bluuebunny/crossref_metadata_2025 huggingface dataset:
732 Delay to Elective Colorectal Cancer Surgery and its Potential Implications During the Covid-19 Pandemic: A Systematic Review and Metanalysis
Authors: Whittaker T , Abdelrazek M , Fitzpatrick A , Froud J , Kelly J , Williamson J , Williams G
Published: October 2021

Aim

The ongoing Covid-19 pandemic has interrupted the surgical treatment of colorectal cancer (CRC). This systematic review will assess literature concerning the risk of delay of elective surgery for CRC patients, focusing on overall survival (OS) and disease-free survival (DFS).

Method

A systematic review was performed as per PRISMA guidelines (PROSPERO ID: CRD42020189158). Medline, EMBASE and Scopus were searched. Delay to elective surgery was defined as the period between CRC diagnosis and the day of surgery. Metanalyses of the outcome’s OS and DFS were conducted. Forest plots, funnel plots, and tests of heterogeneity were produced. An estimated Number Needed to Harm (NNH) was calculated for statistically significant pooled Hazard Ratios (HRs).

Results

Of 3753 articles identified, seven met the inclusion criteria. Encompassing 314560 patients, three of the seven studies showed that a delay to elective resection is associated with poorer OS or DFS. OS was assessed at a one-month delay, the HR for six datasets was 1.13 (95%CI 1.02-1.26, p = 0.020) and at three months the pooled HR for three datasets was 1.57 (95%CI 1.16-2.12, p = 0.004). Estimated NNHs for a delay at one month and three months were 35 and 10 respectively. Delay was non-significantly negatively associated with DFS on meta-analysis.

Conclusions

This review recommends that elective surgery for CRC patients is not postponed, as evidence suggests delays from diagnosis are associated with poorer outcomes. Focused research is essential so that patient groups can be prioritized based on risk factors for future pandemics.
790 Upper Gastrointestinal (UGI) Mural Thickening on Computed Tomography (CT) and its Significance in The Multi-Disciplinary Team (MDT) Pathway
Authors: Ashmore C , Hunter D , Kenningham R , Bowrey D
Published: October 2021

Aim

Patients are frequently referred to the UGI MDT based on CT reported thickening of either the oesophagus, stomach, or duodenum. We have sought to illustrate the efficacy of CT within the UGI cancer referral pathway.

Method

A retrospective analysis was carried out on patients referred to the UGI MDT at a University Teaching Hospital over a 22-month period. Patients referred with CT evidence of UGI tract thickening prior to endoscopy were included. CT findings were correlated with symptomatology, subsequent endoscopy, and histology findings.

Results

442 patients were referred to the UGI MDT between April 2014 and February 2016. 125 were referred for CT thickening alone (67 (53.2%) oesophageal, 49 (39.2%) gastric, 9 (7.2%) duodenal). 49 (39.2%) patients were subsequently diagnosed with UGI cancer, 57 (45.6%) had evidence of benign disease and 18 (14.4%) patients had no abnormality evident on endoscopy. CT thickening of 15mm and above was significantly more likely be malignant versus thickening less than 15mm [42/87 (48.3%) vs 7/38 (18.4%); p < 0.05]. Patients with thickening in the presence of a hiatus hernia were significantly less likely to have an associated cancer vs those without [3/26 (13%) vs 20/42 (51.1%); p < 0.05].

Conclusions

We conclude that patients should not be referred for MDT opinion on CT evidence of UGI thickening alone. All patients should have an endoscopy prior to referral, particularly those with a hiatal hernia on CT. A high index of suspicion for malignancy should be adopted in patients with thickening greater than 15mm on imaging.
1209 Effect Of COVID-19 On the Referral Base, Presentation, Treatment, And Immediate Outcome of Oral Cancer in An East Yorkshire Regional OMFS Head and Neck Unit. An Epidemiological Review Of 2019 vs 2020
Authors: Gladwin L , O'Higgins C , Crank S , Mizen K , Philip J
Published: October 2021

Introduction

The COVID-19 pandemic has drastically altered healthcare provision in primary and secondary care settings in the UK due to significant resources being prioritised for coronavirus care. Services have been affected at all levels of the referral ladder due to reductions and in some cases complete cancellation of face-to-face care. Throughout the pandemic the OMFS unit observed increasing numbers of patients with later stage oral malignant disease, therefore significantly more invasive surgical intervention, and reconstruction, associated with increased morbidity and mortality.

Method

This retrospective review collated data of all OMFS patients with oral squamous cell carcinomas requiring surgical intervention between the 23rd March and the 31st December 2019 compared with the same time period in 2020. Data collected included age, sex, time from referral to both 1st appointment and treatment, TNM staging, types of neck dissection and reconstruction, length of stay in hospital and any adjunctive treatment required.

Results

On comparison of the data sets, the 2020 cohort of patients had an overall later TNM staging result, with an increasing requirement for radical neck dissections and postoperative adjunctive treatment such as chemo/radiotherapy. The study found that on average, patients experienced a shorter waiting time from referral to initial assessment and commencement of treatment during the pandemic when compared to the previous year.

Conclusions

Overall, less patients were referred into hospital during period of the pandemic, however patients seen were diagnosed with significantly more advanced disease, this is likely attributed to reduced primary care services and delayed presentation.
1226 The Clinical Utility of Prostate Health Index Density in The Diagnosis of Clinically Significant Prostate Cancer: A Systematic Review
Authors: Tezcan E , Abdalla O
Published: October 2021

Aim

Prostate health index (PHI) is a diagnostic test for prostate cancer that combines free prostate specific antigen (PSA), total PSA and [-2]proPSA. PHI has been shown to be more accurate than PSA testing at detecting prostate cancer and its use has been shown to reduce unnecessary prostate biopsies. Prostate health index density (PHID), derived by dividing PHI by prostate volume, has been suggested as a more accurate test compared to standard PHI by several authors. The aim of this systematic review was to evaluate the diagnostic accuracy of PHID for clinically significant prostate cancer, identify an optimal diagnostic threshold and assess the clinical utility of PHID as a novel diagnostic test for prostate cancer.

Method

A systematic review of primary studies was conducted. Medline, Embase, Scopus and Cochrane databases were searched with key terms. Results were screened and full papers reviewed by two reviewers with pre-determined inclusion criteria. QUADAS-2 was used for quality appraisal. Data analysis was conducted in line with PRISMA guidelines.

Results

Nine studies were included. Quality appraisal revealed a high degree of heterogeneity between studies. PHID thresholds ranged 0.32-1.38. PHID had an area under the curve value of 0.59-0.9 and negative predictive value of 81-100% for clinically significant disease. PHID outperformed PHI in three studies, but this was not replicated in the other studies.

Conclusions

This systematic review found PHID did not consistently outperform PHI. PHID was found to have low clinical utility in the diagnosis of prostate cancer based on the available evidence, with further research warranted.
388 Controlling the Controls: What Is Negative Pressure Wound Therapy Compared to In Clinical Trials?
Authors: McMillan H , Vo U , Richards T
Published: October 2021

Aim

Closed incision negative pressure wound therapy (ciNPWT) appears to reduce surgical site infection (SSI). However, randomised controlled trials have compared to ‘standard wound care’ but there appears no standard and care is variable. The aim of this review was to assess the control arms compared in trials of ciNPWT for potential confounding variables that could influence the rates of SSI and therefore the trial outcomes.

Method

A mapping review of the PubMed database was undertaken in the English language for randomised controlled trials comparing use of ciNPWT to alternative dressings on closed surgical wounds and with surgical site infection as an outcome. Data regarding ciNPWT duration and frequency of change were documented. In the comparator arm potential factors that may influence SSI rates were reviewed including method of wound closure, control dressing type and frequency of change and patient washing were extracted.

Results

27 studies were included in the mapping review. Most studies did not control for skin closure method or consider differences in patient showering. There was heterogeneity in terms of ciNPWT duration and whether this was changed. There was little control in the comparator arms. A variety of control dressings were compared and overall, these were changed more frequently than the ciNPWT dressing in most studies. No ‘standard of care’ was apparent.

Conclusions

In randomised trials of ciNPWT there was no control over ‘standard of care’ comparison dressings. Various potential confounders could influence SSI rates. Future studies should aim to control the controls when assessing the efficacy of ciNPWT for SSI prevention.
444 Acute Surgical Admissions at the End of Life: An Analysis of Deaths in Non-operatively Managed Patients
Authors: Clements H , El Boghdady M , Alijani A
Published: October 2021

Aim

Patients with advanced illnesses are often admitted with acute surgical emergencies. There is currently no evidence characterising such admissions. We aimed to evaluate emergency patients, managed non-operatively, who died during the same admission.

Method

This single-centre retrospective, observational study collected data points for a 12-month period including age, prior documented do not resuscitate order (DNAR), existing cancer, Charlson Comorbidity Index, frailty, surgical diagnosis, interval from admission to death and care given. Patients who underwent surgical intervention were excluded. Non-parametric tests were used for statistical analysis.

Results

72 patients were included. 68.1% of patients died within 6 days of admission (median 4.0 days). Patients with visceral perforation, obstruction, bowel ischaemia or known malignancy were more likely to die within 6 days than those with pancreatitis, sepsis, or new malignancy (median 2 vs 7 days, p < 0.001). Patients with frailty (2 vs 4 days, p = 0.017) and existing DNAR (3 vs 4 days, p = 0.048) died more rapidly than those without. Age and comorbidity index did not impact time to death.

Conclusions

Frailty, surgical diagnosis and existing DNAR were predictors of shorter admission to death interval, while age and comorbidity index were not. This has implications on inpatient palliative care service planning.
119 The Potential of Low-fidelity Arthroscopic Simulation Training in Trauma and Orthopaedic Surgery: A Systematic Review of Experimental Studies
Authors: Srivastava A , Gibson M , Patel A
Published: October 2021

Aim

In an era of budget tightening and work-hour guideline reductions that have significantly reduced surgical exposure, low-fidelity arthroscopic simulators have an essential role to play in surgical training. The COVID-19 pandemic has only further amplified the need for alternative training models, as 91% of orthopaedic trainees have had elective procedures cancelled. The purpose of this systematic review is to synopsise the limited literature regarding the effectiveness of low-fidelity training models in the instruction of novices, and to formulate recommendations for future studies.

Method

The Embase, PubMed, Web of Science and Scopus databases were electronically searched. Studies from any year that described the use of orthopaedic, low-fidelity arthroscopic training models in novice populations were included. Questionnaires, case studies and review studies were excluded. Risk of bias assessments were also conducted for all studies.

Results

16 studies were identified. Using the PRISMA algorithm, 6 studies were deemed relevant. A cross-study comparison revealed low-fidelity arthroscopic simulators reduced time to completion outcomes (P < 0.05), increased ASSET scores (P < 0.01) and confirmed face validity and transfer of skills (cadaver, live patients).

Conclusions

Low-fidelity simulator training significantly improves the arthroscopic performance of novices, without the high setup costs and practical constraints of high-fidelity equivalents. Low-fidelity arthroscopic simulators remain a promising training apparatus in an era of reduced surgical exposure (COVID-19). We have identified the need for consistent outcome measures with greater sample sizes across future studies. We recommend the use of standardised pre-intervention teaching (e.g., ABOS curriculum) and further transference, construct, and face validity evaluations to support future result interpretations.
124 The Microsurgical Learning Curve: Can We Make the First Steps Faster and Safer; A Cadaveric Study with A Novel Principle of Learning
Authors: Medjoub K , Wielechowska K , Harris T , Curnier A , Ahmed J
Published: October 2021

Aim

Learning anew surgical technique can be a daunting experience for both the teacher and learner. Raising free flaps is a complex process, and our aim is to find out whether using Hi-fidelity simulation on cadavers can make the learning faster and safer.

Method

We used fresh frozen cadavers according to our local protocols. In the first stage of the study, we used 4 upper limbs in the first instance using different dye techniques. We use these in an international course and obtain feedback from the trainees.

Results

To a novel learner, we found that using a bright green dye was the important factor in making the first steps of learning easier and faster. This is perhaps due to the confounding information when raising the flap. We found that it made understanding the concept of free flap raising much faster when clarified with colour. It also made anticipating the steps easier when identifying the perforators. To an experienced trainee/consultant: We found teaching the concept of perforators easier, the ease of finding the perforators would raise confidence of the novel trainees. They will be able to conceptualize the principles of flap raising much faster. They believed it would also make them quicker at anticipating steps of the procedure.

Conclusions

Learning is an incredible process that we still have to better control and understand. Using simple tricks such as colour changes can make initial learning faster, which means cheaper and safer
823 The ‘Blue Blood' Chicken Thigh Model: Microsurgery Simulation Teaching for Surgical Trainees
Authors: Sarai R , Abdelrahman A , Rehman K U
Published: October 2021

Introduction

The simulation of microsurgery via various models helps surgical trainees to further their instrument handling and techniques. This model allows trainees to strengthen hand-microscope-eye coordination; a crucial ability required when handling critical vessels and tissues. The ‘Blue Blood’ Chicken Thigh Model imitates delicate vessels enabling the enhancement of dexterity.

Aim

To raise awareness amongst trainees in how the model may be used as a simulation tool for learning. To outline the arrangement of the ‘Blue Blood’ chicken thigh model allowing the practice of exceptionally fine suturing such as end-end anastomosis and end-side anastomosis. To improve trainee confidence in instrument handling and technique.

Method

A Microsurgery course was set up for maxillofacial surgical trainees within the West Midlands Deanery in November 2019. Detailed steps of dissecting the femoral vessels and preparing the ‘Blue Blood’ Chicken Thigh Model were presented. Microsurgical tools were then used to practise end-end and end-side anastomosis.

Results

The feedback received from the trainees was positive and it is hoped this will become an annual session for all trainees. Many trainees felt this was a resourceful tool to help them practise - even at home.

Conclusions

It is important for trainees to be able to display precise hand-eye movements especially when concerned with anastomosis techniques. This model will allow trainees to be able to simulate such an environment outside of theatre where they can spend time to hone skills and become comfortable with handling finer tissues and instruments.
1306 Recommendations for the Use of Simulators in Cardiothoracic Surgical Training
Authors: Whittaker G , Salmasi Y , Asimakopoulos G , Athanasiou T
Published: October 2021

Aim

To systematically review the simulators that are currently available for cardiothoracic surgical procedures and the validation evidence supporting them. Additionally, to recommend several simulators for training based on analysis of results.

Method

A systematic literature search of the MEDLINE® (1946 to December 2019) and EMBASE® (1947 to December 2019) databases was performed to identify simulators for basic skills and procedures in cardiothoracic surgery. A selection of keywords and MeSH terms were used to execute the literature search. After identification of relevant articles, data were extracted and analysed.

Results

Ninety simulators were found in eighty-one articles. Simulators for basic skills (n=24) and coronary artery bypass graft (n=22) were the most commonly described, followed by miscellaneous (n=14), valve surgery (n=13), thoracic lobectomy (n=10), and mechanical circulatory support (n=7). The majority of models were either benchtop (n=42) or hybrid (n=33) modalities. Evidence of validity was demonstrated in 38 (42.2%) simulators. Five (5.6%) simulators had three or more elements of validity established and only one (1.1%) accomplished full validation.

Conclusions

Five simulators were recommended for supplemental training in cardiothoracic surgery. Low-fidelity models can provide a broad foundation for surgical skills development and high-fidelity simulators can be used for immersive training scenarios and appraisals. These should be utilised in early training, at which point the learning curve of trainees is steepest.
1393 The Impact of Using A Virtual Reality Surgical Curriculum to Train Scrub Practitioners in Complex Orthopaedic Surgery
Authors: Edwards T C , Patel A , Szyszka B , Coombs A W , Kucheria R , Cobb J P , Logishetty K
Published: October 2021

Background

The training scrub practitioners receive varies considerably in comparison to their surgical counterpart, although their performance is key to a proficient surgical team. For infrequent procedures that require specific and often intricate equipment such as revision total knee arthroplasty (RTKA), their training may be limited to an initial guidance session by company representatives. This study aims to evaluate the impact of using a virtual reality (VR) curriculum to train scrub practitioners in the performance of a RTKA.

Method

Ten orthopaedic scrub practitioners were enrolled into VR training across four sessions. Each VR session consisted of training where participants were guided through the assembly of equipment and steps of the surgery. In the concluding three sessions, each training session was supplemented by an assessment session in VR without guidance. The outcomes measured in VR assessment were incorrect procedural sequence, duration of surgery and efficiency of movement. The transfer of skills outside VR were assessed pre-training and post-training by the participants performance in a sequence of tasks using real equipment.

Results

All participants enhanced their surgical performance in successive assessed VR sessions reducing their operative time by 47%, assistive prompts by 75% and dominant hand motion by 28%. Improvements in VR showed effective transfer when assessed using real equipment with participants achieving superior scores post-training (11.3% versus 83.5%).

Conclusions

VR enables safe learning and provides measurable feedback of procedural steps and technical skills of complex orthopaedic surgery. VR is an effective training tool for scrub practitioners, with transfer to the real world.
1505 EASiE: ENT and Airway Simulation in Emergencies
Authors: Gurung P , Luff E , Waters C , Castelhano R
Published: October 2021

Aim

A literature review of undergraduate ENT teaching found that most final year medical students and junior doctors did not feel adequately prepared for clinical practice in ENT. Other surveys found junior doctors lack confidence in recognising or initiating management in patients with blocked tracheostomies. To improve this, we ran a simulation session designed to replicate airway emergencies that junior doctors should be able to manage. The aim was to improve confidence in and knowledge of basic management of airway emergencies, including tracheostomies.

Method

Groups of 4-6 final year medical students participated in 3 scenarios: 2 tracheostomy-related and 1 partially compromised airway. The students had attended a session introducing tracheostomies and the algorithms produced by the National Tracheostomy Safety Project for tracheostomy emergencies. A semi-structured debrief followed each scenario, highlighting key learning points. The students completed a pre- and post-session questionnaire, rating confidence in several domains related to the scenarios.

Results

Of 24 participants, the percentage of students who felt confident or very confident in the following domains were compared pre- and post-simulation respectively: recognising a potential airway problem (0% vs 71%); identifying an altered airway (0% vs 75%); managing a potentially compromised surgical airway (4% vs 71%); initially managing a compromised airway (8% vs 67%); and identifying when to escalate with a potential airway problem (25% vs 96%).

Conclusions

Simulation is a valuable tool that can be used to improve both knowledge and confidence in managing potential airway problems in final year medical students. This supports findings from other studies.
50 A Cross-Sectional Study Examining the Association Between MRCS Performance and Surgeons Receiving Fitness to Practice Sanctions
Authors: Ellis R , Scrimgeour D , Cleland J , Lee A , Brennan P
Published: October 2021

Aim

Fitness to practice (FtP) investigations by the General Medical Council (GMC) can be one of the most stressful experiences in a surgeon’s career. Demographic factors are known to alter the likelihood of GMC investigation. Despite this there are no studies assessing risk factors in surgeons for FtP sanctions. Thus, we used the newly created Intercollegiate Membership of Royal College of Surgeons (MRCS) examination database to identify risk factors for and the prevalence of GMC sanctions in early-career surgeons.

Method

FtP sanction data contained in the GMC list of registered medical practitioners (LRMP) database was linked at person-level to all UK graduates who had attempted MRCS Part A or Part B between September 2007 and January 2020. Data were anonymised by the Royal College of Surgeons of England prior to analysis.

Results

f 11,660 candidates who had attempted the MRCS within the study period only 31 (0.3%) candidates had GMC FtP sanctions within the last two years. Of these, 12 had active conditions on their registration, 7 had active undertakings and 14 had warnings. Candidate demographics were similar between cohorts and there were no significant differences between MRCS performance identified.

Conclusions

In this, the largest study of MRCS candidates to date, the prevalence of active FtP sanctions in early-career surgeons was 0.3%, significantly lower than the prevalence of sanctions across more experienced UK surgeons (0.9%). These data highlight early-career surgeons as a low-risk group for disciplinary action and should reassure patients and medical professionals of the rarity of FtP sanctions.
55 Are Virtual Journal Clubs A Viable Alternative in The Covid-19 Era?
Authors: Morris J , Jenny H , Park C , Scarborough A , Antoniou V , Heylen J , Anakwe R
Published: October 2021

Introduction

During the COVID-19 pandemic, face to face journal clubs have been curtailed due to Governmental guidance for social distancing. We present an example of a virtual journal club set up for Orthopaedic senior house officers (SHOs) & trainees in the North West Thames (NWT) Deanery from April to August 2020.

Method

Our aims were to establish a regular online journal club for orthopaedic trainees in NWT that successfully met the objectives of the more established face to face meetings. Assessment of each session was evaluated using a post attendance survey created using an established online generator.

Results

64.4% (16/25 participants) had not attended a virtual journal club before, with 100% (33/33) reporting that they would attend another virtual journal club. 39.4% (13/33) of attendees agreed or strongly agreed that they could participate in sessions over more conventional meetings. 24.2% (8/33) of participants reported experiencing technical issues during the sessions. 90.9% (30/33) of respondents reporting the virtual model to be more convenient than standard journal clubs.

Conclusions

The potential benefits of significantly increased accessibility increased visiting expert contribution whilst still adhering to government guidelines; weighed against marginally less effective teaching nonetheless results in an overall benefit.
184 Effects of The Coronavirus Pandemic on Medical and Surgical Education: Results of An International Survey by The International Association of Student Surgical Societies (IASSS)
Authors: Kirby E , Franco H , Burger S , Shadé Breedt D , Davies J , Azam S , Weyers J , Chan K S
Published: October 2021

Aim

Coronavirus disease 2019 (COVID-19) presents a variety of unforeseen challenges to medical students and surgical trainees. Adaptations to the content and delivery of medical education are inevitable as institutions respond to the virus. Departments face significant restructuring, with important implications for training. Our aim was to assess the global impact of the first wave of COVID-19 on medical and surgical education.

Method

Between 12 May and 26 May 2020, an online survey was conducted and circulated to contacts of the International Association of Student Surgical Societies, including medical students and healthcare practitioners. All data were anonymous; no personal identifiable information was collected. Consent was implied by participation in the survey, which was on a voluntary basis.

Results

We collated 527 responses from 111 institutions across 26 countries. Globally, 93.5% of medical student placements were affected by the first wave of COVID-19, with examination restructuring and alternative teaching methods employed by 87.8% of medical schools. Trainee redeployment was common in both surgical (61.5%) and non-surgical (77.1%) disciplines. Surgical services were significantly affected, with reduced elective procedures in 93% of institutions. On an individual level, COVID-19 resulted in prolonged absence from clinical duties and mental health concerns at all levels of training.

Conclusions

Our data highlight drastic changes in medical and surgical education and practice as a result of the first wave of COVID-19. These changes are significant at all levels of training, both institutionally and individually. The pandemic is likely to have persistent consequences for future trainees in terms of education and career progression.
238 MRCS Performance Predicts Surgical Career Outcomes
Authors: Ellis R , Scrimgeour D , Cleland J , Lee A , Brennan P
Published: October 2021

Aim

Successful completion of the MRCS examination is mandatory for progression into higher surgical (registrar) training in the UK. National selection for training programmes is a highly competitive process. Despite this, the ranking of applicants does not currently include MRCS performance scores. This offers a unique opportunity to compare two independent assessments of surgical trainees to establish whether MRCS performance can predict future surgical career outcomes and competitiveness in training.

Method

All UK candidates who attempted MRCS between 2007-2020 were matched to career outcome data using the GMC list of registered medical practitioners and anonymised (n = 2910). Chi-squared tests determined associations with first attempt MRCS pass/fail outcomes. Multinomial regression models were developed to establish the predictive power of success at MRCS in determining surgical specialty and training deanery choices.

Results

There was statistically significant variability in MRCS Part A pass rates, ranging from 55.1%-76.7% between surgical specialties (P=0.001) but no significant variability in Part B pass rates (P=0.655). There was significant variability in Part A and Part B pass rates between training deaneries (P=0.010 and P=0.036 respectively). Pass rates ranged from 59.9%-77.7% for Part A and 70.1%-85.0% for Part B between training deaneries. Those in more competitive specialties and training deaneries performed better in MRCS in terms of first attempt pass rate, scores and number of attempts taken to pass.

Conclusions

MRCS performance is an early predictor of surgical career choice and competitiveness. Trainees who perform well at MRCS are more likely to enter competitive surgical specialties and training deaneries.
279 Preparing Foundation Trainees for Surgical On-Calls
Authors: Boyle M , Thu K , Mroczek T , Scicluna M , Byrne A
Published: October 2021

Aim

Foundation trainee feedback has highlighted low levels of confidence with the prospect of surgical on-calls. Key areas of concern are assessing and managing the acute surgical patient, identifying which patients need an operation and having the technical skills to competently assist in theatre. This lack of confidence prevents trainees engaging in an educational and rewarding rotation. We have designed and facilitated a day of robust workshops, addressing these key educational needs.

Method

Pre and post course questionnaires assessed the efficacy of teaching. Lectures on the assessment and management of acute surgical patients in general surgery, urology and trauma and orthopaedics were delivered by core surgical trainees. A named consultant oversaw quality assurance. Addressing the technical skills development need, an afternoon of surgical skills workshops covered, suturing, knot tying, laparoscopic principles, and theatre etiquette. Small groups of trainees rotated through each workshop, delivered by senior specialty trainee registrars, to ensure high fidelity training

Results

Trainees rated themselves in key areas pre and post course on a scale from 1-5. Pre course, 66% of trainees scored 3+ in “confidence in managing a surgical patient on-call”. This rose to 100% post course. Similarly; “Confidence in decision making regarding whether a patient should proceed to theatre” increased from 37.5% to 93.7%. “Suturing skills” improved from 37.5% to 100%.

Conclusions

All trainees that attended the course displayed marked improvement in their confidence and competence. We feel this course or similar should be incorporated into the foundation teaching program locally and has scope to be expanded regionally.
318 Adapting Surgical Intercalation Teaching to The Pandemic – A Novel Near-Peer Educational Model for Intercalating Medical Students
Authors: Srivastava A , Thirupathirajan V A R , Duffy E
Published: October 2021

Aim

The COVID-19 pandemic has reduced medical student exposure to traditional formats of surgical teaching, thereby irrefutably altering surgical education for the foreseeable future. The pandemic has compounded the preliminarily reported disconnect intercalating students experience, as well as depriving students of opportunities for surgical exposure. The aim of our study is to devise an innovative near-peer system to supplement surgical teaching and guidance for the ‘Surgical Sciences’ Intercalated BSc offered at University College London, hence promoting surgical education.

Method

Past students (preceding two cohorts) were competitively recruited, termed mentors. Each student was paired with a mentor for one-to-one guidance. Mentors and programme directors formulated surgical, module-specific, virtual tutorials (Zoom). Mentees were surveyed using predesigned Google Forms to gauge subjective utility. Likert Scales (0-10) were used for quantitative analysis and free-text fields for further commentary.

Results

Mentors and programme directors devised 8 module-specific, surgical tutorials over term 1, spaced on average at every 1.5 weeks. A statistically significant increase in confidence reported per taught module, from 5.85±1.16 to 7.85±0.93 (P < 0.0001), was observed. Mentees report an overall recommendation of 93.19% that all tutorials be rerun for the upcoming cohort. 75% of mentees predict their designated mentors will be ‘very useful’ in their surgical education.

Conclusions

A novel model of near-peer education for surgical intercalation studies has been successfully established, whereby students receive valuable education and guidance from mentors with relevant surgical experiences. Students report significant utility in this programme, which can be a constant in otherwise turbulent times for surgical education.
393 Opportunities to Improve the Pan-Surgical Intercollegiate Elogbook: A National, Cross-Specialty Scoping Survey
Authors: James T , Glasbey J
Published: October 2021

Aim

The Pan-surgical Intercollegiate eLogbook represents the world’s largest repository of training and operative data. ASiT have recently published concerns from a nationwide survey demonstrating widespread inaccuracies in eLogbook operative case reporting. This study aimed to add to this work by identifying opportunities to improve the way eLogbook data is used and interpreted.

Method

An online, self-administered, voluntary questionnaire was created on Google Forms (Google Inc, Menlo Park, CA) to explore patterns of use of the eLogbook, and highlight areas for improvement. The survey was disseminated to surgical trainees across the UK and Ireland using specialty networks and deanery training forums.

Results

Fifty trainees across the country from all ten surgical specialties completed the questionnaire. 54% of respondents reported using the Mobile eLogbook Application to record procedural data and 62% reported doing this on the same day of the procedure. 52% reviewed their eLogbook data less frequently than monthly. Just 16% thought the current presentation of eLogbook data were ‘very useful’ or ‘useful’. 72% were happy to record more detailed procedural data. 88% were interested in anonymously comparing procedural data with peers, and four-fifths reported that hospital or regional level data would influence their application choices. 96% reported that access to trainer’s supervision data would influence planning of their daily clinical activity.

Conclusions

This survey has identified several solutions for improving engagement and utility of the Intercollegiate eLogbook. Trainees report a desire to access enhanced analysis of individual, local, regional and national operative data.
440 Training in Microbiological Sampling for Toe Amputations in Diabetic Foot Disease: A Survey of UK Vascular Trainees
Authors: Dawson J , Travers H , Wall M
Published: October 2021

Aim

To determine usual practice and extent of training received by United Kingdom (UK) vascular surgery trainees in microbiological sampling for toe amputations in diabetic patients.

Method

A prospective online survey was distributed via social media networks and trainee organisations. All vascular surgery trainees in the UK were invited to participate. A total of 29 responses were included in the analysis.

Results

86% of respondents have been trained in toe amputations during registrar training. 66% have not been taught which samples to send for microbiological analysis. 10% receive regular training reviews in toe amputations. There is significant variability in the types of samples sent by trainees for microbiological analysis and the majority of trainees did not know how their samples are processed in the laboratory.

Conclusions

Toe amputations appear to be a neglected aspect of training for UK vascular surgery registrars. Lack of consistency in microbiological sampling techniques may prevent optimum antimicrobial stewardship and therefore increase the risk of further complications including major amputation. Inclusion of diabetic foot sepsis as a critical condition in the new vascular surgery curriculum may help to address this issue. A national consensus needs to be reached on how microbiological samples should be taken and processed in order for trainees to be taught in a consistent manner.
448 Foundation Doctor Local Peer-Led and Organised Basic Surgical Skills in General Surgery and Plastic Surgery
Authors: Thakkar R , Lloyd N , Ghauri S
Published: October 2021

Aim

Foundation doctors are under pressure early in their careers to attend highly subscribed and expensive surgical courses. We assessed the feasibility of a foundation doctor led and locally organised basic surgical skills introduction.

Method

The lead foundation doctor organised a basic surgical skills introduction for foundation year doctors at Salisbury District Hospital liaising with the postgraduate centre and local surgical consultants. This training was supervised by local consultants and registrars. This teaching delivered theory and practise in suturing, knot tying and laparoscopy by local and familiar trainers. Feedback was collected using the Likert scale.

Results

12 foundation doctors attended. 100% either agreed or strongly agreed the introduction was helpful and well organised. 25% either agreed or strongly agreed feeling confident with suturing and knot tying before the teaching which increased to 92% after teaching. Only 8.3% either agreed or strongly agreed feeling confident with the principles of basic laparoscopy before teaching which increased to 83% after teaching. 100% either agreed or strongly agreed the teaching will improve their clinical practise and enhance their interest in surgery. 92% strongly agreed or agreed that the teaching improved their knowledge in basic surgical skills, and the peer led and organised structure was an effective teaching method.

Conclusions

Foundation doctor locally peer led teaching organised with supervision by local consultants is an effective method of delivering basic surgical skills with improvement especially marked in basic laparoscopy and help enhance interest in surgical training.
453 Introduction of A Novel Online Learning Platform Increases Junior Doctors Confidence Prior To Starting Trauma & Orthopaedic On-Calls
Authors: Curtis A , Foster P , Mutimer J
Published: October 2021

Aim

Trauma and Orthopaedic (T&O) junior doctors are expected to manage on-calls involving a high volume of patients presenting with a wide variety of complex conditions. Despite this, many junior doctors feel poorly prepared at the start of their placements with individual hospitals providing variable levels of induction. We therefore aimed to provide a free ‘Introduction to T&O on-calls’ course for junior doctors.

Method

The online platform ‘Zoom’ was used to provide 13 interactive lectures by T&O trainees and consultants over a single day in July 2020. In total, 280 UK junior doctors attended with 91.1% completing feedback. Pre- and post-course questionnaires were used to establish improved knowledge.

Results

Only 7.4% of participants either had or were aware of a local trust induction covering T&O on-calls. The course had an overall satisfaction rating of 90%, with participants showing a 15.3% improvement in on-call knowledge from pre-course to post-course (p<0.05). Prior to the course only 35% of participants felt prepared to perform an on-call which increased to 77% after the course. Almost all participants (90%) agreed that similar courses in other surgical specialties (General surgery (79%), Urology (60%), Vascular surgery (60%), ENT 55%)) which are commonly cross covered by junior doctors would be hugely beneficial.

Conclusions

Our principal focus moving forward is to establish a formal national induction programme for T&O junior doctors that is recognised by the relevant T&O organisations. This will instil confidence in the junior doctors whilst achieving patient safety and excellence during busy T&O on-calls.
513 Clinical Audit Platform for Students (CAPS): A Pilot Study
Authors: Hashmi Y , Kumar P R , Morad R , Dewan V
Published: October 2021

Introduction

Clinical audit projects work to decrease the occurrence of clinical mistakes and ensure current practice is optimal for patients. However, many clinicians are unable to carry out regular audits given their time constraints. Conversely, medical students are often eager to complete audits early in their career to strengthen their portfolios. As such, the clinical audit platform was designed to connect willing supervisors and these medical students.

Method

A medical school Trauma & Orthopaedics (T&O) society organised clinical audit teaching sessions for interested students. Allocation of students to project supervisors was based on similar topic interests. There was regular communication to track progress and anonymised feedback forms were distributed to all students and supervisors after the programme.

Results

A total of 17 responses were received from the 19 students who were involved in a project. Based on a 5-point Likert scale, students displayed a mean improvement in their understanding of a clinical audit (1.18 ± 1.07, p < 0.001), the confidence to approach a supervisor (1.29 ± 1.21, p < 0.001) and the ability to conduct an audit by themselves in the future (1.77 ± 1.15, p < 0.001). Eagerness to pursue a career in T&O increased from 35.3% to 70.6% of students following the programme. Of the 7 affiliated supervisors, 5 provided feedback and all were happy with the quality of work produced.

Conclusions

The platform produced high quality projects which were disseminated both locally and nationally, demonstrating positive collaboration between students and clinicians. We present our findings to encourage similar audit platforms to be adopted at other locations.
596 Redeployment of Surgical Trainees to Intensive Care During the COVID-19 Pandemic: Evaluation of the Impact on Training and Wellbeing
Authors: Payne A , Alfa-Wali M , Rahman R , Bullingham R , Vamadeva S
Published: October 2021

Aim

The aim of this study was to evaluate the impact of redeployment of surgical trainees to intensive care units (ICUs) during the COVID-19 pandemic in terms of transferrable technical and nontechnical skills and wellbeing.

Method

This was a survey study consisting of a 23-point questionnaire. The study involved senior house officer level surgical trainees that had been redeployed to the (ICU) across all hospitals in London during the COVID-19 pandemic. The survey was sent to 90 surgical trainees. Thirty-two trainees responded to the questionnaire and were included in the study results.

Results

All respondents spent between 4 and 8 weeks working in ICU. Prior to redeployment, 78% of participants had previous experience of ICU or an affiliated specialty, and >90% had attended at least 1 educational course with relevance to ICU. There were statistically significant increases in confidence performing central venous cannulation and peripheral arterial catheterisation (p < 0.05). With regards to clinical skills, respondents reported feeling more confident managing ventilated patients, patients on noninvasive ventilation, dialysis, and circulatory failure patients after working in ICU. Respondents (97%) felt that the experience would be beneficial to their future careers but 53% felt the redeployment had a negative impact on their mental health.

Conclusions

Redeployment of surgical trainees to ICU led to increased confidence in a number of technical and nontechnical skills. However, proactive interventions are needed for training surgeons with regard to their psychological wellbeing in these extraordinary circumstances and to improve workforce planning for future pandemics.
602 From Laptop to Laparotomy: A Retrospective Evaluation of Virtual Teaching Methods in Surgical Anatomy During COVID-19
Authors: Paluch A , Lakpriya S , Moyes S , Evans L
Published: October 2021

Introduction

Sound knowledge of anatomy is the cornerstone of safe surgical practice and COVID-19 has created new barriers to universally achieving this standard of education. There has been drastic change to the way in which anatomy education is delivered, with the loss of ‘face-to-face’ and ‘hands-on’ teaching methods creating unique challenges in a subject that relies on students’ understanding of 3-D concepts. Globally, institutions have switched to online learning methods and student experience is vital in shaping this new landscape and optimising resources.

Method

A retrospective, online survey distributed to a cohort of Year 2 BMBS students after a term of anatomy teaching during COVID.

Results

40 students participated in the survey. Qualitative feedback was largely positive towards online learning. Smaller groups and facilitator-led sessions, for example utilising virtual ‘breakout rooms’, were more favourable. Sessions based around clinical scenarios appeared the most popular, followed by those using an online quiz format and then those using virtual dissections on an anatomy app (63%, 39% and 18% of students rating each option respectively as ‘extremely helpful’). Where feedback was negative, themes included a perceived lack of 3-D visual aids or ‘real-life’ anatomy and difficulty navigating the anatomy app used for virtual dissection.

Conclusions

Small group sessions with a focus on clinical scenarios were the most popular. The ability to visualise structures in 3-D remains an important component of student experience. The challenge lies in simultaneously delivering new anatomical concepts while supporting students to adapt to the new technology that will enable this.
685 Implementation of Education Fellows on General Surgery Medical School Rotations Facilitates Student Learning and Improves Learning Experience
Authors: Chong S J K , Mortimer L , Quick C , West L , Khera G
Published: October 2021

Aim

A UK teaching hospital expanded their established education fellow programme to the General Surgery department to assist with departmental teaching of third-year medical students from the affiliated medical school on clinical placement. Teaching on ward rounds, bedside teaching and clinical tutorials were three areas identified as requiring improvement based on previous student feedback. Observation of Upper and Lower Gastrointestinal (GI) malignancy multi-disciplinary meetings (MDMs) via Microsoft Teams was also introduced as a new teaching initiative.

Method

Four post-foundation training education fellows were allocated on alternating weeks to supervise third-year medical students on upper and lower GI ward rounds and during GI MDM observation, conduct bedside teaching and facilitate blended-learning clinical tutorials in accordance with the 2020 GMC Medical Licensing Assessment curriculum. A mixed-methods survey was sent to students after surgical placement and the results compared to student feedback from previous years.

Results

31 out of 52 students (60%) on placement responded. 100% rated the fellow-led clinical tutorials as “excellent”. 87% of respondents rated the upper and lower GI ward rounds as either “excellent” (52%) or “good” (35%). All respondents rated the implementation of education fellows as either “very helpful” (94%) or “helpful” (6%) for their learning. Most students rated the MDM observation initiative as “good” (36%) or “average” (36%).

Conclusions

Implementation of education fellows on third-year medical student placements in General Surgery facilitates self-reported student learning and is associated with a drastically improved student learning experience. More work is required to develop GI MDM-based teaching to improve student learning experiences from MDMs.