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Operative numbers and CCT ‘A line in the Sand’

Operative numbers and CCT ‘A line in the Sand’. Mick Powell and Owen Sparrow Past and present SAC Chair Acknowledging Ken Lindsay’s and Cristel Santos’ part. Big Changes over the last 26 years. Reg/SR to Calman to ST

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Operative numbers and CCT ‘A line in the Sand’

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  1. Operative numbers and CCT‘A line in the Sand’ Mick Powell and Owen Sparrow Past and present SAC Chair Acknowledging Ken Lindsay’s and Cristel Santos’ part.

  2. Big Changes over the last 26 years • Reg/SR to Calman to ST • Big increase of training grade personnel in every unit, ST trainees stable, but: Specialist fellowships, ‘Research Posts’, Rota fillers in general • 48 Hours • Rota Compliance

  3. Numbers and experience • Does surgical experience/competence equal numbers? • Does lack of numbers equal inability? • What is the role of the SAC? • Overview log book pre Rita G • Delay ‘signing off’ CCT? • What is the SAC’s duty?

  4. 1990 – 2005 (A Jenkins to M Garnett) P only No III Ventriculostomy No ISAT Little spinal fixation No 18 weeks Last 38 CCT SS/SU/P/T Endoscopy ++ ISAT and coiling 70+% Spine teams 18 weeks The Data from SAC CCT filesOverall numbers stable

  5. Trauma

  6. CSF Circulation

  7. Adult tumours

  8. Vascular

  9. Functional / Epilepsy

  10. Spine

  11. Paediatric cases

  12. Techniques

  13. My logbook as P’sReg Frenchay8/80-2/82Research Frenchay 4/02-3/83SR NHNN 4/83-5/85 • Trauma:EDH/ASDH = 69 • BH for CSDH/Press m:101 • BH and stereo biop: 49 • Cranio tum: 91 • Mening : 10 • TSS : 10 (+3 Cranial) • Acoustics: 2 • Shunt: 112 • Aneurysms: 23 • AVM: 1 • Ant Spine: 66 • L lam: 43 • L Disc : 59 • Sp tum intra d: 18 • Extra d sp Tum: 7

  14. What we look for • Overall numbers: >1200 • Cranial Microscope cases (SS/SU/P): Aneurysms: 9 TSS: 13 Acoustics: 1 AVM: 2 III Vent: 4 MVD: 5 Epilepsy: 1 Meningiomas: 27 (?1/2 relevant) • Total: >40 • But Few reach that so we accept >30

  15. To Reinforce that message >30 Cranial Microscope cases as SS/SU/P

  16. Conclusion • Very clear evidence that trainees are doing fewer complex cranial cases • TPD’s, individal trainers and above all trainees must monitor these numbers carefully • Trainers MUST make every effort to allow trainees to have hands on cranial microscope experience • Trainees should not be frightened that taking more time will adversely affect their career appointment chances. A RITA D is not a bad thing or a stain on their CV • Remember, an inexperienced uncertain consultant will find it difficult to command respect and lead a team.

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