Surgical training in the United Kingdom is undergoing substantial changes.
Dr Borowski and colleagues from the United Kingdom assessed the training opportunities available to trainees in operations for colorectal cancer.
The research team evaluated the effect of colorectal specialization on training, and the effect of consultant supervision on anastomotic complications, postoperative stay, operative mortality and 5-year survival.
The team made unadjusted and adjusted comparisons of outcomes for unsupervised trainees.
|Unsupervised operations reduced to 6% in 2002|
The researchers audited supervised trainees and consultants as the primary surgeon in 7,411 operated patients included in the Northern Region Colorectal Cancer Audit between 1998 and 2002.
The research team evaluated surgery performed in 656 patients by unsupervised trainees, and in 1578 patients by supervised trainees.
Unsupervised operations reduced from 12% in 1998 to 6% in 2002.
The team found consultants with a colorectal specialist interest were more likely than nonspecialists to be present at surgical resections, and to provide supervised training.
Patients operated on by unsupervised trainees were more often high-risk patients.
However, consultant presence was not significantly associated with operative mortality or survival in risk-adjusted analysis.
The team found supervised trainees had a case-mix similar to consultants, with shorter length of hospital stay, but similar mortality, and survival.
Dr Borowski’s team concluded, “A third of patients were operated on by trainees, who were more likely to perform supervised resections in colorectal teams.”
“There was no difference in anastomotic leaks rates, operative mortality or survival between unsupervised trainees, supervised trainees and consultants when case-mix adjustment was applied.”
“This study would suggest that there is considerable underused training capacity available.”