David J. Hillis

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.

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 todays surgeons.

Variation in the costs of surgery: seeking value

153 T Co-operation and Development (OECD) countries. Australia currently spends US

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

6140 per capita — or 9.1%of its gross domestic product— on health care. Moreover, there is evidence that health care costs, including out-of-pocket (OOP) expenses, are rising. In Australia, 68% of health care costs are funded through the public health system, with 32% from other sources, including private health insurers and OOP expenses. To encourage Australians to take out health insurance, the private health system is subsidised by a private health insurance rebate, which costs the public about

Students as teachers.

5 billion per year. Private health insurers derive their income from premiums, which have risen an average of just under 6% per year since 2012, well above the inflation rate or the consumer price index. Individual OOP expenses are also rising at an average rate of 6.2%; they have more than doubled in a decade and accounted for 17.8% of Australia’s

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

140 billion health care spending in 2013e14.

Discrimination, bullying and sexual harassment: where next for medical leadership?

OBJECTIVES The Baume Report (1994) on Australias 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

MJA 199 (11) · 16 December 2013 754 Before impeaching facet joint injections and medial branch blocks, and thereby medial branch neurotomies, as well as lumbar transforaminal epidural steroid injections, Harris and Buchbinder should consider: • interprofessional patient-centred approaches are key; • pharmacological management is often ineffective; • their view does not reflect the current practice of Australian pain medicine physicians; • these procedures help people struggling to continue in social roles and maintain quality of life, so they help to reduce the economic impact of spinal pain on Australian society. We support education to improve evidence-based practice of interventional procedures.