Core Surgical Training Research Articles

968 Delivering Human Factors and Non-Technical Skills Training Using Interactive Online Platforms in the COVID Era

Abstract Aim To evaluate the impact and effectiveness of an interactive online human factors (HF) and non-technical skills (NTS) course delivered to Core Surgical Trainees during the COVID-19 pandemic Method A 1-day HF and NTS course was conducted online, using the Zoom platform, to Core Surgical Trainees in the North West. The course consisted of interactive lectures, small group teaching sessions, and self-directed learning with written reflections. Pre- and post-course surveys were administered, evaluating the participants’ awareness, knowledge and skills using a 5-part Likert scale, along with a multiple-choice assessment of knowledge. Statistical analysis was undertaken with significance considered at p < 0.05 Results The course was attended by 63 CT1/2 participants, representing all surgical specialties. In the post-course evaluation, participants’ self-rating of awareness and knowledge for both HF and patient safety increased by between 10-20%. There was a significant increase in the mean post-course test score from 7.54 (SD ± 1.7) to 8.65 (SD ± 1.2) out of 10 (p < 0.0001). The course overall was rated relevant and useful (weighted averages 4.4 and 4.5 respectively) Conclusions To our knowledge, this is the first time a video conferencing platform has been used to deliver a live HF/NTS course. This study provides evidence supporting the use of such interactive online platforms in postgraduate surgical education. Training and professional development must continue, despite the evolving pressures from COVID-19. Embracing new methods of education delivery is required, with ongoing reporting and evaluation of education practice, sharing lessons learned and informing the evidence base in postgraduate surgical training during this time

Prognostic significance of drivers at work and learning styles in surgical training

Purpose of the studyDrivers at work (DW) and Learning Styles (LS) refer to contentious theories that aim to account for differential career development yet seldom feature in assessment. This study...

ST3 national selection for surgical specialty training in the UK: a comparative analysis

Introduction National recruitment at ST3 level is the point for aspiring surgical trainees to obtain a national training number and progress to consultancy. In the 2020 recruitment year, face-to-face interviews were not possible owing to the COVID-19 pandemic. This highlighted wide ranging variability in recruitment processes for different surgical specialties. Methods Person specification details and portfolio scoring matrices were accessed through the Oriel recruitment portal. These were analysed and broken down into common domains for comparison purposes by two authors. Overall scores were totalled. Each domain was assessed in terms of its importance to each specialty by calculating its percentage contribution to overall portfolio marks. Results There was variability in all aspects of portfolio assessment and scoring. This started with how many overall ranking marks were contributed by the portfolio to each specialty. Further analysis and comparison of scoring domains demonstrated heterogeneity in how each specialty assesses and awards candidates marks based on achievements. Large emphasis is placed on certain domains by some specialties but not others. Conclusions The degree of variation in ST3 portfolio assessment and the differences between surgical specialties in how the scoring domains are valued has implications for core surgical trainees and those looking to apply for higher surgical training at ST3 level. Currently, core surgical trainees are assessed using a common process of annual review of competence progression that may not be suited to helping prepare candidates for gaining a national training number. There is no available evidence to account for variability between surgical specialty recruitment processes. Further work is needed to assess whether ST3 selection scoring variation has any impact on trainee progression to higher surgical training.

How do Trainers and Trainees use Formative Workplace-based Assessments of Operative Competence to Deliver and Receive Structured Feedback?

The aim of this study is to assess the quality of feedback provided to surgical trainees in the operating theatre, and to further investigate how trainees and trainers use workplace-based assessment in practice with regards to frequency and timing of assessments. A retrospective study of all submitted Supervised Structured Assessments of Operative Performance (SSAOPs) from April 25, 2016 to February 2, 2021 was conducted. Surgical trainees in the Republic of Ireland across all national surgical training sites submitted SSAOPs through an online platform. Assessments of operative competence (SSAOPs) from all Core Surgical Trainees (in their first two years of dedicated post-graduate surgical training) were included for analysis, regardless of surgical subspecialty. A total of 2294 assessments were submitted from April 25, 2016 to February 2, 2021 by 330 core surgical trainees and 379 surgeon assessors. Five hundred of these assessments were randomly selected and scored for quality of feedback using a modified "Task, Gap, Action (TGA)" framework. Of all 2294 submitted assessments, 1905 (83.04%) were submitted in the latter 3 months of each rotation, and 803 (35%) were submitted in the last month. Only 51 of 270 (18.89%) of trainees in their first year and 33 of 236 trainees in their second year (13.98%) submitted more than the minimum required number of assessments (6 per year). Of 500 randomly selected assessments, 362 (72.4%) had documented written feedback. The mean 'Gap' and 'Action' scores were low, at 0.44/3 and 0.53/3 respectively. Trainees do not submit more than the required number of operative workplace-based assessments. Assessments are submitted at the end of the trainee's rotation, limiting their formative value. The quality of written feedback is poor and could be improved significantly by encouraging a "Task," "Gap" and "Action" approach.

Mapping out a virtual surgical curriculum: opinions on a core surgical training programme with technology-enhanced learning

Virtual teaching may be a useful tool for surgical training.

Riding the waves: the ongoing impact of COVID-19 on a national surgical training cohort

BackgroundThe World Health Organisation declared a global pandemic on the 11 March 2020 resulting in implementation of methods to contain viral spread, including curtailment of all elective and non-emergent interventions. Many institutions have experienced changes in rostering practices and redeployment of trainees to non-surgical services. Examinations, study days, courses, and conferences have been cancelled. These changes have the potential to significantly impact the education and training of surgical trainees.AimTo investigate the impact of the COVID-19 pandemic on training, educational, and operative experiences of Irish surgical trainees.MethodsSurgical trainees were surveyed anonymously regarding changes in working and educational practices since the declaration of the COVID-19 pandemic on 11 March 2020. The survey was circulated in May 2020 to both core and higher RCSI surgical trainees, when restrictions were at level five. Questions included previous and current access to operative sessions as well as operative cases, previous and current educational activities, access to senior-led training, and access to simulation-/practical-based training methods. A repeat survey was carried out in October 2020 when restrictions were at level two.ResultsOverall, primary and secondary survey response rates were 29% (n = 98/340) and 19.1% (n = 65/340), respectively. At the time of circulation of the second survey, the number of operative sessions attended and cases performed had significantly improved to numbers experienced pre-pandemic (p < 0.0001). Exposure to formal teaching and education sessions returned to pre-COVID levels (p < 0.0001). Initially, 23% of trainees had an examination cancelled; 53% of these trainees have subsequently sat these examinations. Of note 27.7% had courses cancelled, and 97% of these had not been rescheduled.ConclusionSurgical training and education have been significantly impacted in light of COVID-19. This is likely to continue to fluctuate in line with subsequent waves. Significant efforts have to be made to enable trainees to meet educational and operative targets.

Trainee perspective of the causes of stress and burnout in surgical training: a qualitative study from Wales

ObjectivesStress and burn-out among surgical trainees has been reported most prevalent in core surgical trainees (CST) and female trainees in particular. This study aimed to identify factors perceived by CSTs...

BEST of Surgical Training: the pan-London Core Surgical Training induction programme: “There’s no I in team, but there is a me.”

BackgroundIn the UK, Core Surgical Training (CST) marks the start of a surgical career, but previous experience and skills vary widely. Whilst Individual hospital Trusts offer local inductions, these are generally of a generic, administrative nature rather than advising trainees on how best to harness training opportunities. We designed a regional induction programme, ‘Building Excellence in Surgical Training’ (BEST) to address this, develop essential technical and non-technical skills, and engender support networks. MethodsAll incoming London Core Surgical Trainees (annual cohort size 90) were invited to participate, during the week prior to commencement of training. Trainees undertook 3 modules (portfolio, surgical skills and human factors-based simulation) and a research paper presentation day. We collected qualitative and quantitative data through a structured evaluation form, pre and post course Likert-scale scores and self-assessment utilising the non-technical skills for surgeons (NOTSS) framework. Results972 CSTs have completed BEST over the past 12 years. In 2019, significant improvements were seen in: confidence for starting CST, 45% (n = 22/49)-83% (n = 33/40,p = 0.00045); feeling the core programme cared about them, 55% (n = 27/49)-98% (n = 41/42, p =< 0.00001); getting to know peers 16% (n = 8/49)-88% (n = 35/40, p =< 0.00001); understanding human factors 82% (n = 40/49)-95% (n = 36/38, p = 0.00427); gaining confidence of trainers, 49% (n = 23/47)-86% (n = 31/36, p = 0.00114), and ability to speak out over patient safety concerns, 78% (n = 38/49)-97% (n = 37/38,p = 0.00019). NOTSS assessments showed significant improvement across all 4 criteria (n = 142, p =< 0.00001). ConclusionBEST equips trainees with the fundamental skills and confidence to safely embark on surgical training and provides tools to navigate the challenges training presents. The ethos of collaboration and support will aid the development of more resilient and empowered surgeons, vital in this era.

Enhanced stress-resilience training for surgical trainees.

IntroductionCore surgical training programmes are associated with a high risk of burnout. This study aimed to assess the influence of a novel enhanced stress-resilience training (ESRT) course delivered at the start of core surgical training in a single UK statutory education body.MethodAll newly appointed core surgical trainees (CSTs) were invited to participate in a 5-week ESRT course teaching mindfulness-based exercises to develop tools to deal with stress at work and burnout. The primary aim was to assess the feasibility of this course; secondary outcomes were to assess degree of burnout measured using Maslach Burnout Inventory (MBI) scoring.ResultsOf 43 boot camp attendees, 38 trainees completed questionnaires, with 24 choosing to participate in ESRT (63.2 per cent; male 13, female 11, median age 28 years). Qualitative data reflected challenges delivering ESRT because of arduous and inflexible clinical on-call rotas, time pressures related to academic curriculum demands and the concurrent COVID-19 pandemic (10 of 24 drop-out). Despite these challenges, 22 (91.7 per cent) considered the course valuable and there was unanimous support for programme development. Of the 14 trainees who completed the ESRT course, nine (64.3 per cent) continued to use the techniques in daily clinical work. Burnout was identified in 23 trainees (60.5 per cent) with no evident difference in baseline MBI scores between participants (median 4 (range 0–11) versus 5 (1–11), P = 0.770). High stress states were significantly less likely, and mindfulness significantly higher in the intervention group (P < 0.010); MBI scores were comparable before and after ESRT in the intervention cohort (P = 0.630, median 4 (range 0–11) versus 4 (1–10)).DiscussionDespite arduous emergency COVID rotas ESRT was feasible and, combined with protected time for trainees to engage, deserves further research to determine medium-term efficacy.

Is there enough time to train? An audit of core surgical training rotas

BackgroundThe Joint Committee on Surgical Training (JCST) have published a series of quality indicators (QIs) which act as a benchmark against which the quality of surgical training can be assessed. This audit aims to compare core surgical training (CST) rotas in our region against the JCST QI 10's minimum standard of 5 consultant supervised training sessions per week. MethodsCore surgical trainees in one training region were contacted requesting their on-call rotas from rotations undertaken during the 2019/20 academic year. Rotas were analysed in a protocolised manner, with the number of potential training sessions available calculated and compared against the JCST QI 10 minimum recommendation. ResultsTwenty-four rotas were assessed across 17 hospitals. Only six (25%) of rotas achieved the JCST QI 10 standard. There was a mean deficit of 18.5 (±29.5) training sessions per 6-month rotation. Rotas compliant with JCST QI 10 used a mean rota pattern of 1 in 11 compared to 1 in 9 for those failing to meet the target.Further analysis, comprising of the addition of expected consultant led training whilst on call, led to an improvement in compliance to 9 (38%) and 13 (54%) of rotas when there was an addition of 0.5 h and 1 h of consultant supervised training time per on-call session respectively. ConclusionMany core surgical trainee rotas in the region are non-compliant with JCST QI 10, indicating a lack of regular consultant-led training opportunities. A move to a reduced on-call commitment with the use of supporting medical practitioners could be considered to improve this.

Prognostic significance of competition ratios in surgical specialty training selection

BackgroundA competition ratio (CR) indicates the ratio of total applications for a training post when compared with numbers of specialty posts available. This study aimed to evaluate CRs’ influence on...

Dual Degree Training: Balancing Clinical Aptitude and Medical Licensure Requirements

Dual Degree Training: Balancing Clinical Aptitude and Medical Licensure Requirements

959 Undertaking Core Surgical Training Less Than Full Time: A Qualitative Study of Experiences

Abstract Introduction The Royal College of Surgeons identifies Less Than Full Time Training (LTFT) as a key factor in attracting excellent candidates at Core level. Previous evaluations of LTFT have, however, focused on ST3 and beyond. This study focuses on Core Surgical Training (CST), to determine how well it is delivering for LTFT trainees. Method Participants undertaking any part of CST LTFT were eligible. An electronic, self-administered questionnaire was accessed by participants. Results There were 11 participants. The majority (55%) rated the information available, which often related to more senior trainees, as poor. A third reported it ‘very difficult’ to arrange a LTFT training post. A significant proportion felt their access to operative experience was decreased and 45% reported feeling less confident. Positive aspects were improved work-life balance and being able to maintain a surgical career with a family. Suggestions for improvements included normalising LTFT in surgery to reduce stigma, having dedicated LTFT TPDs, clear pathways, and longer rotations. Conclusions Training LTFT offers many benefits – not least, increasing workforce diversity. However, for many, training LTFT at Core level produces additional stress, work and stigma. If the surgical community is serious about maintaining an excellent, diverse workforce, these issues should be tackled sooner rather than later.

845 Flattening the Learning Curve: The Evaluation of Extended Laparoscopic Simulation Training for Novice Surgeons

Abstract Introduction Associated with faster postoperative recovery, reduced length of hospital stays and scarring; laparoscopy has become the favoured approach for many surgical procedures across a range of specialties. However, due to its challenging learning curve, it has also been associated with increased theatre time and higher complication rates. Method A prospective, observational study with box trainers was carried out by novice medical students and trainees to evaluate the efficacy of long duration courses on skill acquisition. The novice group undertook a 5-week curriculum composed of lectures, demonstrations and spaced timed-assessments involving 3 tasks: hoop placement, stacking of sugar cubes and surgical cutting. Results Time taken for novice participants to complete a task individually and collectively improved markedly from the first to the third attempt, with an overall 44% reduction in time observed over the 5-weeks. We invited back 6 novice participants and 6 core surgical trainees after 4-weeks to complete the same tests. There was a further 18% time improvement in the novice group, with 44% faster task completion. Conclusions Given the success of this study and other simulation courses reported in the literature, we recommend more courses adopt a spaced-out approach; and a simulation curriculum for surgical trainees to cultivate greater skill acquisition.

962 COVID-19 And ST3 National Selection in Surgery: What Happens to Core Surgical Trainees When We Remove the Face-to-Face Interview?

IntroductionThe 2020 ST3 recruitment year for Higher Surgical Training (HST) did not have a face-to-face interview due to COVID-19. Candidates were solely scored on portfolio self-assessment alone. We have assessed the impact on Core Surgical Trainee progression into ST3 by comparing the 2020 recruitment year with 2019.MethodTotal numbers of applicants to ST3 for all 7 surgical sub-specialties that recruit at ST3 level were obtained via Freedom of Information requests from Health Education England (HEE). These were sorted by those who were in CST, had completed CST or had an alternative equivalence certificate.ResultsOverall applicant numbers were up in 2020, mainly from an increase in applicants with a Certificate of Readiness to Enter Higher Surgical Training. Overall ST3 positions appointed to were down. CST progression rate was down slightly, with an increase in appointees >10 years since graduation.ConclusionsThe 2020 recruitment year for ST3 HST had a higher number of applicants and lower places available than 2019. The majority of the extra applicants were trainees who have not completed CST in the UK. CST progression rate to HST was down slightly. The lack of face-to-face interview may benefit some candidates graduating >10 years ago.

420 Accuracy of Documenting Complications When Consenting Patients for Laparoscopic Appendectomy

Abstract Background Appropriately performed informed consent acts as a shield against false complaints or claims of malpractice against the doctors. Laparoscopic Appendectomy accounts for a significant portion of general surgical workload hence shows a difference in the patient consenting. Method A proforma was devised which included recognised complications of Laparoscopic Appendectomy and grade of the consenting medical professional. The proforma containing 10 standard complications was then cross-referenced with the consent forms of 38 patients and the documented risks in each form was noted. Result The result showed a wide variation in the documentation of complications based on the grades of the medical professional. Out of 38 consent forms, 32/38 ( 84.21 %) were completed by Junior Grade Doctors out of which 15/32 by FY2 and 17/32 by Core Surgical Trainees (CST) and 6/38 (15.78 %) by Specialist Registrars (SpR). Of the set standard 10 complications, FY2 documented an average of 4.2, CST documented 6.2 and SpR documented 8.16 complications. Conclusions The study showed a need of improvement in the documentation of complications especially among Junior Doctors. Procedure specific complication stickers was developed for a standardised list of complications which will act as a source of information for the patient and prompt doctors to discuss the risks.

525 Automated Continuous Instrument Tracking in Laparoscopic Box Trainers Predicts Performance at Assessment: A Prospective Cohort Study in Core Surgical Trainees

Abstract Introduction Box-trainers enable deliberate practice of laparoscopic skills and can be equipped with instrument tracking metrics to provide feedback. However, the relationship between metrics, assessment outcomes and practice are unclear. Method Core surgical trainees were provided take-home box trainers with SurgTrac™ instrument tracking metrics for practice (eoSurgical Ltd., Scotland, UK). Practice was incentivised by certification and video assessment of a basic task, peg capping. Assessment was by consultant general surgeons, using objective structured assessment of technical skills (OSATS). The following metrics were analysed: task duration, distance moved by instruments, average instrument speed, average instrument acceleration, left- or right-handedness and instrument smoothness. Metrics were correlated to OSATS scores using regression analysis. Threshold for significance was p = 0.05. Results During the study period, there were 1639 peg capping performances by 85 trainees; 103 video recordings were submitted for assessment. All metrics were significantly associated with OSATS score, except instrument acceleration. The multiple linear regression model was highly correlated with actual scores (Pearson correlation 0.658; p &amp;lt; 0.001). Practice was positively correlated with regression model predicted OSATS score (regression analysis; ANOVA p &amp;lt; 0.001). Conclusions Instrument tracking metrics reliably predict OSATS performance and practice improves predicted score. Trainees can use metrics in unsupervised practice and gauge whether they are improving as expected.

643 Near-Peer Surgical Teaching for Junior Doctors: A 16-Month Retrospective Analysis

Abstract Introduction Surgical departments across the UK are having to mitigate service demands, budget constraints and changes to work patterns with their statutory duty to provide high-quality training and education. Securing consultant-led teaching has also become increasingly difficult leading to the rise of near-peer teaching. We evaluate the long-term effectiveness of near-peer surgical teaching for junior doctors. Method We developed a rolling 12-week trainee-led didactic surgical education programme for Foundation doctors and Core Surgical Trainees. Junior doctors delivered teaching to peers with registrar input; session and supervision feedback was recorded using 5-point scales and free-text responses. Results 42 junior doctors responded to our end-of-programme feedback surveys covering December 2018 to April 2020. The overall programme (8.83±1.08/10), relevance (4.62±0.58/5), presentation quality (4.60±0.50/5) and supervisor knowledge (4.81±0.40/5) were rated highly by respondents. Attendees also reported significant improvements in subject knowledge (3.72±0.92/5 to 4.50±0.56/5, P &amp;lt; 0.0001), clinical confidence, presentation and teaching skills. Conclusions Our near-peer teaching programme addressed the educational needs of junior doctors and developed their presentation and organisational skills. Supervision and input from registrars facilitated discussion and reinforced key concepts. The success of this programme highlights the role that trainees can play in designing, developing, and leading an effective surgical teaching programme.

354 Differential Attainment in Surgical Training

Abstract Introduction Differential attainment (DA), according to the General Medical Council (GMC), is the gap between attainment levels in different groups. Attainment measures should cover aspects that include academic performance and career progression. Two such areas in surgical training are the MRCS examinations and ARCPs, both of which are required for progression in a career in surgery. Our aim was to investigation whether socio-economic background was a significant factor for progression in surgical training. Method Data from the GMC for Core Surgical Trainees (CSTs) taking the MRCS examination between 2016 and 2019 and CST ARCP outcomes between 2017 and 2019 were obtained. Socio-economic background was assessed using the Index of Multiple Deprivation (IMD). ARCP and MRCS outcomes were assessed against IMD. Results Trainees from IMD Q1&amp;2 (most deprived) had a significantly higher (p &amp;lt; 0.01) mean number of attempts (1.86) to pass MRCS examinations than trainees from IMD Q4&amp;5 (least deprived) (1.54). IMD Q1&amp;2 were significantly more likely to obtain unsatisfactory outcomes (24.4%) than trainees from IMD Q4&amp;5 (14.2%) (p &amp;lt; 0.05). Conclusions There is clear evidence that differential attainment exists within Core Surgical Training. The reasons for this are likely to be complex and more work is needed to further investigate the relationship.

602 Specialty Training Progression from Core Surgical Training: Is There Evidence from Plastic Surgery of The Importance of Location, Location, Location?

Abstract Introduction Obtaining a National Training Number (NTN) in Plastic Surgery is highly competitive (&amp;lt;40 posts per year), with applicant:post ratios between 3.73 to 4.19 in 2017-2019. Our aim was to compare deaneries for numbers successfully progressing directly from CT2 into a ST3 post in Plastic Surgery. Method Data for surgical trainees progressing directly from CT2 to ST3 (2017-2019) in all specialties was obtained from the GMC. The percentage of those directly progressing that obtained a Plastic Surgery NTN and the total number progressing was calculated. Results A total of 840 trainees obtained a NTN directly from CT2 between 2017 and 2019, 61 of whom did so in plastic surgery. Of those directly progressing, there was no significant difference between deaneries for the percentage of plastic surgery posts obtained. The highest number of trainees progressed from London deaneries (16 total (26%); 7 South, 6 NC&amp;E, 3 NW) and the lowest number from Yorkshire and Humber (1). Conclusions Higher numbers of those undertaking core surgical training in London progress directly from CT2 to ST3 in Plastic Surgery. Low total numbers highlight the competitive nature of obtaining a Plastic Surgery NTN, necessitating many to undertake additional experience prior to obtaining a training number.