Core Surgical Training Research Articles

A Multi-site Cross-Sectional Survey Exploring Medical Undergraduate Knowledge of Oral and Maxillofacial Surgery.

To evaluate medical student exposure to OMFS and knowledge of which clinical cases are appropriate to refer to the OMFS surgeon and the academic requirements to pursue a career in OMFS. The investigators designed and distributed a cross-sectional survey to a cohort of current UK medical students. The primary outcome was medical student knowledge of the role of the OMFS, which was measured by their ability to correctly identify which cases were appropriate to refer to OMFS. Secondary outcomes included: identifying the proportion of students exposed to OMFS and the nature of this exposure; identifying student knowledge of the requirements to commence OMFS speciality training; and comparing knowledge of OMFS in those exposed to OMFS at medical school and those not exposed. The investigators hypothesised that undergraduates exposed to OMFS would have a greater understanding of the role of the OMFS and the requirements to pursue this speciality. Of the 299 participants included in this study, 77.4% (230) had no exposure to OMFS at medical school. Overall, the students exposed to OMFS at medical school performed superiorly (mdn = 13) to the OMFS-naïve students (mdn = 13), z-score = 2.185, p = 0.03, in correctly identifying cases to refer to an OMFS surgeon. They also were more likely to correctly identify the requirement of core surgical training (CST) (p = 0.04, χ 2 = 4.182) and membership of the Royal College of Surgeons (p = 0.02, χ 2 = 9.879) as needed to begin OMFS speciality training. Exposure to OMFS is still limited within the medical undergraduate curriculum, and this is reflected in poor knowledge of OMFS. An increase in the amount of contact with OMFS at an undergraduate level would not only help create greater interest in OMFS as a career but would help doctors of all specialities when exposed to OMFS.

The development of cadaveric simulation for core surgical trainees

How valuable is cadaveric simulation as an educational tool?

Learning Style Variation: A British Core Surgical Trainee Perspective

Brown, Chris MBBCh, MRCS; Luton, Oliver W. MBBCh, MRCS; Robinson, David MBBCh, MRCS; Abdelrahman, Tarig BM, MRCS, MD; Hopkins, Luke MBBCh, MRCS; Egan, Richard J. MD, FRCS; Powell, Arfon G. PhD, MRCS; Pollitt, John FRCS; Lewis, Wyn FRCS, DSc Author Information

Evaluation of the Integrated Plastic and Reconstructive Surgery Prerequisite Core Surgical Training Experience: A Residents' Perspective.

A key educational component of the integrated plastic and reconstructive surgery (PRS) training model is the prerequisite, or core, experiences. The aim of this study is to assess the integrated PRS residents' experience with this early part of training. A 20-question survey was developed and piloted before deployment to integrated PRS training programs from 4 United States Census regions. Respondents were asked to characterize their prerequisite clinical and operative experiences. Results were analyzed using pairwise correlation statistics and logistic regression modeling following Bonferroni correction for multiple hypothesis testing. One hundred ninety six residents (22 programs) participated in the study (response rate, 65.3%). The majority of residents were satisfied with their prerequisite experiences. Most did not take the American Board of Surgery In-Training Examination, which was perceived as noncontributory to PRS training. The majority of residents preferred to have fewer prerequisite experiences. Operative hours per week were predictive of resident satisfaction with the clinical and operative prerequisite experiences (both P < 0.001). Perception of general surgery program director investment in PRS education was also predictive of resident satisfaction with clinical and operative experiences (P = 0.05 and P < 0.001, respectively). The present study demonstrates that PRS residents are satisfied with the quality of prerequisite training but prefer less overall. Reevaluation of the benefits of the American Board of Surgery In-Training Examination and individual essential rotations for resident education would be welcomed. Furthermore, this study identifies the residents' clinical and operative experience and perceived general surgery program director involvement as important determinants of integrated resident satisfaction with prerequisite training.

When can I drive? Advising patients when to drive after general surgical procedures

Introduction Advising patients when they are medically fit to drive following general surgical procedures is crucial to minimise risk to patients, the general public as road user’s and pedestrians and also avoid negligence claims against medical practitioners. Historically, in the UK, this advice has come from a number of sources including surgeons, general practitioners, insurers and the Driver and Vehicle Licensing Agency (DVLA). The aim of this study was to review how current surgical teams distribute this advice and what this advice is based upon. Materials and methods An online survey was devised and distributed to all consultant general surgeons and trainees in the North East of England via email. Leading vehicle insurance companies and the DVLA were contacted to assess what advice they gave for specific procedures (ventral hernia, appendicectomy, cholecystectomy, fundoplication). Results A total of 135 surveys were distributed, 56 were returned, with a response rate of 41.5%. Twenty-two (39.3%) of respondents were consultants, 30 (53.6%) were speciality trainees (ST3-8) and 4 (7.1%) were core surgical trainees (CT1-2). Some (14.2%) gave driving advice to every patient, 39.3% gave advice to most patients; 42.9% gave advice pre-operatively in clinic, 39.3% gave the advice pre-operatively on the day of surgery, and 96.4% of responders based their advice on traditional teaching. Discussion and conclusions: There is variation in the content and timing of advice regarding driving after general surgical procedures. This inconsistency will undoubtedly lead to incorrect information being distributed to patients and will impact post-operative patient safety. We suggest formulating consistent advice in a written format, standardising the process which in turn will protect patients and surgeons.

Simulation in urology to train non-technical skills inward rounds.

To report our experience of an exercise designed to train newly appointed urology trainees in non-technical skills on ward rounds as a part of a simulation 'boot camp', through a qualitative analysis of participant feedback on the utility of this method of training. The simulations took place in a high-fidelity simulated ward bay. Forty-eight doctors with formal urology training ranging between 2 and 60months (mean 19.1 ± 11.6months) took part. Thirty-one participants were on a formal urology specialty training pathway. The remaining participants were core (pre-specialty) surgical trainees. The entry requirement was that participants must be junior-level urologists, ideally at the beginning of specialty training. Participants individually led a simulated ward round, which was devised using actors to play patients and a simulated 'switchboard' for telephone conversations. Distractions were introduced deliberately for participants to manage an emergent urology-related scenario. 'Freeze-frames' were used to 'pause' the ward round, whereby observing consultants provided feedback on performance. After the simulated exercises, a whole-group structured debriefing took place. Non-Technical Skills for Surgeons (NOTSS) scores were generated for participants by seven consultant urologists. Participants completed a two-part feedback form. Part one involved nine questions scored on a Likert scale, and part two required free-text responses. The mean (±sd) itemized NOTSS scores for situational awareness, decision-making, communication and teamwork, and leadership were 3.01 (±0.15), 2.95 (±0.16), 3.05 (±0.19), and 2.98 (±0.15), respectively. From the thematic analysis, participants commented positively on the number of scenarios per participant, the use of actors as patients and real staff, and the use of freeze-frames for immediate feedback. Residents also provided suggestions for distractions to be considered in the future. This simulated ward round was generally well received by participants, and the obtained feedback provides an insight into how this can be adapted to maximize the benefits for new specialty residents. The mean NOTSS scores indicated that non-technical skills performances could be improved. This supports our rationale to train non-technical skills in a safe environment to bolster career transition into positions of greater decision-making autonomy.

Core surgical training - Are we meeting the standards of training?

Core surgical training - Are we meeting the standards of training?

Notice of on-call rotas – A closed loop audit of London NHS trust compliance with the code of practice in core surgical trainees

Notice of on-call rotas – A closed loop audit of London NHS trust compliance with the code of practice in core surgical trainees

Core surgical training: training or service provision? Assessing compliance against JCST quality indicators for London core surgical trainees

Core surgical training: training or service provision? Assessing compliance against JCST quality indicators for London core surgical trainees

The core surgical trainee rest audit

The core surgical trainee rest audit

Cost effectiveness of a core surgical training induction bootcamp

Cost effectiveness of a core surgical training induction bootcamp

Core surgical training in Wales: pilot study of a multidisciplinary surgical boot camp

An attempt to create the ultimate core surgical training post.

The impact of junior surgical jobs in cardiothoracic surgery on career choice in the United Kingdom.

Cardiothoracic surgery is a small specialty, often with a limited presence on the undergraduate curriculum. In the past, there was a heavy reliance on postgraduate exposure to inform career choice. Recent changes in recruitment to the specialty in the United Kingdom may reduce exposure of the best trainees to the specialty, and reduce the quality of future surgeons. This study will evaluate the impact of junior surgical jobs on future career preferences. We asked all 126 core surgical trainees in the Northern Ireland Deanery their surgical specialty preferences over 2years. Trainees were asked for their first and second preferences on each occasion. In total 502 first and second preferences were declared. Past and present postings were then correlated with this information to see if working in a cardiothoracic unit impacted on specialty preference choices. Cardiothoracic surgery is the least popular of all the surgical specialties amongst junior surgical trainees (3.6%)-with general surgery, breast surgery, and orthopaedic surgery, drawing 53% of trainees. In trainees who had previously worked in cardiothoracic surgery, 75% expressed a wish to return to the specialty, making it the most dominant. The role of junior surgical jobs in the specialty is immensely important on career choice. Moving to a more junior recruitment may exclude excellent candidates who have simply not experienced cardiothoracic surgery.

509 The Future of Burns Surgery Training-using handheld technology

Surgical simulation has revolutionized surgical training in the U.K. We wished to determine the effectiveness of a novel smartphone application to teach core surgical trainees how to tangentially excise and skin graft an unhealed burn wound. The burns program was presented to regional core surgical trainees. A written multiple choice test was provided before and after the presentation. Results were analyzed to determine the difference between pre and post test scores. 38 trainees completed the assessment. 28 had no experience of burns surgery (group 1) whilst 8 had 4–6 months experience (group 2) and 2 participants had 12–18 months experience (group 3). Group 1’s mean score improved from 30% to 72%. Group 2’s mean score improved from 45.8% to 72.4% and group 3’s mean score increased from 85% to 100%. To our knowledge this is the first smartphone educational program to simulate burns surgery. Our results demonstrate the educational benefit of handheld technology for burns surgery simulation. Novel handheld technology is an exciting new method for future medical students and junior trainee surgeons to learn burns surgical procedures and improve the practice of burn care.

It’s time to train… How we combine high quality Urological training with service provision in a busy DGH setting

This article was migrated. The article was not marked as recommended. Introduction : With constrained training time, we must look for and optimise the educational opportunities within the "service" element of our workload. We proposed that In Patient referrals be used as educational cases. Methods : We reviewed these referrals over 5 years (2013-2017) and mapped the referrals against the curricula for Core Surgical Training (CST) and General Practice Trainees (GP). Results: Curriculum mapping against the Urology components of the curricula for GP found all but one of the topics was addressed. For CST all topics were covered. The topics mapped against the curricula were common reasons for referral, therefore we expect that even in a short attachment a Trainee could see most if not all of these. Conclusion : On average, 0.69 referrals were received per day. Therefore one training case takes relatively little time and should be achievable by even the busiest Trainers and Trainees.We demonstrate that using inpatient referrals from other teams as an educational resource effectively covers the breadth of the Urology components of both GP and CST curricula. We propose that this approach could be usefully employed by other units and specialities

“Run-through” training at specialist training year 1 and uncoupled core surgical training for oral and maxillofacial surgery in the United Kingdom: a snapshot survey

Training in oral and maxillofacial surgery (OMFS) in the UK has undergone considerable changes during the last 10years, and “core” surgical training has replaced “basic” surgical training. In 2014 a pilot “run-through” training programme from specialist training year one (ST1)-ST7 was introduced to facilitate early entry into the speciality. Run-through training guarantees that a trainee, after a single competitive selection process and satisfactory progress, will be given training that covers the entire curriculum of the speciality, whereas uncoupled training requires a second stage of competitive recruitment after the first one (for OMFS only) or two years of “core” training to progress to higher specialty training.The first two years of run-through training (ST1-ST2) are the same as for core surgical training. Dual-qualified maxillofacial aspirants and those in their second degree course are curious to know whether they should go for the uncoupled core surgical training or the run-through programme in OMFS. The General Medical Council (GMC) has now agreed that run-through training can be rolled out nationally in OMFS. To assess the two pathways we used an online questionnaire to gain feedback about the experience from all OMFS ST3 and run-through trainees (ST3/ST4) in 2016–2017. We identified and contacted 21 trainees, and 17 responded, including seven run-through trainees. Eleven, including five of the run-through trainees, recommended the run-through training programme in OMFS. Six of the seven run-through trainees had studied dentistry first. The overall mean quality of training was rated as 5.5 on a scale 0–10 by the 17 respondents. This survey gives valuable feedback from the current higher surgical trainees in OMFS, which will be useful to the GMC, Health Education England, OMFS Specialist Advisory Committee, and those seeking to enter higher surgical training in OMFS.

Does choice of medical school affect a student’s likelihood of becoming a surgeon?

Surgeons are an integral provider of elective and emergency secondary care in the UK. However, the supply of surgeons is struggling to keep up with the demand; for at least the past four years, there have remained unfilled core surgical training (CST) posts despite other specialties (eg radiology, public health medicine and ophthalmology) achieving consistent 100% fill rates. 1 , 2

An audit of clinical training exposure amongst junior doctors working in Trauma & Orthopaedic Surgery in 101 hospitals in the United Kingdom

BackgroundThere are concerns regarding early years’ training for junior doctors in Trauma & Orthopaedic Surgery (T&O) in the United Kingdom. Our primary objective was to audit the clinical activities undertaken by junior doctors working in Trauma & Orthopaedic (T&O) surgery in the National Health Service (NHS) in a typical workweek. A secondary objective was to audit the clinical exposure of junior surgeons in training to the Joint Committee on Surgical Training (JCST) standards for minimum weekly clinical exposure in T&O surgery.MethodsWe recruited collaborators in 101 T&O surgery departments in NHS hospitals to participate in this study. Clinical activity diaries from 935 doctors working in T&O surgery in the 101 participating NHS hospitals were involved. All junior doctors covering the junior on call tier were included. Collaborators collected clinical activity data from 08:00 18/01/2015 to 20:00 22/01/2015. Clinical activities recorded in sessions (morning, afternoon, evening) depending on what activity that doctor undertook for the majority of that session. Clinical activities were grouped into operating theatre/room, outpatient clinic, on call, “not in work” (i.e. leave, sickness), teaching, and ward cover sessions. The weekly clinical activity of Core Surgical Trainees (CSTs) were analyzed in accordance to two JCST standards for minimum weekly clinical exposure.ResultsOverall, junior doctors working in T&O surgery attended a theatre list session 8.5% of the time, an outpatient clinic 3.2%, were on call 14.8%, a teaching session 1.7%, providing ward cover 34.6%, and on a zero session 20.7% of the time. Only 5% of core surgical trainees (n = 200) met both the JCST standards for minimum weekly clinical exposure in the specialty.ConclusionsJunior surgeons in training, working in Trauma & Orthopaedic surgery in the United Kingdom are not meeting the minimum weekly clinical sessions laid out by the JCST. Further work to develop models allowing for enhanced training experiences and improved clinical exposure to operating lists and outpatient clinics would be beneficial.

Run-through OMFS training at ST1 versus conventional Core Surgical Training (CST)

Run-through OMFS training at ST1 versus conventional Core Surgical Training (CST)

The role of anatomy demonstrators: A surgical trainees' perspective.

Core Surgical Trainees (CST) in the London (UK) Postgraduate School of Surgery receive clinical anatomy teaching in their first year of training, and, in their second year, give 30 sessions of anatomy teaching to medical and other students. This study set out to investigate the role of demonstrators from the perspective of the trainees. A focus group was convened to ascertain trainees' perspectives on demonstrating anatomy and to identify problems and improvement strategies to optimize their ability to enhance students' learning. A questionnaire was formulated and all second-year CST (n = 186-from two cohorts) in the London Postgraduate School of Surgery were invited. A total of 109 out of 186 trainees completed the questionnaire. A high percentage (98%) of trainees that completed the questionnaire responded that demonstrating was an invaluable part of their training. Sixty-two per cent responded that anatomy teaching they received in their first year of core surgical training helped them in their teaching role and 80% responded that it helped them prepare for surgical training. The study also revealed the need for improved communication between trainees and the London Postgraduate School of Surgery/Medical Schools/National Health Service Trusts to address issues such as trainees' perceived difficulty in fulfilling their teaching session requirement. The stakeholders have acknowledged and addressed the outcomes to improve the experience for both surgical trainees and students. The results indicate that anatomy demonstrating delivers important benefits to early surgical trainees, in addition to those received by the students that they teach. Clin. Anat. 31:409-416, 2018. © 2017 Wiley Periodicals, Inc.