Core training and surgical opportunities: A UK-based analysis
Background and aim: The COVID-19 pandemic, the new ISCP curriculum and the EWTD significantly reduced surgical exposure for trainees. This study analysed the operative experience of Phase 1 trainees (CT1/ST1 vs CT2/ST2) against the ARCP criterion of 120 procedures yearly.
Methods: National survey research in October 2021. Study end-point was the completion of >4 weekly procedures, equivalent to 120 cases per year. Chi-Square test and multivariate regression analysis were performed.
Results: 205 participants from 5 Deaneries were included, 48.3% were CT1/ST1 and 51.7% were CT2/ST2. 54.5% of year-1 and 50% of year-2 trainees were 28-30 years old, 55.6% and 50.9% were male, and 39.4% and 38.7% were White British. 39.4% of CT1/ST1 and 22.6% of CT2/ST2 performed <4 weekly procedures (p=0.01), with no difference in the “Observed” (p=0.6) or “Assisted” (p=0.3) number of cases. CT2/ST2 recorded more “ST-S” (p 0.04), “S-TU” (p=0.03) and “Performed” (p=0.02) operations. For CT1/ST1, older age (HR 2.4, 95% CI [1.1; 5.3], p 0.02) and southern deaneries (HR 1.7, 95% CI [1.2; 2.4], p 0.004) were independent factor for <4 weekly procedures. For CT2/ST2, northern regions were associated with more favourable training (HR 1.4, 95% CI [1.1;1.7], p=0.01).
Conclusion: Over one third of Phase 1 trainees do not meet the ARCP requirement of >120 procedures annually. Age and region of training are independent factors in the number of logbook cases.
Relevance for patients: This research focuses on training opportunities for junior surgical residents across the United Kingdom. The degree and type of exposure to the operating theatre has a significant impact on the development of surgical competencies. These are undoubtedly related to patient outcomes, as the quality of care delivered to patients and relatives greatly relies on the training background of future consultant surgeons.
[1] ISCP, Intercollegiate Surgical Curriculum Programme. The New Surgical Curriculum for August 2021. Available from: https://www.iscp.ac.uk/iscp/curriculum-2021 [Last accessed on 2022 Jun 26].
[2] Huang C, Wang Y. Li X, Ren L, Zhao J, Yu H, et al. Clinical Features of Patients Infected with 2019 Novel Coronavirus in Wuhan, China. Lancet 2020;395:497-506.
[3] Senni M. COVID-19 Experience in Bergamo, Italy. Eur Heart J 2020;41:1783-4.
[4] Bonalumi G, di Mauro M, Garatti A, Barili F, Gerosa G, Parolari A, et al. The COVID-19 Outbreak and its Impact on Hospitals in Italy: The Model of Cardiac Surgery. Eur J Cardiothorac Surg 2020;57:1025-8.
[5] JCST. COVID-19 and Trainee Progression in 2020- 19 March 2020; 2020. Available from: https://www.key documents.jcst [Last accessed on 2022 Jun 26].
[6] Fitzgerald JE, Giddings CE, Khera G, Marron CD. Improving the Future of Surgical Training and Education: Consensus Recommendations from the Association of Surgeons in Training. Int J Surg 2012;10:389-92.
[7] Ferrel MN, Ryan JJ. The Impact of COVID-19 on Medical Education. Cureus 2020;12:e7492
[8] Joyce DP, Ryan D, Kavanagh O, Traynor O, Tierney S. Impact of COVID-19 on Operative Experience of Junior Surgical Trainees. Br J Surg 2021;108:e33-4.
[9] Khan KS, Keay R, McLellan M, Mahmud S. Impact of the COVID-19 Pandemic on Core Surgical Training. Scott Med J 2020;65:133-7.
[10] IBM Technology Company. IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, New York: IBM Technology Company; 2019.
[11] Carr AS, Munsch C, Buggle S, Hamilton P. Core Surgical Training and Progression into Specialty Surgical Training: How do we Get the Balance Right? Ann R Coll Surg Engl (Suppl) 2011;93:244-8.
[12] Mishreki AP, Couch, DP. Keys to Successful Progression Directly from CT2 to ST3 in General Surgery: A Trainee’s Perspective. Ann R Coll Surg Eng (Suppl) 2012;94:320-2.
[13] Robinson DB, Hopkins L, James OP, Brown C, Powell AG, Egan RJ, et al. Surgical training Rotation Design: Effects of Hospital Type, Rotation Theme and Duration. BJS Open 2020;4:970-6.
[14] Thomas C, Elsey E, Boyce T, Catton J, Lewis W. Data from Two Deaneries Regarding the Ability of Higher Surgical Training Programmes to Deliver Curriculum Targets. Bull R Coll Surg Engl 2015;97:e50-3.
[15] Harries RL, Gokani VJ, Smitham P, Fitzgerald EF, Councils of Association of Surgeons in Training and British Orthopaedic Trainees Association. Less than Full-time Training in Surgery: A Cross-Sectional Study Evaluating the Accessibility and Experiences of Flexible Training in the Surgical Trainee Workforce. BMJ Open 2016;6:e010136.
[16] Scrimgeour DS, Brennan PA, Griffiths G, Lee AJ, Smith F, Cleland J, et al. Does the Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination predict ‘On-the-job’ Performance During UK Higher Specialty Surgical Training? Ann R Coll Surg Engl 2018;100:1-7.