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Increasing learning opportunities in surgery

In partnership with Health Education England, the University Hospital of South Manchester’s pilot was designed to develop ways to increase the amount of training for core surgical trainees by putting in place dedicated training lists and safely enhance the development of surgical and professional skills through simulation.


Related themes

  • Rotas and scheduling
  • Multi-professional team
  • Change and empowering employees

Background

Nationally, there are only a finite numbers of hours available for core surgical training, which, alongside a reduction in cases (as surgery is being delivered differently), means it is essential that learning can be maximised in the time available. A review of the trainee logbooks at the University Hospital of South Manchester confirmed that these factors were also affecting their trainees’ exposure to operative core surgical training.

How they did it

The pilot improved patient safety, quality of care and core surgical training, by ring-fencing a proportion of existing operating lists as ‘BTBC lists’. The implementation of the pilot saw surgical lists protected for core trainees giving them the opportunity to carry out a wider variety of procedures and have access to a broader range of learning experiences.

A series of cadaveric skills workshops were developed to allow trainees to improve on their skills in a safe environment. This enabled them to transfer these into the clinical setting as part of their training timetable and deliver improved training without compromising patient care.

Core trainees in their first and second year completed all aspects of the patient’s journey through surgery with direct consultant supervision. This not only improved education and learning but offered a better patient experience as the patient saw the same surgeon before surgery and then post-operatively in the recovery area and on the ward.

Who was involved

A full time administrator and a clinical lead were required to develop and implement the project. Consultant champions were identified to deliver dedicated theatre lists as part of their existing job plans in the time allocated for direct clinical care (DCC) and supporting professional activities (SPAs).

Outcomes

  • Significantly improved amount of supervised operative training for core surgical trainees in most participating specialties using existing resources within the time available for training
  • Quality of patient care was maintained in an environment that supports training. This was supported by quantitative data around hernia surgical procedures that showed the standard of care was maintained while the procedure was conducted
  • A multi-professional learning environment was created as operating department practitioner (ODP) trainers and trainees were invited to join simulated workshops using cadavers. This saw improvements in multi-professional working and communication
  • 76% of trainees felt the theatre sessions were enough to gain the appropriate experience and 84% felt that the theatre lists had the right mix to suit their training needs
  • A 65% increase in the proportion of operations with a training component carried out by core surgical trainees in general surgery
  • The use of cadavers enabled trainees to gain confidence by getting experience in certain areas much earlier than they would have without the pilot
  • The hospital readmission rate is often viewed as a marker for quality of care. When operation records of all the patients on BTBC lists from August 2012 – July 2013 were analysed, it was found that none of the patients on the BTBC lists required readmission for a problem relating to their operation.

What they’ve said

“Revolutionary approach to postgraduate surgical training. Supervised, non-pressured training, with excellent hands on teaching and assessment” Trainee

“BTBC has provided trainees with the opportunity to practice their craft in a supervised learning environment whilst continuing to provide a service.” Postgraduate Medical Education Director

“The Better Training Better Care pilot has enhanced engagement between trainees and trainers. The programme has improved trainee feedback, encourages safe surgery, team working and mapping of clinical progression. A highlight has been the cross-disciplinary cadaveric course, which generated huge enthusiasm from participants and faculty.” Consultant Vascular Surgeon

Toolkit

Please look at the toolkit materials in the documents section below. The top tips and business cases have been developed by the BTBC team to support organisations to implement these changes and the case studies and project resources have been developed and approved by the project teams.

The top tips include lessons learnt that have been identified throughout the project. The business case will guide you through the management principles and communications and engagement activities. The case studies provide a detailed overview of the project. Feel free to adapt these resources to suit your projects. Your organisation may have its own materials and templates that you can use or you may find the NHS Improving Quality (NHS IQ) learning handbook useful too.

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