Private sector surgical training: feasibility through the lens of appendicectomy

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Traditionally, training in medicine and surgery has been a public hospital responsibility in Australia and other Commonwealth countries.1 In 2013–2014, 61% of surgical procedures were performed in private hospitals, a statistic that has been stable over the past 10 years.2 It has been recognized previously by the Royal Australasian College of Surgeons (RACS) and the Australian Government that training can and should occur in the private sector, although this does challenge pre‐existing notions of specialist training in Australia; namely, that training is a public sector responsibility only.3
Although the private sector cannot completely replace the public sector for training in the foreseeable future, there is considerable interest to use the private sector to meet the growing demand for training opportunities as well as increasing the scope of training. Already, there are numerous training positions in the private sector. Little has been published on the experience of training registrars in this environment. Watters et al.1 previously described two such surgical training positions at Geelong Hospital, where each training position had both public and private hospital exposure. However, it did not provide a breakdown of whether cases were done in the private or public hospitals, and it must be presumed that most of the operating experience was gained in the public system.
One of the major concerns with training in the private sector is the perception of patients on the quality of care. Koirala et al.5 found that vast majority of private patients (86.7%) were happy to personally participate in operative training of registrars although did not specify what kind of involvement that was. In agreement with this, Wong et al.6 wrote that with full supervision of the trainee by the consultant, 75% of patients were happy for a trainee to perform a significant part of the operation. Interestingly, 50% of patients were happy for a trainee to perform most of the surgery, whereas 41% were happy for them to perform the entire operation.
In Australia, surgical education and training (SET) has been a 5–6 years program, with immediate entry into one of the nine surgical specialities. Epworth Hospital, Melbourne, Australia is a tertiary‐level private hospital with a history of training and a commitment to the training of future generations of medical practitioners. Annually, it has nearly 47 000 admissions (26 000 through the emergency department), 21 operating theatres and 1200 visiting specialists. There is a Department of Surgery through the University of Melbourne, as well as designated supervisor of training who is a current visiting general surgeon. Training registrars come from a diverse array of specialities including general surgery, orthopaedics, obstetrics & gynaecology, as well as internal medicine trainees such as oncology and general medicine.
During the timeframe of this study, there was one unaccredited and two accredited SET 1 general surgical registrars present. This study looks to examine the training experience of registrars in a completely private hospital setting using appendicectomy. Appendicectomy is seen as a rite of passage for surgical trainees. Many of the skills learnt in this procedure can be applied to more complex cases. Furthermore, it is often the first intra‐peritoneal operation that trainees are allowed to complete unassisted in the public hospital system. Through this prism, we are hoping to evaluate the feasibility of training in the private sector.
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