Core Surgical Training Research Articles

Scratching beneath the surface: How organisational culture influences curricular reform.

Curricular reform is often proposed as the means to improve medical education and training. However, reform itself may not lead to noticeable change, possibly because the influence of organisational culture on change is given insufficient attention. We used a national reform of early-years surgical training as a natural opportunity to examine the interplay between organisational culture and change in surgical education. Our specific research question was: in what ways did organisational culture influence the implementation of Improving Surgical Training (IST)? This is a qualitative study underpinned by social constructivism. Interviews were conducted with core surgical trainees (n = 46) and their supervising consultants (n = 25) across Scotland in 2020-2021. Data coding and analysis were initially inductive. The themes indicated the importance of many cultural factors as barriers or enablers to IST implementation. We therefore carried out a deductive, secondary data analysis using Johnson's (1988) cultural web model to identify and examine the different elements of organisational culture and their impact on IST. The cultural web enabled a detailed understanding of how organisational culture influenced IST implementation as per Johnson's six elements-Rituals and Routines (e.g. departmental rotas), Stories (e.g. historical training norms and culture), Symbols (e.g. feedback mechanisms, visibility and value placed on education), Power Structures (e.g. who has the power in local contexts), Organisational Structures (e.g. relationships and accountability) and the Control System (e.g. consultant job plans and service targets)-and how these interact. However, it did not shed light on the influence of exogenous events on change. Our data reveal cultural reasons why this curricular reform met with varying degrees of success across different hospital sites, reinforcing that curricular reform is not simply about putting recommendations into practice. Many different aspects of context must be considered when planning and evaluating change in medical education and training.

Motivators and deterrents for early career female doctors applying to surgical training programmes in the UK National Health Service: a mixed-methods study

ObjectivesTo perform a mixed-methods study identifying motivators and deterrents to female doctors interested in core surgical training (CST). To provide tangible implementations based on the findings.DesignThis study used quantitative (questionnaires)...

Core surgical training: The influence of time and date on interview outcome

IntroductionCore Surgical Training has become increasingly competitive over the last 5 years with the competition ratio reaching 4.16 in 2021 compared to 2.31 in 2015. This is thought to be due to two key factors: a large yearly increase in the number of applicants and an unchanging number of jobs. Steps are taken by HEE to ensure the process is as standardised and fair as possible. Interview date and time selection remains the only aspect of the process that candidates currently control. We aim to explore whether time and date of an interview has any impact on interview scores within CST. MethodsThis study is a national, retrospective cohort study. A freedom of information act request was submitted to HEE to acquire anonymised interview scores and date/time of interview for all CST interviews conducted for the 2022–2023 cohort. ResultsAcross the two-week period whereby interviews were held 1264 interviews were undertaken. Candidates with morning interviews had a mean score of 111 (±16) and candidates in the afternoon had a mean score of 108 (±18.5) (p = 0.023). Candidates interviewing in week 1 had a mean score of 107 (±18) and candidates interviewing in week 2 had a mean score of 112 (±16.4) (p < 0.001). DiscussionA small difference in score has a significant impact for candidates with their geographical location, specialty choice or event enrolment in the core training programme potentially impacted. It is therefore imperative that these findings receive further evaluation going forward to ensure the process is fair and robust for all participants

The Effect of Sociodemographic Factors on Obtaining a Place in Core Surgical Training.

Competition for Core Surgical Training (CST) is rising, placing a strong emphasis on interview performance. Several interview courses offer to help candidates secure their chosen surgical job but at premium fees. A group of London-based CSTs started a free course offering high-quality mock interview experiences to over 90 applicants in 2022, with the aim of providing an accessible opportunity for financially disadvantaged candidates. Course candidates completed three sets of questionnaires, pre- and post-mock interview, and a final one upon job allocation. Candidates' educational background and schooling history were obtained as well as their self-assessment score, eventual rank after interview and the rank of the job they had accepted. The three sets of questionnaires were completed by 87, 73 and 45 candidates respectively. Overall, there was a statistically significant difference in self-reported confidence scores after the course (P < 0.001). There was no significant difference in the self-assessment score of the 44.2% of candidates who had attended private education in the UK, compared to publicly educated (P = 0.0525), nor was there a difference in their rank after interviews (P = 0.236). Candidates who spent £50 or more had higher self-assessment scores (P = 0.042) but they didn't rank higher in overall scores (P = 0.591). Interview preparation courses are helpful in increasing candidates' confidence, however spending more money does not translate into a better overall interview performance. Our study suggests that candidates from private education backgrounds do not have an advantage in the CST application process.

Prognostic value of interview rank when hiring for health: staff and nonsense or significant metric?

Introduction Core surgical training recruitment works via a centralised national selection process, during which each applicant is assigned an interview performance rank. The aim of this study was to evaluate the relative performance of core surgical trainees related to interview rank (CSTIR) in a single UK statutory education body. Methods Data for two cohorts of core surgical trainees (87 individuals) were analysed prospectively over two years (2018–2021). The primary outcome measures were Membership of the Royal College of Surgeons (MRCS) examination pass and specialty national training number (NTN) appointment. Results The overall MRCS pass rate was 67.8% and the NTN success rate was 43.7%. CSTIR &lt;332 was associated with MRCS pass (88.0% vs 59.7%, odds ratio [OR]: 4.90, p = 0.017) and CSTIR &lt;550 with NTN success (57.4% vs 42.6%, OR: 3.56, p = 0.006). Multivariate analysis revealed that NTN appointment was associated with audit completion (OR: 1.49, p = 0.045), scientific publication (OR: 2.08, p = 0.008), CSTIR (OR: 6.02, p = 0.014), universal annual review of competence progression Outcome 1 (OR: 25.10, p = 0.002) and Improving Surgical Training programme (OR: 108.96, p &lt; 0.001). Conclusions CSTIR was independently associated with conversion to higher surgical specialty NTN, suggesting that the current recruitment process predicts likely success in training.

Differential attainment, socioeconomic factors and surgical training.

Differential attainment (DA) is the gap in levels of achievement between different groups; socioeconomic factors are thought to play a significant role in DA. The aim of this study was to review and assess the evidence for DA in early surgical training and to examine the potential influence of socioeconomic status. Data were obtained from the General Medical Council GMC for those taking Membership of the Royal College of Surgeons (MRCS) examinations between 2016 and 2019 and core surgical training annual review of competency progression (ARCP) outcomes between 2017 and 2019. The index of multiple deprivation (IMD) was used as a measure of socioeconomic background. Trainees were then divided into deprivation quintiles (DQ1=most deprived, DQ5=least deprived). MRCS and ARCP outcomes were compared between DQ groups using 95% confidence intervals and chi-square tests. Those from lower socioeconomic backgrounds had significantly lower overall MRCS pass rates (DQ1=45.5%, DQ2=48.9% vs DQ4=59.6%, DQ5=61.5%, p<0.05) and 1st time pass rates (DQ1&2=46.6% vs DQ4&5=63.5%, p<0.001). Additionally, they had a significantly higher number of attempts required to pass MRCS (DQ 1&2=1.86 vs DQ 4&5=1.54, p<0.01). Those from lower socioeconomic backgrounds had a significantly greater proportion of unsatisfactory ARCP outcomes (DQ1&2=24.4% vs DQ 4&5=14.2%, p<0.05). There is clear evidence of the influence of socioeconomic background on DA in early surgical training. However, the reasons for this are likely complex and more work is required to investigate this relationship.

8 The Impact of Early Surgical Training on MRCS Performance

Abstract Aim Surgical training experiences differ across Foundation Programme (FP) and Core Surgical Training (CST) deaneries in the UK. We, therefore, assessed whether MRCS success is associated with FP and CST deaneries. Method UK FP (n=553) and CST (n=1104) trainees who attempted MRCS over a three-year period were included. Chi-squared tests examined univariate associations. Multivariate logistic regression identified the likelihood of MRCS success depending on deanery, adjusted for socio-demographic factors. Results MRCS Part A success was associated with FP deanery (P&amp;lt;0.01). Part A and Part B success was associated with CST deanery (P=0.01). FP trainees from Thames Valley (Odds ratio [OR] 5.75 (95%CI 1.57–20.99) and North, Central and East London (OR 3.66 [95%CI 1.14–11.80]) were more likely to pass Part A than their peers. CST trainees from Thames Valley (Odds Ratio [OR] 2.52 (95%CI 1.00–6.42), North Central and East London (OR 2.37 [95%CI 1.04–5.40]) and South London (OR 2.36 [95%CI 1.09–5.10]) were more likely to pass Part A. CST trainees from North Central and East London were also more likely to pass Part B (OR 10.59 [95%CI 1.23–51.00]). There was no significant correlation between MRCS performance and National Training Survey satisfaction scores. Conclusions MRCS success is associated with FP and CST deanery; however, MRCS performance does not correlate with subjective assessment of teaching or training quality. Academic ability likely has a larger impact on MRCS performance than training experiences with the more popular deaneries attracting the highest performing candidates. These results will be of interest to trainees, trainers, and training deaneries.

888 Utility of a Virtual Mock Interview Course to Prepare Trainees on UK Core Surgical Training Interviews – a Cross-Sectional Study

Abstract Aim To assess the usefulness of a virtual mock interview course to prepare trainees for UK Core Surgical Training (CST) interviews. Method Junior doctors interested in applying for CST attended a one-day interview course delivered by highly ranked surgical trainees. All attendees were invited to complete pre- and post-interview course questionnaires to assess usefulness in improving the confidence and preparedness for interviews. Results A total of 60 trainees attended the course with an 87% (52/60) response rate to both pre- and post-course surveys. Most trainees were FY2 doctors (50%) applying to CST for the first time (78%). Before the course, 60% of attendees reported feeling “not so confident” for their upcoming interview; 38% of participants felt “somewhat confident” whilst 2% reported feeling “very confident.” 100% of doctors found the pre-mock interview presentations “very useful” or “extremely useful”. Matched data revealed an improvement in attendees’ overall confidence (p&amp;lt;0.0001), with 98% reporting they felt “somewhat” or “very confident” and 2% reporting feeling “extremely confident” about upcoming interviews. Conclusions We demonstrate evidence of a successful CST virtual mock interview course that significantly aids preparation and improves confidence for junior doctors.

778 Portfolio for Core Surgical Training: International Doctors’ Experience

Abstract Introduction As the number of international medical graduates (IMG) applying for Core Surgical Training (CST) is growing, the understanding of the portfolio and application system is crucial to succeeding in this competitive application process. We conducted a webinar to grow the awareness of the system, especially amongst doctors still in the process of moving to the UK for surgical training. Method The webinar was part of an online teaching series for IMG doctors run by the SSID society. It was conducted in two separate two-hour sessions using a virtual conferencing tool in September and October 2021. Alongside, it was streamed on Facebook live to grow the reach. The advertising was done via flyers on social media and various WhatsApp groups. Each webinar was delivered by an IMG doctor in CST in the UK where they shared their personal experiences. Feedback was collected after each webinar using an online form generating tool and analysed on Excel. The certificate of attendance was distributed via E-mail. Results The webinar was viewed by 1200 on Facebook Live. Feedback was received from 66 attendees. 96.96% agreed that the webinar improved their understanding of the portfolio and 94.45% agreed they learned about ways to improve their portfolio. 89.39% agreed that they would change their practice after attending this webinar. Conclusions Simple online webinars can improve the understanding of the portfolio requirements for CST amongst IMG doctors. Subsequently, this could allow for early portfolio preparation opportunities, improve application self-assessment scores, and reduce the years needed to get a successful training number.

879 Attitudes to Research and Academic Careers Among Surgical Trainees and Medical Students: A Survey of Attendees at the 2021 Oxford Surgical Innovation Conference

Abstract Introduction Participation in research throughout medical training is essential in developing and implementing evidence-based practice. Increasing competitiveness across many surgical specialties has led to increased desire to participate in research by medical students and surgical trainees of all grades, with the aim of increasing their employability. Method The Oxford surgical innovation conference (OxSI) took place on the 23rd of April. The 121 attendees were surveyed regarding their attitudes to medical research, levels of research experience, and their confidence in seeking out and engaging with research opportunities. Survey respondents included clinical medical students, foundation trainees, core surgical trainees and higher specialist trainees. Results From 121 surveyed attendees at OxSI 2021, we received 88 responses (72%). 90% of respondents were interested in/pursuing a surgical career, with 70% interested in a career in academic surgery specifically. Furthermore, 97.8% agreed that engaging in research and innovation are an important part of surgical training. However only 48.9% were actively engaged in research. Furthermore only 26.2% of respondents were confident in engaging in independent research, with 56.8% stating they would not know how to engage in research or pursue new surgical innovations without outside assistance. Conclusions There is significant interest among medical trainees in research and academic surgical careers. However, many struggle to engage with research due to time constraints, or inadequate exposure to research opportunities. This survey suggests a larger study examining barriers to research exposure and participation could assist in addressing the discrepancy between desire to engage with research and opportunities to do so.

939 Enhancing Core Surgical Training with the Implementation of Key Performance Indicators: A Closed Loop Quality Improvement Project

Abstract Aim The COVID-19 pandemic has brought innumerable challenges to surgical training, especially with regard to theatre opportunities for core surgical trainees. This study aims to evaluate the implementation of training-oriented key performance indicators (KPIs) in supporting trainees to meet the Joint Committee on Surgical Training (JCST) quality indicators for core surgical training. Method A six-month long closed-loop quality improvement project. Two KPIs were developed following discussion with trainees and departmental leads, evaluation of the rota, and review of the JCST quality indicators: theatre/normal-working-day-attendance (T/A) ratio and missed-theatre-sessions/normal-working-day-attendance (M/A) ratio. Our calculations projected a T/A ratio of 1.00 and M/A ratio of 0.20 to be fully compliant with the JCST quality indicators. Data were collected prospectively from eight trainees, who provided feedback on training opportunities and allocation equitability. Results Following implementation of the KPIs, there was a significant increase in the mean T/A ratio from 0.70 (range=0.55–0.82) to 1.00 (range=0.95–1.17) (p=0.03), and a significant decrease in the mean M/A ratio from 0.55 (range=0.45–0.70) to 0.20 (range=0.11–0.22) (p=0.01). There were significant improvements in trainee satisfaction with training opportunities from 50% to 85% (p=0.02) and allocation equitability from 66% to 95% (p=0.01). Conclusions The development and implementation of training oriented KPIs led to increased allocation and fewer missed theatre sessions, enabling trainees to meet the JCST quality indicators. Furthermore, our data demonstrate smaller variances between trainees, thus, highlighting greater equitability of training opportunities. These findings are supported by the improved trainee satisfaction with training opportunities and allocation equitability reported.

29 The Surgical Trainee Personality: Selected or Shaped?

Abstract Aim This study aims to describe the personality differences between trainees at different stages prior to and during surgical training. Method The Mental Muscle Diagram Indicator was distributed electronically to doctors in training in South West London. A total of 553 trainees completed the personality questionnaire. Specifically, there were general surgery specialty (n = 53), core surgical (n = 254), and foundation trainees (n = 246). 52% of trainees were female. Results Women scored significantly higher in the Extraversion, Sensing and Judging personality domains (p &amp;lt; 0.0001), there were no significant differences between genders for ‘Thinking’. One-way ANOVA only showed a significant difference in the ‘Judging’ domain between grades. Tukey's test was performed showing the difference arose from FT to CST (p = 0.008). Two-way ANOVA showed an interaction between gender and grade for ‘Judging’ and as such simple main effects were performed, with alpha = 0.017 to control for type 1 errors. Significant differences were found in the Judging domain between genders during in FT (p=0.002) and CST (p=0.002), and there was no significant difference for SpRs (p=0.15). Conclusions This study demonstrated differences in personality types between trainee stages and gender. These differences appear to decrease as trainees progress through their training, although the cause of this is unclear.

771 Surgical Training for International Doctors in the United Kingdom: How Do We Improve?

Abstract Aim The number of international medical graduates (IMGs) in the various surgical specialties in the United Kingdom (UK) has been growing recently. Owing to the differences in the undergraduate medical training between the UK and other countries, it can be very challenging for IMGs to establish themselves in the competitive surgical training programs in the UK. With that in mind, some International Core Surgical Trainees founded the Surgical Society of International Doctors (SSID) as an initiative to connect, support and promote aspiring international surgeons in the UK. Method SSID was formed by recruiting other committee members with similar backgrounds and interests as leads for education, research, networking, and regional representatives. The society currently has 13 active members, a website - www.surgicalsid.com and an active social media presence. Monthly committee meetings and WhatsApp group chats are used to organise and run various society activities. Results The two projects undertaken so far are: Conclusions Our society is expanding with increasing members and growing interest from medical colleagues, and rising followers on the website and social media. We plan to expand our reach with more events, conferences, research collaborations and opportunities for international doctors.

887 Design and Implementation of a Standardised Protocol to Assess the Pre-Operative Prophylactic Antimicrobial Guidelines in Vascular Surgery – a Trust-Wide Experience

Abstract Aim The project's aim was to design and implement a replicable protocol in order to assess the pre-operative prophylactic antimicrobial prescribing that could be universally applied to all patients undergoing major vascular surgery. Method A retrospective audit was undertaken to establish existing guidelines in circulation and current practice trends at Worcestershire Acute Hospitals NHS Trust. Multiple theoretical models to stratify procedure and infection risks were designed including clean verses dirty site surgery, procedure specific surgery, procedures with or without utilisation of prosthesis, universal one size fits all guidelines. A panel consisting of consultant vascular surgeons, the antimicrobial stewardship lead consultant microbiologist, and a core surgical trainee co-ordinating the project appraised the results. Criteria included ease of implementation minimising prescribing errors, anaphylaxis, and the need for a tailored guideline for different major vascular procedures to determine suitability of the guideline. Results The initial audit signified a need to standardised guidelines in order to provide patients with a standardised care pathway that utilises best practice. In this instance an anatomical approach to the pre-operative prophylactic antimicrobial guideline for major vascular surgery was adopted and implemented at Trust level. Conclusions A replicable protocol has been established in order to appraise, design, and implement antimicrobial guidelines that can be transferable between departments and trusts alike.

WE3.10 The Impact of Simulation Training on Junior Doctors Managing Surgical Emergencies

Abstract Aim The use of simulation for the training of junior doctors in surgery usually involves either practicing technical skills or exercising communication skills. We have identified a gap in crisis resource management training of junior surgical trainees with scenario-based simulation. We have developed a one-day simulation course on general surgical emergencies and evaluated its impact. Methods The course included a human factors presentation and several scenarios of acute surgical emergencies. It was aimed at core surgical trainees, but other junior doctors were invited. High fidelity human simulator (SimMan®) was used and controlled by faculty. Surgical scenarios were selected in order to provide insight for the appropriate resuscitation for acute surgical patients. The impact of the course was evaluated with a post course questionnaire. Results Ten courses were completed between 2015 and 2021. A total of 58 doctors attended, 45 were core surgical trainees. All 51 participants who responded to the questionnaire rated the course “Good (4/5)” or “Excellent (5/5)”. Following the course, of 51 participants, 50 felt better prepared and 51 were confident in recognising unwell surgical patients; 42 felt better prepared and 50 confident in providing resuscitation; 46 felt better prepared and 51 confident in escalating care. During debriefs and on free text feedback, participants frequently reported the course helped develop their non-technical skills. Conclusion The General Surgical Emergencies simulation courses were rated useful by the learners. The course has positively impacted on the preparedness and confidence of junior surgical trainees in recognising unwell surgical patients, providing initial resuscitation and escalating care.

SP3.2.2 Improving Acute Surgical Services and Establishing Same Day Emergency Care Clinic in a District General Hospital

Abstract Introduction Surgical Same Day Emergency Care (SDEC) clinic service is a new challenging trend nationwide. We would like to share our experience establishing SDEC in a DGH setting. Our clinic runs two sessions daily Monday to Friday with capacity of 16 patients. The patients presented for; clinical follow-up post-discharge, radiological imaging and blood tests. All referrals are triaged by specialist nurses, seen by doctors of different grades - core surgical trainees and specialty doctors and supervised by the Consultant on-call. Methods Prospective ongoing audit carried out in SDEC monitoring the number of patients reviewed, diagnosis, investigations and outcome. We audited the documentation on the hospital's electronic system. Results In October 2021, 62 patients were reviewed, 97% had decisions made same day and only 3% required admission to SAU, 50% were allocated to a named consultant, 69% had blood tests, 53.2% had radiological investigations, 25% of patients were discharged with plans to follow up in elective clinics, and 1 patient was booked for elective operation. Our recommendations to improve quality of service were to allocate a dedicated staff nurse and healthcare assistant for more efficient workflow. Improving documentation of outcomes and allocating patients to named consultant for follow up. Conclusion Our model demonstrated successful service to provide semi-urgent care to surgical patients. SDEC has the capacity for more patients and subsequently will offload pressure from the emergency services provided by A&amp;E and surgical admissions unit. This also makes a significant impact for on-call team to allow more focus on treatment of acute emergencies.

EP-364 The new normal in the post-pandemic world: Our experience of organising a three-part webinar series for the CST 2022 Applicants

IntroductionIn the time of COVID-19, the influx in the use of the online platform has been paramount. The surgical world is no exception with the first virtual selection process for Core Surgical Training (CST) 2021 applicants. We, the current core trainees from the Kent, Surrey and Sussex (KSS) deanery organised this three-part webinar series for CST 2022 applicants to aid our future colleagues.Materials and MethodsThe event poster was circulated among the surgical tutors, medical education department across the KSS region, all the foundation schools and to Foundation Trainees Surgical Societies (FTSS) across the UK. It was advertised on Facebook, Twitter, WhatsApp and Eventbrite. Google Workspace was used to manage registered participants and Microsoft Teams were used for the webinars.DiscussionA total of 526 participants registered. 69.9% of them registered through social media whereas 16.4% and 9.8% through the medical education department and word of mouth respectively. The first part covering the CST program overview and self-assessment guidance was attended by 96 of them on 16 November 2021. The second part covering interview stations was attended by 29 participants on 14 December 2021. We received positive feedback from 42 and 8 participants following each webinar respectively. We currently have 88 participants registered for our mock interview sessions planned for late January 2022.ConclusionsThe virtual selection process is here to stay. Well-organised events like this will help the candidates prepare well for their interview as well as helping the current trainees with their teamwork, leadership and organisation skills.

WE3.9 Operative competence should be assessed on a procedure-specific basis: analysis of submitted Supervised Structured Assessments of Operative Performance (SSAOPs) by Core Surgical Trainees in Ireland using Generalisability Theory

Abstract Introduction Competency-based training programmes require reliable summative assessment methods. The aim of this study is to assess the reliability of the Supervised Structured Assessment of Operative Performance (SSAOP) tool in determining the operative competence of core surgical trainees in Ireland. Methods SSAOP scores from April 2016 - February 2021 were analysed. Reliability analyses for assessment of laparoscopic appendicectomy were compared to those across all submitted procedural assessments. Generalizability and decision studies determined the number of assessments and observers needed to achieve a reliability coefficient (G) of ≥0.7 and ≥0.8 (appropriate for low- and high-stakes assessment respectively). Results 2,294 SSAOPs were analysed; 85 were completed for laparoscopic appendicectomy. G ≥0.70 is achieved using a single assessor observing a minimum of 3 laparoscopic appendicectomy cases, though G ≥0.70 cannot be achieved for assessments across a wider group of procedures without large numbers of assessors and cases. G ≥0.80 can be achieved with a minimum of two random assessors each observing 3 cases using the Overall Performance rating, or by two assessors and 6 assessments using the ‘Total Checklist’ score. Reliable assessment of a trainee's skill across all procedures, regardless of sub-specialty, could only be achieved using 89 cases and 7 assessors using the Overall Performance rater, or 67 cases and 9 assessors using the Total Checklist. Conclusion Operative competence should be assessed on a procedure-specific basis. Assessing overall competence across procedures is not feasible in practice. Trainers and trainees should focus on repeated assessments observing index procedures suitable for a given trainee's stage of training.

SP1.2.7 Relative quality of UK post graduate School of Surgery web-site information

Abstract Introduction Internet-derived health care information is increasingly accessed by patients, yet its quality is variable and equivalent educational and training information for medical professionals is less well understood. The aim of this study was to assess the quality of information available on the UK's Post-Graduate School of Surgery (SoS) websites with a validated 20-point tool (WebQual 4.0). Method Eight clinicians (Consultants 2, SpRs 2, Core Surgical Trainees 2, and Foundation Program doctors 2) evaluated SoS web-site quality in three domains: Usability, Information Quality, and Interaction (Likert scale: 1 - very much disagree, 5 - very much agree). Ranked scores were calculated as the sum of domain medians. A separate eight trainee focus group then appraised the top three websites related to COREQ recommendations. Results Inter-rater agreement and correlation was good (rho &amp;gt;0.800, p&amp;lt;0.001). Median (range) overall website score was 3 (2–5) and individual domain scores were: Usability 3.75 (2–5, p=0.001); Information Quality 3 (2–5, p=0.001); Interaction 3 (2–5, p=0.001). The three highest ranked Deaneries were HENW, HEEE, and HEKSS with scores of 14, 13.5 and 12 (out of 15) respectively. Focus group priorities included: minimising text, embedding educational and extracurricular content, and clear hospital placement mapping. Conclusion UK SoS website information was in general poor, with greater than two-fold variance in overall quality. Improved web-site standardisation should help and enhance trainee application and career progression.

SP7.3 Behind Every Stereotype is a Grain of Truth: Perceptions of a Career in General Surgery Amongst Doctors

Abstract Introduction General Surgery (GS) educational community of practice faces crisis. Recruitment challenged by cultural norms of postponing post-foundation training; and retention with perceptions of elitism, discrimination and inflexibility. Surgical pedagogy has been examined through skill acquisition but what of the hidden curriculum. Three research aims were posed: who is a General Surgeon, what are the enablers or barriers to pursuing this career and is our current UK training system fit for purpose. Methods Qualitative methodology within a constructivist research paradigm was utilised. Recruitment via the snowballing technique included representative sampling of junior doctors, including men, women and those from diverse ethnic backgrounds. 1:1 Semi-structured interviews explored participant perspectives of training, recruitment and work-life balance. Data was transcribed, familiarised, de-constructed and generated. Latent data analysis, coding and development, maintained reflexivity. ‘Data sets’ were transformed to a thematic map and key themes identified. Results and Discussion Foundation, specialty doctors, core and higher surgical trainees were included (60% men, 40% women). Fundamental themes of support, attitudes and sacrifice were identified, interacting to influence educational narrative. Support comprised personal, institutional, academic and cultural forms. Attitudes of elitism, implicit and explicit gender bias, microaggressions and overt discrimination concealed as surgical tradition. An overarching concept of sacrifice was noted: personal, professional, fiscal and emotional, the so-called surgical currency. Conclusions The study explored phenotype, motivation, intellect and philosophy within GS. Highlighting issues in the system surrounding negative attitudes, cultures and behaviours, education is a powerful tool which can be used to challenge perceptions and improve training.