Trauma Surgery: New inking

EMERGENCY SURGERY TRAINING FOR THE GENERAL SURGEON IS A COMPETENCY-BASED PROGRAMME IN EVOLUTION, SAYS SURGEON PROFESSOR PAUL BALFE, FRCSI 2006

t’s generally recognised that emergency surgery (both trauma and non-trauma) has in some ways played second ddle to other areas of surgical endeavour by way of resource investment, training etc. By its nature, it o en occurs out of hours, isn’t always consultant supervised and there may be signi cant interpersonal and interinstitutional variability in outcomes.

Recognising the imperative that surgical training should aim to equip practitioners with the knowledge and skills required to competently deal with the range of presentations that might reasonably be expected on emergency take, the four Royal Colleges of the UK and Ireland set about developing a new Higher Surgical Training (HST) curriculum which would once again put the acquisition of emergency surgical competencies front and centre of the HST programme.

e new surgical curriculum came into e ect in July 2021 and, in addition to the knowledge and competencies speci ed with respect to the trainee, the onus is now squarely on trainers only to sign o a trainee when they are satis ed that the trainee is capable of managing the breadth of undi erentiated emergency take as a Day 1 consultant. To that extent, the training programme is now rmly competency rather than time based.

e launch of the new curriculum followed closely on the launch by the Irish government of a comprehensive blueprint for ‘A Trauma System for Ireland’ which will see the rollout of what is hoped will be a top-quality trauma network over the next six to eight years. e network will comprise a ‘Hub and Spoke’ model involving two Major Trauma Centres (Mater Misericordiae University Hospital (MMUH) and Cork University Hospital (CUH) and ten Trauma Units throughout the country. e core trauma team will comprise: general surgery, trauma and orthopaedics, emergency medicine and anaesthesia/critical care. is core team will be expected to handle the breadth of undi erentiated emergency take, calling on other specialties as available and as required.

To re ect the new curriculum requirements, trainees now sitting the FRCSI exam will be expected to have acquired the requisite knowledge and competencies in the area of emergency surgery. But while the College already had a good nontrauma emergency surgery training programme run in conjunction with the World Society of Emergency Surgery (WSES), until recently there was no corresponding programme for trauma surgery training.

Professor Paul Balfe

At the height of the pandemic, when it was unclear if and when it would ever end and travel restrictions would li , we decided to develop a trauma surgery skills course from the ground up for our Irish HSTs drawing on our own collective experience and the best of international practice. To date, two courses were successfully rolled out in 2022 with further courses scheduled for 2023. But regardless of how successful such stand-alone courses may be, they necessarily operate in something of a silo without connection to a wider trauma forum/community.

Following some preliminary discussions, in 2022 the then RCSI President, Professor P. Ronan O’Connell established a small working group with a view to exploring the possibility of adopting one of the existing internationallyaccredited training modules – either the De nitive Surgical Trauma Care (DSTC)/De nitive Anaesthetic Trauma Care (DATC) or De nitive Surgical Trauma Skills (DSTS) – into the College’s formal training programme. In addition, there was recognition of the need to forge international relationships with a view to creating rotation and fellowship opportunities for our HSTs in the area of trauma surgery.

In November 2022, Mr Sean Johnston, Chair, General Surgery Training Committee (GSTC), Ms Caroline McGuinness and I travelled to Johannesburg where we had the opportunity to completely immerse ourselves in every aspect of the DSTC/DATC from both the surgical and operational perspective. We also visited two Level 1 trauma centres and had very positive discussions with relevant parties regarding the possibility of Irish ST8/ST8+ trainees rotating through such units. It was ironic, and in some ways hilarious, that when we arrived at the 4,000 bed Chris Hani Baragwanath Academic Hospital and walked into the Trauma Resuscitation Bay, the rst person we encountered was Dr Jimmy Lee from Ireland, who had just completed his training in emergency medicine and who was spending three months at the hospital before taking up a consultant post in UCHG.

It is planned to similarly assess the RCSE’s DSTS course in June 2023. Both courses will then be evaluated against a set of objective criteria and a formal recommendation made as to which should be adopted by the College in the best interests of our trainees/practitioners and ultimately our patients. Whichever course is chosen, it is envisaged that suitably credentialled Irish faculty would join international faculty in delivering the courses.

It is important we get this right given the changing practice landscape and the College is absolutely committed to doing so.

By Professor Paul Balfe, General Surgery Lead, Trauma Education and Training, RCSI; Mr Sean Johnston, Chair, GSTC, RCSI; Professor Kevin Barry, Dean of Postgraduate Surgical Training, RCSI. ■