Mark Pettus, M.D.: Redesigning BMC training for general surgery residency



I wish to offer some clarity and perspective with respect to the recent closure of Berkshire Medical Center's Accreditation Council of Graduate Medical Education (ACGME) sponsored program in general surgery.

Historically, medical education has been a bit of a black box. Many are aware of its presence and impact yet the rapidly evolving landscape of medical education and its regulatory and financial underpinnings are not often well understood. As a third-year medical student at The UMass Medical School in 1982, I had my first clinical experience in general surgery at BMC. As Dr. Stephen Tracy noted in his August 4, letter to The Eagle, there is a long and rich legacy of medical education here. Many of the physician "giants" he noted were my teachers during my rotations at BMC at that time. It was a singular experience!

As a consequence, I did not hesitate to make the Berkshires my home after completing my training in Boston in 1988 because I had experienced first-hand the beauty of our communities and the unique strengths of BMC as an outstanding community hospital and academic environment. Many outstanding members of our medical staff have come to the Berkshires for that reason. I have held various leadership positions in our teaching programs through the years and currently serve as Director of Medical Education, overseeing our training programs in internal medicine, general surgery, psychiatry and dentistry. This is a position I am honored and proud to serve in.

Since joining BMC's medical staff in 1988 I have never, for a moment, questioned our organization's commitment to medical education. It is deeply embedded in our organization's DNA and has long guided our mission to bring the best clinical care possible to our communities. Much of the care we provide and the exemplary talent of the administrators and clinicians who provide it have been influenced by the infrastructure we have in medical education.

The closure of our ACGME-sponsored general surgery program has served as a wake-up call for those of us who commit much of our lives to teaching and to patient care. I feel it is important to emphasize that none of the concerns that resulted in our program's closure were based on patient care, quality, or safety. We have state-of-the-art systems that drive quality and continue to do so. They are as good as any systems you will find in our state. Many of the factors that led to this outcome have already been addressed and others are undergoing thoughtful and deliberate review by clinical and administrative leadership. There are no valid excuses for what happened and new leadership is currently in place to redesign our surgery residency program as we move forward.


BMC is also unique in that we continue to sponsor general surgery training for osteopathic medical graduates. This program currently exists under the leadership of Drs. Michael DiSiena (AOA Surgical Residency Program Director) and Stephen Kisiel (Osteopathic Director of Medical Education). We currently have three osteopathic surgical residents in training and anticipate significant growth over the next 1-2 years. In addition we have a fully integrated osteopathic training program in internal medicine. There are few fundamental differences between osteopathic (DO) and allopathic (MD) training. It is very unusual for a community hospital our size to offer the scope and depth of care and education we do. As the health care landscape rapidly changes, the model for medical education must change with it.

That said, ours can be a challenging market to support the number of specialists (and primary care) necessary to meet the evolving needs of our trainees. In some instances, e. g. neurosurgery, we are large and sophisticated enough to require expertise yet too small to support the numbers necessary to share call and 24/7 emergency department coverage which creates unique recruitment-retention challenges compared to what might see in a large metro market. Some surgical training requirements mandate an experience we cannot offer in the Berkshires -- e.g. transplantation. This challenge requires partnerships with institutions that can provide such care and we have developed relationships that foster this collaboration, such as Baystate Medical Center. There is greater emphasis on "hospitalist models" where physicians are employed to do just hospital care. This is a novel model in the field of surgery and we are now exploring this possibility.

There is a growing role for physician assistants and nurse practitioners in new care delivery models. As regulatory challenges present themselves, the training environment in 2014 for a community hospital, particularly in general surgery, requires careful consideration of infrastructure, resources, and design. This looks very different now compared to when I arrived here over 25 years ago.

Our administrative and clinical leadership could not be more responsive to this challenge as we learn and adapt to the program's closure. I am very confident our current general surgery training program will continue to grow and over the next couple years will become stronger than ever, training a full cadre of surgical residents comprised of both DO and MD medical graduates. I feel the commitment to medical education at BMC has never been stronger. This is a remarkable legacy that has touched many lives locally and beyond for more than two generations and will continue to do so.

Dr. Pettus is FACP director of Medical Education, Wellness and Population Health Berkshire Health Systems, associate dean of Medical Education UMass Medical School.


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