Acute surgical experience of Australian general surgical trainees.

BACKGROUND: A principle of Australian general surgical training is exposure to a variety of operative and clinical experiences. These are potentially being impacted upon by expanding post-fellowship training positions, mandatory reduced working hours, and advances in non-operative care. This study aims to report the recent acute surgical experience of Australian general surgical trainees. METHODS: A de-identified summary of general surgical trainee logbook data was obtained from General Surgeons Australia, over a 6-year period (2009-2014). Case volumes in operative and non-operative acute surgical cases were analysed, encompassing 5307 individual logbooks from 12 consecutive training terms. RESULTS: There was a mean of 112.2 ± 6.8 total major operative cases per trainee per term. There was an increase in case volumes reported from terms 1-8 (from 102.1 to 122.9), with the most recent reported volume being 117.8 cases per trainee in term 12. The total major operative primary operator rate increased from 35.5% in term 1 to 40.6% in term 8, with the most recent reported rate being 41.8% in term 12. Open and laparoscopic colorectal case volumes have remained stable. Operative trauma case volumes have increased. CONCLUSION: The acute surgical operative case experience of general surgical trainees has not declined. However, it should continue to be monitored in view of the changing scope of surgical practice.

The impact of fellowships on surgical resident training in a multispecialty cohort in Australia and New Zealand.

INTRODUCTION: Fellowships in surgery are increasing in number, and concerns have been raised regarding their impact on resident training. Although fellows may contribute to resident education and training, they also compete for operative and other experience. This study aimed to quantify the impact of fellowships on resident training in a binational multispecialty cohort. METHODS: The operative case volumes and primary operator rates of surgery trainees (residents) in Australia and New Zealand were compared between units with and without fellows. Trainees also were surveyed using Likert Scales to assess quality of operative and other experience in units with and without fellows. RESULTS: Data from 911 trainees over 2 terms was analyzed; survey response rate 42%. Of all trainees, 42% worked with fellows. Trainees in units without fellows were involved in more major (P = .03) and minor (P < .0001) cases. Primary operator rates were comparable, but trainees in units without fellows were less often assistants, reported an increased quality of elective operating experience, and reported more favorable completion of learning objectives (all P < .05). These findings were consistent between tertiary and nontertiary hospitals. Thematic analysis showed positive benefits of fellows in teaching, training and mentorship, but negative impacts on case exposure, competition for operating, and clinical experience. CONCLUSION: Fellows may assist in the teaching and training of residents, but residents working with fellows experience a decreased quantity of operative experience that may impact several aspects of the quality of training. Surgical educators must actively balance the learning needs of fellows and residents.

Acute leg ischemia secondary to embolization of an Angio-Seal device.

Angio-Seal is a vascular closure device designed for repairing arterial puncture sites used for various endovascular procedures. It has a better safety and efficacy profile compared to manual compression in the previous studies. However, there are significant complications that may arise from the use of Angio-Seal like infections, aneurysm formation, and vessel occlusion. Our case is a demonstration of one such complication. We conclude with a discussion of the present literature available with regards to the Angio-Seal device.