title: An Objective Assessment of the Surgical Trainee in an Urban Trauma Unit in South Africa: A Pilot Study.
abstract: Surgical outcomes are provider specific. This prospective audit describes the surgical activity of five general surgery residents on their trauma surgery rotation. It was hypothesized that the operating surgical trainee is an independent risk factor for adverse outcomes following major trauma.
  
  
  
  This is a prospective cohort study. All patients admitted, over a 6-month period (August 2014-January 2015), following trauma requiring a major operation performed by a surgical trainee at Groote Schuur Hospital's trauma unit in South Africa were included. Multiple logistic regression models were built to compare risk-adjusted surgical outcomes between trainees. The primary outcome measure was major in-hospital complications.
  
  
  
  A total of 320 major operations involving 341 procedures were included. The mean age was 28.49 years (range 13-64), 97.2 % were male with a median ISS of 9 (IQR 1-41). Mechanism of injury was penetrating in 93.42 % of cases of which 51.86 % were gunshot injuries. Surgeon A consistently had the lowest risk-adjusted outcomes and was used as the reference for all outcomes in the regression models. Surgeon B, D, and E had statistically significant higher rates of major in-hospital complications than Surgeon A and C, after adjusting for multiple confounders. The final model used to calculate the risk estimates for the primary outcome had a ROC of 0.8649.
  
  
  
  Risk-adjusted surgical outcomes vary by operating surgical trainee. The analysis thereof can add value to the objective assessment of a surgical trainee.
authors.affiliation: Department of General Surgery, Codman Center Massachusetts General Hospital, Boston, USA. spnric004@myuct.ac.za.|Department of General Surgery, University of Cape Town, Cape Town, South Africa. spnric004@myuct.ac.za.
authors.forename: Richard Trafford
authors.initials: RT
authors.lastname: Spence
authors.affiliation: Department of General Surgery, Vancouver General Hospital, Vancouver, Canada.|Department of General Surgery, University of British Columbia, Vancouver, Canada.
authors.forename: Eiman
authors.initials: E
authors.lastname: Zargaran
authors.affiliation: Department of General Surgery, Vancouver General Hospital, Vancouver, Canada.|Department of General Surgery, University of British Columbia, Vancouver, Canada.
authors.forename: Morad
authors.initials: M
authors.lastname: Hameed
authors.affiliation: Department of General Surgery, University of Cape Town, Cape Town, South Africa.|Department of Trauma Surgery, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: Andrew
authors.initials: A
authors.lastname: Nicol
authors.affiliation: Department of General Surgery, University of Cape Town, Cape Town, South Africa.|Department of Trauma Surgery, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Navsaria
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000379:methods; D008505:Medical Staff, Hospital / Q000193:education; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery*; D010865:Pilot Projects; D011183:Postoperative Complications; D011446:Prospective Studies; D013019:South Africa; D014193:Trauma Centers / Q000592:standards*; D014194:Traumatology / Q000193:education*; D019037:Urban Health Services / Q000592:standards; D014948:Wounds, Gunshot / Q000601:surgery; D055815:Young Adult