AMC Accreditation Submission 2016

326 Pages·2016·5.46 MB·English

by  Leanne Hook

ACCREDITATION SUBMISSION 2016
AUSTRALIAN MEDICAL COUNCIL (AMC)
RACS
ROYAL AUSTRALASIAN COLLEGE OF SURGEONS
ACCREDITATION MARCH 2017

ACCREDITATION SUBMISSION 2016
AUSTRALIAN MEDICAL COUNCIL (AMC)

RACS
ROYAL AUSTRALASIAN COLLEGE OF SURGEONS

ACCREDITATION MARCH 2017
Royal Australasian College of surgeons
College of Surgeons Gardens
250-290 Spring Street
EAST MELBOURNE VIC 3002

Associate Professor David Hillis
Chief Executive Officer
Telephone: [phone]
Email: [email protected]

Accreditation Submisson Contact:

Ms Kathleen Hickey
Director Education Development and Assessment
Telephone: [phone]
Email: [email protected]

Ms Zaita Oldfield
Manager, Education Development & Research
Telephone: [phone]
Email: [email protected]

New Zealand Office
Level 3, 8 Kent Terrace
Mount Victoria
Wellington 6011

Postal address
PO Box 7451
Newtown
Wellington 6242

Telephone: [phone]
Email: [email protected]

Accreditation Submission 2016
OFFICE OF THE PRESIDENT
Mr Philip Truskett AM

Telephone [phone]
Facsimile [phone]
Email: [email protected]
8 December 2016

Professor Chris Baggoley AO
Chair, AMC Accreditation Team of RACS
Australian Medical Council Limited
PO Box 4810
KINGSTON ACT 2604

Dear Professor Baggoley,
AMC accreditation 2017
The Royal Australasian College of Surgeons (RACS) welcomes the Australian Medical Council (AMC)
accreditation team to review our activities in ensuring surgical standards across Australia and New Zealand.
RACS is built on quality improvement principles and enshrines that across all of our activities. We believe
surgical standards are in an ongoing cycle of improvement. The community we treat demands nothing less
than ongoing rigour in the review of ourselves and the organisations that oversee our training, education and
ongoing professional development. As such, surgical standards will always need to be reviewed and raised.
It is up to RACS and our Fellows to define this in the formal curriculum we teach and examine, and to
demonstrate in the informal and hidden curricula in our ongoing behaviour and activities. We are very aware
that we are all leaders and role models.
In 2016-17, RACS actively interacts with the community, with government and the many stakeholders within
the health sector. We work collaboratively with the many surgical societies and associations that assist us in
delivering our formal educational programs. We are always reviewing these programs and comparing them
internationally. We aim to continue to identify better practice and incorporate it into our programs. In
particular, RACS acknowledges the importance of training our Fellows to positively impact on cultural
change across the health sector.
While all training and educational programs can be improved due to the complexity of relationships and
interactions, RACS and the specialty societies and associations are very proud of the standard achieved. We
believe we provide thoroughly competent surgeons to enter the workforce as independently practising
specialist surgeons in all of our nine specialties.
Since we were last accredited by the AMC, RACS has not stood still. We continue to explore options and
possibilities to ensure that the expectations from the proud history of surgery will live on within the continually
updated expectations of the community of today.
RACS welcomes you and your accreditation team. We look forward to demonstrating our areas of excellence
and identifying areas that require improvement into the future.
Yours sincerely

Mr Phil Truskett AM
President

College of Surgeons of Australia and New Zealand ABN 29 004 167 766
College of Surgeons’ Gardens, 250-290 Spring St, East Melbourne VIC 3002 Australia
Telephone: [phone] Facsimile: [phone] Email: [email protected]
Website: www.surgeons.org

TABLE OF CONTENTS
Executive summary ........................................................................................................... 1
1. The context of training and education ......................................................................... 7
1.1 Governance ............................................................................................................................. 7
RACS background ............................................................................................................................................. 7
Governance ....................................................................................................................................................... 8
Management structure ..................................................................................................................................... 13
Strategic review ............................................................................................................................................... 13
1.2 Program management .......................................................................................................... 14
Education Board .............................................................................................................................................. 14
1.3 Reconsideration, review and appeals processes ............................................................... 18
Complaints ....................................................................................................................................................... 18
1.4 Educational expertise and exchange................................................................................... 20
Educational collaboration................................................................................................................................. 21
1.5 Educational resources .......................................................................................................... 22
1.6 Interaction with the health sector ........................................................................................ 24
Building Respect, Improving Patient Safety .................................................................................................... 25
Community representation............................................................................................................................... 26
Indigenous health ............................................................................................................................................ 26
1.7 Continuous renewal .............................................................................................................. 27
Strengths ......................................................................................................................................................... 28
Challenges ....................................................................................................................................................... 28
Plans ................................................................................................................................................................ 29
2. The outcomes of specialist training and education .................................................. 33
The role of the surgeon.................................................................................................................................... 34
Consultation with stakeholders ........................................................................................................................ 34
2.2 Program outcomes ............................................................................................................... 36
2.3 Graduate outcomes .............................................................................................................. 38
Strengths ......................................................................................................................................................... 38
Challenges ....................................................................................................................................................... 38
Plans ................................................................................................................................................................ 39
3. The specialist medical training and education framework ...................................... 43
3.1 Curriculum framework .......................................................................................................... 43
Overview .......................................................................................................................................................... 43
JDocs Framework ............................................................................................................................................ 43
Stages in the surgical career ........................................................................................................................... 44
3.2 Curriculum content and alignment ...................................................................................... 47

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Alignment of the curriculum to outcomes ........................................................................................................ 48
Scientific and technical competencies ............................................................................................................. 49
Scientific foundations and research ................................................................................................................. 50
Health advocacy .............................................................................................................................................. 50
Quality and safety in healthcare ...................................................................................................................... 50
Leadership and management .......................................................................................................................... 51
The trainee as teacher and scholar ................................................................................................................. 51
Aboriginal and Torres Strait Islander and Māori health ................................................................................... 51
Culture and health ........................................................................................................................................... 51
Curriculum review ............................................................................................................................................ 52
3.3 Continuum of training, education and practice .................................................................. 53
Horizontal and vertical alignment .................................................................................................................... 53
3.4 Structure of the curriculum .................................................................................................. 55
Part-time and interrupted training .................................................................................................................... 55
Elective study ................................................................................................................................................... 56
Comparison with other surgical training programs .......................................................................................... 56
Flexible training ................................................................................................................................................ 56
Strengths ......................................................................................................................................................... 56
Challenges ....................................................................................................................................................... 57
Plans ................................................................................................................................................................ 57
4. Teaching and learning ................................................................................................. 61
4.1 Teaching and learning approach ......................................................................................... 61
Overview .......................................................................................................................................................... 61
Range of learning approaches ........................................................................................................................ 61
4.2 Teaching and learning methods .......................................................................................... 62
Practice-based learning ................................................................................................................................... 62
Adjuncts to learning ......................................................................................................................................... 63
Skills courses and simulation .......................................................................................................................... 64
Increasing independence................................................................................................................................. 65
Other professional development opportunities ................................................................................................ 65
Strengths ......................................................................................................................................................... 65
Challenges ....................................................................................................................................................... 66
Plans ................................................................................................................................................................ 66
5. Assessment of learning .............................................................................................. 69
5.1 Assessment approach .......................................................................................................... 69
Overview .......................................................................................................................................................... 69
Governance ..................................................................................................................................................... 71
Policies............................................................................................................................................................. 71
Emerging trends .............................................................................................................................................. 71
Reviews of assessment undertaken 2014-2016 ............................................................................................. 72
5.2 Assessment methods ........................................................................................................... 74

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Work-based assessments ............................................................................................................................... 74
In-training assessment (ITA) - formative and summative workplace assessment .......................................... 75
Logbooks ......................................................................................................................................................... 76
Skills courses ................................................................................................................................................... 76
Examinations ................................................................................................................................................... 76
Standard setting for the early and specialty-specific examinations ................................................................. 77
Fellowship examination ................................................................................................................................... 78
Skills course assessment and feedback .......................................................................................................... 81
Probation ......................................................................................................................................................... 81
Dismissal from surgical training ....................................................................................................................... 82
5.4 Assessment quality .............................................................................................................. 84
Consistency of assessors and examiners ....................................................................................................... 84
Monitoring pass rates ...................................................................................................................................... 84
Trainee withdrawals ......................................................................................................................................... 85
Standardisation and consistency ..................................................................................................................... 86
Monitoring question standardisation ................................................................................................................ 87
Monitoring work-based assessment ................................................................................................................ 87
Strengths ......................................................................................................................................................... 87
Challenges ....................................................................................................................................................... 88
Plans ................................................................................................................................................................ 88
6. Monitoring and evaluation .......................................................................................... 91
6.1 Monitoring ............................................................................................................................. 91
Course evaluations .......................................................................................................................................... 91
Expert Advisory Group investigations 2015..................................................................................................... 92
Monitoring the program.................................................................................................................................... 92
RACSTA end of rotation surveys ..................................................................................................................... 93
Specialists Training Program (STP) project evaluation ................................................................................... 93
Survey of STP-funded training posts ............................................................................................................... 93
Workforce numbers and distribution ................................................................................................................ 93
Supervisor participation ................................................................................................................................... 93
Trainee participation ........................................................................................................................................ 93
6.2 Evaluation ...................................................................................................................... 95
Standards ........................................................................................................................................................ 95
Evaluation ........................................................................................................................................................ 95
Fellowship exam written hurdle requirements ................................................................................................. 96
Leaving surgical training .................................................................................................................................. 96
Predictive validity of selection tools ................................................................................................................. 97
Selection diversity: Gender bias in SET applicant outcomes .......................................................................... 97
RACS Review of assessments ........................................................................................................................ 97
SET evaluation 2013 ....................................................................................................................................... 98
SET evaluation 2014 ....................................................................................................................................... 98
Ongoing evaluations ........................................................................................................................................ 98
Engagement with stakeholders ....................................................................................................................... 99
6.3 Feedback, reporting and action ................................................................................. 100
Strengths ....................................................................................................................................................... 101
Challenges ..................................................................................................................................................... 101
Plans .............................................................................................................................................................. 101
7. Trainees ...................................................................................................................... 105
7.1 Admission policy and selection ......................................................................................... 105

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Selection process .......................................................................................................................................... 107
7.2 Trainee participation in training organisation governance .............................................. 110
7.3 Communication with trainees ..................................................................................... 112
7.4 Trainee wellbeing ........................................................................................................ 114
7.5 Resolution of training problems and disputes .......................................................... 116
Strengths ....................................................................................................................................................... 116
Challenges ..................................................................................................................................................... 117
Plans .............................................................................................................................................................. 117
8. Implementing the program – delivery of education and accreditation of
training sites .................................................................................................................. 121
8.1 Supervisory and education roles ....................................................................................... 121
Supervisors of training ................................................................................................................................... 121
Appointment and tenure ................................................................................................................................ 122
Supervisor training ......................................................................................................................................... 122
Feedback on supervisor performance ........................................................................................................... 123
Assessors ...................................................................................................................................................... 124
Evaluation of assessors and feedback from trainees .................................................................................... 124
Assisting trainees to find a mentor ................................................................................................................ 124
8.2 Training sites and posts ..................................................................................................... 125
Accreditation of posts .................................................................................................................................... 126
Aboriginal and Torres Strait Islander health .................................................................................................. 130
Strengths ....................................................................................................................................................... 131
Challenges ..................................................................................................................................................... 131
Plans .............................................................................................................................................................. 131
9. Continuing professional development, further training and remediation ............ 135
9.1 Continuing professional development .............................................................................. 135
Overview ........................................................................................................................................................ 136
Governance ................................................................................................................................................... 136
Program requirements ................................................................................................................................... 136
Participation and compliance ......................................................................................................................... 136
Professional development and approval of education activities .................................................................... 138
Review and consultation ................................................................................................................................ 138
9.2 Further training of individual specialists .......................................................................... 140
Requests for further training .......................................................................................................................... 140
Formal assessment of ongoing competence ................................................................................................. 140
9.3 Remediation ........................................................................................................................ 141
Complaints management ............................................................................................................................... 141
Strengths ....................................................................................................................................................... 142
Challenges ..................................................................................................................................................... 142
Plans .............................................................................................................................................................. 142
10. Assessment of specialist international medical graduates ................................. 145
10.1 Assessment framework .................................................................................................... 145

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