Effects of changing work patterns on general surgical training over the last decade
ABSTRACT BACKGROUND There is concern across all medical specialties that shift patterns and reduced working hours are detrimental to training, and that craft specialties have been most affected. This study aimed to examine the effects of these changes to training on the quantity of operating performed by surgical trainees in a UK teaching hospital. METHODS This retrospective study of prospectively collected computerised theatre data examined elective and emergency general surgical operations performed over four time periods: 1996 (Calman), 2001 (New Deal), 2004 and 2009 (European Working Time Directive). Procedures were analysed according to grade of surgeon and time of day. RESULTS In 1996, most appendicectomies (72.2%) were performed by senior house officers (SHOs), compared with 3.8% in 2009. By 2009, SHOs did not perform any emergency procedures other than abscess drainage and appendicectomy. The proportion of emergency operating performed by specialist registrar (SpRs) has remained constant, but elective operating has reduced from 34.6% (1996) to 15.7% (2009). Supervision of both SHOs and SpRs has increased between 1996 and 2009 in both elective and emergency work. CONCLUSIONS The proportion of operating performed by SpRs and SHOs has fallen over the last decade, coinciding with implementation of structural changes to training, the advent of minimally invasive techniques, and the drive for a consultant led health service. Trainees may therefore require increased supervision as well as protected theatre sessions to balance operative training with ward based duties. Education must be integrated into working practice in order for trainees to achieve expected competencies and ultimately produce adequately experienced consultants.
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ABSTRACT: The aim of this review was to assess the place of retroperitoneal (RP) aortic surgery for abdominal aortic aneurysms (AAAs) in the endovascular era and evaluate the evidence supporting it in preference to the more traditional transperitoneal approach. As endovascular graft technology improves, open aortic surgery is declining. AAAs unsuitable for endovascular aneurysm repair are, by definition, anatomically challenging. The RP approach is especially suited to anatomic challenges such as those posed by contemporary open AAA because it facilitates access to the suprarenal aorta. There is evidence that the RP approach reduces postoperative morbidity and length of stay compared with transperitoneal approaches. The evidence available indicates that the RP approach should be the first considered for any AAA unsuitable for endovascular aneurysm repair; however, the technique is more difficult to learn and less commonly practiced than the transperitoneal approach. Combined with a decrease in training hours in the United Kingdom, there is a real threat that the RP technique will only be performed by an ever-decreasing number of enthusiasts.Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 07/2012; 56(3):834-8. DOI:10.1016/j.jvs.2012.04.021 · 2.98 Impact Factor
- BMJ (online) 11/2012; 345:e7382. DOI:10.1136/bmj.e7382 · 16.38 Impact Factor
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ABSTRACT: Background: Many ENT conditions can be treated in the emergency clinic on an ambulatory basis. Our clinic traditionally had been run by foundation year two and specialty trainee doctors (period one). However, with perceived increasing inexperience, a dedicated registrar was assigned to support the clinic (period two). This study compared admission and discharge rates for periods one and two to assess if greater registrar input affected discharge rate; an increase in discharge rate was used as a surrogate marker of efficiency. Method: Data was collected prospectively for patients seen in the ENT emergency clinic between 1 August 2009 and 31 July 2011. Time period one included data from patients seen between 1 August 2009 and 31 July 2010, and time period two included data collected between 1 August 2010 and 31 July 2011. Results: The introduction of greater registrar support increased the number of patients that were discharged, and led to a reduction in the number of children requiring the operating theatre. Conclusion: The findings, which were determined using clinic outcomes as markers of the quality of care, highlighted the benefits of increasing senior input within the ENT emergency clinic.The Journal of Laryngology & Otology 11/2012; 127(1):1-5. DOI:10.1017/S0022215112002538 · 0.70 Impact Factor