Endocrine surgery fellowship is necessary for competent endocrine surgical practice: perspectives from Australia and New Zealand

Background: Currently pathways to practice in endocrine surgery vary based on location and surgical training programme. International data highlights the impact of surgeon volume on outcomes, and the importance of understanding the learning curve in developing minimum training competencies. This study aims to explore how surgeons obtain competence in endocrine surgery in Australia and New Zealand, and perceptions around competence and scope of practice.

Methods: A web-based survey was distributed to fellows practicing endocrine surgery. Participants were invited to complete a semi-structured interview to explore key themes around competence. Thematic analysis was performed.

Results: Responses from 87 surgeons, with 30% practicing primarily in a regional or rural area, showed 94% emphasized post-fellowship training to be competent in endocrine surgery. Median primary operator procedural volume learning curves were 50 thyroid, 30 parathyroid and 20 laparoscopic adrenalectomy procedures. Semi-structured interviews with 12 participants identified four major themes: (1) learning opportunities during general surgical education and training programmes alone are insufficient for consultant-level competence; (2) the importance of sufficient training to develop clinical decision-making, insight and judgement to appropriately select patients in the management of endocrine disease; (3) expected standards of clinical and technical performance are independent of practice location or context; (4) the importance of multi-disciplinary teams for complex cases including advanced cancers.

Conclusions: Practicing endocrine surgeons acknowledge formal fellowship training is required to achieve competence across technical and non-technical domains. The definition of competence and expectations regarding technical outcomes are independent of practice location or context.