1. 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

2. 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.

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

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

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

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

7. Supervision in the Operating Room

8. Educational Opportunities

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

10. 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

11. 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

12. 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…….?

13. 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?

14. Thank You