Surgeons’ priorities probed

SURGEONS do not fully recognise their position to influence wider society, says a leading surgeon, after research revealed that trainees and Fellows of the Royal Australasian College of Surgeons prioritise individual expertise over common goals.

Professor Guy Maddern, head of surgery at the University of Adelaide and director of surgery at the Queen Elizabeth Hospital and Royal Adelaide Hospital, told MJA InSight that while technical skills and direct patient care were vitally important attributes of surgeons, “we need to give equal weighting to all competencies of surgical practice”.

“If we only focus on what surgery can do for one individual, we lose sight of the broader issues of care”, he said.
    
Professor Maddern was responding to a study, published in the MJA, based on a 2010 questionnaire for trainees and Fellows of the RACS asking them to rate the importance of nine surgical competencies and their 27 attributes as defined by the college. (1)

The competencies were technical expertise, communication, professionalism, medical expertise, judgement and decision making, scholarship and teaching, collaboration and teamwork, management and leadership, and health advocacy. (2)

Based on 1834 questionnaires returned, the results showed statistically significant differences between the perceived importance of competencies and attributes.

The responses showed the attributes considered most important were competence, insight and recognising conditions amenable to surgery, while the least important were responding to community and cultural needs, supporting others, and maintaining personal health and wellbeing.

Key differences were noted for the competency of collaboration and teamwork, which was ranked as more important by trainees than by Fellows. Female trainees and Fellows regarded all attributes as more important than male trainees and Fellows.

The authors wrote that their results showed a greater emphasis on individual skills rather than on achieving a common goal, and that this gap needed to be addressed in selection of trainees, in current surgical training and in ongoing professional development for surgeons.

“Competencies that are not reinforced by educators, mentors, trainers and the broader peer group are more likely to be neglected, with possible detriment to clinical practice”, they wrote.

Study coauthor Associate Professor David Hillis, chief executive officer of RACS, told MJA InSight that the research provided a valuable insight into the surgical profession.

“Professionalism and competence for a surgeon is more than just technical skills. It’s about expertise in communication, teamwork, ethics as well as advocacy and leadership”, he said.

While the research indicated that these attributes were regarded as important by the trainees and Fellows of the RACS, there was still room for improvement.

Professor Hillis said the RACS should lead a cultural change that prioritised skills equally throughout a surgeon’s entire career.

“It is important that the RACS continues to rethink its approach to professionalism and surgical competence to ensure that all trainees and Fellows have the broader skills required of the professional surgeon in the 21st century”, he said.

Dr Charles Douglas, senior lecturer at the school of medicine and public health at the University of Newcastle, said the study reflected a high degree of consensus within the RACS that the current descriptors of professional obligations were appropriate and are “attributes and competencies to which we should aspire”.

However, Dr Douglas did not feel that any conclusion should be drawn from the relative differences in the prioritisation of competencies.

He told MJA InSight that if people feel they need to rank a set of priorities, something has to be prioritised last by default. “But the reality here is that there was surprisingly little difference in mean score for the most important and least important attributes.”

Dr Douglas said it was important to acknowledge that the study’s participants still considered responding to community and cultural needs as an important attribute.

“Saying that this was one of the ‘least important’ [attributes] is creating a misleading impression”, he said.

However, Professor Maddern believed the results of the research should inform appropriate adjustments to the existing curricula used in the training of surgeons.

Current examinations tended to have a clinical focus on technical skills, and “held back on incorporating the more generalisable and non-technical approaches to surgical practice”.

This included a greater emphasis on day surgery initiatives, home care programs, health advocacy and team work, Professor Maddern said.

1. MJA 2015; 202: 433–438
2. RACS; Surgical Competence and Performance
(Photo: Jan Van De Vel / Science Photo Library)