bluuebunny/crossref_metadata_2025_split huggingface dataset:
347 Perspectives of Surgical Simulation Training in Medical Students: A Narrative Synthesis
Authors: Singh A , Baskaran R 
Published: August 2024

Abstract

Aim
Simulation serves as a crucial instrument for replicating authentic surgical environments. The acquisition of proficiency in surgical skills is a mandated criterion for medical students, as articulated by the General Medical Council. There is a paucity of data pertaining to the efficacy of simulation training in both acute and chronic surgical contexts. The objective of this study is to assess the effectiveness of simulation in training medical students and to consolidate insights into innovative methodologies for surgical education.

Method
A literature search was performed on Embase, Medline and Global Health using the search terms: medical student* AND surgical simulation AND (United Kingdom OR UK OR England), including data from 1947 to 2023. The inclusion criteria were: (i) Surgical simulation (ii) Medical student training (iii) United Kingdom. 8 studies were included and appraised by 2 blinded individuals. The results and conclusions were constructed into a narrative synthesis.

Results
Studies have highlighted the lack of adequate surgical skills training in British medical schools. Cross-sectional and survey-based research underscores the positive outcomes of simulated learning by implementing virtual reality and simulated surgical patient pathways. Significant improvement in students’ awareness, confidence, performance, and learning standards has been demonstrated across studies.

Conclusions
Simulated training emerges as a valuable approach for instructing medical students. Within British medical institutions, there is an imperative to accentuate the emphasis on surgical pedagogy. The deployment of innovative techniques not only endows the prospective healthcare workforce with heightened surgical competencies but also augments the exposure of medical students to surgery as a potential discipline.
359 The Ebbs and Flows of Empathy: A Qualitative Study of Surgical Trainees in the UK
Authors: Yannamani P , Gale N K 
Published: August 2024

Abstract

Background
Empathy is widely recognised as an important element of medical practice contributing to patient outcomes and satisfaction. It is also an important element of collaborative work in a healthcare team. However, there is evidence to suggest that empathy towards patients declines over time, particularly in surgical specialities. There is little qualitative research on this decline in surgical trainees, particularly in the UK. Therefore, the aim of this study was to explore how trainee surgeons experience empathy over the course of their career, both towards patients and colleagues and how they perceive it in others.

Method
10 semi-structured interviews were carried out with surgical trainees of different grades and specialties in January and February 2022. Framework analysis was used to interpret the data.

Results
Participants experienced an evolution in empathy over their career as their personal and professional experience was added to. They drew a distinction between desensitisation and actual decline in empathy and identified more with experiencing the former in their careers. Participants also felt interprofessional relationships require empathy, and this could be improved upon. Finally, they highlighted specific impacts of the COVID-19 pandemic upon their training, including reduced theatre time.

Conclusions
Participants felt training could be improved in regard to accessing training opportunities and relationships with colleagues, although many felt empathy between colleagues is better than it has been in the past. This project highlighted areas for future research, such as with surgeons in later stages of their careers, or mixed-methods projects.
528 Leicester SCRUBS Surgical Mentoring Scheme for Medical Students
Authors: Bowerman K , Martin J , Agarwal R 
Published: August 2024

Abstract

Background
Surgically themed mentoring schemes for medical students are critical in inspiring the next generation of surgeons. With surgical skills not classically taught as much compared to other aspects of the medical curriculum, alongside the ever-building NHS backlog, other avenues must be utilized to inspire and train future surgeons. The University of Leicester surgical society, alongside clinicians at University Hospitals of Leicester, therefore, have run a surgically themed mentoring programme for clinical medical students to address this.

Method
Clinical year medical students sign up to the scheme annually and are assigned a registrar or consultant mentor, matching preferences in specialty, gender, and ethnicity where possible. The scheme has now run for three years, with data collected post-scheme annually via a mixed methods survey.

Results
In the 2022-23 cohort, 81 Leicester medical students enrolled into the scheme. Students’ pre-scheme expectations were met, including increasing surgical opportunities, developing a surgical portfolio, and increasing research and audit opportunities. An increase in the quantitative likelihood of pursuing a surgical career was observed, rising from 3.48 to 3.65 (Likert scale 1-5). However, students said they would prefer more structure to the scheme and a mock agenda to aid meetings with their mentors.

Conclusions
Overall, there is a clear benefit in surgical mentoring for medical students and may contribute to increasing numbers entering surgical training. Further work needs to be done to generate a structure to guide frequency and content of meetings with mentors. This is currently being developed for the fourth cohort.
695 Simulated Multidisciplinary Team Meeting: A Novel Approach to Vascular Trainee Education
Authors: Boyce R 
Published: August 2024

Abstract

Aim
The multidisciplinary team (MDT) meeting is well recognised for its utility and role in facilitating the harmonisation of management approaches across multiple specialties for the delivery of quality care and improved patient outcomes. The discussion of complex and highly nuanced clinical cases lends itself to excellent educational opportunities and improved clinical decision-making. While vascular MDTs are routinely conducted across centres nationally there is currently no formal integration of this activity into the training curriculum for vascular trainees. This simulated vascular MDT was predicated upon this premise and was piloted at the recently concluded 5th East of England Regional Endovascular Skills Course for a cohort of 16 regional vascular trainees on 6th October 2023 which took place at Colchester Hospital.

Method
A series of peripheral vascular cases of varied complexity were presented to the vascular trainees who were then tasked with formulating management plans. A consultant radiologist and senior anaesthetic trainee was present to provide input related to imaging and preoperative assessment and perioperative planning.

Results
Pre-MDT questionnaires were distributed which assessed the trainees’ stage of training, experience, and comfort level with the various types of cases which were presented. Post-MDT questionnaires were used to assess the trainees’ opinions on this exercise and obtain feedback.

Conclusions
The responses obtained revealed overwhelming support for including this exercise in future training courses and regional teaching days. A strong recommendation can be made for incorporating simulated vascular MDTs into the vascular training curriculum.
979 Enhancing Surgical Training Through Augmented Reality: A Pilot Study on the Use of the Microsoft HoloLens for Live-Streaming from Theatre
Authors: Patel R D , Patrick S , Hanibal G , Murphy Lonergan R , Naparus A , Bartholomew B 
Published: August 2024

Abstract

Aim
Reduced theatre exposure for trainees and students is increasingly detrimental to the surgical workforce. One potential solution is live-streaming from the operating theatre - the Microsoft HoloLens, a mixed-reality headset, facilitates immersive two-way audio and video stream from the perspective of the surgeon. This pilot explores the use of the HoloLens to facilitate trainees’ operative exposure.

Method
Patient operation (BCC removal with rotational flap) was live streamed to an audience of trainees using the HoloLens device and platform Remote Assist. This activity was incorporated into an existing course on plastic surgery aimed at postgraduates.
Written consent was gained and later verified from the patient, to live-stream the procedure for educational purposes. Recording was prohibited. Evaluation of the experience was obtained from the surgeon and observers (n=8) via a post-procedure focus group and anonymous written feedback. Qualitative analysis of feedback was performed by OpenAI GPT.

Results
Observers cited that learning was facilitated by excellent image and audio quality, close communication with the surgeon and improved visibility of the procedure from the operator’s perspective. They also referenced interactive audience discussion and increased comfort as benefits over scrubbed theatre time. Learning was disrupted by technical delays and hardware unreliability. The device also blighted the surgeon’s visual field, comfort, and initial confidence in theatre.

Conclusions
Overall, we demonstrate the value of the HoloLens in increasing surgical exposure, with myriad of observer perceived benefits, likely at the surgeon’s expense.
1216 A QIP to Improve FY1s’ Prescribing in Acute Pain for Patients Admitted Under General Surgery at a District General Hospital
Authors: Carter L , O’Callaghan G , Pagarkar A , Shah K , Engleback M 
Published: August 2024

Abstract

Aim
To improve self-reported confidence in prescribing analgesia in acute pain amongst FY1s on General Surgery at a DGH by improving knowledge of relevant guidelines and improving pain management teaching for FY1s.

Method
We surveyed General Surgery FY1s to assess self-reported confidence scores for prescribing in acute pain and to collect qualitative data about barriers to good pain prescribing. Our first intervention was to create a dedicated folder on the shared drive for the FY1s to easily access the pain management guidelines, as surveys showed that the FY1s found the intranet difficult to navigate and the guidelines difficult to find. Our second intervention was to implement the Essential Pain Management course (initially developed by the Australian and New Zealand College of Anaesthetists and supported by the Royal College of Anaesthetists and the Faculty of Pain Medicine in the UK) as part of the FY1 teaching programme. We reassessed self-reported confidence scores in pain prescribing after each of these interventions.

Results
The first cohort of FY1s had initial self-reported confidence scores of 3.76/5. Following our first intervention this improved to 4.25/5 - a 13% improvement. Our second intervention improved the self-reported confidence scores from 3.2/5 to 4.2/5 – a 31% improvement.

Conclusions
Implementation of the Essential Pain Management course for FY1s can have a positive impact on self-reported confidence in pain prescribing for patients admitted under General Surgery at a DGH, more so than simply improving awareness and knowledge of the guidelines.
1023 Implementation of NHS Net Zero: An Analysis of Clinician Engagement and Quality Improvement
Authors: Sinha V , Taylor L , Swarnkar P , Vijayan R 
Published: August 2024

Abstract

Aim
Since the NHS Net zero report in 2020, UK hospital trusts have been working to achieve net zero carbon emissions by 2040. Henceforth, sustainability leads and working groups have been appointed to formulate and implement “Green Plans”. Clinician involvement and quality improvement (QI) are crucial to achieving net zero emissions. 133 Hospital Trusts in England were surveyed, to establish the extent to which sustainability has been embedded into clinical governance and quality improvement.

Method
130 NHS Trusts in England were contacted during two time periods between 2021 and 2023 using Freedom of Information (FOI) requests. Each trust received a standardised sustainability questionnaire involving induction programmes, clinical governance, audits, QI and research projects. Trusts were required to respond within 20 working days upon receiving an FOI request. Follow-up emails were sent to trusts which did not respond within the timeframe. Requests for further clarification were answered. Data collection and extraction were undertaken using an Excel spreadsheet.

Results
In 2023 sustainability was identified as the theme of 38.8% of audits, QI, or research projects. Most trusts had a sustainability working group (70.7%), the majority of trusts had 0-5 clinicians in their sustainability working group (44.4%). 73.2% of respondents had a sustainability lead, 22.4% included sustainability in clinical governance meetings, and 18.1% included sustainability in junior doctor inductions.

Conclusions
Clinicians remain poorly engaged in matters relating to healthcare sustainability and carbon impact. This may represent a glaring omission in Trusts’ Net Zero plans and a missed opportunity to maximise progress.
440 Intra-Articular Haematoma Block vs Procedural Sedation for Manipulation of Closed Ankle Fracture Dislocations: An Efficacious, Resource Sparing Solution?
Authors: Elmesalmi M , Morcos Z , Mcfall J , Hindi F , KoÇ T 
Published: August 2024

Abstract

Background
Emergency Departments faced amplified pressures during COVID, with Procedural sedation (PS) demands on clinical spaces and PPE use. Queen Alexandra Hospital, Portsmouth, tested intra-articular haematoma blocks (IAHB) as an alternative to PS for manipulating closed ankle fracture dislocations.

Method
Between October 2020 and April 2021, patients with displaced ankle fractures received IAHB using 10ml of 1% lignocaine. Data collected comprised pain scores, time from first x-ray to reduction, and acceptability of the reduction. A retrospective analysis compared this with patients who underwent PS for ankle fractures between March and August 2020.

Results
25 patients received IAHB and 28 received PS . Time from the first x-ray to manipulation was faster with IAHB (65.9 min) compared to PS (82.9 min). In the IAHB group, six had unsatisfactory first attempts, of which five had a second manipulation, with three being successful. One required manipulation under anaesthesia, and another had an unsuccessful PS followed by fixation. In the PS group, five had unsatisfactory reductions. One underwent multiple PS attempts before fixation, and four others required external or open reduction. The number of unsuccessful reductions was similar in both groups. Importantly, IAHB demonstrated significant reductions in pain scores with no post-operative infections. The cost analysis revealed a notable difference, with the approximate cost per case being £0.60 for IAHB, compared to £4.50 for procedural sedation.

Conclusions
IAHB for ankle fractures is effective, safe, and cost-efficient. It negates risks of PS and the need for specific clinical space and skilled personnel for sedation.
527 Identifying the Validity of ChatGPT in the Diagnosis of Orthopaedic Emergencies
Authors: Pankhurst A , Kumar N 
Published: August 2024

Abstract

Aim
Chat Generated Pre-Trained Transformer (ChatGPT) is a large language model that is pre-trained to predict the next token in a document. Our aim is to evaluate the clinical accuracy of ChatGPT in the diagnosis and management of orthopaedic emergencies. ChatGPT has been tested to pass high level medical licencing and board exams. However, there remains concerns regarding the use of artificial intelligence (AI) models, specifically surrounding data governance and accuracy.

Method
Ten clinical scenarios were drafted and then vetted by fellowship level orthopaedic surgeons. The scenarios cover the breadth of orthopaedic emergencies such as septic arthritis, open fractures, and cauda equina syndrome. The scenarios were run through ChatGPT which generated differentials and management options. The answers were then scored by orthopaedic registrars.

Results
The results demonstrated that ChatGPT is largely accurate and safe in the diagnosis of orthopaedic emergencies. In particular, it demonstrated excellent scoring regarding conversation structure with clearly written diagnosis and management plans.

Conclusions
This novel validity study demonstrates that ChatGPT has potential in the diagnosis of orthopaedic emergencies. Given the nature of the AI model, the answers are continually changing as more information is fed into the transformer, thus reproducibility remains a major challenge in testing the model. Furthermore, scoring the quality of the answers provided by the model is subjective. Nevertheless, this study suggests that ChatGPT could provide clinical assistance and more research in the area is necessary to test its limits and safety.
1116 Staples vs. Sutures for Skin Closure in Patients Who Had Hip Arthroplasty for Treatment of a Neck of Femur Fracture
Authors: Okata D , Khin C , Kyaw O , Bannister P , Stott P 
Published: August 2024

Abstract

Aim
Following an arthroplasty procedure (hemi and total) for fractured neck of femur, the incision can be closed with sutures or clips, depending on surgeon’s preference. This study aims to evaluate the incidence of complications when comparing skin closure with staples vs. sutures in patients who have had a hip arthroplasty for treatment of neck of femur fractures.

Method
We analysed the numbers of patients who had further procedures following a hip arthroplasty. We compared the 2 groups for numbers and types of further procedures. A retrospective study which looked at neck of femur fracture patients who were treated with a hip arthroplasty within a 1-year period. We looked at the type of skin closure used during the operation and if any of these patients needed to have a further procedure such as a washout, DAIR or revision surgery.

Results
A total of 372 patients were studied. 247 had a hemiarthroplasty and 125 had a total hip replacement. There was no statistical difference in the patient’s demographics (age and sex). Of the 128 patients that had skin closure with staples, 7 of them required further procedures (5.5%), while of the 244 patients had skin closure with sutures, 4 of them required further procedures (1.6%).

Conclusions
Skin closure using sutures is associated with a much lower risk of surgical site infection and further procedures when compared to skin closure with staples in neck of femur fracture patients who have been treated with a hip arthroplasty.
1204 Efficacy of Novel Regional Anaesthetic Techniques in Day-Case Hip and Knee Arthroplasty
Authors: White C , Yakubi M , Manlapaz K , Knight U , Abdalla W , Tiwatane S , Subramanian P 
Published: August 2024

Abstract

Introduction
Pericapsular nerve group block (PENG) and infiltration of local anaesthetic between the popliteal artery and capsule of the knee (iPACK) are novel regional anaesthetic techniques that have not been well studied. PENG targets the anterior hip capsule through blocking articular branches of the femoral, obturator and accessory obturator nerves whilst sparing motor function. iPACK targets the sensory articular branches of the sciatic nerve whilst sparing motor branches of the tibial and common peroneal nerves. This study aims to evaluate the efficacy of PENG and iPACK in day-case arthroplasty.

Method
A case-series of 30 consecutive day-case arthroplasty patients undergoing total hip replacement (THR) (12/30), total knee replacement (TKR) (13/30) and unicompartmental knee replacement (UKR) (5/30). Multimodal analgesia included paracetamol, NSAID and high dose dexamethasone.

Results
For THR patients, the mean post-operative visual analogue scores (VAS) for pain were 4/10 (immediate post-operative), 5/10 (6 hours post-operative) and 5/10 (24 hours post-operative). The mean time to mobilisation was 188 minutes (90 – 360 minutes). The mean post-operative opioid consumption was 25mg (0 – 55mg).
For TKR and UKR patients, the mean post-operative VAS for pain were 4/10 (immediate post-operative), 5/10 (6 hours post-operative) and 5/10 (24 hours post-operative). The mean time to mobilisation was 176 minutes (60 – 480 minutes). The mean post-operative opioid consumption was 65mg (0 – 240mg). The mean pre-discharge knee range of motion was 90 degrees (80 – 95 degrees). There were no nerve block related complications.

Conclusions
PENG and iPACK are novel regional anaesthetic techniques that show promise in day-case arthroplasty.
647 An Audit of Spontaneous Stone Passage in Patients on the Waiting List for Ureteroscopy
Authors: McGurk S , Gabriel M , Wilson G 
Published: August 2024

Abstract

Aim
To determine the waiting list time from emergency stenting to elective management of ureteric stones. To identify the number of emergency patients who spontaneously pass their stone, whilst awaiting elective Ureteroscopy. To assess the benefit of pre-operative CT in reducing negative elective ureteroscopy rates.

Method
Retrospective study of all patients who underwent emergency stenting for renal colic and were placed on the waiting list for ureteroscopy. Patients were identified from the waiting list register using the relevant procedure codes and data was taken from the electronic patient record system.

Results
We identified 51 patients who were added to the waiting list in 2022 following emergency stenting for renal colic. Median waiting list time from emergency stent to URS was 21 weeks, with 41% affected by cancellations. 21 patients had pre-operative CT scans, of which 7 had passed their stones. 2 patients were found to have no stones at the time of ureteroscopy. 14 patients had encrusted stents at the time of elective surgery.

Conclusions
Our negative ureteroscopy rate was surprisingly low, however it may still be beneficial to repeat imaging in patients waiting longer than 6 months for surgery or where symptoms have changed. Of those patients who had undergone pre-operative imaging, a third had passed their stones. Thus, avoiding the risks of a further surgery and anaesthetic.
1130 Clinical Outcomes of Sacral Nerve Stimulation for Neuromodulation of the Lower Urinary Tract in a Tertiary Hospital
Authors: Akpala A , King T 
Published: August 2024

Abstract

Aim
To assess clinical outcomes in terms of first to second stage conversion rates, revision rates , complications, battery life span and device survival for all patients undergoing sacral neuromodulation for the past 5 years at the Queen Elizabeth hospital Birmingham.

Method
Retrospective observational study. Only patients who had first stage of sacral neuromodulation between January 2017 and January 2023 were included in the study. The data collected included age, type of first stage i.e PNE vs tined lead, response after first stage, if a second trial was carried out, response after second trial, indication for SNS, complications, revisions, etc.

Results
94% of the total (198 ) patients had PNE at first trial while 6% had tined lead. 130 patients had a positive response after first trial, 48 had a negative response and 20 had equivocal response. 15 patients from the equivocal group had a second trial with tined lead with 53.3% receiving a positive response making our conversion rate 69% . Of the 100 patients who had permanent implant fitted, only 18 had complications and 14 of these required revision. The indications for the revision were lead migration (36%), connection failure (14%), battery charging problem (7%), pain around battery site (36%) and device infection (7%).

Conclusions
The conversion and complication rates are comparable to national standards while the infection rates were lower than what has been reported in the literature. Higher conversion rates may be attained when tined lead is used at first trial.