Registrar operating experience over a 15-year period: More, less or more or less the same?

Morris-Stiff, G.; Ball, Elizabeth; Torkington, Jared; Foster, M. E.; Lewis, MH; Havard, Timothy

doi:10.1016/s1479-666x(04)80078-7

Cited by 42 publications

(27 citation statements)

References 2 publications

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“…Recent data from the United States has shown concerning deficiencies in the operative exposure of general surgical trainees upon the completion of training [18]. Similar trends have recently emerged for senior trainees in general surgery [6,7] and orthopaedics [8-11] from the United Kingdom. We have now shown that operative exposure during basic surgical training is sub-optimal.…”

Section: Discussionmentioning

confidence: 83%

“…Recent data from the United States, suggests that the operative exposure of junior surgical trainees may be affected by these changes to an even greater extent [4,5]. Data has been published on the operative experience of senior trainees in general surgery [6,7] and orthopaedics [8-11] in the United Kingdom and Ireland. However, few studies have specifically reported the operative experience of trainees in the formative years of surgical training and those that have been published are based on a subset of operations [12,13] or a single institution [14-16].…”

Section: Introductionmentioning

confidence: 99%

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Analysing the operative experience of basic surgical trainees in Ireland using a web-based logbook

et al. 2011

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BackgroundThere is concern about the adequacy of operative exposure in surgical training programmes, in the context of changing work practices. We aimed to quantify the operative exposure of all trainees on the National Basic Surgical Training (BST) programme in Ireland and compare the results with arbitrary training targets.MethodsRetrospective analysis of data obtained from a web-based logbook (http://www.elogbook.org) for all general surgery and orthopaedic training posts between July 2007 and June 2009.Results104 trainees recorded 23,918 operations between two 6-month general surgery posts. The most common general surgery operation performed was simple skin excision with trainees performing an average of 19.7 (± 9.9) over the 2-year training programme. Trainees most frequently assisted with cholecystectomy with an average of 16.0 (± 11.0) per trainee. Comparison of trainee operative experience to arbitrary training targets found that 2-38% of trainees achieved the targets for 9 emergency index operations and 24-90% of trainees achieved the targets for 8 index elective operations. 72 trainees also completed a 6-month post in orthopaedics and recorded 7,551 operations. The most common orthopaedic operation that trainees performed was removal of metal, with an average of 2.90 (± 3.27) per trainee. The most common orthopaedic operation that trainees assisted with was total hip replacement, with an average of 10.46 (± 6.21) per trainee.ConclusionsA centralised web-based logbook provides valuable data to analyse training programme performance. Analysis of logbooks raises concerns about operative experience at junior trainee level. The provision of adequate operative exposure for trainees should be a key performance indicator for training programmes.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Analysing the operative experience of basic surgical trainees in Ireland using a web-based logbook

et al. 2011

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“…13 Low exposure in some fields of patient mix was also found in undergraduate medical curricula, clerkships, and other specialist training programmes. 5,[14][15][16][17][18][19][20][21][22] Ericsson's 'Deliberate practice' theory argues that low exposure has a negative impact on competency development. It assumes that becoming an expert requires sufficient practical experience and appropriate reflection, which can be stimulated by feedback from coaches or trainers.…”

Section: Introductionmentioning

confidence: 99%

Opening the black box: the patient mix of GP trainees

et al. 2011

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“…MMC will lead to ag reater reliance on operative skills transfer programmes and structured teaching to deliver surgeons with operative and diagnostic abilities suitable for consultant practice. It has not yet been proved that skills transfer programmes are an adequate substitute for actual operating hours to developt echnical skills, 7,8 nor that structured teaching over as hortened training period can match years of clinical experience. Carli et al 9 found a 4-h formal training session given to family doctors showed improvements in correct melanoma diagnosis rates; other studies have demonstrated similar improvements following skin cancer educational programmes.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Skin Lesions by Trainee Surgeons: Experience Improves Accuracy

Pearl

Townley

Stott

et al. 2009

annals

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Ann RC oll Surg Engl 2009; 91:4 94-499 494The UK Government's restructuring of specialist training,outlinedinModernising Medical Careers (MMC), 1 will have asignificanti mpact on surgical training in all surgical specialties including plastic surgery.Frequent evaluationofboth the surgical and diagnostic skills of traineesw ill be needed to determine the impact of shortened specialisttraining.Skin lesions make up alarge part of the plastic surgeon's out-patient workload and one of the effectso ft he Government's'two-week rule' and guidelines for referral of suspected skin cancers has been an increase in total referral ratios from primary to secondary care. 2The rise in the number of suspect lesions being referred represents as ignificant service requirement and one that will result in junior registrars seeing an increasing number of skin lesions. Whilst several studies have compared the clinical accuracy of consultants and specialist registrars, [3][4][5] few have addressed the learning curve of individual trainees with regard to clinical diagnosis.There is little evidence to reflect how quickly (or even if) trainees' clinical diagnostic skills improve with time, given regular exposure to skin pathology.T he clinically obvious melanoma or basal cell carcinoma can be recognised from the textbook; however,an umber of skin lesions (both benign and malignant) do not always fit textbook descriptions. The diagnosis of these lesions and decisions regarding appropriate management can be difficult for the trainee and comes with experience.In this study,weassessed the diagnostic accuracy of junior surgical trainees attending ar apid-access pigmented lesion clinic. Accurate clinical diagnosis depends on the reliable recognition of signs and symptoms. This expertise comes from experience in seeing patients which has been traditionallyg ained over al ong training period. Shortened specialist training (Modernising Medical Careers)h as led to ag reater reliance on structured teaching and skills transfer programmes. The accuracy of clinical diagnosis and the rate at which diagnostic skills improve during training is important for the assessment of trainees, and the delivery of care. PLASTIC SURGERY Ann RC oll Surg Engl

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Registrar operating experience over a 15-year period: More, less or more or less the same?

Cited by 42 publications

References 2 publications

Analysing the operative experience of basic surgical trainees in Ireland using a web-based logbook

Analysing the operative experience of basic surgical trainees in Ireland using a web-based logbook

Opening the black box: the patient mix of GP trainees

Diagnosis of Skin Lesions by Trainee Surgeons: Experience Improves Accuracy

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