ROYAL AUSTRALASIAN COLLEGE OF SURGEONS Paediatric Surgical Education and Training Regulations Board of Paediatric Surgery Last updated June 2015 These regulations are specific to the SET program in Paediatric Surgery, and do not cover in detail, requirements that are already explicit in College Policies. The Board advises that these regulations should be read in conjunction with College policies
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ROYAL AUSTRALASIAN COLLEGE OF SURGEONS
Paediatric Surgical Education and Training Regulations
Board of Paediatric Surgery
Last updated June 2015
These regulations are specific to the SET program in Paediatric Surgery, and do not cover in detail, requirements that are already explicit in College Policies. The Board advises that these regulations should be read in conjunction with College policies
1.1 DEFINITION OF TERMS FOR THE PURPOSE OF THESE REGULATIONS ...................................................................... 3 1.2 PURPOSE ................................................................................................................................................. 3 1.3 ADMINISTRATION AND OWNERSHIP .............................................................................................................. 3 1.4 PURPOSE AND OBJECTIVE OF THE TRAINING PROGRAM .................................................................................... 3
2. DURATION OF THE SET PROGRAM ............................................................................................... 4
3. REQUIREMENTS OF SURGICAL EDUCATION AND TRAINING (SET) PROGRAM IN
PAEDIATRIC SURGERY .............................................................................................................................. 4
3.1 OVERVIEW ............................................................................................................................................... 4 3.2 EARLY SET............................................................................................................................................... 5 3.3 MID AND SENIOR SET TRAINEES .................................................................................................................. 5 3.4 SUMMARY OF ASSESSMENTS ....................................................................................................................... 6 3.5 RESEARCH ............................................................................................................................................... 7 3.6 REGISTRAR ANNUAL TRAINING SEMINAR ....................................................................................................... 7 3.7 CURRICULUM ........................................................................................................................................... 8
4.1 DEFERRAL, INTERRUPTION AND FLEXIBLE TRAINING ......................................................................................... 9 4.2 LEAVE ..................................................................................................................................................... 9 4.3 WITHDRAWAL FROM TRAINING PROGRAM .................................................................................................. 10
5. PAEDIATRIC SURGERY TRAINING POSITIONS .......................................................................... 10
5.1 TRAINING POSITION PLACEMENT ............................................................................................................... 10 5.2 ALLOCATION PROCESS .............................................................................................................................. 10
6. ASSESSMENT OF PERFORMANCE DURING CLINICAL TRAINING ........................................ 11
6.1 OVERVIEW AND PROCESS ......................................................................................................................... 11 6.2 TRAINEE PORTFOLIO ................................................................................................................................ 13 6.3 ASSESSMENT OF OPERATIVE EXPERIENCE DURING CLINICAL TRAINING ............................................................... 13 6.4 TRAINEE EVALUATION FORM – SET ONE, MID AND SENIOR SET ..................................................................... 14 6.5 TRAINEE PROGRESS OVERVIEW .................................................................................................................. 15 6.6 EARLY SET ASSESSMENTS ......................................................................................................................... 15 6.7 360 DEGREE EVALUATION SURVEYS ........................................................................................................... 16 6.8 MEASURE OF OPERATIVE UNDERSTANDING AND SURGICAL EXPERIENCE (MOUSE) FORMS .................................. 17 6.9 CRITICAL APPRAISAL TASKS (CATS) ............................................................................................................ 17 6.10 DIRECTED ONLINE GROUP STUDIES (DOGS) ................................................................................................ 18
7.1 PAEDIATRIC LIFE SUPPORT (PLS AND APLS) COURSES ................................................................................... 19 7.2 EARLY MANAGEMENT OF SEVERE TRAUMA (EMST) COURSE .......................................................................... 19 7.3 AUSTRALIAN AND NEW ZEALAND SURGICAL SKILLS EDUCATION AND TRAINING (ASSET) COURSE .......................... 19 7.4 CARE OF THE CRITICALLY ILL SURGICAL PATIENT (CCRISP) COURSE .................................................................. 19 7.5 EMERGENCY MANAGEMENT OF SEVERE BURNS (EMSB) COURSE .................................................................... 19 7.6 CRITICAL LITERATURE EVALUATION AND RESEARCH (CLEAR) COURSE............................................................... 19
submissions, MOUSEs, evidence of completion of compulsory courses, and other
relevant training documentation.
6.2.3 The trainee portfolio should be brought to the trainee formal meetings with the
Board.
6.2.4 The trainee portfolio should also be brought to the beginning of term meeting with
supervisors to assist with the needs assessment of the trainee and subsequent
setting of goals for the forthcoming rotation.
6.2.5 The trainee portfolio must be available to be discussed with the supervisor and
trainers at face to face feedback meetings.
6.3 Assessment of Operative Experience during Clinical Training
6.3.1 From the commencement of SET, trainees will maintain a logbook by using the
MALT system according to College processes. Data entry should not be delayed
more than four weeks at any one time, and must be completed for each rotation in
time for the submission of the End of Term Assessment and Log Book Summary.
6.3.2 A Summary of Operative Experience (Logbook summary) must be submitted to the
Board signed by the Surgical Supervisor and trainee on time at the mid-term
assessment due date during Early SET. Those trainees in surgical posts of other
specialties will use the relevant speciality logbook summary form.
6.3.3 A surgical supervisor’s signature on the Logbook summary acknowledges that it is
the logbook information the trainee is presenting for that period of training but
responsibility to ensure the accuracy of the data remains with the trainee.
6.3.4 A completed logbook summary must also be submitted to the Board at the
conclusion of each six month rotation during SET on dates as advised in the
Training Calendar. Reports not signed by both parties will be considered invalid and
that period of training may be assessed as unsatisfactory.
6.3.5 The trainee is responsible for forwarding the completed logbook summary to the
Board by the communicated due date or within one week of signing of the logbook
summary, whichever is sooner.
6.3.6 If the logbook summary is not received by the due date for each rotation that period
of training may not be accepted by the Board.
6.3.7 Trainees are required to keep a copy of their signed logbook summaries for their
training portfolio.
6.3.8 The Board will assess trainee logbooks to ensure they adequately cover the major
areas of the curriculum.
6.3.9 At its discretion, the Board may extend the duration of the trainee’s SET program if
the logbook figures or level of participation are considered deficient or marginal in
any area.
6.3.10 The Board is responsible for the review of logbook and accreditation of clinical
rotation.
6.3.11 Adequate operative experience must be evident to the Board Chair prior to any
trainee presenting for the Fellowship Examination in Paediatric Surgery.
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6.3.12 Inaccurate recording of procedures in the operative logbook may be treated as
misconduct and may form grounds for dismissal in accordance with the College
Dismissal from Surgical Training policy, Misconduct policy and these regulations.
6.4 Trainee Evaluation Form – SET One, Mid and Senior SET
6.4.1 When a due date for submission of Training documentation is advised by the Board
of Paediatric Surgery:
a. A Trainee makes a request of the Surgical Supervisor at least two weeks prior
to the Board due date to complete the required forms. The Surgical Supervisor
(or College notified delegate in case of leave) will then coordinate the
subsequent process.
b. The department meets as a whole regarding their Trainees and the Trainee
Evaluation Form is discussed and completed by the department on that
occasion.
c. The Trainee Evaluation Form should be a consensus statement by the
Department. Therefore all Consultants within the Department who have clinical
interactions with the Trainee are required to sign the Trainee Evaluation Form.
Where a consensus cannot be reached by a Department, any dissenting
Department member/s must prepare a separate Trainee Evaluation Form which
also must be discussed with the Trainee.
d. It is acceptable to acknowledge on Trainee Evaluation Forms that a consultant
from the Department who is on extended leave will be unable to sign the form.
e. A meeting is arranged between the Trainee, the Surgical Supervisor (or college
notified delegate in case of leave) and/or other appropriate consultant/s within
the department, to discuss the training documentation, following which the
Surgical Supervisor and Trainee must sign the forms prior to the Trainee
forwarding a copy of the complete set of forms to the Executive Officer on or
before the due date. Reports not signed by all parties will be considered invalid.
6.4.2 Trainees must complete a face-to-face mid-term assessment and an end-of-term
assessment with their Surgical Supervisor, in which any deficiencies or areas of
potential improvement should be discussed with mechanisms for correction
identified. Positive feedback is equally advisable in the assessment process. Areas
of above or below average performance should be highlighted with constructive
comment as to further development. This meeting should include a review of the
Goals and Objectives established at the start of the rotation (Section 6.1.8).
a. Where areas are identified and recorded on the Form as Borderline or
Unsatisfactory, the Surgical Supervisor will discuss this formally with the trainee
and agree to an appropriate remedial action or performance management plan.
b. Advice may be sought from the Board in developing a performance
management plan.
c. The evaluation must be submitted to the Board at the conclusion of each
quarter or rotation by the due date.
6.4.3 An Overall Unsatisfactory Assessment is defined as
● Two or more Unsatisfactory (N) ratings
● One or more Unsatisfactory (N) ratings in the same criterion as identified
in a previous assessment period
● Two or more Borderline (B) ratings (persisting deficiencies) in a previous
assessment in the same criterion
● The Trainee failing to submit training documentation and assessments by
due date
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6.4.4 Where a deficiency is identified, the Board may request more frequent submission of
a trainee evaluation report.
6.4.5 If a clinical rotation has been recorded as unsatisfactory the rotation will not be
accredited towards the trainee’s surgical education training and will be repeated.
The trainee will remain at the SET level of the unsatisfactory rotation.
6.4.6 The areas of deficiency that resulted in the unsatisfactory assessment are identified
by the Board and advised in writing to the trainee. The trainee is also advised that
he/she is on probation and of the duration of the period of probation. The current
surgical supervisor will be informed.
6.4.7 The trainee is responsible for forwarding completed training documentation to the
Executive Officer and ensuring receipt on or before the communicated due date. If
the documentation is not received by the communicated due date that period of
training may be assessed as unsatisfactory and the trainee may be placed on
probation. (See Section 9)
6.4.8 Trainees are advised to keep a copy of all training documentation.
6.4.9 Where deficiencies or training issues are identified, the Board will assist in co-
ordinating a remedial action or a performance management plan with the Trainee
and surgical supervisor.
6.4.10 If a trainee’s performance in a clinical rotation has been assessed as unsatisfactory,
the Board will follow the process outlined in Section 9.
6.5 Trainee Progress Overview
6.5.1 The Trainee Progress Overview Form has been developed to provide Trainees,
Surgical Supervisors and the Board with a summary of trainee progress and identify
strengths and weaknesses.
6.5.2 Trainees are required to take their completed form to any meeting with their Surgical
Supervisor.
6.5.3 Trainees are required to submit an updated form at the conclusion of each six (6)
month rotation in addition to other in-training assessment forms outlined in section 6,
on the due dates.
6.5.4 The trainee will be responsible for forwarding the completed form to the Board by
the due date. If the form has not been received by the communicated due date the
training rotation may be assessed as unsatisfactory.
6.5.5 Trainees must keep a copy of the current Trainee Progress Overview Form in their
training portfolio.
6.6 Early SET Assessments
6.6.1 Mandated Presentations
SET One (1) trainees are required to present on topics as outlined in the SET One
Assessment Plan. The Supervisor or a FRACS/VRPS consultant trainer will sign
that satisfactory completion of each presentation has occurred in the Trainee’s SET
One Assessment Plan Record. Presentations are to be 5 – 10 minutes in length
and are to be given by the trainee without reference to notes. Audio-visual aids are
to be restricted to pictures of radiology or patients to illustrate a significant symptom
or sign. Minimum audiences for presentations are a FRACS Paediatric surgical
consultant or VRPS and one other medical member of the surgical team.
a. Presentations for perioperative management should demonstrate a safe
working knowledge of diagnosis, investigation and management of those
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conditions in children. Presentations for perioperative management should be in
the following format:
● Key pathological features of condition
● Key presenting features
● Key diagnostic features and investigations
● Essential perioperative management steps
b. Presentations for specific mandated paediatric conditions should demonstrate
knowledge of key features of presentation, pathogenesis and diagnosis of those
conditions. In depth knowledge of management of these specific mandated
conditions at a Fellowship level is not required in SET One (1). Presentations
should be in the following format:
● Key pathological features of condition
● Key presenting features
● Key diagnostic features and investigations
6.6.2 Mini-CEX Forms
● Completed forms must be submitted at the end of each quarter in Early
SET or as directed by Board.
● Eight (8) mini-CEX performed on mandated peri-operative management
cases are to be submitted in SET One (1) as outlined in the SET One
Assessment Plan.
● A minimum four (4) mini-CEX per year are to be submitted in Early SET.
● Mini-CEX forms are to be completed by FRACS consultants or VRPS
unless otherwise directed by Board.
● Failure to submit all completed forms may result in an unsatisfactory term
assessment.
6.6.3 Direct Observation of Procedures (DOPS) Forms
● A minimum of one (1) completed form must be submitted at the end of
each quarter in Early SET or as directed by the Board.
● Failure to submit all completed forms may result in an unsatisfactory term
assessment.
6.7 360 Degree Evaluation Surveys
6.7.1 Completed 360 Degree Evaluation Surveys must be submitted at the end of each
quarter in Early SET or as directed by the Board. Four (4) surveys are to be
completed in each year of Early SET.
6.7.2 Trainees in Mid and Senior SET may be also be directed by the Board to complete
360 Degree Evaluation Surveys after review of their trainee evaluations.
6.7.3 Relevant Trainees will be required to nominate names and contact details of two (2)
Ward Charge Nurses; two (2) clinical, ward or departmental administrative staff; one
(1) Theatre Coordinator and one (1) Nurse Manager Emergency Department from
the hospital that the trainee is working at or has worked with during the previous
three months.
6.7.4 Trainees are advised to obtain approval from prospective participants in the surveys
before nominating them.
6.7.5 The Trainee will also be required to complete a self-assessment; which is to be
included with their assessment reports by the due date.
6.7.6 The forms are scored in the following categories: Technical Expertise, Scholar and
Teacher, Communication, Collaboration, Management and Leadership, Health
Advocacy and Professionalism.
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6.7.7 All scores, including the trainee’s, are collated onto a summary sheet which is
reviewed by the Board. The trainee may request a copy of the summary sheet.
6.8 Measure of Operative Understanding and Surgical Experience (MOUSE) Forms
6.8.1 SET One (1) Trainees must submit a minimum of three (3) MOUSE on mandated
procedures at the end of each quarter or as directed by the Board. Mandated
Procedures are outlined in the SET One Assessment Plan.
6.8.2 Additional MOUSE in paediatric surgical procedures may be submitted to
demonstrate competency or formative feedback.
6.8.3 Mid and Senior SET Trainees are required to complete a minimum of six (6)
MOUSE forms at regular intervals (monthly recommended) throughout each six
month rotation. Three (3) completed MOUSE need to be submitted at the end of
each quarter and end of term assessment period; by the due date. Trainees may be
directed to complete more frequent MOUSE forms.
6.8.4 All paediatric surgical procedures may be considered for MOUSE assessment and
feedback at any stage of training.
a. Mid SET Trainees are requested to complete MOUSE forms in the SET Board
of Paediatric Surgery Summary of Operative Experience categories Minor 3
(such as appendicectomy and non-neonatal herniotomy) and Major 2 (such as
neonatal herniotomy and orchidopexy).
b. Senior SET trainees are required to include cases from Major 1 especially
neonatal index cases.
c. Failure to demonstrate competency (as defined in the curriculum) will result in
failure to satisfactorily complete the current SET Phase.
6.8.5 Trainees are required to initiate the assessment.
6.8.6 Trainees are advised to discuss with the assessing Consultant how areas of
deficiency could be improved during the next procedure.
6.8.7 All assessors of MOUSE forms must be Paediatric Surgery Fellows of the Royal
Australasian College of Surgeons or Board approved VRPS in New Zealand.
6.8.8 Failure to submit all completed forms by the due date may result in an unsatisfactory
term assessment.
6.9 Critical Appraisal Tasks (CATs)
A Critical Appraisal Task (CAT) is a training tool designed to enable trainees to address a clinical question using the best available evidence. Trainees are expected to appraise the relevant literature and, based upon this, to concisely provide a rationale for their chosen management. These tasks equip the trainee to continually adjust management approaches during their career as a paediatric surgeon, as new information becomes available. CATs are designed to approximate the framework expected during written components of the Fellowship Examination.
6.9.1 CATs must be completed by Mid and Senior SET trainees.
6.9.2 Trainees must submit eight (8) CATs during Mid to Senior SET of which six (6) must
be satisfactory.
6.9.3 Two (2) CATs per year are conducted. Trainees must submit their CAT electronically
by the due date.
The submission must include a cover sheet with the following information:
● CAT title,
● due date,
● Trainee name.
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The submission will answer all questions clearly identified and referenced where
appropriate.
A bibliography must be included in the submission.
6.9.4 A Board member is allocated the role of CATs coordinator and authors CATs topics.
6.9.5 The CATs coordinator is tasked with recruiting other authors and assessors from the
ANZAPS membership.
CATs are assessed by the author and one other nominated ANZAPS member
using the prescribed assessment template.
6.9.6 Assessment templates are used for Mid SET trainees and Senior SET trainees.
6.9.7 Representative answers will be made available to all trainees, to assist improvement
of future submissions.
6.9.8 CATs are not completed by interrupted trainees unless a specific request is made
and approved by the Board.
6.10 Directed Online Group Studies (DOGS)
DOGS have been designed to encourage discussion and understanding of management plans related to clinical paediatric surgical problems and are based on our curriculum modules. The answer will be in the style of a medium or short clinical exam question, either in the written paper or viva section of the Fellowship Exam. Marking will take into account the SET level of the candidate.
6.10.1 Two (2) DOGS are to be completed annually, and each will be available on the
college website for a period of three (3) weeks; as specified in the training calendar.
a. Session 1:
Trainees are asked to read the case presentation and submit responses to case
questions which require both core knowledge and clinical judgement. Trainees
are notified of the broad assessment criteria and they are encouraged to refer to
it in order to help form their responses. Session 1 is open for seven (7) days.
b. Session 2:
Allows trainees to access a feedback forum. During this session trainees are
asked to identify a clinical issue related to the case from their own clinical
experience and submit it to a “Practice Issues Forum”. The role of the
facilitators at this point is to monitor and respond to feedback, to probe trainees’
responses and to pose further questions to generate discussion. Session 2 is
open for seven (7) days.
c. Session 3:
Requires trainees to select at least two of the issues submitted by their
colleagues and to provide comments based on their own experience. The
facilitator joins in the discussion as required. New clinical issues may be raised
in this session. Session 3 is open for seven (7) days.
6.10.2 DOGS are compulsory for all Mid and Senior SET trainees.
6.10.3 Trainees must complete a total of eight DOGS of which six (6) must be satisfactory.
6.10.4 A Board member is allocated to the role of DOGS coordinator. The DOGS
coordinator is tasked with authoring DOGS topics and recruiting other authors and
assessors from the ANZAPS membership.
6.10.5 Following completion of the DOGS, the trainee submission and discussion forum is
accessed from the website and forwarded to the facilitator(s) for marking.
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7. COURSES
7.1 Paediatric Life Support (PLS and APLS) Courses
7.1.1 Trainees must satisfactorily complete either the PLS or APLS Course prior to their
training or by the end of Early SET. Although a number of courses are conducted
throughout Australia and New Zealand, there are waiting lists and trainees are
encouraged to complete the course prior to commencement on the SET program.
7.1.2 Trainees should visit the College website for more details on the course.
7.2 Early Management of Severe Trauma (EMST) Course
7.2.1 Trainees must satisfactorily complete the College EMST Course either prior to their
training or by the end of Early SET. Although a number of courses are conducted
throughout Australia and New Zealand, there are waiting lists and trainees are
encouraged to complete the course prior to commencement on the SET program.
7.2.2 Trainees should visit the College website for more details on the course.
7.3 Australian and New Zealand Surgical Skills Education and Training (ASSET) Course
7.3.1 Trainees must satisfactorily complete the College ASSET Course either prior to their
training or by the end of Early SET. Although a number of courses are conducted
throughout Australia and New Zealand, there are waiting lists and trainees are
encouraged to complete the course prior to commencement on the SET program.
7.3.2 Trainees should visit the College website for more details on the course.
7.4 Care of the Critically Ill Surgical Patient (CCrISP) Course
7.4.1 Trainees must satisfactorily complete the College CCrISP Course either prior to their
training or by the end of Early SET. Although a number of courses are conducted
throughout Australia and New Zealand, there are waiting lists and trainees are
encouraged to complete the course prior to commencement on the SET program.
7.4.2 Trainees should visit the College website for more details on the course.
7.5 Emergency Management of Severe Burns (EMSB) Course
7.5.1 Trainees must satisfactorily complete the Australian and New Zealand Burns
Association (ANZBA) EMSB Course either prior to their training or by the end of
Early SET.
7.5.2 Trainees should visit www.anzba.org.au for more details on the course.
7.6 Critical Literature Evaluation and Research (CLEAR) Course
7.6.1 Trainees must satisfactorily complete the Critical Literature Evaluation and Research
(CLEAR) Course either prior to their training or by the end of Early SET.
Check assessment criteria
Read case scenario
Answer questions
Check group replies
Respond to facilitator questions
Post issue to Professional Practice forum
Check group issues
Select and respond to at least two issues
Join discussion of specific issues
DOGS facilitator reviews answers and may pose additional questions