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Laparoscopic Colorectal Training in Wales- Prof Haray
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
6.
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)
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
18.
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)