Gilbert Bain Hospital

Abstract Aims In Scotland, a small number of early surgical trainees have undertaken a core surgical training (CST) placement in small rural hospitals. This study aimed to explore and determine characteristics of surgical training in Scottish rural hospitals, identifying any advantages or capacity for improvement in these training environments. Methods Semi-structured interviews of individuals who have undertaken a CST placement in a Scottish rural hospital. Interview transcripts were anonymised and thematically analysed. Results Ten trainees were interviewed and 4 themes that highlight the benefits and challenges of rural surgical training were identified. Themes were identified from the trainees' reflections on their training experience. Theme 1 “Training as an opportunity to gain technical and non-technical skills” The findings reveal a complex landscape where rural trainees often experience high autonomy in clinical decision-making and broad-based clinical exposure. This exposure enriched their learning experience, provided comprehensive preparation for exams, and was complemented by excellent exposure to non-technical aspects of surgery. Theme 2 “Training as an opportunity to understand the healthcare environment” which trainees reported allowed them to see the struggles of the rural surgeon and skills needed as a generalist. Theme 3 “Training as a community experience” Trainees reported on the community within and outside the hospital. Theme 4 “Training as an overall self-development experience” where trainees report on the experience uniqueness and its importance for their growth. Conclusion Rural surgical training offers a unique and valuable experience, fostering not only technical skills but also essential non-technical competencies in a supportive and collaborative environment.

ObjectivesColorectal polyp cancers present clinicians with a treatment dilemma. Decisions regarding whether to offer segmental resection or endoscopic surveillance are often taken without reference to good quality evidence. The aim of this study was to develop a treatment algorithm for patients with screen-detected polyp cancers.DesignThis national cohort study included all patients with a polyp cancer identified through the Scottish Bowel Screening Programme between 2000 and 2012. Multivariate regression analysis was used to assess the impact of clinical, endoscopic and pathological variables on the rate of adverse events (residual tumour in patients undergoing segmental resection or cancer-related death or disease recurrence in any patient). These data were used to develop a clinically relevant treatment algorithm.Results485 patients with polyp cancers were included. 186/485 (38%) underwent segmental resection and residual tumour was identified in 41/186 (22%). The only factor associated with an increased risk of residual tumour in the bowel wall was incomplete excision of the original polyp (OR 5.61, p=0.001), while only lymphovascular invasion was associated with an increased risk of lymph node metastases (OR 5.95, p=0.002). When patients undergoing segmental resection or endoscopic surveillance were considered together, the risk of adverse events was significantly higher in patients with incomplete excision (OR 10.23, p<0.001) or lymphovascular invasion (OR 2.65, p=0.023).ConclusionA policy of surveillance is adequate for the majority of patients with screen-detected colorectal polyp cancers. Consideration of segmental resection should be reserved for those with incomplete excision or evidence of lymphovascular invasion.