School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
Division of Women's and Children's, Western Health, St Albans, Victoria, Australia.
BMJ Qual Saf. 2020 Feb;29(2):113-121. doi: 10.1136/bmjqs-2019-009596. Epub 2019 Jul 30.
Unlike some other safety critical professions, there is no mandatory age of retirement for doctors, including surgeons. Medical regulators in Australia are implementing additional checks on doctors from the age of 70. We describe expert opinions on assuring performance and supporting career transitions among older surgeons.
In this qualitative study, experts in four countries were purposively selected for their expertise in surgical governance. Experts responded to interviews (Australia, New Zealand and UK) or a survey (Canada). A tiered framework of interventions was developed by integrating findings with previous literature and responsive regulation theory.
52 experts participated. Participants valued the contribution of senior surgeons, while acknowledging that age-related changes can affect performance. Participants perceived that identity, relationships and finances influence retirement decisions. Experts were divided on the need for age-specific testing, with some favouring whole-of-career approaches to assuring safe care. A lack of validated tools for assessing performance of older surgeons was highlighted. Participants identified three options for addressing performance concerns-remediate, restrict or retire-and emphasised the need for co-ordinated and timely responses.
Experts perceive the need for a staged approach to assessing the performance of older surgeons and tailoring interventions. Most older surgeons are seen to make decisions around career transitions with self-awareness and concern for patient safety. Some older surgeons may benefit from additional guidance and support from employers and professional colleges. A few poorly performing older surgeons, who are recalcitrant or lack insight, require regulatory action to protect patient safety. Developing robust processes to assess performance, remediate deficits and adjust scopes of practice could help to support safe career transitions at any age.
与其他一些安全关键职业不同，医生（包括外科医生）没有强制性退休年龄。澳大利亚的医疗监管机构正在对 70 岁以上的医生进行额外检查。我们描述了确保老年外科医生表现和支持职业过渡的专家意见。
在这项定性研究中，从四个国家中选择了具有外科手术治理专业知识的专家作为研究对象。专家通过访谈（澳大利亚、新西兰和英国）或调查（加拿大）作出回应。通过将研究结果与之前的文献和响应式监管理论相结合，制定了一个分层的干预框架。
52 名专家参与了研究。参与者重视资深外科医生的贡献，同时承认年龄相关的变化可能会影响表现。参与者认为身份、关系和财务状况会影响退休决定。专家们对是否需要进行特定年龄的测试存在分歧，一些人赞成采用整个职业生涯的方法来确保安全护理。研究还强调了缺乏用于评估老年外科医生表现的经过验证的工具。参与者确定了三种解决表现问题的方案-补救、限制或退休-并强调需要协调和及时的应对措施。
专家认为需要采取分阶段的方法来评估老年外科医生的表现，并调整干预措施。大多数老年外科医生在做出职业过渡决策时都具有自我意识并关注患者安全。一些老年外科医生可能会受益于雇主和专业学院提供的额外指导和支持。一些表现不佳的老年外科医生，他们固执己见或缺乏洞察力，需要监管行动来保护患者安全。制定评估表现、纠正缺陷和调整实践范围的健全流程，可以帮助支持任何年龄段的安全职业过渡。
