Royal Australasian College Of Surgeons Research Articles

E kaua e hoki i te waewae tūtuki, ā, apā anō hei te ūpoko pakaru - a systematic review of neurosurgical disease and care for Māori in New Zealand.

The Royal Australasian College of Surgeons (RACS) Te Rautaki Māori cites the need for more research dedicated to health equity in surgery for Māori. However, the gaps in research for Māori in surgery have not yet been highlighted. This review is the first in a series of reviews named Te Ara Pokanga that seeks to identify these gaps over all nine surgical specialties. The aim of this study was to assess neurosurgical disease incidence and perioperative outcomes for Māori at any point from referral through to the postoperative period. A systematic review of Māori neurosurgical disease and care for Māori in NZ was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement assisted study selection and reporting. Kaupapa Māori (Māori-centred) research methodology and the Māori Framework were utilized to evaluate Māori research responsiveness. Nine studies were included in this review. All studies were retrospective cohort studies and only two studies had at least one Māori clinical or academic expert named on their research team. Therefore, only one study was deemed responsive to Māori. Studies assessing long-term outcomes from the management of neurosurgical disease for Māori and patient and whānau experiences of neurosurgical care are lacking. This study indicates the limited scope of research conducted for Māori in neurosurgery. The broader clinical implications of this review highlight the need for good quality research to investigate access to and long-term outcomes from the management of neurosurgical disease for Māori.

Rural general surgical provision from the perspective of twenty-two rural general surgeons: a thematic analysis.

Australia continues to suffer from a geographical maldistribution of general surgical services with only 20% of general surgeons working rurally despite 29% of Australia's population residing outside major metropolitan centres. This qualitative study explored the impact of human capacity and infrastructure upon rural general surgery provision. This qualitative study employed semi-structured interviews of rural general surgeons. Participants were recruited via the Royal Australasian College of Surgeons (RACS) Rural newsletter and purposive sampling. All interviews were conducted between January 2023 and April 2023. Transcripts were transcribed, de-identified, and thematically analysed. Two female and 20 male rural general surgeons were interviewed from seven of the eight Australian State or Territories. Four main themes were identified which reflected the impact of human capacity and infrastructure upon Australian rural general surgery provision: (1) small hospital syndrome - and the impact, (2) the rural general surgeon identity, (3) infrastructure and disempowerment and (4) over-reliance on visiting surgeons. Improving access to equitable general surgical care for rural Australians requires appropriate infrastructure and a well-trained, sustainable multidisciplinary surgical team (human capacity). A greater understanding of the issues may help drive rational, long-term supportive solutions.

A qualitative evaluation of rural and provincial surgery wānanga to enhance cultural safety among surgical registrars in Taranaki, New Zealand.

The Royal Australasian College of Surgeons (RACS) recently instituted cultural safety and cultural competency as its 10th competency with formalized cultural safety training yet to be instituted. Wānanga are Indigenous Māori teaching institutions that can be used contemporarily for cultural safety training. In 2022, surgical registrars based at Taranaki Base Hospital (TBH) held in-hospital wānanga ranging from 1 to 3 h focussed on cultural safety, professionalism and wellbeing. This study explores the perspectives of these registrars who attended wānanga using a Kaupapa Māori aligned methodological stance and interpretive phenomenological analysis. Twenty-six wānanga were held from March 22nd 2022 to January 30th 2023. Six registrars provided their perspectives with four major themes emerging from their stories including: cultural safety; unity; time, place and person; and a new era. Registrars valued the wānanga which was scheduled for Friday afternoons after daily clinical duties. Wānanga facilitated unity and understanding with registrars being able to reflect on the context within which they are practicing - describing it as a new era of surgical training. 'Time' was the biggest barrier to attend wānanga however, the number of wānanga held was testament to the commitment of the registrars. Regular wānanga set up by, and for, surgical registrars cultural safety development is feasible and well subscribed in a rural or provincial NZ setting. We present one coalface method of regular cultural safety training and development for surgical registrars and trainees in NZ.

Consensus statement: support for supervisors of surgical training in Australia and Aotearoa New Zealand.

The Supervisor Support Consensus Statement has been developed after consultation with supervisors of surgical training for the Royal Australasian College of Surgeons (RACS) programmes in Australia and Aotearoa New Zealand and other key stakeholders. Six key areas have been recognized with specific recommendations crafted to improve the support and recognition of Supervisors: 1. Clarity of role, 2. Education and Training, 3. Local support, 4. RACS support, 5. Recognition and valuing of the Supervisor role, 6. Risk Management. The purpose of this consensus statement is to clearly articulate supervisor opinions on the support they require to undertake this important role. It has been produced by an independent writing group of experienced surgical supervisors and educators, with support from RACS education department. The consensus statement is a response to a needs assessment of supervisors of surgical training. The statements in this consensus document have been generated from comments and feedback from supervisors that have been refined through process of extensive consultation using a Delphi methodology. We advise specialty training Committees consider these statements and mandate them as part of their accreditation of terms. The role of the supervisor of training requires greater recognition, and incorporation in the Enterprise Bargaining Agreement (EBA) in Australia and the ASMS Te Whatu Ora SECA in Aotearoa New Zealand would ensure the provisions in this document are enacted. The six areas identified have transferability to other specialities and countries and are valuable when considering how to support supervisors involved in training our next generation of specialist doctors.

Review of Māori equity in surgical trainee selection.

The Royal Australasian College of Surgeons (RACS) aims to achieve Māori health equity and cultural safety within the surgical workforce. The RACS Māori Health Strategy and Action Plans encourage Surgical Education and Training (SET) selection criteria that recognizes and credit applicants who identify as Māori or demonstrate competence in Māori health issues. This study investigates the current SET selection criteria for Māori entering surgical specialties. The selection criteria for each surgical speciality for the proposed 2024 intake were examined through a documentary analysis. Criteria were reviewed for applicability to Māori identification and/or cultural competency. Criteria related to Māori identification and/or cultural competency make up 6%, 2%, and 1.5% of Otolaryngology and Head and Neck, General, and Vascular Surgery total SET selection score respectively. Criteria related to Māori identification and/or cultural competency make up 9% and 0.1% of Orthopaedic and Plastics and Reconstructive Surgery ranking scores for interview eligibility respectively. Cardiothoracic Surgery, Paediatric Surgery, Neurosurgery and Urology specialties do not incorporate any criteria appertaining to Māori. Allocation of research-related points determined by authorship may disincentivize Māori trainees. Some surgical specialties fail to recognize or credit Māori identification and cultural competency in SET selection criteria. There is a need for regular auditing to ensure SET criteria align with the RACS aspirations for Māori health equity and cultural safety within the surgical workforce.

The impact of COVID-19 on general surgical trainees' surgical exposure in Australia.

The COVID-19 pandemic disrupted the provision of surgical services in Australia. To prepare for a surge of COVID-19 patients, elective surgery was mandatorily reduced or ceased at multiple timepoints in Australian states between 2020 and 2022. Operative exposure is a critical component of surgical training in general surgery, and readiness for practice is an ongoing priority. However, the impact of COVID-19 on operative exposure in Australian General Surgical Trainees (AGST) has not been quantified. This study was a retrospective longitudinal cohort study using de-identified operative logbook data for Australian General surgical Trainees (AGST) from the Royal Australasian College of Surgeons (RACS) Morbidity and Audit Logbook Tool (MALT) system between February 2019 and July 2021. Bivariate analysis was used to determine the impact of COVID-19 on general surgical trainees' exposure to operative surgery and trainees' operative autonomy. Data from 1896 unique 6-month training terms and 543 285 surgical cases was included over the data collection period. There was no statistically significant impact of the COVID-19 pandemic on AGST operative exposure to major, minor operations, endoscopies, or operative autonomy. The impact of COVID-19 on surgical trainees globally has been significant. Although this study does not assess all aspects of surgical training, this data demonstrates that there has not been a significant impact of the pandemic on operative exposure or autonomy of AGST.

Retraction: 'Clinical effect of surgical treatment for lung metastasis and prognostic risk factor analysis: a single-centred cohort study' by Dongge Peng, Wei Sun, ANZ Journal of Surgery 2023, 93: 1551-1558.

The above article, published online on 24 May 2023 in Wiley Online Library (https://onlinelibrary.wiley.com/doi/10.1111/ans.18491) has been retracted by agreement between the journal's Editor in Chief, Julian A. Smith, the Royal Australasian College of Surgeons and John Wiley & Sons Australia, Ltd. The retraction has been agreed due to major overlap with a previously published article from the same group of authors (DOI: 10.7507/1007-4848.202111005). The authors have been informed of the decision to retract but they did not respond.

PP68 When Evidence Takes A Backseat To Politics – The Rise Of Robot Surgery In Australia

IntroductionA 2018 health technology assessment (HTA) on robot-assisted surgery (RAS) led to a national committee recommendation, which some state Health Ministers adopted as policy, which stated: (i) no further public investment in RAS until subsequent HTAs demonstrate improved evidence; and (ii) clinical and patient outcomes from existing platforms should inform future decisions. This work also identified the Royal Australasian College of Surgeons (RACS) does not accredit any RAS training program for Australian surgeons, nor is there any nationally agreed or consistent credentialing mechanism, which creates ambiguity for hospitals (can this surgeon safely deliver?). Some state governments are ignoring its own policy and investing in RAS. At the same time, some public hospitals are ignoring the policy and procuring RAS through affiliated private hospitals. While market competition is expected to reduce price, governments responding to ‘squeaky wheels’ sets a dangerous precedent for high-cost technology procurement, especially if it needs to be replaced, and cost of delivery may not offset revenue generated.MethodsAustralia’s states and territories can collaborate to commission HTAs. Since 2015, they have, jointly or independently, commissioned HTAs to monitor RAS evidence, which led to the 2018 HTA and policy. However, this policy is being ignored by hospitals and governments.ResultsRACS is working with local agencies to develop accredited training programs for different RAS platforms, which should offer comfort to provider hospitals regarding surgeon credentialing. Surgeons and patients are increasingly vocal regarding RAS, resulting in some governments investing in RAS. Not consulting with all stakeholders has led to confusion and a questionable role for policy makers. Private hospitals operated by public hospitals are procuring RAS in contravention of the policy and with no consequences, creating further confusion.ConclusionsWhile accredited surgeon training will improve skills and outcomes, governments ignoring their own policy is resulting in unplanned technology introduction, which led to the need for HTA in the first place. Do we need to rethink the role of HTA, or should we accept that politics trumps evidence?

Orthopaedic surgery academic productivity - how do we measure up?

Research is vital for evidence-based surgery. Understanding scientometric differences among surgical specialties has scope to inform discussions within and across surgical specialities to develop and maintain a culture of research productivity. This study aims to quantify Australian orthopaedic surgical academic productivity compared to the other specialties within the Royal Australasian College of Surgeons' (RACS). A list of Australian surgeons registered with RACS was compiled using the "find a surgeon" function on the RACS Web site. This list was cross-referenced with the specialty databases on their respective websites. A name search of the SCOPUS database for each individual surgeon was performed. For each individual h-index, m-index, total active publishing years, total publications, and total citations were collected. Orthopaedic surgeons had the equal lowest h-index median 2 (interquartile range:3), the shortest duration involved in research median 5years (14), produced the fewest articles median 2 (7) and attained the second lowest number of citations median 28 (116) of the Australian surgical specialties. When the 10 individuals with highest h-index are compared among specialties, orthopaedic surgeons rank second with a median of 37 (6.5). Our objective data provides a factual comparison and baseline assessment of one aspect of research productivity. It can challenge currently held perceptions of performance and can inform conversations about strategic development. We recommend this assessment to other international Colleges and Societies on regular basis. These accurate academic productivity metrics provide opportunity for developing and maintaining a culture of sustained, significant contribution to surgical research.

Women in surgery: trends in nine surgical specialties.

Gender disparity in surgery remains an issue worldwide. We analysed the trends in gender distribution in surgical subspecialties across Australia and New Zealand over the last 8 years. Workforce reports from the Royal Australasian College of Surgeons were reviewed from 2014 to 2021. Data relating to 4802 applicants, 1554 trainees and 6839 active surgeons across nine surgical subspecialties was analysed. Statistical analysis was performed using a difference of proportions hypothesis test. Predictions regarding time to parity were performed using a linear regression model. All nine surgical subspecialties' surgeon numbers saw a steady increase in the representation of women between 2014 and 2021. The most significant rise seen in general surgery from 14% to 21% (P ≤ 0.001). Proportions of women trainees were variable, the only significant rise was seen in orthopaedics from 9% to 19% (P ≤ 0.001). Proportions of women applicants and successful applicants have also been variable. General surgery saw the only consistent increase in women applicants over the last 6 years, from 35% in 2016 to 43% in 2021. Linear regression predictions estimate that paediatric surgery will be the first to reach gender parity in 23 years, and orthopaedics the last, in 186 years. A steady increase in women has been observed across all surgical subspecialities over the last 8 years. However, estimates based on current trends suggest that gender parity may be out of reach for the next eight generations in subspecialties such as cardiothoracic and orthopaedic surgery.

Gender associations with selection into Australian General Surgical Training: 2016-2022.

For those who have maintained an interest in general surgery after medical school and their early post-graduate years, selection is the first step to a career in general surgery. Identifying differences secondary to gender in selection tools and their outcomes should assist the Royal Australasian College of Surgeons and the Australian Board in General Surgery to improve gender equity in the general surgical workforce. Selection tools for general surgery include the curriculum vitae (CV), referee report (RR) and multiple mini-interview (MMI). All applicants' CV, RR and MMI scores achieved in the general surgery selection process were reviewed by gender over a seven-year period. In all years, there were lower numbers of female applicants to selection. There were differences identified between genders in the CV and MMI, with females scoring lower in the CV and higher in the MMI when compared to males. There were no differences identified in the RR or proportion of applicants that were successful in their application based on gender. The CV and MMI utilized for selection into general surgery were associated with gender bias. However, the lower number of females selected into training reflects the lower number of female applicants overall. There was no overall impact from gender found in an applicant's ability to be selected into general surgery in Australia.

Greener theatre, greener surgery - environmental sustainability in a rural surgical setup.

Greener theatre, greener surgery - environmental sustainability in a rural surgical setup.

Rudeness and civility in health care

Rudeness and civility in health care

MP25-01 AN ETHICAL ROBOTIC SURGICAL TRAINING CURRICULUM USING SIMULATION AND 3D PRINTED SYNTHETIC ORGANS

You have accessJournal of UrologyCME1 Apr 2023MP25-01 AN ETHICAL ROBOTIC SURGICAL TRAINING CURRICULUM USING SIMULATION AND 3D PRINTED SYNTHETIC ORGANS Daniel Costello, Dean Driscoll, Ahmed Ghazi, and Anthony Costello Daniel CostelloDaniel Costello More articles by this author , Dean DriscollDean Driscoll More articles by this author , Ahmed GhaziAhmed Ghazi More articles by this author , and Anthony CostelloAnthony Costello More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003253.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It is no longer necessary to rely on live animals or cadavers for surgical training. We used 3D printing technology and injection moulding to produce realistic hydrogel synthetic organs for robotic surgery training. These synthetic organ models were a key pillar in a novel multistep robotic surgery curriculum. Phase 1 included an online learning program the first robotic surgery course accredited by the Royal Australasian College of Surgeons. This course included access to a catalogue of live 3D video accessible through VR headsets. Participants then proceeded to VR simulation training, dry lab exercises and human factors training in preparation for procedural training on hydrogel organs. When proficiency was achieved finally live human surgery. Following are results from the synthetic organ robotic procedures. METHODS: Three different synthetic organ models were fabricated for this study; an anatomically correct insufflatable anterior abdominal wall for port placement, a robot assisted partial nephrectomy model and a robot assisted radical prostatectomy model. These models were fabricated using 3D digital models segmented from patient CT images using computer aided-design software. These models were uploaded to 3D printers to generate negative moulds, which were injected with polyvinyl alcohol, a low-cost hydrogel. These positive casts went through freeze thaw cycles achieving different tissue consistencies. These casts were layered in anatomically correct positions creating multi-step procedural models with clinically relevant objective surgical performance metrics. Metrics include blood loss, nerve injury measured by digital strain gauges, cancer margins using fluorescence, anastomosis leak tests, operative time and video based skill assessment. RESULTS: Twenty surgeons performed robotic surgery on 5 synthetic abdomens, 10 hydrogel partial nephrectomies and 30 radical prostatectomies. Participants ranged in experience from novice to experts. Clinically relevant performance metrics were recorded and GEARS video tool was used to assess proficiency. Preliminary validity assessments demonstrate face, content, construct, concurrent and predictive validity. CONCLUSIONS: We demonstrated feasibility and preliminary educational validity of realistic synthetic human organ models for urological robotic surgery. These models offer a viable alternative to live animal and cadaver surgery training, without associated cost, ethical and accessibility drawbacks. Source of Funding: An equipment grant was provided by Intuitive Surgical for simulation surgeries © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e342 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Costello More articles by this author Dean Driscoll More articles by this author Ahmed Ghazi More articles by this author Anthony Costello More articles by this author Expand All Advertisement PDF downloadLoading ...

On being entirely ordinary

On being entirely ordinary

Trends in Incisional and Ventral Hernia Repair: A Population Analysis From 2001 to 2021.

Background Incisional and ventral hernias are highly prevalent, with primary ventral hernias occurring in approximately 20% of adults and incisional hernias developing in up to 30% of midline abdominal incisions. Recent data from the United States have shown an increasing incidence of elective incisional and ventral hernia repair (IVHR) and emergency repair of complicated hernias. This study examines Australian population trends in IVHR over a two-decade study period. Methods This retrospective study was performed using procedure data from the Australian Institute of Health and Welfare and population data from the Australian Bureau of Statistics captured between 2000 and 2021 to calculate incidence rates per 100,000 population by age and sex for selected subcategories of IVHR operations. Trends over time were evaluated using simple linear regression. Results There were 809,308 IVHR operations performed in Australia during the study period. The cumulative incidence adjusted for population was 182 per 100,000; this increased by 9.578 per year during the study period (95%CI = 8.431-10.726, p<.001). IVHR for primary umbilical hernias experienced the most significant increase in population-adjusted incidence, 1.177 per year (95%CI = 0.654-1.701, p<.001). Emergency IVHR for incarcerated, obstructed, and strangulated hernias increased by 0.576 per year (95%CI = 0.510-0.642, p<.001). Only 20.2% of IVHR procedures were performed as day surgery. Conclusions Australia has seen a significant increase in IVHR operations performed in the last 20 years, particularly those for primary ventral hernias. IVHR for hernias complicated by incarceration, obstruction, and strangulation also increased significantly. The proportion of IVHR operations performed as day surgery is well below the target set by the Royal Australasian College of Surgeons. With the increasing incidence of IVHR operations and an increasing proportion of these being emergent, elective IVHR should be performed as day surgery when it is safe.

Gender representation in surgery: progress and challenges in recent years.

Gender representation in surgery: progress and challenges in recent years.

25, 50 and 75 years ago.

25, 50 and 75 years ago.

Career reflections of retired surgeons.

Career reflections of retired surgeons.

Strides Toward Advancing Spine Surgery: Synergy Between Australasia and the International Society for the Advancment of Spine Sugery.

The Royal Australasian College of Surgeons, formed in 1927, is a nonprofit organization training surgeons and maintaining surgical standards in Australia and New Zealand. It promotes, teaches, and assesses standards across 9 surgical specialties in Australia and New Zealand: cardiothoracic surgery,