Evaluation of Stress Levels of Trainee Cardiac Surgery Residents during Training Interventions Using Physiological Stress Parameters

Background: This study analysed the psychological and psycho-emotional stress in cardiac surgery. Using heart rate variability (HRV) analysis, it is possible to record intraoperative objective stress responses in surgeons. The aim of the study was to assess with the help of HRV parameters the postulated increased stress levels of cardiac surgeons in training compared to experienced senior cardiothoracic surgeons in exactly the same work situation in order to make qualification-differentiated statements about physiological stress during surgical interventions. Methods: During surgical teaching procedures, long-term ECG data (n = 15 each) for two operating residents and their assisting senior physicians were recorded. Time and frequency domain HRV parameters were analysed. Results: The time-related parasympathetic-dominated HRV parameters RMSSD (19.5 ms vs. 28.1 ms), NN50 (297.67 vs. 693.40), and cardiac interval mean RR (692.8 ms vs. 737.3 ms) indicate a higher stress level in the operating residents compared to the experienced surgeons. The higher stress index (11.61 vs. 8.86) confirms this. Conclusion: Compared to experienced surgeons, operating residents showed lower parasympathetic activity and higher stress levels during cardiac surgery training procedures.

EP.TU.590Making the cut – Tailoring an undergraduate surgical teaching programme a QI project

Aims This project set out to improve the quality of surgical teaching for final year students on a DGH placement. A four-week programme was introduced and regular modification was undertaken through systematic gathering of feedback. The sessions developed were interactive question-based tutorials, suturing, and on-call simulation with common F1 scenarios. Methods Material was developed and piloted based on topics the facilitators felt were poorly taught as students. Feedback was gathered by questionnaire after each session comparing the student’s confidence before and after, along with suggestions for improvement. This process was repeated through all six rotations. Results A total of 95 questionnaires were completed. Average confidence increased from 52% to 77%. The programme was expanded based on suggestions to include orthopaedic examinations and plastic surgery. The tutor pool was increased to include more foundation doctors to ensure sustainable weekly delivery. Examples of how suggestions were implemented include: Conclusions The success of the teaching programme was evident through positive feedback and good student attendance. By playing to the strength of foundation trainees as recent graduates, the programme complemented content-based teaching from more senior colleagues with sessions targeting practical F1 skills and exam specific needs of students. Early piloting also meant ability to constantly adapt the programme to enhance its benefit to the students.

EP.TU.207Maintaining High Quality Surgical Teaching during the COVID-19 Pandemic

Aims The COVID-19 pandemic has resulted in many changes to the delivery of undergraduate surgical education. Formal teaching is now online and exposure to the many different aspects of General Surgery is greatly reduced. We explored how the changes made to the 4-week General Surgery rotation at a district general hospital have impacted on students and their learning. Methods Online survey was used to collect feedback from the students and was compared to data collected prior to the pandemic. Results A total of 10 survey responses were received. Despite the timetable changes, 80% of students rated the placement as Good-Excellent. The students received more registrar/consultant level teaching than previously and rated the teaching to be of a good standard. They logged more clinical procedures and clerked more patients than previously, but clinic attendance remained poor and operating theatre sessions static. Conclusion Despite the added pressures of the pandemic, undergraduate surgical education has been maintained to a high standard. The struggles experienced with the decrease in elective operating lists and fewer surgical clinics does not appear to have impacted significantly when compared to pre-pandemic data. However, this is certainly an area that needs to be improved upon to ensure adequate exposure to surgery. The increase in procedural and clerking experience is perhaps a reflection of greater time spent on the wards. This is certainly of benefit in preparation for foundation training and any missed opportunities for exposure to surgical pathologies have been alleviated by the increase in formal senior-level teaching.

EP.TU.825Virtual general surgery teaching for higher surgical trainees in KSS during COVID-19

Aims From the start of the coronavirus pandemic, it became clear that the traditional deanery teaching model for higher surgical trainees had to change. Face-to-face lectures and tutorials are not appropriate in light of UK government measures, social distancing and reduced non-essential travel. To replace deanery teaching days we established a once weekly programme of evening tutorials, delivered via Zoom by Consultant surgeons, covering a breadth of general surgical specialities. Each session was archived and a secure digital link provided for trainees to watch later if necessary. We conducted a survey of higher surgical trainees to assess response. Methods A 10-question web survey distributed to all general surgery trainees in West KSS. 24/38 trainees responded (response rate 63.2%). Results 75% rated the teaching as very or extremely useful. Commute, personal responsibilities and late theatre/ clinic sessions were barriers to joining teaching live. 71% found it very or extremely enjoyable. 78% found it at least as good as traditional teaching days. 87% found it very or extremely relevant to their development as a surgeon. 42% would prefer the Zoom format was utilised for longer sessions, to further recreate the traditional teaching "day". Conclusions Feedback was broadly positive and the tutorials were well received, but probably need to run less frequently than once a week. Half day sessions could be considered. The teaching quality was rated overall better or at least as good as in-person teaching. There appears to be clear benefit in detailed, reflective surgical teaching delivered efficiently via Zoom.

EP.TU.480Novel virtual near-peer surgical teaching for foundation doctors

Aims Studies have shown that new medical graduates feel unprepared for their role as clinicians. Courses and teachings have been cancelled due to COVID-19. Our aim was to assess demand for surgical teaching and provide a new surgical course delivered virtually to fill this gap. Methods FY1 doctors from a large teaching hospital were invited to fill in a questionnaire to assess their preparedness for surgical specialties and subsequent appetite for near-peer teaching. The findings were used to create a virtual surgical teaching course. A post-course questionnaire was distributed to assess the success of the course. Results Fifteen FY1 doctors completed the questionnaire. 73% (11) felt they had not had sufficient teaching on surgical specialties during medical school. 93% (14) felt they did not have sufficient teaching on managing surgical patients in foundation training. None felt ‘very confident’ managing patients peri-operatively. None felt ‘very confident’ managing surgical complications. 66.7% (10) and 53.3% (8) said they had not had any teaching from SHOs or SpRs respectively. Of those who had, 66.7% (4) and 85.7% (6) found it ‘very useful’. 100% (15) said they would be interested in surgical teaching delivered by CSTs. Twelve FY1 doctors completed the post-course feedback. 83% (10) found the course ‘extremely useful’ and relevant to their surgical ward based jobs. Conclusion FY1s are not confident in managing surgical patients on the wards. There is a demand for surgical teaching for FY1s. Virtual lunch-time teaching is an effective way to encourage and continue surgical teaching throughout the pandemic.

TP8.2.22 Mind the Gap: Overcoming the disruption of surgical teaching during COVID-19 redeployment

Aims Due to the pandemic, surgical FY1s in our trust were re-deployed to cover medical patients. In addition to cancellation of surgery-specific teaching, there was less time spent by FY1s with senior surgical colleagues during the normal working day. Our FY1s appeared less confident in managing unwell surgical patients, and there was dissatisfaction for both FY1s and seniors. This project aimed to identify the particular areas of concern and deliver a tailored teaching session. Methods Surgical FY1s and SpRs were surveyed. We received 10 (83%) FY1 responses and 5 (42%) SpR responses. Management of common surgical presentations, routine administrative and clerical tasks were identified as areas of need. A teaching session was delivered via online conferencing software and uploaded to a video sharing website where it could be viewed at a later date. Seven of 12 (58%) surgical FY1s attended live and completed a post-teaching session feedback survey. Results Seven (100%) FY1s rated the session ‘very useful’, and a majority found the ‘common surgical presentations’ section of most value. All respondents felt more confident with both clerking surgical patients and administrative tasks following the refresher session. Conclusions This project demonstrated the need for additional training sessions to compensate for loss of opportunities due to re-deployment. Utilising remote teaching proved an acceptable alternative to previous in-person options. The tailored refresher session successfully improved confidence in target areas and should be delivered routinely.

TP8.2.7 The Post Graduate Virtual Learning Environment: an effective platform for the delivery of a surgical teaching programme in the West Midlands

Aim The Postgraduate Virtual Learning Environment (PGVLE) is a digital platform developed by HEEWM in response to the COVID-19 pandemic to deliver a virtual teaching programme to surgical trainees. The programme is delivered through the BigBlueButton; an integrated virtual classroom. All teaching sessions are recorded and archived to allow trainees to review content at their convenience. We performed a contemporaneous study to review the effectiveness and quality of the platform in delivering teaching and suggest its future role in the surgical curriculum. Method Anonymised feedback was gathered of trainee’s perspective of the platform experience, the quality of teaching and the archived content. All trainees were General Surgery higher trainees (HST) (ST3-ST8). The data from sequential teaching days was analysed. Results Of 90 HST, on average 40 attended each monthly training day (consistent with pre-COVID attendance). 122 trainee responses were completed. 68% of respondents were between ST3-ST5. 91% rated the administration and delivery of the teaching sessions as excellent or very good. 16% of trainees watched the archived sessions after the teaching day of which 46% felt it met their educational expectations. Conclusions The PGVLE is an effective platform for the delivery of a virtual surgical teaching programme. It met with high levels of trainee satisfaction in the context of the pandemic. The archived content provides advantages to consolidation of learning. It is thought that the PGVLE platform will become a key feature of the surgical training programme in a hybrid learning model, related to relevant curricula, in the future.

913 Near-Peer Teaching for Surgical Foundation Year Doctors During COVID-19 Pandemic

Introduction Literature has shown near-peer teaching to be an effective method of improving learning. There is little data on surgical teaching initiatives of this kind. Nationally and locally, teaching sessions and courses have been cancelled due to the pandemic. A new surgical lunch-time virtual course was created to fill this gap. Method FY1 doctors from University Hospital Wales were invited to participate in a survey exploring the need and topics for surgical teaching. Results were used to create a surgical teaching course. Near-peer, core surgical trainees were recruited to teach. A post-course questionnaire was distributed to FY1 doctors who attended the teaching to assess the success of the course. Results 15 FY1 doctors completed the initial questionnaire. 33% (5) were currently on a surgical placement. 60% (9) had an upcoming surgical placement. 73% (11) felt they did not have sufficient teaching on surgical specialties during medical school. 93% (14) felt they did not have sufficient teaching on how to manage surgical patients as a FY1. 100% (15) responded they would be interested in surgical teaching delivered by core surgical trainees. Eight topics were suggested, and lunchtime sessions were created. Post-course feedback was completed by 12 FY1 doctors. 88% (10) of respondents found the course ‘extremely useful’ and relevant to their surgical jobs. Conclusions There is a demand for surgical teaching for FY1s. Near-peer education designed by FY1s and delivered by CSTs is an effective way for teaching relevant surgical knowledge. Lunch-time virtual teaching is a good way to continue teaching sessions through the pandemic.

318 Adapting Surgical Intercalation Teaching to The Pandemic – A Novel Near-Peer Educational Model for Intercalating Medical Students

Aim The COVID-19 pandemic has reduced medical student exposure to traditional formats of surgical teaching, thereby irrefutably altering surgical education for the foreseeable future. The pandemic has compounded the preliminarily reported disconnect intercalating students experience, as well as depriving students of opportunities for surgical exposure. The aim of our study is to devise an innovative near-peer system to supplement surgical teaching and guidance for the ‘Surgical Sciences’ Intercalated BSc offered at University College London, hence promoting surgical education. Method Past students (preceding two cohorts) were competitively recruited, termed mentors. Each student was paired with a mentor for one-to-one guidance. Mentors and programme directors formulated surgical, module-specific, virtual tutorials (Zoom). Mentees were surveyed using predesigned Google Forms to gauge subjective utility. Likert Scales (0-10) were used for quantitative analysis and free-text fields for further commentary. Results Mentors and programme directors devised 8 module-specific, surgical tutorials over term 1, spaced on average at every 1.5 weeks. A statistically significant increase in confidence reported per taught module, from 5.85±1.16 to 7.85±0.93 (P < 0.0001), was observed. Mentees report an overall recommendation of 93.19% that all tutorials be rerun for the upcoming cohort. 75% of mentees predict their designated mentors will be ‘very useful’ in their surgical education. Conclusions A novel model of near-peer education for surgical intercalation studies has been successfully established, whereby students receive valuable education and guidance from mentors with relevant surgical experiences. Students report significant utility in this programme, which can be a constant in otherwise turbulent times for surgical education.