What is COSMOS
Consultation Skills That Matter for Surgeons (COSMOS) is an RCSEd modular training programme designed to develop the consultation and communication skills that underpin effective surgical care in both elective and emergency settings.
COSMOS focuses on the consultation and communication skills surgeons need to build shared understanding, rapport and shared decision making with patients. Patients who are involved in their treatment decisions:
- Do better
- Have less pain
- Cope better with complications
- And much more
You have probably experienced the difference between caring for patients who are fully involved in and committed to their treatment decisions, including the associated risks, and those where the surgeon and patient are not on the same page. But how can we develop these consultation skills and apply them effectively in real-world surgical practice?
Who is COSMOS for
The programme is intended for surgical trainees from CT2 to ST6. COSMOS begins at the current level of the group, recognising that participants are usually already experienced in surgical practice.
How is COSMOS Delivered
Developed through a collaboration between the RCSEd ICONS (Informed Consent) and Scottish Surgical Boot Camps faculties, COSMOS combines practical and interactive learning across each module.
Each module includes:
- Pre-course learning through audio and video resources
- A training day featuring teaching, facilitated discussion, video scenario analysis, simulation scenarios with volunteer patients and rapid debriefing
- Post-course resources through a Virtual Learning Environment
COSMOS Training Programme
COSMOS is delivered as a modular training programme, with each module focusing on consultation and communication skills relevant to different stages of surgical training. The modules build on participants' existing experience and cover topics including shared decision making, communication of risk, difficult conversations, surgical complications, adverse events and end-of-life care.
Modules are designed for specific stages of surgical training, although the recommended year groups are not strictly prescriptive. Each module combines pre-course learning, an interactive training day and post-course resources to support the application of consultation skills in clinical practice.
Explore the COSMOS modules below to see the recommended training stage, key topics, learning format and current development status.
- Shared Decision Making with patients, using a “3-talk” model
- How patients understand risk
- Cultural variations
Commissioned by the Scottish Core Surgery Training programmes since 2020. Piloted in E & W Midlands 2026.
- Opening & closing: video scenarios & discussion
- Shared decision making, 3-talk model: teaching and discussion
- 4 short simulations, small group debrief
- Commn of risk: discussion of pre-crs video
- Handouts
- Workplace consultation + video-assisted remote debrief (optional)
- The difficult conversations with patients through complications and adverse events
- M&M / SAER processes
- Responding to complaints
- “2nd casualty” phenomenon
Commissioned by the Scottish General Surgery Training programmes since 2023 Piloted in E & W Midlands 2026.
- Facilitated discussions using video analysis
- Didactic sessions 2 simulations
- Small group debrief
- Handouts
- Podcast link
- Palliative care conversations
- Medicolegal considerations, childhood, trainees as agents of change
Book a COSMOS Module
Explore our COSMOS modules and develop practical consultation skills for surgical practice. Choose the module that matches your training stage and learning needs.
COSMOS Module A: Shared Decision Making
CT2/ST2-ST3
Develop skills in shared decision making, communication of risk and cultural competence through practical surgical consultation training.
Book hereCOSMOS Module B: When it all goes wrong
ST3-ST5
Develop skills for difficult conversations following surgical complications and adverse events, including responding to patient complaints.
Book hereCOSMOS Learning Objectives
Module A
By the end of module A, participants will be able to:
- Explain the need for Consultation Skills, therapeutic conversations and Shared Decision Making with patients.
- List core elements of good consultation, and pitfalls.
- Demonstrate use of the “team talk and options talk” parts of the “3 talk” model.
- Adapt to cultural considerations.
Module B
By the end of module B, trainees will be able to:
- Establish priorities, and show skills for the immediate management of a patient and team following recognition of an adverse event, with attention to the conversations with patients, families and team.
- Explain a complication or adverse event to a patient or relatives, showing appropriate candour and care, taking account of their needs and those of the team and organisation, and minimising further harm.
- Conduct a conversation with a patient and/or relatives about a complaint, with concern for (a) listening and acknowledging, (b) appropriate use of “sorry”, and (c) best ongoing care.
- Take part in an SAER or other learning forum, with humble enquiry, fairness and maximising of learning.
- Understand the nature of “2nd casualty” injury in clinicians, how it affects performance, and when peer support or professional support is needed.
Module C
By the end of module C, trainees will be able to:
- Hold a series of conversations with adults and their families/carers on end-of-life issues, reaching Shared Understanding, with compassion.
Module D
Module D still in planning.
Gallery
Contact us
Prospective faculty can enquire by emailing l.mcgregor@rcsed.ac.uk or kenneth.walker@nhs.scot.
Training Programme Directors interested in commissioning modules for their programmes should email kenneth.walker@nhs.scot.