Junior Surgical Trainees Research Articles

SP1.14 - Advancing Surgical Education: A Pilot Study Evaluating the Impact of Augmented Reality in Post-Graduate Surgical Skill Training

Abstract Aim The landscape of post-graduate surgical education, influenced by the clinical pressures of the COVID-19 pandemic, has prompted a shift towards prioritizing patient safety and embracing simulated technology for skill development and assessment. This study aims to evaluate the influence of (LapAR™) simulation on the acquisition of surgical skills and the overall training experience for junior surgical trainees. Methods 15 trainees and 2 consultants were recruited across five training sites. Participants used (LapAR™) at home to perform ten appendicectomies, interspersed with LapPass tasks. Objective metrics, including completion time and distance, were quantified, followed by comprehensive interviews. Results Junior surgical trainees demonstrated improvements in completion time, distance travelled, smoothness, acceleration, and ambidexterity during repeated laparoscopic appendicectomies. It is of interest that trainees were meeting consultant benchmarks across all modalities. Qualitative analysis emphasized the relevance of Augmented Reality in early surgical training, advocating for its mandatory integration. Participants sought prolonged access to (LapAR™), acknowledging its value for list preparation, skill acquisition, and knowledge enhancement. Home-based training offered flexibility, contrast to the pressures of traditional surgical environments. Despite technical challenges, (LapAR™) delivered realistic educational benefits. Conclusion (LapAR™) presents a scalable and transformative approach to enhancing surgical skills while addressing common challenges faced by trainees. This study validates its efficacy through improved skills aligned with objective metrics, positive evaluations of educational content, and unanimous agreement on the realism of the simulation. Augmented Reality bridges the gap between surgical training and practice, offering a scalable solution to elevate the standards of surgical education.

772 Assessing the Impact of Gaming Skills on Robotic Surgical Skill Acquisition and Learning Curves

Abstract Robotic surgery has rapidly advanced across various medical specialties over the past decade. Extensive research has confirmed the benefits of robotic surgery, leading to improved surgical outcomes and patient satisfaction. Historically, only highly experienced consultants in laparoscopic and open surgery received training in robotic surgery to the detriment of junior surgical trainees. Virtual reality simulators have introduced gamification to enhance surgical skills. Studies have shown that individuals with gaming experience, musical aptitude, and sports backgrounds exhibit improved psychomotor skills relevant to surgery, including hand-eye coordination, reaction time, and visuospatial awareness. Despite this, there is a lack of research on how gaming and musical abilities impact robotic surgical skill acquisition and learning curves. This prospective, observational, and comparative study involved 15 novice surgeons with no prior robotic experience recruited from various UK medical institutions. Participants were divided into two groups based on their video game experience. While statistical significance was not reached (p 0.26), an observed trend favoured the gaming cohort's performance (M 56.29, SD 57.85) on the robotic surgical simulator compared to the non-gamer group (M 38.41, SD 46.77) possibly due to the limited sample size. Gamers exhibited notably superior reaction time scores (p 0.037) Additionally, gamers demonstrated enhanced overall performance in spatial reasoning and the Beat Saber game, assessing hand-eye coordination, though these differences did not reach statistical significance. This study suggests that video gaming experience may provide novice surgeons with certain advantages when beginning training on the high-fidelity dVSS robotic surgical simulator. Further research with larger participant groups may confirm these findings.

342 Procedure Room Lists for Core Trainees

Abstract Aim To reduce the waiting list times for local anaesthetic (LA) “lumps and bumps” in our trust and simultaneously increase our junior surgical trainees’ logbook numbers and confidence; by piloting a trainee led procedure room list during covid recovery. Method Clinic letters for the 49 patients on the waiting list were vetted for appropriate cases by the firm core trainee (CT) and registrar. The CT liaised with supervising colleagues, admissions, and management to plan and complete ad hoc “procedure room” lists in free slots of the existing theatre timetable. Results From 08/09/22 to 01/12/22 (12 weeks), 27 procedures were completed by junior surgical trainees over seven sessions. The trust’s waiting list for benign local anaesthetic procedures decreased from 49 weeks to 1 week. Trainee logbook numbers for these procedures increased nearly 20-fold compared to similar 12-week periods earlier in training. Comparison in confidence levels of the trainees, as assessed by a questionnaire, increased markedly from the beginning to the end of the project, in suturing, diathermy, and excision of benign subcutaneous lesions. There were no complaints or adverse events. Conclusions This quality improvement project was led from inception to completion by surgical trainees and played a significant part in the trust’s COVID recovery. Trainee delivered “lumps and bumps” lists can be introduced safely within the envelope of existing resources and can lead to improved trainee operative numbers and confidence. We are working to create a formal pathway for these patients and embed this into the local core training curriculum.

Management of common surgical complications

<h2>Abstract</h2> No surgery is ever free of the risk of a complication. As the number of surgeries increase annually, the incidence of complications is expected to rise proportionally. Surgical complications are associated with significant physiological and psychological morbidity and mortality. While there are generic complications that affect all types of surgery, each specific type of surgery in addition carries its own speciality-specific complications. General complications like pain, bleeding, atelectasis, infection and venous thromboembolism are just a few that can complicate the postoperative recovery phase. It cannot be overemphasized that the key to managing surgical complications is preventing them from manifesting in the first place. Preoperative assessment clinics and the implementation of the WHO checklist have allowed the identification and optimization of risk factors. This article explores the prevention and management of common surgical complications which a junior surgical trainee is likely to face.

EGS P15 Role of electronic consent in emergency surgery – A QIP in a high volume surgical emergency unit at a tertiary hospital

Abstract Background The Royal College of Surgeons of England discusses the significance of maintaining a written record of consent in addition to completing the consent form under section 4.10 of the supported decision-making guide to good practice - “any written information given to the patient should also be recorded and copies should be included in the patient's notes”. Studies show high error rates (27–50%) with handwritten consent forms due to poor legibility, incomplete/ inaccurate information, increased variability, and risk of misplacement. The consequences of these errors can lead to poor patient experience as well as unfavourable outcomes at the operational and institutional levels. Missing or incomplete consent is also the most common reason for first case delay (average 1–75mins). This prompted the QIP and generation of a standard template for the common emergency general surgery procedures in a high-volume Surgical Emergency Unit (SEU) at the John Radcliffe Hospital. Methods Procedure-specific Electronic Surgical Consent (eSConsent) template for common emergency general surgery operations was added to the online database to easily be added to the electronic patient record. The format, as outlined below, was designed to allow even junior surgical trainees to adapt and perform the consent process early on in their placement- Results The consent for all the emergency general surgery cases in a given week was reviewed and the compliance to maintaining eSConsent was audited. The first cycle between 20th-26th September 2021 showed compliance of only 18% (9 out of 49 operations). After discussing the audit findings with the members of the surgical team involved in the consenting process in the local meeting and implementing eSConsent, the compliance increased to 83.7% (36 of 43 cases) in the following week, 78% (33 of 43 cases) between 12th-18th November 2021 and 73% (28/38 operations) in the beginning of March 2022. Conclusions A consent form is a medicolegal document. Health care systems have taken advantage of technology to facilitate accuracy and robust monitoring. The emergency surgical consent process can benefit from this to avoid delays, errors and litigation. This transition is justifiable from our results and easily translated to practice particularly by using simple technology demonstrated in our QIP. Challenges including trainee changeover and new recruitments will expectedly affect the compliance of eSConsent but a proper induction to ensure adequate staff education will help overcome this. Weekly data capture has been adopted in our department as a surveillance protocol to ensure adherence and to standardize our practice.

EGS P09 An Ambulatory General Surgical Service, Reducing the On-Call Burden and Improving Patient Experience

Abstract Background The management of acute General Surgical patients is dramatically changing with the emergence of Emergency General Surgery departments. The trend is moving towards consultant-led services, and managing patients on ambulatory pathways. This prospective study aims to demonstrate the impact of a consultant-led ambulatory surgical clinic and primary care telephone access on the acute surgical take in a busy tertiary hospital. Methods Data was collected from March 2021-March 2022. Patients were included via the primary care access line, as well as patient attendances either via surgical assessment unit (SAU), or ambulatory surgical clinic (ASC). Their pathways were recorded i.e. admit, discharge, further ambulatory investigation, listed for surgery. Results Consultants took 6,948 calls from primary care from March 2021–22. 43.7% of patients were given an appointment for ASC, 37.3% admitted to SAU, 3.5% directed to ED, and 15.5% given advice or redirected elsewhere. 54.6% of those seen in ASC were discharged without further follow up, the other 45.4% were either admitted, followed up or added to a waiting list. General Surgery patient attendances to SAU fell from an average of 1020 per month between March to October 2021 to 542 attendances November 2021 to present. Conclusions The introduction of a consultant-led ambulatory service has reduced the on-call burden by half. The dramatic reduction in SAU attendances is likely to be the result of developed ambulatory pathways, improved communication with primary care and Consultant Emergency General Surgeons, and autonomy of Junior Surgical Trainees to redirect ED referrals onto refined and supported ambulatory pathways. A Consultant-led primary care access line has reduced ED attendances and allowed for effective streaming of patients. These changes have improved the patient experience significantly, by directing them straight to specialty with same or next day consultant clinics, and reduced waiting times overall. There has been a significant reduction in complaints and consistent improvement in patient feedback.

Merits and demerits of entrustable professional activities for assessments of surgical residents: A systematic review

: For competency-based medical education (CBME), there has been increasing focus on entrustable professional activities (EPA) as one of the modalities for assessment of competence. This study aims to investigate the effectiveness, the merits and the demerits of EPAs for evaluation of the competency of the surgical trainees. : We performed a systematic literature search in PubMed, EMBASE, MEDLINE, and ERIC. Keywords used for searching included “entrustable professional activity”, “surgery”, “surgical”, “resident” and “residency”. The search was limited to the English language but not limited to the publication time. The searched articles were included in this study if the searched articles were related to “entrustable professional activity” and “surgical residency”. : Included studies were published from 2016 to 2022 and were written in English. : From 67 studies retrieved from the databases, 12 articles were included in this study after screening. There were totally 1990 surgical residents and 1165 faculty included in these studies. : By EPA assessments, it was found the performance of the senior residents was better than that of the junior residents. However, there was no significant difference between junior surgical residents and medical students for the abilities of using concise, clear and comprehensive professional clinical language to do a handover with other health care professionals. There were significant amount of surgical residents had no or faint idea about EPA assessments. Regardless of pre-operative, intra-operative and post-operative assessments, EPAs could be as effective as milestones for evaluation. : EPAs could be a good tool for assessment of the abilities of surgical residents and could differentiate the abilities between senior and junior surgical trainees, but multiple EPAs should be used for comprehensive evaluation and the ability of communication with other professional healthcare givers by using clear, concise and comprehensive clinical language seemed to be left behind.

Perspectives on simulation-based assessment of operative skill in surgical training

Introduction The perspectives of the wider surgical community toward simulation-based assessment (SBA) in training is a gap in the literature. This study aims to explore the factors associated with the acceptable use of SBA in surgical training, through the perceptions and experiences of a broad range of stakeholder representatives, building on findings from a review of the published literature. Materials and methods Ten semi-structured interviews were conducted, using a sequential transformative qualitative methods approach, with representatives from identified key stakeholder groups; executive management, risk management, a practicing surgeon, an anaesthesiologist, a theatre-nursing representative, a representative from simulation industry, a patient, a medical student, a junior surgical trainee, and a senior surgical trainee. Interview transcripts underwent reflexive thematic analysis using an inductive and constructivist framework (NVIVO software, NVIVO 12, QSR International). Results Four themes emerged: the ‘need’ for SBA, the concept of a ‘minimum standard’, the ‘optimum design’ of an SBA framework, and ‘fairness’. SBA is a potential solution to challenges in the current training environment. It emerged that it should not replace trainer judgement, but could ensure that trainees meet a minimum operative competency standard. SBA should be used to identify underperforming trainees early in training to provide targeted remediation. The application of SBA in high-stakes settings such as trainee selection, autonomy granting, and end-of training certification has perceived benefits over current assessment methods. Conclusions This study builds on findings from prior research to explore factors regarding the acceptable use of simulation as an assessment method in surgical training, including perspectives from a broad range of stakeholder representatives. Findings can inform the development of simulation-based assessment curricula in surgical training.

772 Perspectives on Simulation as an Assessment Tool in Surgical Training: A Qualitative Study of Key Stakeholders

Abstract Aim The perspectives of the wider surgical community toward simulation-based assessment (SBA) in training is a gap in the literature. This study aims to generate a conceptual framework regarding the acceptable use of SBA in surgical training, through the perceptions and experiences of a broad range of stakeholders. Method A sequential transformative qualitative methods approach employing constructivist grounded theory was used. Ten semi-structured interviews were conducted representatives from identified key stakeholder groups; executive management, risk management, a practicing surgeon, an anaesthesiologist, a theatre-nursing representative, a representative from simulation, a patient, a medical student, a junior surgical trainee and a senior surgical trainee. interview transcripts underwent content analysis using NVIVO software (NVIVO 12, QSR International). Results Four themes emerged: the ‘need’ for SBA, the concept of a ‘minimum standard’, the ‘optimum design’ of an SBA framework, and ‘fairness’. SBA is a potential solution to challenges in the current training environment. It emerged that it should not replace trainer judgement but could ensure that trainees meet a minimum operative competency standard. SBA should be used to identify underperforming trainees early in training, to provide remediation. The application of SBA in high stakes settings such as trainee selection, autonomy granting, and end-of training certification has perceived benefits over current assessment methods. Conclusions This study generates a conceptual framework regarding the acceptable use of simulation as an assessment tool in surgical training, including perspectives from a broad range of stakeholders. Findings can inform the development of simulation-based assessment curricula in surgical training.

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.

The impact of virtual reality simulation training on operative performance in laparoscopic cholecystectomy: meta-analysis of randomized clinical trials.

BackgroundSimulation training can improve the learning curve of surgical trainees. This research aimed to systematically review randomized clinical trials (RCT) evaluating the performance of junior surgical trainees following virtual reality training (VRT) and other training methods in laparoscopic cholecystectomy.MethodsMEDLINE (PubMed), Embase (Ovid SP), Web of Science, Scopus and LILACS were searched for trials randomizing participants to VRT or no additional training (NAT) or simulation training (ST). Outcomes of interest were the reported performance using global rating scores (GRS), the Objective Structured Assessment of Technical Skill (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS), error counts and time to completion of task during laparoscopic cholecystectomy on either porcine models or humans. Study quality was assessed using the Cochrane Risk of Bias Tool. PROSPERO ID: CRD42020208499.ResultsA total of 351 titles/abstracts were screened and 96 full texts were reviewed. Eighteen RCT were included and 15 manuscripts had data available for meta-analysis. Thirteen studies compared VRT and NAT, and 4 studies compared VRT and ST. One study compared VRT with NAT and ST and reported GRS only. Meta-analysis showed OSATS score (mean difference (MD) 6.22, 95%CI 3.81 to 8.36, P < 0.001) and time to completion of task (MD −8.35 min, 95%CI 13.10 to 3.60, P = <0.001) significantly improved after VRT compared with NAT. No significant difference was found in GOALS score. No significant differences were found between VRT and ST groups. Intraoperative errors were reported as reduced in VRT groups compared with NAT but were not suitable for meta-analysis.ConclusionMeta-analysis suggests that performance measured by OSATS and time to completion of task is improved with VRT compared with NAT for junior trainee in laparoscopic cholecystectomy. However, conclusions are limited by methodological heterogeneity and more research is needed to quantify the potential benefit to surgical training.

Developing and leading a sustainable organization for early career acute care surgeons: Lessons from the inaugural American Association for the Surgery of Trauma Associate Member Council

The associate membership of the American Association for the Surgery of Trauma (AAST) was established in 2019 to create a defined but incorporated entity within the larger AAST for the next generation of acute care surgeons. The Associate Member Council (AMC) was subsequently established in 2020 to provide the new AM with an elected group of leaders who would represent them within the AAST. In its inaugural year, this cohort of junior faculty and surgical trainees had developed for the AM a set of bylaws, a mission statement, a strategic vision, and a succession plan. The experience of the AAST AMC is exemplary of what can be accomplished with collaboration, mentorship, innovation, and tenacity. It has the potential to serve as a template for the creation and vitalization of future professional groups. In this piece, the AMC proposes a blueprint for the successful conception of a new organization.

A Multicenter Analysis of the Early Impact of COVID-19 on Junior Resident Operative Case Volume

IntroductionInstitutions have reported decreases in operative volume due to COVID-19. Junior residents have fewer opportunities for operative experience and COVID-19 further jeopardizes their operative exposure. This study quantifies the impact of the COVID-19 pandemic on resident operative exposure using resident case logs focusing on junior residents and categorizes the response of surgical residency programs to the COVID-19 pandemic. Materials and methodsA retrospective multicenter cohort study was conducted; 276,481 case logs were collected from 407 general surgery residents of 18 participating institutions, spanning 2016-2020. Characteristics of each institution and program changes in response to COVID-19 were collected via surveys. ResultsSenior residents performed 117 more cases than junior residents each year (P < 0.001). Prior to the pandemic, senior resident case volume increased each year (38 per year, 95% confidence interval 2.9-74.9) while junior resident case volume remained stagnant (95% confidence interval 13.7-22.0). Early in the COVID-19 pandemic, junior residents reported on average 11% fewer cases when compared to the three prior academic years (P = 0.001). The largest decreases in cases were those with higher resident autonomy (Surgeon Jr, P = 0.03). The greatest impact of COVID-19 on junior resident case volume was in community-based medical centers (246 prepandemic versus 216 during pandemic, P = 0.009) and institutions which reached Stage 3 Program Pandemic Status (P = 0.01). ConclusionsResidents reported a significant decrease in operative volume during the 2019 academic year, disproportionately impacting junior residents. The long-term consequences of COVID-19 on junior surgical trainee competence and ability to reach cases requirements are yet unknown but are unlikely to be negligible.

Development of a rating scale for objective assessment of performance in laparoscopic appendicectomy surgery.

BackgroundsLaparoscopic appendicectomy (LA) is the most common index procedure for junior surgical trainees. Despite the shift towards competency‐based training, there is no method of quantitatively assessing performance during LA. This study aimed to obtain expert consensus regarding the items required to create a LA Rating Scale (LARS).MethodsA list of steps required for LA surgery, as well as descriptors of “poor”, “average” and “excellent” performance for each of these steps were created for potential inclusion into an objective assessment tool for LA surgery. Using a Delphi method, 20 experts from multiple institutions rated on a Likert scale from 1 to 5 the suitability of these steps and descriptors of performance. Responses were obtained until consensus (Cronbach's α > 0.8) was achieved.ResultsFifteen experts participated in the study. Consensus was achieved for all items during the first iteration of the Delphi with a Cronbach's α of 0.96. The Cronbach's α for the steps was 0.87 and 0.92 for the descriptors of performance. Steps and descriptors of performance that >80% of experts rated as ≥4 were used to create the final LARS tool.ConclusionMulti‐institutional expert consensus was obtained regarding the steps and, for the first time, descriptors of performance for LA, demonstrating their face and content validity, as well as generalisability. Subsequently, the LARS tool was created that can be used to quantitatively assess intra‐operative performance. This instrument can be used to identify weaknesses in performance and facilitate deliberate practice, thus shifting training in LA to a competency‐based approach.

Elective Laparoscopic Cholecystectomy as an Entrustable Professional Activity (EPA) for General Surgical Trainees in Australia

To evaluate the operation time and surgical outcomes of elective laparoscopic cholecystectomy performed by surgical trainees at different levels of training at Eastern health and hence, to establish the efficacy and safety of elective laparoscopic cholecystectomy as an Entrustable Professional Activity for surgical trainees in general surgery. Elective laparoscopic cholecystectomies performed at our institution between January 2018 and January 2019 were included. Analyses were divided among three groups - consultants (C), fellows (F) and registrars (R). Standard technique with critical view of safety was used. A total of 592 patients was included, with a mean age of 54 ± 63 years old. The average operation time was 84 ± 51 minutes. Surgical education and training (SET) 2 trainees took significantly longer when compared to their SET3 and above counterparts as a primary operator (SET2: 131 ± 32 min, Reference; SET3: 78 ± 21 min, p = 0.003; SET4: 80 ± 33 min, p = 0.004; SET5: 77 ± 28 min, p = 0.003; F: 93 ± 77 min, p = 0.036; C: 85 ± 59 min; p = 0.007). Consultant primary operators took an average of 15 minutes longer to complete the operation when assisted by a SET trainee compared to the non-SET registrars (p = 0.03). The overall complication rate was 3.2% and was not significantly different among all three groups (p = 0.17). No death was recorded during the study period. The readmission and return to theatre rates were 7.8% and 0.8% respectively and were not significantly different among the groups (p-values = 0.61 and 0.69). All conversion to open were performed by the consultant primary operator. Elective laparoscopic cholecystectomy can be safely performed by surgical trainees at all SET levels when under appropriate supervision, although junior surgical trainees that is SET 2 took longer to complete the procedure. This operation seemsto have a steep, but relatively short, learning curve and it may be broken down into various components. These components, with the addition of time, may be suitable as an Entrustable Professional Activity tool for assessing the competency of early SET trainees.

SP2.2.6An audit on core surgical trainees’ operating theatre experience to improve compliance against JCST training quality indicators

Abstract Aims The primary aim of this study was to audit the experience of core surgical trainees in operating theatres with a view to devise some interventions to improve the quality of theatre experience. Methods This study was a prospective audit that involved filling out a set proforma by all core surgical trainees working in a busy surgical department of a tertiary care university hospital. The proforma included a breakdown of questions to signpost indicators of quality experience and check compliance with the Joint Committee on Surgical Training (JCST) guidelines. It was completed with particular consideration given to the experience while trainees were on their CEPOD week to facilitate accuracy and relevance of feedback. Results 8 core surgical trainees filled out the proforma. 75% of trainees had the opportunity to reflect the case with the senior surgeon. Lowest compliance was shown for pre-operative discussion of crucial learning points with the senior surgeon. Only 50% of trainees had a chance to do a briefing pre-operatively which is one of the JCST quality indicator for core surgical trainees. Conclusion This audit demonstrates the potential for improvement in the operating theatre experience of junior surgical trainees considering JCST Quality Improvement indicators. A checklist may be introduced to achieve maximum utilisation of the finite training opportunities available to current junior surgical trainees. A loop closing audit after the checklist will be able to assess the change in practice and theatre experience.

TP8.2.15 Higher General Surgical Trainee preferences for Annual Review of Competency Progression during COVID-19 Pandemic

AimsThe COVID-19 pandemic has caused significant disruption in surgical training. We aim to explore the preferences of higher general surgical trainees for Annual Review of Competency Progression (ARCP) also compare the responses across different training grades.MethodsAll higher general surgical trainee in a single deanery were invited to participate in an online voluntary anonymous survey. The respondents were divided in two groups: junior (ST3-ST5) and senior higher surgical trainees (ST6-ST8) and responses compared. ResultsSixty-four of 88 trainees responded. Thirty-three (51.6%) were ST3–ST5, 24 (37.5%) were ST6–ST8 and 7 (10.9%) were out-of-training. More trainees in ST3–ST5 group preferred to defer the next rotation for 12 months (18.2% vs 0%, p = 0.034), repeat current sub-specialty (33.3% vs 4.2%, p = 0.009), or add 12 months to training and delay predicted CCT date by 12 months (18.2% vs 0%, p = 0.034). Most trainees in both groups preferred the option of prolonging training should be offered to all trainees with an option to decline extension if ARCP competencies met (66.7% vs 50.0%, p = 0.276).ConclusionsThe preference for ARCP and length of training was different between two training groups, hence the need of trainees should be considered by training committees when addressing the impact of COVID-19.

982 Higher General Surgical Trainee preferences for Annual Review of Competency Progression during COVID-19 Pandemic

Abstract Aim The COVID-19 pandemic has caused significant disruption in surgical training. We aim to explore the preferences of higher general surgical trainees for Annual Review of Competency Progression (ARCP) also compare the responses across different training grades. Method All higher general surgical trainee in a single deanery were invited to participate in an online voluntary anonymous survey. The respondents were divided in two groups: junior (ST3-ST5) and senior higher surgical trainees (ST6-ST8) and responses compared. Results Sixty-four of 88 trainees responded. Thirty-three (51.6%) were ST3–ST5, 24 (37.5%) were ST6–ST8 and 7 (10.9%) were out-of-training. More trainees in ST3–ST5 group preferred to defer the next rotation for 12 months (18.2% vs 0%, p = 0.034), repeat current sub-specialty (33.3% vs 4.2%, p = 0.009), or add 12 months to training and delay predicted CCT date by 12 months (18.2% vs 0%, p = 0.034). Most trainees in both groups preferred the option of prolonging training should be offered to all trainees with an option to decline extension if ARCP competencies met (66.7% vs 50.0%, p = 0.276). Conclusions The preference for ARCP and length of training was different between two training groups, hence the need of trainees should be considered by training committees when addressing the impact of COVID-19.

79 Remote Delivery of an International Surgical Education Webinar Series for Medical Students During COVID-19

Abstract Aim The 2019 novel coronavirus (COVID-19) pandemic caused the cancellation of lectures and clinical placement-based education for medical students across the UK. With resumption of university teaching, remote delivery via online platforms has seen increased implementation to prevent overcrowding and comply with social distancing measures. This article explores the efficacy of an internationally delivered online surgical webinar series to facilitate undergraduate surgical education on a long-term basis. Method The University of Manchester undergraduate surgical society, Scalpel, in collaboration with three Junior Surgical Trainees designed and organised an online surgical teaching programme aimed at medical students. The syllabus was constructed in accordance with the Royal College of Surgeons England’s (RCSEng) National Undergraduate Curriculum in Surgery. Multiple-choice questionnaires (MCQs) were used to evaluate knowledge during the sessions and Likert scales were utilised to assess subjective improvement of knowledge. The teaching programme was delivered remotely using Zoom (Zoom Video Communications, Inc.). Results he average attendance for the lectures was 68. The reach of the webinar series was international. The average increase in correct answers between pre and post lecture MCQs was +78.7% (+72.4, +18.6, +76.6, +43.5, +161, +100). Likert scale analysis demonstrated 100% improvement of knowledge. Conclusions This study demonstrates a positive outcome to remote, extra-curricular surgical education in the time of COVID-19. The methodology outlined herein has the potential for easy replication on a more widespread scale to provide routine supplementation for medical student and surgical trainee education during the ongoing pandemic.

997 A Systematic Review of Hernia Repair Simulation Models

Abstract Introduction There are barriers to education in both open and laparoscopic hernia repair technique, due to the laparoscopic learning curve, as well as reduced theatre time for junior surgical trainees. This is particularly evident during the current COVID-19 pandemic. Simulation models may provide further opportunities for training in hernia repair outside of the traditional surgical apprenticeship model. Method A systematic review was carried out following PRISMA guidelines to identify and evaluate simulation models in hernia repair. Of the 865 records screened, 26 were found to be relevant. These were assessed for face, content, and construct validity, as well as attempts to assess educational impact. Results Simulation models were identified comprising of animal tissues, synthetic materials, as well as VR technology. Models were designed for instruction in repair of inguinal, umbilical, incisional and diaphragmatic hernias. 4 of the 21 laparoscopic hernia repair models described demonstrated validity across several domains, and 3 of these 4 models were part of simulation-based courses demonstrating transferability of skills learnt in simulation to the operating room. Of the 5 open hernia repair simulation models, none were found to have demonstrated an educational impact in addition to assessing validity. Conclusions Few models individually were able to demonstrate validity and educational impact. Several novel assessment tools have been developed for assessment of progress when performing simulated and real laparoscopic inguinal hernia repair. More study is required, particularly for open hernia repair, including randomized controlled trials with large sample sizes to assess the transferability of skills.