704
Other surgical jurisdictions are facing up to this challenge. The four UK surgical colleges lay out the core competencies required of all trainees, those aligned to all four colleges and all surgical specialties, in their conjoint Intercollegiate Surgical Curriculum.8 The formulation of such a curriculum required collaboration between colleges, regional training organizations (Deaneries) and specialist bodies. Details of the research knowledge and skills trainees are required to attain and the methods by which these will be assessed are clearly described (Table 1). Responsibility for the delivery of training is devolved to local Deaneries.9 Surgery and surgical training in Australia and New Zealand is at a crossroads. Failure to address this specific short-fall in surgical training will have serious consequences to the standing of surgery in the scientific community, and will mean that surgeons will not be equipped to actively participate in the acquisition and application of scientific advances. Those fellows and trainees who did respond to the survey have made a very clear statement about the importance of developing a curriculum to ensure that all trainees acquire key research knowledge and skills; whether this view is representative of all fellows and trainees cannot be determined if they are not surveyed. And while a referendum may not be required, there does need to be informed debate about the research knowledge and skills that are necessary for surgeons to participate in the advance of surgery and surgical care. References 1. Debas HT, Bass BL, Brennan MF et al. American Surgical Association Blue Ribbon Committee Report on Surgical Education. Ann. Surg. 2005; 241: 1–8. 2. Specialist Education Accreditation Committee. Standards for Assessment and Accreditation of Specialist Medical Education Programs and Profes-
Perspectives
3. 4. 5. 6.
7. 8.
9.
sional Development Programs by the Australian Medical Council 2010. Kingston, ACT: Australian Medical Council Limited, 2010. Medical Council of New Zealand. Good Medical Practice, a Guide for Doctors. Wellington, NZ: Medical Council of New Zealand, 2008. Dienstag JL. Relevance and rigor in premedical education. N. Engl. J. Med. 2008; 359: 221–4. Collins JP, Gough IR, Civil ID, Stitz RW. A new surgical education and training programme. ANZ J. Surg. 2007; 77: 497–501. Royal Australasian College of Surgeons. Surgical Education and Training (SET). 2013. [updated 2011; Cited 12 Mar 2013.] Available from URL: http://www.surgeons.org/becoming-a-surgeon/surgical-educationtraining.aspx Windsor J. Shifting the curve, promoting surgical research in training. Surgical News 2011; 12: 2. The Intercolliegiate Surgical Curriculum. Core Surgical Training Syllabus 2010. [PDF on Internet]. 2010. [updated August 2010; Cited 11 Mar 2013.] Available from URL: https://www.iscp.ac.uk/documents/ syllabus_CORE_2010.pdf The Intercolliegiate Surgical Curriculum. Professional Behaviour and Leadership Syllabus 2010. [PDF on Internet]. 2010. [updated August 2010; Cited 11 Mar 2013.] Available from URL: https://www.iscp.ac.uk/ static/public/ProfessionalBehaviourAndLeadership2010.pdf
Deborah M. Wright,* BMedSc, MBChB Nicholas J. Evennett,† MD, FRACS John A. Windsor,*‡ MD, FRACS *Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, †Department of General Surgery, Auckland City Hospital, Auckland, New Zealand, and ‡Section of Academic Surgery, Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia doi: 10.1111/ans.12243
Checklists are not only for the operating room Well-conducted double-blind randomized controlled trials (RCTs) have long been regarded as providing the gold standard level of evidence within medicine. However, in the field of surgery, these are often difficult to perform, and even when performed are often criticized for their methodological flaws or that they lack real world application. Methodologically flawed studies can result in significant bias and lead to incorrect and misleading conclusions. Over the last decade, surgeons will have witnessed a rise in the frequency of meta-analyses and systemic reviews within surgical journals. When done well, many surgeons would regard that these types of study provide one of the highest levels of evidence on which to base patient care. Yet, they too suffer from the same methodological foibles as RCTs. So, how does the researcher perform a robust RCT, meta-analysis or systematic review and how does a reviewer or reader of the research identify the good from the bad? The aim of this perspective is to highlight two methodological checklists that are available on the internet to help both parties when designing or interpreting these potential gold standards of surgical research.
CONSORT is an acronym for CONsolidated Standards Of Reporting Trials. It was developed in the 1990s by a group of interested parties (CONSORT study group) who had noted that in the 1970–1980s many of the published randomized trials lacked transparent methodological rigor. It was estimated that blinding was reported in only 30% of trials from major journals, primary end points were described in 27%, sample size was provided in only 43% of negative trials and
Other surgical jurisdictions are facing up to this challenge. The four UK surgical colleges lay out the core competencies required of all trainees, those aligned to all four colleges and all surgical specialties, in their conjoint Intercollegiate Surgical Curriculum.8 The formulation of such a curriculum required collaboration between colleges, regional training organizations (Deaneries) and specialist bodies. Details of the research knowledge and skills trainees are required to attain and the methods by which these will be assessed are clearly described (Table 1). Responsibility for the delivery of training is devolved to local Deaneries.9 Surgery and surgical training in Australia and New Zealand is at a crossroads. Failure to address this specific short-fall in surgical training will have serious consequences to the standing of surgery in the scientific community, and will mean that surgeons will not be equipped to actively participate in the acquisition and application of scientific advances. Those fellows and trainees who did respond to the survey have made a very clear statement about the importance of developing a curriculum to ensure that all trainees acquire key research knowledge and skills; whether this view is representative of all fellows and trainees cannot be determined if they are not surveyed. And while a referendum may not be required, there does need to be informed debate about the research knowledge and skills that are necessary for surgeons to participate in the advance of surgery and surgical care. References 1. Debas HT, Bass BL, Brennan MF et al. American Surgical Association Blue Ribbon Committee Report on Surgical Education. Ann. Surg. 2005; 241: 1–8. 2. Specialist Education Accreditation Committee. Standards for Assessment and Accreditation of Specialist Medical Education Programs and Profes-
Perspectives
3. 4. 5. 6.
7. 8.
9.
sional Development Programs by the Australian Medical Council 2010. Kingston, ACT: Australian Medical Council Limited, 2010. Medical Council of New Zealand. Good Medical Practice, a Guide for Doctors. Wellington, NZ: Medical Council of New Zealand, 2008. Dienstag JL. Relevance and rigor in premedical education. N. Engl. J. Med. 2008; 359: 221–4. Collins JP, Gough IR, Civil ID, Stitz RW. A new surgical education and training programme. ANZ J. Surg. 2007; 77: 497–501. Royal Australasian College of Surgeons. Surgical Education and Training (SET). 2013. [updated 2011; Cited 12 Mar 2013.] Available from URL: http://www.surgeons.org/becoming-a-surgeon/surgical-educationtraining.aspx Windsor J. Shifting the curve, promoting surgical research in training. Surgical News 2011; 12: 2. The Intercolliegiate Surgical Curriculum. Core Surgical Training Syllabus 2010. [PDF on Internet]. 2010. [updated August 2010; Cited 11 Mar 2013.] Available from URL: https://www.iscp.ac.uk/documents/ syllabus_CORE_2010.pdf The Intercolliegiate Surgical Curriculum. Professional Behaviour and Leadership Syllabus 2010. [PDF on Internet]. 2010. [updated August 2010; Cited 11 Mar 2013.] Available from URL: https://www.iscp.ac.uk/ static/public/ProfessionalBehaviourAndLeadership2010.pdf
Deborah M. Wright,* BMedSc, MBChB Nicholas J. Evennett,† MD, FRACS John A. Windsor,*‡ MD, FRACS *Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, †Department of General Surgery, Auckland City Hospital, Auckland, New Zealand, and ‡Section of Academic Surgery, Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia doi: 10.1111/ans.12243
Checklists are not only for the operating room Well-conducted double-blind randomized controlled trials (RCTs) have long been regarded as providing the gold standard level of evidence within medicine. However, in the field of surgery, these are often difficult to perform, and even when performed are often criticized for their methodological flaws or that they lack real world application. Methodologically flawed studies can result in significant bias and lead to incorrect and misleading conclusions. Over the last decade, surgeons will have witnessed a rise in the frequency of meta-analyses and systemic reviews within surgical journals. When done well, many surgeons would regard that these types of study provide one of the highest levels of evidence on which to base patient care. Yet, they too suffer from the same methodological foibles as RCTs. So, how does the researcher perform a robust RCT, meta-analysis or systematic review and how does a reviewer or reader of the research identify the good from the bad? The aim of this perspective is to highlight two methodological checklists that are available on the internet to help both parties when designing or interpreting these potential gold standards of surgical research.
CONSORT is an acronym for CONsolidated Standards Of Reporting Trials. It was developed in the 1990s by a group of interested parties (CONSORT study group) who had noted that in the 1970–1980s many of the published randomized trials lacked transparent methodological rigor. It was estimated that blinding was reported in only 30% of trials from major journals, primary end points were described in 27%, sample size was provided in only 43% of negative trials and
