Surgical Competencies Required in Newly Commencing Colorectal Surgeons: an Educational and Training Spectrum



Surgical training models have changed from master-apprentice to competency-based training. We aimed to determine the relative importance and peak periods of acquiring these competencies in newly commencing colorectal surgeons.


A mailed questionnaire to all current Colorectal Surgical Society of Australia and New Zealand (CSSANZ) members was conducted between October and December 2016 assessing the relative importance of each competency and the period or activity of learning or training contributing most to achieving that competency.


The response rate was 43% (90/208) with 87% (n = 75) agreed or strongly agreed to the relevance and applicability of the nine RACS competencies. Competencies varied in perceived importance (strongly agreed: judgment-clinical decision-making (JU) 63%, collaboration/teamwork (CT) 53%, technical expertise (TE) 47%, communication (CO) 44%, medical expertise (ME) 34%, scholarship/teaching (ST) 33%, professionalism (PR) 33%/ethics (ET) 24%, health advocacy (HA) 18%, management (MX) 13%/leadership (LE) 17%), and the peak period for acquiring them (registrar: CO 39%, ST 30%; fellow: TE 62%, CT 44%, ME 40%, JU 38%; consultant: MX/LE 52%, HA 48%, PR/ET 33%).


Surgical competencies for colorectal surgeons are accumulated and acquired at varying degrees and periods across a spectrum of continuing registrar, fellow, and consultant education and training. These findings serve as a baseline for further refinement of current and continuing educational and training programs.

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Fig. 1


  1. 1.

    Hamdorf JM, Hall JC. Acquiring surgical skills. Br J Surg. 2000;87(1):28–37.

    Google Scholar 

  2. 2.

    Royal College of Physicians and Surgeons of Canada. The CanMEDS. Physician Competency Framework—Better Standards, Better Physicians, Better Care. 2005.

  3. 3.

    Arora S, Sevdalis N, Suliman I, Athanasiou T, Kneebone R, Darzi A. What makes a competent surgeon?: experts’ and trainees’ perceptions of the roles of a surgeon. Am J Surg. 2009;198(5):726–32.

    Google Scholar 

  4. 4.

    Royal Australasian College of Surgeons. A guide to surgical education & training, 2nd edn. Melbourne: Royal Australasian College of Surgeons, 2018.

  5. 5.

    Rademakers JJ, De rooy N, Ten cate OT. Senior medical students’ appraisal of CanMEDS competencies. Med Educ 2007;41(10):990–994.

  6. 6.

    Ringsted C, Hansen TL, Davis D, Scherpbier A. Are some of the challenging aspects of the CanMEDS roles valid outside Canada? Med Educ. 2006;40(8):807–15.

    Google Scholar 

  7. 7.

    Gawande AA, Thomas EJ, Zinner MJ, Brennan TA. The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery. 1999;126(1):66–75.

    Google Scholar 

  8. 8.

    Verma S, Flynn L, Seguin R. Faculty’s and residents’ perceptions of teaching and evaluating the role of health advocate: a study at one Canadian university. Acad Med. 2005;80(1):103–8.

    Google Scholar 

  9. 9.

    Borman KR, Vick LR, Biester TW, Mitchell ME. Changing demographics of residents choosing fellowships: longterm data from the American Board of Surgery. J Am Coll Surg. 2008;206(5):782–8.

    Google Scholar 

  10. 10.

    Nousiainen MT, Latter DA, Backstein D, Webster F, Harris KA. Surgical fellowship training in Canada: what is its current status and is improvement required? Can J Surg. 2012 Feb;55(1):58–65.

    Google Scholar 

  11. 11.

    Simon MA. Evolution of the present status of orthopaedic surgery fellowships. J Bone Joint Surg Am. 1998;80(12):1826–9.

    Google Scholar 

  12. 12.

    Sachdeva AK, Blair PG, Lupi LK. Education and training to address specific needs during the career progression of surgeons. Surg Clin North Am. 2016 Feb;96(1):115–28.

    Google Scholar 

  13. 13.

    Sue GR, Bucholz EM, Yeo H, Roman SA, Jones A, Bell RH, et al. The vulnerable stage of dedicated research years of general surgery residency: results of a national survey. Arch Surg. 2011 Jun;146(6):653–8.

    Google Scholar 

  14. 14.

    Vincent C, Young M, Phillips A. Why do people sue doctors? A study of patients and relatives taking legal action. Lancet. 1994;343:1609–13.

    Google Scholar 

  15. 15.

    Arora S, Sevdalis N, Nestel D, Tierney T, Woloshynowych M, Kneebone R. Managing intraoperative stress: what do surgeons want from a crisis training program? Am J Surg. 2009;197(4):537–43.

    Google Scholar 

  16. 16.

    Baldwin PJ, Paisley AM, Brown SP. Consultant surgeons’ opinion of the skills required of basic surgical trainees. Br J Surg. 1999;86(8):1078–82.

    Google Scholar 

  17. 17.

    Hall JC, Ellis C, Hamdorf J. Surgeons and cognitive processes. Br J Surg. 2003;90(1):10–6.

    Google Scholar 

  18. 18.

    Sonnadara RR, Mui C, Mcqueen S, et al. Reflections on competency-based education and training for surgical residents. J Surg Educ. 2014;71(1):151–8.

    Google Scholar 

  19. 19.

    Bhatti NI, Cummings CW. Competency in surgical residency training: defining and raising the bar. Acad Med. 2007;82(6):569–73.

    Google Scholar 

  20. 20.

    Hawkins RE, Welcher CM, Holmboe ES, Kirk LM, Norcini JJ, Simons KB, et al. Implementation of competency-based medical education: are we addressing the concerns and challenges? Med Educ. 2015;49(11):1086–102.

    Google Scholar 

  21. 21.

    Ten cate O. Competency-based education, entrustable professional activities, and the power of language. J Grad Med Educ. 2013;5(1):6–7.

    Google Scholar 

  22. 22.

    Ten cate O. Nuts and bolts of entrustable professional activities. J Grad Med Educ. 2013;5(1):157–8.

    Google Scholar 

  23. 23.

    Moore D, Young CJ, Hong J. Implementing entrustable professional activities: the yellow brick road towards competency-based training? ANZ J Surg. 2017;87(12):1001–5.

    Google Scholar 

  24. 24.

    El Boghdady M, Alijani A. Feedback in surgical education. Surgeon. 2017;15(2):98–103.

    Google Scholar 

  25. 25.

    van Rossum TR, Fedde S, Sluiter HE, Bosman PJ, Rijksen L, Heyligers IC. Flexible competency based medical education: more time efficient, higher costs. Med Teach. Informa UK Ltd; 2018;0(0):315–317.

  26. 26.

    Ten cate O. Trust, competence, and the supervisor’s role in postgraduate training. BMJ. 2006;333(7571):748–51.

    Google Scholar 

  27. 27.

    Arora S, Sevdalis N, Nestel D, Woloshynowych M, Darzi A, Kneebone R. The impact of stress on surgical performance: a systematic review of the literature. Surgery. 2010;147(3):318–30 330.e1–6.

    Google Scholar 

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Thanks to Colorectal Surgical Society of Australia and New Zealand for their approval to distribute the survey.

Author information




Vasant Rajan, Jonathan Hong, and Christopher Young contributed to the conception, design, analysis, and interpretation of data, as well as drafting and critically revising the manuscript. Vasant Rajan was additionally responsible for the acquisition of data. Assad Zahid contributed to the analysis and interpretation of data, as well as drafting and critically revising the manuscript.

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Correspondence to Christopher J. Young.

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This paper furthers the understanding and relevance of competency-based surgical education and training to the professional development of a colorectal surgeon.

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Zahid, A., Rajan, V., Hong, J. et al. Surgical Competencies Required in Newly Commencing Colorectal Surgeons: an Educational and Training Spectrum. Med.Sci.Educ. (2020).

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  • Competency
  • Surgery
  • Training
  • Colorectal