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Head and neck tumors: Educational aspects
PRESIDENTIAL ADDRESS
Head and Neck Tumors: Educational Aspects
John C. Gaisford, MD, Pittsburgh, Pennsylvania
As I end my year as president of The Society of Head and Neck Surgeons, I feel this may be the opportune time to share with you a few of my reflections on the present and future purpose of our society. I would like to begin by quoting our society’s purpose as defined in our Constitution and By-Laws. “The object and purpose of the Corporation shall be to serve as a medium for the exchange and advancement of scientific knowledge relevant to the management of head and neck tumors, exclusive of lesions of the brain, with particular reference to the surgery of cancer.” As each year we continue to attend meetings and listen to the presentation of a uniquely wide range of topics on head and neck tumors, it is certainly evident that our interest in advancing scientific knowledge of this disease entity is genuine and sustained. It is the other aspect of our society’s purpose, that of exchanging this information, that I would like to pursue in this discussion. We do exchange our scientific knowledge with great diligence, through meetings such as this and through our publications, but primarily with the others in our particular specialty. What I now question is whether or not we should confine this exchange of knowledge so exclusively to those of us who have chosen to specialize in head and neck tumor work and to the residents who plan to enter our specialty. My contention is that, as individuals and as a society, we should consider disseminating appropriate segments of our scientific knowledge to physicians who are not members of and will never From The Western Pennsylvania Hospital, Pittsburgh, Pennsylvania. Presented at the Twenty-Fifth Annual Meeting of The Society of Head and Neck Surgeons, Pittsburgh, Pennsylvania, April 1-4, 1979. Address for reprints: John C. Gaisford, MD, The Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, Pennsylvania 15224.
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enter our specialty. Dr. Stuart Strong, in his manpower study, stated that the 40,000 new cases of head and neck cancer each year would be treated by members of our society or the American Society of Head & Neck Surgeons. What was not stated, and is central to my thesis, is that of those 40,000 cases of head and neck cancer, the vast majority were originally seen, not by members of our societies, but by physicians in other disciplines with little or no training in even the fundamental treatment of tumors. It is toward these physicians that I believe part of our individual and society’s educational efforts should be directed. This may seem like a grandiose scheme but in actuality, our educational efforts would, from a practical point of view, be limited primarily to physicians at the medical school and resident level of training. And, as a society, I feel we are uniquely qualified for this undertaking. We have a multiplicity of backgrounds and training. The total management of head and neck tumors is multidisciplinary, involving surgeons (from a number of specialties), immunologists, radiotherapists, and dentists. Almost all of us have affiliations with university health centers, with cancer centers, or with plain community hospitals. In these institutions are the medical students and residents who will become tomorrow’s family practitioners, specialists in internal medicine, obstetricians, gynecologists, and surgeons in a variety of surgical specialties. I would like to suggest, and even urge, that each one of us exert whatever influence he has in these training institutions to have the fundamentals of head and neck tumor work taught to these young physicians. I obviously cannot detail what segments of our knowledge and experience should be disseminated. Most of you are surgeons and some are radiologists,
The American Journal of Surgery
Presidential Address
chemotherapists, or immunologists, to mention a few of our specialty groups, and I cannot presume to tell you what to teach others. I do feel, however, that each one of us knows best his educational environment in the different institutions. We all have differing abilities and opportunities to influence the educational content of resident training in the areas outside our specialty. But I feel that most of us agree that it is not unreasonable or impractical to try to insure that residents, and also medical students, know how to properly obtain a patient’s history and perform a physical examination in the anatomic area of the head and neck; know what a cancer of the mouth looks like; and know that lumps in the neck or a sore in the mouth may mean metastatic cervical disease and primary cancer. I will be the first to admit that involving ourselves in an educational effort with physicians outside our own specialty will require an effort and may be unrewarding. Certainly my own personal experience has not always been encouraging. I began to present my basic views on head and neck cancer 35 years ago in Pittsburgh. At first I was asked to speak once a year on mouth cancer to the junior medical and dental students at the local university health center. The number of sessions in the series was soon reduced. I spoke at innumerable dental and medical meetings in the surrounding areas and naively expected that everyone who listened to me would at least be able
Volume 139, October 1979
to diagnose mouth cancer in its early stages and make the proper referrals for treatment. It didn’t happen that way. Far advanced cases have continued to present. However, as you can see, I am not discouraged. I am still convinced that the education of those outside our society on the fundamental treatment of head and neck tumors is essential to our success. I am confident that we all agree that our management of head and neck tumors would be measurably improved if small lesions were diagnosed early and referred quickly for definitive treatment. This society is the group to undertake this educational endeavor. Our members are, in my opinion, the most erudite in the country in the problems of head and neck tumors. Our educational program for those entering our specialty continues to improve. The efforts of Dr. John Lore in working toward establishing head and neck training fellowships in the United States and Canada are, I believe, particularly significant. Our annual programs are outstanding and reflect the dedication of our society to meeting the challenge of providing optimal care for patients with head and neck tumors. I applaud every effort we have made to live up to our society’s high objectives and purposes. I only ask that we broaden our efforts to include those who see our patients before we do. I wish to close by thanking you for having me as your president. It has been an honor I will cherish.
473
Head and Neck Tumors: Educational Aspects
John C. Gaisford, MD, Pittsburgh, Pennsylvania
As I end my year as president of The Society of Head and Neck Surgeons, I feel this may be the opportune time to share with you a few of my reflections on the present and future purpose of our society. I would like to begin by quoting our society’s purpose as defined in our Constitution and By-Laws. “The object and purpose of the Corporation shall be to serve as a medium for the exchange and advancement of scientific knowledge relevant to the management of head and neck tumors, exclusive of lesions of the brain, with particular reference to the surgery of cancer.” As each year we continue to attend meetings and listen to the presentation of a uniquely wide range of topics on head and neck tumors, it is certainly evident that our interest in advancing scientific knowledge of this disease entity is genuine and sustained. It is the other aspect of our society’s purpose, that of exchanging this information, that I would like to pursue in this discussion. We do exchange our scientific knowledge with great diligence, through meetings such as this and through our publications, but primarily with the others in our particular specialty. What I now question is whether or not we should confine this exchange of knowledge so exclusively to those of us who have chosen to specialize in head and neck tumor work and to the residents who plan to enter our specialty. My contention is that, as individuals and as a society, we should consider disseminating appropriate segments of our scientific knowledge to physicians who are not members of and will never From The Western Pennsylvania Hospital, Pittsburgh, Pennsylvania. Presented at the Twenty-Fifth Annual Meeting of The Society of Head and Neck Surgeons, Pittsburgh, Pennsylvania, April 1-4, 1979. Address for reprints: John C. Gaisford, MD, The Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, Pennsylvania 15224.
472
enter our specialty. Dr. Stuart Strong, in his manpower study, stated that the 40,000 new cases of head and neck cancer each year would be treated by members of our society or the American Society of Head & Neck Surgeons. What was not stated, and is central to my thesis, is that of those 40,000 cases of head and neck cancer, the vast majority were originally seen, not by members of our societies, but by physicians in other disciplines with little or no training in even the fundamental treatment of tumors. It is toward these physicians that I believe part of our individual and society’s educational efforts should be directed. This may seem like a grandiose scheme but in actuality, our educational efforts would, from a practical point of view, be limited primarily to physicians at the medical school and resident level of training. And, as a society, I feel we are uniquely qualified for this undertaking. We have a multiplicity of backgrounds and training. The total management of head and neck tumors is multidisciplinary, involving surgeons (from a number of specialties), immunologists, radiotherapists, and dentists. Almost all of us have affiliations with university health centers, with cancer centers, or with plain community hospitals. In these institutions are the medical students and residents who will become tomorrow’s family practitioners, specialists in internal medicine, obstetricians, gynecologists, and surgeons in a variety of surgical specialties. I would like to suggest, and even urge, that each one of us exert whatever influence he has in these training institutions to have the fundamentals of head and neck tumor work taught to these young physicians. I obviously cannot detail what segments of our knowledge and experience should be disseminated. Most of you are surgeons and some are radiologists,
The American Journal of Surgery
Presidential Address
chemotherapists, or immunologists, to mention a few of our specialty groups, and I cannot presume to tell you what to teach others. I do feel, however, that each one of us knows best his educational environment in the different institutions. We all have differing abilities and opportunities to influence the educational content of resident training in the areas outside our specialty. But I feel that most of us agree that it is not unreasonable or impractical to try to insure that residents, and also medical students, know how to properly obtain a patient’s history and perform a physical examination in the anatomic area of the head and neck; know what a cancer of the mouth looks like; and know that lumps in the neck or a sore in the mouth may mean metastatic cervical disease and primary cancer. I will be the first to admit that involving ourselves in an educational effort with physicians outside our own specialty will require an effort and may be unrewarding. Certainly my own personal experience has not always been encouraging. I began to present my basic views on head and neck cancer 35 years ago in Pittsburgh. At first I was asked to speak once a year on mouth cancer to the junior medical and dental students at the local university health center. The number of sessions in the series was soon reduced. I spoke at innumerable dental and medical meetings in the surrounding areas and naively expected that everyone who listened to me would at least be able
Volume 139, October 1979
to diagnose mouth cancer in its early stages and make the proper referrals for treatment. It didn’t happen that way. Far advanced cases have continued to present. However, as you can see, I am not discouraged. I am still convinced that the education of those outside our society on the fundamental treatment of head and neck tumors is essential to our success. I am confident that we all agree that our management of head and neck tumors would be measurably improved if small lesions were diagnosed early and referred quickly for definitive treatment. This society is the group to undertake this educational endeavor. Our members are, in my opinion, the most erudite in the country in the problems of head and neck tumors. Our educational program for those entering our specialty continues to improve. The efforts of Dr. John Lore in working toward establishing head and neck training fellowships in the United States and Canada are, I believe, particularly significant. Our annual programs are outstanding and reflect the dedication of our society to meeting the challenge of providing optimal care for patients with head and neck tumors. I applaud every effort we have made to live up to our society’s high objectives and purposes. I only ask that we broaden our efforts to include those who see our patients before we do. I wish to close by thanking you for having me as your president. It has been an honor I will cherish.
473