REGISTRAR PERCEPTIONS ON GENERAL SURGICAL TRAINING IN SOUTH AFRICA: A REPORT BY THE SOUTH AFRICAN SOCIETY OF SURGEONS IN TRAINING (SASSIT).

BACKGROUND: Surgical training varies significantly even amongst universities within the same country. This trend is reflected in South Africa and provides an opportunity for innovation to improve the quality of general surgical training.

METHOD: A prospective descriptive study was performed by means of a confidential questionnaire distributed to general surgical registrars at all 8 training centres in South Africa. Participants were asked to give comments regarding adequacy of formal academic teaching, level of supervision during surgical procedures, exposure to and training in minimally invasive surgery (MIS), and preparation for examinations. Descriptive statistics were generated with Microsoft Excel. Ethics clearance was obtained from the University of Witwatersrand Human Research Ethics Committee.

RESULTS: Of 200 questionnaires distributed, 105 (52.5%) were returned. In total 44% (105/241) of all registrars from 6 training institutions participated. The majority (89.5%; 94/105) of respondents reported that they attended less than 6 hours of formal academic teaching per week and 71.4% (75/105) indicated that their institution offered less than 6 hours of formal academic teaching per week. Furthermore, 76.2% (80/105) of respondents regarded lack of protected academic time as the greatest hindrance to their surgical training and 95.2% (99/105) reported that clinical responsibilities prevented them from attending formal academic teaching regularly. Overall, only 31.4% (33/105), 41.9% (44/105) and 37.1% (39/105) were satisfied with the amount of formal academic teaching, level of supervision during theatre procedures and exposure to MIS, respectively. Lack of resources and lack of appropriate skills were identified as a hindrance to MIS training by 47.6% (50/105) and 28.6% (30/105) of respondents, respectively.

CONCLUSION: Surgical registrars are dissatisfied with the amount of formal academic teaching and protected academic time, level of supervision in theatre and their exposure to MIS. These challenges compromise trainees' ability to practise independently on qualification. Numerous interventions are necessary and possible to address these challenges.