Higher surgical trainees are failing to achieve national standards for endoscopy practice. There is an urgent need to address the deficiencies in endoscopy training to ensure a competent cohort of surgical endoscopists.

The development of a screening test for cervical dysplasia has been a major force in diminishing the worldwide incidence of invasive cervical cancer. Screening intervals recommended by professional organizations have changed over the past half century. Recognition of the human papillomavirus (HPV) as the causative agent and enhanced understanding of the natural history of HPV and cervical dysplasia in different age groups have prompted the American College of Obstetricians and Gynecologists and other professional societies to defer Pap smear screening to intervals no less than 2 years apart in women 21-29, and every 3 years in women 30 and over assuming no prior history of cervical dysplasia. Screening should start no sooner than age 21. These recommendations more closely resemble those currently practiced in Europe and other parts of the developed world. Those who have undergone hysterectomy no longer need screening unless high-grade dysplasia was present. Although the value of pelvic examination is not debated in women with symptoms referable to the female genital tract, the endorsement by several professional societies of less than annual cervical cancer screening in healthy women also begs the question of whether annual pelvic examination (speculum and/or bimanual examination) benefits asymptomatic women. Some sexually transmitted infections are amenable to self-insertion of a vaginal probe or detectable by voided urine specimen. Bimanual examination is insensitive in detecting early ovarian cancer with a high false-positive rate leading to patient anxiety, excessive diagnostic testing, and unnecessary surgical procedures. Future study should focus on the frequency in which healthy asymptomatic women should undergo pelvic examination.

III.

Aims COVID-19 has had a global impact on all aspects of healthcare including surgical teaching and training. This study aimed to quantify the impact of COVID-19 on operative case numbers recorded by surgeons in training, and annual review of competency progression (ARCP) outcomes in the United Kingdom. Methods Anonymised operative logbook numbers were collated from e-logbook and ARCP outcome data were collated from the Intercollegiate Surgical Curriculum Programme (ISCP) database for trainees across core and the ten higher surgical specialities. Operative logbook numbers and ARCP outcomes were compared between pre-COVID dates. Effect sizes are reported as incident rate ratios (IRR) with 95% confidence intervals (CI). Results 5599 surgical trainees in 2019 and 5310 in 2020 in surgical specialty training were included. The IRR was reduced across all subspecialties because of the COVID-19 pandemic (0.55; 95% CI 0.53-0.57). Elective surgery (0.60; 95% CI 0.59-0.61) was affected more than emergency surgery (0.88; 95% CI 0.86-0.89). Regional variance with reduced operative activity was demonstrated across all specialities. 1 in 8 in their final year of training have not been able to achieve curriculum requirements and have had training extended. 1 in 4 trainees entering their final year of training are behind their expected training trajectory. Conclusion COVID-19 continues to have a significant impact on surgical training in the UK. Urgent, co-ordinated action is required by key stakeholders to mitigate for these effects and maintain future surgical training.

ObjectiveTo determine whether obstetrics and gynecology (ob/gyn) patients in a large military teaching hospital have a negative attitude toward the wearing of surgical scrubs by ob/gyn providers.MethodsA convenience sample questionnaire on patient preferences, including two questions relating independently to military and civilian staff attire, was offered to clinic patients over a 2 month period. Univariate and multiple logistic regression analyses were used to identify patient groups less accepting of the surgical scrubs in clinics.ResultsOver ninety-one percent of respondents viewed surgical scrubs with a white coat to be acceptable clinical attire for military or civilian providers. Eight percent preferred the more formal uniform or business dress. Non-white and Hispanic patients had higher rates of preference for more formal dress.ConclusionsThe majority of ob/gyn patients surveyed did not view the use of surgical scrubs with a white coat negatively.

Background: The purpose of this study was to test the hypothesis that racial differences in satisfaction can be found among OB/GYN patients on a US naval base.

Aims A significant proportion of patients never fully recover baseline activity levels following major abdominal surgery. Postoperative muscle atrophy may be a major contributing factor to this, but is often overlooked. This study aimed to quantify the degree of muscle loss in patients undergoing routine recovery following major abdominal surgery and in patients admitted to critical care. Methods Fifteen patients undergoing major open colorectal resection were recruited. Cross surface area (CSA) and muscle thickness (MT) of a quadriceps muscle, Vastus Lateralis (VL) were measured pre-operatively and on post-operative day (POD) 5 using ultrasound. Knee extension strength was also measured pre-operatively and on POD5 using a handheld dynamometer. A systematic literature review was performed to identify studies reporting muscle loss in patients admitted to an intensive treatment unit (ITU), with pooled means of changes in quadriceps muscle CSA calculated. Results By POD 5 VL CSA had decreased by 9.16% (± 2.0), and MT had decreased by 8.14% (± 5.93). Associated with this, knee extensor strength decreased by 19.69% (± 12.91). Systematic review identified 4 studies reporting muscle loss in ITU patients, including a total of 126 patients. Pooled mean of quadriceps CSA in patient admitted to ITU decreased by 13.9% (-12.5% -20.75%) by POD7. Conclusions Major abdominal surgery is associated with a significant loss of muscle mass and function. Losses are larger in patients requiring ITU admission. This may have a significant impact on patients’ full recovery to baseline function and further work is required to investigate this.

Background The publication of data from the National Emergency Laparotomy Audit (NELA) has resulted in overall improvement in post-operative mortality rates. However, little is known about the characteristics of patients that die in the immediate post-operative period. These patients may represent a missed opportunity for the consideration of palliation. We describe this specific group of patients where death occurred within three days of emergency laparotomy, and investigate predictors of early mortality. Methods All patients enrolled in the NELA database from December 2013–2020 were included. Early post-operative death was defined as all-cause mortality within three days of emergency laparotomy. Multi-level logistic regression was carried out with potentially clinically important predictors defined a priori. Frailty was modelled separately due to missing data. Results Four per cent of patients (7,442/180,987) died in the early post-operative period and 85% were admitted to critical care post-operatively. Median NELA risk score was 32.4% compared to 3.8% in the rest of the cohort (p<0.001). One in four patients were commenced on an end-of-life pathway following laparotomy. Significant predictors on multivariate analysis included female sex, increasing age, higher ASA, surgery for intestinal ischaemia or perforation, hypotension, reduced GCS, urgency of surgery, cardiac and respiratory signs (n=178,442). The addition of frailty (n=52,766) was also predictive (OR 1.37; 95% CI 1.22–1.55) when added to the model. Conclusion Early post-operative mortality is associated with quantifiable predictable factors in addition to the NELA risk score. This finding has significant implications for the multi-disciplinary team having shared decision-making discussions with extremely high-risk patients.