FORUM EKSPERTÓW
Research and Surgical Education

It is a most gratifying sign of the rapid progress of our time that our best text-books become antiquated so quickly.



Theodore Billroth (1829-1894)



These wise words of one of the founding fathers of modern surgery still ring true more than a century after his death. Today’s surgical literature is expanding at an exponential rate, with thousands of studies published monthly and new journal titles added continuously. The technological leap in biomedical sciences as well as the “publish or perish” culture of academic medicine has fueled this escalation in published medical literature. Cardiothoracic surgery as a specialty is no exception to this trend. As such, a surgeon should not only be able to contribute to surgical science but also be skilled at evaluating the quality, relevance, and importance of the work of others. In the era of “evidence based medicine” how well are we qualified to examine “the evidence”? With limitations on work-hours, increasing complexity of procedures, rising demands for clinical productivity, and a complex reimbursement environment, the landscape of cardiothoracic training is changing rapidly. With these changes, there is increasing concern that one of the foundations of surgical training, research experience, is being eroded and may compromise the caliber of surgical expertise in the future. It is perhaps timely to review the value of research not only for advancement of surgery, but also for its paramount role in surgical training.

American medical education at the turn of the twentieth century was arguably the worst in the industrialized world, with medical degrees being granted in as short as two sixteen-week terms. The turning point came in 1910 with the publication of the Flexner Report, which brought revolutionary reform to medical education, requiring medical schools to be affiliated with universities, have laboratory facilities, and pursue research. This was not a novel concept, but an aggressive adaptation of the European system that was already in existence. The model for this reform was the Johns Hopkins School of Medicine, which was at the forefront of embracing and evolving these ideals. William Halstead was a professor of surgery at Johns Hopkins during this time and established the first surgical residency in the United States as American medical education was undergoing a major transition. Halstead emphasized mentorship in surgical...


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