PERSPECTIVES ANZJSurg.com
A Cowlishaw conundrum Venture to the first floor of the College of Surgeons in Melbourne and then along a corridor, and one will find the seemingly permanently closed doors of the Council room: behind those doors reposes the Cowlishaw collection of historical books, one of the truly great assets of the College. The loneliness of that scenario brings to mind the lines of W.S. Gilbert in ‘The Mikado’, “to sit in solemn silence in a dull, dark dock, in a pestilential prison, with a life-long lock,”
When one is able to view the magnificent collection, housed in bespoke cases provided by our anaesthetic colleagues, one is left to ponder not only its accessibility, but also, its utility. To most Fellows and surgical trainees, busy attending courses, meetings and lectures at the College, this may appear irrelevant nonsense; however, this collection represents the very foundations of the science and art of contemporary surgery. Leslie Cowlishaw, whose name the collection bears, was born in Sydney into comfortable circumstances and travelled twice to Europe prior to commencing medical studies at the University of Sydney. Following graduation in 1906, he again travelled to Europe and it was then that his collecting of material chronicling the history of medicine commenced. He knew what he wanted and knew where to seek the books, for he was in contact with the great booksellers of Europe and Great Britain: thus he gradually obtained the necessary background reference works to give him his great knowledge of the history and literature of medicine and surgery. Between 1906 and 1914, he obtained many of the early printed books in his library; during 1912 and 1913, in particular, he obtained a number of his finest books. Cowlishaw was one of the first to enlist in the Australian Imperial Force, when war was declared in 1914, and he served as a medical officer in Egypt and on Gallipoli, until he was evacuated to England with scarlet fever. It was there that he met Sir William Osler, whose greatest work, ‘The Principles and Practice of Medicine’, motivated many years later, the Bodley’s Librarian to note that Osler, had, ‘succeeded in making a scientific treatise literature’: Osler, at the age of 56, had come to Oxford in May 1905 to occupy the Chair of Regius Professor of Medicine. Osler, a self-confessed bibliomaniac, compiled the ‘Bibliotheca Osleriana’, which catalogued the more than 7500 titles in his magnificent library;1 he termed Cowlishaw, the ‘bibliophile from the bush’ encouraging Cowlishaw’s collecting and presented him with a number of books: Osler’s friendship is surely the imprimatur of the Cowlishaw collection. © 2013 Royal Australasian College of Surgeons
It should be remembered that Johannes Gutenberg first produced his printed Bible in 1455 and this lead to the eventual replacement of handwritten manuscripts: Incunabula, books published prior to 1501 are rare; the College has in its collection, no less than eight such items. When our College obtained this library, it purchased more than books, it purchased the research and reference material of a discriminating scholar gathered together with great care over a lifetime. The fascinating story of this acquisition is provided in Kenneth Russell’s Introduction to his monumental ‘Catalogue of the Historical Books in the Library of the Royal Australasian College of Surgeons’.2 The Cowlishaw Symposium was instituted in October 1996 with the notion of awakening Fellows’ knowledge of, and, interest in, the collection.3 In 2012, the ninth biennial Cowlishaw Symposium was conducted and seven Fellows of the College were among the presenters: essentially, the speakers are required to select a volume from the Cowlishaw collection, and study it, to enable its presentation and discussion. The aim of the symposium is, of course, to bring to the attention of all associated with the College, and beyond, the importance and the breadth of the treasures contained within the collection. The symposium has a single-day format at the College and incorporates the Kenneth Fitzpatrick Russell lecture. In the past, all papers were published in this Journal but nowadays space constraints prevent such luxury; on this occasion, one selected paper will be published in the Journal and all will be available on the College website. Professor David Watters’ paper, ‘Guy de Chauliac: pre-eminent surgeon of the Middle Ages’4 has been selected as representative of the spirit which Osler, Cowlishaw and Russell would have sought. The Cowlishaw collection contains Guy de Chauliac’s ‘Cyrurgia’ of 1499, and no less than three editions of his ‘Grande Chirurgie’, 1598, 1619 and 1659. Fellows are encouraged to come to the College and arrange to view the magnificent collection, which is of national importance, and to gain from it an insight into the foundations of their craft and hopefully to develop and nurture an interest in the history of surgery. The conundrum remains; is a one-day symposium held biennially, sufficient to do justice to Leslie Cowlishaw’s library, and, Kenneth Russell’s mighty endeavours in ensuring the delivery of this collection to our College; a collection which he protected, catalogued and cared for, to his last? For the forseeable future, this treasure trove continues its lonely vigil over a normally vacant Council Room. References 1. Osler Sir W. Bart. Bibliotheca Osleriana. A catalogue of books illustrating the history of medicine and science, collected, arranged, and annotated by Sir William Osler, Bt. and bequeathed to McGill University. Oxford: Clarendon Press, 1929.
ANZ J Surg 83 (2013) 699–705
700
Perspectives
2. Russell KF. Catalogue of the Historical Books in the Library of the Royal Australasian College of Surgeons. Melbourne: Queensberry Hill Press, 1979. 3. Faris IB. Editorial Comment. ‘The Cowlishaw Symposium’. Aust. N. Z. J. Surg. 1997; 67: 497. 4. Watters DAK. Guy de Chauliac: pre-eminent surgeon of the Middle Ages. ANZ J. Surg. 2013; 83: 730–4.
Peter F. Burke, MBBS (Melb.), FRCS (Eng.), FRACS, FACEM, DHMSA Latrobe Regional Hospital, Traralgon, Victoria, Australia doi: 10.1111/ans.12347
Demand for surgical simulated learning Supervisors and trainees views: Do they align? The Royal Australasian College of Surgeons recently conducted the Simulated Surgical Skills Program in an attempt to better understand the role, function and outcomes of laparoscopic surgical simulation.1–4 Following this programme, access to simulation learning activities and the resources valued by surgical supervisors and/or Surgical Education Training (SET) trainees in Australia was investigated. An electronic survey concerning access to simulation activity and perception of simulation training was provided to 1478 surgical supervisors with an interest in academic surgery, education or research, and all 1091 SET trainees across Australia. The survey was administered online and was open to respondents for 18 days, from 14 May to 31 May 2012. The questionnaires were completed by 21% of the supervisors (315/1478) and 13% of SET trainees (140/1091). For ease of interpretation of the data collected, the simulation activities were grouped as follows: • Basic 1: Basic suturing and knot tying • Basic 2: A – Laparoscopic depth perception, camera navigation and tissue cutting B – Laparoscopic ligating loop, intra- and extracorporeal knot tying • Advanced: A – Laparoscopic hernia repair, appendicectomy, cholecystectomy and colonoscopy B – Knee and shoulder arthroscopy
Access to simulation activity Fifty-nine per cent of supervisor respondents had ready access to Basic 1 group activities at their workplace, 29% had access to Basic 2 activities and 10% had access to Advanced activities. General surgery supervisors reported greatest access to both groups of basic activities. Thirty-five per cent of trainee respondents reported access to Basic 1 activities at their workplace, 15% to Basic 2 activities and 4% to Advanced activities. There was a tendency for access to increase as the respondents’ SET level increased and that, similar to the supervisors, general surgery trainees had greater access than trainees from other specialties. Averaged over the 14 activities surveyed, 25% of supervisors, 17% of senior trainees (SET 3+) and 9% of junior trainees (SET 1 and SET 2) had access to simulation activities. A significant
trend (P = 0.003) was demonstrated, which showed that access to simulation activities increased as respondents’ experience increased.
Preferred simulation activities and ‘unmet demand’ Surgical supervisors expressed their opinions about the simulated learning activities that trainees under their supervision should undertake and trainees reported which activities they would use if available. Information obtained from the survey was also described in terms of ‘unmet demand’, that is, the difference between the proportion of respondents who would use an activity if it were available and the proportion who already had access to the activity. Over 90% of supervisors reported a desire for trainees to have access to Basic 1, 66% for Basic 2A, 55% for Basic 2B, 42% for Advanced A and 27% for Advanced B group activities. A high unmet demand was reported in all individual Basic group activities and Advanced A group activities, ranging from 27% to 36%, while unmet demand in the Advanced B group activities was less at 17%. The largest unmet demands were recorded by orthopaedic surgeons and otolaryngologists for Basic 1 activities, by urological and general surgeons for Basic 2 activities, by general surgeons for Advanced A group activities, and by orthopaedic surgeons for the Advanced B group activities (Fig. 1). For the SET trainee respondents, adequate access was reported for Basic 1 activities, with no unmet demand, while there was considerable unmet demand for Basic 2A (40%) and Advanced A (36%) activities. There was a trend for unmet demand to decrease as training level increased. There were large differences between specialties with the largest unmet demand for Basic 2B activities for general surgery and urological trainees, for Advanced A activities for general surgery trainees, and for Advanced B activities for orthopaedic surgery trainees (Fig. 1).
Discussion Although simulation has gained recognition in surgical training around the world, the access to simulated learning activities by SET © 2013 Royal Australasian College of Surgeons
A Cowlishaw conundrum Venture to the first floor of the College of Surgeons in Melbourne and then along a corridor, and one will find the seemingly permanently closed doors of the Council room: behind those doors reposes the Cowlishaw collection of historical books, one of the truly great assets of the College. The loneliness of that scenario brings to mind the lines of W.S. Gilbert in ‘The Mikado’, “to sit in solemn silence in a dull, dark dock, in a pestilential prison, with a life-long lock,”
When one is able to view the magnificent collection, housed in bespoke cases provided by our anaesthetic colleagues, one is left to ponder not only its accessibility, but also, its utility. To most Fellows and surgical trainees, busy attending courses, meetings and lectures at the College, this may appear irrelevant nonsense; however, this collection represents the very foundations of the science and art of contemporary surgery. Leslie Cowlishaw, whose name the collection bears, was born in Sydney into comfortable circumstances and travelled twice to Europe prior to commencing medical studies at the University of Sydney. Following graduation in 1906, he again travelled to Europe and it was then that his collecting of material chronicling the history of medicine commenced. He knew what he wanted and knew where to seek the books, for he was in contact with the great booksellers of Europe and Great Britain: thus he gradually obtained the necessary background reference works to give him his great knowledge of the history and literature of medicine and surgery. Between 1906 and 1914, he obtained many of the early printed books in his library; during 1912 and 1913, in particular, he obtained a number of his finest books. Cowlishaw was one of the first to enlist in the Australian Imperial Force, when war was declared in 1914, and he served as a medical officer in Egypt and on Gallipoli, until he was evacuated to England with scarlet fever. It was there that he met Sir William Osler, whose greatest work, ‘The Principles and Practice of Medicine’, motivated many years later, the Bodley’s Librarian to note that Osler, had, ‘succeeded in making a scientific treatise literature’: Osler, at the age of 56, had come to Oxford in May 1905 to occupy the Chair of Regius Professor of Medicine. Osler, a self-confessed bibliomaniac, compiled the ‘Bibliotheca Osleriana’, which catalogued the more than 7500 titles in his magnificent library;1 he termed Cowlishaw, the ‘bibliophile from the bush’ encouraging Cowlishaw’s collecting and presented him with a number of books: Osler’s friendship is surely the imprimatur of the Cowlishaw collection. © 2013 Royal Australasian College of Surgeons
It should be remembered that Johannes Gutenberg first produced his printed Bible in 1455 and this lead to the eventual replacement of handwritten manuscripts: Incunabula, books published prior to 1501 are rare; the College has in its collection, no less than eight such items. When our College obtained this library, it purchased more than books, it purchased the research and reference material of a discriminating scholar gathered together with great care over a lifetime. The fascinating story of this acquisition is provided in Kenneth Russell’s Introduction to his monumental ‘Catalogue of the Historical Books in the Library of the Royal Australasian College of Surgeons’.2 The Cowlishaw Symposium was instituted in October 1996 with the notion of awakening Fellows’ knowledge of, and, interest in, the collection.3 In 2012, the ninth biennial Cowlishaw Symposium was conducted and seven Fellows of the College were among the presenters: essentially, the speakers are required to select a volume from the Cowlishaw collection, and study it, to enable its presentation and discussion. The aim of the symposium is, of course, to bring to the attention of all associated with the College, and beyond, the importance and the breadth of the treasures contained within the collection. The symposium has a single-day format at the College and incorporates the Kenneth Fitzpatrick Russell lecture. In the past, all papers were published in this Journal but nowadays space constraints prevent such luxury; on this occasion, one selected paper will be published in the Journal and all will be available on the College website. Professor David Watters’ paper, ‘Guy de Chauliac: pre-eminent surgeon of the Middle Ages’4 has been selected as representative of the spirit which Osler, Cowlishaw and Russell would have sought. The Cowlishaw collection contains Guy de Chauliac’s ‘Cyrurgia’ of 1499, and no less than three editions of his ‘Grande Chirurgie’, 1598, 1619 and 1659. Fellows are encouraged to come to the College and arrange to view the magnificent collection, which is of national importance, and to gain from it an insight into the foundations of their craft and hopefully to develop and nurture an interest in the history of surgery. The conundrum remains; is a one-day symposium held biennially, sufficient to do justice to Leslie Cowlishaw’s library, and, Kenneth Russell’s mighty endeavours in ensuring the delivery of this collection to our College; a collection which he protected, catalogued and cared for, to his last? For the forseeable future, this treasure trove continues its lonely vigil over a normally vacant Council Room. References 1. Osler Sir W. Bart. Bibliotheca Osleriana. A catalogue of books illustrating the history of medicine and science, collected, arranged, and annotated by Sir William Osler, Bt. and bequeathed to McGill University. Oxford: Clarendon Press, 1929.
ANZ J Surg 83 (2013) 699–705
700
Perspectives
2. Russell KF. Catalogue of the Historical Books in the Library of the Royal Australasian College of Surgeons. Melbourne: Queensberry Hill Press, 1979. 3. Faris IB. Editorial Comment. ‘The Cowlishaw Symposium’. Aust. N. Z. J. Surg. 1997; 67: 497. 4. Watters DAK. Guy de Chauliac: pre-eminent surgeon of the Middle Ages. ANZ J. Surg. 2013; 83: 730–4.
Peter F. Burke, MBBS (Melb.), FRCS (Eng.), FRACS, FACEM, DHMSA Latrobe Regional Hospital, Traralgon, Victoria, Australia doi: 10.1111/ans.12347
Demand for surgical simulated learning Supervisors and trainees views: Do they align? The Royal Australasian College of Surgeons recently conducted the Simulated Surgical Skills Program in an attempt to better understand the role, function and outcomes of laparoscopic surgical simulation.1–4 Following this programme, access to simulation learning activities and the resources valued by surgical supervisors and/or Surgical Education Training (SET) trainees in Australia was investigated. An electronic survey concerning access to simulation activity and perception of simulation training was provided to 1478 surgical supervisors with an interest in academic surgery, education or research, and all 1091 SET trainees across Australia. The survey was administered online and was open to respondents for 18 days, from 14 May to 31 May 2012. The questionnaires were completed by 21% of the supervisors (315/1478) and 13% of SET trainees (140/1091). For ease of interpretation of the data collected, the simulation activities were grouped as follows: • Basic 1: Basic suturing and knot tying • Basic 2: A – Laparoscopic depth perception, camera navigation and tissue cutting B – Laparoscopic ligating loop, intra- and extracorporeal knot tying • Advanced: A – Laparoscopic hernia repair, appendicectomy, cholecystectomy and colonoscopy B – Knee and shoulder arthroscopy
Access to simulation activity Fifty-nine per cent of supervisor respondents had ready access to Basic 1 group activities at their workplace, 29% had access to Basic 2 activities and 10% had access to Advanced activities. General surgery supervisors reported greatest access to both groups of basic activities. Thirty-five per cent of trainee respondents reported access to Basic 1 activities at their workplace, 15% to Basic 2 activities and 4% to Advanced activities. There was a tendency for access to increase as the respondents’ SET level increased and that, similar to the supervisors, general surgery trainees had greater access than trainees from other specialties. Averaged over the 14 activities surveyed, 25% of supervisors, 17% of senior trainees (SET 3+) and 9% of junior trainees (SET 1 and SET 2) had access to simulation activities. A significant
trend (P = 0.003) was demonstrated, which showed that access to simulation activities increased as respondents’ experience increased.
Preferred simulation activities and ‘unmet demand’ Surgical supervisors expressed their opinions about the simulated learning activities that trainees under their supervision should undertake and trainees reported which activities they would use if available. Information obtained from the survey was also described in terms of ‘unmet demand’, that is, the difference between the proportion of respondents who would use an activity if it were available and the proportion who already had access to the activity. Over 90% of supervisors reported a desire for trainees to have access to Basic 1, 66% for Basic 2A, 55% for Basic 2B, 42% for Advanced A and 27% for Advanced B group activities. A high unmet demand was reported in all individual Basic group activities and Advanced A group activities, ranging from 27% to 36%, while unmet demand in the Advanced B group activities was less at 17%. The largest unmet demands were recorded by orthopaedic surgeons and otolaryngologists for Basic 1 activities, by urological and general surgeons for Basic 2 activities, by general surgeons for Advanced A group activities, and by orthopaedic surgeons for the Advanced B group activities (Fig. 1). For the SET trainee respondents, adequate access was reported for Basic 1 activities, with no unmet demand, while there was considerable unmet demand for Basic 2A (40%) and Advanced A (36%) activities. There was a trend for unmet demand to decrease as training level increased. There were large differences between specialties with the largest unmet demand for Basic 2B activities for general surgery and urological trainees, for Advanced A activities for general surgery trainees, and for Advanced B activities for orthopaedic surgery trainees (Fig. 1).
Discussion Although simulation has gained recognition in surgical training around the world, the access to simulated learning activities by SET © 2013 Royal Australasian College of Surgeons
