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Background: Simulation-based care pathway approach (CPA) training is a novel approach in surgical education. The objective of the present study was to determine whether CPA was feasible for training surgical residents and could improve efficiency in patients' management. A common disease was chosen: acute appendicitis. Methods: All five junior residents of our department were trained in CPA: preoperative CPA consisted in virtual patients (VPs) presenting with acute right iliac fossa pain; intraoperative CPA involved a virtual competency-based curriculum for laparoscopic appendectomy (LAPP); finally, post-operative VP were reviewed after LAPP. Thirty-eight patients undergoing appendectomy were prospectively included before (n = 21) and after (n = 17) the training. All demographic and perioperative data were prospectively collected from their medical records, and time taken from admission to management was measured. Results: All residents had performed less than 10 LAPP as primary operator. Pre- and intraoperative data were comparable between pretraining and post-training patients. Times to liquid and solid diet were significantly reduced after training [7 h (2–20) vs. 4 (4–6); P = 0.004, and 17 h (4–48) vs. 6 (4–24); P = 0.005] without changing post-operative morbidity [4 (19%) vs. 0 (0); P = 0.11] and length of stay [48 h (30–264) vs. 44 (21–145); P = 0.22]. Conclusions: CPA training is feasible in abdominal surgery. In the current study, it improved patients' management in terms of earlier oral intake. [ABSTRACT FROM AUTHOR]

Background: Recent evidence has demonstrated the variability in quality of postoperative care, as measured by rates of failure to rescue (FTR). The identification of structure- and process-related factors affecting the quality of postoperative care is the first step towards understanding and improving outcomes. The aim of this review is to review current evidence for structure and process factors affecting postoperative care. Methods: A systematic review was conducted. Studies were selected that examined structure or process variables affecting FTR rates and postoperative outcomes. Quality analysis with Jadad and Newcastle-Ottawa scales was conducted and poor-quality studies were excluded. Results: Thirty-seven studies were included in final analysis. Of these, 23 were related to enhanced recovery protocols in seven surgical specialties. Twenty-one of these 23 studies reported decreases in length of stay. Six studies also reported decreases in morbidity. No studies reported increases in stay duration or morbidity. Of the 16 studies that examined other structural and process factors, the strongest evidence was for the association between nursing ratios and FTR rates. The effects of hospital size, resources, and subspecialist care processes were less clear. Conclusion: Process-led care represents a clear, evidence-based approach that can be integrated on a local scale, without necessitating major structural or organisational change, to improve outcomes and may also be cost effective. To foster success, process improvement must be driven on a local level and backed up by appropriate understanding, education, and multidisciplinary involvement. [ABSTRACT FROM AUTHOR]

Training in surgical disciplines in the United Kingdom has undergone tremendous change over the past two decades. The introduction of specialist training programmes, working time directives, quality ratings and a drive toward ambulatory and minimal access surgery have led to challenges with respect to training and service commitments of healthcare professionals. A structured and centralised training system was introduced, with the concept of core followed by specialty-specific progression, in an openly competitive manner. Within this system is the need to commence training on simulation models, and to demonstrate proficiency prior to performance of tasks on patients. This should be underpinned by objective measures such as video or dexterity-based tools. There is also a clear need to provide personal, professional and leadership development in the form of mentorship and appraisal systems. Though continuing to develop, the profession must be mindful of current and future advances to ensure the delivery of surgeons for the future who aspire toward excellence. [ABSTRACT FROM AUTHOR]

A response from the authors of the article "Postoperative Complications Do Not Affect Long-Term Outcome in Esophageal Cancer Patients" published in the journal in 2014 is presented.