Defining our destiny: trainee working group consensus statement on the future of emergency surgery training in the United Kingdom

Emergency general surgeons, subspeciality surgeons and the future management of emergency surgery: results of a national survey

AIM

This study aimed to survey consultants' experience of working as or with emergency general surgery (EGS) surgeons and to investigate the role they fulfil in the management of general and subspeciality emergencies.

METHOD

An electronic survey, designed to capture both quantitative and qualitative data, was piloted and then circulated to members of the Association of Coloproctology of Great Britain and Ireland.

RESULTS

Two hundred and forty-two responses were received from 848 recipients (a 29% response rate) covering 104 of 135 (77%) acute NHS Trusts in England. EGS surgeons were in post in 43/141 (30%) hospitals overall and 12/24 (50%) of hospitals in London. Most respondents working in units with EGS surgeons found them to be advantageous (46/63, 73%). Consultants working with EGS surgeons were significantly more likely to support their use (49/63, 78%) than those without them (83/178, 47%) (χ²  = 16.9, P < 0.001). EGS surgeons were considered to improve the delivery of EGS (78%), create time for subspecialists (70%) and provide service (73%). However, there were concerns about the quality of surgery (43%), an insufficient standard of specialist care (54%) and compromise in the training of juniors (25%). Respondents commented on a lack of job structure with a high attrition rate (21%), the insufficient quality of applicants (18%) and that subspecialization and split on-call was preferable (17%).

CONCLUSION

Respondents were supportive of the ability of EGS surgeons to relieve pressure on subspecialists; however, there were significant concerns about the sustainability and quality of the EGS surgeon role. Emergency colorectal resections should have the input of a surgeon who performs elective colorectal resections.

[Evolution of enhanced recovery after surgery: from the beginning of the study of stress to the introduction in emergency surgery]

Effectiveness of enhanced recovery program is being earnestly confirmed in various surgical areas. Certain aspects of fast track rehabilitation are analyzed in the article.

The 100 most cited manuscripts in emergency abdominal surgery: A bibliometric analysis

BACKGROUND

The number of citations a scientific article receives provides a good indication of its impact within any given field. This bibliometric analysis aimed to identify the 100 most cited articles in Emergency Abdominal Surgery (EAS), to highlight key areas of interest and identify those that have most significantly shaped contemporary clinical practice in this newly evolving surgical specialty. This is of increasing relevance as concerns grow regarding the variable and suboptimal outcomes in Emergency General Surgery.

MATERIALS AND METHODS

The Thomson Reuters Web of Science database was used to search using the terms [Emergency AND Abdom* AND Surg*] to identify all English language, full manuscripts. Results were ranked according to citation number. The top 100 articles were further analysed by subject, author, journal, year of publication, institution, and country of origin.

RESULTS

The median (range) citation number of the top 100 out of 7433 eligible papers was 131 (1569-97). The most cited paper (by Goldman et al., Massachusetts General Hospital, New England Journal of Medicine; 1569 citations) focused on cardiac risk stratification in non-cardiac surgery. The Journal of Trauma, Injury, Infection and Critical Care published the most papers and received most citations (n = 19; 2954 citations. The majority of papers were published by centres in the USA (n = 52; 9422 citations), followed by the UK (n = 13; 1816 citations). The most common topics of publication concerned abdominal aneurysm management (n = 26) and emergency gastrointestinal surgery (n = 26).

CONCLUSION

Vascular surgery, risk assessment and gastrointestinal surgery were the areas of focus for 59% of the contemporary most cited emergency abdominal surgery manuscripts. By providing the most influential references this work serves as a guide to what makes a citable emergency surgery paper.

Modular emergency general surgery training: A pilot study of a novel programme

Introduction Pan-speciality consensus guidance advocates mandatory emergency general surgery (EGS) training modules for specialist registrars (StRs). This pilot study evaluated the impact of EGS modules aimed at StRs over 1 year. Methods Eleven StRs were allocated a focused 4-week EGS module, in addition to the standard 1:12 on-call duty rota, in a tertiary surgical centre. Primary outcome measures included the number of indicative emergency operations and validated Procedure Based Assessments (PBAs) performed, both during the EGS module and over the training year. Results StRs performed a median of 11 (range 5-15) laparotomies during the EGS module versus 31 (range 9-49) over the whole training year. StRs attended 43.7% of available laparotomies during the module (range 24.1-63.7%). EGS modules provided more than one-third of the total emergency laparotomy experience, and a quarter of the emergency colectomy, appendicectomy and Hartmann's procedure experience. There were no differences in EGS module-related outcomes between junior and senior StRs. Significantly more PBAs related to laparotomy and segmental colectomy were completed during EGS modules than the on-call duty rota, at 32% versus 14% (p<0.001) and 48% versus 22% (p=0.019), respectively. Performance levels were maintained following module completion. Conclusions These findings provide an important baseline when considering future modular EGS training.

Association of surgeons in training 40th anniversary conference: Liverpool #ASiT2016

The Association of Surgeons in Training (ASiT) is a professional body and registered charity working to promote excellence in surgical training for the benefit of junior doctors and patient alike. ASiT is independent of the National Health Service (NHS), Surgical Royal Colleges and specialty associations, and represents trainees in all ten surgical specialities. We were delighted to be celebrating our 40th Anniversary Conference in the fantastic city of Liverpool with over 700 delegates in attendance and in the company of many ASiT Past Presidents. The conference programme focused on how to overcome threats to training in light of the recent turbulent events associated with the junior doctor contract dispute with inspiring talks from Professor Sir Bruce Keogh, NHS Medical Director and Rt Hon Heidi Alexander MP, Shadow Health Secretary. The other central topic to the conference was 'celebrating excellence in surgical training' and we were thankful to many other high profile speakers who attended to help in this celebration. In addition, over £4000 was distributed between more than 30 prizes and was awarded by the incoming President, Mr Adam Williams, to delegates who presented the highest scoring academic work from over 1200 submitted abstracts.

The Association of Surgeons in Training Conference: #ASiT2015 Glasgow

The Association of Surgeons in Training (ASiT) is a professional body and registered charity working to promote excellence in surgical training for the benefit of junior doctors and patients alike. ASiT is in-dependent of the National Health Service (NHS), Surgical Royal Colleges, and specialty associations and represents trainees in all ten surgical specialties. ASiT was delighted to welcome a number of distinguished guests and speakers to Glasgow for #ASiT2015. The theme of 'The Future of Surgery' delved into challenges surgical training faces, exciting developments into using technology to help patients, a glance at the past with the development of the Glasgow Coma Score and whether mortality truly is the future of measured outcomes. More than £3500 of prizes was awarded by the incoming President, Miss. Rhiannon Harries to the highest scoring papers presented selected from over 1000 abstracts submitted.