The Turkish Surgical Society, which dates back to the year 1929 when the Turkish Surgical Society was founded, is celebrating its 90th anniversary this year. After the military coup on September 12, 1980, the first seeds of the Turkish Surgical Society were sown in an extraordinary period when all non-governmental organizations were closed down, some of which suspended, and all decisions and accounts scrutinized. Devoted studies in such a difficult period will take their deserved place in the history of Turkish Surgery as admirable services (1).
We believe that it is a historical duty to commemorate our sixty-six colleagues who aren’t with us anymore, and in particular, our founding president of the Turkish Surgical Society Professor Dr. Ahmet Yaycıoğlu, our subsequent term presidents Professor Dr. Şadan Eraslan, Professor Dr. Yılmaz Sanaç, and Professor Dr. Sermet Akgün, Professor Dr. Kaya Çilingiroğlu, and Operator Dr. Kemal Altay with respect and gratitude for their outstanding services to Turkish Surgery. Likewise, we feel indebted to wish a healthy and long life to Professor Dr. Erol Düren, Professor Dr. Cemalettin Topuzlu and Operator Dr. Yılmaz Kadıoğlu, who are also among the founding members of our association and still with us.
The Turkish Surgical Society gathering in the offices of our founders during the years of establishment was able to buy an apartment for the first time in 1989 in “Sağlık Sokak” located right behind the Ministry of Health and continued its services there for many years. And on May 8, 2004, it started to operate in a 450 square meter headquarters building built on a 1666 square meters land in Çayyolu neighbourhood in Ankara. In this headquarters building with 2.5 floors, there were conference rooms, offices and meeting rooms. At that time, the number of associations that could have such a headquarters building with its own equity could be counted on the fingers of one hand (2).
Health Manpower and General Surgery Specialty
According to the “General Surgery Manpower in Turkey” Report written by Professor Dr. Cem Terzi and his friends and found among the publications of Turkish Surgical Society in 2009, the 2007 records had shown that there were 3594 general surgeons found to be actively working in Turkey. According to the same data, it was reported that 40% of general surgery specialists were working in Istanbul, Ankara and Izmir (3).
In addition, according to Health Education in Turkey and Health Manpower Status Report (2014), there were 4258 actively working general surgery specialists in Turkey. The number of active general surgeons per 100.000 people was reported as 5.63 (4).
U.E.M.S. Section and Board of Surgery meeting was held on April 5-6 in Istanbul with the participation of the Turkish Surgical Society. In this meeting, the President of the Turkish Surgical Society, Professor Dr. Seher Demirer, emphasized that there were 5596 general surgeons in Turkey and 282 of these were female. As of today, the number of surgeons who are active members of the Turkish Surgical Society has reached 3903 among the general surgeons actively working in our country. The number of approved site members is 6082. Considering these numbers, it is understood that 69.74% of the active surgeons are registered members of the Turkish Surgical Society (5).
Today, in the 90th year of the Turkish Surgical Society, the number of registered members has reached 3903 (6). It is stated in the 2018 Health Statistics Yearbook of the Turkish Republic Ministry of Health that there are 153.128 doctors available in our country. However, there is no data on how many of these are actively working general surgeons (7).
Proficiency Exams
The Board of Proficiency that began active duty after being elected at the National Surgery Congress in 2000, held its first exam on June 20, 2000 (8). After this date, 35 written and 30 oral exams have been reached in the Board Exams. The Turkish Surgical Society, which plays a pioneering role among the specialist associations in these exams, is thus proud. An analysis of the Board Exams held for 19 years revealed that 2075 specialists took the written exam and there were 635 general surgery specialists who took the exam for the second time or more. Of all the candidates, 817 were successful and were entitled to take the 2nd stage oral exam. 450 of the 474 specialists who took the oral exam were awarded with a passing grade and qualified for the Turkish Surgical Society Board Certificate. Following the written and oral examinations held since 2001, 262 of the 450 general surgery specialists who received the Turkish Surgical Board Certificate, have re-certified their certificates by applying to the Turkish Surgical Society (9).
Accreditation
Accreditation means being audited by an autonomous committee from outside the institution and, if appropriate, being authorized and subsequently being audited periodically. The Turkish Surgical Society, which has pioneered among other associations on this subject as well as many others, started its accreditation activities in 2002. The Co-Authorization Board of the Turkish Surgical Society, which started to work on this date, visits the General Surgery Departments and Clinics that perform surgical training after graduation, and accredits by evaluating the assistant report card, internal and external rotations, opportunities of other clinics, national and international publications in line with objective criteria. In this context, the Turkish Surgical Society published an Assistant Report book in 2006 and determined the criteria junior and senior residents are obliged to meet in terms of knowledge, skill, attitude and behaviour (10).
According to the data from Turkish Republic’s Ministry of Health’s Health Statistics Yearbook (2018), there are a total of 1534 hospitals in our country, including 889 State Hospitals, 68 University Hospitals and 577 Private Hospitals (11). Based on these data, general surgery speciality training is provided in 957 hospitals. In the 17 years since 2002, only 20 General Surgery Clinics / Departments have been accredited and this is thought-provoking. The ratio of General Surgery Clinics accredited in total is 2.08%. Of the accredited general surgery clinics, only 2 were officially accredited (12).
In our country, accreditation activities in the field of health have been realized much later. In Turkey, the Regulation on the Accreditation in Health System was published on 09.01.2013. Subsequently, with Law No. 6569, Turkey’s Health Care Quality and Accreditation Institute was established.
Medical Malpractices
The Turkish Penal Code, which entered into force in 26.09.2004 and Compulsory Financial Insurance on Medical Malpractice introduced in 21.07.2010 have brought some legal obligations and challenges to general surgeons as well as to all other healthcare workers. Insurance of the physicians actively working in the profession is one of them.
General surgery, which was one of the most popular branches in previous years, has begun to be preferred in lower ranks together with other surgical branches. In cases examined at the High Council of Health and the Forensic Medicine Institute, our colleagues are ordered by the court to pay significant indemnifications in actions brought when results arise against general surgeons. In order for us to defend our rights well before the law, we must first know what they are and their limits. The high amount of compensation determined when judicial lawsuits were brought to a conclusion led our colleagues, who are general surgery specialists, to gravitate towards Defensive Medicine practices in Turkey as well as all over the world.
The Turkish Surgical Society, showing awareness on the above-mentioned issues as always, has established the Ethics Committee and the Medicolegal commissions and tried to help our colleagues by publishing examples of our sine qua non Informed Consent on our website.
President of the Turkish Surgical Society, Professor Dr. Seher Demirer, said the following in a statement: “Our association has a law office. When our General Surgeon colleagues apply to us in writing about their complaints and litigation processes, we respond to them through our law office. As an NGO, we cannot intervene in the judiciary process. However, in terms of guiding our colleagues correctly and ensuring that they get out of this process with minimum damage, the Turkish Surgical Society stands behind our general surgeon colleagues.” (13).
International Relations
In the European Union, which was initially founded with the participation of Germany, France, Italy, Netherlands, Belgium and Luxembourg in 1958, doctors have established the European Association of Medical Experts (U.E.M.S.) to determine the key quality indicators of postgraduate medical education.
The Turkish Medical Association joined U.E.M.S. as an associate for the first time in 1994. In order to be an active member of this organization, the first criterion was to be a member of the European Union.
In 1996, the Turkish Surgical Society also became a member of the U.E.M.S.’s Section and Board of Surgery at the International Congress organized by Eurosurgery in Rome and our first representative was Professor Dr. Semih Baskan. In the following years, Professor Dr. İskender Sayek, Professor Dr. Sadık Kılıçturgay, Professor Dr. Ethem Geçim and Professor Dr. Cem Terzi took over this task (14).
U.E.M.S. Section and Board of Surgery convened in Istanbul on October 6, 2002 with a large participation, and the Turkish Surgical Society hosted this meeting. This highly successful organization was also appreciated by our foreign colleagues. The Core Training Program Booklet prepared by the Turkish Surgical Society’s Proficiency Committee was translated into English and was presented to President Professor Polonius in the meeting held in Graz, Austria in 2018. The report titled “Who Should Perform Thyroidectomy?” prepared by Associate Professor Mahir Özmen was also presented to the President of EBS at the same meeting and sent to the e-mail addresses of the other members. In 2008, Professor Dr. Michael Polonius of U.E.M.S. Section and Board of Surgery was invited to the National Surgery Congress that we organized, and he gave a lecture on two topics: “Subdisciplines in Surgery” and “The Concept of Intensive Care in Surgery” (15).
On May 7-8 of 2010, this time U.E.M.S. Section and Board of Surgery held its General Assembly in Izmir. In this meeting, our country was represented by Professor Dr. Cem Terzi, and important decisions were taken including the curriculum - considered an important part of the examinations - was accepted, the participation of general surgeons of full member states such as Turkey was accepted in line with the proposal of Turkish Surgical Society. At this same general assembly, it was decided to hold the first exam in Turin, Italy. At the end of the meeting, Professor Dr. Michael Polonius was re-elected as the president (16).
After a long break, U.E.M.S. Section and Board of Surgery Spring General Meeting was held on 5-6 April 2019 in Istanbul. Professor, Dr. Seher Demirer, the President of Turkish Surgical Society, Vice President of the Turkish Surgical Society, Dr. Mahir Özmen, Turkish Representative of Surgery Section, Professor Dr. Mehmet Faik Özçelik and Professor Dr. Neşet Köksal gave speeches and informed their visiting colleagues. In the general assembly of the U.E.M.S. Section and Board of Surgery the next day, general surgery training and risk quality assignments were performed with standard data. Professor Dr. Mehmet Faik Özçelik, representative of Turkish Surgical Society, speaking at U.E.M.S. Section and Board of Surgery meeting, announced general surgeons from Turkey that qualified for the European Surgery Board’s Proficiency Certificate. According to this data, 63 general surgeon colleagues have been entitled to get their certificates so far. Among these groups, it was determined that the most successful ones who took the exam were from the speciality of Colon-Proctology (23) (17) (Table 1).
Continuous Professional Development
At the World Congress held in 1990, the World Medical Association made the following definition: “Medical education is a learning process that begins with the entrance to medical school and ends with retirement”. This concept has changed in the 21st century and Lifelong Learning has come to the fore. Turkish Surgical Society performs its duties almost like a post-graduation higher education institution with national congresses, regional congresses, research congresses, courses and panels it has organized especially in recent years. In addition, it has begun to grant awards and scholarships to support young researchers in particular.
The Turkish Surgical Society continues its practices regularly in order to support young researchers. In this context, the following scholarships are given:
- Turkish Surgical Society Scholarship
- Turkish Surgical Society Overseas Education Scholarship
- Dr. Feza Remzi Scholarship
- Kemal Özden Scholarship
- Nevin Baykent Scholarship
In the same context, the Turkish Surgical Society grants awards in different branches:
- Turkish Surgical Society Award & Support,
- Support to International Surgical Congresses,
- Promoting Scientific Publications,
- National Surgical Congress Awards,
- Overseas Education Support Award,
- Proficiency Board Support Award,
- Overseas Project Support Award (18)
The Turkish Surgical Society is proud and honoured to grant 68 Scholarship Awards and 59 Incentive Awards in total to young surgeons (19).
Taking into account the difficulties encountered by young general surgical residents in the operations, the Turkish Surgical Society has prepared 15 sets of drawings for various surgeries to assist them in this regard and offered them to their service. Test Preparation Book for preparing for Board Exams, Board Exam Course notes, preparing a presentation in English - which is an issue young residents have difficulty in in international congresses-, and a medical presentation booklet in English, which would make it easy for them to make presentations, should also be included in the services provided. For the informed consent, nine different Informed Consent Forms explaining different surgical procedures and complications were prepared and explained on the website of the association. Another service that the Turkish Surgical Society has provided to young researchers in recent years is the practice that we define as Virtual Academy. In this practice providing great convenience for young research associates and residents to improve and train themselves when they have free time both in their clinics and at home, modules, manuals and current articles are included. These contemporary practices, which provide easy access to current information, are followed with interest by young surgeons (20).
In addition to scientific activities organized in its new headquarters, the Turkish Surgical Society has also organized public awareness meetings together with non-governmental organizations in the prevention and treatment of different types of cancer for our neighbours living in the neighbourhood, revealing a good example of the public services mentioned in our statute.
In 2009, since it was the 80th anniversary of the Turkish Surgical Society, a comprehensive book was published and broached to our general surgeons. It has been 10 years since then. Now, we are celebrating our 90th anniversary. In the 21st century, there are huge and rapid developments in medical technologies. Particularly, the concepts of Industry 4.0 and Health 4.0, which have been in our agenda since 2013, have begun to introduce brand new concepts and practices into our daily practice each passing day.
We have tried to summarize the activities of our Turkish Surgical Society, the great leader of Turkish Surgery which reached its 90th year, especially for the last 10 years. We hope to share more with our members on our 100th anniversary, which we will celebrate in 10 years, and we pay our respects to you.
The last sentence belongs to our doyen academic member Professor Dr. Erol Düren, one of the founding members of Turkish Surgical Society:
“If We Know Where We Come From, We Can Predict Where We Can Go”.
With all respect,
Professor. Dr. Semih Baskan