Purpose: Part-time training offers general surgery trainees a pathway to improved work–life balance; however, concerns remain regarding its impact on clinical training quality, continuity of care, and trainee well-being. This study aimed to compare perceptions of training quality and well-being between part-time and full-time general surgery training. Methodology: A survey was conducted among general surgery trainees who had undertaken part-time training over a five-year period. Respondents rated domains of training quality, well-being, and handover practices using a 0–10 visual analogue scale (VAS), converted to a 100-point scale, with a 10-point difference considered significant. Comparative ratings were collected for both part-time and full-time training experiences. Results: Twenty-three trainees responded. Part-time training was rated more favourably for personal well-being, with marked improvements in work–life balance (+72.6), physical health (+69.9), and family time (+72.6). Sleep duration increased by almost two hours per night. Research productivity was rated higher (+50.4), and theoretical knowledge scores were superior during part-time training (81.0 vs 41.4). These benefits were offset by lower ratings for operative exposure (72.6 vs 84.4), patient continuity (56.0 vs 81.0), and post-operative follow-up (34.7 vs 59.1). Handover practices varied widely, ranging from daily to weekly or ad hoc exchanges, contributing to perceived inconsistencies in patient care. Conclusion: General surgery trainees perceived part-time training as strongly beneficial for well-being, theoretical knowledge, and research productivity. Contrastingly, reduced continuity of care and operative exposure were identified as key limitations. Standardised rostering and handover processes may help preserve the benefits of part-time training while safeguarding the quality of general surgery training.

Purpose: This study characterises the evolving interest of Australian medical students in surgical careers. By profiling exposure, mentorship, and research participation, we aim to identify motivators and barriers shaping surgical career decision-making. Methodology: Data is being collected via an ongoing, cross-sectional anonymous online survey of Australian medical students consisting of 42 questions. The instrument evaluates shifts in surgical interest, subspecialty preferences, and the impact of early clinical exposure or mentorship. It further assesses involvement in student societies and perceived hurdles via Likert-scale items. Results: In this preliminary cohort of 80 respondents (median age 22; 58.8% male; 25% preclinical; 62.5% metro), early data suggest surgical interest is high but dynamic - 53.2% currently favour a surgical career, and 51.9% report increased interest since starting medical school. General surgery had the highest proportion indicating interest (19.0%), followed by orthopaedics (15.2%). While pre-clinical exposure was reported by only 46.8%, it appears influential, with 51.9% of those exposed noting increased interest. Conversely, mentorship remains a gap, with only 26.6% reporting a surgical mentor. Research involvement (22.8%) also correlates with higher interest. Significant perceived barriers include lifestyle concerns (77.2%), competitive selection (73.4%), and demanding training (72.2%). Interest was similar between rural and metro respondents (57.9% vs 54.0%). Most respondents (72.6%) are willing to spend 3+ years as an unaccredited registrar. Key motivators include "hands-on" satisfaction (85.9%) and intellectual challenge (82.1%). Conclusions: Early findings indicate surgical interest is influenced by the quality of exposure and research. Low mentorship rates and significant lifestyle concerns suggest a need for structured support. Findings support earlier clinical exposure and formalised mentorship to improve pathway clarity.

Background and purpose: Microsurgery demands meticulous technical precision and refined motor skills. Traditionally, these competencies were acquired through apprenticeship-based models, including live animal laboratories and operating theatre exposure. However, ethical and financial considerations, reduced training hours and increasing emphasis on patient safety have driven microsurgical education toward simulation-based training. This review aims to explore strategies in simulation-based microsurgical education, highlighting effectiveness and potential to enhance trainee competency. Methodology: This presentation reviews the historical development and contemporary advances in microsurgical training and simulation. Training modalities are categorised into low-fidelity bench models, synthetic and biological simulators, virtual reality (VR), augmented reality (AR) and robotic-assisted platforms. Educational effectiveness is evaluated in terms of skill acquisition, transferability to the operating theatre, accessibility, cost-effectiveness and assessment capability. Results: Simulation-based microsurgical training has shown to improve learning efficiency and trainee confidence prior to clinical participation. Low-cost bench and synthetic models effectively support early skill development, whilst high-fidelity VR and robotic platforms enable objective performance metrics, standardised assessment and deliberate practice without patient risk. Structured simulation curricula have demonstrated improved operative readiness and patient safety outcomes. Conclusion: Microsurgical training has evolved from traditional apprenticeship models to competency-based, simulation-enhanced education. Advances in simulation technology provide ethical, scalable and effective solutions for training and assessment. Continued innovation and validation will be essential to integrate simulation fully into surgical training pathways and to support the future microsurgical workforce.

Purpose: The Otolaryngology Head and Neck Surgery (OHNS) training scheme in Aotearoa New Zealand and Australia has undergone extensive changes over the last decade with a marked increase in the number of work based assessments (WBA) that must be completed throughout training. The current paper based system places a significant administrative burden on trainees in addition to the existing clinical duties. WBA tools have been utilized for many years overseas with positive feedback. We aim to compare satisfaction rates with, and opinions of, the existing paper based assessment model with the proposed WBA for trainees and consultant supervisors. Method: The prospective study includes two surveys, the first for the current paper based assessment and the second for the WBA. Surveys are sent to all current OHNS NZ Trainees and ORL Departments in New Zealand. The responses are collected anonymously on SurveyMonkey. The first survey is completed six months prior to the introduction of WBA and the second survey completed 18 months after implementation. Results: 71 responses were collected for the first survey on paper based assessment and 58 responses for the second survey on WBA. Respondents found WBA easier to complete (p=0.03), less time consuming (p=0.003), less stressful (p=0.05) and the format less restricting (p=0.011) compared to paper based assessments. Thematic analysis found paper based assessments to be complex, with excessive detail and often not applicable to procedures being assessed. Technical challenges related to access and completion of the WBA were raised. Respondents found consultant engagement a challenge for both assessment platforms. Conclusion: Overall, respondents were positive with the digital transition. The issues raised mostly surround usability rather than feasibility. We expect with greater familiarity of the WBA, there will be greater engagement from both trainees and supervisors.

Background: Rural general surgeons are essential for equitable surgical care in Australia. Despite recent RACS rural training initiatives, evidence guiding effective rural surgical education remains limited and fragmented. This review synthesised current knowledge on rural general surgical education in Australia, to identify gaps for developing sustainable training models aligned with RACS competencies. Methodology: Structured narrative review of MEDLINE and grey literature (2000-2025) from surgical colleges and rural health agencies. Eligible publications described rural/regional Australian general surgery education, teaching models, supervision, simulation-based training, operative exposure and non-technical skills. Studies were synthesised thematically and mapped to RACS General Surgery SET competencies. Results: A limited body of peer-reviewed studies and key policy documents were identified. Emerging themes included traditional apprenticeship-style supervision models, variable access to operative exposure in smaller centres, and recent initiatives using simulation or mobile skills training to compensate for limited case-mix. Evidence was particularly limited for structured rural teaching frameworks and systematic non-technical skills development specific to rural general surgery contexts. This gap persists despite RACS incorporation of NOTSS into Surgical Education and Training programs. Priority gaps included structured simulation access, formalised perioperative teaching frameworks, and systematic mentoring in situation awareness, decision-making, communication and teamwork. Conclusions: Current literature provides limited guidance for structured rural general surgical education in Australia, with training programs remaining metropolitan-centric. Defining context-appropriate models for regional centres could strengthen rural pathways and support RACS workforce sustainability goals by addressing non-technical skills and competency-based assessment.

Purpose: Grommet insertion is a procedure frequently encountered by junior doctors and surgical trainees. However, opportunities for supervised procedural training are limited by service demands, patient safety concerns, and restricted access to simulation facilities. Commercial otology simulators are often expensive and not universally available. This study describes the development of a low-cost, readily accessible simulator designed to facilitate safe and effective training in grommet insertion. Methods: A simulation model was constructed using inexpensive, commonly available materials. Suction tubing was used to replicate the external auditory canal approximating average canal length and diameter. A latex glove secured at the distal end simulated the tympanic membrane and handle of malleus marked with a marking pen. The tubing was mounted through a cruciate incision in a standard glove box, providing stability and appropriate angulation. The model allows use of standard otological instruments under direct vision or microscopy, enabling practice of myringotomy incision, grommet placement, and fine instrument handling. Results: The simulator was assembled at minimal cost and demonstrated face validity by reproducing key technical challenges of grommet insertion, including restricted access, depth perception, and precision of movement. Survey feedback from otorhinolaryngology consultants/fellows, trainees and junior doctors indicated improved procedural confidence and understanding of technique with majority of respondents stating they would recommend it to junior doctors. The model is portable, reusable, and easily reproducible, allowing repeated practice without patient risk. Conclusion: This low-cost grommet insertion simulator provides an effective and scalable training tool. Its affordability, simplicity, and accessibility support widespread adoption in surgical skills training, with potential benefits for procedural competence, confidence, and patient safety.

Background: Scholarship and teaching is integral to becoming a successful surgeon, indeed it is one of the ten core competencies identified by the Royal Australasian College of Surgeons. Despite its importance, there is considerable variation in the way this competency is taught and assessed as part of general surgical training. Both countries primarily use the production of research as a metric to gauge mastery. Aims: This narrative review explores the experiences reported by institutions regarding mandatory research production as part of specialist training. Methods: A review of the literature was conducted using PubMed and Ovid search terms [research], [surg*], [requirement*], [residency] and [training] with Boolean modifiers to provide a comprehensive search. Relevant papers underwent qualitative review to identify themes and “common themes” were defined as those appearing in three or more publications Results: The search yielded 47 unique publications, of which 15 were relevant. Three common themes emerged: (a) Integration within training, (b) Infrastructure, support and mentorship, and (c) Outcomes of trainee research. Discussion: The reviewed papers generally expressed dissatisfaction with current frameworks. Integration could be facilitated by protected, dedicated research time but requires further funding to offset the reduction in clinical time. Infrastructure, support and mentorship is improved by university affiliation but creates discrepancies between urban and rural centres. Reduced quality of research output likely reflects the variability in competency assessment. The introduction of Entrustable Professional Activities in General Surgery Education and Training provides a new framework for teaching and assessing scholarship. Furthermore, it better integrates research within training and reallocates infrastructure and support to trainees undertaking more intensive and academically satisfying projects. Conclusion: Alternative frameworks for assessing scholarship mastery allows precious resources to be dedicated to higher quality research.

Abstract Background Increasing subspecialisation in breast surgery has reduced operative exposure for general surgery trainees. Ongoing concerns remain that trainee involvement as primary operator may be associated with increased perioperative morbidity. This study compares complication rates between trainee- and consultant-performed breast surgery within a specialist unit. Methods A retrospective review was conducted of all breast surgical procedures performed over a five-year period from January 2016 to December 2021. The primary outcome was postoperative complication rate, comparing procedures performed by trainees and consultants as primary operators. Outcomes were further stratified by procedure type, including benign surgery, primary breast cancer surgery, and re-excision. Results A total of 2,646 operative cases were included. Consultants were the primary operator in 1,544 cases (58.35 percent), and trainees in 1,102 cases (41.65 percent). The overall complication rate was 2.83 percent (n = 75). There was no statistically significant difference in complication rates between consultant- and trainee-performed procedures (2.65 percent vs 3.08 percent, p = 0.59). For mastectomy-only procedures, complication rates were higher in the consultant group compared with the trainee group (7.3 percent vs 2.8 percent), although this difference was not statistically significant (p = 0.18). Haematoma was the most common complication in both groups. Conclusion Breast surgery performed by general surgery trainees was not associated with increased perioperative morbidity compared with consultant-performed procedures. These findings support supervised trainee involvement as primary operator within specialist breast units, particularly in the context of declining operative exposure during surgical training.

Background: Early post-operative complications contribute substantially to preventable morbidity, unplanned ICU admissions, and prolonged hospital stay in Australian surgical services. Although evidence-based protocols exist, effective translation into bedside care during the first 48 hours after surgery depends largely on junior doctors, particularly after hours. Observational data demonstrate persistent gaps in confidence and execution relating to analgesia titration, venous thromboembolism prophylaxis, drain assessment, and escalation of clinical deterioration. These gaps represent a modifiable driver of surgical hospital-acquired complications and align with National Safety and Quality Health Service Standard 5. Methods: Module X: Foundations of Evidence-based Post-operative Care was developed as an eight-hour blended educational intervention for postgraduate year 1–2 medical officers in a regional surgical service. The curriculum integrates flipped learning, case-based discussion, ward-based simulation, and supervised bedside skills practice. Educational design aligns with Miller’s Pyramid of Clinical Competence and Kolb’s experiential learning cycle. Core content targets five high-impact complications: surgical-site infection, post-operative haemorrhage, venous thromboembolism, respiratory failure, and acute delirium. Performance is assessed using structured viva, simulation-based OSCE checklists, mini-CEX, and guided reflective debriefs. Results: The programme was designed for feasibility within existing teaching structures, requiring no additional capital investment and a faculty-to-learner ratio of 1:6. A needs analysis identified low baseline confidence in analgesia adjustment (71%), drain interpretation (58%), and escalation pathways (54%), informing curriculum priorities. Conclusion: A structured, context-adaptable educational intervention targeting junior-doctor post-operative decision-making is a scalable strategy to improve early surgical safety, particularly in regional settings.

Purpose: Competency-based training (CBT) emphasises progression based on demonstrated competence rather than time-based exposure. Regional hospitals offer procedural volume and continuity but require structured assessment frameworks to support safe trainee autonomy. This study describes the implementation of a CBT model incorporating procedural assessment to guide graduated autonomy. Methodology: A prospective observational study was conducted over two training terms within one calendar year in a regional general surgery unit at Goulburn Valley Health. Participants included two General Surgery Education and Training (GSET) trainees and one Surgical Education and Training (SET) trainee. A structured CBT framework was implemented incorporating procedure-specific workplace-based assessments, defined supervision levels, and entrustment decisions. Data collected included procedural exposure, assessment completion rates, level of intra-operative autonomy, and supervisor and trainee feedback. Results: Across the study period, trainees participated in 186 operative cases, including 124 core general surgery procedures suitable for competency-based assessment. A total of 98 procedural assessments were completed (median 32 per trainee), with 87% rated as meeting or exceeding expected competence. Progression to reduced supervision occurred in 72% of assessed procedures following repeated satisfactory assessments. No adverse patient outcomes were attributable to trainee autonomy. Supervisors reported increased confidence in entrustment decisions, while trainees reported improved clarity regarding expectations, feedback, and progression. Conclusion: Competency-based training supported by structured procedural assessment and graduated autonomy is feasible and effective in a regional general surgery unit. Regional training environments, with appropriate supervision and governance, are well suited to CBT implementation and may enhance trainee development while maintaining patient safety.