The learning preferences of aspiring orthopaedic surgeons in the UK

BACKGROUND/AIMS

The workload of orthopaedic trainees is rapidly increasing at the expense of training. Trainees are expected to assimilate large quantities of information efficiently. This prospective cohort study explores the learning styles, resource preferences and educational needs of aspiring orthopaedic trainees.

METHOD

A 21-item questionnaire was distributed to delegates of an orthopaedic teaching series. Data were obtained pertaining to demographics, visual, aural, read/write and kinaesthetic learning styles, study materials used and teaching exposure.

RESULTS

Participants had a strong preference for visual (48.0%) and kinaesthetic (43.0%) learning modalities. Most participants prepared for written exams using online question banks (85.9%), clinical exams using question banks (37.5%) and discussion with colleagues (27.3%), and surgical procedures intraoperatively (43.8%). Only 12.4% of participants felt the teaching they received was consistently adapted to their visual, aural, read/write or kinaesthetic learning preference.

CONCLUSIONS

The surgical landscape is rapidly changing. It is vital that trainers take into consideration how budding orthopaedic surgeons learn and make the relevant accommodations, to ensure optimal learning.

The Experiences, Influences and Concerns of Future Orthopaedic Surgeons: Comparing Uk and non-UK Perspectives

AIMS/BACKGROUND

This study aims to identify and analyse the factors that influence or discourage junior doctors in the UK and across the world from wanting to pursue a career in orthopaedics.

METHODS

A prospective, cohort study was carried out via an online questionnaire targeted at aspiring orthopaedic surgeons.

RESULTS

A total of 654 respondents met inclusion criteria; 370 (56.6%) were UK-based and 284 (43.4%) were based abroad. The practical and technical nature of orthopaedics was the biggest influencing factor globally. UK respondents were notably more concerned by the financial impact of training (49%) followed by poor work-life balance (36%). Themes from the comments section revealed concern regarding gender bias and a lack of diverse role models within orthopaedics.

CONCLUSIONS

Reducing the cost and length of training, diversification of role models, removal of bias and increasing positive early experiences may help to encourage people of all backgrounds to pursue a career in orthopaedic surgery.

Bullying in trauma and orthopaedics: a survey of staff in orthopaedic departments in the UK

Background/aims

An orthopaedic department requires good teamwork and communication to function. This is undermined by bullying and harassment, which may affect the victim's health and career.

Methods

A 26-item questionnaire was sent to all delegates who registered for a free orthopaedic webinar teaching series via email and social media. This study includes the responses from all those who had worked in a UK orthopaedic department.

Results

There were 168 respondents from varying backgrounds; 17.9% had experienced bullying or harassment in their orthopaedic department, while 36.3% had witnessed it. Women and people from ethnic minority backgrounds suffered 10.2% and 6.9% higher rates of bullying than their male or white counterparts respectively.

Conclusions

The results demonstrate that despite attempts to reduce bullying in orthopaedics, it remains prevalent, and particularly affects women and those from ethnic minority backgrounds. Orthopaedic departments must adapt to reflect changes in society.

Diversity in surgery: the perceptions of aspiring surgeons

Background/Aims

This study aimed to explore definitions of diversity, and views and attitudes towards diversity in healthcare among future generations of surgical trainees.

Methods

This was a prospective, cohort study via an online questionnaire during a virtual, nationwide surgical course, targeted at aspiring surgeons.

Results

Out of 202 participants, 166 met the inclusion criteria. Participants' definitions of diversity most frequently included race, gender and ethnicity, with fewer than 50.0% recognising pregnancy, communication style or political preference in their definition. Of the respondents, 56.0% (93/166) believed that the surgical community did not do enough to encourage diversity. The rising cost of training, lack of diverse role models and dated ideologies were identified as barriers to achieving greater diversity within surgery.

Conclusions

Important components of diversity continue to be under-recognised. Surgery must maximise diversity to attract, support and motivate the next generation of surgeons, for the benefit of the health service and the populations it serves.

The impact of virtual medical student surgical conferences

BACKGROUND

In recent years, the number of people pursuing a surgical career in the UK has decreased. The COVID-19 pandemic has led to the cancellation of surgical placements for medical students and has affected surgical education. This study evaluates the perceptions and impact of a 1-day virtual surgical conference for medical students considering pursuing a surgical career.

METHODS

All delegates of the 2021 Barts and The London International Surgical Conference were invited to participate in two online surveys pre- and post-conference. Data were collected and analysed to evaluate delegates' reasons for attending the conference, and attitudes towards virtual conferences and a surgical career before and after the conference.

RESULTS

Out of 132 participants, 106 (80.3%) completed both the pre- and post-conference surveys. Clinical students showed a statistically significant difference in interest in pursuing a surgical career after the conference than before (P=0.03), unlike pre-clinical students (P=0.12). Post-conference, 43 (40.6%) preferred a virtual to a face-to-face conference, which was a slight increase from 40 (37.7%) pre-conference, while 73 (68.9%) and 80 (75.5%) participants favoured virtual talks and presentations respectively. In contrast, only 12 (11.3%) and 21 (19.8%) students preferred workshops and networking virtually. Furthermore, delegates liked the global accessibility and environmentally-friendly nature of virtual conferences but found they can be less engaging and be disrupted by a poor internet connection.

CONCLUSIONS

Virtual surgical conferences have many benefits and can help encourage medical students towards a surgical career. They could help bridge the surgical educational gap in medical school during these unprecedented times. Virtual conferences, which have a broader and more inclusive reach, could be an important complement to conventional conferences after the pandemic.

A top-down approach for setting climate targets for buildings: the case of a New Zealand detached house

Climate change mitigation requires the construction of low/zero-carbon buildings, and this is a challenge for designers. The use of Life Cycle Assessment (LCA) provides useful information to support eco-efficiency improvements and therefore, to reduce the climate impacts of building designs. However, it does not provide information about whether a proposed design aligns with achieving the global climate target of limiting global warming to below 1.5°C or 2°C. This study, therefore, introduces an LCA-based top-down approach for setting climate targets for the whole life cycle of buildings in terms of greenhouse gas emissions. It involves assigning a share of the 2°C global carbon budget for 2018-2050 to a country, to the construction sector of the country, and finally to a building. The approach includes a stock model that accounts for the projected growth in the number of buildings and associated climate impacts in a country up to 2050. The proposed approach was applied to a detached house in New Zealand, the most common residential building type in the country; it was found that the climate target of a New Zealand detached house over a 90-year lifetime is 71 tCO2eq. This modelling approach has potential to guide designers and other interested stakeholders in development of building designs enabling the building sector to operate within a selected global climate target (such as the 1.5°C or 2°C target).

The Academic Surgical Collaborative: A three-year review of a trainee research collaborative

INTRODUCTION

The Academic Surgical Collaborative (ASC) is a trainee research collaborative (TRC) formed in the UK in October 2014. Three years on, the achievements are presented along with advice for emerging and established TRCs. Methods: A retrospective review of internal, member-maintained ASC records was conducted. Membership numbers, PubMed indexed publications, presentations and prizes awarded were all calculated over time. Google Scholar was used to calculate citations per ASC publication. An online survey was distributed to members to ascertain member satisfaction.

RESULTS

With 62 active members (predominantly medical students) the ASC has published 33 PubMed indexed papers over three years, with a mean of 21 citations per paper (SD 89, range 0-491). 54 presentations have been delivered and eight prizes have been awarded for ASC research projects. 60% of ASC members believe the ASC delivers research that improves patient care. Key learning points for the ASC have been the use of a set of resources distributed to new members, the value of regular meetings, close mentoring throughout research projects to develop the skills of junior researchers, encouragement for junior members to present at conferences, and an ongoing focus on research conduct and improving evidence based medicine.

CONCLUSIONS

The ASC has fulfilled many of its goals set out at its inception. The ASCs subsequent aims are to enhance existing research training for junior members, advances in the field of core outcome development and also multi-collaborative research.

Reduced primary cilia length and altered Arl13b expression are associated with deregulated chondrocyte Hedgehog signaling in alkaptonuria

Alkaptonuria (AKU) is a rare inherited disease resulting from a deficiency of the enzyme homogentisate 1,2-dioxygenase which leads to the accumulation of homogentisic acid (HGA). AKU is characterized by severe cartilage degeneration, similar to that observed in osteoarthritis. Previous studies suggest that AKU is associated with alterations in cytoskeletal organization which could modulate primary cilia structure/function. This study investigated whether AKU is associated with changes in chondrocyte primary cilia and associated Hedgehog signaling which mediates cartilage degradation in osteoarthritis. Human articular chondrocytes were obtained from healthy and AKU donors. Additionally, healthy chondrocytes were treated with HGA to replicate AKU pathology (+HGA). Diseased cells exhibited shorter cilia with length reductions of 36% and 16% in AKU and +HGA chondrocytes respectively, when compared to healthy controls. Both AKU and +HGA chondrocytes demonstrated disruption of the usual cilia length regulation by actin contractility. Furthermore, the proportion of cilia with axoneme breaks and bulbous tips was increased in AKU chondrocytes consistent with defective regulation of ciliary trafficking. Distribution of the Hedgehog-related protein Arl13b along the ciliary axoneme was altered such that its localization was increased at the distal tip in AKU and +HGA chondrocytes. These changes in cilia structure/trafficking in AKU and +HGA chondrocytes were associated with a complete inability to activate Hedgehog signaling in response to exogenous ligand. Thus, we suggest that altered responsiveness to Hedgehog, as a consequence of cilia dysfunction, may be a contributing factor in the development of arthropathy highlighting the cilium as a novel target in AKU.

The use of study registration and protocols in plastic surgery research: A systematic review

BACKGROUND

In 2013, the Declaration of Helsinki changed to mandate that all research studies involving human subjects, rather than just clinical trials alone, must have a protocol registered in a publicly accessible database prior to the enrolment of the first patient. The objective of this work was to assess the number of research studies involving human participants published in leading journals of plastic surgery that had either published a protocol or registered a protocol with a publicly accessible database.

MATERIALS AND METHODS

This systematic review examined all research articles involving human participants published in Plastic and Reconstructive Surgery, The Journal of Plastic Reconstructive and Aesthetic Surgery and The Annals of Plastic Surgery from 1st April 2014-31st March 2015. The primary outcome measure was whether each study had either published or registered a protocol with any mainstream registry database. ClinicalTrials.gov, the International Standard Randomized Control Trial Number (ISRCTN) registry, the WHO (World Health Organisation) International Clinical Trials Registry Platform, The Cochrane Collaboration, the Research Registry, PROSPERO and PubMed were all reviewed.

RESULTS

Of 595 included articles, the most common study designs were case series (n = 185, 31.1%). There were 24 randomized controlled trials (RCTs, 4.0%). A total of 24 studies had a protocol registered (4.0%). The most common database to register a protocol was with ClinicalTrials.gov (n = 17). The study design that most commonly had a registered protocol was the RCT (n = 8 of 24, 33.3% of RCTs). Three studies published a protocol in a journal (0.6%).

CONCLUSION

Publication or registration of protocols for recent studies involving human participants in major plastic surgery journals is low. There is considerable scope to improve this and guidance is provided.