LAUSR

The 10 core competencies from the Royal Australasian College of Surgeons (RACS) outline key attributes required to be a safe and competent surgeon. The core competencies feature in all aspects of the practice of surgery, from surgical selection and training, through to continuing professional development. While ‘Scholar and Teacher’ is one named competency, all 10 competencies are attained through teaching, training and modelling. Within that context, it is important to consider the framework surgeons and registrars use to teach these competencies. When teaching, what educational principles do surgeons believe, intend to follow, and put into action? In an era focusing on the need to ‘Operate with Respect’, how well can these teaching perspectives affect positive cultural change in the workplace? While the perspectives of surgeons when teaching is critical to their educational practices, surgical educational literature focuses predominantly on curriculum development and trainee-based outcomes. Capturing surgeons’ perspectives will provide insight into how the core competencies are taught and practiced. With this in mind, and following institutional ethics approval, we undertook a study to assess the teaching perspectives of surgeons and registrars in our department. We assessed this using the Teaching Perspectives Inventory (TPI; www.teachingperspectives.com/tpi/). This tool has been validated extensively and applied to inform educational practices in medicine and surgery. The TPI assesses an individual’s beliefs, intentions and actions as they relate to five perspectives – Transmission, Apprenticeship, Development, Nurturing and Social Reform (Table 1). The TPI is intended as a tool to ‘promote reflection, discussion, clarification, and, most important, respect for the intellectual, relational, moral, and cultural aspects that are essential to understanding what it means to teach’. There is a theoretical minimum score of 9 and a maximum score of 45. The value of each perspective is subjective, may differ between contexts and depends on what the teacher wants to achieve through their teaching. However, there is no one desirable domain and all domains can be simultaneously utilized. The interpretation of the TPI is based on observation of differences in scores. In practice, differences in scores indicate that teachers engage significantly less with teaching practices in one domain when compared to teaching practices that are reflective of the comparison domain. The interpretation of the TPI is based on observation of differences in scores. In practice differences in scores indicate that teachers engage significantly less with teaching practices in one domain when compared with teaching practices that are reflective of the comparison domain. Surgeons and registrars within the Department of General Surgery at a tertiary teaching hospital were invited to complete the TPI, with 32 responses returned (surgeons n = 12, registrars n = 20; female n = 18, male = 14, response rate 47%). Surgeons and registrars overall exhibited the same pattern in how they perceived their beliefs, intentions and actions when teaching (Fig. 1). The domain used the most when teaching was Apprenticeship, while the domain used the least was social reform. The difference in scores between Apprenticeship and Social Reform domains was statistically significant (median 36 vs. 25, P < 0.001) as assessed using standard two-tailed non-parametric tests. There was no statistically significant difference between responses from surgeons and registrars across the domains. These findings provide unique insight into the teaching perspectives of surgeons and registrars who do not necessarily have formal roles or training as surgical educators. The apprenticeship model of surgical education has a strong and long-standing heritage. Its modern roots are often attributed to Halstead, although surgical practices have occurred throughout the ages in all cultures and surgical skills and knowledge handed down through informal apprenticeships. More recently, research into surgical education has gradually shifted towards competency and simulation-based strategies, although these can still function within an apprenticeship framework. However, there is some evidence that access to apprenticeship style education is becoming limited with changes in working hours and clinical exposure. Despite this, Apprenticeship remains the dominant domain for both registrars and consultants, likely reflecting the prevailing educational philosophy in surgery. Given that the members of the department have trained in many hospitals in the region and internationally, it is plausible a dominance of Apprenticeship and subordination of Social Reform would be found in surgical departments across Australia and New Zealand. This finding of dominance of the apprenticeship domain, while