Dataset Information

Changing Autonomy in Operative Experience Through UK General Surgery Training: A National Cohort Study.

ABSTRACT:

Objectives

To determine the operative experience of UK general surgery trainees and assess the changing procedural supervision and acquisition of competency assessments through the course of training.

Background

Competency assessment is changing with concepts of trainee autonomy decisions (termed entrustment decisions) being introduced to surgical training.

Methods

Data from the Intercollegiate Surgical Curriculum Programme and the eLogbook databases for all UK General Surgery trainees registered from August 1, 2007 who had completed training were used. Total and index procedures (IP) were counted and variation by year of training assessed. Recorded supervision codes and competency assessment outcomes for IPs were assessed by year of training.

Results

We identified 311 trainees with complete data. Appendicectomy was the most frequently undertaken IP during first year of training [mean procedures (mp) = 26] and emergency laparotomy during final year of training (mp = 27). The proportion of all IPs recorded as unsupervised increased through training (P < 0.05) and varied between IPs with 91.2% of appendicectomies (mp = 20), 40.6% of emergency laparotomies (mp = 27), and 17.4% of segmental colectomies (mp = 15) recorded as unsupervised during the final year of training. Acquisition of competency assessments increased through training and varied by IP.

Conclusions

The changing autonomy of trainees through the course of an entire training scheme, alongside formal competency assessments, may provide evidence of changing entrustment decisions made by trainers for different key procedures. Other countries utilizing electronic logbooks could adopt similar techniques to further understanding of competency attainment amongst their surgical trainees.

SUBMITTER: Elsey EJ

PROVIDER: S-EPMC6369871 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Publications

Changing Autonomy in Operative Experience Through UK General Surgery Training: A National Cohort Study.

Elsey Elizabeth J EJ Griffiths Gareth G West Joe J Humes David J DJ

Annals of surgery 20190301 3

<h4>Objectives</h4>To determine the operative experience of UK general surgery trainees and assess the changing procedural supervision and acquisition of competency assessments through the course of training.<h4>Background</h4>Competency assessment is changing with concepts of trainee autonomy decisions (termed entrustment decisions) being introduced to surgical training.<h4>Methods</h4>Data from the Intercollegiate Surgical Curriculum Programme and the eLogbook databases for all UK General Surg ...[more]

PMID: 30260805

Similar Datasets

Project description:ImportanceThe need for trainee sex equality within surgical training has resulted in an appraisal of the training experience in the New Zealand general surgery training program.ObjectiveTo investigate the association between trainee sex and surgical autonomy in the operating room in the New Zealand general surgery training program.Design, setting, and participantsRetrospective cohort study conducted from December 10, 2012, to December 10, 2017, examining all endoscopic, major, and minor procedures performed by all New Zealand general surgery trainees in every training hospital in New Zealand.Main outcomes and measuresThe primary outcome was the level of meaningful autonomy by each New Zealand general surgery trainee (ie, trainee as primary operator without the surgeon mentor scrubbed for the case). Outcomes were compared using multivariable analysis.ResultsThis study included 120 New Zealand general surgery trainees (42 women [35%] and 78 men [65%]) who were analyzed over 279.5 trainee-years (88.5 trainee-years for women and 191.0 trainee-years for men). Included were 119 380 general surgery procedures (17 465 endoscopic, 56 964 major, and 44 951 minor) in 18 hospitals. By the end of the 5-year training program, female trainees had a lower cumulative mean autonomous caseload than male trainees for endoscopic (284.0 [95% CI, 207.0-361.0] vs 352.2 [95% CI, 282.9-421.6], P = .03), major (139.9 [95% CI, 76.7-203.2] vs 198.1 [95% CI, 142.3-254.0], P = .02), and minor (456.3 [95% CI, 394.8-517.9] vs 519.9 [95% CI, 465.6-574.2], P = .007) procedures.Conclusions and relevanceAfter accounting for differences among trainees, hospital type, number of female and male surgeon mentors at each hospital, and trainee seniority, female trainees performed fewer cases with meaningful autonomy compared with male trainees. These findings support the need for pragmatic solutions to address this bias and further investigations on mechanisms contributing to discrepancies.

Dataset Information

Changing Autonomy in Operative Experience Through UK General Surgery Training: A National Cohort Study.

Objectives

Background

Methods

Results

Conclusions

Publications

Changing Autonomy in Operative Experience Through UK General Surgery Training: A National Cohort Study.

Similar Datasets

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