The Future of Surgical Careers: 4 things we can expect
Mr Alexander Yao
Mr Alexander Yao
The future is notoriously difficult to predict. This is especially true given the rapid rate of change and innovation happening in our current information age. Blockchain, artificial intelligence (AI) and big data are just a few of the technologies showing potential for multi-sector disruption. They could change the way we live our lives completely.
What impact will new technologies have on our future careers in medicine and surgery? The answer is uncertain, making it both unsettling and exciting. By extrapolation and observation of current trends, we can try our best to answer the important question: what can we expect for our future surgical careers?
- New (sub)-specialities
Just as the late 20th century saw a complexity-shift in labour from manual tasks to more complex knowledge-work, we are likely to see a similar change in healthcare and surgery. Digitalisation and new technology will likely dramatically reduce the burden of routine tasks or decision-making like ordering routine bloods or investigations, or automate these completely. Surgeons of the future can expect to see themselves specialise further into higher areas of complexity, sub-specialising in order create a niche that differentiates themselves from both colleagues and AI. Almost certainly, AI-resistant behavioural skills like psychological, social and emotional intelligence will form a major part of these niches.
(ii) Personalised surgery. Superspecialisation will also likely follow our current trend towards personalised medicine and surgery. Wearable health technology and big data constructed from these allow profiling of individuals based on a huge number of parameters: genotype, phenotype, co-morbidities, biochemical, consumer and physiological data. This data will allow optimisation of risk and outcome to create bespoke management plans based on personal profile. Algorithms will provide suggestions from a myriad of conservative, medical, and surgical options. Surgeons will need to train to be able to deliver these options.
(iii) Hybrid specialties and cross-disciplinary pollination. The last 50 years has seen a collision of disciplines with the emergence of new fields. Internet and yearbook forms Facebook. Evolutionary biology and computer science principles form machine learning. Indeed one of the keys to innovation is association. We see the same in medicine. Engineering and neurology forms cybernetics. Surgery and telecommunications enables robotics. Radiology and surgery enables image-guidance. Further examples include: 3D printing in prostheses, bioengineering, biocybernetics, and bionics. Already, these technologies have transformed the practice of several specialties. Their further growth may result in entirely new specialties based on these.
- Telemedicine (tele-surgery)
(i) Communication. Widespread, high-speed internet has allowed medicine to spread beyond the confines of traditional primary or secondary care establishments. Increasingly, we hear about how care-providers are bringing medical expertise directly to the patient on their phone or computer. Patients are now able to access consultations from their phone (e.g. Bablyon is one of many providers). Several secondary care departments run “virtual clinics” over the phone or voice-over-internet provider (VOIP) to cover certain follow-up consultations requiring nothing more than an update of (negative) investigation results. Surgeons have transmitted videos of their operations in real-time to distant experts to get advice and even supervision regarding their procedures. The potential of efficiency and convenience for both provider and end-user is great.
(ii) Robotics. Thus far, telemedicine has largely been confined to transmission of medical knowledge. Telesurgery has been, as yet, rather limited. However, robotics offer the potential for distant surgeons at a control console in one country to operate in another country with the robot in real-time.
(iii). Mobilisation. Telemedicine segregates location and skills/knowledge of professionals amplifying their potential for national and international impact. It also facilitates the development of a private healthcare market as entry barriers decrease. True portfolio careers for doctors could eventually become a reality. Telemedicine technology opens the horizon for both hub-and-spoke model global surgery and service-commissioning.
- New training
(i) New areas.New technology and tools demand an evolution of surgical training curricula. New knowledge and skills will be required to reflect these changes. A key area amongst this training will be in regards to the ethics and therefore legal ramifications related to novel technologies. If an AI-assisted surgeon makes an error, who is accountable? Surgeon, manufacturer of hardware, or the software engineer? Understanding new legislation and regulation will be key. Technical skills training will focus further involve augmented reality and virtual reality. Non-technical skills, cognitive, resilience, and psychological training will gain greater importance especially as some technical skills become increasingly automated.
(ii) Personalised training.Superspecialisation and the availability of digital, modular education demands a more bespoke personalised training programme. Trainees will likely have a core-curriculum, supplemented by a large variety of modules teaching both knowledge and technical skills. Trainees are likely to benefit from a broader range of training resources brought closer to home. Virtual reality and augmented reality consoles will collect data to deliver personalised feedback and performance metrics. Trainees will be able to compare with their colleagues and have their scores inspected by supervisors.
Just as Alexa and Google Assistant have slowly integrated into our daily lives, AI-based software will likely play a much larger role in future surgical decision-making. Algorithms processing millions of data will be able to give us better risk stratification and outcome information than our own reasoning in the vast majority of cases. Unlike us humans, decisions are objective and, by definition, not subject to human-error. Rather than replace doctors, AI will become another professional colleague whose opinions we can leverage.
The next 50 years in the surgical field likely to see many novel and exciting developments. These are changes will be likely be highly unpredictable, dramatic and subject to rapid change. Our profession will need to adapt surgical training to facilitate our evolving specialties, telemedicine and AI. Furthermore, we will have to ask ourselves some difficult questions regarding AI and professional accountability.
Whereas these changes offer some answers to the question of what we can expect, perhaps the more important question is how can we best prepare for these changes? Undoubtedly preparation demands we focus not just on developing new technical skills but also mental training. Cultivating our ability and desire to learn, creativity and adaptability will be essential to making ourselves future-ready. Similarly, keeping our why in focus will act as a compass in uncertain times. For most of us, service to others is a key ingredient of this why.
The organisation Project Cutting Edge (www.projectcuttingedge.com) aims to facilitate the transition of aspiring surgeons into the world 21st surgical careers. It aims to empower future leaders to a successful and happy professional career in a sustainable manner. Subscribe to our mailing listto get updated on what you can do to build your future-ready career.
Mr Alexander Yao is an ENT ST3 registrar in Birmingham and runs Project Cutting Edge: a free portfolio building project for all those interested in applying for surgery (https://www.projectcuttingedge.com)