Coffee Break Conversations with Surgical Supervisors

Rebecca is an Otolaryngologist based in Wellington New Zealand. She is experienced in surgical education and supervision. She was a supervisor of training for nine years and the Chair of Otolaryngology for New Zealand for 4 years. During this time she became involved in curriculum writing and development. The skills, experience and interest in teaching and assessment prepared Rebecca well to take on the role as Chair of the RACS Professional Skills Curriculum Working Party. During this work she developed a particular interest in today’s topic of Judgement of clinical decision-making.
In this podcast Rebecca provided her insights in response to the following questions:
What is competence in the area of judgment and clinical decision-making?
What do patients and the community expect from surgeons with regard to judgement and decision-making?
Can critical thinking frameworks be helpful?
When might it be challenging to apply the principles of good judgment and clinical decision making?
How to assess whether a trainee or SIMG is competent in judgment and decision making?
How to support trainees and SIMGs develop their skills in this area especially if they are struggling?
To provide feedback, suggest topics for discussion, share ideas or offer to be a guest, please complete the feedback survey or email Catherine Hunt Medical Educator RACS  [email protected].
 
Links to key pages on RACS Website:
Supervisor Support Hub | RACS (surgeons.org)
The Supervisor Framework | RACS (surgeons.org)
RACS Professional Skills Curriculum | RACS (surgeons.org)
The SET program | RACS (surgeons.org)
 
RACS eLearning Course
Human Factors: Decision making.
 
Recommended reading:
Australian Commission On Safety and Quality in Health Care. Shared decision making [Internet]. 2019 [cited 2023 Nov 15]. Available from: www.safetyandquality.gov.au/our-work/partnering-consumers/shared-decision-making
Crebbin, W., Beasley, S., Tobin, S., Guest, G., Duvivier, R., & Watters, D. (2019). Judgement: Clinical decision‐making as a core surgical competency. ANZ Journal of Surgery, 89(6), 760-763. https://doi.org/10.1111/ans.15098
Croskerry, P. (2017). A Model for Clinical Decision-Making in Medicine. Medical Science Educator, Published online: 14 December 2017. https://doi.org/10.1007/s40670-017-0499-9
Hoffmann, T. C., Légaré, F., Simmons, M. B., McNamara, K., McCaffery, K., Trevena, L. J., Hudson, B., Glasziou, P. P., & Del Mar, C. B. (2014). Shared decision making: What do clinicians need to know and why should they bother? Medical Journal of Australia, 201(1), 35-39. https://doi.org/10.5694/mja14.00002
Jenicek, M., Croskerry, P., & Hitchcock, D. L. (2011). Evidence and its uses in health care and research: the role of critical thinking. Medical science monitor: International Medical Journal of Experimental and Clinical Research, 17(1), RA12–RA17. https://doi.org/10.12659/msm.881321
Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S. Y., Noble, D., Norton, C. A., Roche, J., & Hickey, N. (2010). The 'five rights' of clinical reasoning: an educational model to enhance nursing students' ability to identify and manage clinically 'at risk' patients. Nurse education today, 30(6), 515–520. https://doi.org/10.1016/j.nedt.2009.10.020
Little, A. S., & Wu, S. J. (2022). Cognitive bias and neurosurgical decision making. Journal of Neurosurgery, 137(1), 1-312. https://doi.org/10.3171/2021.9.JNS212058
Papp, K. K., Huang, G. C., Lauzon Clabo, L. M., Delva, D., Fischer, M., Konopasek, L., Schwartzstein, R. M., & Gusic, M. (2014). Milestones of critical thinking: A developmental model for medicine and nursing. Academic Medicine, 89(5), 715-720.
https://doi.org/10.1097/ACM.0000000000000220
Richards, J. B., Hayes, M. M., & Schwartzstein, R. M. (2020). Teaching clinical reasoning and critical thinking: From cognitive theory to practical application. Chest, 158(4), 1617-1628. https://doi.org/10.1016/j.chest.2020.05.525
Sharples, J. M., Oxman, A. D., Mahtani, K. R., Chalmers, I., Oliver, S., Collins, K., Austvoll-Dahlgren, A., & Hoffmann, T. (2017). Critical thinking in healthcare and education. BMJ (Online), 357, j2234-j2234. https://doi.org/10.1136/bmj.j2234
Thampy, H., Willert, E., & Ramani, S. (2019). Assessing clinical reasoning: Targeting the higher levels of the pyramid. Journal of General Internal Medicine: JGIM, 34(8), 1631-1636. https://doi.org/10.1007/s11606-019-04953-4
 
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This episode on is the second of a two-part episode on Health Advocacy.
Part 1, with Dr Neill Boustred, focussed on Health Advocacy of the Surgeon – assessing and teaching trainee and Specialist International Medical Graduate (SIMG) surgeons to advocate for the benefit of the recipients of healthcare.
In this second part, Health Advocacy for the Surgeon – the focus is on assessing and teaching trainees and SIMGs to advocate for the wellbeing of the surgical workforce.
Episode guest – Dr Ruth Bollard:
Dr Ruth Bollard is a General Surgeon who has been operating and consulting in Ballarat for over 15 years. Ballarat is a regional Australian setting and is where she provides important surgical services.
Dr Bollard has a clinical interest and expertise in breast cancer and reconstructive surgery. She has more than 20 years of experience in the field of Oncoplastic breast surgery and more than 30 years of experience in general surgery.
Dr Bollard has been an elected councillor of the Royal Australasian College of Surgeons (RACS) since 2016 and has made significant contributions to surgical education and training through numerous roles, committees and working groups.
She currently holds the positions of:
Executive member, RACS Education Committee
Chair, RACS Specialist International Medical Graduate Committee
 Dr Bollard has demonstrated a keen interest in the topic of Health Advocacy as evidenced by her leadership in wellbeing initiatives at RACS including being the:
Current RACS representative on Black Dog Institute Health Professionals Advisory Group
Chair of Intercollegiate Wellbeing working party, (2019 – 2023)
This working party collaborated with medical colleges across Australia and New Zealand to produce the Wellbeing Charter for Doctors
Wellbeing Charter for Doctors in Australia and New Zealand (2021)
Chair of Safe Working Hours Committee RACS, (2018 – 2019)
This committee consulted to develop and publish standards for safe working hours and conditions for surgeons.
RACS Position Paper Standards for Safe Working Hours and Conditions (2019)
 
Key points in this conversation on Health Advocacy:
Promoting and creating an optimal environment for the wellbeing of recipients of healthcare and the providers of healthcare in a sustainable and responsible way is very challenging. There are many competing factors to consider. What is important, is to consider as many factors as possible for the unique circumstances of individuals and try to make choices that support the wellbeing of all concerned.
The wellbeing of our surgeons, trainees and SIMGs and other healthcare providers is critical to providing safe, accessible, sustainable, person-centred healthcare. We need to continue to find ways to adapt to the needs of our doctors so they can continue to provide safe care.
Work needs to continue in line with that already undertaken with such initiatives as those in the RACS Position Paper Standards for Safe Working Hours and Conditions (2019) and the Wellbeing Charter for Doctors in Australia and New Zealand (2021)
Teaching and assessing Health Advocacy can be approached using many different strategies including:
Being a role model - overtly demonstrating and intentionally drawing attention to attitudes and behaviours that promote and support: the wellbeing of users of healthcare and those who provide the care.
sustainability measures including financial, environmental and workforce.

Setting activities that require a trainee or SIMG to apply principles of health advocacy. An example of this is writing a business case for additional resources.
Leading activities that require evaluation of performance in the area of health advocacy, encourage reflection, and support feedback. e.g. the 360-degree feedback process.
Including questions on health advocacy in assessment activities when assessing other areas of competence. E.g exam questions, MiniCEX, case-based assessments, MDT meetings, case presentations and in direct observation of practice.
 
To provide feedback, suggest topics for discussion, share ideas or offer to be a guest, please complete the feedback survey via the following link https://forms.office.com/r/xP3uWrGQ6K or email Catherine Hunt Medical Educator RACS   [email protected]
 
RACS Resources to Support Surgical Supervisors
Supervisor Support Hub | RACS (surgeons.org) 
The Supervisor Framework | RACS (surgeons.org)
RACS Professional Skills Curriculum | RACS (surgeons.org)
RACS Webpage - Surgeon wellbeing
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This episode on Health Advocacy is in 2 parts.
Part 1 focuses on Health Advocacy of the Surgeon – that is how surgeons advocate for the benefit of the recipients of healthcare. How supervisors can teach and assess competence in Health Advocacy. 
Part 2 will be about Health Advocacy for the Surgeon – where we will focus on the wellbeing of the surgeon. 
Guest for part 1 is Dr Neill Boustred, an Australian-based Ear Nose and Throat Surgeon. He completed his post-graduate training in South Africa and Sydney and is a Fellow of the South African and Australian Colleges of Surgery. He is also a member of the Australian and American Societies of Otolaryngologists.
He has Worked in Australia in the North Shore area of NSW since 1997 at Hornsby Hospital and the Sydney Adventist Hospital. He also holds positions at Concord Hospital and Macquarie University Hospital. He is a senior lecturer at Sydney and Macquarie Universities. 
He is the immediate past Chair of the board of Otolaryngology, Head and Neck Surgery for Australia and New Zealand and remains closely involved in the teaching of both postgraduate and undergraduates in Australia and in Southeast Asia.
Questions
In this podcast we discussed Neill’s thoughts on the following:
1. Being competent in the area of Health Advocacy?
2. What patients and the community might expect from surgeons and the provision of healthcare? 
3. Some effective ways to assess whether a trainee or SIMG meets the expected standard of Health Advocacy?
Summary 
Key take-home points from the conversation with Dr Neill Boustred around Health Advocacy in relation to Health Advocacy for the recipients of healthcare were: 
1.    Understand what health advocacy is in relation to the context in which you work. Be it a large tertiary centre or a small community. 
2.    Have genuine care and concern for:
- individual patients, their wants and needs and their communities.  
- the people who work within the system.
- the provision of optimal care for the individual based on the bigger picture for that person – not a treatment modality that is just based on the disease.  Social determinants of healthcare
- sustainability of the healthcare system as a whole. Financial and environmental 
3.    Be a role model for trainees and SIMGs. 
4.    It’s important to dedicate time to focus on how a trainee is performing and progressing. 
5.    You can incorporate teaching and assessing health advocacy in many settings using different assessment methods including:
- Direct observation of practice 
- Case-based discussions 
- MDT / M &M meetings
- Mini CEX
- Essays 
- Exams 
6.    Feedback – honest, timely, regular and give the trainee the opportunity to act on the feedback and improve. 
We look forward to sharing more in Part 2 of Health Advocacy, where we will discuss Health Advocacy for the wellbeing of the surgeon.
To provide feedback, suggest topics for discussion, share ideas or offer to be a guest, please complete the feedback survey via the following link https://forms.office.com/r/xP3uWrGQ6K or email Catherine Hunt Medical Educator RACS  [email protected]
Supervisor Support Hub | RACS (surgeons.org)
RACS Professional Skills Curriculum | RACS (surgeons.org)
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In this first episode, we identify key issues for effective clinical supervision. They include genuine care and concern for the trainee, knowledge of the curriculum, giving regular and honest feedback, and being familiar with the resources available.
RACS Medical Educator and host of Coffee Break Catherine Hunt speaks with:
RACS Principal Educator and Head of Education Services, Debbie Paltridge
RACS 2022 supervisors of the year for NSW, Associate Professor Sarah Aitken
 
MORE INFORMATION
Supervisor Support Hub 
https://www.surgeons.org/Fellows/for-educators-trainers/Supervisor-Support-Hub
The Supervisor Framework 
https://www.surgeons.org/Fellows/for-educators-trainers/Supervisor-Support-Hub/The-Supervisor-Framework
RACS Professional Skills Curriculum 
https://www.surgeons.org/Resources/reports-guidelines-publications/useful-guides-standards/RACS-Professional-Skills-Curriculum
 
Surgical Education and Training (SET) policies:
The SET program 
https://www.surgeons.org/Trainees/the-set-program
AMEE – An International Association for Health Professionals Education 
https://amee.org/home
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