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