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Effective training is an essential component of every profession, and surgery is no exception. Traditionally, surgical training was mostly opportunity-based, often described as the ‘see one, do one, teach one’ approach, ascribed to Sir William Halsted.1 This method of training exclusively relied on opportunistic encounters of a variety of different cases and conditions and was extremely time-dependent. This apprenticeship model often prolonged training in order to gain sufficient surgical exposure and operative experience. However, over time, surgical training has shifted from an apprenticeship model to a competency-based model, according to which trainees must demonstrate competence in predefined areas of the curriculum to complete their training.2
Training and competence
Competence is ‘the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and the community being served’.3 The core components of competence may be broadly categorised as4:
Competence in non-technical skills – knowledge, communication, cognitive skills, including safe decision-making, stress management skills and working within a multidisciplinary team.
Competence in technical skills – physical examination, manipulation of tools and psychomotor skills.
Based on such parameters, the UK General Medical Council (GMC), the American Board of Medical Specialties (ABMS) and the Royal Australasian College of Surgeons (RACS) have developed criteria for competency within clinical practice,5–7 with Canada developing the Canadian Medical Education Directives for Specialists (CanMEDS)8 (table 1).
Competence should develop during a training pathway in a stepwise manner. Knowledge and basic skills are learnt during medical school and developed through the foundation years (also known as internship) of training (figure 1). Once registered on a surgical specialty, they are then expected to reach competency and …
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