ICOSET 2019 Review

21–22 March 2019, Edinburgh

The Royal College of Surgeons of Edinburgh (RCSEd) and the Faculty of Surgical Trainers’ (FST) hosted the 2019 International Conference on Surgical Education and Training (ICOSET), and presented to the nearly 300 international delegates an amazing line-up of world-renowned speakers and an innovative programme. And, as RCSEd President Mike Griffin said as he opened the conference, it is about caring “for our trainees who are the future of surgery – let’s get on with it!”

An astonishing two million people viewed #ICOSET2019, making it a truly global conference and a sell out as 280 delegates from around the world poured in to participate in a programme of demanding and engaging sessions.

ICOSET 2019 opened with the most thought-provoking and exciting debate – challenging delegates to weigh up whether the old model of surgical training is past its sell-by date or not. This set the tone for the rest of the two days leaving Surgeons Quarter a-buzz with chatter and debate.

The debate and discussion were clearly focused on how to professionalise the trainer within surgical training into the future. As FST Surgical Director Craig McIllhenny asked: “We have trained generations of surgeons successfully using the apprenticeship model, but is it really still fit for purpose in the 21st century, and has the time come for us to accept a paradigm shift in training and move with up-to-the minute educational theory? The debates will get to the very heart of this current and real question.”

Surgical training is in trouble, Professor Oscar Traynor asserted, as he claimed that the apprenticeship training model is dead. He argued that astronauts go into space fully trained through simulation: “In the 21st century simulation is the preferred model of training … But we use a model of surgical training based in the 19th century.”

In defence of the status quo, Professor Brian Dunkin contended: “The apprenticeship model allows the achievement of measurable competency,” adding that when robots are introduced to training, trainees become bystanders: “The apprenticeship model allows trainees to provide a service and allows us to pay our trainees and it allows for a return on that investment.”

Delegates voted by a large majority to retain the existing model of training.

Taking that discussion forward to its logical conclusion, delegates debated the assertion that all surgeons have a duty to be trainers in a move to contest long-held working traditions. Simon Paterson-Brown, Consultant General Surgeon at the Royal Infirmary of Edinburgh, argued against the motion. Every surgeon, he said, relies on their trainee to keep them up-to-date and on their toes: “You’ll do elective surgery and go home if you’re not training".

While Fergal Mansell, Consultant at the Royal Hospital for Children, Bristol, asserted: “A good trainer is more than someone who does role play.”

The result? Delegates said that not everyone should be a trainer.

The FST AGM, held during ICOSET, confirmed David O’Regan as the new FST Surgical Director, and carried a motion to embed an interview process for the appointment of future FST Surgical Directors in the future. This would “create a wider field”, Craig McIllhenny commented.

A series of packed workshops and parallel sessions through ICOSET took the debate further. Overall, conference wanted to professionalise trainers and training and had clear ideas how to achieve it that included not throwing out some existing models with the bathwater.