Rural Surgery Committee

CAGS will begin to explore a hub and spoke model of distributed surgical care, in which teaching hospitals provide standard, a priori clinical and educational support to smaller centres within their catchments. This is already a fundamental aspect of integrated systems of trauma care, however, the ideal is often incompletely realized, even in the most mature provincial trauma systems. CAGS proposes to partner with rural surgery advocacy organizations to improve the access to trauma and surgical services by:

  • Supporting surgeons and rural family physicians already engaged in hub spoke type educational mentorship programs
  • Piloting more formal mini fellowships to improve knowledge of systems of triage and inclusive patient care, enhance local surgical skills where appropriate and strengthen existing hub spoke networks through the creation of personal relationships between surgeons and rural health care providers
  • Extending the reach of systems of trauma and surgical care through the application of mobile communication technologies within the pilot hub-spoke networks

By working to address geographic vulnerability in Canadian health care, CAGS will also begin to address longstanding health disparities among our First Nations populations. Interestingly, the same strategies used to address disparities in access to surgical care within Canada, may also be applicable in global health. Creating a Canadian network that extends this knowledge to the global context is another one of CAGS’ public health priorities.

1. Canadian rural surgery committee

Project leads

 

  • Peter Miles MD: Chair, CAGS Rural Surgery Committee
  • Garth Warnock MD: Surgeon, Vancouver General Hospital
  • Stu Iglesias MD: Rural Coordination Centre of BC
  • Stephen Hiscock: MD:  Surgeon, Salmon Arm, BC
  • Randy Friesen MD: Surgeon, Prince Albert, Saskatchewan (Essential Surgical Skills)
  • Nadine Caron MD: Surgeon, Prince George, BC
  • Lauren Smithson MD: Surgeon,
  • Travis Schroeder, MD: Resident Member, McMaster University
  • Caitlin Champion, MD: Resident Member, University of Ottawa

    Purpose: To improve access to high quality essential surgical and trauma care by rural and remote populations

Target Population

Canadian rural and remote communities

Logistics

This is a proposal for CAGS to engage more actively with rural health advocacy groups to find constructive and safe ways to improve rural access to surgical and trauma care. It is likely that the best solutions to surgery access issues will be very context dependent, and will be determined by local work force, health systems, geography, and even climate. Some of these solutions, and the role of CAGS, will become apparent during the course of frank and sustained dialogue between all organizations committed to optimizing access to surgical care.

One immediate action that could be taken by CAGS is to endorse and support the creation of 2 pilot fellowships for rural clinicians (PAs, GPs, surgeons) in enhanced surgical care and enhanced trauma care. These pilot programs would be 1-3 months in duration, with set goals and objectives, designed curricula, integrated standard courses (eg ATLS), and defined evaluation metrics. Furthermore, the pilot programs themselves would have clear evaluation metrics, agreed upon by the CAGS membership.

Pilot 1 A hub and spoke network model for trauma systems in BC

This is a 1-3 month mini fellowship open to health care practitioners providing trauma care in the rural communities of BC that are within the catchment of the province’s level 1 trauma center, the Vancouver General Hospital. Features of this experience would include:

  • Pre stated goals and objectives agreed upon by the hub and spokes
  • A 1-3 month rotation embedded with the VGH trauma service
  • Basic orthopedic trauma
  • Skills lab (basic surgical skills)
  • Airway management days
  • ATLS and/or Definitive Surgical Trauma Care Course
  • Prescribed reading
  • Training in clinical practice guidelines and triage and transfer guidelines
  • Telemedicine and tele ultrasound
  • Presentation at rounds
  • Partnership with the Rural Coordination Centre of BC
  • Matched funding by CAGS and rural programs???
  • Evaluations of student and faculty
  • Evaluations of pilot (registration, student evaluations, follow up evaluations of utility, transfer process and patient outcomes (derived from BC Trauma Registry))
Figure: The BC provincial trauma systems – opportunities for stronger networks

Pilot 2 – A hub and spoke model for enhanced surgical skills in Manitoba

The enhanced surgical skills mini fellowship would be patterned after an education program for family medicine residents that is already in place at the Grace Hospital in Winnipeg. Rural practitioners (PAs, RNs, family MDs, surgeons), already involved in the delivery of surgical services would be eligible to attend a 1-3 month, tailored mini-fellowship, in which they would be embedded on a busy emergency general surgery service. Although the goals and objectives would be tailored to the needs of local communities, a minimum standard of competence would need to be demonstrated before any acknowledgment of training could be issued. The training would not be limited to technical skills, but would also focus on patient assessment and resuscitation. Objectives for the mini fellowship might include:

  • Patient assessment (e.g. Alvarado Score)
  • Management of septic and hemorrhagic shock
  • Abdominal sepsis
  • Open appendectomy
  • Open hernia repair
  • Lumps and bumps
  • Informed consent
  • Transfer protocols and destinations (predefined transfer agreements)
  • Obstetrical and urologic emergencies