A recently published study by researchers at the Lawson Health Research Institute and the Institute for Clinical Evaluative Sciences found that Ontarians who underwent surgery at teaching hospitals spent an average of 22 per cent more time on the operating table than those who received treatment at regular hospitals. In particular, the study – which was led by Dr. Christopher Vinden and published in the Canadian Journal of Surgery – found that patients who were operated on at teaching hospitals spent more time under anesthesia and were at greater risk of adverse outcomes such as infection, trauma, deep vein thrombosis, and blood clots which can lead to lung complications.

“It will be vitally important to identify at what point, for each type of surgery, this longer duration due to teaching introduces excess patient risk, and to find ways to minimize the risk,” Dr. Vinden told the National Post.

The study, which was the first to quantify the time added to surgeries in teaching situations, raises some difficult questions. The ability to train new surgeons, the National Post article correctly states, is undeniably an essential part of a sustainable health care system. How, then, can surgical fellows receive adequate training while ensuring patients are not subjected to undue risks? Can funding for teaching hospitals be adjusted to mitigate risk factors? Are patients who suffer injuries during teaching surgeries entitled to compensation through medical malpractice lawsuits?

Prolonged surgeries are not, unfortunately, the only issue facing Ontario’s surgical training and accreditation process. In Canada – and indeed in most developed countries – there is no standardized assessment of surgical fellows’ skill levels during training or after hiring. Rather, surgical residents are tested on their technical knowledge through written exams, and on their judgement through oral exams. Once a surgeon’s licence is issued, no skills assessment is required for its annual renewal.

Whether this lack of technical assessment has directly led to increased instances of surgical or medical malpractice is difficult to determine. But in 2013, a study published in the New England Journal of Medicine found that “patients receiving operations from surgeons with better skill had a lower chance of death, and fewer complications, reoperations and readmissions to hospital,” according to a CBC article.

In other words, not all surgeons are created equal. As in any other profession, different doctors will possess different skill levels, and those patients lucky enough to be treated by more skilled surgeons are less likely to encounter instances of medical malpractice.

St. Michael’s hospital in Toronto is hoping to improve patient safety by piloting a technical exam for colorectal surgery fellows. The exam is expected to identify residents with deficient technical skills and remediate them during their training.

“This is the first time that any North American surgical society has moved forward with developing a technical skills exam with the purpose of certification for high stakes assessment,” said Dr. Sandra de Montbrun, who worked with the American Society of Colon and Rectal Surgeons to develop a technical skills exam for certification in the United States.

If the new testing method proves successful, it could change the way surgeons train and are certified across different surgical fields. And while prolonged surgeries at teaching hospitals would still be necessary, a technical skills test may prevent unqualified surgical fellows from entering the field before they are technically proficient.

If you or a member of your family has suffered an injury through an instance of medical malpractice, contact the Medical Malpractice Group at Neinstein Personal Injury Lawyers today. They can advise you of your next steps towards legal compensation.

Greg Neinstein