Sarcopenia versus clinical frailty scale in predicting the risk of postoperative mortality after emergency laparotomy: a retrospective cohort study.

OBJECTIVES: To compare predictive significance of sarcopenia and clinical frailty scale (CFS) in terms of postoperative mortality in patients undergoing emergency laparotomy METHODS: In compliance with STROCSS statement standards, a retrospective cohort study with prospective data collection approach was conducted. The study period was between January 2017 and January 2022. All adult patients with non-traumatic acute abdominal pathology who underwent emergency laparotomy in our centre were included. The primary outcome was 30-day mortality and secondary outcomes were in-hospital mortality and 90-day mortality. The predictive value of sarcopenia and CFS were compared using the receiver operating characteristic (ROC) curve analysis and multivariable binary logistic regression analysis. RESULTS: A total of 1043 eligible patients were included. The risk of 30-day mortality, in-hospital mortality, and 90-day mortality were 8%, 10%, and 11%, respectively. ROC curve analysis suggested that sarcopenia is a significantly stronger predictor of 30-day mortality (AUC: 0.87 vs. 0.70, P<0.0001), in-hospital mortality (AUC: 0.79 vs. 0.67, P=0.0011), and 90-day mortality (AUC: 0.79 vs. 0.67, P=0.0009) compared with CFS. Moreover, multivariable binary logistic regression analysis identified sarcopenia as an independent predictor of mortality [coefficient: 4.333, OR: 76.16 (95% CI 37.06-156.52), P<0.0001] but not the CFS [coefficient: 0.096, OR: 1.10 (95% CI 0.88-1.38), P=0.4047]. CONCLUSIONS: Sarcopenia is a stronger predictor of postoperative mortality compared with CFS in patients undergoing emergency laparotomy. It cancels out the predictive value of clinical frailty scale in multivariable analyses; hence among the two variables, sarcopenia deserves to be included in preoperative predictive tools.

Effect of intraoperative botulinum toxin injection on delayed gastric emptying and need for endoscopic pyloric intervention following esophagectomy: a systematic review, meta-analysis, and meta-regression analysis.

The aim of this study was to evaluate the effect of intraoperative botulinum toxin (BT) injection on delayed gastric emptying (DGE) and need for endoscopic pyloric intervention (NEPI) following esophagectomy. In compliance with Preferred Reporting Items for Systematic reviews and Meta-Analyses statement standards, a systematic review of studies reporting the outcomes of intraoperative BT injection in patients undergoing esophagectomy for esophageal cancer was conducted. Proportion meta-analysis model was constructed to quantify the risk of the outcomes and direct comparison meta-analysis model was constructed to compare the outcomes between BT injection and no BT injection or surgical pyloroplasty. Meta-regression was modeled to evaluate the effect of variations in different covariates among the individual studies on overall summary proportions. Nine studies enrolling 1070 patients were included. Pooled analyses showed that the risks of DGE and NEPI following intraoperative BT injection were 13.3% (95% confidence interval [CI]: 7.9-18.6%) and 15.2% (95% CI: 7.9-22.5%), respectively. There was no difference between BT injection and no BT injection in terms of DGE (odds ratio [OR]: 0.57, 95% CI: 0.20-1.61, P = 0.29) and NEPI (OR: 1.73, 95% CI: 0.42-7.12, P = 0.45). Moreover, BT injection was comparable to pyloroplasty in terms of DGE (OR: 0.85, 95% CI: 0.35-2.08, P = 0.73) and NEPI (OR: 8.20, 95% CI: 0.63-105.90, P = 0.11). Meta-regression suggested that male gender was negatively associated with the risk of DGE (coefficient: -0.007, P = 0.003). In conclusion, level 2 evidence suggests that intraoperative BT injection may not improve the risk of DGE and NEPI in patients undergoing esophagectomy. The risk of DGE seems to be higher in females and in early postoperative period. High quality randomized controlled trials with robust statistical power are required for definite conclusions. The results of the current study can be used for hypothesis synthesis and power analysis in future prospective trials.

Trainee burnout: when does the fire start?

PURPOSE OF THE STUDY: Burnout is an increasingly recognised phenomenon in acute healthcare specialities and associated with depersonalisation, ill health and training programme attrition. This study aimed to quantify contributory physiological variables that may indicate stress in newly qualified doctors. STUDY DESIGN: Post Graduate Year 1 doctors (n=13, 7 f, 6 m) were fitted with a VivaLNK wellness device during four prior induction days, followed by their first 14 days work as qualified doctors. Minute-by-minute Heart Rate (HR), Respiratory Rate (RR), and Stress Index (SI) data were correlated with Maslach Burnout Inventories, Short Grit Scales (SGS) and clinical rota duties: Induction vs Normal Working-Day (NWD) versus On-call shift. RESULTS: In a total 125 recorded shift episodes, on comparing Induction versus NWD versus On-call shift work, no variation was observed in HR above baseline (25.47 vs 27.14 vs 24.34, p=0.240), RR above baseline (2.21 vs 1.86 vs 1.54, p=0.126) or SI (32.98 vs 38.02 vs 35.47, p=0.449). However, analysis of participant-specific temporal SIs correlated with shift-related clinical duties; that is, study participants who were most stressed during a NWD, were also more stressed during Induction (R2 0.442, p=0.026), and also during On-call shifts (R2 0.564, p=0.012). Higher SGS scores were inversely related to lower SIs (coefficient -32.52, 95% CI -45.881 to 19.154, p=0.001). CONCLUSION: Stress and burnout stimulus appear to start on day one of induction for susceptible PGY1 doctors, and continues into front-line clinical work irrespective of shift pattern. Short Grit Scale questionnaires appear an effective tool to facilitate targeted stress countermeasures.

Lessons learnt from the first 200 unselected consecutive cases of laparoscopic exploration of common bile duct stones at a district general hospital.

BACKGROUND: The management of choledocholithiasis evolves with diagnostic imaging and therapeutic technology, facilitating a laparoscopic approach. We review our first 200 cases of laparoscopic exploration of the common bile duct, highlighting challenges and lessons learnt. METHODS: We retrospectively studied the first 200 cases of laparoscopic cholecystectomy with common bile duct exploration between 2006 and 2019. The database contains demographics, clinicopathological characteristics, diagnostic modalities, operative techniques, duration and outcomes. RESULTS: We compared two approaches: transcystic vs. transcholedochal in our 200 cases. Choledocholithiasis was suspected preoperatively in 163 patients. 21 cases found no stones. Of the remainder, 111/179 cases were completed via the transcystic route and the remaining were completed transcholedochally (68/179); 25% of the transcholedochal cases were converted from a transcystic approach. CBD diameter for transcystic route was 8.2 vs. 11.0 mm for transcholedochal. Total clearance rate was 84%. Retained or recurrent stones were noted in 7 patients. Length of stay was 5.8 days, 3.5 days in the transcystic route vs. 9.4 days after transcholedochal clearance. Eight patients required re-operation for bleeding or bile leak. No mortalities were recorded in this cohort, but 2 cases (1%) developed a subsequent CBD stricture. CONCLUSION: Concomitant laparoscopic common bile duct clearance with cholecystectomy is feasible, safe and effective in a district general hospital, despite constraints of time and resources. The transcystic route has a lower complication rate and shorter hospital stay, and hence our preference of this route for all cases. Advancements in stone management technology will allow wider adoption of this technique, benefitting more patients.

Prognostic significance of low muscle volume in patients undergoing surgery for oesophageal cancer.

BACKGROUND & AIMS: This study aimed to determine the prognostic significance of low muscle volume (LMV) Bioelectrical Impedance Analysis (BIA), defined skeletal muscle index (SMI, Kg/m2 male ≤8.75, female ≤5.75) in patients undergoing potentially curative surgery for Oesophageal Cancer (OC). METHODS: A prospective study of 122 patients diagnosed with OC [median age 65 yr, 104 male, 65 neoadjuvant therapy] who underwent preoperative BIA (Maltron Bioscan 920). Primary outcome measure was Overall Survival (OS). RESULTS: LMV was identified in 11 (9.0%) of patients, which was associated with low lean muscle mass (27.3 vs. 31.1 kg, p = 0.012), low body fat (8.8 vs.19.3 kg, p < 0.001), and greater total body water (72.2 vs. 62.2%, p = 0.001), and more open & close laparotomies (36.4 vs. 8.1%, p = 0.012). Median and 5-year OS was 16 months and 18.2% in LMV patients, compared with 51 months and 52.4% in non-sarcopenic patients (p = 0.002). On multivariable analysis of pre-operative variables, only LMV (HR 2.75; 95% CI 1.33-5.66, p = 0.006) was associated with OS. CONCLUSION: BIA is an important prognostic indicator in OC and focused pre-habilitation consequently has strong potential.

Egalitarianism in surgical training: let equity prevail.

This study aimed to quantify core surgical trainee (CST) differential attainment (DA) related to three cohorts; white UK graduate (White UKG) versus black and minority ethnic UKG (BME UKG) versus international medical graduates (IMGs). The primary outcome measures were annual review of competence progression (ARCP) outcome, intercollegiate Membership of the Royal College of Surgeons (iMRCS) examination pass and national training number (NTN) selection. Intercollegiate Surgical Curriculum Programme (ISCP) portfolios of 264 consecutive CSTs (2010-2017, 168 white UKG, 66 BME UKG, 30 IMG) from a single UK regional post graduate medical region (Wales) were examined. Data collected prospectively over an 8-year time period was analysed retrospectively. ARCP outcomes were similar irrespective of ethnicity or nationality (ARCP outcome 1, white UKG 60.7% vs BME UKG 62.1% vs IMG 53.3%, p=0.395). iMRCS pass rates for white UKG vs BME UKG vs IMG were 71.4% vs 71.2% vs 50.0% (p=0.042), respectively. NTN success rates for white UKG vs BME UKG vs IMG were 36.9% vs 36.4% vs 6.7% (p=0.023), respectively. On multivariable analysis, operative experience (OR 1.002, 95% CI 1.001 to 1.004, p=0.004), bootcamp attendance (OR 2.615, 95% CI 1.403 to 4.871, p=0.002), and UKG (OR 7.081, 95% CI 1.556 to 32.230, p=0.011), were associated with NTN appointment. Although outcomes related to BME DA were equitable, important DA variation was apparent among IMGs, with iMRCS pass 21.4% lower and NTN success sixfold less likely than UKG. Targeted counter measures are required to let equity prevail in UK CST programmes.

Summative Supervisor Reporting: A Quality Performance Perspective.

OBJECTIVE: This study aimed to quality assure Assigned Educational Supervisor (AES) reports, using UK Joint Committee on Surgical Training objective criteria, to evaluate contribution to Annual Review of Competence Progression. DESIGN: Consecutive 145 AES reports from 75 trainers regarding 68 Core Surgical Trainees were assessed from 9 hospitals (2 Tertiary centers [77 reports], 7 District General Hospitals [68 reports]). Reports were assessed by independent assessors based on free text related to performance mapped to curricular objectives, operative logbooks, and Clinical Supervisor reports, and overall summary grades assigned ranging from development required, adequate, good to excellent. SETTING: A core surgical training program serving a single UK (Wales) deanery. PARTICIPANTS: Sixty-eight consecutively appointed core surgical trainees and 75 consultant surgeon trainers. RESULTS: Summary grades of adequate or above were achieved in 101 of 145 (69.7%) reports. Trainees' objective setting meetings were completed within 6 weeks of starting placements in 124 of 145 (85.5%). The proportions of AES reports containing free text commentary on curricular objectives, portfolio objectives, and operative logbook development were 128 of 145, 123 of 145, and 55 of 145, respectively. AES report quality was not associated with hospital status, subspecialty, or trainee grade. Female trainers were significantly more likely to provide reports graded as Good or Excellent compared with their male colleagues (7 of 12 vs. 27 of 133, χ2 (2) = 9.389, p = 0.009). AES reports for male trainees were significantly more likely to be rated as further development required (40 of 85, 47.1%) when compared with female trainees (4 of 32, 12.5%, p = 0.007). CONCLUSIONS: Three in ten AES reports were insufficient to contribute to objective Annual Review of Competence Progression outcomes and a gender gap was apparent related to engagement. AES trainers should provide more focus if this summative tool is to be an effective career progression metric.

Stress and Burnout in Training; Requiem for the Surgical Dream.

OBJECTIVE: Burnout among trainee doctors is common with as many as two-thirds reporting poor health. This study aimed to assess burnout in a cohort of UK core and higher general surgical trainees. DESIGN: The Maslach Burnout Inventory for Medical Personnel was distributed to 158 surgical trainees to evaluate emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). High EE (≥27) and DP (≥10), low PA (≤33) scores were taken to indicate burnout. SETTING: A single UK (Wales) Deanery. PARTICIPANTS: One hundred responses were received; 65 core surgical trainees, 31 Higher Surgical Trainees (HST), and 4 not specified. RESULTS: Median EE, DP, and PA scores were 22.0 (range 2-50), 7.5 (0-25), and 36.0 (19-47), respectively. High burnout by domain was: EE (n = 33), DP (n = 39), PA (n = 34), with 59% of trainees demonstrating burnout in ≥1 one domain, with strong interdomain correlation (EE:DP r = 0.351, p < 0.001; EE:PA r = -0.455, p < 0.001; DP:PA r = -0.446, p < 0.001). Female gender (p = 0.020), core surgical training grade (p = 0.012), and being childless (p = 0.033) were independently associated with higher levels of EE; whereas HST grade (p = 0.007), age >30 years (p = 0.010), married/partner status (p = 0.001), and parenthood (p = 0.015), were associated with lower levels of burnout with regard to DP. Binary logistic regression revealed lower burnout in all domains to be associated with HST status (hazard ratio 0.116, 95% confidence interval 0.014-0.980, p = 0.048) and male gender (hazard ratio 4.365, (1.246-15.293), p = 0.021). CONCLUSIONS: Burnout among surgical trainees was common in at least 1 Maslach Burnout Inventory domain. Urgent counter measures are required to protect the health and wellbeing of trainees at risk, which ought to be associated with commensurate improvement in patient safety.

To bed or not to bed: the sleep question?

BACKGROUND: Sleep deprivation and fatigue from long-shift work impacts doctors' personal safety, inhibits cognitive performance and risks clinical error. The aim of this study was to assess the sleep quality of surgical trainees participating in European Working Time Directive-compliant training rotations within a UK deanery. METHODS: A trainee cohort numbering 38 (21 core, 17 higher surgical trainees, 29 men and 9 women, median age 31 (25-44 years)) completed a sleep diary over 30 days using the Sleep Time (Azumio) smartphone application and triangulated with on-call rosters to identify shift patterns. The primary outcome measure was sleep quality related to rostered clinical duties. RESULTS: Consecutive 1152 individual sleep episodes were recorded. The median time asleep (hours:min) was 6:29 (5:27-7:19); the median sleep efficiency was 86% (80%-93%); the median light sleep (hours:min) was 2:50 (1:50-3:49); and the median rapid eye movement (REM) sleep (hours:min) was 3:20 (2:37-4:07). Significant adverse sleep profiles were observed in trainees undertaking emergency on-call duty when compared with elective (non-on-call) duty; the median time asleep (hours:min) 5:49 vs 6:43 (p<0.001); the median sleep efficiency was 85% vs 87% (p<0.001); the median light sleep (hours:min) was 2:16 vs 2:58 (p<0.001); and REM sleep (hours:min) was 2:57 vs 3:27 (p<0.001). Recovery of sleep duration, efficiency and quality necessitated five full days of time. CONCLUSION: Surgical emergency on-call duty adversely influences sleep quality. Proper consideration of fail-safe rota design, prioritising sleep hygiene, recovery and well-being, allied to robust patient safety and quality of care should be made a priority.

Prospective Cohort Study of Haptic Virtual Reality Laparoscopic Appendicectomy Learning Curve Trajectory.

Background: Simulation training is strongly advocated by 24/7 risk-rich professions because swift learning curve inflection point attainment delivers earlier competence; the left-shift effect. The aim of this study was to determine the value of haptic laparoscopic virtual reality simulation, by iterative benchmark exercise (n = 8), before simulated laparoscopic appendicectomy (SLA); the hypothesis was that favorable benchmark learning curve trajectories would be associated with improved SLA competence when compared with consultant expert performance. Methods: A 28-trainee cohort completed 1349 Laparoscopic Haptic Virtual Reality Skills (LHVRS) tasks, during which 19 ergonomic variables were assessed by virtual interface, including force feedback (Surgicalscience.com), before 153 SLAs. Primary outcome measure was SLA composite competence score related to six consultant trainer experts. Results: Of the eight LHVRS tasks, the three with the steepest learning curve trajectories correlated with better median overall SLA competence scores, namely tissue grasping/lifting (rho = 0.362, P = .049), fine dissection (rho = 0.388, P = .028), and camera navigation (rho = 0.518, P = .007); fine dissection was the only haptic laparoscopic virtual reality simulation task that predicted a SLA score within a Youden index defined, 70% of the consultant expert level (area under curve [AUC] = 0.803, P = .028). A significant SLA learning curve emerged, with a learning curve trajectory inflection point at the fourth SLA attempt (first SLA 30.5% versus fourth SLA score 76.0%, gradient 76°, P = .010). Conclusion: Learning curve trajectory can be measured, influenced, and accelerated significantly; a pronounced left-shift effect, with translational potential for enhanced shorter training time and improved patient safety.

Influence of Trainer Role, Subspecialty and Hospital Status on Consultant Workplace-based Assessment Completion.

OBJECTIVE: Performance assessment is challenging to administer and validate, yet remains central to patient safety and quality of care. The aim of this study was to evaluate Consultant Surgeon trainer performance with respect to Workplace Based Assessment (WBA) completion. DESIGN: All WBAs for 60 Core Surgical Trainees (n = 2932) recorded in one academic year were analyzed using the Intercollegiate Surgical Curriculum Progamme. Primary outcome measures were numbers of WBAs performed related to trainer role (Assigned Educational Supervisor vs. Clinical Supervisor vs. No Training Role), gender, surgical subspecialty, hospital status (teaching vs. district general), and trainer RCSEng. TrACE course accreditation. SETTING: A core surgical training program serving a single UK (Wales) deanery. PARTICIPANTS: Sixty consecutively appointed core surgical trainees. RESULTS: Median WBA number performed irrespective of trainer role was 6 (range 0-51), consisting of CBD 2 (0-18), mini-CEX 2 (0-22), DOPS 2 (0-32), and PBA 0 (0-10). Assigned Educational Supervisor trainers were more likely to complete the full range of WBAs compared with Clinical Supervisor and No Training Role assessors; WBA 17 vs. 6 vs. 3; CBD 5 vs. 2 vs. 1; mini-CEX 5 vs. 2 vs. 1; DOPS 4 vs. 2 vs. 1; and PBA 0 vs. 0 vs. 0 (p < 0.001). WBAs completed varied by subspecialty; first quartile performance: ENT, Plastic Surgery, (median 12, interquartile range 13), compared with fourth quartile: OMFS, Urology, T&O, and Cardiothoracic Surgery (median 5, interquartile range 11, p = 0.016). Hospital status, gender, and TrACE accreditation were not associated with WBA performance. CONCLUSIONS: Important variations in trainer WBA completion were apparent; training programme directors and trainees alike should be aware of this when agreeing educational contracts.

Relative Value of Adapted Novel Bibliometrics in Evaluating Surgical Academic Impact and Reach.

BACKGROUND: The Hirsch index, often used to assess research impact, suffers from questionable validity within the context of General Surgery, and consequently adapted bibliometrics and altmetrics have emerged, including the r-index, m-index, g-index and i10-index. This study aimed to assess the relative value of these novel bibliometrics in a single UK Deanery General Surgical Consultant cohort. METHOD: Five indices (h, r, m, g and i10) and altmetric scores (AS) were calculated for 151 general surgical consultants in a UK Deanery. Indices and AS were calculated from publication data via the Scopus search engine with assessment of construct validity and reliability. RESULTS: The median number of publications, h-index, r-index, m-index, g-index and i10-index were 13 (range 0-389), 5 (range 0-63), 5.2 (range 0-64.8), 0.33 (range 0-1.5), 10 (range 0-125) and 4 (range 0-245), respectively. Correlation coefficients of r-index, m-index, g-index and i10-index with h-index were 0.913 (p < 0.001), 0.716 (p < 0.001), 0.961 (p < 0.001) and 0.939 (p < 0.001), respectively. Significant variance was observed when the cohort was ranked by individual bibliometric measures; the median ranking shifts were: r-index - 2 (- 46 to + 23); m-index - 6.5 (- 53 to + 22); g-index - 0.5 (- 24 to + 13); and i10-index 0 (- 8 to + 11), respectively (p < 0.001). The median altmetric score and AS index were 0 (range 0-225.5) and 1 (range 0-10), respectively; AS index correlated strongly with h-index (correlation coefficient 0.390, p < 0.001). CONCLUSIONS: Adapted bibliometric indices appear to be equally valid measures of evaluating academic productivity, impact and reach.

Surgical gender gap: a curriculum concordance and career vector perspective.

INTRODUCTION: Women's participation in medicine has increased dramatically during the last 50 years, yet Office for National Statistics data (2016) regarding annual pay continue to show an unequivocal 34% deficit in female doctors' remuneration compared with their male counterparts. This study aimed to identify whether there are measurable differences in the training, career vectors and profiles of higher general surgical trainees (HSTs), related to gender. METHOD: The Deanery roster supplemented with Intercollegiate Surgical Curriculum Programme and Scopus data was used to identify the profiles of 101 consecutive HSTs (38 women, 63 men, single UK deanery). Primary outcome measures were training programme attrition rate, time to completion of training and achievement of third level 4 competence (3L4C) in indicative operations. Secondary outcomes were publication number, citations and Hirsch Indices (HIs). RESULTS: Attrition rates were similar irrespective of gender (female n=3 (7.9%) vs male n=6 (9.5%), p=0.871). Training duration was on average 16 months longer in women (94 (72-134) months) than men (78 (72-112), p=0.002). Operative learning curve trajectories were similar; median operations required to achieve 3L4C was 380 (f) versus 410 (m, p=1.00). Academic profiles of men were stronger than women, specifically higher degrees; men (n=31, 83.8%), women (n=6, 16.2%, p=0.001); median (range) publication number 8 (0-57) versus 3 (0-38, p=0.003), citations 43 (0-1600) versus 9 (0-774, p=0.001), and HI 3 (0-26) versus 2 (0-12, p=0.002). CONCLUSION: A complex variable gender gap was apparent related to time in training and academic profile, but not training attrition or operative learning curve trajectory.

FRCS first pass variance: deanery and specialty contrariety.

BACKGROUND: FRCS exit examination success may be interpreted as a surrogate marker for UK Deanery-related training quality. The aim of this study was to evaluate relative FRCS examination pass rates related to Deanery and Surgical Specialty. METHODS: Joint Committee on Surgical Training-published examination first attempt pass rates were scrutinised for type I higher surgical trainees and outcomes compared related to Deanery and Surgical Specialty. RESULTS: Of 9363 FRCS first attempts, 3974 were successful (42.4%). Median and mean pass rates related to Deanery were 42.1% and 30.7%, respectively, and ranged from 26.7% to 45.6%. Median (range) pass rates by specialty were urology 76.3% (60%-100%), trauma and orthopaedic surgery 74.7% (58.2%-100%), general surgery 70.0% (63.1%-86%), ENT 62.5% (50%-100%), cardiothoracic surgery 50.0% (25%-100%), oral and maxillofacial surgery 50% (40.0%-100%), neurosurgery 50% (22.7%-100%), plastic surgery 47.6% (30.0%-100%) and paediatric surgery 25% (16.7%-100%). Significant variance was observed across all specialties and deaneries (p=0.001). CONCLUSION: As much as threefold variance exists related to FRCS examination first attempt success, trainees should be aware of this spectrum when preferencing deaneries during national selection.

Rural Rotations at Core: Rarefied Exposure or Real Experience?

OBJECTIVE: Surgical rotations involving rural General Hospitals (rGH) are frequently associated with recruitment challenges, partly because of adverse perceptions regarding distances from social support networks and training opportunities. The aim of this study was to determine the outcomes of core surgical training rotations involving rGHs when compared with urban hospitals in a single UK Deanery. DESIGN: Online Intercollegiate Surgical Curriculum Programme portfolios from 163 core surgical trainees (CST) were examined related to postlocation, operative experience, workplace-based assessments, and academic achievement. Of the 163 CSTs, 27 had completed at least 50% of their 2-year training posts at rGHs and were compared with 136 control CSTs completing rotations in urban general and teaching hospitals (uGH). The primary outcome measures were MRCS pass rate and success at national ST3 selection. SETTING: A core surgical training program serving a single UK Deanery. PARTICIPANTS: Consecutive 177 CSTs appointed to a single UK Deanery between 2010 and 2016. RESULTS: Success at MRCS and national ST3 selection were similar for CSTs from rGH vs uGH rotations-MRCS success: 70.4 vs 72.8% (p = 0.816), and ST3 success: 22.2% vs 27.0% (p = 0.811). Median rGH vs uGH curriculum-based outcomes were operative case load: 378 vs 422 (p = 0.300); workplace-based assessments completed: 79 vs 94 (p = 0.499); audits performed: 4 vs 4 (p = 0.966); learned society communications: 1 vs 2 (p = 0.020); and scientific publications: 0 vs 0 (p = 0.478). CONCLUSION: CST rotations including rGHs produced a different spectrum of training experience compared with uGH rotations but overall primary outcomes were similar.

Surgical academic reach: the higher degree effect quantified.

INTRODUCTION: Proof of professional specific academic attainment is embedded within the Joint Committee on Surgical Training 2013 general surgery curriculum, mandating that all higher general surgical trainees (HST) obtain three peer-reviewed publications to qualify for Certification of Completion of Training. Yet, Modernising Medical Careers (MMC) has been associated with a trend away from the gold standard postgraduate credentials of higher degrees by research. This study aimed to evaluate the academic achievements of a post-MMC UK Deanery HST cohort to determine what additional benefits higher degree study might confer. METHOD: The Scopus bibliographic database (Elsevier, RELX Group) was used to characterise the academic profiles of 101 consecutive HSTs and supplemented with Intercollegiate Surgical Programme Curriculum data. Primary outcome measures were numbers of publications, citations and Hirsch indices (HI). RESULTS: Thirty-seven HSTs (36.6%) had been awarded higher degrees (29 Doctor of Medicine, 8 Doctor of Philosophy). Academic profiles of HSTs with higher degrees were stronger than those of HSTs without, specifically: median (range) publication numbers 16 (2-57) vs 2 (0-11, P<0.001), citations 93 (0-1600) vs 6 (0-132, P<0.001), first author publications 6 (0-33) vs 3 (0-106, P<0.001), communications to learnt societies 30 (5-79) vs 8 (2-35, P<0.001) and HI 6 (1-26) vs 1 (0-6, P<0.001). CONCLUSION: Proof of academic reach by higher degree was associated with important enhanced professional credentials, strengthening HIs sixfold. Trainers and trainees alike should be aware of the relative magnitude of such benefits when planning educational programmes.

The 100 most cited manuscripts in emergency abdominal surgery: A bibliometric analysis.

BACKGROUND: The number of citations a scientific article receives provides a good indication of its impact within any given field. This bibliometric analysis aimed to identify the 100 most cited articles in Emergency Abdominal Surgery (EAS), to highlight key areas of interest and identify those that have most significantly shaped contemporary clinical practice in this newly evolving surgical specialty. This is of increasing relevance as concerns grow regarding the variable and suboptimal outcomes in Emergency General Surgery. MATERIALS AND METHODS: The Thomson Reuters Web of Science database was used to search using the terms [Emergency AND Abdom* AND Surg*] to identify all English language, full manuscripts. Results were ranked according to citation number. The top 100 articles were further analysed by subject, author, journal, year of publication, institution, and country of origin. RESULTS: The median (range) citation number of the top 100 out of 7433 eligible papers was 131 (1569-97). The most cited paper (by Goldman et al., Massachusetts General Hospital, New England Journal of Medicine; 1569 citations) focused on cardiac risk stratification in non-cardiac surgery. The Journal of Trauma, Injury, Infection and Critical Care published the most papers and received most citations (n = 19; 2954 citations. The majority of papers were published by centres in the USA (n = 52; 9422 citations), followed by the UK (n = 13; 1816 citations). The most common topics of publication concerned abdominal aneurysm management (n = 26) and emergency gastrointestinal surgery (n = 26). CONCLUSION: Vascular surgery, risk assessment and gastrointestinal surgery were the areas of focus for 59% of the contemporary most cited emergency abdominal surgery manuscripts. By providing the most influential references this work serves as a guide to what makes a citable emergency surgery paper.

Surgical Education's 100 Most Cited Articles: A Bibliometric Analysis.

BACKGROUND: Bibliometric analysis highlights the key topics and publications, which have shaped surgical education. Here, the 100 most cited articles in the arena of surgical education were analyzed. METHODS: Thomson Reuters Web of Science was interrogated using the keyword search terms "surgery" and ("learning" or "skills" or "competence" or "assessment" or "training" or "procedure-based assessments" or "performance" or "technical skills" or "curriculum" or "education" or "mentoring"] to identify all English language full articles, and the 100 most cited articles were analyzed by topic, journal, author, year, institution, and country of origin. RESULTS: A total of 403,733 eligible articles were returned and the median citation number was 164 (range: 107-1018). The most cited article (by Seymour, Yale University School of Medicine, Annals of Surgery, 1018 citations) focused on the use of virtual reality surgical simulation training. Annals of Surgery published the highest number of articles and received the most citations (n = 16, 3715 citations). The countries with the greatest number of publications were the USA (n = 45), Canada (n = 19), and the UK (n = 18). The commonest topics included simulation (n = 45) and assessment of clinical competence (n = 40). CONCLUSION: Surgical skill acquisition and assessment was the area of focus of 85% of the most cited contemporary articles, and this study provides the most cited references, serving as a guide as to what makes a citable published work in the field of surgical education.