605 Whose Operation Is It Anyway? Is There Consensus on Supervision Codes Use for General Surgical Procedures?
H Cohen, R Simson, R Bamford- Surgery
Abstract
Aim
Operative numbers are critical in applications to Core and Higher Surgical training, ARCP and CCT requirements. However, instructions for the use of supervision codes on the surgical eLogbook and ISCP are ambiguous. This study seeks to determine if there is a consensus for supervision coding for common general surgical operations.
Method
A survey of 10 operative vignettes was distributed to doctors who used the eLogbook. Participants were asked to indicate if they would code the operation Assisted (A) or Supervised Trainer Scrubbed (STS) from the vignette provided.
Results
The survey received 258 responses from doctors across all grades. In one appendicectomy vignette describing involvement at each key step but no dissection, 55% coded it as Assisted and 40% STS. For a laparoscopic cholecystectomy vignette which described dissecting the gallbladder off the liver and closing the ports, 59% coded it as Assisted and 37% STS. By including port insertion in this vignette 25% coded it as assisted and 72% as STS. Only 20% agreed with the statement “I find it easy to understand what supervision code I should record in my logbook”.
Conclusions
This study shows little consensus on supervision codes for general surgical operations and considerable ambiguity in the system. The description of the codes on eLogbook is not fit for purpose with minimal supporting guidance on ISCP. Clearer guidelines are required to enable trainees to use consistent coding to ensure validity in the use of indicative numbers in applications and as a marker of progress.