Review of Māori equity in surgical trainee selection

BACKGROUND

The Royal Australasian College of Surgeons (RACS) aims to achieve Māori health equity and cultural safety within the surgical workforce. The RACS Māori Health Strategy and Action Plans encourage Surgical Education and Training (SET) selection criteria that recognizes and credit applicants who identify as Māori or demonstrate competence in Māori health issues. This study investigates the current SET selection criteria for Māori entering surgical specialties.

METHODS

The selection criteria for each surgical speciality for the proposed 2024 intake were examined through a documentary analysis. Criteria were reviewed for applicability to Māori identification and/or cultural competency.

RESULTS

Criteria related to Māori identification and/or cultural competency make up 6%, 2%, and 1.5% of Otolaryngology and Head and Neck, General, and Vascular Surgery total SET selection score respectively. Criteria related to Māori identification and/or cultural competency make up 9% and 0.1% of Orthopaedic and Plastics and Reconstructive Surgery ranking scores for interview eligibility respectively. Cardiothoracic Surgery, Paediatric Surgery, Neurosurgery and Urology specialties do not incorporate any criteria appertaining to Māori. Allocation of research-related points determined by authorship may disincentivize Māori trainees.

CONCLUSIONS

Some surgical specialties fail to recognize or credit Māori identification and cultural competency in SET selection criteria. There is a need for regular auditing to ensure SET criteria align with the RACS aspirations for Māori health equity and cultural safety within the surgical workforce.

Academic paediatric surgery in Australia and New Zealand: Its governance, drivers, successes and challenges

Traditionally, academic surgeons have been expected to excel in research, administration, teaching and clinical work. For many, to be strong in all of these areas is aspirational rather than a reality - and it may not always be a desirable expectation. It is more likely that future academic surgeons will have exceptional ability in several of these domains, but probably not all. Clinical expertise (even if it is within a narrow field) is critical to gaining credibility with non-academic surgical colleagues; and research leadership and substantial ongoing academic output is critical to maintaining credibility among academic surgical colleagues - and facilitates funding success. The Board of Paediatric Surgery is the specialty training board of the Royal Australasian College of Surgeons (RACS) that is responsible for the training program in paediatric surgery for both Australia and New Zealand. "Scholarship and teaching" is designated as being one of the nine competencies RACS expects of all surgeons. Expertise in the domain of scholarship (and research) occurs at two levels: (1) A working knowledge of scientific method, having a critical and curious mind matched with an ability to formulate a research question and contribute to research studies, and an ability to analyse research data and to use it to inform clinical practice. This is expected of all surgeons; and (2) A career academic surgeon with a formal commitment to research which becomes a major component of their work, with the requisite expertise in scientific method to be able to design, set up and complete research studies. The RACS provides support for academia in surgery to flourish in multiple ways and at various stages in the surgeons' career, as described in this chapter. Increasingly, the academic surgeon has to forge links and to collaborate with other research groups. At least in Australia and New Zealand, departments should work to ensure that their academic surgeons are not excessively burdened with departmental leadership and governance roles that do not require specific academic expertise. Arguably, future academic paediatric surgeons will expect to have a better balance in their lives than some of their predecessors!