Gynecological surgery: Second rate training for second rate patients?
Gynecological surgery training in the United States suffers from a dangerous deficit – one, which represents a threat to the health of 50% of the population: women.
Over the years, professionals in diverse fields in the United States have appreciated the value of a broad-based and liberal education prior to specializing.
It is, in fact, critical for the health of our society to educate specialists broadly - because, such educated professionals are far more likely to approach problems using a multidimensional lens.
A broadly educated professional is far more likely to detect deficits in thinking and to use multi-disciplinary guidance in the practice of his/her profession. But professionals who train and practice in an isolated "silo", separated from others, are prone to committing fundamental errors that are fully evident to outsiders.
Therein, lies a critical system failure in gynecological surgery – a failure, which is masked from general knowledge because the public, and many healthcare professionals, do not see the inner workings of the medical education system.
It is a fact that all surgical specialists in the United States, except gynecological surgeons, cross-train in a multi-disciplinary way following graduation from medical school.
Neurosurgeons, urologists, plastic surgeons, ENT surgeons, cardiothoracic surgeons, vascular surgeons, cancer surgeons, even many anesthesiologists, cross-train together, anywhere from one to 7 years, before specializing.
But not gynecological surgeons!
This is an astonishing fact that all members of the public must understand and ponder - because gynecologists are charged with the care of 50% of the population.
In fact, many women have gynecologists as their primary physicians – particularly in rural and inner city settings.
Of course, highly decorated gynecological leaders would reject our critique and label our alarm as being a subjective one from "unfortunate patients who were harmed because medicine is not a 'perfect' science".
But the "proof is in the pudding" and the "gynecological pudding" is responsible for having caused some very real and terrible disasters in women's health – disasters that are fully avoidable if these surgeons trained appropriately and used a multidisciplinary approach to their practice and innovation.
Of course, our critique is not a personal attack on anyone – nor is it ego-based, as we are sure to be accused of being. We recognize that many of our gynecological surgery colleagues, some dear friends to us, will take offense to this perspective.
But the truth is the truth. And this system level deficit in gynecological surgery education is something the public is sure to recognize - where many invested gynecological surgeons will fail to see or acknowledge.
The facts are that: 1) gynecological surgeons do no cross-training with other surgeons, 2) the specialty and its associated industry is guilty of having made some unforgivable blunders that have cost irreplaceable lives and 3) instead of humbly acknowledging their errors once discovered, gynecological leaders have incredibly continued to vigorously defend their wrong-doing.
What is the result of limited surgical education in the "gynecological silo"? basic tenets of surgical practice, immediately evident to other surgical specialists and to the lay-public, are ignored by gynecological surgeons.
And when the grave or deadly consequences of such "errors of under-education" harm women, these professionals have either ignored or blatantly rationalized the damage done to their patients. When that happens, there is only one way to describe it: professional ignorance, or worse, deception.
Here, we are informing the public and the leaders of graduate medical education in the United States of a serious defect in gynecological surgery training.
Perhaps, if gynecological leaders and the leaders of graduate medical specialty education choose to keep a blind eye to this women's health hazard, the public will demand better.
The solution is so simple: Gynecological surgery residency programs should include a 1-2 year period of cross training with general surgeons and other surgical specialties.
Why should women's reproductive health stand so compromised by limited training in an over-confident "silo" - particularly when men's reproductive health, delivered by urologists, enjoys a cogent multi-disciplinary system of training?
Is the health of women less important?
Or perhaps we do not think about women's health with as much clarity and care as we do about men's health in the year 2015.
Perhaps women remain "second-rate" citizens in the United States of America?
Hooman Noorchashm and Amy Reed, husband-and-wife physicians, have campaigned to ban electric morcellators since December 2013, soon after Reed's unsuspected uterine cancer was spread by the device during a routine hysterectomy.
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