Surgeons to face competence tests: Accidents lead royal colleges to introduce recertification system

ALL SURGEONS in the United Kingdom will be required to prove their competence every five years under a new 'recertification' system, the medical establishment said yesterday.

If they refused to continue their education and if their standards of work were not acceptable, they could be told to change their job or stop practising.

Surgeons will have to amass 'Brownie points' based on attending lectures and workshops; assisting in and performing sufficient specialist operations to maintain their ability; and having the necessary training for new procedures.

The new guidelines, established by the four royal surgical colleges of England, Glasgow, Edinburgh and Ireland and the nine associations of surgical specialists, grew out of concern that some practitioners were using minimally invasive or 'keyhole surgery' with little training or experience.

A number of keyhole surgical accidents had been reported, and in the first keyhole surgery damages case pounds 22,500 was paid to a Manchester woman after a doctor admitted liability, having cut through her bile duct while removing her gall bladder.

'It is our view that that type of rapid introduction (of a new procedure) should not happen again in an uncontrolled manner,' Professor Norman Browse, president of the Royal College of Surgeons of England, said at the launch of the guidelines in London yesterday.

New techniques would have to undergo testing and approval similar to that necessary for the introduction of a new drug, he said.

Professor Patrick Boulter, president of the Royal College of Surgeons of Edinburgh, said a time when the requirements would be mandatory was envisaged.

Professor Browse said: 'What happened in 1987 and 1988 was that technologies which had become highly sophisticated and developed outside medicine, such as aspects of fibre-optics and using TV cameras, were suddenly introduced into surgical practice.

'Quite suddenly surgeons saw the potential for using them in abdominal surgery. They were introduced extraordinarily rapidly.'

The guidelines say simply undertaking training will no longer be proof of ability. As much importance is given to experience. 'A surgeon who performs a specific operation once or twice a year is unlikely to be as experienced and therefore as competent as a surgeon who performs the same procedure 30 times a year,' they say.

They acknowledge that the new approach will lead to more specialisation, saying 'rare conditions and rare operations should only be treated in specialist centres'.

A survey of surgeons using keyhole surgery for gallbladder operations found that 53 per cent completed the ideal training package of a workshop, assisting in operations, and then being assisted at them; 25 per cent had done two of the three components; and 5 per cent had done none.