Acquiring surgical skills: the role of the Royal Australasian College of Surgeons.

Contemporary surgeons are expected to develop and maintain competence across a range of skills far broader than that demanded of last century's surgeons. This is increasingly difficult to achieve in a competitive clinical environment in which the effectiveness of the traditional apprenticeship model can be compromised. New training paradigms must be found to ensure that the quality of surgical training is maintained and enhanced. Acquiring technical skills in the operating theatre is expensive, but training using simulations in the skills laboratory is gaining credibility and validity as a means to augment the clinical experience and accelerate training. The emerging role of surgical skills courses extends to training in behaviour and attitude. At the same time, there is a rapidly growing demand for training courses in technical surgical skills, particularly from prevocational trainees aspiring to enter surgical training. This group has been neglected by the new Surgical Education and Training programme, and re-engagement with them is now a priority. Most skills courses rely on surgeons willing to teach pro bono, and paying tutors would impose a significant additional cost on surgical training. However, recruiting enough fellows to meet the demand for tutors remains a challenge. The Royal Australasian College of Surgeons is actively engaged in supporting and developing skills training courses and programmes to address the range of skills required for surgical competence.

Correlation of selection scores with subsequent assessment scores during surgical training.

BACKGROUND: Determining admission criteria to select candidates most likely to succeed in surgical training in Australia and New Zealand has been an imprecise art with little empirical evidence informing decisions. Selection to the Royal Australasian College of Surgeons' Surgical Education and Training programme is based entirely on applicants' performance in structured curriculum vitae (CV), referees' reports and interviews. This retrospective review compared General Surgery (GS) trainees' performance in selection with subsequent performance in assessments during training. METHODS: Data from three cohorts of GS trainees were sourced. Scores for four selection items were compared with scores from six training assessments. Interrelationships within each of the sets of selection and assessment variables were determined. RESULTS: A single significant relationship was found between scores on the three selection tools. High scores in the CV did not correlate with higher scores in any subsequent assessments. The structured referee report score, multi-station interview score and total selection score all correlated with performance in subsequent work-based assessments and examinations. Direct observation of procedural skills (DOPS) scores appear to reflect increasing acquisition of operative skills. Performance in mini clinical examinations (Mini-CEX) was variable, perhaps reflecting limitations of this assessment. Candidates who perform well in one examination tend to perform well in all three examinations. CONCLUSIONS: No selection tool demonstrated strong relationships with scores in all subsequent assessments; however referee reports, multi-station interviews and total selection scores are indicators for performance in particular assessments. This may engender confidence that candidates admitted into the GS training programme are likely to progress successfully through the programme.