Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2021; 12(4): 234-245
Published online Apr 18, 2021. doi: 10.5312/wjo.v12.i4.234
Hanging up the surgical cap: Assessing the competence of aging surgeons
Abigail Frazer, Michael Tanzer
Abigail Frazer, Michael Tanzer, Department of Orthopaedic Surgery, McGill University, Montreal H3G 1A4, QC, Canada
Author contributions: Both authors made substantial contributions to conception and design of the study, acquisition of data, or analysis and interpretation of data.
Conflict-of-interest statement: There is no conflict to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Michael Tanzer, FRCS, MD, Doctor, Full Professor, Surgeon, Department of Orthopaedic Surgery, McGill University, 1650 Cedar Ave B5159, Montreal H3G 1A4, QC, Canada. michael.tanzer@mcgill.ca
Received: December 24, 2020
Peer-review started: December 25, 2020
First decision: January 18, 2021
Revised: January 28, 2021
Accepted: April 5, 2021
Article in press: April 5, 2021
Published online: April 18, 2021
Abstract
BACKGROUND

As the average age of surgeons continues to rise, determining when a surgeon should retire is an important public safety concern.

AIM

To investigate strategies used to determine competency in the industrial workplace that could be transferrable in the assessment of aging surgeons and to identify existing competency assessments of practicing surgeons.

METHODS

We searched websites describing non-medical professions within the United States where cognitive and physical competency are necessary for public safety. The mandatory age and certification process, including cognitive and physical requirements, were reported for each profession. Methods for determining surgical competency currently in use, and those existing in the literature, were also identified.

RESULTS

Four non-medical professions requiring mental and physical aptitude that involve public safety and have mandatory testing and/or retirement were identified: Airline pilots, air traffic controllers, firefighters, and United States State Judges. Nine late career practitioner policies designed to evaluate the ageing physician, including surgeons, were described. Six of these policies included subjective performance testing, 4 using peer assessment and 2 using dexterity testing. Six objective testing methods for evaluation of surgeon technical skill were identified in the literature. All were validated for surgical trainees. Only Objective Structured Assessment of Technical Skills (OSATS) was capable of distinguishing between surgeons of different skill level and showing a relationship between skill level and post-operative outcomes.

CONCLUSION

A surgeon should not be forced to hang up his/her surgical cap at a predetermined age, but should be able to practice for as long as his/her surgical skills are objectively maintained at the appropriate level of competency. The strategy of using skill-based simulations in evaluating non-medical professionals can be similarly used as part of the assessment of the ageing surgeons’ surgical competency, showing who may require remediation or retirement.

Keywords: Aging surgeon, Competency, Surgical skill, Surgeon retirement

Core Tip: A surgeon should not be forced to hang up his/her surgical cap at a predetermined age, but should be able to practice for as long as his/her surgical skills are objectively maintained at the appropriate level of competency. The strategy of using skill-based simulations in evaluating non-medical professionals can be similarly used as part of the assessment of the ageing surgeons’ surgical competency, showing who may require remediation or retirement.