Complex Cancer Clinic, St Mark's The National Bowel Hospital, London, UK.
Colorectal Dis. 2024 Aug;26(8):1551-1559. doi: 10.1111/codi.17084. Epub 2024 Jul 11.
Surgery for complex colorectal cancer is elaborate: preoperative assessment, patient selection, radiological interpretation, operative strategy, operative technical skills, operative standardization, postoperative care and management of complications are all critical components. Given this complexity, training that encompasses all these crucial aspects to generate suitably edified surgeons is essential. To date, no curriculum exists to guide training in advanced and recurrent pelvic malignancy, particularly for complex colorectal cancer. Such a curriculum would potentially offer numerous advantages, not only for individual surgeons but also for research, governance, international collaboration and benchmarking. The aim of this study was to design and develop a framework for a curriculum for fellowship training in complex colorectal cancer that encompasses pelvic exenteration surgery.
Kern described a six-step method for curriculum design that is now widely adopted in medical education. Our study utilizes steps 1-4 of Kern's method to develop a syllabus and assessment framework for curriculum development for fellowship training in complex colorectal cancer encompassing pelvic exenteration. A literature review was conducted to address step 1, followed by targeted needs assessment in step 2 by conducting focus groups with trainees, fellows and experts to identify learning needs and goals with objective setting for step 3. An expert consensus group then voted on these recommendations and developed educational strategy recommendations as step 4. For the purposes of brevity, 'pelvic exenteration' in the text is taken to also encompass extended and multivisceral resections that fall under the remit of complex [colorectal] cancer.
Step 1 of Kern's method identified a gap in the literature on curricula in complex cancer surgery. Step 2 identified key areas regarded as learning needs by trainees, including anatomy, hands-on experience and case volume. Step 3 defined the goals and objectives of a fellowship curriculum, defined in six domains including theoretical knowledge, decision-making, technical skills, postoperative management and continuing professional development. Finally, as a prelude to stages 5 and 6, a strategy for implementation and for feedback and assessment was agreed by an expert consensus meeting that defined case volume (a minimum of 20 pelvic exenteration operations within a fellowship period) and coverage of this syllabus with derived metrics.
Our working group has developed a curriculum framework for advanced fellowship training in complex cancer in the UK. Validation is needed through implementation, and affirmation of its utility, both nationally and internationally, must be sought.
复杂结直肠癌的手术非常精细：术前评估、患者选择、影像学解读、手术策略、手术技术、手术标准化、术后护理以及并发症的处理都是关键环节。鉴于这种复杂性，涵盖所有这些关键方面的培训对于培养出合格的外科医生至关重要。迄今为止，尚无课程可以指导高级和复发性盆腔恶性肿瘤的培训，特别是针对复杂结直肠癌。这样的课程可能会带来许多优势，不仅对单个外科医生，而且对研究、治理、国际合作和基准测试也是如此。本研究的目的是设计和开发一个涵盖盆腔切除术的复杂结直肠癌 fellowship培训课程框架。
Kern 描述了一种在医学教育中广泛应用的六步课程设计方法。我们的研究利用 Kern 方法的步骤 1-4，为涵盖盆腔切除术的复杂结直肠癌盆腔切除术 fellowship培训制定教学大纲和评估框架。进行了文献回顾以解决步骤 1，然后通过与学员、研究员和专家进行焦点小组讨论来进行步骤 2 的有针对性的需求评估，以确定学习需求和目标，并设定步骤 3 的目标。然后，一个专家共识小组对这些建议进行投票，并制定教育策略建议作为步骤 4。为了简洁起见，文本中的“盆腔切除术”也包括属于复杂[结直肠]癌症范围的广泛和多脏器切除术。
Kern 方法的步骤 1 确定了复杂癌症手术课程文献中的一个空白。步骤 2 确定了学员认为是学习需求的关键领域，包括解剖学、实践经验和病例量。步骤 3 定义了 fellowship 课程的目标和目标，在六个领域中进行了定义，包括理论知识、决策、技术技能、术后管理和持续专业发展。最后，作为步骤 5 和 6 的前奏，一个专家共识会议商定了实施策略以及反馈和评估，该策略定义了病例量（ fellowship 期间至少完成 20 例盆腔切除术）和涵盖本教学大纲的衍生指标。
我们的工作组已经为英国的复杂癌症高级 fellowship 培训制定了课程框架。需要通过实施来验证，并在国内外寻求对其效用的认可。
