Undergraduate surgical education is failing to prepare medical students to care for patients with surgical conditions, and has been significantly compromised by the COVID-19 pandemic. We performed a literature review and undertook semi-structured reflections on the current state of undergraduate surgical education across five countries: Egypt, Morocco, Somaliland, Kenya, and the UK. The main barriers to surgical education at medical school identified were (1) the lack of standardised surgical curricula with mandatory learning objectives and (2) the inadequacy of human resources for surgical education. COVID-19 has exacerbated these challenges by depleting the pool of surgical educators and reducing access to learning opportunities in clinical environments. To address the global need for a larger surgical workforce, specific attention must be paid to improving undergraduate surgical education. Solutions proposed include the development of a standard surgical curriculum with learning outcomes appropriate for local needs, the incentivisation of surgical educators, the incorporation of targeted online and simulation teaching, and the use of technology.

Objectives: The identification and management of incidentalomas is becoming increasingly problematic, particularly in relation to brachial plexus imaging because the prevalence of incidental findings is unknown. Therefore, we aimed to estimate the prevalence of incidental findings in symptomatic patients undergoing MRI of the brachial plexus. Methods: This retrospective cohort study included all children and adults who underwent MRI over a 12 year period, in a tertiary care centre in the UK. An incidental finding was any abnormality which was not a direct injury to or disease-process of the brachial plexus. An “incidentaloma” was defined by the need for further investigation or treatment. Multivariable logistic regression was used to estimate the odds ratio (OR) of an “incidentaloma”. To estimate which factors were associated with the number of incidental findings, multivariable Poisson regression was used. Results: Overall, 502 scans (72%) reported incidental anomalies. Although the number of MRIs performed per annum increased by 23%, the prevalence of “incidentalomas” remained static (p = 0.766). Musculoskeletal incidental findings were the most prevalent (63%) and when identified, there were a median of 3 incidental anomalies per patient. Overall, 125 (18%) anomalies were “incidentalomas” which required further investigation or treatment. The odds of having further investigation or treatment was strongly related to the frequency of incidental findings [adjusted OR 1.16 95% CI (1.08, 1.24)] and when a tumour was identified [adjusted OR 2.86 95% CI (1.81, 4.53)]. The number of incidental findings recorded per scan increased when trainees co-reported with consultants [adjusted IRR 0.36 95% CI (0.05, 0.67)] and in the presence of a tumour [adjusted IRR 0.39 95% CI (0.28, 0.49)] Conclusions: The prevalence of clinically important incidental findings on brachial plexus MRI is lower than organ-specific imaging, but still 18% of scans identified an ‘incidentaloma’ which required further investigation or treatment. Advances in knowledge: This cohort study shows that approximately 1 in 5 symptomatic patients undergoing a brachial plexus MRI had a clinically important incidental findings, which required further investigation or treatment. This information can be used to inform patients consenting to clinical or research imaging.

Representation of researchers from underprivileged backgrounds in unknown in academic medicine. We present the inspiring experiences of Professor Philip Quirke describing his humble beginnings in the East End of London to becoming an internationally acclaimed academic clinician. Importantly he offers his advice on what someone from a similar background should consider with similar aspirations.

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