Are trainees working in obstetrics and gynecology confident and competent in the care of frail gynecological oncology patients?

TY - JOUR

T1 - Are trainees working in obstetrics and gynecology confident and competent in the care of frail gynecological oncology patients?

AU - Owens, Gemma Louise

AU - Sivalingam, Vanitha

AU - Abdelrahman, Mohamed

AU - Beirne, James P.

AU - Blake, Dominic

AU - Collins, Anna

AU - Davies, Rhianna

AU - Dilley, James

AU - Farquharson, Malcolm

AU - Frimpong, Diana

AU - Gomes, Nana

AU - Hawco, Sarah

AU - Ilenkovan, Narthana

AU - Jones, Eleanor

AU - Jones, Sadie Esme Fleur

AU - Khan, Tabassum

AU - Leung, Elaine

AU - Otify, Mohamed

AU - Parnell, Laura

AU - Rimmer, Michael P.

AU - Ryan, Neil

AU - Sanderson, Peter

AU - Stocker, Linden

AU - Wilkinson, Michael

AU - Wong, Siewchee

AU - Bharathan, Rasiah

AU - Wan, Yee-Loi Louise

AU - Audit and Research in Gynaecological Oncology (ARGO) Collaborative

N1 - © IGCS and ESGO 2020. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2020/12/8

Y1 - 2020/12/8

N2 - Introduction: Older patients undergoing cancer surgery are at increased risk of post-operative complications, prolonged hospital stay, and mortality. Identification of frailty can help predict patients at high risk of peri-operative complications and allow a collaborative, multidisciplinary team approach to their care. A survey was conducted to assess the confidence and knowledge of trainees in obstetrics and gynecology regarding identification and management of peri-operative issues encountered in frail gynecological oncology patients.Methods: A web-based survey was distributed via the Audit and Research in Gynaecological Oncology (ARGO) collaborative and UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG) . The survey on the management of frail peri-operative patients was disseminated to doctors-in-training (trainees) working in obstetrics and gynecology in the United Kingdom (UK) and Ireland. Specialty (ST1-7), subspecialty, and general practice trainees, non-training grade doctors, and foundation year doctors currently working in obstetrics and gynecology were eligible. Consultants were excluded. Study data were collected using REDCAP software hosted at the University of Manchester. Responses were collected over a 6-week period between January and February 2020.Results: Of the 666 trainees who participated, 67% (425/666) reported inadequate training in peri-operative management of frail patients. Validated frailty assessment tools were used by only 9% (59/638) of trainees and less than 1% (4/613) were able to correctly identify all the diagnostic features of frailty. Common misconceptions included the use of chronological age and gender in frailty assessments. The majority of trainees (76.5%, 448/586) correctly answered a series of questions relating to mental capacity; however, only 6% (36/606) were able to correctly identify all three diagnostic features of delirium. A total of 87% (495/571) of trainees supported closer collaboration with geriatricians and a multidisciplinary approach.Conclusions: Obstetrics and gynecology trainees reported inadequate training in the peri-operative care of frail gynecological oncology patients, and overwhelmingly favored input from geriatricians. Routine use of validated frailty assessment tools may aid diagnosis of frailty in the peri-operative setting. There is an unmet need for formal education in the management of frail surgical patients within the UK and Irish obstetrics and gynecology curriculum.

AB - Introduction: Older patients undergoing cancer surgery are at increased risk of post-operative complications, prolonged hospital stay, and mortality. Identification of frailty can help predict patients at high risk of peri-operative complications and allow a collaborative, multidisciplinary team approach to their care. A survey was conducted to assess the confidence and knowledge of trainees in obstetrics and gynecology regarding identification and management of peri-operative issues encountered in frail gynecological oncology patients.Methods: A web-based survey was distributed via the Audit and Research in Gynaecological Oncology (ARGO) collaborative and UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG) . The survey on the management of frail peri-operative patients was disseminated to doctors-in-training (trainees) working in obstetrics and gynecology in the United Kingdom (UK) and Ireland. Specialty (ST1-7), subspecialty, and general practice trainees, non-training grade doctors, and foundation year doctors currently working in obstetrics and gynecology were eligible. Consultants were excluded. Study data were collected using REDCAP software hosted at the University of Manchester. Responses were collected over a 6-week period between January and February 2020.Results: Of the 666 trainees who participated, 67% (425/666) reported inadequate training in peri-operative management of frail patients. Validated frailty assessment tools were used by only 9% (59/638) of trainees and less than 1% (4/613) were able to correctly identify all the diagnostic features of frailty. Common misconceptions included the use of chronological age and gender in frailty assessments. The majority of trainees (76.5%, 448/586) correctly answered a series of questions relating to mental capacity; however, only 6% (36/606) were able to correctly identify all three diagnostic features of delirium. A total of 87% (495/571) of trainees supported closer collaboration with geriatricians and a multidisciplinary approach.Conclusions: Obstetrics and gynecology trainees reported inadequate training in the peri-operative care of frail gynecological oncology patients, and overwhelmingly favored input from geriatricians. Routine use of validated frailty assessment tools may aid diagnosis of frailty in the peri-operative setting. There is an unmet need for formal education in the management of frail surgical patients within the UK and Irish obstetrics and gynecology curriculum.

KW - gynecology

KW - postoperative care

KW - surgical oncology

U2 - 10.1136/ijgc-2020-001834

DO - 10.1136/ijgc-2020-001834

M3 - Article

C2 - 33046571

SN - 1048-891X

VL - 30

SP - 1959

EP - 1965

JO - International Journal of Gynecological Cancer

JF - International Journal of Gynecological Cancer

IS - 12

ER -