Surgical News - Royal Australasian College of Surgeons

Transcription

THE ROYAL AUSTRALASIAN COLLEGE OF SURGEONS
SURGICAL NEWS
Vol:7 No:1 Januar y/Februar y 2006
New On-line Library Resources
pages 18-19
JANUARY/FEBRUARY HIGHLIGHTS:
PAGE 9
PAGES 10-11
PAGES 14 -15
PAGES 26-27
USING EMAIL
EDUCATION REPORT
INTERNATIONAL DEVELOPMENT
ANNUAL SCIENTIFIC CONGRESS
“The appropriate use of email
can greatly enhance surgeonpatient interaction.”
John Collins explains the
assessment of International
Medical Graduates.
Perry Burstin talks about
volunteer humanitarian work in
Vanuatu.
The 75th ASC is coming up and
will be having a broad appeal to
Fellows and Trainees.
SURGICAL NEWS 02
/ Vol:7 No:1 January/Febraury 2006
PRESIDENT’S REPORT
Russell Stitz, President
“We need able, committed surgeons at
representative level if we are to be effective.”
Welcome to the first Surgical News for 2006
W
e are keen for this to become a more entertaining, informative
bulletin in keeping with our desire to improve communication
between the College, its Fellows and Trainees and vice versa. At the risk
of being repetitive, I need to emphasise that the College is its Fellows
and the Community badly needs the support of a robust, standardsbased College in partnership with its Speciality Organisations. A
bloated, inefficient bureaucracy has lost sight of the goal of cost effective
surgical care. Solutions to the health care problems will only eventuate
if clinicians are re-engaged in a meaningful way.
I am pleased to say that the Trainees, at a workshop in November, have
forged ahead with the formation of a Trainee Association and have
already appointed an interim Executive to introduce more detailed
processes. The Association will be facilitated by the College but will
remain an autonomous body within the whole fraternity.
In an editorial in The Australian on 12 January 2006, it was again
claimed that selection of surgical trainees was a “closed shop” despite
the ACCC authorisation and the review process. I have responded
strongly in a letter to the editor but to date this has not been published.
We have to use every avenue possible to inform the community that
surgical training is pro bono. That is, we train free of charge our eventual competitors in the interests of perpetuating high standard surgical
care in Australia and New Zealand.
At the recent meetings with John Horvath and Andrew Simpson
(policy advisor to the Health Minister) we voiced our concerns about
the limitations of the Productivity Commission study into Workforce. These concerns were highlighted with the release of the final
report on 19 January, 2006. Unfortunately, the study is a superficial,
bureaucratic examination of a complex problem and fails to seriously
address the problems with the workforce. Certainly, it does not address
productivity in any way and by virtue of its Terms of Reference it was
unable to examine the problems of resourcing and poor utilization of
those resources within the public hospital system. Instead, predictably, it concentrated on the need to be “more flexible” with transfer of
tasks away from doctors to other health professionals. This is despite
the fact that there is a National/International shortage of doctors and
nurses. Publicly, I have emphasised our view that we support task delegation within a team environment where the leader is the highest trained
clinician, which in our case is the appropriate surgeon. In the College
media release, we emphasised the absolute requirement for the maintenance of surgical standards, training and the Productivity Commission
did not seem to have learnt the lessons outlined in the recent Queensland Inquiry and Royal Commission. The Report will be presented to
COAG next month and our future strategy will depend on their approach at that time.
It is a pleasure to announce that Justice Geoff Davies, the recent Royal
Commissioner in the Bundaberg Inquiry, has agreed to become our
first expert Community Advisor on Council. He is enthusiastic to contribute using his accumulated knowledge of the health care problems in
Queensland and we are looking forward to his wise counsel.
February Council week will be intellectually stimulating and important in mapping strategic changes to College activities. February is
the time of elections both to Council, to the National Board in New
Zealand and to Regional Committees. I strongly urge Fellows to consider standing for appropriate positions. We need able, committed surgeons at representative level if we are to be effective. On the Wednesday, the College Council meets with the Speciality Presidents to discuss
future directions I am keen to more formally structure these meetings as
an influential part of College policy development. At the meeting, the
initial development of the integrated (seamless) training process will be
presented for discussion. I need to reassure Fellows that it is our intention to build on the current proven success of our training programmes
and to augment these using modern educational processes and experience in sister colleges overseas. Radical change is not going to occur but
educationally and politically, we need to follow a policy where there is
a holistic surgical training programme designed to produce high quality
surgeons without segregating it into Basic Surgical Training and Specialty Surgical Training. The educational components of the current
programmes will be incorporated into this new process.
Based on the concept that surgical education is a continuum from
selection as a trainee to retirement, Council has asked the CEO to
develop a structure which incorporates this principle. As a result, we
are exploring the proposal that we should develop Boards of Training
and Standards which can apply both to pre-fellowship training and
throughout our surgical career. This approach will facilitate the
development of sub speciality groups without denigrating the absolute
requirement for the ongoing need for generalists.
SURGICAL NEWS P03
/ Vol:7 No:1 January/February 2006
PRESIDENT’S REPORT
Russell Stitz, President
I remain greatly concerned about the state of our public hospital
system in Australia and New Zealand and the inability of government to address the issues. We must continue to agitate for change in
the Federal/State funding mechanism in Australia. This is wasteful
with duplication and an excessive bureaucracy which is insensitive to
clinical outcomes.
The Federal Government funds over half the budget of public hospitals
and yet has little influence over the way the hospitals deliver care. Administration has become more remote from clinicians as exemplified in
the Queensland Inquiries.
There is little evidence that substantial change has occurred in Queensland despite the Government “throwing money” at Queensland Health.
This situation is similar in other states. There are widespread claims
that NSW has budgetary problems and New Zealand health care is
chronically under funded. Because of the on-costs related to surgery,
surgical matters will always be at the forefront in hospital funding.
The College has available to it the expertise to influence the direction
of surgical care and we must use this influence for the benefit of our
patients.
After being given an assurance that training standards, selection and
assessment are the province of the College and its Speciality groups,
the College is working collaboratively with The Institute of Medical
Education and Training (IMET) in NSW to improve the delivery of
Basic Surgical Training in that State. IMET is currently in dialogue
with general surgeons, and otolaryngologists to examine methodologies for facilitating training in these specialty areas. IMET is an autonomous body but is funded by NSW Health so we must be vigilant
that the College remains the professional body responsible for surgical
training standards and that short term political expediency does not
denigrate these standards. In addition, we have stressed that RACS
Intellectual Property related to training is owned by the College and
its Specialty organisations.
The Australian & New Zealand Audit of Surgical Mortality (ANZASM), based on the successful Western Australian model, continues
to gain momentum. South Australia, Tasmania and Queensland have
commenced the audit process which is predicated on de-identified data
and voluntary reporting by Fellows. However, for credibility in the
community, nothing short of 100 per cent compliance in reporting will
be sustainable. Although the models vary slightly in each State, in essence, the State Health Departments fund the project which is run by
the College. The College is currently in dialogue with the Clinical Excellence Commission in NSW and we are hopeful that we will have a
benchmarked system throughout Australia and New Zealand over the
next 12 months.
The College and its Speciality groups have considerable experience
now in the audit process. When Governments fund these audit initiaSURGICAL NEWS P04
tives, there is an increasing demand for the College to address under
performance. Currently, Ian Dickinson is chairing a working party
to address the latter. From the College point of view, we are keen to
identify under performance at an early stage and institute measures to
correct this in a collegiate rather than a punitive manner. The reality
is that if we are to remain a self regulating body, we require processes
which address this issue.
Although audit is the only component of our current professional
development programme which assesses performance, I am firmly
convinced that we need to promote the concept of small group learning particularly in the operating theatre environment where surgeons
can not only visualise procedures but can discuss management in an
informal environment.
ASERNIPs continues to provide a valuable service to the Australian
community. It has been a major initiative of the College and has prospered under the guidance of Guy Maddern and his team. In this age
of technology, it is vital that it continues to receive adequate long term
funding from the Commonwealth Government.
Another area which does not receive enough publicity, is that of the
International Projects in which Fellows continue to do an enormous
amount of good work.
The Vice-President, Stephen Deane, has responsibility for the Relationships portfolio and we are both keen to obtain as much feedback as
possible from Fellows and Trainees. I am most grateful for all the hard
work performed by Fellows in voluntary representative and educational
roles and I look forward to seeing personally as much of this endeavour
as possible in 2006.
Congratulations to
Anne Kolbe former
President of the
College for
winning the
Officer of the New
Zealand Order of
Merit in the New
Zealand New
Years Honours,
for services to
medicine.
SCIENTIFIC RESEARCH
John Mitchell Crouch Fellowship
John Mitchell Crouch
Professor Chris Christophi’s research into the uses of laser hyperthermia ablation and new drug
delivery systems targeting the tumour vasculature for the treatment of liver cancer has won him
the Colleges’ most prestigious research endowment – the John Mitchell Crouch Fellowship.
P
rofessor Christophi is Head and Professor
of the Department of Surgery at the Austin Hospital and the University of Melbourne.
“The other experimental aspect of our work is looking at the laser
ablation of tumours, and in particular the exact amount of heat required.
The Fellowship is awarded by the College
Council each year for outstanding contributions to the advancement of surgery or to fundamental scientific research in the field.
“These techniques may be applied by percutaneous means, with minimal morbidity, hospital stay and treatment costs.
Professor Christophi said the majority of his research work involved
the treatment of colorectal liver metastases which remain the most important predictor of outcome for the 14,000 patients diagnosed with
colorectal cancer in Australia each year.
The spread of the cancer to the liver accounts for almost 70 per cent of
such deaths. Until now the treatment of the majority of patients with
colorectal liver metastases has been palliative, usually involving chemotherapy, with liver resection and focal ablative techniques playing an
important role in a small subgroup of patients.
“Colorectal cancer is the most common cancer in both genders and 50 per
cent of cases will develop liver metastases,” Professor Christophi said.
“Only 10-15 per cent of those can be successfully resected so it is imperative that we find different ways of mechanically treating these tumours.”
As such, the major focus of his work is investigating vascular targeting
agents to attack tumour vessels and laser ablation. “Unlike conventional
chemotherapy that attacks the cells, we are looking at new drug delivery
systems that can attack the tumour vessels that feed it,” he said.
“Tumour vessels are extremely permeable so we can get a much higher
dosage of the necessary drugs into the tumour itself by this method.
“At the same time, the development of novel agents such as antivascular
agents and the refinement of more effective and selective chemotherapy may
be used in combination with these techniques to enhance patient survival.”
Professor Christophi’s team at the Austin and the University of Melbourne
is also collaborating on this research with the Department of Pharmacology
in Kumamoto, Japan, and pharmaceutical researchers in the US.
Most of his team’s laboratory experimentation is being conducted at
the University of Melbourne with the clinical work undertaken at the
Austin Hospital. He said he was greatly honoured to win the $55,000
Fellowship, funding that had been spent on consumables, laboratory
animals and the salaries of research assistants.
“The John Mitchell Crouch Fellowship is one of the icons of the College and because of that status, it acts as a stimulus for other funding,”
Professor Christophi said.
“This in turn means it is a great way to get projects off the ground
which then attracts both wider support and greater expertise.
‘This type of funding is extremely valuable in such a competitive
environment.
“To be in a position to show other funding organisations that the College Council is supportive of various projects is immensely helpful.”
Correspondence to Surgical News should be sent to:
[email protected]
Surgical News Authorised by Dr David Hillis
© 2006 Royal Australasian College of Surgeons
Letters to the editor should be sent to:
[email protected]
The Royal Australasian College of Surgeons and the publisher cannot
be held responsible for errors or any consequences arising from the use
of information contained in this newsletter. Publication of advertisements does not constitute any endorsement by the publisher or the
Royal Australasian College of Surgeons of the products advertised.
or The Editor, Surgical News,
Royal Australasian College of Surgeons,
Spring Street, Melbourne Victoria 3000. Tel:+61 3 9249 1200;
fax: +61 3 9249 1219; Internet: www.surgeons.org
Published by Metropolis Media Pty Ltd ACN 094 587 72
SURGICAL NEWS P05
RELATIONSHIPS REPORT
Stephen Deane, Vice President
Surgical Workforce Census 2005
Episode 1: The Ageing of the Surgical Workforce
A
s you are all aware the survey of the Australian College Surgical
Workforce was undertaken by the College from October to December 2005. As reported in the newsletter from the New Zealand
National Board, New Zealand is undertaking a separate survey of its
workforce. Results of both surveys will be integrated when the results
of the New Zealand survey are available.
Table 1: 2005 Royal Australasian College of Surgeons ‘Active’
Fellowship by Work Status, Australia.
The Australian census was sent to all Fellows in Australia classified
as ‘active’ on the College database. A response rate of 80 per cent
was achieved. Several Speciality Societies including the Australian
Orthopaedic Association, the Neurosurgical Society of Australasia, the
Australian Society of Plastic Surgeons and the Australian and New
Zealand Society for Vascular Surgery contacted their members directly
as did the Regional Chairs with the assistance of the regional managers
and offices. Their support is acknowledged and appreciated.
The survey results therefore represent the most robust collection of information relating to surgical work practises and patterns, current gaps,
and future supply issues currently available in Australia.
Ongoing analysis of the data will provide the College with a comprehensive understanding of complex workforce dynamics in play today
within the surgical sector and will enable the College to strengthen its
capacity to support and respond to the information needs of external
bodies.
Stated Workforce Status No.
%
Active
2935
86.3%
Semi-retired
291
8.6%
Retired
109
3.2%
Temporarily not in practice 66
1.9%
Total
100.0%
3401
Source: RACS (2005) RACS iMIS Database; RACS (2005) Surgical Workforce Survey
The age breakdown of the Australian Active Fellowship is shown in Table 2. The table shows a considerably aged workforce, with 43 per cent of
the Active Fellowship aged 55 years or over and only 16.1 per cent aged
under 40 years.
Overall, the average age of the Active College Fellowship in Australia
is 55.6 years. The average age of new Fellows has also increased 4 per
cent from 2000 to 2005, with the average age of new Fellows now at
36.6 years. Across specialties Paediatric surgeons (average age = 61.4
years) and General surgeons (average age = 59.2 years) are the most
aged group of surgeons (Refer to Table 2).
Analysis of the census includes all Fellows engaged in consulting and
operating sessions as well as involvement in other non-direct patient
care activities such as administration, professional development, management and committee-related activities, medico-legal and education.
Figure 1 further demonstrates that the College workforce is aged by
comparing it to the wider health sector workforce and the general
workforce across Australia.
Ageing
Table 2: 2005 Royal Australasian College of Surgeons Active Fellowship by Age, Australia.
Population ageing is having a two-fold effect on the provision of surgical services in Australia. Firstly, the surgical workforce is ageing and
this trend will continue. On the other side, demand for surgical services
is also affected as a result of the increased number and mix of older
patients requiring specialist surgical services
Table 1 considers the number of surgeons who are registered with on
the College database as Active Fellows, by their current working status
in relation to operating and/or consulting practice. The table shows
that approximately 466 (or 13.7 per cent) of the ‘Active’ Fellowship on
the database subsequently classified themselves as either semi-retired,
retired or temporarily not in practice. This means that nearly 1 in 7
‘Active’ Fellows are not participating in the surgical workforce or have
reduced participation due to semi-retirement.
Age Group
No.
%
<39
545
16.1%
40-44
525
15.4%
45-49
486
14.3%
50-54
399
11.7%
55-59
435
12.8%
60-64
455
13.4%
65-69
280
8.2%
70+
276
8.2%
Total
3401
100.0%
Source: RACS (2005) RACS iMIS Database; RACS (2005) Surgical Workforce Survey
SURGICAL NEWS P06
Figure 1: RACS Active Australian Surgical Workforce by the Health Workforce and Australian Workforce.
RACS Surgical Workforce By Age By Sector Comparisons
45%
40%
40%
35%
31%
30%
29% 29%
28%
25%
25%
26%
26%
23%
20%
16%
15%
11%
10%
5%
10%
3%
2%
<34
35-44
45-54
55-64
2%
65+
Age Group (Years)
RACS Surgical Workforce
Health Workforce
Australian Workforce
Source: RACS (2005) RACS iMIS Database; ABS (2001) Census of Population and Housing
As an aged workforce, the surgical service sector requires uniquely designed strategies to support retention, create longer-term sustainability and manage succession.
Episode 2 next month will provide information on retirement intentions and views of their workload.
ACCREDITATION OF HOSPITALS AND POSTS FOR SURGICAL TRAINING
The College in collaboration with its Boards, the various Specialist Surgical Societies/Associations and the Jurisdictions has developed
a revised set of criteria, and process for the accreditation of hospitals and posts for surgical training. Council approved these in October
2005 and they are currently being implemented. Revision will occur during 2006 based on feedback from those using the document.
For complete details of the new criteria and processes, please refer to the College website at www.surgeons.org. Accreditation
documentation will be mailed in February to the Chief Executive Officers of surgical hospitals and to surgical supervisors.
SURGICAL NEWS P07
SURGICAL SKILLS
Janty Taylor
New Australian and New Zealand Surgical Skills
and Education Training course (ASSET)
Beginning in March a new DVD will be viewed which is part of the ASSET course.
A
new Australian and New Zealand Surgical Skills Education and
Training (ASSET) course has been developed for Basic Surgical
Trainees (BSTs) by the Basic Surgical Skills Committee. The ASSET
course was first piloted in August 2005 and will be fully introduced in
2006 for all BSTs. It is the first such course developed solely by the
College and available to all regions as part of the structured basic surgical trainee programme. The newly developed course replaces the previous UK-based course and provides an educational package of agreed
generic surgical skills required by BSTs in the Australian and New Zealand context. The modular format gives a flexible program which easily
accommodates updates and changes and the insertion of new segments.
It is a practical three day course with demonstration by surgeons and
hands on practice by trainees as the main teaching methods. Courses
are conducted in Skills Centres in Melbourne, Sydney, Perth, Brisbane,
Adelaide, Auckland and Christchurch.
Development of a DVD. In December 2005 the Basic Surgical Skills
(BSS) Committee developed a DVD as a component of the ASSET
course materials for trainees. Filming took place over a week in the
RACS Skills Centre in Melbourne. CMEE4 Productions was contracted
to develop the DVD. The BSS Committee members developed scripts
and demonstrated the surgical techniques in the DVD with assistance
from staff in the Skills Training Department and Skills Centre of RACS.
The members included:
Mr Iain Skinner Chair
Mr Richard Perry
Mr Matthew Carmody
Mr Rob Davies
Mr Matt Lawrence
Mr Matt Clark
Mr David Bainbridge
The DVD follows the course curriculum in its modular format covering
topics including, – surgical instruments, suturing, wound management,
electrosurgery and bone handling. Trainees will be able to view demonstrations of the modular components of the curriculum on the DVD.
ASSET course materials will also include a course manual to be printed
with sponsorship assistance from the primary sponsor of Applied Medical. Future editions of the manual will include illustrations images from
the DVD. ASSET cards being developed will contain information about
the qualities and features of different suture material and brands. Cards
will be used during the course and retained by trainees for reference and
a quiz situation.
SURGICAL NEWS P08
Robert Davies suturing
Printing of the manual would not be possible without the generous
financial donation from Applied Medical. The BSS Committee and
the College would like to acknowledge and thank Applied Medical for
their contribution. Also the materials and equipment used during the
filming of the DVD were supplied by the other sponsors – Stryker,
Ansell Healthcare, Johnson and Johnson, Kimberley Clark, Conmed
Linvatec, Olympus, Smith and Nephew, Tyco and Synthes who support the ASSET course. The sponsors are an integral component of
the course.
The BSS Committee extends its sincere thanks to surgeons who instruct
on the ASSET course. The valuable experience and expertise they
bring ensures a quality educational programme for the BSTs. Without
the continued interest and generous commitment of time and energy
by Fellows of the College who instruct on the programme, it would
not have achieved its success. Instructing on the ASSET courses is a
rewarding experience providing a chance to interact with each year’s
intake of new trainees. The Committee invites Fellows to join the
dynamic and enthusiastic ASSET faculty especially at such an exciting
time. Fellows interested in coming on board are encouraged to contact
Janty Taylor who is responsible for the ASSET program in the Skills
Training Department of the College on 61 3 9276 7450.
USING EMAIL
Leigh Delbridge
Using email to enhance communication
The fundamental basis of the doctor-patient relationship has always been face-to-face communication.
H
owever advances in communications technology have, from
time to time, challenged that assumption. When the telephone
was introduced more than 100 years ago, it was regarded by many as
the death-knell for the doctor-patient relationship but how many of
us nowadays could survive in practice without a mobile phone to assist with patient care. Many current critics have, likewise, decried the
use of computer-based technology as potentially interfering with doctor-patient interaction. However, there are many positive examples
of the use of such technology. Remote care using internet technology
significantly increases access to medical expertise, tele-rounding using
robots to complement formal post-operative care has been shown to
augment patient satisfaction, and text-messaging has been successfully
employed as a reliable means of patient contact.
E-mail is another technology which has transformed general communication worldwide, however little has been published about its effect
on doctor-patient relationships despite the widespread and dire warnings about the potential minefield of legal disasters and litigation that
might accompany its use. Whilst some caution should accompany the
utilisation of any such form of communication, I firmly believe that the
appropriate use of e-mail can greatly enhance surgeon-patient interaction in the peri-operative setting.
In a recent study published in the ANZ Journal of Surgery (Ketteridge
et al. 2005;75:680-3) we demonstrated that making e-mail access available to patients after their initial pre-operative consultation significantly
increased the level of patient communication without any detectable
downside. In a further, as yet unpublished, prospective randomised
controlled trial of patients who were, or who were not directed to use
e-mail for any questions or queries that might arise following their initial consultation, we found that e-mail access significantly increased the
level of pre-operation interaction, without any reduction in measured
satisfaction outcomes.
communication and often ask questions or raise personal issues that
they may have felt inhibited about in a face-to-face consultation.
Clearly there is the potential for intrusion on the surgeon’s time and
space, as e-mails tend to be answered after the day’s work, often at
home. This intrusion is, of course, balanced by the time freed up not
having to return or answer phone calls at the office, or see patients for a
further consultation and, for most surgeons, such time spent is clearly
going to be cost-effective.
There remain a number of important issues in relationship to the use of
e-mail by surgeons. Unsolicited e-mails should never be answered, as
this may create unwittingly a patient doctor-relationship, a potentially
dangerous situation from the point of view of litigation. In our studies we have emphasised that e-mail communication should be confined
to patients who have already been seen in consultation and who have
been specifically requested to use that source of information for asking
questions. Urgent messages must never be sent by e-mail as the time
of receipt of the e-mail information can never be guaranteed. Likewise
it is clearly inappropriate to tell patients bad news or important test
by e-mail. Despite these concerns I believe that the use of e-mail
provides a very effective means of communication for patients undergoing elective surgery.
Leigh Delbridge using email to enhance patient communications
There are clearly major advantages associated with the use of e-mail
as a means of communication between surgeon and patient. It avoids
interruptions to office routine by avoiding the need to answer phone
calls from patients at all times of the day, or having to engage in “phonetag” if calls are answered at the end of the day’s work. E-mail responses
can also be written undisturbed with appropriate thought being given
to the reply, ensuring that it is composed and accurate, something not
readily achieved with a hurried phone conversation. Copies of e-mails
kept in the file provide clear and indisputable evidence of the responses
provided, an invaluable resource should litigation ensue. Our study
also demonstrated that many patients “open up” when using e-mail
SURGICAL NEWS P09
EDUCATION REPORT
John Collins, Dean of Education
The Assessment of International Medical Graduates (IMGs)
I
n 2005, 118 IMGs applied to the College for assessment of their training. The purpose of assessment is “to determine whether an IMG has
the capacity to practice surgery independently, safely and effectively to
the same standard as an Australian or New Zealand trained surgeon”.
The College is responsible for this assessment and is required to report
to the Australian Medical Council (AMC) on the process and outcome of
individual and overall assessments. It is also required to report to the Australian Competition & Consumer Council (ACCC) on overall outcomes.
It is important that Fellows, Trainees and IMG’s have an informed
understanding of the current process, the challenges being experienced
by those intimately involved and the efforts being made to achieve an outcome which best meets the needs of society and the applicants.
THE CURRENT PROCESS
Medical Council Involvement
IMGs apply to the Australian Medical Council (AMC) or the Medical
Council of New Zealand for specialist assessment which then requests
specific information. The initial assessment by the AMC is to establish
Bono Fide qualifications, occupational English test result (or exemption)
and completed supporting documents. If the documents are in order the
application is referred to the College for in depth assessment. The Medical Council of New Zealand assesses an IMG’s eligibility for registration
within a vocational scope of practice and “takes into account” advice from
the appropriate vocational body e.g. the College. The Council has the
discretion to determine whether the applicant’s qualifications, training
and experience are appropriate for registration within the vocational
scope in which they have applied. A major review of the methodology
used by the Medical Council of New Zealand to assess IMG’s is currently underway.
Paper-based Assessment
The College process commences with a paper-based assessment by the
Dean of Education and the appropriate Board Chair. A proforma has
been developed which lists each of the requirements to train as a surgeon
developed by the College and its various Boards. The paper-based assessment then focuses on the challenge of establishing whether or not an
applicant has undertaken substantially comparable education, training,
experience and assessment. Referee’s reports, which must include at least
one relating to recent practice, are reviewed and a current certificate of
good standing sighted. Based on this, one of five recommendations is
made which may vary from requiring the individual to undertake complete surgical training to those who are considered to be comparable under all requirements. For those who are seeking an Area of Need position
SURGICAL NEWS P10
their assessment involves establishing whether they have the competencies required to undertake the roles listed in the job description. The job
description is also reviewed to ensure that the position is appropriate and
viable for a surgical specialist.
Semi-structured Interview
An interview follows for all except those who need to undertake Basic
Surgical Training. The purpose of this interview is to pursue any issues raised through the paper-based assessment and to explore with the
applicant a range of aspects relating to surgical practice, e.g. recency of
clinical experience, and ability in terms of professional performance, ethics, insight, teamwork, approach to patients and communication skills,
through a standardised list of questions. It is not an assessment of surgical
knowledge. This interview which is chaired by the relevant Board Chair
includes a surgeon from another specialty, a jurisdictional representative
and a College staff member. A second surgeon from the same specialty
as the applicant is also frequently present.
Recommendations
Following the interview a final recommendation is made which may vary
from a requirement to undertake full specialist training and/or the Fellowship Examination, to Admission to Fellowship pursuant to the Articles of Association Number 21. A period of “oversight” varying between
12 and 24 months is recommended for those who are required to take
the Fellowship Examination or 12 months for those being considered for
Article 21.
CHALLENGES PRESENTED BY THE
CURRENT PROCESS
These surround the attempts to assess the system under which the applicant has trained, rather than assessing the individual, and, that the
only authentication of the individual’s competence as a surgeon is by
way of a paper-based assessment.
1. Is the IMG’s training, experience and assessment substantially comparable?
In order to undertake an assessment of the system under which an applicant has trained a lengthy, labour-intensive and expensive exercise
takes place involving a request for documentation from various universities, colleges, employers and medical registration boards. Lack of
documentation or at times cooperation by some of these groups can be
frustrating both to the College and to the IMG being assessed.
Uncertainty regarding the reliability of documentation, incomplete important information and concerns relating to the dependability of its
translation into English can each be a major challenge, and all have accompanying risks. These problems are not of course universal and many
IMGs do provide complete, certified and up-to-date information.
Practice environments, curriculum and assessment may be very different in the country of origin and in some European countries surgical
training may not have an exit examination using instead a mentoring
approach. A further issue relates to whether a “training program” does
in fact focus on training and whether it has regular external assessment
as occurs with this College through the AMC. It is of relevance that
evidence of external assessment of all university degree programs is
now one of the necessary requirements before such degrees will be recognised across international boundaries.
independent practice is appropriate for those with eight or more years of
specialist practice or those whose practice is confined to a subspecialty area. However members of each of the nine Court’s of Examiners
believe they have the combined expertise and experience to assess candidates from various backgrounds and ensure a uniform standard. While a
porfolio of experience does recognise a person’s learning, demonstration
that they have the up-to-date factual knowledge necessary to practise in
their specialty is required in many countries although there is no uniformity as to how this should be assessed.
3. Should every IMG take the Fellowship examination?
Some principles and points for discussion
1. The College has a moral, ethical and professional obligation to the
public to ensure that each surgeon obtaining the FRACS has met
the standards required.
2. There must be a uniform standard required for all who obtain the
FRACS.
3. There must be no compromise of the current pathway to Fellowship required of those who train in Australia or New Zealand.
4. Consideration should be given to assessing the surgical competencies of individual IMGs rather than relying on an assessment of
their training system and experience.
5. IMGs should be required to undertake six to 12 months of clinical assessment in Australia or New Zealand and only in exceptional
circumstances should this assessment be replaced by oversight.
6. The majority of IMGs should take the Fellowship Examination after the satisfactory completion of a period of clinical assessment.
7. Appropriate locations and funding are required to provide IMGs who
wish to practise in Australia or New Zealand with the opportunity to
experience local healthcare systems and have their performance assessed over time. Those responsible for the funding and administration of healthcare which includes Governments and the jurisdictions
must take the major responsibility for solving the logistical problems
involved in finding suitable placements. The College is very willing
to support such endevours. There are already inadequate numbers
of posts to accommodate specialist trainees and the placing of IMGs
must not jeopardize this any further.
8. The current process for providing oversight/supervision is experiencing numerous problems particularly with those in Area of Need
positions or who are professionally isolated. It is not possible to undertake this at a distance nor can it be the responsibility of one surgeon. The alternative of spending six–12 months in an appropriate
unit, where a clinical assessment can be guaranteed in the same way
as for our trainees would seem a more valid option.
Most would agree that exemption should be given to those who have
an eminent academic career in established, new or emerging specialties. The second group which needs further discussion are those who
have been in active specialist or sub-specialist practice for many years.
The Medical Council of New Zealand recently raised for discussion
whether an examination developed to assess trainees before they enter
International Medical Graduates are an important part of the surgical
workforce and make a substantial contribution to the healthcare of Australians and New Zealanders. The College is committed to ensuring that
they are assessed in an appropriate, objective, fair and transparent manner while at the same time being able to reassure the public that all who
provide surgical care meet the required standards.
2. Should there be automatic recognition of overseas surgical
qualifications?
One of the recommendations in the ACCC Review was that the College
“should complete and publish a list of recognised overseas qualifications
within six months of the release of the Review’s final report,” that is,
by the end of 2005. From our experience to date in assessing overseas
training programmes this would seem to be an near impossible task not
just because of the difficulties faced in obtaining up-to-date, appropriate and reliable information but also because of the ongoing changes in
training around the world, the most recent of which is associated with
Modernising Medical Careers in the United Kingdom. Allegations of bias
have been voiced by some IMGs when one program is regarded as substantially comparable and another is not. The Royal College of Physicians
and Surgeons of Canada (RCPSC) has made a determined effort to review
overseas qualifications across the many specialties it is responsible for, and
although some were considered acceptable at the time they were reviewed,
the majority were either unacceptable or unable to be properly assessed.
The Canadian College has had similar problems to those experienced
by this College with obtaining adequate, credible, and up-to-date information and has decided to discontinue its previous practice of assessing
international postgraduate medical education systems in favour of individual competency assessment. Historically those who wished to obtain a
Fellowship from the Canadian College have been required to present for
examination after one year of clinical assessment in Canada, and only in
rare circumstances has an exemption to this requirement been granted.
SURGICAL NEWS P11
QUEEN’S BIRTHDAY
Les Bokey
Queen’s Birthday honours for services to colorectal surgery
The Australian honours system recognises the outstanding achievements and contributions
made by individuals to their community, their country or at an international level.
S
urgical News was pleased to note that in the 2005 Queen’s Birthday Honours List. Professor Les Bokey was one such individual
singled out for his services to medicine as a colorectal surgeon, and
for the establishment of surgical educational programs, research, and
medical administration.
Les is a busy and indefatigable clinician, committed academic surgeon
and medical administrator who has achieved an international reputation in his chosen discipline of colorectal surgery. Les was born in Alexandria, a city renowned as a birthplace of Hellenistic civilisation and the
centre of a large Jewish community who speak both Greek and French.
When the Suez Canal crisis erupted in 1956 Les and his family became
refugees initially in France and later migrated to Australia.
Les graduated from the University of Sydney in 1969 and obtained
his Fellowship in 1975. He then steadfastly pursued a career in colorectal surgery encouraged by the members of the Colorectal Unit at
Sydney Hospital, then the cornerstone of the discipline in this country. Like many, Les travelled overseas to continue his training, first to
London working with Ian Todd at St. Bartholomew’s Hospital, and
then to Goteborg in Sweden with Nils Kock and subsequently as an
international scholar to the Cleveland Clinic Foundation in the USA.
He returned to Sydney in 1979 and joined Professor Murray Pheils at
Concord Hospital as his Senior Surgical Registrar where today, he
occupies the inaugural Chair of Colorectal Surgery at Sydney University.
Les is Head of Department of the Concord Hospital Colorectal Unit.
He was made Head of Surgery in the Faculty of Medicine in 1993 and
subsequently Associate Dean of Surgical Sciences in 1999. Currently,
he is Director of Gastroenterology and Liver Services for the Sydney
Southwest Area Health Services. Such a rapid ascent through the academic hierarchy is testimony to his abilities as a capable and astute
administrator with exceptional organisational skills; as a distinguished
academic and teacher; and to the respect that he enjoys from his peers.
His expertise and technical innovations, especially in rectal cancer surgery, are recognised in the international peer-reviewed literature. He
has been a generous and effective teacher of many young surgeons from
both Australia and overseas and a constant contributor to important
activities within the community beyond his immediate clinical and academic commitments.
Les Bokey remains a private person devoted to his family. He is touched
to be honoured in this way and recognises the support of his colleagues
in the creation of the colorectal unit at Concord Hospital; “this is good
for Concord Hospital and for colorectal surgery”.
Pierre Chapuis,
Concord Hospital
PROVINCIAL SURGEONS OF AUSTRALIA ANNUAL SCIENTIFIC CONFERENCE
Kalgoorlie
22 – 25 November 2006
* Please note date change
This year’s Provincial Surgeons of Australia (PSA) Annual Scientific
Conference will now be held in Kalgoorlie from 22 – 25 November
2006. The theme of this year’s PSA Conference is ‘Rural Trauma’
which will complement the Mining Regions of Kalgoorlie. The Convener is Mr Mike McGushin who is planning a significant scientific
programme accompanied by an exciting social programme which will
showcase many famous Kalgoorlie attractions. Please mark these new
dates in your diary and look out for more information about the 2006
Kalgoorlie PSA, in the next issue of Surgical News.
If you require further information please contact Kymberley Walta
from the College Conferences and Events Department on +61 3 9276
7406 or email [email protected]
SURGICAL NEWS P12
Training opportunities in the Top End
The Royal Darwin hospital is a 350 bed teaching hospital and is perhaps one
of the last bastions of true General Surgery in the country. Its isolation and
size mean that to be a general surgeon in Darwin, you cannot restrict yourself
to Gastro-intestinal surgery. General surgeons in Darwin handle neurosurgical
trauma, thoracics, burns, plastics, hands, urology, vascular and paediatrics,
often with support from visiting subspecialists. Consequently, the training
opportunities are huge at all levels and vastly different from large southern
centres. Trainees frequently mention the great variety and the large numbers
of cases they have exposure to. This is definitely a ‘cutting job’.
David Read & Lou Lemch fishing for Barramundi
We have four posts for basic surgical trainees, who are employed at a junior
registrar level. Three advanced trainees rotate from North Queensland, Sydney
and South Australia. Finally, there is a college-accredited one year fellowship in
Rural Surgery. Research opportunities abound in the Menzies Institute, a worldrenowned centre with emphasis on Aboriginal Health and tropical diseases.
I would expect that after a year in Darwin, a trainee should be comfortable
repairing a tendon, grafting a burn, placing a ureteric stent and, placing an
intracranial pressure monitor.There is also a high trauma load, and we have
now developed considerable expertise in disaster management.
Borroloola Community Health Centre
Registrars are expected to accompany surgeons on ‘specialist outreach’ visits
to isolated rural communities. These visits offer insight into issues facing the
providers of indigenous health care. They frequently involve a light aircraft
trip into Arnhem land, and offer opportunities for the purchase of indigenous
art or a spot of barra fishing once the day’s work is done.
The Darwin lifestyle is another reason that virtually all trainees enjoy their
rotations here. No traffic, great weather, sailing, fishing, subsidised accommodation adjacent the hospital, only five minutes walk from the beach.
Mr Darren Foreman was a BST 3 when he worked for a year in Darwin to gain
general surgical experience prior to entering advanced training for urology.”
Crossing the MacAthur River
“The surgical opportunities for a Resident were far greater than I had
experienced elsewhere, and my logbook showed 2 years worth of
operative experience at the end of 12 months.”
Australian and New Zealand Head and Neck Society (ANZHNS ) Annual Scientific Conference
The 7th Annual Scientific Conference of the ANZHNS was held at the
Hilton Sydney from the 24 – 27 November 2005. This conference provided a valuable opportunity for over 200 Otolaryngology, Head and Neck
Surgeons, Medical Oncologists, Surgical Oncologists, Radiation Oncologists, Registrars, Speech Therapists, Nurses and other health professionals to come together and share their combined knowledge in a collective
scientific environment.
Four international guests contributed to the Conference including Professor Jean Bourhis from France, Dr Ralph Gilbert from Canada, Dr Robert Amdur from America and Professor Mark McGurk, from the United
Kingdom. Delegates thoroughly enjoyed this opportunity to listen to international opinions which was thought provoking and inspiring.
A major highlight of the meeting was a presentation by The Hon Tony
Abbott MHR, Minister for Health and Ageing on the topic of ‘Inequality
in Cancer Care Delivery’ and delegates appreciated the opportunity to
address the Minister in an open forum.
Associate Professor Chris Milross, Director of the Radiation Oncology
Department at the Sydney Cancer Centre should be congratulated on
convening a successful Conference. The outcome of this Conference
would not have been possible without the dedication of the Convener
and his Committee comprising of Dr Bob Smee, Dr Gary Morgan and
Dr Carsten Palme. The Convener and the Committee would like to
thank the College Conferences and Events Department for their management of the Conference and support of the Society. Membership of
the ANZHNS gives multiple opportunities to keep up with the latest
clinical and research developments in the field of head and neck oncology
as well as access to local and international leading oncological surgeons
for specific clinical case questions and issues. For further information
visit www.anzhns.org
SURGICAL NEWS P13
INTERNATIONAL DEVELOPMENT
Perry Burstin
Progressing From Provision to Training
“Give a person a fish and he’ll eat for a day. Teach him to fish and he’ll have food for a lifetime”
W
hen I commenced the inaugural Vanuatu National Ears, Nose,
Throat (ENT) workshop with these words, my team members later
jokingly said they thought I was going to be handing out rods and bait!
In four previous AusAID funded ‘Pacific Islands Project’ trips to the country, it felt like we were only ever really scratching the surface of the medical
and surgical problems. My concern in general with the overall program
effectiveness was of treating relatively small numbers of patients, often
with severe pathology at the end of the disease spectrum. There was also
the issue of many people in outlying island villages never really getting the
chance to avail themselves of primary, let alone tertiary care.
Given education is the means to sustainable independence, the concept
of organizing a training conference slowly developed momentum. The
idea was that not only would patients be more competently triaged,
assessed at an earlier stage, intensively worked-up and better managed
post-operatively with improved outcomes, but basic treatment would
be possible on an all-year-round basis. It was hoped this model would
exponentially expand the options available to the population at large, so
as to make a major impact on health care in the country.
Remuneration is poor within the medical sector and retention of doctors
particularly difficult; they often seem to move around between various
Pacific Island countries looking for better opportunities and giving them
exportable qualifications invariably leads to the desire for emigration.
For these reasons, a locally sustainable ENT surgical service in Vanuatu
is a long way off becoming a reality.
The training project took shape after several months of consultation
with AusAid, the PIP and the Vanuatu Director General of Health. In
addition to significant AusAID funding, generous private benefactors
as well as donations in lieu of presents for my wife’s birthday party (exact number withheld!) helped raise over $12,000. Five nurses from the
Islands of Santo, Tanna, Mallekula, Epi and Banks were flown in, with
a further seven attending from the main island of Efate. The workshop
was held over seven full days, including a lecture program on all facets
of Oto-Rhino-Laryngology, Head and Neck Surgery.
History taking and examination techniques were highlighted, in particular, minor otologic outpatient procedures. I invited a friend and
colleague, Mr. Roger Grigg to participate in the trip and we alternated operating sessions, formal tutorials and clinics to give the trainees broad exposure. This was complemented by two audiologists who
taught air and bone conduction testing, the principles of masking and
hearing assessment techniques in younger children. The basics of amplification were covered and a number of worthy candidates identified and some fitted with hearing aids. Ear mould production was
reactivated using resourceful local techniques. Previously donated second
hand analogue-type aids have a very limited lifespan, especially in tropical
climates. We were fortunate to have a Melbourne based company offer to
provide new digital aids at below cost price and this promises to make an
enormous contribution in the area of aural rehabilitation.
Nurses tend to be the stable population within the hospital system and
have close links with the community at large. I felt it was at least initially better to commence a grass-roots program with nurse practitioners,
hopefully expanding it in due course. This model has been previously
applied successfully in developing countries and completes the link to
reach out to people at the village level and hence make the program a
truly national and inclusive one.
Whilst training and education are essential, nurse practitioners need to
have appropriate examination equipment to undertake this type of care.
When one considers the vast expenditure on prosthetic devices, disposable single use items and general wastage in our own health system, it
was heartening that a relatively small outlay for basic instrumentation
could make such a significant and positive impact. Comprehensive ENT
examination sets were purchased and included: hand held otoscopes with
battery supplies; ear specula; wax curettes; ear suckers; angled hooks;
cotton broaches; micro-crocodile grasping forceps; thudicum nasal specula; large bore suckers; nasal packing forceps; tongue depressors; angled
laryngeal mirrors; cautery sticks; topical ear and nasal medications.
I knew this was feasible given the high level of skill and diagnostic ability exhibited by the principal ENT nurse at Port Vila General Hospital,
Andorine Aki, who had been well coached several years earlier by the
current PIP ENT Specialty Director, Mr. Malcolm Baxter. When I
asked her a while back at our first clinic together how she knew the first
three patients coming in had an attic cholesteatoma, fungal otitis externa
and a dry posterior retraction pocket respectively, she produced an old
atlas, pointed to representative pictures and said, ‘because they look exactly like this’ – and she was spot on!
The trainees were individually shown how to use the equipment. They
were provided with laminated anatomical diagrams for reference and patient education as well as a resident level ENT textbook. The six principal
nurses representing the main island regions were each given sets ; these
contain a log book and diligent recording of patient numbers and diagnoses
should help with planning, as well as creating a database for determining
pressing operative requirements on future trips. It’s also hoped that responsibility for maintenance and safe-keeping of the equipment will be
empowering and strengthen their commitment to continue in this field.
SURGICAL NEWS P14
Team members from last visit – before the running session!
Course participants and P.I.P team.
We still need to carry with us a large number of bags and suitcases filled
with equipment. Disposables and medicines are taken so as not to tax
the local supplies.
Parents are forced to raise money to send their kids to school given no government subsidies exist. This is rather tragic when one considers expatriate businessmen earn vast amounts of money and pay no tax, leaving the
government bereft in terms of social infrastructure spending, apart from
what they raise on V.AT. for goods. Addressing inequities of this system in
a fundamental manner (AusAid and advisory agencies would be of invaluable assistance) seem a logical way to obtain funding to improve health and
education in the long term.
The devastating effects of complicated ear disease was highlighted by the
fact that a 20 year-old patient a fortnight before our visit had slumped into
a coma and died after developed a brain abscess from a recently diagnosed
cholesteatoma. It’s hoped these consequences can be largely avoided by earlier detection and treatment of the disease. A lecture to the local medical staff
was also given and the Consultant General Surgeon shown how to perform
potentially life-saving bony mastoid trephination and myringotomies. .
A vast array of ENT pathology has been encountered, with most being the
consequences of acute and chronic otitis media and rhino-sinusitis; among
the more interesting have included; a large vagal schwannoma extending
to the skull base, plunging cervical ranulas, a petrous apex choesteatoma
with labyrinthine erosion, Bezold’s sternomastoid abscess secondary to
suppurative mastoiditis, massive lobular keloids, mid-facial destruction
probably secondary to yaws and nasal bony widening from huge allergic
polyps extruding from the nares. There seems to be very little head and
neck cancer which is fortunate, given the lack of facilities for overall
management.
There have been many enjoyable diversions over the years which
include marlin fishing, jungle treks, climbing an active volcano, swimming
around secluded island beaches, bustling market days, witnessing traditional
custom-village life and attending the running of the Vanuatu Cup as guests
of the High Commissioner. Refreshing morning team jogs have developed a
tradition, but most have declined the warm down yoga session. Melanesian
feasts including local dishes of yam, lap-lap, taro and manyok, consumed to
the sounds of an accompanying ‘string band’ are a highlight; there’s always
the ongoing quest for the perfect pina-colada served in a coconut shell.
I chose to do aid work in Vanuatu because it was an idyllic location
(with lovely French-inspired cuisine) and hoped the problems would
be on a smaller scale than in many third world countries. It’s always
struck me that whilst most patients are relatively poor, they’re friendly,
generous and particularly happy people. There’s a strong sense of community spirit, respect for their elders and a very rich culture.
Despite this rosier assessment, there are still some fairly major endemic
problems which need addressing. Unemployment is high, domestic
violence is far from unknown and primary education is not compulsory.
Whilst the magnitude of starvation, poor sanitation and ravages of
infectious diseases in parts of Africa and Asia seem beyond our comprehension, the scale of problems in these smaller Pacific Island Countries are manageable. I believe Australia has a responsibility and obligation as neighbours
to provide assistance, both in monetary terms as well as manpower. Foreign
Aid expenditure as a percentage expression of our Gross National Income
(GNI) fell under the Keating administration, and has plummeted to embarrassingly low levels in recent years. Australia’s contribution will be lifted
from 0.28 per cent to 0.36 per cent of GNI by a September 2005 1.5 billion
dollar pledge. This is still well short of the goal of 0.7 per cent of GNI which
has been signed by the Prime Minister as part of Australia’s commitment to
the UN Millennium Development Goals.[1]
It’s my hope this pilot program will be successful and provide sustainable
overall results; the nurses have already expressed a willingness to have
another workshop organized next year to consolidate their knowledge.
Expanding training to other countries in the region is the next phase.
Volunteer humanitarian work has certainly constituted the highlight of
my professional working life. They say “no one ever gets dizzy from doing
too many good turns”; as has also been previously said, “no one person
can change the world, but you can change the world for one person”.
Acknowledgments:
Dr. Mathew Hayhoe: Anaesthetist
Nurses: Terry Tiong, Judy Dehnert and Hayley Martin
Audiologists: John Hill and Dino Hodge
Generous benefactors – ‘Anonymous’ and Peter Sandars of Adapt
Engineering
Widex Australia for providing hearing aids and facilitating mould production
Australian Hearing for donating spare audiometers
Como Pharmacy in South Yarra for supplying medicines.
My wife and family for their continuing support
SURGICAL NEWS P15
PROFESSIONAL STANDARDS
Ian Dickinson, Chair, Professional
Development & Standards Board
Professional Development
Continuing Professional Development Program
Verification
All active Fellows of the College (engaged in medicine, surgery and
medico legal services) are required to participate in the CPD Program.
The program aims to advance the individual surgeon’s surgical knowledge and skills for the benefit of patients and provide surgeons with
tangible evidence of participation in and compliance with the program
by the award of a certificate.
Each year 2.5 per cent of Fellows are randomly selected to verify the information contained in their annual recertification data form/online diary. If
you have been selected for 2005, you will have been notified accordingly.
2005 CPD recertification data forms
Fellows should by now have received a Recertification Data Form for
2005. This data form is to record details of your continuing professional development activities during 2005, and should be returned to
the College by 31 March, 2006. Please contact Sarah Lawrence, Department of Professional Standards, on +61 3 9249 1282 or email sarah.
[email protected] if you require assistance completing your data
form.
CPD Online
Data collection for the 2006 CPD Program is available online via the
College website (www.surgeons.org). Fellows are able to access a personal CPD Online Diary using usernames and passwords to maintain
CPD records in a real time format. Fellows using the CPD Online
Diary for 2006 will no longer be required to complete the hard copy
recertification data form issued at the conclusion of 2006, however Fellows are encouraged to continue keeping evidence of CPD activities for
verification purposes. CPD Online training and telephone assistance
is available through the Department of Professional Standards on +61
3 9249 1282.
at the Annual Scientific Congress (ASC)
Sydney
Coming soon to Queensland...
SURGEONS AS MANAGERS WORKSHOP
WORK-LIFE BALANCE - NEW!
Saturday 13 May 2006
Cost: $360 (Members) 1 CPD POINT PER HOUR
Helps individuals to identify their values and addresses the principles of work/life
balance, including a model to help achieve balance.
WRITING REPORTS FOR COURT
Sunday 14 May 2006 (half-day)
Cost: $540 (Members) 7 CPD POINTS
Offers skills-based training in drafting medical reports for use in legal matters.
Involves small-group practical exercises.
MENTORING IN THE WORKPLACE - NEW!
Sunday 14 May 2006 (half-day)
Cost: $100 (Members) 1 CPD POINT PER HOUR
Enhances skills of surgeons who act as mentors in the workplace, not only with
surgical trainees. Topics include dealing with difficult situations in mentoring
relationships.
SURGICAL TEACHERS COURSE
Friday- Saturday 19- 20 May 2006
Cost: $200 (Members) 60 CPD POINTS
Develops educational skills of surgeons responsible for the teaching and
assessment of trainees. Includes leadership and change.
Contact the Department of Professional Development
Ph: +61 3 9249 1106 Fax: +61 3 9276 7432
Email: [email protected]
SURGICAL NEWS P16
This three day workshop covers a range of practical
business and management skills. The course is conducted
as a weekend retreat; partners and families are welcome.
The workshop can also be taken as a core module of the
Graduate Certificate in Business Administration.
7- 9 July 2006, Sofitel Gold Coast
15 - 17 September 2006, Noosa
COST: $815 (Members)
Price includes two nights accommodation, meals and conference attendance for
one delegate. For partner or family rates, please contact the department.
1 CPD POINT PER HOUR
Contact the Department of Professional Development
Ph: +61 3 9249 1212 Fax: +61 3 9276 7432
Sydney Upper Gastrointestinal Surgical Society and the
Australasian Pancreatic Club
Present a full day symposium on
PANCREATIC CANCER
On Saturday 11 March, 2006 at the Novotel, Olympic Boulevard, Homebush Bay, Sydney
Faculty:
Guest Speaker:
Prof. Douglas B. Evans, Hamill Foundation Distinguished Professor of Surgery
University of Texas M. D. Anderson Cancer Center
A.Prof Minoti Apte
Dr Doug Fenton-Lee
Dr Davendra Segara
Dr Andrew Biankin
A.Prof David Goldstein
Dr Garett Smith
Dr Maxwell Coleman
A.Prof. James Kench
Dr Michael Talbot
Dr Saxon Connor
A.Prof Reginald Lord
Prof. James Toouli
Dr Amanda Dawson
Dr Neil Merrett
Prof. John Windsor
Dr Richard Eek
A.Prof. Ian Norton
Prof. Jeremy Wilson
Topics:
Early Diagnosis - Pancreatic Cancer and Chronic Pancreatitis, Precursor lesions. Familial Pancreatic Cancer: Managing asymptomatic
relatives. Staging for Pancreatic Cancer: the role of new technologies and laparoscopy. Current treatment and patient selection. Advances in systemic treatment and Neoadjuvant chemoradiotherapy. Quality of Life and Palliation for patients with advanced disease.
Proudly sponsored by:
Roche Pharmaceuticals where ‘actions
speak louder than molecules’
A conference Dinner open to all delegates on the night of the conference will be held at The Malaya, 39 Lime Street, King Street Wharf,
Sydney Ph: +61 2 9279 1170 www.themalaya.com.au
REGISTRATION FORM
Name:...................................... Address:......................................................................……………………………………………………….....
Phone:................………........... Name on Badge:...…………...............……................……………………………………………………….......
Members (APC/SUGSS):
$ 170
$ ..................
Fellow:
$ 220
$ ..................
Trainee:
$ 90
$ ..................
Senior Fellow:
$ 50
$ ..................
Scientist:
$ 50
$ ..................
University Student:
$ 30
$ ..................
Conference Dinner:
$ 50
$ ..................
Membership Dues
$ 50
$ ..................
TOTAL CHEQUE:
$ ..................
Registration on day of Meeting $ 220 - Registration at 0800
PLEASE MAKE CHEQUES PAYABLE TO SYDNEY UPPER GASTRO INTESTINAL SURGICAL SOCIETY
Please return registration forms to: Ms Andrea Green, Suite 7, Level 3
North Shore Private Hospital
ST LEONARDS NSW 2065 Ph: 02 9926 6897, Fax: 02 9926 8930
SURGICAL NEWS P17
FELLOWSHIPS & STANDARDS
Ross Blair,
Fellowship Sevices
New Online Library Resources
N
ew online library resources, these include the latest edition of many of the leading surgery reference books, now available in full text, as well
as the complete Clinics of North America journal series, and many new journals.
The Online Library can be accessed from any computer through the College website (www.surgeons.org), after entering your user name and
password in the login box. Any Fellow or Trainee who’d like assistance with using the Online Library should contact the Library on +61 3 9249
1271 or email [email protected]
Keep your Online Library page bookmarked and stay tuned for new titles which will continue to be added throughout the year.
Surgical Clinics of North
America
World Journal of Surgery
Institute
Journal of Trauma
Obesity Surgery
Surgical Endoscopy
Surgical Oncology Clinics of North
America- Trauma Grapevine
Cardiothoracic Surgery
Basic Surgical Training
Prescribed Reading
Modern operative techniques in
liver surgery (pdf chapter)
Robbins and Cotran: Pathologic
basis of disease
Review of medical physiology
(Ganong)
Supplementary Reading
Sabiston textbook of surgery
Oxford textbook of surgery
Harrison’s principles of internal
medicine
Operative surgery manual
(Khatri)
Hoffman’s Hematology: basic
principles and practice
Ford: Clinical toxicology
Murray and Nadel: Textbook of
respiratory medicine
Journals
Annals of Surgery
ANZ Journal of Surgery
Lancet
Mayo Clinic Proceedings
New England Journal of
Medicine
SURGICAL NEWS P18
Books
Braunwald’s heart disease : a textbook of cardiovascular medicine
Pediatric cardiology for practitioners
Sabiston & Spencer Surgery of
the chest
Journals
American Heart Journal
American Journal of Cardiology
Annals of Thoracic Surgery
Cardiology Clinics
CardioVascular and Interventional Radiology
Cardiovascular Research
Chest
European Heart Journal
European Journal of CardioThoracic Surgery
Heart and Lung: The Journal of
Acute and Critical Care
Internet Journal of Thoracic and
Cardiovascular Surgery
Journal of the American College
of Cardiology
Journal of Cardiovascular Surgery
Journal of Thoracic &
Thoracic Surgery Clinics
formerly Clinics in Chest
Surgery
General Surgery
Books
Bland: The breast
Clinical oncology (Abeloff)
Current surgical therapy
(Cameron)
Operative surgery manual
(Khatri)
Sabiston textbook of surgery: the
biological basis of modern
surgical practice
Shackelford’s surgery of the
alimentary tract
Sleisenger & Fordtran’s Gastrointestinal and liver disease
Williams textbook of endocrinology
Journals
Annals of Surgical Oncology
Digestive Surgery
Diseases of the Colon & Rectum
Gastroenterology Clinics of
North America
Gastrointestinal Endoscopy Clinics of North America
Journal of Gastroenterology
Journal of Hepato-Biliary- Pancreatic Surgery
Journal of Hepatology
Journal of the National Cancer
Neurosurgery
Books
Textbook of clinical neurology
(Goetz)
Journals
Acta Neurochirurgica
Child’s Nervous System
Journal of Clinical Neuroscience
Journal of Neuro-Oncology
Journal of Neurosurgery
Journal of Stroke and Cerebrovascular Diseases
Lancet Neurology
Neurosurgery
Neurosurgery Clinics of North
America
Neurosurgical Focus
Pediatric Neurology
Pediatric Neurosurgery
Spine
Surgical Neurology
Orthopaedic Surgery
Books
Campbell’s operative orthopaedics
DeLee & Drez’s orthopaedic sports
medicine; principles and practice
Skeletal trauma: basic science,
management and reconstruction
(Browner)
Skeletal trauma in children (Green)
Journals
Acta Orthopaedica Scandinavica
Archives of Orthopaedic and
Trauma Surgery
Arthroscopy
Clinical Orthopedics & Related
Research
Clinics in Sports Medicine
Foot and Ankle Clinics
Foot & Ankle International
Foot and Ankle Surgery
Gait and Posture
JAAOS: Journal of the American
Academy of Orthopaedic Surgeons
Journal of Arthroplasty
Journal of Bone & Joint Surgery
(UK)
Journal of Bone & Joint Surgery
(USA)
Journal of Knee Surgery
Journal of Orthopaedic Research
Journal of Orthopaedic Science
Journal of Orthopaedic Surgery
Orthopedic Clinics of North
America
Orthopedics
Skeletal Radiology
Spine
Otolaryngology Head
& Neck Surgery
Books
Otolaryngology—head & neck
surgery (Cummings)
Journals
Acta Otolaryngologica
Annals of Otology, Rhinology &
Laryngology
Atlas of the Oral and Maxillofacial
Surgery Clinics
Current Opinion in
Otolaryngology & Head and
Neck Surgery
Ear, Nose and Throat Journal
Journal of Laryngology and
Otology
Laryngoscope
Oral and Maxillofacial Surgery
Clinics of North America
Otolaryngologic Clinics of North
America
Otolaryngology Head & Neck
Surgery
Plastic and
Reconstructive Surgery
Books
Grabb & Smith’s Plastic Surgery
(coming soon)
Journals
Annals of Plastic Surgery
Atlas of the Hand Clinics
Atlas of the Oral and
Maxillofacial Surgery Clinics
Breast
British Journal of Plastic Surgery
Burns
Clinics in Plastic Surgery
European Journal of Plastic
Surgery
Facial Plastic Surgery Clinics of
North America
Hand Clinics
Journal of Hand Surgery
(British Volume)
Journal of Hand Surgery (USA)
JPRAS: an international journal
of surgical reconstruction
(previously British Journal of
Plastic Surgery)
Oral and Maxillofacial Surgery
Clinics of North America
Plastic & Reconstructive Surgery
Journals
Child’s Nervous System
European Journal of Pediatrics
Journal of Pediatric
Ophthalmology and Strabismus
Journal of Pediatric Surgery
Journal of Pediatrics
Pediatric Cardiology
Pediatric Nephrology
Pediatric Neurology
Pediatric Neurosurgery
Pediatric Radiology
Pediatric Surgery International
Books
Vascular surgery (Rutherford)
Current surgical therapy (Cameron)
Journals
Annals of Vascular Surgery
CardioVascular and Interventional
Radiology
Cardiovascular Research
European Journal of Vascular and
Endovascular Surgery
Journal of Cardiovascular Surgery
Journal of Stroke and
Cerebrovascular Diseases
Journal of Thoracic &
Journal of Vascular Research
Journal of Vascular Surgery
JVIR Journal of Vascular and
Interventional Radiology
Vascular and Endovascular Surgery
Additional Surgery
Resources
Paediatric Surgery
Books
Pediatric surgery (O’Neill)
The Harriet Lane handbook:
a manual for pediatric house
officers
Krugman’s infectious diseases of
children
Pediatric cardiology for
practitioners
Principles and practice of pediatric infectious diseases (Long)
Skeletal trauma in children (Green)
Adult and pediatric urology
(Gillenwater)
Vascular Surgery
Books
Current surgical therapy
(Cameron)
Operative surgery manual (Khatri)
Oxford Textbook of Surgery
Sabiston textbook of surgery : the
biological basis of modern surgical
practice
Urology
Books
Adult and pediatric urology
(Gillenwater)
Campbell’s Urology
Brenner and Rector’s The kidney
Journals
American Journal of Nephrology
BJU International and
Supplement
International Urogynecology
Journal
International Urology and
Nephrology
Journal of Urology
Urologic Clinics of North America
Urology
World Journal of Urology
Journals
Ambulatory Surgery
American Journal of Surgery
American Surgeon
Annals of Surgery
ANZ Journal of Surgery
BMC Surgery
Canadian Journal of Surgery
Contemporary Surgery
European Journal of Surgery
Journal of the American College
of Surgeons
Surgery
Surgical Clinics of North America
Surgical Endoscopy
Surgical Laparoscopy & Endoscopy
& Percutaneous Techniques
World Journal of Surgery
SURGICAL NEWS P19
Anne Casey,
Library and Web Manager
IMPROVING HEALTH
Louise Lawler
Louise Lawler discusses her research made possible
through the Rowan Nicks / Russell Drysdale Fellowship.
W
ith the aim of
improving Indigenous community health
I have traced causative
factors of chronic ill
health to family, parenting and school. My goal
is to subvert the decline of
youth into unemployment
and the inherent implications of stunted life-long
learning,
undeveloped
communication and social skills, risk-taking
behaviour, poor lifestyle
choices, substance abuse,
violence and crime. Thus
the ideation behind the title “Cutting out Bad Apples”, relates to preventing the creation of ‘bad apples’ and diverting potential ‘bad apples’
into productive pursuits while simultaneously begging the question of
what happens to ‘bad apples’ that are ‘cut out’ of school and/or society?
What are the life courses that remain available to these young people?
The premise is that the next time we meet them after school has ‘cut
them out’, they are coming through our windows sporting balaclavas or
lying cold and damaged on a morticians slab long before they should,
costs in terms of life, social and emotional well-being and public funding we can ill afford.
An initial cohort of
nine male students
formed a separate Year
11 class with whom I
worked. The curriculum comprised three
mainstream subjects,
English, Maths and
Sport, Leisure and
Recreation and three
special classes with
me, designed to provide students with
communication and
social skills, a broad
understanding
of
society, culture and
communities, personal development, job seeking skills, CV development and practical work experience. This curriculum, a major outcome
of the Fellowship endeavour, has been developed throughout the year
and is now being melded into a transferable and sustainable program
any school could conduct.
Cutting out “Bad Apples”
The Fellowship has enabled me to play an active role in the lives of 21
youth during the course of the 2005 school year. Students were initially nominated by the Principal of Dubbo College Senior Campus and
consisted of those students who returned to Year 11 because they had
not attained employment post Year 10 and who had no motivation to
work towards the Higher School Certificate (HSC). These students are
notoriously disruptive to classes who are intent on improving scholarly
efforts of HSC candidates. During the year previous school leavers who
had not gained or sustained employment and current Year 10 students
who were at risk of leaving school prior to gaining the School Certificate
swelled the numbers.
SURGICAL NEWS P20
The success of a venture such as this depends on making connections
with the students over the full range of their life experiences. This involves getting to know the ‘person’ the student is, meeting their family,
knowing their peer group, sporting preferences and social activities.
The literature attests that resilience and productivity in adolescents are
artefacts of positive interaction with as few as one significant adult in
this developmental period. Sadly, many of these children lack a significant adult in their family life! This is not generally due to an absence
of parents or adult supervisors, indeed Indigenous households often
swarm with them, it is due mostly to a dearth of quality interaction and
support offered by the adults surrounding these young people. Unfortunately, school and teachers are the only other pool from which these
significant adults can be drawn and in today’s hectic society teachers are
struggling to keep up. It is becoming the exception that one may have
the personal or professional resources to become a ‘significant other’ for
the numbers of students who require additional attention.
Some of the boys playing basketball
What is missing? To quote a particularly philanthropic businessman
who employs students in the Fellowship program, “it takes a village to
raise a child, and we are remiss in our duties”! While families and schools
struggle to manage our youth, too many others - individuals, the media,
businesses and government agencies maintain a running commentary
on the “problems associated with youth”. Where in this, does one find
the village and support that is required to rear the children?
For many Indigenous families dysfunction is the norm and yet these
are the very families that find the village even harder to elicit support
from, due to the generalisations arising from negative media coverage
that simultaneously gives scant regard to reporting positive but less
news-worthy stories. This works against all Indigenous families.
A case study that exemplifies this is that of a young man living with
an older sibling and his birth parents. Both parents are employed in
blue-collar positions and enjoy a reasonable level of financial flexibility
and own their home. This boy has a mobile phone, mp3 player, stereo
equipment, TV, DVD and computer with Internet access in his bedroom. Materially he lacks for nothing. Conversely this lad suffers from
severe lack of intimate ‘care’ and the resultant social isolation.
The family reaction to a diagnosis of ADHD at age 11 years has been
to treat the lad as though he has some incurable and debilitating mental
illness. No one in the family harbours expectations of him, considering
him incapable of controlling his behaviour, performing academically,
completing tasks and ultimately of obtaining gainful employment. The
family attitude to this young man is that he is mentally retarded, where
in actuality he is highly intelligent and possibly is much more academically endowed than other family members. This family sociology has
stymied his personal and professional development and by his 15th
birthday had leached away all traces of self-belief, self-esteem and motivation to attempt anything available to him including continuing at
school, undertaking training or gaining employment.
Taking its lead from the family attitude and lack of understanding and
support, the school community has adopted a similar attitude to this
young man. From Year 7 through to Year 11 teachers speak negatively
about him and some have even excluded him for particular classes e.g.
technical classes that use power tools on OH & S grounds. However,
this is largely the result of previous teachers’ verbal reports and informal discussion about the occasional wilder antic. In truth this young
person is tried, judged and found lacking well before he meets prospective teachers, the result is that he has learned that he cannot win and so
does not try, he cannot be successful so he does not compete, he is only
acknowledged when he is misbehaving and so he craves and seeks consideration using the lessons he has learned. Ultimately he has become a
‘designer delinquent’, slowly but surely constructed over his formative
school years. At the age of 15 years he recognises this yet is unable to
control or change it, he should be angry but he is not – yet.
“The success of a venture such as this depends on
making connections with the students over the full
range of their life experiences.”
Enter - one significant adult. Someone who did not heed the horror
stories circulating and the certainty of the destruction this young man
has yet to orchestrate if he is not expelled from school. Someone who
ignored the loudness and the obscenities issuing from him and overlooked the absence of school uniform, bag and the chronic tardiness in
attending class. Simultaneously, however, there were brief encounters
of quiet one-on-one conversation, acknowledgement of the ‘person’
as opposed to the student, someone who laughed at occasional antics
– that, let’s face it, were funny! Someone who enquired if he had had
breakfast and arranged something from the breakfast club when he had
not. Someone enquired as to how he felt today, Someone who discovered his passion and aptitude for a sport and attended a game or two.
Someone who always followed through on what they said they would
do or arrange and someone who explored with him the sort of things he
might be interested in or wanted to know.
SURGICAL NEWS P21
IMPROVING HEALTH
Louise Lawler
“In the words of another of the program’s graduates they now
have a better chance of “growing up to be wealthy (sic), healthy
and wise, instead of filthy, stinkin’ and a wise-arse crook!”
Cutting out “Bad Apples”
This was a gradual process and at times seemed a doomed exercise. Yet
over a period of just under eight months a transformation occurred.
Trust was established, a tentative relationship developed, ideas of selfworth took root and started to grow and the wild and disruptive behaviour toned down to a lesser frequency and intensity. So subtly did
this transformation occur that it was almost missed by teachers and the
student himself. The result: the student has gained the courage to leave
school and move into the world beyond and while not yet employed has
had a series of casual jobs and has the implanted idea of working in the
future in something that takes his interest. He has a much improved
self-esteem and now respects himself for who he is and who he can become and demands the same from others through discerningly bestowing respect on those he comes into contact with who earn it, a relatively
simple accomplishment described as “they smile at me”.
This program, made possible by the wonderful concept of Rowan
Nicks’ support has overseen similar transformations in no less than 21
young people this year. Twenty-one no longer ‘bad apples’ but young
people at the beginning of a life in which they will be better positioned
to create a life more fulfilling, productive and enjoyable than would
be experienced without involvement in the program. In the words of
another of the program’s graduates they now have a better chance of
“growing up to be wealthy (sic), healthy and wise, instead of filthy,
stinkin’ and a wise-arse crook!”
The work now is to extend this program and to challenge more businesses and government agencies to aid the process by making positions
available for part-time work for more troubled youth and to assist them
to learn and practice the skills to become ‘work ready’. Dubbo College
has made a commitment to continue the program and to build upon it
to ensure it is sustainable and transferable. A community committee
has been established to ‘awaken the village’ to their responsibilities and
to provide support for this role through a mentor program to assist staff
of business and school to construct a nurturing environment for disengaged youth. Perhaps we have coined a new proverb “It takes a village
to grow good apples.”
ORTHOPAEDICS CURRICULUM WORKSHOP
Orthopaedics Curriculum Group
On Saturday 25 November 2005, the Chair of the Board of Orthopaedics held a 1 day curriculum workshop at RACS headquarters to
develop a strategy for production of modules for the Orthopaedics
specialist training program. The group comprised Elton Edwards,
John Batten, Ian Farey, Robyn Westcott, Des Soares, Gordon Morrison, John North, Wendy Crebbin, Mellick Chahade and Max Esser (not in photo). The workshop also provided an opportunity to
introduce newly appointed Orthopaedics Education Officer, Robyn
Westcott, who will liaise closely with Wendy Crebbin, who for the
last 2 years has been working with all specialty groups to ensure that
training programs meet the requirements for AMC accreditation.
SURGICAL NEWS P22
Update your library
with 20% off on all
Blackwell Publishing books
Simply visit the RACS website at www.surgeons.org,
login as a Member and follow the links.
Browse the Blackwell Publishing website
(www.blackwellpublishing.com) for all your book
choices, and enter the discount code listed on the RACS
website for Members, when finalising your purchase.
2006
INAUGURAL
&
Younger Fellows
Trainees
GALA DINNER
Date:
Venue:
Cost:
Dress:
Don’t forget, all RACS Fellows
also have full and complete
online access to the College’s
official journal, ANZ Journal of
Surgery. It’s FREE for Fellows
and available through the RACS
Member website. Log on today
for more information.
Monday, 15 May 2006
The Museum of Contemporary Art on Circular
Quay - a spectacular waterfront location with
cityscape and harbour views.
$100 per person
Ladies - Cocktail
Gentlemen - Lounge Suit
The Younger Fellows Committee invites all Younger Fellows, College Trainees and their partners
to attend the inaugural Younger Fellows and Trainees Gala Dinner on Monday, 15 May 2006
(the first evening of the College Congress). Guests will be delighted with an evening of fine
dining, music and fabulous entertainment but we can’t give all our secrets away… just yet.
As this is the Congress opening night, pre-Congress bookings are essential. For more
information or to register please contact the Younger Fellows Secretariat:
Phone +61 3 9249 1212
Facsimile +61 3 9276 7432
Email [email protected]
Proud Sponsors:
SURGICAL NEWS P23
ASERNIPS
Professor Guy Maddern, Surgical
Director, ASERNIPS
ASERNIP-S is evolving and is being seen at the forefront of the
assessment and evaluation of new technologies in surgery
throughout Australia and New Zealand.
I would like to introduce Kerin
Williams as the new Manager of
ASERNIP-S. Kerin has a longestablished background in a variety
of health positions, with qualifications in Psychology, Business
Management and Nursing; she
has managed State and National
projects for the Department of
Health and Ageing over the past 10
years and has widespread experience
working with General Practitioners. Kerin is keen to further develop
the work of ASERNIP-S across
ASERNIP-S is rapidly expanding, and increasingly being seen at
the forefront of the assessment and
evaluation of new technologies in
surgery across Australia and New
Zealand and collaborative work with
similar organizations overseas is developing the ASERNIP-S profile internationally. With the exponential
rise in the use of new technologies
in surgery, the work of ASERNIPS helps ensure that new procedures
are introduced in an appropriate
and safe manner. As a result of our
direct involvement with the Australian surgical community through
the College, ASERNIP-S is made
aware of emerging trends in surgical practice and uncertainty around
new techniques or technologies.
Over the past seven years, ASERNIP-S has come to be regarded as
an important independent authority for the assessment of evidence in
surgery and has been responsible for
a significant cultural change in the
approach of surgeons to evidencebased practice.
SURGICAL NEWS P24
What do we do?
• Evidence-based surgical evaluations
• Early warning of new technologies and techniques
• Timely reporting to hospitals
credentialing committees
• Consumer involvement and information
• Quality improvement focus
1. Systematic reviews
Since its establishment, ASERNIP-S has produced more than
40 systematic reviews of surgical
techniques and technologies. All reports undergo internal and external
peer review and from these reports
publications are prepared for international and local peer reviewed
journals. All hospitals in Australia
are provided with summaries of our
completed reviews. In 2001 we produced a booklet providing guidance
on how procedures should be introduced into the health system.
We have also developed other re-
the nine specialist surgical areas
and would welcome enquiries from
individual surgeons, hospital or
practice-based groups with regard
to the assessment and review of new
technologies in surgery.
The Australian Safety and Efficacy
Register of New Interventional
Procedures – Surgical (ASERNIP-S) is a health technology
assessment agency established in
1998 by the Minister for Health
and Ageing to evaluate new surgical
view products to meet the particular needs of our stakeholders:
Accelerated systematic reviews
Accelerated systematic reviews are
produced more rapidly than systematic reviews. They are prepared
in response to a pressing need for a
systematic summary and appraisal
of the available literature on a new or
emerging surgical procedure. Accelerated systematic reviews involve the
same methodology as full systematic
reviews, but the types of studies considered may be restricted (for example, by only including comparative
studies and not case series).
Technology overviews
The technology overview follows a
systematic process but is not as expansive as a full systematic review.
The overview does not attempt to
compare a new intervention with a
standard intervention or provide a
recommendation for use. The aim
is to provide information to assist
decision-makers to make their own
evidence-based recommendations
(one example is robotic surgery
techniques and technologies. In
addition to providing assessments
for the Medical Services Advisory Committee (MSAC) for the
purpose of listing on the Medicare
Benefits Schedule, ASERNIP-S
assesses other procedures that have
a high impact in surgery in terms
of morbidity, mortality and health
system challenges. ASERNIP-S
advises hospitals and health services
on significant safety and quality issues affecting the Australian
healthcare system.
with the da Vinci system).
ASERNIP-S can also provide
economic assessments and diagnostic evaluations.
2. Horizon scanning
Since 2000 our horizon scanning
program New and Emerging Procedures – Surgical (NET-S) has
led the way in assessing techniques
and technologies that are ‘on the
horizon’ of impacting on the Australian healthcare system. This
dovetails into our systematic review
work as procedures move closer to
gaining wider acceptance and sufficient evidence is available. In the
past 18 months we have continued
this work for HealthPACT, a committee guiding the process at a national level.
Prioritising summaries
These summaries provide information on a new or emerging
technique or technology. They
can be used as a basis of deciding
whether the procedure should be
further assessed, monitored in a
further 12 months or archived.
Horizon scanning reports
These reports use more grey literature sources than a systematic
review and are generally shorter in
length. The areas covered in this
type of report are: background,
treatment alternatives, clinical
outcomes, potential cost impact,
ethical considerations, training and
accreditation, limitations of the assessment, sources of further information, impact summary, conclusions and references.
3. Consumer summaries
For each ASERNIP-S systematic
review we produce a summary for
consumers in easy-to-read language.
We have strong links with a number
of consumer organisations and have
two consumer representatives on
our Management Committee. We
have had discussions with the College of General Practitioners on
possible collaboration as well as the
Heart Foundation.
4. National clinical audits
ASERNIP-S manages a number of
research audits which have resulted
from recommendations in system-
atic reviews to collect additional evidence on a new procedure. ASERNIP-S manages a secure web-based
clinical audit of surgical practice in
early breast cancer management
(the National Breast Cancer Audit)
which is currently funded by the
Australian Council for Safety and
Quality in Healthcare. This has
been the first national clinical audit
of its kind, enabling users (surgeons,
governments and health services) to
assess individual or local aggregate
practices and compare this with the
national aggregate and some key
performance indicators. The Royal
Australian College of Surgeons
Research and Audit Division also
manages the Australian and New
Zealand mortality audit rollout out
of the ASERNIP-S office. Further
national morbidity audits will soon
be added to our system.
5. Methodological and
review consultation
ASERNIP-S is a contractor for the
NHMRC Health Advisory Committee and has been active in two
working parties to improve the
production of evidence-based clinical practice guidelines in Australia.
We have also worked closely with
the National Institute of Clinical
Studies on a number of reviews fo-
cused on closing the gap between
evidence and practice. Additionally,
we provided a number of overviews
for the National Institute of Clinical
Excellence (NICE) in the United
Kingdom to support the establishment of their Interventional Procedures Program for assessment
of new interventional techniques
and technologies. We have been
substantially involved with two
systematic reviews for the Canadian Coordinating Office for Health
Technology Assessment.
Future directions for ASERNIP-S
I believe that with long-term financial support ASERNIP-S can
continue to expand and provide
high quality outputs. We intend
to focus our efforts on:
• consolidating existing links between our systematic review,
horizon scanning and audit activities to optimize our resources
• refining our rapid publication
products to better meet the
needs of our stakeholders, help
reduce uncertainty and improve
decision-making
• providing a library of evidence
for surgery that can be accessed
by specialty
• looking for obsolescence in current surgical practice
• building on links with interna-
tional health technology agencies
to collaborate on assessment and
research (We play a leading role
in the International Network of
Agencies for Health Technology Assessment (INAHTA), of
which our Surgical Director is
a current Director. In 2006 we
will co-host the HTA International conference and INAHTA
meeting in Adelaide.)
• further expanding our efforts
to provide quality information
directly to consumers
• continuing our methodological
research on new techniques and
technologies and the use of evidence by practitioners in clinical decision-making.
Over the last seven years ASERNIPS has expanded its remit from an
initial focus on systematic reviews to
providing services and outputs that
meet the evolving needs of the Australian healthcare system. Our reviews are valuable decision-making
tools which provide evidence in a
format that can be used by hospitals
and health departments. Continued
links with the Australian surgical
community will ensure that ASERNIP-S maintains its relevance to
those most likely to influence the
quality and safety of healthcare
for Australian consumers - the
practitioners.
AstraZeneca
Upper GI
Research Grant
Recipient- 2006
The College would like to congratulate Dr Ahmad Aly, who is the 2006 recipient of the
AstraZeneca Upper GI Research Grant. Dr Aly is a Consultant surgeon at the Austin Hospital and a
Lecturer for the University of Melbourne.
This grant will be used by Dr Aly to undertake a randomised trial of
“Barretts ablation: YAG laser versus Argon Plasma Coagulation”.
The College wishes to thank AstraZeneca for its continued support of medical research in the field
of Upper GI/HPB Surgery.
SURGICAL NEWS P25
SCIENTIFIC CONGRESS
75th Annual Scientific Congress, Sydney, Sunday 14 – Friday 19 May
By now, all Fellows and registered trainees should have received the Provisional Programme for
the exciting Annual Scientific Congress to be held in Sydney.
T
his important week of College activities has been designed by
Convener, Michael Hollands and Scientific Convener, Phil Truskett, with members of the Sydney executive and the scientific committee to have the broadest possible appeal to Fellows and trainees.
Updates to the Provisional Programme since it was printed are detailed
in the adjacent box.
If you wish to better orientate yourself to Sydney and the immediate
surrounds for the Congress, an excellent map is available on www.
metromonorail.com.au/ mapsydney.asp. In particular, please note
that several Congress hotels were incorrectly plotted on the Provisional Programme map. The confusion arises because there are several hotels with very similar names in the Darling Harbour precinct.
Be careful if you are making your own bookings on the internet. The
corrected map is now in the Provisional Programme on the College
website.
The week has its official commencement with the Ecumenical Service on Sunday, 14 May at 2:00pm. The service will be held in the
beautiful and inspiring St Mary’s Cathedral located adjacent to the
northeast corner of Hyde Park in the heart of Sydney and a short
walk from the Archibald Fountain, built to commemorate the fallen
in World War 1. The Gothic-style cathedral was started in 1868
and completed in 1999. By special arrangement, delegates will be
able to visit the crypt following the service. Bus transport has been
arranged to return delegates to the Convention Centre immediately
after the service but there will be a later bus for those wishing to
visit the crypt. Both the buses will have delegates back in good time
for the Convocation.
The Convocation will be held at the Congress venue, the Sydney
Convention and Exhibition Centre (SCEC) sited on Cockle Bay,
Darling Harbour. It will begin at 6:30pm and delegates attending
are asked to be seated by 6:15pm. The College is honoured that the
President of East Timor has accepted our invitation to deliver the
Syme Oration. In addition to new Fellows receiving their diplomas,
surgeons who have contributed to the College and its programmes
over many years will be honoured by specific awards such as Honorary Fellowships, Excellence in Surgery, the Barnett, Hughes and
SURGICAL NEWS P26
Prince Henry’s medals and awards for Service to the College and
International medals.
The scientific programme starts on Monday and the theme is aptly
pertinent in “Safe Surgery”, a topic of paramount importance to
all practicing surgeons. Whilst the theme is reflected in all the programmes, it finds particular relevance in the Plenary session that
commences each day’s programme.
Each day a different aspect of Safe Surgery is addressed – Safety and
Education, the Workforce, the College, and the Patient. On Friday,
“Safety and the Community” is the topic. How often do surgeons
ask what the community expects of us? Moreover, do we listen?
We have invited two non-surgeons, but certainly not lay people, to
address this issue – ABC media commentator Julie McCrossin and
Craig Knowles, a past NSW Health Minister. Mr Knowles will give
us his views in a talk titled “Doctors and governments: reflection
without portfolio”, but also reflections without the constraints of office! The session will be completed, firstly with Michael Fearnside,
convener of the Medico-legal programme and a member of the NSW
Medical Board, discussing the assessment of surgical performance
from the perspective of a Board. Then the past vice-president of our
College, Mr Peter Woodruff who has been assisting the Bundaberg
Royal Commission, will outline the lessons for us from the inquiry
now that time has added perspective.
In a new initiative Richard Hanney, chair of the Younger Fellows
Committee has arranged a dinner on Monday night for Younger Fellows (and their partners) who may not have a section dinner to attend
and also for Trainees who are attending the Congress. Information
regarding this event is included in the flyer that was included in copies of the Provisional Programme which were posted to Younger
Fellows and trainees and full details regarding the venue, cost and
booking are included in the notice on page 23. Tyco Healthcare and
Johnson & Johnson Medical are thanked for their important support
which has made this event possible. Please book for this event with
Tanya Wilding whose contact details are included in the notice. We
expect a Younger Fellows and Trainees dinner will become a regular
feature of the Congress.
In Sydney we embark by ferry at
Darling Harbour (do not miss either of
the two boats or you will have to swim)
and with champagne accompaniment,
we cross to Luna Park at the
foot of the Harbour Bridge.
The Congress Banquet has become an increasingly impressive
feature of the Congress and this has been reflected in the rising
attendance over the last three years. The Sydney executive have
pulled out all the stops to make this year’s event one to remember and
certainly the standard will be right up there with the catering at the
Perth Banquet last year and “The Three Waiters” performance at
the 2004 Congress. The sight of 800 delegates in Melbourne waving
blue serviettes in time to Rossini provided limitless opportunities
for registrar blackmail and “Who wants to be a colo-rectal surgeon”
in Perth is already folklore and may explain the increase in trainees
in that specialty. In Sydney we embark by ferry at Darling Harbour
(do not miss either of the two boats or you will have to swim) and with
champagne accompaniment, we cross to Luna Park at the foot of the
Harbour Bridge.
A superb menu has been compiled by the Sydney gastronomic subcommittee and an ensemble from Opera Australia will present “Opera
on the High Cs” with suitably naughtical themes.
There will be no continuing respite however and Thursday’s scientific
programme will still start at 8:30am.
If you have misplaced your programme and require another, please
email [email protected] or alternatively the Provisional
Programme with all the updates is available on the College website
where you may also register for the Congress.
Campbell Miles and Lindy Moffat
Alterations to the Provisional Programme
Cardiothoracic Surgery programme: the visit of Dr David Spielvogel
MD from New York is made possible by an unrestricted educational
grant from Johnson and Johnson Medical.
Hepatobiliary and Upper GI Surgery programme: due to commitments
in France, Professor Bernard Norlinger will not arrive until early Monday morning. Hence, Session 2 on Monday has been moved to Session
2 on Tuesday including his keynote lecture at 12noon. The original
session on Tuesday Session 2, “Pancreatic tumours” will swap to the
Monday slot.
Military Surgery programme: the title of the RACS Visitor Lecture to
be delivered by Colonel Peter Byrne on Thursday 18 May at 12noon
will be “Military medical command – an Australian perspective”.
Monday 15 May – Plenary session. This will be co-chaired by Arthur
Richardson (Sydney) and Stephen Deane (Newcastle). Professor Anthony Gallagher, who will talk on the role of simulation, training and
CPD, is Professor of Human Factors at the Royal College of Surgeons
of Ireland. Mr Patrick Cregan (Sydney) will address the issue of simulation and surgical education.
Monday 15 May – Dinner for Younger Fellows and registered trainees.
See all the details on page 23.
Monday 15 May - “Interplast” cocktail party: held at 6:30pm at the
Sydney Convention Centre. All Plastic and Reconstructive surgeons
who have been involved with Interplast are invited to attend.
There have been changes to a number of invited presenters in several
programmes and these appear in the Provisional Programme on the
College website.
SURGICAL NEWS P27
SYDNEY OBESITY SURGERY CENTRE –
VICTORIAN OBESITY SURGERY CENTRE
2006 – WORKSHOPS IN LAPAROSCOPIC
ADJUSTABLE GASTRIC BANDING
Course Director
Dr. Paul Dumbrell
M.B.,B.S., F.R.C.S. (Ed.), F.R.A.C.S.
COURSE OBJECTIVES
• Demonstrate the surgical technique of laparoscopic adjustable gastric banding (LAGB).
• Advise and discuss patient selection for the procedure.
• Discuss the post operative management of LAGB patients.
• Discuss identification and management of common complications specific to LAGB surgery.
How to prevent them, and how to manage them.
• Advise how to set up a multi-disciplinary obesity surgery practice.
• Post course mentoring
The workshops are designed for surgeons with advanced laparoscopic skills or experienced
advanced surgical trainees
SYDNEY
MELBOURNE
Thursday, 1st & Friday 2nd June 2006
Friday, 3rd & Saturday 4th March 2006
Thursday, 16th & Friday 17th November
2006
Friday, 15th & Saturday 16th September
2006
VENUE
VENUE
The Hills Private Hospital, Baulkham Hills,
Sydney
The Hills Lodge Hotel, Castle Hill, Sydney
Warringal Private Hospital, Heidelberg,
Melbourne
Rydges on Bell, Preston, Melbourne
An optional all inclusive course/accommodation package is offered.
CONTACT INFORMATION
Programme Co-ordinator – Janice Vicary
SYDNEY
MELBOURNE
Level 39 Citigroup Building
2 Park Street Sydney NSW 2000
Telephone: 02 9004 7827
Facsimile: 02 9004 7727
5 Burgundy Street
Heidelberg Victoria 3084
Telephone: 03 9450 6800
Facsimile: 03 9457 3295
Workshops sponsored by:
Helioscopie, Matrix Surgical Company, Tyco Healthcare,
The Hills Private Hospital, Warringal Private Hospital.
SURGICAL NEWS P28
HERITAGE REPORT
Geoff Down, College Curator
“The College is in a unique position to recount the
story of surgery in the Asia-Pacific region.”
Towards a museum of surgery
A
significant step forward
was made in late 2005,
when the College Curator
moved into an office in the
lower ground floor of the south
wing. This part of the building had been designated as a
museum during the course of
the year, but the refurbishment
program delayed the move, as
the space was occupied by a
succession of other sections as
their respective work areas were
upgraded.
Most of the museum space is
still being used as a general storage area. In the coming months
however it will be cleared out and
refurbished, and the exhibition
cases presently scattered throughout the building will be moved in.
Releasing the Collections
from their captivity in storage will also be assisted by
rolling out material to the
regional offices. This program is scheduled to begin
in 2006, and is part of the
overall plan to expand the
exhibition activities of the
College. The ultimate objective is a co-ordinated
series of exhibits across
Australia and New Zealand, with the Museum in
Melbourne as the centrepiece.
The College is in a unique
position to recount the
story of surgery in the
Asia-Pacific region. There are many museums and collections in the region covering various aspects of medicine, from individual
hospital collections to the Royal Flying Doctor Service. None however
deals specifically with surgery, so there is a niche to fill. The Heritage and Archives Policy Group (HAPG) has decided that the Museum
should concentrate on the history of surgery in this part of the world,
rather than try to present the entire world history of surgery from the
days of the Egyptians. This means that the main focus will be on surgery since Europeans came into contact with the Australasian region
(ie from the 17th century on). However, the ancient traditions of the
indigenous peoples should also be recognized and explained, while at
the same time being respectful of cultural sensitivities.
be used for the museum
This space will eventually
This area has had a chequered history. For many years it was used
simply as a basement for storage. In the 1960s, after drainage problems
were solved, it housed the Geoffrey Kaye Museum of Anæsthesia. In
the 1970s it became the Faculty Education Centre, and the Geoffrey
Kaye Museum was relocated to the attic. In more recent years it was
home for the Finance Department and Information Services.
The refurbishment program will include upgrading the small area presently fitted out as a kitchen, to convert it to a conservation work area.
The room formerly occupied by Information Services will become the
Collections workroom. The larger of the two offices on the south side
will be removed in order to increase the display space, and the smaller
office will be retained for the Curator.
The Museum will provide an opportunity to exhibit a great deal more
material than is now on display. Most of the Collections objects are in
storage, and this is especially true of the surgical instruments. Bringing
the exhibitions together in one place will allow for more logical and expansive presentation, in fact converting what is now a series of scattered
and unrelated displays into a truly co-ordinated exhibition of surgical
history and technology.
Establishing a museum infrastructure for the Collections also enhances the opportunities for grants and funding, as well as giving
the Collections better support by way of cataloguing and ability
to loan. A new catalogue database has been installed for the Collections, and already a request has been received for an exhibition
of instruments in conjunction with the Brisbane conference of the
Urological Society of Australasia in March. There is a large amount
of interest in the College’s heritage material, and the Museum will
enable that interest to be engaged and satisfied, for the benefit of
Fellows and the public alike.
Top Right: Basic Conservation Lab
SURGICAL NEWS P29
Surgeons – Orthopaedic and General
SURGICAL NEWS P30
Participants in the meeting
Welcome to the Trainees’ Association!
The TA (or more accurately, the interim committee charged with setting it up) has been recently established within the College to represent
trainees’ interests within the institution. This is a response to both the
internal and external perception that the current structure is unable
to fully understand trainees’ perspectives on our involvement in the
surgical profession, and to make us a true part of the fellowship. We are
in a unique position to set up this group with the blessing and financial
assistance of the College, which will hopefully fast track our ability to
represent ourselves effectively within it.
As with any organisation, there is a lot of work to be done in the near
future in establishing this group. Its structure is still a work in progress –
those working on this structure can be reached on RACSTA@surgeons.
org if you want to get involved.
In addition to the bi-national committee that will be the main lead-in to
the College, we are also setting up regional groups to make sure that all
of you have a local ear to listen to you, and mouth to pass on your input.
If you have a specific issue that you want to take forward, these will be
the initial groups to contact. Although a little patience will be needed
in seeing results from these, the more of us that get involved early, the
faster we will see results.
At this stage we need two things – ideas and energy. We want to hear
from you if you have either… especially if you have both. Drop me a
line on [email protected]. I’m looking forward to hearing
from you, and to working with you!
Cheers, Deborah Amott
of Cancer Services
St. Vincent’s Health has a long and distinguished record of providing cancer care services to the
people of Victoria. It is affiliated with The University of Melbourne and employs 5,000 staff,
dedicated to the provision of high-quality integrated adult health care.
The delivery of a comprehensive cancer care service is a key strategic imperative of St. Vincent’s
Health and the Professor/Director will provide pivotal leadership of a cancer executive comprising
key oncological service heads, including medical imaging and pathology. The development of
effective partnerships with consumers, carers, community based providers, professional groups,
government and the private sector is vital to the successful delivery of an innovative model of
cancer care within the framework of the Mission and Values of the Sisters of Charity.
• Newly created
position
The Professor/Director will be a leader in his/her field of cancer with postgraduate qualifications
and an impressive record in oncology research, possessing extensive experience and a
demonstrated commitment to a multi-disciplinary team approach to cancer services delivery.
Please send a CV (Word format)
[email protected] or ring
Jeremy Wurm on 03 9602 1666,
in confidence. www.rustonpoole.com
185BRO RACS
.................................
... Professor/Director
BROOKER
.............................................
C o n s u l t i n g
SURGICAL NEWS P31
DEFINING & ASSESSING
W. Crebbin, PhD, M. Ed. Admin.
(Manager Education Development
and Research Department)
Defining and assessing ‘satisfactory’ performance
One of the difficulties in designing assessment for medical trainees has been defining what
is meant by ‘satisfactory’.
W
hilst a list of ‘unsatisfactory’ and ‘outstanding’ characteristics can
be easily identified, it is the middle-ground that holds the challenge. This is especially true since the concept of competence, based on
CanMEDS 2000, has gained prominence. As part of that change, questions about what is meant by ‘satisfactory’ and by ‘standards’ have been
brought into sharper focus. Additional questions arise about whether
competence must necessarily be equated with minimum expectations
or if a standard can be set to define ‘satisfactory’ performance at a level
significantly above the minimum.
In seeking answers to these questions, a complex mix of assumptions
and ideas intersecting and informing different ideas about knowledge, learning, assessment and competence were identified. Not only
do ideas about each of those domains differ, there is also, within and
across the domains, a great deal of potential confusion and contradiction. From that complexity, five areas have been selected to be addressed in this paper:
a.
Definitions of satisfactory and standards
b.
Approaches to competence
c.
Approaches to assessment
d.
Approaches to knowledge
e.
Approaches to knowledge and skills – transferability
Definitions of Satisfactory and Standards
In seeking clarification of the meanings of ‘satisfactory’ and ‘standards’ it became apparent that each of these words can be interpreted
quite differently. ‘Satisfactory’ is defined as meaning both “adequate”,
and “satisfying expectations…leaving no room for complaint”. The
first of these meanings suggests a quite minimal level of performance,
whilst the second indicates significantly higher criterion.
A ‘standard’ is defined as meaning a “measure serving as a basis”, as
“the degree of excellence…required for a particular purpose”, and
also as “the average quality”. These three meanings provide such a
range of possible interpretations that it is clear that simply drawing
together the intersection between the meanings of ‘satisfactory’ and
‘standards’ cannot be used to establish criterion for assessment. That
process is dependent upon other variables.
SURGICAL NEWS P32
Approaches to Competence
Throughout the introduction of competence many advocates have assumed that the meaning of the term was unproblematic. Little recognition was given to different approaches to competence, or the difference
between competence and performance.
In education there are two opposing paradigms of competence. The ‘Behaviourist’ approach draws from the efficiency movement of the 1920s
as well as the behaviourist psychology approach which flourished in the
1960s. A central tenet of that approach is faith that the defining specific,
discrete, observable behaviours or skills will lead to improvements in
training and the workplace. In the current interpretation of competence
this approach has lead to the development of very precise statements of
performance requirements, often in the form of checklists.
The ‘Holistic’ or ‘Integrated’ approach is founded on the work of
Dewey (early 20th century) and also on cognitive psychology. From this
perspective competence is understood to be complex combinations
of personal attributes (knowledge, capabilities, attitudes, and skills)
formed into coherent structures which facilitate the performance of a
variety of tasks. The demonstration of competence is understood to
be dependent upon the individual’s attributes (including insight and
judgement) plus the demands of the environment in which the attributes are being demonstrated and/or assessed.
Adding to the complexity of definition in this area, in medical education, the distinction between competence and performance-based
assessment has recently been argued. Within this framework, competence-based assessment refers to what doctors do in testing situations (Miller’s third level of ‘shows-how’) while performance-based
assessment is claimed to measure what doctors do in practice (‘does’)
(Fig. 1). Supporters of this approach also argue that it is important to
recognise and assess for differences between what medical professionals do in controlled high-stakes situations and what they do in their
day-to-day practice.
This medical education view of competence is closer to the Holistic/
Integrated approach than the Behaviourist because it attempts to address the complexity of medical professional expectations, and it takes
into account the uncontrolled nature of the working environment.
Does
Shows how
Performance
Competence
Knows how
Knows
Fig. 1. Miller’s Triangle.
Approaches to Assessment
The assessment approach is another area which impacts on the definition of ‘satisfactory’ and the establishment of standards. By analysing
underlying assumptions that inform each approach this area becomes
less confusing because, whilst there are multiple approaches to assessment, they can all be classified according to whether they are based on
the traditional scientific-measurement paradigm, or the more recently
developed judgement paradigm.
Assessment in the scientific-mathematical paradigm is easy to recognise by the emphasis on numerical scores, maximising objectivity, and
reproducibility. This approach also emphasises well founded certain
knowledge and closed problems with definite answers.
The judgement paradigm owes its growth, at least in part, to the need
to assess clinical competence in the final stages of medical training. This
approach also draws from the law and other professions where there is
no clear guidance leading to ‘right answers’. Rather, assessment focuses
on open-ended (holistic) problems, the integration of theory and practice, the provisional nature of decisions, and the need to consider personal and contextual variables. Such a complex mix of knowledge and
judgement cannot be directly observed and needs to be inferred from
observation or other sources of information.
Approaches to Knowledge
A body of research in education has identified that different kinds of
knowledge are amenable to different kinds of criteria and can be appropriately assessed in different ways. What is termed ‘hard knowledge’
(exemplified by anatomy) is considered to have a substantive body of
knowledge that is shared by that knowledge community. In such disciplines, answers to assessment tasks tend to be right or wrong and the
criteria can be specific, requiring little inference.
By contrast, ‘soft knowledge’ (such as history) requires the capacity
to recognise and analyse complex situations. This capacity is based on
familiarity with conventions, values, and diverse influences as much
as knowledge of a specific body of knowledge. In an applied environ-
ment, there is a focus on protocols and procedures demonstrating the
capacity to interpret and integrate knowledge in relation to the context.
Assessment of this kind of knowledge requires criteria that encourage
interpretation and therefore involve high levels of inference.
Approaches to Knowledge and Skills – Transfer ability
The significant growth in the assessment of technical skills is evidenced in the development of increasing sophisticated simulation or
virtual-reality equipment; in defining precise checklists; and in motion
analysis systems that electromagnetically track movement. All of these
approaches have the assessment advantage that they can be standardised and are claimed to be objective.
However, research has demonstrated that technical skills, whilst performed effectively and efficiently in an assessment environment, can
lack transferability into the real-life situation. This is particularly significant in surgery, where even the so-called ‘basic’ technical skills, in
practice, require the integration of expert knowledge, complex decision making, and dexterity. Surgeons are working on a real patient,
with tight time constraints, and are required to make a series of important decisions as they go along. Because competent performance is
dependent upon specific patient and context constraints, assessment
is more difficult to standardise.
Connecting the Four Approaches
In each of the four approaches, at least two quite different perspectives have been identified. However there are significant areas of
concordance across the four approaches. The unifying ideas of one
grouping — Behaviourist views of competence; the traditional scientific-mathematical approach to assessment; ‘hard’ knowledge; and
the assessment of technical skills — are specificity, observability and
objectivity. The second grouping — Holistic/Integrated views of
competence; the judgement approach to assessment; ‘soft’ knowledge; and real-world practice —are unified through a recognition of
complexity, contingency and inference.
Using such groupings it becomes clear that the meaning of ‘satisfactory’
and the setting of ‘standards’ is dependent upon which grouping is favoured. The Behaviourist-scientific approach establishes their standard
and their definition of ‘satisfactory’ mathematically, sometimes with the
aid of tests that have been developed to establish validity and reliability.
The Holistic-judgement approach sets their standard and meaning of
‘satisfactory’ against multiple assessments and workplace requirements.
In medical disciplines both groupings have legitimacy because whilst
much of the basic knowledge is considered ‘hard’, in the applied
context it becomes more like ‘soft’ knowledge because it requires judgements which frequently include ill-defined parameters.
To facilitate decision making about assessment the groupings have
been mapped with definitions of ‘satisfactory’ and ‘standards’ on axis
one and the two identified groupings of paradigms and approaches on
the other (Fig. Two). Within the ‘satisfactory zone’ it is possible to
identify where any specific assessment task is situated in relation to the
varying definitions. For example, an MCQ on anatomy or a basic skills
test could be located on the left side of the ‘satisfactory zone’ with the
standard being possibly towards the lower end of the frame. By contrast
a viva in an exit examination would most likely be located on the right
hand side in the upper quadrant of the zone.
...continued page 34
SURGICAL NEWS P33
OBITUARY
Anne Kolbe
Peter Michael Christie Obituary
O
ne of New Zealand’s pre-eminent liver and hepato-biliary surgeons
Peter Michael Christie, died in Auckland recently – aged 48.
Born in Auckland, Peter attended Auckland Boys Grammar School and
was a graduate of the University of Auckland School of Medicine. He
obtained his FRACS in General Surgery in 1986 and then embarked on
a career as an academic transplant and hepato-biliary surgeon.
help in raising the $2.3 million required for the Transplant Unit. He
described Peter Christie as “an inspirational, talented and great man
who was also a great husband and father”.
Stephen Lynch, FRACS, Director Queensland Liver Transplant Service
said Peter had worked “tirelessly and selflessly” for transplant services in
Australasia. Deborah Verran, FRACS, Chair, Section of Transplant Surgery, the College also paid tribute to Peter’s commitment and dedication.
After completing his training Peter spent two years as a lecturer in surgery, in the Department of Surgery at Auckland Hospital. His research
centred on the assessment and management of patients with complex
fluid, electrolyte and nutritional problems and culminated in the award
of an M.D. Professor Graham Hill described Peter as: “the most teachable, reliable and faithful” student he had ever had.
Peter Christie also made a very significant contribution to hepatobiliary,
pancreatic and upper GI surgery. He was a member of the first dedicated
HBP and Upper GI Unit in New Zealand. He worked simultaneously on
the demanding transplant and general surgical rosters at Auckland Hospital
for 12 years. He had a private general and laparoscopic surgical practice.
Then followed a two-year Fellowship (1990 – 1992) in transplantation surgery under Professor Thomas Starzl at the University of Pittsburgh, USA.
He returned to Auckland in 1992 to take up the position of Senior Lecturer
in Surgery and Transplantation at the University of Auckland.
Colleagues, patients and friends described Peter as “a talented, kind
and caring surgeon who was always available for his patients. He treated people with respect and compassion and was held in high regard by
patients and his colleagues.”
Colleagues, friends and patients describe Peter’s contribution to transplant surgery in New Zealand over the last 12 years as “enormous”. He
was a skilled and committed member of the Auckland renal transplant
team, earning the respect of colleagues and the heartfelt thanks of patients. He spent many long hours caring for patients in end stage liver
disease and single-handedly procured organs for the Australian-based
transplant programme that provided care for New Zealand patients. He
was also a strong advocate for a New Zealand-based service and became
a foundation member of the New Zealand Liver Transplant Unit.
Kevin Wall of the Lions Clubs NZ paid tribute to Peter’s support and
A close colleague said: “Peter had a profound influence for the good
on many generations of students, young doctors and registrars”, they
learned not just about the science and art of surgery – but also about
humility, gentleness and a respect for others from him.
In April this year Peter was diagnosed with cholangiocarcinoma – he had
given so much to medicine and now medicine was unable to help him,
except in a palliative sense. Yet friends say Peter approached his illness
with inspirational determination, bravery and concern for others.
Peter Michael Christie died on 15 July 2005. He is survived by his beloved wife Nicky and three sons John, Adam and Charles.
expert
simple skills/
specific criteria
complex skills/
interpretation
Satisfying expectations
a degree of excellence
...from page 33
Left: Fig. Two. The ‘satisfactory zone’.
Holistic/Integrated
Behaviourist
measurement
judgement
observed
inferred
‘hard’ knowledge
‘soft’ knowledge
transferable
context limited
adequate
inadequate
SURGICAL NEWS P34
The ‘satisfactory zone’ can assist in the selection of the most appropriate assessment task(s) for the required outcome. At the same time criteria can be defined to more closely match the desired points within the
zone according to the most appropriate grouping, the required level of
complexity, and the required standard.
a basis
Key: the ‘satisfactory’ zone
Assessing what doctors do in practice is said to be the international
challenge of this century. Ways to assess competency as it is defined in
its broadest terms to include attitudes, knowledge and skills, as well as
the doctor’s responses to the challenges of clinical uncertainty, are being developed. The identification of the ‘satisfactory zone’ suggested
in this model is a small step in that process.
Care of the Critically ill Surgical
Patient Course
CALL FOR INSTRUCTORS
THE COLLEGE NEEDS YOU!
Do you have an active interest in acute surgical care?
Do you have an interest in teaching trainees?
Instructor Training Process
You can combine these interests by becoming a CCrISP
faculty member.
2. Attend a CCrISP instructor course. However, if you
have previously completed a recognised Instructors
Course such as EMST or Surgeons as Educators you
are not required to complete a CCrISP instructor
course.
“
Becoming an instructor in the CCrISP program
is a valuable contribution to the training of junior
doctors and provides a medical and educational
learning experience for the instructor.
Ian Civil Chair BBST Board
”
1. Attend CCrISP course workshop as an instructor
candidate.
3. Instruct on CCrISP course as an instructor candidate.
4. Once successfully critiqued, instruct on a course as a
fully qualified CCrISP instructor.
What is CCrISP?
• Two and half day course designed to advance the
practical, theoretical and personal skills necessary for
the care of the critically ill surgical patient
Benefits of involvement are:
Who is it for?
• Mandatory for Basic Surgical Trainees within the first
2 years of training
• Medical Officers working and training across the range
of surgical and related disciplines
• Airfares, accommodation and meals incurred during
formal training process covered by the College.
• Networking with peers and other specialty colleagues.
• College Professional Development points- 1 point per
hour plus 4 points preparation.
• Accommodation and travel when instructing interstate
covered by the College.
For further information and an application form please contact:
Antoinette Moar
Skills Training Department
Royal Australasian College of Surgeons
College of Surgeons’ Gardens, Spring Street, Melbourne VIC 3000
Tel: 03 9276 7421 Fax: 03 9249 1298
Or visit the college website http://www.surgeons.org/AM/Template.cfm?Section=Care_of_the_Critically_Ill_
Surgical_ Patient_CCrISP_&Template=/CM/HTMLDisplay.cfm&ContentID=8133
SURGICAL NEWS P35
AUSTRALIA DAY
Australia Day Honours – Congratulations
AC Companion of the Order of Australia
– for eminent achievement and merit of the highest degree in service to
Australia or to humanity at large.
Professor Villis Raymond Marshall - service to medicine, particularly
urology and research into kidney disease, to the development of improved
health care services in the Defence forces, and to the community through distinguished contributions to the development of pre-hospital first aid care
provided by St John Ambulance Australia.
AO Officer in the Order of Australia
– For distinguished service of a high degree to Australia or humanity.
Dr John Brian North RFD - service to medicine as a clinician, surgeon
and teacher, and as a significant contributor to research in the fields of
neurological diseases and treatment of severe head injuries.
AM Member in the Order of Australia
– for service in a particular locatliy or field of activity or to a particular group
Dr John Gratten Baker - service to medicine as a neurosurgeon,
particularly through the provision of neurosurgical services in Central
Queensland.
Mr Geoffrey Ian Bird - service to medicine in the field of reconstructive and plastic surgery, and to international relations through the provision of medical services and training for surgical staff in developing
countries.
Dr Frances Marjorie Booth - service to ophthalmology and to international relations, particularly through the development of an eye health
care project to assist people in remote areas of Papua New Guinea.
Professor Bernard John Einoder - service to medicine, particularly in
the field of orthopaedic surgery including teaching and administrative
roles and through a range of professional associations.
Clinical Professor Kingsley Walton Faulkner - service to medicine as
a surgeon and in surgical skills training, and to the medical profession
through the Royal Australasian College of Surgeons.
Mr John E Frawley - service to medicine in the fields of vascular and
transplantation surgery and as a pioneer in paediatric kidney transplants.
Dr Francis George Smyth - service to medicine through the
development and provision of general oncology and reconstructive
surgical services in Papua New Guinea; and to the community of Port
Moresby.
SURGICAL NEWS P36
Dr David Whitman Vickers - service to medicine in the area of paediatric
microsurgery through the development of surgical procedures to
treat congenital deformities, to the design of specialised operating
instruments, and to professional organisations.
Associate Professor Daryl Robert Wall - service in the field of transplant
surgery, to specialist training and support for transplant recipients to
resume normal lifestyles.
OAM Medal of the Order of Australia
– For service worthy of particular recognition.
Dr Ralph Allan Higgins - service to medicine in the field of ophthalmology, particularly as a contributor to the development of the Sydney
Eye Hospital and through a range of medical organisations.
Dr Leslie Clyde Rae - service to medicine, particularly through the
National Bowelscan Committee, and to aged persons.
Dr Peter Zelas - service to medicine and to the community of western
Sydney, particularly through roles at the Blacktown Hospital and in the
field of colorectal surgery.
Dr Peter Hardy-Smith - service to medicine in the field of ophthalmology and through support for professional organisations.
Dr Rodney A Kirkwood - service to medicine as an ophthalmologist
and to the community of Mackay.
PROJECT CHINA
Gordon Low
So you are going to China for a couple of weeks?
Let me give you a few words of advice.
You will need a visa, usually a single entry. Multiple entry visas are only
issued if you have special reasons. You will need some Chinese dollars ¥,
which is called Ren Min Bei (RMB). Australian and New Zealand dollars
can be exchanged them for ¥ . Of course there is always the ATM and
credit cards! Most hotels and larger restaurants and emporia will happily accept credit cards like VISA, AMEX. Diner’s Club Cards are not welcome.
So you don’t want to get sick! Neither do the locals. Always eat cooked
foods. Fruits are okay provided they look clean and fresh. I think eating
game or raw fish is a little risky because you may pick up a parasites! Drink
bottled water.
pretty good!!! An excellent example is the medication for the prevention
of altitude sickness. They are as good as, if not better than Diamox. This
is a must if you are going to Tibet or scenic spots at the foothills of the
Himalayas.
Just in case you are thinking of insurance, the College has an accident and
sickness policy for everyone travelling overseas on official College business.
It pays to let someone in the College know the purpose of your visit!
If you are going to work in a hospital, make sure you have contact with the
chief of the unit to which you were attached or assigned. Do not rely only
on word of mouth recommendation.
What about a vaccination? I would suggest a Hepatitis A antibody test before you go. If you are a/b negative or below par, have a Hep A vaccination.
Malaria is something you should watch out if you stray from the larger
coastal cities.
Finally for those who go to China under the auspices of Project China beware of drug hoses or instrument makers who rush to provide you with
airfare, the best hotel and who take you sight-seeing if you will only display
the logo of their company! Such offers can very easily upset the programme
planned by your host institution. Ask your host before making promises.
There is some Chinese medicine which the locals swear and these are
Good Hunting.
LOANS FOR
TRAVELLING FELLOWS
The Royal Australasian College of Surgeons provides a number
of interest-free loans to Fellows who plan to undertake approved
studies outside Australia and New Zealand.
To be eligible to apply for a loan, an applicant must:
•
•
•
•
Be a financial member of the College.
Demonstrate financial need.
Be assessed as undertaking appropriate research and/or training.
Not have an application pending, nor have received, a RACS
Scholarship or Fellowship co-incidental with this loan.
• Not receive more than one loan every five years.
Essential Business
Knowledge for
Specialist Practice
THREE DAY BUSINESS COURSE COVERING:
• Practice Management & Systems • Legal Issues
• Industrial Relations • A Secure Financial Future
• Marketing • IT • Accounting
Melbourne: August 18, 19, 20 2006
Applications can be submitted at any time with assessment being
undertaken upon receipt.
Loans will not exceed A$20,000 each and will be subject to the
availability of funding. These loans are interest free for a period of
up to two years.
For further information on applying for a loan,
please contact:
Andrea Warr
Tel: +61 3 9249 1220
THE THIRD PART
03 9830 7299
www.thethirdpart.com.au
Proudly sponsored by ANZ Private Bank and
ANZ Personal Mortgage Managers
SURGICAL NEWS P37
MEMBER BENEFITS
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We’ll just give you the facts instead.
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No Annual Card Fee – Save $70 every year
Free and Automatic enrolment in the leading Membership Rewards Ascent program – Save $80 every year
Earn 1 Rewards point for every dollar spent on the Card
Transfer points to any one of five leading frequent flyer programs, including Qantas*
Low 9.99% p.a. introductory interest rate on purchases for the first six months, with a competitive 16.74% p.a. thereafter
Low 9.99% p.a. Balance Transfer Rate for the first six months**
Up to 55 days interest free on purchases^
•
Only Credit Card endorsed by the College
Visit www.member-advantage.com/racs or call 1300 853 324 for more details or to apply.
American Express credit approval criteria applies. Subject to terms and conditions. Fees and charges apply. All interest rates are quoted as an Annual Percentage Rate. Fees, charges and interest rates
are correct at 10 January 2006 and are subject to change.
*Subject to the terms and conditions of the American Express Membership Rewards program and Ascent partner frequent flyer programs. Frequent flyer program fee may apply. **If you transfer your
balance from another credit card to your RACS Gold Credit Card you will pay 9.99% p.a. on the approved transfer amount for up to six months (your monthly payments will first repay the balance you
have transferred before reducing other amounts, such as new purchases). Minimum payment requirements of the card account apply to balance transfers. There are no interest free days on balance
transfers. After 6 months, the rate will change to the interest rate for purchases at that time. ^The Credit Card gives you up to 55 days interest free on purchases, depending on when your statement is
issued, whether you have obtained a balance transfer and whether or not you are carrying forward a balance on your account from the previous statement period. There are no interest free days for
cash advances or balance transfers.
With savings like these, you’ll feel right at home.
The College offers an exclusive home loan package for members looking to buy, refinance or invest in property.
Developed specifically for you, the RACS Home Loan package provides exceptional savings with significant
interest rate discounts and fee waivers including:
• Up to 0.75% p.a. off AMP Banking’s standard variable, fixed and line of credit interest rates*
• No Annual Package fee – Save $330 every year
• No establishment fee – Save $350**
•
No monthly account fees – Save $120 every year
To find out more, visit www.member-advantage.com/racs or call an AMP Affinity Home Loan Specialist on 1300 360
525 and mention RACS Member Advantage.
Package benefits, including fee waivers and interest rate discounts, which are taken from AMP Banking’s standard interest rates are current as at 22 August 2005. They are subject to change at any
time by AMP Banking and only available for new customers, no switching from existing affinity package available. Only available for loans over $100,000. Other fees and charges apply. Approval is
subject to AMP Banking guidelines. The credit provider is AMP Bank Limited ABN 15 081 596 009, AFSL No. 234517, trading as AMP Banking
*Discount applies to AMP Banking borrowings of $1 million and above. A 0.65% p.a. discount applies for loans between $100,000 and $499,999 and a 0.70% p.a. discount applies for loans
between $500,000 - $999,999. 0.15% p.a. discount applies to fixed rate loans where total AMP Banking borrowings exceed $250,000. **Settlement fee of $350 applies.
RACS Member Advantage Services
Ph:1300 853 324
Web: www.member-advantage.com/racs
SURGICAL NEWS P38
DONATIONS TO THE COLLEGE FOUNDATION THANK YOU
NEW SOUTH WALES
Mr G M Fogarty
A/Prof P R Macneil
A/Prof A J Holland
Mr W P Lennon
Mr G C Burfitt-Williams
Mr J M Grant
Mr H J McEwen
Mr J R Gillies
Mr J D Ritchie
Dr T W O’Connor
Mr N Samaraweera
Mr J E Lorang
Mr M J McNamara
Mr J W Brennan
Mr S Sakker
Mr P J O’Keeffe
Ms M A Beevors
Mr N Jayachandran
Mr J D McKee
Ms G Kourt
Mr S P Sen Gupta
Mr R D Smith
Mr D Youkhanis
Dr R H Pillemer
VICTORIA
Mr A J Day
Mr J H Rush
Mr B J Dooley
Mr W G Doig
A/Prof A G Royse
Mr M D Richardson
Mr R J Bartlett
Mr W M Wearne
Mr T T Pitt
Mr M C Thorne
Mr T H Pham
Mr P F Burke
Prof H K Graham
Miss J Kesari
Mr D C Burke
A/Prof J G Meara
Mr S F Wickramasinghe
Mr M C Douglas
A/Prof G C Fabinyi
Dr V Kertsman
Mr J W Upjohn
Mr N Kosanovic
QUEENSLAND
Mr N D Fox
Mr J F Leditschke
Mr P Y Scarlett
A/Prof G A Gole
Mr F A Bartholomeusz
Mr K W Zabell
NEW ZEALAND
Mr T F Clements
Mr M Mahadevan
HONG KONG
Mr P Y Lau
SINGAPORE
Mr S L Cheah
United Kingdom
Mr A J Millar
SOUTH AUSTRALIA
Mr B G Cohen
Mr C M Lee
Mr N A McIntosh
Mr N L Minnis
Mr T M Stevenson
Mr J Miller
A/Prof P G Devitt
WESTERN AUSTRALIA
Mr C K Hendry
Mr B G Lykke
Mr A H Beeley
Mr D M Collopy
Mr H L Coates
Mr J AHodge
Mr S Sakker
Total
$11,511.50
Yes, I also want to help fund the RACS Foundation Research, Scholarships and Fellowships
NAME:
SPECIALTY
ADDRESS:
TELEPHONE:
FACSIMILE
My cheque or Bank Draft (payable to Royal Australasian College of Surgeons) for $
is enclosed, or please debit my credit card account for $
AMEX
Diners Club
Aust Bankcard
NZ Bankcard
Mastercard
Visa
Credit Card No:
Card Holder’s Name – Block letters
Expiry
Card Holder’s Signature
/
Date
I would like my donation to go to the following specific cause/project:
I do not give permission for acknowledgement of my gift in any College Publication
Please send your donation to: Royal Australasian College of Surgeons,
AUSTRALIA AND OTHER COUNTRIES
NEW ZEALAND
Spring Street, Melbourne VIC 3000 Australia.
Tel: +61 3 9249 1200 Fax: +61 3 9249 1219
PO Box 7451,Wellington South New Zealand
Tel: +64 4 385 8247 Fax: +64 4 385 8873
SURGICAL NEWS P39
SURGICAL NEWS P40
ROYAL HOBART HOSPITAL
Surgery in the News
A new $180,000 microscope has dramatically improved the
working lives of plastic surgeons at the Royal Hobart Hospital.
T
he new machine, delivered to the hospital last October under the
Tasmanian Government’s Better Hospital’s funding programme,
replaced the unit’s old foot-pedal controlled microscope that was both
prone to malfunction and difficult to manoeuvre.
Head of Plastic and Reconstructive Surgery at the Royal Hobart Hospital, Associate Professor Frank Kimble, said the new microscope had
been eagerly awaited.
“Most major tertiary teaching hospitals around Australia have this
newer technology so we were delighted when it arrived.
“The older microscope was driven by foot pedals that were at times difficult
to manage accurately which increased stress and complications particularly
when performing the often long procedures associated with delicate microsurgery.
“It also tended to break down a lot which caused delays and great
frustration.”
Associate Professor Kimble said the new German-designed machine
was controlled by buttons that managed zoom and focus and had friction-free movement in three dimensions and a magnification of 40.
He said it allowed the team to repair nerves and blood vessels less than
a millimeter in diameter and was proving particularly valuable for hand
surgery, facial reconstruction and in transferring large blocks of tissue.
Already it has been used to reconstruct the face of a patient who developed a cavity in his chin after the tissue died following radiotherapy for
inoperable tongue cancer.
Associate Professor Kimble and his team used skin from the patient’s leg,
part of his fibula and healthy tissue to rebuild the patient’s face in a grueling
but successful 10-hour operation.
If not for the operation, the patient would have required the removal of
his jawbone, resulting in severe deformity.
The microscope is now being used to assist in the treatment of 20 patients
each month, assisting surgeons to re-attach nerves and vessels unable to be
repaired with the naked eye.
Associate Professor Kimble said that as the major tertiary teaching hospital
in Tasmania, the Plastic Surgery and Burns Units treated the most complex
reconstruction cases, caused by disease or trauma, and that having the best
available equipment would have flow-on effects to patient care.
He said that the microscope could also be linked to screens making it an
invaluable aid in teaching the next generation of plastic surgeons.
“Many of the micro-surgical procedures take a very long time and over
such a long period, members of the surgical team can get tired which is
when mistakes can happen,” Associate Professor Kimble said.
“Therefore any equipment that makes our work easier – while helping to
teach young surgeons - must necessarily have a flow-on effect in regard to
patient care and surgical outcomes.”
Associate Professor Frank Kimble trained as a Plastic and Reconstructive
Surgeon in the United Kingdom and South Africa. He immigrated to
Hobart in 1998 and took up his position at the Royal Hobart Hospital.
He also holds the post of Clinical Associate Professor of Surgery at the
University of Tasmania.
His main areas of interest are hand surgery, facial surgery, hand infections and genital reconstruction.
SURGICAL NEWS P41
Shopping
for a
new car?
Australasian
Vehicle
Buying
Services LMCT 9828
Telephone:
Fax:
Website:
Email:
1300 76 49 49
1300 76 49 47
www.avbs.com.au
[email protected]
Adelaide Brisbane Hobart
Melbourne Perth Sydney
we make it easy!
•
•
•
•
•
Professional Development Workshops
NEW in 2006...
Coming Up...
Saturday 8 April Melbourne - Mentoring in the Workplace
NEW
GRADUATE CERTIFICATE IN BUSINESS
ADMINISTRATION
Coming Soon...
(ASC) Saturday 13 May - Work Life Balance NEW
(ASC) Sunday 14 May - Writing Reports for Court
(ASC) Sunday 14 May - Mentoring in the Workplace NEW
(ASC) Friday 19 May - 20 May - Surgical Teachers Course
27 May Brisbane - Practice Management for Practice Managers
5 June Brisbane - Mentoring in the Workplace NEW
24 June Sydney - Risk Management Masterclass (General Surgery)
24 June Adelaide - Winding Down from Surgical Practice
7 July - 9 July Gold Coast - Surgeons as Managers
To register or for more information:
Phone +61 3 9249 1106
Facsimile +61 3 9276 7432
Email [email protected].
Test drive
Trade-in
Finance
Purchase
Delivery
Developed with the Queensland University of Technology,
Brisbane Graduate School of Business, the eight-module
program is offered via intensive three day sessions, online distance and/or on campus in Brisbane. Enquiries are
welcome.
Contact:
The Department of Professional Development
Ph: +61 3 9276 7473 Fax: +61 3 9276 7432
Please note attendance at the Surgeons as Managers workshop
counts as a core module of the qualification.
We want you!
If you are a Fellow and have an interesting and fascinating story or idea please feel
free to contact the College, the address details can be found on page 5.
SURGICAL NEWS P42
r
e
p
Ma
c
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Don't be one of the crowd. Our financial solutions are independent and tailored for
your cash flow and practice needs. Give us a call and be surprised by our flexibility.
Finance for:
• Equipment, Fitout & Motor Vehicles
• 100% Commercial Property Finance
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ongoing fees
• Goodwill & Practice Purchase Loans
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Experien Medical Finance – experience in
independent finance for health professionals.
Contact 1300 131 141
www.experien.com.au
SURGICAL NEWS P43
With our moisturising surgical gloves, you’ll
resist the harshest conditions. Be Ansell sure.
Gammex® PF HydraSoft® moisturises your dried skin
whilst providing premium barrier protection
Gammex® PF HydraSoft® delivers new standards
of protection by caring for your skin whilst you operate.
Surgical scrubs are drying and abrasive so we have
added a moisturiser to the polymer lining of our leading
surgical glove, Gammex® PF. Your skin is your primary
barrier and now your secondary barrier, the surgical
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Ansell and Gammex® PF HydraSoft® are trademarks owned by Ansell Limited, or one of its affiliates.
© 2005 All Rights Reserved.

Surgical News - Royal Australasian College of Surgeons

Transcription

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