National Working Group on ESS publishes joint position paper

Dr. Stuart Iglesias

After four years of dedicated work, the National Working Group on Enhanced Surgical Skills (ESS) is proud to announce the publication of the Joint Position Paper on Rural Surgery and Operative Delivery in the fall issue of the Canadian Journal of Rural Medicine. The paper was jointly written by the Canadian Association of General Surgeons (CAGS), the College of Family Physicians of Canada (CFPC), the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the Society of Rural Physicians of Canada (SRPC), and produced through the collaboration of the National Working Group on ESS with administrative support from the Rural Coordination Centre of BC (RCCbc).

This milestone paper is one of five pillars identified in a national strategy developed by the National Working Group on ESS to provide a formal structure for the training and sustainment of enhanced surgical skill practice in rural Canada. Dr. Stuart Iglesias, lead for the National Working Group on ESS, noted that the group has made significant progress in fulfilling their five pillar strategy, and provided RCCbc’s BC Rural Update with a recent update of the group’s progress.

Pillar I – The Joint Position Paper (JPP). The collaborative development of the JPP represents a shift towards support for the establishment of enhanced surgical skills training and credentialing in Canada. Although the JPP was formally published in the SRPC’s Canadian Journal of Rural Medicine (CJRM) Iglesias notes that it will also be republished on the web site of the SOGC with an accompanying letter from CEO, Dr. Jennifer Blake, to provide context. The CFPC will also republish the JPP on its web site in 2016 to broadly include more physicians in this critical discussion.

Pillar II – Curriculum. The proposed curriculum for a national ESS training program was just published in the December issue of the Canadian Journal of Surgery. The curriculum addresses important questions like “what defines an ESS?” and “how do you properly evaluate an ESS graduate?” and, more importantly, will establish an “across-the-board” standard for current and future ESS physicians. Iglesias points out that evaluation is vital to the new curriculum: “there is a proposal for evaluation in there, it is quite rigorous, and it includes both written and oral exams for ESS graduates. There is no program yet that does that.”

The Canadian Journal of Surgery has also co-published two commentaries (supportive and critical) alongside the proposed curriculum. “The curriculum is expected to be a bit controversial,” says Iglesias but he is quick to point out that the discussion is essential and even welcome as it will focus the national medical community on key issues in rural surgical practice.

Pillar III – CFPC ESS Program Committee (Section of Communities of Practice in Family Medicine). Chaired by Dr. Brian Geller of Meadow Lake, SK, this section has committed in principle to issuing a Certificate of Added Competence (CAC), which will establish a pathway that formally recognizes and trains family physicians in enhanced surgical skill practice. The principle is contingent on getting the ESS program established alongside the approved curriculum. “There are some technical issues to be resolved, and a number of steps that have to happen before a CAC can be established,” cautions Iglesias. Overall, however, he is encouraged by the CFPC’s willingness to engage in the establishment of a CAC, and notes that the community of practice will bring a wealth of expertise from across the medical spectrum of practice to inform the process.

Pillar IV – Credentialing and Privileging. The fourth pillar of the national strategy encompasses credentialing and privileging of ESS family physicians in their home communities. The need for this pillar was highlighted by British Columbia’s provincial privileging process, which, according to Iglesias, “was actually hugely beneficial for ESS surgeons in the rural communities because […] for the first time ever […] we were given a code of ESS skills.” This pillar is benefitting greatly from the innovative work being done in Alberta’s Northern Zone. The issues surrounding credentialing and privileging are critical to the provision of in-community surgical services in rural communities throughout Canada.

Pillar V – Communities of Practice. The way forward for the National Working Group on ESS will ultimately involve the development of communities of practice comprising networks of family doctors, surgeons, OB/GYNs, and other related groups sharing their common interest in enhanced surgical skills to engage with and develop these areas further. The discussions hosted by the National Working Group on ESS have been rich and it is hoped that the work can be expanded in the near future to include anaesthesiologists, members of the universities, and other stakeholders in rural surgery.

At the upcoming Summit on Rural Surgery and Operative Delivery being held on January 23, 2016 in Banff, AB (after the annual Enhanced Surgical Skills CME Program on January 21-22, 2016), the National Working Group on ESS will gather stakeholders from across the country to discuss the future direction of the network. Iglesias explains, “Banff is envisioned as a call to come together, to rethink, reset, and decide if we need to re-charge and re-name ourselves going forward.” One possible name Iglesias mentioned was the “National Working Group on Rural Surgery and Operative Delivery,” which would comprise a broader coalition of members, including general surgery, OB/GYNs, anesthesiologists, and university representation. According to Iglesias, “what we morph into at Banff will probably reformulate [the success of the first three pillars] as part of our go forward plan. The same way that these five pillars were identified in 2012 in Whistler, we will probably reformulate them and give them new meaning and new life in Banff in 2016.”

For more information on the comprehensive slate of rural surgical CME and strategic discussion opportunities taking place in Banff in late January, visit the SRPC website.


The ESS CME Program is sponsored by the Saskatchewan Union of Nurses, the Alberta Rural Physician Action Plan (RPAP), the Rural Coordination Centre of BC (RCCbc), the Saskatchewan Medical Association (SMA), and the Society of Rural Physicians of Canada (SRPC).

The Summit on Rural Surgery and Operative Delivery is sponsored by RPAP, RCCbc, and the Committee on Rural and Regional Practice (CoRPP) of the SMA.