SP2.1.11Real-world use of workplace-based assessments in surgical training: a UK nationwide exploration of trainee perspectives and consensus recommendations from the Association of Surgeons in Training

Abstract Background The utility of Workplace-Based Assessments (WBAs) in surgical training depends on the way they are completed. This study aims to ascertain the real-world usage of WBAs, as perceived by UK surgical trainees. Methods An anonymous national online questionnaire was conducted via the Association of Surgeons in Training (ASiT). The evaluation employed mixed methods to interpret quantitative and qualitative data. Suggestions for improvement were identified from free-text comments and considered through a formal two-round modified Delphi consensus process by ASiT council members. Results Analysis included 906 complete responses from all surgical specialities across all training levels. WBA use was perceived to deviate markedly from the Joint Committee on Surgical Training standards with significantly identified misuse across all surgical specialities. Inaccurate completion was acknowledged by 89.6% of respondents, and some trainers appear complicit with 40.9% of respondents aware of 'unobserved sign-off', and 33.6% aware of 'password disclosure' by trainers. Most trainees felt the Annual Review of Competency Progression (ARCP) respected WBA quantity above quality (55.4%), and a third felt pressure to overstate the number completed (32.0%). Main reasons for misuse were time restraints, lack of engagement and the will to achieve career progression targets. Conclusions UK surgical trainees perceive a significant deviation from WBAs standards due to multiple factors. The frequency and nature of misuse are worrying and undermines the existing evidence for the WBAs role in training. We present consensus recommendations from ASiT for the improvement of WBA use in UK surgical training.

Download Full-text

Personalising care of adults with asthma from Asia: a modified e-Delphi consensus study to inform management tailored to attitude and control profiles

npj Primary Care Respiratory Medicine ◽

10.1038/npjpcrm.2016.89 ◽

2017 ◽

Vol 27 (1) ◽

Cited By ~ 2

Author(s):

Alison Chisholm ◽

◽

David B Price ◽

Hilary Pinnock ◽

Tan Tze Lee ◽

...

Keyword(s):

Social Scientist ◽

Free Text ◽

Delphi Consensus ◽

Online Questionnaire ◽

Consensus Recommendations ◽

International Panel ◽

Delphi Round ◽

Asthma Patients ◽

Management Approaches ◽

And Control

Abstract REALISE Asia—an online questionnaire-based study of Asian asthma patients—identified five patient clusters defined in terms of their control status and attitude towards their asthma (categorised as: ‘Well-adjusted and at least partly controlled’; ‘In denial about symptoms’; ‘Tolerating with poor control’; ‘Adrift and poorly controlled’; ‘Worried with multiple symptoms’). We developed consensus recommendations for tailoring management of these attitudinal–control clusters. An expert panel undertook a three-round electronic Delphi (e-Delphi): Round 1: panellists received descriptions of the attitudinal–control clusters and provided free text recommendations for their assessment and management. Round 2: panellists prioritised Round 1 recommendations and met (or joined a teleconference) to consolidate the recommendations. Round 3: panellists voted and prioritised the remaining recommendations. Consensus was defined as Round 3 recommendations endorsed by >50% of panellists. Highest priority recommendations were those receiving the highest score. The multidisciplinary panellists (9 clinicians, 1 pharmacist and 1 health social scientist; 7 from Asia) identified consensus recommendations for all clusters. Recommended pharmacological (e.g., step-up/down; self-management; simplified regimen) and non-pharmacological approaches (e.g., trigger management, education, social support; inhaler technique) varied substantially according to each cluster’s attitude to asthma and associated psychosocial drivers of behaviour. The attitudinal–control clusters defined by REALISE Asia resonated with the international panel. Consensus was reached on appropriate tailored management approaches for all clusters. Summarised and incorporated into a structured management pathway, these recommendations could facilitate personalised care. Generalisability of these patient clusters should be assessed in other socio-economic, cultural and literacy groups and nationalities in Asia.

Download Full-text

982 Higher General Surgical Trainee preferences for Annual Review of Competency Progression during COVID-19 Pandemic

British Journal of Surgery ◽

10.1093/bjs/znab259.884 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

K Khan ◽

G Torpiano ◽

N Galbraith ◽

M McLellan ◽

A Lannigan

Keyword(s):

Surgical Training ◽

Annual Review ◽

Surgical Trainee ◽

Training Groups ◽

Surgical Trainees ◽

The Impact

Abstract Aim The COVID-19 pandemic has caused significant disruption in surgical training. We aim to explore the preferences of higher general surgical trainees for Annual Review of Competency Progression (ARCP) also compare the responses across different training grades. Method All higher general surgical trainee in a single deanery were invited to participate in an online voluntary anonymous survey. The respondents were divided in two groups: junior (ST3-ST5) and senior higher surgical trainees (ST6-ST8) and responses compared. Results Sixty-four of 88 trainees responded. Thirty-three (51.6%) were ST3–ST5, 24 (37.5%) were ST6–ST8 and 7 (10.9%) were out-of-training. More trainees in ST3–ST5 group preferred to defer the next rotation for 12 months (18.2% vs 0%, p = 0.034), repeat current sub-specialty (33.3% vs 4.2%, p = 0.009), or add 12 months to training and delay predicted CCT date by 12 months (18.2% vs 0%, p = 0.034). Most trainees in both groups preferred the option of prolonging training should be offered to all trainees with an option to decline extension if ARCP competencies met (66.7% vs 50.0%, p = 0.276). Conclusions The preference for ARCP and length of training was different between two training groups, hence the need of trainees should be considered by training committees when addressing the impact of COVID-19.

Download Full-text

Management of repository corticotrophin injection therapy for pulmonary sarcoidosis: a Delphi study

European Respiratory Review ◽

10.1183/16000617.0147-2019 ◽

2020 ◽

Vol 29 (155) ◽

pp. 190147 ◽

Cited By ~ 1

Author(s):

Franck F. Rahaghi ◽

Nadera J. Sweiss ◽

Lesley Ann Saketkoo ◽

Mary Beth Scholand ◽

Joseph B. Barney ◽

...

Keyword(s):

Adverse Events ◽

Delphi Study ◽

Severe Disease ◽

Pulmonary Sarcoidosis ◽

Event Management ◽

Delphi Consensus ◽

Consensus Recommendations ◽

Modified Delphi ◽

Immunosuppressive Medications ◽

Starting Dose

In patients treated with repository corticotrophin injection (RCI) for pulmonary sarcoidosis, effective management of adverse events may improve adherence. However, management of adverse events may be challenging due to limitations in real-world clinical experience with RCI and available published guidelines.We surveyed 12 physicians with a modified Delphi process using three questionnaires. Questionnaire 1 consisted of open-ended questions. Panellists' answers were developed into a series of statements for Questionnaires 2 and 3. In these, physicians rated their agreement with the statements using a Likert scale.Key consensus recommendations included a starting dose of 40 units twice a week for patients with less severe disease, continued at a maintenance dose for patients who responded, particularly those with chronic refractory sarcoidosis. Panellists reached consensus that concomitant steroids should be quickly tapered in patients receiving RCI, but that concomitant use of immunosuppressive medications should be continued. Panellists developed consensus recommendations for adverse event management, and reached consensus that RCI should be down-titrated or discontinued if other interventions for the adverse effects fail or if the adverse effect is severe.In the absence of clinical evidence, our Delphi consensus opinions may provide practical guidance to physicians on the management of RCI to treat pulmonary sarcoidosis.

Download Full-text

Recommendations for the clinical management of patients receiving macitentan for pulmonary arterial hypertension (PAH): A Delphi consensus document

Pulmonary Circulation ◽

10.1177/2045893217721695 ◽

2017 ◽

Vol 7 (3) ◽

pp. 702-711 ◽

Cited By ~ 4

Author(s):

Franck F. Rahaghi ◽

Hassan M. Alnuaimat ◽

Rana L.A. Awdish ◽

Vijay P. Balasubramanian ◽

Robert C. Bourge ◽

...

Keyword(s):

Pulmonary Arterial Hypertension ◽

Adverse Events ◽

Arterial Hypertension ◽

Functional Class ◽

Event Management ◽

Delphi Consensus ◽

Consensus Recommendations ◽

Modified Delphi ◽

Consensus Document ◽

Pulmonary Arterial

In patients treated with macitentan (Opsumit®, Actelion Pharmaceuticals Ltd., Basel, Switzerland) for pulmonary arterial hypertension (PAH), prevention and/or effective management of treatment-related adverse events may improve adherence. However, management of these adverse events can be challenging and the base of evidence and clinical experience for macitentan is limited. In the absence of evidence, consensus recommendations from physicians experienced in using macitentan to treat PAH may benefit patients and physicians who are using macitentan. Consensus recommendations were developed by a panel of physicians experienced with macitentan and PAH using a modified Delphi process. Over three iterations, panelists developed and refined a series of statements on the use of macitentan in PAH and rated their agreement with each statement on a Likert scale. The panel of 18 physicians participated and developed a total of 118 statements on special populations, add-on therapy, drug–drug interactions, warnings and precautions, hospitalization and functional class, and adverse event management. The resulting consensus recommendations are intended to provide practical guidance on real-world issues in using macitentan to treat patients with PAH.

Download Full-text

Differences in progression by surgical specialty: a national cohort study

10.1101/2021.05.10.21256963 ◽

2021 ◽

Author(s):

carla hope ◽

Jon Lund ◽

gareth griffiths ◽

david humes

Keyword(s):

Cohort Study ◽

Surgical Training ◽

General Surgery ◽

Primary Outcome Measure ◽

Older Age ◽

Annual Review ◽

Surgical Specialty ◽

Surgical Trainees ◽

National Cohort ◽

To Receive

The aim of surgical training across the ten surgical specialties is to produce competent day one consultants. Progression through training is assessed by the Annual Review of Competency Progression (ARCP). Objective This study aimed to examine variation in ARCP outcomes within surgical training and identify differences between specialties. Design A national cohort study using data from United Kingdom Medical Education Database (UKMED) was performed. ARCP outcome was the primary outcome measure. Multi-level ordinal regression analyses were performed, with ARCP outcomes nested within trainees. Participants Higher surgical trainees (ST3-ST8) from 9 UK surgical specialties were included (vascular surgery was excluded due to insufficient data). All surgical trainees across the UK with an ARCP outcome between 2010 to 2017 were included. Results Eight thousand two hundred and twenty trainees with an ARCP outcome awarded between 2010 and 2017 were included, comprising 31,788 ARCP outcomes. There was substantial variation in the proportion of non-standard outcomes recorded across specialties with general surgery trainees having the highest proportion of non-standard outcomes (22.5%) and urology trainees the fewest 12.4%. After adjustment, general surgery trainees were 1.3 times more likely to receive a non-standard ARCP outcome compared to trainees in T&O (OR 1.33 95%CI 1.21-1.45). Urology trainees were 36% less likely to receive a non-standard outcome compared to T&O trainees (OR 0.64 95%CI 0.54-0.75). Female trainees and older age were associated with non-standard outcomes (OR 1.11 95%CI 1.02-1.22; OR 1.04 95%CI 1.03-1.05). Conclusion There is wide variation in the training outcome assessments across surgical specialties. General surgery has higher rates of non-standard outcomes compared to other surgical specialities. Across all specialities, female sex and older age were associated with non-standard outcomes.

Download Full-text

Improving primary palliative care – a Delphi consensus study on measures for general practice in Germany

BMC Primary Care ◽

10.1186/s12875-021-01613-7 ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

Esma Sümeyya Bilgin ◽

Rojda Ülgüt ◽

Nils Schneider ◽

Stephanie Stiel

Keyword(s):

Palliative Care ◽

General Practice ◽

Delphi Study ◽

Health Care Research ◽

Free Text ◽

Delphi Consensus ◽

Intervention Package ◽

Online Questionnaire ◽

Junior Research ◽

Strongly Agree

Abstract Background The majority of severely ill and dying people in Germany can be administered primary palliative care (PPC) by general practitioners (GP). However, the current provision of PPC does not match the needs of the population. Although several public health strategies aim at strengthening the role of GPs in PPC provision, it remains challenging for GP teams to integrate PPC into their daily routines. Aim A Delphi study with GPs was conducted to achieve consensus on specific measures for improving the integration of PPC into everyday GP practice. Methods The study is part of the junior research project “Primary Palliative Care in General Practice” (ALLPRAX). After having developed, tested and evaluated 26 practical measures for GP practices to improve their PPC, a Delphi consensus study among GPs took place. In 2020, 569 GPs were asked to rate the relevance and feasibility of the measures on a 4-point Likert scale via an anonymous online questionnaire. Consensus was defined as a sum percentage of ‘strongly agree’ and ‘somewhat agree’ responses ≥75% after two rounds. Between these rounds, measures that were not consented in the first round were adapted in light of respondents’ free text comments and suggestions. Results The response rate was 11.3% in round 1 (n = 64) and 53.1% in round 2 (n = 34). From the initial n = 26 measures, n = 20 measures achieved consensus and were included in the final intervention package. The consented measures pertained to four main topics: advance care planning with patients, consulting and informing patients and family caregivers, GP office organisation and continuing education. N = 6 measures did not achieve consensus, predominantly due to time and workload constraints. Conclusion The consented measures provide valuable support to improve the provision of PPC by GPs. They can be used freely and flexibly, according to the needs of individual GP teams, and are thus suitable for implementation nationwide. Trial registration The study was registered in the German Clinical Trials Register (Registration N° DRKS00011821; 4 December 2017; https://apps.who.int/trialsearch/) and the German Register of Health Care Research (Registration N° VfD_ALLPRAX_16_003817; 30 March 2017).

Download Full-text

Achieving engagement with a Deliberate Practice programme using portable laparoscopy simulators - “Incentivised Laparoscopy Practice”

10.1101/2020.11.13.20225839 ◽

2020 ◽

Author(s):

Kenneth G Walker ◽

Jennifer Cleland ◽

Paul M Brennan ◽

Vivienne I Blackhall ◽

Laura G Nicol ◽

...

Keyword(s):

Surgical Training ◽

Curriculum Reform ◽

Deliberate Practice ◽

Important Variable ◽

Annual Review ◽

Group Practice ◽

List Type ◽

Multi Centre Study ◽

Surgical Trainees ◽

Intermittent Feedback

ABSTRACTBackgroundThe transfer validity of portable laparoscopy simulation is well established. However, attempts to integrate take-home simulation into surgical training have met with inconsistent engagement, as reported in our 2014-15 study of an Incentivised Laparoscopy Practice (ILP) programme. Our subsequent multi-centre study examined barriers and facilitators, informing revisions of the programme for 2018-20. We now report engagement with the revised versions.MethodsIn ILP v2.1 and 2.2, two consecutive year-groups of new CSTs (n= 48 and 46) were loaned portable simulators. The 6-month programme included induction, technical support, and intermittent feedback. Six tasks were prescribed, with video instruction and charting of metric scores. Video uploads were required and scored by faculty. A pass resulted in an eCertificate, expected at Annual Review. ILP was set within a wider reform, “Improving Surgical Training”.ResultsILP v2.1 and 2.2 saw pass rates of 94% and 76% (45/48 and 35/46 trainees respectively), compared with only 26% (7/27) in v1, despite the v2.1 and v2.2 groups having less electronic gaming experience. In the ILP v2.2 group, 73% reported their engagement was adversely affected by COVID19 redeployments.ConclusionsSimply providing kit, no matter how good, is not enough. To achieve trainee engagement with take- home simulators, as in ILP v2, a whole programme is required, with motivated learning, individual and group practice, intermittent feedback, and clear goals and assessments. ILP is a complex intervention, best understood as a “reform within a reform, within a context.” This may explain why trainee engagement fell away during early pandemic conditions.WHAT IS ALREADY KNOWN ON THIS SUBJECTAttaining automation of motor skills is essential to free up operating surgeons’ attention for higher cognitive functions.Laparoscopic operating skills can transfer from simulation to the operating room, and deliberate practice is the most important variable in the development of expertise.Simply providing take-home portable simulators to surgical trainees, even with online training programmes, is insufficient to facilitate consistent deliberate practice by more than a minority of trainees.WHAT THIS STUDY ADDSA package of evidence-based reforms transformed participation of Core Surgical trainees in a 6-month programme of practice using take-home portable simulators, resulting in near- 100% engagement.Such reforms are complex, including motivators for learning, individual and group practice, intermittent feedback, clear goals and assessments, and adoption into a wider curriculum reform called “Improving Surgical Training”.The improved engagement with this form of remote simulation-based training did not continue in the face of a national “lockdown” for the COVID19 pandemic, where there was widespread redeployment of trainees.

Download Full-text

Early indicators of disease progression in Fabry disease that may indicate the need for disease-specific treatment initiation: findings from the opinion-based PREDICT-FD modified Delphi consensus initiative

BMJ Open ◽

10.1136/bmjopen-2019-035182 ◽

2020 ◽

Vol 10 (10) ◽

pp. e035182 ◽

Cited By ~ 1

Author(s):

Derralynn A Hughes ◽

Patricio Aguiar ◽

Patrick B Deegan ◽

Fatih Ezgu ◽

Andrea Frustaci ◽

...

Keyword(s):

Fabry Disease ◽

Disease Progression ◽

Treatment Initiation ◽

Specific Treatment ◽

Free Text ◽

Point Scale ◽

Delphi Consensus ◽

Modified Delphi ◽

Patient Reported ◽

Early Indicators

ObjectivesThe PRoposing Early Disease Indicators for Clinical Tracking in Fabry Disease (PREDICT-FD) initiative aimed to reach consensus among a panel of global experts on early indicators of disease progression that may justify FD-specific treatment initiation.Design and settingAnonymous feedback from panellists via online questionnaires was analysed using a modified Delphi consensus technique. Questionnaires and data were managed by an independent administrator directed by two non-voting cochairs. First, possible early indicators of renal, cardiac and central/peripheral nervous system (CNS/PNS) damage, and other disease and patient-reported indicators assessable in routine clinical practice were compiled by the cochairs and administrator from panellists’ free-text responses. Second, the panel scored indicators for importance (5-point scale: 1=not important; 5=extremely important); indicators scoring ≥3 among >75% of panellists were then rated for agreement (5-point scale: 1=strongly disagree; 5=strongly agree). Indicators awarded an agreement score ≥4 by >67% of panellists achieved consensus. Finally, any panel-proposed refinements to consensus indicator definitions were adopted if >75% of panellists agreed.ResultsA panel of 21 expert clinicians from 15 countries provided information from which 83 possible current indicators of damage (kidney, 15; cardiac, 15; CNS/PNS, 13; other, 16; patient reported, 24) were compiled. Of 45 indicators meeting the importance criteria, consensus was reached for 29 and consolidated as 27 indicators (kidney, 6; cardiac, 10; CNS/PNS, 2; other, 6; patient reported, 3) including: (kidney) elevated albumin:creatinine ratio, histological damage, microalbuminuria; (cardiac) markers of early systolic/diastolic dysfunction, elevated serum cardiac troponin; (CNS/PNS) neuropathic pain, gastrointestinal symptoms suggestive of gastrointestinal neuropathy; (other) pain in extremities/neuropathy, angiokeratoma; (patient-reported) febrile crises, progression of symptoms/signs. Panellists revised and approved proposed chronologies of when the consensus indicators manifest. The panel response rate was >95% at all stages.ConclusionsPREDICT-FD captured global opinion regarding current clinical indicators that could prompt FD-specific treatment initiation earlier than is currently practised.

Download Full-text

The ISCP Systems Group: Enhancements to the Learning Agreement and ARCP

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363511x575480 ◽

2011 ◽

Vol 93 (6) ◽

pp. 198-200 ◽

Cited By ~ 1

Author(s):

Ian Eardley ◽

Maria Bussey ◽

Jeremy Brooks-Martin

Keyword(s):

Surgical Training ◽

Training Programme ◽

Educational Needs ◽

Learning Culture ◽

Formative Feedback ◽

Annual Review ◽

Programme Director ◽

Surgical Trainees ◽

Educational Supervisor ◽

Standards Of Conduct

The Intercollegiate Surgical Curriculum Programme (ISCP) is bringing about a change of learning culture for surgical trainees in which learning is transparent and there is explicit formative feedback. A key principle is that surgical trainees should be able to demonstrate that their learning has met defined standards of conduct and practice. The programme director (PD) is responsible for the training programme within which trainees now have regular appraisals with an assigned educational supervisor (AES) using a learning agreement (LA) and a review of progress through an annual review of competence progression (ARCP). These support trainees by helping them to identify their educational needs and then, in conjunction with their AES, to plan and manage their surgical training.

Download Full-text

TP8.2.15 Higher General Surgical Trainee preferences for Annual Review of Competency Progression during COVID-19 Pandemic

British Journal of Surgery ◽

10.1093/bjs/znab362.086 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Khurram Khan ◽

Giuliana Torpiano ◽

Norman Galbraith ◽

Morag McLellan ◽

Alison Lannigan

Keyword(s):

Surgical Training ◽

Annual Review ◽

Surgical Trainee ◽

Training Groups ◽

Surgical Trainees ◽

The Impact

Abstract Aims The COVID-19 pandemic has caused significant disruption in surgical training. We aim to explore the preferences of higher general surgical trainees for Annual Review of Competency Progression (ARCP) also compare the responses across different training grades. Methods All higher general surgical trainee in a single deanery were invited to participate in an online voluntary anonymous survey. The respondents were divided in two groups: junior (ST3-ST5) and senior higher surgical trainees (ST6-ST8) and responses compared. Results Sixty-four of 88 trainees responded. Thirty-three (51.6%) were ST3–ST5, 24 (37.5%) were ST6–ST8 and 7 (10.9%) were out-of-training. More trainees in ST3–ST5 group preferred to defer the next rotation for 12 months (18.2% vs 0%, p = 0.034), repeat current sub-specialty (33.3% vs 4.2%, p = 0.009), or add 12 months to training and delay predicted CCT date by 12 months (18.2% vs 0%, p = 0.034). Most trainees in both groups preferred the option of prolonging training should be offered to all trainees with an option to decline extension if ARCP competencies met (66.7% vs 50.0%, p = 0.276). Conclusions The preference for ARCP and length of training was different between two training groups, hence the need of trainees should be considered by training committees when addressing the impact of COVID-19.

Download Full-text