BTS 2012 Report – How to train a renal transplant surgeon? A survey of consultants and trainees

by Maria Dalby reporting on the presentation by Miriam Manook et al, Guy’s Hospital, London.  Adequate training of transplant surgeons is essential for good clinical outcomes. Although surgical training in renal transplantation has to date not been standardised, there is a recognised need for this and training programmes are currently being evaluated for implementation. A team of researchers led by Dr Miriam Manook, clinical fellow in renal transplantation at Guy’s Hospital in London, conducted a survey of transplant surgeon consultants and trainees to capture their experiences and views on what the contents of such a programme should be. The findings of this survey were presented as a poster at the 2012 BTS annual congress.

The survey was carried out in the form of an online questionnaire to all renal surgical consultants and trainees in the Pan-Thames group. A total of 11 consultants (50% response rate) and 12 trainees (54% response rate) completed the survey. More than half of the trainee respondents (54.5%) were in a designated training post at the time of responding, and 75% of trainees stated that they intended to train in transplantation. Half of the consultant respondents had been in their current position for  up to 6 years.

All trainees and the majority of the consultants (87.5%) agreed that experiencing more than one transplant unit constituted an important aspect of the training. Nearly two thirds of the consultants (62.5%) had experienced 4 transplant units during training, and 41.7% of the trainee respondent had experienced 3 units.

“Units are so different in the processes and thoughts regarding techniques, organ acceptance and placing patients on the transplant list. My understanding of national transplant issues increased dramatically, moving from unit to unit.” Consultant responder

Both groups agreed overall regarding the scope and duration of surgical placements, with a minimum of vascular surgery, urology, emergency surgery, endocrine, colorectal, upper GI, paediatric and hepatobiliary surgery, and liver transplantation. The trainee group felt that the appropriate vascular experience was 6-12months, compared with 0-6 months in the consultant group. Similarly and perhaps not surprisingly, trainees and consultants differed with respect to the number of index operations required to acquire a certificate of completion of specialist training (CCST): the consultants deemed between 15 and 60 renal transplants as a lead surgeon as sufficient for a CCST, whereas a majority of the trainees (58.3%) felt that the number of renal transplants completed as lead surgeon should be in excess of 60 renal transplants for a CCST.

In addition, 50% of the trainees wanted experience of > 60 laparoscopic donor nephrectomies as lead surgeon, while the consultants deemed it acceptable to have completed 0-15 (37.5% of consultants), 15-30 (25%) or 30-60 (37.5%) such operations. An overwhelming majority of the consultants also stated that immunology (71.5%) and histocompatibility/tissue typing (87.5%) should be offered formally as non-surgical options on a transplant training programme, compared with 36.4% of the trainees on both. To have a second sub-specialty alongside transplantation was seen as more important by the trainees than the consultants. Of those who supported a second accreditation, urology or vascular surgery were the most common choices in either group.

“… the surgical management of the renal transplant patient requires multidisciplinary input. Having a second sub-speciality allows the ‘transplant team’ of surgeons to deal with these issues i.e. vascular access/urology/endocrine, with a particular interest in the transplant population.” Trainee responder

The researchers concluded that the survey, although small, indicated a need for a wider exposure within general surgical training as well as specific non-surgical skills, and that new training programmes need to address the breadth of experience required within an increasingly sub-specialised training system.