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

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. Welsh Training -
Some Key Differences
•No Lapco
•Limited WAG funding for National Training Programme
Some Similarities
•Funding from industry
– Courses
– Animal lab
– Preceptorship

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. WAG Funding–National Prog.
Programme for Consultants
• Very limited training
• A few immersion courses
• No structured masterclass or outreach programme

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

7. PCH contributions: Training in
Laparoscopic Colorectal Surgery
• In house -
– 2 Consultants
– 4 Middle Grades (2 on-going)
– Several SpRs
• External -
– Structured Preceptorship Programme

8. 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

9. 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

10. 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

11. 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)

12. Structured Preceptorship Programme
provides
Facilitation & Support
NOT
Assessment of Competence/ Accreditation
Different from Lapco

13. Programme Evaluation
• Prospective data collection during programme
• Evaluation based on Interviews with the
preceptee surgeons - questionnaire .

14. 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

15. 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

16. 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!

17. Welsh Training in LCS….
• 2 day Course - live-linked operations
– since 2010
– At PCH
– Well subscribed Consultants/ SpRs
– Very positive feedback

19. 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)