bluuebunny/crossref_metadata_2025 huggingface dataset:
1141 Robotic Assisted Surgery in Horseshoe Kidneys: A Safety and Feasibility Multicentre Case Series
Authors: Ng A , Nathan A , Campain N , Yuminaga Y , Mumtaz F , Gulamhusein A , Tran M , Barod R , Patki P
Published: October 2021

Introduction

Horseshoe kidneys (HSK) are the most common renal fusion abnormality. However, they are only present in 0.2% of the population. Due to anatomical variation in vasculature, ectopia and malrotation, surgery has traditionally been performed via an open approach. We aimed to assess the safety and feasibility of robot-assisted surgery for HSK.

Method

Six patients (four female, two male) with HSKs were operated on between 2016 and 2019 across two high-volume centres by high-volume surgeons. All operations were robot-assisted, with three partial nephrectomies and one nephroureterectomy for renal masses and two benign nephrectomies for non-functioning kidneys. 3D reconstruction using CT renal angiograms was used to help identify vasculature and tumour location (where appropriate).

Results

The median age was 53 years (IQR 47-58.3) and the median BMI was 25 (IQR 25-25.8). Median tumour size in the four patients with renal masses was 35.5 mm (IQR 25.3-44.8). Median console time was 120 minutes (IQR 117-172.5) and the median estimated blood loss was 150 mL (IQR 112.5-262.5). The median pre-operative eGFR was 76 (IQR 70-86.5) and median post-operative eGFR was 65.5 (IQR 59.3-80.8). All operations were uneventful, there were no perioperative transfusions and no complications reported. Length of stay was two days for all patients.

Conclusions

We report the largest series of mixed robotic-assisted surgery on HSK. Robotic surgery is safe and feasible for HSK in high-volume centres with acceptable perioperative outcomes. Further prospective, longer-term, multi-centre studies are required to evaluative if robotic surgery for HSK is superior to open surgery.
1158 Summarising the Reporting of Study Outcomes in Robotic Oesophagectomy: A Systematic Review
Authors: Ramirez J , Jones C , Gourbault L , Hurst W , Abbas A , Zucker B , Shah M , Scroggie D ,   on behalf of the RoboSurg collaborative
Published: October 2021

Introduction

There is an increasing adoption of robotic oesophagectomy in place of standard techniques for oesophageal cancer resection. This is potentially due to its perceived technical benefits and improved short-term outcomes. Consistency in outcome selection, definition and reporting between studies is required for effective evidence synthesis and prevention of research waste. The aim of this review is to perform an in-depth analysis of outcome reporting in robotic oesophagectomy.

Method

Systematic searches were conducted using key words for robotic surgery and oesophageal cancer, from inception to February 2020. Studies reporting any outcome for robotic oesophagectomy were included. Outcomes in each study were recorded verbatim and categorised into twelve domains. Outcomes were independently categorised by two reviewers. Where reported, the follow-up period was also recorded.

Results

Of 954 abstracts screened, 226 full texts were reviewed and 102 included. Only one study was a RCT. A total of 1422 outcomes were reported. Each study had a median of 14 reported outcomes (range 1-25). Outcomes related to complications (n = 578, 99 studies), technical/operative factors (n = 290, 90 studies), and pathology (e.g., resection margin) (n = 197, 83 studies) were reported most frequently. No single outcome, or outcome domain was reported in all studies. No studies used a core outcome set for reporting. Forty-five studies stated a follow-up period, ranging from <1 month to 58 months.

Conclusions

There is significant heterogeneity in the selection and reporting of outcomes in robotic oesophagectomy. This calls for the use of a core outcome set to allow standardisation and transparency of outcome reporting.
39 Virtual Clinics in Foot & Ankle Surgery: Patient and Clinician Perceptions and Review of The Literature
Authors: Rhind J H , Devany A , Ramhamadany E , Ismael S , Heaver C , Hill S
Published: October 2021

Aim

The COVID 19 worldwide pandemic has led to the popularisation of, “Virtual” clinics. Within orthopaedics, little is known about the use of virtual clinics within foot and ankle surgery, specifically.

Method

A cross sectional observation study of patients and clinicians in response to virtual clinics in foot and ankle surgery. Patients seen in a virtual clinic were contacted from two weeks after their consultation by telephone with a 12-point questionnaire. Demographic information was also collected. Clinicians in foot and ankle also completed a 10-point questionnaire.

Results

100 patient responses were collected. Patient satisfaction with virtual clinics was positive, 65% were very happy (Likert scale rating 5). >90% of patients felt they received enough information, felt involved, felt it was helpful and knew who to contact if there was a problem. However, 79% would still prefer a face-to-face consultation. 22% would have preferred a video consultation. Clinician responses were more cautious, 60% were neither happy nor unhappy (Likert scale rating 3). Virtual clinics may be faster for the clinician.

Conclusions

Virtual clinics may be more convenient for patients with high satisfaction levels but represent significant clinical challenges for foot and ankle surgeons. Elements of virtual clinics may persist post pandemic, particularly in routine follow up patients. Virtual clinics are not appropriate for new patient referrals.
959 Extinction of The Stoma Clinic. Virtual Support for The Newly Formed Stoma
Authors: Alford N , McDonald S , Okocha M
Published: October 2021

Aim

214 stomas were created between January 2019 and January 2020 at our Tertiary Colorectal Centre. We surveyed patients to identify desirable features for a mobile stoma support application to mitigate potential challenges of limited in-person review. The aim is three-fold: To survey stoma patients, identify literature on mobile applications supporting stoma patients and evaluate available stoma support applications.

Method

A survey of 60 newly formed stoma patients focused on mobile application support. A systematic search, following the PRISMA checklist, determined the use of mobile applications in supporting stoma patients. A comprehensive search of mobile applications on IOS and Android stores was performed.

Results

79% of patients under 70 years old, and 58% of patients over 70, were interested in using a mobile application. 45 patients wanted an application that could photograph their output. Output and soft tissue management were the most cited reasons for contacting the stoma care nurse. The literature search yielded 196 publications; 4 studies met the eligibility criteria. One study found self-efficacy of stoma care improved after the app-based intervention. One stoma mobile application met the inclusion criteria: ‘Ostobuddy osto companion’; features include measurement of output volume, photography and diary keeping. 21 fluid intake applications included features to customise water input and record fluid history.

Conclusions

Mobile applications can ease the strain on services whilst improving care. This study indicates, a mobile application including a stoma output diary and photography would be well received by patients and could improve self-efficacy and care of the stoma.
1174 The Reporting of Centre and Surgeon Experience in Studies of Robot Assisted Cholecystectomy: A Systematic Review
Authors: Ramirez J , Jones C , Leow T W , Rozwadowski S , Wijeyaratne M , Jones A , Hoffman C , Kirkham E ,   on behalf of the RoboSurg collaborative
Published: October 2021

Introduction

Over 90% of cholecystectomies are performed using minimally invasive techniques. Robotic cholecystectomy (RC) has been developed to overcome technical limitations of laparoscopy, including improved range of movement and visualisation. Despite becoming increasingly widespread, the safety and efficacy of RC remain unestablished. This review aims to analyse the quality assurance reporting through centre and surgeon expertise in RC.

Method

A systematic search was conducted to identify all published studies reporting RC. Data on quality assurance measures were collected, including: centres involved, surgeons’ experience and training.

Results

Of the 1425 abstracts screened, 90 full-text papers were included. Sixty-four studies (71%) were single institutions. Of the thirty studies (33%) reporting centre type, 28 were conducted in specialist/regional/tertiary centres. Only four stated their caseload of RC. No studies described pre-specified criteria or minimum experience required for a surgeon to participate. Fifty-two (58%) reported the number of surgeons operating and 13 (14%) stated surgeons’ training grade. Two quantified previous RC experience, 7 stated prior laparoscopic experience. Only 21 (23%) described training prior to the surgeons’ first in-human procedure; animal based (n = 12), simulation (n = 12), observation (n = 4), lab-based (n = 3). Specific mentorship was reported in 8 studies, and 13 described dual operating.

Conclusions

Little information was provided about the experience and training of operating surgeons, making it difficult to ascertain whether replicable techniques were utilised which would allow development of a learning curve. This highlights the need for better transparency when reporting surgical innovation, to ensure the safe, evidence-based adoption of new technologies into clinical practice.
1285 Reporting of Robotic Pancreaticoduodenectomy As A Surgical Innovation: Systematic Review and Narrative Synthesis
Authors: Scroggie D , Lee K S , Purves R , Sewart E , Van Laarhoven S , Robinson T , Rees J , Pathak S
Published: October 2021

Aim

Pancreaticoduodenectomy (PD) is most commonly performed using open surgical techniques. Minimal access approaches have reduced the morbidity of many types of surgery, however technical limitations have hindered the widespread adoption of laparoscopic methods for PD. There has been increasing use of surgical robots to facilitate a minimal access approach, motivated by improved visualisation, ergonomics and dexterity compared to standard laparoscopic methods. Methods for the safe introduction of novel techniques are lacking, and the way in which surgical innovations are reported may affect adoption into clinical practice. The aim of this study is to understand how robotic PD has been reported as a surgical innovation.

Method

A systematic review is being conducted by the trainee led RoboSurg Collaborative. A literature search was performed to identify primary research reporting outcomes of robotic PD. Articles are being screened in duplicate by title and abstract, then by full text review. The following data will be extracted: study methodology and rationale; centre, surgeons and patient details; governance and ethical considerations; learning curves; details of the intervention, including modifications; and how outcomes were reported, including use of core outcome sets. The data will be analysed using a narrative synthesis method.

Results

The search identified 1305 articles reporting on robotic pancreas surgery. An interim report of progress will be presented.

Conclusions

A rich narrative synthesis will enable innovators to understand how robotic PD has been reported. This will encourage transparent, methodical, and meaningful reporting of robotic PD, increasing the quality of clinical evidence.
334 Localisation of Sentinel Node for Cutaneous Melanoma of Trunk
Authors: Rezacova M , McGaughey A
Published: October 2021

Aim

Our aim was to review localisation of sentinel node for cutaneous melanoma of trunk based on position. This was to investigate whether we can predict sentinel node position and therefore avoid scintigram.

Method

We have collected 50 patients with cutaneous melanoma of the trunk who underwent sentinel node biopsy. We have reviewed and recorded position of the melanoma and most likely position of sentinel biopsy. This has been on the day of surgery compared to scintigram.

Results

Majority of the melanomas have drained into the predicted location. Midline melanomas had tendency to drain bilaterally. The most difficult to predict were melanomas on the anterior aspect of trunk.

Conclusions

In majority of cases surgeons were able to predict position of sentinel node biopsy and therefore scintigram might not be necessary. If such approach is adapted, the need for radiologist involvement on the day of surgery may decrease.
811 Management of Patients with HPV-associated Oropharyngeal Cancer: A Units' Experience
Authors: Fernando S , Leow J , Wildan T
Published: October 2021

Aim

The low positive predictive value (PPV) of initial post-therapy PET-CT in patients with Human papillomavirus (HPV-) associated oropharyngeal squamous cell carcinoma (OPSCC) presents a challenge for teams managing residual disease after initial treatment. We aimed to investigate current management, post treatment surveillance protocols and outcomes of these patients within our unit.

Method

A retrospective review was performed of p16 positive OPSCC patients treated in 2018. Their primary treatment modality (radiotherapy (RT) or chemoradiotherapy (CRT), neck dissection), post-therapy PET-CT results, management decisions and final clinical outcomes were recorded.

Results

38 patients with p16 positive OPSCC were included in the study. 36 (94.7%) received primary CRT or RT, and 2 (5.3%) had primary neck dissections with adjuvant RT. 21 patients were found to have residual disease on the 3-month post-treatment PET-CT. Of these, 9 underwent further PET-CT surveillance, all showing no residual disease. 8 patients received ultrasound +/- fine needle aspiration, from which 1 showed incurable residual and distant metastasis. 2 underwent clinical surveillance, showing no residual disease. 1 had immediate salvage surgery, with further recurrence. 1 patient with persistent disease and lung metastasis received palliative immunotherapy.

Conclusions

31 patients were disease free at the end point of this study. This study explores the need for further investigation into features of residual disease in post treatment PET-CT that would indicate initial treatment failure and possible further early intervention. A surveillance strategy following initial post treatment PET-CT needs to be developed to aid in making this decision as early as possible in the post treatment phase.
874 Solitary Fibrous Tumours of the Pleura: Immunohistochemistry
Authors: Ishak L , Kostoulas N
Published: October 2021

Aim

To evaluate immunohistopathology markers of solitary fibrous tumours of the pleura (SFTP), including markers of benign and malignant variants.

Method

Retrospective review of immunohistopathology reports on 4 patients diagnosed with SFTP between January-October 2020 at the Golden Jubilee National Hospital. Data was collated on markers tested or detected. Benign and malignant cases were compared. A literature review was conducted to summarise the current evidence.

Results

Ki-67, Anti-bcl-2, CD99, STAT6, Desmin, AE1/3, Calretinin and S100 were tested in 100% (4/4) cases. CD34, EMA and CD117 were tested in 75% (3/4). Betacatenin and Vimentin were tested in 25% (1/4). Of those tested, Ki-67 was present in 100% (4/4), Anti-bcl-2 and CD99 in 75% (3/4), STAT6 in 50% (2/4), Desmin in 25% (1/4), AE1/3 in 25% (1/4), Calretinin in 25% (1/4), S100 in 0% (0/4), CD34 in 67% (2/3), EMA in 0% (0/3), CD117 in 0% (0/3), Betacatenin in 100% (1/1) and Vimentin in 100% (1/1). One out of 4 cases were malignant based on clinical presentation. Of the markers tested in all cases, Desmin was only detected in the malignant case, AE1/3 and Calretinin only in the benign cases, and the other markers in both benign and malignant cases. Anti-bcl-2 and Ki-67 intensity did not correlate with tumour diameter or malignant potential. Immunohistopathology could not confirm SFTP diagnosis in 50% (2/4) cases; it could not determine malignant potential or SFTP-subtype in 100% (4/4) cases.

Conclusions

A better understanding of SFTP immunohistopathology is needed for investigating SFTP, including benign and malignant tumour variants.
972 Investigating the Modified Glasgow Prognostic Score as A Tool in Patients Undergoing Surgery for Sarcoma - A Newcastle Cohort Study
Authors: Chan C , Rankin K
Published: October 2021

Aim

Sarcomas are an aggressive group of cancers with a poor prognosis. The modified Glasgow Prognostic Score (mGPS) uses CRP and albumin levels to generate a score from 0 to 2. A higher mGPS is associated with worse outcomes and is validated in various carcinomas. However, less evidence exists for its usefulness in sarcoma and this study aims to further investigate this area.

Method

All patients with a bone or soft tissue sarcoma diagnosis presenting to the North of England Bone and Soft Tissue Tumour Service between 2010 – 2014 were analysed. A retrospective review of clinical notes, pre-operative biochemistry results and oncological outcome was performed. Primary outcome measures were local recurrence or metastasis and overall survival (OS).

Results

80 patients met the inclusion criteria (28 females and 52 males). 64% of patients were aged >50 at diagnosis. 78% of tumours were high grade (Trojani Grade 2/3) and 71% were >5cm in size. 51 patients had a calculated mGPS=0, 19 patients had mGPS=1 and 10 patients had mGPS=2. In the mGPS=0 group, 22% developed recurrence or metastases and median OS was 42.2 months. For an mGPS of 1 and 2, the rate of recurrence or metastasis was 58% and 60% respectively, and median OS was 41.6 and 39.9 months.

Conclusions

Pre-surgical CRP and albumin levels (mGPS) may be important in predicting outcome and aiding the management of sarcoma patients. In this cohort, a higher mGPS (1/2) was associated with increased frequency of recurrence or metastasis, however further data is required to determine statistical significance.
1104 Plasma Circulating Cell-Free Messenger RNA as a Potential Biomarker of Melanoma
Authors: Ita M , Wang J H , Fanning N , Kaar G , Lim C , Redmond H
Published: October 2021

Introduction

Blood-borne cell-free nucleic acids are increasingly emerging as significant non-invasive adjuncts to current methods of disease status evaluation in cancer patients. In this study, we sought to examine whether significant differences exist in the plasma transcriptomic profile of advanced melanoma patients with a high disease burden compared to patients with therapeutic response.

Method

Plasma circulating cell-free messenger ribonucleic acid (ccfmRNA) was extracted from twenty patients with stage IV melanoma receiving immunotherapy. Pathway focused gene expression analysis was performed. Patients were assessed with paired blood sample collection and CT scan assessments at baseline and at 3 months follow up. Response Evaluation Criteria in Solid Tumours (RECIST 1.1) was used for tumour burden estimation.

Results

In stage IV melanoma patients, CCL5, GZMB and MYD88 genes were significantly over-expressed (p < 0.05 versus healthy controls). In patients with high disease burden or progressive disease, CCL18, CCR1, CCR4, CD274, CSF2, and GBP1 genes were significantly over-expressed (p < 0.05 versus patients with therapeutic response). Finally, in stage IV melanoma patients with brain metastases, CCL18, CCR1, CCR4, CD274, CSF2, EGF, GBP1, and PTGS2 genes were significantly over-expressed (p < 0.05, versus patients without brain metastasis).

Conclusions

Significant differences were observed in the plasma transcriptomic profile between the various melanoma patient groups, and we postulate that these differences may be exploited to identify novel therapeutic targets or biomarkers relevant to melanoma. CCL4 and CCL5 are prognostic in melanoma, both genes had significantly higher expressions in low disease burden patients compared to patients with a high disease burden.
375 Points Mean Prizes, The Impact of Portfolio Points and Clinical Specialty on The Engagement of Trainees in Research
Authors: McVeigh J , Jeilani M , Super J
Published: October 2021

Aim

Research and scholarship are key outcomes for medical education in order to learn transferable skills outside of the core curriculum as highlighted in 2018 by the General Medical Council. We have provided a historical snapshot of the key factors influencing medical undergraduates and trainees engaging in research. We distributed an anonymous survey to all UK Foundation Trusts and medical schools, which covered simple demographic information, factors influencing involvement in research and intended clinical specialty. Descriptive statistics were calculated for the responses.

Results

There were 264 responses to the survey, 119 (45.1%) from women. The strongest motivating factor for respondents was points for future applications, which accounted for 138 (52.2%) of responses, and became increasingly important with seniority of respondent. Time accounted for the largest obstacle to engagement in research, with 151 (57.3%) votes. For the 83 responses from aspiring surgeons, the mean number of PubMed citable publications was 2.52 compared to 1.28 for the respondents who listed a non-surgical specialty as their intended career path.

Conclusions

The UK Foundation Programme recently decided to remove additional educational achievement points (including two points for publications) for the 2023 intake of Foundation doctors. Such a decision, combined with our finding of point-driven reasoning for engagement in research, could result in fewer juniors conducting research. However, given our results highlighting increased engagement in research of aspiring surgeons, it is hoped that this decision will not affect the field of surgical research, but further qualitative analysis is required to explore this.
1287 A Comparison of Surgical Decompression and Steroid Injections to Treat Carpal Tunnel Syndrome: A Meta-Analysis
Authors: La Costa F
Published: October 2021

Introduction

Carpal tunnel syndrome (CTS) is caused by compression of the median nerve at the wrist. It accounts for 90% of all entrapment neuropathies, with a 7-16% in the UK. It has a significant impact on patients’ daily lives. Clinically, CTS results in paraesthesia, while extreme cases may involve muscular atrophy and weakness. There is currently a disparity between optimal treatments for CTS. Therefore, this paper aims to identify the optimal treatment for CTS with post-treatment BCTQ (Boston Carpal Tunnel Questionnaire) scores (including both functional and symptomatic severity) at 1, 3 and 6 months.

Method

The BCTQ scores for were sited from PubMed, Google Scholar and the University of Dundee Library search engine by entering key words such as “carpal tunnel syndrome”, “surgical decompression”, “surgical release” and “steroid injection”. Means and standard deviations for pre- and post-treatment after 1, 3 and 6 months were obtained. From this, forest plots were constructed using a software where steroid injection and surgical decompression were inputted separately, and effect sizes were then compared for 1, 3 and 6 months.

Results

The meta-analysis included reviewing 133 articles. The effect size was determined using the random effects model. Steroid injection was more effective than surgical decompression after 1 and 3 months. However, after 6 months, surgical decompression was more effective.

Conclusions

Identification of long-term relief of CTS through surgical decompression allows the reduction of symptom recurrence and thus costly follow-up appointments. This study provides robust clinical findings for the optimal treatment of CTS.
64 Seizing an Opportunity: Setting Up A Virtual Wetlab During the COVID19 Pandemic
Authors: Holland L , Ahmed I
Published: October 2021

Aim

The COVID19 pandemic has negatively impacted surgical training across the globe. In the UK, educational events and training days were cancelled for trainees at all levels. However, these unusual times provide opportunity to develop novel teaching methods. Our aim was to design a “virtual cardiac surgery wetlab” that allows real-time skills training.

Method

With support from industry partners Edwards Lifesciences, Wetlab and Connexon365 (Webinar Hosting Platform) all the necessary materials were distributed. A package was sent to trainer and trainees that included microinstruments, sutures, synthetic vessels and valve models, high-definition camera, along with printed instructions and video to outline set-up of the rig. Trainees only need to provide is a computer. A consultant surgeon demonstrated how to perform a coronary anastomosis and aortic valve replacement and was then able to supervise trainees and provide real-time feedback using the online platform.

Results

Feedback from trainer and trainees has shown that the system is an easy-to-set-up, effective training tool for teaching cardiac surgery skills including coronary anastomosis and valve surgery. The online platform enabled good vision and engagement between trainer and trainee and also enabled recording of the session. Distributing all of the materials nationwide means the virtual wetlab can take place anywhere, including in the comfort of home, for both trainee and trainer.

Conclusions

Surgical skills training can still take place effectively in the absence of “real life” wetlabs. Given the current COVID19 pandemic continues to interrupt traditional surgical teaching, this method has potential to be adopted nationwide to minimise the disruption.
81 VIRTUAL: Virtual Interactive Surgical Skills Classroom – An Ongoing Randomized Controlled Trial
Authors: Fricker M , Nathan A , Hanna N , Asif A , Patel S , Georgi M , Hang K , Sinha A , Mullins W , Shea Jessie , Lamb Benjamin , Sridhar Ashwin , Kelly John , Collins Justin
Published: October 2021

Introduction

High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction. They may optimise resources and increase accessibility, facilitating larger-scale training with a similar educational benefit. We aim to evaluate the efficacy of virtual BSS classroom training compared to both non-interactive video and face-to-face teaching.

Method

72 medical students will be randomly assigned to three equal intervention groups based on year group and surgical skill confidence. Interventions will be implemented following an instructional video. Group A will practice independently, Group B will receive face-to-face training, and Group C will attend a virtual classroom. Participants will be recorded placing three interrupted sutures with hand tied knots pre- and post-intervention, and Objective Structured Assessment of Technical Skills (OSATS) will be blind marked by two experts. Change in confidence, time to completion and a granular performance score will also be measured. Each intervention’s feasibility and accessibility will be assessed.

Results

Data collection will be completed in January 2021. Significant improvement in OSATS within groups will be indicative of intervention quality. Difference in improvement between groups will determine the relative performance of the interventions.

Conclusions

To our knowledge, this will be the largest randomised control trial investigating virtual BSS classroom training. It will serve as a comprehensive appraisal of the virtual classroom’s suitability as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and in the future.
131 Perioperative Management of Warfarin on Surgical Wards at District General Hospital
Authors: Artyushina A , Norton E , Pathan A , Sen R
Published: October 2021

Introduction

Many patients admitted to surgical wards are on warfarin. Poor knowledge of guidelines regarding reversal and restarting of anticoagulant medications can delay surgery, lead to poor outcomes and delay the discharge of patients. The aim of this audit was to establish whether junior doctors are confident in managing warfarin according to local guidelines and to improve their knowledge and confidence.

Method

A questionnaire was used to assess confidence of junior doctors currently working in general surgical departments. An educational poster was placed in the junior doctors’ office and the questionnaire was repeated. We then conducted a teaching session on the perioperative management of warfarin and repeated the questionnaire again.

Results

Confidence in reversing and restarting warfarin was significantly higher following the teaching session (p = 0.017 and p < 0.001 respectively). No significant difference was seen following the introduction of educational posters. Confidence in applying the guidelines on perioperative warfarin management was significantly higher following the teaching session (p < 0.001). Following the introduction of educational posters and the formal teaching session doctors felt they knew better how to access the guidelines (not statistically significant for either guideline) and referred to them more (p = 0.0178 for warfarin reversing and p = 0.0940 for warfarin restarting guideline).

Conclusions

Having doctors who are confident in managing warfarin is crucial to avoid delays in treatment and discharge. This audit showed that a teaching session indeed improved doctors’ knowledge and confidence. Regular formal teaching is essential, and a repeat audit is planned to be performed during the next rotation.
370 Evaluating Knowledge of Common Surgical Instruments During Early Surgical Training in the United Kingdom: A Call for Formalised Training?
Authors: Chang C , Munro S
Published: October 2021

Aim

Knowledge of surgical instruments and their use is essential to effective surgical practice, enabling efficient task-specific utilisation and promoting clear intraoperative communication; thus, reducing the risk of error. However, variations in surgical instruments across different specialities and eponymous names can pose barriers to learning for early surgical trainees. There is a paucity of data on surgical instrument knowledge among early surgical trainees, and their knowledge acquisition route.

Method

questionnaire was distributed among early surgical trainees (ST3 and below) between 18 August 2020 and 18 November 2020 across various UK regions. Respondents were asked to answer ten multiple-choice questions to assess their surgical instrument knowledge levels. Respondents were also asked about their training level, experience, and opinion regarding formal surgical instrument teaching.

Results

Thirty-seven trainees responded to the questionnaire. The majority (81%) received no formal surgical instrument training. Most respondents (96%) feel they would benefit from formal training. The average test score was 50%. There was no evidence of improved performance with formal training, though the formal training received averaged less than one hour. Higher scores were associated with increased seniority and training years, indicating most trainees are learning ‘on-the-job‘.

Conclusions

There is generally an unsatisfactory level of knowledge in surgical instruments in early surgical trainees. Trainees have also overwhelmingly indicated a desire for formalised training on surgical instruments. The authors believe the lack of formal training may contribute to this knowledge gap and intend to design a new short course to address this.
511 Organising A Surgical Conference During The COVID-19 Pandemic – Is It ‘Virtually’ The Same?
Authors: Hashmi Y , Sahu M A , Hatt K , Osman S , Bhuiyan Z A , Ahmed U
Published: October 2021

Introduction

Surgical conferences are invaluable events for healthcare professionals; they provide opportunities to engage with upcoming scientific discoveries, network professionally with peers as well as expand learning through lectures and workshops. For medical students, conferences provide an opportunity to expand understanding beyond the undergraduate curriculum in an interactive manner. COVID-19 has caused disruption to the organisation and attendance of in-person conferences (IPCs). Virtual conferences (VCs) offer a viable solution, allowing delegates to attend from the comfort of their own homes.

Method

The aim of our study was to evaluate an organised VC and explore the perceived benefits and limitations of VCs compared to IPCs. A virtual one-day trauma & orthopaedics (T&O) conference was organised involving lectures, workshops, poster, and oral presentations. Anonymous questionnaire forms were distributed to delegates following the conference to assess the aims of our paper.

Results

From 106 responses, 96.2% rated the conference as ‘Excellent’ or ‘Good’ with 92.5% stating that it increased their passion for T&O surgery. Based on a five-point Likert scale (5= strongly agree, 1= strongly disagree), mean score of agreement for preferring VCs to IPCs was 3.30(± 1.24). Key advantages of the VC were a lower cost (70.8%) and not having to travel (77.4%), whereas the main limitation was the inability to participate in hands-on workshops (84.9%).

Conclusions

Despite the success of our VC, delegate feedback indicates a mixed response comparing VCs to IPCs. We share our findings to encourage similar events to be organised and for other specialties.
544 Allocation of Training Opportunities: Evaluation of a Rota Improvement Project
Authors: Orchard M , Griggs R
Published: October 2021

Aim

Surgical registrars are under increasing pressure to achieve their competencies for ARCP under the constraints of EWTD, service provision and on call requirements. Less than full time (LTFT) and academic trainees can struggle to get fair allocation of training opportunities. These pressures can lead to competition between registrars for training opportunities and resentment can develop. We created a novel rota allocation method by which theatre, clinic and endoscopy training sessions were allocated based on percentage of elective days worked across the month, ensuring all trainees had the same opportunities.

Method

The system was implemented for 3 months in the colorectal departments at 2 hospitals. Full time, LTFT and academic trainees were treated equally with theatre, endoscopy and clinics allocated by percentage of elective days per month. The spreadsheet of allocations was viewable by all trainees to ensure transparency. All surgical registrars involved were invited to complete a feedback questionnaire on the new system.

Results

The rota was implemented for 3 months with full allocation of shifts during the study period. Trainees were successfully allocated training sessions proportionally to elective days. 7/ 10 registrars gave feedback, 85% of whom felt the system was fair and 71% thought it improved working relationships between trainees. Comments included “scrupulously fair”, “highly efficient” and gives “more transparency”.

Conclusions

Allocation of trainees to clinical training opportunities can be difficult. We present an innovative method by which trainees get equal and fair access to the training opportunities available and has consequently helped to improve working relationships between peers.
550 The Surgical Skills Day: A Model for Addressing Deficiencies in Undergraduate Surgical Skills Training
Authors: Lee K S , Priest S , Wellington J , Owoso T , Atiemo L , Craft Z , Blencowe N , Hinchliffe R
Published: October 2021

Aim

The General Medical Council (GMC) requires all newly qualified doctors to be competent in certain surgical skills, including the provision of basic wound closure. Yet there is a profound lack of undergraduate competence in, and exposure to, basic surgical skills such as wound closure. The Surgical Skills Day (SSD) aimed to provide medical students with additional skills training.

Method

Student self-assessment and instructors’ assessment forms were completed prior to and following a workshop on basic wound closure skills. Paired t-tests were used to statistically compare the two pre- and post-instruction data sets.

Results

A total of 46 students attended the SSD; 29 consented to the skills assessment. 100% (n = 29) self-reported improved competency in at least one of the skills following tuition (p < 0.001). Instructors’ assessment agreed that 100% (n = 29) of students improved in at least one of the skills assessed (p < 0.001). 100% of the attendees agreed that additional practical surgical skills should be incorporated into the undergraduate curriculum. 64% (n = 21) of students also confirmed that they were more likely to pursue a career in surgery following the SSD.

Conclusions

Current clinical teaching in basic suturing is unsuitable for long term retention. SSDs can improve skills acquisition and elevate student confidence. This data builds on our previous work by documenting the high efficacy in skills acquisition as a result of SSD tuition. We recommend that SSDs be integrated into medical school curricula in order to address shortcomings in current undergraduate programmes.
557 Becoming Virtual: Lessons Learned from Moving Wessex Core Surgical Training Deanery Teaching On-Line
Authors: Robinson P , Morton L , West C
Published: October 2021

Aim

Surgical training has been significantly impacted by COVID-19. Social distancing requirements mandated a change in face-to-face teaching with many deaneries adopting ‘virtual' sessions. Surgical training does not immediately lend itself to e-learning owing to its hands-on nature. We describe our experiences in developing a virtual teaching program for Core Surgical Trainees within the Wessex Deanery. We provide tips, tricks, and pitfalls for educators to establish or improve similar programs.

Method

From June 2020 monthly, in-person teaching was replaced with virtual sessions. Quantitative and qualitative feedback directed improvements in the program. In addition to knowledge-based lectures we integrated on-line learning tools (LapPass) and utilised surgical videos to ensure continued development of surgical skills. Mock MRCS and ST3 interviews were conducted remotely using ‘break-out rooms. Where face-to-face teaching was essential (Boot Camp, Field Camp) safety was ensured with reduced numbers (split sessions), social distancing and appropriate PPE.

Results

All trainees strongly agreed (67%) or agreed (33%) that virtual teaching works well. There were no significant differences in feedback scores compared with face-to-face teaching. Attendance increased by 42%. Interactivity was maintained with ‘cameras on, mics off', polling apps and chat box function. Advantages include uploading webinars for future review, ability for educators to present from multiple locations, increased availability and breadth of speakers and reduced burden on clinical commitments.

Conclusions

The COVID-19 pandemic has dictated an evolution of surgical teaching. Virtual teaching has many advantages over face-to-face and should continue to play a part in postgraduate medical education, even after social distancing restrictions are lifted.
731 Operation Notes: Is Informal Training Enough?
Authors: Shanks L A , Smith K J E
Published: October 2021

Aim

Operation notes are essential for continuity of patient care, communication between colleagues, medicolegal records and for coding and remuneration. This study aims to assess core surgical trainees (CST’s) understanding of completing accurate and detailed operation notes and their awareness of the RCS England Good Surgical Practice document (GSP 2014).

Method

Current CST’s who attended regional teaching were surveyed on their knowledge of what an adequate operation notes entails. Trainees then attended a 40-minute lecture on this topic and were then re-surveyed.

Results

Thirty trainees completed both questionnaires. No trainees had previously received formal teaching on how to complete operation notes. Most had received informal training in the clinical setting, usually by a registrar (93.3%). Operation notes were considered important for medicolegal reasons (53.3%), continuity of care (96.6%) and communication (53.3%). No one identified their importance for coding. Initial assessment showed only 26.6% of CST’s were aware of RCS GSP document. Responses regarding relevant information to be included in operation notes were variable: patient demographics (23.3%), procedure (93.3%) and post-operative instructions (90%). Improvements, between 3 - 70% increase, were noted in all questionnaire domains post teaching session. All trainees found a more formal session to be beneficial.

Conclusions

Although a small study, this demonstrates global improvements in knowledge after formal teaching session over informal clinical training. We believe this topic should be included in boot camp training at the start of core surgical training. It should include education in coding to ensure CST’s appreciate the significance of health information management.
756 Adapting Undergraduate Teaching in the COVID 19 Era
Authors: Armstrong L , O'Brien S , Weir C
Published: October 2021

Aim

The COVID-19 pandemic has drastically impacted medical education, particularly in terms of content delivery and clinical placement efficacy. The initial suspension of placements was devised to limit exposure and redirect medical staff to critical areas. Nevertheless, clinical placements are an important pillar of the undergraduate curriculum and new techniques must be developed to better facilitate its delivery. Our aim was to create a programme that effectively met the required curriculum learning outcomes for medical students.

Method

In September 2020, students from Queen’s University, Belfast, returned to placement following months of online and distance learning. Having previously focused on bedside and case-based teaching, our priority remained with patient and student safety. Complimentary non-clinical and simulation methods were introduced including laparoscopic skills, suture and knot tying sessions and foundation competencies. Rating scale questionnaires were distributed over a four-week period following each session.

Results

32 sessions were carried out and 53 questionnaires returned. Three key areas were reviewed; teaching delivery, usefulness of session and content/relevance, with each area scored out of 10. Collectively across all sessions, 94.3%, 92.4% and 88.7% respectively were scored 9 or greater for each key area.

Conclusions

The COVID-19 crisis has led to the development of alternative methods of undergraduate teaching. The insurance of patient safety whilst preparing students for their future career is a priority. We have successfully developed an effective and useful placement that blends clinical knowledge and skill-based learning. Given the ongoing pandemic and redirection of resources, further novel ways of teaching should be considered.
758 Online Surgical Journal Clubs: Are They Effective?
Authors: Michael K , Clayton B , Chiuta S
Published: October 2021

Aim

Much of medical education has been abruptly forced online during the COVID-19 pandemic. Traditional journal clubs thrive on group interaction and debate. The aim of this project is to assess whether an online surgical journal club could replicate this experience and learning.

Method

A fortnightly, chat-based online surgical journal club with national reach was re-launched under SCALPEL (Manchester Medical School’s surgical society) with defined learning objectives, inclusion of studies from different surgical sub-specialities and a proforma to aid critical appraisal. Anonymous feedback forms were sent to participants to assess confidence in critically appraising the literature before and after attendance, and differences in means were analysed using paired t-test.

Results

32 feedback forms from participants, the majority of whom were final year medical students (34.4%) were analysed. 28.1% had previously attended a journal club. 65.6% of attendees had prior involvement in a research project which led to a publication for 18.8%, while 59.4% were interested in applying for the Academic Foundation Programme (AFP). The self-reported confidence of participants to identify the study design, interpret the results and statistical analyses; and scrutinise the strengths and weaknesses of a study increased by 12.2%, 14.7% and 15.9% respectively (p = <0.001). Furthermore, 96.9% of attendees stated they would attend another online journal club in the future, with 59.4% favouring an online format.

Conclusions

Online surgical journal clubs are effective and are here to stay following the conclusion of social distancing. They have the advantage of further outreach and may encourage greater participation than traditional journal clubs.
814 No Animals Were Harmed in The Making of This Microsurgical Model. A Novel Microsurgery Practice Model
Authors: Abdelaty M , Molajo A
Published: October 2021

Introduction

Microsurgery forms the cornerstone of plastic and reconstructive surgery. Traditionally this is taught and practiced using anaesthetised rats or the chicken leg model. Whilst these models described provide useful training opportunities for surgeons, they present their own logistical difficulties. The rat model requires a license to utilise animal tissue. There are potential infection risks of using raw chicken for microsurgery practice

We present a novel model to overcome the problems discussed above and allow microsurgery practice.

Method

A surgical glove is gently stretched over a gallipot. Two parallel longitudinal incisions are made using a scalpel. The warmup stage involves tubularising the section of surgical glove. The created tube is then divided, and anastomosis is performed. Multiple anastomoses can be performed along the length of the tube.

Results

The model has been used for warm up and anastomosis practice. It removes the barriers that make regular microsurgery practice difficult - namely access to anaesthetised animals (licensed facility required) and raw chicken (messy and potential infection risk)

Conclusions

We introduce a novel and accessible microsurgical practice model. It is used for learning and maintaining microsurgical skills and circumvents the barriers of previously described models.
960 Is the Increase in Laparoscopy Leaving Medical Students Behind?
Authors: Schaffer S , O'Neill P , Thomas M C
Published: October 2021

Introduction

Laparoscopy use is exponentially increasing, rapidly becoming the gold standard for many procedures. It is technically demanding, requiring specialised training which is not accessible in early medical education. Studies have shown that interest can be stimulated by experiential learning. Our study evaluates current medical students’ interest and exposure to laparoscopy.

Method

Multiple-choice questionnaires were sent to London medical students assessing their interest and exposure to laparoscopic training in medical school.

Results

231 medical students (86 pre-clinical, 145 clinical students) participated. 174 (75.3%) students reported receiving no laparoscopic training during their medical education. 32 (13.9%) students reported less than one hour of training, 21 (9.1%) students reported two to three hours of training, and 4 (1.7%) students reported receiving three to ten hours of training. 100% of students were interested in receiving further laparoscopic simulation training.

Conclusions

There is insufficient training and exposure of laparoscopy during medical school. The majority of current medical students receive minimal exposure to laparoscopy, despite wanting further training. Teaching basic laparoscopic skills to medical students may provide a feasible option of engaging students in laparoscopy.