Poster Presentation NSW State Cancer Conference 2023

How are surgeons trained in endocrine surgery? A mixed method study exploring competency in endocrine surgery in Australia and New Zealand (#311)

Tony Lian 1 2 , David Leong 1 3 , Krishna Vikneson 1 4 , Jessica Wong 1 , Mark Sywak 1 2 , Stan Sidhu 1 2 , Alex Papachristos 1 2 , Anthony Glover 1 2 4
  1. Department of Endocrine Surgery, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
  2. Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  3. Endocrine Surgical Services Unit, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia
  4. The Kinghorn Cancer Centre, Garvan Institute of Medical Research, St. Vincent’s Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia

AIMS

Currently there is no formal post-fellowship training program in endocrine surgery in Australia, and pathways to practice vary based on training location and surgical training program. Surgical practice for treatment of patients with endocrine cancers must maintain a balance between the need for speciality expertise and access to care. International data highlight the impact of surgeon volume on outcomes, and the importance of understanding the learning curve in developing minimum training competencies for endocrine procedures.  Examining the current training pathways in Australia would enable the proposal of a framework for minimum training competencies, ensuring the delivery of an appropriate standard of care. This study aimed to explore endocrine surgery training in Australia and New Zealand and perceptions around competency and scope of practice. 

METHODS

A web-based survey was distributed to fellows practicing or training in endocrine surgery. Participants were invited to complete a semi-structured interview to explore key themes around competency. Thematic analysis was undertaken, through a social constructivist lens.  

RESULTS

The survey was completed by 87 surgeons, with 30% practicing primarily in a regional or rural area. Key findings included 94% of participants stating additional 1-2 years of fellowship training after completion of surgical specialisation was required to be competent in endocrine surgery. Both technical and non-technical skills including communication, collaboration and professionalism were essential for competence. Median procedural volume learning curves as a primary operator were 100 thyroid, 50 parathyroid and 20 laparoscopic adrenalectomy procedures.  

Semi-structured interviews with 12 participants identified four major themes: 1. the importance of sufficient training to ensure appropriate clinical decision making in the ‘time-critical’ environment of the operating theatre and in the clinical management of both malignant and non-malignant endocrine disease including the insight to recognise their own and their institutions’ limitations and to tailor an appropriate scope of practice; 2. expected standards of clinical and technical performance are independent of practice location or context; 3. the importance of utilising a multi-disciplinary team for complex cases including advanced cancers; 4. learning opportunities during the general surgical education and training program are not sufficient for consultant-level subspecialty competence in endocrine surgery.

CONCLUSION 

Practicing endocrine surgeons acknowledge that formal fellowship training is required to achieve competence across technical and non-technical domains, especially in the management of endocrine cancers, when a multi-disciplinary team approach is essential. The definition of competence and expectations regarding technical outcomes are independent of practice location or context.