Gender associations with selection into Australian General Surgical Training: 2016-2022.

BACKGROUND: For those who have maintained an interest in general surgery after medical school and their early post-graduate years, selection is the first step to a career in general surgery. Identifying differences secondary to gender in selection tools and their outcomes should assist the Royal Australasian College of Surgeons and the Australian Board in General Surgery to improve gender equity in the general surgical workforce. Selection tools for general surgery include the curriculum vitae (CV), referee report (RR) and multiple mini-interview (MMI). METHODS: All applicants' CV, RR and MMI scores achieved in the general surgery selection process were reviewed by gender over a seven-year period. RESULTS: In all years, there were lower numbers of female applicants to selection. There were differences identified between genders in the CV and MMI, with females scoring lower in the CV and higher in the MMI when compared to males. There were no differences identified in the RR or proportion of applicants that were successful in their application based on gender. CONCLUSION: The CV and MMI utilized for selection into general surgery were associated with gender bias. However, the lower number of females selected into training reflects the lower number of female applicants overall. There was no overall impact from gender found in an applicant's ability to be selected into general surgery in Australia.

Informed consent: perceptions and practice of orthopaedic trainees.

BACKGROUND: The purpose of informed consent is to provide patients with adequate information about a proposed plan or intervention, including the benefits and risks, so that they can make an informed decision about their medical treatment. The literature suggests that trainees are often delegated the task of obtaining consent with inadequate knowledge, skill or experience. The aim of this study is to determine the extent orthopaedic surgical trainees have been exposed to education about the informed consent, their perceived ability to obtain consent effectively and the frequency with which they routinely address elements of the process when consenting patients. METHODS: An eight-item questionnaire assessing trainees' experience with informed consent was distributed to trainees undertaking Australian orthopaedic surgery training in 2019. RESULTS: Of the 239 trainees, 102 completed the questionnaire. Although 99% of trainees were confident that they can obtain valid consent from patients, when asked about aspects of the process, many trainees do not address them. Only 29% of trainees always ask patients about goals of care and 21% always advise the patient of who will be performing the procedure. Trainees who indicated that they had received education on informed consent during surgical training are significantly more likely to address key elements. CONCLUSION: Trainees' perceptions of their knowledge and skill in relation to informed consent does not align with their reported practice. Although the majority of trainees had received some education on informed consent, greater emphasis on explicit teaching and formal assessment should be undertaken during surgical training, prior to trainees completing this activity independently.

Gender associations with selection into Australian Orthopaedic Surgical Training: 2007-2019.

BACKGROUND: Communities have better health outcomes when their clinicians reflect the diversity of the communities they serve. More than 50% of Australian medical school graduates are female, yet women represent less than 5% of Australian orthopaedic surgeons. Selection into orthopaedic surgical training in Australia is an annual, nation-wide process, based on curriculum vitae (CV), referee reports and performance in multiple mini-interviews (MMI). The influence of applicant gender on these selection scores was examined. METHODS: The CV, referee reports and MMI scores used for selection for each year from 2007 to 2019 were analysed from the perspective of the applicant's gender. RESULTS: Over the years of the study, male applicants had higher CV scores and referee report scores, which determined the gender proportions invited to interview. By contrast, the interview process and selection from interview did not demonstrate a gender association. CONCLUSION: We describe the impact of selection tools, utilized over the past 13 years, on the gender diversity of trainees commencing orthopaedic surgery training in Australia. Leaders in postgraduate training should examine commonly used selection procedures to identify and reduce the unconscious biases that may affect their performance and value.

Australian orthopaedic surgery training: Australian Orthopaedic Association's strategic education review.

BACKGROUND: The Australian Orthopaedic Association (AOA) is the peak professional body for orthopaedic surgeons in Australia and is responsible for their training and continuing medical education. The 2012 AOA strategic education review employed a gap analysis to identify issues and generate a roadmap for the enhancement of AOA's education and training activities. This paper describes the process and outcomes of this review, which led to the 'AOA 21' Education Re-design Project, and the review's relevance to surgical education in Australia. METHODS: The AOA strategic education review was undertaken by international clinician education and orthopaedic experts, and involved AOA staff, fellows and trainee members throughout Australia. This review progressed through four phases: a review of current training; a global 'best-practice' perspective; a set of aspirational goals; and a roadmap for implementation. RESULTS: Seven key strengths (e.g. camaraderie in training and surgical skills teaching) and 15 challenges (e.g. 'non-technical' skills teaching, subjective methods of decision making and inadequate assessment practices) were identified in the review stage. Sixteen major recommendations for improvements incorporating current or emerging world's best education practices were targeted in an 8-year implementation framework. CONCLUSION: The AOA's strategic education review serves as a roadmap for other specialty training organizations to review their programmes and implement contemporary best practices in surgical training. The AOA 21 project has positioned orthopaedic surgery as a leader in competency-based surgical education and training in Australia.