Abstract
Purpose of the study: What is the effect on the length of a procedure and the number of procedures performed on the list when a trainee is involved? What percentage of cases had trainee involvement for orthopaedic surgery?
Methods: Data was taken from two different sources, firstly, the ORMIS theatre system and patient operation notes. These were used to determine the length of six different types of orthopaedic procedures and the level of the main surgeon. The second source used was a consultant’s logbook comprising 227 primary total knee replacements between 2004 and 2008.
Results: The data collected via the ORMIS system produced trends suggesting trainees took longer to perform procedures than consultants. The data from the consultant logbook statistically proved this. List times appeared unaffected by trainee presence. In Orthopaedic surgeries, 92% times trainees were present during the procedure and out of this 17% cases were performed by trainees. For total knee replacements done by trainees the procedure took significantly longer surgical time than consultant performed procedures (p = 0.0337).
Among these cases, 71% were performed by senior trainees. The consultant’s log book data also suggested the similar trends. Statistically, trainee performed with consultant scrubbed versus consultant performed (P = < 0.0001), trainee performed with consultant in theatre versus consultant performed(P = 0.0318) and trainee performed with consultant scrubbed versus trainee performed with consultant in theatre (P = 0.002)
Discussion & Conclusion: To train the surgeon adds to the length of procedures and this is currently not accounted for, in the finance received to perform the operation by the hospital.
To counter this, training hospitals should be given financial incentives to train in surgery, or procedures performed by trainees should be priced differently to account for the time lost by training.
Correspondence should be addressed to: BASK c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
