Evaluation of Wales Postgraduate Medical and DentalEducation Deanery outcomes at core and higher generalsurgery before and after national reconfiguration, enhancedselection, and Joint Committee on Surgical Training definedcurricular standards

This thesis examines contemporary outcomes of surgical training in Wales and the UK. The hypotheses tested were: Core Surgical Training (CST) outcome is related to specific curricular defined goals, and themed focused CST rotations improve success at National Training Number (NTN)appointment; CST rotations including rural placements provide training comparable with non-rural placements; General Surgery (GS) Certificate of Completion of Training (CCT) curricular guidelines require focused appraisal and rotation planning; GS Higher Surgical Trainee (HST) indicative procedure targets are not in keeping with competence achievement determined by Procedural Based Assessment (PBA); Dedicated Emergency General Surgery (EGS) modules enhance HST training experience; H-Indices are a valid measure of GS consultant academic productivity and identify training research opportunity. Successful ST3 NTN appointment improved from 5.3 to 33.3% (p=0.005) following CST [OR 4.789 (1.666 - 13.763), p=0.004] and is independently associated with success. ST3 appointment was similar irrespective of rural or non-rural CST rotational placement (18.1 vs. 22.1%, p=0.695). Of the 155 UK GS HST CCTs awarded in 2013, global operative log book and academic achievements varied widely, with two-thirds of trainees achieving elective operative targets, but only half the requisite experience in EGS, and 5% nonoperative targets. Wales’ HSTs level 4 GS operative competencies varied 4- fold, ranging from 0.76 to 3.4 times national targets. EGS modular training introduction delivered a high volume of index EGS procedures and higher rates of PBA completion when compared with controls. H-indices were a robust measure of surgeons’ academic activity (p<0.001).