Researchers are proposing regular, in-depth evaluations throughout surgeons’ careers to determine when it is time for them to stop using the knife.
- Although cognitive decline may impair the clinical performance of older surgeons, their patients have better outcomes due to their years of experience.
- These specialists cannot, on their own, recognize the alteration of their physical and cognitive functions and clinical skills with age.
- The ACS therefore recommends that doctors take cognitive tests throughout their career, “regardless of age and experience.”
“Research shows that with age, motor and cognitive abilities tend to decline. This decline can impair a surgeon’s clinical performance below the acceptable level of competence,” said Dr. Todd K. Rosengart, professor at Baylor College of Medicine (United States). Problem: There is little guidance on how to best ensure their skills throughout their career while maintaining patient safety. That is why the American College of Surgeons (ACS) recently proposed a roadmap to address the issue of aging among surgeons.
Better results in older surgeons due to greater experience
As part of the study, published in the journal Journal of the American College of Surgeons, the ACS reviewed 62 cohorts comparing the age and skills of specialists. Their analysis shows that the onset and rate of age-related decline in clinical performance varies among individuals. Some of the research reviewed reveals a link between increasing age and decreasing medical knowledge, less adherence to evidence-based standards of care, and poorer patient outcomes. However, other work has highlighted the greater experience of older surgeons compared to younger ones, which may offset at least some of the effects of cognitive decline. “These older specialists can achieve better results because over the years they have learned to avoid problems or manage complex cases.”
The authors also identified studies suggesting that surgeons alone cannot recognize the impairment of their physical and cognitive functions and clinical skills with age. As a reminder, potential warning signs of age-related decline may include forgetfulness, unusual delays, signs of poor clinical judgment, major changes in referral patterns, unexplained absences, confusion, personality change, being disturbed, drastic change in appearance, and unusually late and inconsistent documentation.
Cognitive tests during the career of surgeons “regardless of their age and experience”
Faced with these data, the ACS recommends the implementation of a “comprehensive career-long testing strategy for all surgeons and surgical trainees, regardless of age and experience. We do not believe that a cognitive test is the one and only standard for competency approval. We offer a mosaic of cognitive tests, including clinical performance, peer assessment, etc., that would potentially be different at each institution. By doing this, we can help destigmatize concerns related to aging and performance. “, explained Dr. Todd K. Rosengart.
After retirement, if desired, a “senior” surgeon can continue to contribute in various ways. “He could serve as a wonderful first assistant to a younger surgeon who could benefit from that surgeon’s skills and experience.” Another surgeon might feel ready to leave the operating room and continue to be an active member of the hospital in other ways, such as in quality improvement, research, education, mentoring or coaching, or community outreach.
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