Royal Australasian College Of Surgeons Research Articles

Leadership and surgical training part 2: training toolkit for leadership development during surgical training.

The Royal Australasian College of Surgeons identifies leadership as an everyday surgical skill and one of the 10 key competences expected of surgeons. However, there is limited opportunity for formal leadership training and development prior to becoming a consultant, with surgical leadership curricula within worldwide training programmes often poorly defined. As a consequence of a focus on general professional skill development, rather than specific training and assessment in leadership, observed trainee leadership skills show scope for improvement. Many studies indicate trainees report leadership skills training as beneficial and are receptive to interventions. However, most surgical leadership development courses prepare pre-identified leaders for formal leadership positions rather than developing all surgical trainees leadership skills. Although the recently established Royal Australasian College of Surgeons 'Surgeons as Leaders in Everyday Practice' course helps to fill this gap, it is aimed at consultant surgeons. Most successful leadership development programmes are also longitudinal throughout surgical training and multi-faceted.

Leadership and surgical training part 1: preparing to lead the way?

Every day surgeons lead teams on the wards, in clinics and operating theatres, but most trainees and some surgeons do not consider themselves as leaders. Leadership skills are increasingly important for surgeons, who need knowledge of organizational structure and policy, management strategy and team dynamics to deliver and improve health care in resource-constrained environments. The Royal Australasian College of Surgeons recognizes leadership as one of 10 core surgical competencies but leadership curricula within surgical training programmes are not well defined. There is limited opportunity for formal leadership training and development prior to becoming a consultant.

Comparative bibliometric analysis of publications by past Royal Australasian College of Surgeons research scholarship recipients.

The Royal Australasian College of Surgeons awards scholarships to surgeons, surgical trainees and recipients focused on developing their clinical knowledge and improving outcomes for patients. A bibliometric analysis of research scholarship recipients publications and h-index scores was conducted to understand the benefits of receiving these scholarships. A bibliometric analysis of Royal Australasian College of Surgeons scholarship recipients in 2015 was performed using Open Researcher and Contributor ID (ORCID), Scopus, Google Scholar, ResearchGate, LinkedIn and PubMed to identify the number of publications, h-index scores, field-weighted citation impact and the relative citation ratio. Nineteen research scholarship recipients authored 842 publications, with 491 (58%) published after completion of their scholarship. Seven recipients published 50% or more of their articles in the 5 years since completion. Five recipients have each published more than 45 articles since 2015. H-index scores varied between Scopus and Google Scholar (overall range: 4-34). Scopus identified the most publications, followed by ResearchGate. Determining publication numbers for recipients was problematic due to self-reporting in some databases (i.e. Google Scholar, ResearchGate), variations in author names (i.e. maiden to married name), duplication of publications and the inclusion of supplementary material (i.e. extra tables) in self-reporting databases. Field-weighted citation impact and relative citation ratio values exceeded 1 on 12 occasions demonstrating recipients are more cited than the global average. Continuous tracking of publication rates and h-index scores of scholarship recipients demonstrates recipients' continuing interest in advancing and disseminating medical knowledge to improve patient outcomes. The 2015 scholarship recipients publication numbers continued to increase after their scholarship tenure.

Utilization of telehealth by surgeons during the COVID 19 pandemic in Australia: lessons learnt.

BackgroundThe COVID‐19 pandemic has led to the rapid and widespread adoption of telehealth. There is a need for more evidence regarding the appropriateness of telehealth, as well as greater understanding of barriers to its sustained use within surgery in Australia.MethodsA survey weblink was sent via email to 5558 Australian Fellows of the Royal Australasian College of Surgeons in August 2020. A single reminder email followed this 2 weeks later. Mixed methods analysis was performed of the survey data.ResultsThere were 683 (12.3%) complete responses. Telehealth (telephone or video‐link) consultations were undertaken by 638 (85%) respondents as a result of the pandemic, with 583 (85%) of these expressing a desire for continued access to telehealth. Seventy‐seven percent of respondents felt that a satisfactory level of care could be delivered via telehealth in half or more consultations. However, only 38% of respondents felt that quality of care was equivalent comparing telehealth and face‐to‐face consultations, with the inability to perform a clinical examination a frequent concern. The majority agreed that telehealth was appropriate for clinical meetings and arranging investigations (91% each), whereas only 22% and 17%, respectively, felt telehealth was an appropriate means to break bad news and manage conflict. Medicolegal, technical and financial concerns were raised as prominent barriers to the sustained use of telehealth.ConclusionSurgeons show good insight into the clinical appropriateness and limitations of telehealth. Medicolegal, technical and financial barriers need to be addressed in order to fully utilize the benefits of telehealth into the future.

Neuroanatomy Teaching in Australian and New Zealand Medical Schools

Graduate doctors' knowledge of central and peripheral nervous system anatomy is below an acceptable level. New technologies have been introduced to enhance education in the context of integrated curricula and reduced anatomy teaching hours in medical schools. However, it is unknown how varied this instruction has become between universities. This mixed methods study aimed to describe neuroanatomy teaching in medicine across Australia and New Zealand. An electronic survey was sent to Australian (n= 22) and New Zealand (n= 2) medical schools, endorsed by the Royal Australasian College of Surgeons. Academics were asked to comment on the course, content, instruction, and assessment of neuroanatomy for the 2019 academic year. Ninety-two percent (22/24) of medical schools responded. Neuroanatomy content and instructional methodology was highly variable between institutions. The average time dedicated to teaching neuroanatomy was 46.0 hours (±38.1) with a range of 12-160 hours. Prosections (77%) and models (77%) were used at most universities. Dissection was utilized at 13 of 22 (59%) universities. Incorporation of new technologies was highly variable, the most common being 3-dimensional software (59%) and eBook (55%). Adoption of any virtual reality technologies was low (36%). Seven universities used an established curriculum (29%), whereas most did not (61%). Academics indicated anxiety and motivation were key elements of student engagement. Results demonstrate widespread heterogeneity in the way neuroanatomy is taught to medical students. A standardized curriculum may improve collaboration between universities and facilitate translation of future research in the area into practice.

RACS and its Fellows: a contribution to sustainable healthcare improvement in South East Asia.

The question of whether small non-government organizations with comparatively small budgets can make a substantial contribution to sustainable improvement in health care in low- and middle-income countries is crucial to funding global surgical projects. The Royal Australasian College of Surgeons and its Fellows have partnered with local organizations and clinicians to deliver a wide range of projects in South East Asia. These projects have proved sustainable and have increased healthcare capacity in these nations. This provides strong evidence that small non-government organizations such as the Royal Australasian College of Surgeons can make a major contribution to global surgeryI.

Academic paediatric surgery in Australia and New Zealand: Its governance, drivers, successes and challenges

Traditionally, academic surgeons have been expected to excel in research, administration, teaching and clinical work. For many, to be strong in all of these areas is aspirational rather than a reality – and it may not always be a desirable expectation. It is more likely that future academic surgeons will have exceptional ability in several of these domains, but probably not all. Clinical expertise (even if it is within a narrow field) is critical to gaining credibility with non-academic surgical colleagues; and research leadership and substantial ongoing academic output is critical to maintaining credibility among academic surgical colleagues - and facilitates funding success. The Board of Paediatric Surgery is the specialty training board of the Royal Australasian College of Surgeons (RACS) that is responsible for the training program in paediatric surgery for both Australia and New Zealand. “Scholarship and teaching” is designated as being one of the nine competencies RACS expects of all surgeons. Expertise in the domain of scholarship (and research) occurs at two levels: (1) A working knowledge of scientific method, having a critical and curious mind matched with an ability to formulate a research question and contribute to research studies, and an ability to analyse research data and to use it to inform clinical practice. This is expected of all surgeons; and (2) A career academic surgeon with a formal commitment to research which becomes a major component of their work, with the requisite expertise in scientific method to be able to design, set up and complete research studies. The RACS provides support for academia in surgery to flourish in multiple ways and at various stages in the surgeons’ career, as described in this chapter. Increasingly, the academic surgeon has to forge links and to collaborate with other research groups. At least in Australia and New Zealand, departments should work to ensure that their academic surgeons are not excessively burdened with departmental leadership and governance roles that do not require specific academic expertise. Arguably, future academic paediatric surgeons will expect to have a better balance in their lives than some of their predecessors!

Surgery triage during the COVID-19 pandemic.

BackgroundThe novel coronavirus, SARS‐CoV‐2, caused the COVID‐19 global pandemic. In response, the Australian and New Zealand governments activated their respective emergency plans and hospital frameworks to deal with the potential increased demand on scarce resources. Surgical triage formed an important part of this response to protect the healthcare system's capacity to respond to COVID‐19.MethodA rapid review methodology was adapted to search for all levels of evidence on triaging surgery during the current COVID‐19 outbreak. Searches were limited to PubMed (inception to 10 April 2020) and supplemented with grey literature searches using the Google search engine. Further, relevant articles were also sourced through the Royal Australasian College of Surgeons COVID‐19 Working Group. Recent government advice (May 2020) is also included.ResultsThis rapid review is a summary of advice from Australian, New Zealand and international speciality groups regarding triaging of surgical cases, as well as the peer‐reviewed literature. The key theme across all jurisdictions was to not compromise clinical judgement and to enable individualized, ethical and patient‐centred care. The topics reported on include implications of COVID‐19 on surgical triage, competing demands on healthcare resources (surgery versus COVID‐19 cases), and the low incidence of COVID‐19 resulting in a possibility to increase surgical caseloads over time.ConclusionDuring the COVID‐19 pandemic, urgent and emergency surgery must continue. A carefully staged return of elective surgery should align with a decrease in COVID‐19 caseload. Combining evidence and expert opinion, schemas and recommendations have been proposed to guide this process in Australia and New Zealand.

Development of the 'People-Processes-Paradigm' critical analysis tool for mortality and morbidity reviews: improving understanding of systems factors.

The impact of systems problems and human factors on delivering safe, high-quality patient care is well recognized. In the surgical setting, mortality and morbidity reviews (MMRs) are the key forum for reviewing and analysing adverse events in patient care yet there is a paucity of simple tools for undertaking such analyses. The aim of this study was to develop and pilot a new tool for analysing mortality and morbidity cases incorporating human factors and systems analysis. The published literature, professional standards, guidelines and existing audit tools for MMRs were reviewed. The 'People-Processes-Paradigm' tool was developed and pilot testing was undertaken and stakeholder feedback was obtained. Models found for undertaking systems-based analysis of adverse surgical events included the 3D model, SEIPS and the Queensland Health human error and patient safety (HEAPS) Incident Management Tool. Guidelines for standards in MMRs are provided by the Royal Australasian College of Surgeons, New South Wales Clinical Excellence Commission and Australia and New Zealand audit of surgical mortality (ANZASM). The People-Processes-Paradigm model incorporates these standards and evidence-based systems analysis tools into a single effective tool. The pilot study evaluating the use of this tool demonstrated it to be practical and easily applicable to regular use by clinicians, with the ability to be tailored to individual health service use. Improvements such as electronic format and clarification of case selection processes were recommended by users. The People-Processes-Paradigm tool has been developed for surgeons by surgeons incorporating current professional, legal and regulatory requirements in Australasia, easily transferrable to electronic platforms. This model requires further testing for validation.

Gender Representation by Specialty Track at Surgical Meetings: The American and Australasian Experiences

BackgroundWe compared the representation of women panelists at two large, general interest surgical meetings: the American College of Surgeons (ACS) Clinical Congress and Royal Australasian College of Surgeons (RACS) Scientific Congress. Materials and methodsWe performed comprehensive analyses of panels and panelists at ACS and RACS meetings (2013-2018). Manual review was conducted to determine counts and proportions of invited panelists by gender. We made within- and between-meeting comparisons regarding gender representation by specialty track. Tracks were characterized after our review of meeting programs. ResultsThere were 4542 panelists and 1390 panels at RACS from 2013 to 2018. At ACS, there were 3363 panelists over 693 panels. The specialty tracks with the highest proportion of men-only panels were transplant (75%) and cardiothoracic (63%) at ACS and cardiothoracic (83%) and multidisciplinary (81%) at RACS. The lowest proportions of men-only panels were in breast and pediatric surgery at ACS (5% and 11%, respectively) and breast and rural surgery at RACS (24% and 36%, respectively). At ACS, the highest proportions of women panelists were on panels in breast (63%) and endocrine surgery (48%) and in breast (44%) and rural surgery (33%) at RACS, while the lowest proportion of women panelists were in transplant (10%) and cardiothoracic (14%) at ACS and multidisciplinary (8%) and cardiothoracic (7%) at RACS. ConclusionsThere is a persistent difference in gender representation at surgical meetings, particularly within certain subspecialties. Program chairs and committees could increase the proportion of women by focusing on who serves as panelists overall and within specialty tracks.

Gender equity within medical specialties of Australia and New Zealand: cardiology's outlier status.

Gender disparity remains a prominent medical workforce issue, extending beyond surgical specialties with low proportions of female doctors. To examine female representation within Australia and New Zealand (NZ) among physician specialties and certain comparator surgical specialties with a focus on cardiology as an outlier of workforce gender equality. Data of practising medical specialists, new consultants and trainees were sought from the Australian Health Practitioner Regulation Agency, the Medical Council of NZ and the Royal Australasian College of Surgeons (2015-2017). The stratified data pertaining to interventional cardiologists were obtained through direct contact with individual hospitals (from 2017 to 2018) and derived from state-based cardiac registries. In Australia and NZ, there were fewer female practising adult medicine physician consultants (n = 8956, 32%, P < 0.001), with gender disparities seen across most physician specialties. Cardiology (15%) was the only physician specialty with <20% representation; gastroenterology (23%), neurology (27%) and respiratory medicine (29%) had <30% female representation at the consultant level. The rates of cardiology (15%) and interventional cardiology (5%) were similar to general surgery (15%) and orthopaedics (4%). Although more than half of physician trainees are female, and most physician specialties are approaching or have equal gender ratios at the trainee level, cardiology (23%) and interventional cardiology (9%) remain significantly underrepresented. Cardiology is the only physician specialty with <20% female consultants, and this disparity is reflected throughout every stage of the cardiology training programme. Increased awareness and proactive strategies are needed to improve gender disparity within this underrepresented medical specialty.

Four types of gender bias affecting women surgeons and their cumulative impact

Women are under-represented in surgery, especially in leadership and academic roles, and face a gender pay gap. There has been little work on the role of implicit biases in women’s...

ASERNIP-S: unusual acronym, outstanding results.

In the late 1990s, concerns regarding the introduction of new surgical procedures arose following the rapid uptake of some minimally invasive procedures. At that time, the evidence was not clear on the safety and effectiveness of these new procedures, and it was recommended that data be collected to look at both short- and long-term outcomes. Based on a UK group, 'the Safety and Efficacy Register of New Interventional Procedures (SERNIP)', the Australian SERNIP was born under the auspices of the Royal Australasian College of Surgeons, with '-S' added to the acronym to highlight the focus on surgery. ASERNIP-S was established to review the evidence on new interventional procedures before their introduction into the Australian healthcare system. The programme operated with initial national government funding for 7 years. Following establishment of the Medical Services Advisory Committee, ASERNIP-S became a contractor and remains so today. ASERNIP-S was an also an early adopter of Horizon Scanning, a key activity informing of new procedures/technologies on the verge of introduction into our healthcare system. A strong international reputation of ASERNIP-S is recognised, both by lead roles of international networks and in working relationships with overseas agencies. In recent years the remit of ASERNIP-S has expanded to include research and evaluation services across the Royal Australasian College of Surgeons (including committees) and for Specialty Surgical Societies. Externally funded work is growing, including for the Federal Office of Public Health in Switzerland and the Ludwig Boltzmann Institute in Austria. It is unknown what the future will be for this unusually titled programme, but its long history in promoting and supporting surgical evidence and innovation is clear.

OP1 “First do no harm”: Significance of delays to surgery in patients with non-metastatic breast cancer

Background The majority of patients in Australia with non-metastatic breast cancer will undergo primary surgery with curative intent. This involves many complex decisions that inevitably increase time from diagnosis to surgery. Current guidelines suggest surgery should occur within 30 days of a decision to treat1. However, there may be appropriate reasons to justify a delay to surgery. This study aims to analyse factors that contribute to an increased time to surgery (TTS) and establish whether the associated wait time is justifiable in the context of improved individualised breast cancer management. Methods This is a retrospective analysis of all patients at Austin Health surgically managed for non-metastatic invasive breast carcinoma between 20013 and 2019. TTS was defined as time between informed diagnosis and cancer surgery. Patients were categorised into TTS groups of ≤30 and >30 days. Kaplan-Meier survival analysis was used to evaluate the impact of TTS on survival outcomes. Results A total of 842 patients were included. Median number of days to surgery was 34 days. 43.9% of the total cohort received surgery within the recommended 30 days. Factors identified to be associated with an increased TTS were screening, transfer of care, ER positive tumour, mastectomy, immediate reconstruction and use of pre-operative imaging including MRI and staging scans. Median follow up for the cohort was 30 months. Between wait groups of ≤30 and >30 days, there were no significant association found between TTS and survival outcomes for DFS (HR 1.20 95% CI 0.56 to 2.60) and OS (HR 1.58 95% CI 0.82 to 3.03). Conclusions Breast cancer management involves many complex factors that significantly increases time from diagnosis to surgery. Surgery within 30 days of diagnosis is not associated with improved DFS and OS. Time delays associated with integral element of care should be used to guide a revision of current TTS recommendations. 1. Royal Australasian College of Surgeons. Elective Surgery Urgency Categories. 2019.

Joseph Selwyn Gruss, F.R.C.S.(C.), 1945 to 2019

Joseph Selwyn Gruss, F.R.C.S.(C.), 1945 to 2019

Intraoperative nerve monitoring in endocrine surgery: prevalence and reasons for its use in Australia and New Zealand.

Intraoperative nerve monitoring (IONM) has increasingly been used in thyroid surgery by general, endocrine and head and neck surgeons. The purpose of this paper was to explore the prevalence and reasons for the usage of IONM in endocrine surgery in Australia and New Zealand. A survey was sent to general surgeons registered with the Royal Australasian College of Surgeons involved in endocrine surgery and members of the Australian and New Zealand Endocrine Surgeons. Users were divided into surgeon type, area of work, hospital type and volume of surgery. These data were analysed with univariate and multivariate logistic regression models. Significant differences in IONM usage levels were observed between endocrine and general surgeons, area of work and volume of surgery performed. Endocrine surgeons are significantly more likely to use IONM than general surgeons. Surgeons who work in tertiary hospitals are more likely to use IONM as compared to those working in district hospitals. Surgeons who perform less than 100 thyroidectomies were more likely to be users of IONM. IONM is not routinely used in thyroid surgery in Australia and New Zealand. The main reasons for the use of IONM given in our study by routine users were to establish familiarity of equipment and medicolegal reasons. Selective users chose as the most common reasons, a documented pre-existing unilateral nerve paresis or a hostile surgical field. Non-users stated that there was conflicting evidence that it improves outcomes and increased costs.

General Surgeons Australia's 12-point plan for emergency general surgery.

In the last decade, emergency general surgery (EGS) in Australia and New Zealand has seen a transition from the traditional on-call system to the acute surgical unit (ASU) model. The importance and growing demand for EGS has resulted in the implementation of the General Surgeons Australia's 12-point plan for emergency surgery. Since its release, the 12-point plan has been used as a benchmark of a well-functioning ASU, both locally and abroad. This study aims to provide a descriptive review on the relevance of the 12-point plan to the ASU model and review the current evidence to support this framework. The review concludes that the establishment of the ASU model has met the aims set out by the Royal Australasian College of Surgeons for EGS. The 12-point plan is relevant and has good evidence to support its framework.

Revisiting Mackay Online

Revisiting Mackay Online

The O.P.E.N. Survey: outreach projects in Ear, Nose and Throat (ENT) in New South Wales

Background: This study aims to map the coverage of Ear, Nose and Throat (ENT) outreach clinics in New South Wales (NSW) over a 5-year period [2012–2016]. It also aims to determine the extent of engagement in outreach work among NSW and ACT-based ENT surgeons over this period. Methods: Online and telephone survey of ENT surgeons practising in NSW and ACT conducted between December 2016 and May 2017. The survey was designed to identify the location, frequency and the number of ENT surgeons providing outreach services in NSW. A secondary outcome of the survey was the current and future rates of participation in outreach projects by NSW and ACT-based ENT surgeons. Results: Eighteen surgeons provided at least one ENT outreach service in NSW between 2012 and 2016. The average yearly commitment was 5.5 days (SD 4.2 days). Eighteen distinct towns in NSW received an outreach service. In the majority of cases, a visiting surgeon provided outreach services to the same town for at least three consecutive years. Surgeons who obtained their Fellowship of the Royal Australasian College of Surgeons (FRACS) after 2005 had the highest interest in future participation. Conclusions: Approximately 1 in 5 NSW and ACT-based ENT surgeons perform outreach activities. The data suggests that many remote and rural towns within NSW are not receiving outreach services. Better coordination of services and a commitment to regular and well-constructed outreach programs could redress this imbalance. The expressed intention to become involved in future outreach programs, particularly among the younger surgeons, needs to be encouraged and supported for this to be realised.

Abstract Journal Transplantation Surgery

ANZ Journal of SurgeryVolume 89, Issue S1 p. 201-202 Abstract Journal Transplantation SurgeryFree Access Abstract Journal Transplantation Surgery First published: 24 April 2019 https://doi.org/10.1111/ans.15205AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume89, IssueS1Supplement: Royal Australasian College of Surgeons 88th Annual Scientific Congress, Bangkok, Thailand, 6–10 May 2019May 2019Pages 201-202 RelatedInformation