title: Surgical education and training in an outer metropolitan hospital: a qualitative study of surgical trainers and trainees.
abstract: The landscape of surgical training is changing. The anticipated increase in the numbers of surgical trainees and the shift to competency-based surgical training places pressures on an already stretched health service. With these pressures in mind, we explored trainers' and trainees' experiences of surgical training in a less traditional rotation, an outer metropolitan hospital. We considered practice-based learning theories to make meaning of surgical training in this setting, in particular Actor-network theory. We adopted a qualitative approach and purposively sampled surgical trainers and trainees to participate in individual interviews and focus groups respectively. Transcripts were made and thematically analysed. Institutional human research ethics approval was obtained. Four surgical trainers and fourteen trainees participated. Almost without exception, participants' report training needs to be well met. Emergent inter-related themes were: learning as social activity; learning and programmatic factors; learning and physical infrastructure; and, learning and organizational structure. This outer metropolitan hospital is suited to the provision of surgical training with the current rotational system for trainees. The setting offers experiences that enable consolidation of learning providing a rich and varied overall surgical training program. Although relational elements of learning were paramount they occurred within a complex environment. Actor-network theory was used to give meaning to emergent themes acknowledging that actors (both people and objects) and their interactions combine to influence training quality, shifting the focus of responsibility for learning away from individuals to the complex interactions in which they work and learn.
authors.affiliation: Department of Surgery (Austin Health), Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Austin Hospital, PO Box 5555, Heidelberg, VIC, 3084, Australia. dnestel@unimelb.edu.au.
authors.forename: Debra
authors.initials: D
authors.lastname: Nestel
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Harlim
authors.affiliation: Department of Leadership and Management, Faculty of Business and Law, Swinburne University of Technology, Melbourne, Australia.
authors.forename: Melanie
authors.initials: M
authors.lastname: Bryant
authors.affiliation: Paediatric Surgery, Royal Children's Hospital, Melbourne, Australia.
authors.forename: Rajay
authors.initials: R
authors.lastname: Rampersad
authors.affiliation: Plastic and Reconstructive Surgery Group, Monash University, Clayton, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Hunter-Smith
authors.affiliation: Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Australia.
authors.forename: Bob
authors.initials: B
authors.lastname: Spychal
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D004521:Educational Measurement; D017144:Focus Groups; D013502:General Surgery / Q000193:education*; D006786:Hospitals, Urban; D006801:Humans; D007407:Interviews as Topic; D007858:Learning; D036301:Qualitative Research
keywords: Actor–network theory; Practice-based learning; Surgical education; Surgical training; Thematic analysis