TY - JOUR
AU - Allum, W
AB - Abstract Background Over the past 10 years, the National Health Service in England has started to publish surgeon-specific outcomes publicly. The aim of this study was to investigate how this has affected training case exposure for surgeons in training. Methods Anonymized data were collected from the Intercollegiate Surgical Curriculum Programme database for operations in each specialty with published surgeon outcomes, involving surgical trainees on an approved training programme between 1 January 2011 and 31 December 2016. Trainee and supervisor involvement in operations before and after the start of publication of surgeon-specific outcomes were compared using mixed-effects models. Results A total of 163 076 recorded operative procedures were included. A statistically significant improvement in exposure to training procedures was observed for anterior resection of rectum, carotid endarterectomy, gastrectomy, meningioma excision, prostatectomy and thyroidectomy following the introduction of publication of surgeon outcomes. In coronary artery bypass grafting (CABG) and total hip replacement (THR), however, there was a reduction in involvement in training procedures. This was apparent for both trainee and supervisor involvement in CABG, and for trainee involvement in THR. Conclusion Exposure to training procedures has improved rather than declined in the UK in the majority of surgical specialties, since the publication of surgeon-specific outcomes. The aim of this study was to investigate how surgeon-specific outcome reporting has affected training case exposure for surgeons in training. Anonymized data were collected from the Intercollegiate Surgical Curriculum Programme database for operations in each specialty with published surgeon-specific outcomes involving surgical trainees on an approved training programme between 1 January 2011 and 31 December 2016. A total of 163 076 recorded procedures showed a statistically significant improvement in exposure to training cases for anterior resection of rectum, carotid endarterectomy, gastrectomy, meningioma excision, prostatectomy and thyroidectomy following the introduction of surgeon-specific outcomes. In coronary artery bypass grafting (CABG) and total hip replacement (THR), however, there was a reduction in involvement in training cases. This was apparent for both trainee and supervisor involvement in CABG, and for trainee involvement in THR. Graphical Abstract Open in new tabDownload slide Surprisingly, improves access to training Introduction In 2002, surgeon-specific outcome reporting was first introduced for cardiothoracic surgery in England following the Bristol Heart Inquiry1. The aim was to ‘spread best practice and identify issues that need investigating’. In 2013, the National Health Service England initiative of Consultant Outcome Publication, managed by the Healthcare Quality Improvement Partnership, published quality measures at the level of individual consultant, team and unit using national clinical audit and administrative data. By 2014, publication had been mandated in 12 national clinical audits, covering several surgical specialties and some non-surgical interventional specialties (Table S1, supporting information)2. Publishing surgeon data is not unique to the UK3,4. Individual-level outcome is contentious in both the UK and the USA, with concerns raised about the reliability of outcomes for low-volume procedures, the appropriateness of outcome measures, the potential for cherry-picking of easy procedures by surgeons, and the lack of acknowledgement of the teamwork involved in surgical care3,5–10. However, a recent study11 found no evidence that the introduction of surgeon-specific outcome reporting in colorectal cancer surgery had led to risk-averse clinical practice behaviour, or gaming of data. High-quality surgical training is essential to ensure the best care to both current and future patients, yet few have considered the potential impact of surgeon outcome reporting on the provision of surgical training9,10. The hypothesis of this study was that surgeon-specific outcome reporting would reduce training procedure exposure (both trainee involvement and graduated autonomy), as trainers would be concerned about the effect on their practice. Evidence for this would be an increase in the number of procedures with the trainee assisting, and a reduction in the number of procedures performed by trainees, both supervised and unsupervised. The aim of the study, therefore, was to investigate this hypothesis within the UK across a range of surgical procedures. Methods The Joint Committee on Surgical Training (JCST) works on behalf of the Royal Colleges of Surgeons of the UK and Ireland, and has responsibilities for all matters relating to surgical training including curriculum development and implementation. It also works with the UK General Medical Council (GMC) and training providers on the quality of surgical training. The surgical training pathway for the ten recognized surgical specialties (cardiothoracic surgery, general surgery, neurosurgery, oral and maxillofacial surgery, otolaryngology, paediatric surgery, plastic surgery, trauma and orthopaedics, urology and vascular surgery) has been described previously12. In brief, training in these surgical specialties takes a minimum of 7–8 years (dependent on the specialty) following successful completion of the postgraduate 2-year foundation programme (UK) or intern year (Ireland) (Fig. S1, supporting information). Those appointed to specialty or run through training are awarded a National Training Number (NTN). Successful completion of training is recognized through certification by the regulator, the GMC. The Intercollegiate Surgical Curriculum Programme (ISCP) is a national, cross-specialty web-based training management system under the jurisdiction of the JCST, which has representation across governing bodies within surgical training (Royal Colleges of Surgeons of the UK and Ireland). All surgical specialty trainees are expected to demonstrate operative competence (through Procedure Based Assessments (PBAs) via the ISCP database; https://iscp.ac.uk) and operative experience (by maintaining an e-logbook; https://www.elogbook.org) in order to be awarded certification by the GMC. Details of the operative experience and competencies related to this study are described in Table S2 (supporting information). Operative supervision levels for trainees are classified as follows: observed; assisted (A); supervised – trainer scrubbed (STS); supervised – trainer unscrubbed (STU); performed (P); and training another trainee. Study design The study was approved by the ISCP Data Analysis, Audit and Research Group, and data were managed in accordance with ISCP data governance. Index operations were selected to cover a range of procedures: anterior resection of rectum, carotid endarterectomy, coronary artery bypass grafting (CABG), excision of meningioma, gastrectomy, prostatectomy, thyroidectomy and total hip replacement (THR). The operation codes, as recorded in the e-logbook, included in this study are detailed in Table 1. Anonymized data were collected from all selected operations from consecutive trainees in each relevant specialty between 1 January 2011 and 31 December 2016. Data collected were: specialty, date of operation, operation code, trainee sex, training region, supervision level and date of award of NTN. Data were also collected on the number of trainees recommended for certification in each specialty per year, and the total number of trainees in each specialty per annum. Table 1 e-logbook recorded operations included Operation . e-logbook recorded operations included . Specialty . Anterior resection Rectum – anterior resection, coloanal anastomosis +/– pouch Rectum – anterior resection General surgery Carotid endarterectomy Carotid endarterectomy General surgery Carotid endarterectomy and patch Carotid endarterectomy, no patch Vascular Coronary artery bypass grafting Coronary artery bypass grafting alone Cardiothoracic surgery Excision of meningioma – convexity Excision of meningioma – convexity Neurosurgery Gastrectomy Total gastrectomy Subtotal gastrectomy D2 total gastrectomy D2 subtotal gastrectomy General surgery Prostatectomy Radical prostatectomy Urology Thyroidectomy Thyroid lobectomy Total thyroidectomy Total thyroidectomy + cervical nodes Subtotal thyroidectomy, toxic goitre General surgery Thyroid lobectomy Total thyroidectomy Hemithyroidectomy Subtotal thyroidectomy Otolaryngology Total hip replacement Total hip replacement cemented Trauma and orthopaedics Operation . e-logbook recorded operations included . Specialty . Anterior resection Rectum – anterior resection, coloanal anastomosis +/– pouch Rectum – anterior resection General surgery Carotid endarterectomy Carotid endarterectomy General surgery Carotid endarterectomy and patch Carotid endarterectomy, no patch Vascular Coronary artery bypass grafting Coronary artery bypass grafting alone Cardiothoracic surgery Excision of meningioma – convexity Excision of meningioma – convexity Neurosurgery Gastrectomy Total gastrectomy Subtotal gastrectomy D2 total gastrectomy D2 subtotal gastrectomy General surgery Prostatectomy Radical prostatectomy Urology Thyroidectomy Thyroid lobectomy Total thyroidectomy Total thyroidectomy + cervical nodes Subtotal thyroidectomy, toxic goitre General surgery Thyroid lobectomy Total thyroidectomy Hemithyroidectomy Subtotal thyroidectomy Otolaryngology Total hip replacement Total hip replacement cemented Trauma and orthopaedics Open in new tab Table 1 e-logbook recorded operations included Operation . e-logbook recorded operations included . Specialty . Anterior resection Rectum – anterior resection, coloanal anastomosis +/– pouch Rectum – anterior resection General surgery Carotid endarterectomy Carotid endarterectomy General surgery Carotid endarterectomy and patch Carotid endarterectomy, no patch Vascular Coronary artery bypass grafting Coronary artery bypass grafting alone Cardiothoracic surgery Excision of meningioma – convexity Excision of meningioma – convexity Neurosurgery Gastrectomy Total gastrectomy Subtotal gastrectomy D2 total gastrectomy D2 subtotal gastrectomy General surgery Prostatectomy Radical prostatectomy Urology Thyroidectomy Thyroid lobectomy Total thyroidectomy Total thyroidectomy + cervical nodes Subtotal thyroidectomy, toxic goitre General surgery Thyroid lobectomy Total thyroidectomy Hemithyroidectomy Subtotal thyroidectomy Otolaryngology Total hip replacement Total hip replacement cemented Trauma and orthopaedics Operation . e-logbook recorded operations included . Specialty . Anterior resection Rectum – anterior resection, coloanal anastomosis +/– pouch Rectum – anterior resection General surgery Carotid endarterectomy Carotid endarterectomy General surgery Carotid endarterectomy and patch Carotid endarterectomy, no patch Vascular Coronary artery bypass grafting Coronary artery bypass grafting alone Cardiothoracic surgery Excision of meningioma – convexity Excision of meningioma – convexity Neurosurgery Gastrectomy Total gastrectomy Subtotal gastrectomy D2 total gastrectomy D2 subtotal gastrectomy General surgery Prostatectomy Radical prostatectomy Urology Thyroidectomy Thyroid lobectomy Total thyroidectomy Total thyroidectomy + cervical nodes Subtotal thyroidectomy, toxic goitre General surgery Thyroid lobectomy Total thyroidectomy Hemithyroidectomy Subtotal thyroidectomy Otolaryngology Total hip replacement Total hip replacement cemented Trauma and orthopaedics Open in new tab Procedures in which the trainee had recorded performing only a component of the operation were excluded. Those recorded as observed were reclassified as assisting, and those documented as training another trainee were reclassified as performed. All undefined supervision levels were excluded from analysis. For the purposes of this study, training grade was recorded as number of years since award of NTN as of 1 January of the respective calendar year of interest. Those who had completed less than 3 years of training since award of NTN were classified as junior and those who had completed 3 years or more of training were classified as senior. Statistical analysis Data are presented as a comparison of before and after surgical outcomes reporting, as defined by the date when the national clinical audit relevant to the index operation was included in the Consultant Outcome Publication programme (either 2013 or 2014; Appendix S1, supporting information). Trainee involvement in the operation was defined in two ways: trainee performed the operation regardless of level of supervision (STS/STU/P) versus trainee assisted (A); and supervised – trainer unscrubbed and trainee performed (STU/P) versus trainee assisted and supervised – trainer scrubbed (A/STS). Differences in trainee involvement in surgery before and after the publication of surgeon-specific outcomes were tested using Pearson χ2 and Kruskal–Wallis tests for categorical and continuous variables respectively. Univariable and mixed-effects hierarchical multilevel logistic regression models were constructed with two levels: trainees nested within training regions (treated as a random effect). Other explanatory variables included, such as sex, differences in the proportions of trainees at different training levels (classified as junior or senior), and specialty where multiple specialties performed the included operation, were all treated as fixed effects. Model discriminative ability was determined using the C-statistic (area under the receiver operator curve). Coefficients generated are presented as odds ratios (ORs) with 95 per cent confidence intervals. All analyses were performed in R version 3.1.1 (R Foundation for Statistical Computing, Vienna, Austria) using the packages forcats, tidyverse, Hmisc, gdata, pglm, lme4, summarizer, pROC and tidyforest. Results The total number of recorded operations included in this study was 163 076. Some 38 419 were recorded by female trainees and 124 657 by male trainees (Table 2). The total number of trainees registered in each specialty per annum included in this study, as well as the total number of trainees recommended for certification per annum, is shown in Table S3 (supporting information). Table 2 Demographic data . Anterior resection (n = 34 538) . Carotid endarterectomy (n = 16 953) . Coronary artery bypass grafting (n = 15 727) . Excision of meningioma – convexity (n = 1705) . Gastrectomy (n = 6656) . Prostatectomy (n = 4016) . Thyroidectomy (n = 31 650) . Total hip replacement – cemented (n = 51 831) . All operations (n = 163 076) . Year 2011 5730 3013 1477 243 1089 977 5162 7916 25 607 2012 6157 3138 2291 293 1186 896 5215 8708 27 884 2013 5969 2758 2698 282 1183 739 5263 8982 27 874 2014 5810 2628 2776 273 1055 606 5362 8424 26 934 2015 5586 2752 3369 327 1123 450 5326 8913 27 846 2016 5286 2664 3116 287 1020 348 5322 8888 26 931 Sex F 10 006 4633 3028 261 1531 578 10 998 7384 38 419 M 24 532 12 320 12 699 1444 5125 3438 20 652 44 447 124 657 Training level Junior 9630 5972 8462 359 1378 1528 12 279 19 737 59 345 Senior 24 908 10 981 7265 1346 5278 2488 19 371 32 094 103 731 Training region England 28 715 13 921 14 469 1530 5379 2867 27 130 39 121 133 132 Northern Ireland 1017 680 143 30 309 158 853 1198 4388 Scotland 3523 1583 590 110 648 581 2848 10 703 20 586 Wales 1283 769 525 35 320 410 819 809 4970 Supervision level Assisted 16 275 8154 8741 416 3473 3043 12 875 25 358 78 335 Supervised –trainerscrubbed 16 975 7433 5178 748 2986 864 15 355 21 911 71 450 Supervised – trainerunscrubbed 651 561 432 113 120 22 1302 1248 4449 Performed 637 805 1376 428 77 87 2118 3314 8842 . Anterior resection (n = 34 538) . Carotid endarterectomy (n = 16 953) . Coronary artery bypass grafting (n = 15 727) . Excision of meningioma – convexity (n = 1705) . Gastrectomy (n = 6656) . Prostatectomy (n = 4016) . Thyroidectomy (n = 31 650) . Total hip replacement – cemented (n = 51 831) . All operations (n = 163 076) . Year 2011 5730 3013 1477 243 1089 977 5162 7916 25 607 2012 6157 3138 2291 293 1186 896 5215 8708 27 884 2013 5969 2758 2698 282 1183 739 5263 8982 27 874 2014 5810 2628 2776 273 1055 606 5362 8424 26 934 2015 5586 2752 3369 327 1123 450 5326 8913 27 846 2016 5286 2664 3116 287 1020 348 5322 8888 26 931 Sex F 10 006 4633 3028 261 1531 578 10 998 7384 38 419 M 24 532 12 320 12 699 1444 5125 3438 20 652 44 447 124 657 Training level Junior 9630 5972 8462 359 1378 1528 12 279 19 737 59 345 Senior 24 908 10 981 7265 1346 5278 2488 19 371 32 094 103 731 Training region England 28 715 13 921 14 469 1530 5379 2867 27 130 39 121 133 132 Northern Ireland 1017 680 143 30 309 158 853 1198 4388 Scotland 3523 1583 590 110 648 581 2848 10 703 20 586 Wales 1283 769 525 35 320 410 819 809 4970 Supervision level Assisted 16 275 8154 8741 416 3473 3043 12 875 25 358 78 335 Supervised –trainerscrubbed 16 975 7433 5178 748 2986 864 15 355 21 911 71 450 Supervised – trainerunscrubbed 651 561 432 113 120 22 1302 1248 4449 Performed 637 805 1376 428 77 87 2118 3314 8842 Open in new tab Table 2 Demographic data . Anterior resection (n = 34 538) . Carotid endarterectomy (n = 16 953) . Coronary artery bypass grafting (n = 15 727) . Excision of meningioma – convexity (n = 1705) . Gastrectomy (n = 6656) . Prostatectomy (n = 4016) . Thyroidectomy (n = 31 650) . Total hip replacement – cemented (n = 51 831) . All operations (n = 163 076) . Year 2011 5730 3013 1477 243 1089 977 5162 7916 25 607 2012 6157 3138 2291 293 1186 896 5215 8708 27 884 2013 5969 2758 2698 282 1183 739 5263 8982 27 874 2014 5810 2628 2776 273 1055 606 5362 8424 26 934 2015 5586 2752 3369 327 1123 450 5326 8913 27 846 2016 5286 2664 3116 287 1020 348 5322 8888 26 931 Sex F 10 006 4633 3028 261 1531 578 10 998 7384 38 419 M 24 532 12 320 12 699 1444 5125 3438 20 652 44 447 124 657 Training level Junior 9630 5972 8462 359 1378 1528 12 279 19 737 59 345 Senior 24 908 10 981 7265 1346 5278 2488 19 371 32 094 103 731 Training region England 28 715 13 921 14 469 1530 5379 2867 27 130 39 121 133 132 Northern Ireland 1017 680 143 30 309 158 853 1198 4388 Scotland 3523 1583 590 110 648 581 2848 10 703 20 586 Wales 1283 769 525 35 320 410 819 809 4970 Supervision level Assisted 16 275 8154 8741 416 3473 3043 12 875 25 358 78 335 Supervised –trainerscrubbed 16 975 7433 5178 748 2986 864 15 355 21 911 71 450 Supervised – trainerunscrubbed 651 561 432 113 120 22 1302 1248 4449 Performed 637 805 1376 428 77 87 2118 3314 8842 . Anterior resection (n = 34 538) . Carotid endarterectomy (n = 16 953) . Coronary artery bypass grafting (n = 15 727) . Excision of meningioma – convexity (n = 1705) . Gastrectomy (n = 6656) . Prostatectomy (n = 4016) . Thyroidectomy (n = 31 650) . Total hip replacement – cemented (n = 51 831) . All operations (n = 163 076) . Year 2011 5730 3013 1477 243 1089 977 5162 7916 25 607 2012 6157 3138 2291 293 1186 896 5215 8708 27 884 2013 5969 2758 2698 282 1183 739 5263 8982 27 874 2014 5810 2628 2776 273 1055 606 5362 8424 26 934 2015 5586 2752 3369 327 1123 450 5326 8913 27 846 2016 5286 2664 3116 287 1020 348 5322 8888 26 931 Sex F 10 006 4633 3028 261 1531 578 10 998 7384 38 419 M 24 532 12 320 12 699 1444 5125 3438 20 652 44 447 124 657 Training level Junior 9630 5972 8462 359 1378 1528 12 279 19 737 59 345 Senior 24 908 10 981 7265 1346 5278 2488 19 371 32 094 103 731 Training region England 28 715 13 921 14 469 1530 5379 2867 27 130 39 121 133 132 Northern Ireland 1017 680 143 30 309 158 853 1198 4388 Scotland 3523 1583 590 110 648 581 2848 10 703 20 586 Wales 1283 769 525 35 320 410 819 809 4970 Supervision level Assisted 16 275 8154 8741 416 3473 3043 12 875 25 358 78 335 Supervised –trainerscrubbed 16 975 7433 5178 748 2986 864 15 355 21 911 71 450 Supervised – trainerunscrubbed 651 561 432 113 120 22 1302 1248 4449 Performed 637 805 1376 428 77 87 2118 3314 8842 Open in new tab Trainee involvement After the introduction of publication of surgeon-specific outcomes, there was an increase in the percentage of procedures in which the trainee performed the operation regardless of level of supervision (STS/STU/P) rather than assisting (A) for anterior resection of rectum (OR 1·33, 95 per cent c.i. 1·28 to 1·40; P < 0·001), carotid endarterectomy (OR 1·19, 1·11 to 1·29; P < 0·001), gastrectomy (OR 1·21, 1·10 to 1·34; P < 0·001), meningioma excision (OR 1·70, 1·34 to 2·16; P < 0·001), prostatectomy (OR 1·37, 1·18 to 1·60; P < 0·001) and thyroidectomy (OR 1·12, 1·07 to 1·17; P < 0·001). However, for CABG (OR 0·59, 1·55 to 1·64; P < 0·001) and THR (OR 0·96, 0·93 to 1·00; P = 0·031), the opposite effect was apparent (Fig. 1). This was confirmed by univariable and multivariable analysis, when evaluated by individual year (2011–2016) regardless of region, sex, training grade and operation code (Table S4, supporting information). Fig. 1 Open in new tabDownload slide Effect of introduction of surgeon-specific outcomes on trainee involvement STS, supervised – trainer scrubbed; STU, supervised – trainer unscrubbed; P, performed; A, assisting. Supervisor involvement After the introduction of publication of surgeon-specific outcomes, there was an increase in the percentage of procedures in which the trainer was not scrubbed (STU/P versus A/STS) for anterior resection of rectum (OR 1·31, 95 per cent c.i. 1·26 to 1·37; P < 0·001), carotid endarterectomy (OR 1·19, 1·11 to 1·28; P < 0·001), gastrectomy (OR 1·22, 1·10 to 1·35; P < 0·001) and thyroidectomy (OR 1·08, 1·03 to 1·13; P = 0·001). However, for CABG (OR 0·58, 0·55 to 0·63; P < 0·001) the opposite effect was apparent. There was no difference seen for excision of meningioma (OR 0·94, 0·76 to 1·17; P = 0·599), prostatectomy (OR 1·15, 0·77 to 1·75; P = 0·471) and THR (OR 0·99, 0·95 to 1·02; P = 0·501) (Fig. 2). This effect was confirmed by univariable and multivariable analysis, when evaluated by individual year (2011–2016) regardless of region, sex, training grade and operation code (Table S5, supporting information). Fig. 2 Open in new tabDownload slide Effect of introduction of surgeon-specific outcomes on supervisor involvement STU, supervised – trainer unscrubbed; P, performed; A, assisting; STS, supervised – trainer scrubbed. Discussion In contrast to the hypothesis, this study found evidence that training case exposure has increased rather than declined in most surgical specialties since surgeon-specific outcomes have been reported. This effect was seen in the years following its introduction in each national audit, and was consistent across sensitivity analyses for the degree of trainee involvement. However, the opposite effect was seen for CABG and THR. The reasons for these findings have not been explored in this study, and are likely to be multifactorial. Each national audit is managed by the relevant specialist association, and so there is potential for variable attitudes towards outcomes reporting and surgical training exposure. Certainly, there is much evidence to support that trainees under appropriate supervision have similar outcomes to trainers, and hence should not affect published outcomes13–18. Further exploration of trainers' attitudes towards outcomes publication and training should be performed by qualitative analysis. Recommended numbers of index procedures within surgical specialties to obtain certification were introduced by the JCST at varying time points during the study, and may have had an impact on the results. For example, recommended procedure numbers in general surgery were introduced during 2013, whereas this occurred later in 2016 for cardiothoracic surgery. There is also a difference between specialties in that some state an indicative overall number of major procedures relevant to their specialist interest (for example cardiac procedures) and others specify an indicative number of specified index procedures (such as anterior resection of rectum for general surgical trainees with a colorectal surgery special interest). With a change in certification guidance during the study interval, it may be that trainees in the later years were more focused on the achievement of specific experience and competencies. A number of variables may have confounded the results for cardiothoracic surgery and orthopaedics. There appeared to be a slower uptake of recording of e-logbook data by trainees in cardiothoracic surgery than in the other specialties in the years just before this study (297 CABG and 2740 carotid endarterectomy procedures in 2010, compared with 1477 and 3013 respectively in 2011). It is possible that data from the early years of this study are less reflective of true practice in the specialties that had less buy-in to mandatory trainee e-logbook use at an earlier stage. Khan and colleagues19 previously found that training exposure was reduced following the original introduction of surgeon outcome reporting in cardiothoracic surgery, in 2002–2004 in a retrospective analysis at a single hospital. In orthopaedics, in 2012, the Medicines and Healthcare products Regulatory Agency20 issued an update medical device alert for metal-on-metal hip replacements. This may explain why training exposure to hip surgery may have been decreased over the interval studied as trainers were more likely to perform hip surgery themselves. For excision of meningioma and prostatectomy, there were too few procedures to allow statistical analysis at the level of supervisor involvement (A/STS versus STU/P), which makes it difficult to draw any meaningful conclusions. Urology trainees are expected to achieve only ten radical prostatectomy procedures at level 1 (able to assist) PBA at certification. Therefore, the number of urology trainees who would likely record a radical prostatectomy procedure as STU or P would be expected to be low. There was also a decline in overall number of radical prostatectomies during the study, which is likely to have been due to an increase in robotic prostatectomy, which has a separate operation code. There are several limitations of this study. The data submitted to the e-logbook are at the discretion of the individual trainee, and so there may be a question regarding their validity. It was not possible to take account of the number of trainees who did not access theatre cases or the number of non-training-grade doctors involved in theatre procedures over time, so there may have been a variable number of operations performed without a trainee present. There is also a limitation in the present data set with accurate identification of trainees with a declared special interest, for example those who declared a special interest in upper gastrointestinal surgery, who therefore had specific training needs in gastrectomy. For this study, training grade was recorded as number of years since award of NTN as of 1 January of the respective calendar year of interest, and therefore failed to take into account part-time trainees, academic or military trainees, those taking time out of training (research, experience or career break), or trainees who required additional training time. The definition of junior or senior training grade used in univariable and multivariable analysis may therefore not be entirely accurate. However, grouping trainees into two broad cohorts aimed to minimize this error. Contrary to expectation, it was found that exposure to the index procedures in this study improved following the introduction of surgeon-specific outcome reporting, except in cardiac and orthopaedic surgery, where there appears to have been an adverse effect. These findings should reassure healthcare systems around the world that currently have, or are planning to implement, similar publication. Acknowledgements The authors acknowledge C. Santos (JCST ISCP Data Manager). Disclosure: The authors declare no conflict of interest. Open in new tabDownload slide References 1 Bristol Royal Infirmary Inquiry . The Report of the Public Inquiry into Children's Heart Surgery at the Bristol Royal Infirmary 1984–1995: Learning from Bristol . Chaired by I. Kennedy; 2001 . http://webarchive.nationalarchives.gov.uk/20090811143745/http:/www.bristol-inquiry.org.uk/final_report/the_report.pdf [accessed 28 October 2018]. 2 Healthcare Quality Improvement Partnership . 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All Metal-on-Metal (MoM) Hip Replacements: Updated Advice for Follow-up of Patient ; 2017 . https://www.gov.uk/drug-device-alerts/medical-device-alert-metal-on-metal-mom-hip-replacements-updated-advice-with-patient-follow-ups [accessed 28 October 2018]. © 2019 BJS Society Ltd Published by John Wiley & Sons Ltd This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © 2019 BJS Society Ltd Published by John Wiley & Sons Ltd
TI - Effect of publishing surgeon-specific outcomes on surgical training
JO - British Journal of Surgery
DO - 10.1002/bjs.11150
DA - 2019-07-01
UR - https://www.deepdyve.com/lp/oxford-university-press/effect-of-publishing-surgeon-specific-outcomes-on-surgical-training-RWGrls9KSN
SP - 1019
EP - 1025
VL - 106
IS - 8
DP - DeepDyve
ER -