Surgical Skills Workshops Should Be a Part of the United Kingdom Undergraduate Medical Curriculum.

INTRODUCTION:  Medical students across the United Kingdom (UK) report poor satisfaction with surgical teaching. The Surgical Skills Day (SSD) begins to address this by exposing medical students to surgery through an easily accessible one-day practical workshop. This study shows how the SSD encourages undergraduate engagement in surgery. METHOD:  Feedback forms were emailed to attendees of the SSD and their anonymised responses were used to evaluate the SSD. RESULTS:  A total of 144 students attended the SSD across three years and the feedback response rate was 74% (n = 107). Key findings were that 100% of respondents (n = 107) would like the SSD to be an annual event, 79% (n = 83) were more inclined to pursue a surgical career following the event, and 97% (n = 103) would like to see practical surgical skills incorporated into the curriculum. The SSD was able to engage undergraduates with surgery through mentorship, practical skills, specialty exposure, and teaching of the General Medical Council (GMC) mandated skills. CONCLUSIONS:  Undergraduate surgical teaching in the UK is insufficient. The student-led annual SSD showed improved engagement in practical surgical skills and increased enthusiasm for a surgical career. In light of this, the authors feel the SSD or similar event should be integrated into the UK medical school curriculum.

The Role of Simulation in Microsurgical Training.

Simulation has been established as an integral part of microsurgical training. The aim of this study was to assess and categorize the various simulation models in relation to the complexity of the microsurgical skill being taught and analyze the assessment methods commonly employed in microsurgical simulation training. Numerous courses have been established using simulation models. These models can be categorized, according to the level of complexity of the skill being taught, into basic, intermediate, and advanced. Microsurgical simulation training should be assessed using validated assessment methods. Assessment methods vary significantly from subjective expert opinions to self-assessment questionnaires and validated global rating scales. The appropriate assessment method should carefully be chosen based on the simulation modality. Simulation models should be validated, and a model with appropriate fidelity should be chosen according to the microsurgical skill being taught. Assessment should move from traditional simple subjective evaluations of trainee performance to validated tools. Future studies should assess the transferability of skills gained during simulation training to the real-life setting.

One-Stop Clinic Utilization in Plastic Surgery: Our Local Experience and the Results of a UK-Wide National Survey.

Introduction. "See and treat" one-stop clinics (OSCs) are an advocated NHS initiative to modernise care, reducing cancer treatment waiting times. Little studied in plastic surgery, the existing evidence suggests that though they improve care, they are rarely implemented. We present our experience setting up a plastic surgery OSC for minor skin surgery and survey their use across the UK. Methods. The OSC was evaluated by 18-week wait target compliance, measures of departmental capacity, and patient satisfaction. Data was obtained from 32 of the 47 UK plastic surgery departments to investigate the prevalence of OSCs for minor skin cancer surgery. Results. The OSC improved 18-week waiting times, from a noncompliant mean of 80% to a compliant 95% average. Department capacity increased 15%. 95% of patients were highly satisfied with and preferred the OSC to a conventional service. Only 25% of UK plastic surgery units run OSCs, offering varying reasons for not doing so, 42% having not considered their use. Conclusions. OSCs are underutilised within UK plastic surgery, where a significant proportion of units have not even considered their benefit. This is despite associated improvements in waiting times, department capacity, and levels of high patient satisfaction. We offer our considerations and local experience instituting an OSC service.

Patient-reported outcomes to evaluate surgery.

The role of patient-reported outcomes (PROs) in surgery evaluation is increasing. PROs include measures of health-related quality of life (HRQL), patient satisfaction and utility. It is hypothesized that they add to traditional end points by providing detailed assessment of the impact of surgery on patient well-being as well as assessing patient preferences. In addition, qualitative observations from in-depth or semistructured interviews, or focus groups provide data about patient experiences and views of surgery that may supplement standard outcomes and quantitative PROs. This type of detail may contribute to clinical decision-making and informed consent. It is essential, however, that PROs are valid and reliable, and that robust methodology is used in trials and other research settings to incorporate PROs in a clinical context. Future work focusing upon the role of PROs in surgical decision-making is needed, and there is a need to develop methods for communicating PROs to patients. In addition, evaluating surgery with qualitative approaches will add useful insights into how patients experience surgery. This review article focuses on evaluating surgery with measures of HRQL and the qualitative methods that may supplement quantitative outcomes.

Quality of life after surgery for colorectal cancer: clinical implications of results from randomised trials.

GOALS OF WORK: Health-related quality of life (HRQL) is an important outcome after surgery for colorectal cancer (CRC), and accurate assessment is required to fully inform clinical decision making. The purpose of this review is to summarise randomised surgical trials in CRC with robust HRQL to consider the role of HRQL in surgical decision making. MATERIALS AND METHODS: A systematic review in Medline and the Cochrane Controlled Trials Register identified randomised surgical trials with HRQL. HRQL assessment was categorised as robust according to predefined criteria, and the clinical implications of HRQL were considered. MAIN RESULTS: One hundred seventy-seven articles were identified, and a detailed review reduced this to eight trials. Four compared laparoscopic with open surgery, and four evaluated coloanal anastomotic techniques. The most commonly used HRQL instrument was the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30, and HRQL was usually a secondary outcome measure. In four (50%) trials, HRQL assessment was categorised as methodologically robust, although only two trials had sample size calculations based upon a HRQL endpoint. Six trials based the final treatment recommendation in the context of the HRQL outcomes. CONCLUSION: In randomised surgical trials in CRC, HRQL assessment informs clinical decision making, and future trials require robust assessment of relevant patient-reported outcomes.