The Wider Surgical Team

Ian Eardley

Consultant Urologist

Leeds Teaching Hospital Trust

The Surgical Team

The Wider Surgical Team

• Loss of the “Surgical Firm”

• The RCS Extended Team Project

• Data from a Trainee Survey

Team Theory

• Interdependent team • No significant task can

be accomplished without the help and cooperation of any of the members

• Within that team, members typically specialise in different tasks

• The success of every individual is inextricably bound to the success of the whole team

The Traditional Surgical Team

The traditional

surgical team

Continuity

Safety

Mentoring

Apprentice

Reassurance

Satisfaction

The Problems

Problems

Reduced numbers of Core trainees

Loss of surgical

FY1 posts

Money EWTR

Simap and

Jaeger

My “On Call” week

Friday Saturday Sunday Monday Tuesday Wednesday

Thursday

Consultant IE IE IE IE IE IE IE

SPR SPR1 SPR2 SPR2 SPR3 SPR3 SPR3 SPR3

CT CT1 - - CT2 - CT3 -

FY FY1 FY2 (Psych)

FY2 (Psych)

FY3 FY3 FY3 FY4

Overnight SPR

(at home)

Different SPR on every night

Overnight CT2

(on site)

Different Core trainee on every night Paper handover of overnight admissions

The Consequences

Consequences

Loss of continuity

of care

Inefficient care

Patient safety issues

Reduced quality of training

An Alternative Workforce

• Advanced practitioners

• Surgical care practitioners

• Physician associates

SCP Scope of Practice

0 20 40 60 80 100 120 140

Preoperative assessment

Consent

Patient prep

Surgical assistant

Independent operating

Ward rounds

Post op care

Identification sick patients

On call / emergency

Outpatients

Training trainees

Prescribing

Weekly

Monthly

SCP Scope of Practice

0 20 40 60 80 100 120 140

Preoperative assessment

Consent

Patient prep

Surgical assistant

Independent operating

Ward rounds

Post op care

Identification sick patients

On call / emergency

Outpatients

Training trainees

Prescribing

Weekly

Monthly

SCP Scope of Practice

0 20 40 60 80 100 120 140

Preoperative assessment

Consent

Patient prep

Surgical assistant

Independent operating

Ward rounds

Post op care

Identification sick patients

On call / emergency

Outpatients

Training trainees

Prescribing

Weekly

Monthly

SCP Scope of Practice

0 20 40 60 80 100 120 140

Preoperative assessment

Consent

Patient prep

Surgical assistant

Independent operating

Ward rounds

Post op care

Identification sick patients

On call / emergency

Outpatients

Training trainees

Prescribing

Weekly

Monthly

RCS Extended Team Project (HEE Funded)

Trainee Survey

• FY1 FY2 Core trainees

• Workload

• Work Type

Task Analysis

• Diary Exercise

• FY1 FY2 Core trainees

Case Studies

• Visit of selected units

• Examples of good practice

July 2015 Oct / Nov 2015 Nov / Dec 2015

Write up and Report by Feb 2016

To explore the potential role of an alternative workforce to support Junior Doctors

Trainee Survey: Methodology

• Online survey targeted at foundation doctors and surgical trainees

(up to ST3)

• The link to the survey was publicised to CST1-2 and ST3 surgical

trainees through the websites and social media platforms of the

RCS, Association of Surgeons in Training, and British Orthopaedic

Trainees Association

• All foundation and surgical trainees (CST1-2, ST3) in three LETBs

were sent the survey directly by email from their postgraduate dean

• The survey was in the field for four weeks during July 2015

Results

406

355

73

74

82

F1

F2

CST1

CST2

ST3+

Base: 990 doctors in training

Foundation doctors

There were 15,395 foundation doctors in the UK in 2013 (GMC, 2014)

77% of our sample were foundation doctors

This survey was completed by 5% of all doctors in foundation training

Chart 14: Current stage of training

Surgeons in training

There were 4,371 surgeons in training in England in 2014 (RCS, 2015)

15% of respondents to complete this survey were core surgical trainees; 8% were higher surgical trainees (ST3 or above)

This survey was completed by 5% of surgeons in training in England

Service versus Training

74%

59%

49%

% time on 'service requirements'

Foundation trainees

Core trainees

Surgical trainees

Chart 12: % of time in average week spent delivering service requirements Base: 990 doctors in training

Foundation doctors are more likely than surgical trainees to report that a higher proportion of their time is spent delivering service requirements – rather than training in surgery

Higher surgical trainees report that less than half their time (49%) is spent delivering service requirements

Core trainees report that 59% of their time is spent on service delivery

Task Analysis

13

15

7

86

104

106

83

16

70

9

2

26

13

11

19

13

10

4

60

53

62

103

16

30

33

34

67

16

54

19

Receiving bedside teaching

Attending formal/didactic teaching

Attending simulation teaching/training

Undertaking ward rounds

Completing discharge paperwork and admin

Other administrative tasks

Clerking and admitting new patients

In meetings (e.g. MDT, M&M)

Performing simple procedures on foundation curriculum

Performing core surgical skills and procedures

In theatre as primary surgeon

In theatre as an assistant

In theatre observing surgery

In outpatient clinics

Undertaking audit, research or CPD

Foundation trainees

Surgical trainees

Chart 2: Mean amount of time spent during doctors’ last working shift (minutes) Base: 990 doctors in training

Foundation doctors spend significantly longer on ward rounds, paperwork and other administrative tasks, and performing simple practical procedures

Surgical trainees spend significantly longer clerking and admitting patients, performing core surgical skills, and in outpatient clinics

Time for teaching is low for both groups

Educational Value

4.6

3.7

4.6

2.2

3.7 3.6

4.2 3.9

4.2 4.1 3.8

4.6

2.0

3.9 3.9

4.9 4.5

4.1

Foundationtrainees

Surgical trainees

Chart 9: Mean educational value score (1-5) for each task Base: 990 doctors in training

Foundation doctors place highest educational value on receiving teaching, and clerking new patients

Surgical trainees place highest educational value on theatre time, receiving teaching and outpatient clinic work

Exposure to Common Surgical Conditions

84%

34%

20%

13%

79%

31%

79%

40%

95%

66%

68%

46%

87%

67%

93%

80%

90%

77%

82%

72%

84%

76%

87%

81%

Acute appendicitis

Acute limb ischaemia

Abdominal trauma

Ruptured aortic aneurysm

Acute urinary retention

Testicular torsion

Acute bowel obstruction

Fractured neck of femur

Foundationtrainees

CST1-2

ST3+

Chart 8: Experience of common surgical conditions – all trainees (%) Base: 990 doctors in training

Contracted Work Hours

45.3

47.4 47.7

48.4

50.8 51.1

Foundation traineesCore traineesHigher trainees

Average rota hours(weekly)

Average hoursworked (weekly)

Chart 11: Average week working hours in trainees’ surgical post

Base: 990 doctors in training

Overall, the 990 respondents were required to work an average of 45.8 hours and actually worked 49 hours on average, per week

Foundation doctors are required to work fewer hours than core and higher surgical trainees – and the hours they actually work are fewer than for surgical trainees

RCS Extended Team Project (HEE Funded)

Trainee Survey

•FY1 FY2 Core trainees

•Workload

•Work Type

Task analysis

•Diary Exercise

•FY1 FY2 Core trainees

Case studies

•Visit of selected units

•Examples of good practice

Outcomes

•Potential workforce models

•Potential for a Faculty within RCS