Optimizing US surgical trainees for global engagement

Briefing and debriefing are common practices for safety in high risk industries but are not systematically done in surgery. Regular debriefing of performance after operative surgery can greatly assist surgical trainees' development and help optimize learning from the limited time they spend in the Operating Room (OR). We developed and tested the NOTSS (Non-Technical Skills for Surgeons) behaviour rating system with subject matter experts. It allows surgeons to observe trainees' behaviour in the OR and provide them with structured feedback for improvement. This paper describes process of debriefing and the results of a pilot usability trial. The majority of participants reported that the NOTSS system was useful for debriefing trainees, provided a common language to discuss non-technical skills, and was a valuable adjunct to current assessment tools. Some surgeons found interpersonal skills more difficult to rate than cognitive skills. 73% felt that routine use of the system would enhance patient safety.

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845 Flattening the Learning Curve: The Evaluation of Extended Laparoscopic Simulation Training for Novice Surgeons

British Journal of Surgery ◽

10.1093/bjs/znab134.171 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S A Joiya ◽

M Hamid ◽

Z Siddiqui

Keyword(s):

Learning Curve ◽

Skill Acquisition ◽

Postoperative Recovery ◽

Task Completion ◽

Complication Rates ◽

Novice Group ◽

Surgical Trainees ◽

Long Duration ◽

Hospital Stays ◽

Novice Surgeons

Abstract Introduction Associated with faster postoperative recovery, reduced length of hospital stays and scarring; laparoscopy has become the favoured approach for many surgical procedures across a range of specialties. However, due to its challenging learning curve, it has also been associated with increased theatre time and higher complication rates. Method A prospective, observational study with box trainers was carried out by novice medical students and trainees to evaluate the efficacy of long duration courses on skill acquisition. The novice group undertook a 5-week curriculum composed of lectures, demonstrations and spaced timed-assessments involving 3 tasks: hoop placement, stacking of sugar cubes and surgical cutting. Results Time taken for novice participants to complete a task individually and collectively improved markedly from the first to the third attempt, with an overall 44% reduction in time observed over the 5-weeks. We invited back 6 novice participants and 6 core surgical trainees after 4-weeks to complete the same tests. There was a further 18% time improvement in the novice group, with 44% faster task completion. Conclusions Given the success of this study and other simulation courses reported in the literature, we recommend more courses adopt a spaced-out approach; and a simulation curriculum for surgical trainees to cultivate greater skill acquisition.

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An analysis of the cost of postgraduate training in surgery in Ireland compared to other specialties

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02641-z ◽

2021 ◽

Author(s):

Earley H. ◽

Mealy K.

Keyword(s):

Surgical Training ◽

Financial Support ◽

Postgraduate Training ◽

Medical Training ◽

Medical Council ◽

List Type ◽

Training Costs ◽

Considerable Cost ◽

Surgical Trainees ◽

The Cost

Abstract Introduction Postgraduate specialty training in Ireland is associated with considerable cost. Some of these are mandatory costs such as medical council fees, while others are necessary to ensure career progression, such as attendance at courses and conferences. In particular, surgical specialities are believed to be associated with high training costs. It is unknown how these costs compare to those borne by counterparts in other specialities. Aims The aims of this study were to Quantify the amount that trainees in Ireland spend on postgraduate training Determine whether a difference exists between surgery and other non-skill-based specialties in terms of expenditure on training Methods A standardised non-mandatory questionnaire was circulated to trainees across two training centres in Ireland. Trainees at all levels were invited to participate. Results Sixty responses were obtained. Fifty-seven questionnaires were fully completed and included for analysis. The median expenditure on training was higher for surgical than non-surgical specialities. Subgroup analysis revealed surgical training was associated with higher expenditure on higher degrees and courses compared to medical training (p = 0.035). > 95% of trainees surveyed felt that greater financial support should be available for trainees during the course of their training. Conclusions This study demonstrated that a career in surgery is associated with higher ongoing costs for higher degrees and courses than counterparts in non-surgical training. All surgical trainees surveyed felt that better financial support should be available. Increasing financial support for may be a tangible way to mitigate against attrition during training.

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Riding the waves: the ongoing impact of COVID-19 on a national surgical training cohort

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02739-4 ◽

2021 ◽

Author(s):

Orla Hennessy ◽

Amy Lee Fowler ◽

Conor Hennessy ◽

David Brinkman ◽

Aisling Hogan ◽

...

Keyword(s):

Surgical Training ◽

World Health Organisation ◽

World Health ◽

Training Methods ◽

Viral Spread ◽

Surgical Services ◽

Global Pandemic ◽

Surgical Trainees ◽

Secondary Survey ◽

The Impact

Abstract Background The World Health Organisation declared a global pandemic on the 11 March 2020 resulting in implementation of methods to contain viral spread, including curtailment of all elective and non-emergent interventions. Many institutions have experienced changes in rostering practices and redeployment of trainees to non-surgical services. Examinations, study days, courses, and conferences have been cancelled. These changes have the potential to significantly impact the education and training of surgical trainees. Aim To investigate the impact of the COVID-19 pandemic on training, educational, and operative experiences of Irish surgical trainees. Methods Surgical trainees were surveyed anonymously regarding changes in working and educational practices since the declaration of the COVID-19 pandemic on 11 March 2020. The survey was circulated in May 2020 to both core and higher RCSI surgical trainees, when restrictions were at level five. Questions included previous and current access to operative sessions as well as operative cases, previous and current educational activities, access to senior-led training, and access to simulation-/practical-based training methods. A repeat survey was carried out in October 2020 when restrictions were at level two. Results Overall, primary and secondary survey response rates were 29% (n = 98/340) and 19.1% (n = 65/340), respectively. At the time of circulation of the second survey, the number of operative sessions attended and cases performed had significantly improved to numbers experienced pre-pandemic (p < 0.0001). Exposure to formal teaching and education sessions returned to pre-COVID levels (p < 0.0001). Initially, 23% of trainees had an examination cancelled; 53% of these trainees have subsequently sat these examinations. Of note 27.7% had courses cancelled, and 97% of these had not been rescheduled. Conclusion Surgical training and education have been significantly impacted in light of COVID-19. This is likely to continue to fluctuate in line with subsequent waves. Significant efforts have to be made to enable trainees to meet educational and operative targets.

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P38 COVID-19 impact on Surgical Training And Recovery Planning (COVID-STAR) Survey

BJS Open ◽

10.1093/bjsopen/zrab032.037 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

◽

Joshua Clements

Keyword(s):

Surgical Training ◽

Negative Impact ◽

Healthcare Delivery ◽

Cross Sectional Study ◽

Surgical Trainee ◽

Surgical Specialty ◽

Cross Sectional ◽

Training Time ◽

Surgical Trainees ◽

And Training

Abstract Background The COVID-19 pandemic has resulted in dynamic changes to healthcare delivery. Surgery as a specialty has been significantly affected and with that the delivery of surgical training. Method This national, collaborative, cross sectional study comprising 13 surgical trainee associations distributed a pan surgical specialty survey on the COVID-19 impact on surgical training over a 4-week period (11th May - 8th June 2020). The survey was voluntary and open to medical students and surgical trainees of all specialties and training grades. All aspects of training were qualitatively assessed. This study was reported according to STROBE guidelines. Results 810 completed responses were analysed. (M401: F 390) with representation from all deaneries and training grades. 41% of respondents (n = 301) were redeployed with 74% (n = 223) redeployed > 4 weeks. Complete loss of training was reported in elective operating (69.5% n = 474), outpatient activity (67.3%, n = 457), Elective endoscopy (69.5% n = 246) with > 50% reduction in training time reported in emergency operating (48%, n = 326) and completion of work-based assessments (WBA) (46%, n = 309). 81% (n = 551) reported course cancellations and departmental and regional teaching programmes were cancelled without rescheduling in 58% and 60% of cases respectively. A perceived lack of Elective operative exposure and completions of WBA’s were the primary reported factor affecting potential training progression. Overall, > 50% of trainees (n = 377) felt they would not meet the competencies required for that training period. Conclusion This study has demonstrated a perceived negative impact on numerous aspects of surgical training affecting all training specialties and grades.

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354 Differential Attainment in Surgical Training

British Journal of Surgery ◽

10.1093/bjs/znab134.131 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

Z Vinnicombe ◽

M Little ◽

J Super

Keyword(s):

Academic Performance ◽

Surgical Training ◽

General Medical Council ◽

Career Progression ◽

Medical Council ◽

Multiple Deprivation ◽

Surgical Trainees ◽

Economic Background ◽

The Relationship ◽

Index Of Multiple Deprivation

Abstract Introduction Differential attainment (DA), according to the General Medical Council (GMC), is the gap between attainment levels in different groups. Attainment measures should cover aspects that include academic performance and career progression. Two such areas in surgical training are the MRCS examinations and ARCPs, both of which are required for progression in a career in surgery. Our aim was to investigation whether socio-economic background was a significant factor for progression in surgical training. Method Data from the GMC for Core Surgical Trainees (CSTs) taking the MRCS examination between 2016 and 2019 and CST ARCP outcomes between 2017 and 2019 were obtained. Socio-economic background was assessed using the Index of Multiple Deprivation (IMD). ARCP and MRCS outcomes were assessed against IMD. Results Trainees from IMD Q1&2 (most deprived) had a significantly higher (p < 0.01) mean number of attempts (1.86) to pass MRCS examinations than trainees from IMD Q4&5 (least deprived) (1.54). IMD Q1&2 were significantly more likely to obtain unsatisfactory outcomes (24.4%) than trainees from IMD Q4&5 (14.2%) (p < 0.05). Conclusions There is clear evidence that differential attainment exists within Core Surgical Training. The reasons for this are likely to be complex and more work is needed to further investigate the relationship.

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379 The Critical Care Experience of Irish Surgical Non-Consultant Hospital Doctors, Are We Equipped to Assist During the Covid-19 Outbreak and Beyond?

British Journal of Surgery ◽

10.1093/bjs/znab134.135 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

E Burke ◽

P Balfe

Keyword(s):

Critical Care ◽

Intensive Care ◽

Healthcare Systems ◽

Care Environment ◽

Care Experience ◽

Electronic Survey ◽

Surgical Trainees ◽

Hospital Doctors ◽

Basic Course ◽

Further Development

Abstract Introduction The ongoing COVID-19 pandemic has presented unforeseen threats and stresses to healthcare systems around the world, most notably in the ability to provide critical care. Aim To assess surgical NCHD experience in providing critical care and working in an intensive care environment. Method An electronic survey was distributed amongst surgical trainees and then amongst individual surgical departments. Ten questions were included in the survey assessing the NCHD’s experience with aspects of critical care. Results 39 respondents including 16 specialist registrars, 3 senior registrars, 11 registrars and 9 senior house officers. 18% of respondents had previous experience in anaesthetics or intensive care. 23% self-reported being competent in performing endotracheal intubation. 15% self-reported being competent in the use of CPAP and BiPaP, 5% did not know what these were. 20% self-reported being competent in the use of AIRVO. 15% self-reported being competent in placing central and arterial lines. 15% self-reported being competent in starting and adjusting inotropes/vasopressors. 49% reported completing a CCRISP or BASIC course. 85% felt that a rotation in anaesthesia should be a routine part of surgical training. Conclusions Whilst there is critical care experience amongst the surgical NCHD cohort there remains room for further development.

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Global engagement for health could achieve better results now and after 2015

The Lancet ◽

10.1016/s0140-6736(12)61809-1 ◽

2012 ◽

Vol 380 (9853) ◽

pp. 1533-1534 ◽

Cited By ~ 5

Author(s):

Gunilla Carlsson ◽

Anders Nordström

Keyword(s):

Global Engagement

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