Attracting medical students and doctors into surgical training in the UK and Ireland

Evaluation of a 3D-printed hands-on radius fracture model during teaching courses

OBJECTIVE

This study aimed to evaluate the effectiveness of a 3D-printed hands-on radius fracture model for teaching courses. The model was designed to enhance understanding and knowledge of radius fractures among medical students during their clinical training.

METHODS

The 3D models of radius fractures were generated using CT scans and computer-aided design software. The models were then 3D printed using Fused-Filament-Fabrication (FFF) technology. A total of 170 undergraduate medical students participated in the study and were divided into three groups. Each group was assigned one of three learning aids: conventional X-ray, CT data, or a 3D-printed model. After learning about the fractures, students completed a questionnaire to assess their understanding of fracture mechanisms, ability to assign fractures to the AO classification, knowledge of surgical procedures, and perception of the teaching method as well as the influence of such courses on their interest in the specialty of trauma surgery. Additionally, students were tested on their ability to allocate postoperative X-ray images to the correct preoperative image or model and to classify them to the AO classification.

RESULTS

The 3D models were well received by the students, who rated them as at least equal or better than traditional methods such as X-ray and CT scans. Students felt that the 3D models improved their understanding of fracture mechanisms and their ability to explain surgical procedures. The results of the allocation test showed that the combination of the 3D model and X-ray yielded the highest accuracy in classifying fractures according to the AO classification system, although the results were not statistically significant.

CONCLUSION

The 3D-printed hands-on radius fracture model proved to be an effective teaching tool for enhancing students' understanding of fracture anatomy. The combination of 3D models with the traditional imaging methods improved students' ability to classify fractures and allocate postoperative images correctly.

Twelve tips for optimising learning for postgraduate doctors in the operating theatre

Learning in the operating theatre forms a critical part of postgraduate medical education. Postgraduate doctors present a diverse cohort of learners with a wide range of learning needs that will vary by their level of experience and curriculum requirements. With evidence of both trainee dissatisfaction with the theatre learning experience and reduced time spent in the operating theatre, which has been exacerbated by the effects of the Covid-19 pandemic, it is vital that every visit to the operating theatre is used as a learning opportunity. We have devised 12 tips aimed at both learners and surgeons to optimise learning in the operating theatre, set out into four domains: educational context, preparation, learning in theatre, feedback and reflection. These tips have been created by a process of literature review and acknowledgment of established learning theory, with further discussion amongst surgical trainees, senior surgical faculty, surgical educators and medical education faculty.

The Experiences, Influences and Concerns of Future Orthopaedic Surgeons: Comparing Uk and non-UK Perspectives

AIMS/BACKGROUND

This study aims to identify and analyse the factors that influence or discourage junior doctors in the UK and across the world from wanting to pursue a career in orthopaedics.

METHODS

A prospective, cohort study was carried out via an online questionnaire targeted at aspiring orthopaedic surgeons.

RESULTS

A total of 654 respondents met inclusion criteria; 370 (56.6%) were UK-based and 284 (43.4%) were based abroad. The practical and technical nature of orthopaedics was the biggest influencing factor globally. UK respondents were notably more concerned by the financial impact of training (49%) followed by poor work-life balance (36%). Themes from the comments section revealed concern regarding gender bias and a lack of diverse role models within orthopaedics.

CONCLUSIONS

Reducing the cost and length of training, diversification of role models, removal of bias and increasing positive early experiences may help to encourage people of all backgrounds to pursue a career in orthopaedic surgery.

Motivators and deterrents for early career female doctors applying to surgical training programmes in the UK National Health Service: a mixed-methods study

OBJECTIVES

To perform a mixed-methods study identifying motivators and deterrents to female doctors interested in core surgical training (CST). To provide tangible implementations based on the findings.

DESIGN

This study used quantitative (questionnaires) and qualitative (semistructured interviews (SSIs)) analyses. Participants completed online questionnaires on Qualtrics and SSIs were conducted remotely on Microsoft Teams. Questions were derived from previous studies and a novel term, the gender impact rating (GIR), was coined to assess the impact of gender on opportunities available during CST application.

SETTING

Participants were working in the UK National Health Service and data collected from December 2020 to January 2021.

PARTICIPANTS

A total of 100 female surgical trainees in the UK ranging from Foundation Year 2 to Core Training Year 2.

MAIN OUTCOME MEASURES

Participants ranked factors by their influence on their CST application. Of the 100 trainees, 21 were randomly selected for an SSI to explore their questionnaire responses. Statistical analyses were performed using MATLAB and SPSS, alongside a thematic analysis of the interviews.

RESULTS

A total of 44 out of 100 questionnaire respondents ranked early exposure to surgery as the most influential motivator, while 43% selected work-life balance as the greatest deterrent and 33% suggested mentoring schemes to encourage women to apply to CST. The median GIR was 3 out of 5, indicating a moderate perceived impact of gender on opportunities available during CST application. Qualitative analysis found four overarching themes: institutional factors (including mentorship schemes), organisational culture (including active engagement), social factors and personal factors.

CONCLUSION

Thematic analysis suggested that seniors involving women in theatre and a supportive work environment would encourage entry of more female surgeons. Therefore, the proposed implementations are the active engagement of women in theatre and destigmatising less than full-time training. Further research into ethnicity and personality on motivations to enter surgery is advised.

Early Barriers to Career Progression of Women in Surgery and Solutions to Improve Them: A Systematic Scoping Review

OBJECTIVE

This study aims to summarize the evidence concerning the barriers that exist to the career progression of women in surgery and to provide potential solutions to overcome these obstacles.

BACKGROUND

Visible and invisible impediments can hinder female doctors' pursuit of a surgical career, from choosing a surgical specialty to training opportunities and all the way through career progression.

METHODS

Database search of original studies about barriers for female surgeons during choice of surgical career, residency, and career progression. A query including possible solutions such as mentorship and network was included.

RESULTS

Of 4618 total articles; 4497 were excluded as duplicates, having incorrect study focus, or not being original studies; leaving 120 studies meeting the inclusion criteria. Of the articles included, 22 (18%) focused on factors affecting the pursuit of a surgical career, such as surgical work hours and limited time for outside interests, 55 (46%) analyzed the main barriers that exist during surgical residency and fellowship training, such as discrimination and sexual harassment, 27 (23%) focused on barriers to career advancement, heavy workloads, ineffective mentorship, unclear expectations for advancement, inequality in pay or work-home conflicts. Among studies reporting on possible solutions, 8 (6.5%) articles reported on the role of effective mentorship to support career advancement and to provide moral support and 8 (6.5%) on the emerging role of social media for networking. Our analysis showed how different impediments hinder surgical career progression for women, with notable consequences on burnout and attrition.

CONCLUSIONS

Identification and recognition of obstacles to career progression is the first step to addressing the gender gap in surgery. Active strategies should be improved to promote a culture of diversity and to create equal opportunity for women in surgery, while implementing structured mentoring programs and investing on an adequate communication on social media to engage the future generations.

An analysis of gender disparities amongst United States medical students, general surgery residents, vascular surgery trainees, and the vascular surgery workforce

Gender diversity in medicine continues to be a critical topic, and gender diversity within surgical fields remains an overarching challenge. In the following review, we objectively address the data available in terms of training slots for women in general and vascular surgery and within the vascular surgery workforce. Overall, women comprise 36% of active physicians in the 2019 Association of American Medical Colleges data. The number of women in surgical fields is lower representing 22% in general surgery, 9% in neurosurgery, 6% in orthopedic surgery, 17% in plastic surgery, 8% in thoracic surgery, and 15% in vascular surgery. Also notable is the lower academic ranks held by women in surgery. The proportion of women instructors in surgery in 2020 was 61%, assistant professors 30%, associate professors 23%, and full-time professors only 13.5%. There are multiple opportunities across the divisional/institutional/societal domains in which mentorship and sponsorship can promote gender equity and inclusion. Recruitment and retention of women and minorities into the vascular academic and private practices is essential to ensure best patient outcomes and quality of care for our patients. We hope that by shedding light on this topic, there will be greater awareness and improved strategies to address the disparities within institutions.

Trainee perspective of the causes of stress and burnout in surgical training: a qualitative study from Wales

OBJECTIVES

Stress and burn-out among surgical trainees has been reported most prevalent in core surgical trainees (CST) and female trainees in particular. This study aimed to identify factors perceived by CSTs to be associated with stress and burnout in those at risk.

DESIGN

An open-ended questionnaire was distributed to 79 CSTs and two researchers categorised responses independently, according to Michie's model of workplace stress.

SETTING

A UK regional postgraduate medical region (Wales).

PARTICIPANTS

Sixty-three responses were received; 42 males, 21 females. The response rate was 79.7%.

RESULTS

Inter-rater reliability was good (k=0.792 (79.2%), p<0.001). The most common theme of Michie's model related to CST stress and burnout was career development, with most statements associated with curriculum, examination and academic demands required to attain a CST certificate of completion of training, and higher surgical national training number appointment. This was closely followed by those intrinsic to the job with recurrent discussion around the difficulties balancing work perceived to be service provision (ward work and on-calls), outpatient clinic and operative experience. Conversely, the most common themes relevant to stress and burnout among female trainees were associated with relationships at work (primarily the male-dominated nature of surgery), extraorganisational factors (family-work life balance) and individual characteristics (personality and physiological differences).

CONCLUSION

CSTs' perceptions regarding the causes of National Health Service related stress and burnout are numerous, and these findings provide a basis for the development of targeted stressor counter-measures to improve training and well-being.

Maximizing opportunities at medical school to support a career in surgery

INTRODUCTION

During medical school, students have numerous opportunities to develop their portfolios for a career in surgery, such as undertaking additional surgical placements and participating in surgical research. However, at present, there is little guidance available for medical students on how to build a strong portfolio for the UK core surgical training application. This article outlines work undertaken to provide concise guidance to support future surgeons, via application of the competency-based CanMEDS framework to the current UK core surgical training specification.

MATERIALS AND METHODS

A pre-conference meeting was arranged for medical students at the Society of Academic and Research Surgeons annual conference in January 2018. Self-selected research enthusiasts from different university years discussed practical approaches to pair the CanMEDS model with the core surgical training specification, with support from the STARSurg Collaborative committee to facilitate discussion. A nominal group-based method was adopted in order to reach areas of consensus.

RESULTS

Practical tips and recommendations for each respective CanMEDS domain (communicator, collaborator, leader, health advocate, scholar, professional) were made in relation to the core surgical training specification. These included key action points and named opportunities that are currently available to UK medical students.

CONCLUSIONS

A consensus approach was taken to address key areas of competence across each CanMEDS domain. This informed the development of a guidance framework to support students to develop a strong portfolio for a core surgical training application. This framework can be followed by medical students, equipping them with the skills necessary to succeed in their future surgical career.