D J H Shipway1, J S L Partridge2, C R Foxton3, B Modarai4, J A Gossage5, B J Challacombe6, C Marx7, J K Dhesi8. 1. Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London, United Kingdom. Electronic address: shipway@doctors.net.uk. 2. Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London, United Kingdom; Division of Health and Social Care Research, Kings College, London, United Kingdom. 3. Department of Ear, Nose and Throat Surgery, Royal United Hospital Bath NHS Trust, Combe Park Bath, Somerset, United Kingdom. 4. Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom. 5. Department of Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom. 6. Department of Urology, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London, United Kingdom. 7. Royal College of Surgeons of England, London, United Kingdom; Department of Orthopaedic Surgery, Ipswich Hospital NHS Trust, Ipswich, Suffolk, United Kingdom. 8. Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London, United Kingdom.
Abstract
OBJECTIVE: Increasing numbers of older patients are undergoing surgery. Older surgical patients are at a higher risk of perioperative complications and mortality. Multimorbidity, frailty, and physiological changes of ageing contribute to adverse outcomes. These complications are predominantly medical, rather than directly surgical. Guidelines recommend preoperative assessment of comorbidity, disability, and frailty in older patients undergoing surgery and closer perioperative collaboration between surgeons and geriatricians. We conducted a survey to assess knowledge and beliefs of surgical trainees toward common perioperative problems encountered in older surgical patients. DESIGN: Paper-based survey. SETTING: Unselected UK surgical training-grade physicians (CT1-ST8) attending the 2013 Congress of The Association of Surgeons of Great Britain and Ireland, Glasgow, UK, May 1-3, 2013. PARTICIPANTS: A total of 160 eligible UK surgical trainees attending the conference were invited to participate in the survey. Of them, 157 participated. RESULTS: Of the trainees, 68% (n = 107) reported inadequate training and 89.2% (n = 140) supported the inclusion of geriatric medicine issues in surgical curricula. Of the respondents, 77.2% (n = 122) were unable to correctly identify the key features required to demonstrate mental capacity, and only 3 of 157 respondents were familiar with the diagnostic criteria for delirium. Support from geriatric medicine was deemed necessary (84.7%, n = 133) but often inadequate (68.2%, n = 107). Surgical trainees support closer collaboration with geriatric medicine and shared care of complex, older patients (93.6%, n = 147). CONCLUSIONS: UK surgical trainees believe that they receive inadequate training in the perioperative management of complex, older surgical patients and are inadequately supported by geriatric medicine physicians. In this survey sample, trainee knowledge of geriatric issues such as delirium and mental capacity was poor. Surgical trainees support the concept of closer liaison and shared care of complex, older patients with geriatric medicine physicians. Changes to surgical training and service development are needed.
OBJECTIVE: Increasing numbers of older patients are undergoing surgery. Older surgical patients are at a higher risk of perioperative complications and mortality. Multimorbidity, frailty, and physiological changes of ageing contribute to adverse outcomes. These complications are predominantly medical, rather than directly surgical. Guidelines recommend preoperative assessment of comorbidity, disability, and frailty in older patients undergoing surgery and closer perioperative collaboration between surgeons and geriatricians. We conducted a survey to assess knowledge and beliefs of surgical trainees toward common perioperative problems encountered in older surgical patients. DESIGN: Paper-based survey. SETTING: Unselected UK surgical training-grade physicians (CT1-ST8) attending the 2013 Congress of The Association of Surgeons of Great Britain and Ireland, Glasgow, UK, May 1-3, 2013. PARTICIPANTS: A total of 160 eligible UK surgical trainees attending the conference were invited to participate in the survey. Of them, 157 participated. RESULTS: Of the trainees, 68% (n = 107) reported inadequate training and 89.2% (n = 140) supported the inclusion of geriatric medicine issues in surgical curricula. Of the respondents, 77.2% (n = 122) were unable to correctly identify the key features required to demonstrate mental capacity, and only 3 of 157 respondents were familiar with the diagnostic criteria for delirium. Support from geriatric medicine was deemed necessary (84.7%, n = 133) but often inadequate (68.2%, n = 107). Surgical trainees support closer collaboration with geriatric medicine and shared care of complex, older patients (93.6%, n = 147). CONCLUSIONS: UK surgical trainees believe that they receive inadequate training in the perioperative management of complex, older surgical patients and are inadequately supported by geriatric medicine physicians. In this survey sample, trainee knowledge of geriatric issues such as delirium and mental capacity was poor. Surgical trainees support the concept of closer liaison and shared care of complex, older patients with geriatric medicine physicians. Changes to surgical training and service development are needed.
Keywords:
Interpersonal and Communication Skills; Medical Knowledge; Patient Care; Professionalism; Systems-Based Practice; education; older adults; perioperative care; surgery; training