title: The perioperative specialist practitioner: developing and evaluating a new surgical role.
abstract: BACKGROUND
  This paper describes the design, implementation and evaluation of a new professional role in surgery. The role of the perioperative specialist practitioner (PSP), conceived as a response to the Working Time Directive, provides integrated preoperative and postoperative care to patients undergoing surgery in hospital.
  
  
  METHODS
  A 1-year training programme was designed, dealing with a wide range of knowledge, skills and attitudes. Effective communication was a key component. Nine intensive 5-day modules at Imperial College London (London, UK) alternated with supervised experience of the surgical team at each participant's home trust. Detailed evaluation of the role and the training programme was provided by an independent research team, using an interview-based qualitative approach. Observational data were provided by the project team. Data were analysed using standard qualitative methods.
  
  
  RESULTS
  27 PSPs across 12 National Health Service trusts took part in two PSP training programmes. A total of 124 interviews (94 individual and 30 group) were carried out with PSPs and their colleagues. Overall, the role was seen as successful and positive, with great potential for dealing with reductions in junior medical cover. Each site encountered different opportunities and problems. Lack of mentorship was a key issue, and the role provoked considerable opposition in trusts. The training programme was viewed as highly successful.
  
  
  CONCLUSIONS
  PSPs can provide high levels of expertise, but within clear limits. Our training programme has been effective and is perceived to be of high quality. However, introducing a new role requires time and sensitivity if opposition is to be minimised.
authors.affiliation: Department of Biosurgery and Surgical Technology, Faculty of Medicine, Imperial College London, Chancellor's Teaching Centre, St Mary's Hospital, Praed Street, London, UK. r.kneebone@imperial.ac.uk
authors.forename: R
authors.initials: R
authors.lastname: Kneebone
authors.forename: D
authors.initials: D
authors.lastname: Nestel
authors.forename: J
authors.initials: J
authors.lastname: Chrzanowska
authors.forename: A E
authors.initials: AE
authors.lastname: Barnet
authors.forename: J
authors.initials: J
authors.lastname: Younger
authors.forename: A
authors.initials: A
authors.lastname: Burgess
authors.forename: A
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000328:Adult; D016390:Allied Health Occupations / Q000193:education* / Q000639:trends; D006779:Hospitals, Public; D006801:Humans; D008131:London; D008875:Middle Aged; D010348:Patient Care Team; D018802:Patient-Centered Care; D019990:Perioperative Care / Q000639:trends; D010865:Pilot Projects; D024382:Professional Role; D016730:Program Development; D015397:Program Evaluation; D036301:Qualitative Research; D012577:Schools, Medical; D013043:Specialties, Surgical / Q000193:education* / Q000639:trends; D013192:Staff Development; D013222:State Medicine; D000078329:Workforce