Original ArticleDo Surgical Trainees Believe They Are Adequately Trained to Manage the Ageing Population? A UK Survey of Knowledge and Beliefs in Surgical Trainees
Introduction
Increasing numbers of older people are undergoing both emergency and elective surgery, such that approximately 60% of all general surgical procedures are performed on patients older than 65 years, with an expected 31% rise by 2020.1, 2, 3, 4 This projected increase is not restricted to general surgery but is anticipated across all subspecialties. However, older surgical patients remain at a higher risk of both postoperative complications and mortality when compared with their younger counterparts.5, 6, 7, 8 Age-related changes in physiology and the association of ageing with multimorbidity result in poor physiological reserve, frailty, and an increased risk of adverse postoperative outcome. A national UK report examining older patients, who died within 30 days of surgery, identified a range of deficiencies throughout the surgical pathway.9 These included inadequate preoperative assessment of comorbidity, frailty, and risk combined with suboptimal intraoperative and postoperative care. The report recommended closer integration between geriatric medicine and surgery to ensure comprehensive preoperative risk assessment, medical optimization, and high-quality postoperative care.9 This was followed in 2012 by the publication of guidelines on preoperative assessment of older surgical patients by the American College of Surgeons National Surgical Quality Improvement Program and American Geriatrics Society (ACS NSQIP/AGS),10 recognizing that responsibility for perioperative care has to be shared between surgeons and geriatricians. Although collaboration was encouraged, the ACS NSQUIP/AGS guidelines also emphasized that surgeons of the future should be familiar with perioperative medical problems commonly encountered in older patients.9, 10 Such familiarity requires training. The purpose of this survey was to assess the current knowledge, attitudes, and behavior of UK surgical trainees regarding issues commonly encountered in the ageing surgical population.
The following hypotheses were proposed:
- 1.
Surgical trainees receive adequate training in the perioperative management of complex, older surgical patients.
- 2.
Surgical trainees have adequate knowledge of common perioperative medical problems in complex, older surgical patients.
- 3.
Surgical trainees currently receive adequate geriatric medicine support when managing complex, older surgical patients.
- 4.
Surgical trainees support the concept of liaison services and shared care of complex, older surgical patients with geriatric medicine.
Section snippets
Setting, Participants, and Recruitment
Participants were enrolled purposively through their attendance at the 2013 Association of Surgeons of Great Britain and Ireland Congress (Glasgow, UK, May 1-3, 2013). To be eligible to participate in this survey, congress delegates were required to be UK surgical trainees, who are in training grades CT1-ST8. The exclusion criteria included consultant or associate specialist status, non-UK trainee, or foundation trainee status. Conference delegates were approached as they exited the auditorium
Results
A total of 160 surgical trainees were approached and 157 agreed to take part in the survey. The response rate was therefore 98% (n = 157/160). Core surgical trainees (CT1-2) represented 32.5% (n = 51) and specialist registrar trainees (ST3-8 and research fellows) represented 67.5% (n = 106). General surgical trainees constituted 37.5% (n = 59), with the remainder from a range of subspecialties (Table 1). Throughout the results presented, there were no significant differences observed between
Key Findings
This is the first UK survey examining knowledge and beliefs of surgical trainees of the issues encountered in older surgical patients. The key findings of this survey require a collaborative response to meet the challenges posed by the changing demographics of the surgical population.
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2018, American Journal of SurgeryCitation Excerpt :The importance of education among healthcare workers aimed at improving care for the older frail patient has already been acknowledged for years, but it has not gained a regular place in most medical and surgical (post)graduate curricula.17 Main obstacles seem the ageism (negative attitude to elderly in general), the lack of knowledge and the fear by young doctors to deal with complex patients such as a frail elderly surgical patient.8,27–29 Therefore, we chose knowledge, self-confidence and attitude as main outcomes of our learning tool.
Source of funding: D.J.H.S. was funded by Guy’s and St Thomas’ Charity.
There has been no previous publication or communication of this data to any society or meeting.
This survey was registered with Guy’s and St Thomas’s NHS Foundation Trust research department but was found not to require ethics committee approval.