Trainee Group Research Articles

Electrophysiology and hyperscanning applied to e-learning for organizational training

PurposeThe purpose of this study is to investigate the effects of the remote training process on distance learning with the application of neurometrics and investigate the features of the training that promote better synchronization between trainers and trainees in terms of cognitive and emotional processes favorable to learning, during a condition of remote professional training.Design/methodology/approachThe authors proposed a hyperscanning paradigm together with a conversational analysis to assess remote online training by collecting neurophysiological measures (frequency band analysis: delta, theta, alpha and beta) via multiple wearable electroencephalograms (EEGs) during a session of remote training.FindingsResults showed increased delta activity in the trainer when he was leading the session and when the participants were exchanging feedback. The delivery of feedback was also linked to increased theta activity compared with the normal activity of the trainees. Finally, synchronization of EEG between trainer and trainee groups was found for the beta band.Research limitations/implicationsThis study proposes to adopt a new multi-methodological approach that combines conversational analysis with the detection of remote neurometric parameters, in the field of educational neuroscience applied to organizational contexts.Practical implicationsFindings can help trainers in the development of their skills as trainers and in modeling remote training in organizations.Originality/valueFindings highlight the crucial role of particular phases of the e-learning process, such as the feedback phase and the interaction trainer group, and they pointed out the relevance of neurophysiological measures to test the e-learning process.

Vascular Surgery Trainees' Experience with Open Lower Extremity Revascularization in an Era of Endovascular-First Therapy

The impact of the adoption of endovascular-first therapies for lower extremity revascularization on vascular trainees’ experience with open bypass is not known. We sought to determine trends in open versus endovascular lower extremity revascularization case volumes among graduating vascular fellows (5+2) and integrated vascular residents (0+5). We reviewed the Accreditation Council for Graduate Medical Education 2012-2021 case log data for graduating vascular surgery fellows (5+2) and integrated residents (0+5). We retrieved the mean number of femoropopliteal and infrapopliteal revascularization procedures carried out by each trainee group, both open and endovascular. The means were plotted against time. A Mann Kendall test was conducted to detect trends in the average number of cases performed by vascular graduates. Between 2012 and 2021, integrated vascular residents graduated with an average of 21.9 femoropopliteal and 22.5 infrapopliteal bypasses which were 4.4 ± 1.4 and 3.0 ± 1.9 more than vascular surgery fellows, respectively. For both trainee groups, the mean number of open procedures—femoropopliteal or infrapopliteal—was consistent over the course of the years with no statistically significant trend observed (Figs 1 and 2). Integrated vascular residents graduated with an average of 47.9 femoropopliteal and 22.7 infrapopliteal endovascular procedures, which were 6.2 ± 2.9 and 3.1 ± 1.7 more than vascular surgery fellows, respectively. We observed a statistically significant increase in the mean number of femoropopliteal and infrapopliteal endovascular procedures in this time period –in both trainee groups. The mean number of femoropopliteal endovascular cases increased by 105.5% (31.1 to 63.9; P < .001) for integrated residents and 110.3% (26.2 to 55.1; P < .001) for vascular fellows. Likewise, the mean number of infrapopliteal endovascular cases increased by 120.3% (14.3 to 31.5; P < .001) for integrated residents and 94.1% (13.6 to 26.4; P < .001) for vascular fellows. The overall case volume of femoropopliteal and infrapopliteal procedures, combining open and endovascular techniques, increased for both trainee groups, which is mainly due a significant increase in peripheral vascular intervention volume. The total case volume of lower extremity revascularization has increased for all vascular trainees but graduates of integrated residency programs have a more robust experience. Despite a significant rise in endovascular case volume, however, the average number of open bypass procedures performed by graduating vascular surgery trainees is not affected and has remained stable.Fig 2Trends in open infrapopliteal bypass revascularization.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The effect of short-term training about depth predicting score on the diagnostic ability of invasion depth for differentiated early gastric Cancer among non-expert endoscopists

BackgroundThe depth-predicting score (DPS) was proposed based on conventional white-light imaging (C-WLI) endoscopic features of early gastric cancer (EGC) to determine the invasion depth of the neoplasm. However, the effect of DPS on training endoscopists remains unclear. Therefore, we aimed to investigate the effect of short-term DPS training on improving the diagnostic ability of EGC invasion depth and compare the training effect among non-expert endoscopists at different levels.MethodsIn the training session, the definitions and scoring rules of DPS were instructed, and classic C-WLI endoscopic example graphics were exhibited to the participants. Another C-WLI endoscopic images of 88 cases of histologically proven differentiated EGC were selected as an independent test dataset for evaluating the training effect. Each participant was tested, and the diagnostic accuracy rate of invasion depth was calculated differently one week before the training and after the completion of training.ResultsA total of 16 participants were enrolled and completed the training. Participants were divided into a trainee group and a junior endoscopist group according to the total number of C-WLI endoscopies performed. The total number of C-WLI endoscopies performed showed a significant difference between the trainee group and junior endoscopist group (350 vs. 2500, P = 0.001). No significant difference between the trainee group and junior endoscopist group was observed for pre-training accuracy. The overall diagnostic accuracy of invasion depth was improved significantly after completing DPS training compared with before (68.75 ± 5.71% vs. 61.58 ± 9.61%, P = 0.009). In the subgroup analysis, the post-training accuracy was higher than the pre-training accuracy, but significant improvement was observed only in the trainee group (61.65 ± 7.33% vs. 68.32 ± 5.71%, P = 0.034). In addition, no significant difference in post-training accuracy between the two groups was observed.ConclusionShort-term DPS training can improve the diagnostic ability of the invasion depth of EGC and homogenize the diagnostic ability of non-expert endoscopists at different levels. The depth-predicting score was convenient and effective for endoscopist training.

A questionnaire-based survey exploring attitudes to human factors within the orthodontic team

Introduction Orthodontic service provision relies on good organisational systems for high standards of patient care and safety. Human factors (HFs) are non-technical skills associated with communication, leadership and teamwork, important for safe patient care. This investigation explored attitudes and understanding of HFs within orthodontic clinical training in the United Kingdom.Materials and methods A questionnaire-based qualitative and quantitative analysis including members of the orthodontic clinical team was undertaken at two teaching centres. A modified Operating Rooms Managements Attitudes questionnaire was used with a 5-point Likert scale. Participants indicated agreement or disagreement with statements around nine themes: leadership structure; confidence assertion; information sharing; stress; fatigue; teamwork; work values; error-procedural compliance; and organisational climate. Internal consistency among themes was assessed with Cronbach's alpha and differences in responses with chi-squared tests at 5%.Results In total, 80 responses were received from 96 invitees. Positive attitudes towards teamwork, error-procedural compliance, and organisational climate were found. Orthodontic consultants, trainees, and nurses recognised that human error is not a sign of incompetence. Stress and fatigue were less acknowledged by consultants and trainee groups. Trainees, nurses and therapists valued information sharing over the consultant group. Orthodontic trainees and nurse responses suggested further training might be required in leadership structure, confidence assertion, and work values.Conclusions Differences in attitudes and understanding of HFs within different professional groups in the orthodontic team exist.

Significance of surgical first assistant expertise for surgical site infection prevention: Propensity score matching analysis.

Surgical site infection (SSI) is one of the most common postoperative complications in patients undergoing major operations, such as spinal fusion surgery, and a major contributor to patient morbidity and mortality. SSI is considered the most preventable type of infection; however, the risk of SSI is multifactorial. This study aimed to determine the extent to which the expertise of the surgical first assistant (SFA) affected SSI rates. We retrospectively reviewed 528 patients at a single institution who underwent lumbar spine fusion surgery via the posterior approach performed by a single surgeon between January 2012 and May 2020. The SFAs participating in the surgeries were classified into 2 groups: a certified neurosurgery specialist and relatively less experienced neurosurgery resident trainees. To reduce potential selection bias and confounding factors, propensity score matching was performed between the 2 groups. In 170 of the 528 lumbar spine fusion surgeries, the SFA was a certified neurosurgery specialist. In the other 358 surgeries, the SFA was a resident trainee. Seventeen patients met the SSI criteria. The SSI rate was significantly different between the 2 groups (0.6% (1 patient) and 4.5% (16 patients) in the certified specialist and resident trainee groups, respectively; P = .02). After propensity score matching, 170 paired patients were selected. After adjusting for confounding factors, SFAs that were certified neurosurgery specialists were associated with a lower likelihood of SSI (adjusted OR 0.09; 95% CI, 0.01 to 0.79; P = .029) than SFAs that were neurosurgery residents. A higher level of SFA expertise was significantly associated with a lower overall SSI rate in lumbar spine fusion surgeries. It is difficult to predict the incidence of SSI; however, this finding suggests the importance of SFA expertise in preventing SSI.

일반항공 비행교관 역량별 행동지표 및 비행교관 교육요구 분석

This study aims to provide information necessary for developing a “Competency-Based Training and Evaluation Plan” for general aviation flight instructors in Korea. General aviation training experts designed a survey by selecting “Behavior Indicators” from the ICAO Flight Instructor Competency Model. This study analyses the importance of Behavioral Indicators, the level of instructor performance, and the training needs for flight instructors. According to the factor analysis, ICAO “Flight Instructor Competency Model” is found as a valid tool to measure general aviation flight instructor competencies. According to the training needs analysis, flight instructors training program needs to be improved on “Training Environment Management”, “Teaching Method”, and “Interaction” competencies. When compared with trainee group, flight instructors &amp; examiners have a higher training demand for “Teaching &amp; Learning Environment Management”. This study suggests the flight instructor training program requires to be reorganized based on the competencies related to the flight instructor duties in the training environments.

Effects of an incentive spirometer versus a threshold inspiratory muscle trainer on lung functions in Parkinson’s disease patients: a randomized trial

Upper airway obstruction, reduced maximal expiratory and inspiratory flows, reduced lung volumes, abnormal ventilatory control, and diaphragmatic dyskinesias are reported in patients with Parkinson’s disease (PD). Inspiratory muscle training (IMT) has been reported to be effective in improving respiratory functions; however, no studies have compared the effects of the incentive spirometer (IS) with the threshold inspiratory muscle trainer (TIMT) in patients with PD. The study aimed to compare the effects of IS and TIMT on maximum inspiratory pressure (MIP), 6-min walk distance (6-MWD), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow rate (PEFR) in patients with stage 1–3 according to the Hoehn and Yahr scale. 18 patients were randomly assigned to two groups, i.e., incentive spirometer (IS) and threshold inspiratory muscle trainer (TIMT) group. The IS group received IMT with volume-based IS, and the TIMT group received IMT with TIMT. MIP, 6-MWD, FVC, FEV1, and PEFR were measured before and after six weeks of training. In IS group: A significant increase (p < 0.05) was observed in MIP and 6-MWD by 18.13 and 5%, respectively. In the TIMT group: A significant increase (p < 0.05) was observed in MIP and 6-MWD by 30.15 and 8.94%, respectively. Both groups observed no significant difference (p > 0.05) in FVC, FEV1, and PEFR. When the two groups were compared, a greater increase (p < 0.05) was observed in the MIP and 6-MWD in the TIMT group compared to IS group. IMT with IS or TIMT for six weeks effectively increased MIP and 6-MWD in patients with stage 1–3 (Hoehn and Yahr scale) of PD. No improvement was observed in FVC, FEV1, or PEFR with any of the techniques. TIMT is more effective than IS in improving MIP and 6-MWD.

Does Training Background Influence Outcomes after Coronal Scalp Incision for Treating Craniomaxillofacial Injuries?: A German Pilot Study

ObjectivesTo examine outcomes of the coronal scalp approach to craniomaxillofacial (CMF) fractures performed by oral-maxillofacial or craniofacial plastic surgery residents (OMFS/CFPS-Rs) vs. trauma surgery residents (TS-Rs), and to determine differences in treatment outcomes between both operator groups.MethodsThis retrospective cohort study enrolled a sample of CMF fracture adult patients treated via the coronal approach in a German level one trauma center during a two-year interval. The predictor variable was training background (OMFS/CFPS-Rs vs. TS-Rs; each n = 5). All trainees must assist in ≥ two surgeries before self-performance. The main outcomes were length of hospital stay (LHS) and coronal flap-related complications (CFRCs). Appropriate statistics were computed at α = 95%.ResultsOf the 97 patients identified during the study period; 71 of whom (19.7% females; mean age, 40.2 ± 15.2 years; 46.5% operated by TS-Rs; 38% combined upper and midfacial fractures) met the inclusion criteria. Operative time, LHS, CFRCs, readmission rates, and post-discharge emergency room visits were not significantly different between the trainee groups. 60% of CFRCs were visible/unfavorable or hypertrophic scar with/without alopecia. The number needed to treat of short LHS was 44 (95% confidence interval [CI], 3.9 to 4.8), the number needed to harm of CFRCs was 14 (95% CI, 3.6 to 7.4), i.e., the likelihood to be helped or harmed was 0.32.ConclusionsCoronal flap raising by OMFS/CFPS-Rs does not appear beneficial over that by TS-Rs in terms of LHS and CFRCs evaluated until postoperative month six. Trainees from any surgical specialties could gain partial independence from skilled surgeons in CMF trauma “sub-steps” and favorable clinical outcomes. Further studies in a larger sample cohort are required to confirm this pilot data.

Application of a highly simulated and adaptable training system in the laparoscopic training course for surgical residents: Experience from a high-volume teaching hospital in China

ObjectiveTo explore the effectiveness, feasibility, and training effect of a highly simulated and adaptable laparoscopic training system in the advanced integrated two-stage laparoscopic simulation training course for surgical residents. MethodsThis study prospectively took the surgical residents who received the advanced integrated two-stage laparoscopic simulation training course in our hospital from December 2019 to December 2021 as the research objects. In the stage one course, the trainees are randomly distributed into the dry simulation system group and Darwin laparoscopic training system group. The subjective assessment results of the trainees from the two groups are collected by questionnaires, and the simulation assessment results of the two groups are evaluated in a unified, objective, and standardized assessment form. The pre-course and post-course questionnaires were used to evaluate the feasibility and effectiveness of the Darwin system in the stage two course. ResultsA total of 62 trainees completed the stage one and stage two courses. In the stage one course, the trainees were randomly distributed into the dry simulation trainer group (N = 19) and the Darwin group (N = 43). The results of the subjective assessment questionnaire showed that compared with the dry simulator group, the students in the Darwin group had higher subjective scores (P < 0.05). The objective assessment results for the 3 modules of "One Track Transfer", "One Tunnel Pass" and "High and Low Pillars" in the Darwin group were significantly better than those in the dry simulator group (P < 0.05). The trainees who received the stage two course completed the questionnaires before and after the course. The results showed that compared with pre-course evaluation, "basic theoretical knowledge of laparoscopy", "basic skills of laparoscopy", "laparoscopic suture technique" and "camera-holding technique" were significantly improved after training (P < 0.05). ConclusionThe highly simulated and adaptable laparoscopic training system is effective and feasible in the advanced integrated two-stage laparoscopic simulation training course for surgical residents.

Improvement of detection sensitivity of upper gastrointestinal epithelial neoplasia in linked color imaging based on data of eye tracking.

Linked color imaging (LCI) is useful for screening in the gastrointestinal tract; however, its true clinical benefit has not been determined. The aim of this study was to determine the objective advantage of LCI for detection of upper gastrointestinal neoplasms. Nine endoscopists, including three novices, three trainees, and three experts, prospectively performed eye tracking. From 30 cases of esophageal or gastric neoplasm and 30 normal cases without neoplasms, a total of 120 images, including 60 pair images of white light imaging (WLI) and LCI taken at the same positions and angles, were randomly shown for 10s. The sensitivity of tumor detection as a primary endpoint was evaluated and sensitivities by organ, size, and visual gaze pattern were also assessed. Color differences (ΔE using CIE1976 [L*a*b*]) between lesions and surrounding mucosa were measured and compared with detectability. A total of 1080 experiments were completed. The sensitivities of tumor detection in WLI and LCI were 53.7% (50.1-56.8%) and 68.1% (64.8-70.8%), respectively (P=0.002). LCI provided higher sensitivity than WLI for the novice and trainee groups (novice: 42.2% [WLI] vs 65.6% [LCI], P=0.003; trainee: 54.4% vs 70.0%, P=0.045). No significant correlations were found between sensitivity and visual gaze patterns. LCI significantly increased ΔE, and the diagnostic accuracy with WLI depended on ΔE. In conclusion, LCI significantly improved sensitivity in the detection of epithelial neoplasia and enabled epithelial neoplasia detection that is not possible with the small color difference in WLI. (UMIN000047944).

Effects of cross-training on motor function and length of stay after total hip arthroplasty: A randomized controlled trial.

There is no consensus about which training methods will give better early outcomes after total hip arthroplasty (THA). To investigate the short-term effects of cross trainer exercise on physical function and walking ability following THA. Fifty patients who underwent THA were randomly allocated into two groups. The intervention program was started 3 days after surgery. The main physical function results were pain, hip range of motion, knee extensor strength, single-leg stance time, and walking performance test. In addition, the number of days of requiring to walk and the length of hospital stay were recorded. In the comparison between groups at discharge, the patients in the cross trainer group had significantly less hip pain while walking, improvement in knee extensor strength, increased single-leg stance time, as well as increased walking speed and stride length at discharge. The number of days required to walk and length of stay were also significantly lower in the intervention group. Conclusions: Cross trainer exercise commencing 3days postoperatively improves physical function and walking ability after THA.

Knowledge, skills and abilities (KSAs) as a metric to re-conceptualise aptitude: a multi-stakeholder perspective

ABSTRACT Aptitude is a hypernym used in training and practice-based contexts to refer to a person’s natural or acquired ability to do something. It tends to be an attribute that is ‘forward-looking’, i.e. referring to a person’s probability of achieving success in the future. This paper adopts a retrospective perspective in looking at the ‘success achievement’ of (would-be) interpreters and employs the term knowledge, skills and abilities (KSAs). The research questions that this paper addresses relate to frequency of KSAs referred to across four ‘stakeholder areas’ relevant to interpreter performance: studies from pedagogues on training and (pre-qualification) testing; testing/credentialing authorities; industry-based organisations; and trainee and practising interpreters themselves. Comparison across the four stakeholder areas shows that the training and testing, and credentialing stakeholder areas most frequently identify linguistic and transfer-based KSAs, with moderate attention afforded to intercultural skills, discourse analysis skills, social interactional skills and knowledge bases across different thematic areas, and demonstration of knowledge of ethics. The industry-based stakeholder area records high levels of frequency for KSAs to do with research, terminology, business, self-assessment and ICT skills, alongside linguistic, and interactional KSAs. Overall, however, the broadest spread of frequently identified KSAs is recorded amongst the trainee and practitioner stakeholder group.

Effects of Inspiratory Muscles Trainer in Pulmonary Rehabilitation Program among COPD Patients

Background: Chronic obstructive pulmonary disease (COPD) is associated with prolonged respiratory problems and compromised airflow. Eventually, routine activities become troublesome. Pulmonary rehabilitation program and specific training of inspiratory muscles can do management of such patients. Aim: To find out the effects of Inspiratory Muscle Trainer on dyspnea in moderate COPD patients during Pulmonary Rehabilitation in terms of improvement of pulmonary lung function and Multidimensional Dyspnea profile. Study Design: Randomized controlled trial. Methodology: Two groups were designed; in one group Pulmonary Rehabilitation Program was applied in other group both PRP and IMT was given. Patients were recruited into two groups by simple random technique. Pre-treatment measurements were taken and then Sessions of 4 weeks with 5 days per week were given and post treatment assessment was done. Data was evaluated by using SPSS version 24. Independent sample t-test was applied to determine any significant difference between Pre-treatment and Post-treatment Functional pulmonary assessment between two groups. Results: Findings revealed that differences between two groups were statistically significant (p &lt;0.05) and also statistically significant difference were observed within group analysis (p&lt; 0.05) with respect to dyspnea , fatigue , quality of life. Practical Implication: This study considered moderate COPD patients for Inspiratory Muscle training (IMT) along with Multi-Disciplinary Approach in slowing down the worsening of disease and in this way prevented the future complications. Conclusion: It was concluded that inspiratory muscle trainer group was more effective as compare to standard rehabilitation in improving pulmonary function testing and reducing dyspnea among COPD patients. Keywords: Dyspnea, Inspiratory Muscle Training and Pulmonary Rehabilitation Programme.

Evaluation of lMM CD program on coconut cultivation; as an e-extension tool

Various traditional and modem technology transfer tools are used in the Coconut Research Institute (CRI) to educate the clients. Interactive Multimedia Compact Disc (IMM CD) programs on coconut is one of the modem e- extension tools among them.&#x0D; This research is aimed at evaluation of IMM CD-1 on coconut cultivation, using a quality (features) evaluation test and a utility evaluation test. Eighty three people who visited to the CRI in three groups for trainings were selected under the Convenient Sampling Technique. The groups represented 22 Agriculture Diploma Students, 21 newly recruited Coconut Development Officers (CDOs) and40 innovative, volunteer growers.&#x0D; The first two trainee groups i.e.; Agriculture Diploma Students and CDOs together as a group of 43 were made to evaluate qualities in the IMM CD-1 by allowing them to be at CRI auditorium in two groups; using a questionnaire and formulated the responses into individual satisfaction index values. Considering all the values Overall clientele Satisfactory Index Value was calculated and it was 90.38% and this value interpretes the CD being in the highest quality. The satisfaction scores given by the Agriculture students were higher than the scores given by the CDOs while showing the higher e-exposure and the higher competency of e-technology of students. The legibility of the text in the IMM CD has been scored as the best quality.&#x0D; The grower group was given the opportunity to buy the CD, use it at home and to respond to a questionnaire with open ended questions to test the overall utility of the CD. After 02 months responses were collected and formulated the results into a SWOT table. This test revealed that IMM CD-1 was highly accepted by the young growers than elderly growers. The elderly growers were not familiar with the e-technology and it was seen their need of computer training. It was obvious that the importance of translation of this CD into Tamil and English languages and to update the technical content timely.

OGBN O04 Upper Gastrointestinal Training in the UK &amp; Ireland – a Roux Group Study

Abstract Background Surgical training programmes in the United Kingdom and Ireland (UK&amp;I) are in a transition period evidenced by new surgical curricula. This study is the first to collate the opinions of UK&amp;I trainee and consultant surgeons regarding the current Upper Gastrointestinal (UGI) training model. Methods A questionnaire was developed and distributed via national UGI societies and the social media platform, Twitter. A total of 241 responses were received with all UK&amp;I regions represented. Results The median time to Certificate of Completion of Training (CCT) of 13 years was considered reasonable (50.2%), however the majority (67.2%) found training to be unfocused. The suggested targets for publications, presentations and audits were 3–5 (trainee vs consultant &amp;lt;3 vs 3–5, p&amp;lt;0.001), &amp;lt;3 (&amp;lt;3 vs 3–5, p=0.002) and 3–5 (&amp;lt;3 vs 3–5, p&amp;lt;0.001) respectively. The majority (61.9%) considered a higher academic degree advantageous but felt it should not be compulsory. Interestingly, most respondents (63.5%) had or planned to undertake one. Crucially, there were geographical discrepancies in access to training, particularly in bariatrics, robotic surgery, and endoscopy. Proficiency in diagnostic endoscopy was deemed essential for CCT and consultant practice (81.7% and 67.6% respectively). The current index UGI operative requirements were felt to be achievable (87.6%) but inadequate for day one consultant practice (74.7%), an opinion shared by both the trainee and consultant groups (p=0.662). Reassuringly, most respondents (76.3%) deemed there to be a role for on-the-job operative training following consultant appointment. Post-CCT fellowships were not considered necessary for consultant appointment, however the majority (73.6%) again recognised its advantage. Conclusions While variations were seen in the opinions of trainee and consultant surgeons, the current CCT requirements as outlined by the Joint Committee on Surgical Training are consistent with the overall perspective of the UGI community. Areas for improvement include flexibility in geographical working and provisions for endoscopy training, to ensure equal access.

EGS P20 Emergency General Surgery – A state of the nation survey

Abstract Background ERAS (enhanced recovery after surgery) programmes have delivered improved outcomes across the elective surgery landscape but emergency surgery has historically lagged behind with its improvements. The introduction of acute care surgery principles in the United States and projects such as NELA (National Emergency Laparotomy Audit) in the United Kingdom are working to change this. Despite the improvement in outcomes seen by NELA there lacks clarity over the structure and provision of services across the UK. No study to date has examined how Emergency General Surgery care is currently organised and therefore how these organisational structures are changing as new innovations to patient care are delivered. This study aims to ascertain the current organisation structures of emergency surgical care within England and whether there are plans for this to change. Methods A survey was defined and sent to hospitals across England via Freedom of Information (FOI) Requests. Trusts were identified from the online NHS Service Directory and cross referenced with the NELA list of participating hospitals. This led to FOIs sent to 123 acute Trusts in England. Responses not received within 8 weeks were not included in the study. Questions were identified and wording agreed by the authors. Trusts were asked their current working structure and whether they have plans to change within the next five years. Organisational structures were categorised as A; Mixed general surgical take under a non-specific general surgery consultant, B; Daily allocation of acute admission to a general surgery subspecialty (Upper GI / Colorectal / Hepatobiliary), C; Dedicated Emergency General Surgery consultants / service during weekdays only (Monday to Thursday, or Monday to Friday), D; Dedicated Emergency General Surgery consultants / service weekdays and weekends, or E; Other. Results 101 out of 124 trusts responded within the 8-week timeframe. 3 trusts declined to supply information on organisational structure. The remaining reported organisational structures of A; n=36, B; n= 16, C; n=10, D; n=30, E; n=5. In total 41.24% of hospitals reported having an active EGS service in place. Mean bed numbers across different organisational types were Group A; 617.62, Group B; 867, Group C; 648, Group D; 559.5, Group E; 800.71. Mean admissions were Group A; 3983.08, Group B; 6088.29, Group C; 4432.14, Group D; 4123.52, Group E; 4578. Mean NELA cases were Group A; 134.29, Group B; 187, Group C; 164, Group D; 142.11, Group E; 187.17. Regarding number of consultants in place to run an EGS service group C reported a range of 2 to 14 consultants, with a mean of 6. Group D reported a range of 3 to 13 consultants, with a mean of 8.14. Regarding plans to move towards an EGS service group A reported Yes; 9 (25%), No; 22 (61.11%), TBD; 2 (5.56%), no answer given; 3 (8.33%). Group B reported Yes; 3 (18.75%), No; 10 (62.5%), TBD; 3 (18.75%). Conclusions The speciality of Emergency General Surgery (EGS) within the United Kingdom is expanding with annual EGS symposiums being held by professional bodies such as ASGBI, EGS trainee groups forming such as the Moynihan Academy, and large institutions altering their service specifically towards hiring consultants in EGS positions. This follows the Royal College's Acute and Emergency Care joint position statement, the consensus statement from ASGBI and the Getting It Right First Time (GIRFT) emergency surgery report which explicitly state that a dedicated surgical assessment unit, with senior surgeon directing patient throughput has been shown to reduce costs and increase effectiveness of a surgical department. This study shows that 41.24% of trusts in England deliver an EGS service but in heterogenous structured formats. What is clear is that a dedicated EGS service is becoming more popular, with 25% of group A services, and 18.75% of group B services reporting active plans in the next 5 years to create this service. This further impresses the need for categorisation of service provision types, and the sharing of information, to ensure that England does not end with a patchwork of service types confusing patients and rotating clinical practitioners alike.

139. The JTG and Facebook: Progression & Potential

The Junior Trainee Group (JTG) of the British Association of Oral and Maxillofacial Surgeons (BAOMS) represents everyone interested in OMFS from first day of university until entering specialty training. The JTG engages, supports and inspires the next generation of OMFS surgeons.

Factors Affecting the Learning Curve in the Endoscopic Ultrasound-Guided Sampling of Solid Pancreatic Lesions: A Prospective Study.

Endosonography is associated with a long learning curve. We aimed to assess variables that may influence the diagnostic outcomes in endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) of solid pancreatic tumors regarding the level of endoscopists' experience. Consecutive patients undergoing EUS-guided puncture of solid pancreatic tumors (eight endosonographers, including six trainees) were prospectively enrolled. An experienced endosonographer was defined as having performed at least 250 EUS examinations, including 75 FNA/Bs. The final diagnosis was determined by cytopathology, histopathology, or clinical follow-up. In total, 283 EUS-FNA/Bs of solid pancreatic tumors (75.6% malignant) in 239 patients (median age 69 years, 57.6% males) were enrolled. Trainees performed 149/283 (52.7%) of the interventions. Accuracy and sensitivity for detecting malignancy were significantly higher in the expert group than in the trainee group (85.8% vs 73.2%, p=0.01 and 82.5% vs 68.4%, p=0.02). Solid lesions evaluated by an expert using FNB needles showed the best odds for a correct diagnosis (odds ratio, 3.07; 95% confidence interval, 1.15 to 8.23; p=0.02). More experienced endoscopists achieved better accuracy in sampling via the transduodenal approach (86.7% vs 68.5%, p<0.001), in the sampling of malignant lesions (82.5 vs 68.4, p=0.02), and in the sampling of lesions located in the pancreatic head (86.1 vs 69.1, p=0.02). In cases involving these factors, we observed a moderate improvement in the diagnostic accuracy after 40 attempts. Transduodenal approach, pancreatic head lesions, and malignancy were recognized as the most important clinical factors affecting the learning curve in EUS-FNA/B of solid pancreatic lesions.

Mental practice for laparoscopic salpingectomy

Mental practice (MP) is a method of enhancing surgical training by rehearsal of a task without physical action. The primary objective of the study was to develop and validate a MP tool for laparoscopic salpingectomy (LS). An imagery script for LS was developed and used to facilitate a structured MP session for trainees in Obstetrics and Gynaecology and expert gynaecologists across three teaching hospitals in the UK. A virtual platform was used for one trainee group to assess its feasibility compared to a face-to-face approach. Pre- and post-session assessments were conducted to evaluate the impact of the script on motivation, confidence, preparedness and quality of imagery and demonstrated a significant improvement in global imagery scores for both novice groups. The expert group scored significantly higher than the face-to-face novice group on all items both before and after MP, indicating construct validity. There were no significant differences demonstrated between the two novice groups, thus demonstrating the virtual platform to be a non-inferior approach – an important consideration in the current COVID era.

The Impact of Homemade Laparoscopic Box Trainers on Medical Student Surgical Skills: A Randomized Control Pilot Study

<h3>Study Objective</h3> While instructional videos are commonly used in surgical education, there is a paucity of data on home laparoscopic box trainers. This pilot study evaluated impacts of augmenting instructional videos with these devices. <h3>Design</h3> This was a randomized controlled pilot study evaluating laparoscopic surgical performance on the LapSim virtual surgical simulator before and after a two-week curriculum of instructional videos alone (n=8, 47.1%) versus videos plus a home laparoscopic box trainer (n=9, 52.9%). The LapSim recorded mistake number, time, and instrument path length to complete each task. Participants completed surveys about their perceptions of surgery before and after the course. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> Preclinical medical students were recruited. Those with extensive surgical experience or did not complete the course were excluded. <h3>Interventions</h3> Two-week curriculum of instructional videos alone versus videos plus a home laparoscopic box trainer. <h3>Measurements and Main Results</h3> For the box trainer group vs. the videos alone group: mean change in mistakes was -10.0 (standard deviation [SD]:17.1) versus +0.5 (SD:21.59) (p=0.28); mean change in time was -433.24 (SD:304.67) seconds versus -366.16 (SD:240.10) seconds (p=0.62); mean change in instrument path length was -4.27 (SD:4.38) meters versus -3.19 (SD:4.86) meters (p=0.64). The box trainer group ranked "I feel as though surgery comes naturally" 1.58 points higher (95% confidence interval [CI]: 0.85, 2.32; p<0.01) and "I am worried about being skilled at surgery" 1.26 points lower (95% CI: 2.29, -0.24; p=0.02) upon completing the study. The videos alone group reported no significant changes in survey responses. <h3>Conclusion</h3> Home laparoscopic box trainers can generate confidence and reduce anxiety regarding surgical fields. This study provides a framework for future larger scale works.