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Craft specialties such as surgery endured widespread disruption to postgraduate education and training during the pandemic. Despite the expansive literature on rapid adaptations and innovations, generalisability of these descriptions is limited by scarce use of theory-driven methods. In this research, we explored UK surgical trainees' (n = 46) and consultant surgeons' (trainers, n = 25) perceptions of how learning in clinical environments changed during a time of extreme uncertainty (2020/2021). Our ultimate goal was to identify new ideas that could shape post-pandemic surgical training. We conducted semi-structured virtual interviews with participants from a range of working/training environments across thirteen Health Boards in Scotland. Initial analysis of interview transcripts was inductive. Dynamic capabilities theory (how effectively an organisation uses its resources to respond to environmental changes) and its micro-foundations (sensing, seizing, reconfiguring) were used for subsequent theory-driven analysis. Findings demonstrate that surgical training responded dynamically and adapted to external and internal environmental uncertainty. Sensing threats and opportunities in the clinical environment prompted trainers' institutions to seize new ways of working. Learners gained from reconfigured training opportunities (e.g., splitting operative cases between trainees), pan-surgical working (e.g., broader surgical exposure), redeployment (e.g., to medical specialties), collaborative working (working with new colleagues and in new ways) and supervision (shifting to online supervision). Our data foreground the human resource and structural reconfigurations, and technological innovations that effectively maintained surgical training during the pandemic, albeit in different ways. These adaptations and innovations could provide the foundations for enhancing surgical education and training in the post-pandemic era.

Introduction: Curricular reform is often proposed as the means to improve medical education and training. However, reform itself may not lead to noticeable change, possibly because the influence of organisational culture on change is given insufficient attention. We used a national reform of early‐years surgical training as a natural opportunity to examine the interplay between organisational culture and change in surgical education. Our specific research question was: in what ways did organisational culture influence the implementation of Improving Surgical Training (IST)? Methods: This is a qualitative study underpinned by social constructivism. Interviews were conducted with core surgical trainees (n = 46) and their supervising consultants (n = 25) across Scotland in 2020–2021. Data coding and analysis were initially inductive. The themes indicated the importance of many cultural factors as barriers or enablers to IST implementation. We therefore carried out a deductive, secondary data analysis using Johnson's (1988) cultural web model to identify and examine the different elements of organisational culture and their impact on IST. Results: The cultural web enabled a detailed understanding of how organisational culture influenced IST implementation as per Johnson's six elements—Rituals and Routines (e.g. departmental rotas), Stories (e.g. historical training norms and culture), Symbols (e.g. feedback mechanisms, visibility and value placed on education), Power Structures (e.g. who has the power in local contexts), Organisational Structures (e.g. relationships and accountability) and the Control System (e.g. consultant job plans and service targets)—and how these interact. However, it did not shed light on the influence of exogenous events on change. Conclusion: Our data reveal cultural reasons why this curricular reform met with varying degrees of success across different hospital sites, reinforcing that curricular reform is not simply about putting recommendations into practice. Many different aspects of context must be considered when planning and evaluating change in medical education and training. Shah et al. explore how context and organizational culture influence curricular reform, reinforcing the view that such reform is not simply about putting recommendations into practice. [ABSTRACT FROM AUTHOR]

The shift from traditional apprenticeship models to competency-based curricula, compounded by working hour restrictions and rapid advances in surgical technology, has altered the delivery of early years surgical training. Simulation has been widely incorporated in other high-risk, high-reliability industries, but it has only just begun to be embedded in surgical programmes over the last two decades. In this article, we review key concepts in surgical simulation. Using Scotland's Core Surgical Training Programme as an example, we demonstrate the implementation of these concepts into a national integrated simulation strategy for early years surgical training. We highlight other global examples of simulation use in surgical curricula. The key messages for all stakeholders in surgical training are: (i) simulation is an adjunct to clinical training; (ii) simulation is a tool; however, it is not the tool that should be the main object of interest, but the learning for which it is used; and (iii) in the absence of a constructively aligned and purposeful programme that is valued by trainees, trainers and the training system, it is not enough to issue the kit, no matter how good the simulators are. [ABSTRACT FROM AUTHOR]

The last two decades have seen the emergence of significant evidence that has altered certain aspects of the management of acute pancreatitis. While most cases of acute pancreatitis are mild, the challenge remains in managing the severe cases and the complications associated with acute pancreatitis. Gallstones are still the most common cause with epidemiological trends indicating a rising incidence. The surgical management of acute gallstone pancreatitis has evolved. In this article, we revisit and review the methods in diagnosing acute pancreatitis. We present the evidence for the supportive management of the condition, and then discuss the management of acute gallstone pancreatitis. Based on the evidence, our local institutional pathways, and clinical experience, we have produced an outline to guide clinicians in the management of acute gallstone pancreatitis. [ABSTRACT FROM AUTHOR]

B Introduction: b The aim of this study was to investigate the modalities to diagnose colorectal carcinoma in patients over the age of 45, following an appendicectomy. 4 patients were found to have proximal colonic polyps, whilst 1 patient was found to have ascending colon cancer - identified 5 months post-appendicectomy. The reaudit conveyed - of the 62 patients >45 years old, who had appendicectomies - 83.3% underwent a pre-operative CT. [Extracted from the article]

The article presents a study which examines the role of ultrasonography (US) as a first-choice imaging method for suspected acute appendicitis in children. In 1986, Puylaert first introduced the use of US with a 5-12MHz linear-array transducer combined with the graded compression technique when acute appendicitis is being suspected. In comparison with computed tomography (CT), it notes that US is inexpensive, non-invasive and does not use ionising radiation. Despite its advantages, it relates that US has limitations wherein its diagnostic accuracy is being hindered by various factors including excessive bowel gas, obesity, and uncooperative patients. It concludes that US can be routinely used in diagnosing acute appendicitis in paediatric population presented with acute abdominal pain.

B Introduction: b The bimodal age distribution in presentation of acute appendicitis prompts consideration of other aetiologies in patients outside the typical age distribution. Thirteen (32.5%) colonoscopy referrals were specifically for post-appendicectomy examination, while other indications include previous cancer. [Extracted from the article]

B Introduction: b Negative pressure wound therapy use in elective and emergency colorectal surgery has demonstrated significant reduction in superficial and deep surgical site infection complication rates. This study evaluated the reduction in wound complications when using negative pressure wound therapy in elective stoma reversal surgery. None of the twelve patients in the intervention group suffered wound complications, but five of the thirty-six patients in whom negative pressure wound therapy was not utilised suffered surgical site infection-related complications. [Extracted from the article]