The last 3 years of a global crisis caused by a pandemic have had a significant impact on society and were likely a catalytic factor in also changing our medical landscape. All surgical specialties were severely impacted by shortages in staff, ICU beds and inpatient resources. Yet the first strike was the restriction of working hours also during training. Ultimately, this has led and will most likely continue to lead to a deficit in training opportunities for residents and young attendings alike.

As do all challenges of this magnitude, this challenge poses a risk to our established structures but is also a golden opportunity for all surgical specialties to rethink processes, concepts and paradigms, especially for training the next generation.

Today, surgical simulation is seen as a relevant tool for training in medicine in general and in the field of surgical specialties in particular. It is even an integrated and structured part of surgical training and validation of surgical skills in some countries.

In France, for instance, the French National Authority for Health established the integration of simulation into teaching programs in 2012, with the motto “never the first time on the patient”. Indeed, it does not come as a surprise that this concept was articulated as early as 1927 by William Mayo. To the open mind, it is more surprising that this paradigm has not become a universal approach. On the other hand, some countries are willing to take this concept even further. In Switzerland, for example, counting of simulation cases as part of the surgical workload during training is being discussed.

In Austria, we seem to be far away from implementing these ideas; however, circumstances and desperate need will inevitably force a change of our current system not only for the sake of our patients but also in order to maintain and improve future surgical training. Most importantly, the upcoming generation of young surgeons is no longer willing to continue training in a manner Mayo refuted as early as in the 1920ies.

Obviously, changes will need new concepts, new ratios of trainers to trainees, new infrastructures and funding. We as surgeons should embrace this opportunity to hold on to proven standards, to innovate training and thus to allow for the vision of a bright surgical future. If not, we will lose our cutting edge.

Yours sincerely,

Afshin Assadian