By Robert Munashe Maweni F1 Croydon University Hospital Surgical Learning Activities For Surgical House Officers – Do they improve the surgical rotation experience? By Robert Munashe Maweni F1 Croydon University Hospital

Multivariate Analysis Surgical Learning Activities For Surgical House Officers – Do They Improve The Surgical Experience? Robert M Maweni1, Robert W Foley2, Micol Lupi1, David Shier3, P. Ronan O’Connell2, 4, Stella Vig1 1. Croydon University Hospital, London, United Kingdom 2. UCD School of Medicine and Medical Science, University College Dublin, Ireland 3. Kingston Hospital, London, United Kingdom 4. St Vincent’s University Hospital, Dublin, Ireland Results Objectives Methods 115 doctors completed the questionnaire with 72% achieving at least half of the learning activities. On multivariate analysis, satisfaction with surgical experience was statistically significantly associated with an increased number of completed learning activities (odds ratio 24.3, p=0.002), independent of one’s interest in surgery or satisfaction with teaching received. To ascertain whether house officers (HOs) attain a more satisfactory surgical rotation experience when they perform basic surgical learning activities. We also sought to establish how many and which learning activities HOs achieve and the effect on their experience. A questionnaire listing 20 learning activities and questions regarding satisfaction with overall experience was disseminated to HOs in the UK and Ireland who had completed ≥3 months of surgical rotations. Satisfaction with surgical experience was dichotomised in order to perform logistic regression using R Studio software v0.98. Table 1: Study Cohort Characteristics All Survey Respondents 115   Country UK 51 Ireland 64 Surgical Specialty† General Breast 15 Colorectal 22 Trauma & Orthopaedics 18 Urology 25 Vascular Other Interest In A Surgical Career 23 ≥10 SLACs Performed 20 ≥10 SLEs Performed 8 Satisfied with Experience 32 Teaching 21 Opportunity to Assist Opportunity to Scrub-in 35 Opportunity to Attend Theatre 34 Conclusion Surgical HOs who performed basic surgical learning activities reported significantly greater satisfaction with surgical rotations. Therefore, we recommend facilitating HOs completion of these activities as this will ensure that basic surgical competencies are achieved and that HOs will be more satisfied with their surgical experience.   Univariate Analysis Multivariate Analysis Odds Ratio (95% CI) p value Odds Ratio 95% CI Outcome = Satisfactory Experience Country¥ 1.11 (0.46-2.71) 0.815 1.21 (0.19-7.93) 0.835 Surgical Specialty† 0.39 (0.16-0.96) 0.041* 0.19 (0.03-1.00) 0.066 Interest in Surgery 3.34 (1.19-9.79) 0.023 1.36 (0.17-10.17) 0.748 Satisfactory Teaching 96.67 (17.6-1819.8) <0.001* 213.81 (27.2-5194.6) ≥ 10 SLE’s Performed 16.5 (4.8-77.5) 34.36 (5.35- 373.5) †Numbers do not equal total respondents as house officers may have completed more than 1 rotation * p<0.05 denoting statistical significance ¥ Ireland or the United Kingdom † General Surgery compared to non-general specialties

Surgical Learning Activities Since the EWTD and “New Deal” have limited the surgical exposure and increased the workload of trainees, a major priority of post graduate surgical training is to develop new and efficient educational tools to ensure proficiency in surgery House Officers (HOs) who have surgical rotations are well placed to learn from highly skilled seniors throughout their rotations – however the majority spend their time in indirect patient care activities Our results show that overall there are opportunities for HOs to practice and develop core surgical skills throughout their rotations, with 72% and 15% of respondents achieving at least 50% or 75% of the listed learning events, respectively; The most commonly performed being scrubbing, injection of LA and perioperative management anticoagulant/anti-platelet therapy.

Effect of Learning Activities on Rotation Satisfaction On univariate analysis: Irish interns were significantly more likely to have performed ≥10 basic SLACs (OR: 3.2; 95% CI, 1.06-10.9; p=0.047). HOs were significantly more likely to engage in basic SLACs if they were interested in a career in surgery (OR: 6.3; 95% CI, 2.03- 21.3; p=0.001). Indeed; HOs were also more likely to report a satisfactory experience from their surgical rotation if they were interested in a surgical career (OR: 3.3; 95% CI, 1.19-9.79; p=0.02) Engagement in more basic SLACs was positively associated with satisfaction in overall training experience (OR: 16.5; 95% CI, 4.8- 77.5; p<0.001). Surgical specialty is associated with a difference in satisfaction, with general surgical HOs reporting a significantly worse surgical experience (OR: 0.39; 95% CI, 0.16-0.96; p=0.04). Self-reported surgical experience did not differ based on whether the SLACs were performed or performed as SLEs. On multivariate analysis: performance of at least 10 of the SLACs was significantly associated with interest in surgery (OR: 6.50; 95% CI, 1.5-32.8; p=0.01) and satisfaction with surgical experience (OR: 28; 95% CI, 4.5-246.5; p<0.001) when controlled for potential confounders such as surgical specialty assignment, satisfaction with teaching and country of employment. Satisfaction with surgical experience was statistically significantly associated with an increased number of completed learning events as demonstrated in the previous paragraph, but was also significantly associated with satisfaction with surgical teaching received (OR: 213; 95% CI, 275194; p<0.001) independent of one’s interest in surgery, country of employment and surgical specialty rotation. Conclusion The finding that high SLAC engagement was strongly associated with a positive overall satisfaction in training experience, independent of interest in a surgical career and speciality of the surgical firm shows that there is much to gain from improving overall attitudes towards supervised learning activities and increasing participation, particularly in the context of surgical skills.