Baylor University Medical Center Proceedings January 2014, Volume 27, Number 1 | Page 74

industrialized nations. The speed with which SARS spread from
pig farms in rural China to North America is just one example
of how epidemics go global.
And then there is the psychological fallout of living through
more frequent natural disasters—the breakdown in social cohesion, the lost income, debt, and property damage—that can
spill over into mental health problems such as anxiety, depression, posttraumatic stress disorder, substance abuse, domestic
violence, and suicide. These repeated natural disasters could lead
to the collapse of our normally well functioning public health
system. Katrina-like flooding, for example, stresses the health
system to the breaking point where basic sanitation, uncontaminated food or water, and the ability to control communicable
diseases disappear.
We must all drive less, fly less, eat less, consume less, and
pollute less, and we must do it quickly or there will be less

people to talk about it. There is much each of us can do now.
An unhealthy planet means unhealthy people.

William Clifford Roberts, MD
6 November 2013
1.
2.
3.

Yergin D. The Prize: The Epic Quest for Oil, Money and Power. New York:
Simon & Schuster, 1991.
Yergin D. The Quest: Energy, Security, and the Remaking of the Modern
World. New York: Penguin Books, 2012.
Marsa L. Fevered: Why a Hotter Planet Will Hurt Our Health—and How
We Can Save Ourselves. New York: Rodale, 2013.

Reader comments
Inadequate surgical education
Dear Dr. Roberts:
I always look forward to “Facts and Ideas from Anywhere.” Since “anywhere” encompasses operating theaters
around the world, I thought that you would be interested
in the attached paper from the recent edition of Annals of
Surgery (1).
I have been involved in surgical education for my entire
professional career. I have worked with residents, given grand
rounds, participated in seminars, and have even written two
books on the traditional morbidity and mortality conference.
Over that time frame, classical surgical education (as have all
medical specialties) has slowly suffered from the intrusion of
unstoppable social and political forces. Medical education is
accommodating those forces. Human pathology is not. So when
respected leaders of education tell us that surgical graduates
are unprepared for fellowships and for practice, one just has to
stand up and take notice.
Here are the numbers from this publication:
1. 21% of the residents arriving for a fellowship were unprepared for the operating room.
2. 38% demonstrated a lack of patient ownership.

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3. 30% could not independently perform a laparoscopic cholecystectomy.
4. 66% were unable to operate for more than 30 minutes unsupervised during a major procedure.
5. 30% could not atraumatically manipulate tissue laparoscopically.
6. 26% could not recognize anatomic planes.
7. 56% could not suture laparoscopically.
8. 28% were not familiar with therapeutic options.
9. 24% could not recognize the early signs of a complication. (This
one particularly bothered me!)
Since many of us will be facing a surgical procedure in the
future, I thought that I would call these facts and these ideas
to your attention.
—Leo Gordon, MD, FACS
Los Angeles, California
1.

Mattar SG, Alseidi AA, Jones DB, Jeyarajah DR, Swanstrom LL, Aye RW,
Wexner SD, Martinez JM, Ross SB, Awad MM, Franklin ME, Arregui
ME, Schirmer BD, Minter RM. General surgery residency inadequately
prepares trainees for fellowship: results of a survey of fellowship program
directors. Ann Surg 2013;258(3):440–449.

Baylor University Medical Center Proceedings

Volume 27, Number 1