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Training, assessment and accreditation in surgery
  1. Abdullatif Aydin, TUF Simulation Research Fellow1,
  2. Rebecca Fisher1,2,
  3. Muhammad Shamim Khan1,3,
  4. Prokar Dasgupta1,3,
  5. Kamran Ahmed1,3
  1. 1 MRC Centre for Transplantation, King’s College London, London, UK
  2. 2 School of Medicine, University of Edinburgh, Edinburgh, UK
  3. 3 Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, King’s Health Partners, London, UK
  1. Correspondence to Dr Abdullatif Aydin, MRC Centre for Transplantation, Guy’s Hospital, King’s College London, Strand, London WC2R 2LS, UK; abdullatif.aydin{at}kcl.ac.uk

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Introduction

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).

View this table:
Table 1

Components of competency from ABMS core competencies, GMC Good medical practice, the CanMEDS, and the RACS competencies

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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