ASiT - Excellence in Surgical Training - RCSEng Bulletin

BMJ: British medical journal

ANZ Journal of Surgery, 2009

International Journal of Surgery, 2019

Annals of Surgery, 2017

S urgical education has traditionally focused on the surgical clerkship during medical school and general surgery residency. Over the past 20 years, however, there has been a tremendous evolution in this very important mission of academic surgery. The most dramatic of these changes affecting resident training began with the implementation of residency work-hour restrictions in 2003. Changes in assessment of competency of the surgical trainee, challenges in providing resident autonomy in the era of reporting surgical outcomes and RVU-based compensation, and the increased emphasis on fellowship training, including integrated training programs or early specialization, have dramatically affected the training of surgical residents. Undergraduate medical education in surgery has been affected as medical schools have shortened the time spent on surgical rotations, while students are being asked to make decisions regarding choice of specialty earlier to consider new integrated specialty tracks. On a positive note, after selection of surgical specialty, many schools have an increased emphasis on preparation for residency training with ''surgical boot camps.'' Maintenance of certification of trained specialists has added to the administrative burden of surgeons already at risk for burnout. Finally, questions as to how to introduce new technology, or to retrain or retool practicing surgeons, have yet to be answered. Thus, one can safely conclude that the changes in surgical education are now extending throughout the lifetime of a surgeon. Despite these extensive changes and challenges existing at all levels, surgical education has only been the focus of the American Surgical Association (ASA) Presidential Forum twice over the past 20 years. In 2004, 1 with a report that preceded the presentation of the ASA ''Blue Ribbon'' panel, 2 and in 2012, with a review of the issues in general surgery resident training. 3 It is the purpose of this panel to provide an overview of surgical education from medical school until the late stages of a surgeon's practice. To lead the discussions, we have called on leading experts and innovators in surgical education from both the United States and the United Kingdom, and also members of the leadership of the American Board of Surgery (ABS).

Health service reconfigurations may result in increasing numbers of minor surgical procedures migrating from secondary care in hospitals to primary care in the community. Procedures may be performed by General Practitioners with a specialist interest in Surgery, or secondary care Surgeons who are sub-contracted to perform procedures in the community. Surgical training in such procedures, which are currently hospital based, may therefore be adversely affected unless surgical training also takes advantage of these opportunities. There is potential for surgical trainees to benefit from training in the community setting. ASiT supports the development of formal surgical training in the community setting for junior surgical trainees, providing high standards of patient care and training provision are ensured. Anticipated problems relating to the migration of surgical services to the community relate to the availability and quality assurance of training opportunities in primary care, its funding, including exposure to issues of indemnity cover for trainees, and also the release of surgical trainees from hospital duties in order to attend these training opportunities. These consensus recommendations set out a framework through which both patient care and training remain at the forefront of these continued service reconfigurations.

Postgraduate Medical Journal, 2021

Postgraduate training in surgical specialties is one of the longest training programmes in the medical field. Most of the surgical training programmes require 5–6 years of postgraduate training to become qualified. This is usually followed by 1–2 years of fellowship training in a subspecialised interest. This has been the case for the last 20–30 years with no significant change. The surgical practice is transforming quickly due to the advances in medical technology. This transformation is not matched in the postgraduate training, there is minimal exposure to the new technological advances in early years of postgraduate training. The current postgraduate training in surgical specialties is not fit for the future. Early exposure to robotic and artificial intelligence technologies is required. To achieve this, a significant transformation of surgical training is necessary, which requires a new vision and involves significant investment. We discuss the need for this transformation in th...

Journal of Surgical Sciences, 2019

not available Journal of Surgical Sciences (2017) Vol. 21 (1) :2-4

The Bulletin of the Royal College of Surgeons of England, 2018

Surgical skills training is an important aspect of both undergraduate and post-graduate medical education.1 Unfortunately, surgical skills training for medical students and foundation year doctors can be variable and dependent on particular surgical rotations. Medical students have reported receiving negative comments in theatre, being made to feel unwelcome and having a lack of structured teaching during theatre sessions.2,3 Although the focus of theatre lists must be patient-centred, current training schemes allow less time for clinical exposure, meaning that every clinical encounter must be considered a training opportunity. This is both the responsibility of the surgical team and of medical students and junior doctors; students who are encouraged to scrub, be involved and are better prepared are more likely to attend theatre again.4 Exposure and experiences within surgical firms are also significant factors in determining the choice of surgery as a career.5,6 They allow not only development of practical skills but also discussion about career and lifestyle.7 Ultimately, the nurturing and attention to training of medical students and junior doctors will ensure that surgery continues to attract excellent candidates.

Journal of the Royal Society of Medicine, 2006

The Chief Medical Officer, Sir Liam Donaldson, has recently published his recommendations 1 on how the government should respond to the serious criticisms of medical regulation and the General Medical Council made by Dame Janet Smith in her final report of the Shipman Inquiry. 2 In a thoughtful and well-written report, he places the regulation of doctors within the wider set of systems for improving and quality assuring modern practice. Doctoring is at the heart of the healthcare system. Sir Liam's focus throughout is, therefore, on how to make sure that in future everyone in the UK who needs a doctor gets a good doctor. 3 It means that patients should feel they can trust any doctor without even having to think about it, 2 and that doctors themselves would entrust members of their family to any colleague without a moment's hesitation.

Innovative Surgical Sciences, 2019

The first residency programs for surgical training were introduced in Germany in the late 1880s and adopted in 1889 by William Halsted in the United States [Cameron JL. William Stewart Halsted. Our surgical heritage. Ann Surg 1997;225:445–58.]. Since then, surgical education has evolved from a sheer volume of exposure to structured curricula, and at the moment, due to work time restrictions, surgical education is discussed on an international level. The reported effect of limited working hours on operative case volume has been variable [McKendy KM, Watanabe Y, Lee L, Bilgic E, Enani G, Feldman LS, et al. Perioperative feedback in surgical training: a systematic review. Am J Surg 2017;214:117–26.]. Experienced surgeons fear that residents do not have sufficient exposure to standard procedures. This may reduce the residents’ responsibility for the treatment of the patient and even lead to a reduced autonomy at the end of the residency. Surgical education does not only require learning...