By Gustavo Stringel, MD, MBA
In recent years, medical and surgical resident have been working fewer hours per week, in contrast to the 80+ hour-workweeks that were common in the past. Fortunately, we have options available to deal with the problem of the reduced workweek. In sum, we must enhance those hours our residents do spend on the job.
First, we must recognize that though all doctors have received training, not all have the same levels of cognition and psychomotor skills, and so we must tailor their training accordingly. Secondly, we can improve our ability to give feedback to the interns and residents under our supervision and provide honest, constructive critiques to help them learn. A key weapon in our training arsenal is the simulator. As medicine has become more sophisticated, so has our ability to train through simulations. While it is true that our simulators are not as sophisticated as flight simulators, for instance, certain skills can be acquired through repeated training in simulated surgeries.
Next, we can develop a system of meaningful rewards to motivate interns and residents to work harder during their reduced workweeks. Research has shown that people will work harder if they believe that their efforts will lead to rewards. Most residents are motivated, but they may become discouraged in the face of the constraints placed upon them by the hospital work environment and the relative loss of autonomy they experience as trainees. We must encourage residents to work around these obstacles.
Finally, we must never forget the circumstances that brought us to this point and strive to make the best use of whatever hours are available to us. Since we typically measure experience in terms of time, if we must reduce the time available to gain experience, we must make that time more meaningful.
This article is a brief synopsis of points raised by Dr. Gustavo Stringel in his Presidentâs Address to the Society of Laparoendoscopic Surgeons, which was published in the Societyâs Journal in 2010. Dr. Stringel currently holds the posts of Surgeon in Chief and Director of Pediatric Surgery and Minimally Invasive Surgery at the Westchester Medical Centerâs Maria Fareri Childrenâs Hospital.
Based in Valhalla, New York, renowned pediatric surgeon Dr. Gustavo Stringel is surgeon in chief of Maria Fareri Children’s Hospital. For over two decades, Dr. Gustavo Stringel has been at the forefront of the field of laparoscopic surgery for young patients.
Laparoscopic techniques are frequently used for a wide range of common pediatric procedures, typically with outcomes that are superior to those of more invasive open operations. Modern pediatric laparoscopic surgeries include appendectomies, various tumor and organ biopsies, and hernia exploration and repair, among many others.
Laparoscopic surgery wasn’t always available for children. In the early 1990s, laparoscopy was a fairly well-developed field in adult and gynecological medicine. The world of pediatric medicine, however, lagged behind for a couple of reasons. First, existing equipment was not ideally sized for children’s bodies. Secondly, a number of doctors resistant to pediatric laparoscopy suggested that the natural resilience of children to surgery made laparoscopy an unnecessary replacement for more traditional open surgery.
Fortunately, a few insightful pediatricians like Dr. Stringel identified the advantages of laparoscopy in the early 1990s, and worked hard toward establishing the necessary knowledge and expertise to safely operate laparoscopically on young patients. The less invasive nature of laparoscopy was found to be advantageous to children, as well, with quicker recovery times, fewer infections, and less postoperative pain. With the advent of smaller instruments better suited to children’s procedures, the results only improved.
Thanks to the persistence of those pioneering pediatric surgeons, today pediatric laparoscopic procedures are routine and produce positive outcomes for thousands of young patients every year.
Chief of pediatric surgery at Maria Fareri Children’s Hospital in Valhalla, New York, Dr. Gustavo Stringel is an accomplished surgeon with over 30 years of experience. Especially renowned for his innovation and skill in laparoscopic procedures, Dr. Gustavo Stringel also teaches medicine in his position as a professor of surgery and pediatrics at New York Medical College.
A relatively common infant ailment requiring surgery is pyloric stenosis, which consists of an irregularly large growth of muscle around the pylorus, the connection between the stomach to the small intestine. The result of this extra tissue is that food is restricted from passing through into the intestine. The condition is usually quickly identified, as it causes projectile vomiting. Pyloric stenosis most often occurs in infant males around a month old.
Fortunately, pyloric stenosis is easily corrected with surgery. The operation involves cutting the muscle tissue constricting the pylorus, which does not damage the stomach itself. This procedure can be done laparoscopically. In this case, the resulting tiny incisions not only leave practically no scarring later in life, but also greatly reduce the incidence of infection immediately following the surgery.