Objective

The Specialist Advisory Committee (SAC) in Cardiothoracic Surgery recently released guidelines that clarify the definition of a trainee case for isolated coronary artery bypass graft surgery (CABG), aortic valve replacement and lobectomy. For a trainee to have performed the case, they are required to have performed the majority of both proximal and distal anastomoses. The objective of this audit was to compare current practice against these newly developed guidelines.

Methods

This was a retrospective audit of prospectively collected clinical registry data for consecutive isolated CABG cases performed at a single institution between January 2015 and March 2015. Data on who performed each constituent part of the case were analysed. A trainee was defined as a national trainee or a clinical fellow and performing ≥50% of the anastomoses was considered to be the majority.

Results

A total of 150 cases were included. The majority were elective (72%) and most (68%) were on-pump. The mean number of grafts performed was 2.7 (SD 0.8). A trainee was recorded as first operator for 48 (32%) cases. A trainee performed the majority of distal anastomoses in 36% of cases and the majority of proximal anastomoses in 38% of cases. A trainee performed the majority of both distal and proximal anastomoses in 29% of cases. The new guidelines were adhered to in 135 (90%) of cases.

Conclusion

Accurate recording of trainee operative experience is increasingly important given the potential introduction of case number requirements. This audit demonstrates that there is already good adherence to the recently published SAC guidelines on case definition for trainees at our institution. It is anticipated that this adherence will improve following the dissemination of the new guidelines to trainees and trainers.