RACS Short Course

Blue skies - a nice start to any morning reminding us of the heart-warming weather we regularly miss most days of the week, if not all of them. The hospital was limping along in its journey of healing, morbidity and mortality, guided shrewdly by bureaucracy. Walking into the outpatient's clinic, one could see the endless faces fixated on you. Expression of hope, relief that someone has arrived with the curative potential. It is the neurosurgical registrar and two medical students behind him. Little do the patients know who's who - in their eyes, it is very likely that they see the specialist with two doctors to assist him. Our clothing are all the same with badges pinned somewhere on our shirts, blouses or trousers... not really legible from a distance and too awkward to peer at up close since they are usually pinned next to the crotch or by the breast.

Today, however, is a unique day with an event in the outpatient's clinic after the patients are seen. The Royal Australasian College of Surgeons (RACS) has organised a formative assessment for the general surgical candidates before their actual examination - something of a rehearsal before the play. This process involves as much theatrics as it does knowledge. The candidates are from different hospitals with different backgrounds, highly variable exposure with the common potential to heal with steel tested vigorously by the College.

In the afternoon, I was to be a volunteer to help with this nerve racking event. For the candidates, the hospital organised patients with known surgical problems to come in and discuss their issues and problems, guided by an examiner who is a subspecialist in General Surgery. My role was to greet the patients, offer them refreshments and take them over to their designated rooms until the candidates arrived for examination. That got rather busy and eventually the candidates arrived. A few of the patients were actually inpatients with real-time issues and it was so selfless of them to come and volunteer their time to assist these candidates with their examinations. I wished we could offer them more than sandwiches and cheap coffee.

The consultants arrived and I offered them refreshments and showed them to their rooms, where they would be the examiners and so they could meet the patients they would be presenting.

The main consultant running the show, Dr. HN is a General Surgeon in the true sense - a surgeon that has not subspecialised in anything, but rather can operate on any part of the human body except for the central nervous system and the heart; perhaps orthopaedics have a better grasp on the bones as well. She told me to get as much out of the experience as I could, seeing as though I was the only medical student to volunteer.

Take your medical student badge off - let them assume the worst. You can be a formal observer and as far as they are concerned, you're from the College of Surgeons.


That was very exciting - I was to be treated as a colleague, not a subordinate. It was exciting because I could watch some of them in the examination setting and apply what little knowledge I had, while they thought I knew much more than they. Of course, I was an observer - I could not speak or do anything other than watch, which was a privilege in its own right.

Aside from writing everything I saw, I just wish to point out how important to most basic clinical skills are to medicine - not the extensive knowledge of Bailey & Love's Short Practice of Surgery. How much  we take for granted, such as introducing ourselves and asking for permission. How important our posture and body language is to patients, what it might portray and how different that may be from our intention. How incredibly important our responses are to patients when they answer questions...

Many of the candidates, according to Dr. HN, were far from ready for the formal examinations in three week's time. True, the nervousness, anxiety and ultimate fear of uttering "I don't know" would be disabling in any examination, but in my eyes surgeons are to be those people who can respond quickly and effectively under pressure. Yes, general surgeons need to have a vast amount of knowledge on many regions of the body, many surgical techniques and their principles; so it may be reasonable to think that they could forget the basics after reading the complexity behind the most common operations.

Yet, some of these candidates were far from ready to become consultants. They couldn't "consult" the examiners! Interestingly the College of Surgeons allows candidates to decide when they are ready to sit the test. So submitting an application to be examined really means that you have read enough, seen enough and done enough to declare yourself as ready to be tried by the panel of who one considers peers.

The successful registrar may submit their application to sit the final examinations, but they must never forget that one can never see enough, one can never be exposed to enough medicine or surgery to be completely sound in any specialty. Every patient is a new challenge and doctors must meet their unique needs, address their personal, social and professional issues, while offering them medical or surgical therapy that is known to work on the general population satisfactorily based on valid scientific evidence and sound clinical judgement.