386 A Comparison of Academic Output of Welsh Plastic Surgery Trainees Pre- and Mid-COVID-19 Pandemic

Aim

The COVID-19 pandemic has affected doctors worldwide, with 1.5 million surgeries being postponed or cancelled in England and Wales during 2020. Surgeons in competitive specialties requiring active research portfolios may have used this time to strengthen their academic work. This cross-sectional study provides insight into the academic output of Welsh plastic surgery trainees during the COVID-19 pandemic, which could be used to highlight contributing factors to benefit future training.

Method

A cross-sectional study was distributed to all Welsh burns and plastic surgery trainees from specialty trainee levels 3–8. Data was obtained comparing publications achieved, abstracts submitted, and projects undertaken pre-pandemic, March 1^st to 31^st August 2019 and mid-pandemic, March 1^st to 31^st August 2020.

Results

Of the 12 Welsh plastic surgery trainees, 75% participated in this survey, with representation from all years of training. Mid-pandemic, an average of 3 publications were achieved per trainee when compared with 1.4 pre-pandemic. 78% submitted abstracts during both periods, increasing from 1.5 to 2.44 mid-pandemic. Although the average number of projects undertaken pre- and mid-pandemic was 3.2 and 3.1 respectively, the number of trainees undertaking projects increased by 22% to 100%. Most commonly, this was attributed to an increase in capacity.

Conclusions

Our study demonstrated that overall, academic output increased significantly during the COVID-19 pandemic. Unsurprisingly, this sudden decrease in surgical activity led to trainees in this highly competitive specialty employing their time towards research. Further studies investigating the factors enabling trainees to increase their academic productivity would be beneficial as routine surgical activity resumes.

Epidemiology and financial implications of self-inflicted burns

INTRODUCTION

The cost of the treatment of burns is high especially in self-inflicted burns with prolonged treatment. We performed a retrospective review of the self-inflicted burns at our regional burns centre to determine the costs incurred in their management and to identify factors which could reduce the financial burden in the future.

METHODS

The data was collected retrospectively of all the inpatient and outpatient self-inflicted burns presenting to our regional burns centre in the year 2011.

RESULTS

Twenty one patients (out of a total of 870 patients) presented with self-inflicted burns to our centre in 2011. Five (23.8%) were major burns with an average of 53.2% Total Body Surface Area (TBSA) and 16 (76.2%) were minor burns with an average of 0.5% TBSA. 11 (52.4%) patients had flame burns including 4 self-immolation burns. The mortality rate was 4.8% (n=1). Five (23.8%) patients underwent surgical treatment. Seven (33.3%) patients were treated in intensive care and with average stay of 46.85 days. Critical care and theatre attendances made up most of the costs with average ICU stay per patient calculated at £313,131/day. The total cost of all 21 patients was £1,581,856.

CONCLUSION

Burns are preventable injuries, early detection and intervention in patients with propensity to self-inflict burns can possibly reduce the costs of treatment in the future.

Foot burns: Epidemiology and management

This is a retrospective study of the epidemiology and management of isolated foot burns presenting to the Welsh Centre for Burns from January 1998 to December 2002. A total of 289 were treated of which 233 were included in this study. Approximately 40% were in the paediatric age group and the gender distribution varied dramatically for adults and children. In the adult group the male:female ratio was 3.5:1, however in the paediatric group the male:female ratio was more equal (1.6:1). Scald burns (65%) formed the largest group in children and scald (35%) and chemical burns (32%) in adults. Foot burns have a complication rate of 18% and prolonged hospital stay. Complications include hypertrophic scarring, graft loss/delayed healing and wound infection. Although isolated foot burns represent a small body surface area, over half require treatment as in patients to allow for initial aggressive conservative management of elevation and regular wound cleansing to avoid complications. This study suggests a protocol for the initial acute management of foot burns. This protocol states immediate referral of all foot burns to a burn centre, admission of these burns for 24-48 h for elevation, regular wound cleansing with change of dressings and prophylactic antibiotics.

The MD-medical doctorate or mandatory doctorate?

The introduction in the UK of the Calman Registrar training scheme envisaged seamless progression from Senior House Officer (SHO) grade through to Consultancy. Within this framework research was acknowledged to be a valuable (but optional) part of the training programme, as laid out by the 'Orange Guide' to Specialist Registrar (SpR) Training [A Guide to Specialist Registrar Training 1998; HM Press]. Time is provided for this activity within the SpR training scheme, but it is becoming increasingly evident that the majority of formal research (towards post graduate degrees) is being carried out by so-called 'gap' SHO's in order to gain entry into Higher Surgical Training (HST) programmes [Ann R Coll Surg Engng 81 (1999) 182], [Br J Plast Surg 55 (2002) 463-468]. With this in mind, a survey of all Plastic Surgery SHO's in the UK was undertaken to assess the extent of clinical research undertaken by individuals, and the perceived need for formal research for career progression.