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      A cross sectional study of surgical training among United Kingdom general practitioners with specialist interests in surgery

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          Abstract

          Objectives

          Increasing numbers of minor surgical procedures are being performed in the community. In the UK, general practitioners (family medicine physicians) with a specialist interest (GPwSI) in surgery frequently undertake them. This shift has caused decreases in available cases for junior surgeons to gain and consolidate operative skills. This study evaluated GPwSI's case-load, procedural training and perceptions of offering formalised operative training experience to surgical trainees.

          Design

          Prospective, questionnaire-based cross-sectional study.

          Setting/participants

          A novel, 13-item, self-administered questionnaire was distributed to members of the Association of Surgeons in Primary Care (ASPC). A total 113 of 120 ASPC members completed the questionnaire, representing a 94% response rate. Respondents were general practitioners practising or intending to practice surgery in the community.

          Results

          Respondents performed a mean of 38 (range 5–150) surgical procedures per month in primary care. 37% (42/113) of respondents had previously been awarded Membership or Fellowship of a Surgical Royal College; 22% (25/113) had completed a surgical certificate or diploma or undertaken a course of less than 1 year duration. 41% (46/113) had no formal British surgical qualifications. All respondents believed that surgical training in primary care could be valuable for surgical trainees, and the majority (71/113, 63%) felt that both general practice and surgical trainees could benefit equally from such training.

          Conclusions

          There is a significant volume of surgical procedures being undertaken in the community by general practitioners, with the capacity and appetite for training of prospective surgeons in this setting, providing appropriate standards are achieved and maintained, commensurate with current standards in secondary care. Surgical experience and training of GPwSI's in surgery is highly varied, and does not yet benefit from the quality assurance secondary care surgical training in the UK undergoes. The Royal Colleges of Surgery and General Practice are well placed to invest in such infrastructure to provide long-term, high-quality service and training in the community.

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          Most cited references27

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          Improving the future of surgical training and education: consensus recommendations from the Association of Surgeons in Training.

          In the past decade surgical training in the United Kingdom (UK) has seen radical overhaul with the introduction of formal training curricula, competency based assessment, and a new Core Surgical Training programme. Despite this, and in common with many other countries, numerous threats remain to sustaining high-quality surgical training and education in the modern working environment. These include service delivery pressures and the reduction in working hours. There are numerous areas for potential improvement and dissemination of best training practice, from incentivising training within the National Health Service (NHS) through top-down government initiatives, to individualised information and feedback for trainees at the front-line. This document sets out the current structure of surgical training in the UK, and describes the contribution to the current debate by the Association of Surgeons in Training. Highlighting areas for improvement at national, regional, local and individual levels, the Association proposes 34 action points to enhance surgical training and education. Adoption of these will ensure future practice continues to improve on, and learn from, the longstanding history of training provided under the guidance of the Royal Surgical Colleges. Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
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            Publication of surgeon specific outcome data: a review of implementation, controversies and the potential impact on surgical training.

            Government-mandated publication of named surgeon-specific outcome data (SSD) has recently been introduced across nine surgical speciality areas in England. This move is the first time that such national data has been released in any country, and it promises to provide a significant advancement in health service transparency. Data is derived from nine preexisting national surgical audit databases. However, eight of these were not originally designed for this purpose, and there is considerable controversy surrounding data quality, risk adjustment, patient use and interpretation, and surgeons' subsequent case selection. Concerns also surround the degree to which these results truly reflect the individual consultant, or the wider hospital team and accompanying resources. The potential impact on surgical training has largely been overlooked. This paper investigated the background to SSD publication and controversies surrounding this, the potential impact on surgical training and the response to these concerns from medical and surgical leaders. As SSD collection continues to be refined, the most appropriate outcomes measurements need to be established, and risk adjustment requires ongoing improvement and validation. Prospective evaluation of changes in surgical training should be undertaken, as any degradation of will have both short and long-term consequences for patients and surgeons alike. It is important that the literature supporting the safety of supervised trainee practice is also promoted in order to counterbalance any potential concerns that might detract from trainee operating opportunities. Finally, it is important that outcomes data is communicated to patients in the most meaningful way in order to facilitate their understanding and interpretation given the complexities of the data and analysis involved.
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              Excising basal cell carcinomas: comparing the performance of general practitioners, hospital skin specialists and other hospital specialists.

              General practitioners (GPs) are not encouraged to excise basal cell carcinomas (BCCs). Despite this, as many of 10% of BCCs may be excised by GPs. GPs may be able to have a greater role in the diagnosis and management of BCC, but much needs to be learnt before this can be advocated.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2015
                8 April 2015
                : 5
                : 4
                : e007677
                Affiliations
                [1 ]The Association of Surgeons in Training , London, UK
                [2 ]University of Birmingham , Birmingham, UK
                [3 ]Queen Elizabeth Hospital , Birmingham, UK
                [4 ]University College London , London, UK
                [5 ]Royal Free Hospital , London, UK
                [6 ]Saint John's Hospital , Livingston, West Lothian, UK
                [7 ]Royal College of Surgeons of England , London, UK
                [8 ]Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University , Göteborg, Sweden
                [9 ]University of Leicester , Leicester, UK
                Author notes
                [Correspondence to ] H J M Ferguson; fergusonh@ 123456doctors.org.uk
                Article
                bmjopen-2015-007677
                10.1136/bmjopen-2015-007677
                4390688
                25854975
                02c6c6c8-7d0c-46e1-854b-5079905a05ad
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 14 January 2015
                : 12 March 2015
                : 18 March 2015
                Categories
                Surgery
                Research
                1506
                1737
                1696
                1709
                1737

                Medicine
                community surgery,surgical training,medical education & training,surgery
                Medicine
                community surgery, surgical training, medical education & training, surgery

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