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 0trainee unit approaches SCTS education  Weeks 1-4 VATS lobectomy trainer appointed, honorary contract arranged, preliminary site visit to assess equipment needs  Week 4trainee visits trainer unit for observation and discussion; case video to take home  Week 5-7trainer 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 8-12trainee does 2-4 cases unsupervised, video recorded for subsequent discussion-critique with trainer ; identification of specific technical issues  Weeks 12-16further 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