Article Text

Download PDFPDF
40-4-40: educational and economic outcomes of a free, international surgical training event
  1. James Glasbey,
  2. Piriyah Sinclair,
  3. Helen Mohan,
  4. Rhiannon Harries
  5. on behalf of ASiT 40-4-40 Course Organisers
  1. Association of Surgeons in Training, Royal College of Surgeons of England, London, UK
  1. Correspondence to James Glasbey, Association of Surgeons in Training, Royal College of Surgeons of England, 35-43 Lincoln’s Inn Fields, London WC2A 3PE, UK; publicity{at}, jamesglasbey{at}


Purpose of study To demonstrate a model for delivery of an international surgical training event, and demonstrate its educational and economic outcomes.

Study design The Association of Surgeons in Training (ASiT) ran a course series on 16 January 2016 across the UK and Ireland. A mandatory, self-reported, online questionnaire collected delegate feedback, using 5-point Likert Scales, and a NetPromoter feedback tool. Precourse and postcourse matched questionnaires were collected for ‘Foundation Skills in Surgery’ (FSS) courses. Paired economic analysis was performed. Statistical analysis was carried out using RStudio (V.3.1.1 Boston, Massachusetts, USA).

Results Forty courses were held across the UK and Ireland (65.0% technical, 35.0% non-technical), with 184 faculty members. Of 570 delegates, 529 fully completed the feedback survey (92.8% response rate); 56.5% were male. The median age was 26 years (range: 18–67 years). The mean overall course NetPromoter Score was 8.7 out of 10. On logistic regression high NetPromoter Score was associated with completing a Foundation Skills in Surgery course (R=0.44, OR: 1.49, p=0.025) and having clear learning outcomes (R=0.72, OR: 2.04, p=0.029) but not associated with specialty, course style or teaching style. For Foundation Skills in Surgery courses, delegates reported increased commitment to a career in surgery (p<0.001), confidence with basic surgical skills (p<0.001) and confidence with assisting in theatre (p<0.001). A comparable cost saving of £231,462.37 was calculated across the 40 courses.

Conclusion The ASiT ‘40-4-40’ event demonstrated the diversity and depth of surgical training, with 40 synchronous technical and non-technical courses, demonstrable educational benefit and a significant cost saving to surgical trainees.

  • Medical education
  • Medical training
  • Surgery

Statistics from


  • Twitter @asitofficial

  • Contributors JG acts as overall guarantor for this study. All authors (JG, PS, HM, RH, 40-4-40 Course Organisers) contributed to review and refinement of the final manuscript. Headline authors contributed specifically to directing the international training programme (JG, PS, RH); delivering the training courses (40-4-40 Course Organisers); designing the study tool (JG, PS, RH); statistical analysis (JG, RH); drafting the manuscript (JG).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Collaborators ASiT 40-4-40 Course Organisers: James Akman, Oroog Ali, Richard Bamford, Sabapathy Subramanian, Aneel Bhangu, Andrew J Beamish, Robert Bethune, David M Bunting, Rhodri Costello, Emma Das, Ciara Deall, David R Evans, Elizabeth Elsey, Nicholas Farkas, Saadia Farooq, J Edward Fitzgerald, Vimal J Gokani, Andrew Gordan, Buket Gundogan, Gemma Humm, Heman M Joshi, Rakan Kabariti, Kenneth M Keogh, Chetan Khatri, Goldie Khera, Rebekah Law, Matthew Lee, Alexander Martin, Elizabeth Matthew, Frank D McDermott, Ciara McGoldrick, Phillip J McElnay, Devender Mittapalli, Helen M Mohan, Rachael Morley, Dmitri Nepogodiev, Adam Peckham-Cooper, Bruce Philip, Ana-Catarina Pinho-Gomes, Raj Rajaganeshan, Chritopher Rao, Sabina Y Rashid, Andrew J Robson, Duncan SG Scrimgeour, Rishabh Singh, Joseph Shalhoub, Ajay Sharma, Anna E Sharrock, Uttam Shiralkar, Nathan A Stephens, Phillip Touska, Stella Vig, Daniel White, Jonathan R Wild, Adam Williams, Sophie Williams.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.