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      Is Open Access

      Modern Plastic Surgical Practice: Technical Competence Alone Is Not Enough

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          Abstract

          Annually, an estimated 234 million major surgical operations occur worldwide, with concomitant seven million complications and one million deaths. It is now well established that technical competence is necessary, but not sufficient for modern surgical practice and outcomes. Breakdown in non-technical skills has been attributed as a key root cause for near misses and patient harm in the operating room. This article discusses the multi-faceted skills-set that is necessary for the modern surgeon to succeed and for optimal patient outcomes. This includes technical skills, non-technical skills, with a focus on key CanMEDS framework domains, including leadership, communication, evidence-based surgery and mentorship.

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          Most cited references69

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          Systematic review: the relationship between clinical experience and quality of health care.

          Niteesh K. Choudhry, Robert Fletcher, Stephen B Soumerai (2005)
          Physicians with more experience are generally believed to have accumulated knowledge and skills during years in practice and therefore to deliver high-quality care. However, evidence suggests that there is an inverse relationship between the number of years that a physician has been in practice and the quality of care that the physician provides. To systematically review studies relating medical knowledge and health care quality to years in practice and physician age. English-language articles in MEDLINE from 1966 to June 2004 and reference lists of retrieved articles. Studies that provided empirical results about knowledge or a quality-of-care outcome and included years since graduation or physician age as explanatory variables. We categorized studies on the basis of the nature of the association between years in practice or age and performance. Overall, 32 of the 62 (52%) evaluations reported decreasing performance with increasing years in practice for all outcomes assessed; 13 (21%) reported decreasing performance with increasing experience for some outcomes but no association for others; 2 (3%) reported that performance initially increased with increasing experience, peaked, and then decreased (concave relationship); 13 (21%) reported no association; 1 (2%) reported increasing performance with increasing years in practice for some outcomes but no association for others; and 1 (2%) reported increasing performance with increasing years in practice for all outcomes. Results did not change substantially when the analysis was restricted to studies that used the most objective outcome measures. Because of the lack of reliable search terms for physician experience, reports that provided relevant data may have been missed. Physicians who have been in practice longer may be at risk for providing lower-quality care. Therefore, this subgroup of physicians may need quality improvement interventions.
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            Should operations be regionalized? The empirical relation between surgical volume and mortality.

            Harold Luft, John P. Bunker, Alain C Enthoven (1979)
            This study examines mortality rates for 12 surgical procedures of varying complexity in 1498 hospitals to determine whether there is a relation between a hospital's surgical volume and its surgical mortality. The mortality of open-heart surgery, vascular surgery, transurethral resection of the prostate, and coronary bypass decreased with increasing number of operations. Hospitals in which 200 or more of these operations were done annually had death rates, adjusted for case mix, 25 to 41 per cent lower than hospitals with lower volumes. For other procedures, the mortality curve flattened at lower volumes. For example, hospitals doing 50 to 100 total hip replacements attained a mortality rate for this procedure almost as low as that of hospitals doing 200 or more. Some procedures, such as cholecystectomy, showed no relation between volume and mortality. The results may reflect the effect of volume or experience on mortality, or referrals to institutions with better outcomes, as well as a number of other factors, such as patient selection. Regardless of the explanation, these data support the value of regionalization for certain operations.
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              Team leadership

              Stephen J Zaccaro, Andrea Rittman, Michelle Marks (2001)
              Article 0 comments Cited 172 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): World J Plast Surg
                Journal ID (iso-abbrev): World J Plast Surg
                Journal ID (publisher-id): WJPS
                Title: World Journal of Plastic Surgery
                Publisher: Iranian Society for Plastic Surgeons (Tehran, Iran )
                ISSN (Print): 2228-7914
                ISSN (Electronic): 2252-0724
                Publication date (Print): May 2020
                Volume: 9
                Issue: 2
                Pages: 119-127
                Affiliations
                [1 ]Department of Surgery and Cancer, Imperial College London, UK;
                [2 ]Kellogg College, University of Oxford, UK
                Author notes
                [* ]Corresponding Author: Ankur Khajuria, BSc (Hons) MBBS (Dist.) FHEA FRSPH MRCS (Eng) MAcadMEd, Department of Surgery and Cancer, Imperial College, London, Praed Street, W2 1NY, UK. Tel: +44 7742052320, Email: ak8609@imperial.ac.uk
                Article
                DOI: 10.29252/wjps.9.2.119
                PMC ID: 7482526
                SO-VID: d10e86a5-9571-4b2d-a884-76d856b48185
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 15 July 2019
                Date revision received : 22 February 2020
                Date accepted : 29 February 2020
                Categories
                Subject: Review Article

                Keywords: plastic surgery,technical skills,non-technical skills,mentorship,leadership
                Data availability:
                Keywords: plastic surgery, technical skills, non-technical skills, mentorship, leadership

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