By Conor Delaney, MD, PhD
Rectal cancer is an integral part of a colorectal surgeon's practice, and one for which the technique used, training and experience of the surgeon can have significant impact on cure and complication rates. Although there is general agreement that performance of a total mesorectal excision (TME) has improved the outcomes of rectal cancer surgery, there are no standards for how it is taught and performed.
Through the Rectal Cancer Coordinating Committee, ASCRS has set up a committee to develop an educational program for TME. The mission of this program is to improve national outcomes for rectal cancer by developing an educational module which teaches surgeons and residents the principles of multidisciplinary perioperative rectal cancer treatment to a standard acceptable to ASCRS. The committee includes representatives from the Rectal Cancer Coordinating Committee, Standards Committee, Continuing Education Committee, ASCRS Research Foundation, American Board of Colon and Rectal Surgery, Program Directors, Operative Competency Committee, College of American Pathologists, the Commission on Cancer, and SAGES.
The committee had two 5-hour, in-person workshops, immediately before the Annual Meeting in Phoenix, during which they performed a job task analysis, a necessary first step in developing a valid curriculum. The workshop was held with the assistance of Kryterion, an educational company which has supported the FLS (Fundamentals of Laparoscopic Surgery) and FES (Fundamentals of Endoscopic Surgery) programs developed by our colleagues in SAGES.
The job task analysis outlined sections of the curriculum and testing modules, including background information (anatomy and rationale for TME and neoadjuvant therapy), pre-operative assessment and surgical planning, operative principles and steps (which will apply to laparoscopic, open and robotic approaches), management of intraoperative difficulties and complications, post-operative care, and management of specific post-operative complications, such as anastomotic leak.
The program will be called Fundamentals of Rectal Cancer Surgery (FRCS).
Next steps will involve development of the specifics of the curriculum, item writing, alpha review and beta testing, and development of scoring standards to determine a passing grade commensurate with competence. A model for teaching and assessing the skills required for TME will also be developed.
Over the next few months, members of ASCRS may receive a link to a survey to grade the importance of the tasks developed by the committee at the recent workshop. We hope you will take the time to complete this, as we wish to make this module as robust and valid as possible.