An audit of clinical training exposure amongst junior doctors working in Trauma & Orthopaedic Surgery in 101 hospitals in the United Kingdom

Abstract

Background: There are concerns regarding early years' training for junior doctors in Trauma & Orthopaedic Surgery (T&O) in the United Kingdom. Our primary objective was to audit the clinical activities undertaken by junior doctors working in Trauma & Orthopaedic (T&O) surgery in the National Health Service (NHS) in a typical workweek. A secondary objective was to audit the clinical exposure of junior surgeons in training to the Joint Committee on Surgical Training (JCST) standards for minimum weekly clinical exposure in T&O surgery.

Methods: We recruited collaborators in 101 T&O surgery departments in NHS hospitals to participate in this study. Clinical activity diaries from 935 doctors working in T&O surgery in the 101 participating NHS hospitals were involved. All junior doctors covering the junior on call tier were included. Collaborators collected clinical activity data from 08:00 18/01/2015 to 20:00 22/01/2015. Clinical activities recorded in sessions (morning, afternoon, evening) depending on what activity that doctor undertook for the majority of that session. Clinical activities were grouped into operating theatre/room, outpatient clinic, on call, "not in work" (i.e. leave, sickness), teaching, and ward cover sessions. The weekly clinical activity of Core Surgical Trainees (CSTs) were analyzed in accordance to two JCST standards for minimum weekly clinical exposure.

Results: Overall, junior doctors working in T&O surgery attended a theatre list session 8.5% of the time, an outpatient clinic 3.2%, were on call 14.8%, a teaching session 1.7%, providing ward cover 34.6%, and on a zero session 20.7% of the time. Only 5% of core surgical trainees (n = 200) met both the JCST standards for minimum weekly clinical exposure in the specialty.

Conclusions: Junior surgeons in training, working in Trauma & Orthopaedic surgery in the United Kingdom are not meeting the minimum weekly clinical sessions laid out by the JCST. Further work to develop models allowing for enhanced training experiences and improved clinical exposure to operating lists and outpatient clinics would be beneficial.

Keywords: Exposure; Orthopaedic; Surgeons; Surgery; Training; Trauma.

Fig. 1

Flowchart outlines grades of doctor in postgraduate surgical training and non-training pathways in the United Kingdom

Fig. 2

Flowchart demonstrating Cohort groups, split into Core surgical trainees, non-core surgical Trainees, and non-permanent doctors. CT1 = Core trainee year 1, CT2 = Core trainee year 2, CT3 = Core trainee year 3, ST1 = Specialist trainee year 1, ST2, = Specialist trainee year 2, ST3 = Specialist trainee year 3, FY1 = Foundation doctor year 1, FY2 = Foundation doctor year 2, LAT = Locum appointment for training, LAS = Locum appointment for service, TGD = Trust grade doctor, GPT = General practice trainee, NST = Other non-surgical trainee, AHP = Allied healthcare professional, CDF = Clinical development fellow, RF = Research fellow, LOC = Locum doctor, CC = Cross-cover doctor

Fig. 3

Map of United Kingdom and Ireland demonstrating geographical spread of the 101 participating hospitals

Fig. 4

Histograms illustrating frequency of number of sessions undertaken by Core surgical trainees versus non-Core surgical trainees in Theatre, Clinic, Ward Cover, On Call, and Off Work

Fig. 5

illustrates the proportions of clinical activities undertaken by Core Surgical Trainees and non-Core Surgical Trainee doctors

Fig. 6

Flowchart demonstrating numbers of Core surgical trainees meeting the two national JCST Core Quality Indictors relating to T&O surgery