Clinical Training Posts
Clinical training posts facilitate workplace hands-on service learning and exploration in a range of training environments providing the opportunity for the trainee to develop, with supervision, the requisite experience, knowledge, skills and attributes necessary to become a competent independent specialist neurosurgeon.
Clinical training posts are accredited in accordance with the Training Post Accreditation Regulations . Each clinical training post has an allocated supervisor, satisfying the requirements in the Training Post Accreditation Regulations. Each training unit has its own profile for patient case mixes, supervision, staffing levels, working requirements for trainees and equipment. The Board believes it is essential for trainees to be exposed to varied working environments during training. A training post involving multiple hospitals is counted as one training unit for the purpose of the Training Program Regulations.
Trainees will be allocated to a region where it is intended they will undertake most of their training. This allocation will be made at the start of their training based on their pre-training appointments. The region, once determined, may only be changed by applying in accordance with the Regulations.
Trainees will rotate through a minimum of three training units during their Training Program to ensure they receive a wide exposure to systems, supervisors and case mixes. Trainees will ordinarily spend no more than two years in any one training unit. Exceptions may be made, particularly where the trainees’ region has less than three accredited training units. The Board approves the allocation of trainees to accredited posts during all clinical training years. Trainees must be prepared to be assigned to a post anywhere in Australia and New Zealand. Singapore trainees must be prepared to be assigned to the posts in Singapore for at least three years of their Training Program. Trainees should expect to move from their region at least once during their training. Trainees are not permitted to swap training post allocations.
Click here to view information on the training posts and the training post allocation process
Professional Performance Assessment
The standards in the Professional Performance Assessment (PPA) Report are the minimum standards the Board expects trainees to have prior to entering the Training Program. These minimum standards must be maintained or exceeded at all times during the Training Program. Completion of the PPA Report, on the prescribed form, must be undertaken quarterly during each year of training as part of the Training Program or more frequently where requested by the Board Chair or where the supervisor identifies performance concerns.
The trainee and the supervisor should have a meeting to discuss the PPA Report which is completed by the supervisor. The Board Chair or nominee may attend any meeting relevant to trainee performance and prepare notes of the meeting for the training record. For each assessment area within the PPA Report, guidelines of what would be considered the minimum acceptable standard of performance are provided. The guidelines are some common examples and are not exhaustive. Unsatisfactory performance includes all unethical or improper conduct and also includes the types of honest mistakes, errors of judgement and poor standards in service delivery.
The rating scale is:
- Fully satisfied
- Partly satisfied
- Not satisfied
For the 2021 training year, the due dates for the Professional Performance Assessment Reports are as follows:
- 6 May 2021 (first quarter 2021)
- 5 August 2021 (second quarter 2021)
- 4 November 2021 (third quarter 2021)
- 6 February 2022 (fourth quarter 2021)
If any area of the PPA Report is assessed as ‘Not Satisfied’ or ‘Partly Satisfied’ the supervisor should provide examples and suggestions for improvement. Supervisors are responsible for ensuring the completed PPA Report is submitted to the Board in the prescribed manner by the due date. Trainees should be provided with a copy for their records.
A Performance Improvement Notice (Regulation 3.2) or an Unsatisfactory Performance Notice (Regulation 3.3) will be issued if any area within the PPA Report is assessed as ‘Not Satisfied’ or ‘Partly Satisfied’. If a PPA Report is not submitted by the supervisor, the Board Chair may nominate an alternate Surgical Trainer within the training institution to complete the PPA Report provided that consultant has had direct supervision of the trainee.
Where one is not scheduled by the Board, the trainee may request in writing within 14 days of receiving a PPA Report a meeting between the trainee, the surgical supervisor and a representative of the Board to seek clarification of the reasons for the supervisor’s assessment and the remediation plan in place.
Where a trainee has exceeded the maximum leave entitlement for a rotation (see Regulation 1.5.1) and the rotation has been deemed unassessed, the Board Chair or nominee may determine that a Professional Performance Assessment Report is not required for that rotation. The Board Chair or nominee will notify the supervisor and the trainee in such circumstances.
Download the Professional Performance Assessment Report here
Download the Training Program Regulations here
Operative Experience Assessment
Appropriately supervised operative experience obtained during clinical training, including good case mixes and caseloads, are essential learning opportunities for trainees to acquire the necessary technical skills and expertise to practice as an independent neurosurgical consultant. Trainees must maintain an operative experience log of all procedures they participate in as part of the Training Program in accredited training posts using the Board determined system or report.
A logbook summary report must be submitted at the end of each six-month clinical training period and must be verified by the surgical supervisor as an accurate record. For each operative case where more than one surgical procedure is undertaken only one procedure may be recorded. For a procedure to be recorded the trainee must have been involved in the performance of the surgery and the pre and post-operative management of the patient in the unit in which the accredited training post is located. When completing the logbook summary report the following classifications apply:
- Primary Surgeon is when the trainee performs all of the principal procedure (eg clipping the aneurysm, removing tumour, inserting both ends VP shunt). There may be an experienced assistant/supervisor scrubbed.
- Secondary Surgeon is when the trainee performs a significant part of the principal procedure (eg exposure of aneurysm, exposure and part resection of tumour, one end of VP shunt), or performs one of procedures classified as being performed by conjoint surgeons (eg performing laminectomy where conjoint surgeon performs fusion). This would be more than simple opening/closure of simple craniotomy/spinal cases.
- Assistant Surgeon includes basic opening/closure of a routine case performed by another surgeon and other standard surgical assistant tasks.
When considering the logbook summary report to determine satisfaction of training requirements, minor and miscellaneous neurosurgical procedures will be excluded from the total major neurosurgical procedures performed. Inaccurate recording of procedures in the logbook summary report may constitute misconduct.
The trainee is responsible for ensuring that the completed logbook summary report is submitted by the due date and that they have adequate records to justify the logbook summary report.
The use of the RACS online logbook system (MALT) is now compulsory for new trainees commencing in 2021. MALT is a system used to electronically log procedures, conduct self-audit and peer-review audit. MALT can be accessed from any web-enabled device. To access MALT, you will need to sign into the RACS website. Full details can be found on the RACS website https://www.surgeons.org/en/research-audit/morbidity-audits/morbidity-audit-and-logbook-tool. If you require assistance gaining access or using MALT, please contact the MALT team by telephone on 08 8219 0939 or email at [email protected].
The training requirements relating to operative experience are as follows:
- Participation in a minimum of 80 major neurosurgical procedures for each six months; and
- Participation in a minimum of 200 major neurosurgical operative procedures during Basic Training; and
- Participation in a minimum of 800 major neurosurgical operative procedures during Intermediate Training;
- Participation in a minimum of 50 major paediatric neurosurgical cases which can include those completed during Basic Training and Intermediate Training;
- Participation in a minimum of 200 major neurosurgical operative procedures during Advanced Training of which at minimum of 100 must be as primary surgeon.
For the 2020 training year, the due dates for the logbook summary report is as follows:
- 5 August 2021 (first and second quarter 2021)
- 6 February 2022 (third and fourth quarter 2021)
Download the Operative Logbook Summary Report here
Download the Training Program Regulations here
Direct Observation of Procedural Skills Assessments (DOPS)
The Neurosurgical Direct Observation of Procedural Skills Assessments (the DOPS) are designed to assess both knowledge and technical proficiency in discrete procedural skills. The procedure must be performed by the trainee and observed by an Assessor.
The Assessor must be the Surgical Supervisor or another Surgical Trainer recognised by the Board who has supervised the trainee undertaking the procedure on multiple occasions. Where the Assessor is not the Surgical Supervisor, the Surgical Supervisor must also sign the DOPS form to confirm they are confident with the assessment completed by the Assessor.
The trainee should initiate a DOPS when they feel they have a reasonable chance of demonstrating safe and efficient independent practice.The Assessor, in completing the DOPS, is confirming the trainee can perform all the principal procedure independently in a consistently safe and effective manner based on their direct observations of the trainee performing the procedure.
Type 1 DOPS procedures must be assessed as satisfied by two different Assessors from two different training units. The Type 1 DOPS procedures are as follows:
Type 2 DOPS procedures must be assessed as satisfied by two different Assessors from two different training units. The Type 2 DOPS procedures are as follows:
Type 3 DOPS procedures must be assessed as satisfied by one Assessor. The Type 3 DOPS procedures are as follows:
The SET Program training requirements are as follows:
- Trainees must be assessed by one Assessor as having satisfied each Type 1 DOPS procedure at the conclusion of Basic Training; and
- Trainees must be assessed by two different Assessors from two different training units as having satisfied each Type 1 DOPS procedure at the conclusion of Intermediate Training (including those completed during Basic Training); and
- Trainees must be assessed by two different Assessors from two different training units as having satisfied each Type 2 DOPS procedure at the conclusion of Intermediate Training (including those submitted during Basic Training):
- Trainees must be assessed by one Assessor as having satisfied any five of the Type 3 DOPS procedures at the conclusion of Advanced Training (including those submitted during Basic and Intermediate Training).
Any DOPS form can be submitted to the Board at any time during the SET Program. The DOPS will only be assessed as satisfied if:
- The DOPS form has been signed by the Assessor;
- The date the procedure was last observed by the Assessor is recorded on the DOPS form;
- The DOPS form is submitted to the Board by the trainee within two weeks of the date the procedure was last observed by the Assessor as recorded on the DOPS form; and
- Where the Assessor is not the Surgical Supervisor, the Surgical Supervisor has sign the DOPS form to confirm they are confident with the assessment completed by the Assessor.
If a trainee disputes a training requirement decision, the trainee is required to submit an application for Reconsideration or Review in accordance with Regulation 1.8 within 14 days of receiving the relevant decision.