Program improves access to surgery for rural, remote patients in Prince Albert Parkland

ESS program crop

A program based at Prince Albert Parkland’s Victoria Hospital, aimed at improving access to surgeries in smaller and more remote communities, is gaining more recognition across Canada.

The Enhanced Surgical Skills (ESS) program is operated through the University of Saskatchewan, and is based at the Victoria Hospital in Prince Albert.

The purpose of the program is to support family physicians to obtain skills for specific procedures, so that patients in more rural or remote locations do not have to travel as far to receive the service.”
(Dr. Ruth O’Carroll, ESS program lead at Victoria Hospital)

Dr. O’Carroll said the program is flexible depending on the interests of the residents in the program. The focus is on general surgery and obstetrics and gynecology; however, residents will often spend some time in orthopedics, urology, and otolaryngology (ear, nose and throat). Specialists from those groups work with ESS residents, and are ultimately responsible for assessment of skills for different procedures.

“The program is focused on specific procedures and ensuring that the resident is able to perform them. It does not replace a specialist with broader skills within those areas,” said Dr. O’Carroll.

Procedures can vary, but usually include things like:
•    Scopes (gastro and colon)
•    Appendectomies
•    Some hernias
•    Abscesses
•    Caesarian sections
•    Tubal ligations
•    Some higher-risk births
•    Vasectomies and circumcisions (with urologist)
•    Tonsils (with ENT)
•    Carpal tunnel (with ortho)

Dr. O’Carroll said there have been some challenges in getting the program accepted. “We needed to demonstrate that the program’s training was appropriate for the type of procedures being done.”

The ESS program took a step forward when its curriculum was published in the Canadian Journal of Surgery (December 2015), and it was featured at a summit meeting in Banff in January 2016. This meeting included representatives of the College of Family Physicians of Canada, the Royal College of Physicians of Canada (certifies specialists), the Society of Obstetricians and Gynecologists of Canada, the Canadian Association of General Surgeons, and the Society of Rural Physicians of Canada.

Part of increased acceptance of the program is meeting a variety of criteria for the physicians who are expanding their own scope of practice. The program needs to ensure continuing medical education is available, developing specific programs for those physicians to maintain skills and be up-to-date on procedures, techniques, technology, and any changes for best practice. Also, the program must also undergo a regular evaluation with patient safety as a focus.

Patient selection is very important. They may consult with a patient, and then decide to refer that patient to a specialist because it is not something they are comfortable doing. This could include someone with more complex health issues.” (Dr. Ruth O’Carroll)

Patients with more complex health issues, such as heart disease or other health concerns, may be assessed before being referred to a specialist for surgery. It is about the skills of the individual, as well as support for patients, and the availability of other services such as an intensive care unit.

As part of the application process for the program, physicians need to demonstrate that they have support from a community and host hospital, to ensure other staffing (anesthetists, nurses), equipment, and operating room time are available.

While it is currently the only program of its type in Canada, there are others in development. The Prince Albert Parkland program has 11 graduates, with two more completing training in June 2016. Two residents train each year; starting in July and continue until the following June. At the end of the program, each of the specialists provides a letter stating the ESS resident has obtained the competencies for specific procedures. The ESS participants are not considered a specialist in the general areas.

Program participants currently work in Saskatchewan (Prince Albert, Meadow Lake), British Columbia (Revelstoke, Vanderhoof), Alberta (Rocky Mountain House, Taber, Pincher Creek), Manitoba (Neepawa) and Nunavut.

Photo: Dr. Ruth O’Carroll, centre, a general surgeon who is the lead for the Enhanced Surgical Skills program at the Victoria Hospital, is flanked by the 2015-2016 program participants Dr. Audree Bedard, left, and Dr. Erin Sullivan. When they complete the program this June, Dr. Bedard will be returning to Peace River, AB, while Dr. Sullivan will be practicing in Meadow Lake, SK.

 

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