Surgical training rotation design: effects of hospital type, rotation theme and duration

Educational impact of COVID-19 on foundation doctors and the decision to take a break from structured approved training programmes in the United Kingdom

INTRODUCTION

The COVID-19 pandemic impacted the Foundation Programme for doctors in the United Kingdom. Foundation doctors were working under increased pressure and significant changes were made to their training.

AIMS

The aim of this study is to explore the educational impact the COVID-19 pandemic had on foundation doctors and to understand how this resulted in doctors choosing to take time away from structured training programmes within the United Kingdom to make up for lost educational opportunities.

METHODS

In this phenomenological research, semi-structured interviews were carried out with post-foundation doctors who had completed their training during the pandemic. The data collected from these interviews were coded to carry out a thematic analysis.

RESULTS

All 12 participants reported that their formalised teaching had been cancelled, and due to the pandemic, many doctors felt that service provision was prioritised over their postgraduate education. Some doctors had positive experiences of informal teaching; however, many felt they missed out on educational opportunities. Doctors acknowledged that this was a contributing factor when deciding to take time out of training. This also resulted in doctors seeking educational opportunities outside of training.

DISCUSSION

The pandemic created many educational challenges for foundation doctors; this has contributed to doctors deciding to take time away from training. In some cases, due to a focus on service provision and their 'lost education', doctors are using time away from training to address their own specific educational needs. The impact of this 'lost education' requires further research and needs to be considered when doctors do apply to speciality training.

The certificate of readiness to enter higher surgical training (CREHST) route: Proportion of applicants and likelihood of success

OBJECTIVE

To compare the distribution of Higher Surgical Training (HST) applications received through the Certificate of Readiness for Higher Surgical (CREHST) route with the traditional Core Surgical Training (CST) route and to evaluate the likelihood of success in obtaining an HST post for each route across all surgical specialities.

METHODS

A national, retrospective cohort study was conducted to compare the proportion of applications and likelihood of success in obtaining an HST post between the two routes during the 2021-22 application cycle in the United Kingdom. Univariate statistical analysis was performed for categorical variables using the chi-squared test, or Fisher exact test. Relative risk was calculated for each route and each surgical speciality.

RESULTS

The study included 1964 HST applicants, of which 46% (n = 904) were via the CREHST route. This proportion varied from 23% for otolaryngology to 66% for vascular surgery. The study found that 20% (n = 98) of the available HST posts were awarded to CREHST applicants, ranging from 0% for cardiothoracic surgery to 39% for vascular surgery. For most specialities, applicants from the CREHST route were significantly less likely to be awarded a training post, with relative risks ranging from 0.07 (95% CI 0.01-0.51, p < 0.0001) for otolaryngology to 0.4 (95% CI 0.25-0.79, p = 0.0032) for urology.

CONCLUSIONS

This study provides valuable insight into the proportion and success of HST applications via the CREHST route. The findings demonstrate that the use of the CREHST route is commonplace across all surgical specialties, but the likelihood of a successful application is significantly lower when compared to the traditional CST route for most specialties.

Core training and surgical opportunities: A UK-based analysis

BACKGROUND AND AIM

The COVID-19 pandemic, the new Intercollegiate Surgical Curriculum Programme curriculum and the European Work Time Directive significantly reduced surgical exposure for trainees. This study analyzed the operative experience of Phase 1 trainees (CT1/ST1 vs. CT2/ST2) against the Annual Review of Competence Progression (ARCP) criterion of 120 procedures yearly.

METHODS

National survey research in October 2021. Study end-point was the completion of >4 weekly procedures, equivalent to 120 cases per year. Chi-square test and multivariate regression analysis were performed.

RESULTS

205 participants from 5 Deaneries were included, 48.3% were CT1/ST1 and 51.7% were CT2/ST2. About 54.5% of year-1 and 50% of year-2 trainees were 28 30 years old, 55.6% and 50.9% were male, and 39.4% and 38.7% were White British. About 39.4% of CT1/ST1 and 22.6% of CT2/ST2 performed <4 weekly procedures (P = 0.01), with no difference in the "Observed" (P = 0.6) or "Assisted" (P = 0.3) number of cases. CT2/ST2 recorded more "ST-S" (p 0.04), "S-TU" (P = 0.03), and "Performed" (P = 0.02) operations. For CT1/ST1, older age (HR 2.4, 95% CI [1.1; 5.3], P = 0.02) and southern deaneries (HR 1.7, 95% CI [1.2; 2.4], P = 0.004) were independent factor for <4 weekly procedures. For CT2/ST2, northern regions were associated with more favorable training (HR 1.4, 95% CI [1.1; 1.7], P = 0.01).

CONCLUSION

Over one third of Phase 1 trainees do not meet the ARCP requirement of >120 procedures annually. Age and region of training are independent factors in the number of logbook cases.

RELEVANCE FOR PATIENTS

This research focuses on training opportunities for junior surgical residents across the United Kingdom. The degree and type of exposure to the operating theatre have a significant impact on the development of surgical competencies. These are undoubtedly related to patient outcomes, as the quality of care delivered to patients and relatives greatly relies on the training background of future consultant surgeons.