SCTS EDUCATION
VATS lobectomy consultant mentoring
Leads: Tom Routledge, Mike Shackcloth
Background
UK VATS lobectomy uptake remains patchy
Increasing evidence that it is standard of care
for early stage lung cancer
Difficult to get up to speed as a consultant
Current training models not fully effective
-too brief
-often do not succeed
How will we be better?
Current model –
see one, do a couple with a famous expert helping,
do a few unsupervised, find some difficulties,
lose heart and fade out
New model
-
see one or two, do a few with a trainer, do a few unsupervised,
find some difficulties…
…and then get the trainer back in to do another couple,
with specific advise about your difficulties, go back to
unsupervised practice, find more difficulties –
repeat this loop as much as required
adjuncts – video critique and discussion
Advantages – why we will succeed
UK-surgeon delivered, allowing more iterations of the
training loop
Flexibility to deliver as many training visits as are
required
Video case critique – adjunct to live training
Typical schedule
 Week 0
trainee unit approaches SCTS education
 Weeks 1-4 VATS lobectomy trainer appointed, honorary
contract arranged, preliminary site visit to assess
equipment needs
 Week 4
trainee visits trainer unit for observation and
discussion; case video to take home
 Week 5-7 trainer visits trainee unit to operate together
on 3-4 cases over a couple of weeks or so; specific
training on disaster scenario management to optimise
patient safety in the next phase
 Weeks 8-12
trainee does 2-4 cases unsupervised,
video recorded for subsequent discussion-critique with
trainer ; identification of specific technical issues
 Weeks 12-16
further visits by trainer to co-operate
with focus on the issues identified during unsupervised
operating
 Rinse and repeat as desired
 Audit phase
Challenges
Surgical pride – many people still try and self teach this, which is
slow, dangerous and doesn’t work – you wouldn’t let your registrar
do this so why would you?
Scheduling cases to mutual convenience of trainer / trainee while
meeting treatment targets
Major time commitment from trainers (and their base unit)
Consent and Governance issues with surgery being carried out by
a visiting doctor
Solutions
• A regionalised team of trainers –
• to minimise impact on any one person, & reduce travelling times
•
Lead time, to allow for :
•
•
•
•
honorary contracts
to arrange and agree cross cover at trainers base units
new procedure permissions at trainee hospitals
full buy in from patients
Next steps
•
Regional trainers to be finalised, with full agreement from their home
units and clinical leads
•
Interested trainee units to approach SCTS Education, who will liase
with operational lead to assist in administrative phase
•
1-2 surgeons to be trained initially, with the intention that they roll out
training across their departments
Measuring success
• Targets•
VATS resection rates over 30% at 1 year and 50% at 2 years
• Monitored rates of major vascular injury, conversion, death
• BUT do not use conversion as an endpoint – encourage conversion
in learning phase