Introduction Group and Save samples (G&S) are routinely performed before laparoscopic appendectomies (LA). Cycle-1 of this QIP showed <1% of patients required blood products perioperatively. We recommended and implemented that a G&S request should be at the clinician’s discretion and not routinely performed. Cycle-2 assesses the impact of our recommendation. Method In Cycle-1 patients who had undergone LA and laparoscopic conversion to open appendicectomies between January - December 2018 were identified using Operating Room Management Information System. Patients who had G&S performed and patients receiving blood products were identified using the hospital’s electronic patient records and online pathology reporting service. Patients from December 2019 to June 2020 formed Cycle-2 of this QIP. Results 124 patients were included in Cycle-2 (versus 263 in Cycle-1). 58% of patients had G&S taken (versus 99.6% in Cycle-1). 0.81% required a transfusion post-operatively (versus 0.76% in Cycle-1). The average number of G&S per patient was reduced by 1.19, saving the Trust £23.80 per patient. Conclusions Blood products are not routinely required peri-operatively, therefore G&S should be ordered at the clinician’s discretion. This safely saves the Trust significant cost and improves patient experience by eliminating the discomfort of unnecessary blood tests.

Introduction Surgical departments across the UK are having to mitigate service demands, budget constraints and changes to work patterns with their statutory duty to provide high-quality training and education. Securing consultant-led teaching has also become increasingly difficult leading to the rise of near-peer teaching. We evaluate the long-term effectiveness of near-peer surgical teaching for junior doctors. Method We developed a rolling 12-week trainee-led didactic surgical education programme for Foundation doctors and Core Surgical Trainees. Junior doctors delivered teaching to peers with registrar input; session and supervision feedback was recorded using 5-point scales and free-text responses. Results 42 junior doctors responded to our end-of-programme feedback surveys covering December 2018 to April 2020. The overall programme (8.83±1.08/10), relevance (4.62±0.58/5), presentation quality (4.60±0.50/5) and supervisor knowledge (4.81±0.40/5) were rated highly by respondents. Attendees also reported significant improvements in subject knowledge (3.72±0.92/5 to 4.50±0.56/5, P < 0.0001), clinical confidence, presentation and teaching skills. Conclusions Our near-peer teaching programme addressed the educational needs of junior doctors and developed their presentation and organisational skills. Supervision and input from registrars facilitated discussion and reinforced key concepts. The success of this programme highlights the role that trainees can play in designing, developing, and leading an effective surgical teaching programme.

Perforation of the oesophagus is a relatively rare but life-threatening condition, which requires early laparoscopic or surgical intervention. The aim of this work was to describe the causes, management and outcomes of emergency patients treated at a single high volume upper gastrointestinal specialist unit in the United Kingdom. In this retrospective case series, we identified all patients who presented to a tertiary upper gastrointestinal surgery unit with a spontaneous or iatrogenic oesophageal perforation. Patient demographics, clinical management, and outcomes were identified by hand review of the medical notes. Between March 2011 to July 2020, 58 patients were identified. The median age was 71 years (interquartile range 52 years to 83 years) and 64% were male. A total of 83% of patients had benign perforations, the rest being malignant. Management of all patients was supportive in 41%, endoscopic in 19% and surgical in 40%. In total 63% of spontaneous benign perforations were managed surgically, and only 6% endoscopically. The median length of hospital stay for all patients that survived more than 90 days was 13 days. The 90-day mortality rate for all patients was 42%. Oesophageal perforations are a relatively rare but lethal disease, carrying a mortality. Whilst surgery has historically been the most common management of benign spontaneous perforations, endoscopic treatments are likely to become increasingly common in the future.

Introduction While the need for gender equality has been well recognised within the medical profession, attitudes of patients towards doctors of different genders has not been addressed. We aim to identify whether gender biases exist within the minds of patients we treat and how we can address this. Method A survey was disseminated through social media platforms and work communication groups. Data was collected on gender, ethnicity, frequency of being mistaken for different members of the healthcare team and frequency of being asked to perform non-medical tasks. A free text option was available for respondents to elaborate on the context and how this made them feel. Results 88 doctors (26 male, 62 female) responded. 65% (40) of females have had their roles misidentified at least once a week, compared to 0%(0) of males. 75% (46) of women reported negative emotions associated with being mistaken in their role, 25% (15) were neutral, none were positive. 62% (38) of female doctor’s report being asked to perform non-medical tasks at least once a week compared to 31% (8) of male doctors. Conclusions There is a clear disparity in how patients perceive male and female roles in medicine, with females being less likely to be identified as a doctor and twice as likely to be asked to perform non-medical tasks. As well as being potentially disruptive to their role, responses suggest that this impacts negatively on the confidence of these respondents. Further exploration of this subject, the impacts and remedies will be required in future.