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Emergency General Surgery; are Trainers and Trainees perspectives in line with population needs?

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Background

In the last five years publication of several key documents has raised the profile of Emergency General Surgery (EGS). Many more consultant surgeon posts (over 20%) are being advertised for general and emergency surgeons.  This suggests a gap in need at trust level which may be unaddressed by the current lack of subspecialty training programme in EGS.

The aim of this study was to ascertain both Consultants and Trainees opinion with regards to experience and attitudes towards Emergency General Surgery in 2014, but is this in line with the expectations of trainees and consultants?

 

Methods

An online tool (www.surveymonkey.net) was used to determine UK experience and attitudes towards Emergency General Surgery (EGS).  One online link was distributed to Consultant members of the ASGBI excluding those appointed as EGS Consultants and a different link to all UK trainees in national training number (NTN) posts (not including ROI trainees) in January 2014.  Results were analysed using R commander.  Chi squared test was used for categorical variables. 

 

Results

309 trainees, ST3-8 level or equivalent (22.8% response rate), and 229 consultants (28% response rate) responded to the survey. More males than females responded to both surveys (89.6% trainees, 86.6% consultants).  Most consultants had been in post for more than ten years (67.1%) and subspecialty interest was wide ranging (fig 1, Fig 2).

More recently appointed consultants less often felt ready for independent EGS duty than those appointed previously10-20 yrs in post (80% ready)
5-10 yrs in post (70% ready)
2-5 yrs in post (62% ready)
52% of consultants in post <5yrs would have felt ‘better prepared’ for EGS with a dedicated period of EGS training, compared with 13% of those in post >20yrs (p=0.022)

92.4% of trainees felt more intensive training in emergency surgery would be beneficial to their training i.e. 6 month post in acute surgery

Only 8.2% of trainees stated EGS as their long-term career plan. Aspects cited as potentially increasing their interest in EGS are shown in box 1.

When asked to rank levels of interest, EGS and general surgery were popular second choices (fig 2, blue).
Reason for lack of interest is shown in Fig 3. 
 
44% of consultants see EGS as a subspecialty
70% of consultants envisage a future model of EGS cover utilising EGS surgeons.
21% of trainees believe EGS will be delivered by EGS consultants
 
Conclusion

It is an exciting time for EGS and changes should be embraced.  24% percent of all posts advertised now are EGS or General surgery posts.  Our study has highlights the disparity between public and societal need, and career aspirations of higher surgical trainees. A dedicated period of EGS training during higher surgical training is welcomed by the majority of current trainees.

It is likely that EGS Provision within the NHS will continue to undergo significant change over the next decade. Current higher surgical training and ever increasing specialty training does not encourage trainees to pursue more general career paths and this may be detrimental to the future of UK emergency surgical service provision.

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