Independent Trainee Research Articles

Outcomes After Independent Trainee Versus Consultant-led Emergency Laparotomy: Inverse Propensity Score Population Dataset Analysis.

We utilized a population dataset to compare outcomes for patients where surgery was independently performed by trainees to cases led by a consultant. Emergency laparotomy is a common, high-risk, procedure. Although trainee involvement to improve future surgeons' experience and ability in the management of such cases is crucial, some studies have suggested this is to the detriment of patient outcomes. In the UK, appropriately skilled trainees may be entrusted to perform emergency laparotomy without supervision of a consultant (attending). Patients who underwent emergency laparotomy between 2013 and 2018 were identified from the National Emergency Laparotomy Audit of England and Wales. To reduce selection and confounding bias, the inverse probability of treatment weighting approach was used, allowing robust comparison of trainee-led and consultant-led laparotomy cases accounting for eighteen variables, including details of patient, treatment, pathology, and preoperative mortality risk. Groups were compared for mortality and length of stay. A total of 111,583 patients were included in the study. The operating surgeon was a consultant in 103,462 cases (92.7%) and atrainee in 8121 cases (7.3%). Mortality at discharge was 11.6%. Trainees were less likely to operate on high-risk and colorectal cases. After weighting, mortality (12.2% vs 11.6%, P = 0.338) was equivalent between trainee- and consultant-led cases. Median length of stay was 11 (interquartile range 7, 19) versus 11 (7, 20) days ( P = 0.004), respectively. Trainee-led operations reported fewer cases of blood loss >500mL (9.1% vs 11.1%, P < 0.001). Major laparotomy maybe safely entrusted to appropriately skilled trainees without impacting patient outcomes.

Content and Engagement Among Plastic Surgeons on Instagram.

Patients routinely use social media to locate providers, review before-and-after photographs, and discuss experiences, making it a powerful marketing tool for plastic surgeons. A few studies have systematically evaluated plastic surgery app content. This study aims to analyze engagement levels and content posted by top plastic surgeon influencers on Instagram (Menlo Park, CA). The authors conducted a cross-sectional study in February 2022 to identify the top 10 global plastic surgeons on Instagram. Influencers were ranked based on the number of followers, and their latest 20 posts were analyzed. A total of 200 posts were categorized by 2 independent trainees as one of the following: marketing, education, personal, and miscellaneous. The number of likes was recorded as a proxy for engagement, and the average engagement for each category was calculated. The top 10 influencers work primarily in private practice focusing on aesthetic procedures. Out of 200 categorized posts on Instagram, marketing posts had the greatest presence (64.5%), followed by personal (20%), miscellaneous (11%), and educational (4.5%). More still images were posted (56.5%) than videos (43.5%). The highest average engagement was for personal content (P = .005). No significant differences in engagement levels were found between photo and video content (P = .24). Although most content posted related to marketing efforts, many influencers were also using social media to post about their personal lives and promote their ancillary businesses. Although marketing content was the most common, engagement levels were the highest for personal and educational content, and no significant differences in engagement were found between videos and photos.

The vascular surgery in-training examination predicts performance on qualifying examination.

Vascular surgery trainees participate in the vascular surgery in-training examination (VSITE) during each year of their training. Although the VSITE was developed as a low-stakes, formative examination, performance on that examination might correlate with the pass rates for the Vascular Surgery Board written qualifying examination (VQE) and oral certifying examination (VCE) and might, therefore, guide both trainees and program directors. The present study was designed to examine the ability of the VSITE to predict trainees' performance on the VQE and VCE. All first-time candidates of the Vascular Surgery Board VQE and VCE were analyzed from 2016 to 2020, including those from both the integrated and independent training pathways. VSITE scores from the final year of training were associated with the VQE scores and the probability of passing the VQE and VCE both. Linear and logistic regression models were used to determine the ability of VSITE results to predict the VQE scores and the probability of passing each board examination. VSITE scores available for the 559 candidates (69.3% male; 30.7% female) who had completed the VQE and 369 candidates (66.7% male; 33.3% female) who had completed both the VQE and the VCE. The linear regression model results for the final year of training showed that the VSITE scores explained 34% of the variance in the VQE scores (29% for the integrated and 37% for the independent trainees). Logistic regression demonstrated that the final year VSITE scores were a significant predictor of passing the VQE for both integrated and independent trainees (P< .001). A VSITE score of 500 during the final year of training predicted a VQE passing probability of >90% for each group of candidates. The probability of passing the VQE decreased to 73% for candidates from integrated programs, 61% for candidates from independent programs, and 64% for the whole cohort when the score was 400. The VSITE scores were a significant predictor of passing the VCE only for the candidates from independent programs (odds ratio, 1.01; 95% confidence interval, 1.00-1.02; P< .01), for whom a VSITE score of 400 correlated with an 82% probability of passing the VCE. VSITE performance is predictive of passing the VQE for trainees from both integrated and independent training paradigms. Vascular surgery trainees and training programs should optimize their preparation and educational efforts to maximize performance on the VSITE during their final year of training to improve the likelihood of passing the VQE. Further analysis of the predictive value of VSITE scores during the earlier years of training might allow the board certification examinations to be administered earlier in the final year of training.

A training curriculum for retrieving, structuring, and aggregating information derived from the biomedical literature and large-scale data repositories.

Background: Biomedical research over the past two decades has become data and information rich. This trend has been in large part driven by the development of systems-scale molecular profiling capabilities and by the increasingly large volume of publications contributed by the biomedical research community. It has therefore become important for early career researchers to learn to leverage this wealth of information in their own research. Methods: Here we describe in detail a training curriculum focusing on the development of foundational skills necessary to retrieve, structure, and aggregate information available from vast stores of publicly available information. It is provided along with supporting material and an illustrative use case. The stepwise workflow encompasses; 1) Selecting a candidate gene; 2) Retrieving background information about the gene; 3) Profiling its literature; 4) Identifying in the literature instances where its transcript abundance changes in blood of patients; 5) Retrieving transcriptional profiling data from public blood transcriptome and reference datasets; and 6) Drafting a manuscript, submitting it for peer-review, and publication. Results: This resource may be leveraged by instructors who wish to organize hands-on workshops. It can also be used by independent trainees as a self-study toolkit. The workflow presented as proof-of-concept was designed to establish a resource for assessing a candidate gene’s potential utility as a blood transcriptional biomarker. Trainees will learn to retrieve literature and public transcriptional profiling data associated with a specific gene of interest. They will also learn to extract, structure, and aggregate this information to support downstream interpretation efforts as well as the preparation of a manuscript. Conclusions: This resource should support early career researchers in their efforts to acquire skills that will permit them to leverage the vast amounts of publicly available large-scale profiling data.

Assessing the Prevalence of Microaggressions in Plastic Surgery Training: A National Survey.

Background:There has been increased awareness of microaggressions occurring during medical training. However, the prevalence and characteristics of microaggressions specifically in plastic surgery residency remain unknown. We aimed to fill this literature gap by conducting a nationwide survey to better understand and characterize microaggressions in plastic surgery training.Methods:A survey was distributed between March and May 2021 via the American Society of Plastic Surgeons Resident Representatives to 1014 integrated and 214 independent track plastic surgery trainees in the United States. Multiple Pearson’s chi-square of independence and Fisher exact tests evaluated comparisons of microaggressions by sex, race, Hispanic origin, sexual orientation, and year in training. A multivariate regression analysis assessed associations between variables.Results:One hundred twenty-five participants responded to the survey (response rate: 10.2%). Of those who responded, 68.8% had experienced microaggressions in the past year. Female trainees experienced microaggressions more frequently than male trainees (P < 0.05). Asian trainees had higher odds to be a target of microaggressions compared with White trainees (P = 0.013). Nonheterosexual trainees were more likely to have experienced microaggressions compared with heterosexual trainees (P < 0.05). Independent trainees were more likely to experience microaggressions than PGY 1–2 and 3–4 integrated residents (P < 0.05).Conclusions:Approximately seven in every 10 trainees stated that they experienced microaggressions in the past year. Females, racial minorities, sexual minorities, and independent trainees had higher odds of reporting that they experienced microaggressions. Further studies are needed to assess the implementation of strategies that address this problem to resolve inequities.

Structure of professional pedagogical competence of a future english teacher

The article discusses the professional and pedagogical competence, structure and foundations of the future English teacher. There are also comments on the content, technological and personal basis, types of competence. In particular, according to the curriculum of higher education, the period of thirteen weeks of pedagogical practice provides an opportunity to work for a temporary period as an independent trainee coach - an English teacher. The spiritual development of the student and the study of English affect not only his consciousness, but also his spiritual experiences, which ultimately contribute to his formation as an expert in the field.

A protocol for a nationwide multicentre, prospective surveillance cohort and nested-consented cohort to determine the incidence and clinical outcomes of slipped capital femoral epiphysis.

AimsSlipped capital femoral epiphysis (SCFE) is one of the most common hip diseases of adolescence that can cause marked disability, yet there is little robust evidence to guide treatment. Fundamental aspects of the disease, such as frequency, are unknown and consequently the desire of clinicians to undertake robust intervention studies is somewhat prohibited by a lack of fundamental knowledge.MethodsThe study is an anonymized nationwide comprehensive cohort study with nested consented within the mechanism of the British Orthopaedic Surgery Surveillance (BOSS) Study. All relevant hospitals treating SCFE in England, Scotland, and Wales will contribute anonymized case details. Potential missing cases will be cross-checked against two independent external sources of data (the national administrative data and independent trainee data). Patients will be invited to enrich the data collected by supplementing anonymized case data with patient-reported outcome measures. In line with recommendations of the IDEAL Collaboration, the study will primarily seek to determine incidence, describe case mix and variations in surgical interventions, and explore the relationships between baseline factors (patients and types of interventions) and two-year outcomes.DiscussionThis is the first disease to be investigated using the BOSS Study infrastructure. It provides a robust method to determine the disease frequency, and a large unbiased sample of cases from which treatment strategies can be investigated. It may form the basis for definitive robust intervention studies or, where these are demonstrated not to be feasible, this may be the most robust cohort study.

A protocol for a nationwide multicentre, prospective surveillance cohort and nested-consented cohort to determine the incidence and clinical outcomes of slipped capital femoral epiphysis

Aims Slipped capital femoral epiphysis (SCFE) is one of the most common hip diseases of adolescence that can cause marked disability, yet there is little robust evidence to guide treatment. Fundamental aspects of the disease, such as frequency, are unknown and consequently the desire of clinicians to undertake robust intervention studies is somewhat prohibited by a lack of fundamental knowledge. Methods The study is an anonymized nationwide comprehensive cohort study with nested consented within the mechanism of the British Orthopaedic Surgery Surveillance (BOSS) Study. All relevant hospitals treating SCFE in England, Scotland, and Wales will contribute anonymized case details. Potential missing cases will be cross-checked against two independent external sources of data (the national administrative data and independent trainee data). Patients will be invited to enrich the data collected by supplementing anonymized case data with patient-reported outcome measures. In line with recommendations of the IDEAL Collaboration, the study will primarily seek to determine incidence, describe case mix and variations in surgical interventions, and explore the relationships between baseline factors (patients and types of interventions) and two-year outcomes. Discussion This is the first disease to be investigated using the BOSS Study infrastructure. It provides a robust method to determine the disease frequency, and a large unbiased sample of cases from which treatment strategies can be investigated. It may form the basis for definitive robust intervention studies or, where these are demonstrated not to be feasible, this may be the most robust cohort study.

European multicenter survey on approaches in pediatric laparoscopic appendectomy

This survey reviewed the practice of laparoscopic appendectomy in pediatric surgical centers across Europe. An online survey questionnaire was created and data obtained analyzed. There were 58 responders (52 Consultants and 6 trainees), of them n = 24 performed > 100 laparoscopic procedures per year. Procedures were performed by trainee with scrubbed consultant supervision n = 30, trainee with unscrubbed consultant n = 14, independent trainees n = 8 and consultants n = 6. Optic port preferences were 10 mm (n = 29), 5 mm (n = 24) and 12 mm (n = 3). Working port placement preference was sectorization n = 32, triangulation n = 16 and n = 10 decided based on intraoperative findings. Mesoappendix was dissected by monopolar hook n = 26, bipolar forceps n = 20, harmonic devices n = 8, and bipolar scissors n = 4. Appendix ligation was done with 3 vicryl endoloops (n = 36), 2 vicryl endoloops (n = 13), 3 polydioxanone (PDS) endoloops (n = 7) and endostaplers (n = 2). Appendix was removed through optic 10–12 mm port (n = 27), exchanging 5 mm for 10–12 mm port (n = 9), endobag (n = 8), sterile glove digit endobag (n = 7), through 5 mm ports (n = 5) and along 5 mm port (n = 2). In complicated appendicitis, n = 48/58 would proceed with laparoscopy on prior confirmed perforation and n = 53/58 would continue with laparoscopy when intraoperative findings showed complicated appendicitis. In the presence of pus, n = 52/58 would perform peritoneal lavage and n = 4/58 would only suction pus. Complicated appendices were removed via endobag n = 30, through 10–12 mm port n = 10, sterile glove digit n = 10, exchange 5 mm for 10–12 mm port n = 7 and along with work port n = 1. Opinions were divided with regards to approach in performing various steps of pediatric laparoscopic appendectomy in institutions throughout Europe.

Considering the interdependence of clinical performance: implications for assessment and entrustment.

IntroductionOur ability to assess independent trainee performance is a key element of competency‐based medical education (CBME). In workplace‐based clinical settings, however, the performance of a trainee can be deeply entangled with others on the team. This presents a fundamental challenge, given the need to assess and entrust trainees based on the evolution of their independent clinical performance. The purpose of this study, therefore, was to understand what faculty members and senior postgraduate trainees believe constitutes independent performance in a variety of clinical specialty contexts.MethodsFollowing constructivist grounded theory, and using both purposive and theoretical sampling, we conducted individual interviews with 11 clinical teaching faculty members and 10 senior trainees (postgraduate year 4/5) across 12 postgraduate specialties. Constant comparative inductive analysis was conducted. Return of findings was also carried out using one‐to‐one sessions with key informants and public presentations.ResultsAlthough some independent performances were described, participants spoke mostly about the exceptions to and disclaimers about these, elaborating their sense of the interdependence of trainee performances. Our analysis of these interdependence patterns identified multiple configurations of coupling, with the dominant being coupling of trainee and supervisor performance. We consider how the concept of coupling could advance workplace‐based assessment efforts by supporting models that account for the collective dimensions of clinical performance.ConclusionThese findings call into question the assumption of independent performance, and offer an important step toward measuring coupled performance. An understanding of coupling can help both to better distinguish independent and interdependent performances, and to consider revising workplace‐based assessment approaches for CBME.

Efficiency and patient experience with propofol vs conventional sedation: A prospective study.

To determine whether anaesthesiologist-administered sedation with propofol (AAP) or endoscopist-administered conscious sedation (EAC) with fentanyl/midazolam shortens colonoscopy duration/total room time. This is a prospective, non-randomized, comparative study that enrolled patients greater than 18 years of age undergoing colonoscopy in a single Canadian academic outpatient endoscopy unit over a three-month consecutive period. Colonoscopies in this unit are performed both with AAP and EAC. Patient demographics, procedure-related data and adverse events were documented. Additionally, the level of procedure difficulty, and whether a staff endoscopist, trainee with assistance, or independent trainee, performed the procedure were documented. A validated modified 4-question, 5-point Likert scale telephone survey was used to assess patient satisfaction with colonoscopy. The telephone patient satisfaction survey was conducted 24-72 h following the procedure. Two hundred and thirty patients were enrolled during the study period with 126 patients in the AAP group and 104 patients in the EAC group. Mean procedure time was 18.3 ± 10.1 min in the AAP group and 14.7 ± 7.1 min in the EAC group (P = 0.002). Mean total room time was 36.8 ± 13.7 with AAP and 30.1 ± 11 min with EAC (P < 0.001). Multivariate analysis revealed the use of AAP (P = 0.002), resident participation (P < 0.001), diagnostic interventions (P = 0.033), therapeutic interventions (P < 0.001), lower body mass index (P = 0.008) and American Society of Anaesthesiologist class (P = 0.016), to be predictors of longer total room time. Patient age and gender were not significant predictors. After excluding cases in which trainees were involved, there was no significant difference in procedure time between the two groups (P = 0.941), however total room time was still prolonged in the AAP group (P = 0.019). The amount of pain experienced was lower with AAP (P = 0.02), with a trend toward overall higher patient satisfaction (P = 0.074). There were 2 sedation-related adverse events, both in the AAP group involving a patient with aspiration requiring hospitalization and a patient with hypoxia managed with bronchodilators. EAC results in reduced total room time compared to AAP. Resident participation doubles procedure time regardless of sedation type.

Laparoscopic Donor Nephrectomy Training in the UK: Results From an Independent Trainee Survey.

Laparoscopic Donor Nephrectomy Training in the UK: Results From an Independent Trainee Survey.

Evaluation of Plastic Surgery Training Programs

The authors aimed to differentiate between combined/integrated and independent (traditional) methods of plastic surgery training with regard to quality of trainees, caliber of graduates, and practice or career outcomes once graduated. To compare combined/integrated with independent residency program training, the authors conducted a Web-based survey of the American Society of Plastic Surgeons members looking at their experience and practice outcomes (n = 1056) and interviews of plastic surgery faculty looking at the quality of trainees (n = 72). The member survey evaluated background information, research credentials, pathway satisfaction, postgraduation activities, current practice, and academic affiliation. Faculty teacher interviews focused on knowledge base, diagnostic and treatment judgment, technical abilities, research capabilities, and prediction of future career success. The member survey showed no difference (p > 0.05) between combined/integrated and independent trainees in practice type (cosmetic/reconstructive), practice volume, or academic achievements. Combined/integrated trained surgeons are three times more likely to recommend their training pathway and two times more likely to enter fellowship after residency. Alpha Omega Alpha Honor Medical Society membership correlated with a greater likelihood of having an academic practice at 5 and 10 years or more and higher professorship titles. Faculty evaluations showed that combined/integrated residents were superior in knowledge (49 percent versus 32 percent) but that independent residents were superior in technical ability (51 percent versus 20 percent) and research (57 percent versus 19 percent). Most faculty were unable to choose a pathway producing superior residents. Regarding future practice outcomes, there was not a superior training pathway. Regarding quality of trainees, there were differences in faculty evaluations, but there was no consensus on a better pathway.

The older patient, the general practitioner and the trainee: patients’ attitudes and implications for training

The training of future general practitioners (GPs) in the management of older and chronically ill patients is assuming increasing significance with population ageing. Such training, however, may be hampered by the reluctance of older patients to consult GP trainees for chronic problem care. This paper reports on a cross-sectional study investigating the attitudes of older patients to GP trainees, to inform strategies to improve older patient-trainee interaction. The primary hypothesis tested was that older patients' acceptance of trainees for their chronic disease management would be improved by strengthening the relational link with their regular GP around trainee consultations. The survey instrument was distributed to 1900 patients aged 60 and over from 38 training practices in five Australian states using a stratified, randomised cluster sampling process. Generalised estimating equation models were used to undertake logistic regression for analysis. The response rate was 47.9% (n=911). Eighty-three percent were happy to see a trainee for a minor problem. Of respondents with a chronic/complex condition, 25.4% were comfortable with independent trainee chronic/complex care, increasing to 77.9% if their usual GP was called in to double-check management. Modelling confirmed increased likelihood of comfort with trainee chronic/complex care with involvement of the regular GP (P<0.001). Strong agreement that their regular doctor was happy for them to see a trainee was associated with frequency of trainee visits (P=0.002); satisfaction with trainee consultations (P<0.001); and comfort in independent trainee chronic/complex care (P<0.001). There is the potential to develop models of trainee chronic/complex care that maintain older patient satisfaction and retain the favourable patient outcomes associated with interpersonal continuity. Strengthening interpersonal continuity of care with the patient's usual GP around trainee consultations, and open communication regarding having trainees involved in their care, appear key to such models. Further research involving prospective trials is required.

Simulator training reduces radiation exposure and improves trainees' performance in placing electrophysiologic catheters during patient-based procedures

Currently, training in interventional electrophysiology is based on conventional methodologies, and a paucity of data on the usefulness of simulation in this field is available. The purpose of this study was to evaluate the impact of simulator training on trainees' performance in electrophysiologic catheter placement during the early phase of their learning curve. Inexperienced electrophysiology fellows were considered. A hybrid high-fidelity simulator (Procedicus VIST, version 7.0, Mentice AB Gothenburg, Sweden for Biosense Webster) was used. The following parameters were evaluated in 3 consecutive patient-based procedures before and after two training sessions of at least 1.5 hours on the simulator: (1) ability to place catheters in conventional recording/pacing sites (coronary sinus, His-bundle area, high right atrium, and right ventricular apex); (2) amount of help provided by the supervisor (scale from 1-3; 3 for maximal help); (3) fluoroscopy time; and (4) positioning time. Seven fellows performed 168 catheter placements during 42 patient-based procedures with no complications. Comparing parameters before and after simulator training, there was a significant reduction in the mean amount of help and in fluoroscopy and positioning times per placement: from 1.71 ± 1.24 to 0.42 ± 0.68 (P <.001), from 121 ± 88 seconds to 76 ± 54 seconds (P <.001), and from 175 ± 138 seconds to 102 ± 74 seconds (P <.001), respectively. Overall fluoroscopy time per patient decreased from 567 ± 220 seconds to 305 ± 111 seconds (P <.0001). Improvement appeared to be related to simulator training alone and not to the previously performed patient-based procedures. During the early phase of the trainees' learning curve, simulator training significantly improves the independent trainees' performance with reduction in radiation exposure.

UK endoscopy trainees provide a significant quantity of service delivery

IntroductionIn September 2009, the JAG Endoscopy Training System (JETS) e-portfolio was launched. Since its release, over 75% of UK trusts have set the system up and over 70 000 procedures...

OC-021 Flexible sigmoidoscopy completion rates. Time to change certification criteria?

Introduction The current JAG eligibility criteria for provisional certification in flexible sigmoidoscopy, state that the descending colon intubation rates should be >90%. This is also true for full certification in this procedure. However, a flexible sigmoidoscopy is often limited by a number of factors such as poor bowel preparation, achievement of clinical intention, patient discomfort and difficult sigmoid looping. In these circumstances, the descending colon is not intubated and it was felt that this occurred more than just 10% of the time. Therefore, we aimed to review 500 flexible sigmoidoscopies performed by independent endoscopists (nurse endoscopists, consultant gastroenterologist/surgeon and trainee gastroenterologist/surgeon) and assess the percentage of descending colon intubation as well as the limiting factors. Methods All flexible sigmoidoscopies that were performed from January 2009 to June 2009 were reviewed. The endoscopist, the extent of the procedure, and the limiting factor(s) if the descending colon was not intubated were all recorded. Results The majority of procedures (65%) were performed by a consultant and 54% of procedures (272/500) reached the descending colon. The independent nurse endoscopists were more likely to intubate the descending colon (72% intubation rate) than the consultant or independent trainee endoscopist. Out of the 46% (228/500) of procedures that did not reach the descending colon, the majority were limited by bowel preparation (36%). 25% did not complete the procedure as the clinical intention was achieved prior to reaching the descending colon and this decision was made by the performing endoscopist, who was a consultant in 93% of these cases. Other reasons include patient discomfort (11%), technical difficulty (stricture or tight bend)(7.5%), colitis (4%) and in a small number of cases, the patient had findings which warranted a full colonoscopy at another time in the future so would return for re-assessment. 12% (28/228) of the incomplete procedures had no clear reason as to why the procedure was abandoned. Only one of these patients had “moderate” discomfort recorded on the pain score and so pain did not seem to be a limiting factor. Conclusion The current JAG certification criteria for flexible sigmoidoscopy are under review and the data here suggest that the descending colon intubation rate of >90% is inappropriate as an eligibility criterion for certification. One of the reasons that the descending colon intubation rate is lower for a consultant is that they are more likely to decide that the clinical intention has been achieved before reaching the descending colon.

New Annie and Willie Nelson Professor says award is music to his ears

New Annie and Willie Nelson Professor says award is music to his ears

Outcome in patients with colorectal cancer managed by surgical trainees.

The surgeon is an important variable that influences outcome following colorectal cancer surgery. Operative training of suitable quality and quantity is essential if intersurgeon variation is to be reduced. The aim of this study was to examine the outcome of colorectal cancer surgery when a high proportion of the operations were performed by trainee surgeons. A prospective 7-year (1989-1996) audit of 306 consecutive colorectal cancers referred to a single general surgeon with a colorectal interest was carried out. The outcome (anastomotic leakage, 30-day mortality rate, local recurrence and cancer-related survival) of operations performed by the consultant was compared with that of his trainees. Some 245 (92.5 per cent) of 265 patients undergoing laparotomy had a resection. Seventy (28.6 per cent) and 67 (27.3 per cent) of operations were performed by supervised and independent trainees respectively. There was no difference between the consultant, supervised and independent trainees for 30-day mortality rate (6.5, 6 and 4 per cent respectively), clinical anastomotic leakage rate (9, 2 and 5 per cent) and local recurrence rate (2, 3 and 7 per cent). There was no difference between the three groups for adjusted 5-year disease-related survival rates. Properly supervised trainees can resect a high proportion of colorectal cancers without compromising immediate outcome or long-term survival. Presented in part to the annual meeting of the Association of Surgeons of Great Britain and Ireland, Bournemouth, UK, April 1997, and published in abstract form as Br J Surg 1997; 84(Suppl): 56