Laparoscopic Colorectal Training in Wales- Prof Haray

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Presentation given by Prof Haray at the Dukes' Club AGM 2012

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Laparoscopic Colorectal Training in Wales- Prof Haray

  1. 1. LAP COLORECTAL SURGERY TRAINING IN WALES P.N. Haray Consultant Colorectal Surgeon, Prince Charles Hospital, Merthyr Tydfil External Professor of Coloproctology, University of Glamorgan Wales
  2. 2. Welsh Training - Some Key Differences•No Lapco•Limited WAG funding for National Training Programme Some Similarities•Funding from industry – Courses – Animal lab – Preceptorship
  3. 3. WAG Funding–National Prog.• 50% of initial funding - Integrated Operating theatre!!! Yet to be built 4 yrs later! Programme for SpRs –Structured R & L resection courses –?Opportunity to attend sessions with faculty –Limited by trainer availability and trainee enthusiasm –No structured rotations from training committee
  4. 4. WAG Funding–National Prog. Programme for Consultants• Very limited training• A few immersion courses• No structured masterclass or outreach programme
  5. 5. Industry Support SpRs / Consultants:• Courses• Animal workshop (either Paris OR Hamburg)• Consultants: Structured training programme delivered through the colorectal department at Prince Charles Hospital
  6. 6. PCH contributions: Training inLaparoscopic Colorectal Surgery• In house - – 2 Consultants – 4 Middle Grades (2 on-going) – Several SpRs• External - – Structured Preceptorship Programme
  7. 7. Structured Preceptorship Programme Pre-requisites:• Preceptee should be a trained colorectal surgeon (consultant) with laparoscopic skills• Should have attended lab & animal workshops• Demonstrable support from Hospital management to develop LCS• Honorary contract to Preceptor
  8. 8. Structured Preceptorship Programme 1st Stage - ‘Masterclass’ • At Prince Charles Hospital • Attended by preceptee with team (surgical asst/ anaesthetist/ theatre staff ) • 2 to 3 resections, non-training list, fully interactive
  9. 9. Structured Preceptorship Programme 2nd Stage - ‘Outreach’• At Preceptee’s hospital• Two cases/day, list performed by preceptee, with support – (tapered approach scrubbed up - verbal support only) – Procedures broken down… The Step wise approach• Patient safety/ duration of procedure etc. kept under control by Preceptor
  10. 10. Why Outreach Preceptorship?• Training provided in trainee’s environment• Setting up a new service needs ‘team training’• Initial visit by Preceptor + Theatre Sister & Middle Grade surgeon from PCH• Clinical governance/post op with Preceptee• No. of visits (& cases) dependent on individual preceptee’s progress (bespoke training)
  11. 11. Structured Preceptorship Programme provides Facilitation & Support NOT Assessment of Competence/ Accreditation Different from Lapco
  12. 12. Programme Evaluation• Prospective data collection during programme• Evaluation based on Interviews with the preceptee surgeons - questionnaire .
  13. 13. Results - Summary• No. of consultants preceptored – 13 ( 3 still in programme)• No. of Hospitals covered -7• No. of Master classes - 27• No. of outreach visits - 45
  14. 14. Results - Summary• Median No. of visits 3• Median No. of cases 6• No. of Conversions 1• Major intra operative events 0• Major morbidity 2 ( delayed anastomotic leak,)• 30 day Mortality- 1• No. of procedures performed by preceptees after programme 3 – 100+Overall satisfaction by preceptees & Teams 100% Data presented: WSS
  15. 15. Structured Preceptorship Programme• Preliminary evaluation - very encouraging• One to one coaching at the point of service development & delivery is being welcomed.• Challenging task…. but very rewarding!
  16. 16. Welsh Training in LCS….• 2 day Course - live-linked operations – since 2010 – At PCH – Well subscribed Consultants/ SpRs – Very positive feedback
  17. 17. Welsh Training in LCS….• Training DVD (Ethicon® + Storz®) – The Stepwise Approach for LCS – Interactive – All Standard Resections – Tips Tricks & Potential Hazards• Trainer DVD – Training the Trainers in LCS (In production)

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