Surgical training salvage during COVID-19: A hospital quality perspective

Introduction: Vicissitudes including re-deployment, elective cancellations, and remote educational events have restricted training opportunities during The COVID pandemic. This study aimed to analyse COVID's impact on global Higher Surgical Trainee (HST) performance metrics including hospital adaptability and variance. Material(s) and Method(s): Intercollegiate Surgical Curriculum Programme (ISCp) portfolios of 50 HSTs (median age 36 (range 29-46) yr., female 15, male 35), including 191 six-month rotational placements, were analysed over two years (March 2019 to 2021). Primary effect measures were: operative logbook numbers, index procedures validated against curriculum requirements and Work Based Assessments (WBA). Result(s): During COVID-19, operative experience per placement declined 26.1% (median 211 vs. 156, p<0.010), with a 32.1% decline in trainee primary surgeon experience (162 vs. 110, p<0.010). Regarding index procedures: cholecystectomy declined 45.5% (11 vs. 6, p=0.027) and inguinal hernia 62.5% (8 vs. 3, p<0.010). WBAs were similar (17 vs. 13, p=0.364). Despite relative equivalence before COVID, median total number of operative procedures performed in District General Hospitals (DGH, n=65) were 40.9% fewer than Tertiary Hospitals (TH, n=110, p<0.010). Radar plots of composite metrics ranged from 11.1 to 75.6% coverage before (p=0.011) vs. 13.3 to 68.9% after COVID (p=0.015). Discussion(s): Hospital training metrics varied over five-fold, a difference likely amplified by COVID, with THs more adaptable to existential shared lessons.

Hospital compound level endoscopy training quality performance: Scoping the spectrum

Introduction: Endoscopy training varies across specialties, with variation in access to training lists, and the need to accommodate endoscopy training amongst other elective and on call demands. This past year, the COVID- 19 pandemic has jeopardised training opportunities further. Currently the quality assurance of endoscopy training is assessed by the Global Rating Scale (GRS) in all UK Endoscopy Units, overseen by the Joint Advisory Group on Gastrointestinal Endoscopy (JAG). This is a bi-annual, self-assessed score rating training according to the training environment, trainers, and assessment and appraisal, yet does this provide a sufficiently detailed and objective measure of the delivery of training at unit level Aims & Methods: This study aimed to assess the quality of endoscopy training in a single UK Statutory Educational Body (SEB), related to individual hospitals, compared with the Joint Advisory Group on Gastrointestinal Endoscopy Training (JETS) certification standards. Training procedures numbering 28,928 recorded by 211 consecutive cross-specialty trainee endoscopists registered with JETS in 18 hospitals during 2019 were analysed. Data included trainer and trainee numbers, training list frequency, procedures, Direct Observation of Procedural Skills (DOPS) completion and Key Performance Indicators (KPI). Results: Annual median training procedures per hospital were 1395 (interquartile range (IQR) 465-2365). Median (IQR) trainers and trainees per unit were 11 (6-18) and 12 (7-16) respectively (ratio 0.8 (0.7-1.3)). Annual training list frequency per trainee was 13 (10-17), 35.0% short of JAG standard (n=20, p=0.001, effect size -0.56), and median points per adjusted training list were 11 (5-18). Median DOPS completion per trainee and trainer were 3 (1-6) and 4 (1-7) respectively;completing 0.2 DOPS (0.1-0.4) per list and amounting to 6 (2-12) per 200 procedures: less than half of the JAG standard (p<0.001, -0.61). Median KPI for OGD: J Manoeuvre 94% (90-96), D2 intubation was 93% (91-96);and for Colonoscopy: Caecal intubation 82% (72-90), and Polyp Detection Rate 25% (18-34). Compound hospital training quality score varied 3-fold, the highest performing hospital scoring 26;compared to the poorest performing scoring 9: median 17 (14-20). Conclusion: Important disparities in hospital endoscopy unit performance were observed and disguised by the cloak of clinical pressures currently prevalent in the NHS. Compound hospital training quality varied three-fold, and Trainees, Trainers and Training Programme Directors alike, should be aware of such data when planning educational programmes, so that the quality of endoscopy training may be focused and optimised. JAG now considers simulation to be an important and integral marker of training. Adding simulation to the training armamentarium should be urgently recognised as a paramount constituent of the recovery-phase of COVID-19 training catch-up strategy, in order to overcome rationed front-line clinical training opportunities and also to address the pressing clinical service back-log of urgent suspected cancer referrals. Development of a Nationally agreed and accredited curriculum allied to Endoscopic Virtual Reality Haptic Feedback will be key to recovery and improved endoscopy training.

Enhanced stress-resilience training for surgical trainees.

INTRODUCTION: Core surgical training programmes are associated with a high risk of burnout. This study aimed to assess the influence of a novel enhanced stress-resilience training (ESRT) course delivered at the start of core surgical training in a single UK statutory education body. METHOD: All newly appointed core surgical trainees (CSTs) were invited to participate in a 5-week ESRT course teaching mindfulness-based exercises to develop tools to deal with stress at work and burnout. The primary aim was to assess the feasibility of this course; secondary outcomes were to assess degree of burnout measured using Maslach Burnout Inventory (MBI) scoring. RESULTS: Of 43 boot camp attendees, 38 trainees completed questionnaires, with 24 choosing to participate in ESRT (63.2 per cent; male 13, female 11, median age 28 years). Qualitative data reflected challenges delivering ESRT because of arduous and inflexible clinical on-call rotas, time pressures related to academic curriculum demands and the concurrent COVID-19 pandemic (10 of 24 drop-out). Despite these challenges, 22 (91.7 per cent) considered the course valuable and there was unanimous support for programme development. Of the 14 trainees who completed the ESRT course, nine (64.3 per cent) continued to use the techniques in daily clinical work. Burnout was identified in 23 trainees (60.5 per cent) with no evident difference in baseline MBI scores between participants (median 4 (range 0-11) versus 5 (1-11), P = 0.770). High stress states were significantly less likely, and mindfulness significantly higher in the intervention group (P < 0.010); MBI scores were comparable before and after ESRT in the intervention cohort (P = 0.630, median 4 (range 0-11) versus 4 (1-10)). DISCUSSION: Despite arduous emergency COVID rotas ESRT was feasible and, combined with protected time for trainees to engage, deserves further research to determine medium-term efficacy.