Senior Trainees Research Articles

Urban-rural geographic distribution of Otorhinolaryngologist, Head and Neck surgeons in Aotearoa New Zealand.

We identified geographic distribution of Otorhinolaryngologist, Head and Neck surgeons in Aotearoa New Zealand. To identify the future workforce pipeline, we explored trainee intentions for specialist practice. A survey was distributed to all New Zealand Society of Otolaryngology, Head and Neck Surgery (NZSOHNS) members and all current New Zealand Otolaryngology, Head and Neck surgery trainees. Data were gathered on work location and patterns of work, including on-call commitments and full-time equivalent hours worked. Trainees were asked about future career plans. An 88% response rate was achieved encompassing senior medical officers (SMOs) and trainees. A total of 64.8% (68) of respondents reported primarily working in a metropolitan hospital and 26.7% (28) reported working in a regional centre. Rates of internationally trained surgeons were significantly higher in regional centres compared to metropolitan hospitals (64.3% vs 32.4%, p<0.05). Regional respondents had higher after hours on-call burden, a higher full-time equivalent (FTE) worked and higher average hours worked per week. Retirement intentions within the next 10 years were high in both groups (64% regional and 52.9% metropolitan, p<0.05). The regional workforce in ORLHNS work longer hours, are older and are reliant on internationally trained surgeons. Current training of ORLHNS surgeons is unlikely to keep pace with expected retirements.

Large language models in pathology: A comparative study of ChatGPT and Bard with pathology trainees on multiple-choice questions

Large language models (LLMs), such as ChatGPT and Bard, have shown potential in various medical applications. This study aimed to evaluate the performance of LLMs, specifically ChatGPT and Bard, in pathology by comparing their performance with those of pathology trainees, and to assess the consistency of their responses. We selected 150 multiple-choice questions from 15 subspecialties, excluding those with images. Both ChatGPT and Bard were tested on these questions across three separate sessions between June 2023 and January 2024, and their responses were compared with those of 16 pathology trainees (8 junior and 8 senior) from two hospitals. Questions were categorized into easy, intermediate, and difficult based on trainee performance. Consistency and variability in LLM responses were analyzed across three evaluation sessions. ChatGPT significantly outperformed Bard and trainees, achieving an average total score of 82.2% compared to Bard's 49.5%, junior trainees' 45.1%, and senior trainees' 56.0%. ChatGPT's performance was notably stronger in difficult questions (63.4%–68.3%) compared to Bard (31.7%–34.1%) and trainees (4.9%–48.8%). For easy questions, ChatGPT (83.1%–91.5%) and trainees (73.7%–100.0%) showed similar high scores. Consistency analysis revealed that ChatGPT showed a high consistency rate of 80%–85% across three tests, whereas Bard exhibited greater variability with consistency rates of 54%–61%. While LLMs show significant promise in pathology education and practice, continued development and human oversight are crucial for reliable clinical application.

Education in Laparoscopic Cholecystectomy: Design and Feasibility Study of the LapBot Safe Chole Mobile Game.

Major bile duct injuries during laparoscopic cholecystectomy (LC), often stemming from errors in surgical judgment and visual misperception of critical anatomy, significantly impact morbidity, mortality, disability, and health care costs. To enhance safe LC learning, we developed an educational mobile game, LapBot Safe Chole, which uses an artificial intelligence (AI) model to provide real-time coaching and feedback, improving intraoperative decision-making. LapBot Safe Chole offers a free, accessible simulated learning experience with real-time AI feedback. Players engage with intraoperative LC scenarios (short video clips) and identify ideal dissection zones. After the response, users receive an accuracy score from a validated AI algorithm. The game consists of 5 levels of increasing difficulty based on the Parkland grading scale for cholecystitis. Beta testing (n=29) showed score improvements with each round, with attendings and senior trainees achieving top scores faster than junior residents. Learning curves and progression distinguished candidates, with a significant association between user level and scores (P=.003). Players found LapBot enjoyable and educational. LapBot Safe Chole effectively integrates safe LC principles into a fun, accessible, and educational game using AI-generated feedback. Initial beta testing supports the validity of the assessment scores and suggests high adoption and engagement potential among surgical trainees.

Development and validation of a simulation-based assessment of operative competence for higher specialist trainees in general surgery

BackgroundSimulation is increasingly being explored as an assessment modality. This study sought to develop and collate validity evidence for a novel simulation-based assessment of operative competence. We describe the approach to assessment design, development, pilot testing, and validity investigation.MethodsEight procedural stations were generated using both virtual reality and bio-hybrid models. Content was identified from a previously conducted Delphi consensus study of trainers. Trainee performance was scored using an equally weighted Objective Structured Assessment of Technical Skills (OSATS) tool and a modified Procedure-Based Assessment (PBA) tool. Validity evidence was analyzed in accordance with Messick’s validity framework. Both ‘junior’ (ST2–ST4) and ‘senior’ trainees (ST 5–ST8) were included to allow for comparative analysis.ResultsThirteen trainees were assessed by ten assessors across eight stations. Inter-station reliability was high (α = 0.81), and inter-rater reliability was acceptable (inter-class correlation coefficient 0.77). A significant difference in mean station score was observed between junior and senior trainees (44.82 vs 58.18, p = .004), while overall mean scores were moderately correlated with increasing training year (rs = .74, p = .004, Kendall’s tau-b .57, p = 0.009). A pass-fail score generated using borderline regression methodology resulted in all ‘senior’ trainees passing and 4/6 of junior trainees failing the assessment.ConclusionThis study reports validity evidence for a novel simulation-based assessment, designed to assess the operative competence of higher specialist trainees in general surgery.Graphical abstract

1276 Creating Safer Theatres. Tackling Religious Headwear Discrimination Nationally

Abstract Aim To identify and challenge discriminatory EDI practices. To improve adoption of national policies on surgical headwear in theatre. Method Freedom of information requests were sent to 124 hospitals with emergency general surgery theatres. Data requested included total staff number, BAME staff percentage, theatre staff percentage, Muslim theatre staff (including ODPs, porters, medical, nursing staff, surgeons, junior doctors), female Muslim staff number, and copies of uniform policies, especially on religious headwear. Two senior trainees reviewed policies. Results 100 of 124 trusts responded to the FOI request. Percentage of BAME staff ranged from 5% to 47%. 12 trusts had no BAME members of staff working in theatres or could not release this data for risk of their few personal being identified. 97 policies were reviewed. 80% of the policies reviewed adhered or replicated the national guidance. Potentially discriminatory practices included necessitating disposable head wear be always worn, lack of specific guidance on the wearing of hijabs, and one policy which appeared to request they would not be worn. Conclusions This project highlights significant disparities in EDI policies within hospital theatre teams, especially regarding religious headwear. The lack of specific accommodations for religious garments creates an exclusionary environment. This can lead to increased stress and lower sense of belonging amongst minority staff. The findings emphasise the need for hospitals to re-evaluate and reform their policies, those with poor practices have been contacted. We aim to foster a more inclusive, equitable workplace.

Unsatisfactory Post-operative Imaging Is Predictive of Revision Surgery in Intracapsular Hip Fracture Fixation.

Failed fixation of intracapsular hip fractures in young patients is associated with high morbidity and cost. Accordingly, we set out to determine the association between unsatisfactory post-operative imaging (judged by two fellowship-trained trauma consultants and a senior trainee) and the risk of subsequent reoperation, including adjustment for potential confounding variables. Ninety-four (94) patients aged <60 were included in the study from a single major trauma centre. Exhausted patients (19%) required further surgery, with the most common reason being avascular necrosis (n=10) followed by non-union (n=6). Univariate analysis found only smokers and unsatisfactory fracture reduction to be predictive of failure (p < 0.05). Other demographics and recognised scoring systems from the literature were poor predictors of failure apart from the Haiduewych classification system, utilised to assess the quality of reduction, which showed a trend towards significance (p0.053). Multivariate analysis showed smoking and unsatisfactory fracture reduction to be strong predictors of failure (p<0.05).In those with unsatisfactory fracture reduction, 50% required reoperation compared to 17.5% of those with satisfactory reduction. This study highlights the key principles of ensuring adequate intraoperative reduction and fixation, in keeping with GIRFT principles. Avoiding secondary reoperation is crucial to prevent long-term negative outcomes for this typically high functional demand group of patients. We recommend regular, consultant peer review of post-operative imaging as a method of identifying substandard fracture fixations and those at risk of failure. This will allow opportunities for teaching, clinical improvement, andmultidisciplinary team (MDT) discussions of at-risk patients.

An evaluation of the West of Scotland in-programme Chief Resident role

BackgroundPostgraduate leadership education is an evolving field. Locally we have an established ‘Chief Residency’ programme where centres have two to four senior trainees completing leadership duties alongside clinical workload, supported by local directors of medical education. This is twinned with a 4-day central training programme and peer-support network. MethodsTo assess perspectives of the CR role, we adopted a qualitative case-study design using an electronic questionnaire delivered to previous chief residents between 2020 and 2023. Results were analysed using thematic analysis. ResultsTrainees valued involvement within quality improvement and trainee support, demonstrating successful multi-departmental projects. Leadership education was viewed ubiquitously positively but participants felt further work is needed to address role legitimacy locally. A proposed solution was junior doctor leadership teams to address workload and emotional challenges. ConclusionThis model provides further evidence of the value in investing in trainee leadership positions, demonstrating organisational impact. Future work will research hospital peer leadership teams.

Development of an online teaching platform to improve access to postgraduate pathology training in sub-Saharan Africa.

Resource barriers to the provision of accessible training in cancer diagnosis in lower- and middle-income countries (LMICs) limit the potential of African health systems. Long-term provision via teaching visits from senior pathologists and trainee foreign placements is unsustainable due to the prohibitive costs of travel and subsistence. Emerging eLearning methods would allow pathologists to be trained by experts in a cheaper, more efficient, and more scalable way. This study aimed to develop an online teaching platform, starting with hematopathology, for trainee pathologists in sub-Saharan Africa, initially in Nairobi, Kenya, and Lusaka, Zambia. Course materials were prepared for both Canvas and the Zoom eLearning platforms using digitally scanned slides of lymph nodes and bone marrow trephines. Initial in-person visits were made to each site to establish trainee rapport and maximize engagement, evaluate different methods and course content, and obtain feedback to develop the project. The knowledge of trainees before and after course completion was used to measure initial effectiveness. Online teaching with the preferred platform is to be continued for 1 year before re-evaluation for long-term effectiveness. Canvas was selected as the preferred delivery platform as it is freely available and has good functionality to support all required tasks. Face-to-face teaching was considered optimal to establish the initial rapport necessary to maximize subsequent engagement with online teaching. Challenges have included sub-optimal internet speeds and connections and scheduling issues. Weekly online hematopathology teaching sessions using live image capture microscope sessions, Zoom, and Canvas have been delivered to students in Kenya and Zambia, with good attendance and interaction in case discussions. Our team has successfully designed and delivered an online training program in hematopathology to trainee pathologists in Kenya and Zambia, which has been ongoing for over a year. This project is now being scaled to other sub-Saharan countries and other sub-specialties.

Investigation of divergent thinking among surgeons and surgeon trainees in Canada (IDEAS): a mixed-methods study

ObjectiveTo assess the creative potential of surgeons and surgeon trainees, as measured by divergent thinking. The secondary objectives were to identify factors associated with divergent thinking, assess confidence in creative...

Primary and Specialty Care Trainees' Perceptions About Proton Pump Inhibitor Use.

Proton pump inhibitors (PPIs) are widely prescribed with proven efficacy in many indications, yet longstanding controversy about potential adverse events persists. We aimed to acquire knowledge about perceptions of outpatient PPI long-term prescribing (≥8 wk) among primary and specialty care trainees at 2 Canadian Universities. Family medicine, internal medicine, and gastroenterology trainees completed a web-based survey that included 20 clinical scenarios assessing trainee knowledge about PPI efficacy. Contextual PPI prescribing decisions were also elicited, balancing possible PPI indications versus side effects. Management strategies were compared between junior and senior trainees, as well as across training programs. Over a 4-month period,163 trainees (age <26 y: 12%; age 26 to 45: 88%; 59% females) participated in the survey (family medicine: 51%, internal medicine: 44%, and gastroenterology: 5%); 83% were considered junior residents. Only 42% had received formal education on prescribing PPI long-term. Overall, 93% believed they would benefit from such teaching, with 98% stating they would follow related guidelines. No between-group differences were noted in knowledge of appropriate PPI indications nor possible side effects when comparing juniors to seniors, or among different specialties. Across different management scenarios, inappropriate PPI discontinuation was chosen by 14.3% to 67.2%, whereas inappropriate PPI continuation was reported in up to 57%. Trainee seniority and specialty did not differ in appropriate deprescribing rates. Training level and primary versus specialty care settings are associated with frequent inappropriate PPI prescribing and deprescribing. These findings highlight the need for and may inform future educational programs on PPI usage.

Pediatric disaster preparedness curriculum across emergency medicine residencies.

To assess pediatric disaster medicine (PDM) instruction in emergency medicine (EM) residency programs and to identify barriers to integrating these skills into EM training. National survey study of United States EM Residency Program Directors (PDs) and Assistant PDs during the 2021-2022 academic year. Of the 186 EM residency programs identified, a total of 24 responses were recorded with a response rate of 12.9 percent. Importance of training was rated 5.79 (standard deviation 2.51) using the Likert scale ranging from 1 to 10. Out of 24 programs, 17 (70.8 percent) do not have any PDM training as part of residency training. Live drill, simulation, and tabletop were identified as most effective methods to deliver PDM training with the Likert scale score of 4.78, 4.6, and 4.47, respectively. Senior trainees' level of -knowledge/skills with family reunification (Likert 2.09/5; chemical-biological-radiological-nuclear explosive 2.95/5) and mass casualty preparation of the emergency department (3.3/5) as assessed by the respondents. The main barrier to education included logistics, eg, space and costs (Likert 3.7/5), lack of didactic time (3.7/5), and limited faculty knowledge, skill, or experience (3.3/5). PDM training is lacking and requires standardization. This study highlights the opportunity for the creation of a model for EM resident education in PDM.

The Leaders in Epidemiology, Antimicrobial Stewardship, and Public Health (LEAP) Fellowship, a Novel Training Program in Public Health for Infectious Diseases Physicians.

The severe acute respiratory syndrome coronavirus 2 pandemic demonstrated a critical need for partnerships between practicing infectious diseases (ID) physicians and public health departments. The soon-to-launch combined ID and Epidemic Intelligence Service fellowship can only address a fraction of this need, and otherwise US ID training lacks development pathways for physicians aiming to make careers working with public health departments. The Leaders in Epidemiology, Antimicrobial Stewardship, and Public Health (LEAP) fellowship is a model compatible with the current training paradigm with a proven track record of developing careers of long-term collaboration. Established in 2017 by the ID Society of America, Society for Healthcare Epidemiology of America, Pediatric ID Society, and supported by the Centers for Disease Control and Prevention, LEAP is a single-year in-place, structured training for senior trainees and early career ID physicians. In this viewpoint, we describe the LEAP fellowship, its outcomes, and how it could be adapted into ID training.

The residency levels' effect on pediatric dental rehabilitation operation time

BackgroundPostgraduate pediatric dental residents' competency, to perform dental rehabilitation procedures under General anesthesia (GA), at different levels of training is challenging for operation time control. An adequate operation time (OT) for children decreases morbidity risk and improves hospital time utilization efficiency. The aim of the study is to assess the effect of pediatric dental resident training level on OT for pediatric dental rehabilitation procedures under GA at King Abdulaziz Medical City (KAMC).MethodsA cross-sectional study included pediatric dental rehabilitation performed under GA by pediatric dental residents at (KAMC) -Jeddah from October/2015 to September/2022. The primary outcome was OT, and the predictive variable was resident training levels. A linear regression analysis was used to compare OT between procedures performed by junior (years 1–2) or senior (years 3–4) trainees, adjusting for patient and operative factors.ResultsOne thousand seven pediatric dental rehabilitation cases were performed under GA by junior (13) and senior (31) residents. The univariant analysis indicated that OT for senior residents was significantly longer (13 min) than for junior residents. However, the linear regression analysis showed that senior residents had a significantly shorter OT when considering the more dental procedures performed per case under GA than junior residents. Senior residents took significantly more radiographs and performed more primary pulp therapies and multi-surface anterior colored restorations under GA than junior residents.ConclusionsThe OT for pediatric dental rehabilitation procedures under GA is associated with resident training level. The total OT was significantly longer based on procedure number, type, and resident level. The study indicated that senior residents could manage more complex cases in a shorter time. The finding emphasizes the importance of assigning GA cases to residents based on their level and the case's complexity. Additionally, it helps standardize the resident privileges under GA and understand the impact of residency training on hospital efficiency.

Does Virtual Video Endoscopy simulation training aid postgraduate endoscopy trainee learning of pathology in the era of COVID-19?- A single centre experience in a Dublin Teaching Hospital

COVID-19 has had a significant impact on post-graduate gastrointestinal endoscopy education in Ireland. The signature pedagogy of endoscopy education is the hands-on apprenticeship model however this was impeded during the restrictions imposed by the pandemic. To progress endoscopy learning at a time when exposure was reduced, we, as consultant trainers, focused on teaching pathology recognition, a known deficit in the current endoscopy curriculum. A series of five virtual endoscopy simulation sessions consisting of endoscopic videos and pictures demonstrating upper gastrointestinal pathology were taught to six endoscopy trainee specialist registrars in a single Dublin teaching hospital. Pathology quizzes were administered to trainees pre and post undertaking the sessions to measure learning. Semi-structured interviews were used to assess the utility of the sessions and a qualitative analysis of responses was undertaken. Amongst the six trainees, virtual video endoscopy simulation training led to a statistically significant increase in endoscopy trainees’ pathology recognition scores in the post-intervention quiz. All trainees found the virtual video simulation sessions to be useful and relevant to their stage of training, with demonstration of active learning after the teaching sessions. However, the personal and professional effect of the pandemic on trainees was profound, with senior trainees being disproportionally affected. Trainees also identified that the current apprenticeship model for endoscopy learning is no longer fit for purpose. Given the effect of the pandemic on trainee learning it is important that we take a systematic approach to analyse teaching tools that were used during the pandemic to ensure that they are helping trainees reach their learning goals.

FC8: Revising Competencies in Geriatrics for Canadian Medical Students: Adding a Mental Health Perspective

In Canada, adults 85 years and older represent one of the fastest growing segments of the population1. Mood disorders and chronic illness often intersect, worsening health outcomes in late life2. In view of demographic trends, medical schools should ensure trainees are equipped with the knowledge, skills and attitudes to work with older adults. However, there continues to be much variation in how medical schools incorporate geriatric content into their curricula.In 2009, the Canadian Geriatrics Society (CGS) outlined 20 competencies in geriatrics to inform medical school curricula, but uptake was minimal. Of note, there were significant gaps in these competencies, which omitted mention of late-life depression. Geriatric mental health experts did not provide input.The objective of this project was to address gaps in geriatric competencies for medical students through an expert review process involving a biopsychosocial approach.Methods:The CGS established a 15-member national working group with representation from geriatric psychiatry, family medicine, a 95-year-old senior, geriatrics and medical trainees. Potential competencies were derived from existing Canadian geriatrics frameworks [Geriatrics 5M, CanMEDs] and 2009 competencies. A modified Delphi process yielded rankings for each competency using a 7-point Likert scale.Results:Between 2019 and 2021, 3 successive national surveys were completed. In the first (n=66), 34 competencies were identified. Agreement in the final survey was 87-95% (mean 90%). 51 participants completed all three. Significant topic omissions in the 2009 list of competencies were frailty, end-of-life care, delirium prevention, health promotion and the assessment and management of depression.Conclusions:Three national surveys expanded the core competencies in geriatrics for medical school curricula from 20 to 31. Expert consensus was high. Themes mapped along existing geriatrics frameworks and incorporated a holistic lens incorporating the perspectives of an older adult and geriatric psychiatrist. In addition to late-life depression, the importance of addressing ageism was also highlighted.Learning objectives for each competency are modifiable for level of training and individual program, offering flexibility. The CGS will continue to advocate for inclusion of updated, expanded competencies into training and licensure in geriatrics.1)Statistics Canada 2021, Canadian Government, accessed 1 January 2023, &lt;. Accessed 20/01/23 &lt;https://www12.statcan.gc.ca/census-recensement/2021/as-sa/98-200-X/2021004/98-200-x2021004-eng.cfm&gt;1)Hall CA, Reynolds III CF. Late-life depression in the primary care setting: challenges, collaborative care and prevention. Maturitas. 2014 Oct; 79(2):147-52.

A national perspective on exposure to essential surgical procedures among medical trainees in Nigeria: a cross-sectional survey and recommendations

BackgroundIn sub-Saharan Africa, recent graduates from medical school provide more direct surgical and procedural care to patients than their counterparts from the Global North. Nigeria has no nationally representative data on the procedures performed by trainees before graduation from medical school and their confidence in performing these procedures upon graduation has also not been evaluated.MethodsWe performed an internet-based, cross-sectional survey of recent medical school graduates from 15 accredited Federal, State, and private Nigerian medical schools spanning six geopolitical zones. Essential surgical procedures, bedside interventions and three Bellwether procedures were incorporated into the survey. Self-reported confidence immediately after graduation was calculated and compared using cumulative confidence scores with subgroup analysis of results by type and location of institution. Qualitative analysis of free text recommendations by participants was performed using the constant comparative method in grounded theory.ResultsFour hundred ninety-nine recent graduates from 6 geopolitical zones participated, representing 15 out of a total of 44 medical schools in Nigeria. Male to female ratio was 2:1, and most respondents (59%) graduated from Federal institutions. Students had greatest practical mean exposure to bedside procedures like intravenous access and passing urethral foley catheters and were most confident performing these. Less than 23% had performed over 10 of any of the assessed procedures.They had least exposures to chest tube insertion (0.24/person), caesarean Sect. (0.12/person), and laparotomy (0.09/person). Recent graduates from Federal institutions had less procedural exposure in urethral catheterization (p < 0.001), reduction (p = 0.035), and debridement (p < 0.035).Respondents that studied in the underserved North-East and North-West performed the highest median number of procedures prior to graduation. Cumulative confidence scores were low across all graduates (maximum 25/60), but highest in graduates from Northern Nigeria and private institutions. Graduates recommended prioritizing medical students over senior trainees, using simulation-based training and constructive individualized non-toxic feedback from faculty.ConclusionNigerian medical students have poor exposure to procedures and low confidence in performing basic procedures after graduation. More attention should be placed on training for essential surgeries and procedures in medical schools.

OGC P10 Implementation of an Oesophago-Gastric Robotic Programme in a Tertiary Centre and the Evolution to a Structured Training Programme for Career OG Trainees

Abstract Background Robotic surgery affords advantages over standard laparoscopic surgery, for both patients and surgeons. Robot-assisted minimally invasive oesophagectomy (RAMIO) has demonstrated shorter operative time and improved lymph node yield (RAMIE trial). Benefits to the surgeon, and patient, include enhanced visualisation, greater precision, and improved ergonomics. During any transition to robotic surgery the need to maintain patient safety and outcomes, especially during the learning curve, is paramount. The impact on training should not be underestimated, with lost opportunities for trainees to develop procedural competence whilst on rotation. We describe the evolution of a robotic oesophago-gastric programme in a tertiary upper GI centre. Methods Implementation began in 2019 with online modules, simulation, and wet-lab workshops. There was external proctorship of the first two consultants for fundoplication then again for thoracic–phase robotic surgery 28 months later. Meanwhile these consultants facilitated the training of consultant colleagues to ensure a whole-team transition to robotics. This rapidly led to the introduction of component-based training of senior trainees in all abdominal aspects of robotic UGI surgery. This will ultimately progress to training career OG cancer surgeons in full RAMIO. Throughout the implementation process, regular audit allowed us to ensure that there was no adverse impact on patient outcomes. Results 246 robotic UGI procedures were performed since September 2020, progressing step-wise from anti-reflux to RAMIO. Initially two consultants were trained, with staged introduction of two others. Subsequently, senior trainees commenced training in sequential components of procedures. Since progression to full RAMIO, the majority (82%) of two-phase oesophagectomies have been robotic. Of non-robotic, one (3%) abdominal conversion for bleeding, one planned open abdomen, and 12% due to a lack of robot access. Introduction of training of non-consultant grades in June 2022 occurred in parallel with thoracic phase training of three consultants. Trainees performed substantial components of 33/130 cases over this time. Conclusions We report the structured, stepwise evolution of an oesophago-gastric robotic programme in a tertiary centre up to full RAMIO with the inclusion of in-house mentoring and training of career OG trainees. Weekly robotic operating lists and high throughput of cases have facilitated uptake across all surgeons and in the majority of cases. The uptake across all consultants has facilitated relatively early on-console training of senior trainees to minimise the impact upon their career development. As an established service with full team engagement, moving forward we anticipate even greater robotic access and trainee involvement.

HPB P51 One hundred consecutive pancreaticoduodenectomies performed by a newly appointed consultant surgeon: perioperative clinical outcomes

Abstract Background Pancreaticoduodenectomy (PD) involves surgical resection of pathology affecting the pancreas and periampullary region. PD was historically associated with high rates of morbidity and mortality. More recently there has been a reduction in 90-day mortality (2-5% in most series), however morbidity remains high. Postoperative pancreatic fistula (POPF) remains a main source of major morbidity after PD. There is conflicting data regarding POPF and morbidity rates, which may be higher for newly appointed compared to established consultants, reflecting reduced operative exposure for senior trainees. We present a consecutive series for a newly appointed consultant surgeon, with particular attention on clinical outcomes. Methods Between July 2018 and April 2023, 100 consecutive pancreaticoduodenectomies were performed by a single surgeon (AA). Pancreatico-jejunostomy reconstruction was performed in all cases using a 2 layer duct to mucosa technique, reproduced from a senior surgical mentor (AD) during training. A post hoc analysis of a prospectively maintained database was performed to determine outcomes of these patients. Data collected included patient demographics, neoadjuvant therapy, intraoperative details, Pancreatic Fistula Risk Scores, morbidity details, length of stay and 90-day readmission. POPF was defined according to the latest definition by the International Study Group of Pancreatic Surgery. Results 43 patients underwent a pylorus preserving procedure whereas 57 underwent a classic PD (M:F 3:2; median age 66 (range 20–85) years; median BMI 25.4; ASA ≥ III n=38). The mean operative time was 479 minutes; mean blood loss was 719ml and mean pancreatic duct size was 4.8mm. 13 patients underwent portal vein resection. Median hospital stay was 8 days (range 5–35). Clinically significant pancreatic fistula rate was 6% (5 Grade B and 1 Grade C). 90-day mortality was zero and major morbidity (Clavien-Dindo grade ≥ III) rate was 7%. 90 day readmission rate was 6%. Conclusions This case series of 100 PDs by a newly appointed consultant demonstrates clinical outcomes which are comparable to more experienced established consultants in the best performing units. These outcomes can be attributed to standardisation and reproduction of operative reconstruction technique learned during training from a senior surgical mentor, meticulous post-operative care and multidisciplinary team working at a high-volume pancreatic surgery centre. Excellent clinical outcomes from PD can be achieved by new consultant surgeons, in an era of relatively diminished surgical exposure during training, by following these tenets.

Surgeons' personality, characteristics and presence of meaning in life

BackgroundSurgeons work long shifts and are frequently on call. Pressure to make quick and accurate decisions along with the responsibility of performing complex procedures contribute to surgeons' high stress-levels, anxiety and altered empathy level. We aimed to study surgeons' personality and meaning in life at two different centres. MethodsGeneral surgeons completed 47 questions. Visual analogous scale-items with controlled internal consistency (Cronbach alpha) coefficients varying from .77 to .85 were used from the following scales: Global Measure of Perceived Stress; Hostility Questionnaire; Jefferson Scale of Physician Empathy; Meaning in Life Questionnaire–SF; Rosenberg Self-Esteem Scale; Spielberger State Anxiety Scale and Quality of Work life Scale. Multiple linear regression analyses, parametric or non-parametric tests were employed when considered adequate. ResultsFifty-four participants were recruited from 3 different levels of training. Gender differences in Anxiety, Physician Empathy and presence of meaning in life (MIL-P) were revealed. Junior trainees differed from senior trainees and consultants as regards MIL-P, Anxiety, Stress and work-related factors. The surgeons' self-rated self-esteem was work-related. Surgeons' Quality of Work Life was best predicted by Physician Empathy but also their self-rated Self-Esteem contributed significantly to the prediction. Surgeons' MIL-P was significantly predicted by Physician Empathy and State Anxiety. ConclusionSurgeons’ current personality attributes might not apply to all of them. Female surgeons were more empathetic and felt more presence of meaning in life than male surgeons, and men were less anxious than female surgeons. Junior trainees experienced less anxiety than senior trainees but were more stressed than consultants. The most significant predictors of surgeons' personality were their experience of presence of meaning in life along with their level of empathy.

Surgeon’s narcissism, hostility, stress, bullying, meaning in life and work environment: a two-centered analysis

IntroductionDisruptive physician behaviour can affect patients’ safety. If surgical trainees throughout higher education experience disruptive behaviour, impaired work-life may follow. Therefore, we aimed to study surgeons' level of narcissism (N), hostility, and stress in relation to their work environment and potential experience of bullying. We also scrutinized search for or presence of meaning in life.MethodsGeneral surgeons in UK National Health Service from 2 hospitals participated with 3 levels of training: junior trainees (JT), senior trainees (ST), and consultants (CONS). Participants completed 52 VAS-formed questions plus demographics. Modified questionnaires were used for assessments of ‘hostility’, ‘narcissism’, meaning in life, quality of work-life, and bullying.ResultsAltogether 33% of surgeons displayed narcissism and 22% could exhibit disruptive behaviour. By MANOVA significant differences between low, medium, and high narcissism groups were revealed in hostility (p<.01), perceived stress (p=.001), and presence of meaning in life (p<.05). Regression analyses explained hostility both by N-scale (p=.000) and ‘being bullied during training’(p=.009) but negatively by ‘presence of meaning in life’(p=.004). Surgeons’ perceived stress was explained both by N-scale (p=.000) followed by ‘seeing others bullied during training (p=.000) and negatively by ‘working extra days beyond schedule’ (p=.007). The presence of meaning in life was explained mostly by good beneficial stress (p= .000) but negatively both by ‘doing extra work beyond schedule’ (p= .016) and hostility (p= .003).ConclusionSurgeons may exhibit disruptive behaviour in a challenging situation. The narcissim-scale was the best predictor of hostility and perceived stress. Being bullied during surgical training predicted hostility. Seeing others being bullied during surgical training predicted stress. Beneficial stress is explained best by surgeons’ experience of the presence of meaning in life.