Academic requirements for Certificate of Completion of Training in surgical training: Consensus recommendations from the Association of Surgeons in Training/National Research Collaborative Consensus Group

Development of Research Core Competencies for Academic Practice Among Health Professionals: A Mixed-Methods Approach

BACKGROUND AND OBJECTIVES

Of the 4 pillars of academic practice for nursing and allied health, research has been the least developed and no standard competency framework exists that is embedded in health professional scopes of practice. The objective of this article is to report on the preliminary development and pilot-testing of research and academic scholarship core competencies for nonphysician health professionals working within a large urban academic health sciences center.

METHODS

We conducted an internal and external environmental scan and multiphase consultation process to develop research and academic core competencies for health professionals working within an interprofessional setting.

RESULTS

The final framework outlines 3 levels of research proficiency (novice, proficient, and advanced) and the relevant roles, specific competencies, and observable actions and/or activities for each proficiency level.

CONCLUSIONS

Organizations should consider the integration of the framework within performance management processes and the development of a road map and self-assessment survey to track progress over time and support health professionals with their academic practice goals.

Physician trainee research collaboratives: a mixed methods exploration of UK experience

BACKGROUND

Physician trainee research collaboratives (TRCs) help trainees develop research skills and establish peer networks. We aimed to identify the structure, activity and views of physician TRCs in the UK.

METHODS

Representatives from physician TRCs in the UK were invited to complete an online survey and participate in a focus group.

RESULTS

Representatives from 23 physician TRCs completed the survey. There was wide variation in collaborative structure, senior input and funding resources. Seventy-four per cent of physician TRCs had published peer-reviewed articles, with 70% reporting ongoing projects at the time of the survey. The survey and focus group identified improved patient care, research and leadership skills as benefits of collaborative work; while institutional and consultant support, limited time for research, funding opportunities and restrictions on group authorship were cited as challenges to collaborative success.

CONCLUSION

Physician TRC activity continues to grow and demonstrates a dynamic approach to research for all trainees.

BJS commission on surgery and perioperative care post-COVID-19

BACKGROUND

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues' experiences and published evidence.

METHODS

In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them.

RESULTS

BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training.

CONCLUSION

The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.

Making large-scale surgical trials possible: collaboration and the role of surgical trainees

BACKGROUND

Recruitment to surgical randomised controlled trials (RCTs) can be challenging. The Sunflower study is a large-scale multi-centre RCT that seeks to establish the clinical and cost effectiveness of pre-operative imaging versus expectant management in patients with symptomatic gallstones undergoing laparoscopic cholecystectomy at low or moderate risk of common bile duct stones. Trials such as Sunflower, with a large recruitment target, rely on teamworking. Recruitment can be optimised by embedding a QuinteT Recruitment Intervention (QRI). Additionally, engaging surgical trainees can contribute to successful recruitment, and the NIHR Associate Principal Investigator (API) scheme provides a framework to acknowledge their contributions.

METHODS

This was a mixed-methods study that formed a component part of an embedded QRI for the Sunflower RCT. The aim of this study was to understand factors that supported and hindered the participation of surgical trainees in a large-scale RCT and their participation in the API scheme. It comprised semi-structured telephone interviews with consultant surgeons and surgical trainees involved in screening and recruitment of patients, and descriptive analysis of screening and recruitment data. Interviews were analysed thematically to explore the perspectives of-and roles undertaken by-surgical trainees.

RESULTS

Interviews were undertaken with 34 clinicians (17 consultant surgeons, 17 surgical trainees) from 22 UK hospital trusts. Surgical trainees contributed to patient screening, approaches and randomisation, with a major contribution to the randomisation of patients from acute admissions. They were often encouraged to participate in the study by their centre principal investigator, and career development was a typical motivating factor for their participation in the study. The study was registered with the API scheme, and a majority of the trainees interviewed (n = 14) were participating in the scheme.

CONCLUSION

Surgical trainees can contribute substantial activity to a large-scale multi-centre RCT. Benefits of trainee engagement were identified for trainees themselves, for local sites and for the study as a whole. The API scheme provided a formal framework to acknowledge engagement. Ensuring that training and support for trainees are provided by the trial team is key to optimise success for all stakeholders.

Core content of the medical school surgical curriculum: Consensus report from the association of surgeons in training (ASIT)

BACKGROUND

The length of time dedicated to the undergraduate surgical curriculum is decreasing. With reduced time on surgical placements, students may be underexposed to their core learning needs. The aim of this study was to reach a national consensus on the core content of the undergraduate surgical curriculum in the UK. This will support medical students and medical schools in designing curricula to meet the core learning needs of students to prepare them for clinical practice.

MATERIALS AND METHODS

A proposed consensus document was created, using the Royal College of Surgeons of England undergraduate curriculum as a guide. This was circulated to an external advisory group for electronic suggestions of additional content not already described. Suggestions were discussed with the steering committee prior to inclusion within document. The resulting consensus document was presented to a face-face consensus meeting of medical students and foundation doctors at the Association of Surgeons in Training (ASiT) conference 2019 for live voting. Eighty percent agreement required to reach consensus. Any discussion of topics was transcribed to allow qualitative summary of discussion of those topics which did not reach consensus agreement.

RESULTS

Electronic suggestions yielded an extra 8 topics for inclusion into the final consensus document. A total of 52 people participated in the consensus session. The consensus discussed a total of 69 knowledge topics, practical skills and clinical examinations; of which 10 did not reach consensus agreement. Areas failing to reach consensus included knowledge topics in Ear Nose and Throat surgery, Vascular surgery and Neurosurgery as the consensus concluded that these topics were supplementary to core needs.

CONCLUSION

This paper presents a national consensus of the undergraduate surgical curriculum. This document should be used in conjunction with the RCS of England undergraduate curriculum to ensure students have an adequate surgical education.

Variations in competencies needed to complete surgical training

Background

This study aimed to analyse the degree of relative variation in specialty-specific competencies required for certification of completion of training (CCT) by the UK Joint Committee on Surgical Training.

Methods

Regulatory body guidance relating to operative and non-operative surgical skill competencies required for CCT were analysed and compared.

Results

Wide interspecialty variation was demonstrated in the required minimum number of logbook cases (median 1201 (range 60-2100)), indexed operations (13 (5-55)), procedure-based assessments (18 (7-60)), publications (2 (0-4)), communications to learned associations (0 (0-6)) and audits (4 (1-6)). Mandatory courses across multiple specialties included: Training the Trainers (10 of 10 specialties), Advanced Trauma Life Support (6 of 10), Good Clinical Practice (9 of 10) and Research Methodologies (8 of 10), although no common accord was evident.

Discussion

Certification guidelines for completion of surgical training were inconsistent, with metrics related to minimum operative caseload and academic reach having wide variation.

Augmenting ENT surgery outside the medical school curriculum: the role of a 1-day otolaryngology course

Background

ENT is highly under-represented in the saturated UK medical school curriculum, comprising less than 1 per cent of the curriculum. A 1-day course was implemented in order to raise awareness of ENT among medical students, educate them in the specialty and teach a basic skill.

Methods

The skills day comprised lectures by consultants followed by a consultant-led workshop teaching tracheostomy. Pre- and post-course questionnaires assessed perceptions of ENT, confidence performing tracheostomy and interest in ENT as a career.

Results

Perceptions of ENT as a specialty were improved by up to 80 per cent (p < 0.01). There was improved understanding of and confidence in performing tracheostomies. Interest in a career in ENT was increased by 77 per cent (p < 0.01).

Conclusion

A 1-day course run by a student body can be a powerful adjunct to the medical school curriculum, in terms of educating undergraduates in ENT and inspiring the pursuit of ENT as a career.

Time Out of General Surgery Specialty Training in the UK: A National Database Study

OBJECTIVE

General surgery specialty training in the United Kingdom takes 6 years and allows trainees to take time out of training. Studies from the United States have highlighted an increasing trend for taking time out of surgical training for research. This study aimed to evaluate trends in time out of training and the impact on the duration of UK general surgical specialty training.

DESIGN, SETTING, AND PARTICIPANTS

A cohort study using routinely collected surgical training data from the Intercollegiate Surgical Curriculum Program database for General surgery trainees registered from August 1, 2007. Trainees were classified as Completed Training or In-Training. Out of training periods were identified and time in training calculated (both unadjusted and adjusted for out of training periods) with a predicted time in training for those In-Training.

RESULTS

Of the trainees still In-Training (n = 994), a greater proportion had taken time out of training compared with those who had completed training (n = 360; 54.5% vs 45.9%, p < 0.01). A greater proportion of the In-Training group had undertaken a formal research period compared with the Completed Training group (35.1% vs 6.1%, p < 0.01). Total unadjusted training time in the Completed Training group was a median 6.0 (interquartile range 6.0-7.0) years compared with a predicted unadjusted training time in the In-Training group, with an out of training period recorded, of a median 8.0 (interquartile range 7.0-9.0) years.

CONCLUSIONS

Trainees are increasingly taking time out of surgical training, particularly for research, with a subsequent increase in total time of training. This should be considered when redesigning surgical training programs and planning the future surgical workforce.

ENT audit and research in the era of trainee collaboratives

Large surgical audits and research projects are complex and costly to deliver, but increasingly surgical trainees are delivering these projects within formal collaboratives and research networks. Surgical trainee collaboratives are now recognised as a valuable part of the research infrastructure, with many perceived benefits for both the trainees and the wider surgical speciality. In this article, we describe the activity of ENT trainee research collaboratives within the UK, and summarise how INTEGRATE, the UK National ENT Trainee Research Network, successfully delivered a national audit of epistaxis management. The prospective audit collected high-quality data from 1826 individuals, representing 94% of all cases that met the inclusion criteria at the 113 participating sites over the 30-day audit period. It is hoped that the audit has provided a template for subsequent high-quality and cost-effective national studies, and we discuss the future possibilities for ENT trainee research collaboratives.

The changing tides of Irish orthopaedic research

INTRODUCTION

Research is fundamental to bridging theory, practice and education in orthopaedics. Following the restructuring of the surgical training pathway in Ireland, the opportunity to undertake clinical- or lab-based research has fallen.

AIMS

Our aim was to investigate the trends of research in orthopaedics and the implications there.

METHODS

We reviewed the trend in publications by Irish trauma and orthopaedic (T&O) trainees over the past 20 years across three different classes of journal. We also reviewed the Irish participation in the annual British Orthopaedic Association (BOA) meeting over the past 10 years as well as the rates of abstract submission to the annual Irish Orthopaedic Association (IOA) meeting.

RESULTS

We found that publication rates were as follows: JBJS 2005-2010 mean 4.8 vs. 2000-2005 mean 1.6 and 2010-2015 mean 0.2; Injury 2005-2010 mean 3.6 vs. 2000-2005 mean 3.4 and 2010-2015 mean 2.2; IJMS 2010-2015 mean 4.4 vs. 2000-2010 mean 1.1. The number of Irish presentations at the BOA fell from a mean of 5 between 2000 and 2010 to a mean of 1.2 between 2011 and 2017. The rate of IOA abstract submissions compared over the same period has fallen by 21%. We also found that 4% of Irish orthopaedic publications in the IJMS were scientific in nature; this figure was 3.7% of publications in injury and 32.6% in JBJS (UK).

CONCLUSIONS

There has been a significant decrease in publication rates by T&O trainees in high-quality journals. There has also been a notable decline in Irish representation at the BOA and a drop in the number of abstract submissions to the IOA. We suggest these findings coincide with the streamlining of surgical training in Ireland, which does not provide for the pursuit in research that is crucial to our practice as clinicians, to the future of our specialty and to the Irish orthopaedic representation internationally.

The British Neurosurgical Trainee Research Collaborative: Five years on

Since its inception in 2012, the British Neurosurgical Trainee Research Collaborative (BNTRC) has established itself as a robust example of a trainee-led research collaborative. This article summarises the work of the collaborative over its first 5 years of existence, outlining the structure, its research projects, impact and future directions.

Association of Surgeons in Training conference: Bournemouth 2017

The Association of Surgeons in Training (ASiT) is a professional body and registered charity working to promote excellence in surgical training for the benefit of junior doctors and patients alike. The Association provides support at both regional and national levels throughout the United Kingdom and Republic of Ireland. Originally founded in 1976, ASiT is independent of the National Health Service (NHS), Surgical Royal Colleges, and specialty associations. The 2017 Annual Conference in Bournemouth brought together over 700 delegates for a diverse educational weekend with numerous expert guest speakers. With a theme of '#AdvancesIn,' we looked to celebrate cutting edge progress in training, clinical management, medical technology, leadership and entrepreneurialism. These updates were complimented by debates on current training in surgery and an array of focussed parallel sessions. For the first time, delegates were also able to interact with the conference digitally, with the debut of our conference smartphone App. The weekend started with 9 pre-conference courses covering a diverse range of topics including core laparoscopic, vascular, orthopaedics, neurosurgical skills, leadership and global surgery. Over 1000 abstract submissions were received and those successful competed for over 30 awards, representing nearly £4000 in trainee prizes and bursaries. As the only national surgical trainee meeting for all specialties, ASiT continues to grow and we look forward to an even larger and more successful international conference next year in Edinburgh 6-8th April 2018 with the theme of #nurturingexcellence.

Surgical academic reach: the higher degree effect quantified

INTRODUCTION

Proof of professional specific academic attainment is embedded within the Joint Committee on Surgical Training 2013 general surgery curriculum, mandating that all higher general surgical trainees (HST) obtain three peer-reviewed publications to qualify for Certification of Completion of Training. Yet, Modernising Medical Careers (MMC) has been associated with a trend away from the gold standard postgraduate credentials of higher degrees by research. This study aimed to evaluate the academic achievements of a post-MMC UK Deanery HST cohort to determine what additional benefits higher degree study might confer.

METHOD

The Scopus bibliographic database (Elsevier, RELX Group) was used to characterise the academic profiles of 101 consecutive HSTs and supplemented with Intercollegiate Surgical Programme Curriculum data. Primary outcome measures were numbers of publications, citations and Hirsch indices (HI).

RESULTS

Thirty-seven HSTs (36.6%) had been awarded higher degrees (29 Doctor of Medicine, 8 Doctor of Philosophy). Academic profiles of HSTs with higher degrees were stronger than those of HSTs without, specifically: median (range) publication numbers 16 (2-57) vs 2 (0-11, P<0.001), citations 93 (0-1600) vs 6 (0-132, P<0.001), first author publications 6 (0-33) vs 3 (0-106, P<0.001), communications to learnt societies 30 (5-79) vs 8 (2-35, P<0.001) and HI 6 (1-26) vs 1 (0-6, P<0.001).

CONCLUSION

Proof of academic reach by higher degree was associated with important enhanced professional credentials, strengthening HIs sixfold. Trainers and trainees alike should be aware of the relative magnitude of such benefits when planning educational programmes.

The need for multidisciplinarity in specialist training to optimize future patient care

Harmonious interactions between radiation, medical, interventional and surgical oncologists, as well as other members of multidisciplinary teams, are essential for the optimization of patient care in oncology. This multidisciplinary approach is particularly important in the current landscape, in which standard-of-care approaches to cancer treatment are evolving towards highly targeted treatments, precise image guidance and personalized cancer therapy. Herein, we highlight the importance of multidisciplinarity and interdisciplinarity at all levels of clinical oncology training. Potential deficits in the current career development pathways and suggested strategies to broaden clinical training and research are presented, with specific emphasis on the merits of trainee involvement in functional multidisciplinary teams. Finally, the importance of training in multidisciplinary research is discussed, with the expectation that this awareness will yield the most fertile ground for future discoveries. Our key message is for cancer professionals to fulfil their duty in ensuring that trainees appreciate the importance of multidisciplinary research and practice.