To obtain detailed information about the degree of surgical trainee supervision and delegation of procedures in a subspecialised department.
Operative procedures and their logical components were recorded in a database constructed in Microsoft Access. Information about operating surgeon and assistants and their grade was registered prospectively over 12 months.
A total of 1250 intermediate or major procedures were performed by eight consultants, one staff specialist, four senior registrars, three specialist registrars, and five registrars.
Number of components performed by surgeons in each grade and the degree of supervision and delegation.
Eight hundred and eighty five of the operations were elective, while 365 were done as emergency procedures. Emergency procedures were far more often done by surgeons in training than by a staff surgeon, while the opposite was true for elective operations. Out of 323 elective operations done by surgeons in training, 189 were done under supervision (58.5%), while 119 out of 276 emergency operations done by surgeons in training were supervised (43.1%; p=0.0002). One hundred and twenty eight of 638 (20%) open abdominal operations were done by the most junior surgeons, and yet they closed 36% of all abdominal wounds. Although the most junior surgeons only served as operating surgeons in 39 of 334 bowel operations (12%), they constructed 24% of all stomas, and 20% of all anastomoses. Registrars and specialist registrars never constructed stomas or anastomoses without supervision.
Detailed information about individual and general training and supervision was achieved by a simple registration. Significant additional information was obtained about the extent of delegation of components compared with standard registration of operative procedures.
Cites: J R Soc Med. 1999 Jul;92(7):329-3110615268
Cites: Surgery. 2000 Oct;128(4):613-2211015095
Cites: Hosp Med. 1999 Mar;60(3):210-110476246
Cites: Ann R Coll Surg Engl. 1999 Mar;81(2 Suppl):73-510364933
Cites: BMJ. 1999 Mar 13;318(7185):702-310074013
Cites: BMJ. 1999 Mar 13;318(7185):682-310073992
Cites: Surg Endosc. 1998 Jul;12(7):960-29632870
Cites: J Laparoendosc Adv Surg Tech A. 1997 Feb;7(1):29-359453862
Cites: BMJ. 1997 Nov 15;315(7118):1306-79390067
Cites: BMJ. 2001 Dec 1;323(7324):126611731377
Cites: Br J Surg. 1991 Oct;78(10):1156-81958972
Cites: Ann R Coll Surg Engl. 1994 Jul;76(4 Suppl):176-818092743
Cites: Ann R Coll Surg Engl. 1996 Jan;78(1 Suppl):11-38659992
Cites: Ann R Coll Surg Engl. 1996 Jul;78(4 Suppl):177-98943622