we know, the less we actually may know. As new techniques develop and their use is closely examined and reported, details about the patient’s disease and the surgeon’s skill and judgment turn out to matter more and more in the decision-making process. So it is with acute cholecystitis.

I have recently been puzzled and intrigued by changing trends in the management of acute cholecystitis that are apparent in the medical literature, discussions in the ACS Communities, and practice in my local community.
 

When I was a resident, the debate about early cholecystectomy vs antibiotics with interval operation 6 weeks later was just being settled in the literature in favor of early cholecystectomy. The weight of evidence in the surgical literature found that delay made the eventual operation more difficult and costly.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

The more we think we know, the less we actually may know. As new techniques develop and their use is closely examined and reported, details about the patient’s disease and the surgeon’s skill and judgment turn out to matter more and more in the decision-making process. So it is with acute cholecystitis.

I have recently been puzzled and intrigued by changing trends in the management of acute cholecystitis that are apparent in the medical literature, discussions in the ACS Communities, and practice in my local community.
 

When I was a resident, the debate about early cholecystectomy vs antibiotics with interval operation 6 weeks later was just being settled in the literature in favor of early cholecystectomy. The weight of evidence in the surgical literature found that delay made the eventual operation more difficult and costly.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

The more we think we know, the less we actually may know. As new techniques develop and their use is closely examined and reported, details about the patient’s disease and the surgeon’s skill and judgment turn out to matter more and more in the decision-making process. So it is with acute cholecystitis.

I have recently been puzzled and intrigued by changing trends in the management of acute cholecystitis that are apparent in the medical literature, discussions in the ACS Communities, and practice in my local community.
 

When I was a resident, the debate about early cholecystectomy vs antibiotics with interval operation 6 weeks later was just being settled in the literature in favor of early cholecystectomy. The weight of evidence in the surgical literature found that delay made the eventual operation more difficult and costly.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.