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8. Developing a curriculum for advanced fellowship training in complex cancer for the UK.

Author

Mohan, Helen, Harji, Deena, Drami, Ioanna, Griffiths, Ben, Larkins, Kirsten, Boyle, Kirsten, Daniels, Ian R., Baker, Richard, Jenkins, John T., Evans, Martyn, Burns, Elaine, Sutton, Paul, Simpson, Alastair, Mirnezami, Alex, Parkin, Edward, Kapur, Sandeep, Coyne, Peter, Harris, Dean, Tiernan, Jim, and Stearns, Adam

Subjects
CAREER development, PELVIC exenteration, EDUCATIONAL planning, LITERATURE reviews, CURRICULUM frameworks
Abstract

Aim: Surgery for complex colorectal cancer is elaborate: preoperative assessment, patient selection, radiological interpretation, operative strategy, operative technical skills, operative standardization, postoperative care and management of complications are all critical components. Given this complexity, training that encompasses all these crucial aspects to generate suitably edified surgeons is essential. To date, no curriculum exists to guide training in advanced and recurrent pelvic malignancy, particularly for complex colorectal cancer. Such a curriculum would potentially offer numerous advantages, not only for individual surgeons but also for research, governance, international collaboration and benchmarking. The aim of this study was to design and develop a framework for a curriculum for fellowship training in complex colorectal cancer that encompasses pelvic exenteration surgery. Method: Kern described a six‐step method for curriculum design that is now widely adopted in medical education. Our study utilizes steps 1–4 of Kern's method to develop a syllabus and assessment framework for curriculum development for fellowship training in complex colorectal cancer encompassing pelvic exenteration. A literature review was conducted to address step 1, followed by targeted needs assessment in step 2 by conducting focus groups with trainees, fellows and experts to identify learning needs and goals with objective setting for step 3. An expert consensus group then voted on these recommendations and developed educational strategy recommendations as step 4. For the purposes of brevity, 'pelvic exenteration' in the text is taken to also encompass extended and multivisceral resections that fall under the remit of complex [colorectal] cancer. Results: Step 1 of Kern's method identified a gap in the literature on curricula in complex cancer surgery. Step 2 identified key areas regarded as learning needs by trainees, including anatomy, hands‐on experience and case volume. Step 3 defined the goals and objectives of a fellowship curriculum, defined in six domains including theoretical knowledge, decision‐making, technical skills, postoperative management and continuing professional development. Finally, as a prelude to stages 5 and 6, a strategy for implementation and for feedback and assessment was agreed by an expert consensus meeting that defined case volume (a minimum of 20 pelvic exenteration operations within a fellowship period) and coverage of this syllabus with derived metrics. Conclusions: Our working group has developed a curriculum framework for advanced fellowship training in complex cancer in the UK. Validation is needed through implementation, and affirmation of its utility, both nationally and internationally, must be sought. [ABSTRACT FROM AUTHOR]

Published
2024
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20. Investigating the use of hospital episode statistics data to measure variation in performance and quality in colorectal surgery

Author

Burns, Elaine, Faiz, Omar, Aylin, Paul, and Darzi, Ara

Subjects
610
Abstract

This thesis provides a comprehensive overview of general and subspecialist colorectal surgery in England. It examines variation in provision and outcome of colorectal surgery in structure, process and outcome factors at the patient, consultant team and NHS Trust levels. Finally, this thesis examines the potential role of increasing surgical caseload to reduce any demonstrable variation and improve outcome. To address these questions, current issues in surgical quality as well as the coding accuracy reported in the published literature have been reviewed. Colorectal resection and the more specialised procedure of restorative proctocolectomy were examined from the Hospital Episode Statistics dataset. Novel outcome measures were derived using longitudinal analysis. Regression analysis was used to understand the predictors of process factors and outcome measures. I have defined new outcome measures and demonstrated considerable variation in these new measures and in more traditional accepted measures in both general and subspecialist colorectal surgery from routinely collected datasets. Routinely collected data offer an exciting potential data source for measuring performance and quality. If data accuracy can be assured, measures such as reoperation may be used alongside established measures of quality in a meaningful way to benchmarking performance of surgical providers. The methods described in this thesis can be applied to a broad range of surgical specialties. Though volume may have a role in determining outcome and reducing variation in subspecialist colorectal surgery, it is by no means the panacea to improve quality across all providers in general colorectal care. The impact of volume on outcome in more general colorectal surgery is less clear. Though centralisation is likely to have benefits, further evidence of the optimum way to implement such changes is needed rather than indiscriminately increasing volume across all providers for general colorectal surgical care.

Published
2013
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33. Model of care matters: An integrative review

Author

Cutajar, Lisa, primary, Dahlen, Hannah G., additional, Leechburch Auwers, Amanda, additional, Vir, Swati, additional, Berberovic, Bessie, additional, Jedrzejewski, Tracy, additional, and Burns, Elaine S., additional

Published
2023
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35. 'Meeting the Mum where she is at': Recommended Best Practice to Support Vulnerable New Mothers

Author

Tracey, Danielle, Burns, Elaine, and Nash, Simone

Abstract

Becoming a new mother can be a complicated life transition with physical, emotional, and psychological changes. Women with additional vulnerabilities are at greatest risk from physical and mental ill-health due to adversities faced when becoming a new mother. The impetus for the current White Paper arose from the desire to develop a deeper understanding of the needs of vulnerable new mothers, the perceived impact of the Early Years Support Service, and the best practice guidelines for how to support new mothers with additional vulnerabilities. This White Paper is based on the first empirical study of the Early Years Support Service, involving 47 stakeholders with direct experience including: 22 mothers who had or currently use the Early Years Support Service, 15 volunteers, 6 staff, 4 significant others. The Early Years Support Service is available to primary carers irrespective of gender. All of the service users who participated in this study identified as mothers and thus this White Paper discusses the experiences of mothers.

Published
2023
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