1Health Education and Improvement Wales. 2Morriston Hospital, Swansea Bay University Health Board. 3Cwm Taf Morgannwg University Health Board. 4Cardiff and Vales University Health Board Aims:

This study aimed to assess training quality, related to individual hospital units, by means of trainee performance analysis.

Methods:

Consecutive 52, General Surgery Higher Specialty Trainees recorded 353 consecutive six-month placements in 11 hospitals (2 Tertiary, 9 District General). Data included hospital status, subspecialty, operative logbook number, Workplace-Based Assessment (WBA) completion, learned society communications, scientific publications, and Annual Review of Competence Progression (ARCP) outcomes.

Results:

Operative logbook activity varied by hospital in three regards: total logbook caseload 1st quartile, median (IQR) 135 (53) vs. 4th quartile, 163 (58), p < 0.001), number of procedures with trainee as primary operator 1st quartile 86 (34) vs. 4th 126 (69), p < 0.001), total number of index procedures 1st quartile 33 (20) vs. 4th quartile 45 (22), p = 0.001. Total operative activity varied by subspecialty: 1st quartile (LQ) Vascular, Transplant, and Hepato-Pancreatico-Biliary (median 133) vs. 4th quartile (UQ) Breast, and Endocrine (median 175, p < 0.001). WBA completion varied by subspecialty (Upper GI, median 10 vs. Vascular, median 7, p = 0.002), but not by hospital status. Publication profile varied by hospital (median 0 (1), p = 0.001), but not by hospital status. Five hospital units were associated with a greater number of adverse ARCP outcomes (41/200 placements vs. 7/153 placements, p = 0.003).

Conclusions:

Important performance training metric variation related to 6-month hospital placements were apparent, trainees in UQ units achieved 20% more operations, 40% more WBAs, and one more publication, compared with LQ units. Trainees, trainers, and programme directors alike, should be aware of unit level comparative data when planning educational programmes.