This training programme aims to enhance pre-operative shared decision-making between patients and surgeons, which has been shown to improve treatment outcomes and patient coping with complications.
Effective communication is vital, especially when complications arise, to maintain trust and support both patients and healthcare providers.
Consultations at critical stages, such as end-of-life or childhood, present unique challenges that require specific skills.
In busy surgical services, finding the time and energy for meaningful patient conversations can be challenging. Developing these skills often occurs informally over time.
Fortunately, there are models, guidance, and techniques available to assist healthcare professionals. Both faculty and trainees can enhance their skills through deliberate practice and feedback.
By adopting a 'Safety 2' approach, which emphasizes positive outcomes alongside traditional risk management, we aim to train trainees to approach consultations with the same diligence as operations, without increasing their workload.
The COSMOS programme has evolved from the College’s one-day ICONS (Informed Consent) course. It now offers a modular, helical programme consisting of a training day each year for four years (ideally ST2-5), complemented by pre- and post-course materials.
Module Overview
1. Module A (CT2 / ST2-4)
o Topics: Opening & Closing, Shared Decision Making (3-talk model), Communicating Risk, Cultural Competence
o Pre-course: Video scenarios & discussion
o Post-course: Teaching and discussion, 4 short simulations, small group debrief
2. Module B (ST3-5)
o Topics: “When it all goes wrong”, Conversations with patients, teams, 2nd casualties, Responding to complaints
o Pre-course: Module A recap video including new scenario
o Post-course: Facilitated discussions using video analysis, 2 simulations, small group debrief
3. Module C (ST4-6)
o Topics: Childhood, End of Life, Cultural Competence, Subspecialty Issues
o To pilot in 2025
4. Module D (ST5-7)
o Topics: Consent, Bringing it all together
o To design & pilot in 2026
To date, Module A has been established as part of the Scottish Core Surgery Year 2 “Booster Camp” and is set to expand to other UK deaneries. Module B has been piloted twice in 2024 and is being integrated into Scottish General Surgery training programmes.
We plan to grow the faculty to support this expansion. All faculty members will receive training on debriefing after simulations and will have opportunities to shadow modules before delivering them. Ongoing faculty coaching and accreditation will be established in 2025.
For Training Programme Directors interested in commissioning modules for their programmes, please email kenneth.walker@nhs.scot.
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