Orthopaedic surgical training exposure at a South African academic hospital – is the experience diverse and in depth?
Keywords:orthopaedic registrar surgical experience, South African orthopaedic training exposure, orthopaedic case exposure
Background: With increasing pressure on our training hospitals, we undertook to ascertain whether our clinical orthopaedic surgery training platform is providing adequate surgical exposure, both in diversity and the level of trainee participation.
Methods: The orthopaedic surgery database was interrogated for theatre procedures logged for th 12-month period 1 January to 31 December 2018. Each theatre case was assessed as to the level of trainee participation, whether it was performed during or after hours, and categorised as being elective or trauma in nature, as well as the orthopaedic subdiscipline.
Results: A total of 3 147 orthopaedic surgical procedures were logged with an even split of elective (51.1%) and trauma (49.9%) cases. Adults predominated in the trauma group while the paediatric service contributed most to the elective cases, followed by arthroplasty and spine. Overall, 25.5% of procedures were performed by consultants and 74.5% by registrars. Registrars were more frequently the primary surgeon in trauma cases (90%) compared to elective procedures (59%) (p < 0.001). Of the elective cases, 37% were performed by registrars as supervised unscrubbed and 22% as supervised scrubbed operations. In total, 17.5% of cases were performed after hours, with 31.7% of trauma surgeries and only 2.9% of elective surgeries occurring after hours. Registrars were the primary surgeon in 98.7% of after-hours trauma cases and 58% of afterhours elective cases under unscrubbed supervision.
Conclusion: Our study presents the surgical experience and level of participation available to orthopaedic surgical trainees in a South African training hospital where their exposure was an equal number of elective and trauma cases. The vast majority of the cases were performed by the registrars in their supervised unscrubbed capacity although the more complex, elective cases were performed by consultants. Almost all after-hours trauma cases were performed by registrars. This suggests the platform allows for a high level of registrar surgical participation and training despite the challenges. Further review is required to assess achievement of trainee competency and whether in fact the current experience is adequate.
Level of evidence: Level 4