PFET Spinal Surgery - Spine Society of Australia

Minutes of the Meeting to discuss PFET in Spinal Surgery
Friday 29 August, 2008
RACS, Melbourne
Attendees:
NSA – Eric Guazzo (President,) Michael Murphy ( Vice President), Shirley Arbuthnott
(Education and Training Officer)
AOA – John Batten (Vice President), Ian Burgess (CEO)
SSA – Peter McCombe (President), Graeme Brazenor (Secretary)
RACS – Glenn McCulloch (Chair)
Conflict of Interest:
Mr Glenn McCulloch declared a conflict of interest in his position as a RACS Councillor. No
other conflict of interest was declared.
The Chair requested views on Post Fellowship training in Spinal Surgery from each of the
organisations represented:
Spinal Society of Australasia
Mr Peter McCombe reported that the SSA considered the development of an in-principle
agreement to be important considering the necessity for cross-disciplinary training in
spinal surgery. The orthopaedic members of the SSA dealt with scoliosis and spinal
deformities which represented a subtly different workload to neurosurgery.
Australian Orthopaedic Association
Mr John Batten reported that the AOA aimed to achieve an in-principle agreement to
provide appropriate training in and collaboratively achieve better outcomes for spinal
surgery. The NZAOA would also require formal involvement prior to proceeding to
agreement.
The AOA did not intend to devalue its primary Fellowship, considering it important to retain
their core membership and acknowledge training from a cross disciplinary perspective. All
issues would be discussed by the Orthopaedic Board, including the possibility of conducting
PFT training either post or pre Fellowship.
The AOA believed that the NSA had different objectives, considered that neurosurgical
training did not provide complete spinal surgery training and that newly graduated
neurosurgeons were currently deficient in the bio mechanical area of spinal surgery.
Orthopaedic surgeons, although not exposed to as much spinal surgery, were traditionally
exposed to a more complex level of spinal surgery in terms of dealing with major
deformities. Neurosurgeons had less exposure to complex cases and it would be
advantageous to include complex procedures in PFT.
It was considered advantageous for the two specialties to amalgamate and the AOA would
not consider it a problem if the best outcome was for neurosurgery to absorb this
additional training.
Neurosurgical Society of Australasia
Mr Eric Guazzo reported that the NSA supported Post Fellowship training, was interested in
developing competencies across the field of spinal surgery and was keen to collaborate
with the AOA to develop this. Core principles were that a PFT in spinal surgery should not
undervalue Fellowship training and should deliver expertise not currently available in the
discipline of neurosurgery. Core training was to be expanded upon and not devalued by
PFT in spinal surgery. It was considered important not to render Fellowship training sub
standard and agreed that each discipline involved had important attributes to contribute to
PFT.
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The NSA considered it important to recognise that surgical training had progressed
dramatically during the previous 10 years, spinal surgery was currently a predominant part
of the neurosurgery discipline and neurosurgery trainees were expected to have a level of
competency in spinal surgery upon achieving Fellowship. Neurosurgery trainees currently
spend 50% of their time training in spinal surgery and are expected to have attained
significant competency upon completion of their Fellowship. The NSA therefore believed
that neurosurgery trainees were provided with competent training in spinal surgery and it
was intended that a PFT in spinal surgery would enhance and not detract from current
training. The NSA did not feel challenged in the area of spinal surgery but recognised a
strong need for PFT and felt it important for the neurosurgical specialty.
Mr Eric Guazzo spoke to the Working Document, recognising that newly graduated
Neurosurgery Fellows wishing to perform complex spinal procedures did require additional
training. He also stated that in the core curriculum in neurosurgery there were sections on
biomechanics and surgical materials. It would not be considered necessary for every
neurosurgeon to complete a PFT in spinal surgery as core competencies in spinal surgery
were achieved as part of the Neurosurgery Fellowship.
The NSA’s principle objective was to provide high-end training in spinal surgery if required.
The importance of spinal surgery training was recognised and the definition of PFT needed
to be resolved as to what each discipline could offer in the case of skill mix.
Royal Australasian College of Surgeons
Glenn McCulloch indicated that the aim of the RACS was to encourage and facilitate PFT in
disciplines where there was a need driven by the specialties (not by the College). Other
areas that had expressed interest were Hand Surgery and Cranio-facial Surgery. He also
indicated that there were potentially other suppliers such as Universities.
The College was keen for MoU's to be developed between the specialty societies, the RACS
and the sub-specialty societies.
Summary
It was noted that the College was keen to develop Post Fellowship Training in any area
deemed necessary and had agreed to support those organisations with a common interest.
The two basic principles were that training must be specialty driven and that cooperation
must exist between the relevant bodies. Those organisations which had expressed an
interest to date were colorectal surgery, plastic surgery, trauma and craniofacial surgery.
It was not intended that PFT become a credentalling phenomenon used by the hospital. It
was intended that consultants with an FRACS in an appropriate discipline with appropriate
training could practice spinal surgery within their own scope of practice. PFET was intended
for high end spinal surgery.
It was agreed that it would be in patients’ best interests to have access to surgeons with
training in both disciplines. As spinal surgery is, in general, a small component of
orthopaedic surgery many orthopaedic surgeons would not consider it a serious loss if this
was removed from the orthopaedic training program. It would, however, be considered
dysfunctional for spinal surgery to be removed from neurosurgery .
All parties agreed it essential to develop an MOU to further develop the concept of PFET in
spinal surgery. It was agreed that Stacie Gull, Executive Director of the NSA, in
collaboration with Ian Burgess, CEO of SSA, would develop a draft MoU which would in due
course be circulated to all parties via email for comment. It was suggested that the MOU
between the NSA and Macquarie University and the RACS (regarding pre-fellowship
training at MU) could be used as a guide.
It was agreed that the starting point for recently qualified neurosurgeon and orthopaedic
surgeon may be vastly different. It was agreed important to provide relevant logbook data
on both orthopaedic and neurosurgical experience for the next meeting. The SSA and the
NSA were to produce comparable data regarding the level of expertise and experience in
spinal surgery of newly graduating orthopaedic surgeons and neurosurgeons.
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The question of the actual numbers of spinal procedures done by neurosurgeons and
orthopaedic surgeons was discussed. Mr Peter McCombe agreed to obtain a quote for the
obtaining of this data from the Department of Health and Ageing. The NSA may share this
cost.
Mr Bill Sears, SSA had expressed a willingness to be involved in the PFT process and it was
agreed that both Mr Sears’ thoughts and the NSA’s thoughts on curriculum would be
circulated for information.
All
parties agreed that face-to-face meetings were more beneficial than teleconferences
and each party agreed to bear the costs of their representatives’ attendance.
Action Summary:
• Decisions to be made on: Chair and membership of the Committee, the life of the
Committee, observers permitted during meetings, voting rights and voting
mechanisms, the necessity for all decisions to be unanimous and the financial
relationship between the parties.
• Ms Stacie Gull and Mr Ian Burgess to develop a discussion document/ MOU for
circulation to all parties.
• Relevant logbook data for both neurosurgery and orthopaedic surgery to be
available at the next meeting.
• The views on curriculum of both Mr Bill Sears and the NSA would be circulated to
all parties for information.
• Next meeting to be a face to face meeting in about early November 2008. The
place and date and composition of the working party to be decided.
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