Background: Socioeconomic status and distance from hospital have been shown to be associated with poor surgical outcomes related to acute appendicitis. Indigenous populations experience greater socioeconomic disadvantages and poorer healthcare access than their non-Indigenous counterparts. This study aims to determine whether socioeconomic status and road distance from hospital are predictors of perforated appendicitis. It will also compare surgical outcomes of appendicitis between Indigenous and non-Indigenous populations. Methods: We performed a 5-year retrospective study of all patients who underwent appendicectomy for acute appendicitis at a large rural referral centre. Patients were identified using the hospital database for theatre events coded as appendicectomy. Regression modelling was used to determine if socioeconomic status and road distance from hospital were associated with perforated appendicitis. The outcomes of appendicitis between Indigenous and non-Indigenous populations were compared. Results: Seven hundred and twenty-two patients were included in this study. The rate of perforated appendicitis was not significantly impacted by socioeconomic status (OR 0.993, 95% CI 0.98-1.006, P = 0.316) or road distance from hospital (OR = 0.911, 95% CI 0.999-1.001, P = 0.911). Indigenous patients did not have a significantly higher rate of perforation compared to non-Indigenous patients (P = 0.849) despite having overall lower socioeconomic status (P = 0.005) and longer road distance from hospital (P = 0.025). Conclusion: Lower socioeconomic status and longer road distance from hospital were not associated with an increased risk of perforated appendicitis. Indigenous populations have poorer socioeconomic status and longer road distance to hospital but did not have higher rates of perforated appendicitis.

Introduction: The increasing duration of time before the commencement of formal surgical education training (SET) in Australia has emphasised the need for pre-SET “aspiring” surgical trainees to develop greater competency in both generic and specialty-specific skills to fulfil these public hospital positions, however there is no formalised curriculum or guide. This paper investigates current inconsistencies in the training of Australian pre-SET aspiring surgical trainees and attempts to define which skills are required. Methods: We conducted semi-structured interviews with pre-SET supervisors in general and specialty surgery fields at a large tertiary teaching hospital in Sydney, Australia, to assess expectations and competencies of pre-SET surgical trainees. A mixed-method analysis was used with inductive content analysis used for the rich interview data and quantitative analysis of 5-point Likert scale scores for the essential skills syllabus and eligibility requirements. Results: Eighteen interviews were conducted. Three major themes arose from inductive content analysis: participants perceived that pre-SET trainees met basic expectations, significant variability in skill level exists between trainees, and simulation was suggested as a potential solution to address gaps in training. Quantitative analysis of Likert scores suggests that trainee competency was inadequate (or not required) for several skills. For general surgery, trainee competency was deemed inadequate for proctoscopy, rigid sigmoidoscopy and appendicectomy. Conclusions: There is a critical need to clearly define the skills expected of pre-SET trainees and their role within the healthcare system. This study provides insights into the content of that skillset, which could be used to design relevant and useful training programs for pre-SET trainees. The value of simulation training was universally noted by participants. They believed that this could improve competency for pre-SET trainees in technical and non-technical skills.