| Royal Prince Alfred Hospital
Institute of Academic Surgery
'Effective teaching may be the hardest job there is' William Glasser
The training pathway for surgeons starting from a medical student and progressing through to post fellowship level is provided by several different organisations with various expectations regarding the performance of the trainees along the way. This includes the University and associated Clinical School, the hospitals where the trainees are based, the College and individual specialty Societies and overall guiding bodies such as the Health Education and Training Institute (HETI) and the Clinical Excellence Commission (CEC).
Many aspects of the organisation and provision of surgical training at RPA are excellent, especially for advanced trainees on the Surgical Education and Training (SET) program. The IAS works in collaboration with surgical departments to deliver and coordinate quality post-graduate surgical education and training.
Education and training for perioperative nursing is often more structured, with a tighter regimen of credentialing for individual competencies. To compliment this and further educate nurses on disease states that are treated surgically, the IAS has developed programs to empower perioperative nursing professionals.
Education and training in surgery and perioperative care takes many forms. The old model of apprenticeship in theatres still has a role, but there is more that can be done. Many of the competencies needed to be a surgeon can be acquired outside the theatre environment.
There are two areas where the old model falls down - firstly in non-technical competencies such as teamwork, communication and leadership, where simulation is much more effective, and secondly in lower-level technical skills, because the adoption of minimally invasive surgery has removed many opportunities for teaching basic surgical handicraft.
In an effort to augment theatre experience in these areas, many institutions offer short intense courses, often held over weekends. These help, but single exposures can be educationally ineffective with poor retention rates.
The preferred model is the one embraced at the Toronto General Hospital and adopted locally in the HETI based Graduate Diploma of Essential Surgical Skills.
Trainees have repeated opportunities for incremental training that incorporates both technical and non-technical skills, and that assesses the trainees for competency over a planned and prolonged program. This will be the preferred model for education and training at the IAS wherever possible. Short courses will still be delivered, however, especially for more advanced trainees.
It is anticipated that the IAS will play an increasing role in the planning and delivery of the training and education sessions that are currently delivered in RPA, with expansion into more structured longitudinal programs as more teachers are engaged from each Department.
The processes of delegation and escalation are central to both clinical care and to education and training. As highlighted in the Garling Report (2008), supervision of junior doctors is an area of weakness in our hospital system. The problem is present in other clinical disciplines, but to a lesser degree.
Delegation of clinical care needs to be structured, explicit and predictable. Escalation of care needs to be on the basis of clearly understood parameters, with well understood lines of communication.
The IAS will be in the forefront of advances in this area, and of research into the impact of changes.
The skills and knowledge to be a good supervisor are not innate or necessarily born of experience in patient care alone. The IAS will work closely with the Medical Training Unit and HETI to make the best of all available resources to ensure that all RPA clinical staff are trained to be good supervisors, especially in perioperative care.
Please feel free to contact Brindha Shivalingam, Director of Surgical Education at the IAS, for more information or advice regarding surgical supervision.