Outcomes after surgery performed by associate clinicians vs doctors (2021)

Certainly relevant to Sierra Leone and other poor countries, probably not relevant to rich countries that generally have surgeons do this type of surgery.

This still seems significant to me.

Most of the comments so far seem focused on the fact this was done in a resource-limited setting, and comparing specialists to generalists. I think that's important to keep in mind, and maybe the title was misleading (I didn't post the article).

However, a study like this would be difficult to do in less resource-limited settings due to all sorts of issues, some of which are due to prudence, and some of which probably less so. It's typical of medical research in developed countries to not lower the standard of care, so this sort of study might never get done otherwise.

So, if you take it for what it is, it's suggesting that a type of procedure classically pointed to as a reason for strict medical licensing forms in fact does not necessarily work the way you think in terms of training background and outcomes. It doesn't point to getting rid of licensing, it just suggests that a particular type of educational and training background does not necessarily result in better outcomes.

This type of finding isn't uncommon in different areas of medicine, and the research is often fighting against double standards, in the sense that you're not just comparing training models, you're comparing time with training program experience as well: the alternative training tracks are often newer and involve less opportunities to have worked out problems, improve certain issues etc.

The irony is that this sort of thing is playing out in the US anyway, under the radar. For example, medical schools are often reducing coursework to a 1.5 years or even 1 year, meaning that a PA with an additional 2-3 years of training post degree often has as much experience in the clinic as a new MD. If you took them and gave them 3-4 years of additional training, they'd probably look similar in outcomes to someone coming out of a residency. I might be wrong about that, but healthcare administrators are increasingly voting with their dollars and apparently don't really see a significant difference in outcome.

At least the way it's used in the US (I know hacker news is not only the US) a medical assistant is someone who has less training than a nurse and is often doing administrative work.

Maybe we need to start training non-MD specialist to perform only specific surgeries.

Crooked incision: flank incisions rarely end up perfectly straight and I understand the cesarian in the conscious patient is not optimal from a surgical positioning standpoint, though good for the patient and baby.

Odd spacing: in live tissue, even when you measure 6mm or whatever the tissue seems to move. In addition, there is often a bit of subcutaneous tissue that is hidden better with one placement over another.

Half hitches: these are bad knots, and one of the failure modes of the square knot. If surgeons are leaving lots of these they might be careless. However, monofilament suture has more likelihood to form them and it's preferred on the skin.

Loose ends: monofilament suture is a little unforgiving and the last throw often does not stay in place. This is why 4 throws of the square knot is preferred.

Speed: how long do you want your patient to wait for you to finish the cosmetic portion of the incision? A model might have a plastic surgeon on hand to finish the job.

The layers you cannot see are the important ones from the standpoint of no hernia or infection. Hopefully they are all done flawlessly, but there cosmesis is not the goal.