INTRODUCTION: The experience in the operation theatres is pivotal for surgical education. A measure of the educational environment in the operating room as perceived by residents would assist educators and trainees in gauging the quality of the learning occurring within their institute.     METHODS:  A cross-sectional survey using the surgical theatre educational environment measure (STEEM) 40-item inventory to measure theatre learning environment perception of surgery and allied residents in public sector hospitals of Rawalpindi. Internal reliability of the inventory was assessed using the Cronbach α coefficient. P≤ 0.05 was considered significant.   RESULTS:  107 respondents were included in the study. Mean score of the survey was 133.7± 20.2. No significant differences in perception were found among residents at different stages and gender, except in learning subscale of the inventory for both gender and residents and the teaching and training subscale among residents at different levels. The inventory showed a high internal consistency with a Cronbach α of 0.851.   CONCLUSION: Surgical training and education have still a long way to go in the public sector. Much needed collaborations with education specialist and senior surgeons is required. Interval collection of feedback and perceptions of the educational environment is also necessary.

Introduction Operation notes are recognized as standard for documentation of details of operation but still it's often neglected. Proper documentation is necessary as it is correlated with good patient care, quality assurance, future decisions, and medico-legal issues. Aim The objective of this study is twofold: one to compare the documentation of notes against standard RCS (Royal College of Surgeons) guidelines and secondly making sure that surgeons follow these by educating them through presentations, brochures, aide memoires and introduction of proformas. Method We prospectively studied 50 post-op notes against standard RCS guidelines consecutively both pre and post intervention. Asymmetric data was analyzed after 4 weeks using the Fischer-Exact Test and statistical significance was set as <0.05. Results A total of 18 guidelines were audited. First loop showed deficiencies in fields of elective/emergency, operative diagnosis, operative findings, complications, extra procedure performed, tissue removed/added, details of closure, blood loss and antibiotic prophylaxis. After intervention documentation improved and percentages rose and reached almost 100%. Conclusion Proper documentation is of great importance as it carries both medical and legal implications. Three step intervention showed remarkable improvement in documenting of these operation notes according to standard RCS guidelines.

Aim Ankle fractures are common among adult age group with an incidence of 174 per 100000 per year and they pose serious problems in management of geriatric age group because of osteoporotic bone. Our aim of current clinical audit was to introduce changes in current clinical practice by recommendations according to Standard BOAST guidelines of management of Ankle Fractures. Method Clinical Audit was carried out in Department of Orthopedics Benazir Bhutto Hospital in Outdoor and Emergency in March 2021 in patients of age group 20–70 years taking 50 patients for pre- and post-audit assessment. Emergency, Outdoor Slips were evaluated according to Standards of Practice formulated. Then a presentation was given to medical staff on Guidelines of Ankle fractures management, and they were informed about the deficiencies in their documentation and management. Panaflexes of Guidelines were displayed in ER, ward and then re-evaluation was done after 4 weeks in April 2021 using proformas in which clinical notes, discharge certificates and emergency slips were used for data analysis and observing improvement. Results The results of asymmetric data were calculated by Fischer Exact Test and with a p-value of <0.05 considered as significant. Results were very pleasing as they showed great improvements in documentation as well as management of patients in accordance with the set guidelines and protocols. Conclusion Clinical Audits should be carried out on regular basis in hospital settings as they help to improve the standards of care as well as proper documentation which has medico-legal importance.