A tale of two centres
Chicago and Toronto are two major North American cities, both with several University teaching hospitals. In Chicago I visited Northwestern and in Toronto the University Hospital Network, the several teaching hospitals in Toronto working together.
What strikes you as you enter them is the considerable local philanthropy which has gone to build them. The buildings are all named after local benefactors, whose name does not necessarily have world wide resonance, Galter in Chicago and Eaton in Toronto are both people of local rather than worldwide renown.
It is also apparent that North America views health care with great seriousness. They are both impressive medical complexes, with space for patients and for teaching. They have both made considerable investments in surgical education, both at under and postgraduate level. Both have well resourced, charismatically led surgical skills centres and both let me have an office for my stay!
In both I met a whole series of committed clinicians, research scientists and teachers, who gave generously of their time and expertise. In both I was fed copiously!
In both the leader is one of the major players in surgical education in North America. In fact there is a foursome, renowned as the main initiators of surgical education, Richard Reznik in Toronto and Debra Da Rosa at Northwestern, as well as Ajit Sachdeva in Chicago at the American College of Surgeons (right next to Northwestern) and Gary Dunnington at Southern Illinois. They have all inspired each other and all worked together on the Surgeons as Educators programme. All were extremely welcoming and all gave me an inspired view of their units.
In Chicago, I spent three hectic days looking at and listening to the scope of the programme. I met the main teachers and the researchers and was allowed to try their simulators, meet their residents and speak to the main players. They have some interesting ideas, they have created an apprenticeship scheme, whereby a trainee is attached to a trainer for a couple of months and does everything with them, this sits alongside the normal programme which fill the rest of the time. I saw a talented trainee at the end of their training being taken through a complex operation (a pancreatectomy), both trainer and trainee filled you with confidence, this was an operation done with tempo and clarity, each step was discussed before execution. The student who was second assistant was expected to know the anatomy and physiology, and did!
I then spent half a day at the American college of surgeons, where they very kindly put on a seminar for me outlining the work that they were doing. They have great energy and address problems with panache.
The University of Toronto had three facilities associated with education, the Wilson Centre primarily concerned with educational research, the Skills lab for surgical skills simulation and the Faculty development unit which was concerned with faculty development. I spent time in all three, and all gave me plenty of ideas of how we might do things. The skills lab was used by first year trainees every week as in SIU and they had a clearly structured programme to follow, with six faculty teaching week by week. The Faculty development unit ran courses for teachers, but in the main had only managed to recruit surgical trainers who were in difficulty. There is a case, as back home, to use development resources for all staff, good and bad. Then I was told about the regular evaluation that went on for the faculty. They were all told how they performed on a regular basis and this was particularly helpful for the struggling trainer. As usual it was not as simple as that, and one of the faculty told me how demotivating it was to receive moderate reviews (you are the 52 most popular trainer!) and we both agreed that feedback needs to be distilled rather than given raw!
Both had rigorous assessment programmes, involving local and national tools. There was several knowledge based tests that all the trainees undertook, there were clinical skills vivas , which were fairly structured. They both used OSCEs (Objective Structured Clinical Examinations) and OSATS (Objective Structured Assessment of Technical Skills).
There was much to admire and plenty to adopt at both places. Thanks to all my hosts for their kindness and concern.
Main points to be considered for use in the Oxford Programme:
Recruit theatre nurses to run surgical skills lab
Recruit nurse educators to help deliver training, for students preparing for surgery and residents.
Have regular surgical skills training, rather than separate courses
Consider part of a trainees training as an apprentice to a particularly good teacher
Develop faculty, encourage sharing of ideas as the best way to teach surgery
Now for Stanford and the University of California San Francisco.
Chicago and Toronto are two major North American cities, both with several University teaching hospitals. In Chicago I visited Northwestern and in Toronto the University Hospital Network, the several teaching hospitals in Toronto working together.
What strikes you as you enter them is the considerable local philanthropy which has gone to build them. The buildings are all named after local benefactors, whose name does not necessarily have world wide resonance, Galter in Chicago and Eaton in Toronto are both people of local rather than worldwide renown.
It is also apparent that North America views health care with great seriousness. They are both impressive medical complexes, with space for patients and for teaching. They have both made considerable investments in surgical education, both at under and postgraduate level. Both have well resourced, charismatically led surgical skills centres and both let me have an office for my stay!
In both I met a whole series of committed clinicians, research scientists and teachers, who gave generously of their time and expertise. In both I was fed copiously!
In both the leader is one of the major players in surgical education in North America. In fact there is a foursome, renowned as the main initiators of surgical education, Richard Reznik in Toronto and Debra Da Rosa at Northwestern, as well as Ajit Sachdeva in Chicago at the American College of Surgeons (right next to Northwestern) and Gary Dunnington at Southern Illinois. They have all inspired each other and all worked together on the Surgeons as Educators programme. All were extremely welcoming and all gave me an inspired view of their units.
In Chicago, I spent three hectic days looking at and listening to the scope of the programme. I met the main teachers and the researchers and was allowed to try their simulators, meet their residents and speak to the main players. They have some interesting ideas, they have created an apprenticeship scheme, whereby a trainee is attached to a trainer for a couple of months and does everything with them, this sits alongside the normal programme which fill the rest of the time. I saw a talented trainee at the end of their training being taken through a complex operation (a pancreatectomy), both trainer and trainee filled you with confidence, this was an operation done with tempo and clarity, each step was discussed before execution. The student who was second assistant was expected to know the anatomy and physiology, and did!
I then spent half a day at the American college of surgeons, where they very kindly put on a seminar for me outlining the work that they were doing. They have great energy and address problems with panache.
The University of Toronto had three facilities associated with education, the Wilson Centre primarily concerned with educational research, the Skills lab for surgical skills simulation and the Faculty development unit which was concerned with faculty development. I spent time in all three, and all gave me plenty of ideas of how we might do things. The skills lab was used by first year trainees every week as in SIU and they had a clearly structured programme to follow, with six faculty teaching week by week. The Faculty development unit ran courses for teachers, but in the main had only managed to recruit surgical trainers who were in difficulty. There is a case, as back home, to use development resources for all staff, good and bad. Then I was told about the regular evaluation that went on for the faculty. They were all told how they performed on a regular basis and this was particularly helpful for the struggling trainer. As usual it was not as simple as that, and one of the faculty told me how demotivating it was to receive moderate reviews (you are the 52 most popular trainer!) and we both agreed that feedback needs to be distilled rather than given raw!
Both had rigorous assessment programmes, involving local and national tools. There was several knowledge based tests that all the trainees undertook, there were clinical skills vivas , which were fairly structured. They both used OSCEs (Objective Structured Clinical Examinations) and OSATS (Objective Structured Assessment of Technical Skills).
There was much to admire and plenty to adopt at both places. Thanks to all my hosts for their kindness and concern.
Main points to be considered for use in the Oxford Programme:
Recruit theatre nurses to run surgical skills lab
Recruit nurse educators to help deliver training, for students preparing for surgery and residents.
Have regular surgical skills training, rather than separate courses
Consider part of a trainees training as an apprentice to a particularly good teacher
Develop faculty, encourage sharing of ideas as the best way to teach surgery
Now for Stanford and the University of California San Francisco.
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