Working Outside of the Operating Room to Advance Surgical Care

Headshot of Douglas S. Smink, MD, MPH

As someone who has dedicated his career to patient care, education and research, Douglas S. Smink, MD, MPH, embodies the classic tripartite mission of an academic medical center.

In addition to practicing minimally invasive general surgery at both Brigham and Women’s Hospital and Brigham and Women’s Faulkner Hospital, Dr. Smink is the current president of the Association of Program Directors in Surgery (APDS), chief of Surgery at the Brigham’s Faulkner Hospital and vice chair of education for the Brigham’s Department of Surgery.

Dr. Smink recently discussed his experience leading the APDS as well as his research focused on gastrointestinal training.

Supporting Trainees and Program Directors

Founded in 1977, the APDS supports residency program directors by developing and disseminating standards and practices for training the next generation of general surgeons. The APDS works with national organizations including the American Board of Surgery (ABS), the American College of Surgeons and the Accreditation Council for Graduate Medical Education (ACGME) on educational developments and innovation.

Dr. Smink has been a member of the APDS for over a decade and assumed the presidency in May 2021. “Program directors have the development of trainees at the front of their minds, and I mesh well with those individuals,” he says. “I feel it’s important to be part of a group that’s supporting both trainees and program directors. Also, I’ve always found surgical education to be a vibrant field with lots of innovation going on, and it’s been fun to be part of that.”

One initiative under Dr. Smink’s leadership has involved competency-based education. Traditionally, residencies are designed to be completed in a set period of time. Rather than adhering to a predefined schedule, competency-based education requires the learner to prove proficiency in certain tasks before moving on to next-level tasks.

While the ABS and the ACGME determine the requirements for residency and board certification, the APDS and its members have assisted in developing assessment tools to gauge proficiency and have teamed with program directors on meeting their educational goals.

“A larger-scale rollout [of the assessment tools] will start next year,” Dr. Smink says. “Although we’re not leading this effort, the APDS is very much at the table to ensure it’s a workable system that we think will be very valuable.”

Another major priority for the APDS over the past year has been improving the selection process for residency programs. The pandemic has fueled the transition to virtual interviews, which in turn has led to applicants interviewing with and applying to exponentially more programs.

The APDS has collaborated with the Association of American Medical Colleges on a pilot program to develop a supplemental application for prospective residents. The intention is to pose more relevant questions that will give residency programs deeper insights about applicants. The application also asks applicants to mark five programs as “favorites.”

“Programs learn which applicants ‘signal’ them,” Dr. Smink says. “We’re trying to help programs sift through the 1,000-plus applications they receive to identify those applicants who are most interested and will have the highest yield. We also think this will help trainees stand out to the programs they are most interested in.”

Incorporating Modern Techniques for GI Training

In his research, Dr. Smink focuses on resident and faculty education through simulation, team training and coaching. He says his interest in GI training—and the impact that individuals can have on residents’ career development—dates back to his time as a trainee.

“I always wanted to be the person who would give back to the next generation,” he says. “Initially, I wanted to be a good teacher, which is obviously important. But I realized I could have an even broader impact if I got involved in surgery education on a larger scale. So I decided to become a program director and to do education research that would help advance the field.”

Dr. Smink is co-leading the Provider Awareness and Cultural Dexterity Toolkit for Surgeons (PACTS) study. This study will test a curriculum that aims to teach residents to become more culturally dexterous in caring for patients of increasingly diverse backgrounds. “We’re trying to offset health care disparities by helping our physicians to be better communicators and more empathetic with their patients,” he says. “We hope to show that this will result in better patient care and better surgical outcomes.”

He is also co-leading the Surgical Coaching for Operative Performance Enhancement Program (SCOPE), which provides peer (faculty-to-resident or faculty-to-faculty) coaching. The idea is to supplement what occurs in the operating room with after-the-fact conversations using recall or video to analyze, assess and uncover ways to improve.

“These are one-on-one, self-reflective, goal-oriented discussions,” Dr. Smink says. “We think it’s a novel and impactful way for surgeons to develop rather than relying on lectures or textbooks.”

Looking ahead, Dr. Smink relishes the opportunity to conduct more education research that other programs can replicate or build upon at their own institutions.

“In the so-called ‘good old days,’ learning was very much about seeing people doing procedures in the OR,” he concludes. “Now we know there’s a science to how we educate, and we can be better, more efficient and more effective by using some of these modern techniques.”

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