Introduction
Surgical training in the United Kingdom consists of a well-defined curriculum set by the Intercollegiate Surgical Curriculum Project (1). In order to meet the outcome of this curriculum and progress through different stages in their training, surgical trainees need to demonstrate competency in specialty-based knowledge, clinical judgement and operative skills at each benchmark review. Given the time constraints from the European Working Time Directive and general service provision within the NHS, educational opportunities are limited and these opportunities need to be utilized strategically (2). The operating theatre being the primary learning environment for trainees to acquire procedural skills, needs to be optimized to ensure effective training can take place.
The operating theatre as a learning environment is well studied in current literature (3,4). Common themes of such a conductive learning environment include relationship-based mentoring, availability of time and structured teaching (5). Trainees’ positive perception on the quality of the learning environment is imperative for successful training (3,6). As such, studies on evaluating the learning environment in the form of trainee-led feedback questionnaire have been performed in the past. Notable examples include the Postgraduate Hospital Education Environment Measure (7) and the Anaesthetic Trainee Theatre Education Environment Measure (8). An effective feedback instrument will allow trainers to identify the strengths and weaknesses in the learning environment, guide future changes, and ensure successful training. Regarding feedback instrument for the theatre learning environment, the Cassar questionnaire was developed almost two decades ago and is orientated towards basic surgical trainees (9). In this study, we built on the Cassar questionnaire and developed an updated feedback instrument that reflects the evolvement of surgical training in the past twenty years and tailored this instrument towards higher surgical trainees. This instrument was then validated in a three-stage validation process and is currently utilized in our local specialty training program.