Postgraduate Surgical Training Research Articles

Revision Rates in Cosmetic Plastic Surgery with and without Resident Involvement.

Changes in surgical education have caused concern over residents' preparedness for independent practice. As the field of otolaryngology requires such a wide breadth of expertise, ill preparation becomes especially costly. This study explores how the presence and participation of a postgraduate year 3 (PGY3) otolaryngology resident in surgery impacts revision rates and operating time as gauges for the resident competency and indirect training costs. A retrospective chart analysis of patients who underwent cosmetic plastic surgery at sites for PGY3 otolaryngology residents' facial plastic surgery rotations was conducted. Residents performed one side of bilateral procedures (eg, blepharoplasties) and approximately 50% of midline procedures (eg, rhinoplasties). Chi-squared testing and odds/risk ratios were done to assess the effect of resident involvement on revision rates. Operating time was compared using t tests. When a resident was involved in cosmetic surgery, the revision rate was 22.2% compared with 3.6% without. The likelihood of a future revision surgery was 7.57 times higher when a resident participated in the original operation. Resident involvement was not a statistically significant predictor of exceeding the allotted operating time. The revision rate of cosmetic surgery was much higher when a resident was involved. Otolaryngology residents would benefit from increased facial plastic and reconstructive surgery training. As a response to this analytical study, this clinical rotation was moved to be offered at a later stage of postgraduate surgical training to allow residents to gain more experience and be better set up for success in the rotation.

Surgical trainee experiences from 2013 to 2023 within the United Kingdom as reported by the General Medical Council National Training Survey

IntroductionThe General Medical Council (GMC) issues annual surveys to all doctors within the United Kingdom (UK) in a formal postgraduate training scheme. This facilitates the monitoring of experiences for quality assurance purposes. Low job satisfaction has been associated with heightened levels of burnout and staff turnover, alongside deteriorating clinical care and productivity levels. MethodsWe gathered and extracted data from the publicly available online GMC reporting tool. Data ranged from 2013 to 2023 and spanned 12 postgraduate surgical training programmes across all 18 indicators available. In total, 198 individual metrics were recorded, in addition to burnout. We conducted trend analysis and yearly average mean scores for individual metrics, burnout and geographical differences for 141 individual training programmes within the 16 training regions. ResultsOf the 198 metrics analysed, 83 (42 ​%) were found to have statistically significant negative trends (P ​< ​0.05), in comparison to 24 (12 ​%) with positive trends. 5 specialities had over 50 ​% of metrics showing a significant negative trend. Overall satisfaction was negative in all 12 programmes, with eight reaching significance (P ​< ​0.05). Of 141 individual training programmes, 29 ​% showed a significantly negative trend in overall satisfaction, with 1 ​% demonstrating a significant positive trend (P ​< ​0.05). ConclusionOur study is the first to explore long-term trends in trainee reported surgical training experiences within the UK. Our data have revealed widespread worsening trainee reported experiences and dissatisfaction across multiple specialities and geographical regions, especially in key areas of overall satisfaction, self-development, and clinical supervision.

Impact of COVID-19 pandemic on surgical residency: Residents' perception

BACKGROUND: World Health Organization declared COVID-19 outbreak a pandemic, and till the month of March 2023, globally, there have been 761,402,282 confirmed cases of COVID-19, including 6887,000 deaths. In India, almost 44,707,525 cases been recorded till date. Here, almost 30,000,000 cases been recorded after the second wave. The working force fighting this pandemic is majority formed by resident doctors all over the country and globally. MATERIALS AND METHODS: This study was conducted among 110 residents pursuing postgraduation in surgery and allied departments in various training institutions in Tamil Nadu for a duration of 6 months (after the second wave). A pretested and validated questionnaire was formulated to assess the effect of COVID-19 pandemic on surgical trainee's residency program from their perspective. The questionnaire contained basic social-demographic details and general information like the details of surgical specialty they are admitted to, the overall details of changes in their surgical residency experience in the times of COVID pandemic and the changes faced by them in their day-to-day clinical, diagnostic, and surgical learning. The questionnaire also investigated the redeployment status of the surgical trainees to COVID treatment units and their perspective on the changes in their clinical research and surgical skills training. RESULTS: The study participants, 66%, were aged between 25 and 30 years, followed by 30 and 35 years (25.5%). Almost 80% of the participants belong to the final year of postgraduation; 67.3% of surgical trainees strongly perceives and all 100% of them accept the fact that their surgical residency has been affected by the ongoing pandemic. Fifty percent of the trainees were redeployed to COVID duties for 8 h a day shift and rest attended a minimum of 4 h of COVID duties. More than 75% of the residents had COVID duties of 5–10 h/day and more than 90% of these redeployed trainees involved in COVID duties have expressed that they had been suffering from extra stress and more than 60% were suffering from stress grade between 5 and 10 suggestive of high-stress level. Fifty-nine percent of the postgraduates in the current study mentioned that they require extra-surgical or skill-based training after their postgraduation period. CONCLUSION: The influence of COVID-19 on surgical trainees in various institutions of India has been immense due to overburdening of health systems by the large population of the country. Second wave of COVID, especially, has drastically changed the postgraduate surgical trainees' lives. Detrimental effects are not restricted to operative and clinical experience but also the mental health and well-being of them. The observations of the present study make recommendations for the future provision of training through skill-based surgical simulations so that the lost days of their trainings can be compensated and they become the confident surgeons of the future.

920 Regular Formal Surgical Skills Training for Undergraduates - an Easy Way to Increase Enthusiasm for Postgraduate Surgical Training?

Abstract Aim Despite the publication of a clearly defined surgical curriculum by the Royal College of Surgeons of England, the availability of surgical training opportunities at medical school remains highly variable [1]. While one-off training days can increase students’ surgical skills confidence, we wanted to explore the effect of a regular skills course on students’ skills confidence, and the effect this had on their willingness to attend theatre lists and purse surgical training after graduation. Method We designed a 6-session training program covering the Basic Surgical Skills curriculum produced by the RCS. It also included robotic surgery simulation. The course was run twice due to high demand for places. Core trainees were recruited to help supervise the course. The course was sponsored by both ASiT and Medtronic and was free for attendees. Results The course received excellent feedback. Free text sections highlighted how regular skills training allowed for consolidating learning. Attendees were significantly more likely to feel confident in performing all the techniques covered after the course (Chi Squared, p &amp;lt; 0.05). 16/17 attendees (94.1%) candidates agreed that the course filled a gap in what teaching is provided by the medical school, and all attendees felt more confident attending theatre lists after attending the course. Of note, most students agreed the course had increased their inclination towards a surgical career (12/17 70.2%.). Conclusions The course highlights the importance of regular surgical skills teaching. It also highlights an important knock-on effect of making students more confident attending lists, and more likely to pursue surgical careers.

Educational Environment in Operating Theatres of Bangladesh: Views of Surgical Trainees and Trainers

The quality of the educational environment in the operating theatre is one of the key determinants for the effective training of surgical trainees. This descriptive cross-sectional study was aimed to evaluate the views of postgraduate surgical trainees and their trainers to identify the strength and weaknesses of the educational environment of the operating theatres of Bangladesh. Data were collected by physical means from 349 surgical allied trainees of 14 different disciplines who are having a minimum of three months of working experience in operating theatre as postgraduate trainees. To evaluate the perception of trainees’ internationally validated questionnaire STEEM consisting 40 items was used. To highlight the perspective of Bangladesh, an additional self-made questionnaire consisting ten items was also used. Both questionnaires have five answering options (1-5) for each item as per Likert scale. A score of 60% was considered as satisfactory. To have more vivid ideas six sessions of focus group discussion with trainees and12 in-depth interviews of trainers with minimum five years of teaching experience in his/her specialty from most of the surgical disciplines were also carried out. In this study, the reliability score of STEEM and the self-made questionnaires were 0.757 and 0.730 respectively as determined by Cronbach’s alpha. In general, the perception of trainees regarding the educational environment in OT of Bangladesh was grossly satisfactory with a mean score of STEEM 134.32±14.05 (67%) and 36.80±5.25 (73%) for self-made questionnaire. But group D subscale of STEEM (workload, support and supervision) failed to reach satisfaction level with a mean score of 20.89±5.36 (52%) and the difference between the four subgroups of STEEM was statistically significant. The satisfaction level of juniors in group B subscale of STEEM (perception of learning opportunities) was significantly higher than seniors. The perception between trainees of different disciplines was also statistically significant. From focus group discussions of trainees and in-depth interviews of trainers, this study revealed that trainees’ felt deprived of ‘hands on’ training and perioperative briefing either due to the huge workload or long learning curves of the junior faculties. Quality of training is somehow neglected due to physical absence of faculty members after routine office hour and also because of deficient simulation or skill lab. Trainees also claimed that their financial hardship making them bound for extracurricular activities compromising their full-time residential training. The overall educational environment in operating theatres of Bangladesh as perceived by trainees and trainers is satisfactory. To ensure the full engagement of the trainees under the direct supervision of faculties curriculum should be upgraded with the provision of a modern skill lab, workload should be managed and their financial issues need to be addressed sympathetically by the appropriate authority. Bangladesh Journal of Medical Education Vol.14(2) July 2023: 33-44

Feasibility of Implementing Mini-Clinical Evaluation Exercise (Mini-CEX) as a Formative Assessment Tool in Postgraduate Surgical Training

Background: Mini-CEX (Mini Clinical Evaluation Exercise) is extensively used in the west as a Workplace-based Assessment (WPBA) tool. However, its utility remains an infrequent in postgraduate medical training in Pakistan. Methods: Forty-eight mini-CEX sessions involving 11 faculty members and 15 postgraduate trainees were conducted over a 3‐month study period. Standardized American Board of Internal Medicine Mini‐CEX evaluation form was used to evaluate the students. The faculty and trainees were asked to provide feedback for these sessions on questionnaires consisting of close‐ and open‐ended questions. Results: Faculty satisfaction with mini-CEX was high, with all agreeing that it was an appropriate method of trainees’ assessment and teaching, and that it should be included in the curriculum. However, two-third of the faculty felt that it was not possible to assess students through mini-CEX more frequently. All trainees agreed that the sessions made them aware of their weaknesses and strengths. However, majority (73.3) complained that they were not given a chance to give reflection on their performance during the feedback session. Both residents and faculty suggested to incorporate Mini‐CEX in curriculum. Conclusion: It is feasible to use mini‐CEX for formative assessment of residents. Keywords: Workplace-based assessment, mini-clinical evaluation exercise, feedback

Variant anatomy of non-recurrent laryngeal nerve: when and how should it be taught in surgical residency?

While the performance of a thyroidectomy is generally associated with a low risk of injury to the recurrent laryngeal nerve (RLN), the presence of a non-recurrent nerve (NRLN) increases the risk of this complication. Generally, the intraoperative detection via visual appreciation of variant anatomy of the RLN has been regarded as poor, possibly due to a lack of knowledge of both the normal and aberrant anatomy of the RLN. Articles for the review were searched through PubMed using the search terms and their combinations: "non-recurrent laryngeal nerve," "thyroidectomy," "injury," "palsy," "variant anatomy," and "residency," from January 1, 2000, to December 2022. Papers considered for the review were the articles published in English, with additional classic and articles of surgical importance retrieved from the reference list of papers. Only papers relevant to the scope of the review were considered for this review. The NRLN has been found to be associated with concurrent vascular abnormalities, such as the presence of an aberrant right subclavian artery (ARSA) or an arteria lusoria originating from the aortic arch. However, it seems that both the normal as well as aberrant anatomy of the RLN is currently not emphasized enough during postgraduate surgical training. With the increased use of intraoperative neuromonitoring (IONM), detection of NRLN has become possible through appropriate neural mapping during thyroid surgery, besides other pointers such as visualization during surgery, computerised tomography, and duplex ultrasound scans to visualize the variant vascular anatomy. There is also a possible role for cadaveric courses, either during medical school or in a post-graduate setting-adapted to the student's level to teach the variant anatomy. With the development of newer techniques such as artificial intelligence, there are potential new options for teaching and training anatomy in the near future. Adequate knowledge of the normal and aberrant anatomy of the RLN remains essential for the best outcomes in thyroid surgery, even in the era of the IONM. Moving forward, the knowledge of (aberrant) anatomy should be made an integral part of the core competencies of both medical students and surgical trainees. It is imperative that leaders of the different field work closely together to combine their knowledge towards providing their trainees with the best possible training options.

IMPACT OF COVID-19 PANDEMIC IN THE TRAINING OF SURGICAL POSTGRADUATES, IN TEACHING MEDICAL COLLEGES AND HOSPITAL ACROSS KARNATAKA, INDIA

Purpose of the study Post Graduate surgical training is a well-structured, surgically oriented program which helps in training and grooming of PG students to excel as surgeons and teachers in the future. COVID-19 pandemic has altered the lives of the whole medical fraternity to say the least, but this impact over the PG Training programs has been enormous, especially on the surgical fraternity. Our aim was to understand the impact of covid-19 pandemic in the training of surgery residents in hospitals across Karnataka and to come up with a suitable solution to mitigate the effect of covid 19 pandemic on the training programme. An online survey of 11 questions with sub-questions ha Design ving multiple choice answers were circulated amongst post-graduate students in surgery department and faculty members to study the impact of the pandemic in post-graduate surgical training. 156 PG trainees and 55 trai Results ners participated showing there was significant impact on elective and emergency surgical training. Majority of the surgical trainees haven't performed elective or emergency surgeries required for their level. 78% responded that there was inadequate exposure to Post-operative and in patient care. 89% said their clinical skills were inadequate and 75% r e s p o n d e d t h a t p o s t g r a d u a t e s a r e m e n t a l l y s t r e s s e d a n d h a v e l o w c o n f i d e n c e . Conclusion Covid 19 pandemic had a significant impact on the surgical post graduate training programme on trainee as well as on the trainers, across Karnataka. As a result of the pandemic, most of the young postgraduates are mentally stressed with low confidence in performing or assisting surgeries and in clinically evaluating patients. The Government and medical council should take serious consideration of the plights of PGs and come up with a suitable solution to control the damage and to be prepared in future to face such a problem with minimal effect on training programmes

33. Microsurgical Simulation Training Enhances Medical Student Acting Internship Experience

Background: Microsurgical education typically does not begin until surgical residency, and requires significant investment of time and practice.1,2 Various models and simulations have been reported to support microsurgical training, and have mostly focused on post-graduate surgical trainees.3 It has been demonstrated that medical students are capable of learning microsurgical techniques and exposure to microsurgery may improve their interest in plastic surgery.4 There is limited literature on how exposure to microsurgery training influences senior medical students applying to plastic surgery residency. Methods: Fourth year medical students completed a four hour, individual training session with expert microsurgeon (WZ) during their acting internship. Pre-training and post-training survey responses were compared using Wilcoxon signed rank test. Results: Twelve medical students completed the training session. Eighty-three percent of students (10/12) came from institutions without a microsurgery fellowship program. Two-thirds of students had no prior hands-on microsurgery experience. Ninety-one percent of students (11/12) were either extremely or somewhat uncomfortable performing end-to-end anastomoses of synthetic vessels. After the session, 58% of students (7/12) felt extremely or somewhat comfortable, with only 17% feeling somewhat uncomfortable (p=0.003). All students rated the session as very or extremely useful, with 91% finding the level of instruction and skills practiced reasonable. When asked to rank their interest in plastic surgery subspecialties, one-third of students ranked microsurgery higher than they did prior to the training session (p=0.450). Ninety-one percent of students reported that it was important for them to be at a residency program that would prepare them to perform microsurgery independently after graduation. Conclusion: Medical students can successfully learn microsurgical skills, including vessel anastomoses, in just a single training session. Hands-on microsurgical practice opportunities enrich the acting internship experience, and may inspire greater medical student interest in the subspecialty as well as the hosting residency program. A microsurgical curriculum for medical students is in development, with plans to further optimize learning and professional growth.

545 Review of the Validity of DOPS as an Assessment Tool for the Procedural Skills of Surgical Trainees

Abstract Introduction Surgical trainees at all stages are mandated to use workplace-based assessments (WBAs) to gain feedback from their trainers. Direct observation of procedural skills (DOPS) is a tool to assess hands-on surgical skills. This review of the literature seeks to ascertain how valid DOPS are as an assessment tool for the procedural skills of surgical trainees according to the APA (American Psychology Association) validity framework. Method Relevant literature was identified through a structured search of Medline, CINAHL and web of science databases, with further papers included on citation review. Following this, papers meeting the inclusion and exclusion criteria were included in the final review specifying those investigating WBAs including DOPS, assessments in practice rather than simulation and specifically for post-graduate surgical trainees. Results 16 papers were included in the final analysis. Extracted data from the returned papers was assessed for evidence of validity within each of the five domains on the APA framework: validity based on consequence, response process, reliability, content, and relationship to other variables. Conclusions There are studies that show good parameters for reliability and validity for specific DOPS used in endoscopy and otolaryngology. However, there is confusion over the purpose of DOPS amongst trainers and trainees as to whether they should be used formatively or summatively. There is a wealth of evidence examining the perspectives of trainees and trainers into the summative nature of DOPS, however future research should be conducted into to validity of DOPS as a summative tool for career progression and selection processes.

Surgical residency training program in Somalia: Outcomes of 8 years

Objective Improving global surgery through postgraduate medical training in Africa is needed. In this context, implementing surgical residency programs into international developments for global surgery might play a great role to achieve successful results in low-income countries. The aim of this study is to provide insight about postgraduate surgical training program that was initiated in Somalia where there was no prior formal surgical residency program. Methodology General surgery residency program was initiated within the collaboration of Istanbul Medeniyet University and Benadir University. Medical doctors from Somalia, who were successful on enrollment exams, were selected for program. All residents completed a 3-year of theoretical and practical training, continuing 2 months at Istanbul Medeniyet University Department of General Surgery each year. Results Since 2013, 24 residents graduated from the program and 22 of them currently work as attending physicians in Somalia. Abdominal wall hernias, proctological diseases, cholelithiasis, thyroid diseases and breast diseases are the most common pathologies within the elective operations by graduated general surgeons. Also, appendectomy, infection-induced perforation or ischemia of colon and small bowel and acute mechanical intestinal obstruction due to tumors and adhesions are the most common emergency surgeries. Interventions due to blunt and penetrating trauma are frequently performed. Conclusions This surgical residency program provides surgical care and supports health systems in Somalia. We believe such programs are important to reduce global burden of surgical diseases.

Training and Assessment in Urology: Perspective From a Third World Country.

Formative assessments are an essential yet often overlooked aspect of postgraduate surgical training. This report explores the strategies by which formative assessments are integrated into postgraduate surgical training in Pakistan (using urology as an example), by comparing the regional recommendations and infrastructures offered by local governing bodies to that of a more structured system, as offered by the General Medical Council (GMC). The College of Physicians and Surgeons Pakistan (CPSP) serves as the de facto local accrediting body for postgraduate surgical training and makes a conscious effort in maintaining the standard of training throughout the country. However, although formative assessment activities are encouraged in its roster, they are rarely monitored as strictly as summative outcomes. This is a far cry from how the structured format is exemplified by the GMC’s various guidelines and protocols. It must be emphasized that in order to improve the overall quality of training, measures need to be made to improve the ways in which feedback and formative activities are implemented and monitored.

Surgical trainees achieving the CanMEDS roles in the COVID-19 era: What have we learned and where do we go?

Summary The COVID-19 pandemic has substantially changed the practice of medicine with a shift to virtual clinical encounters, alternative management of surgical diseases owing to restrictions on elective operations, and physician redeployment to other medical services requiring coverage. These changes may limit opportunities for trainees to gain surgical expertise and have the potential to drastically affect postgraduate surgical education. However, the pandemic has also created a number of opportunities to navigate these challenges and enhance how surgical education is delivered. For example, there are now more learning opportunities available to trainees because of virtual educational sessions. We highlight some considerations in adapting postgraduate surgical training to achieve competency in the CanMEDS roles in the COVID-19 era.

Ethical perspectives on the Japanese guidelines for cadaver surgical training (CST).

Cadaver surgical training (CST), which aims to maintain patient safety, provided anatomists with new duties and increased their workload. In Japan, with development of relevant guidelines, CST programs have been implemented and promoted mainly by surgical societies. This paper examines ethics of and anatomists' attitude toward the Japanese CST guidelines. The guidelines were well established to ensure that ethical issues such as financial exploitation and commercialism involved in procurement of cadavers for training do not emerge, as these can create the dilemma of how to allocate cadavers for undergraduate education and postgraduate surgical training, given the increase in demand for cadavers. Fair allocation must accommodate and respect the donor's advance will. Also, the guidelines must offer more detailed commentary on informed consent, particularly with regard to disclosure of information to donor candidates. The guidelines should explain better the legality of CST, the roles of anatomists, and surgeon preparedness.

Start small and aim big in conducting a basic surgical skills workshop for medical students

Introduction: Medical students (MS) may lack the knowledge and experience in performing basic surgical skills (BSS) when they first commence their postgraduate surgical training. We conducted a pilot BSS workshop with specific learning outcomes for MS. Methods: Our BSS workshop program consisted of reading the pre-workshop online modules, watching the instructional videos of skills demonstration, and completing the pre-workshop multiple-choice questions (MCQ). MS attended the onsite workshop a week later, which consisted of a basic surgical theory lecture, live demonstration of the skills by the teaching faculty and, supervised skills training coupled with feedback. Surgical skills taught were knot tying, suturing techniques, laparoscopic peg transfer, precision cutting, application of endoloop ties. A standardised surgical skills rubric was used to assess the competency and safety of BSS. A post-workshop MCQ was administered to assess the knowledge learned. The criteria for successful completion of BSS were a satisfactory grade in the surgical skills assessment and a pass score in the MCQ. Results: All the participating MS achieved a satisfactory grade in the surgical skills assessment and passed the MCQ. Several pedagogical methods were used to enhance knowledge learning and practical skills competency including a flipped classroom in blended learning, technology-enhanced learning, kinesthetic learning, and providing effective feedback. Conclusion: MS taught in BSS workshop can achieve competency in knowledge, skills, safe attitude and prepare them for future postgraduate surgical training. In the current COVID-19 pandemic, our challenge is to develop similar BSS in a safe environment using technology-enhanced tools such as online instructional videos and online feedback.

Current Concepts in Gender-Affirming Surgery Postgraduate Training.

Background Recent advocacy efforts and expanded insurance coverage has increased health care utilization among transgender patients. Therefore, it is pivotal that surgical residents are properly trained to care for transgender patients in both clinical and surgical settings. Yet, no formal curriculum or training requirements exist for surgical residents. The aim of this systematic review is to understand the surgical trainee's postgraduate education and training with respect to transgender health and gender-affirming surgeries (GAS). Methods A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant literature search was performed on December 04, 2020 in PubMed, Elsevier Embase, and Wiley Cochrane Central Register of Controlled Trials. The retrieved hits were screened and reviewed by two independent reviewers. Results Our literature search identified 186 unique publications, of which 14 surveys and one interventional study from various surgical specialties including plastic surgery, urology, otolaryngology, oral and maxillofacial surgery (OMS), dermatology, and obstetrics and gynecology (OBGYN) were included in this study. The majority of residents and program directors in surgical specialties believe education related to transgender health is important, and the current exposure in surgical training does not sufficiently prepare surgical residents to care for this marginalized population. Conclusion Current postgraduate surgical training in gender-affirming surgery is nonuniform across surgical specialty, geographical region, and individual program. Incorporating training modules and hands-on experiences into surgical trainee education will better prepare residents for the numerous clinical and surgical interactions with transgender patients. Further research is required to better understand how to best incorporate these experiences into existing surgical curriculums.

New context, new content-Rethinking genital anatomy in textbooks.

It has been widely claimed that reductions in allocated teaching time and the widespread implementation of short‐cut teaching methodologies have led to a shortfall in anatomy knowledge among graduating doctors. This decline in knowledge is evident in the failure of anatomy content to prepare graduates for contemporary clinical practice. The implications for postgraduate surgical training are addressed in the numerous extracurricular anatomy courses available to surgical candidates. This paper focuses on genital diversity and its relevance to non‐surgical graduates, thus highlighting another potential impact of this knowledge shortfall on frontline clinic consultations. As the gender revolution and female genital cosmetic surgery industry flourish, nothing in contemporary anatomy textbooks addresses issues of diversification of female genitalia nor gives medical graduates a realistic view of what is normal regarding female genital appearance.

Exploring human factors in the operating room: scoping review of training offerings for healthcare professionals

BackgroundHuman factors (HF) integration can improve patient safety in the operating room (OR), but the depth of current knowledge remains unknown. This study aimed to explore the content of HF training for the operative environment.MethodsWe searched six bibliographic databases for studies describing HF interventions for the OR. Skills taught were classified using the Chartered Institute of Ergonomics and Human Factors (CIEHF) framework, consisting of 67 knowledge areas belonging to five categories: psychology; people and systems; methods and tools; anatomy and physiology; and work environment.ResultsOf 1851 results, 28 studies were included, representing 27 unique interventions. HF training was mostly delivered to interdisciplinary groups (n = 19; 70 per cent) of surgeons (n = 16; 59 per cent), nurses (n = 15; 56 per cent), and postgraduate surgical trainees (n = 11; 41 per cent). Interactive methods (multimedia, simulation) were used for teaching in all studies. Of the CIEHF knowledge areas, all 27 interventions taught ‘behaviours and attitudes’ (psychology) and ‘team work’ (people and systems). Other skills included ‘communication’ (n = 25; 93 per cent), ‘situation awareness’ (n = 23; 85 per cent), and ‘leadership’ (n = 20; 74 per cent). Anatomy and physiology were taught by one intervention, while none taught knowledge areas under work environment.ConclusionExpanding HF education requires a broader inclusion of the entirety of sociotechnical factors such as contributions of the work environment, technology, and broader organizational culture on OR safety to a wider range of stakeholders.

Innovative curriculum is needed to address residents\u2019 attitudes toward older adults: the case of geriatric trauma

BackgroundMedical trainees’ negative perceptions towards older adult care have been widely reported, catalyzing targeted curricula in geriatric medicine. Little is known about surgical residents’ attitudes toward and perceptions of the educational value of caring for injured older adults. This information is needed to ensure the surgical workforce is adequately trained to care for this growing patient population. In this study, we assessed surgical trainees’ attitudes towards geriatric trauma care to inform a curriculum in geriatric trauma.MethodsWe surveyed North American general surgery trainees’ beliefs and attitudes toward caring for older trauma patients, and the educational value they ascribed to learning about older trauma patient care. Descriptive statistics were used to report participant characteristics and responses.ResultsThree hundred general surgery trainees from 94 post-graduate programs responded. Respondents reported too much time co-ordinating care (56%), managing non-operative patients (56%), and discharge planning (65%), all activities important to the care of older trauma patients. They recognized the importance of geriatric trauma care for their future careers (52%) but were least interested in reading about managing geriatric trauma patients (28%). When asked to rank clinical vignettes by educational value, respondents ranked the case of an older adult as least interesting (74%). As respondents progressed through their training, they reported less interest in geriatric trauma care.ConclusionsOur survey results demonstrate the generally negative attitudes and beliefs held by postgraduate surgical trainees towards the care of older adult trauma patients. Future work should focus on identifying specific changes to the postgraduate surgical curriculum which can effectively alter these attitudes and beliefs and improve the care for injured older adults.

Surgical training during the COVID-19 pandemic - a single institution's trainee survey

Few studies have assessed the impact of COVID-19 on surgical training in low- and middle-income countries. The aim of this study was to survey the effect of the COVID-19 pandemic on postgraduate surgical training, research and registrar wellbeing in South Africa.A cross-sectional study was conducted as an online survey from 5 October 2020 to 1 December 2020. The study population was registrars from all surgical disciplines at the Faculty of Medicine and Health Sciences of Stellenbosch University. The survey consisted of 26 multiple-choice and five open-ended qualitative questions on the impact of COVID-19 on physical and mental wellbeing, skills acquisition and postgraduate research.Of 98 surgical registrars, 35 (36%) responded. Twenty-three (65.7%) reported missed planned surgical rotations, 30 (85.7%) decreased surgical training time, and 22 (62.9%) reported a perceived decrease in training quality. Simulated skills training was only available to eight (22.9%) participants. Twenty-four (68.6%) experienced burnout and/or depression symptoms during the pandemic. Twenty-seven (77.1%) reported that postgraduate research was unaffected by the pandemic.During the COVID-19 pandemic, surgical trainees at this institution reported a decrease in the quality of surgical training and skills acquisition and a negative impact on their mental wellbeing.