Trauma experience in the UK and Ireland: Analysis of orthopaedic training using the FHI eLogbook

• Published in: Injury Vol. 39; no. 8; pp. 844 - 852
• Main Authors: Jameson, S.S, Lamb, A, Wallace, W.A, Sher, J.L, Marx, C, Reed, M.R
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.08.2008; Elsevier
• Subjects: Accreditation - methods; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Assessment; Biological and medical sciences; Clinical Competence - standards; Databases, Factual - standards; Diseases of the osteoarticular system; Education, Medical, Graduate - methods; Education, Medical, Graduate - organization & administration; Educational Measurement - methods; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Humans; Injuries of the limb. Injuries of the spine; Internship and Residency - organization & administration; Ireland; Logbook; Medical Records Systems, Computerized - standards; Medical sciences; Orthopaedic training; Orthopedic Procedures - education; Orthopedics; Orthopedics - education; Statistics as Topic; Surgical experience; Traumas. Diseases due to physical agents; United Kingdom; Europe; Ireland; Logbook; Surgical experience; Orthopaedic training; Assessment; Treatment; Surgery; Orthopedics; Anesthesia; Trauma
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2008.03.030

Summary Surgical trainees routinely provide evidence of their training and operative experience for assessment. National comparative data on the number of procedures performed during training was previously unavailable in the UK. Since 2003 every trainee in Trauma and Orthopaedics (T&O) in the UK and Ireland has submitted data recording their operative experience electronically via the Faculty of Health Informatics (FHI) eLogbook. This provides detailed data on trainee, trainer, hospital and training programme performance. This data has been analysed for trauma surgery. By March 2007 there were 1053 T&O Specialist Registrars with operations logged. Trauma operations performed and uploaded during the previous 3 years have been included. Each trainee's work is analysed by ‘year-in-training’ (YIT, 1–6). Data on levels of supervision and potentially missed opportunities (where the trainee was present but assisted rather than performed the operation) was analysed. The mean number of trauma operations performed annually by trainees was 109, 120, 110, 122, 98 and 84 (total 643) for YIT 1–6, respectively. 22% of the operations at which a trainee was present were potentially missed opportunities. A high level of experience is gained in hip fracture surgery (121 operations performed), intramedullary nailing (38) and ankle (47) stabilisation over the 6 years of training. However, the mean number of tendon repairs (18), tension band wires (13), external fixators (12) and childrens’ supracondylar fracture procedures (9) performed is low. We also report figures for complex fracture stabilisation. The eLogbook remains a powerful tool which can provide accurate information to support in-depth analysis of trainees, trainers, and training programmes. Based on this analysis, we suggest ‘standard setting’ to identify trainees performing fewer operations than required during their training. We have also established a baseline which can be used to identify the consequences of changes to length of training and working hours.