Is day case surgery the key to basic surgical training?

Abstract

The logbooks of 5 senior house officers (SHOs) were audited to determine progression of surgical skills on a single vascular firm. Total surgical experience and, in particular, experience in varicose vein and arterio-venous fistula surgery, performed in the day-case unit (DCU), were examined. Trainees were divided into those undertaking their first surgical SHO post (group 1, n = 2) and those who had had previous surgical exposure (group 2, n = 3) on the basic surgical training rotation. SHOs were exposed to a mean of 273 (+/- 41 SD) operative cases in 6 months. Emergency work comprised 15% (+/- 7%) of workload. Day cases accounted for 35% (+/- 3%) of elective workload. A mean of 66 (+/- 5) varicose vein and AVF cases were undertaken in the DCU. This represented 82% (+/- 6%) of day-case operative experience for the firm. SHOs undertook 12 (+/- 6) VV/AVF cases unassisted, 35 (+/- 5) cases with senior assistance, and 20 (+/- 11) as first assistance in the DCU. All SHOs progressed to being able to perform arterial bypass and amputation (with senior assistance) during their time on the firm. There was no significant difference in experience or progression to major vascular surgery between group 1 and group 2 in this study except in lower limb amputation procedures. It is concluded that vascular surgical firms can provide a good introduction to surgical skills. Most experience as first operator was gained in the DCU and we suggest that those undergoing basic surgical training might benefit from an attachment to the DCU early in their rotations.