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Being a Respectful Surgeon Matters
A/Prof Stephen TobinDean of Education –RACS
Uni Newcastle15 November 2017
• I am employed part-time by RACS
• I am self-employed surgeon in private practice (as well)
• I have medical school appointments
• I have a daughter at medical school
• No financial gains
Disclosures
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• Consider the issues in Australia and New Zealand
• How this is relevant to medical school?
• Evaluation of RACS Action Plan
• What about the outcomes?
• What does change and the future look like?
Objectives
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• Binational professional medical college• Headquarters Melbourne, founded 1927-
• About 6500 surgeons, 1200 trainees, 70 IMGs
• Standards, education/training & professional development
• Accredited by Australian Medical Council
• Role accepted by government (community)
RACS
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RACS – mission and values …• Leading advocate for surgical standards, education and
professionalism in Australia and New Zealand– Service– Integrity– Respect– Compassion– Collaboration
• CODE OF CONDUCT• NINE COMPETENCIES
– Surgical Competence and Performance Guide
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SET 2007-2008 ….. 2017RACS as ‘umbrella’ / accredited professional organisationAlso responsible for Fellows (thus Code-of-Conduct, CPD, standards)• SET selection through to Fellowship examination• Devolved model – ‘partnering’ agreements • 9 specialties, 13 programs• SET evaluation 2014, AMC review 2017• “CBME”, albeit time-framed
• Also, IMGs-on-pathway to FRACS
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• Woman vascular surgeon, book launch Sydney• Friday before long weekend• Initial view to wait/ignore• Day 4 : Expert Advisory Group as external response• Hosting major international meeting that week (!)
• DISRUPTION
• REPORT / APOLOGY / ACTION PLAN NOVEMBER 30
Media storm March 2015
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EAG : Sept. 2015• Key findings (one-half of members)
– 49% of respondents - DBSH– 63% of trainees - DBSH– 30% of women - sexual harassment– 71% of hospitals noted DBSH by surgeons– Many IMGs report discrimination– No difference across regions & NZ
• 42 recommendations, 8 goals• 5 year project• RACS President – David Watters’ apology
VUSM - CPPA
• 25 years • Study patients filing malpractice claims• Data via (now >134 campuses)
– Patient Advocacy Reporting System (PARS)– Co-worker Observation Reporting System (CORS)
• Management program– Behaviour Learning – People– Organisation
• CULTURE
• EDUCATION
• PROFESSIONAL BEHAVIOURS
• COMPLAINTS
Building Respect, Improving Patient Safety
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Respect is believing or understanding that someone or something has value and should be treated in an
appropriate way
• to avoid harming or interfering with’• OED
Respect
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‘It means valuing each others points of views. It means being open to being wrong. It means accepting people as they are. It means not dumping on someone because you're having a bad day. It means being polite and kind always, because being kind to people is not negotiable. It means not dissing* people because they're different to you. (*disrespecting, dismissing)
It means not gossiping about people or spreading lies.’
Respect
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• Respect means much
• Respect matters
• How we do this matters for patients
• We are not surgeons without patients
• We can not be surgeons without the health care team
#OperateWithRespect
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Engage / Collaborate
Leadership development
Campaign
Code of conduct
Hospital appointments MSF /
Results
Foundation course
Training board members
Supervisors / selection
Post Accreditation & Annual surveyUNIT/trainee support
IMG support & oversight
Coach/mentor surgeons
Diverse college
BRIPS Education-Courses & Resources
Complaints process
Surgeons
IMGS Trainees
Fair, Timely Transparent Investigation Resolution
RACSTA support
Culture change and Leadership- Goals 1 - 5
Surgical education- Goals 6,7
Complaints managementGoal 8
RACS ACTION PLAN
• First five goals (1-5) are about the culture• “Culture eats strategy…....”
• COLLABORATION
• LOUD statements >>> CAMPAIGN
• EDUCATOR training
• PROFESSIONALISM training
• COMPLAINTS process
What RACS has done
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• Met at least once with all AU Health Departments and NZ Ministry of Health
• 50 + meetings with hospitals to explore areas of alignment based on Vanderbilt Principles
• Regional Chairs and Fellows key part of these meetings
• Medical schools & professionalism curricula
• Launch of Let’s Operate with Respect Campaign
Area 1: Engagement and collaboration
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Find out more: www.surgeons.org/respect
• First digital campaign for RACS• Significant consultation to agree brand• Videos, social media, posters …• #OperateWithRespect hashtag used > 1500 times• >3 million impressions• > 1.1 million unique page views to the ‘about respect’
section of the website• International interest
Let’s Operate with Respect Campaign
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• Gender equity– Increase women in surgery
• Selection, Training*, Fellowship (14%)
• Inclusive culture and leadership excellence– Aborginal & TorresStrait Islanders– Maori
• Board & committee diversity– Women, community
*attrition
Diversity & Inclusion Plan
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• Monash, Sydney• Melbourne, ANU, Adelaide, Flinders
• MoU – University of Otago
• Professionalism curriculum – Involve surgeons, RACS resources
• Medical students “surgical society”• Behaviour of surgeons: shared information
*Sunshine Coast, Macquarie
Medical Schools - 22*
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e-learning module Operate with Respect– mandatory for all RACS Fellows, Trainees & IMGs– CPD requirement for 2017– 73% have completed module
Foundation Skills for Surgical Educators (FSSE)Mandatory 1 day course for all surgeons who supervise, teach or train SET trainees and/or assess IMGs- > 2800 by end 2017, +600 exemptions >> about 3400- 36 courses – 2016; 124 courses – 2017
Operate With Respect one-day courseEnormous work by working group
Area 2 - Education
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FSSE Overview
Learning • What is learning • Understanding learners• Adult learning theory• Involving learners
Teaching• Planning learning • Teaching strategies • Teaching in different
clinical settings• Roles of the teacher
Feedback• Effective Feedback• Model for Feedback • Practising feedback• Summary of lessons
learnt
Assessment • Purpose of Assessment• Formative & summative
assessment• Strategy & Tools • RACS assessments• Evaluation of teacher role
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• Some use VANDERBILT principles• 3 Pilots &Trained Faculty
• 12 courses for 2017; 20+ for 2018
• Covers: • INTRODUCTION / CASE STUDY• BUILDING RESPECT• BUILDING RESILIENCE• SPEAKING UP (practice, role-plays)
Operating with Respect F2F
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Speaking Up
Resilience
BuildingRespect
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– Clinical Director, IMG Assessment & Support– Creation of IMG Committee– Strengthening processes for IMG Assessment
– Consolidation of data from Trainee end of term surveys
– Development of Leadership Course• 2 pilots 2017; 1 course 24-25/11; 4 in 2018
Progress
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Area 3 – Complaints Management
• Implemented complaints hotline, phone and email • Resourced with staff and support• Implemented a complaint-specific database• Published a complaints policy, manual and user guide• Revised policies encompassing external oversight and
the new Code of Conduct and strengthened and aligned the sanctions policy
• Resolved five outstanding long-term complaints.
125 complaint enquiries registered in 2016
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2016 Activity : mostly “Bullying”
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• 73% compliance with OWR online module• To be 100% for CPD by end 2017• CPD compliance is required for medical registration
• FSSE will be about 85-90%• 111 courses 2017, 46 courses 2015-2016
• OWR F2F mandated by end 2018• Current defined target cohort achievable
Metrics for courses
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• CULTURE
• ASSUMPTIONS cf. clinical courses
• ENGAGEMENT
• Requires Fellows to own• Trainees to be able to speak up• IMGs to be supported (respected)
Are courses the answer?
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• EVALUATION science
• Positive metrics
• All of system, but measured within hospitals• Quality & safety of patient care• Better trainee progress • Understanding educator role (surgical education)• Role modelling (good behaviours)
OUTCOMES
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• Both are inevitable
• Patients• Community• Government
• Surgeon role refined = more than operations• Better trainee progress through improved program• More tailored IMG review and recognition• Workplace recognition of supervisor/educator role
CHANGE and the FUTURE
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• RACS Fellows, • Trainees, IMG surgeons,• Staff
• EAG visited yesterday• ThreadConsulting engaged for evaluation
Acknowledgements
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Find out more: www.surgeons.org/respect
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