TP8.2.17 Supplementing Undergraduate ENT Teaching: A Neglected Surgical Speciality?

Aims A 2020 survey of undergraduate ENT education found there was wide variability between Medical Schools despite a standardised curriculum, published by ENT UK. To improve this, a group of CTFs designed and led teaching sessions covering each aspect of ENT based on the ENT UK curriculum. The aim was to improve confidence in and knowledge of ENT conditions expected at junior doctor level. Methods Final year students participated in three 1-2 hour teaching sessions focused on ‘Otology’, ‘Rhinology’ and ‘Head & Neck’. Each session started with an MCQ assessing prior knowledge, with a post-teaching MCQ to assess for improvement. There was an additional questionnaire to measure confidence in several domains pre- and post-teaching, and of the undergraduate teaching they had received within their medical schools. Results Overall, students’ pre-ENT teaching and post-ENT teaching MCQ scores improved from 67% to 87%. The percentage of students who felt ‘fairly confident’ and/or ‘completely confident’ in the following domains were compared pre- and post-teaching respectively: recognising ENT conditions (26% vs 42%); managing & treating ENT conditions (5% vs 42%); and recognising surgical airways (3% to 40%). 47% of students found tutorials based on ENT ‘very useful’ for their learning, compared to 16% for outpatient clinics & lectures. 94% of students had received ENT teaching for a period of < 2 weeks, with 37% of those receiving <1 week. Conclusions This project demonstrates how a small series of curriculum specific ENT teaching can help final year students to supplement their knowledge and confidence in ENT.

Primary umbilical endometriosis – A rare presentation of cutaneous endometriosis

Primary umbilical endometriosis is a rare condition with an overall incidence of around 0.5% to 1% among all the endometriosis cases, but at times it poses a diagnostic dilemma. In our institution we encountered a case of primary umbilical endometriosis presented to multiple surgical speciality departments. A prompt clinical examination with surgical biopsy was the key tool which lead to the diagnosis and providing a complete cure for the patient. Pelvic endometriosis affects 5-10% of women in the child bearing age group. The most pronounced symptoms are dyspareunia, pelvic pain, and infertility. Clinical presentations of umbilical endometriosis are as a nodule with or without associated umbilical pain and bleeding. This patient was given primary hormonal therapy and later underwent a biopsy which paved way for an accurate diagnosis of primary umbilical endometriosis. In this case of umbilical swelling, conditions like a benign nevus, lipoma, abscess, cyst, hernia, as well as metastatic deposit from a systemic malignancy were considered in the clinical differential diagnosis. However surgical excision helped us arrive at a definitive diagnosis and cure for the patient.

356 An Unfortunate Case of Spinal Injury and Bladder Dysfunction During the Covid-19 Pandemic

There is no doubt that COVID-19 has had a profound impact on every medical and surgical speciality. In the height of the pandemic many non-emergency services were shut down, including dental services, with unexpected consequences. We present a case which highlights the unexpected and indirect consequences of a national lockdown on a Urology patient and discuss learning points. A 54-year-old male, previously fit and well suffered with a small dental abscess, media outlets were reporting that dental surgeries were closed, and he therefore attempted to drain the abscess himself. The infection spread to his epidural space, causing compression via a collection at L2 and consequently spinal cord injury. This was managed with urgent lumbar decompression and antibiotics. A specialist functional urology team were involved after his transfer to the tertiary spinal unit 3 months after his first presentation. He was catheterised but suffered with recurrent catheter blockages. Video urodynamics demonstrated a stable bladder with a low-pressure leak point, managed with urethral catheterisation. A repeat video urodynamics demonstrated a loss of compliance and stress incontinence. Unclear as to whether he would regain function rehabilitation techniques are currently being attempted prior for definitive operative management with an artificial sphincter. This case highlights the indirect impact of COVID-19 on UK urology services, and this has not been widely reported.

Evolving Trends in Surgical Management of Breast Cancer: An Analysis of 30 Years of Practice Changing Papers

The management of breast cancer has evolved into a multidisciplinary evidence-based surgical speciality, with emphasis on conservative surgery. A number of landmark trials have established lumpectomy followed by radiation as the standard of care for many patients. The aim of this study is to construct a narrative review of recent developments in the surgical management of breast cancer and how such developments have impacted surgical practice. A comprehensive literature search of Pubmed was conducted. The latest search was performed on October 31st, 2020. Search terms “breast cancer” were used in combinations with specific key words and Boolean operators relating to surgical management. The reference lists of retrieved articles were comprehensively screened for additional eligible publications. Articles were selected and reviewed based on relevance. We selected publications in the past 10 years but did not exclude commonly referenced and highly regarded previous publications. Review articles and book chapters were also cited to provide reference on details not discussed in the academic literature. This article reviews the current evidence in surgical management of early-stage breast cancer, discusses recent trends in surgical practice for therapeutic and prophylactic procedures and provides commentary on implications and factors associated with these trends.

548 “The New Normal”? How We Adapted Simulation Training in The Midst of the Coronavirus Pandemic

Introduction Delivering high quality teaching during an international pandemic is challenging but becomes increasingly important when trainees are taking on new roles and responsibilities. Instead of ceasing our simulation programme, we adapted it to comply with local infection control guidelines. We devised in-situ high-fidelity ward round simulations for all levels of trainee, from newly qualified doctors to senior registrars. Method The ward round consisted of three simulated patients with a range of conditions appropriate for the level of trainee, role-played by faculty members. The simulations were offered to all Foundation Year Doctors, Junior Middle Grade Doctors and Surgical Speciality Trainees with all participants wearing Personal Protective Equipment (PPE) according to COVID-19 infection control policy. Results A total of 81 trainees took part in the simulations. Almost all reported it as ‘very useful’ and that it improved confidence in progressing to the next stage of their career. Trainees also found it enjoyable and that personalised feedback allowed them to identify areas for development. Conclusions We have shown that ward round simulations can be run safely and effectively despite current COVID-19 restrictions. Even senior trainees found that a ward round simulation was useful and were keen to see it become a regular part of deanery teaching.

Nutrition training in residency and fellowship programme: time for a change

Background: Despite several measures, the nutrition education during undergraduate and postgraduate training has been identified to be suboptimal. The objective of this study was to assess the nutrition knowledge, attitudes and practice of residents, fellows and teaching faculties, following a reformation in the training curriculum, in a tertiary teaching hospital. Method: We conducted an anonymous survey involving residents, fellows and teaching faculties in medical and surgical speciality. We assessed four domains: (a) recognition, (b) knowledge, (c) application of basic principles of nutritional and (d) attitude towards clinical nutrition during residency and fellowship training. Each domain had five multiple choice questions and the attitude section was assessed using a five-point Likert scale. Result: We distributed the survey to 305 doctors: 265 completed the first three domains and 259 completed all the domains. The overall mean ± SD score between residents (6.5 ± 1.9), fellows (6.8 ± 1.8) and teaching faculties (6.5 ± 2.2) was similar. All scored similarly in the recognition, knowledge and application domain of the questionnaire. When subcategorised, the gastroenterology sub-speciality scored significantly higher than the rest (8.1 ± 2.2 vs. 6.4 ± 1.9, p = 0.001). Sixty-three per cent and 44% of the responders felt there was lack of adequate focus on clinical nutrition training in residency and during daily ward round, respectively. Only 10% of responders felt confident in providing nutritional counselling and treatment for malnourished patients. Conclusion: Our study shows the current nutritional education during residency and fellowship training is still inadequate and falls short in achieving the recommended goals.

How to Perform Videos in Dermatologic Surgery? A Simple and Inexpensive Recording Technique

Video recording surgical procedures is one of the most valuable tools for teaching and self-assessment in Dermatologic Surgery. A number of recording systems have been described in the literature. Nevertheless, they’re usually expensive (~500€) and time-consuming to prepare, the latter being a major disadvantage for a busy surgical speciality such as Dermatology. The authors describe a simple and inexpensive technique for surgical video capture in Dermatologic Surgery. For this setup, the surgeon needs only a smartphone with a camera (which is nowadays ubiquitous), a bike phone holder (10€ to 30€), an adjustable intravenous pole and, optionally, a powerbank. With the patient in position for the surgical intervention (seated or lying on his back on the surgical table, depending on the procedure), the bike phone holder should be attached to the vertically adjustable intravenous pole. The smartphone must be then set on the bike phone holder, with its “recording mode” already started. Optionally, a powerbank can also be attached to the intravenous pole to provide extra charge for longer procedures. The height of the intravenous pole, as well as its position and distance to the surgical table, should be adjusted accordingly before the intervention, in order to provide the best recording definition. The authors describe a simple, easy to setup, inexpensive system to record videos in Dermatologic Surgery.

Cosmetic surgery: medicolegal considerations

Cosmetic surgery is one of the two branches of plastic surgery. The characteristic of non-necessity of this surgical speciality implies an increased severity in the evaluation of the risk-benefit balance. Therefore, great care must be taken in providing all the information necessary in order to obtain valid consent to the intervention. We analyzed judgments concerning cosmetic surgery found in national legal databases. A document of National Bioethics Committee (CNB) was also analyzed. Conclusion: The receipt of valid, informed consent is of absolute importance not only to legitimise the medical-surgical act, but it also represents the key element in the question concerning the existence of an obligation to achieve certain results/use of certain methods in the cosmetic surgery.