Aims. The aims of this study were to describe the demographic, socioeconomic, and educational factors associated with core surgical trainees (CSTs) who apply to and receive offers for higher surgical training (ST3) posts in Trauma & Orthopaedics (T&O). Methods. Data collected by the UK Medical Education Database (UKMED) between 1 January 2014 and 31 December 2019 were used in this retrospective longitudinal cohort study comprising 1,960 CSTs eligible for
Aim. S. aureus and S. epidermidis remain the leading biofilm-forming agents causing orthopedic implant-associated infections (OIAI), but other coagulase-negative Staphylococcus (CoNS) with clinical importance is emerging. Besides, few studies have assessed specific genomic traits associated with patient outcome. This is a preliminary descriptive study of phenotypic and genomic features identified in clinical isolates of S. aureus and CoNS isolates recovered from OIAIs patients that progressed to treatment failure. Methods. Ten isolates were identified by matrix-time-of-flight laser-assisted desorption mass spectrometry (MALDI-TOF-MS) and tested for antibiotic susceptibility and biofilm formation. Genotypic characteristics, including, MLST (Multi Locus Sequence Typing), SCCmec typing, virulence and resistance genes were assessed by whole-genome sequencing (WGS) that was performed on an Illumina HiSeq 2500 platform. Bioinformatics analyzes were performed using CGE, PATRIC, VFDB, CARD RGI, SnapGene, BLAST, and PubMLST. S. aureus (215, 260 and 371) isolates belonged to CC5 (ST5 and ST105, spa type t002) and carried SCCmec type I (1B), II (2A) and V(5C2), respectively. Results. They carried multiple resistance genes, with all resistant to methicillin (MRSA), and harboured mecA, blaZ. S. aureus 215 and 371 carried ermA gene and multiple genes for aminoglycosides resistance including aph(3’)-III, ant(9)-Ia, and ant(4)-Ib, and for quinolones. S. aureus 260 also carried resistance genes for tetracycline, quinolones and trimethoprim (dfrC). All MRSA were strong biofilm producers harboring the complete icaADBC and icaR operon, and also carried multiple adhesion and toxin-related virulence genes. Seven CoNS isolates comprising five species (S. epidermidis, S. haemolyticus, S. sciuri, S. capitis and S. lugdunensis) were analyzed, with mecA gene detection in five isolates. S. haemolitycus (95) and S. lugdunensis were unable to form biofilm and did not harbor the complete icaADBCR operon. S. epidermidis (216, 403) and S. haemolyticus (53,95) isolates belonged to the ST2/CC2, ST183, ST9 and
Nationwide changes in the organisation of specialist medical training present a challenge to surgical trainees in terms of exposure to an adequate case load, the acquisition of practical experience and therefore also of judgement and decision-making. When accompanied by accredited trainers exposure to practice in the developing world offers trainees the opportunity to enhance their clinical exposure as well as skills in communication, teaching, management and leadership. This paper analyses the training value for orthopaedic trainees of a novel orthopaedic project undertaken in Kenya in February 2009 utilising an entire UK orthopaedic team. The first Kenya Orthopaedic Project (KOP) was organised by an orthopaedic trainee and took place at Nanyuki District General Hospital in February 2009. Kenya does not have the luxury of a national health service and patients must pay for any clinics or surgery. The cost of orthopaedic surgery in this environment is prohibitive and many fractures go untreated, as do other common pathologies such as severe osteoarthritis and osteomyelitis. The UK team undertaking the project included two accredited consultant orthopaedic surgeons and an orthopaedic trainee. Clinics, surgery and teaching sessions were performed for one week with the aim of relieving the sheer volume of orthopaedic cases and to provide those impoverished patients with treatment they would not otherwise receive. Data was taken from elogbook to analyse the average number of cases performed by an orthopaedic
Global literature suggests that female surgical trainees have lower rates of independent operating (operative autonomy) than their male counterparts. The objective of this study was to identify any association between gender and lead/independent operating in speciality orthopaedic trainees within the UK national training programme. This was a retrospective case-control study using electronic surgical logbook data from 2009 to 2021 for 274 UK orthopaedic trainees. Total operative numbers and level of supervision were compared between male and female trainees, with correction for less than full-time training (LTFT), prior experience, and time out during training (OOP). The primary outcome was the percentage of cases undertaken as lead surgeon (supervised and unsupervised) by UK orthopaedic trainees by gender.Aims
Methods
Skills simulation is increasingly used as a training tool in postgraduate surgical training. Trainee's perception of the value of this experience has not previously been investigated. Our aim was to investigate the value of surgical simulation training delivered by an arthroscopy skills course. We constructed a subject-specific, self-assessment questionnaire based around the ISCP Peer Assessment Tool. The questionnaire was administered to candidates before and after attending the Plymouth Arthroscopy Skills Course. Participant demographic data was recorded. Questionnaire data was interrogated to give an overview of the course, as well as the benefit of site-specific skills stations. Statistical analysis showed the data to be normally distributed. The paired T-test was used to compare mean values. Twelve surgical trainees attended the course – CT2 trainees (n=4);
Skills simulation is increasingly used as a training tool in postgraduate surgical training. Trainee's perception of the value of this experience has not previously been investigated. The aim of this investigation was to investigate the value of surgical simulation training delivered by an arthroscopy skills course. We constructed a subject-specific, self-assessment questionnaire based around the ISCP Peer Assessment Tool. The questionnaire was administered to candidates before and after attending the Plymouth Arthroscopy Skills Course. Participant demographic data was recorded. Questionnaire data was interrogated to give an overview of the course, as well as the benefit of site-specific skills stations. Statistical analysis showed the data to be normally distributed. The paired T-test was used to compare mean values. Twelve surgical trainees attended the course – CT2 trainees (n=4);
Complete ruptures of the ulnar collateral ligament (UCL) of the thumb are a common injury, yet little is known about their current management in the UK. The objective of this study was to assess the way complete UCL ruptures are managed in the UK. We carried out a multicentre, survey-based cross-sectional study in 37 UK centres over a 16-month period from June 2022 to September 2023. The survey results were analyzed descriptively.Aims
Methods
The number of females within the speciality of trauma and orthopaedics (T&O) is increasing. The aim of this study was to identify: 1) current attitudes and behaviours of UK female T&O surgeons towards pregnancy; 2) any barriers faced towards pregnancy with a career in T&O surgery; and 3) areas for improvement. This is a cross-sectional study using an anonymous 13-section web-based survey distributed to female-identifying T&O trainees, speciality and associate specialist surgeons (SASs) and locally employed doctors (LEDs), fellows, and consultants in the UK. Demographic data was collected as well as closed and open questions with adaptive answering relating to attitudes towards childbearing and experiences of fertility and complications associated with pregnancy. A descriptive data analysis was carried out.Aims
Methods
This study sought to compare the rate of deep surgical site infection (SSI), as measured by the Centers for Disease Control and Prevention (CDC) definition, after surgery for a fracture of the hip between patients treated with standard dressings and those treated with incisional negative pressure wound therapy (iNPWT). Secondary objectives included determining the rate of recruitment and willingness to participate in the trial. The study was a two-arm multicentre randomized controlled feasibility trial that was embedded in the World Hip Trauma Evaluation cohort study. Any patient aged > 65 years having surgery for hip fracture at five recruitment centres in the UK was considered to be eligible. They were randomly allocated to have either a standard dressing or iNPWT after closure of the wound. The primary outcome measure was deep SSI at 30 and 90 days, diagnosed according to the CDC criteria. Secondary outcomes were: rate of recruitment; further surgery within 120 days; health-related quality of life (HRQoL) using the EuroQol five-level five-dimension questionnaire (EQ-5D-5L); and related complications within 120 days as well as mobility and residential status at this time.Aims
Methods
The imminent introduction of the new Trauma & Orthopaedic (T&O) curriculum, and the implementation of the Improving Surgical Training initiative, reflect yet another paradigm shift in the recent history of trauma and orthopaedic training. The move to outcome-based training without time constraints is a radical departure from the traditional time-based structure and represents an exciting new training frontier. This paper summarizes the history of T&O training reform, explains the rationale for change, and reflects on lessons learnt from the past. Cite this article:
Surgical treatment of hip fracture is challenging; the bone is porotic and fixation failure can be catastrophic. Novel implants are available which may yield superior clinical outcomes. This study compared the clinical effectiveness of the novel X-Bolt Hip System (XHS) with the sliding hip screw (SHS) for the treatment of fragility hip fractures. We conducted a multicentre, superiority, randomized controlled trial. Patients aged 60 years and older with a trochanteric hip fracture were recruited in ten acute UK NHS hospitals. Participants were randomly allocated to fixation of their fracture with XHS or SHS. A total of 1,128 participants were randomized with 564 participants allocated to each group. Participants and outcome assessors were blind to treatment allocation. The primary outcome was the EuroQol five-dimension five-level health status (EQ-5D-5L) utility at four months. The minimum clinically important difference in utility was pre-specified at 0.075. Secondary outcomes were EQ-5D-5L utility at 12 months, mortality, residential status, mobility, revision surgery, and radiological measures.Aims
Methods
There are significant differences in the methods and styles of orthopaedic surgical training between continents, all with the aim to produce competent consultant surgeons, but the differences in training content and pathway are vast. We review and contrast the key differences between three continents.
The annual incidence of hip fracture is 620 000 in the European Union. The cost of this clinical problem has been estimated at 1.75 million disability-adjusted life years lost, equating to 1.4% of the total healthcare burden in established market economies. Recent guidance from The National Institute for Health and Clinical Excellence (NICE) states that research into the clinical and cost effectiveness of total hip arthroplasty (THA) as a treatment for hip fracture is a priority. We asked the question: can a trial investigating THA for hip fracture currently be delivered in the NHS? We performed a contemporaneous process evaluation that provides a context for the interpretation of the findings of WHiTE Two – a randomised study of THA for hip fracture. We developed a mixed methods approach to situate the trial centre within the context of wider United Kingdom clinical practice. We focused on fidelity, implementation, acceptability and feasibility of both the trial processes and interventions to stakeholder groups, such as healthcare providers and patients.Objectives
Methods
The long-term functional outcome of total hip arthroplasty (THA)
performed by trainees is not known. A multicentre retrospective
study of 879 THAs was undertaken to investigate any differences
in outcome between those performed by trainee surgeons and consultants. A total of 879 patients with a mean age of 69.5 years (37 to
94) were included in the study; 584 THAs (66.4%) were undertaken
by consultants, 138 (15.7%) by junior trainees and 148 (16.8%) by
senior trainees. Patients were scored using the Harris Hip Score
(HHS) pre-operatively and at one, three, five, seven and ten years
post-operatively. Surgical outcome, complications and survival were
compared between groups. The effect of supervision was determined
by comparing supervised and unsupervised trainees. A primary univariate
analysis was used to select variables for inclusion in multivariate
analysis. Aims
Patients and Methods
The aim of this study was to investigate the
effect of training on the arthroscopic performance of a group of
medical students and to determine whether all students could be
trained to competence. Thirty-three medical students with no previous
experience of arthroscopy were randomised to a ‘Trained’ or an ‘Untrained’
cohort. They were required to carry out 30 episodes of two simulated
arthroscopic tasks (one shoulder and one knee). The primary outcome variable
was task success at each episode. Individuals achieved competence
when their learning curve stabilised. The secondary outcome was
technical dexterity, assessed objectively using a validated motion
analysis system. Six subjects in the ‘Untrained’ cohort failed to
achieve competence in the shoulder task, compared with one in the ‘Trained’
cohort. During the knee task, two subjects in each cohort failed
to achieve competence. Based on the objective motion analysis parameters,
the ‘Trained’ cohort performed better on the shoulder task (p <
0.05) but there was no significant difference for the knee task
(p >
0.05). Although
The Postgraduate Medical Education and Training Board wants either ‘run through’ or ‘uncoupled’ orthopaedic training to be adopted throughout the United Kingdom but it is not willing to let both continue together as is the current situation. This annotation explores the argument for and against ‘run through’ training.