scholarly journals Differences in progression by surgical specialty: a national cohort study

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.

scholarly journals O46 Differences in ARCP outcome by surgical specialty: a longitudinal cohort study

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
C Hope ◽  
J Lund ◽  
G Griffiths ◽  
D Humes
Keyword(s):  
Cohort Study ◽  
General Surgery ◽  
Primary Outcome Measure ◽  
Older Age ◽  
Longitudinal Cohort Study ◽  
Annual Review ◽  
Surgical Specialty ◽  
Longitudinal Cohort ◽  
The Uk ◽  
To Receive

Abstract Introduction Surgical training in the UK is comprised of ten specialties: cardiothoracic, general, neurosurgery, oral and maxillofacial (OMFS), otolaryngology, paediatric, plastic, trauma and orthopaedics, urology and vascular surgery. Progression through training is assessed by the Annual Review of Competency Progression (ARCP). The aim is to examine ARCP outcomes within UK surgical specialty training and identify differences between specialties. Method A longitudinal cohort study using data from United Kingdom Medical Education Database (UKMED) was performed across surgical specialities. ARCP outcome was the primary outcome measure. Multi-level univariate and multiple ordinal regression analyses were performed. Result 8,220 trainees with an ARCP outcome between 2010 and 2017 were included, comprising 31,788 ARCP outcomes. There was substantial variation in the proportion of non-standard outcomes 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 outcome compared to T&O trainees (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 outcomes of surgical ARCP’s across specialties. General surgery has higher rates of non-standard ARCP outcomes compared to other surgical specialities. Across all specialities, female sex and older age were associated with non-standard outcomes. Further studies are required to explore these associations. Take-home Message There is significant variation in ARCP outcomes between specialities. Women and older trainees receive significantly more non-standard outcomes.

scholarly journals SP10.2.6 The Quantitative Impact of COVID-19 on surgical training in the United Kingdom

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Joshua Clements ◽  
Joshua Burke ◽  
Carly Hope ◽  
Deirdre Nally ◽  
Gareth Griffiths ◽  
...  
Keyword(s):  
United Kingdom ◽  
Surgical Training ◽  
Elective Surgery ◽  
Outcome Data ◽  
Annual Review ◽  
Surgical Specialty ◽  
The United Kingdom ◽  
Surgical Trainees ◽  
Rate Ratios ◽  
The Impact

Abstract Aims COVID-19 has had a global impact on all aspects of healthcare including surgical teaching and training. This study aimed to quantify the impact of COVID-19 on operative case numbers recorded by surgeons in training, and annual review of competency progression (ARCP) outcomes in the United Kingdom. Methods Anonymised operative logbook numbers were collated from e-logbook and ARCP outcome data were collated from the Intercollegiate Surgical Curriculum Programme (ISCP) database for trainees across core and the ten higher surgical specialities. Operative logbook numbers and ARCP outcomes were compared between pre-COVID dates. Effect sizes are reported as incident rate ratios (IRR) with 95% confidence intervals (CI). Results 5599 surgical trainees in 2019 and 5310 in 2020 in surgical specialty training were included. The IRR was reduced across all subspecialties because of the COVID-19 pandemic (0.55; 95% CI 0.53-0.57). Elective surgery (0.60; 95% CI 0.59-0.61) was affected more than emergency surgery (0.88; 95% CI 0.86-0.89). Regional variance with reduced operative activity was demonstrated across all specialities. 1 in 8 in their final year of training have not been able to achieve curriculum requirements and have had training extended. 1 in 4 trainees entering their final year of training are behind their expected training trajectory. Conclusion COVID-19 continues to have a significant impact on surgical training in the UK. Urgent, co-ordinated action is required by key stakeholders to mitigate for these effects and maintain future surgical training.

Prognostic significance of competition ratios in surgical specialty training selection

2021 ◽  
pp. postgradmedj-2020-139491
Author(s):  
Katie Mellor ◽  
David B Robinson ◽  
Oliver Luton ◽  
Osian P James ◽  
Arfon GMT Powell ◽  
...  
Keyword(s):  
Maxillofacial Surgery ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Scientific Publication ◽  
Primary Outcome Measure ◽  
Youden Index ◽  
Annual Review ◽  
Critical Ratio ◽  
Surgical Specialty ◽  
Surgical Trainees

BackgroundA competition ratio (CR) indicates the ratio of total applications for a training post when compared with numbers of specialty posts available. This study aimed to evaluate CRs’ influence on National Training Number (NTN) selection in a single UK Statutory Education Body.MethodsConsecutive core surgical trainees numbering 154 (105 men, 49 women; median years since graduation: four) were studied over a 6-year period. Annual specialty specific CRs were obtained from Health Education England’s website, and primary outcome measure was UK NTN appointment.ResultsOverall NTN appointment was 45.5%. Median CR was 2.36; range Oral & Maxillofacial Surgery 0.70 (2020) to Neurosurgery 22.0 (2020). Multivariable analysis revealed that NTN success was associated with: CR (OR 0.46, p=0.003), a single scientific publication (OR 6.25, p=0.001), cohort year (2019, OR 12.65, p=0.003) and Universal Annual Review of Competence Progression Outcome 1 (OR 45.24, p<0.001). CRs predicted NTN appointment with a Youden index defined critical ratio of 4.42; 28.6% (n=8) versus 49.2% (n=62), p=0.018.ConclusionCRs displayed 30-fold variation, with CRs below 4.42 associated with twofold better NTN promotion, but strong clinical competence and academic reach again emerged as the principal drivers of career advancement.

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

BJS Open ◽  
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 &gt; 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 &gt; 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, &gt; 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.

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

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.

scholarly journals Impact of the COVID-19 pandemic on core surgical training

2020 ◽  
Vol 65 (4) ◽  
pp. 133-137 ◽  
Author(s):  
Khurram Shahzad Khan ◽  
Rona Keay ◽  
Morag McLellan ◽  
Sajid Mahmud
Keyword(s):  
Surgical Training ◽  
Teaching Hospital ◽  
General Surgery ◽  
Negative Impact ◽  
Outpatient Clinics ◽  
Box Trainer ◽  
Surgical Trainees ◽  
Long Term Impact ◽  
The Impact

Background and aims COVID-19 pandemic has caused significant disruption in training which is even more pronounced in the surgical specialties. We aim to assess the impact of COVID-19 pandemic on core surgical training. Methods All core surgical and improving surgical trainees in West of Scotland region were invited to participate in an online voluntary anonymous survey via SurveyMonkey. Results 28 of 44 (63.6%) trainees responded, 15 (53.6%) were CT1/ST1. 14 (50.0%) working in teaching hospital and 15 (53.6%) working in general surgery. 20 (71.4%) felt that due to the pandemic they have less opportunity to operate as the primary surgeon. 21 (75.0%) have not attended any outpatient clinics. 8 (28.6%) did not have any form of access to the laparoscopic box-trainer. 20 (71.4%) felt their level of confidence in preforming surgical skills has been negatively impacted. 18 (64.3%) found it difficult to demonstrate progress in portfolio. 21 (75.0%) trainees have not attended any teaching. 10 (35.7%) trainees have been off-sick. 8 (28.6%) trainees have felt slightly or significantly more stressed. Conclusion COVID-19 pandemic has an unprecedented negative impact on all aspects of core surgical training. The long term impact on the current cohort of trainees is yet to be seen.

scholarly journals Post-Stroke Patients with Moderate Function Have the Greatest Risk of Falls: A National Cohort Study

2019 ◽  
Author(s):  
Wycliffe Enli Wei ◽  
Deidre Anne De Silva ◽  
Hui Meng Chang ◽  
Jiali Yao ◽  
David Bruce Matchar ◽  
...  
Keyword(s):  
Cohort Study ◽  
Fall Risk ◽  
Primary Outcome Measure ◽  
National Registry ◽  
Stroke Patients ◽  
Functional Level ◽  
Stroke Registry ◽  
Post Stroke ◽  
National Cohort ◽  
Risk Of Falls

Abstract Background Stroke patients have increased risks of falls. We examined national registry data to evaluate the association between post-stroke functional level and the risk of low falls among post-stroke patients. Methods This retrospective cohort study analyzed data from national registries to examine the risk factors for post-stroke falls. Data for patients who suffered ischemic strokes and survived the index hospital admission was obtained from the Singapore National Stroke Registry and matched to the National Trauma Registry, from 2011 to 2015. The primary outcome measure was a low fall (fall height ≤0.5m). Competing risk analysis was performed to examine the association between functional level (by modified Rankin score [mRS] at discharge) and the risk of subsequent low falls. Results In all, 2,255 patients who suffered ischemic strokes had recorded mRS. The mean age was 66.6 years and 58.5% were men. By the end of 2015, 54 (2.39%) had a low fall while 93 (4.12%) died. After adjusting for potential confounders, mRS was associated with fall risk with an inverted U-shaped relationship. Compared to patients with a score of zero, the sub-distribution hazard ratio (SHR) increased to a maximum of 3.42 (95%CI:1.21-9.65, p=0.020) for patients with a score of 2. The SHR then declined to 2.45 (95%CI:0.85-7.12, p=0.098), 2.86 (95%CI:0.95-8.61, p=0.062) and 1.93 (95%CI:0.44-8.52, p=0.38) for patients with scores of 3, 4 and 5 respectively. Conclusions An inverted U-shaped relationship between functional status and fall risk was observed. This is consistent with the complex interplay between decreasing mobility (hence decreased opportunity to fall) and increasing susceptibility to falls. Fall prevention intervention could be targeted accordingly.

scholarly journals Testicular torsion treatment: the horns of a dilemma?

2020 ◽  
Vol 102 (1) ◽  
pp. 49-53 ◽  
Author(s):  
S Lewis ◽  
L Hopkins ◽  
T Evans ◽  
W Lewis ◽  
R Harries
Keyword(s):  
General Surgery ◽  
Testicular Torsion ◽  
Questionnaire Response ◽  
Surgical Trainee ◽  
Surgical Specialty ◽  
Head Of School ◽  
Confidence Levels ◽  
Surgical Trainees ◽  
Self Administered Questionnaire ◽  
Confidence Rate

Introduction Testicular torsion treatment rests on the horns of a dilemma, with widespread national variation in whether the responsible surgical specialty is general surgery or urology, even in hospitals with both general surgery and urology emergency service assets. This study aimed to quantify higher surgical trainee operative experience and confidence in managing suspected testicular torsion in a single UK deanery (Wales). Materials and methods Anonymised logbook data were obtained via the Intercollegiate Surgical Curriculum Programme version 10 using the head of school report function for all general surgery (n=53) and urology (n=15) higher surgical trainees, which were combined with the distribution of an electronic self-administered questionnaire. Results Median operative scrotal explorations recorded for all general surgery higher surgical trainees and senior general surgery higher surgical trainees (ST7+) was 7 (range 1–22) and 10 (range 1–22), compared with 21 (range 9–64, p=0.00104) and 24 (19–64, p<0.001) for urology higher surgical trainees. The questionnaire response rate was 64.6% (general surgery 31/50, urology 11/15). Confidence levels in assessing adult and paediatric patients were lower in general surgery when compared with urology higher surgical trainees: median adult confidence rate 7/10 compared with 9/10, and paediatric confidence rate 7/10 compared with 8/10 (p<0.001 and p=0.053, respectively). All higher surgical trainees preferred urology as the accountable hospital specialty when both assets were available. Discussion and conclusion General surgery higher surgical trainees receive less than 50% of the operative exposure of urology higher surgical trainees in emergency scrotal surgery, which has important implications for curriculum competence development and patient safety.

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

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.

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