Surgical Training Quality: A Comparison Between the UK & the USA Pritam Singh, Rajesh Aggarwal, Daniel A Hashimoto, Noel N Williams, Ara Darzi Presented by Pritam Singh

Background USA UK Attending 10 years 5 years Resident Attending 80 hours 48 hours Common end-product of both training programs is a trained surgeon capable of independent practice.

Background Joint Committee on Surgical Training Quality indicators for surgical training. Similar indicators inferred from ABS ACGME Surgical Residency program requirements

Objectives Improve Surgical Training Evaluate surgical training quality in UK & USA Compare & Identify differences Identify improvements

Methods Questionnaire developed Themes from JCST Quality indicators Program Directors University of Pennsylvania North and South West Thames London invitation 2 Week reminder Data collection online Analysis n = 64 n = 182

Results 76 residents (31%) completed the survey. USA 29 (45%) UK47 (26%) UK trainees Older Further in training year

Supervision in the Operating Room

Educational Opportunities

Access to Simulators USA All residents Laparoscopy Box Trainer VR Laparoscopy Simulator Endoscopy Simulator

Results Summary - Compare & Identify Differences USA residents More Supervised operating opportunities Scheduled teaching Access to simulators UK residents More Experience of operating independently Exposure to gastrointestinal endoscopy training Emergency operative cases (UK 2.04 v USA 1.34 cases per week) No significant difference Number of operative cases performed or assisted electively

Limitations Response rate Two training programs Retrospective self reporting Focus on quantity rather than quality Emergency team structure Assumes Attending status is equivalent Fellowship training Sub-specialist training

Discussion – Identify improvements USA More efficent? Supervision Teaching Simulation Less focus on non-essential skills such as GI endoscopy or Inexperienced? UK More experienced? Independence Trained to a specialist level or Inefficient? Which is better…….?

Future Research Improve Surgical Training Evaluate surgical training quality in UK & USA Compare & Identify differences Identify improvements Current focus is on quantity How do we define high quality?

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