Changing Autonomy in Operative Experience Through UK General Surgery Training: A National Cohort Study

Elizabeth J. Elsey (Lead / Corresponding author), Gareth Griffiths, Joe West, David J. Humes

    Research output: Contribution to journalArticle

    2 Citations (Scopus)
    77 Downloads (Pure)

    Abstract

    Objectives: To determine the operative experience of UK general surgery trainees and assess the changing procedural supervision and acquisition of competency assessments through the course of training.

    Background: Competency assessment is changing with concepts of trainee autonomy decisions (termed entrustment decisions) being introduced to surgical training.

    Methods: Data from the Intercollegiate Surgical Curriculum Programme and the eLogbook databases for all UK General Surgery trainees registered from August 1, 2007 who had completed training were used. Total and index procedures (IP) were counted and variation by year of training assessed. Recorded supervision codes and competency assessment outcomes for IPs were assessed by year of training.

    Results: We identified 311 trainees with complete data. Appendicectomy was the most frequently undertaken IP during first year of training [mean procedures (mp) = 26] and emergency laparotomy during final year of training (mp = 27). The proportion of all IPs recorded as unsupervised increased through training (P < 0.05) and varied between IPs with 91.2% of appendicectomies (mp = 20), 40.6% of emergency laparotomies (mp = 27), and 17.4% of segmental colectomies (mp = 15) recorded as unsupervised during the final year of training. Acquisition of competency assessments increased through training and varied by IP.

    Conclusions: The changing autonomy of trainees through the course of an entire training scheme, alongside formal competency assessments, may provide evidence of changing entrustment decisions made by trainers for different key procedures. Other countries utilizing electronic logbooks could adopt similar techniques to further understanding of competency attainment amongst their surgical trainees.

    Original languageEnglish
    Pages (from-to)399-406
    Number of pages8
    JournalAnnals of Surgery
    Volume269
    Issue number3
    Early online date26 Sep 2018
    DOIs
    Publication statusPublished - 1 Mar 2019

    Fingerprint

    Cohort Studies
    Laparotomy
    Emergencies
    Colectomy
    Curriculum
    Outcome Assessment (Health Care)
    Databases

    Cite this

    Elsey, Elizabeth J. ; Griffiths, Gareth ; West, Joe ; Humes, David J. / Changing Autonomy in Operative Experience Through UK General Surgery Training : A National Cohort Study. In: Annals of Surgery. 2019 ; Vol. 269, No. 3. pp. 399-406.
    @article{9b711678bb4442849903fb132a9c4796,
    title = "Changing Autonomy in Operative Experience Through UK General Surgery Training: A National Cohort Study",
    abstract = "Objectives: To determine the operative experience of UK general surgery trainees and assess the changing procedural supervision and acquisition of competency assessments through the course of training.Background: Competency assessment is changing with concepts of trainee autonomy decisions (termed entrustment decisions) being introduced to surgical training.Methods: Data from the Intercollegiate Surgical Curriculum Programme and the eLogbook databases for all UK General Surgery trainees registered from August 1, 2007 who had completed training were used. Total and index procedures (IP) were counted and variation by year of training assessed. Recorded supervision codes and competency assessment outcomes for IPs were assessed by year of training.Results: We identified 311 trainees with complete data. Appendicectomy was the most frequently undertaken IP during first year of training [mean procedures (mp) = 26] and emergency laparotomy during final year of training (mp = 27). The proportion of all IPs recorded as unsupervised increased through training (P < 0.05) and varied between IPs with 91.2{\%} of appendicectomies (mp = 20), 40.6{\%} of emergency laparotomies (mp = 27), and 17.4{\%} of segmental colectomies (mp = 15) recorded as unsupervised during the final year of training. Acquisition of competency assessments increased through training and varied by IP.Conclusions: The changing autonomy of trainees through the course of an entire training scheme, alongside formal competency assessments, may provide evidence of changing entrustment decisions made by trainers for different key procedures. Other countries utilizing electronic logbooks could adopt similar techniques to further understanding of competency attainment amongst their surgical trainees.",
    author = "Elsey, {Elizabeth J.} and Gareth Griffiths and Joe West and Humes, {David J.}",
    note = "Funding; This report is independent research arising from a doctoral research fellowship awarded to E.E., DRF-2016-09-07, supported by the National Institute for Health Research. E.E. was previously funded by the Royal College of Surgeons of Edinburgh for work related to this study as part of a wider research programme. D.J.H. is funded by an NIHR Postdoctoral Fellowship. The funders had no role in the design of the study and the collection, analysis, and interpretation of data and the writing of the article and the decision to submit it for publication. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, Health Education England, or the Department of Health",
    year = "2019",
    month = "3",
    day = "1",
    doi = "10.1097/SLA.0000000000003032",
    language = "English",
    volume = "269",
    pages = "399--406",
    journal = "Annals of Surgery",
    issn = "0003-4932",
    publisher = "Lippincott, Williams & Wilkins",
    number = "3",

    }

    Changing Autonomy in Operative Experience Through UK General Surgery Training : A National Cohort Study. / Elsey, Elizabeth J. (Lead / Corresponding author); Griffiths, Gareth; West, Joe; Humes, David J.

    In: Annals of Surgery, Vol. 269, No. 3, 01.03.2019, p. 399-406.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Changing Autonomy in Operative Experience Through UK General Surgery Training

    T2 - A National Cohort Study

    AU - Elsey, Elizabeth J.

    AU - Griffiths, Gareth

    AU - West, Joe

    AU - Humes, David J.

    N1 - Funding; This report is independent research arising from a doctoral research fellowship awarded to E.E., DRF-2016-09-07, supported by the National Institute for Health Research. E.E. was previously funded by the Royal College of Surgeons of Edinburgh for work related to this study as part of a wider research programme. D.J.H. is funded by an NIHR Postdoctoral Fellowship. The funders had no role in the design of the study and the collection, analysis, and interpretation of data and the writing of the article and the decision to submit it for publication. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, Health Education England, or the Department of Health

    PY - 2019/3/1

    Y1 - 2019/3/1

    N2 - Objectives: To determine the operative experience of UK general surgery trainees and assess the changing procedural supervision and acquisition of competency assessments through the course of training.Background: Competency assessment is changing with concepts of trainee autonomy decisions (termed entrustment decisions) being introduced to surgical training.Methods: Data from the Intercollegiate Surgical Curriculum Programme and the eLogbook databases for all UK General Surgery trainees registered from August 1, 2007 who had completed training were used. Total and index procedures (IP) were counted and variation by year of training assessed. Recorded supervision codes and competency assessment outcomes for IPs were assessed by year of training.Results: We identified 311 trainees with complete data. Appendicectomy was the most frequently undertaken IP during first year of training [mean procedures (mp) = 26] and emergency laparotomy during final year of training (mp = 27). The proportion of all IPs recorded as unsupervised increased through training (P < 0.05) and varied between IPs with 91.2% of appendicectomies (mp = 20), 40.6% of emergency laparotomies (mp = 27), and 17.4% of segmental colectomies (mp = 15) recorded as unsupervised during the final year of training. Acquisition of competency assessments increased through training and varied by IP.Conclusions: The changing autonomy of trainees through the course of an entire training scheme, alongside formal competency assessments, may provide evidence of changing entrustment decisions made by trainers for different key procedures. Other countries utilizing electronic logbooks could adopt similar techniques to further understanding of competency attainment amongst their surgical trainees.

    AB - Objectives: To determine the operative experience of UK general surgery trainees and assess the changing procedural supervision and acquisition of competency assessments through the course of training.Background: Competency assessment is changing with concepts of trainee autonomy decisions (termed entrustment decisions) being introduced to surgical training.Methods: Data from the Intercollegiate Surgical Curriculum Programme and the eLogbook databases for all UK General Surgery trainees registered from August 1, 2007 who had completed training were used. Total and index procedures (IP) were counted and variation by year of training assessed. Recorded supervision codes and competency assessment outcomes for IPs were assessed by year of training.Results: We identified 311 trainees with complete data. Appendicectomy was the most frequently undertaken IP during first year of training [mean procedures (mp) = 26] and emergency laparotomy during final year of training (mp = 27). The proportion of all IPs recorded as unsupervised increased through training (P < 0.05) and varied between IPs with 91.2% of appendicectomies (mp = 20), 40.6% of emergency laparotomies (mp = 27), and 17.4% of segmental colectomies (mp = 15) recorded as unsupervised during the final year of training. Acquisition of competency assessments increased through training and varied by IP.Conclusions: The changing autonomy of trainees through the course of an entire training scheme, alongside formal competency assessments, may provide evidence of changing entrustment decisions made by trainers for different key procedures. Other countries utilizing electronic logbooks could adopt similar techniques to further understanding of competency attainment amongst their surgical trainees.

    U2 - 10.1097/SLA.0000000000003032

    DO - 10.1097/SLA.0000000000003032

    M3 - Article

    C2 - 30260805

    VL - 269

    SP - 399

    EP - 406

    JO - Annals of Surgery

    JF - Annals of Surgery

    SN - 0003-4932

    IS - 3

    ER -