Current Status and Future Perspective of General Surgical Trainees in the Netherlands

The introduction of a 42 + 4 h work week for surgical residents in Switzerland - a stakeholder analysis

BACKGROUND

The Swiss national union of residents and attendings (VSAO) has voiced its desire for a transition from the current 48 h work week to a 42 + 4 h work week, in which 42 h be focused on patient care with the remaining 4 h be dedicated solely to training purposes. This could potentially result in a significant decrease in surgical education time. The current study seeks to address the issues involved in its implementation as well as possible compensatory mechanisms.

METHODS

This mixed methods study seeks to clearly underline the challenges associated with the implementation of a 42 + 4 h work week. First, the major stakeholders were identified and analysed via umbrella review. Thereafter, a classic stakeholder analysis was performed. Via morphological matrix, possible models for the implementation of a 42 + 4 h work week were developed and evaluated. Finally, representatives from the identified stakeholder groups were interviewed and given the opportunity to provide feedback.

RESULTS

A total of 26 articles were identified by the literature search and were used to identify the major stakeholders and issues involved in the implementation of the desired work hour regulation. Overall, these showed conflicting results with regard to the effect decreased working hours would have on surgical training and patient outcomes. In the end, the morphological matrix produced three feasible and desirable models for the implementation of a 42 + 4 h work week. Each included compensatory mechanisms like auxiliary staff, reduction in administrative tasks, and a switch to EPAs. In their interviews, the stakeholders generally supported these solutions.

CONCLUSION

Given the increasing emphasis on the importance of a positive work-life balance, it seems inevitable that the next few years will see the introduction of a 42 + 4 h work week in Switzerland. However, it is imperative that every effort be made to preserve the quality of training and patient care for the next generations. This will require the cooperation of all stakeholders in order to find workable solutions.

Surgical residents' perceptions of the operating theatre educational environment at St. Paul's Hospital Millennium Medical College: A cross-sectional survey

Background

The educational environment refers to the "climate" that influences all aspects of learning in an educational context and the experience in the operating room is particularly crucial in surgical residents learning. Hence, this study aimed to assess surgical residents' perceptions of the operating theatre educational environment and associated factors in the surgical department at St. Paul's Hospital.

Methods

This cross-sectional study was conducted in March 2022 among surgical residents at St. Paul's Hospital Millennium Medical College to assess their perceptions of the operating room educational environment using the OREEM questionnaire. Descriptive statistics (mean, median, SD) were used to summarize demographic data and OREEM scores. The student t-test and one-way analysis of variance (ANOVA) testing followed by posthoc tests were used for comparison of quantitative data, with p-values < 0.05 considered significant.

Results

Of the participants, 103 (79.8%) were male and 26 (20.2%) were female with a mean age of 28 years. The overall mean score was 69% with subscale scores for teaching and training at 47.9/65.0 (73.7%), learning opportunities at 34.5/55.0 (62.7%), the atmosphere at 28.9/40.00 (72.4%) and workload/supervision/ support at 27.5/40.0 (68.7%). Male and female residents differed significantly in perceptions of "atmosphere" (t127 = 3.35, p < 0.001) and in junior versus senior residents' perceptions of the "learning opportunities" and "atmosphere" at p-values of 0.023 and 0.028 respectively. However, age, marital status, and specific surgical training programs did not have a significant effect on the scores.

Conclusion

Overall, residents had positive perceptions of their training and teaching, learning opportunities, the atmosphere in the operation theatre, and the supervision they received in the operation theatre. The operating room's "teaching and training" component received the highest score, while the operating room's "learning opportunities" component received the lowest. This indicates the importance of establishing a positive learning environment with sufficient "hands-on" experience, especially during emergencies. In addition, preoperative planning, case discussions, and feedback after the surgery should be routine.

A Survey of Perceptions of Surgical Trainees on Feedback During Training in West Africa

BACKGROUND

Feedback has become an integral part of learning within the medical profession, particularly as training becomes more trainees'-centered. Feedback from the trainees about their training and trainers is essential for effective and high-quality training. The purpose of this survey was to evaluate trainees' perceptions on feedback on their postgraduate training and trainers in West Africa.

METHODS

Cross-sectional self-administered written survey of junior and senior registrar attending the annual revision and update course of the West African College of Surgeons. Information sought included sociodemographic variables, perception on feedback, opportunity to give feedback, trainee-trainers relationship and their opinion on different aspects of the postgraduate program where they would like to give feedback.

RESULTS

The response rate was 81.5% (66/81). Median age was 33 years. Sixty trainees (90.9%) were junior registrars. Sixty-four (97%) trainees would like to give feedback about their training and trainers. Only 18 (27.3%) trainees have had opportunity of giving feedback about their training. Most trainees (90.9%) would like to give feedback on patient care and learning environment; 89.4% would like to give feedback on their training curriculum and 87.9% would like to give feedback on their operating room experiences. Most trainees (81.8%) believed trainee feedback is of critical importance to training. With regard to trainees-trainer relationship, 39 (59.1%) trainees were either unsatisfied or reported just a fair relationship.

CONCLUSIONS

This study has shown that many of the trainees lack opportunity of giving feedback on their training but considered feedback critical to their training. Trainees would like to give feedback on patient care, curriculum, learning environment and operative room experience. Trainee feedback should be encouraged in surgical training in West Africa.

Weekly working hours for Norwegian hospital doctors since 1994 with special attention to postgraduate training, work-home balance and the European working time directive: a panel study

OBJECTIVES

To examine the weekly working hours of Norwegian hospital doctors from 1994 to 2012 with special emphasis on the quality of postgraduate training and work-home balance, and in relation to the requirements of the European Working Time Directive (EWTD).

DESIGN

Panel study based on postal questionnaires.

SETTING

Norway.

PARTICIPANTS

Unbalanced cohort of 1300-1600 doctors in 1994, 1995, 1996, 1997, 2000, 2002, 2004, 2006, 2008, 2010 and 2012.

OUTCOME MEASURES

Self-reported total weekly working hours and whether 45 weekly working hours are too short, sufficient, or too long to meet the quality requirements of obligatory postgraduate training for junior doctors.

RESULTS

From 1994 to 2012, the number of weekly working hours was stable for senior (46-47 h) and junior (45-46 h) hospital doctors. In 2012, significantly more senior (27-35%) than junior (11-20%) doctors reported suboptimal work-home balance, defined as working more than 48 h a week. The majority perceived the present situation with an average of 45 h per week for juniors as sufficient for obligatory postgraduate specialist training, but doctors of higher age (OR 1.04, 95% CI 1.01 to 1.08), senior doctors (1.07, 1.04 to 1.11) and doctors working in surgical specialties (OR 1 vs laboratory medicine 0.03, 0.01 to 0.25, internal medicine 0.31, 0.17 to 0.58, psychiatry 0.12, 0.04 to 0.36, paediatrics 0.36, 0.12 to 1.07, anaesthesiology 0.08, 0.02 to 0.39, gynaecology 0.07, 0.01 to 0.56 and others 0.39, 0.04 to 3.56) were more likely to want the work-week to be longer.

CONCLUSIONS

The weekly working hours of Norwegian hospital doctors were always below the EWTD requirements. A significant growth of hospital doctor density over the past two decades, national regulations and cultural values might be important factors. Specialty differences in perception of sufficient training time may call for more flexibility in working time regulations.

Post-graduate surgical training in Nigeria: The trainees' perspective

Background:

Quality surgical training is crucial to meeting manpower needs and creating a vibrant healthcare delivery. Feedback from trainees provides insight to understanding training challenges and needs to improve the programme. The objective of this study was to determine the challenges faced by surgical trainees and their perception of their training in Nigeria.

Materials and Methods:

A questionnaire survey of trainees in 16 academic surgical training centres in Nigeria between September and December 2012.

Results:

Of 235 respondents, 227 were males (96.6%) and 8 females (3.4%) with mean age of 33.9 years. A significant proportion (62.3%) of the respondents believed that the volume and diversities of surgical cases managed during their training were sufficient; however, 53.9% were less satisfied with their operative experience. Majority (71.8%) of the respondents felt “supported” by their trainers but they also believed that the training was skewed towards service provision. They were not actively involved in research due to lack of funds in 77.7%, lack of time/motivation in 15.8%, indifference in 11.8% and poor knowledge of research methods in 9.2%. Inadequate training facilities (50.7%), poor welfare (67.2%), inadequate sponsorship (65.9%) and poor remuneration (88.3%) were identified among their challenges. On the whole, majority (62.3%) believed that their training would adequately prepare them to function independently.

Conclusion:

Surgical residents in Nigeria face a variety of challenges. Based on our findings, a training that tracks and keeps trend with global changes through a higher investment in surgical training, improved facilities and residents’ well-being from both the teaching authorities and government will more likely improve the quality of training.

Is current surgical training efficient? A national survey

OBJECTIVES

Evaluation of surgical training in Denmark is competency based with no requirement for a specific number of procedures. This may affect monitoring of surgical progress adversely and cause an underestimation of the time needed to acquire surgical competencies. We investigated the number of common surgical procedures performed by trainees. Trainees' and consultants' expectations from the training program were also investigated.

DESIGN AND PARTICIPANTS

A questionnaire was sent to all 115 surgical trainees in Denmark. We asked how many common surgical procedures the trainees had performed during their postgraduate training, whether self-reported procedural confidence was achieved during their training, and whether their training expectations were met. Another questionnaire dealt with the consultants' expectations of the surgical training.

RESULTS

The total number of common surgical procedures (Lichtenstein hernia repair, appendectomy, laparoscopic appendectomy, and laparoscopic cholecystectomy) that were performed varied between trainees. One group performed few common procedures during training. A low number in 1 procedure correlated with a similar pattern in other procedures. Approximately one-third did not perform common elective procedures independently until their fifth year. Consultants and trainees viewed training differently.

CONCLUSIONS

Our study reveals no common trend in the numbers and types of procedures performed during training. The number of procedures seems to reflect the individual trainee and a local tradition rather than the particular training program. An informal competency-based assessment system with lack of quantitative requirements evidently involves a risk of skewness in training.

Effect of the ACGME duty hours restrictions on surgical residents and faculty: a systematic review

PURPOSE

Educators in surgical training programs are concerned that the Accreditation Council for Graduate Medical Education (ACGME) duty hours limitations may adversely affect surgical residents' education, especially their operative experience, so the authors aimed to evaluate the impact of duty hours reductions on surgical residency.

METHOD

The authors searched English- and French-language literature (2000-2008) for articles about the impact of duty hours restrictions on surgical residents' education and well-being and on faculty educators. They used the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and ERIC. The authors included every report that examined the effects of duty hours limits on surgical training, excluding opinion papers and editorials. Two reviewers independently performed data extraction and quality assessment for all reports and resolved disagreements by consensus.

RESULTS

The authors retrieved 1,146 reports and included 56 in the study. They compiled positive and negative outcomes on (1) residents' education, (2) resident lifestyle, and (3) surgical faculty. Overall, the effects of duty hours reductions on residents' education and lifestyle were positive or neutral, but the effects on surgical faculty were negative. The 16 articles with the highest-quality scores had 27 positive themes and 11 negative themes.

CONCLUSIONS

This is the largest and most current review of the literature addressing the effect of the ACGME duty hours limitations on surgical training. Limitations had a positive effect on residents but a negative effect on surgical faculty. Importantly, duty hours limitations did not adversely affect surgical residents' operating-room experience.

Transatlantic comparison of the competence of surgeons at the start of their professional career

Background

Although the objective in European Union and North American surgical residency programmes is similar—to train competent surgeons—residents' working hours are different. It was hypothesized that practice-ready surgeons with more working hours would perform significantly better than those being educated within shorter working week curricula.

Methods

At each test site, 21 practice-ready candidate surgeons were recruited. Twenty qualified Canadian and 19 qualified Dutch surgeons served as examiners. At both sites, three validated outcome instruments assessing multiple aspects of surgical competency were used.

Results

No significant differences were found in performance on the integrative and cognitive examination (Comprehensive Integrative Puzzle) or the technical skills test (Objective Structured Assessment of Technical Skill; OSATS). A significant difference in outcome was observed only on the Patient Assessment and Management Examination, which focuses on skills needed to manage patients with complex problems (P &lt; 0·001). A significant interaction was observed between examiner and candidate origins for both task-specific OSATS checklist (P = 0·001) and OSATS global rating scale (P &lt; 0·001) scores.

Conclusion

Canadian residents, serving many more working hours, perform equivalently to Dutch residents when assessed on technical skills and cognitive knowledge, but outperformed Dutch residents in skills for patient management. Secondary analyses suggested that cultural differences influence the assessment process significantly.