Background The utility of Workplace-Based Assessments (WBAs) in surgical training depends on the way they are completed. This study aims to ascertain the real-world usage of WBAs, as perceived by UK surgical trainees. Methods An anonymous national online questionnaire was conducted via the Association of Surgeons in Training (ASiT). The evaluation employed mixed methods to interpret quantitative and qualitative data. Suggestions for improvement were identified from free-text comments and considered through a formal two-round modified Delphi consensus process by ASiT council members. Results Analysis included 906 complete responses from all surgical specialities across all training levels. WBA use was perceived to deviate markedly from the Joint Committee on Surgical Training standards with significantly identified misuse across all surgical specialities. Inaccurate completion was acknowledged by 89.6% of respondents, and some trainers appear complicit with 40.9% of respondents aware of 'unobserved sign-off', and 33.6% aware of 'password disclosure' by trainers. Most trainees felt the Annual Review of Competency Progression (ARCP) respected WBA quantity above quality (55.4%), and a third felt pressure to overstate the number completed (32.0%). Main reasons for misuse were time restraints, lack of engagement and the will to achieve career progression targets. Conclusions UK surgical trainees perceive a significant deviation from WBAs standards due to multiple factors. The frequency and nature of misuse are worrying and undermines the existing evidence for the WBAs role in training. We present consensus recommendations from ASiT for the improvement of WBA use in UK surgical training.
Excellent surgical trainers play a key role in teaching, mentoring and inspiring the next generation of trainee surgeons. Although there are differences in approach, personality and technique among trainers, common themes exist for those that truly shine as examples of good training. The good surgical trainer has long been the "unsung hero" of patient safety, inspiring and imparting wisdom and skill in trainee surgeons, and instilling a sense of confidence and compassion. In order to recognise exceptional trainers, the Association of Surgeons in Training (ASiT) introduced the Silver Scalpel Award in 2000. The award acknowledges talented trainers who go the "extra mile" for their trainees, and the selection process includes both written nominations and structured interviews with the nominees. We wished to identify what makes the best trainers excellent, to see if these attributes could be used to develop recommendations on how to train and how to support trainers. Here we present an outline of key attributes of an excellent surgical trainer, based on qualitative synthesis of the interview sheets from Silver Scalpel interviews. These results clearly highlight that good trainers are first and foremost good doctors, and that good training goes hand-in-hand with excellent patient care. This symbiotic relationship between training and patient outcomes should be acknowledged, and trainers should be supported by their employers to empower them to carry out their dual roles of training and patient care to the best of their ability. Trainers are key role models to inspire the next generation of surgeons and exceptional trainers should be celebrated.
Published in 2013, the Shape of Training review is an independent review of postgraduate medical training overseen by Professor david Greenaway. 1 This review has set out recommendations for the structure and delivery of training for the next 30 years, 1 including a framework and timescale for this reconfiguration. There is a wide range of key themes, listed in Table 1 . The changes proposed in its 19 recommendations are far-reaching, with implications for both current and future surgical trainees in the UK.
In 2011 the royal college of surgeons published From Theory to Theatre. This document states that delivering high quality research is the responsibility of anyone involved in any aspect of surgery. In 2012 the college outlined plans to develop a nationwide research infrastructure to allow the expansion of clinical trials in surgery. This incorporates trainee research groups, which are growing in popularity and productivity. The aim is to give surgical trainees the opportunity to facilitate large scale, multicentre clinical trials. Current activity is therefore placing increasing emphasis on conducting good quality research at all stages of surgical training.
In 2011 the royal College of Surgeons produced a document entitled FromTheory toTheatre: Overcoming Barriers to Innovation in Surgery that states:'Delivering high quality research is the responsibility of anyone involved in any aspect of surgery.' It highlights that in 2008–2009 surgical research received just 1.5% of the £1.53 billion total governmental spend on medical research. From this came a call for a review of public funding of translational research in surgery and academic departments of surgery in delivering this research. The overall outcome was the creation of 15 recommendations.
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Understanding what the current generation of trainees want to achieve is the key to understanding the future of the workforce Introduction Reform to surgical training over the last three decades has significantly affected the surgical workforce, career planning and progression. Despite changes to consultant job plans, there are no published data on trainees' aspirations and priorities for their future practice. In order to inform the design and structure of consultant job plans, this study sought to produce a trainee consensus statement regarding essential and desirable aspirations for their future professional practice as consultant surgeons. Methods This study used qualitative methodology with an initial survey to define themes, followed by an open invitation to a consensus session held at the Association of Surgeons in Training annual conference in Belfast in 2019. Results Fourteen essential and eight desirable aspirations for consultant practice were voted in and ratified at a formal consensus session. Essential aspirations included: regular theatre lists of cases in the clinician's subspecialty area of interest; regular theatre lists for teaching; regular ward rounds of the clinician's own patients; regular involvement in multidisciplinary team meetings, and morbidity and mortality meetings; a fixed elective schedule; specialty specific procedural lists; flexible working; dedicated time for administration, teaching, education and continuing professional development; options for sabbatical leave; and working in a supportive department. Conclusions This is the first formal national consensus process used to identify what surgical trainees deem as essential and desirable aspirations for their future practice as consultants. Healthcare employers should consider these aspirations when creating job plans and posts to attract trainees, encourage job satisfaction, improve workforce retention, and ultimately improve service delivery and patient care.
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