3.1 selection and trainees - racs | royal australasian ... · 3.1 selection and trainees 3.1.1...

3. SPECIALIST SURGICAL TRAINING 3.1 SELECTION AND TRAINEES 3.1.1 Policy and Procedures The responsibility for the administration, regulation and assessment of applicants for surgical training lies with the relevant training boards, which advise the Council of the College through the Board of Specialist Surgical Training. Trainees apply in open competition, and the College selection processes are based on the principles outlined in the 1998 report, ‘Selection into Specialist Training Programs’ by the Medical Training Review Panel (Brennan Principles). In October 2004 the Board of Specialist Surgical Training conducted a workshop at the College to discuss the principles and processes of selection. Attendees included the Censor-in-Chief, representatives of the Court of Examiners, Chairs of the Specialty Boards, the Dean of Education, the College legal advisor, and jurisdictional representatives from the Specialty Boards. The workshop covered all aspects of the selection process and the expected criteria to be used by all specialties. Each of the Boards of Specialist Surgical Training annually review their selection processes and produce a report. These reports form the basis of reviews conducted prior to the subsequent year’s selection to continuously refine the process. The College is collaborating with the jurisdictions to ensure effective inclusion of jurisdictional representatives on all College selection panels. In 2004 the College ran a series of seven interviewer training workshops in Australia with a total of 116 Fellows attending. These workshops were designed to enhance the interview skills of Fellows on trainee selection panels for both Basic and Specialist Surgical Trainee selection. Attendees were provided with a training manual for subsequent reflection and reference. The workshops were well attended and feedback from the Fellows was very positive. The interviewer manual was revised in 2004 to ensure that it remains up-to-date with the most current selection principles and practices. Training Boards must receive approval from Education Policy Board for the selection tools they use and the weighting given to them. A range of selection tools is used and may include any combination of the following:

• referees’ reports • professional performance assessments • curriculum vitae • in-training assessment reports, and • semi-structured and specialty-specific interviews.

The proportional scores attributed to each selection tool will be reasonable and fair to all applicants:

• no selection tool will be ascribed a weighting of more than 40% of the final score • the combined score for referees’ reports and professional performance assessments will

total no more than 40% of the final score • referees' reports should be written in a standardised pro forma with a view to achieving

objectivity, comparability and quantification • professional performance assessments will be recorded in a standardised pro forma with

a view to achieving objectivity, comparability and quantification

Royal Australasian College of Surgeons – Activities Report 2004 Specialist Surgical Training – 1

• all procedures for assessing referees’ reports and professional performance assessments will be fully publicised

• in selection advertising and application materials, the volume of instructions and requirements must be appropriate to the weighting given to the relevant selection tool in the final score

• the weighting of selection tools in the final score is determined prior to commencement of the selection process

• all applicants who meet the minimum criteria based on written application materials must be interviewed.

Selection of trainees occurs between May and November and can be divided into four stages: Stage one – Submission of application The trainee applies directly to the relevant Training Board of the College using the specialty proforma. Stage two – Paper assessment to assess eligibility A paper assessment is undertaken by administrative staff who screen for eligibility. Stage three – Interview Each specialty board nominates a selection committee to undertake the selection process, the size and composition of which is determined in accordance with the number of applicants. Members are trained in the College’s selection principles and procedures. Each selection committee includes a Jurisdictional Representative in consultation with Australian health ministers, and according to the ACCC determination of June 2003 (Authorisation No. A90765). Interviews of applicants are conducted by panels of interviewers, comprising no more than six people, the majority of whom are surgeons. The specialty board decides on the composition of the interviewing and applicants are notified of the composition (but not names of interviewers) at the time of notification of the interview. All interviewing panels will have a Jurisdictional Representative as a member. At the time of interview, all applicants receive the same, standardised, validated questions, although the College recognises that applicants may be asked different follow-up questions within reason. All applicants will be given a similar length of time to respond to each question, and each interview will be of the same length of time. Stage four – Ranking and allocation to a training post Once the interviews have been completed, the applications are scored and ranked. Feedback to unsuccessful applicants All unsuccessful applicants, if they desire, are be provided with written feedback on their standing and performance in the application and selection process, which will include:

• information on their score in the selection process • information on their ranking and on the cut-off score • information about how to improve their application for future attempts for which they may

be eligible • those assessed as being suitable for training but who were not selected because of a

lack of training places must be advised and where possible given access to interim arrangements – these applicants will be offered Transitional Surgical Trainee (TST) status.


Applications from overseas-trained doctors Overseas trained doctors must first undergo an assessment by the college. For further details, refer to section 3.5, below. Issues raised by trainees Feedback from trainees is received through a number of avenues. The Board of Specialist Surgical Training appoints two trainee representatives who are able to raise and discuss issues of concern to trainees. The Australian Orthopaedic Registrars Association is an avenue for orthopaedic trainees to raise issues related to training in general or specific to the Orthopaedic Surgery training program. Each Specialty website contains a forum for trainees to conduct and/or participate in their own forum. During 2005 this facility will be promoted amongst the trainees in each of the specialty groups. The College has developed a “reconsideration and review process” to better handle concerns about decisions made within the Education portfolio, as described earlier for Basic Surgical Training. Concerns have been voiced, by new graduates from medical school who are contemplating a career in surgery and by some Basic Surgical Trainees, about the disarticulation between Basic Surgical Training and Specialist Surgical Training. The College has also recognised that surgical training must become seamless and the Educational Policy Board has made a recommendation to Council that this be implemented. Issues of work-life balance, safe hours and perceived communication problems with the College have also been raised and are being addressed. Trainees’ association At present there is no RACS trainees association and trainee representation is performed by the Australian Medical Association, specifically Doctors in Training. The College liaises regularly with the AMA to ensure that trainees’ needs are addressed. The College encourages trainee representation on its major Boards and Committees and in February 2005 the College Council agreed to progress the establishment of a Trainee Association and a Trainee Advocate. The College is exploring options to facilitate the formation of a trainee representative organisation and is currently reviewing the Canadian and UK models. 3.1.2 Role of the College MEMORANDA OF ASSOCIATION AND AGREEMENTS WITH THE SPECIALTY SOCIETIES AND ASSOCIATIONS All specialty training in Australia is accredited by the Australian Medical Council (AMC). Delivery of the surgical training programs is undertaken through a contractual relationship between the College and 13 specialty groups who represent the nine surgical disciplines in Australia and New Zealand. Surgical training is delivered in accordance with a “user pays” and cost neutral philosophy. The income derived from trainee fees is pooled and shared between Australia and New Zealand. The Service Agreements have three core funding components: College Component (estimated at approximately 16% of the total trainee fee). Expenses that fall into this category are estimated overhead costs that are met by the College in delivery of the surgical training programs.


Base Services Component (estimated at approximately 16% of the total trainee fee). Expenses that fall into this category are:

• representation by the specialist group at the BSST meetings • conduct of the Specialty Board in day to day administration of the surgical training

programs • general office expenses related to administration of the training program, and • expenses incurred by the Board Chair. Although the agreement is between the College

and the Society, the responsibility for delivery of the training program lies with the Boards who report through the College governance structures to the College Council.

Service Activity Component (estimated at approximately 68% of the trainee fee). Expenses that fall into this category have been broken down into six core activities:

• Course Development • Trainee Selection • Hospital Post Accreditation • Course Delivery • Records Management • Program Management

Usually either the College or the Society will contract responsibility for all of an activity, however, occasionally responsibility is shared. Funding is allocated in accordance with the responsibility negotiated, although in most instances, it will be one party only who will receive funding. The following table provides an overview of the activities allocated across all regions. Society * Course

Development Trainee Selection

Post Accreditation

Course Delivery

Records Management

Program Management

GSA RACS RACS RACS RACS RACS RACS NZAGS RACS RACS RACS SOC RACS SOC AOA SOC SOC SOC SOC SOC SOC NZOA SOC SOC SOC SOC SOC SOC NSA SOC SOC SOC SOC SOC SOC ASPS SOC SOC SOC SOC RACS SOC NZAPS RACS RACS RACS RACS RACS RACS ASCTS RACS RACS RACS RACS RACS RACS AAPS RACS RACS RACS RACS RACS RACS USA SOC SOC SOC SOC SOC SOC ASOHNS RACS RACS RACS SOC SOC SOC NZSOHNS RACS RACS RACS SOC SOC SOC ANZSVS RACS RACS RACS RACS RACS RACS SOC = Society is responsible RACS = RACS is responsible * Abbreviations for the Societies and Associations: GSA - General Surgeons Australia; NZAGS - New Zealand Association of General Surgeons; AOA - Australian Orthopaedic Association; NZOA - New Zealand Orthopaedic Association; NSA - Neurosurgical Society of Australasia; ASPS - Australian Society of Plastic Surgeons; NZAPS - New Zealand Association of Plastic Surgeons; ASCTS - Australian Society of Cardiac and Thoracic Surgeons; AAPS - Australasian Association of Paediatric Surgeons; USA - Urological Society of Australasia; ASOHNS - Australian Society of Otolaryngology - Head and Neck Surgeons; NZSOHNS - New Zealand Society of Otolaryngology - Head and Neck Surgeons; ANZSVS - Australian New Zealand Society of Vascular Surgeons.


3.1.3 Quantitative Data In Specialist Surgical Training the total intake for 2004 was 232. In New Zealand the intake was 34. In Australia the intake was 198, distributed across the Surgical Specialties as follows: Specialist Surgical Training intake for Australia, 2004 Specialty Number Cardiothoracic Surgery 4 General Surgery 95 Neurosurgery 16 Orthopaedic Surgery 40 Otolaryngology - Head & Neck Surgery 16 Paediatric Surgery 1 Plastic & Reconstructive Surgery 13 Urology 12 Vascular Surgery 1 198

Applicants for Specialist Surgical Training (2005 intake)

Specialty Eligible

Applicants "Cut off"

Score UnsuccessfulOffers

Accepted % Selected Cardiothoracic 22 65 15 6 27.3 General Surgery 151 50 50 101 66.9 Neurosurgery 23 * 11 11 47.8 Orthopaedic 117 50 61 56 47.9 Otolaryngology 48 65 27 17 35.4 Paediatric 9 60 3 6 66.7 Plastic & Recon. 51 60 33 14 27.5 Urology 39 40 21 18 46.2 Vascular 24 50 12 11 45.8 484 - 233 240 49.6

* For Neurosurgery, applicants must score a) a percentage adjusted score of 43 or above in the Structured Curriculum Vitae scoring process; b) a percentage adjusted score of 34 or aboive in a minimum of two of the four chosen Stuctured Referee Reports; c) a combined percentage score of 44 or above for the Structured Referee Reports; and d) a rating of suitable or above in each of the eight sections and three scenarios during the interview to be deemed suitable for selection.


Specialist Surgical Training posts (as at 31 December 2004) Specialty ACT NSW QLD SA/NT TAS VIC WA Aust NZ O/S TotalCardiothoracic 0 11 3 1 1 8 2 26 4 0 30 General Surgery 6 99 44 19 8 69 21 266 52 35 353 Neurosurgery 1 14 6 2 1 9 3 36 4 2 42 Orthopaedic 4 53 29 11 3 32 17 149 40 1 190 Otolaryngology 1 18 9 6 1 13 5 53 12 0 65 Paediatric 0 6 2 1 0 5 1 15 2 0 17 Plastic & Recon. 0 15 6 6 1 15 7 50 13 0 63 Urology 1 12 9 3 2 10 3 40 8 0 48 Vascular 0 6 3 3 0 6 1 19 3 0 22 13 233 111 52 17 167 60 653 135 37 830 At 31 December 2004, there are no Specialist Surgical Training posts unfilled

TRANSITIONAL STATUS TRAINEES In 2003 the College introduced a temporary trainee status called “Transitional Surgical Trainees” (TST) for trainees who were unsuccessful in their application to SST, even though they satisfied the selection criteria. A TST was defined as an applicant who has met the eligibility and selection criteria as outlined by the Specialty Boards and whose application was unsuccessful due to the limited number of available training positions. Under this policy, a trainee would be permitted another application to Specialist Surgical Training. Trainees who had not met the requisite criteria would not be eligible to lodge another application to Specialist Surgical Training. The College has decided to extend the TST arrangements until such time as sufficient accredited SST positions have been established to meet projected workforce requirements. It has also been decided that TSTs may apply to all SST specialties in 2005. Currently there are 33 registrars who have been offered 2005 TST status (of whom 27 have registered). Of 20 TSTs who were offered the opportunity to extend their 2004 TST status, 4 have registered. 3.2 TRAINING 3.2.1 Qualitative Data Goals The goal of Specialist Surgical Training is to train surgeons to the point where they are competent to practice independently and safely and provide the highest standards of care to their patients. The principles of training are guided by international evidence based medical education, vocational and adult learning. The College continues to work with a number of Federal, State and Territory Government departments and working groups to review the goals of surgical education and training within the broad spectrum of delivery of services within the Australian health system. As trainees are located in various regions in a bi-national training program, the College utilises a combination of face to face, computer assisted and distance learning educational resources in a range of settings including hospitals, skills centres and universities.


The College has incorporated the CanMEDS principles into its curricula and is also collaborating with a number of organisations, including the AMC, and the Committee of Presidents of Medical Colleges to ensure that curricula meet required standards for quality assurance. Curriculum The Specialist Surgical Training curriculum has been developed in accordance with the AMC accreditation requirements and includes clearly articulated learning objectives and competencies, an explanation of the philosophy and goals of the training courses and learning materials for self directed learning. Curriculum maps for most of the specialty areas have been developed to provide an overview of the entire specialist surgical training curriculum and to facilitate the linking of assessment and content. Below is a diagrammatical representation of the various components of surgical training.

The College has well-developed content and assessment for training. However, the aim of more recent curriculum development has been to develop clearly articulated learning objectives, objectives regarding what the trainee should be able to do, and competencies necessary to practise as an independent specialist in the Australian and New Zealand health systems. This requires two further levels of curriculum development. The first is to link content with objectives and desired competencies. The second is to gain a better understanding of how learning occurs, which requires linking competencies, objectives and appropriate assessment procedures.


The following table details progress on curriculum development by Surgical Specialty. Specialty Learning objectives

clearly stated Defined surgical competencies for each subject area

Curricula published on College website

Cardiothoracic To be commenced 2005

To be commenced 2005


General Completed Completed Completed 2004 Neurosurgery Completed Completed Completed 2004 Orthopaedics To be commenced

2005 To be commenced 2005


Otolaryngology Completed Completed To be released June 2005

Paediatrics Completed In progress To be released progressively during 2004-2005

Plastics & Reconstructive

Completed Completed Completed March 2005

Urology Completed Completed Completed 2004 Vascular In progress In progress To be released

progressively during 2004-2005

OUTER METROPOLITAN SPECIALIST TRAINING PROGRAM As some surgical procedures are only provided through the private sector, extension of training into this sector has potential for increasing opportunities for training. Since 2004, the College has participated in the federally funded “Outer Metropolitan Specialist Training Program. Initially, the College hoped to create opportunities for 20 trainees to undertake rotations in the private sector. However, due to program restrictions this target has not been met. A significant limiting factor has been the geographic definition of “outer metropolitan”. As there are few hospitals in outer metropolitan regions with the infrastructure necessary to support surgical training, opportunities were severely restricted. In addition, the time restriction of Commonwealth funding to one year is not viable for a 4 year training program. SUPERVISORS, ASSESSORS, TRAINERS AND MENTORS Appointment of supervisors, and roles of the assessors and trainers In each hospital there is a Specialty Supervisor for each discipline that has a specialist surgical program. The process for appointing a Specialty Supervisor involves nomination by the hospital. This nomination is then approved by the Specialty Board and the Board of Specialty Surgical Training. Specialty Supervisors work under the direction of the Chairmen of the Regional Subcommittees of the Surgical Boards. Normally they will be members of the surgical staff of the hospital and will hold office for three years, after which time they are eligible for re-appointment. Under normal conditions, Specialty Supervisors will retire after 6 years however, in the smaller specialties reappointment after 6 years may be necessary. Reappointment may be denied on the basis of poor general performance, repeated absences from meetings at the local Regional Surgical Training Committee/Board level, failure to supervise and advise Trainees adequately and failure to maintain good communications and relations with trainees and key bodies involved in the surgical training program.


The duties of a supervisor are to:

• advise Specialist Surgical Trainees on all aspects of surgical training • ensure that Specialist Surgical Trainees are appropriately registered • to monitor Log Book entries by regular inspection • arrange regular meetings with surgeons and to discuss programs and progress of

individual trainees • provide confidential reports to the Regional Subcommittee of the Specialty Board

through • which the Board will be able to make recommendations regarding eligibility to sit the

Fellowship Examination and regarding progress and completeness of training • be a member of the Regional Subcommittee of the Specialty Board • be present at the inspection of their Specialty Program at the hospital by the College • participate in the selection of Specialist Surgical Trainees together with hospital • representatives and the Regional Subcommittee of the Specialty Board Committee.

Training policies and manuals Assessors, trainers and board members are encouraged to attend “Surgeons as Educators Workshops”, “Surgical Teachers Workshops” and “Interviewer Training Workshops”. During 2004, the College revised its “Interviewers’ Training Manual”. During 2005, it will develop a manual for all assessors and examiners that will include the following:

• description of the assessment processes used by the College • overview of assessments methods and tools used by each specialty • descriptions of the role and responsibilities of assessors, senior examiners and

members of the Court of Examiners • policies relating to assessment are being revised and published on the College website.

In training assessment Trainee performance is evaluated regularly during each rotation period and throughout training for overall competent performance. The RACS Competencies that are assessed are:


esearch and continuing medical education are monitored via presentations, publications and

onducted by the Specialist Supervisor, Hospital Supervisor,

nation, the Board Chair and Censor-in-Chief will

,

ction system, which will be used to

RACS Competencies

1. Medical expertise: • access and apply relevant knowledge to clinical practice

2. Technical expertise: • safely and effectively perform appropriate surgical procedures

3. Judgement – clinical decision making: • design and carry out effective management plans • organise diagnostic testing, imaging and consultation as needed

4. Communication: • communicate effectively

5. Collaboration: • work in collaboration with members of an interdisciplinary team where appropriate

6. Management and leadership: • balanced decision making • effectively use resources to balance patient care and systemic demands • manage and lead clinical teams • maintains accurate records

7. Health advocacy: • promote health maintenance of patients • promote health maintenance of colleagues • look after their own health

8. Scholar and teacher: • recognise the value of knowledge and research and its application to clinical

practice

9. Professionalism: • appreciate the ethical issues associated with surgery.

Rpatient management review. n training assessments are cI

Supervisor or Assessor in consultation with the trainee. Both the trainee and the surgical supervisor sign the assessment form.

rior to application to sit the Fellowship ExamiPreview the trainee’s performance prior to granting approval to sit the Fellowship Examination. This process involves an examination of the progress reports and an inspection of the Log Booktogether with any other material pertinent to the candidate.

uring 2004-5 the College introduced an electronic data colleDprovide statistical data for formative and summative assessment and examinations. In 2005 the College will also install a database for the management of question banks, and the design and delivery of examinations. This database will provide statistical data on performance of individual examination questions.


3.2.2 Quantitative Data Correction of earlier data In the last report on this data for the period to June 2004, several trainees were double-counted. Some of these were Tasmanian trainees administered by the Victorian regional office, and similar errors also occurred between General Surgery and other disciplines (several specialties require a period of General Surgery training, but such trainees should only be counted in their ‘originating’ specialty, eg Cardiothoracic). The College regrets this error, has corrected its processes for this and future reports, and is pleased to report that this revised total of 845 remains a strong increase over the 2003 figure of 811. Specialist Surgical Trainees (as at 31 December 2004) Specialist Surgical Trainees by region and year of training Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 7 63 33 15 9 53 18 198 37 1 236 2 5 58 28 15 3 43 13 165 31 7 203 3 0 52 24 14 1 34 12 137 34 11 182 4 0 54 23 7 0 31 11 126 30 17 173 5 0 13 4 4 2 11 1 35 6 8 49 6 0 1 1 0 0 0 0 2 0 0 2 12 241 113 55 15 172 55 663 138 44 845

Programs differ in duration; not all have fifth or sixth years of training. See below for detail. Only two trainees in 2004 were part-time; one male and one female, both in South Australia, and both in the General Surgery program. Male Specialist Surgical Trainees by region and year of training Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 6 45 26 13 8 41 15 154 26 1 181 2 5 50 23 13 3 36 11 141 22 7 170 3 0 44 23 13 1 31 11 123 30 11 164 4 0 44 21 6 0 26 10 107 25 11 143 5 0 12 3 3 1 11 0 30 5 6 41 6 0 1 1 0 0 0 0 2 0 0 2 11 196 97 48 13 145 47 557 108 36 701

Female Specialist Surgical Trainees by region and year of training Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 1 18 7 2 1 12 3 44 11 0 55 2 0 8 5 2 0 7 2 24 9 0 33 3 0 8 1 1 0 3 1 14 4 0 18 4 0 10 2 1 0 5 1 19 5 6 30 5 0 1 1 1 1 0 1 5 1 2 8 6 0 0 0 0 0 0 0 0 0 0 0 1 45 16 7 2 27 8 106 30 8 144


Female Specialist Surgical Trainees by region and year of training As a percentage of total trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 14.3 28.6 21.2 13.3 11.1 22.6 16.7 22.2 29.7 0.0 23.3 2 0.0 13.8 17.9 13.3 0.0 16.3 15.4 14.5 29.0 0.0 16.3 3 - 15.4 4.2 7.1 0.0 8.8 8.3 10.2 11.8 0.0 9.9 4 - 18.5 8.7 14.3 - 16.1 9.1 15.1 16.7 35.3 17.3 5 - 7.7 25.0 25.0 50.0 0.0 100.0 14.3 16.7 25.0 16.3 6 - 0.0 0.0 - - - - 0.0 - - 0.0 8.3 18.7 14.2 12.7 13.3 15.7 14.5 16.0 21.7 18.2 17.0


Cardiothoracic Surgery (as at 31 December 2004) Cardiothoracic Surgery Trainees

Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total 1 0 1 0 1 0 0 0 2 2 0 4 2 0 1 2 0 0 0 0 3 0 0 3 3 0 2 0 0 1 3 0 6 0 0 6 4 0 3 0 0 0 0 1 4 1 1 6 5 0 3 1 0 0 3 0 7 0 0 7 6 0 1 1 0 0 0 0 2 0 0 2 0 11 4 1 1 6 1 24 3 1 28

Male Cardiothoracic Surgery Trainees

Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total 1 - - - 1 - - - 1 2 - 3 2 - 1 2 - - - - 3 - - 3 3 - 2 - - 1 3 - 6 - - 6 4 - 3 - - - - 1 4 1 1 6 5 - 2 1 - - 3 - 6 - - 6 6 - 1 1 - - - - 2 - - 2 0 9 4 1 1 6 1 22 3 1 26

Female Cardiothoracic Surgery Trainees

Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total 1 - 1 - - - - - 1 - - 1 2 - - - - - - - 0 - - 0 3 - - - - - - - 0 - - 0 4 - - - - - - - 0 - - 0 5 - 1 - - - - - 1 - - 1 6 - - - - - - - 0 - - 0 0 2 0 0 0 0 0 2 0 0 2


General Surgery (as at 31 December 2004) General Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 5 28 13 6 6 26 3 87 11 0 98 2 1 23 10 4 1 24 6 69 13 3 85 3 0 19 7 4 0 10 4 44 10 11 65 4 0 21 9 2 0 10 3 45 11 13 69 5 0 7 1 3 1 2 1 15 6 8 29 6 98 40 19 8 72 17 260 51 35 346

Male General Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 4 19 10 4 5 19 2 63 7 - 70 2 1 18 7 4 1 20 5 56 8 3 67 3 - 13 6 4 - 8 4 35 7 11 53 4 - 15 9 1 - 10 2 37 10 7 54 5 - 7 - 2 1 2 - 12 5 6 23 5 72 32 15 7 59 13 203 37 27 267

Female General Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 1 9 3 2 1 7 1 24 4 - 28 2 - 5 3 - - 4 1 13 5 - 18 3 - 6 1 - - 2 - 9 3 - 12 4 - 6 - 1 - - 1 8 1 6 15 5 - - 1 1 - - 1 3 1 2 6 1 26 8 4 1 13 4 57 14 8 79


Neurosurgery (as at 31 December 2004) Neurosurgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 1 1 0 0 0 2 2 6 3 1 10 2 0 7 3 1 0 2 1 14 1 1 16 3 0 4 3 1 0 0 0 8 2 0 10 4 0 4 2 0 0 3 1 10 0 0 10 5 0 1 0 0 1 2 0 4 0 0 4 1 17 8 2 1 9 4 42 6 2 50

Male Neurosurgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 1 - - - - 2 2 5 2 1 8 2 - 6 3 1 - 2 - 12 1 1 14 3 - 3 3 1 - - - 7 2 - 9 4 - 3 1 - - 1 1 6 - - 6 5 - 1 - - - 2 - 3 - - 3 1 13 7 2 0 7 3 33 5 2 40

Female Neurosurgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 - 1 - - - - - 1 1 - 2 2 - 1 - - - - 1 2 - - 2 3 - 1 - - - - - 1 - - 1 4 - 1 1 - - 2 - 4 - - 4 5 - - - - 1 - - 1 - - 1 0 4 1 0 1 2 1 9 1 0 10


Orthopedic Surgery (as at 31 December 2004) Orthopedic Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 0 15 8 3 1 10 5 42 10 0 52 2 4 12 8 3 2 6 3 38 10 2 50 3 0 12 6 3 0 8 4 33 9 0 42 4 0 14 7 2 0 8 3 34 8 0 42 4 53 29 11 3 32 15 147 37 2 186

Male Orthopedic Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 - 13 7 3 1 9 5 38 10 - 48 2 4 11 7 3 2 5 3 35 9 2 46 3 - 12 6 3 - 8 4 33 9 - 42 4 - 14 6 2 - 8 3 33 6 - 39 4 50 26 11 3 30 15 139 34 2 175

Female Orthopedic Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 - 2 1 - - 1 - 4 - - 4 2 - 1 1 - - 1 - 3 1 - 4 3 - - - - - - - 0 - - 0 4 - - 1 - - - - 1 2 - 3 0 3 3 0 0 2 0 8 3 0 11


Otolaryngology - Head & Neck Surgery (as at 31 December 2004) Otolaryngology - Head & Neck Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 1 7 4 1 1 4 2 20 3 0 23 2 0 4 3 3 0 4 1 15 2 0 17 3 0 3 2 3 0 4 0 12 3 0 15 4 0 4 2 1 0 2 1 10 4 0 14 1 18 11 8 1 14 4 57 12 0 69

Male Otolaryngology - Head & Neck Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 1 5 2 1 1 3 2 15 - - 15 2 - 4 2 2 - 4 1 13 1 - 14 3 - 2 2 2 - 4 - 10 3 - 13 4 - 3 2 1 - 1 1 8 3 - 11 1 14 8 6 1 12 4 46 7 0 53

Female Otolaryngology - Head & Neck Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 - 2 2 - - 1 - 5 3 - 8 2 - - 1 1 - - - 2 1 - 3 3 - 1 - 1 - - - 2 - - 2 4 - 1 - - - 1 - 2 1 - 3 0 4 3 2 0 2 0 11 5 0 16


Paediatric Surgery (as at 31 December 2004) Paediatric Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 0 1 1 1 0 1 0 4 1 0 5 2 0 0 0 0 0 0 0 0 0 0 0 3 0 0 1 0 0 0 1 2 1 0 3 4 0 1 0 0 0 0 0 1 1 0 2 5 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 2 2 1 0 1 1 7 3 0 10

Male Paediatric Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 - - - 1 - - - 1 1 - 2 2 - - - - - - - 0 - - 0 3 - - 1 - - - - 1 1 - 2 4 - - - - - - - 0 1 - 1 5 - - - - - - - 0 - - 0 6 - - - - - - - 0 - - 0 0 0 1 1 0 0 0 2 3 0 5

Female Paediatric Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 - 1 1 - - 1 - 3 - - 3 2 - - - - - - - 0 - - 0 3 - - - - - - 1 1 - - 1 4 - 1 - - - - - 1 - - 1 5 - - - - - - - 0 - - 0 6 - - - - - - - 0 - - 0 0 2 1 0 0 1 1 5 0 0 5


Plastic & Reconstructive Surgery (as at 31 December 2004) Plastic & Reconstructive Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 0 4 3 2 1 6 2 18 4 0 22 2 0 5 1 2 0 4 2 14 3 1 18 3 0 4 1 2 0 3 1 11 4 0 15 4 0 2 1 1 0 5 1 10 3 1 14 0 15 6 7 1 18 6 53 14 2 69

Male Plastic & Reconstructive Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 - 4 3 2 1 5 1 16 2 - 18 2 - 5 1 1 - 3 2 12 2 1 15 3 - 4 1 2 - 3 1 11 4 - 15 4 - 2 1 1 - 3 1 8 2 1 11 0 15 6 6 1 14 5 47 10 2 59

Female Plastic & Reconstructive Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 - - - - - 1 1 2 2 - 4 2 - - - 1 - 1 - 2 1 - 3 3 - - - - - - - 0 - - 0 4 - - - - - 2 - 2 1 - 3 0 0 0 1 0 4 1 6 4 0 10


Urology (as at 31 December 2004) Urology Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 0 5 4 1 0 4 3 17 3 0 20 2 0 5 1 2 0 3 0 11 2 0 13 3 0 6 4 0 0 5 1 16 2 0 18 4 0 3 1 0 0 2 1 7 2 2 11 0 19 10 3 0 14 5 51 9 2 62

Male Urology Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 - 3 4 1 - 3 2 13 2 - 15 2 - 4 1 2 - 2 - 9 1 - 10 3 - 6 4 - - 4 1 15 2 - 17 4 - 2 1 - - 2 1 6 2 2 10 0 15 10 3 0 11 4 43 7 2 52

Female Urology Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 - 2 - - - 1 1 4 1 - 5 2 - 1 - - - 1 - 2 1 - 3 3 - - - - - 1 - 1 - - 1 4 - 1 - - - - - 1 - - 1 0 4 0 0 0 3 1 8 2 0 10



Vascular Surgery (as at 31 December 2004) Vascular Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 0 1 0 0 0 0 1 2 0 0 2 2 0 1 0 0 0 0 0 1 0 0 1 3 0 2 0 1 0 1 1 5 3 0 8 4 0 2 1 1 0 1 0 5 0 0 5 5 0 2 2 1 0 4 0 9 0 0 9 0 8 3 3 0 6 2 22 3 0 25

Male Vascular Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 - 1 - - - - 1 3 - - 3 2 - 1 - - - - - 1 - - 1 3 - 2 - 1 - 1 1 7 2 - 8 4 - 2 1 1 - 1 - 3 - - 3 5 - 2 2 1 - 4 - 9 - - 9 0 11 2 2 0 6 2 23 1 0 24

Female Vascular Surgery Trainees Year ACT NSW QLD SA/NT TAS VIC WA AUST NZ O/S Total

1 - - - - - - - 0 - - 0 2 - - - - - - - 0 - - 0 3 - - - - - - - 0 1 - 1 4 - - - - - - - 0 - - 0 5 - - - - - - - 0 - - 0 0 0 0 0 0 0 0 0 1 0 1

Rural Surgical Training (as at 31 December 2004) Active Trainees undertaking rural surgical training Specialty ACT NSW QLD SA/NT TAS VIC WA Aust General Surgery 1 10 3 3 0 6 0 23 Orthopaedic 0 8 3 2 0 6 3 22 Otolaryngology 0 4 2 1 0 3 2 12 1 22 8 6 0 15 5 57 Male Active Trainees undertaking rural surgical training Specialty ACT NSW QLD SA/NT TAS VIC WA Aust General Surgery 1 6 1 3 0 4 0 15 Orthopaedic 0 7 3 2 0 5 3 20 Otolaryngology 0 4 0 1 0 3 2 10 1 17 4 6 0 12 5 45 Female Active Trainees undertaking rural surgical training Specialty ACT NSW QLD SA/NT TAS VIC WA Aust General Surgery 0 4 2 0 0 2 0 8 Orthopaedic 0 1 0 0 0 1 0 2 Otolaryngology 0 0 2 0 0 0 0 2 0 5 4 0 0 3 0 12 These trainees are also included in the SST figures above

3.3 ASSESSMENT 3.3.1 Qualitative Data Formative assessment The College introduced several types of formative assessment during 2004 and is exploring ways to introduce multiple forms of assessment that will assist in translating learning into the clinical environment. Specialty Boards are continuing to review their assessment in light of trainees’ changing educational experiences prior to commencing surgical training, the changing knowledge and skill requirements within the training program (including competencies), and changes in the clinical environment. In particular the teaching and learning of Anatomy for both Basic and Specialist Surgical Training has been the focus of attention and a working party will report on this shortly. Adapted 360° Rating Scale Orthopaedic Surgery initiated the use of these rating scales and several other Surgical Specialties are exploring their use or have already adopted this practice.


General Surgery has introduced a mid-term assessment process to facilitate the early identification of unsatisfactory performance by trainees and to provide opportunities for trainees to improve their performance. Specialty-Specific Principles and Basic Sciences There are many benefits to trainees of understanding early in their specialty training, the important principles and relevant basic science which underpin that specialty. For this reason some specialties have introduced a curriculum which includes an examination at the end of the first year of specialty training, and others are contemplating doing so. Orthopaedic Surgery and Plastic and Reconstructive Surgery see this as a hurdle examination, whereas Paediatric Surgery considers it to be a component of the Fellowship Examination. Logbooks and Trainee Evaluation Forms The publishing of surgical competencies has led to changes being made to trainee logbooks, (which record the details of a trainee’s clinical experience), to ensure they reflect the defined surgical procedures. Trainee Evaluation Forms are being aligned with the surgical competency statements. It is intended to expand the on-line materials to include all nine specialties during 2005. Stages in trainee examination Examination of trainees progresses in 6 stages:

1. Recommendation to sit the examination 2. Application and payment of examination fees 3. Sitting the Written 4. Presenting for the Clinicals 5. Presentation of results 6. Convocation

Approval to sit the Fellowship Examination The trainee must seek approval to sit the Fellowship Examination. If after reviewing the trainee’s performance, the Board Chair approves the trainee for the examination, the trainee can submit a formal application. Once eligibility has been confirmed and fees have been paid the trainee will be advised of the examination procedures and dates. Eligibility criteria:

• Trainees must have completed Basic Surgical Training, passed the Part 1 (Basic Surgical Training) Examination and Assessment Package, and have been registered Accredited Specialty Surgical Trainees of the College and satisfied the period of Specialty Surgical Training as approved by the appropriate Surgical Board. An investigative project must have been completed and approved by the Surgical Board.

• Overseas Trained Doctors may apply to sit the Fellowship Examination and their eligibility to present will be determined by the Censor-in-Chief in conjunction with the relevant Surgical Board.

• Trainees must make an application to the Department of Assessment and Overseas Trained Doctors on the appropriate form by the official closing date.

• In Orthopaedic Surgery, an 'Orthopaedic Principles and Basic Science' (OPBS) examination must be passed before the candidate can sit for the final Fellowship Examination. The OPBS examination is usually held in the first half of the first year of Specialty Surgical Training in Orthopaedic Surgery.

• All outstanding fees must be paid the due date prior to the application being accepted.

In making a decision as to the eligibility of a Trainee to sit for the Examination, the Specialty Board Chairman may take into account:

• Recommendations from the appropriate Surgical Board. The Chairman of the Surgical Board should certify that the Trainee has completed the proper length and components


of training and that progressive assessment throughout the training period was satisfactory.

• Information from the Log Book. Examinations are held in designated venues in Australia and New Zealand, and consist of seven separate segments, including: Segment Details Written paper 1 (duration 2 hours) MCQ papers will be sat in Orthopaedic Surgery, Neurosurgery and Vascular Surgery Written paper 2 (duration 2 hours) This paper may include a question on Anatomy and Developmental Anatomy.

Held on the same day several weeks in advance of the oral examinations

A Clinical Examination of a 'Long Case' or 'Medium Cases' (duration 30 minutes)

This session comprises of short cases where patients present with common conditions. The examination in Urology consists of a 'structured oral examination' with two brief clinical scenarios. In Orthopaedic Surgery both clinical examinations comprise three 'medium' cases.

A Clinical Examination of a Number of 'Short Cases'

A variable number of cases may be shown. Spot diagnosis, short answer treatment and precise investigation programs are required and encouraged. Short cases are replaced by a 'diagnostic' examination involving predominantly x-ray images in Urology.

A Half-Hour Viva on Operative Surgery

A pair of Examiners will examine the candidate on this subject for 25 minutes, and will base their examination upon photographic slides, CD Roms, pathology museum specimens, x-rays or other imaging modalities, etc. At the Examiner's request, the facilities to utilise any or all of these examination aids will be made available.

A Half-Hour Viva on Surgical Pathology

Similar in all ways to the operative surgery viva, except for the content and subject matter of the examination. This viva is replaced by 'Clinical Investigation and Management in Orthopaedic Surgery with pathology being covered in the Orthopaedic Principles and Basic Science (OPBS) examination

A Half-Hour Viva on Surgical Anatomy, with Specimens

Dissected specimens are selected by the Examiners. Recent emphasis has been towards surgical exposures, incisions, dissection planes and danger areas, rather than pure anatomy. Cross sectional anatomy is becoming more important with increasing use of Computerised Tomography (CT) and Magnetic Resonance Imaging (MRI). In Urology, operative surgery and anatomy are combined in two 25 minute vivas. In Orthopaedic Surgery, anatomy is covered in the OPBS examination (see below).


Marking system used for Fellowship examination The marking system adopted for each segment of the examination is the 'close marking system', i.e. the marks are clustered with figures close together to represent certain standards.

9½ Awarded for exceptional performance 9 Represents a 'satisfactory' standard so that a pass in the entire

examination requires seven segments of 9 each = 63 marks. Candidates are expected to reach 9 in each Clinical segment.

8½ Represents a standard expressed as 'doubtful in this segment'; it is not a frank fail and its significance may be modified in the light of performance in other segments and by discussion by all members of the Court before a final decision is taken. Although it is possible to be approved overall with an 8½ in one, or even both of the Clinicals, in the light of performances in all other segments, this is unlikely.

8 A clear fail. No mark below this is awarded. Outright Fail:

• candidates obtaining 61½ or less will not be approved • candidates obtaining 8 in either of the clinical segments will not be approved.

Pass:

• candidates obtaining a mark of 63 or more, with at least 9 in each clinical, will be automatically approved

• candidates obtaining 62½ or more, with at least 9 in one clinical, may be presented in block form by their Specialty Court for approval without discussion.

Results that must be discussed by the Court:

• candidates obtaining a mark of 62½ or more who are not recommended for approval by their Specialty Court must be discussed by the full Court

• candidates with a mark of 62 on the primary count: o with 9 or better in both Clinicals may be approved after discussion o with 8½ in one Clinical may possibly be approved after discussion o with 8½ in both Clinicals may be discussed and approved, but this is unlikely.

Candidates in the doubtful ranges 62, 62½ or totals which include less than 9 in clinical segments, are discussed in considerable detail. Marking proceeds in three stages:

1. Once the examination has been completed the Examiners meet in pairs to write up the examination reports and present marks to the administrative staff in preparation for the full Court Meeting.

2. The Specialty Courts meet to discuss the results. 3. The full Court meets to discuss results. The Court may ask the specialty courts to and

answer questions on the results. An essential element of the examination system is the debate by the full Court of Examiners following completion of the examination.

Written Examinations Short answer questions These are used by several specialties and discussion is taking place on improved ways to mark them. Some international assessment bodies use computer marking for such questions. General Surgery has replaced its MCQ examination with Spot Questions and is encouraged by its initial experience. Peer Review and Online interactive case studies The Board of Paediatric Surgery has defined their on-line Critical Appraisal Tasks (CATS) and their Directed Online Group Studies (DOGS) as hurdle requirements. These studies are


interactive and are conducted over 4 weeks by Paediatric Surgery. They combine real life de-identified case studies with modules and other written resources in online small group learning led by a supervisor. They incorporate formative feedback from a supervisor and peer review. Progress Overview Form This form is similar in concept to a portfolio. During 2004 Paediatric Surgery developed a Progress Overview Form on which they could maintain a record of their trainees’ progress across the range of different requirements. Forms of Assessment in Specialist Surgical Training, by Surgical Specialty

Specialty

Car

diot

hora

cic

Gen

eral

Neu

rosu

rger

y

Ort

hopa

edic

s

Oto

lary

ngol

ogy

Paed

iatr

ics

Plas

tics

and

Rec

onst

ruct

ive

Uro

logy

Vasc

ular

Adapted 360° Rating Scale – mid-rotation (Formative)

Basic Science Examination (Formative and Summative)

In-training Evaluation Forms (Summative)

Log Books (Formative) Clinical long cases with patient (Summative)

Clinical medium/short cases with patients (Summative)

MCQs (Formative & Summative)

Spot questions (summative)

On-line interactive case studies (Formative)

Peer review (Formative) Progress Overview Form (Formative and Summative)

Simulation (Formative and Summative)

Standardised Patients (Summative)

Vivas (Summative) Diagnostic case – no patient (Summative)

Modules (Formative) Unsatisfactory performance of trainees and remedial action Several actions are being taken to address unsatisfactory trainee performance. In May 2005, the Court of Examiners held a workshop on Linking Curriculum with Assessment and Training. A particular focus of that workshop was the assessment of clearly defined competencies in the Fellowship Examination and an improvement in the feedback to failed candidates.


In 2004 the College undertook an internal review of examination feedback to trainees who had failed the Fellowship Examination. Clear guidelines have been produced to improve the quality of feedback. The College has put in place strategies to review the performance of any trainee who fails an examination twice. The College is currently undertaking a review of the outcomes of its Fellowship Examination over the last five years. This information will be used to inform curriculum development, suitable remedial action and improvement in this assessment. Some specialties are introducing mid-rotation assessments. Orthopaedic Surgery and General Surgery have introduced three-monthly assessment reports to assist in the early identification of any unsatisfactory performance.


3.3.2 Quantitative Data Fellowship Examination, 2004 Candidates undertaking Specialty ACT NSW QLD SA/NT TAS VIC WA Aust NZ O/S TotalCardiothoracic 0 3 1 0 0 2 0 6 0 0 6 General Surgery 1 24 8 3 0 14 6 56 12 14 82 Neurosurgery 0 5 0 0 0 1 0 6 0 0 6 Orthopaedic 0 17 8 3 1 8 4 41 9 1 51 Otolaryngology 0 5 2 2 0 3 1 13 3 0 16 Paediatric 0 0 0 0 0 0 0 0 0 0 0 Plastic & Recon. 0 3 2 3 1 4 3 16 4 1 21 Urology 0 4 4 1 0 3 1 13 4 2 19 Vascular 0 2 3 0 1 4 1 11 2 0 13 1 63 28 12 3 39 16 162 34 18 214 Candidates successfully completing Specialty ACT NSW QLD SA/NT TAS VIC WA Aust NZ O/S TotalCardiothoracic 0 0 0 0 0 1 0 1 0 0 1 General Surgery 0 18 7 3 0 8 3 39 10 6 55 Neurosurgery 0 4 0 0 0 1 0 5 0 0 5 Orthopaedic 0 16 7 1 1 7 3 35 8 1 44 Otolaryngology 0 5 2 1 0 3 1 12 3 0 15 Paediatric 0 0 0 0 0 0 0 0 0 0 0 Plastic & Recon. 0 3 2 3 1 4 3 16 3 1 20 Urology 0 4 4 1 0 3 1 13 3 2 18 Vascular 0 2 3 0 0 1 0 6 1 0 7 0 52 25 9 2 28 11 127 28 10 165 Annual pass rate Specialty ACT NSW QLD SA/NT TAS VIC WA Aust NZ O/S TotalCardiothoracic - 0.0 0.0 - - 50.0 - 16.7 - - 16.7 General Surgery 0.0 75.0 87.5 100.0 - 57.1 50.0 69.6 83.3 42.9 67.1 Neurosurgery - 80.0 - - - 100.0 - 83.3 - - 83.3 Orthopaedic - 94.1 87.5 33.3 100.0 87.5 75.0 85.4 88.9 100.0 86.3 Otolaryngology - 100.0 100.0 50.0 - 100.0 100.0 92.3 100.0 - 93.8 Paediatric - - - - - - - - - - - Plastic & Recon. - 100.0 100.0 100.0 100.0 100.0 100.0 100.0 75.0 100.0 95.2 Urology - 100.0 100.0 100.0 - 100.0 100.0 100.0 75.0 100.0 94.7 Vascular - 100.0 100.0 - 0.0 25.0 0.0 54.5 50.0 - 53.8 0.0 82.5 89.3 75.0 66.7 71.8 68.8 78.4 82.4 55.6 77.1


Fellowship Examination data, by event and attempt, 2004 Cardiothoracic Surgery Total First attempt Subsequent attempts Presented Passed Presented Passed Presented Passed May Sydney 4 1 2 1 2 0 October Christchurch 3 0 1 0 2 0 7 1 3 1 4 0

pass rate: 14.30% pass rate: 33.30% pass rate: 0.00% General Surgery Total First attempt Subsequent attempts Presented Passed Presented Passed Presented Passed May Hong Kong 14 6 13 6 1 0 Auckland 11 7 6 4 5 3 Sydney 21 11 11 5 10 6 October Christchurch 49 31 35 27 14 4 95 55 65 42 30 13

pass rate: 57.90% pass rate: 64.60% pass rate: 43.30% Neurosurgery Total First attempt Subsequent attempts Presented Passed Presented Passed Presented Passed May Sydney 4 3 3 2 1 1 October Christchurch 3 1 2 1 1 0 7 4 5 3 2 1 pass rate: 57.10% pass rate: 60.00% pass rate: 50.00% Orthopaedic Surgery Total First attempt Subsequent attempts Presented Passed Presented Passed Presented Passed May Auckland 8 6 8 6 0 0 Sydney 42 31 35 27 7 4 October Christchurch 12 7 1 0 11 7 62 44 44 33 18 11

pass rate: 71.00% pass rate: 75.00% pass rate: 61.10% Otolaryngology - Head & Neck Surgery Total First attempt Subsequent attempts Presented Passed Presented Passed Presented Passed May Auckland 5 5 5 5 0 0 Sydney 11 7 10 6 1 1 October Christchurch 4 3 0 0 4 3 20 15 15 11 5 4

pass rate: 75.00% pass rate: 73.30% pass rate: 80.00%


Fellowship Examination data, by event and attempt, 2004 (continued) Paediatric Surgery -- No exam Plastic & Reconstructive Surgery Total First attempt Subsequent attempts Presented Passed Presented Passed Presented Passed May Auckland 6 4 2 2 4 2 Sydney 14 13 11 10 3 3 October Christchurch 3 3 1 1 2 2 23 20 14 13 9 7 pass rate: 87.00% pass rate: 92.90% pass rate: 77.80% Urology Total First attempt Subsequent attempts Presented Passed Presented Passed Presented Passed May Sydney 14 13 13 12 1 1 October Christchurch 6 5 5 4 1 1 20 18 18 16 2 2

pass rate: 90.00% pass rate: 88.90% pass rate: 100.00% Vascular Surgery Total First attempt Subsequent attempts Presented Passed Presented Passed Presented Passed May Sydney 11 7 9 6 2 1 October Christchurch 5 0 2 0 3 0 16 7 11 6 5 1

pass rate: 43.80% pass rate: 54.50% pass rate: 20.00%

Orthopaedic Principles and Basic Sciences Examination (OPBS) Candidates Presented Passed Pass rate (%)

2004 58 53 91

Paediatric Surgery Basic Science Examinations, 2004 Candidates

Segment Presented Passed Pass rate (%) Anatomy 6 5 83 Pathology 1 1 100


3.4 ACCREDITATION OF HOSPITAL POSTS 3.4.1 Qualitative Data Accrediting hospital posts for Specialist Surgical Training Specialty surgical training is conducted in surgical training posts in which the trainees are supervised and mentored by appropriately qualified surgeons. The accreditation process for training posts is currently managed by the relevant Specialty Board. The accreditation of a hospital surgical training post for specialty surgical training occurs in 6 stages. Stage one – Initiating the process The hospital or surgical unit initiates the process by contacting the relevant Specialty Board, via the College, and requests a review of suitability for placement of an specialty surgical trainee. The relevant Specialty Board sends forms to the hospital seeking preliminary information on services, facilities and operative data. The information requested and forms provided differ for each surgical specialty. Stage two – Accreditation team appointed The Accreditation Team is appointed by the relevant Specialty Board and comprises a minimum of two College Fellows and one jurisdictional representative. One College Fellow must be from a region or state not associated with the hospital, and one may be from the local region. The inclusion of jurisdictional representatives first occurred in accreditations undertaken in 2004 (for 2005 training posts) and reflects the ACCC requirement for accreditation teams to include a jurisdictional representative, where so nominated by the relevant health minister. The hospital is advised of the Accreditation Team members. All Accreditation Team members receive a copy of the documentation provided by the hospital, for review prior to the inspection visit. Stage three – The inspection The hospital is inspected by the Accreditation Team who:

• review the facilities and clarify details from the preliminary data provided by the hospital • consult with current trainees (if reaccreditation) to identify any strengths or weaknesses

of the specialty surgical training post • may discuss issues with hospital administrators, clinicians and others as required, and • advise the hospital of the likelihood of accreditation or renewal of accreditation and

possible trainee numbers for the specialty surgical training post. Stage four – Interim report It is understood that information considered, and processes used, to arrive at a decision regarding the accreditation of the hospital post vary between different specialties. A typical decision making process is understood to be as follows:

• Accreditation Team complete an interim report, which usually includes a recommendation

• interim report is forwarded to the relevant Specialty Board • Specialty Board forwards the interim report to the hospital. The hospital is able to provide

comment and correct any factual errors, and is required to respond within two weeks • hospital response is sent to the Accreditation Team which may undertake follow-up

action in the event there are factual errors in the interim report • interim report is signed off by the Accreditation Team once follow-up action is completed.

Stage five – Final report The final report is forwarded to the relevant Specialty Board for their recommendation. The final report and recommendation are then provided to the Board of Specialist Surgical Training for review, and then through the Education Policy Board, to the College Council for ratification. Written confirmation of the recommendation is provided to the relevant Specialty Board and the hospital. The hospital is required to acknowledge receipt of the recommendation in writing.


Stage six – Reaccreditation / review Hospital posts for specialty surgical training are accredited for up to five years. The period of accreditation may be shorter where there are deficiencies requiring rectification or if it is a new training post. Further evaluation and development As mentioned earlier, considerable effort has and is being put into this area. Generic and Specialty-specific criteria are being revised, taking into account the suggestions of Fellows and the jurisdictions, and the requirements of the ACCC determination. It is intended that the criteria will be laid out in a user-friendly format. An explanatory document, which will accompany the accreditation forms, is also being produced. The Outer Metropolitan Program conducted in 2004-5 has brought a small increase in the number of private hospitals accredited in Urology in Queensland and Western Australia. It has also highlighted opportunities which may be available in private hospitals for increased access to outpatients and ambulatory experience, particularly in NSW. General Surgery is piloting a process which they have developed to more accurately monitor the clinical experiences of their trainees during each rotation. A ‘Points Scheme’, based on trainees’ logbook figures, has been developed by some of the Younger Fellows to more clearly identify the kind of case-mix that they might expect in each post. During the first half of 2005 it will be piloted in South Australia and Northern Territory with the intention of trialling it in a larger region in the second half of the year. Discussion is taking place on the most appropriate method of obtaining feedback from trainees on their training experience. A pilot study is in development to facilitate this process. There are no significant studies in the international literature to inform this process, although certain training schemes in other countries are attempting to overcome this.


3.4.2 Quantitative Data Specialist Surgical Training New Post Accreditation Activity, 2004 Requests for Accreditation of New Posts Specialty ACT NSW QLD SA/NT TAS VIC WA Aust NZ O/S TotalCardiothoracic - - - - - - - 0 2 - 2 General Surgery - 5 5 - - 7 - 17 3 - 20 Neurosurgery - 1 - 1 - - - 2 - - 2 Orthopaedic - 1 1 3 - 2 - 7 4 1 12 Otolaryngology - 2 - - - 1 - 3 - - 3 Paediatric - - - - - - - 0 - - 0 Plastic & Recon. 1 - - - - - - 1 - - 1 Urology - 2 2 - - - - 4 - - 4 Vascular - - - - - - - 0 - - 0 1 11 8 4 0 10 0 34 9 1 44 Accreditation of New Posts Granted Specialty ACT NSW QLD SA/NT TAS VIC WA Aust NZ O/S TotalCardiothoracic - - - - - - - 0 1 - 1 General Surgery - 5 5 - - 7 - 17 3 - 20 Neurosurgery - - - 1 - - - 1 - - 1 Orthopaedic - 1 1 3 - 2 - 7 2 1 10 Otolaryngology - 2 - - - 1 - 3 - - 3 Paediatric - - - - - - - 0 - - 0 Plastic & Recon. - - - - - - - 0 - - 0 Urology - 2 2 - - - - 4 - - 4 Vascular - - - - - - - 0 - - 0 0 10 8 4 0 10 0 32 6 1 39

Cardiothoracic: one New Zealand post was not granted due to insufficient caseload and experience for trainees. Neurosurgery: as at 31 December, accreditation of a post in NSW was incomplete, pending paperwork. Orthopedics: two New Zealand post requests were based on a planned hospital expansion and it was determined that the new system should be fully in place before a final decision is made on additional posts. Plastic & Recon.: accreditation of a post in the ACT was not granted for 2005, as facilities were not yet to standard; this will be reassessed for 2006. Otherwise, all new post accreditations were completed within six months


Specialist Surgical Training Post Reaccreditation Activity, 2004 Requests for Reaccreditation of Existing Posts Specialty ACT NSW QLD SA/NT TAS VIC WA Aust NZ O/S TotalCardiothoracic - 3 - - - - - 3 - - 3 General Surgery - 9 41 - - 1 - 51 2 - 53 Neurosurgery - 1 2 - - 1 - 4 1 - 5 Orthopaedic - 2 31 - - - - 33 2 - 35 Otolaryngology - 7 - - - 6 - 13 - - 13 Paediatric - - 1 - - - 1 2 2 - 4 Plastic & Recon. - - - - - 4 - 4 - - 4 Urology - 2 - - 1 1 - 4 - - 4 Vascular - - - 3 - - 1 4 1 - 5 0 24 75 3 1 13 2 118 8 0 126 Reaccreditation of Existing Posts Granted Specialty ACT NSW QLD SA/NT TAS VIC WA Aust NZ O/S TotalCardiothoracic - 2 - - - - - 2 - - 2 General Surgery - 9 41 - - 1 - 51 - - 51 Neurosurgery - - 2 - - - - 2 1 - 3 Orthopaedic - 2 31 - - - - 33 2 - 35 Otolaryngology - 7 - - - 6 - 13 - - 13 Paediatric - - 1 - - - 1 2 - - 2 Plastic & Recon. - - - - - 4 - 4 - - 4 Urology - 1 - - 1 1 - 3 - - 3 Vascular - - - 3 - - - 3 1 - 4 0 21 75 3 1 12 1 113 4 0 117

Cardiothoracic: one New South Wales post was granted reaccreditation after an appeal and reinspection, and another New South Wales post was disaccrediated due to insufficient training opportunities. General: two New Zealand posts were suspended due to surgical staffing issues, they will be reassessed in 2005. Neurosurgery: the New South Wales and Victorian posts were not granted reaccreditation as at 31 December as the approval process was not yet complete, following late-2004 inspections. Otolaryngology: a Victorian post was granted reaccreditation after an appeal and reinspection. Paediatrics: two New Zealand posts were not reaccredited as at 31 December as the approval process was not yet complete, following late-2004 inspections. Urology: a New South Wales post was disaccredited due to the unavailability of sufficient primary surgical experience. Vascular: a West Australian post was disaccredited due to insufficient supervision and training opportunities. Otherwise, all reaccreditations were completed within six months


3.5 ASSESSMENT OF OVERSEAS TRAINED DOCTORS 3.5.1 Qualitative Data Assessment policy and procedure The processes for assessing the suitability of overseas-trained doctors for practise as surgeons in Australia are in accordance with the principles outlined in the:

• AMC “Application procedures and requirements for specialist assessment” • AMC / Committee of Presidents of Medical Colleges / State and Territory Medical Boards

/ DoHA / State and Territory Health Departments “Assessment process for Area of Need specialists: User’s guide”

• AMC / CPMC (JSCOTS) “Assessment of Overseas Trained Specialists: Template for Colleges”.

In addition in March 2004, the Specialist Medical Colleges in conjunction with Australian Medical Workforce Advisory Committee (AMWAC) reviewed several options to streamline the assessment of overseas trained specialists including the following:

• the possibility of automatic recognition of specific overseas qualifications • the development of a central data base of qualifications • success factors for Area of Need (i.e. employment and career opportunities, family and

social opportunities, etc) • mapping of Area of Need positions • coordination with overseas recruitment agencies.

The Specialist Medical Colleges requested that AMWAC investigate the possibility of providing funding for these initiatives. The College is continuing to explore ways to refine and streamline the paper-based and interview-based assessments. It is also exploring the possibility of automatic recognition of some overseas surgical qualifications, provided the applicants can also demonstrate currency and recency of surgical practice. Currently assessment of the documentation for an Area of Need surgeon takes eight weeks and other assessments take 10-12 weeks. The College has begun to develop a formal process for monitoring Overseas-Trained Doctors who are under assessment. This will be refined in 2005. With the rapid expansion of the specialist surgical training curriculum on the College website, overseas-trained doctors will have greater opportunities for self-education. During 2005 the College will notify Specialty Training groups about overseas-trained doctors in their specialties who are required to sit the Fellowship Examination. The Specialty Boards have developed a system of increasing support to ensure that Overseas-Trained Doctors will undertake the same examination preparation programs as trainees. The Censor-In-Chief and Director, Specialist Surgical Training and Assessment visited the Royal College of Physicians and Surgeons of Canada to assess whether the Canadian training program is substantially comparable to the Australian and New Zealand program. There was significant work planning this visit, including research into the Canadian training system and the design of tools to evaluate Canadian programs.


Assessment criteria The test used by the College to assess the surgical skills, knowledge and experience of an overseas-trained doctor is “substantial comparability to an Australian- or New Zealand-trained surgeon”. The elements of such a test of substantial comparability are that the doctors have an acceptable overseas qualification, acceptable competency according to the RACS list of competencies and acceptable recency and currency of surgical practice. The assessment tools include a paper-based assessment of curriculum vitae, testimonials and log books, an interview to ascertain non-clinical competencies, and practice assessment by oversight. The doctor may be required to present for the Fellowship Examination. Importantly, there is no implication of equivalence of training or conforming within Australian and New Zealand surgical specialties, which gives the College scope to accept experienced surgeons whose training program may have been different. The College assesses each overseas-trained doctor on an individual basis, scrutinising a range of documentation supplied by the doctor that covers their education, training, qualifications and surgical experience. This documentation is forwarded to an assessment team comprising the College’s Dean of Education, the relevant Specialty Board Chair, and the Censor-in-Chief or nominee. Following assessment of the documentation an interview with the applicant is usually scheduled. In rare cases an interview may not be required, such as following review of the documentation showing that the applicant is clearly not substantially comparable to an Australian- or New Zealand-trained surgeon. In such cases the College would issue a written assessment with recommendations. The interview panel comprises the relevant Specialty Board Chairman, the Censor-in-Chief or nominee and a jurisdictional representative. Interview panel members may also include other Specialty Board Chairs or the Dean of Education. The semi-structured interview comprises a series of standard questions and brief hypothetical scenarios. The aim of the semi-structured interview is to explore competencies and attributes relating to surgical practice:

• ability in terms of professional performance • professional ethics • professional insight • professional team work and relationships • professional approach to patients • professional communication skills (including effective spoken communication in English) • the ability to adapt to the Australian health care system (if appropriate).

Each section of the interview is rated by each interviewer before a consensus score is reached. The jurisdictional representatives are equal and full voting members of the panels. The recommendations arising from the interview are determined by the profile of scores across the different competencies and attributes. The College grants exemptions wherever the documentation received from an overseas-trained doctor demonstrates substantial comparability. For some applicants this exemption applies to BST and for others it can apply to both BST and SST. New Zealand In New Zealand, the College provides recommendations, as an agent of and only at the request of the Medical Council of New Zealand, on an overseas trained doctor's comparability to the standard identified by the Medical Council of New Zealand for vocational registration in a surgical vocational scope. The Medical Council of New Zealand considers these recommendations and determines whether to grant the overseas trained doctor medical registration and whether any restrictions or conditions will be placed on that registration. Admission to Fellowship of the Royal Australasian College of Surgeons is via Articles 19 or 21 and is a decision of the College.


3.5.2 Quantitative Data The data in the following table details activity in OTD Assessment. These figures are sorted by those originating from an English-Speaking Country (“ESC”) and otherwise, for the purposes of review by the Australian Competition and Consumer Commission. It is also important to note that the process for calculating “completion time” was adjusted partway through 2004. Originally, the definition of "starting date" was the date of the first inquiry about assessment. In 2004, that definition was changed to "the date of receipt by the College of fully completed documentation". Consequently, the ‘duration’ of many of the assessments completed in 2004 is over-stated. Applications for Overseas Trained Doctor Specialist Assessment, 2004 Australia Area of Need

Applications ESC* Non-ESC & others

Non-ESC only Total

Received 12 2 4 18 Completed 3 2 0 5 Completion Time Less than 8 weeks 1 1 0 2 More than 8 weeks 2 1 0 3 Other than Area of Need

Applications ESC Non-ESC & others

Non-ESC only Total

Received 14 8 27 49 Completed 8 6 17 31 Completion Time Less than 3 months 3 2 3 8 More than 3 months 5 4 14 23 All Positions

Outcome ESC Non-ESC & others

Non-ESC only Total

Complete BST & SST 0 0 0 0 Complete SST only 0 2 10 12 Supervised work 0 2 10 12 Two or less years training for equivalence

5 4 4 13

Apply for Fellowship via Article 21

6 2 3 11

Progess Undertaking training specified

7 4 7 18


The number of OTD assessments is increasing, with the number of applications doubling in the past 6 months:

Period Standard Area of Need

July 2002 - June 2003 41 15 July 2003 - June 2004 46 19

July 2004 - December 2004 43 14


3.1 selection and trainees - racs | royal australasian ... · 3.1 selection and trainees 3.1.1...

Documents