Professionalism and the role of medical colleges.

BACKGROUND: There has been substantial interest and emphasis on medical professionalism over the past twenty years. This speaks to the history of the medical profession, but increasingly to a broader understanding of the importance of socialisation and professional identity formation. METHOD: A literature review was undertaken of professionalism and the role of professions and medical professional organisations. RESULTS: A key outcome has been the recognition that medical professionalism must be actively taught and assessed. Substantial effort is required to improve the educational environment, so that it nurtures the development of professionalism within the work-place. Although medical colleges have been prominent in identifying and progressing the recent developments within professionalism there is still much to be done to deliver fully on the societal contract between the public and the profession. There are key gaps to address, particularly with regards to self-regulation, civil behaviour and effective leadership and advocacy. CONCLUSION: Medical colleges need to take direct responsibility for the professionalism of their members. The expectations of the community are increasingly clear in this regard.

Priorities for professionalism: what do surgeons think?

OBJECTIVE: To gain an understanding of the relative importance of the nine surgical competencies and their 27 attributes defined by the Royal Australasian College of Surgeons (RACS), which together provide the curriculum framework for today's surgeons. DESIGN, SETTING AND PARTICIPANTS: Between 9 August and 30 September 2010, trainees and Fellows of the RACS across Australia and New Zealand actively involved in educational activities rated, via questionnaire, the importance of the RACS competencies (technical expertise, communication, professionalism, medical expertise, judgement and decision making, scholarship and teaching, collaboration and teamwork, management and leadership, and health advocacy) and associated attributes. MAIN OUTCOME MEASURES: Importance ranking of competencies and their attributes for surgical education and training. RESULTS: Of 3054 questionnaires distributed, 1834 (60%) were returned. We identified clear priorities in the perceived relative importance of the nine competencies and 27 attributes. The most important attributes were competence, insight, and recognising conditions amenable to surgery; least important were responding to community and cultural needs, supporting others, and maintaining personal health and wellbeing. Key differences were noted for the competency of collaboration and teamwork, which was ranked as more important by trainees than by Fellows. Female trainees and Fellows regarded all attributes as more important than did male trainees and Fellows. CONCLUSION: In a complex environment with multiple pressures, the priorities of the competencies are important. Trainees and Fellows had a very similar approach to the prioritisation of the attributes. Of concern is the lesser importance given to attributes beyond individual expertise.

Educational and health impact of the Baume Report: 'A Cutting Edge: Australia's Surgical Workforce'.

OBJECTIVES: The Baume Report (1994) on Australia's surgical workforce had the potential to impact upon the health and educational sectors. This paper analyses the recommendations of this report and their impact at the time and 15 years later (2009). METHODS: A questionnaire-based study was performed with the 18 senior Fellows and the Royal Australasian College of Surgeons (RACS) solicitor who had been instrumental in facilitating responses to the review. RESULTS: The 19 respondents were asked to evaluate 22 areas from the Baume Report. The most highly ranked areas identified as being reasonable in 1994 were: additional funding being made available for more training positions, identifying workforce deficits, moving towards compulsory continuing professional development and having evidence of competence before introducing new technology. In 2009, the most highly ranked areas were: funding for more training positions; compulsory continuing professional development, involving the profession in improvements and broadening the training environment beyond public hospitals. Areas considered to be substantially addressed were: the selection process and encouragement of diversity, workforce numbers and deficits, confirming the educational merit of the training program and the role of professional colleges. CONCLUSIONS: The Baume Report highlighted many issues including workforce planning, the role of professional organisations in society and the complex interface between health and education. Issues of ongoing standards through a surgical career, access for patients to surgical services, funding for more training posts to provide the appropriate workforce level and distribution, and the assessment and introduction of technology remain priorities. Time has not diminished the relevance of these issues. WHAT IS KNOWN ABOUT THIS TOPIC?: The impact of key government reviews can always be substantial. The Baume Report was directed to postgraduate specialist medical training, particularly surgical training. There have been substantial changes in the health and educational sectors since the report, with significantly more regulation and transparency. WHAT DOES THIS PAPER ADD?: Analysis of the Baume Report after 15 years by the senior office bearers of the RACS who were actively involved in handling and implementing many of the recommendations provides an insight into the dynamics of specialist training. It outlines the significant changes that have occurred and the things that still need to be done. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: Professional bodies have an influential presence across society. They are particularly focused on the standards required to become a practitioner of that profession and the ongoing maintenance of these standards. However, this comes with responsibility for and accountability to society and the community. External reviews, particularly with a political imperative, change both the dynamics and key relationships, issues that the professional bodies must commit to addressing in a positive manner.

Sustaining the surgical educator workforce in Australia and New Zealand.

BACKGROUND: The education and training of tomorrow's surgeons are predicated upon the involvement of a broad spectrum of surgical educators. Identification of the factors that influence their ongoing participation is crucial for its continuity. METHODS: A study was performed on 695 surgeons identified as having major involvement in surgical education and training using a questionnaire based on a number of educational themes. RESULTS: Four hundred and thirty-eight surgeons (63%) completed the questionnaire. The majority found teaching rewarding and would recommend it to colleagues, although fewer would advocate being a supervisor or course instructor. The highest motivating factors were sharing knowledge, enjoyment of teaching, necessity to remain up to date and the interaction that teaching provides with colleagues. Barriers included insufficient time because of other work commitments, lack of support from hospital management and intrusion on work­life balance. Surgeons saw themselves as successful in answering trainees' questions, appropriately delegating patient care, providing feedback and creating a positive learning environment. They were least confident in helping trainees to identify their learning needs and develop their learning goals. New courses were considered desirable in assessment, providing feedback and the management of underperforming trainees. CONCLUSIONS: Enjoyment of teaching, sharing knowledge and the requirement to keep up to date, motivate surgeons to teach. Lack of time for teaching, and lack of recognition and support act as barriers. Designated time for teaching, being equipped for the educational roles involved, and the provision of appropriate recognition and support are necessary to sustain this essential resource.

Managing the complexity of change in postgraduate surgical education and training.

Pressure of workforce shortages, educational reform, heightened regulatory requirements and increased community expectations and scrutiny, has led to demand for substantial change in the provision of surgical education and training. The Royal Australasian College of Surgeons has responded positively to these external factors through an extensive review of local and worldwide practice and opinion, providing ongoing realignment of its governance and committee structure, substantially adjusting the structure of its educational program and increasing the educational support to trainees and supervisors. The College looks to the Council and its senior Fellows to create the direction and drive, but these changes need to be supported and implemented with care by the management and administrative staff of the College and specialist societies. This is in an opinion-rich zone with substantial regulatory scrutiny.

Task transfer: the view of the Royal Australasian College of Surgeons.

The Royal Australasian College of Surgeons (RACS) supports the evolution of appropriate task transfer in a team environment led by the most experienced clinician - in our case, the surgeon. A clear requirement needs to be identified for task transfer; it should not be used to avoid redressing the current inefficient use of existing surgeons resulting from ongoing underfunding. Maintenance of standards, defined curricula, professional titles and monitored outcomes are essential.