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The eLogbook and the Extended Surgical Team

13 April 2023 1:03pm

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Surgical training has evolved over the years, but the pace of change accelerated in the 1990s. The publication, in 1993, of the Calman report on specialist medical training, shortened surgical training to six years. Prior to this, surgical training had been deemed to be complete three years after appointment as a senior registrar, a post which often took many years to achieve. At about the same time junior doctors agreed the ‘New Deal’ on working hours with the government. The net effect of these combined changes saw surgical experience at the time of consultant appointment shortened from approximately 45,000 hours to around 16,000 hours. This reduction in hours of experience made it essential that the breadth and volume of experience at completion of training was closely monitored. In the specialty of trauma and orthopaedics, this led to the BOA education committee, led by Mr Paul Calvert and Mr Lester Sher, to the publishing of a syllabus for orthopaedic training and proposing the creation of a logbook. Paper logbooks had been part of early years basic surgical training since the early 90s and had spawned a number of PC based versions. A trial of these in higher orthopaedic training proved to be hugely problematic and after a review, the RCSEd then faculty of medical informatics, led by Prof. Angus Wallace, commissioning a web-based logbook which was developed by Dr Andrew Lamb, introduced in 2003 and mandated for all orthopaedic trainees the following year.

Since then, the eLogbook has grown to be the logbook for all ten surgical specialties in the UK and has become the world’s biggest surgical logbook by far with over 56m operations recorded and almost 20,000 users in 120 countries. Its reports allow trainees not just to count their operative experience and see its breadth, but also allows them to see how their experience compares to their peers. Training programme directors can see all those reports on individual trainees, but they can also see reports that allow them to identify good training opportunities and good trainers, as well as seeing where their programme compares to others across the country. This success and the wealth of useful information provided is despite the deliberate decision, taken when the logbook was designed, to keep it minimalist and simple.

The logbook is unarguably a valuable and essential tool for surgical trainees and trainers, but is it any use to members of the extended surgical team? The short answer to that is: definitely yes! It’s free and easy to use, available on a PC or mobile device and keeps your data secure. Every member of the surgical team, not just trainee surgeons, should be able to provide evidence of their progression in the volume and breadth their experience and if you use the same logbook as everyone else there is an opportunity of comparing yourself to others. That said, members of the extended surgical team may have different and perhaps more complex requirements of a logbook than the basic logbook as it stands. Some of you may be doing parts of procedures, such as closing wounds. Others may be using local anaesthetic techniques. Both the above groups may therefore want to record more detail on what they are doing than the basic logbook asks for.

The logbook offers a degree of extensibility that can let it meet those requirements. The functions available under the menu option ‘local audits’ allow users to create supplementary questionnaires that can be completed when certain procedures are recorded in their logbook. So, for example, if you are in a surgical first assistant role, the logbook by default will simply provide you with a list of all the operations where you have been assisting. You might wish to collect evidence of you involvement in these procedures that goes beyond the simple description ‘Assisting’ and also record details of the techniques you use. To do this you would create an ‘audit questionnaire’ that allowed you to collect details of what layers you closed and what suturing techniques you used. You would then link that questionnaire to the operations you regularly assist at. A detailed description of how you would do this is beyond the scope of this article, but video guides on the logbook website describe the process in detail. The data collected is downloadable into MS Excel so that you can then generate your own reports that describe your experience in the detail required.

In conclusion, the logbook is a powerful and versatile tool for all members of the surgical team. I would encourage all of you to create your account today and start collecting data on your practice now.