Utrecht, 27-01-2010
Patient skills of Dutch and Canadian surgeons
University Medical Center (UMC) Utrecht publication in the British Journal of Surgery
After qualification, surgeons in the Netherlands have a similar level of knowledge and the same surgical skills as their Canadian colleagues. However, Dutch surgeons are less competent in patient management. Together with their Canadian colleagues, Professor Olle ten Cate and surgeon Dr. Marlies Schijven of the University Medical Center (UMC) Utrecht, state the above in their paper published online in the British Journal of Surgery on January 21, 2010. Canadian surgeons have a workweek of between 70 to 80 hours while Dutch surgeons work 48 hours a week.
Ten Cate and Schijven and their Canadian colleagues reached this conclusion following a detailed comparison of the qualities of Canadian and Dutch surgical residents. The UMC Utrecht authors and surgeons from the University of Toronto organized this study in 2009. Twenty surgeons who were at the start of their professional career, were recruited from both countries. They had to complete a surgical assessment in their respective countries with experienced surgeons from the Netherlands and Canada acting as examiners. A Dutch account of this assessment can be found in UMC’s magazine Uniek.
The Canadian and Dutch surgeons did not differ regarding their surgical knowledge and technical skills but the Canadians were significantly better skilled in patient management. Patient management includes, communicating well with the patient, requesting the right additional diagnostic tests, making the most appropriate diagnosis, and ultimately setting up the clinical course of action – which does not necessarily have to be a surgical one.
“It is quite unusual that Dutch surgeons who work considerably fewer hours score the same regarding their knowledge and surgical skills”, Schijven said. “Apparently, surgical residents focus more on their surgical skills and less on skills associated with managing patients optimally in the clinical setting. But patient-management skills are very important when trying to achieve an optimal treatment which often includes making difficult choices.
Ten Cate and Schijven propose changing the surgical curriculum so that surgical residents attend a sufficient number of interdisciplinary meetings and also work enough hours in the outpatient department. That is how and where they will gain more experience with patients. “Working more hours is not an option – we certainly don’t want to return to an 80-hour workweek. We have to rearrange the training hours more efficiently and perhaps set other priorities for the allotted time.”
Currently there is an international discussion going on about how many hours are required to train a surgeon. The workweek is much longer in the United States and Canada than it is in Europe. While surgeons with relatively shorter workweeks are more satisfied about the balance between their work and private lives, it is possible that their training is slightly inferior. However, reports of surgical errors due to overtiredness are more common in North America. In Canada, surgeons work an 80-hour week and in the Netherlands this is 48 hours. This means that over the years, Canadian surgeons spend many more hours in training than their Dutch colleagues.
Marlies Schijven is now working at the Academic Medical Center of the University of Amsterdam.