bluuebunny/crossref_metadata_2025 huggingface dataset:
376 Factors Affecting Female Medical Student Interest in Surgery - A Nationwide Cross-Sectional Survey
Authors: Tran T T , Dolfini L , Oremakinde O , Rasul S , Zahra S A , Harky A , Pandey S
Published: May 2021

Introduction

We aim to elucidate female student interest in Surgery and factors that are deterring students from considering a surgical career. With this information, we can evaluate if there are changes that can be made within medical education.

Method

A cross-sectional online survey was distributed via LimeSurvey to medical students across 33 UK medical schools. Our survey assessed student interest in a surgical career, personal experience on clinical placements, and what attracts or dissuades students from a surgical career.

Results

211 student responses were collected. 57% of students indicated an interest in Surgery. 55% of female and 63% of male students expressed surgical interest. 65.7% of second-year students indicated surgical interest, compared to 54.3% of students in final year; a 17.35% decrease. When asked, 88% of students believe there is disproportionate female to male surgeons.

Conclusions

Although our survey revealed that there is a healthy interest in Surgery, the number of women considering Surgery continues to dwindle throughout training, leading to massive discrepancy. It is paramount that there are both male and female mentors for students to visualise that there are no limitations for women in the field of Surgery.
378 The Future Potential of Artificial Intelligence in Upper Gastrointestinal Endoscopy, A Scoping review
Authors: Burke E , Awan F , Balfe P
Published: May 2021

Introduction

The use of Artificial Intelligence (AI) in medicine is accelerating. Recently there have been significant advancements made in its role in upper GI endoscopy.

Aim

To assess current research questions exploring the use of AI in diagnosing upper GI pathology at endoscopy.

Method

A scoping review of studies published on PubMed over the last 5 years using the search string: (((artificial intelligence) OR AI)) AND (Gastroscopy OR OGD OR EGD OR oesophagus OR esophagus OR stomach OR Gastric) was conducted.

Inclusion criteria: retrospective and prospective studies, published in the English language. Data extracted: country of origin for the research, clinical question, demographics, form of AI and study design.

Results

Search run on 5thof February 2020 yielded 2542 results. Articles meeting inclusion criteria numbered 25. Research originated in Japan (32%), Europe (24%), China (20%), South Korea (8%), other (16%). Clinical questions being explored included: use of AI for detecting gastric cancer, assessing depth of gastric cancer invasion, detecting early neoplasia in Barrett’s Oesophagus, real time gastric polyp detection and H.Pylori infection status.

Conclusions

AI use in upper GI endoscopy is being evaluated at an increasing rate. Surgeons must be ready to gain a working knowledge of this technology to safely interpret its results.
383 An International Comparison of Competency-Based Orthopaedic Curricula and Minimum Operative Numbers
Authors: Tahir M , Rahman U , Gulati A
Published: May 2021

Introduction

The requirements for completion of surgical training can vary across different countries. This review aims to assess key differences among orthopaedic curricula in selected high-income countries, focusing on their criteria for assessing technical competence for completion of training.

Method

Current orthopaedic training curricula in the UK, USA, Canada, Australia, and Germany were reviewed. Data extracted included training duration, minimum or desirable operative experience requirements, methods, and timing of in-training assessments.

Results

The overall training duration ranged between 9-10 years in the UK and Australia, compared to 5-6 years in all other countries. While operative logbook was an essential component of formative and end-of-training reviews in all countries, minimum indicative numbers in index operations were a requirement only in the UK (minimum total required; 1800, index operations; 365) and USA (minimum total required; 1000, index operations; 455). On average, USA residents performed 1,700 procedures compared to German residents performing 730 procedures before completion of training.

Conclusions

There is a lack of robust data describing the operative experiences of orthopaedic trainees outside of the UK and USA. Contrary to common perception, surgeons exiting training and entering independent practice in the above countries are not trained to the same minimum standard.
394 An Anatomy Near-Peer Teaching Programme
Authors: Stubley T , Taylor J
Published: May 2021

Introduction

The time dedicated to teaching of anatomy in medical schools, as well as the importance placed upon it, is decreasing. Many students struggle with learning the vast quantity of information necessary and few medical students receive instruction on how to teach. A near-peer teaching programme was designed to allow tutors to develop vital teaching skills and provide tutees with a closer look at the more complicated aspects of the anatomy course.

Method

Sessions took place once or twice a week throughout the academic year and were subdivided into examination technique sessions, core anatomical knowledge sessions and prosection sessions. Tutors were recruited primarily from the intercalated Clinical Anatomy BSc. Tutees were provided anonymous feedback forms following each session and completed pre and post session MCQ tests. Tutors completed a feedback form following the programme’s completion.

Results

96.9% of students reported an improvement in understanding of the topic. Students reported an increase in how prepared they felt for examinations (p < 0.001) as well as an improvement in MCQ scores (p < 0.001). 93.8% of tutors stated the programme helped prepare them for future teaching.

Conclusions

The results of this programme strongly support the use of near-peer teaching in anatomy education, with clear benefits for tutors and students.
423 Massive Open Online Courses in Anatomy Education: A Systematic Review
Authors: Cheong J , Keenan I
Published: May 2021

Introduction

Massive open online courses (MOOCs) have become increasingly popular for remotely delivering education to global audiences. MOOCs can provide an online platform for participants coming from a variety of professional backgrounds and international locations. Our systematic review investigated current literature surrounding MOOCs, and identified the value of such courses with respect to anatomical and medical education.

Method

Our literature search strategy involved exploring the PubMed database for the terms ’MOOC + Anatomy’ and ‘MOOC + Medical Education’ identified 290 relevant articles. Following implementation of the PRISMA criteria, 24 articles out of 290 were selected for inclusion in our systematic review.

Results

Participants completing MOOCs in anatomical and medical education generally showed increased knowledge and skills. We found that MOOC discussion forums encourage participants’ social learning development. MOOCs have shown to address participants’ needs and expectations while supplementing traditional learning approaches. However, the majority of experimental research studies did not include pre-post testing or appropriate controls. Furthermore, high levels of participant attrition, inability to address all learning approaches were identified as limitations with respect to MOOCs.

Conclusions

Although MOOCs have shown success in providing an excellent platform for learning, it has yet to show definitive improvements when compared to traditional teaching methods.
432 What Are the Promoting and Discouraging Factors for Choosing A Career in Surgery According to Undergraduate Medical Students in A District General Hospital? A Questionnaire and Review of The Literature
Authors: Harris C
Published: May 2021

Introduction

The aim was to identify which factors promote and discourage undergraduate medical students, based in a district general hospital, for choosing a career in surgery. A review of the current literature on this topic was undertaken in conjunction with the questionnaire.

Method

An online structured questionnaire was sent to all undergraduate clinical medical students based in Northumbria Specialist Emergency Care Hospital (NSECH), a teaching DGH. As well as the questionnaire, a systematic review of the literature was conducted on EMBASE, MEDLINE and Google Scholar using key search terms to review factors that influenced surgical career choices.

Results

The response rate was 46% (44/95). 75% of students rated variety of work, intellectually interesting and environment as the most important factors for their future careers. Status, financial rewards, and research opportunities were least important influences for respondents’ career decision making. A systematic literature review highlights that lifestyle factors, work-life balance were particularly important, perceived prestige and financial rewards were associated surgical career choices amongst medical students.

Conclusions

Multiple factors influence medical students career decision making and it is important to identify these factors for many reasons. Further research is recommended to further explore medical students’ perceptions on promoting and discouraging factors for surgical careers.
435 A Prospective Study of Post-operative Surgical Site Infection
Authors: Shah J
Published: May 2021

Introduction

Organ specific surgical site infections are those that involve any part of the anatomy other than the incised body wall layer opened or manipulated during an operation. The proper understanding of bacteriology and mode of infections has surely reduced the incidence of wound infection, but it is not totally controlled.

Method

A total of 582 consecutive patient undergoing major and minor surgeries between March 2010 and October 2011 were included in the study. Detail history, physical examination, laboratory and radiological investigation according to Performa with special reference to any factor that could lead to postoperative infection – Age, sex, socioeconomic status, nutrition was recorded. Initial assessment of intra operative findings divided these cases into clean, clean contaminated, contaminated and dirty SSI.

Result

A total of 582 patients out of these, 100 have SSI, SSI rate in our hospital was found to be 17.18% including all classes of wounds. Coagulase positive staphylococci were responsible for a majority of SSIs and mixed infections were quite common. The other microorganism responsible for SSIs were E.coli, Coagulase negative staphylococci, Pseudomonas and Proteus etc.

Conclusions

The data from our study suggests a need to control modifiable risk factor responsible for development of SSI.
449 Exploring the Use of Virtual Reality in Dermatology Surgery Training
Authors: Kabbani J , Kabbani J
Published: May 2021

Introduction

The role of technology in surgery is continuously evolving, with the use of Virtual Reality (VR) transcending specialties for both practical and educational purposes. VR measures, analyses, and incorporates information into computer-generated environments and has been increasingly used in dermatology. We performed a literature review to assess the merits of VR for dermatological surgery training.

Method

A literature search of PubMed was conducted using the key words “surgery”, “dermatology” and “virtual”. Primary studies assessing the merits of VR for dermatological surgery training were included.

Results

Of 51 articles found, 7 discussed the application of VR in dermatological surgery. Proposed benefits include improved knowledge-retention in trainees, possibly due to the removal of time restrictions imposed with physical cases, as well as increased exposure to rarer presentations. However, concerns include cost considerations and reduced opportunities for developing communication skills. Although VR tools for practicing communication exist, their effectiveness and impact on behaviour remain undetermined.

Conclusions

The use of VR for training in other surgical specialties, alongside demonstrated benefits in the use of VR for dermatological surgery, lends merit to further assessment and incorporation of VR in dermatology training. However, clinicians should be wary of neglecting “soft skills,” such as communication.
536 Use of A Cost-Efficient Colonoscopy Simulation Model to Improve Endoscopy Skills During the COVID Pandemic
Authors: MacDonald S , Edgar B , Stokes E , McDade D , Anderson J , Macdonald A
Published: May 2021

Introduction

The use of endoscopic simulators as a learning aid in surgical training has been well established. This has been emphasised during the challenging times of COVID-19. However, their utility for training is countered by the high cost of the equipment, with the most basic simulators costing upwards of £50,000.

Method

A simple polypectomy simulator model was created using a drain-pipe and surgical gloves. n = 9 junior doctors were timed in their ability to remove the 3 polyps from the simulator. The exercise was repeated over 6 sessions over the course of 3 weeks. Means were compared using ANOVA.

Results

There was a mean relative reduction of 75% in overall time taken to complete the task(p < 0.0001). This improvement was seen for both surgical trainees(p = 0.005) and FY1 novices(p < 0.0001) and junior doctors reported feeling more confident with basic Colonoscopic skills.

Conclusions

We have demonstrated an improvement in performance times across both surgical trainees and novices. In today’s era of COVID-19, when direct training opportunities may become more scarce, simple alternatives may become vital in ensuring progression of basic surgical skills such as endoscopy. This cheap polypectomy simulator can be easily re-created across surgical units and can be used as an adjunct to traditional endoscopic training
563 Dural Tear Closure Training: A Study of a Low-Cost Model
Authors: Thomas D , Dale V , Wills-wood W , Collins I , Springall A , Boss J
Published: May 2021

Introduction

We developed a low cost, easily replicable model that can be used to learn dural tear techniques without posing a risk to patients, therefore, increase patient safety. The aim of this is to produce trainees that are more confident in dural tear closure, reducing the chance of post-operative CSF leak.

Method

Consultants, trainees and medical students completed a training exercise supervised by a consultant spinal surgeon. After they had completed the exercise satisfactorily, participants scored from ‘very much improved’ to ‘very much deterioration’ on a self-assessment 7-point likert scale. Qualitative questions were also asked to assess the accuracy of the model.

Results

60% stated that their skills were ‘a little improved’, and 20% were ‘very much improved’. The consultants were evenly split, with 50% stating that there was ‘no change’. However, 50% of consultants and all the trainees found skills ‘a little improved’. Overall, the model was agreed to be an accurate representation of a dural tear and that it would be useful in clinical training.

Conclusions

show that improving dural tear closure training can be achieved with our model. It is low cost, and manufacturable with equipment that clinical professionals have on hand.
592 Surgical Management of Open Tibia Fractures at A Major Trauma Centre: A Review of Cases Over A One-Year Period
Authors: Khajuria A
Published: May 2021

Introduction

The BOAST/BAPRAS updated the open fracture guidelines in December 2017 to replace BOAST 4 Open fracture guidelines; the changes gave clearer recommendations for timing of surgery and recommendations for reducing infection rates.

Method

Our work retrospectively evaluates the surgical management of open tibia fractures at a Major Trauma Centre (MTC), over a one-year period in light of key standards (13,14 and 15 of the standards for open fractures).

Results

The vast majority of cases (93%) had definitive internal stabilization only when immediate soft tissue coverage was achievable. 90% of cases were not managed as ‘clean cases’ following the initial debridement. 50% of cases underwent definitive closure within 72 hours. The reasons for definitive closure beyond 72hours were: patients medically unwell (20%), multiple wound debridement’s (33%) and no medical or surgical reason was clearly stated (47%).

Conclusions

The implementation of a ‘clean surgery’ protocol following surgical debridement is essential in diminishing risk of recontamination and infection. Hence, this must be the gold standard and should be clearly documented in operation notes. The extent of availability of a joint Orthoplastic theatre list provides a key limiting step in definitive bony fixation and soft tissue coverage of open tibia fractures.
602 Specialty Training Progression from Core Surgical Training: Is There Evidence from Plastic Surgery of The Importance of Location, Location, Location?
Authors: Vinnicombe Z , Little M , Johal K
Published: May 2021

Introduction

Obtaining a National Training Number (NTN) in Plastic Surgery is highly competitive (<40 posts per year), with applicant:post ratios between 3.73 to 4.19 in 2017-2019.

Our aim was to compare deaneries for numbers successfully progressing directly from CT2 into a ST3 post in Plastic Surgery.

Method

Data for surgical trainees progressing directly from CT2 to ST3 (2017-2019) in all specialties was obtained from the GMC. The percentage of those directly progressing that obtained a Plastic Surgery NTN and the total number progressing was calculated.

Results

A total of 840 trainees obtained a NTN directly from CT2 between 2017 and 2019, 61 of whom did so in plastic surgery. Of those directly progressing, there was no significant difference between deaneries for the percentage of plastic surgery posts obtained. The highest number of trainees progressed from London deaneries (16 total (26%); 7 South, 6 NC&E, 3 NW) and the lowest number from Yorkshire and Humber (1).

Conclusions

Higher numbers of those undertaking core surgical training in London progress directly from CT2 to ST3 in Plastic Surgery. Low total numbers highlight the competitive nature of obtaining a Plastic Surgery NTN, necessitating many to undertake additional experience prior to obtaining a training number.
615 Achieving Net Zero Emission by 2050 – The Medical Education Route
Authors: Dunne H , Rizan C , Jones A , Bhutta M , Okorie M
Published: May 2021

Introduction

There is growing demand to reduce the environmental impact of surgery. Healthcare sustainability has recently become a mandatory GMC learning outcome for undergraduates, but expertise amongst faculty and time within the curriculum are limited. We piloted an E-module that uses surgical case studies to teach these concepts.

Method

Evidenced-based multi-media learning principles were used to develop the module. 3rd and 4th year students at Brighton and Sussex Medical School were invited to partake and complete pre- and post-module questionnaires comprising 5-point Likert scales and white-space questions. The primary outcome measures were changes in student-reported understanding of four key concepts:

Environmental impact of healthcare

Influence of climate change on health.

Principles of sustainable clinical practice.

Health co-benefits of climate change mitigation.

Results

33 students completed the E-module. Questionnaire results indicated a significant increase in understanding of all key concepts (p < 0.001). Students most commonly rated improving sustainability of healthcare as ‘extremely important’. Common themes within white space responses included the importance of preventative medicine and that the module was informative, interactive, user-friendly, and engaging. The majority (81%) strongly agreed that all undergraduates should undertake this module.

Conclusions

This E-module is an effective and COVID-19-safe resource. Adapting this module for postgraduate surgical education should be explored.
641 What Is the Most Reliable Way to Secure A Surgical Drain?
Authors: Hughes B , Stallard J , Jivan S
Published: May 2021

Introduction

Surgical drains are used by many specialities, we aim to determine the most robust method of securing them by comparing suturing technique, material and fixation angle.

Method

A Blake’s drain was inserted into a piece of pork belly and secured using a standard ‘three half hitch’ technique with 3.0 Silk, EthilonTM and ProleneTM . For each suture type, drains were sutured in line, at 45 and 90 degrees to the course of the drain. The force needed for the suture to failure was measured and each repeated 3 times. Different suture techniques were then used to determine the strongest fixation.

Results

With the drain exiting inline the moment of failure was, on average, 1.25kg for silk, 3.5kg for EthilonTM and 4.0kg for ProleneTM. Increasing drain fixation angle required more force for the suture to fail. With EthilonTM and ProleneTM, the suture snapped before the drain slipped. Three half hitches was the strongest technique.

Conclusions

Suture material, technique and drain fixation angle had an impact on suture strength with ProleneTM outperforming Silk. We advocate using a ‘three half hitch’ technique with 3.0 ProleneTM to secure a surgical drain. It offers superior strength whilst reducing the risk of localised tissue reactions.
671 Improving the Basic Biochemical Evaluation of Acute Renal Colic – A Two Cycle Audit
Authors: Tezcan E
Published: May 2021

Introduction

Latest guidelines by the European Association of Urology and BAUS recommend all patients presenting with acute renal colic have basic biochemical evaluation including blood calcium, urate, white cell count, CRP, sodium, potassium, and creatinine. Patients with hypercalcaemia or hyperuricaemia are particularly at risk of developing further stones, however compliance with guidelines by AE and urology departments can vary.

Method

Retrospective audit of all acute CT urinary tract (non-contrast) scans between February-April 2020 with a confirmed ureteric stone. Patients previously investigated or re-presenting were excluded. Results were shared and education on guidelines undertaken for junior clinical staff in urology followed by re-audit between May-July 2020.

Results

The first cycle February-April identified 51 patients with acute renal colic. Overall, 47% of patients had all required blood tests performed. Urate was tested in 54.9% of patients and calcium in 58.8%. Re-audit after intervention identified 50 patients. Overall compliance with blood tests increased to 62% of patients, urate tested in 66% and calcium 76%.

Conclusions

Compliance with key screening tests for renal colic patients was generally poor in a district general hospital setting. A key causative factor identified was a lack of awareness of guidelines by junior clinicians. Education demonstrated modest improvement within a short time scale.
686 Emergencies in Plastic Surgery – The Impact of a One-Day Conference on Medical Students’ Confidence
Authors: Ngadimin C , Rai A , Ngaage L M , Dawidziuk A , Kwasnicki R M , Hettiaratchy S
Published: May 2021

Introduction

Plastic surgery emergencies, such as facial trauma, burns, and gunshot wounds, are commonly presenting injuries to the emergency department. However, these topics are rarely part of medical school curriculums and few educational conferences exist on these topics. Hence, we created a novel international medical student conference entitled “Emergencies in Plastic Surgery”. We then evaluated its effectiveness in improving confidence in management of plastic surgery-related emergencies.

Method

We administered pre- and post-event online questionnaires to delegates evaluating self-reported confidence for Facial Trauma, Gunshot Wounds, Burns, Tendon Repair, Splinting, and Lacerations on a 5-point Likert-scale. Responses were matched before statistical analysis.

Results

Of the 85 attendees, three quarters responded (76%, n = 65). The conference significantly increased confidence ratings in all topics (p < 0.001). Prior to the conference, Lacerations had the highest confidence scores (2.36 ± 1.19) whereas Facial Trauma scored the lowest (1.79 ± 0.858). Facial Trauma had the greatest improvement in confidence (mean difference = 2.09 ± 0.974), whereas Lacerations yielded the lowest improvement (mean difference 1.21 ± 1.28). Facial Trauma also yielded the greatest mean satisfaction rating (4.68 ± 0.594).

Conclusions

The conference improved student confidence in all plastic surgery emergencies topics. More complex topics, e.g. facial trauma, yielded the greatest satisfaction and improvement in confidence.
752 Evaluating the Use of Immersive Virtual Reality Simulation in Orthopaedic Trauma Cases; A Construct Reality Study
Authors: Feeley A , Sheehan E , Merghani K
Published: May 2021

Introduction

Changing surgical training models as a result of reduced working hours, shorter schemes and the recent pandemic has resulted in reduced operative hours being logged by trainees. Novel and validated training methods are needed to rectify the deficit faced by surgical trainees, to maintain continued development and retention of skill throughout their training scheme.

Method

A comparative interventional study was carried out in a regional trauma unit hospital. Volunteers were stratified into novice, intermediate and expert groups based on self-reported levels of experience. Each carried out a simulated proximal femoral nail on a virtual platform following instruction on its use. Face and content validity was also assessed.

Results

The proximal femoral nail module demonstrated construct validity. Intermediate surgeons performed significantly better than novices (P=.03), with shorter procedural times (P=.013) Three of the intermediate group achieved the proficiency level set by the expert group. Time taken to completion for expert surgeons was less than intermediate group, although this did not reach significance (P=.16). Face and content validity was reported for the module.

Conclusions

The proximal femoral nail module on the Precision OS platform demonstrated good face, content, and construct validity under expert scrutiny. Further research evaluating use of virtual platforms to optimise surgical training is needed.
804 Using Simulation as A Platform to Prepare for ENT Emergencies in The COVID-19 Era
Authors: Li L , Hopkins M , Oliver N , Wet D T Du , Hathorn I , Mellanby E
Published: May 2021

Introduction

At the onset of COVID-19 crisis, our ENT department was allocated five interim foundation (FiY1) doctors to help support the clinical team at a time of extreme pressure within the NHS. An ENT emergency simulation programme was-established in order to improve the skills, knowledge and confidence of the new doctors, with the course being subsequently incorporated into departmental induction for the new first-on-call-ENT-doctors.

Method

Five FiY1 doctors attended a simulation study day, comprised of a “skills and drills” workshop followed by two interactive scenarios. An interactive SimMan3G-mannequin, technician utilizing a Mask-Ed™, trained confederate nurse and a video flexible laryngoscope trainer were used to provide high-fidelity simulation. Participants rated how prepared-they felt in managing the relevant condition before and after on a Likert scale (1–strongly disagree, 5–strongly agree). The session was repeated for the new nine first-on-call ENT doctors.

Results

Participants in the pilot session felt more prepared in managing both tracheostomy emergencies (1.2vs4.2)-and-epistaxis (2.0vs5.8). Participants in the subsequent session also felt-more-prepared in managing stridor (2.1vs4.6) -and-epistaxis-(3.1vs4.7). All-14-attendants stated that they would recommend the session to others.

Conclusions

Despite-the-simulation-course-being-originally-established-to help support newly qualified-FiY1 doctors during COVID-19, the success of the programme has resulted in its formal incorporation-into departmental ENT induction.
845 Flattening the Learning Curve: The Evaluation of Extended Laparoscopic Simulation Training for Novice Surgeons
Authors: Joiya S A , Hamid M , Siddiqui Z
Published: May 2021

Introduction

Associated with faster postoperative recovery, reduced length of hospital stays and scarring; laparoscopy has become the favoured approach for many surgical procedures across a range of specialties. However, due to its challenging learning curve, it has also been associated with increased theatre time and higher complication rates.

Method

A prospective, observational study with box trainers was carried out by novice medical students and trainees to evaluate the efficacy of long duration courses on skill acquisition. The novice group undertook a 5-week curriculum composed of lectures, demonstrations and spaced timed-assessments involving 3 tasks: hoop placement, stacking of sugar cubes and surgical cutting.

Results

Time taken for novice participants to complete a task individually and collectively improved markedly from the first to the third attempt, with an overall 44% reduction in time observed over the 5-weeks. We invited back 6 novice participants and 6 core surgical trainees after 4-weeks to complete the same tests. There was a further 18% time improvement in the novice group, with 44% faster task completion.

Conclusions

Given the success of this study and other simulation courses reported in the literature, we recommend more courses adopt a spaced-out approach; and a simulation curriculum for surgical trainees to cultivate greater skill acquisition.
889 A Window to Individual Surgical Training Plans
Authors: Hardie J , Page P , Fleming S
Published: May 2021

Introduction

A recent publication in the Plastic and Reconstructive Surgery journal (Rohrich et al., 2020) has attracted controversy for its generalised approach to “millennial” plastic surgeons. We suggest that surgeons in training, trainers and colleagues need to adjust their focus from the group to the individual in order to maximise clinical performance, quality of working life and quality of care delivered to patients.

Method

We outline a simple model, adapted from the Johari window tool, with the aim of delivering a job and training plan with which all parties are content. It considers individual ability to process scenarios and perform tasks (bandwidth), and the resources available to the individual trainee, to assess each aspect of the role.

Results

No two clinicians have the same strengths and weaknesses, and no two posts are identical. The Johari-like matrix allows trainers and trainees to identify which activities are firmly within the bandwidth and resources of the trainee, those which are clearly not, and those which may cause some concern and require further discussion or modification.

Conclusions

In this model, we suggest a framework which may help surgeons in training and trainers alike and provide a means of recording this longitudinally as individuals or roles evolve.
909 Modern Integrated Surgical Teaching for Junior Doctors: Local Workshops and Online Webinars
Authors: Kamble R , Scantling-Birch Y , Larsson E , Samarth G , Maden C
Published: May 2021

Introduction

Reforms in the postgraduate and undergraduate curriculum have resulted in a lack of surgical teaching. By tailoring educational objectives to learning needs of junior doctors, we assessed the perceptions and knowledge transfer of our 2-phase surgical teaching programme.

Method

A perception questionnaire was distributed amongst junior doctors to establish confidence levels in surgical topics. Junior doctors were invited to attend (1) a local surgical techniques workshop and (2) an online national webinar. Perception questionnaire and knowledge tests were delivered before and after each session.

Result

87.5% (n = 14) participants were not confident assessing an unwell surgical patient when on-call. Mean confidence gain before and after the practical session was 4.18 (W = 91.0, p = 0.0002). 106 participants attended the online webinar. 61.3% (n = 65) were quite confident in assessing a sick surgical patient and 56.6% (n = 60) were quite confident managing a sick surgical patient. The majority (97.2%, n = 103) deemed the session to be useful to very useful. Mean knowledge gain before and after the session was 32.8% (t = 4.67, p = 0.009).

Conclusions

Improvement in confidence and knowledge in surgical topics amongst juniors can be feasible by implementing blended learning tools, such as online webinars.
934 Remote one-to-one virtual surgical skills training: Evolving the delivery of operative skills training in the UK
Authors: Asher Christian , Ibrahim Ibrahim , Katsarma Eyfrossini
Published: May 2021

Introduction

COVID-19 has had an unprecedented effect on surgical training, including prerequisite entry-level courses to speciality training. We describe the implementation of a virtual, one-to-one training programme aimed at the acquisition and retention of operative skills.

Methods

Enrolment commenced 8th May 2020 for wound closure techniques or an extended programme including tendon repairs, delivered by Specialist Registrars in Plastic Surgery using Zoom® (v. 5.0.5) via mobile device. Participant feedback was collected retrospectively using a 5-point scale following course completion.

Results

5 participants completed the wound closure programme, and 3 the extended programme, over an average of 5 weeks, with 2 sessions per week. 5 participants were male, 3 female and were of the following grades: 2 CT2, 4 FY2, 1 FY1 and 1 medical student. A total of 103.5 hours of training was recorded to 7 September 2020.

Participants reported that all virtual skills taught were readily transferable to the theatre environment. Following the course, all participants felt confident to complete the skills learnt independently, rating the course as excellent.

Conclusions

The COVID-19 crisis has placed insurmountable obstacles in the face of surgical training. With further validation, we aim to develop surgical skills training with virtual, easily reproducible, cost-effective, trainee centred programmes.
939 Enterovaginal Fistula; Could It Be Gallstones?
Authors: Kapoor S , Boshnaq M , Wright C
Published: May 2021

This is a rare presentation of an impacted gallstone leading to a ileovaginal fistula. A 76-year old female presented with a 4 week history of faecal vaginal discharge and weight loss on a background of endometrial cancer treated with chemotherapy and radiotherapy 9 years ago. She was initially investigated with a pelvc MRI which showed a collection in the vaginal stump. A further abdominal and pelvic CT scan revealed a cholecystoduodenal fistula complicated by an ileovaginal fistula at the point of impaction. The patient underwent a laparotomy with small bowel resection and anastomosis. She was admitted to the intensive care unit post operatively and recovered well. There are no previous reports of a vaginal fistula caused by gallstone ileus. This case highlights a rare complication of gallstones in a patient who has undergone pelvic radiotherapy.
944 ‘A Series of Unfortunate Fractures’: Utilising Opportunities Brought About By COVID-19 To Create A National Online Educational Series
Authors: McCann C , Powell-Bowns M , Molyneux S
Published: May 2021

Background

The Covid-19 pandemic has disrupted the training and education of Junior Doctors. Physical restrictions have highlighted the potential use of remote online platforms to deliver teaching. We aimed to create and deliver a free educational series for Junior Doctors, delivered by Orthopaedic Registrars and Consultants through an interactive online platform.

Method

Teaching material, learning aims, and advertisement tools including mailing lists were developed. Advertisement was arranged on national scale via the British Orthopaedic Association (BOA) and the British Orthopaedic Trainees Association (BOTA). Six sessions were delivered via the ‘Blackboard Collaborate’ platform.

Results

Six sessions were held over six weeks with 546 total attendees, averaging 92 per session. Foundation Doctors and Medical Students accounted for 39.7% and 54.0% of attendees respectively. Attendees were primarily from the UK (90.1%). Average attendee rating for ‘enjoyment of session’ and ‘relevance to education’ was 9.11/10 and 8.66/10 respectively. Of those surveyed, 100% of attendees reported they would recommend this series to a colleague.

Discussion:

This lecture series was created in response to the restrictions on physical meetings and reduced teaching opportunities during the Covid-19 pandemic. High attendance and overwhelmingly positive feedback from this series supports the use of online teaching for the future of Post-graduate education.
959 Undertaking Core Surgical Training Less Than Full Time: A Qualitative Study of Experiences
Authors: Kelly M , Chiang Y , Corte-Real Houlihan M , Haylock-Vize P , Larsen C , Lilis L , Maki S , Milt K M , Shee J , Spoone L , Warre M
Published: May 2021

Introduction

The Royal College of Surgeons identifies Less Than Full Time Training (LTFT) as a key factor in attracting excellent candidates at Core level. Previous evaluations of LTFT have, however, focused on ST3 and beyond. This study focuses on Core Surgical Training (CST), to determine how well it is delivering for LTFT trainees.

Method

Participants undertaking any part of CST LTFT were eligible. An electronic, self-administered questionnaire was accessed by participants.

Results

There were 11 participants. The majority (55%) rated the information available, which often related to more senior trainees, as poor. A third reported it ‘very difficult’ to arrange a LTFT training post. A significant proportion felt their access to operative experience was decreased and 45% reported feeling less confident. Positive aspects were improved work-life balance and being able to maintain a surgical career with a family. Suggestions for improvements included normalising LTFT in surgery to reduce stigma, having dedicated LTFT TPDs, clear pathways, and longer rotations.

Conclusions

Training LTFT offers many benefits – not least, increasing workforce diversity. However, for many, training LTFT at Core level produces additional stress, work and stigma. If the surgical community is serious about maintaining an excellent, diverse workforce, these issues should be tackled sooner rather than later.
1012 Surgical Trainee Satisfaction Variations with Seniority and Region: An Evaluation of General Medical Council National Training Survey
Authors: Fan K S , McKenna J , Chan J
Published: May 2021

Aim

The General Medical Council (GMC) National Training Survey invites all doctors in training and this study evaluates satisfaction in surgical training and variations with speciality, seniority, and training region.

Method

All survey results were obtained from the GMC website. Responses of trainees, ranging from foundation training to registrar, were collected and categorised by speciality, training stage and location.

Results

9465 surgical trainees completed the study in 2019. The highest indicators were Educational Supervision (97.68), Clinical Supervision (87.42) and Clinical Supervision (out of hours) (87.28). The lowest were Workload (44.60), Rota Design (56.00) and Local Teaching (59.31). Highest and lowest ranking specialities were oral and maxillofacial surgery (84.25) and vascular surgery (73.95).

Satisfaction varied significantly across training stages, with speciality trainees highest (82.58) overall and foundation year 1 lowest (70.03). London scored highest (77.95) and Northern Ireland, Scotland and Wales collectively scored 77.13. Within England, South England ranked highest in five specialities but only orthopaedics and neurosurgery showed significant national variations.

Conclusions

Our data show variations in training satisfaction across many training cohorts. Satisfaction increases with surgeon seniority. Trainers and educational boards should target interventions to improve the quality of training for all grades of trainees and ensure appropriate curriculum coverage and address specific concerns.
1019 The Surgical Skills Club: An Adaptable and Sustainable Model for Surgical Teaching
Authors: Chia D , Choo A M H , Dar T , Joshi K S , Seah K T M
Published: May 2021

Introduction

The General Medical Council (GMC) stipulates that medical graduates should obtain competency in basic wound care. In a national review, only 24.7% of UK medical schools provided suturing training. Newly qualified doctors may be less prepared in performing basic surgical skills independently. Hence, Cambridge University Surgical Society initiated a weekly teaching programme, Surgical Skills Club (SSC).

Method

SSC covered instrument handling, knot-tying and various suturing techniques (interrupted, continuous, mattress and subcuticular), with 32 student participants. Trainees led these sessions, with tutor:student ratios at 1:5. SSC was designed to be cost-effective (£8/student); both reusable suturing pads and animal tissue were used. Glass jars were repurposed into knot-tying trainers. Participants completed questionnaires pre- and post-programme, rating confidence in skills on Likert scales; 1 (not confident) to 5 (very confident), alongside qualitative feedback.

Results

SSC was well-subscribed; most participants (88%) would highly-recommend it to peers. Receiving individualised feedback was highly valued. Students were more confident (scores 4 or 5) in skills post-programme compared to pre-programme (instrument handling: 21.9% vs 92.0%; basic knot-tying: 28.1% vs 88.0%; interrupted suturing: 50.0% vs 100%).

Conclusions

We demonstrated the effectiveness of a regular skills-teaching programme, where learning is consolidated through spaced repetition. This sustainable and accessible format can be widely adapted and implemented
503 Clinical Frailty Score (CFS) Vs Antibiotics, Time to Surgery and Time to Computerised Tomography (CT) Scan in An Emergency Surgical Population
Authors: Palaniappan S , Soiza R , Moug S , Myint P
Published: May 2021

Introduction

Frail patients have increased mortality after surgery. However, it is not known if pre-operative process measures such as antibiotic administration, time to CT and time to surgery are influenced by patient frailty.

Method

The Emergency Laparotomy and Laparoscopy Scottish Audit (ELLSA) assessed outcome after emergency surgery across Scottish hospitals (November 2017 – October 2018). Frailty was measured using the 7-point Clinical Frailty Score (CFS). Outcome measures were antibiotic provision for sepsis, admission to CT time, admission to surgery time, CT request to performance time and CT request to surgery time.

Results

1302 patients (median age 63 years [IQR 49-74]; 49% male) with complete data were included. Median time from admission to CT and surgery increased between those with CFS 1 to 6/7 from 597 to 1724 minutes (p < 0.0001) and 1556 to 4120 minutes (p < 0.0001) respectively. Time from CT request to surgery also significantly increased with CFS (p < 0.042). There was no significant association between CFS and antibiotic administration or CT request to performance.

Conclusions

Frail patients have to wait longer for CT scan requests and surgery, but frailty was not associated with antibiotic administration or delays in CT request to performance time. Possible explanations include frailty-related challenges making correct diagnoses and optimal management plans.
813 Risk of Death Following Pulmonary Complications After Surgery with And Without SARS-Cov-2 Infection: A Pooled Analysis of Individual Patient Data from Pre-Pandemic and Pandemic International Cohort Studies
Authors:   STARSurg Collaborative,   COVIDSurg Collaborative
Published: May 2021

Risk of death following pulmonary complications after surgery with and without SARS-CoV-2 infection: a pooled analysis of individual patient data from pre-pandemic and pandemic international cohort studies

Introduction

Diagnostic haematuria services have been reduced due to the COVID-19 pandemic, compromising patient care, and necessitating a more pragmatic pathway.

Method

The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of haematuria. Using this data, we developed strategies using combinations of imaging and cytology as triage tests to maximise cancer detection within a pragmatic pathway.

Results

8112 patients (74·4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70·7%) patients had visible haematuria (VH) and 2375 (29·3%) had non-visible haematuria (NVH). Diagnostic test performance was used to determine optimal age cut-offs for four proposed strategies. We recommended proceeding directly to transurethral resection of bladder tumour for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients to capture high risk bladder cancer.

Conclusions

We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.
158 Oral Submucous Fibrosis in A 2-Year-Old Girl Due to Chewing BIDI Stubs
Authors: Sahni D S , Desai D , Prasad G , Ramsaha S
Published: May 2021

A 2-year-old girl, complaining of a gradual increase in the restriction of the mouth opening for 3 months, was referred to the Otolaryngologists based on background history of recurrent oral ulcers. The local examination showed the presence of oral ulcers on the cheek in addition to abnormal oral mucosa which appeared blanched, opaque and fibrotic. This was clinically diagnosed as Oral Submucous Fibrosis, owing to classical presentation and the lack of systemic features. A detailed social and family history revealed that the father of the child used to smoke BIDI, a traditional form of nonfiltered cigarette. The child used to play with the burnt stubs and keep them in her mouth, chewing them for long durations. This was assumed to be the aetiological factor behind the development of the pathology, in absence of any other contributing factors. The patient was treated conservatively, and symptomatic improvement was noted on follow-up. This is the youngest reported patient with OSMF, and this case history brought an unusual aetiological factor to the fore.
168 Interprosthetic Fractures of The Femur: A Literature Review
Authors: Marzano F , Pace V , Milazzo F , Caraffa A , Antinolfi P
Published: May 2021

Increasing age expectations and number of joint replacement procedures have made interprosthetic femoral fractures (IFF) a progressively more common diagnosis and a challenge for surgeons. A gold standard and universally accepted classifications and guidelines do not exist yet.

Customized structured electronic searches performed in PubMed database. Relevant key terms: IFF, classification interprosthetic fracture, peri-implant femoral fracture, biomechanics interprosthetic femur fracture, radiographic femur fracture, risk factor IFF. 42 articles finally included (up to 2019).

High morbidity and mortality linked to IFF. Standardised classifications, management guidelines and surgical approaches are not available yet. Periprosthetic classification systems are still utilized even if not entirely appropriate. High rate of failure is related to thinner cortical bone, larger medullary canals and variable stresses depending on the distance among implants. High complication rates in all studies. Stress risers and implant stability based on fracture patterns and stress forces. Several surgical options with no uniformity. Less invasive surgical procedures are associated to reduction of metalwork failure rate, better preservation of vascularization and better functional-clinical outcomes.

Lack of specific classification systems and management guidelines. Several surgical options are available with no uniformity of results. Attention to stress risers and preservation of bone stock and vascularization are key aspects for better results.