I had an interesting discussiong with my PhD supervisor. We were doing a laparoscopic cholecystectomy and his philosophy is to not routinely perform a cholangiogram. For those who are not familiar with the topic, this is an xray test performed at laparoscopic cholecystectomy (keyhole gallbladder surgery) which, among other things, proves that you have identified the anatomy correctly. Whether to perform routine cholangiogram (i.e. for every single patient, barring any technical prevention) is an ongoing argument amongst surgeons – one of those decisions where the evidence is not clear and people tend to firmly grasp their choices, and end up really passionate.
I really respect my boss, and he argues that he displays the anatomy well, and therefore there is no reason to routinely cholangiogram. He does show great anatomy, and his point is valid. I am not experienced enough at this procedure to make my own decision, yet. So I said, “The exam answer is to always perform a cholangiogram, right?”
(This is because it is the only way an examiner can guarantee you are going to be safe. They can’t check how well you operate, so this answer proves you are safe surgeon, no matter what your skills.)
My boss, of course, disagreed with my statement. He wants me to have my own opinion and defend it based on the available evidence. This makes sense to me. We should be teaching surgeons to make decisions based on available evidence, and their understanding of their own skills, not based on one-time decisions. And we really shouldn’t be expected to say one thing to examiners where we might be planning to do something entirely different in practice. But my boss is not an examiner. I’ve still got a few years yet to figure out what I will say.
What do you think? Should we favour the safest course, and risk over-investigation, or encourage surgeons to defend their own position, even when they might not agree with the examiner?
Interesting point. “Safe practice” in an exam versus common sense in practice.
It would depend on the examiner I suppose (in this case anyway), some would be impressed that you were able to quote evidence and reasons while others would howl you down or fail you as a reflex.
@dragonfly: I agree – examiners are so varied in their own practice that sayign the “safe” thing is the best option to avoid a clash. However, it’s not really authentic, is it? I would like to be an authentic surgeon, as we need to be honest about what we do without judgement. But it all starts so badly if we don’t do that in the exams.
Yeah. Last time I did something like this in an exam I had the orthopaedic surgeon say “yes, point taken, but for the point of TODAY…..” 🙂
Well Done! I Like it!