Training Of Surgical Specialists Research Articles

Evidence, Availability and Future Visions in Simulation in General and Visceral Surgery

Practice makes perfect - a saying that everyone has certainly heard. Surgeons of all levels of training can demonstrably practice to some extent on simulators. This training outside the operating theatre and independent of patients makes sense, both ethically and financially. Although the effectiveness of simulation in surgery has been proven several times, simulation training is not a mandatory part of surgical specialist training in Germany. Simulation covers a very wide range in terms of application, effort and costs. This review is intended to give an overview of the systems and their areas of application and the target group. The focus lies on the commonly available systems and possible advantages and disadvantages. Practical skills are in the foreground and all three pillars of general and visceral surgery - conventional techniques, laparoscopy and robotics - are taken into account. However, simulators alone do not achieve cost-benefit effectiveness. The full potential of such an investment can only be exploited with a site-specific, structured training concept in which simulation training according to the post-graduate year and appropriate allocation to surgeries in the operating room are closely interlinked. It should always be possible to train basic skills on site. The significant additional costs for complex simulation systems are possible, depending on the financial resources, or should be purchased in a network or for national courses. The techniques of immersive virtual reality in combination with artificial intelligence and deformation algorithms will certainly play a decisive role for the future of simulation, whereby the use of the available systems must be a primary goal. The integration of simulation into specialist training should be striven for, not least in order to justify the costs.

Surgical training in the Caribbean: The past, the present, and the future.

The six million inhabitants of these diverse English-speaking Caribbean countries are grateful to the University of the West Indies, which has been central in the independent training of surgical specialists in all areas of surgery for the past 50 years. Similar to the per capita income, the quality of surgical care, albeit acceptable, is quite variable throughout the region. Globalization and access to information have revealed that the quality of training and surgical care being delivered can be further improved. Technological advances will perhaps never be on par with higher-income countries, but collaborative ventures with global health partners and institutions can ensure that the people of the region will have appropriately trained surgical doctors and, therefore, the provision of accessible quality care will remain a staple, with even the possibility of income generation. This study reviews the journey of our structured surgical training program delivered in the region and outlines our growth plans.

Applications to medical and surgical specialist training in the UK National Health Service, 2021–2022: a cross-sectional observational study to characterise the diversity of successful applicants

ObjectivesTo compare success of applicants to specialty training posts in the UK by gender, ethnicity and disability status.DesignCross-sectional observational study.SettingNational Health Service, UK.ParticipantsAll specialty training post applications to Health Education...

Impact of COVID-19 on surgical specialist training as quantified by trainee complication rates for cataract surgery.

Reduction in elective surgeries during the COVID-19 pandemic has negatively impacted surgical specialist training. Posterior capsule rupture rate (PCR), a complication of cataract surgery, is an objective measure of the quality of ophthalmic surgery. This study aimed to compare PCR pre- and post-COVID-19 in trainees and consultants. A single-centre consecutive cases series of cataract surgeries performed at Groote Schuur Hospital, between 1 February 2017 and 31 May 2021 were analysed. Our main outcome measure was the effect of the volume of cataract surgeries on PCRs between ophthalmology trainees and consultants before and after the COVID-19 reduction in elective surgeries on 23 March 2020. During the study period, 4 157 cataract surgeries were performed (3 493 in the 38 months pre-COVID-19 and 664 in the 14 months post-COVID-19). Fourteen ophthalmology trainees and six consultants performed 2 919 and 1 238 cataract surgeries, respectively. In the trainees the PCR was 4.4% pre-COVID-19 and 10.0% post-COVID-19 (odds ratio [OR] 2.44; p < 0.001; CI 1.71-3.47; relative risk [RR] 2.29). The PCR of consultants remained unchanged with a PCR of 3.4% pre- and post-COVID-19 (OR 1.02; p = 0.97; CI 0.42-2.46; RR 1.02). COVID-19 has caused a marked reduction in the volume of cataract surgery which has resulted in a deterioration in the performance of trainees, but not consultants, and quantifies the negative impact of the pandemic on surgical training in ophthalmology. This highlights the need to develop plans to improve surgical training during the COVID-19 recovery period.

Reshaping surgical specialist training in small animal surgery during and after the COVID-19 pandemic.

ObjectiveTo assess the perceived effects of the COVID‐19 pandemic on small animal surgical specialist training, among trainees and supervisors and to propose changes, based upon the results, that could be incorporated into training programs.Study DesignAnonymous online questionnaire survey.Sample PopulationEighty‐one eligible responses were collected in September 2020, including 52 European College of Veterinary Surgeons (ECVS) residents and 29 ECVS Diplomates acting as supervisors.MethodsDescriptive statistics were used to analyze the data. Fisher's exact test was used to test for significance.ResultsA reduction in surgical case load was reported by 82% (n = 66/81) of respondents, with 82% (n = 54/66) of those believing that COVID‐19 had a mild‐to‐moderate impact on training. Compared to supervisors, residents were less likely to feel that appropriate guidance, a safe working environment, and measures to preserve training had been provided (p < .01). Only 45% (n = 22/49) of residents reported confidence with performing teleconsultations. Ninety percent (n = 73/81) of respondents considered online “case presentations” and “edited surgical video footage” as a positive ancillary tool.ConclusionCOVID‐19 has resulted in a reduction in case load and training for the majority of residents. A discrepancy between the opinions of residents and supervisors was noted on various aspects of COVID‐19 related effects.ImpactOpen communication, as well as the use of additional training tools through digital platforms may help to preserve safe and effective training during times of decreased clinical activity. While this study has focused on surgical specialist training, the results could be applied to other disciplines.

Use of surgical simulators in further education-A nationwide analysis in Germany

HintergrundDie chirurgische Facharztweiterbildung erfordert neben dem Erlernen theoretischen Wissens ebenfalls den Erwerb praktisch-chirurgischer Kompetenzen. Eine Alternative zur Aus- und Weiterbildung am Patienten stellen simulationsbasierte Lehrkonzepte dar. Ziel der vorliegenden Studie ist die Analyse der Verteilung und des Einsatzes chirurgischer Simulatoren in deutschen Kliniken.MethodenDie Datenanalyse erfolgte auf Basis eines individuellen Onlinefragebogens mit insgesamt 19 standardisierten Fragen. Dieser wurde über die E‑Mail-Verteiler der deutschen chirurgischen Fachgesellschaften an die leitenden chirurgischen Klinikärzte versendet.ErgebnisseInsgesamt 267 vollständige Antwortdatensätze wurden analysiert (Rücklaufquote 12,0 %). 84,0 % der Teilnehmer gaben ihre Tätigkeit an einem Lehrkrankenhaus an. Zum Zeitpunkt der Untersuchung waren 143 chirurgische Simulatoren an 35,0 % der in die Auswertung eingeschlossenen Kliniken vorhanden. Regional zeigten sich deutliche Unterschiede zwischen den einzelnen Bundesländern. 21,1 % der Teilnehmer, an deren Klinik kein Simulator zur Verfügung steht, planten eine Neubeschaffung. Studierende (41,1 %) und Ärzte in Weiterbildung (ÄiW, 32,5 %) nutzten das Simulationstraining am häufigsten. Eine Integration in die chirurgische Weiterbildung bestand zu 81,8 % nicht. 94,0 % der beteiligten Kliniken zeigten Interesse an einer zukünftigen Integration in die chirurgische Facharztweiterbildung.SchlussfolgerungDie vorliegenden Ergebnisse bestätigen die besondere Bedeutung des simulationsbasierten Trainings für die chirurgische Weiterbildung an deutschen Kliniken. Gleichzeitig bestehen deutliche Informationsdefizite über das Nutzungsverhalten sowie eine defizitär empfundene Integration des Simulationstrainings in die chirurgische Weiterbildung.

Declining applications to surgical specialist training

An ENT perspective on when we should start to worry.

Module based training improves and sustains surgical skills: a randomised controlled trial.

Traditional surgical training is challenged by factors such as patient safety issues, economic considerations and lack of exposure to surgical procedures due to short working hours. A module-based clinical training model promotes rapidly acquired and persistent surgical skills. A randomised controlled trial concerning supervised hernia repair in eight training hospitals in Denmark was performed. The participants were 18 registrars [Post graduate year (PGY) 3 or more] in their first year of surgical specialist training. The intervention consisted of different modules with a skills-lab course followed by 20 supervised Lichtenstein hernia repairs. Operative performance was video recorded and blindly rated by two consultants using a previously validated skills rating scale (8-40 points). Outcome measures were change in the ratings of operative skills and operative time. In the intervention group (n = 10) the average rating of operative skills before intervention was 22.5 (20.6-24.3) and after 26.2 (23.5-28.8), p = 0.044. At follow-up after 1 year, rating was 26.9 (23.4-30.4), p = 0.019. In the conventionally trained group average rating was 23.4 (19.4-27.3) at start and 21.7 (17.3-26.1) at end, p = 0.51. At start no difference was detected between the two groups, p = 0.59; by 1 year the difference was statistically significant favouring intervention, p = 0.044. Operative time showed similar results in favour of the intervention. A module-based training model in Lichtenstein hernia repair was preferable in both short and long-term compared with standard clinical training. The model will probably be applicable to other surgical training procedures.

An assessment of surgical and anesthesia staff at 10 government hospitals in Sierra Leone.

Strengthening workforce capacity to deliver essential surgical and anesthesia care has been identified as a strategy for addressing the unmet burden of morbidity and mortality in under-resourced countries. Sierra Leone is one of the poorest countries in the world and faces the challenge of stretching limited resources to provide appropriate health care for a population of 6 million. To investigate the training of surgical and anesthesia staff in Sierra Leone and to build an evidence base for future health care policy and training programs tailored to local needs. Health care professionals who conduct surgery or deliver anesthesia at 10 of the 23 government hospitals in Sierra Leone were surveyed regarding training and clinical practices. This study surveyed 36 of 70 surgical staff (51%) and 38 of 68 nurse specialists (56%) nationally. Descriptive analysis of demographic details, training levels, and reported needs for future development. Thirty-six surgeons were surveyed in study hospitals, of whom the majority had limited surgical specialization training, whereas most anesthesia was provided by 47 nurse specialists. All consultants had postgraduate qualifications, but 4 of 6 medical superintendents (67%) and all medical officers lacked postgraduate surgical qualifications or formal surgical specialist training. The number of trained anesthesia staff increased after the introduction of the Nurse Anesthesia Training Program in 2008, funded by the United Nations Fund for Population Activities, increasing the number from 2 to 47 anesthesia staff based at the study hospitals. Although 32 of 37 nurse anesthetists (86%) reported having attended training workshops, 30 of 37 (>80%) described anesthesia resources as "poor," reporting a critical need for anesthesia machines and continual oxygen supply. Of the 37, 25 specifically mentioned the need for a better-functioning anesthesia machine and 16 mentioned the need for oxygen. To address unmet surgical need in the long term, accredited local surgical specialization programs are required; training of nonphysician surgical practitioners may offer a short-term solution. To develop safe anesthesia care, governments and donors should focus on providing health care professionals with essential equipment and resources.

Pretraining Experience and Structure of Surgical Training at a Sub‐Saharan African University

The common goal of surgical training is to provide effective, well-rounded surgeons who are capable of providing a safe and competent service that is relevant to the society within which they work. In recent years, the surgical workforce crisis has gained greater attention as a component of the global human resources in health problems in low- and middle-income countries. The purpose of this study was to: (1) describe the models for specialist surgical training in Uganda; (2) evaluate the pretraining experience of surgical trainees; (3) explore training models in the United States and Canada and areas of possible further inquiry and intervention for capacity-building efforts in surgery and perioperative care. This was a cross-sectional descriptive study conducted at Makerere University, College of Health Sciences during 2011-2012. Participants were current and recently graduated surgical residents. Data were collected using a pretested structured questionnaire and were entered and analyzed using an excel Microsoft spread sheet. The Makerere University, College of Health Sciences Institutional Review Board approved the study. Of the 35 potential participants, 23 returned the questionnaires (65 %). Mean age of participants was 29 years with a male/female ratio of 3:1. All worked predominantly in general district hospitals. Pretraining procedures performed numbered 2,125 per participant, which is twice that done by their US and Canadian counterparts during their entire 5-year training period. A rich pretraining experience exists in East Africa. This should be taken advantage of to enhance surgical specialist training at the institution and regional level.

Surgical Procedure-based Assessment: How Did We Get Here and Where are we Going?

The Intercollegiate Surgical Curriculum Programme (ISCP) has implemented a tool for assessment of surgical technique called procedure-based assessment (PBA). It is part of a spectrum of workplace-based assessments being used for the surgical specialist training programmes. We reviewed the literature on observational assessment of surgical practice in order to analyse how PBAs relate to the evidence base for this form of assessment.

Training the Next Generation of Vascular Specialists:

Several challenges exist with respect to training the current and next generation of vascular specialists. Current advances in technology have led to changes in the length and type of training required to master new endovascular techniques. At the same time, the number of open surgical cases being provided to trainees may not be sufficient to allow them to manage complex open procedures. This growth is occurring at a time when increased external pressures are being applied to shorten training programs. Finally, the next generation of vascular specialists will come from medical students who are accruing a large educational debt during their course of training. Vascular specialists outside the US have already begun to successfully deal with many of these issues, and insight can be gained from their successes and difficulties. In this article, we review the current status of training for vascular and endovascular specialists and discuss the need for changes in current US training paradigms. While this will touch on initiatives in other specialties, including cardiology, vascular medicine, and interventional and neuroradiology, we will focus primarily on changes that are occurring with respect to the training of surgical specialists who manage vascular disease.

The European Working Time Directive and the Effects on Training of Surgical Specialists (Doctors in Training)

Legislation launched with the EWTD was born as a "Protection of the clinical personnel against overwork for the benefit of Patients" (consumer protection and safety). It appeared that this legislation is in direct and severe conflict with former EU legislation to train competent surgical specialists. First experiences with the EWTD show far reaching and serious consequences on the training of surgical specialists as well as on medical care. There will be a reduction of about 30-35% of clinical and operative experience acquired during the usual 6 yrs of training, with many other negative aspects (see p. 7). All measures proposed so far to overcome the ensuing problems are unworkable. The training of competent surgical specialists as required by the Directive 93/16 EEC is no longer possible and serious problems with safe patient care will occur in the short term, if no political actions are taken. The surgical specialties, represented in the UEMS, provide a proposal for a working hour model consisting of 48 hrs working time (incl. service duties) plus additional 12 hrs reserved and protected for teaching and training. This model would adhere to the EWTD on the one hand, yet maintain the desired standard of training. This proposed exemption from the EWTD would be limited to the time of specialist training. We ask the responsible politicians to find a solution rapidly to prevent serious negative consequences. This motion is supported by the surgical specialties (neurosurgery, general surgery, orthopaedic surgery, paediatric surgery, cardio-thoracic surgery, vascular surgery, oto-rhino-laryngology, list not complete) of the member states of the EU, representing more than 80,000 surgical specialists.

The European Working Time Directive and the Effects on Training of Surgical Specialists (Doctors in Training)

Legislation launched with the EWTD was born as a “Protection of the clinical personnel against overwork for the benefit of Patients” (consumer protection and safety). It appeared that this legislation is in direct and severe conflict with former EU legislation to train competent surgical specialists.

The European Working Time Directive and the Effects on Training of Surgical Specialists (Doctors in Training)

The European Working Time Directive and the Effects on Training of Surgical Specialists (Doctors in Training)

The Next Generation of Surgical Residencies

I suggest restructuring general surgical residencies to facilitate training of surgical specialists and subspecialists. Basic surgical education for 1 or 2 years should provide a foundation of fundamental cognitive, technical, and patient management skills useful for all surgery residents, regardless of discipline. Intermediate surgical education for an additional 2 or 3 years should amplify cognitive, technical, and clinical skills and senior responsibility in general surgery for individuals entering a general surgical subspecialty or for advanced general surgery training. Residents seeking a career in advanced general surgery would take 2 additional years of training in advanced surgery. Such individuals could pursue additional subspecialty training and research experience to qualify as academic surgical scientists. Implementation of such innovations in general surgical education awaits the cooperative joint efforts of appropriate accrediting and certifying organizations, specialty societies, and surgical program directors.