POSTGRADUATE TRAINING

ENHANCED SURGICAL AND OBSTETRICAL SKILLS (ESS/OSS)

There is one Canadian medical school which offers a third year Residency (R3) 12 month postgraduate ESS program, the University of Saskatchewan at Prince Albert.

The University of Alberta is in the process of developing a program.  

Many of Canada’s medical schools offer a 3-6 month R3 training program for rural family physicians seeking to offer surgical services limited to operative delivery:

Northern Ontario School of Medicine (Thunder Bay)

University of Manitoba (Winnipeg)

University of British Columbia (Surrey)

University of Alberta (Medicine Hat)

INTERNATIONAL MEDICAL GRADUATES (IMGs)

A large number of Canada’s enhanced surgical skills (ESS/OSS) family practitioners were recruited overseas, acquiring postgraduate surgical training, up to and including a foreign fellowship, prior to immigrating to rural Canada. They acquired credentialing in Canada through practice eligible assessments.

CREDENTIALING 

The most exciting development is the College of Family Physicians of Canada is the elevation of the ESS and OSS training programs to Category 1 status.   The graduates of the 12 month program at the University of Saskatchewan will receive a CAC (ESS) for their surgical skill set.  The graduates of the other programs will receive a CAC (OSS) for their skill set focused on cesarean sections and related obstetrical skills. For a description of the ESS and OSS competencies and procedures, go to the link above.

The Enhanced Skills Surgery community of the CFPC includes addressing educational opportunities for both ESS/OSS physicians and family physicians. The ESS community is also tasked with advising the Board of the CFPC on issues that affect ESS/OSS, and to assist in developing and delivering undergraduate and post graduate curriculum that is relevant to ESS/OSS. If you would like to be involved or have suggestions for membership and future directions please email enhancedskillssurgery@cfpc.ca.

PRIVILEGING 

ESS/OSS physicians have a skill set that crosses numerous disciplines and typically work as generalists in rural communities. Historically privileging authorities have struggled with assessing the quality of the training and range of skills of ESS/OSS physicians. Physician skill sets are also dependent on the team supporting the individual practitioner, practitioner and local experience and local resources.  Elevating the ESS training – including the Operative delivery Skill Set – to Category 1 status with CACs holds great promise for privileging. The adoption of national training standards simplifies the privileging process for ESS physicians working in rural hospitals.  This process is outlined in  “Certificate of Added Competency for Enhanced Surgical Skills – It’s About Our Privileges”.   

The first codified skill set for surgery performed by rural ESS Family Physicians was introduced by the BC privileging project. Credentialing for these procedures is the successful completion of the 12 month Prince Albert program or equivalent experience and training.  An update in 2017 was successful in eliminating all references to number of procedures performed either for training or for currency. Instead, there was a pivot to effective local CQI like the Rural Surgery and Obstetric Network (RSON). 

Click to watch Dr. Stuart Iglesias’ presentation from the panel discussion on "The Evidence Underpinning Privileging and Maintenance of Competency", Montreal, April 2015.

• “Competency in Rural Practice,” by Stuart Johnston, Michael C. Klein, Stuart Iglesias,  Granger Avery. Can J Rural Med 2014; 19(2), p. 43
• “Provincial Privileging Standards Project,” by Granger Avery, Jeanette Boyd, Stuart Iglesias, Stuart Johnston, Michael C. Klein, Alan Ruddiman, Robert Woollard. BC Med J 2014: 56(7), pp. 326-7
• “Provincial Privileging Project Concerns,” by Granger Avery, Jeanette Boyd, Davy Dhillon, Stuart Iglesias, Stuart Johnston, Michael C. Klein (addendum to ,BCMJ letter, above)
• “Backgrounder: British Columbia Privileging Project,” by the Rural Coordination Centre of BC. Unpublished briefing document, 2014.