The aim of this model is to train new surgeons
in a stepwise fashion, to obtain internationally
equalized and comparable surgical skills.
The content of the staircase steps are unique
to each surgical specialty. Consensus regarding
the definition of difficulty levels could initially
be made between a few surgical societies of
one specialty, or regionally, and could later be
expanded to include more surgical organizations
successively. In this way, the work toward an
international standard for equalized surgical
skills levels may start and slowly proceed.
A structured system like this might also have
an impact on surgical quality. As a comparison, it
is well known that the very registration of surgical
infections will reduce the infection rate. The
introduction of stepwise and mandatory practical
examinations might therefore be helpful, just by
their existence. Simultaneously, this model would
create higher security for both trainer and trainee,
as both parts would know the defined goals and
what to expect at each step of the staircase.
Intentionally, the steps have no time limit.
Some of today’s excellent surgeons have had
a long learning curve, and some trainees will
learn specific procedures in a shorter time.
Some surgeons might specialize and get a
license for steps A, C, and E (for example, spine
surgeons). There is also a belief that such a
model could shorten the total training period,
as the very structure might reduce time gaps
when residents are just hanging around.
How can practical examinations be performed?
The crucial factor in this model is the stepwise
practical examination necessary to proceed to
the next level. The model does not state the
exact form of the examination. Any kind of
examination process might be used, and each
training center needs to define the process from
the start. It might, for example, be a live surgical
procedure performed in front of two examiners
or recorded on a video that is then reviewed
by, say, three experienced surgeons or surgical
assistants. As Gallagher, Angelo, and Pedowitz
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