Nine RACS Competencies

The College aims to facilitate safe, comprehensive surgical care of the highest standard to the communities we serve. To meet this standard, College training and development programs aspire to certify specialist surgeons with the following competencies:

Collaboration and Teamwork
Communication
Health advocacy 
Judgement - clinical decision making 
Management and Leadership 
Medical expertise 
Professionalism and Ethics
Scholarship and Teaching
Technical expertise 

Becoming a competent and proficient surgeon - Training Standards for the Nine RACS Competencies

The Training Standards framework provides a guide for trainees, international medical graduates(IMGs), supervisors, interviewers and others about stages of performance that have been attained, or are required, in each of the nine RACS competencies.

Each specialty and training board may decide how to use this resource to advise and assist trainees and supervisors. Specialties may also revise the vignettes that illustrate each competence to make them more specific to their own specialty requirements.

Collaboration and Teamwork

Work in collaboration with members of interdisciplinary teams where appropriate

• Collaborate with other professionals in the selection and use of various types of treatments assessing and weighing the indications and contraindications associated with each type.
• Effectively work with other health professionals to minimise interprofessional conflict and maximise patient care
• Demonstrate a respectful attitude towards other colleagues and members of interprofessional teams
• Develop a care plan for a patient in collaboration with members of an interdisciplinary team
• Recognise the need to refer patients to other professionals
• Initiate the resolution of misunderstandings or disputes

 

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Communication 

Develop rapport, trust and ethical therapeutic relationships with patients and families

• Establish positive therapeutic relationships with patients and their families
• Respect patients confidentiality, privacy and autonomy
• Respect patient diversity and difference (including gender, age, religion, culture, ...

Accurately elicit and synthesise relevant information from patients, families, colleagues and other professionals

• Gather information about a health condition and also about a patient's beliefs, concerns, expectations and illness experience
• Identify when a patient is likely to interpret information as bad news and adjust their communication accordingly

Accurately convey relevant information and explanations to patients and families, colleagues and other professionals

• Communicate information to patients (and their family) about procedures, potentialities, and risks associated with surgery in ways that encourage their participation in informed decision making
• Communicate with the patient (and their family) the treatment options, potentials, complications, and risks associated with the use of drugs
• Appropriately adjust the way they communicate with patients to accommodate cultural and linguistic differences

Develop a common understanding (with patients, families, colleagues and other professionals) on issues, problems and plans

• Discuss relevant information with patients (and their family) in ways that encourage their participation in informed decision making
• Encourage patients to discuss and question
• Effectively identify and explore problems to be addressed from a patient encounter

 

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Health advocacy 

Respond to individual patient health needs

• Identify the health needs of an individual patient

Promote health maintenance of patients

• Advise patients (and their families) on ways to maintain and/or improve their health

Respond to the health needs of the community

• Describe the health needs in the practice communities that they serve
• Identify opportunities for advocacy and health promotion and respond appropriately
• Identify the determinants of health in the populations including barriers to access to care and resources• Identify vulnerable or marginalised populations and respond appropriately

Promote health maintenance of colleagues

• Describe the ethical and professional issues inherent to working in teams

Look after their own health

• Take responsibility to ensure that when they are on duty, or on call, that they are at optimal level of performance

Advocate for improvements in health care

• Identify points of influence in the health care system and its structures
• Describe the role of the medical profession in advocating collectively for health and patient safety
• Advocate for improved resources in the environment where they are employed 

 

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Judgement - clinical decision making 

Provide compassionate patient-centred care

• Recognise the symptoms of, accurately diagnose, and manage common problems in their area of expertise
• Manage patients in ways that demonstrate sensitivity to their physical, social, cultural, and psychological needs
• Use preventative and therapeutic interventions effectively
• Recognise the most common disorders and differentiate those amenable to surgical treatment
• Effectively manage the care of patients with severe and acute trauma including multiple system trauma
• Manage the critically ill patient
• Manage complexity and uncertainty
• Effectively manage complications
• Plan, and where necessary implement, a risk management plan

Perform a complete and appropriate assessment of a patient

• Take a history, perform an examination, and arrive at a well-reasoned diagnosis
• Efficiently and effectively examine the patient

Organise diagnostic testing, imaging and consultation as appropriate

• Select medically appropriate investigative tools and monitoring techniques in a cost-effective, and useful manner
• Appraise and interpret radiographic investigations against patient's needs including
• • plain radiographs
  • ultrasound
  • angiography
  • CT
  • MRI
• Critically evaluate the advantages and disadvantages of different investigative modalities

 

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Management and leadership 

Allocate finite healthcare resources appropriately

• Effectively use resources to balance patient care and systemic demands
• Identify and differentiate between systemic demands and patient needs
• Apply a wide range of information to prioritise needs and demands

Manage and lead clinical teams

• Is respectful of the different kinds of knowledge and expertise which contribute to the effective functioning of a clinical team
• Communicate with and co-ordinate surgical teams to achieve an optimal surgical environment

Manage their practice and career effectively

• Use time management skills appropriately
• Maintain accurate and up-to-date patient records

Serve in administration and leadership roles, as appropriate

• Plan relevant elements of health care delivery (work schedules, …)
• Chair or participate effectively in committees, meetings, etc

 

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Medical expertise 

Establish and maintain clinical knowledge, skills and attitudes appropriate to their practice 

Basic Sciences

• anatomy
• biology
• pathology, particularly oncology
• immunology
• microbiology and antibiotics
• pharmacology
• physiology
• genetics, particularly neonatal

Pre-operative, intra-operative, and post-operative care and assessment in particular

• DVT prophylaxis
• Fluid and electrolytes
• Wound care
• Haemastasis

Apply clinical knowledge in practice to recognise and solve real-life problems in particular, the treatment of pain

• pathophysiology
• psychosocial
• analgesics
• pain relief

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Professionalism and Ethics

Demonstrate a commitment to their patients, profession, and community through ethical practice

• Consistently apply ethical principles
• Recognise and respond appropriately to ethical issues encountered in practice
• Acknowledge their own limitations
• Is accountable for their own decisions and actions
• Maintain appropriate relations with patients
• Manage patients in a culturally appropriate manner

Recognise medico-legal issues

• Identify ethical expectations that impinge on the most common medico-legal issues
• Recognise the principles and limits of patient confidentiality
• Apply appropriate national / state regulations

Demonstrate a commitment to their patients, profession, and community through participation in profession-led regulation

• Employ a critically reflective approach to their practice
• Acknowledge and learn from mistakes
• Participate in peer review

Manage medical indemnity and risk

• Appropriately manage conflicts of interest
• Explain the standards of informed consent
• Summarise key issues in relation to professional liability and negligence

 

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Scholarship and Teacher

Assume responsibility for their own ongoing learning

• Access and interpret relevant evidence
• Integrate new learning into practice
• Document and evaluate any change in practice

Critically evaluate medical information and its sources, and apply appropriately to practice decisions

• Draw on different kinds of knowledge in order to weigh up patients' problems in terms of context, issues, needs and consequences
• Describe the principles of critical appraisal
• Critically appraise new trends in surgery

Facilitate the learning of patients, families, trainees, other health professionals, and the community

• Collaboratively identify the learning needs and desired learning outcomes of others
• Describe principles of learning relevant to medical education
• Develop teaching skills and facilitate medical student learning
• Provide effective feedback

Contribute to the development, dissemination, application, and translation of new medical knowledge and practices

• Select and apply appropriate methods to address a research question
• Describe the principles of research ethics
• Conduct a systematic search for evidence

 

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Technical expertise 

Safely and effectively perform appropriate surgical procedures

• Consistently demonstrate sound surgical skills
• Demonstrate procedural knowledge and technical skill at a level appropriate to their level of experience
• Demonstrate manual dexterity required to carry out procedures
• Adapt their skills in the context of each patient-each procedure
• Maintain skills and learn new skills
• Approach and carry out procedures with due attention to safety of patient, self, and others
• Analyse their own clinical performance for continuous improvement

 

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Domains

These competencies will be demonstrated through clinical skills, patient care and professional judgement across five domains:

• Cognitive - Acquisition and use of knowledge to recognise and solve real-life problems.
• Integrative - Appraisal of investigative data against patient needs in clinical reasoning, manage complexity and uncertainty, application of scientific knowledge in practice,
• Psychomotor - Procedural knowledge, technical skill, manual dexterity, and adaptability.
• Relational - The ability to communicate effectively, accountability, works with others, consultative, resolving.
• Affective/moral - Self-awareness, ethical, critically reflective, responsible, healthy, safe.