Adaptive ageing surgeons

Carmelle Peisah, Chanaka Wijeratne, Bruce Waxman, Marianne Vonau

The surgical workforce is ageing. This will impact on future workforce supply and planning, as well as the professional performance and welfare of surgeons themselves. This paper is a 'call to arms' to surgeons to consider the complex problem of advancing years and surgical performance. We aim to promote discussion about the issue of ageing as it relates to surgeons, while exploring ways in which successful ageing in surgeons may be promoted. The task-specific aspects of surgical practice suggest that it is a physically and cognitively demanding task, reliant on a range of fine motor, sensory, visuospatial, reasoning, memory and processing skills. Many of these skills potentially decline with age, although there is great inter-individual variation, particularly in cognitive performance. Nevertheless, there is some consensus in the literature that age-related cognitive changes exist in a proportion of surgeons, and there is an increase in operative mortality rates for certain surgical procedures performed by older and more experienced surgeons. In the absence of mandatory retirement, guidance is needed in regard to individualizing the timing of retirement and encouraging reflective and adaptive practice based on insight into how one's skills and performance may change with age. This may be best facilitated by some form of informed and guided self-monitoring or 'self-screening'. It should be emphasized that self-screening is not a form of self-treatment but aims to enhance insight, using a tool kit of resources to promote adaptive ageing. Moreover, self-screening should not be restricted to cognition, which is only part of the picture of ageing, but extended to emphasize the maintenance of mental and physical wellness, and the acceptance of independent professional treatment and support when required.