Procedures most frequently performed by South African-trained general surgeons - implications for training and assessment.

Background: Workplace-based assessment (WBA) is being introduced across postgraduate training in South Africa. This study was undertaken to inform the selection of the core procedures for WBA, by determining the most frequently performed procedures in general surgery practice. These findings may also assist academic centres undertaking curriculum review to determine whether or not they are training surgeons who are competent to meet the current local needs of society.

Methods: This study was a cross-sectional observational study using a self-administered survey. General surgeons who passed the final fellowship examinations of the College of Surgeons of South Africa between 2017-2022, working in fulltime specialist practice, were eligible for participation.

Results: The study included 111 surgeons of which the majority (53%) were working full time in government practice, 23% were in private practice and 24% were in a combination of both government and private practice. The 10 most frequently listed procedures were - hernia repair (95%), appendicectomy (91%), emergency laparotomy (88%), laparoscopic cholecystectomy (80%), gastroscopy (80%), colonoscopy (61%), colectomy (55%), lower limb amputation (48%), mastectomy (40%) and intestinal stoma formation (31%). Fifty-seven (51%) participants reported that they felt prepared to independently perform the full range of most frequently listed procedures. Of the 49% who reported feeling unprepared for one or more procedures on completion of training, the most frequently listed procedure was colonoscopy.

Conclusion: This study identified a list of procedures that may be considered as core procedural activities for WBA of South African general surgery trainees.