t the present time, RCSI is the only college of
surgical training in the world which offers a
comprehensive programme of human factors
training integrated with its surgical curriculum.
Professor Oscar Traynor, Director, National
Surgical Training Centre, RCSI, explains why
the CoIlege developed this world-leading initiative in teaching
In terms of surgery, RCSI has been a world leader in the development
of medical professionalism and in the formation of a professionalism
curriculum. Over 10 years ago, we recognised that, while knowledge
and technical expertise are central factors in the quality of patient
outcomes, the influence of the `human factor', such as interpersonal
and communication skills, on those outcomes was significantly
SKILLS ARE NOT ENOUGH
It is clearly important for all surgeons to have a sound knowledge
and understanding of the theory of surgical practice. It is likewise
important for surgeons to be technically adept at the craft of surgery.
On their own, however, knowledge and skills are not enough.
Sometimes, surgeons with less knowledge and less technical expertise
get better outcomes for their patients because they operate on the
right patients at the right time, they continue to perform well under
stress or in times of crisis, and they manage to successfully harness
the support of a multidisciplinary team to get the best results for their
patients. This is the human factor in surgery.
Historically, it had been considered that personal skills are innate
aspects of one's personality and that they can neither be taught nor
acquired. While some individuals seem to be born with these skills,
many others can have these skills improved by formal education and
training, enabling them to function more effectively as part of the
multidisciplinary team in which all surgeons work in the 21st century.
In a pioneering initiative, RCSI launched the first course addressing
precisely those factors, entitled "Human Factors and Patient Safety",
over a decade ago.
The curriculum covers a range of relevant issues such as:
human personality and behaviour;
negotiation skills and conflict resolution;
human error and patient safety; and,
self-management, including time management and stress
The course is scheduled for three full days each year. Training is
directed jointly by a surgeon and a psychologist, acknowledged
experts in the individual subject areas. The training is centred on an
action-based learning format, supported by audio visual tools, where
trainees engage in role-playing within practical scenarios based on
Trainees are encouraged to find solutions to human factor problems
for themselves and are given assignments on which to work between
modules. The assignments reflect the importance of work place
In addition to the three days training, there is an assessment day
with Objective Structured Clinical Examination (OSCE) stations.
Trainees interact with professional actors and are tested in a variety
of situations, such as breaking bad news to a patient or handling a
conflict situation with a colleague. Scores achieved at assessment
form part of the competence assessment and performance appraisal
(CAPA) process for all trainees.
More recently, RCSI has developed the MSc/Postgraduate Diploma in
Human Factors and Patient Safety. Approved by the NUI, the Diploma
and Masters accompany the surgical training programme across the
Basic Surgical Training (BST) and Higher Surgical Training (HST)
The Post-Graduate Diploma entails one taught module each BST year
for a period of three years with one accompanying practical work
experience module during BST. The M.Sc Degree is an additional
taught module with submission of a 15,000-word dissertation to be
completed over one year during HST.
Our Human Factors programme will continue to evolve to reflect the
ongoing changes in the nature of the profession including the increasing
degree to which surgery is influenced by burgeoning technological
innovations. Equally, we plan to reflect the growing influence of the
team dynamic in surgery by developing the interprofessional reach of
the programme to include anaesthetists and nurses.
Professor Oscar Traynor