Perceptions of the Annual Review of Competence Progression (ARCP) in surgical training in the UK and Ireland: A prospective cross sectional questionnaire study.

BACKGROUND: Surgical trainees in the UK and Ireland undergo rigorous formative and summative assessments throughout each placement, and appraisal at an Annual Review of Competence Progression (ARCP). The ARCP evaluates performance during each training year and determines progression to the next year of training. It is critical that the ARCP is a robust and fair process. The Association of Surgeons in Training (ASiT) sought to evaluate surgical trainees' experiences of the ARCP process in order to identify areas for improvement. METHODS: An electronic survey was developed and distributed electronically to the trainee membership of ASiT in the UK and Republic of Ireland. A 57 point survey examined the specifics of one ARCP cycle as well as attitudes to the process in general. Quantitative analysis was performed, along with thematic analysis on the free-text comments. RESULTS: 600 trainees from all deaneries, grades and specialities participated. The survey demonstrated difficulties in preparing for ARCP: insufficient notice (24%), inadequate communication (22%) and lack of engagement of seniors (30-39%). 47% considered the process and standards inconsistent. 82% of trainees considered a face-to-face ARCP advantageous. Such a meeting provided a means of raising concerns regarding training posts (29%), bullying (18%) and patient safety (17%) that would not otherwise have been reported in writing. During qualitative analysis, the following themes emerged: The conflict between potential value and real experience; concerns regarding the quality of assessment and the need for improvement (in process, individual performance and surgical training.) CONCLUSION: This survey demonstrates that trainees appreciate the potential educational value of the ARCP process. However, there is a gap between this potential and trainees experience. Particular concerns include inconsistency, the timing of decision-making and the need to retain a face-to-face meeting. This feedback from trainees can be used to improve the assessment process in relation to procedural developments at the national level and engagement of supervisors and trainers locally. These changes will ensure that the ARCP becomes a higher quality assessment and more constructive for training in future.

Attributes of excellent surgical trainers: An analysis of outstanding trainers.

Excellent surgical trainers play a key role in teaching, mentoring and inspiring the next generation of trainee surgeons. Although there are differences in approach, personality and technique among trainers, common themes exist for those that truly shine as examples of good training. The good surgical trainer has long been the "unsung hero" of patient safety, inspiring and imparting wisdom and skill in trainee surgeons, and instilling a sense of confidence and compassion. In order to recognise exceptional trainers, the Association of Surgeons in Training (ASiT) introduced the Silver Scalpel Award in 2000. The award acknowledges talented trainers who go the "extra mile" for their trainees, and the selection process includes both written nominations and structured interviews with the nominees. We wished to identify what makes the best trainers excellent, to see if these attributes could be used to develop recommendations on how to train and how to support trainers. Here we present an outline of key attributes of an excellent surgical trainer, based on qualitative synthesis of the interview sheets from Silver Scalpel interviews. These results clearly highlight that good trainers are first and foremost good doctors, and that good training goes hand-in-hand with excellent patient care. This symbiotic relationship between training and patient outcomes should be acknowledged, and trainers should be supported by their employers to empower them to carry out their dual roles of training and patient care to the best of their ability. Trainers are key role models to inspire the next generation of surgeons and exceptional trainers should be celebrated.

Meta-analysis of operative experiences of general surgery trainees during training.

BACKGROUND: General surgical training curricula around the world set defined operative numbers to be achieved before completion of training. However, there are few studies reporting total operative experience in training. This systematic review aimed to quantify the published global operative experience at completion of training in general surgery. METHODS: Electronic databases were searched systematically for articles in any language relating to operative experience in trainees completing postgraduate general surgical training. Two reviewers independently assessed citations for inclusion using agreed criteria. Studies were assessed for quantitative data in addition to study design and purpose. A meta-analysis was performed using a random-effects model of studies with appropriate data. RESULTS: The search resulted in 1979 titles for review. Of these, 24 studies were eligible for inclusion in the review and data from five studies were used in the meta-analysis. Studies with published data of operative experience at completion of surgical training originated from the USA (19), UK (2), the Netherlands (1), Spain (1) and Thailand (1). Mean total operative experience in training varied from 783 procedures in Thailand to 1915 in the UK. Meta-analysis produced a mean pooled estimate of 1366 (95 per cent c.i. 1026 to 1707) procedures per trainee at completion of training. There was marked heterogeneity between studies (I2 = 99·6 per cent). CONCLUSION: There is a lack of robust data describing the operative experiences of general surgical trainees outside the USA. The number of surgical procedures performed by general surgeons in training varies considerably across the world.

Fibrin glue in the treatment for pilonidal sinus: high patient satisfaction and rapid return to normal activities.

BACKGROUND: Pilonidal sinus is a common condition often managed with invasive surgery associated with a significant morbidity and often a prolonged recovery time. Fibrin glue has been used in our institution as an alternative to conventional surgery. The purpose of this study was to perform a service evaluation of patient satisfaction and recovery following fibrin glue treatment for pilonidal sinus. METHODS: All pilonidal glue procedures for a single surgeon were identified from theatre and consultant diary records from March 2007 to September 2011. A questionnaire was sent by post to all patients. Patient satisfaction, time to return to normal activities, the need for further procedures and whether they would recommend a glue procedure to a friend were evaluated. RESULTS: Ninety-three patients were identified, accounting for a total of 119 glue procedures and 57/93 responses were received (61 %). The median age of respondents was 26 (17-70) years. Seventy-nine per cent (n = 45) were satisfied, pleased or very pleased with the result of their procedure. Fifty-four per cent (n = 31) were back to normal activities within a week with a further 17 % (n = 10) back to normal activities within 2 weeks. Seventy-four per cent (n = 42) required no further treatment. Of the 15 patients requiring a further procedure, 3 went on to have a repeat glue treatment which resulted in complete healing. Eighty-two per cent (n = 47) would recommend a glue procedure to a friend. CONCLUSIONS: Fibrin gluing for pilonidal sinus should be considered as first-line treatment for most pilonidal sinuses. It has a high level of patient satisfaction and allows a rapid return to normal activities in this group of patients of working age.