One of the many external duties for the president is representing our College at national and international surgical meetings. There is also opportunity to attend conferment ceremonies for Australasian vocational programs. I’ve had the pleasure to do both recently having attended RACMA’s conferment last weekend and the American College of Surgeons ASC the week prior.  These were valuable opportunities to strengthen our relationships and reflect on the role of surgical colleges in a changing environment.

I was particularly struck by the respect in which RACS is held internationally, and by how many of the challenges facing RACS are impacting other Colleges worldwide. Colleges everywhere are working to demonstrate their value to members and to respond to society’s changing expectations of the profession.

But the visit also reinforced something important, and I believe unique to RACS. Our role spans the full pathway into the profession and beyond: from selection, the provision of training, running examinations, through to standard setting of Fellowship. Furthermore, RACS is pivotal to post Fellowship professional development and seeks to provide enduring membership value while advocating on issues pertaining to our core business. Internationally, these functions are   fragmented across different bodies. While each country makes the best of the system it has, I came away with an even greater appreciation of the strength of the integrated, College-led model in Australasia. These components of training and standards are delivered in partnership with our training societies as a training network, and it speaks to the strength we collectively provide.

What we have as a College is distinctive and worth preserving. But preserving it does not mean standing still. As RACS approaches its centenary, the most obvious comment would be the next 100 years will be different. I suspect this pertains to many aspects of our practice including education. The challenge will be continually demonstrating our value as surgeons: to surgeons, to patients and to our communities.

We have much to be proud of, but we cannot afford to rest on our laurels, address our shortcomings and adapt to changing needs.

The good news is that we are making progress. The Surgical Pathways Strategy, launched earlier this year, is one example of how we are working to preserve the strengths of our system while improving the parts that need to change. Communities need timely access to surgical care, wherever they live. Yet despite a substantial supply of locally trained doctors, shortages persist in some specialties and locations. We have a responsibility to examine how our own selection and training processes can better support the workforce the community needs, recognising that to achieve this we will need health services and jurisdictions to take responsibility for components integral to success and beyond our control.

The strategy is now moving into its project phase. Targeted areas include hospital training site accreditation, how training complaints are managed within RACS, the monitoring and evaluation framework of training plus reviewing our College wide cultural preparedness.  At a recent training network meetings there were papers and preliminary discussions reflecting on unintended consequences of research requirements on selection and training processes. 

Research is important to surgical practice, but there is no single RACS-wide research requirement for entry to surgical training. A recent comparison of selection practices across specialties and countries raises questions about the emphasis placed on research output, and particularly where publication numbers and other quantitative measures heavily influence selection.

A unified approach that places greater weight on research capability, rather than simply research productivity, would reduce the duration of preparation for training, the costs associated, and potentially the specificity of research to a particular training program. This could break down barriers for applicants who have fewer opportunities to undertake research. This matters for equity, including for doctors working in rural and regional settings or hospitals without dedicated research departments. Other considerations are how Trainee lead networks or consortia could facilitate this process. We should consider how to recognise potential as well as achievement.

The outcomes of these discussions are still to be determined, but there is agreement across the College and specialty society representatives that the process is imperfect. If we want to retain a surgeon-led approach to selection and training, we must ensure our processes remain fit for purpose and do not create unnecessary barriers.

These are complex issues, and there are no simple solutions. But progress has to be made, and I’m encouraged by the shared commitment across the College and specialty societies to address this. By being willing to evolve, we can preserve what makes RACS and our unique surgical training network distinctive, while ensuring they continue to serve our profession, patients and communities into our next century and beyond.

Warm regards

Dr Phil Morreau
President