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  Ã·´Ü¼ö¼ú¹ý ãËæÑ ÀÇ·á »ç°í¸¦ º¸°í(03/08/30 ÃÖÁ¾)
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·á¸¦ ã¾Æº¸¾Ò½À´Ï´Ù. ±¹Á¦Ã´Ãß±³À°¼¾ÅͶó´Â °ÍÀÌ ¹«¾ùÀÎÁö ¾Æ·¡ ±â»ç¿¡
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Àü¼öµÈ´Ù°í ÇÑ ºÎºÐ¿¡¼­ ±× ¼¾ÅÍ °íÀ¯ÀÇ ±â¼úÀ» ¸»ÇÏ´Â °Í °°Àºµ¥, ÀÚ¼¼ÇÑ
°ÍÀº ¸ð¸¨´Ï´Ù. ±× ±â¼úÀÌ ÀÌ¹Ì ÀÇ·á¿¡¼­ ³Î¸® ÀÎÁ¤¹Þ¾Æ ¾²ÀÌ´Â °ÍÀÎÁö, ¾Æ
´Ï¸é ¾ÆÁ÷ ±×·¸Áö ¸øÇÑ ½ÇÇè ³»Áö °³¹ß ´Ü°è·Î º¸¾Æ¾ß ÇÒÁö°¡ Áß¿äÇÒ °ÍÀÔ
´Ï´Ù. ±×¸®°í Á¦ÀÏ Áß¿äÇÑ °ÍÀº »õ·Î¿î ±â¼úÀ» µµÀÔÇϰųª °³¹ßÇÏ´Â °úÁ¤
ÀÇ À±¸® ÀýÂ÷ÀÔ´Ï´Ù.

¢Æ ±¹Á¦Ã´Ãß±³À°¼¾ÅÍ ¼±Á¤ 
 
 * ±â»ç °ÔÀçÀÏ : 2003-02-27
È«Äá, ½Ì°¡Æú¿¡ ÀÌ¾î ¾Æ½Ã¾Æ¿¡¼­ ³× ¹ø°

À»Áö´ëÇк´¿ø ôÃß¼¾ÅÍ(¼ÒÀå ±èȯÁ¤)°¡ ¼¼°èÀûÀÎ ÀÇ·á¿ëÇ° °ø±Þ¾÷üÀÎ Á¸
½¼¾ØÁ¸½¼ µàÇÇ ¾ÆÅ©·Î¸Þµå(Johnson&Johnson Depuy Acromed)°¡ ÁöÁ¤ÇÑ
¡®±¹Á¦Ã´Ãß±³À°¼¾ÅÍ¡¯·Î ¼±Á¤µÆ´Ù.

±×µ¿¾È Á¸½¼¾ØÁ¸½¼»ç´Â ôÃß¼ö¼úÀÇ ¼±Áø±â¼úÀ» °øÀ¯Çϱâ À§ÇØ ¼¼°èÀûÀ¸·Î
½Ç·ÂÀ» ÀÎÁ¤¹Þ´Â º´¿ø ¹× ÀÇ»çµéÀ» ´ë»óÀ¸·Î ¿©·¯ °¡Áö ½É»ç¸¦ °ÅÃÄ ±¹Á¦
ôÃß±³À°¼¾ÅÍ ¹× Áöµµ±³¼ö¸¦ ¼±Á¤ÇØ¿Ô´Ù.

À»Áö´ëÇк´¿øÀº È«Äá, ½Ì°¡Æú µî¿¡ ÀÌ¾î ¾Æ½Ã¾Æ¿¡¼­´Â ³× ¹ø°·Î Á¸½¼¾ØÁ¸
½¼ÀÇ ¾ö°ÝÇÑ ½É»ç±âÁØÀ» Åë°ú, ±¹Á¦ÀûÀΠôÃß¼¾ÅÍÀÓÀ» °ËÁõ ¹Þ°Ô µÆ´Ù.

Á¸½¼¾Ø¼ÕÁð °ü°èÀÚ´Â ¡°Å¸ º´¿ø¿¡ ºñÇØ À»Áö´ëÇк´¿ø ôÃß¼¾ÅÍ ¼ö¼úÆÀÀÇ
¼ö¼ú ÄÉÀ̽º°¡ ¿ùµîÈ÷ ¸¹°í ¶Ç ¼º°ø·üÀÌ ³ôÀº Á¡, ±×¸®°í º´¿ø¿¡¼­ º¸À¯ÇÏ
°í Àִ ÷´ÜÀÇ·á½Ã¼³°ú Àåºñ µîÀ» ÃæºÐÈ÷ °í·Á, ±¹Á¦Ã´Ãß±³À°¼¾ÅÍ·Î ÁöÁ¤
ÇÏ°Ô µÆ´Ù¡±°í ¹àÇû´Ù.

±¹Á¦Ã´Ãß±³À°¼¾ÅÍ·Î ¼±Á¤ÀÌ µÇ¸é ±¹³»¿Ü ÇÐȸµîÀ» ÅëÇØ ÇØ´ç ¼¾ÅÍ¿¡ ´ëÇÑ
Á¤º¸°¡ ±¹Á¦ÀûÀ¸·Î °øÀ¯µÇ¸ç, ±¹³»»Ó¸¸ ¾Æ´Ï¶ó ÇØ¿Ü¿¡¼­µµ ±³À°»ý Áö¿øÀÚ
¸¦ ¹Þ¾Æ ÀÏÁ¤±â°£ µ¿¾È ÇÔ²² »ýÈ°Çϸ鼭 À»Áö´ëÇк´¿ø ôÃß¼¾ÅÍ°¡ º¸À¯ÇÑ
¼ö¼ú±â¹ý ¹× ÃֽŠ°æÇâÀ» Àü¼öÇØÁÖ°Ô µÈ´Ù.

¶ÇÇÑ ¸Å³â 2ȸ ¼¼°è °¢±¹ÀÇ ±³¼öµéÀÌ Âü¼®ÇÏ´Â ¿öÅ©¼¥À» ¿­°í ¼ö¼ú°úÁ¤ Âü
°ü µîÀÇ Æ®·¹ÀÌ´× ÇÁ·Î±×·¥À» ÁøÇàÇÒ ¿¹Á¤ÀÌ´Ù.

À»Áö´ëÇк´¿ø ôÃß¼¾ÅÍ ¼ÒÀå ±èȯÁ¤±³¼ö´Â °íÅë¹Þ´Â ôÃßȯÀÚµéÀ» À§ÇØ ´õ
¿­½ÉÈ÷ Ä¡·áÇÏ°í ¿¬±¸Ç϶ó´Â äÂïÁú·Î ¾Ë°í, ¾ÕÀ¸·Î ôÃßÄ¡·á±â¼ú °³¹ß°ú
±¹³» ÀÇ·á°èÀÇ ¹ßÀüÀ» À§ÇØ ´õ¿í ¸ÅÁøÇÏ°Ú´Ù´Â ¼Ò°¨À» ¹àÇû´Ù.

±â»çÃâó : ¸ÞµðĮƮ¸®ºå

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¾Æ·¡ µ¿¾ÆÀϺ¸ ±â»ç¸¦ ÂüÁ¶ÇϽʽÿÀ. ÷´Ü ¼ö¼ú¹ýÀÇ ½Ã¿¬ ´ë»óÀÌ µÈ ȯÀÚ
°¡ »ç¸ÁÇÑ »ç°íÀÔ´Ï´Ù. ÷´Ü ¼ö¼ú¹ýÀÎ °ÍÀº "¼ö¼ú½Ç°ú ±¹Á¦Çмú¼¼¹Ì³ª½ÇÀ»
Æó¼âȸ·Î(CC)TV·Î ¿¬°áÇØ »ýÁß°èÇß´Ù"´Â ´ë¸ñ¿¡ ³ªÅ¸³ª ÀÖ½À´Ï´Ù.

ÀÌ ¼ö¼ú¹ýÀÌ Ã·´Ü ¼ö¼ú¹ýÀÌ¸ç ½Ã¿¬ ´ë»óÀÌ µÆ´Ù´Â °ÍÀ» ȯÀÚ³ª °¡Á·¿¡°Ô
¾Ë¸®Áö ¾ÊÀº ¸ð¾çÀÔ´Ï´Ù. º´¿ø Ãøµµ "Çмú¼¼¹Ì³ª¿¡ ¼ö¼ú ³»¿ëÀÌ °ø°³µÈ´Ù
´Â »ç½ÇÀ» ȯÀÚ °¡Á·µé¿¡°Ô ¹Ì¸® ¾Ë¸®Áö ¸øÇÑ °ÍÀº À߸øÀÌ´Ù"¶ó°í ½ÃÀÎÇß
´Ù°í ÇÕ´Ï´Ù.

1. RACS, »õ·Î¿î ¼ö¼ú¹ý   

÷´Ü ¼ö¼ú¹ýÀ» µµÀÔÇÏ´Â °úÁ¤ÀÌ ºÐ¸í ½Å¾à ÀÓ»ó ½ÃÇè°ú À¯»çÇØ¾ß ÇÒ °ÍÀÌ
¶ó°í »ý°¢µÇ¾î ÀÎÅͳÝÀ» ã¾Æº¸´Ï RACS ÀڷḦ ¹ß°ßÇߴµ¥ ´Ù¸¥ ÀÚ·á´Â
´õ ãÁö ¾Ê¾Ò½À´Ï´Ù. RACS(Royal Australasian College of Surgeons)´Â
¿À½ºÆ®·¹Àϸ®¾Æ¿Í ´ºÁú·£µå¿¡¼­ È°µ¿ÇÏ´Â ¿Ü°úÀǻ縦 ȸ¿øÀ¸·Î ÇÑ ´ÜüÀÔ
´Ï´Ù. 
   
ÀÌ ´ÜüÀÇ »õ·Î¿î ¼ö¼ú¹ý µµÀÔ°ú °ü·ÃµÈ ±ÔÁ¤Àε¥, ÀÎÁ¤ ÀýÂ÷¸¦ Æ÷ÇÔÇÑ ÀÏ
Á¾ÀÇ À±¸® ±ÔÁ¤À̶ó°í º¼ ¼ö ÀÖ½À´Ï´Ù. ¾Æ·¡ Àü¹®À»  ÷ºÎÇßÀ¸´Ï Àо½Ã
±â ¹Ù¶ø´Ï´Ù. ÀÌ °æ¿ì »õ·Î¿î ¼ö¼ú¹ýÀº ¿ÜºÎ¿¡¼­ ÀÌ¹Ì »ç¿ëµÇ°í ÀÖ´Â ¼ö¼ú
¹ýÀ̰ųª ¾ÆÁ÷ °³¹ß ÁßÀÎ ¼ö¼ú¹ýÀ» µµÀÔÇÒ °æ¿ì µîÀ» ¸Á¶óÇÏ¿© ¸»ÇÕ´Ï´Ù.
ÀÚü ³»¿¡¼­ °³¹ßµÉ °æ¿ìµµ ¸¶Âù°¡Áö ±ÔÁ¤ÀÌ Àû¿ëµÉ °ÍÀÔ´Ï´Ù.

2. »õ·Î¿î ¼ö¼ú¹ý µµÀÔ 

¾î¶² °æ¿ì³ª ¼ö¼ú¹ý µµÀÔ¿¡´Â º´¿øÀÇ ÀÎÁ¤À§¿øȸ(Credentials Committee)
°¡ ¿ªÇÒÀ» ÇÕ´Ï´Ù. ¿ì¼± À§¿øȸ´Â ÀÌ ¹æ¹ýÀÌ ÀÌ¹Ì ¿Ü°ú¿¡¼­ ÀÎÁ¤À» ¹ÞÀº
¹æ¹ýÀÎÁö, ¾ÆÁ÷ °³¹ß ÁßÀÎ ¹æ¹ýÀÎÁö °áÁ¤ÇÕ´Ï´Ù. ´ÙÀ½¿¡ ±× ¹æ¹ý¿¡ ´ëÇÑ ±â
¼úÀû Æò°¡°¡ ÇÊ¿äÇÒ °ÍÀÔ´Ï´Ù.

ƯÈ÷ ¾ÈÀü¼º¿¡ °üÇؼ­´Â ÀÇ»ç ´Üü»Ó¸¸ ¾Æ´Ï¶ó º¸°Ç °ü·Ã Á¤ºÎ ºÎóÀÇ ±Ô
Á¤µéÀÌ ÀÖÀ» °ÍÀÔ´Ï´Ù. À̸¦ ±âÁØÀ¸·Î Æò°¡ÇÒ »Ó¸¸ ¾Æ´Ï¶ó ±× º´¿ø¿¡¼­ ¾î
¶² ȯ°æ¿¡¼­ ´©°¡ ¼ö¼úÀ» ÇÏ´ÂÁö¸¦ Æò°¡ÇØ¾ß ÇÒ °ÍÀÔ´Ï´Ù. ÀÌ¹Ì ¾ÈÀüÇÑ ¹æ
¹ýÀ¸·Î ÀÎÁ¤¹ÞÀº °æ¿ìµµ ±× ¹æ¹ýÀ» Á¦´ë·Î ½ÃÇàÇÒ ¿©°ÇÀÌ µÇ´ÂÁö Æò°¡ÇÑ´Ù
´Â ÀǹÌÀÔ´Ï´Ù.

3. ±â°ü À±¸® À§¿øȸ

ƯÈ÷ ¾ÆÁ÷ °³¹ß ÁßÀÎ ¹æ¹ýÀÎ °æ¿ì´Â ´Ü¼øÈ÷ º´¿øÀÇ ÀÎÁ¤À§¿øȸÀÇ ½É»ç¸¸À¸
·Î´Â ¾ÈµÇ¸ç ±â°ü À±¸®À§¿øȸÀÇ ½ÂÀÎÀ» ¹Þ¾Æ¾ß ÇÕ´Ï´Ù. ÀÌ °æ¿ì ±â°üÀ̶õ
º´¿øÀÌ ¼ÓÇÑ ±â°üÀÏ °ÍÀε¥ ±×º¸´Ù ³ôÀº ±â°üÀÏ ¼öµµ ÀÖÀ» °ÍÀ̶ó°í ÃßÃø
ÇÕ´Ï´Ù. ´Ù½Ã ¸»Çؼ­ »õ·Î¿î ¹æ¹ýÀ» ½ÃÇàÇϱâ Àü¿¡ ±× ¹æ¹ý¿¡ ´ëÇÑ ±â°ü
À±¸®À§¿øȸÀÇ ½ÂÀÎ ÀýÂ÷¸¦ °ÅÃÄ¾ß ÇÑ´Ù´Â °ÍÀÔ´Ï´Ù.

ÀÌ °æ¿ì ÀýÂ÷´Â ½Å¾à ÀÓ»ó ½ÃÇè ÀýÂ÷¿Í À¯»çÇÒ °ÍÀÔ´Ï´Ù. Á¤½ÄÀ¸·Î ¿¬±¸
°èȹ¼­¸¦ ³»¾î ½ÂÀÎÀ» ¹Þ½À´Ï´Ù. ±× °èȹ¼­¿¡´Â ±× ¼ö¼ú¹ýÀÌ ¾î°¼­ ÇÊ¿ä
ÇÑÁö, ´Ù¸¥ °÷¿¡¼­ ½ÃÇèÀûÀ¸·Î ±× ¼ö¼ú ÀýÂ÷¸¦ ½ÃÇàÇÑ °á°ú°¡ Æ÷ÇÔµÅ¾ß ÇÒ
°ÍÀÔ´Ï´Ù.

±×¸®°í Á¦ÀÏ Áß¿äÇÑ °ÍÀº ±× ¼ö¼ú¹ýÀÇ ´ë»óÀÌ µÉ ȯÀÚÀÇ '³»¿ë ¼³¸í µ¿ÀÇ
¼­(informed consent)'°¡ ÷ºÎµÅ¾ß ÇÕ´Ï´Ù. ¾î¶² ¼ö¼ú¹ýÀÌ¸ç ±âÁ¸ÀÇ ¼ö¼ú¹ý
°ú ºñ±³ÇÏ¿© ¾î¶² À̵æÀÌ ÀÖÀ¸¸ç ¶ÇÇÑ ¾î¶² À§ÇèÀÌ ÀÖ´Ù´Â µîÀÇ ¼³¸íÀ» ÇÑ
´ÙÀ½¿¡ ¼ö¼ú ´ë»óÀÌ µÇ°Ú´Ù´Â µ¿ÀǼ­¿¡ ¼­¸íÇÑ °ÍÀÔ´Ï´Ù.
 
4. ±Ý¹ø ÷´Ü ¼ö¼ú¹ý »ç°í

±Ý¹ø ¼ÒÀ§ ÷´Ü ¼ö¼ú¹ýÀÇ ÀÚ¼¼ÇÑ °ÍÀº ¸ð¸¨´Ï´Ù. Àü³²´ë º´¿øÀ̶ó°í Çß´Â
µ¥, ±¹Á¦Çмú ¼¼¹Ì³ª¿¡ º¸¿©ÁÙ Á¤µµ¶ó¸é ÀÚü °³¹ßÇÑ °ÍÀÌ ¾Æ´Ò±î ÃßÃøÀÌ
µÇ¸ç ÀÌ °úÁ¤¿¡¼­ Àü³²´ë º´¿ø ³»Áö Àü³²´ë ¶Ç´Â ¾î¶² ±â°üÀÇ ½ÂÀÎ ÀýÂ÷¸¦
°ÅÃÆ´ÂÁö, ±×·± ÀýÂ÷°¡ ÀÖ´ÂÁö, ¸ð¸¨´Ï´Ù.

¶ÇÇÑ ±× µ¿¾È ÀÌ ¼ö¼ú¹ýÀ» µµÀÔ ¶Ç´Â °³¹ßÇϸç ȯÀÚÀÇ ³»¿ë ¼³¸í µ¿ÀǼ­¸¦
¹Þ¾Ò´ÂÁöµµ ¸ð¸¨´Ï´Ù. ÷´Ü ¼ö¼ú¹ýÀ̶ó¸ç Àå¸éÀ» ±¹Á¦ ÇмúȸÀÇ¿¡ º¸¿©ÁÖ
¸ç ÀÌ°ÍÀ» ȯÀÚ¿Í °¡Á·¿¡°Ô ¾Ë¸®Áö ¾ÊÀº °ÍÀ¸·Î º¸¾Æ À±¸® ÀÇ½Ä ÀÚü¸¦ °®
°í ÀÖ´Â °ÍÀÎÁö ÀǽÉÀÌ µì´Ï´Ù. ÀÇ»çȸ ¹× °ü·Ã ÇÐȸ¿¡¼­´Â ÀÚü À±¸® ±Ô
Á¤À» ¾î¶»°Ô °¡´Ùµë°í ÀÖ´ÂÁö, ³ë·ÂÀÌ ÇÊ¿äÇÒ °ÍÀÔ´Ï´Ù.   

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µ¿¾ÆÀϺ¸ 2003³â 8¿ù27ÀÏ ¿ÀÀü 8:29 
÷´Ü¼ö¼ú¹ý ãËæÑµÚ È¯ÀÚ ¼ûÁ® 

¼ö¼ú½Ç°ú ±¹Á¦Çмú¼¼¹Ì³ª½ÇÀ» Æó¼âȸ·Î(CC)TV·Î ¿¬°áÇØ »ýÁß°èÇϴ ÷´Ü
¼ö¼ú¹ý ½Ã¿¬(ãËæÑ)ÀÇ ´ë»óÀÌ µÆ´ø 40´ë ¿©¼º ȯÀÚ°¡ ¼ö¼ú ÈÄ 2ÁÖ¸¸¿¡ ¼ûÁö
´Â »ç°í°¡ ¹ß»ýÇØ °æÂûÀÌ Á¶»ç¿¡ ³ª¼¹´Ù.

26ÀÏ ±¤ÁÖ µ¿ºÎ°æÂû¼­¿¡ µû¸£¸é ȯÀÚ ±è¸ð¾¾(49¡¤¿©¡¤´ëÀü À¯¼º±¸)´Â 8ÀÏ
Àü³²´ëº´¿ø¿¡¼­ Á¤¸ð ±³¼ö(Á¤Çü¿Ü°ú)ÀÇ Áýµµ·Î ÈäÃß Á¦1¡­3¹ø ÈÄÁ¾ °ñÈ­Áõ
(»À°¡ ±»¾îÁö¸ç ½Å°æÀ» ´©¸£´Â Áõ»ó)À¸·Î ôÃß ¼ö¼úÀ» ¹Þ¾Ò´Ù.

±×·¯³ª ±è¾¾´Â ¸¶Ãë¿¡¼­ ±ú¾î³ªÁö ¸øÇÏ°í ³ú°¡ º×´Â ³úºÎÁ¾ Çö»óÀ¸·Î ÀǽÄ
ºÒ¸í»óÅ¿¡ ºüÁ³´Ù°¡ 22ÀÏ ¿ÀÈÄ ¼ûÁ³´Ù.

±è¾¾ÀÇ ³²Æí ÃÖ¸ð¾¾(52)´Â ¡°¸ÖÂÄÇÏ´ø ¾Æ³»°¡ ¼ö¼ú Á÷ÈÄ ³ú»ç»óŸ¦ º¸¿´
´Ù¡±¸ç ¡°º´¿øÃøÀÌ ¼ö¼ú Àü¿¡ ¾Æ³»°¡ Çмú´ëȸÀÇ Ã·´Ü ¼ö¼ú¹ý ½Ã¿¬ ´ë»óÀÌ
¶ó´Â »ç½Ç°ú ¼ö¼ú ÈÄ ³ªÅ¸³¯ ¼ö ÀÖ´Â ¹®Á¦Á¡ µîÀ» °¡Á·¿¡°Ô ¾Ë¸®Áö ¾ÊÀº
°ÍÀº ¸í¹éÇÑ °ú½Ç¡±À̶ó¸ç °æÂû¿¡ °í¼ÒÀåÀ» Á¦ÃâÇß´Ù.

¼ö¼ú ´çÀÏ Àü³²´ëº´¿ø »êÇÏ ¡®±¹Á¦Ã´Ãß±³À°¼¾ÅÍ¡¯ ÁÖ°üÀ¸·Î ÀϺ» Áß±¹ ÇÊ
¸®ÇÉ µî ¾Æ½Ã¾Æ ôÃß ¼ö¼ú Àü¹®°¡¿Í ±¹³» Àü¹®ÀÇ µî 50¿©¸íÀÌ Âü¼®ÇÑ °¡¿î
µ¥ ±¹Á¦Çмú¼¼¹Ì³ª°¡ ¿­·ÈÀ¸¸ç Âü¼®ÀÚµéÀº ±è¾¾ÀÇ ¼ö¼ú°úÁ¤À» ¼ö¼ú½Ç°ú ±³
À°¼¾Å͸¦ ¿¬°áÇÑ CCTV¸¦ ÅëÇØ »ýÁß°è·Î º¸¸ç Åä·ÐÀ» ¹ú¿´´Ù.

º´¿øÃøÀº ÀÌ¿¡ ´ëÇØ ¡°³úºÎÁ¾Àº ¼ö¼ú°úÁ¤¿¡¼­ ±ÞÀÛ½º·´°Ô ¹ß»ýÇÒ ¼ö ÀÖÀ¸
³ª ±è¾¾ÀÇ ¼ö¼úÀº Á¤»óÀûÀ¸·Î ÀÌ·ïÁ³´Ù¡±¸ç ¡°Çмú¼¼¹Ì³ª¿¡ ¼ö¼ú ³»¿ëÀÌ
°ø°³µÈ´Ù´Â »ç½ÇÀ» ȯÀÚ °¡Á·µé¿¡°Ô ¹Ì¸® ¾Ë¸®Áö ¸øÇÑ °ÍÀº À߸ø¡±À̶ó°í
¸»Çß´Ù.

ÇÑÆí °æÂûÀº ¼ûÁø ±è¾¾ÀÇ Á¤È®ÇÑ »çÀÎÀ» °¡¸®±â À§ÇØ À̳¯ ºÎ°ËÀ» ½Ç½ÃÇÏ
´Â ÇÑÆí ¼ö¼ú ´ã´çÀǻ縦 ºÒ·¯ °ú½Ç ¿©ºÎ µîÀ» Á¶»çÇÒ ¹æħÀÌ´Ù.

±¤ÁÖ=Á¤½ÂÈ£±âÀÚ shjung@donga.com
 
.........................................
Royal Australasian College of Surgeons

* The following policy is included in College Policy 2.6 (RACS
Representatives on Hospital Electoral Bodies) and also in
College Policy 3.17 (New Technology and Surgical Practice)

New Technology and Surgical Practice
Credentialling Processes

1. New Surgical Procedures
It is very difficult for an individual, a Committee or the College to say
precisely when a new procedure has passed through the experimental
and developmental stages and become part of current surgical practice?
Recognition of this transition really depends upon general acceptance of
the procedure based upon the collective experience, usually of a number
of surgeons from different centres, who carefully evaluate their results,
present them at scientific meetings and publish them in the relevant
scientific literature. With some procedures this is a relatively rapid
process, leading quickly to general acceptance, but with others
evaluation may prove to be lengthy and inconclusive.

Credentials Committees at individual hospitals therefore need to make
their own assessments based upon reported experiences and known
practice elsewhere. In coming to a decision the hospital's Credentials
Committee may also need to consider the procedure in the context of
any new technology likely to be involved, the available facilities and the
supporting staff. It is accepted that on some occasions the Committee
will remain uncertain in which case it should adopt a conservative
approach.

If the procedure is considered to be part of current surgical practice 
then the surgeon may be credentialled to perform the procedure in
accord with the following requirements 2, 3 and 4.

If it is considered that the procedure is still developmental  then this
view must be carefully considered along with all other aspects of the
application and may well influence the decision of the Committee and
any conditions which they may place on the credentials. (See Item 4.8)

If the Hospitals Credentials Committee decides that the new procedure
is still experimental  then a submission should also be made to the
Institutional Ethics Committee for approval. Such a request would also
need to be accompanied by an appropriately-worded patient information
document used for obtaining informed consent.

2. The Technology
With any technology not previously in wide-spread use, assessment
must be made of  resources necessary for the support of the
technology, and safety requirements or standards which may be laid
down by the Standards Association, ACHS, Health Departments,
hospitals or the College. The above matters must be considered
favourably before a surgeon is credentialled to use the new technology.

3. Competency in Use of the New Technology
Surgeons should be certified as knowledgeable of the technology and
competent in its use. The manner in which certification is granted will
vary with the technology eg. lasers, endoscopy, laparoscopy, stereotactic
surgery, etc. In some instances satisfactory knowledge and skills
transfer will occur during standard apprenticeship-style training. In
other situations the needs may be met most appropriately by means
of special instruction. It will then be necessary for the College or the
Specialist Societies to establish and conduct training programs in the
form of specially designed short courses. Satisfactory completion of
these selected programs should become an essential and compulsory
part of surgical training (compare with completion of the EMST
course), in the related disciplines.

The special courses will need to be updated from time to time as the
technology advances or new innovations develop. Each Surgical Board
will need to define those courses necessary for completion in that
particular specialty.

Surgeons already in practice who have not completed courses on the
new technology should do so, or otherwise justify their knowledge and
competence based on past experience, before being credentialled for its
use. Hospital Credentials Committees should consider whether surgeons
have maintained, and if necessary updated, their knowledge and
competence before renewing credentials.

4. The Surgeon
If a new surgical procedure is currently regarded as an acceptable
method of treatment incorporated into current surgical practice  (no
longer experimental or developmental), and the use of any relevant
technology has been approved, then credentials to perform the procedure
and use the technology may be granted if the surgeon:

.1 Is knowledgeable of the relevant anatomy and pathology.
.2 Is experienced in surgery of the region and the system.
.3 Is certified as competent in the use of a particular technology if this
is relevant to the performance of the procedure.
.4 Has a satisfactory record of surgical practice and undergone
appropriate training under a surgeon experienced in the field.
.5 Is prepared to work under the guidance of a more-experienced
surgeon if this is considered to be necessary while additional experience
is obtained.
.6 Is held in good standing by his surgical peers.
.7 Participates in surgical audits and undertakes to maintain full records
and follow-up details of the patients operated upon.
.8 Is prepared to provide a report on the patients treated and results
obtained in such a form and at such intervals as deemed appropriate by
the Credentials Committee. This requirement is of particular relevance
when the Credentials Committee is uncertain of the degree of
acceptance of the procedure and/or the technical skill of the surgeon.

5. Experimental Surgery and Clinical Trials on Humans
A surgeon planning to undertake experimental surgery or developmental
surgery which is not yet regarded as part of current clinical practice, or
to participate in a clinical trial involving the performance of a surgical
procedure, should:

.1 Be credentialled as a qualified and experienced surgeon capable of
performing the relevant surgical procedure (as in 4 above); and in
addition -
.2 Submit research protocols, with appropriate patient information and
consent forms, to the institutional Ethics Committee for approval.
(Approved by Council February 1997)
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