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The President Writes - December 2017

"Embedded within Excellence by Design is the concept of 'entrustable professional activities (EPAs)' as a measure of a surgeon in training's ability"

When I arrived in Scotland over 20 years ago I was reminded that summer in Scotland was a ‘retrospective event’, usually judged - somewhat unkindly - on the evidence of two successive days of sunshine. Living in Edinburgh at the College during my presidency has revealed another yardstick by which summer can be judged – the Edinburgh International Festival and the Fringe Festival. The College is situated at the heart of all these activities and provides many venues for Festival events during the month of August. A happy coincidence, as August traditionally is a quiet month for core College and intercollegiate activities when annual leave and vacation time make progress on many fronts frustratingly slow. It does however, provide me with the opportunity to spend time travelling on the College’s behalf. This year was no exception and it was a privilege to spend time in Singapore, Malaysia, Southern India and Sri Lanka.

In Singapore it was my pleasure to welcome 72 new Members and Fellows drawn from more than 10 countries in the ASEAN region to our College at one of our International Diploma ceremonies, many of whom had travelled a considerable distance with their families to attend the event. There is no doubt that, despite the necessary differences in our clinical practices and workplace, membership of the oldest surgical college is a highly valued credential.

Earlier this year at the College of Surgeons, Academy of Medicine Malaysia scientific conference in Kuching, Sarawak, I was reminded of the role played by our College supporting the development of surgical practice in Sarawak (which was a British Crown Colony at the time) when Sir James Fraser spent five years there from 1953, working for the Government Health Service. Some years later in 1982, he became President of our College. My visit to Kuching coincided with a most successful diet of our membership examination and I would like to express my thanks to all concerned. Staying in the region, I was reminded of the sheer size of the Association of Surgeons of India when I took part in the Tamil Nadu and Pondicherry Chapter meeting in Coimbatore, Tamil Nadu which drew over 1,000 registrants for a three-day regional event. I look forward to meeting more of our Indian Fellows and Members at the 2017 Annual Conference in Jaipur this December where the theme will be ‘Making Surgery Safer for Patients and Surgeons.

From Coimbatore in Southern India it was a small hop to Sri Lanka where we partnered with the College of Surgeons of Sri Lanka Annual Academic Sessions in conjunction with the SAARC (South Asian Association for Regional Co-operation) Surgical Care Society. This years’ meeting, which marks the seventh year of our partnership with the Sri Lankan College’s flagship annual event, was entitled ‘Surgical care – Optime Maxime’ and challenged us all to provide maximum benefit with minimum risk for all of our patients and bore much in common with the Choosing Wisely initiatives that we are engaged with in the UK. The event drew a strong international faculty and audience and is clearly emerging as a major scientific and clinical forum within the region. 

Closer to home this autumn/winter we will see Professor Michael Griffin and Mr Gareth Griffiths take up their Chairmanships of JCIE (Joint Committee on Intercollegiate Examinations) and JCST (Joint Committee on Surgical Training) respectively. I am sure you will join me in wishing them well in these challenging posts, where the landscape is in a constant state of flux. That rapid progress is being made was brought home to me at the Moynihan Chirugical Club meeting held this year in Dundee, where I heard Gareth Griffiths lay out some of the changes we can expect in the coming 12 months in relation to assessment and critically how we are going to define those progress points that guide a trainee towards autonomous practice.

In the September 2017 edition I drew attention to two new GMC documents, “Excellence by Design” and “The General Professional Capabilities Framework” launched earlier this year. Together, these documents shape the framework of future surgical training. Embedded within Excellence by Design was the concept of “entrustable professional activities (EPA’s)” as a measure of a surgeon in training’s ability, ranging from not being allowed to practice up to being allowed to act in a supervisor or instructor capacity. This new framework for capabilities originated in Holland and has been adopted widely in the USA, Australasia and elsewhere and has the benefit of being a descriptor of a trainee’s ability to work (for example, run an out patient clinic) rather than a series of separate workplace based assessments. In the UK the decision has been taken to use the term ‘Capabilities in Practice (CiPs)’ in place of EPA’s (unfortunate in my view – a lost opportunity to establish a common educational currency) to describe a trainee’s progress and level of professional ability in the workplace. It seems likely that CiPs will replace some elements of the existing WPBAs with an emphasis moving away from a granular series of multiple assessments each looking at a narrow range of competencies to a more global assessment of capability in the workplace. The timeframe for the launch is tight (over the next 12 months, I understand) and inevitably the devil will be in the detail. It is, however, clearly the direction of travel and Capabilities in Practice will be featured at length in a forthcoming edition of Surgeons’ News.

One of the highlights of the College’s calendar year is our conjoint scientific meeting with the College of Surgeons of Hong Kong. This years’ meeting held at the Hong Kong Academy of Medicine Jockey Club Building, Aberdeen was a great success. The theme ‘Controversies in Surgery’ provoked a vibrant debate set against the background of state of the art surgical practice drawn from Hong Kong, mainland China and Japan. I was struck particularly by the high volume of work experienced by some centres especially in mainland China where a UK lifetime of sub specialty experience could be accrued in the space of a year.  For those UK surgeons in training who might undertake a period of out of programme experience, there are potentially huge rewards. 

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