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Excess Testing Does Not a Good Surgeon Make: Dan Riew Sounds Off

by Elizabeth Hofheinz, M.P.H., M.Ed., October 16, 2019

Daniel Riew, M.D.

“There is too much unnecessary and irrelevant testing of medical students and residents,” says cervical spine surgeon, Dan Riew, M.D., director of cervical spine surgery at Columbia University in New York. “It all starts in high school where the SATs and related tests are flawed in many ways. We are likely missing out on some talented individuals because those from disadvantaged backgrounds cannot partake of expensive test prep courses. We should instead just rely on how well someone performs in school.”

“Then there is the MCAT, which, in my opinion, is a waste of time. When I took it, the MCAT was not so much a test of knowledge, but of common sense with some basic math and science mixed in. I studied a few days. Now people are studying an entire year and using a lot of different books so as to be prepared for questions on psychology, reading comprehension, etc.”

“And it is on a bell curve and so if you answer a couple of questions incorrectly, it drops you from the 99 th to the 96th percentile. Moving into medical school there are the Board exams, where a highly competitive residency may say, ‘This person was only in the 89th percentile so we won’t interview them.’ The truth may be that this person only missed one or two questions to drop below the 90th percentile. I believe that we are unnecessarily stressing out medical students with tests. Many medical schools now gear their curriculum and teaching to help their students do well for boards, rather than concentrating on teaching students how to be great doctors. If you do well in medical school and do well on your rotations, then why do we need these tests? The fact is that you could be a terrible doctor and still pass the board exams.”

There is an initiative underway, says Dr. Riew, to possibly no longer count the Board exams. “The Board tests should be pass or fail. I understand that it is a way to ensure that someone has a minimal degree of competency, but especially for surgical specialties, how well someone scores on the Board exam has no correlation with how good a surgeon they will become.”

“First, we need to determine what manual and spatial skills are necessary to the surgical profession and identify those people early on who do not have them. As of now, we have a lot of people who get halfway through residency before they and their teachers realize that they lack manual dexterity and/or spatial skills. Not everyone has what it takes to understand a 3D relationship between, say, a bone and an implant. But the field does an inadequate job to address this. While no one thinks that with enough practice they could be a Tiger Woods, the message to budding physicians is, ‘Sure, anybody can be a surgeon!’”

And to rectify this situation, Dr. Riew suggests that the medical profession start the triage process early. “Only those in the top 10-20%, in terms of their surgical skills, should be allowed to choose a surgical specialty. In the first year of medical school they should test for manual dexterity and spatial skills…either someone has it or they don’t. Take college sports. While anyone can play pickup basketball, we don’t allow just anyone on the varsity team. Also, surgical skills such as suturing and tying should be taught on day one of medical school—as of now this doesn’t happen until the third year of medical school. This may be because few surgeons are involved in the medical school curriculum. If someone is going to secretarial school, they have to type on the first day. We know that it takes years of learning and memorizing to master the fund of knowledge to become a competent doctor. But it takes even longer to master the manual skills necessary to become a master surgeon.”

“Because we don’t do the due diligence early enough to identify those who don’t have what it takes to become a great surgeon, society pays a price. We all know that there are very mediocre or even bad surgeons out there. Some individuals just don’t have the technical ability. Or they may be technically proficient but may lack the appropriate knowledge. Or they may have both but lack the judgement. All senior surgeons have to cross our fingers every once in a while because we are unleashing someone on the public that may be competent but may never become truly great.”

Medical Schools need to address this issue in a serious manner.

Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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