History of the Institute of Surgical Research

Gábor Petri, Founder of the Institute

 In 1952-53 four Institutes of Operative Techniques were established in Hungarian Medical Faculties. These independent institutes provided the infrastructure, logistics and educators for both basic and advanced surgical courses at the Universities of Budapest, Pécs, Debrecen and Szeged. The central aim was to teach surgical practice under lifelike conditions and to provide realistic environments for medical students to be trained so as to be able to perform operations, resuscitation and primary wound care in war-like situations. After the easing of the tensions of the cold war, the scope and the depth of teaching underwent significant change, and the courses were focused more on the needs of general medical practice.

In 1976, the names were changed to the Institutes of Experimental Surgery, which became increasingly involved in basic and clinical surgical research, particularly relating to shock, ischaemia-reperfusion, the microcirculation and transplantation. The teaching of practical surgical skills continued too, although at a lower intensity. In the late 1980s, the curricula at the respective universities became virtually identical (tying surgical knots, skin incisions, sutures, control of bleeding, exposure and cannulation of veins, laparotomy, inspection of abdominal organs). The format used most often and most successfully included a demonstration operation on living anaesthetized animals, followed by individual practice on operating tables. The use of animals was expensive, both in terms of expenditure and in terms of staff time for training, but these simulations were considered more representative of the clinical practice than oral lectures or in vitro models. During this period, after the completion of the course, each student was asked to provide written, anonymous feedback on the elements of practical skills. With only a few exceptions, the key features of the operations were accurately remembered. Concerns about the use of animals did not occur until the early 1990s. However, the costs of the courses steadily increased, and from 1998 video demonstrations, dummies and practice boards were introduced to reduce expenses and the use of animals. In 2002-05, new themes were introduced with video demonstrations and computer programs combined with simulated tissue models. Today “Surgical techniques” for third-year medical students became an integral part of the undergraduate surgical education, and a compulsory course at the Universities of Szeged, Debrecen, Budapest and Pécs.

The English-language programme offered for foreign students at the Faculty of Medicine in Szeged started in 1985. Apart from the language of instruction, the curriculum for the foreign medical students corresponds in subjects and duration to that for Hungarian students. The training course includes lectures and six practicals, the practical training is conducted by 3 or 4 faculty members, who meet with groups of 12 to 15 students.

In each semester, an anonymous, question-based survey is conducted among the students after their completion of the programme. The results unequivocally demonstrate the values of the course, but also reveal the need for transformation from a surgery-based curriculum to a much broader range of interests. Indeed, the interest in skills training is increasing steadily by the lack of access to certain invasive procedures and by concerns over the risks posed by the complex clinical environment. Thus, in 2010 the Medical Faculty at the University of Szeged mandated a transition in the process of graduate training programmes from the traditional surgical components to a focus on the skills required in modern-day clinical practice. Today, this conception of graduate medical education does not include specific statements as to which areas of real-life practice should be more adequately represented in the curriculum. As a practical skills laboratory requires careful planning for implementation, a clear definition of the current level of teaching and the expected outcomes became necessary. Nevertheless, we believe that teaching of practical skills can provide long-term effectiveness in competence concerning basic medical skills. Accordingly, the aims are to establish the conditions for the operation of a practical skills training centre at the University of Szeged, and to provide a basis for quality control mechanisms at both undergraduate and postgraduate levels.