[semenko]

This title has little to do with the article (and keeps changing).

This piece compares non-surgeon MDs with non-MDs (medical assistants) performing minor surgeries in resource-limited settings.

Its a bit of an odd comparison, as the non-MDs have specifically trained in a 3-year program to perform minor surgeries (CapaCare).

[derbOac]

Fair point, but then the article is demonstrating that people trained to do specific types of care actually might have better outcomes than generalist education.

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.

[scott00]

The comparison makes sense in the context of Sierra Leone, where the study was done. The full article mentions that there are very few surgeons there, and that basic surgeries are usually done by general MDs or ACs, the types of training compared.

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

[psychphysic]

Wow they really butchered the meaning here then. Thanks for clarifying.

[loaph]

A minor clarification, it compares MDs to ACs. It says ACs are associate clinicians who have an amount training somewhere between a nurse and a doctor.

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.