Appendicectomy as an index procedure to train junior surgical trainees in an era of reduced working hours

Surgical competence and its assessment is one of the most hotly debated topics engaging the profession. In the current climate of diminishing working hours and shorter training, the surgical profession is having to address the complex issue as to how surgery as a craft specialty should be taught, and how to assess when an individual is competent within their chosen sphere as well as how that competence should be maintained. Internationally, there is political pressure upon the professional to achieve contracted activity to comply with political imperatives and, at the same time, to achieve a greater degree of specialisation. Within Europe, the working time directive has led to a shift system of rotas and this, along with a shorter overall period of training, has led to reduced time available to surgical trainees in which to learn their craft.

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The Lost Generation: Impact of the 56-hour EWTD on Current Surgical Training

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363510x491105 ◽

2010 ◽

Vol 92 (3) ◽

pp. 102-106 ◽

Cited By ~ 5

Author(s):

CR Chalmers ◽

S Joshi ◽

PG Bentley ◽

NH Boyle

Keyword(s):

Shift Work ◽

Surgical Training ◽

New Deal ◽

Working Hours ◽

Lost Generation ◽

Surgical Trainees ◽

European Working ◽

Working Time Directive ◽

Training Opportunities ◽

The New Deal

The reform of specialist surgical training – the New Deal (1991), the Calman report (1993) and the implementation of the European Working Time Directive (EWTD, 1998) – has resulted in shorter training periods with reduced working hours. The Calman reform aimed to improve and structure training with regular assessment and supervision whereas the New Deal and the EWTD have concentrated predominantly on a reduction in hours. The adoption of full or partial shift work to provide surgical cover at night compliant to a 56-hour working week, as stipulated by phase one of the EWTD, has resulted in daytime hospital attendance for surgical trainees of an average three days per week despite almost universal acknowledgement of the limited training opportunities available at night.

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Surgical training is undermined by inadequate provision of laparoscopic surgical simulators

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363514x14042954769311 ◽

2014 ◽

Vol 96 (9) ◽

pp. 304-307 ◽

Cited By ~ 6

Author(s):

PM Brennan ◽

JJM Loan ◽

MA Hughes ◽

IAM Hennessey ◽

RW Partridge

Keyword(s):

Surgical Training ◽

Working Hours ◽

Working Time ◽

Surgical Simulators ◽

Surgical Trainees

In parallel with the introduction of working time regulations that have led to changes in working patterns, surgical trainees are taking longer to achieve operative competencies and logging fewer surgical cases. 1–3 The existing style of surgical training appears to provide insufficient operative exposure in limited working hours.

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Working hours and roster structures of surgical trainees in Australia and New Zealand

ANZ Journal of Surgery ◽

10.1111/j.1445-2197.2010.05528.x ◽

2010 ◽

Vol 80 (12) ◽

pp. 890-895 ◽

Cited By ~ 9

Author(s):

Gregory O'Grady ◽

Benjamin Loveday ◽

Simon Harper ◽

Brandon Adams ◽

Ian D. Civil ◽

...

Keyword(s):

New Zealand ◽

Working Hours ◽

Surgical Trainees

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The EWTD 'triple whammy': hitting surgical trainees where it hurts

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363507x161691 ◽

2007 ◽

Vol 89 (1) ◽

pp. 26-28 ◽

Cited By ~ 8

Author(s):

RM Heath ◽

TCS Gate ◽

CM Halloran ◽

M Callaghan ◽

MT Paraoan ◽

...

Keyword(s):

Working Hours ◽

Training System ◽

Training Time ◽

Working Lives ◽

Surgical Trainees ◽

European Working ◽

Trainee Surgeon ◽

Competency Based ◽

The Uk ◽

Working Time Directive

Surgical training in the UK has undergone a revolution following Calmanisation and the implementation of the European Working Time Directive (EWTD). The former envisaged that reduced training time would be compensated for by a more structured, competency-based training system centred upon surgical consultant supervision and regular assessment. The EWTD on the other hand aims to improve the working lives of hospital doctors and to improve patients' safety, as well as to comply with EU law by reducing working hours to 56 by August 2004 and further to 48 hours by 2009. No trainee surgeon can now work longer than 13 hours without rest.

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More Trainees and Less Operative Exposure: A Quantitative Analysis of Training Opportunities for Junior Surgical Trainees

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363510x12689975699630 ◽

2010 ◽

Vol 92 (5) ◽

pp. 170-173 ◽

Cited By ~ 10

Author(s):

EC Toll ◽

CR Davis

Keyword(s):

Postgraduate Medical Education ◽

Working Hours ◽

Training Time ◽

Surgical Services ◽

Medical Careers ◽

Surgical Trainees ◽

European Working ◽

The Uk ◽

Working Time Directive ◽

Training Opportunities

The evolution of postgraduate medical education in the UK continues to influence the quality of surgical training. Many reforms over the last three decades have affected training, including the Calman reforms, Modernising Medical Careers (MMC) and the European Working Time Directive (EWTD). The net effect of these changes is a reduction in working hours and shorter total training time for surgical trainees. Compounded by increasing subspecialisation, centralisation of surgical services and surgeon-specific data reporting, there may be fewer operative opportunities for surgical trainees.

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752 Evaluating the Use of Immersive Virtual Reality Simulation in Orthopaedic Trauma Cases; A Construct Reality Study

British Journal of Surgery ◽

10.1093/bjs/znab134.166 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A Feeley ◽

E Sheehan ◽

K Merghani

Keyword(s):

Construct Validity ◽

Surgical Training ◽

Content Validity ◽

Working Hours ◽

Proximal Femoral Nail ◽

Training Methods ◽

Intermediate Group ◽

Training Scheme ◽

Femoral Nail ◽

Surgical Trainees

Abstract Introduction Changing surgical training models as a result of reduced working hours, shorter schemes and the recent pandemic has resulted in reduced operative hours being logged by trainees. Novel and validated training methods are needed to rectify the deficit faced by surgical trainees, to maintain continued development and retention of skill throughout their training scheme. Method A comparative interventional study was carried out in a regional trauma unit hospital. Volunteers were stratified into novice, intermediate and expert groups based on self-reported levels of experience. Each carried out a simulated proximal femoral nail on a virtual platform following instruction on its use. Face and content validity was also assessed. Results The proximal femoral nail module demonstrated construct validity. Intermediate surgeons performed significantly better than novices (P=.03), with shorter procedural times (P=.013) Three of the intermediate group achieved the proficiency level set by the expert group. Time taken to completion for expert surgeons was less than intermediate group, although this did not reach significance (P=.16). Face and content validity was reported for the module. Conclusions The proximal femoral nail module on the Precision OS platform demonstrated good face, content, and construct validity under expert scrutiny. Further research evaluating use of virtual platforms to optimise surgical training is needed.

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Laparoscopic appendectomy as an index procedure for surgical trainees: clinical outcomes and learning curve

Updates in Surgery ◽

10.1007/s13304-020-00950-z ◽

2021 ◽

Author(s):

Alessandro Ussia ◽

Samuele Vaccari ◽

Gaetano Gallo ◽

Ugo Grossi ◽

Riccardo Ussia ◽

...

Keyword(s):

Learning Curve ◽

Clinical Outcomes ◽

Laparoscopic Appendectomy ◽

Index Procedure ◽

Surgical Trainees

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Post-EWTR: Is the UK Still a Centre of Excellence for Surgical Training?

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363512x13311314198698 ◽

2012 ◽

Vol 94 (8) ◽

pp. 268-273 ◽

Cited By ~ 3

Author(s):

MEA Khan ◽

AD Jordan ◽

T Strange ◽

S Vig

Keyword(s):

Surgical Training ◽

Working Hours ◽

Specialist Training ◽

Current Generation ◽

The Past ◽

Medical Careers ◽

Surgical Trainees ◽

Centre Of Excellence ◽

The Uk ◽

Radical Transformation

Surgical training in the UK has undergone a radical transformation over the past few years. The limitation of working hours imposed by the European workingTime regulations (EWTR) and a shorter path to consultancy through Modernising Medical Careers has resulted in a shortening of training hours between qualification and completion of specialist training. Some estimate total training hours have reduced by 50%, from 30,000 in the old system to just 15,000 currently. Quite reasonably, there is concern that the current generation of surgical trainees will be less skilled and less competent than their predecessors.

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Burnout and attrition in surgical trainees: what can be done to prevent it?

British Journal of Hospital Medicine ◽

10.12968/hmed.2021.0110 ◽

2021 ◽

pp. 1-9

Author(s):

Mary Gibby ◽

Judy McKimm

Keyword(s):

At Risk ◽

Medical Errors ◽

Operative Time ◽

Working Hours ◽

Professional Support ◽

Self Report ◽

Subsequent Reduction ◽

Surgical Trainees ◽

Health Disorders ◽

Training Opportunities

Burnout, mental health disorders and suicide are more common among doctors than the general population. Burnt-out doctors self-report increased rates of medical errors and the provision of suboptimal patient care. Surgeons in training are particularly at risk of burnout and are also less likely to seek professional support. Female surgical trainees have especially high rates of attrition, potentially because of issues surrounding childcare and motherhood. Several strategies to reduce burnout and promote resilience have been trialled among doctors. Schwartz rounds and mindfulness training have been shown to be effective, but only in those motivated to participate. A reduction in working hours has conflicting results, particularly among surgical trainees, which may be linked to the subsequent reduction in training opportunities, such as operative time and the ability to complete assessments. Early identification and targeted support of at-risk individuals is a potentially effective strategy that requires further research.

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