Emergency General Surgery Exposure for Core Surgical Trainees in Scotland - Training or Service Provision?

Introduction Emergency general surgery (EGS) is a key aspect of general surgical training. The core surgical quality indicators (QI) suggest core trainees (CSTs) should be involved in dealing with emergency patients 1x week. However, there are ongoing concerns that CSTs miss important training prospects due to service provision. We aimed to compare the distribution of on-call vs elective work for CSTs across different EGS centres in Scotland. Methods CSTs in general surgery in Scotland were asked to volunteer an anonymised copy of their on-call rota in 2023, which was subsequently analysed for on-call vs elective shifts. An anonymous survey was distributed assessing compliance to QIs. Results Ten rotas were analysed, including 3 tertiary centres and 7 district general hospitals (DGH). 90% of trainees were involved in EGS at least 1x week; 6 were on a junior-tier rather than registrar rota. In a six-month period, CSTs average 51 (42-67) on-call shifts, correlating to >60% of their rota. Those on a registrar rota and in DGHs tended to have less (45 vs 54, 50 vs 55 respectively). Four rotas have dedicated CEPOD shifts. Conclusion Increased exposure to EGS can have positive effects for CSTs. Our results show CSTs have ample on-call rota commitments, thus become familiar with EGS presentations. However, excess service provision for CSTs has been shown to negatively impact training. Thus, training centres must aim to protect training opportunities. Provision of dedicated CEPOD shifts alongside admitting shifts may help maximise satisfaction and training in EGS.