The baseball model: post-WWII surgeons as young as age 18?

Did I know doctors who were "bad actors" or less competent than they should have been. Yes, but they were very much the minority.

During my career, because what I did was quite specialized and often related to emergent trauma, my on-call schedule up to the day I retired was heavier than residents half my age were allowed (one reason I retired when I did because I could not cut down on call). I also spent decades as a reserve surgeon including senior staff positions and combat deployment doing combat surgery. Not to brag on myself, but during my entire career start to finish no patient ever had to skip surgery because they could not afford it - their fee was reduced to minimal or nothing if the circumstances warranted it, which basically meant the reduction came out of my own pocket. Yes, I made a very good living, however had I gone in to other endeavors like relatives and others I knew I would have made a good deal more money with a great deal less disruption in my life - getting up at all hours, missing many childrens events due to professional conflicts or emergencies, exposure to all sorts of diseases including HIV (lots of blood in surgery). I say all this because the picture painted by one poster is distorted - and btw if those folks were so bad, did any of the "good" non-MDs ever report them - I personally had some MDs restricted in surgical access.

However, in terms of the original OP - even if you took someone with the soul of Mother Theresa, the brains of Einstein, and the hand eye coordination and skills of a gold medal athlete, there is no way in the world such a person could be ready to be an independent surgeon at 18. Final word.

Over the years, my view of the medical profession has grown more and more jaundiced; while not privy to the detail info you have and certainly without a medical background of my own, I still can't help but think that many (not all) doctors are frauds...my own primary physician is pretty suspect in my eyes. But, even without my fears and your beliefs, there is NO way I can get behind the idea that surgeons are organic plumbers, ready to cut, cut, cut as soon as they get their A.S.S. degree from Intercourse Community College. This sounds too much like a hospital administrator trying to decrease surgeon pay in order to increase, oh, I don't know, maybe hospital administrator pay...
 
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Armageddon (1998)

Is it easier to train oil drillers to be astronauts, or astronauts to be oil drillers?

The Flexner Report (1910) makes the assumption that being a lab nerd is the one central, essential skill of medicine and that everything else is a mere nicety and/or coachable. And that’s certainly not the only way to do it.
 
For example, car salespersons often classify buyers as trade-in buyers, or down payment buyers, or interest rate buyers, etc. That’s actually somewhat dirty since they’re trying to manipulate you into making a purchase.

But . . . if teachers or sales pro were hired to teach and coach up diabetes patients, they might actually find it very interesting the kind of misconceptions patients get, and take pride in a respectful conversation in which they bring patients up to the next level of understanding.

I understand it’s very cost-effective to meet with diabetes patients more often just because hospitalization is so expensive. And it seems to me that patients would get more out of regular short visits than less frequent long visits in which the patient might get overloaded with too much information.
 
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Armageddon (1998)

Is it easier to train oil drillers to be astronauts, or astronauts to be oil drillers?

The Flexner Report (1910) makes the assumption that being a lab nerd is the one central, essential skill of medicine and that everything else is a mere nicety and/or coachable. And that’s certainly not the only way to do it.

Are you serious in justifying your arguments with a movie and a decades old publication?
 

Jack Brisco

Banned
armageddon-team-670x410.jpg

Armageddon (1998)

Is it easier to train oil drillers to be astronauts, or astronauts to be oil drillers?

The Flexner Report (1910) makes the assumption that being a lab nerd is the one central, essential skill of medicine and that everything else is a mere nicety and/or coachable. And that’s certainly not the only way to do it.


Let me ask you this...if YOU had a life-threatening condition or had been in an accident, and would die without surgery, would you be satisfied having an 18-year-old kid doing the surgery? That's what it all boils down to. Perhaps you are a young person in perfect health and you think you would never be in such a fix. Guess again. Take nothing for granted. ANYTHING can happen at ANY time. And when the shit hits the fan, you want the surgeon who will give you the best chance of seeing tomorrow. I know. I been.
 
@elektro, @sloreck, @Inferus, thank you for your diligent work in helping others. :) And thank you for your diligent years of training.

I still think an 18-year-old could start with simple procedures and then by age 30 have twelve years of experience rather than merely around five.
 
Unintended Consequences of the Flexner Report: Women in Pediatrics

Pediatrics, Barkin, Fuentes-Afflick, et al., Dec. 2010.

https://www.ncbi.nlm.nih.gov/pubmed/21059716

' . . . enshrined an educational model that favored the laboratory over the bedside, the hospital over the home, and the physician-as-researcher over the physician-as-practitioner. . . '

' . . . From 1880 to 1900, the number of female physicians doubled (to 5.6%), and in some cities such as Boston, . . . ’
But with the 1910 Flexner Report we started moving the other direction as far as the number of women physicians.

And like this says, made very specific choices which seemed to have become stronger over the years.
 
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Memorizing and regurgitating things like this seems to be the primary judgement for who gets serious consideration for medical school and who doesn’t.

And I think looking at who’s, say, in the top 20% in physical dexterity and then which of these persons are merely good enough at the science is an alternate and probably a better way to select surgeons. As the main path. And then, I’m very open to all kinds of interesting alternate paths.

Hey, wait a minute, GeoDude, doesn’t a brain surgeon need to be extremely good at looking at frozen thin slices through a microscope and making extremely close determinations on different forms of cancer? I understand that, yes, this is the case. Then get very good at this subset, and don’t piss away your best efforts on a bunch of other tangential stuff.

* as if we were memorizing teams in the Pacific Coast League!
 
@GeographyDude : Believe it not, even for the cut/slice/sew technicians you seem to think surgeons are, a great deal of what you appear to think is extraneous knowledge is often quite useful for surgeons. Furthermore the Flexner Report was in response to the pathetic state of medical education in the USA, where a large number of schools were diploma mills accepting unqualified students who could pay and producing "doctors" of dubious (at best) quality. This situation had been a problem in American medical education for over 60 years.(1) In my retirement I am getting a PhD in history (military history - history of military medicine) and in the course of my research have done a good deal on the development of modern medicine in the US and Europe from the mid 18th century, so I know whereof I speak (I have a copy of the Flexner report in my digital files).

Like everything else, some of medical education is "tradition" (cue Tevya singing) but most of it is there for a reason, and people are trying to update it continually. BTW while patient simulators, computer graphic anatomy and so forth are excellent teaching aids and adjuncts, nothing is the same as the real thing.

(1) Within 18-24 months after the report came out, almost half of the "medical schools" in the USA closed their doors - and it wasn't just lack of labs but also lack of access to hospitals and real live patients that were defects.
 
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Armageddon (1998)

Is it easier to train oil drillers . . .
Are you serious in justifying your arguments with a movie and a decades old publication?
As a fun example that there are different types of intelligence, yes, indeed! :)

And the Flexner Report is so much than just a “decades old . . ” It set the course of modern medical education. And probably needed a course correction around the 1940s, which it didn’t receive.
 
...if YOU had a life-threatening condition or had been in an accident, and would die without surgery, would you be satisfied having an 18-year-old kid doing the surgery?...
No, I’d rather have a 43-year-old who’s had 25 years of exp. starting with the easy stuff!

And that might be the point at which a man or woman is really at the top of their profession for something which does require a fair amount of physical skill.

A lot of this depends on whether a person really believes in multiple forms of intelligence. I do.
 
I work in the medical field and deal with surgeons. Trust me, it's a learned skill and some of the docs aren't as good as you might think.

We separate docs between book smarts (research, clinic, etc) and hands on. The latter acquire the skill from training that the average person could pick up (it's an overhyped technical job, despite what many people will tell you). One doesn't have to know the chemical processes of the body to do surgical procedures (we usually have several docs in the suite to handle their defined field including anesthesia, reperfusion, etc). There is even a move towards replacing many physicians with nurses (which doctors are fighting despite no proof in a drop in care or outcome). We are also taking early steps into using robots to do procedures.

So yes, surgical docs could be replaced by those trained to simply perform procedures.

I'm guessing you are a nurse.
 
. . . even for the cut/slice/sew technicians you seem to think surgeons are, . . .
I said nothing of the sort. I want a young surgeon to be able to perform an appendectomy as skillfully as . .
. . Luis Severino of the New York Yankees strikes out a batter! And I want the young surgeon to be able to handle differences among patients as skillfully as Luis adjusts to differences among batters.

And if age 24 is not enough, for example, to handle an unexpected aneurysm of an abdominal artery, so be it, a longer apprenticeship.

* although with laparoscopic surgery, I think it might be less likely an aneurysm will be seen. But the effects of a ruptured one certainly will be!
 
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As a fun example that there are different types of intelligence, yes, indeed! :)

And the Flexner Report is so much than just a “decades old . . ” It set the course of modern medical education. And probably needed a course correction around the 1940s, which it didn’t receive.

Have you ever considered that the movie is not an accurate example at all and its plot completely unrealistic?
 
I said nothing of the sort. I want a young surgeon to be able to perform an appendectomy as skillfully as . .
. . Luis Severino of the New York Yankees strikes out a batter! And I want the young surgeon to be able to handle differences among patients as skillfully as Luis adjusts to differences among batters.

And if age 24 is not enough, for example, to handle an unexpected aneurysm of an abdominal artery, so be it, a longer apprenticeship.

* although with laparoscopic surgery, I think it might be less likely an aneurysm will be seen. But the effects of a ruptured one certainly will be!

I think you really underestimate the depth of knowledge of human body required for a surgeon, and the pre-requisite knowledge needed to learn medical science.
 
CalBear, I’m glad your dad found a good surgeon (perhaps with your help?) and am even more glad that it worked out so well for him! :)

To me, this is an argument for more practice on surgery and less on chemistry. For the surgeon, that is. For the research doctor in the lab, it would be rather the opposite.

And I think one could find the right kind of soft plastic which imitates cutting and sowing human tissue. Although in this case, I think what you’re
talking about is threading up through an artery to the heart and doing what laypersons sometimes inaccurately call “rotor rooting.”

The experience is not about skills, it's about decision making supported by the the anatomical and physiological knowledge in the surgeon's head.

Have you seen how thick Grey's anatomy is?

Plastic, please. Just the skin is much more complex than that. How
 
Have you ever considered that the movie is not an accurate example at all and its plot completely unrealistic?
This is where we can really end up talking at cross purposes here at AH. For of course I know the movie is unrealistic.

Let me ask you this. Suppose a young adult has great college science scores and also has some medically-related volunteer work, which I understand is one of the more minor factors looked at. But they're currently between the 20th and 40th percentile as far as physical dexterity. But this young man or woman doesn't know this and has their heart set on being a surgeon. How might you see this playing out in a reasonably positive scenario?
 

One of the better medical school autobiographies. Published in 1987 and now way dated.

The part in which she's in some kind of student exchange program between Harvard and a hospital in India is pretty good.
 


Melvin Konner focuses on the third year of medical school in which students begin their clinical rotations. Now I understand many schools try to start some of this in the first two years.

Also published in 1987.
 
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. . . Surgeons often progress to becoming doctors sometime between their late 20s and early 40s, but it's just as "normal" for them to not to. In fact, there's even a career designation of "master surgeon." . . .
I said this toward the bottom of page 1, probably should have led earlier with it.

Yes, I'm envisioning a system in which medical practitioners typically become doctors later than they do in our current system.
 
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