Abstract
Background
The splintering of general surgery into subspecialties in the past decade has brought into question the relevance of a continued emphasis on traditional general surgical training. With the majority of trainees now expressing a preference to subspecialise early, this study sought to identify if the requirement for proficiency in managing general surgical conditions has reduced over the past decade through comparison of general and specialty surgical admissions at a tertiary referral center.
Methods
A cross-sectional review of all surgical admissions at Cork University Hospital was performed at three individual time points: 2002, 2007 & 2012. Basic demographic details of both elective & emergency admissions were tabulated & analysed. Categorisation of admissions into specialty relevant or general surgery was made using International guidelines.
Results
11,288 surgical admissions were recorded (2002:2773, 2007:3498 & 2012:5017), showing an increase of 81 % over the 10-year period. While growth in overall service provision was seen, the practice of general versus specialty relevant emergency surgery showed no statistically significant change in practice from 2002 to 2012 (p = 0.87). General surgery was mostly practiced in the emergency setting (84 % of all emergency admissions in 2012) with only 28 % elective admissions for general surgery. A reduction in length of stay was seen in both elective (3.62–2.58 bed days, p = 0.342) & emergency admissions (7.36–5.65, p = 0.026).
Conclusions
General surgical emergency work continues to constitute a major part of the specialists practice. These results emphasize the importance of general surgical training even for those trainees committed to sub-specialisation.
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References
Longo WE, Sumpio B, Duffy A, Seashore J, Udelsman R (2008) Early specialisation in surgery: the new frontier. Yale J Biol Med 81:187–191
Irish Medical News, Article 11/2/13. Available at: http://www.rcsi.ie/index.jsp?a=2524&n=1220&p=1204. Accessed 08 Sept 2013
Allgood PC, Bachmann MO (2006) Effects of specialisation on treatment and outcomes in screen-detected breast cancers in Wales: cohort study. Br J Cancer 94(1):36–42
Archampong D, Borowski D, Wille-Jorgensen P, Iversen LH (2012) Workload and surgeon’s specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev 3:CD005391
Parks RW, Bettschart V, Frame S, Stockton DL, Brewster DH, Garden OJ (2004) Benefits of specialisation in the management of pancreatic cancer: results of a Scottish population-based study. Br J Cancer 91(3):459–465
Nambiar RM (1995) General surgery in an era of superspecialisation—what is the future? Ann Acad Med Singap 24(1):180–187
Ahmed HM, Gale SC, Tinti MS, Shiroff AM, Macias AC, Rhodes SC et al (2012) Creation of an emergency surgery service concentrates resident training in general surgical procedures. J Trauma Acute Care Surg 73(3):599–604
Health Services Executive, Republic of Ireland. Available at: http://www.cuh.hse.ie/About_CUH/. Accessed 08 Sept 2013
Wiley MM (2005) Using HIPE data as a research and planning tool: limitations and opportunities: a response. Ir J Med Sci 174:52–57
McHugh SM, Loh KP, Corrigan MA, Sheikh A, Lehane E, Hill AD (2012) Patientsmate©: the implementation and evaluation of an online prospective audit system. J Eval Clin Pract 18(2):365–368
Accreditation Council for Graduate Medical Education (ACGME), minimum case list for Colon and Rectal Surgery. Available at: https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramResources/060_CRS_Minimum_Case_Numbers.pdf. Accessed 22 Oct 2013
The American Board of Surgery. SCORE Core Curriculum for Vascular Surgery Residents. Available at: http://www.absurgery.org/default.jsp?certvsqe_primarycert. Accessed 22 Oct 2013
Intercollegiate Surgical Curriculum Programme (ISCP), Competency in Breast Surgery Section, page 26. Available at: https://www.iscp.ac.uk/static/syllabus2013/gs_curric_2013.pdf. Accessed 12 Oct 2013
Endocrine Surgery, Cleveland Clinic, North America. Available at: http://my.clevelandclinic.org/endocrinology-metabolism/departments-centers/endocrine-surgery.aspx. Accessed 22 Oct 2013
Michelassi Fabrizio (2011) American board of surgery certificate in general complex surgical oncology. Ann Surg Oncol 18:2405–2406
Central Statistics Office, Ireland. Available at: http://www.cso.ie/en/statistics/healthandsocialconditions/publiclyfundedacutehospitalsstatistics2009/. Accessed 08 Sept 2013
Gillman LM, Vergis A (2013) General surgery graduates may be ill prepared to enter rural or community surgical practice. Am J Surg 205(6):752–757
Coleman JJ, Esposito TJ, Rozycki GS, Feliciano DV (2013) Early subspecialisation and perceived competence in surgical training: are residents ready? J Am Coll Surg 216(4):764–771
Breen KJ, Hogan AM, Mealy K (2013) The detrimental impact of the implementation of the European working time directive (EWTD) on surgical senior house officer (SHO) operative experience. Ir J Med Sci 182(3):383–387
Acknowledgments
I would like to extend an acknowledgement to all staff in the HIPE department at Cork University Hospital for their time and contribution towards data sourcing for this study. I would also like to thank all the surgical staff at Cork University Hospital.
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Fleming, C.A., Khan, Z., Andrews, E.J. et al. “Is General Surgery Still Relevant to the Subspecialised Trainee?” A 10 Year Comparison of General Versus Specialty Surgical Practice. World J Surg 39, 297–302 (2015). https://doi.org/10.1007/s00268-014-2890-7
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DOI: https://doi.org/10.1007/s00268-014-2890-7