A "common" surgery curriculum: health care delivery and undergraduate surgical education in Australian teaching hospitals.

Undergraduate surgical education should focus on common surgical conditions and management principles. It has become increasingly difficult in Australia because of the changed patient mix in teaching hospitals. There has been an increased number of emergency admissions with a consequent reduction in elective surgery and pressure on inpatient and outpatient referrals. In addition, cost cutting has led to the intensification of staff workloads, thereby reducing potential time for teaching. Australian teaching hospitals are also tertiary referral centers. As such they have become more specialized with a more rapid turnover of acutely ill patients undergoing complex technologic treatments. More diagnosis and management of surgical conditions is conducted in ambulatory settings and through office and day surgery. The Heaslip Project at Flinders University was set up to evaluate and reform the undergraduate surgery curriculum. Graduate and student surveys revealed a need to concentrate on teaching about common surgical conditions, developing proficiency in skills and procedures and providing experience in the common principles of surgical care. These areas have now become the major components of changed surgery clerkships. Students also spend more time interacting with patients, participating in the planning and management of preoperative and postoperative care, and working in outpatient clinics. Although the reforms have addressed the identified concerns, they may not be sufficient if the patient mix in teaching hospitals continues to narrow. Teaching hospitals will continue to provide valuable educational experiences, but they should be supplemented and complemented with the experience of managing surgical patients in the wider community.