Members Of Surgical Societies Research Articles

Current Clinical Practice Patterns in Total Vaginal Hysterectomy.

There are no data on current surgical practice patterns for benign total vaginal hysterectomy (TVH) despite recently published guidelines. The objective was to determine gynecologic surgeon practice patterns regarding TVH perioperative interventions and to assess adherence to clinical practice guidelines. A survey to assess TVH practice patterns was distributed to gynecologic surgical society members for completion. The primary outcome was to compare adherence to practice guidelines between fellowship-trained and non-fellowship-trained gynecologic surgeons. Secondary outcomes included comparing adherence based on age, practice location, and hysterectomy volume. Of the 204 respondents, there were 163 (80%) fellowship-trained and 41 (20%) non-fellowship-trained gynecologic surgeons. Fellowship-trained surgeons were more likely than non-fellowship-trained surgeons to use vaginal packing (34% vs 15%, P = 0.028), which is contrary to the recommendations. No cohort followed the guideline recommending a circular cervicovaginal incision. Fellowship-trained surgeons also were more likely than non-fellowship-trained surgeons to use the clamp and suture technique for vessel ligation (88% vs 68%, P = 0.004); otherwise, there were no significant differences between cohorts for adherence to any of the other guidelines. Although fellowship-trained surgeons were adherent to fewer of the guidelines as compared with surgeons without fellowship training, both groups generally adhered to a majority of the clinical practice guidelines for benign TVH. This information demonstrates a need for the development of targeted education and interventions to increase the use of evidence-based clinical practice guidelines during TVH for both fellowship-trained and non-fellowship-trained gynecologic surgeons.

DElayed COloRectal cancer care during COVID-19 Pandemic (DECOR-19): Global perspective from an international survey

BackgroundThe widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer care during the pandemic. MethodsThe impact of coronavirus disease 2019 on preoperative assessment, elective surgery, and postoperative management of colorectal cancer patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in colorectal cancer care. Respondents were divided into 2 comparator groups: (1) “delay” group: colorectal cancer care affected by the pandemic and (2) “no delay” group: unaltered colorectal cancer practice. ResultsA total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the delay (745, 70.9%) and no delay (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to coronavirus disease 2019 units, units fully dedicated to coronavirus disease 2019 care, and personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology, and prolonged chemoradiation therapy-to-surgery intervals. In the delay group, 48.9% of respondents reported a change in the initial surgical plan, and 26.3% reported a shift from elective to urgent operations. Recovery of colorectal cancer care was associated with the status of the outbreak. Practicing in coronavirus disease-free units, no change in operative slots and staff members not relocated to coronavirus disease 2019 units were statistically associated with unaltered colorectal cancer care in the no delay group, while the geographic distribution was not. ConclusionGlobal changes in diagnostic and therapeutic colorectal cancer practices were evident. Changes were associated with differences in health care delivery systems, hospital’s preparedness, resource availability, and local coronavirus disease 2019 prevalence rather than geographic factors. Strategic planning is required to optimize colorectal cancer care.

Gender representation in leadership roles in UK surgical societies.

Despite making up more than half of new doctors, women are underrepresented in most surgical specialties. Various reasons have been suggested for this including issues with work-life balance, discrimination and a lack of female role models in the specialty. We sought to quantify the extent of gender discrimination in leadership roles in surgical societies in the UK. All major Surgical Specialty Organisations were identified via the Royal College of Surgeons Website. Leadership and committee information was collected via organisation websites on 5th September 2018. All societies were then contacted requesting data including total membership, their stage of training and the gender split. Of the twenty-four organisations contacted, eighteen were able to provide data. Women accounted for 11.8% (2446/20 803) of consultant and 34.3% (5267/15 366) of trainee members. 2/24 presidents; 3/26 of vice presidents; 18.1% (39/215) of executive committees and 13.5% (49/364) of wider committee members were female. Thirty-four committee members were not included as they were not surgeons (23 female; 11 male). Despite accounting for 27% of the surgical workforce and indeed 24% of surgical society members, women account for only 2 of 24 Presidents and 18.1% (39/215) of the executive committees of surgical societies in the UK. Action should be taken so women are fairly represented in leadership roles in surgical societies with one of the benefits being more visible role models for prospective female surgeons.

Structured surgical residency training in Germany: an overview of existing training programs in 10 surgical subspecialties.

IntroductionSurgery and the training of young surgeons face various challenges. Work hour restrictions, demographic changes, medicolegal demands, as well as economic constraints have led to changes in patient care and thus changed surgical residency. In addition to the daily training at work, several theoretical and practical courses are offered to surgical residents. The aim of this manuscript is to provide an overview of the existing courses and programs for surgical residents in Germany. It describes the current structure of surgical training in Germany for 10 subspecialties and sets out existing approaches to implement structured surgical training by professional associations as well as by commercial providers.Materials and methodsThe official homepages of 10 surgical associations were analyzed for information on structured surgical training and a Google search for surgical training programs was conducted. Then, the websites of two commercial providers were searched for information in courses. In addition, the members of the German Young Surgeons Association were asked open questions about the existence of structured resident training and additional training opportunities in their specialty. The courses were analyzed for structural characteristics such as the price and type of course (single course, exam preparatory course, and structured program). A structured program was defined as a set of courses based on learning objectives that are designed to cover all aspects of the specialty and include some form of summative or formative assessment.ResultsSeveral courses are offered by varied providers; some of them associated with surgical associations and some commercial. Seven of 10 professional associations offer single courses and six of them offer exam preparatory courses. Commercial providers only offer single courses. All of these courses are optional; there is no requirement to take part in any of them. None of them is free of charge, but most offer discounts for members of surgical societies. Only one structured program exists for orthopedics and trauma surgery. A fixed schedule does not exist for any surgical subspecialty, but it is rather the responsibility of the trainee or his/her supervisor to pick or suggest a course that suits their personal state of knowledge.DiscussionUntil now, it depends on personal motivation and the generosity of hospitals whether or not surgical residents will receive training outside of their training hospital. Various external courses are offered in all surgical subspecialties to complement on-the-job training. It is unknown how many residents take part in them. The implementation of new, competence-based specialist training regulations in Germany in 2018 may facilitate a change in surgical education. Simulation-based education can promote the acquisition and consolidation of surgical skills. Additional training possibilities and structured programs should be implemented in surgical resident training to foster competence-based education and surgical proficiency.

Developing minimally invasive procedure quality metrics: one step at a time.

Despite extensive first-hand surgical experience, rank and file members of surgical societies are generally not trained in and have not therefore been included in surgical quality measure development. The purpose of this exercise was to determine if a structured quality metric design tool could bridge this gap, facilitating rapid development of focused quality metrics by minimally invasive surgeon attendees of the April 2018 SAGES Annual Meeting. Expert minimally invasive surgeons attended a 90-min workshop with didactic and interactive quality metric design sessions during the Annual Meeting. The interactive portion was formed around a novel structured quality measure development tool that graded presenting symptoms, short-term complications, and long-term disutility of care. For first-time symptomatic inguinal hernia repair, first-time small to moderate size ventral hernia repair, and elective laparoscopic cholecystectomy, each workgroup was able to develop one quality, one short-term complication, and one long-term disutility metric. A structured quality metric design tool facilitates application of knowledge through rapid development of multifaceted, patient-centric outcomes measures by expert minimally invasive surgeons, otherwise not formally trained in metric development. The exercise also highlighted the need to rigorously define denominator populations and to guard against metric-driven undertreatment.

Inadequate fluid resuscitation of the surgical patient with severe sepsis – A survey of junior doctors

s / International Journal of Surgery 11 (2013) 686e745 696 ABSTRACTS Conclusion: Pre-course materials, particularly demonstration videos, are a valuable adjunct to suturing tutorials and can promote self-directed learning. 0785: INADEQUATE FLUID RESUSCITATION OF THE SURGICAL PATIENT WITH SEVERE SEPSIS e A SURVEY OF JUNIOR DOCTORS Michael Courtney, Bussa Gopinath, Matthew Toward, Rajesh Jain, Milind Rao. University Hospital of North Tees, Stockton-on-Tees, UK. Aim: The initial management of unwell surgical patients is commonly performed by junior doctors. Guidelines for severe sepsis recommend a minimum fluid challenge of 20ml/kg. This study aims to evaluate the volume of fluid challenge that junior doctors would give a severely septic surgical patient. Method: 3 scenarios were created involving a surgical patient with severe sepsis; weight differed in each (75kg, 100kg and 50kg), none had comorbidities, and the fluid was crystalloid. A questionnaire was produced asking the volume of fluid challenge that the doctor would give each patient, with multiple-choice answers of 250ml-2000ml. The questionnaire was distributed to junior doctors in a district general hospital for anonymous completion. Results: 77 questionnaires were completed, 40 by F1s, and 37 by SHOs (F2/ CT/Trust grade). All respondents are involved in management of surgical patients during their rotations. Of 231 answers, 12 were 20ml/kg. The median chosen volume in every scenario was 500ml, equating to 6.7ml/kg, 5.0ml/kg, and 10ml/kg respectively. Conclusions: Junior doctors give inadequate fluid challenges to severely septic surgical patients. They do not adjust the fluid volume according to body mass, and consequently heavier patients are more affected. More teaching/training, along with re-audit, is required to ensure improved patient care. 0787: DOES BELONGING TO AN UNDERGRADUATE SURGICAL SOCIETY REALLY IMPROVE STUDENTS' SURGICAL SKILLS? Matthew Smith , Lyudmila Kishikova , Jessica Bewick , Joseph Norris . Brighton and Sussex Medical School, Brighton, UK; Brighton and Sussex University Hospitals Trust, Brighton, UK. Aim: Undergraduate surgical societies provide an excellent opportunity to develop the surgical skills required of graduating doctors. However, the extent of this benefit is difficult to ascertain. Our project aimed to investigate the confidence of active surgical society members in performing basic surgical skills in comparison to a group of students only undergoing compulsory skills session during the undergraduate curriculum. Method: Surgical society members (n 1⁄4 82) and medical students in compulsory teaching (control, n 1⁄4 32) completed an anonymous questionnaire assessing their confidence in performing suturing, knot-tying, handwashing, gowning and assisting during laparoscopy. Student suturing and knot-tying ability was objectively assessed by a surgical registrar and scored on a five-point-scale. Results: The results of the questionnaire demonstrated that active surgical society members felt more confident performing the range of assessed surgical skills than the control group. Furthermore, surgical society members had significantly higher suturing and knot-tying scores than the control group (3 versus 2.6, respectively; p 1⁄4 0.0305). Conclusion: Our results suggest that active surgical society participation increases student confidence in performing basic surgical skills that are often neglected by official undergraduate medical curricula. 0822: APPENDICECTOMY: IS IT STILL AN SHO PROCEDURE? Christopher Emmett, Paul O'Loughlin, Poonam Valand, Claire Millins, John Martin, Venkatesh Shanmugam. Darlington Memorial Hospital,

A Consensus-Based Framework for Design, Validation, and Implementation of Simulation-Based Training Curricula in Surgery

Simulation-based training can improve technical and nontechnical skills in surgery. To date, there is no consensus on the principles for design, validation, and implementation of a simulation-based surgical training curriculum. The aim of this study was to define such principles and formulate them into an interoperable framework using international expert consensus based on the Delphi method. Literature was reviewed, 4 international experts were queried, and consensus conference of national and international members of surgical societies was held to identify the items for the Delphi survey. Forty-five international experts in surgical education were invited to complete the online survey by ranking each item on a Likert scale from 1 to 5. Consensus was predefined as Cronbach's α ≥0.80. Items that 80% of experts ranked as ≥4 were included in the final framework. Twenty-four international experts with training in general surgery (n = 11), orthopaedic surgery (n = 2), obstetrics and gynecology (n = 3), urology (n = 1), plastic surgery (n = 1), pediatric surgery (n = 1), otolaryngology (n = 1), vascular surgery (n = 1), military (n = 1), and doctorate-level educators (n = 2) completed the iterative online Delphi survey. Consensus among participants was achieved after one round of the survey (Cronbach's α = 0.91). The final framework included predevelopment analysis; cognitive, psychomotor, and team-based training; curriculum validation evaluation and improvement; and maintenance of training. The Delphi methodology allowed for determination of international expert consensus on the principles for design, validation, and implementation of a simulation-based surgical training curriculum. These principles were formulated into a framework that can be used internationally across surgical specialties as a step-by-step guide for the development and validation of future simulation-based training curricula.

Collateral damage: The effect of patient complications on the surgeon's psyche

The effect of patient complications on physicians is not well understood. Our objective was to determine the impact of a surgeon's complication(s) on his/her emotional state and job performance. An anonymous survey was distributed to Midwest Surgical Society members and attending surgeons within the Grand Rapids, Michigan, community. There were 123 respondents (30.5% response rate). For the majority of participants, the first complication that had a significant emotional impact on them occurred during residency (51.2%). Most respondents reported this did not impair their professional functioning (77.2%). If a major complication was first experienced after residency, this had a greater likelihood of causing impairment (P < .05). Surgeons primarily dealt with the emotional impact by discussing it with a surgical partner (87.8%). Alcohol or other substance use increased in 6.5% of those surveyed. Most respondents (58.5%) felt it was difficult to handle the emotional effects of complications throughout their careers and this did not improve with experience. The majority of surgeons agreed that it was difficult to handle the emotional effects of complications throughout their careers. Efforts should be made to increase awareness of unrecognized emotional effects of patient complications and improve access to support systems for surgeons.

Lumbar chemical sympathectomy in peripheral vascular disease: Does it still have a role?

Introduction Lumbar chemical sympathectomy (LCS) is used principally in inoperable peripheral vascular disease (PVD) to alleviate symptoms of rest pain and as an adjunct to other treatments for ulcers. No guidelines currently exist in the UK for its use in PVD. The aim of this study was to evaluate the role of LCS with regard to indications and outcomes in the UK and Irish vascular surgical practice. Methods Specifically designed questionnaires were sent to Vascular Surgical Society members. The questions related to their current use of LCS including indications, outcome parameters, use in diabetics and complications encountered. Results Four hundred and ninety postal questionnaires were sent out and 242 responses (49%) were received. Seventy five percent of the respondents ( n = 183) felt that LCS had a role in current practice. Seventy eight percent ( n = 144) performed less than 10 procedures per year and 3% ( n = 5) more than 20 per year. Eighty percent ( n = 145) were performed by anaesthetists, 12% ( n = 23) by radiologists and 8% ( n = 15) by surgeons. Inoperable peripheral vascular disease with rest pain was the main indication in over 80% of responses with 27% using it for the treatment of ulcers. Only 21% used LCS in diabetics. Clinical improvement was used to assess the outcome following LCS in 96% of responses. Complications included neuralgia, ureteric damage and paraplegia following inadvertent extradural injection. Conclusion Although no clear guidance exists for the use of LCS in PVD, the majority of respondents continue to use it. Indications and outcomes are documented in this study of UK and Irish vascular surgical practice.

Assessing the Database Needs of Vascular Surgeons

Vascular surgery is an ideal specialty for developing a shared database, because outcomes measures are precise, national standards have been established, and vascular surgeons have traditionally collected data. A questionnaire of database experience and needs was developed, reviewed by a Western Vascular Society advisory committee, and sent to Western Vascular Society and Rocky Mountain Vascular Surgical Society members. Additionally, we obtained software from existing commercial vascular databases. We had a 57% response from 196 surveys: 36% of vascular surgeons have functional vascular databases, which have been used from 1 to 26 years and contain 71 to 15,000 patients. Databases are used for research, quality control, and billing. Time (38%), expense (19%), and expertise (8%) preclude database use. Of physicians without a database, 17% had used 1 previously, and 89% would like 1. Sixty percent of physicians are unwilling to spend more than 5 minutes on data entry, unless forced to do so for reimbursement or to maintain hospital privileges. Seventy-three percent believe it is more important to control data-entry time than number of variables; 98% are willing to share Health Insurance Portability and Accountability Act-compliant data; 82% have interest in a handheld data-entry system. Thirty-nine percent are willing to spend $1,000 for the initial database, and 88% are willing to spend $500 per year on maintenance. Vascular surgeons have interest and experience with databases, although some have discontinued use. If databases have short entry times, limited costs, permit portable data entry, and allow data sharing, most vascular surgeons are enthusiastic about collecting clinical outcomes data.