bluuebunny/crossref_metadata_2025 huggingface dataset:
977 Breaking Out of Tradition: Designing Escape Rooms as Novel Simulation
Authors: Badenoch T , Benton K , Jacobs E , Law S , Ahmed M , Curtis A , Everett S , Hunter I , Bamford R
Published: November 2022

Aim

The emerging field of gamification, the addition of game play elements to non-game settings, is widely used in business and is increasingly being used in education. Successful methods have included live leader boards and a web-based game solving a protein folding conundrum.

Method

We designed an escape room (ER), incorporating gaming elements, focussing on communication in a surgical environment. A cross over study was delivered to 4th year medical students, comparing traditional simulation. The ER included logic puzzles, hidden clues, padlocked boxes, and surgical skills appropriate to their level. Self-reported engagement and teamwork were recorded, as was observed teamwork and communication skills.

Results

Self-reported engagement was very high for the students compared to more traditional simulation, including better understanding of effective communication strategies. The ER group were less likely to self-identify learning points but structured debrief mitigated this difference.

Conclusions

Gamification techniques can be integrated with good engagement and educational outcomes and should be considered as an adjunct to existing simulation strategy.
72 Medical Students’ Opinion on Academic Surgery as a Career and Access to Opportunities in Surgical Research
Authors: Kathiravelupillai A , Fanning SJ , Robinson A , Jaunoo S
Published: November 2022

Introduction

The clinical academic training pathway in the United Kingdom is offering an increasing number of surgically themed roles. The understanding of research and available academic opportunities amongst applicants is variable. The aim of this study was to capture the understanding and exposure to clinical academia in surgery amongst UK medical students. Methods: We surveyed 100 medical students prior to them attending the inaugural Academic Surgery Virtual Conference based at Brighton and Sussex Medical school. Participants were sent a google survey via email the day prior to attending the conference to be completed anonymously.

Results

52 students completed the pre-conference survey; 55.8% were female, 42.3% male, 1.9% preferred not to disclose gender. Mean ages for females were 21.4 and for males 23.5. An even distribution of students from different year groups responded, from 4 deaneries encompassing different UK medical schools. All participants had an additional degree with a BSc being the most common (n=36, 69.2%). Overall, 61.5% (n=38) of students expressed an interest in an academic surgical career. Only 52.7% (n=30) had previous experience in research, and 36.5% (n=19) knew how to get involved in surgical research. The majority of students had not received any teaching in medical school on academic surgery (n=38, 73.1%).

Conclusion

This survey has identified that amongst a cohort of medical students interested in academic surgery, few had research experience or knew how to get involved in surgical research. Medical schools should provide earlier education on clinical academic pathways to meet the rising demand for clinical academics in surgery.
270 The Innate Aptitude's Effect on the Surgical Task Performance
Authors: El Boghdady M , Ewalds-Kvist BM
Published: November 2022

Aim

Surgery is a craft profession requiring individuals with specific innate aptitudes for manipulative skills, visuospatial and psychomotor abilities. The selection process of surgical trainees excludes aptitude testing for the psychomotor and manual manipulative skills of candidates for required abilities. We scrutinize the effect of innate aptitudes in surgery and its skill-training by systematically reviewing its significance on the surgical task performance.

Method

A systematic review was performed by PRISMA guidelines. A search on PubMed/Medline for English language articles was performed from January 2001 to January 2021. Search terms were ‘aptitude for surgery’, ‘innate aptitude and surgical skills’, ‘manipulative abilities and surgery’ and ‘psychomotor skills and surgery’. The quality of quantitatively researched citations was assessed by MERSQI scores.

Results

The results yielded 1142 studies and 21 met the inclusion criteria and 6 high-quality citations rejected our 3-null hypothesis, and all medical students cannot reach proficiency in skills necessary for a career in surgery. Playing video games and/or musical instruments do not promote surgery skill; yet a valid test with predictive value for novices aspiring for a surgical career is helpful. MERSQI mean score was 11.07 (SD= .98; range 9.25 to 12.75).

Conclusions

Visuospatial aptitude, rate of skill acquisition and quality of surgical performance predicted baseline surgical ability. Additionally, visuospatial aptitude along with psychomotor skills and perceptual talent, furthered laparoscopic simulator performance. The selection process for candidates suitable for a career in surgery requests a simulated surgical environment, where the candidates’ skills also in forms of non-technical aptitudes are assessable.
363 A Comparative Analysis of Night-Time General Surgical Training
Authors: Aseem R , Khan N , Bowbrick G
Published: November 2022

Aim

The aim of surgical training is to ensure trainees acquire competencies to perform as a Day 1 Consultant. The last decade has seen the introduction of European Working Time Directive, NELA guidelines and the revised Junior Doctor Contract. All of these, as well as the COVID 19 pandemic, have caused concerns regarding training. Our aim was to examine any changes to night-time on call activity during this time.

Method

We retrospectively analysed prospectively collected data from 2011, 2018, and 2021, in a busy District General Hospital. The data collection period was 31 days, looking at night-time (8pm to 8am) operative experience, supervision, and non-operative activity. A regression analysis was conducted to compare outcomes. A qualitative survey was used to assess attitudes and confidence.

Results

On average, trainees spent 11% of their time operating independently, 2% operating supervised, 11% attending trauma-calls and 73% clerking/non-educational activities. There was a significant difference between the hours spent on operative versus non-operative activity (P 0.00046) with no differences over the years. Junior trainees did not feel confident operating at night and only 33% of all trainees found night-time training effective.

Conclusions

Nightshifts comprise a substantial proportion of potential training opportunities and managing the unselected emergency take is one of the Capabilities in Practice. Effective solutions must be implemented to help improve night-time surgical experience and confidence in order for this time to be effective for training of both operative and non-operative competency attainment.
386 A Comparison of Academic Output of Welsh Plastic Surgery Trainees Pre- and Mid-COVID-19 Pandemic
Authors: McGregor C , Sin-Hidge C , Wilson-Jones N
Published: November 2022

Aim

The COVID-19 pandemic has affected doctors worldwide, with 1.5 million surgeries being postponed or cancelled in England and Wales during 2020. Surgeons in competitive specialties requiring active research portfolios may have used this time to strengthen their academic work. This cross-sectional study provides insight into the academic output of Welsh plastic surgery trainees during the COVID-19 pandemic, which could be used to highlight contributing factors to benefit future training.

Method

A cross-sectional study was distributed to all Welsh burns and plastic surgery trainees from specialty trainee levels 3–8. Data was obtained comparing publications achieved, abstracts submitted, and projects undertaken pre-pandemic, March 1st to 31st August 2019 and mid-pandemic, March 1st to 31st August 2020.

Results

Of the 12 Welsh plastic surgery trainees, 75% participated in this survey, with representation from all years of training. Mid-pandemic, an average of 3 publications were achieved per trainee when compared with 1.4 pre-pandemic. 78% submitted abstracts during both periods, increasing from 1.5 to 2.44 mid-pandemic. Although the average number of projects undertaken pre- and mid-pandemic was 3.2 and 3.1 respectively, the number of trainees undertaking projects increased by 22% to 100%. Most commonly, this was attributed to an increase in capacity.

Conclusions

Our study demonstrated that overall, academic output increased significantly during the COVID-19 pandemic. Unsurprisingly, this sudden decrease in surgical activity led to trainees in this highly competitive specialty employing their time towards research. Further studies investigating the factors enabling trainees to increase their academic productivity would be beneficial as routine surgical activity resumes.
422 Assessment of an Articulating Laparoscopic Needle Holder (FlexDex™) Compared to a Conventional Rigid Needle Holder in 2-Dimension Vision Amongst Novices: A Randomised Controlled Study
Authors: Farzaneh SB , Motahariasl N , Motahariasl S , Kokotkin I , Sousi S , Zargaran A , Zargaran D , Patel B
Published: November 2022

Aim

This study aims to compare novice performance of advanced bimanual laparoscopic skills using an articulating laparoscopic device (FlexDex™) compared to a standard rigid needle holder amongst surgical novices in 2-dimension (2D) visualisation.

Method

In this prospective randomised trial, novices (n=40) without laparoscopic experience were recruited and randomised into two groups, which used either traditional rigid needle holders or the FlexDex™. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were recorded, and results were evaluated based on completion times, error rates, and learning curves.

Results

The intervention group that used the FlexDex™ completed 10 attempts of the standardised laparoscopic task slower than the control group that used traditional rigid needle holder (415 seconds vs 267 seconds taken for the first three attempts and 283 seconds vs 187 seconds taken for the last three attempts, respectively). The difference in average time for the first three and last three attempts reached statistical significance (P < 0.001). Furthermore, the intervention group demonstrated a higher error rate when compared to the control group (9.2 vs 6.3 errors per individual).

Conclusions

When compared to the FlexDex™, the traditional rigid needle holder was observed to be superior in task performance speed, leading to shorter completion times and quicker learning effect, as well as fewer errors.
452 A National Survey of UK Foundation Trainee's Perceptions of Surgical Skills in the Foundation Training Programme
Authors: Gnanalingham S , Limbachia D
Published: November 2022

Aim

Attention to surgical skills development of UK foundation trainees within the UK foundation training programme appears to be neglected. This study aimed to ascertain junior doctors’ perceptions of surgical skills within the foundation training programme, irrespective of their future career intentions.

Method

An online survey generated using SurveyMonkey was distributed to all 18 UK foundation training schools. This survey assessed foundation trainees’ surgical skills experience in medical school, current career intentions, confidence at basic surgical skills and perceptions of the level of surgical skills training within the foundation programme.

Results

A total of 245 responses were collected. Career intentions amongst foundation trainee respondents was evenly distributed with 39.6% aiming for a career in surgery, 41.6% opting for a non-surgical career and 18.8% of participants were undecided on their future career path.

Trainees felt that they did not have adequate exposure to surgical skills (4.5, Likert scale 1–10) and did not have adequate exposure to specialty specific skills within the foundation training programme (3.3, Likert scale 1–10). On average, 75% of participants believed further exposure to surgical skills training would be beneficial to their professional development. Furthermore, 67% believed that surgical skills should be incorporated in the core competencies for the foundation training programme.

Conclusions

Our study shows that foundation trainees feel that there is a lack of adequate exposure to surgical skills within the foundation programme. Foundation trainees feel change is required to help improve competency in basic surgical skills and as an extension increase interest in a surgical career.
478 Enhancing Technology Interface in the Dissection Room (DR)
Authors: Balfour J , Banziger C , Burr P , Quigley C , Chisholm F
Published: November 2022

Aim

Anatomy teaching increasingly utilises technology alongside dissection to improve anatomy teaching. Student use of the touchscreen computers in dissection sessions at the University of St. Andrews was infrequent, with students lacking confidence in touchscreen use. The aim of this QI project was to improve medical student confidence and increase the use of touchscreen computers in the DR during dissection sessions.

Method

A data-collection tool was designed and tested. It included 4 Likert-style and one blank space question. 111 baseline responses from 3rd-year medical students were collected over 1 week in November 2021. Documentation was optimised for touchscreen usage. Cycle 2 was collected from the same cohort, with 83 responses. The second intervention introduced styluses. Cycle 3, with 85 responses, was collected.

Results

Question 1 examined awareness of touchscreen function. Positive responses (agree and strongly agree) increased from 76.5% to 95.2%, then 97.7% after interventions 1 and 2 respectively. Positive responses for question 2, examining confidence, improved from 53.2% to 88.0%, then 96.5%. Positive responses to question 3, examining the frequency of touchscreen use, improved from 49.6% to 91.6% then 92.9%. Positive responses for question 4, examining how useful touchscreens were for student learning, improved from 70.3% to 94.0%, then 97.7%. Blank space questions demonstrated positive opinions of changes made in the dissection room.

Conclusions

The significant and sustained increase in positive responses regarding student confidence, touchscreen use and the usefulness of touchscreens as an adjunct to dissection in the DR demonstrated significant improvement in the use of the facilities and student educational experience.
538 Peer MRCS Teaching Among Surgical Trainees in the East Midlands Deanery, UK
Authors: Charuvila S , Olaitan O , Srinivasan A , Mepani V , Putt O , See A , Dhingra M
Published: November 2022

Background

During the covid-19 pandemic, the East Midlands South Deanery ran virtual peer-MRCS OSCE teaching. We analysed two surveys to understand the impact of peer-MRCS teaching on surgical trainees in this region.

Method

One survey was completed by peer-MRCS teachers who delivered sessions in 2020–2021. The second survey was completed by prospective MRCS OSCE candidates. Responses were anonymised.

Results

7 / 8 peer teachers and 13/17 prospective learners completed the surveys. 6/7 peer-teachers had previous experience and prior teacher-training ranged from day courses to university degrees. All peer-teachers felt that peer-MRCS teaching enabled them to refresh their anatomy knowledge. 0/7 peer-teachers preferred to deliver practical-skills teaching.

Passion for teaching was identified as a motivating factor by all peer teachers. This was further supported by the general consensus (5/7) for peer teachers preferring feedback that is focused on self-development rather than conveying appreciation. Majority (12/13) of peer learners also preferred to give feedback focused on teacher development and felt they were more likely (7/13) to provide accurate feedback for peer-sessions when compared to formal teaching sessions run by the deanery.

Majority of participating prospective MRCS OSCE candidates (12/13) expressed an interest in peer-MRCS teaching. Low stress environment and cost effectiveness were the top reasons why prospective peer learners preferred virtual peer MRCS teaching.

Conclusions

Overall peer-MRCS teaching in this cohort suggests advantages to both peer-teachers and learners with the potential to improve teaching skills and clinical knowledge among surgical trainees.
563 Help! I’m Starting Surgery: An Educational QI Project to Improve the Surgical Induction Process and FY1's Confidence in Starting Surgery at Bolton Hospital
Authors: Spurring E
Published: November 2022

Introduction

The surgical induction process for FY1's at Bolton consisted of 280-pages of pre-reading and a series of short talks delivered on their first day. Foundation doctors were surveyed (n=20) and only 25% were satisfied/very satisfied with this process.

Aim

To improve satisfaction ratings and junior doctor's confidence in surgical skills required to be a competent surgical FY1 through a series of PDSA cycles.

Method

PDSA Cycle 1: Creation of the survival guide. PDSA cycle 2: Pre-reading was condensed into the survival guide and a 12-week teaching programme was introduced. PDSA cycle 3: The induction agenda was updated, and a tour of the department was added. PDSA cycle 4: Introduction of a Q&A session with a previous surgical junior.

Results

Through the above cycles (PDSA Cycle 1–5) satisfaction ratings improved from 25% to 41%, 28%, 83% and 85% respectively. Junior doctors’ confidence increased on average from 41% to over 90% in each cycle. These skills included: requesting scans, consenting for endoscopy, prescribing, assessing unwell patients, clerking, and managing and explaining post-operative complications.

Conclusions

Following the creation of the survival guide, eradication of extensive pre-reading and the above PDSA cycles, satisfaction ratings improved and FY1's confidence in surgical skills increased. The findings of PSDA cycle 2 could be attributed to the pandemic as induction took place on Microsoft teams rather than face-to-face. To ensure future sustainability, the guide and induction process should be updated and analysed every rotation.
618 A Registrar - Delivered Urology Experience Improves Medical Student Knowledge of the Subject and Increases Interest in a Surgical Career
Authors: Nelson A , McCann K
Published: November 2022

Introduction

Exposure to Urology is thought to vary considerably between medical schools, leading to a lack of competence by foundation doctors in basic urological skills and knowledge, and perhaps low interest in a urological / surgical career. In our hospital students had no dedicated Urology placement until 2020.

Method

A weeklong Urology placement was designed for 3rd year students. This comprised tutorials on topics set out by the university curriculum, a catheter insertion simulation session, and regular theatre and ward rounds. Most students also had the opportunity to insert a catheter on the ward / theatre. Students were encouraged to complete The National Catheter Education Programme, an online course providing a point for CST applications. This placement is registrar delivered, giving a more accurate idea of what a surgical career involves. Student feedback was obtained on the first and last days to ascertain self-rated confidence on a Likert-type scale regarding urological key topics, as well as career intentions.

Results

Self – rated knowledge on the 5 identified topics at the start of the week was most likely to be “Poor,” and by the end “Good” or “Very good.” By the end of the week most students indicated they were much more likely to pursue a career in surgery, although the same response was not seen as strongly for the subspeciality of Urology.

Conclusions

The placement continues to run and develop based on feedback. We look forward with interest to the publication of LEARN (uroLogical tEAching in bRitish medical schools Nationally) — a multicentre audit – to further inform this project.
771 Surgical Training for International Doctors in the United Kingdom: How Do We Improve?
Authors: Uddin A , Vinoo A , Abualsaud S , Eldolify M , Jha G , Korde V , Kuttuva S , Win MM , Pratap H , Sahni D , Subbiah P , Glenn S
Published: November 2022

Aim

The number of international medical graduates (IMGs) in the various surgical specialties in the United Kingdom (UK) has been growing recently. Owing to the differences in the undergraduate medical training between the UK and other countries, it can be very challenging for IMGs to establish themselves in the competitive surgical training programs in the UK. With that in mind, some International Core Surgical Trainees founded the Surgical Society of International Doctors (SSID) as an initiative to connect, support and promote aspiring international surgeons in the UK.

Method

SSID was formed by recruiting other committee members with similar backgrounds and interests as leads for education, research, networking, and regional representatives. The society currently has 13 active members, a website - www.surgicalsid.com and an active social media presence. Monthly committee meetings and WhatsApp group chats are used to organise and run various society activities.

Results

The two projects undertaken so far are:

Conclusions

Our society is expanding with increasing members and growing interest from medical colleagues, and rising followers on the website and social media. We plan to expand our reach with more events, conferences, research collaborations and opportunities for international doctors.
774 Operative Experience Targets in General Surgery Training: A Systematic Review
Authors: Toale C , O'Byrne A , Morris M , O Kavanagh D
Published: November 2022

Aim

Operative experience targets are well established as a proxy measure for operative competence in surgical training across jurisdictions. The aim of this study was to examine the validity evidence of operative experience targets in surgical training as an assessment tool.

Method

A systematic review of the PubMed, EMBASE, Web of Science and Cochrane library databases was conducted in accordance with the PRISMA guidelines. The educational impact of included studies was evaluated using a modified Kirkpatrick model.

Results

Of 3,672 records identified on database searching, 11 papers were ultimately included in a narrative synthesis. Two studies reported a positive relationship between operative experience and self-reported confidence only (Kirkpatrick level 2a). Six studies documented improvements in assessed trainee performance associated with experience (Kirkpatrick level 2b). No study documented trainee behavioural change, or changes in organisational practice, related to experience targets (Kirkpatrick level 3 and 4a). No studies have identified an association between trainees reaching mandated experience targets and improved clinical outcomes.

Conclusions

Definitive evidence comparing either clinical or assessment outcomes for trainees who have reached pre-defined experience targets compared to those who have not is lacking. A number of studies have recorded competent trainee performance in key index procedures only after reaching experience thresholds greatly in excess of currently mandated targets in Ireland and the United Kingdom. This review supports the move away from these targets toward objective assessor-mediated measures of trainee competence.
778 Portfolio for Core Surgical Training: International Doctors’ Experience
Authors: Uddin A , Pratap H , Jha G , Vinoo A , Subbiah P , Sahni D , Win MM , Kuttuva S , Korde V , Eldolify M , Abualsaud S
Published: November 2022

Introduction

As the number of international medical graduates (IMG) applying for Core Surgical Training (CST) is growing, the understanding of the portfolio and application system is crucial to succeeding in this competitive application process. We conducted a webinar to grow the awareness of the system, especially amongst doctors still in the process of moving to the UK for surgical training.

Method

The webinar was part of an online teaching series for IMG doctors run by the SSID society. It was conducted in two separate two-hour sessions using a virtual conferencing tool in September and October 2021. Alongside, it was streamed on Facebook live to grow the reach. The advertising was done via flyers on social media and various WhatsApp groups. Each webinar was delivered by an IMG doctor in CST in the UK where they shared their personal experiences. Feedback was collected after each webinar using an online form generating tool and analysed on Excel. The certificate of attendance was distributed via E-mail.

Results

The webinar was viewed by 1200 on Facebook Live. Feedback was received from 66 attendees. 96.96% agreed that the webinar improved their understanding of the portfolio and 94.45% agreed they learned about ways to improve their portfolio. 89.39% agreed that they would change their practice after attending this webinar.

Conclusions

Simple online webinars can improve the understanding of the portfolio requirements for CST amongst IMG doctors. Subsequently, this could allow for early portfolio preparation opportunities, improve application self-assessment scores, and reduce the years needed to get a successful training number.
833 Is the Undergraduate Medical Curriculum Aligned to and Is It Facilitating Medical Students to Learn the Ear, Nose and Throat Content in the New UK Medical Licensing Assessment? a Study of One UK Medical School
Authors: Summerbell A
Published: November 2022

Aim

Every medical student in the United Kingdom (UK) must pass a new Medical Licensing Assessment (MLA) from 2024/25 before graduating. This includes Ear, Nose and Throat (ENT) content: ‘Conditions’, ‘Patient presentations’ and ‘Practical skills and procedures. Research shows the provision of UK undergraduate ENT training is controversial. This research aimed to determine whether a UK medical school curriculum is aligned to the ENT content in the UK MLA, and if it is facilitating students to learn it.

Method

A mixed methods approach examined one UK medical school curriculum in relation to the ENT content in the UK MLA. A document analysis reviewed the learning set for ENT. A survey collected the final year medical student cohort's recall and perceptions of their ENT learning. Data was analysed using descriptive statistics.

Results

The curriculum documents met 6/10 ENT ‘Conditions’, 6/18 ‘Patient presentations’ and 3/5 ‘Practical skills and procedures. There were 17 (13.1%) survey responses; most students generally recalled learning the ENT content during the curriculum. The teaching activities most commonly used to learn the ENT content generally helped most students to learn it; the activities least commonly used generally helped the fewest students.

Conclusions

The curriculum is largely aligned and facilitates medical students to learn the ENT content in the UK MLA. The results contribute to the existing literature, with further research needed to determine the degree of student learning. Learning outcomes should be added to the curriculum documents for unmet content with learning redirected to the most helpful teaching activities for curriculum optimisation.
888 Utility of a Virtual Mock Interview Course to Prepare Trainees on UK Core Surgical Training Interviews – a Cross-Sectional Study
Authors: Wise K , Ebrahim S , Raja H
Published: November 2022

Aim

To assess the usefulness of a virtual mock interview course to prepare trainees for UK Core Surgical Training (CST) interviews.

Method

Junior doctors interested in applying for CST attended a one-day interview course delivered by highly ranked surgical trainees. All attendees were invited to complete pre- and post-interview course questionnaires to assess usefulness in improving the confidence and preparedness for interviews.

Results

A total of 60 trainees attended the course with an 87% (52/60) response rate to both pre- and post-course surveys. Most trainees were FY2 doctors (50%) applying to CST for the first time (78%). Before the course, 60% of attendees reported feeling “not so confident” for their upcoming interview; 38% of participants felt “somewhat confident” whilst 2% reported feeling “very confident.” 100% of doctors found the pre-mock interview presentations “very useful” or “extremely useful”. Matched data revealed an improvement in attendees’ overall confidence (p<0.0001), with 98% reporting they felt “somewhat” or “very confident” and 2% reporting feeling “extremely confident” about upcoming interviews.

Conclusions

We demonstrate evidence of a successful CST virtual mock interview course that significantly aids preparation and improves confidence for junior doctors.
966 The Surgical Handbook: Enhancing Surgical Education for Medical Students and Foundation Doctors
Authors: Vincent E , Thenabadu S , Yiu C , Ayeni A , Osa-Iduma A , Mishra V
Published: November 2022

Aim

In recent years, the GKT School of Medical Education has introduced a new curriculum resulting in a shift from a single surgical block to an integrated approach. After recognising the potential challenges that the lack of standardisation across various hospitals may cause, we created the Surgical Handbook to supplement learning, improve confidence in approaching surgical patients and prepare students for the United Kingdom Foundation Programme (UKFP).

Method

We sought authorisation for the Surgical Handbook from the GKT medical education faculty, assembled a team and conducted further background research. The National Undergraduate Curriculum by the Royal College of Surgeons of England was an excellent resource in the design of the Surgical Handbook. The handbook underwent multiple cycles of review by senior medical education faculty before its final digital and physical distribution for students.

Results

The Surgical Handbook has resulted in a sustained positive impact on surgical education for GKT students, with feedback highlighting it as an excellent additional resource for placements, exams, and the Foundation Programme.

Conclusions

Most doctors in the United Kingdom will undertake a surgical rotation as part of the Foundation Programme. Preparation for this role is essential and linked to the quality of undergraduate surgical education. Nevertheless, the importance of surgical teaching within the undergraduate curriculum remains a topic of debate. Our Surgical Handbook addresses this issue, and we are in the process of collaborating with other medical schools across the United Kingdom and beyond.
1027 Urology Teaching - Improving Hesitancy by Live-Streaming!
Authors: Shkoukani ZW
Published: November 2022

The covid-19 pandemic and associated social distancing restrictions had a significant impact on medical education and clinical learning opportunities for not only medical students, but for all those involved in the healthcare system. Given that up to 15% of general practitioner appointments and more than 25% of acute surgical referrals are urology related, adequate teaching is pertinent to ensure medical staff have the confidence and competence to manage urological concerns in a clinical setting. This quality improvement project aimed to design and develop an international educational series of virtual teaching sessions by the collaboration of senior urological trainees from various trusts across the United Kingdom.

We designed a once-weekly urology teaching series that targeted all healthcare workers (medical students, junior doctors, nurses, ANPs, PAs…etc). The series continued for 12 consecutive weeks, with each session discussing a different aspect of clinical urology and delivered by different senior urology trainees with varying experiences across the UK. Pre-session surveys and post-session feedback were collected to evaluate levels of confidence in said topics before and after session delivery.

Session attendance averaged 250 individuals per session, of multiple healthcare backgrounds and from varying countries across the world (UK, Asia, Middle East, Australia, New Zealand…etc). Overall confidence improved on average from 2/5 to 4/5 across all 12 sessions. An average of 4.5/5 agreed that the content of the sessions was beneficial, and 4.5/5 would recommend future sessions to colleagues.

Virtual learning can thus be a useful tool to aid in improving medical education, even on an international level.
84 An Analysis into the Prevalence of Work-Related Musculoskeletal Disorders Affecting Surgeons: A Systematic Review
Authors: Daruwalla AC , Patel B
Published: November 2022

Aim

This review sought to answer 3 primary questions- (1) What is the global career prevalence rate of work-related musculoskeletal disorders (WRMSDs) among the surgeon population? (2) What is the prevalence rate of WRMSDs between surgical specialties? and (3) Which anatomical locations are most affected in surgeons with WRMSDs?

Method

A qualitative systematic review of publications was conducted across 4 medical indices, 3 clinical trial registries, and 2 specialised search engines for relevant records published from inception until the 31st of December 2020. The JBI checklist and ROBINS-I tool were used for quality and risk assessment among included studies.

Results

In total, 56 articles met the inclusion criteria set for this review. This gave a pooled total of 13,628 surgeons. From this population, the calculated career prevalence rate of WRMSDs was found to be 71.1%, and the specialties with the highest incidences of WRMSDs were- Dermatology surgery (90.1%), Obstetrics and Gynaecology surgery (81.4%), and Vascular surgery (80.0%). When analysing body regions most frequently affected by WRMSDs, 91.3% of injuries were reported above the waist. More specifically, the most frequently reported injuries were to the back (30.4%), neck (26.2%), and shoulders (16.0%).

Conclusions

Overall, this review found high career prevalence rates of WRMSDs across all analysed surgical specialties. Furthermore, these injuries were most frequently reported in the upper limb and torso of the surgeon. With these findings, it is hoped future interventional studies would aim to target specific ergonomic deficits in specialties at high risk of developing WRMSDs.
110 What Is the Evidence From in Vivo Studies That Mesenchymal Stem Cell Derived Extracellular Vesicles Can Facilitate Tendon and Ligament Repair?
Authors: Lu V , Tennyson M , Zhang J , Khan W
Published: November 2022

Aim

Tendon and ligament injury pose an increasingly large burden to society. With surgical repair and grafting susceptible to failure, tissue engineering provides novel avenues for treatment. This systematic review explores evidence whether mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) can facilitate tendon and ligament repair in animal models.

Method

A systematic search was performed on PubMed, Web of Science, Cochrane Library, Embase. Risk of bias was assessed using Systematic Review Centre for Laboratory animal Experimentation (SYRCLE). Studies administering EVs isolated from human or animal derived MSCs into in vivo models of tendon/ligament injury were included. In vitro, ex vivo, in silico studies were excluded. Data on isolation and characterisation of MSCs and EVs, and in vivo findings in animal models were extracted.

Results

Eleven case-control studies were included for analysis. Six studies utilised bone marrow derived MSCs. All studies characterised MSCs via flow cytometry, which expressed CD44 and CD90, and isolated EVs via ultracentrifugation (average diameter 125nm). Five studies utilised histological scoring systems, all of which reported a lower score with EV treatment, suggesting improved healing ability. Four studies reported increased anti-inflammatory cytokine expression (IL-10, TGF-β1); three studies reported decreased endogenous M1/M2 macrophage ratio with EV treatment. Eight studies reported increased maximum stiffness, breaking load, tensile strength in EV-treated tendons.

Conclusions

MSC-EVs are effective therapeutic agents for tendon/ligament pathologies, attenuating the initial inflammatory response, accelerating tendon matrix regeneration, however evidence linking biomechanical alterations to functional improvement was weak. Future randomised controlled trials are needed to definitely demonstrate MSC-EVs superiority in tendon/ligament injury management.
111 Adipose Tissue-Derived Mesenchymal Stem Cells as a Potential Restorative Treatment for Cartilage Defects: A PRISMA Review and Meta-Analysis
Authors: Meng H , Lu V , Khan W
Published: November 2022

Aim

Joint damage through trauma or degeneration causes cartilage defects, leading to osteoarthritis (OA). Current therapies relieve symptoms or replaces damaged joint, which is costly and fraught with complications. Mesenchymal stem cells (MSCs) have immunomodulatory properties and low immunogenicity, making them a novel avenue for research for OA treatment. This systematic review investigates whether adipose derived MSC (AMSCs) can treat cartilage defects.

Method

A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, Scopus, Web of Science. Clinical, imaging, functional outcomes were extracted from nineteen included studies. Inclusion criteria was studies conducted on human populations that compared effects of AMSCs on cartilage regeneration to non-exposed controls. Studies conducted on animals, ex vivo studies, in vitro studies were excluded.

Results

Nine studies reported improved Visual Analogue Scale (VAS) scores (mean difference -3.30; 95% CI:-3.72,-2.89; p<0.001). Eight studies reported improved Knee injury and Osteoarthritis Outcome Score (KOOS) in five subscales. Pooled analysis of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores in seven studies revealed an improvement (mean difference -25.52; 95% CI:-30.93,-20.10; p<0.001). Cartilage regeneration was assessed using Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. All studies reported improved regeneration, with a pooled end-point score of 68.12 (95% CI:62.18–74.05; p<0.001).

Conclusions

AMSCs are effective therapeutic agents for cartilage defects. We recommend researchers to determine roles of biochemical components that facilitate AMSC-mediated cartilage repair. Establishing the most efficient methods for MSC extraction, culture, delivery, and performing studies with long follow-up times enable future research to provide evidence needed to bring AMSC-based therapies into the market.
167 Efficacy of Minimally Invasive Surgery on Hallux Valgus – a Systematic Review and Meta-Analysis
Authors: Lisacek-Kiosoglous A , Georgiou A , Antoniou S , Ristanis S
Published: November 2022

Aim

The aim of this study is to evaluate the effect of minimally invasive surgery over open surgery for hallux valgus with respect to surgical outcomes and patient reported outcomes.

Method

Medline Complete, PubMed, Cochrane Library, Scopus, SAGE Journals and gray literature were searched. Primary outcomes focused on hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle. Secondary Outcomes included the American Foot & Ankle Society Score (AOFAS), as well as Pain on a Visual Analogue Scale(VAS), patient satisfaction, complications, SF-36 questionnaire and Manchester Oxford Foot Questionnaire (MOXFQ).

Results & Conclusions

8 randomized trials and 7 cohort studies were identified (n=907). Radiological outcomes between similar techniques were found to have no significant difference pre-post operatively at final follow up. Visual analogue scale scores were found to be significantly lower in the MIS groups compared to open techniques (MICA v Scarf) in the short term at Day 1 (P<0.00001) MD= -1.96 95% CI: -2.28, -1.65; I2 = 0%; Week 2 (P=0.001) MD= -1.40; 95% CI: -2.26, -0.54; and Week 6 (P=0.005) MD= -1.50; 95% CI: -2.55, -0.45. There was no statistical difference at 6 months (P=0.46) MD= -0.16; 95% CI: -0.59, 0.27; I2 = 0%; or final follow up (6 m to >24m) (P=0.94) MD= -0.02; 95% CI: -0.44, 0.41; I2 = 0%.). There were no statistically important differences between post-operative AOFAS scores across comparisons, whereas AOFAS mean difference was found to be significantly higher in Open Scarf vs MICA (P = 0.003); MD=-5.54; 95% CI: -9.19, -1.88. I2 = 0%.
180 Retrograde Hindfoot Nailing for the Treatment of Acute Ankle Fractures in the Elderly - a Systematic Review and Meta-Analysis
Authors: Lu V , Tennyson M , Zhou A , Fortune M , Thahir A , Krkovic M
Published: November 2022

Aim

Fragility ankle fractures are traditionally managed conservatively or with open reduction internal fixation (ORIF). Tibiotalocalcaneal (TTC) nailing is an alternative option for the geriatric patient. This meta-analysis provides the most detailed analysis of hindfoot nailing for fragility ankle fractures.

Method

A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, Scopus, Web of Science, identifying fourteen studies for inclusion. Studies including patients over 60 with a fragility ankle fracture, treated with TTC nail were included. Patients with a previous fracture of the ipsilateral limb, fibular nails, and pathological fractures were excluded.

Meta-regression analyses were performed to explore sources of heterogeneity, and publication bias was assessed using Egger's test.

Results

312 ankle fractures were included. The mean age was 77.3 (32–101) years. 26.9% were male, and 41.9% were diabetics. The pooled proportion of superficial infection, deep infection, implant failure, malunion, and all-cause mortality was 0.10 (95%CI:0.06–0.16; I2=44%), 0.08 (95%CI:0.06–0.11, I2=0%), 0.11 (95%CI:0.07–0.15,I2=0%), 0.11 (95%CI:0.06–0.18; I2=51%), and 0.27 (95%CI:0.20–0.34; I2=11%), respectively. The pooled mean post-operative OMAS score was 54.07 (95%CI:48.98–59.16; I2=85%). The best-fitting meta-regression model included age and percentage of male patients as covariates (p=0.0263), and were inversely correlated with higher OMAS scores. Egger's test (p=0.56) showed no significant publication bias.

Conclusions

TTC nailing is an adequate alternative option for fragility ankle fracture management. However, current evidence includes mainly case series with inconsistent outcome measures reported and post-operative rehabilitation protocols. Prospective RCTs with long follow-up times and large cohort sizes are needed to clearly guide the use of TTC nailing for ankle fractures.
322 Comparative Analysis of Endovascular Intervention and Endarterectomy in Patients with Femoral Artery Disease: A Systematic Review
Authors: Sreejith G , Ravikumar N , Law SHC , Anand P , Varghese N , Kagdi S , Kang N , Salam S , Ongidi I , Nashnoush M
Published: November 2022

Aim

To compare the safety and efficacy of endovascular stenting to endarterectomy in treating femoral artery disease.

Method

We searched databases such as PubMed, Ovid, Embase and Scopus for studies done on endovascular and endarterectomy treatments in the last decade. The inclusion criteria comprised of latest studies within the last 10 years, human studies and restricting to only femoral artery disease. Relevancy of the articles were assessed using PRISMA and the Newcastle-Ottawa quality assessment scale. Thereafter, the data were extracted, and the statistical variables were calculated using MedCalc software. The PRISMA checklist was used to assess risk of bias.

Results

Total of twenty-six retrospective, prospective and sub-analysis studies met the inclusion criteria with a total of 7126 patients (endovascular, 2496; endarterectomy, 4630). A division of the outcomes into primary and secondary were assessed based on direct correlation to the parameters evaluated. Our review demonstrated a higher value of technical success for endovascular intervention than endarterectomy with an odds ratio of 4.27 and statistically significant at 95% CI (2.87–6.38). In terms of safety, wound complications, and mortality (short and long-term) were evaluated. For wound infection, endovascular had better odds ratio of 0.65; 95% CI [0.51 to 0.81] and thus preferrable. Delayed wound healing and dehiscence occurred only in 0.15% of endovascular procedures in contrast to 0.99% in endarterectomy. There was no significant difference in both the mortality rates in the two groups appraised.

Conclusions

Endovascular treatment of femoral artery disease is a safe and effective alternative to endarterectomy. It has a lower incidence of wound related and other perioperative complications.
413 Fat Grafting as a Therapeutic Treatment for Frey's Syndrome: A Comprehensive Review of the Literature and Recommendations for Management
Authors: McGregor C , Thomson E , Arvidsson A , Whitaker I
Published: November 2022

Aim

With the reported incidence of Frey's syndrome as high as 59%, the significant morbidity experienced by patients post parotidectomy has resulted in a range of treatment options being proposed with variable outcomes. The lack of consensus has resulted in patients being offered a wide range of treatments with varying success. While fat grafting remains a treatment for contour deformity correction, there is emerging evidence to suggest its effectiveness as a treatment for Frey's syndrome, warranting further investigation. This systematic review aims to evaluate the efficacy of fat grafting as a treatment for Frey's syndrome post parotidectomy.

Method

A systematic review was conducted as per PRISMA guidelines, with all articles from MEDLINE, Embase, Web of Science, Ovid, Scopus, and Cochrane screened by two independent reviewers using discreet inclusion and exclusion criteria followed by in depth full-text reviews.

Results

116 papers were screened with 16 meeting the inclusion criteria (13.8%) totalling 785 patients, with multiple outcome measures for assessing Frey's syndrome. Fat grafting was shown to significantly reduce the incidence of Frey's syndrome in patients having undergone both superficial and total parotidectomies, with 15 studies (93.8%) finding a significant reduction in its incidence post treatment.

Conclusions

With low donor site morbidity, biocompatibility, ease of use, low cost to perform and high patient satisfaction, the systematic review of the evidence supports the use of fat grafting post parotidectomy as an effective treatment for Frey's syndrome. Further research to determine the long-term outcome would inform its suitability as a first line treatment.
493 Hip Arthroscopy for the Primary Management of Femoroacetabular Impingement with Concomitant Chondral Lesions - a Systematic Review and Meta-Analysis
Authors: Lu V , Andronic O , Zhang J , Khanduja V
Published: November 2022

Introduction

Femoroacetabular impingement (FAI) is an important cause of hip pain in the young, active population. Treated by hip arthroscopy (HA), chondral lesions are frequently seen, and there are concerns that patients with chondral defects leading to hip osteoarthritis (OA) will not benefit from HA. This review analyses the use of HA in FAI patients with chondral lesions according to Outerbridge classification.

Method

A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, Web of Science. From twenty-four included studies, patient related outcome measures (PROMs), total hip arthroplasty (THA) conversion rate, radiological outcomes were collected. Clinical studies of HA used for primary FAI management, classifying chondral lesions according to Outerbridge classification were included. Patients treated with open procedure, osteonecrosis, Legg-Calve-Perthes disease, previous ipsilateral hip fractures were excluded. Risk of bias was assessed using ROBINS-I.

Results

Improved post-operative PROMs included mHHS (n=18; mean difference:-2.42; 95%CI:-2.99 to -1.85; p<0.0001), NAHS (n=8; mean difference:-1.73; 95%CI: -2.23 to -1.23; p<0.0001), VAS (n=7; mean difference:2.03; 95%CI:0.93–3.13; p<0.0001). Pooled rate of revision surgery was 10% (95%CI: 7%-14%). Most of this included conversion to THA, with a 7% pooled rate (95%CI: 4%-11%).

Patients had worse PROMs if they underwent HA with labral debridement (p=0.0149), have Outerbridge 3 and 4 lesions (p=0.0116), kissing lesions (p=0.0292). Reconstructive cartilage techniques were superior to microfracture (p=0.0416). Even in “kissing” lesions, employing either microfracture or cartilage repair/reconstruction provided a benefit in PROMs (p=0.0267).

Conclusions

This meta-analysis suggests that acceptable post-operative outcomes following HA in patients with FAI and concomitant moderate-to-severe chondral lesions, can be achieved.