Author: Dr Nick McIntosh

I was deeply honoured to be awarded the Jenepher Martin Surgical Education Research prize at the 94th RACS Annual Scientific Conference. I would like to thank the Academy of Surgical Educators, Associate Professor Jenepher Martin and Drs Josh Salim and Emma Downie for giving me the opportunity to present on the topic of Scholarship in Surgical Training. 

As a final-year post-examination General Surgery Trainee from Aotearoa New Zealand, I have been reflecting on the past five years of training. Through this reflection I have become increasingly aware of dissatisfaction among both Trainees and surgeons regarding how the research process is currently incorporated into training.

Scholarship and Teaching is a vital core competency for a well-rounded surgeon. However, the historical mechanism for assessing this has been tied to traditional academic outputs: obtaining higher degrees and named authorships. Creation, dissemination, application, and translation of medical knowledge are the essential pillars of modern scholarship. However, two critical questions remain: does the mandatory production of traditional academic outputs truly demonstrate scholarly mastery and, more importantly, is it the only way to achieve it? 

This project, Mandatory research during specialty training: Opportunities for parallel frameworks, undertook a thematic analysis of global literature from which three recurring issues emerged, each highly relevant to Australasian surgical training.

Integration strain: an increasing, ageing population is escalating demands on an already stretched healthcare systems in both Australia and Aotearoa New Zealand. As clinical time becomes a scarce resource, it is increasingly untenable to integrate formal research into daily duties. The alternative—dedicated research—removes clinicians from clinical duties entirely. In an evolving healthcare system, the long-term sustainability of the current model becomes uncertain. 

Resource inequity: Affiliation to a university and access to academic resources are unevenly distributed between tertiary, regional and rural hospitals. The rotational nature of surgical training is vital for breadth of experience but is detrimental to long-term or large-scale research projects. The current system inadvertently disadvantages and disincentivises Trainees from working in less-resourced communities.

Output incongruence: Fixed timelines and mandatory requirements result in short-term projects aimed solely at clearing an administrative hurdle rather than fostering the lifelong skills required to advance clinical safety and healthcare leadership. The scholarly skills learned during training should reflect the scholarly demands they will face in practice.  

Throughout my training, I have been mentored by a diverse range of surgeons. While some surgeons pursue rewarding academic careers, others maintain practices that are exclusively clinical. This diversity is a strength of our College. A flexible training framework should encourage and support academic Trainees to undertake high-quality research and higher degrees. At the same time, it should focus on practical scholarly skills for clinically-inclined Trainees such as audit, quality improvement and literature review—skills that will underpin their lifelong practice.

In 2022, RACS General Surgery Education and Training successfully mapped technical procedures and non-technical skills into structured, modular steps through the use of Procedural Based Activity and Entrustable Professional Activity assessments. This format has been applied to Trainees for five years now and covers a wide range of skills—from clinical leadership, to breaking bad news, to thyroidectomies. 

As a College, we have a unique opportunity to map scholarship and teaching to a parallel framework. If we define the scholarly skills, we want our surgeons to possess, we can integrate them into training through structured, modular assessments. This could overcome clinical constraints and rotational inequities while ensuring our Trainees convocate as reflective consultants ready to meet the scholarly needs of their community—academic or clinical, tertiary or rural.