The Right Child/Right Surgeon initiative: A position statement on pediatric surgical training, sub-specialization, and continuous certification from the American Pediatric Surgical Association

Abstract

The past 50 years have witnessed profound changes in the specialty of pediatric surgery in North America. There has been a marked increase in the number of both pediatric surgical training programs and practicing pediatric general and thoracic surgeons. Despite this trend, the population of children in the United States and the birth rate have recently remained relatively flat. Some pediatric surgeons have become “super specialists”, concentrating their practices in oncology or colorectal surgery. This has the potential to result in a dilution of experience for both pediatric surgical trainees and practicing pediatric surgeons, thus limiting their ability to acquire and maintain expertise, respectively. Coincident with this, there has been a relative paradigm shift in recognition that “quality of life” is based more on maintaining a creative balance in lifestyle and is not “all about work”. There has been a parallel growth in the number of practicing pediatric general and thoracic surgeons in urban settings, but we have not appreciated as much growth in rural and underserved areas, where access to pediatric surgical care remains limited and fewer pediatric general and thoracic surgeons practice. This is a complex issue, as some underserved areas are economically depressed and geographically sparse, but others are just underserved with adult providers taking care of children in settings that are often under resourced for pediatric surgical care. This problem may extend beyond the boundaries of pediatric general and thoracic surgery to other specialties. As the premier association representing all pediatric surgeons in the United States, the American Pediatric Surgical Association (APSA) has concluded that the quality of pediatric surgical care will likely decline should the status quo be allowed to continue. Therefore, APSA has initiated a Right Child/Right Surgeon initiative to consider these issues and propose some potential solutions. What follows is a brief statement of intent.

Characterizing rural families’ experiences receiving pediatric surgical care: A qualitative study

“…38 Utilization of telemedicine services can result in fewer costs, increased access, reduced transfers, and improved referral patterns. 8,[38][39][40] However, many families in this study had either never been offered the opportunity to utilize telemedicine or were unaware of the potential to utilize telemedicine.…”

“…Rural children more frequently live in medically underserved and economically disadvantaged areas, which can lead to delays in seeking care 5–7 . In its “Right Child/Right Surgeon” initiative, the American Pediatric Surgical Association recently highlighted the urgent need to ensure access to quality surgical care for children living in underserved and rural areas 8 …”

“…[5][6][7] In its "Right Child/Right Surgeon" initiative, the American Pediatric Surgical Association recently highlighted the urgent need to ensure access to quality surgical care for children living in underserved and rural areas. 8…”

The “chicken-leg anastomosis”: Low-cost tissue-realistic simulation model for esophageal atresia training in pediatric surgery

“…The American Pediatric Surgical Association (APSA) has recently addressed the issue of dilution of experience in pediatric surgery, which currently threatens the quality of children’s surgical care ( 18 ). Amongst the list of possible solutions, APSA underlined the importance of redefining the paradigm of pediatric surgical training, including in the existing curricula the use of simulators and the organization of simulation-based training ( 18 ).…”

Health Literacy Implementation Principles

“…Unfortunately, children across the country and beyond with these conditions often undergo secondary and additional procedures to correct the initial procedure (Ahmad et al, 2022; Bischoff et al, 2017; Wood et al, 2020). Many variables are related to this, including specialty surgical training and optimal outcomes (A-laish et al, 2020; Rentea et al, 2020; Vilanova-Sanchez et al, 2020). Fortunately, the SFL surgeon had formal training in pediatric colorectal surgery.…”