Research in surgical education

Alex Phillips charts the achievements of a joint initiative aimed at developing our understanding of surgical training with a look to future needs

Ajoint FST/ASME (Faculty of Surgical Trainers/Association for the Study of Medical Education) initiative was set up in 2016 as a way for the two organisations to work together to promote and stimulate research into surgical education. Such research is poorly funded, with major challenges for those keen to pursue work in this area to secure funding and develop their ideas.

With a very real understanding that evidence-based medicine helps enhance patient outcomes, it is now also important that we extend this to evidence-based training.

Since it was first initiated, the FST/ ASME grant has awarded more than £20,000 in funding to nine research projects on a range of topics. Projects have included randomised trials, assessment of technical skills and non-technical skills, and have employed both quantitative and qualitative research methods.

Understanding Skills

The first grant winners back in 2016 were Paul Sutton, who sought to explore clinical decision-making in trainees in a simulated environment, and Sotiris Papaspyros, who looked at surgical skill acquisition in a low-fidelity model.

Thus, right from the start these grants have permitted study into practical applications for developing our understanding of surgical training and have ensured that the focus is not simply on operating skills and hand-eye coordination, but also on the other skills and components that make up surgical training.

Joshil Lodhia (in 2017) and Matyas Fehervari (in 2021) both looked at learning surgical skills but with very different approaches. Lodhia, a cardiothoracic trainee at the time, used magnetic sensors to assess fine movements of the surgeon, whereas Fehervari sought to validate online laparoscopic surgical training – perhaps a timely proposal in the middle of the COVID-19 pandemic.

Although we learn much of our craft in the operating theatre, James Ashcroft (in 2021) explored the participation of surgical trainees in this environment. We now recognise that there is more to the making of a surgeon than simply operating.

Assessments

Work-based assessments are now embedded into the surgical curriculum so how do we learn from them? This question was posed by Arpan Tahim (in 2018) as part of his research project and evaluated by Aimee Charnell (in 2020), who learned from outpatient clinics – a vital place of learning for all surgeons. Furthermore, how do we assess our trainees – can we use real-life procedural videos (asked Professor Karin Baatjes, in 2020), which is

Alex Phillips Consultant Oesophagogastric Surgeon and Surgical Director of the FST

something that might make life simpler for assessment?

The use of technology in surgical training has become even more important as a consequence of COVID-19. Virtual reality simulators can help individuals perfect skills, but could training the team together using VR improve performance?

Kartik Logishetty used his research grant to explore this (in 2019).

Future Research

So what should we focus on next? There is no right answer to this question. Yes, we must strive to learn how to best maximise training opportunities so that learning curves can be passed as quickly as possible, but we have all learned that surgical skill is not just about what we do with our hands in the operating theatre.

Decision-making, non-technical skills and the knowledge we impart on the ward and in clinics are every bit as important at influencing patient outcomes. Maximising these opportunities is what is required to ensure we produce well-rounded surgeons who can deal with the demands of modern medicine.

Left and below: As welcome as they are, advances in technology can make this a challenging time for surgical trainees

Technology can no doubt assist with this and there is still much to learn about how technology can facilitate training and support the surgeon to excel at their trade. With robotic surgery increasingly used, how do we ensure our current trainees do not lose out while established surgeons attempt to learn a new surgical skill? The rise in technology and the recovery from COVID-19 make for challenging times for trainees and trainers. It is important that we continue our drive to research novel, efficient ways of training that will have a positive impact on outcomes for both the trainee and patients.