Evaluating the effectiveness of a low fidelity, easily available simulator to teach basic arthroscopy skills to novice learners: A prospective cohort study

BACKGROUND

Arthroscopy proficiency is key to being a competent orthopaedic surgeon and acquiring arthroscopic skills takes years of exposure and diligent practice. However, today's graduating consultants have had considerably less time in operating theatre than their senior colleagues at the same point of their careers.

OBJECTIVES

To evaluate whether: (1) Students could improve their arthroscopic technique using a low fidelity arthroscopic training tool (2) students enjoyed the use of the simulator (3) If certain demographics correlate to performance on the simulator.

METHODS

Medical students who have no previous training in arthroscopy were included. A combined left- and right-handed timed run with a low-fidelity arthroscopic triangulation simulator was recorded before and after 40-minutes of practice.

RESULTS

84 participants took part with an average improvement of was 66.8%. Students felt that their arthroscopic skills increased on average by 36.4%. 73 of the 84 participants gave the maximum score of 5 when asked if they enjoyed the session and 74 participants gave the maximum score of 5 as to whether they would be interested in participating in further sessions. Factors such as biological sex, video game play and sports were found to be statistically significant to performance.

CONCLUSIONS

This study showed a statistically significant improvement in students' arthroscopic performance with a low-fidelity arthroscopic simulator. Students found the experience useful with the vast majority indicating interest in completing further training sessions to help improve practical surgical skills. Video gamers, sports players and males were found to have a correlation with performance on the simulator.

Work like a Doc: A comparison of regulations on residents' working hours in 14 high-income countries

BACKGROUND

Medical residents work long, continuous hours. Working in conditions of extreme fatigue has adverse effects on the quality and safety of care, and on residents' quality of life. Many countries have attempted to regulate residents' work hours.

OBJECTIVES

We aimed to review residents' work hours regulations in different countries with an emphasis on night shifts.

METHODS

Standardized qualitative data on residents' working hours were collected with the assistance of experts from 14 high-income countries through a questionnaire. An international comparative analysis was performed.

RESULTS

All countries reviewed limit the weekly working hours; North-American countries limit to 60-80 h, European countries limit to 48 h. In most countries, residents work 24 or 26 consecutive hours, but the number of long overnight shifts varies, ranging from two to ten. Many European countries face difficulties in complying with the weekly hour limit and allow opt-out contracts to exceed it.

CONCLUSIONS

In the countries analyzed, residents still work long hours. Attempts to limit the shift length or the weekly working hours resulted in modest improvements in residents' quality of life with mixed effects on quality of care and residents' education.

Freestyle Deliberate Practice Cadaveric Hand Surgery Simulation Training for Orthopedic Residents: Cohort Study

BACKGROUND

Cadaveric simulation training may be part of the solution to reduced quantity and quality of operative surgical training in the modern climate. Cadaveric simulation allows the early part of the surgical learning curve to be moved away from patients into the laboratory, and there is a growing body of evidence that it may be an effective adjunct to traditional methods for training surgical residents. It is typically resource constrained as cadaveric material and facilities are expensive. Therefore, there is a need to be sure that any given cadaveric training intervention is maximally impactful. Deliberate practice (DP) theory as applied to cadaveric simulation training might enhance the educational impact.

OBJECTIVE

The objectives of this study were (1) to assess the impact of a freestyle DP cadaveric hand surgery simulation training intervention on self-reported operative confidence for 3 different procedures and (2) to assess the subjective transfer validity, perceived educational value, and simulation fidelity of the training.

METHODS

This study used validated questionnaires to assess the training impact on a cohort of orthopedic residents. The freestyle course structure allowed the residents to prospectively define personalized learning objectives, which were then addressed through DP. The study was conducted at Keele Anatomy and Surgical Training Centre, a medical school with an integrated cadaveric training laboratory in England, United Kingdom. A total of 22 orthopedic surgery residents of postgraduate year (PGY) 5-10 from 3 regional surgical training programs participated in this study.

RESULTS

The most junior (PGY 5-6) residents had the greatest self-reported confidence gains after training for the 3 procedures (distal radius open reduction internal fixation, flexor tendon repair, ulnar shortening osteotomy), and these gains diminished with resident seniority. The confidence gains were proportional to the perceived procedural complexity, with the most complex procedure having the lowest pretraining confidence score across all experience levels, and the greatest confidence increase in posttraining. Midstage (PGY 7-8) residents reported receiving the highest level of educational benefit from the training but perceived the simulation to be less realistic, compared to either the junior or senior residents. The most senior residents (PGY 9-10) reported the greatest satisfaction with the self-directed, freestyle nature of the training. All groups reported that they were extremely likely to transfer their technical skill gains to their workplace, that they would change their current practice based on these skills, and that their patients would benefit as a result of their having undertaken the training.

CONCLUSIONS

Freestyle, resident-directed cadaveric simulation provides optimum DP conditions whereby residents can target their individualized learning needs. By receiving intensive, directed feedback from faculty, they can make rapid skill gains in a short amount of time. Subjective transfer validity potential from the training was very high, and objective, quantitative evidence of this is required from future work.

Analysis of Factors Relevant to Revenue Improvement in Ventral Hernia Repair, Their Influence on Surgical Training, and Development of Predictive Models: An Economic Evaluation

Background: Ventral hernia repairs (VHR) are frequent but loss- making. This study aims to identify epidemiological and procedure related factors in VHR and their influence on surgical training. Methods: Data from 86 consecutive patients who underwent VHR in 2019 was collected. Moreover, 66 primary ventral hernias and 20 incisional hernias were repaired in open procedures. Linear regression models were made. Results: Primary VHR procedures showed a mean deficit of −378.17 CHF per case. Incisional hernia repair procedures resulted in a deficit of −1442.50 CHF per case. The two hernia groups were heterogeneous. For the primary VHR procedures, the surgery time (β = 0.564, p < 0.001) had the greatest influence, followed by the costs of the mesh (β = −0.215, p < 0.001). The epidemiological factors gender (β = 0.143, p < 0.01) and body mass index (BMI) (β = −0.087, p = 0.074) were also influential. For incisional hernia procedures a surgeon’s experience had the most significant influence (β = 0.942, p < 0.001), and the second largest influence was the price of the mesh (β = −0.500, p < 0.001). The epidemiological factor BMI (β = −0.590, p < 0.001), gender (β = −0.113, p = 0.055) and age (β = −0.026, p < 0.050) also had a significant influence. Conclusion: Our analysis shows a way of improving financial results in the field of ventral hernia repair. Costs can be visualized and reduced to optimize revenue enhancement in surgical departments. In our analysis primary ventral hernias are an appropriate training operation, in which the experience of the surgeon has no significant impact on costs. In primary VHR procedures, revenue enhancement is limited when using an expensive mesh. However, the treatment of incisional hernias is recommended by specialists. The financial burden is significantly higher with less experience. Therefore, these operations are not suitable for surgical training. The re-operation rate decreases with increasing experience of the surgeon. This directly affects the Patient Related Outcome (PROM) and quality of treatment. Therefore, high-quality training must be enforced. Since financial pressure on hospitals is increasing further, it is crucial to investigate cost influencing factors. The majority of Swiss public hospitals will no longer be able to operate ventral hernias profitably without new concepts. In addition to purchasing management, new construction projects, and mergers, improving the results of individual departments is a key factor in maintaining the profitability of hospitals in the future regarding hernia repair without losing the scope of teaching procedures.

An effective procedure skills training programme for GIM registrars

Background

The Royal College of Physicians' Acute care toolkit 8 recommends procedural training for medical registrars at all hospitals. We aimed to determine the interest and need, and to pilot the delivery of such training in the procedures outlined by the Joint Royal Colleges of Physicians Training Board (2017).

Methods

An online survey was sent to general internal medicine (GIM) trainees within the Thames Valley Deanery in January 2019. This identified a need for procedure skills training. Ninety per cent of trainees felt simulation training would improve their confidence in the outlined procedures.

We trialled a simulation programme for GIM registrars between September 2019 and October 2019. Sessions lasted 3-3.5 hours and trainees rotated through four stations. Feedback was obtained from trainees and trainers during each pilot session.

Results

Thirty-two trainees attended across both sites. Excellent feedback was obtained and trainee confidence improved by visual analogue scale scoring post-training for all procedures. Almost 90% of trainees felt the sessions would improve safety on GIM on calls.

Conclusion

Simulation training is an effective way to improve trainee confidence in procedural skills and this pilot shows such training is desired and necessitated in higher specialty training. Further work will assess its impact on maintaining trainee skillsets and impact on patient safety.

Supporting laparoscopic general surgery training with digital technology: The United Kingdom and Ireland paradigm

Surgical training in the UK and Ireland has faced challenges following the implementation of the European Working Time Directive and postgraduate training reform. The health services are undergoing a digital transformation; digital technology is remodelling the delivery of surgical care and surgical training. This review aims to critically evaluate key issues in laparoscopic general surgical training and the digital technology such as virtual and augmented reality, telementoring and automated workflow analysis and surgical skills assessment. We include pre-clinical, proof of concept research and commercial systems that are being developed to provide solutions. Digital surgical technology is evolving through interdisciplinary collaboration to provide widespread access to high-quality laparoscopic general surgery training and assessment. In the future this could lead to integrated, context-aware systems that support surgical teams in providing safer surgical care.

The dawn of a new competency-based training era

The imminent introduction of the new Trauma & Orthopaedic (T&O) curriculum, and the implementation of the Improving Surgical Training initiative, reflect yet another paradigm shift in the recent history of trauma and orthopaedic training. The move to outcome-based training without time constraints is a radical departure from the traditional time-based structure and represents an exciting new training frontier. This paper summarizes the history of T&O training reform, explains the rationale for change, and reflects on lessons learnt from the past.

Cite this article: Bone Jt Open 2021;2-3:181–190.

Impact of coronavirus 2019 (COVID-19) on training and well-being in subspecialty surgery: A national survey of cardiothoracic trainees in the United Kingdom

Objectives

The coronavirus 2019 (COVID-19) pandemic has overwhelmed health care systems and disrupted routine care internationally. Health care workers face disruption to their work routines and professional development, as well as an elevated risk of infection and morbidity. We sought to establish the impact of the COVID-19 pandemic on the well-being, practice, and progression of all trainees in cardiothoracic surgery in the United Kingdom.

Methods

A 31-item questionnaire was designed, validated, and disseminated via e-mail and an instant-messaging platform.

Results

In total, 76 (of 118, 64%) cardiothoracic surgical trainees responded, representing all training grades and programs nationally; 48 (63%) and 24 (32%) were concerned about their physical and mental health, respectively, 25 (33%) had taken time off work due to COVID-19, 65 (86%) had treated patients with COVID-19, 36 of whom (55%) were wearing satisfactory personal protective equipment at the time, 41 (54%) remain concerned about personal protective equipment provision at their institution, 42 (55%) had been redeployed to cover other specialties, and 23 (30%) had encountered ethical dilemmas related to care of patients. There was a significant impact on time spent in outpatient clinics (44% reduction), multidisciplinary team meetings (79% reduction), and operating theaters (78% reduction). In total, 67 (88%) of respondents were concerned about the impact on their training, and 54 (71%) felt that the deviation may require an extension in their planned training time.

Conclusions

The duration and impact of the current pandemic is, as yet, uncertain. Timely sharing of experiences, concerns, and expectations will inform health care and education policy and influence practice in the pandemic era and beyond.

Changing Autonomy in Operative Experience Through UK General Surgery Training: A National Cohort Study

Supplemental Digital Content is available in the text

Objectives:

To determine the operative experience of UK general surgery trainees and assess the changing procedural supervision and acquisition of competency assessments through the course of training.

Background:

Competency assessment is changing with concepts of trainee autonomy decisions (termed entrustment decisions) being introduced to surgical training.

Methods:

Data from the Intercollegiate Surgical Curriculum Programme and the eLogbook databases for all UK General Surgery trainees registered from August 1, 2007 who had completed training were used. Total and index procedures (IP) were counted and variation by year of training assessed. Recorded supervision codes and competency assessment outcomes for IPs were assessed by year of training.

Results:

We identified 311 trainees with complete data. Appendicectomy was the most frequently undertaken IP during first year of training [mean procedures (mp) = 26] and emergency laparotomy during final year of training (mp = 27). The proportion of all IPs recorded as unsupervised increased through training (P < 0.05) and varied between IPs with 91.2% of appendicectomies (mp = 20), 40.6% of emergency laparotomies (mp = 27), and 17.4% of segmental colectomies (mp = 15) recorded as unsupervised during the final year of training. Acquisition of competency assessments increased through training and varied by IP.

Conclusions:

The changing autonomy of trainees through the course of an entire training scheme, alongside formal competency assessments, may provide evidence of changing entrustment decisions made by trainers for different key procedures. Other countries utilizing electronic logbooks could adopt similar techniques to further understanding of competency attainment amongst their surgical trainees.

Less is more: creation and validation of a novel, affordable suturing simulator for anorectal surgery

BACKGROUND

Duty hour restrictions have increased the role of simulation in surgical education. A simulation that recreates the unique visual, anatomic, and ergonomic challenges of anorectal surgery has yet to be described. The aim of this study was to develop a low-cost, low-fidelity anorectal surgery simulator and provide validity evidence for the model.

METHODS

A novel, low-fidelity simulator was constructed, and anorectal surgery workshops were implemented for general surgery interns at a single institution. Face and content validity were assessed with separate questionnaires using a 5-point Likert scale. Participants performed a simulated hemorrhoid excision with longitudinal wound closure, and transverse wound closure. Time-to-task completion and quality of suturing/knot tying were evaluated by a blinded observer to assess construct validity.

RESULTS

Material cost was US $11 per simulator. We recruited 20 first-year surgery residents (novices) and 4 practicing colorectal surgeons (experts), and conducted 3 workshops in 2014-2016. All face and content validity measures achieved a median score greater than 4 (range 4.0-5.0). Time-to-task completion was significantly lower in the expert cohort (hemorrhoid excision with longitudinal wound closure: 195 vs. 477 s and transverse closure: 79 vs. 192 s, p < 0.001 for both). Suturing and knot-tying scores were significantly higher in the expert cohort for both tasks (p < 0.05 for all comparisons).

CONCLUSIONS

Our low-fidelity, low-cost anorectal surgery model demonstrated evidence of face, content, and construct validity. We believe that this simulator could be a useful instrument in the education of junior surgical trainees and will allow residents to obtain proficiency in anorectal suturing tasks in conjunction with traditional surgical training.

Shift working reduces operative experience for trauma and orthopaedic higher surgical trainees: a UK multicentre study

INTRODUCTION

In recent years there has been a rise in the number of trauma and orthopaedics trainees working on full shift patterns. Historically, most trauma and orthopaedics trainees worked 24 hours non-resident on-call shifts. The effect of this change in shift patterns has not previously been measured. As two trusts (one trauma unit, one major trauma centre) in our region underwent a change to full shift working, we assessed the impact on the trainees' operating experience.

METHODS

Fifty-five logbooks were analysed across the two trusts over a two-year period, with comparisons made between pre- and post-shift working.

RESULTS

Overall operating fell by 13% for trainees working full shift patterns, which was statistically significant. There was a loss of elective operating of 15% at the trauma unit and 32% at the major trauma centre for trainees doing shift work. The effect on trauma operating opportunities was mixed. Index operating was largely preserved.

CONCLUSIONS

Shift working significantly impacts on surgical training opportunities. We explore approaches to minimising this effect.

Satisfaction of the Irish Trauma and Orthopaedic training programme with the Intercollegiate Surgical Curriculum Programme

BACKGROUND

Surgical training has undergone extensive changes in recent years. The Intercollegiate Surgical Curriculum Programme (ISCP) has been utilised in the UK for many years to facilitate the education and assessment of trainees. It was adopted by the Irish Trauma and Orthopaedics (T&O) training programme in July 2015. This study sought to evaluate the use satisfaction with ISCP in the Irish context.

METHODS

A total of 58 T&O trainers and trainees undertook a paper-based survey during national training days in March and April 2017.

RESULTS

Eighty-nine percent of trainees responded to the survey along with 85% of trainers. Seventy-nine percent of respondents had been using ISCP for over a year. Most aspects of ISPC were rated as average, with the induction process, online multi-source feedback (MSF) and overall user friendliness rating poorly amongst respondents. Seventeen percent felt that ISCP had a positive impact on training, while 66% felt that it did not adversely affect their training opportunities. Forty-three percent reported a negative impact on the trainer-trainee relationship with adoption of ISCP and only 24% felt that the educational feedback was improved with the new system. Forty-two percent agreed that ISCP created a more structured and supervised framework to the training scheme.

CONCLUSIONS

Our survey demonstrated significant concerns and reservations amongst the Irish users of ISCP. The demonstrable level of trainee dissatisfaction with ISCP may represent a frustration that key problems such as the regulated training content of jobs remains unaddressed while ISCP does little to improve meaningful formative feedback.

Validation of an oncoplastic breast simulator for assessment of technical skills in wide local excision

Background

Simulation enables safe practice and facilitates objective assessment of technical skills. However, simulation training in breast surgery is rare and assessment remains subjective. The primary aim was to evaluate the construct validity of technical skills assessments in wide local excision (WLE).

Methods

Surgeons of different grades performed a WLE of a 25-mm palpable tumour on an in-house synthetic breast simulator. Procedures were videotaped (blinded), reviewed retrospectively, and independently rated against a procedure-specific global rating scale by two consultant breast surgeons. Specimen radiographs were obtained and the macroscopic distance from the ‘tumour’ edge to the resection margin was recorded in four cardinal directions. Expert consensus was used to construct an Oncoplastic Deviation Score (ODS), assigning points for excessively wide (more than 10 mm) and, conversely, close (less than 5 mm) macroscopic margins.

Results

Thirty-four surgeons (12 consultant surgeons, 12 specialty trainees and 10 core trainees) participated in the study. Video-based rating scores varied hierarchically with operator expertise (P &lt; 0·050). Inter-rater reliability was excellent (α ≥ 0·80, P &lt; 0·050 for all scales), and inter-rater agreement was moderate (κ = 0·132–0·361, P &lt; 0·050 for all scales). Statistically significant differences were observed on pairwise comparisons between each grade of surgeon in scores for ‘exposure’, ‘skin flap development’, ‘glandular remodelling’, ‘skin closure’ and ‘final product review’ (P &lt; 0·050). Consultants received significantly fewer ODS points than specialty trainees (P = 0·012) and core trainees (P = 0·028). Compared with experts (median 9·0 mm), wider margins were observed amongst specialty trainees (median 12·0 mm) and narrower margins amongst core trainees (median 7·1 mm) (P = 0·001).

Conclusion

Video ratings of performance and a proposed ODS differentiate surgeons based on technical skills in WLE and may be useful for objective assessment of breast surgery trainees.

General medical training in gastroenterology: views from specialist trainees on the challenges of dual accreditation

Higher specialist training in general internal medicine (GIM) and the medical specialties has been subject to many changes and increasing subspecialisation in recent years. The 'Shape of Training' review proposes 'broad-based specialty training', shortening of training by one year, and subspecialisation to be undertaken after the certificate of specialty training is obtained. All higher level gastroenterology trainees based in the UK were invited to complete an online survey between July and September 2012 to assess their experience of gastroenterology and GIM training. Overall, 72.7% of trainees expressed satisfaction with their training in gastroenterology but significantly fewer (43.5%) expressed satisfaction with their training in GIM. Satisfaction with gastroenterology training thus is good, but satisfaction with GIM training is lower and levels of dissatisfaction have increased significantly since 2008. Up to 50% of trainees are not achieving the minimum recommended number of colonoscopy procedures for their stage of training. Experience in GIM is seen as service orientated, with a lack of training opportunities. There is a worrying difficulty in gaining the minimum required experience in endoscopy. If the length of specialist training is shortened and generalised, training in key core specialist skills such as endoscopy may be compromised further.

The impact of shortened postgraduate surgical training on colorectal cancer outcome

BACKGROUND

Shortened postgraduate surgical training reforms, known as Calman, have altered delivery of surgical training in the UK with reduced working hours and training time aiming to produce a more subspecialised workforce.

AIMS

This study aims to compare rectal cancer surgical outcomes of Calman-trained consultants in a single institution to published data. Additionally, the study compared colorectal cancer surgical outcome between Calman-trained consultants (CTCs) and non-Calman consultants (NCTCs) in a national dataset.

METHODS

Local dataset Clinicopathological outcome of rectal cancer resection undertaken by CTCs in a single institution (2006-2010) were compared against NCTC counterparts. National dataset All elective colorectal cancer resections between 2004 and 2008 in English NHS hospitals were included. CTCs (present from 2004 onwards) were compared to NCTCs (present prior to 2004). Outcome measures included 30-day in-hospital mortality, reoperation and readmission rates.

RESULTS

Local dataset One hundred thirteen patients were operated under five CTC. The 30-day in-hospital mortality for CTCs (1%) was favourable compared to published rates (3-5%). Local recurrence rate (4.4%) was comparable to NCTC (3.6%). National dataset Between 2004 and 2008, 44,106 patients underwent elective colorectal resection. Multiple regression demonstrated CTC patients had a reduced length of stay and reduced reoperation rate. No difference in mortality and unplanned readmission rates were seen.

CONCLUSION

CTCs have similar safety outcome to NCTCs for colorectal cancer resection procedures. Further work is needed to assess the impact of further training reductions on clinical outcome.

Daycase hernia surgery: a missed training opportunity

INTRODUCTION

Traditionally uncomplicated elective hernia operations were performed by surgical trainees; allowing them to develop key competencies and skills transferable to emergency hernia surgery. Daycase surgical units (DCU) are increasingly accommodating operations that traditionally contributed to operating lists in general elective theatres. We aim to assess whether DCU could help improve training in hernia surgery.

SUBJECTS AND METHODS

Operative Room Information System (ORMIS) data was collected retrospectively to identify hernia operations performed at a large NHS hospital between January 2007 and 2012. Data collected included operating surgeon(s), procedure performed and procedure time (PT). Hospital coding records were used to collect data related to patient length of stay (LOS), complications, readmissions and deaths within 30 days of procedure.

RESULTS

4668 hernia operations were performed; 3063 in DCU. 91.5% (n = 2803) were open and 8.5% (n = 260) laparoscopic repairs. Trainees assisted in 24.6% (n = 752) and led 7.8% (n = 238) of cases. Overall, the mean PT for consultant led open hernia operations was 37.44 min (95% CI 36.75-38.12) and 43.07 min (95% CI 40.99-45.16) for trainees (p < 0.05). Subgroup analysis of all hernia operations performed showed no significant difference in PT between consultants and trainees when performing open bilateral inguinal, femoral, epigastric, incisional and laparoscopic hernia operations. There were no differences in LOS, readmissions and death rates within 30 days of the operation.

CONCLUSIONS

DCU are an underutilised opportunity for trainees to acquire experience of hernia operations. When given the opportunity to lead hernia operations in DCU, trainees have similar PT and complication rates to consultants in many instances. Trainees should be encouraged to assist and lead hernia cases in DCU under adequate supervision to ensure appropriate competency is achieved and high standards are maintained.

Operative experience of urological trainees in the UK

What's known on the subject? And what does the study add? One of the main components of surgical training is the development of operative skills which, in part, is related to the extent of the practical operative experience. The operative experience of urological trainees in the UK has not being previously published. We examine trainees' current operative experience and analyse the changes over recent years. With a notable decrease in experience of certain procedures, we highlight the possible reasons and discuss the implications for future training. We have examined the operative experience of urological trainees in the UK over a 6-year period. Between 2004 and 2009, urological trainees submitting their operative logbooks to the Specialist Advisory Committee for the award of Certificate of Completion of Training were analysed. We recorded trainees' experience in eight operative procedures; transurethral resection of the prostate (TURP, including bipolar TURP), transurethral resection of bladder tumour (TURBT), radical nephrectomy (RN, open and laparoscopic), radical cystectomy (RC), radical prostatectomy (RP), percutaneous nephrolithotomy (PCNL) and ureteroscopy (flexible and rigid). In all, 251 logbooks were identified over the 6-year period. In 2008/2009, the mean (range) number of cases 'performed' and 'supervised' were as follows; TURP 189 (41-516), TURBT 190 (50-432), open RN 21 (2-78), RC 10 (0-70), RP 13 (0-80), PCNL 19 (0-125), ureteroscopy 131 (14-465), laparoscopic RN 11 (0-97). Latterly there has been a significant reduction in the numbers of TURP, open RNs and RCs. There has been an increase in the use of trainees as assistants for RC, RP and open RN. There was a large variation in numbers of procedures performed between trainees. In summary there has been a recent decline in the numbers of TURP, open RNs and RCs performed. For all procedures, significant variability exists between trainees.

Analysing the operative experience of basic surgical trainees in Ireland using a web-based logbook

BACKGROUND

There is concern about the adequacy of operative exposure in surgical training programmes, in the context of changing work practices. We aimed to quantify the operative exposure of all trainees on the National Basic Surgical Training (BST) programme in Ireland and compare the results with arbitrary training targets.

METHODS

Retrospective analysis of data obtained from a web-based logbook (http://www.elogbook.org) for all general surgery and orthopaedic training posts between July 2007 and June 2009.

RESULTS

104 trainees recorded 23,918 operations between two 6-month general surgery posts. The most common general surgery operation performed was simple skin excision with trainees performing an average of 19.7 (± 9.9) over the 2-year training programme. Trainees most frequently assisted with cholecystectomy with an average of 16.0 (± 11.0) per trainee. Comparison of trainee operative experience to arbitrary training targets found that 2-38% of trainees achieved the targets for 9 emergency index operations and 24-90% of trainees achieved the targets for 8 index elective operations. 72 trainees also completed a 6-month post in orthopaedics and recorded 7,551 operations. The most common orthopaedic operation that trainees performed was removal of metal, with an average of 2.90 (± 3.27) per trainee. The most common orthopaedic operation that trainees assisted with was total hip replacement, with an average of 10.46 (± 6.21) per trainee.

CONCLUSIONS

A centralised web-based logbook provides valuable data to analyse training programme performance. Analysis of logbooks raises concerns about operative experience at junior trainee level. The provision of adequate operative exposure for trainees should be a key performance indicator for training programmes.

Trauma experience in the UK and Ireland: analysis of orthopaedic training using the FHI eLogbook

Surgical trainees routinely provide evidence of their training and operative experience for assessment. National comparative data on the number of procedures performed during training was previously unavailable in the UK. Since 2003 every trainee in Trauma and Orthopaedics (T&O) in the UK and Ireland has submitted data recording their operative experience electronically via the Faculty of Health Informatics (FHI) eLogbook. This provides detailed data on trainee, trainer, hospital and training programme performance. This data has been analysed for trauma surgery. By March 2007 there were 1053 T&O Specialist Registrars with operations logged. Trauma operations performed and uploaded during the previous 3 years have been included. Each trainee's work is analysed by 'year-in-training' (YIT, 1-6). Data on levels of supervision and potentially missed opportunities (where the trainee was present but assisted rather than performed the operation) was analysed. The mean number of trauma operations performed annually by trainees was 109, 120, 110, 122, 98 and 84 (total 643) for YIT 1-6, respectively. 22% of the operations at which a trainee was present were potentially missed opportunities. A high level of experience is gained in hip fracture surgery (121 operations performed), intramedullary nailing (38) and ankle (47) stabilisation over the 6 years of training. However, the mean number of tendon repairs (18), tension band wires (13), external fixators (12) and children's supracondylar fracture procedures (9) performed is low. We also report figures for complex fracture stabilisation. The eLogbook remains a powerful tool which can provide accurate information to support in-depth analysis of trainees, trainers, and training programmes. Based on this analysis, we suggest 'standard setting' to identify trainees performing fewer operations than required during their training. We have also established a baseline which can be used to identify the consequences of changes to length of training and working hours.