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Surgical Training: Impact of Decentralization and Guidelines for Improvement

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Clinical Education for the Health Professions

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Abstract

Future surgeons must develop operative and other skills such as decision-making, operative planning and self-awareness, in addition to traditional medical skills and knowledge. In larger, well-resourced hospital situations, this training can be provided easily. However, smaller hospitals may struggle to provide suitable breadth.

Increasingly, distance education is used to supplement training in smaller hospitals. Education may be coordinated by a central faculty, with the cohort in geographically distributed hospitals, or the cohort may be taught almost entirely by distance syllabus in some circumstances. This creates a spoke and hub educational structure, which has specific limitations and challenges. A combination of central regulation or credentialing faculty with peripheral workplace resident or registrar working placements is a common pattern in surgical training and education. The central hub may only manage assessment and standards, or it may provide formalized education to the whole cohort. The various hospitals (or spokes) are responsible for direct workplace teaching, including technical and nontechnical patient management skills. A curriculum designed to take advantage of this pattern will improve quality, and potentially, trainee outcomes.

This system is effectively a hybrid of direct workplace education and distance education. True distance education, where the educator and the student are geographically separated, is less common in surgical education, but can be used in remote, rural, and low resource settings. In this chapter, I will focus primarily on distance education, but in sympathy with a hybrid approach.

For the purpose of clarity, the term “surgical trainee” will be used to refer to all junior doctors progressing towards a career in surgery. Depending on the educational system, these might be residents or registrars or medical officers. Likewise “surgical training” is the education program that is used to develop these doctors and usually combines teaching of technical skills, base knowledge, and nonclinical skills.

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Authors and Affiliations

  1. Monash Rural Health, Bendigo, Monash University, North Bendigo, VIC, Australia

    Christine M. Cuthbertson

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  1. Christine M. Cuthbertson
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Correspondence to Christine M. Cuthbertson .

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Editors and Affiliations

  1. Monash University, School of Clinical Sciences, Clayton, VIC, Australia

    Debra Nestel

  2. King’s College London, London, UK

    Gabriel Reedy

  3. La Trobe University, School of Nursing and Midwifery, Melbourne, VIC, Australia

    Lisa McKenna

  4. Bond University, Faculty of Health Sciences and Medicine, Gold Coast, QLD, Australia

    Suzanne Gough

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Cuthbertson, C.M. (2023). Surgical Training: Impact of Decentralization and Guidelines for Improvement. In: Nestel, D., Reedy, G., McKenna, L., Gough, S. (eds) Clinical Education for the Health Professions. Springer, Singapore. https://doi.org/10.1007/978-981-15-3344-0_132

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