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The surgeon's assistant's education and role
The surgeon’s assistant‘s education and role
The surgeon’s assistant i s a relatively new
suggested duties have been outlined for
member of the operating room team. In
such functioning programs as the Veterans Administration Hospital, Birmingham, Ala, for the orthopedic physician’s assistant, and for the urologic physician’s assistant. In general, he i s expected to take histories, perform physical examinations, and write routine orders previously agreed upon and under the direct supervision of the physician.
August, the American College of Surgeons published ”Essentials of an approved educational program for the surgeon‘s assistant.” The introduction of a new team member in the operating room raises many questions For operating room nurses. To clarify the function of the surgeon’s assistant and his relationship to nurses and others in the operating room, Harold A Zintel, MD, assistant director of the American College of Surgeons, has prepared answers for the following questions submitted to the American
Harold A Zintel
College of Surgeons by the Association of Operating Room Nurses. Also, the Essentials for educational programs will be reprinted in the January Journal from the Bulletin of the American College of Surgeons.
Q
What functions are surgeon‘s
A
There i s no overall summary of what
assist-
ants now performing?
tasks surgeon’s
assistants are now
performing in the United States. Detailed,
1151
Q
Do these functions overlap with the
pations
operating room nurse’s function?
educational requirements were decided up-
A
The
surgeon‘s
assistant carries
out
duties which are usually performed b y surgeons, and in the limited areas covered, the surgeon’s assistant would b e acting to carry out the limited duties which were previously performed by the surgeon. The functions of the surgeon‘s assistant do not overlap those of the operating room nurse to any significant degree.
Q
Do you envision that the surgeon’s assistant’s function will change or expand as a result of the recently published ACS Essentials?
A
Such change i s not anticipated. Note
that the Essentials are concerned with the educational program. When approved, the specific duties of the surgeon’s assistant will become part of the guidelines which help to explain the Essentials.
Q
The Essentials recommend two years of college or the equivalent as a requirement for selection of students. Of the existing surgeon’s assistant programs, apparently only one meets this requirement. Others require only a
high school educa-
tion, as do most physician’s assistant programs.
Why does the ACS believe thaf two
would
be considered.
The
high
on after consultation with many individuals who have organized surgeon’s assistant educational programs or who have surgeon’s assistants working with them in their daily surgical practice.
Do you anticipate that nurses will become surgeon’s assistants, a n d if so, is this a source ACS will look to? Will operating room technicians be entering these programs and is this training acceptable?
It i s anticipated that nurses will become surgeon‘s assistants. Existing surgeon’s assistant programs encourage nurses to become surgeon’s assistants. As long as admission qualifications are met there should be no restrictions on individuals entering surgeon‘s assistant educational programs because of their previous experience. Operating room technicians would be admitted as will other individuals with the requisite background. However, an operating room technician without previous patient management experience, who has just completed his ORT educational program, would not be qualified to become a student in an educational program for the surgeon’s assistant. Educational programs for ORTs can, of course, b e a t the college level but this is not customary.
A
years of college is necessary for admission to the surgeon’s assistant’s programs?
A
Each educational institution may in-
Is the surgeon’s assistant seen as a
A
The surgeon‘s
limited discipline, or is there career mobility for the surgeon‘s assistant?
terpret “two years of college or the
equivalent”
in a slightly different fashion.
Note that the requirement reads “candidates for admission must have completed . two years of college or the equivalent education beyond high school a t the vocational, nursing, or the collegiate level i s helpful.” The experience qualification for those students who have previously handled patients in military or civilian occu-
..
1152
Q
assistant i s not con-
sidered to be a limited discipline. It i s anticipated that there should and will b e both lateral and upward mobility for the surgeon’s assistant as there i s for anyone in the field of medical care. Given a dedicated, capable individual willing to participate in additional, necessary education, there i s no restriction of his mobility. An op-
AORN Journal, December 1973,Vol 18, N o 6
erating room technician may become in turn, a nurse, a surgeon’s assistant, or an MD. Examples of such mobility are available.
Q
Do we understand correctly that the
A
No statement has been made as to whether the American College of
ACS will not be accrediting surgeon’s
assistant‘s programs? If this i s true, who will be involved in implementing the standards for educational programs?
Surgeons will or will not be involved in the accreditation of surgeon’s assistant educational programs. In 1972 some 15 educational programs graduated 90 individuals who became surgeon’s assistants. As more programs are training such individuals in 1973, i t would appear that accreditation should be established for the educational programs for the surgeon‘s assistants. The College continues to favor accreditation of such programs through the American Medical Association, but if this i s not feasible, the American College of Surgeons i s prepared to function as the accrediting agency.
Q
How will prospective
A
As part of the accreditation process,
students and
employers know which programs meet the ACS standards?
a list will be kept of those educational institutions which implement the standards, adhere to the standards, and most significantly, produce graduates of acceptable caliber. A t present the College provides a list of educational programs from which graduates are known to go on to obtain employment as surgeon’s assistants.
Q
Will surgeon‘s assistants be individ-
ually credentialed before they can practice in any hospital, or will they be credentialed b y the hospital where they are employed? AORN feels that nurses need reassurance that the surgeon’s assistant i s
qualified and trained for his job so that she i s not burdened with the responsibility of critiquing and judging his performance.
A
At least 90 individuals were employed
as surgeon’s assistants for the first time in the year 1972; presumably more than 90 were hired in 1973. Some were trained and working before 1972. It i s apparent that a substantial, uncertain number are practicing at the present time. Since there i s no current national credentialing mechanism, they are practicing without such credentials. The possibility of credentialing surgeon’s assistants by the hospital raises questions which cannot be answered now. Credentialing b y an institution of nurses and other medical or paramedical personnel has been widely discussed but we are not aware of any institution approved to certify its own medical, nursing, and other staff members. Hospital credentialing seems inappropriate because the interpretation of a surgeon’s assistant‘s professional relationships by the American College of Surgeons, the American Hospital Association, and the American Medical Association dictates that an individual, in order to function as a surgeon’s (physician‘s) assistant, must be hired by an individual physician. This physician i s responsible for the surgeon’s assistant’s income, his supervision and his actions as a surgeon’s assistant.
Q
A t present, there seems to be little
A
The legal issues regarding all phy-
legal status for the surgeon’s assistant. Do you anticipate instigating action to change this?
sician‘s assistants are complex, but it seems probable that existing legislation would permit surgeon’s assistants to work in nearly half of the United States. By the end of 1972, 24 states had enacted legislation pertaining to physician’s assistants.’ The American College of Surgeons has
n O R N Journal, December 1973, Vol 18, N o 6
1153
made no effort to influence legislation for surgeon‘s assistants (or physician’s ants) and has no plans to do so.
assist-
more from personality factors than from basic role conflicts. What do you think will be the impact
Q
What do you see as the relationship
between the surgeon’s assistant and other members of the operating room team-nurses, technicians and others?
A
In institutions where surgeon’s assist-
ants are employed, there appears to be no disruption of the relationship of the operating room team. Given time for each to learn the other’s areas of responsibility there results an exceedingly harmonious group. As indicated by the lists of specific duties, previously referred to, and knowing the functions expected of nurses, it seems clear that the surgeon’s assistant is not assuming the duties of any established nursing or paramedical personnel. in most operating rooms a registered nurse supervisor i s in charge. By and large the operating room technician functions as a scrub nurse. The surgeon‘s assistant i s delegated certain of the surgeon’s tasks; he simply extends the ability of the surgeon to do the things the surgeon i s expected to do and authorized by law to do.
Q
Do you anticipate that operating room
A
The surgeon’s assistant acting as he
nurses be asked to take orders from the physician‘s assistant?
does always, for the surgeon, will be expected to write orders, such as postoperative orders, on the patient‘s chart and give such verbal orders as he knows are requested by the physician. In this sense, he will be ”giving” orders to the operating room nurses and others. Because he i s acting in lieu of the surgeon, he will be expected to give only those orders which his employer, the surgeon, wants carried out. Potential problems, as in the relation between physician and nurse, appear to arise
1156
of the surgeon’s assistant on the nurse-surgeon relationship?
A
The appearance of a
properly in-
structed surgeon’s assistant upon the scene could augment or improve the nursesurgeon relationship. The primary objective of surgeons and nurses alike i s improved care of the surgical patient. With introduction of the surgeon’s assistant help for the surgeon, the patient should receive better care than he would if the surgeon had no such assistance. Modern medical practice requires a large group or team of specialists with differing, specific duties, to provide the best care for the patient.
Q
When the surgeon leaves the op-
erating room allowing the surgeon’s assistant to close the wound, has the OR nurse or supervisor any responsibility for the performance? If so, what is the extent of her responsibility?
It would appear that the operating room nurse or the supervisor has the same responsibility for the performance of the surgeon’s assistant that she has for the surgeon. The operating room nurse or supervisor, through proper channels, should report any inadequate performance, including improper conduct, within the operating room. It has been my experience that the nurse can offer helpful suggestions or constructive criticism to a surgeon if the relationship i s one of mutual respect. The surgeon‘s assistant is merely carrying out part of the work of the surgeon. The nurse’s ultimate responsibility to the hospital and i t s patients i s not altered.
A
Will the surgeon’s assistant be subject to the surgeon’s peer reviews?
AORN Journal, December 1973, Vol 18, N o 6
the
The American Medical Association repre-
direct employee of and the legal responsibility of the surgeon, expected to
sentatives wanted those interested in becoming surgeon’s assistants to complete the
function with him and for him in his absence, i s clearly subject to the surgeon’s peer reviews. In some hospitals it i s necessary that the surgeon’s assistant be approved by the medical board and the board of trustees of the hospital before he can serve as a
educational program for the assistant to the primary care physician and then to go on to a ”graduate training“ in surgery to prepare them to be surgeon’s assistants. It seems inappropriate to require individuals to undergo an unduly protracted educational
surgeon’s assistant. Also in some states the
experience when a high level of relevant education could be obtained in a shorter period of time. The avoidance of unnecessarily long educational programs i s a major objective of the public, the legislators, and many educators in the medical arena today. The concept of having generalists train a specialist’s assistant seemed no more acceptable than the outmoded notion of training physicians as general practitioners
A
The
surgeon’s
assistant,
being
surgeon’s assistants are required: 1) to have 2) to have had acceptable training; been approved by the equivalent of a state medical board; and 3) are allowed to work as a surgeon‘s assistant only for a physician who in turn i s approved by the state medical board to hire the surgeon‘s assistant. Certainly any action of the surgeon’s assistant would be something that would fall under the scrutiny of individuals carrying out the process that we call peer review. For several years,
the College has
been working with the AMA to develop standards for the surgeon’s assistant. In publishing the standards, the College is acting independently of the AMA. Why did you decide to go ahead at this time and publish the Essentials?
A
The American College of Surgeons
worked very closely with the AMA for a period of over three years in an attempt to bring about approval and publication of the Essentials for the surgeon’s assistant. After repeated assurances that AMA approval was imminent there were interminable delays. When the AMA listed and presumably assured accreditation of some 40 educational programs for the assistant to the primary care physician, without indication of any provision for the surgeon’s assistant, the College decided to publish the ”Essentials for the Surgeon’s Assistant.” The College felt strongly the need to set standards for deserving educational programs and the graduates of such programs.
before adding on surgical education. The College felt a duty to its Fellows and to the public to publish its recommendations for the Essentials of an approved educational program for the surgeon‘s assistant. The College i s interested in maintaining high standards. It could no longer ignore the following facts: 1) there i s a considerable demand for surgeon’s assistants; 2) educational programs have been established for surgeon‘s assistants; and 3) surgeon’s assistants are now functioning in the field. More training programs are being established each year and more individuals who function as surgeon’s assistants are being graduated each year. Some of these programs may not have high educational standards. For these reasons, the College felt impelled to let the public and the medical world know i t s position regarding adequate education for this category of health worker.
Q
Do you think that the publication of the Essentials will lead to a prolif-
eration of surgeon’s
assistants programs?
If more surgeon’s assistants are available, do you think there will be sufficient jobs available for them?
AORN Journal, December 1973, Vol 18, N o 6
1157
There i s no reason to believe that the
the public, the legislators, and the medical
publication of the Essentials would lead to a proliferation of surgeon’s assistants. As previously mentioned, the educa-
world to know which educational progrums and which graduates do or do not meet the College’s minimal levels. The actions of the
tional programs have been increasing in
College, as with its other efforts in the post 60 years, have been designed to insure the
A
number and the number of individuals being graduated from these programs has been increasing in the past several years. It i s quite possible that both programs and
highest quality of care for the greatest number of patients.
graduates would continue to increase in
FOOTNOTE
number. Publication of the Essentials by the College should not affect the supply and demand of surgeon‘s assistants.
The publication of the Essentials enables
~
~
I. Winston J Dean, “State Legislation for Physician’s Assistants: A Review and Analysis,” H e a l t h Services Reports, January 1973, pp 30-40.
~~~~~~
Au+oma+ic blood pressure monitor A monitor that measures blood pressure automatically at frequent intervals has added to the capability of nurses to manage patients with greater safety in the operating room and intensive care unit. Paul J Poppers, MD, described ultrasonic arteriokinetography as an indirect method SO
accurate that it rivals the direct intra-arterial method and is much simpler to use. Dr
Poppers i s associate professor of anesthesiology of the College of Physicians and Sur. geons, Columbia University, New York. He was speaking to a gathering of the American
Society of Anesthesiologists. The technique has made it possible to take automatic blood pressure measurements for patients in shock. By modifying it for measurement in the leg, those with burns or severe trauma of the arms can be monitored. It has also been adapted for small children and infants. “It appears that ultrasonic arteriokinetography may very well be the most important advance in pediatric anesthesiology of the last decade,” Dr Poppers reported.
The procedure i s based on observing by ultrasound the motion characteristics of an artery beneath a blood pressure cuff in various stages of inflation. Crystals which emit and receive ultrasound are placed on the extremity beneath the blood pressure cuff. The pulsatile movement of the brachial artery in the upper arm produces a Doppler frequency shift in the reflected untrasound. The arterial wall movement changes when the cuff i s inflated above systolic pressure, completely occluding the artery and interrupting all blood flow. As the cuff deflates, compression becomes less than systolic pressure and the artery i s quickly forced open by the blood. The rapid motion produces large Doppler shifts; the first indicates the systolic point. As the cuff i s further deflated, the diastolic point is reached. The blood can flow unhindered, rapid arterial wall motion ceases, and Doppler shifts become small. Thus the systolic and diastolic pressures are determined.
1158
AORN Journal, December 1973, Vol 18, N o 6
The surgeon’s assistant i s a relatively new
suggested duties have been outlined for
member of the operating room team. In
such functioning programs as the Veterans Administration Hospital, Birmingham, Ala, for the orthopedic physician’s assistant, and for the urologic physician’s assistant. In general, he i s expected to take histories, perform physical examinations, and write routine orders previously agreed upon and under the direct supervision of the physician.
August, the American College of Surgeons published ”Essentials of an approved educational program for the surgeon‘s assistant.” The introduction of a new team member in the operating room raises many questions For operating room nurses. To clarify the function of the surgeon’s assistant and his relationship to nurses and others in the operating room, Harold A Zintel, MD, assistant director of the American College of Surgeons, has prepared answers for the following questions submitted to the American
Harold A Zintel
College of Surgeons by the Association of Operating Room Nurses. Also, the Essentials for educational programs will be reprinted in the January Journal from the Bulletin of the American College of Surgeons.
Q
What functions are surgeon‘s
A
There i s no overall summary of what
assist-
ants now performing?
tasks surgeon’s
assistants are now
performing in the United States. Detailed,
1151
Q
Do these functions overlap with the
pations
operating room nurse’s function?
educational requirements were decided up-
A
The
surgeon‘s
assistant carries
out
duties which are usually performed b y surgeons, and in the limited areas covered, the surgeon’s assistant would b e acting to carry out the limited duties which were previously performed by the surgeon. The functions of the surgeon‘s assistant do not overlap those of the operating room nurse to any significant degree.
Q
Do you envision that the surgeon’s assistant’s function will change or expand as a result of the recently published ACS Essentials?
A
Such change i s not anticipated. Note
that the Essentials are concerned with the educational program. When approved, the specific duties of the surgeon’s assistant will become part of the guidelines which help to explain the Essentials.
Q
The Essentials recommend two years of college or the equivalent as a requirement for selection of students. Of the existing surgeon’s assistant programs, apparently only one meets this requirement. Others require only a
high school educa-
tion, as do most physician’s assistant programs.
Why does the ACS believe thaf two
would
be considered.
The
high
on after consultation with many individuals who have organized surgeon’s assistant educational programs or who have surgeon’s assistants working with them in their daily surgical practice.
Do you anticipate that nurses will become surgeon’s assistants, a n d if so, is this a source ACS will look to? Will operating room technicians be entering these programs and is this training acceptable?
It i s anticipated that nurses will become surgeon‘s assistants. Existing surgeon’s assistant programs encourage nurses to become surgeon’s assistants. As long as admission qualifications are met there should be no restrictions on individuals entering surgeon‘s assistant educational programs because of their previous experience. Operating room technicians would be admitted as will other individuals with the requisite background. However, an operating room technician without previous patient management experience, who has just completed his ORT educational program, would not be qualified to become a student in an educational program for the surgeon’s assistant. Educational programs for ORTs can, of course, b e a t the college level but this is not customary.
A
years of college is necessary for admission to the surgeon’s assistant’s programs?
A
Each educational institution may in-
Is the surgeon’s assistant seen as a
A
The surgeon‘s
limited discipline, or is there career mobility for the surgeon‘s assistant?
terpret “two years of college or the
equivalent”
in a slightly different fashion.
Note that the requirement reads “candidates for admission must have completed . two years of college or the equivalent education beyond high school a t the vocational, nursing, or the collegiate level i s helpful.” The experience qualification for those students who have previously handled patients in military or civilian occu-
..
1152
Q
assistant i s not con-
sidered to be a limited discipline. It i s anticipated that there should and will b e both lateral and upward mobility for the surgeon’s assistant as there i s for anyone in the field of medical care. Given a dedicated, capable individual willing to participate in additional, necessary education, there i s no restriction of his mobility. An op-
AORN Journal, December 1973,Vol 18, N o 6
erating room technician may become in turn, a nurse, a surgeon’s assistant, or an MD. Examples of such mobility are available.
Q
Do we understand correctly that the
A
No statement has been made as to whether the American College of
ACS will not be accrediting surgeon’s
assistant‘s programs? If this i s true, who will be involved in implementing the standards for educational programs?
Surgeons will or will not be involved in the accreditation of surgeon’s assistant educational programs. In 1972 some 15 educational programs graduated 90 individuals who became surgeon’s assistants. As more programs are training such individuals in 1973, i t would appear that accreditation should be established for the educational programs for the surgeon‘s assistants. The College continues to favor accreditation of such programs through the American Medical Association, but if this i s not feasible, the American College of Surgeons i s prepared to function as the accrediting agency.
Q
How will prospective
A
As part of the accreditation process,
students and
employers know which programs meet the ACS standards?
a list will be kept of those educational institutions which implement the standards, adhere to the standards, and most significantly, produce graduates of acceptable caliber. A t present the College provides a list of educational programs from which graduates are known to go on to obtain employment as surgeon’s assistants.
Q
Will surgeon‘s assistants be individ-
ually credentialed before they can practice in any hospital, or will they be credentialed b y the hospital where they are employed? AORN feels that nurses need reassurance that the surgeon’s assistant i s
qualified and trained for his job so that she i s not burdened with the responsibility of critiquing and judging his performance.
A
At least 90 individuals were employed
as surgeon’s assistants for the first time in the year 1972; presumably more than 90 were hired in 1973. Some were trained and working before 1972. It i s apparent that a substantial, uncertain number are practicing at the present time. Since there i s no current national credentialing mechanism, they are practicing without such credentials. The possibility of credentialing surgeon’s assistants by the hospital raises questions which cannot be answered now. Credentialing b y an institution of nurses and other medical or paramedical personnel has been widely discussed but we are not aware of any institution approved to certify its own medical, nursing, and other staff members. Hospital credentialing seems inappropriate because the interpretation of a surgeon’s assistant‘s professional relationships by the American College of Surgeons, the American Hospital Association, and the American Medical Association dictates that an individual, in order to function as a surgeon’s (physician‘s) assistant, must be hired by an individual physician. This physician i s responsible for the surgeon’s assistant’s income, his supervision and his actions as a surgeon’s assistant.
Q
A t present, there seems to be little
A
The legal issues regarding all phy-
legal status for the surgeon’s assistant. Do you anticipate instigating action to change this?
sician‘s assistants are complex, but it seems probable that existing legislation would permit surgeon’s assistants to work in nearly half of the United States. By the end of 1972, 24 states had enacted legislation pertaining to physician’s assistants.’ The American College of Surgeons has
n O R N Journal, December 1973, Vol 18, N o 6
1153
made no effort to influence legislation for surgeon‘s assistants (or physician’s ants) and has no plans to do so.
assist-
more from personality factors than from basic role conflicts. What do you think will be the impact
Q
What do you see as the relationship
between the surgeon’s assistant and other members of the operating room team-nurses, technicians and others?
A
In institutions where surgeon’s assist-
ants are employed, there appears to be no disruption of the relationship of the operating room team. Given time for each to learn the other’s areas of responsibility there results an exceedingly harmonious group. As indicated by the lists of specific duties, previously referred to, and knowing the functions expected of nurses, it seems clear that the surgeon’s assistant is not assuming the duties of any established nursing or paramedical personnel. in most operating rooms a registered nurse supervisor i s in charge. By and large the operating room technician functions as a scrub nurse. The surgeon‘s assistant i s delegated certain of the surgeon’s tasks; he simply extends the ability of the surgeon to do the things the surgeon i s expected to do and authorized by law to do.
Q
Do you anticipate that operating room
A
The surgeon’s assistant acting as he
nurses be asked to take orders from the physician‘s assistant?
does always, for the surgeon, will be expected to write orders, such as postoperative orders, on the patient‘s chart and give such verbal orders as he knows are requested by the physician. In this sense, he will be ”giving” orders to the operating room nurses and others. Because he i s acting in lieu of the surgeon, he will be expected to give only those orders which his employer, the surgeon, wants carried out. Potential problems, as in the relation between physician and nurse, appear to arise
1156
of the surgeon’s assistant on the nurse-surgeon relationship?
A
The appearance of a
properly in-
structed surgeon’s assistant upon the scene could augment or improve the nursesurgeon relationship. The primary objective of surgeons and nurses alike i s improved care of the surgical patient. With introduction of the surgeon’s assistant help for the surgeon, the patient should receive better care than he would if the surgeon had no such assistance. Modern medical practice requires a large group or team of specialists with differing, specific duties, to provide the best care for the patient.
Q
When the surgeon leaves the op-
erating room allowing the surgeon’s assistant to close the wound, has the OR nurse or supervisor any responsibility for the performance? If so, what is the extent of her responsibility?
It would appear that the operating room nurse or the supervisor has the same responsibility for the performance of the surgeon’s assistant that she has for the surgeon. The operating room nurse or supervisor, through proper channels, should report any inadequate performance, including improper conduct, within the operating room. It has been my experience that the nurse can offer helpful suggestions or constructive criticism to a surgeon if the relationship i s one of mutual respect. The surgeon‘s assistant is merely carrying out part of the work of the surgeon. The nurse’s ultimate responsibility to the hospital and i t s patients i s not altered.
A
Will the surgeon’s assistant be subject to the surgeon’s peer reviews?
AORN Journal, December 1973, Vol 18, N o 6
the
The American Medical Association repre-
direct employee of and the legal responsibility of the surgeon, expected to
sentatives wanted those interested in becoming surgeon’s assistants to complete the
function with him and for him in his absence, i s clearly subject to the surgeon’s peer reviews. In some hospitals it i s necessary that the surgeon’s assistant be approved by the medical board and the board of trustees of the hospital before he can serve as a
educational program for the assistant to the primary care physician and then to go on to a ”graduate training“ in surgery to prepare them to be surgeon’s assistants. It seems inappropriate to require individuals to undergo an unduly protracted educational
surgeon’s assistant. Also in some states the
experience when a high level of relevant education could be obtained in a shorter period of time. The avoidance of unnecessarily long educational programs i s a major objective of the public, the legislators, and many educators in the medical arena today. The concept of having generalists train a specialist’s assistant seemed no more acceptable than the outmoded notion of training physicians as general practitioners
A
The
surgeon’s
assistant,
being
surgeon’s assistants are required: 1) to have 2) to have had acceptable training; been approved by the equivalent of a state medical board; and 3) are allowed to work as a surgeon‘s assistant only for a physician who in turn i s approved by the state medical board to hire the surgeon‘s assistant. Certainly any action of the surgeon’s assistant would be something that would fall under the scrutiny of individuals carrying out the process that we call peer review. For several years,
the College has
been working with the AMA to develop standards for the surgeon’s assistant. In publishing the standards, the College is acting independently of the AMA. Why did you decide to go ahead at this time and publish the Essentials?
A
The American College of Surgeons
worked very closely with the AMA for a period of over three years in an attempt to bring about approval and publication of the Essentials for the surgeon’s assistant. After repeated assurances that AMA approval was imminent there were interminable delays. When the AMA listed and presumably assured accreditation of some 40 educational programs for the assistant to the primary care physician, without indication of any provision for the surgeon’s assistant, the College decided to publish the ”Essentials for the Surgeon’s Assistant.” The College felt strongly the need to set standards for deserving educational programs and the graduates of such programs.
before adding on surgical education. The College felt a duty to its Fellows and to the public to publish its recommendations for the Essentials of an approved educational program for the surgeon‘s assistant. The College i s interested in maintaining high standards. It could no longer ignore the following facts: 1) there i s a considerable demand for surgeon’s assistants; 2) educational programs have been established for surgeon‘s assistants; and 3) surgeon’s assistants are now functioning in the field. More training programs are being established each year and more individuals who function as surgeon’s assistants are being graduated each year. Some of these programs may not have high educational standards. For these reasons, the College felt impelled to let the public and the medical world know i t s position regarding adequate education for this category of health worker.
Q
Do you think that the publication of the Essentials will lead to a prolif-
eration of surgeon’s
assistants programs?
If more surgeon’s assistants are available, do you think there will be sufficient jobs available for them?
AORN Journal, December 1973, Vol 18, N o 6
1157
There i s no reason to believe that the
the public, the legislators, and the medical
publication of the Essentials would lead to a proliferation of surgeon’s assistants. As previously mentioned, the educa-
world to know which educational progrums and which graduates do or do not meet the College’s minimal levels. The actions of the
tional programs have been increasing in
College, as with its other efforts in the post 60 years, have been designed to insure the
A
number and the number of individuals being graduated from these programs has been increasing in the past several years. It i s quite possible that both programs and
highest quality of care for the greatest number of patients.
graduates would continue to increase in
FOOTNOTE
number. Publication of the Essentials by the College should not affect the supply and demand of surgeon‘s assistants.
The publication of the Essentials enables
~
~
I. Winston J Dean, “State Legislation for Physician’s Assistants: A Review and Analysis,” H e a l t h Services Reports, January 1973, pp 30-40.
~~~~~~
Au+oma+ic blood pressure monitor A monitor that measures blood pressure automatically at frequent intervals has added to the capability of nurses to manage patients with greater safety in the operating room and intensive care unit. Paul J Poppers, MD, described ultrasonic arteriokinetography as an indirect method SO
accurate that it rivals the direct intra-arterial method and is much simpler to use. Dr
Poppers i s associate professor of anesthesiology of the College of Physicians and Sur. geons, Columbia University, New York. He was speaking to a gathering of the American
Society of Anesthesiologists. The technique has made it possible to take automatic blood pressure measurements for patients in shock. By modifying it for measurement in the leg, those with burns or severe trauma of the arms can be monitored. It has also been adapted for small children and infants. “It appears that ultrasonic arteriokinetography may very well be the most important advance in pediatric anesthesiology of the last decade,” Dr Poppers reported.
The procedure i s based on observing by ultrasound the motion characteristics of an artery beneath a blood pressure cuff in various stages of inflation. Crystals which emit and receive ultrasound are placed on the extremity beneath the blood pressure cuff. The pulsatile movement of the brachial artery in the upper arm produces a Doppler frequency shift in the reflected untrasound. The arterial wall movement changes when the cuff i s inflated above systolic pressure, completely occluding the artery and interrupting all blood flow. As the cuff deflates, compression becomes less than systolic pressure and the artery i s quickly forced open by the blood. The rapid motion produces large Doppler shifts; the first indicates the systolic point. As the cuff i s further deflated, the diastolic point is reached. The blood can flow unhindered, rapid arterial wall motion ceases, and Doppler shifts become small. Thus the systolic and diastolic pressures are determined.
1158
AORN Journal, December 1973, Vol 18, N o 6