Surgery in New Zealand

The Pacific Islands Project (PIP), funded by AusAid and managed by the Royal Australasian College of Surgeons (RACS), has progressed through three phases from 1995 to 2010. During this time, it has sent over 520 teams to 11 Pacific Island Countries, providing over 60,000 consultations and some 16,000 procedures. In addition to this delivery of specialist medical and surgical services that were not previously available in-country, the project has contributed as a partner in capacity building with the Fiji School of Medicine and Ministries of Health of the individual nations. By 2011, Fiji School of Medicine, which began postgraduate specialist training in 1998, had awarded 51 doctors a diploma in surgery (1 year), 20 of whom had completed their Masters in Medicine (4 years). PIP was independently evaluated on completion of every phase, including the bridging Phase III (2006-2010). The project delivered on its design, to deliver services, and also helped build capacity. The relationship established with the RACS throughout the project allowed Pacific Island graduates to access the Rowan Nicks scholarship, and the majority of MMed graduates received International Travel Grants to attend the Annual Scientific Meeting. PIP has been a highly successful partnership in delivering and building specialist medical services. Although AusAid contributed some $20 million over 16 years, the value added from pro bono contributions by Specialist Teams, Specialty Coordinators and the Project Directors amounted to an equivalent amount. With the emergence of Pacific Island-trained specialists, PIP is ready to move into a new phase where the agendas are set, monitored and managed within the Pacific, and RACS fulfils the role of a service provider. A critical mass of Pacific Island surgeons has been trained, so that sub-specialization will be an option for the general surgeons of the larger island nations.

Medical Journal of AustraliaVolume 1, Issue 20 p. 742-744 Original Article THE ROYAL AUSTRALASIAN COLLEGE OF SURGEONS IN SOUTH-EAST ASIA Howard H. Eddey, Corresponding Author Howard H. Eddey n/a@dne.dne MelbourneCouncillor, Royal Australasian College of Surgeons, 1967 to 1975; Chairman, Board of Examiners, 1968 to 1973. Address for reprints: Professor H. H. Eddey, Royal Australasian College of Surgeons, Spring Street, Melbourne, Vic. 3000.Search for more papers by this author Howard H. Eddey, Corresponding Author Howard H. Eddey n/a@dne.dne MelbourneCouncillor, Royal Australasian College of Surgeons, 1967 to 1975; Chairman, Board of Examiners, 1968 to 1973. Address for reprints: Professor H. H. Eddey, Royal Australasian College of Surgeons, Spring Street, Melbourne, Vic. 3000.Search for more papers by this author First published: 01 May 1977 https://doi.org/10.5694/j.1326-5377.1977.tb131077.x AboutPDF 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. Volume1, Issue20May 1977Pages 742-744 RelatedInformation

The Royal Australasian College of Surgeons (RACS) has been innovative in developing core competencies, which provide a framework for assessing performance and a 'Code of Conduct', for the lifelong journey of all surgeons. The older surgeon may face significant challenges, having passed their peak, with a lower volume of cases, and potentially increased complications. They also face the challenges of retiring from active clinical practice with its logistical and psychological dilemmas. The RACS has, therefore, put in place several initiatives to deal with these dilemmas. The Senior Surgeons' Group, which conducts annual 'Building Towards Retirement' workshops, has been the driving force behind these initiatives. The group has a regular program in the RACS Annual Scientific Congress, including the multidisciplinary session 'The ageing specialist - challenges for regulators: hypothetical' which took place in 2014, and some of its members are part of a multidisciplinary team with an approach to adapting to ageing that encourages self-reflection and self-monitoring. It has also influenced the RACS Council to change the continuing professional development (CPD) regulations to include requirements for ageing surgeons regards health maintenance, peer reviews, and modified requirements to satisfy CPD completion. The RACS offers a variety of other opportunities for the ageing surgeon to remain active in college activities.

Objective Despite public interest in the rural workforce, there are few published data on the geographical distribution of Australia's rural surgeons, their practice skill set, career stage or work-life balance (on-call burden). Similarly, there has not been a peer-reviewed skills audit of rural training opportunities for surgical trainees. The present study undertook this baseline assessment for Western Australia (WA), which has some of the most remote practice areas in Australia. Methods Hospital staff from all WA Country Health Service hospitals with surgical service (20 of 89 rural health services) were contacted by telephone. A total of 18 of 20 provided complete data. The study questionnaire explored hospital and practice locations of practicing rural surgeons, on-call rosters, career stage, practice skill set and the availability of surgical training positions. Data were tabulated in excel and geographic information system geocoded. Descriptive statistics were calculated in Excel. Results Of the seven health regions for rural Western Australia, two (28.6%) were served by resident surgeons at a ratio consistent with Royal Australasian College of Surgeons (RACS) guidelines. General surgery was offered in 16 (89%) hospitals. In total, 16 (89%) hospitals were served by fly-in, fly-out (FIFO) surgical services. Two hospitals with resident surgeons did not use FIFO services, but all hospitals without resident surgeons were served by FIFO surgical specialists. The majority of resident surgeons (62.5%) and FIFO surgeons (43.2%) were perceived to be mid-career by hospital staff members. Three hospitals (16.7%) offered all eight of the identified surgical skill sets, but 16 (89%) offered general surgery. Conclusions Relatively few resident rural surgeons are servicing large areas of WA, assisted by the widespread provision of FIFO surgical services. The present audit demonstrates strength in general surgical skills throughout regional WA, and augers well for the training of general surgeons. What is known about the topic? A paper published in 1998 suggested that Australia's rural surgeons were soon to reach retirement age. However, there have been no published peer-reviewed papers on Australia's surgical workforce since then. More recent workforce statistics released from the RACS suggest that the rural workforce is in crisis. What does this paper add? This paper provides up-to-date whole-of-state information for WA, showing where surgical services are being provided and by whom, giving a precise geographical spread of the workforce. It shows the skill set and on-call rosters of these practitioners. What are the implications for practitioners? The present study provides geographical workforce data, which is important to health planners, the general public and surgeons considering where to practice. In particular, these data are relevant to trainees considering their rural training options.

Women are under-represented in surgery and leave training in higher proportions than men. Studies in this area are without a feminist lens and predominantly use quantitative methods not well suited to the complexity of the problem. In this qualitative study, a researcher interviewed women who had chosen to leave surgical training. Women were recruited using a purposive snowball strategy through the routine communications of the Royal Australasian College of Surgeons and Royal Australasian College of Surgeons Trainee Association over a 3-week period, and were interviewed over the following 4 months in the past 4 years in person or by telephone. More specific details are available on request from the authors. Supported by male and female co-researchers, and in dialogue with study participants, she then coded the findings and defined themes. An explanatory model was developed by integrating findings with different theories and previous literature. The research team developed three aspects of the model into a visual analogue. 12 women participated in the study, with all Australian states and territories, and New Zealand, as well as five medical specialty streams, represented. The time spent in training ranged from 6 months to 4 years, and all participants, except two, had trained in both metropolitan and rural locations. The findings confirmed factors identified in earlier reports as reasons women leave surgical training, and contributed six new factors: unavailability of leave, a distinction between valid and invalid reasons for leave, poor mental health, absence of interactions with the women in surgery section of their professional body and other supports, fear of repercussion, and lack of pathways for independent and specific support. The relationships between factors was complex and sometimes paradoxical. The visual analogue is a tower of blocks, with each block representing a factor that contributed to the decision to leave surgical training, and with the toppling of the tower representing the choice to leave. The visual analogue indicates that effective action requires attention to the contributory factors, the small actions that can topple the tower, and the contexts in which the blocks are stacked. Women might be best helped by interventions that are alert to the possibility of unplanned negative effects, do not unduly focus on gender, and address multiple factors. This should inform interventions in surgical training, with attention to local social context, health-care setting, and training programme structure. Royal Australasian College of Surgeons Ian and Ruth Gough Surgical Education Scholarship.

Surgical education and training in Australia and New Zealand are based on 6-year undergraduate medical curricula covering the scientific foundations of medical practice. One-year rotating internships are required in all states of Australia to allow medical graduates to satisfy statutory requirements for completing basic medical education prior to gaining credit for training within a specialty. The Royal Australasian College of Surgeons defines the duration and content of training as well as the standards of supervision and guidance that enable surgical trainees to satisfy the requirements leading to Fellowship of the Royal Australasian College of Surgeons. Licensing authorities in several states and the Commonwealth of Australia recognize the award of Fellowship of the Royal Australasian College of Surgeons as sufficient evidence of competence to practice as a specialist surgeon. No formal process of recertification of surgical competence has yet been promulgated in Australia.

Medical Journal of AustraliaVolume 2, Issue 5 p. 139-139 The Royal Australasian College of Surgeon The Royal Australasian College of Surgeons First published: 01 July 1948 https://doi.org/10.5694/j.1326-5377.1948.tb81931.xAboutPDF 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. Volume2, Issue5July 1948Pages 139-139 RelatedInformation

"Go to the People. Live Among Them." Reflections on Anesthetic and Surgical Care in Rural and Remote Regions.

Vascular Surgery in Australia and New Zealand (Australasia)

The role of the surgical skills laboratory is becoming increasingly important as surgical service needs evolve and educational processes seek to become more robust. The skills laboratory offers an opportunity to better prepare residents for their clinical rotations and to accelerate their clinical effectiveness. The Royal Australasian College of Surgeons has developed and introduced a new standardised basic surgical skills curriculum that can be delivered sustainably in centres throughout Australia and New Zealand. A technical skill set required by all surgical disciplines was compiled, and each skill was deconstructed into cognitive steps. Models were devised to simulate an application of each skill, and standardized demonstrations were created and recorded to ensure uniform teaching. Extensive resource material supports the course programme, with information for tutors, technicians, course directors and participants. Currently, clinical rotations offer inconsistent opportunities for trainees to practise their skills after the course. Recruitment and retention of tutors remains a key challenge.

Revisiting Mackay Online

Background: While specialist medical competencies have been clearly defined, the stages and standards for acquiring the competencies have not been described within the clinical context of the workplace. Objective: The Royal Australasian College of Surgeons (RACS) set out to define such a framework to provide performance markers for supervisors and trainees. Method: A working party consisting of Fellows and College staff defined the structure and sequence of the standards. The working party chose to identify progressive development through 5 stages of increasing complexity (from prevocational to novice, to intermediate, to competent to proficient). Key performance markers were described for the 9 RACS competencies and their 3 major patterns of behavior. Results: The resultant document, “Becoming a competent and proficient surgeon: Training Standards for the Nine RACS Competencies,” was distributed to the training boards of all of the surgical specialties in January 2012. After receiving positive feedback, the RACS Education Board and College Council approved it for use. The distribution of this work marks a significant step in meeting the challenge towards defining progressive standards of competence throughout training, not just in surgery, but across all postgraduate medical training. Since the RACS competencies are closely aligned to the original 7 of CanMEDs, these competency standards could be adopted and adapted by medical disciplines other than surgery. Conclusion: We have developed a framework that is aligned to the 9 RACS competencies and that describes performance markers for different levels progressing from novice to Fellowship.

Australian and New Zealand Journal of SurgeryVolume 41, Issue 4 p. 302-309 The History of the Royal Australasian College of Surgeons from 1935 to 1960 Douglas Miller, Douglas Miller SydneySearch for more papers by this author Douglas Miller, Douglas Miller SydneySearch for more papers by this author First published: May 1972 https://doi.org/10.1111/j.1445-2197.1969.tb06532.xCitations: 6AboutPDF 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 onFacebookTwitterLinked InRedditWechat Citing Literature Volume41, Issue4May 1972Pages 302-309 RelatedInformation

Australian and New Zealand Journal of SurgeryVolume 8, Issue 1 p. 104-110 Proceedings of the Royal Australasian College of Surgeons First published: July 1938 https://doi.org/10.1111/j.1445-2197.1938.tb02813.xCitations: 1AboutPDF 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 Citing Literature Volume8, Issue1July 1938Pages 104-110 RelatedInformation

Only about 4% of the fellows of the Royal Australasian College of Surgeons are women. Yet in what has been described as a “world first for a woman” the college...