Is gynaecological surgical training a cause for concern? A questionnaire survey of trainees and trainers

Abstract

AstractBackgroundConcerns have been raised as to whether the current postgraduate training programme for gynaecological surgery is being detrimentally affected by changes in working practices, in particular the European Working Time Directive (EWTD). The purpose of this study was to investigate the surgical activity of obstetrics and gynaecology trainees and to explore trainees' and trainers' opinions on the current barriers and potential solutions to surgical training.MethodsTwo questionnaire surveys were conducted, one to obstetrics and gynaecology trainees working within the West Midlands Deanery and a second to consultant gynaecologists in the West Midlands region.ResultsOne hundred and four trainees (64.3%) and 66 consultant gynaecologists (55.0%) responded. Sixty-six trainees (66.7%) reported attending up to one operating list per week. However, 28.1% reported attending up to one list every two weeks or less and 5 trainees stated that they had not attended a list at all over the preceding 8 weeks. Trainees working in a unit with less than 3999 deliveries attended significantly more theatre sessions compared to trainees in units with over 4000 deliveries (p = 0.007), as did senior trainees (p = 0.032) and trainees attached to consultants performing major gynaecological surgery (p = 0.022). In the previous 8 weeks, only 6 trainees reported performing a total abdominal hysterectomy independently, all were senior trainees (ST6 and above). In the trainers' survey, only two respondents (3.0%) agreed that the current program produces doctors competent in general gynaecological surgery by the end of training, compared to 48 (73.8%) respondents who disagreed.ConclusionsTrainees' concerns over a lack of surgical training appear to be justified. The main barriers to training are perceived to be a lack of team structure and a lack of theatre time.

Training on an inexpensive tablet-based device is equally effective as on a standard laparoscopic box trainer

“…[4] Due to residents spending less time in the operating room (OR), mainly as a result of work hour restrictions, difficulties have arisen in gaining enough surgical experience during training to reliably acquire sufficient laparoscopic skills. [5] In order to overcome this problem, training of basic laparoscopic skills (BLS) outside the OR has gained increasing importance, and various simulation models have been developed to meet this need. [6] …”

Current understanding of learning psychomotor skills and the impact on teaching laparoscopic surgical skills

“…Trainees face many challenges in their attempts to learn the skill set required to perform laparoscopic surgery. The learning curve is steep, the skills required are complex and trainees are faced with challenges of depth perception, visuospatial awareness, lack of direct feedback from tissues and the fulcrum effect of the instruments . Teaching laparoscopic surgery is significantly more stressful for the surgeon than open surgery, as there is limited direct control over the trainee's actions .…”

“…Teaching laparoscopic surgery is significantly more stressful for the surgeon than open surgery, as there is limited direct control over the trainee's actions . The number of hours spent in the operating room has been detrimentally impacted on since the implementation of the European Working Time Directive, Modernising Medical Careers, the increasing number of trainees and the changing nature of gynaecological surgery itself …”

“…The learning curve is steep, the skills required are complex and trainees are faced with challenges of depth perception, visuospatial awareness, lack of direct feedback from tissues and the fulcrum effect of the instruments. 1,2 Teaching laparoscopic surgery is significantly more stressful for the surgeon than open surgery, as there is limited direct control over the trainee's actions. 3 The number of hours spent in the operating room has been detrimentally impacted on since the implementation of the European Working Time Directive, Modernising Medical Careers, the increasing number of trainees and the changing nature of gynaecological surgery itself.…”

“…3 The number of hours spent in the operating room has been detrimentally impacted on since the implementation of the European Working Time Directive, Modernising Medical Careers, the increasing number of trainees and the changing nature of gynaecological surgery itself. 1 The benefits of the laparoscopic approach are well documented and most gynaecological procedures can be approached via the minimal access route. 4 It is an essential skill for today's trainees to attain competence in, as emphasised by the Royal College of Obstetricians and Gynaecologists' (RCOG's) Working Party Report Tomorrow's Specialist.…”