A quantitative approach to understanding the effect of the COVID-19 pandemic on training opportunities for neurosurgical trainees in England.

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. A total of 58 T&O trainers and trainees undertook a paper-based survey during national training days in March and April2017. 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. 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.

This study aimed to quantify core surgical trainee (CST) differential attainment (DA) related to three cohorts; white UK graduate (White UKG) versus black and minority ethnic UKG (BME UKG) versus...

Surgical Residency Training in Nigeria: An Audit Through the Lenses of the Trainee and Trainer

An online workplace-based assessment tool, the Intercollegiate Surgical Curriculum Programme (ISCP), has become mandatory for all British surgical trainees appointed since August 2007. A compulsory pound125 annual trainee fee has also been introduced to fund its running costs. The study sought to evaluate user satisfaction with the ISCP. A total of 539 users across all surgical specialties (including 122 surgeons acting as assessors) were surveyed in late 2008 by online questionnaire regarding their experiences with the ISCP. Sixty-seven percent had used the tool for at least one year. It was rated above average by only 6% for its registration process and only 11% for recording meetings and objectives. Forty-nine percent described its online assessments as poor or very poor, only 9% considering them good or very good. Seventy-nine percent rated the website's user friendliness as average or worse, as did 72% its peer-assessment tool and 61% its logbook of procedures. Seventy-six percent of respondents had carried out paper assessments due to difficulties using the website. Six percent stated that the ISCP had impacted negatively on their training opportunities, 41% reporting a negative impact overall upon their training; only 6% reported a positive impact. Ninety-four percent did not consider the trainee fee good value, only 2% believing it should be paid by the trainee. The performance of the ISCP leaves large numbers of British surgeons unsatisfied. Its assessments lack appropriate evidence of validity and its introduction has been problematic. With reducing training hours, the increased online bureaucratic burden exacerbates low morale of trainees and trainers, adversely impacting potentially upon both competency and productivity.

Introduction: The ISCP (Intercollegiate Surgical Curriculum Programme) was introduced in 2007. It heralded a shift in surgical training from the traditional apprenticeship model, to a system where competence is assessed regularly within the workplace. Central to ISCP is the recording of Workplace Based Assessments, such as PBA (procedure-based assessment) and DOPS (Direct Observation of Procedural Skills). These are assessments “for” learning rather than assessments “of” learning and central to their purpose is detailed feedback from trainer to trainee. The aim of this study was to assess the quality of the feedback recorded on ISCP. Methods: The anonymised ISCP portfolios for 170 core and specialty urology trainees working in 16 deaneries were analysed. Over a three month period 469 DOPS and 592 PBAs were recorded and the presence and quality of assessors' feedback were evaluated according to the presence of five criteria: • Encouragement through positive language, • Including strengths, • Raising appropriate development needs, • Suggestions for appropriate corrective action, • Providing explanations. Results: Feedback was recorded in 49% and 67% of PBAs and DOPS respectively. In those assessments where feedback was recorded, positive language was used in 83% in PBAs and 70% in DOPS. Strengths were recorded in 53% for both tools. Developmental needs, suggestions for development and detailed explanation were recorded in 25%, 26%, 29% for PBAs and 24%, 23%, 19% for DOPS respectively. Conclusion: This study highlights the lack of feedback being recorded on ISCP and the paucity of good quality feedback when it was given.

A regional training day increases foundation doctors' confidence in managing orthopaedic patients

AimsCOVID-19 has had a global impact on all aspects of healthcare including surgical teaching and training. This study aimed to quantify the impact of COVID-19 on operative case numbers recorded by surgeons in training, and annual review of competency progression (ARCP) outcomes in the United Kingdom.MethodsAnonymised operative logbook numbers were collated from e-logbook and ARCP outcome data were collated from the Intercollegiate Surgical Curriculum Programme (ISCP) database for trainees across core and the ten higher surgical specialities. Operative logbook numbers and ARCP outcomes were compared between pre-COVID dates. Effect sizes are reported as incident rate ratios (IRR) with 95% confidence intervals (CI).Results5599 surgical trainees in 2019 and 5310 in 2020 in surgical specialty training were included. The IRR was reduced across all subspecialties because of the COVID-19 pandemic (0.55; 95% CI 0.53-0.57). Elective surgery (0.60; 95% CI 0.59-0.61) was affected more than emergency surgery (0.88; 95% CI 0.86-0.89). Regional variance with reduced operative activity was demonstrated across all specialities. 1 in 8 in their final year of training have not been able to achieve curriculum requirements and have had training extended. 1 in 4 trainees entering their final year of training are behind their expected training trajectory.ConclusionCOVID-19 continues to have a significant impact on surgical training in the UK. Urgent, co-ordinated action is required by key stakeholders to mitigate for these effects and maintain future surgical training.

The compulsory Intercollegiate Surgical Curriculum Programme (ISCP) was introduced in 2007 for all surgical trainees in a bid to provide a platform for better trainee evaluation and assessment. Its introduction received a mixed response and a compulsory annual fee of £125 added to the financial burden now on surgical trainees as they undertake their training. An early appraisal among users discovered general dissatisfaction with the fee and, most importantly, what the ISCP actually offered them in terms of their training. Parallel to these findings, there has been anecdotal and published evidence that the ISCP format for assessment is not adhered to by senior trainers and that this is a result of a general apathy toward the ISCP among senior clinicians.

The Joint Committee on Surgical Training (JCST) is currently in the process of producing an updated version (version 6) of the Intercollegiate Surgical Curriculum Programme (ISCP) website. You may recall an earlier article in the Bulletin setting out plans to run a trainee event to help engage users of the ISCP in this process of continual improvement.

The Intercollegiate Surgical Curriculum Programme (ISCP) ( www.iscp.ac.uk ) is a UK-wide collaborative project involving all the surgical royal colleges and the specialty associations involved in surgical training. Workplace-based assessment (WBA) refers to the assessment of day-to-day working practice 1 and is an integral part of the ISCP assessment framework. The main aim of WBA is to aid learning through constructive feedback. Several WBAs have been adopted by the ISCP including the mini-clinical evaluation exercise (mini-CEX), direct observation of procedural skills (DOPS), case-based discussion (CBD) and procedure-based assessment (PBA). A systematic review of WBAs concluded that there was no clear evidence to show that DOPS can lead to improvements in performance but identified studies that showed largely positive results in terms of learner satisfaction. 2

In August 2008 a compulsory annual fee of £125 was imposed on surgical trainees to support the ongoing costs of the Joint Committee on Surgical Training (JCST). This included the costs of running the Intercollegiate Surgical Curriculum Programme (ISCP) and contributing towards the Orthopaedic Competence Assessment Programme (OCAP). Fees are to be paid by all trainees using ISCP or OCAP surgical curricula from August 2008. This excludes Calman trainees as long as they do not use the electronic portfolio. Calman trainees are, however, able to use the e-logbook without charge.

No one would dispute the fact that the first few years of surgical training are of vital importance; these core years provide the bedrock on which future surgical training and practice is built. It is a matter for serious concern, therefore, that the quality of core surgical training is variable and in some instances falls below an acceptable standard. This is despite determined efforts to improve training and despite the development of the Intercollegiate Surgical Curriculum Programme (ISCP).

BackgroundCOVID-19 has had a global impact on all aspects of healthcare including surgical teaching and training. The COVID-STAR qualitative study demonstrated a perceived negative impact of COVID-19 on numerous aspects of surgical training across all specialties and training grades. The aim of this study is to investigate how COVID-19 has affected operative case exposure and work-based assessments for surgeons in training.MethodsAnonymized data has been sought from the Intercollegiate Surgical Curriculum Programme (ISCP) database for operations and work-based assessments in each specialty, involving surgical trainees on an approved training programme at defined Pre-COVID (16/03/19 – 11/05/19) and COVID (16/03/2020 – 11/05/20) timepoints. Primary outcome measures are the percentage (%) difference in WBA and operative activity between time points respectively. Differences in training activity between time periods will be tested using Pearson χ2 and Kruskal–Wallis tests for categorical and continuous variables respectively.ResultsThis study has been approved by the ISCP Data Analysis, Audit and Research Group, and data will be managed in accordance with ISCP data governance. The hypothesis of this study is that COVID-19 has caused a reduction in the operative and WBA activity of trainees across all specialties.ConclusionThis study seeks to quantify the impact of COVID-19 on operative training activity and completion of WBAs in clinical practice. This information will inform major stakeholders involved in optimising surgical training in the COVID-19 recovery phase.

Background:This study aimed to evaluate core surgical training (CST) differential attainment related to coronavirus disease 2019 (COVID-19), gender and ethnicity. The hypothesis was that COVID-19 adversely influenced CST outcomes.Methods:A retrospective cohort study of 271 anonymised CST records was undertaken at a UK Statutory Education Body. Primary effect measures were Annual Review of Competency Progression Outcome (ARCPO), Membership of the Royal College of Surgeons (MRCS) examination pass and Higher Surgical Training National Training Number (NTN) appointment. Data were collected prospectively at ARCP and analysed with non-parametric statistical methods in SPSS.Results:CSTs numbering 138 completed training pre-COVID and 133 peri-COVID. ARCPO 1, 2 and 6 were 71.9% pre-COVID versus 74.4% peri-COVID (P=0.844). MRCS pass rates were 69.6% pre-COVID versus 71.1% peri-COVID (P=0.968), but NTN appointment rates diminished (pre-COVID 47.4% vs. peri-COVID 36.9%, P=0.324); none of the above varied by gender or ethnicity. Multivariable analyses by three models revealed: ARCPO was associated with gender [m:f 1:0.87, odds ratio (OR) 0.53, P=0.043] and CST theme (Plastics vs. General OR 16.82, P=0.007); MRCS pass with theme (Plastics vs. General OR 8.97, P=0.004); NTN with the Improving Surgical Training run-through programme (OR 5.00, P<0.001). Programme retention improved peri-COVID (OR 0.20, P=0.014) with pan University Hospital rotations performing better than Mixed or District General-only rotations (OR 6.63, P=0.018).Conclusion:Differential attainment profiles varied 17-fold, yet COVID-19 did not influence ARCPO or MRCS pass rates. NTN appointment fell by one-fifth peri-COVID, but overall training outcome metrics remained robust despite the existential threat.

Improving core surgical training in a major trauma centre