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RESISTING RESISTANCE TO CHANGE: A CRITICAL ANALYSIS OF THE STRUCTURE OF SURGICAL RESIDENCY TRAINING PROGRAMS

Katz, Aviva/L (2013) RESISTING RESISTANCE TO CHANGE: A CRITICAL ANALYSIS OF THE STRUCTURE OF SURGICAL RESIDENCY TRAINING PROGRAMS. Master's Thesis, University of Pittsburgh.

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Abstract

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) issued regulations affecting the structure of surgical residency training programs. These regulations placed work hour restrictions on residents. There has been significant resistance by the surgical leadership, including program directors and officers in academic organizations, to the adoption of the changes required by these regulations.
The need for these changes to the structure of the resident’s work environment, and the resistance to the incorporation of these changes, provide an opportunity to examine the ethos and culture of surgical residency for a potential source of this conflict. This thesis claims that a significant element of this resistance is the recognition that the required changes will not only affect the structure of surgical residency training, but also the culture of residency training and the adoption of a traditional surgical identity by the trainees immersed in that culture.
There is increasing evidence of significant ethical problems resulting from the traditional structure of surgical residency training. The norms perpetuated by the traditional approach to surgical training are antithetical to the current ethical norms expected regarding patient care and the surgeon’s personal and professional development. Critical ethical issues addressed in this thesis include those raised by both the apparent generational break between surgeons trained before and after work hour reform, and the conflict in balancing visions of surgical identity and concerns of patient and personal safety.
The thesis argues that there is no well grounded reason for the resistance to incorporating the changes required by the ACGME. Instead, the development of the structure and culture of the surgical residency may have evolved in response to dysfunctional influences, rather than being built on sound pedagogical theory. The resulting surgical identity molded by this culture may then be appreciated as a potentially flawed, dysfunctional social construct. Changes prompted by the ACGME may result in both a healthier surgical work force and the ability to attract a greater diversity of applicants to the field of surgery. The reframing of what is essential to the surgical identity may allow the creation of new models of surgical training.


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Details

Item Type: University of Pittsburgh ETD
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Katz, Aviva/Laviva.katz@chp.eduALK70
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairParker, Lisa/Slisap@pitt.eduLISAP
Committee MemberWicclair, Mark/Rwicclair@pitt.eduWICCLAIR
Committee MemberPinkus, Rosa/Lpinkus@pitt.eduPINKUS
Date: 18 January 2013
Date Type: Publication
Defense Date: 30 November 2012
Approval Date: 18 January 2013
Submission Date: 1 January 2013
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 72
Institution: University of Pittsburgh
Schools and Programs: Dietrich School of Arts and Sciences > Bioethics
Degree: MA - Master of Arts
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: Halstead, Surgical Training, 80 Hour Work Week, Impaired Physician, Cocaine Addiction, Graduate medical education
Date Deposited: 18 Jan 2013 16:41
Last Modified: 19 Dec 2016 14:40
URI: http://d-scholarship.pitt.edu/id/eprint/17039

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