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The impact of shortened postgraduate surgical training on colorectal cancer outcome

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Shortened postgraduate surgical training reforms, known as Calman, have altered delivery of surgical training in the UK with reduced working hours and training time aiming to produce a more subspecialised workforce.

Aims

This study aims to compare rectal cancer surgical outcomes of Calman-trained consultants in a single institution to published data. Additionally, the study compared colorectal cancer surgical outcome between Calman-trained consultants (CTCs) and non-Calman consultants (NCTCs) in a national dataset.

Methods

Local dataset Clinicopathological outcome of rectal cancer resection undertaken by CTCs in a single institution (2006–2010) were compared against NCTC counterparts.

National dataset All elective colorectal cancer resections between 2004 and 2008 in English NHS hospitals were included. CTCs (present from 2004 onwards) were compared to NCTCs (present prior to 2004). Outcome measures included 30-day in-hospital mortality, reoperation and readmission rates.

Results

Local dataset One hundred thirteen patients were operated under five CTC. The 30-day in-hospital mortality for CTCs (1 %) was favourable compared to published rates (3–5 %). Local recurrence rate (4.4 %) was comparable to NCTC (3.6 %).

National dataset Between 2004 and 2008, 44,106 patients underwent elective colorectal resection. Multiple regression demonstrated CTC patients had a reduced length of stay and reduced reoperation rate. No difference in mortality and unplanned readmission rates were seen.

Conclusion

CTCs have similar safety outcome to NCTCs for colorectal cancer resection procedures. Further work is needed to assess the impact of further training reductions on clinical outcome.

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Ethical approval

We have approval under Section 251 (formerly Section 60) granted by the National Information Governance Board for Health and Social Care (NIGB, formerly the Patient Information Advisory Group). We also have approval for using these data for research from the South East Research Ethics Committee.

Financial declaration

The Dr. Foster Unit at Imperial is affiliated with the Centre for Patient Safety and Service Quality at Imperial College Healthcare NHS Trust, which is funded by the National Institute of Health Research. We are grateful for the support from the NIHR Biomedical Research Centre funding scheme. The unit is largely funded by a research grant from Dr. Foster Intelligence (an independent health service research organisation).

Author information

Authors and Affiliations

  1. Department of Surgery, Imperial College, St Mary’s Hospital, Praed Street, London, W21NY, UK

    A. Currie, E. M. Burns, A. Darzi, O. D. Faiz & P. Ziprin

  2. Dr. Foster Unit, Department of Primary Care and Social Medicine, Imperial College, 1st Floor Jarvis House, 12 Smithfield Street, London, EC1A 9LA, UK

    P. Aylin

Authors
  1. A. Currie
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  2. E. M. Burns
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  5. O. D. Faiz
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Consortia

on behalf of the Imperial College Healthcare NHS trust Colorectal Cancer MDT

Corresponding author

Correspondence to P. Ziprin.

Additional information

What’s new in this paper?

This paper is the first to examine the outcomes of shortened postgraduate training methods in outcomes in the setting of predominantly surgically managed rectal cancer.

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Currie, A., Burns, E.M., Aylin, P. et al. The impact of shortened postgraduate surgical training on colorectal cancer outcome. Int J Colorectal Dis 29, 631–638 (2014). https://doi.org/10.1007/s00384-014-1843-9

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  • DOI: https://doi.org/10.1007/s00384-014-1843-9

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