The Surgical Frailty Journey – An Education Programme to Enhance Surgeon Confidence in Managing Frail Patients

The Surgical Frailty Journey – An Education Programme to Enhance Surgeon Confidence in Managing Frail Patients

Introduction: 
Consultant surgeons of the future will need to manage patients with increasing levels of complexity and comorbidity as the population ages. National Emergency Laparotomy Audit (NELA) data highlights that patients over 70 constitute over 50% of emergency laparotomies, with frailty being a key determinant of outcomes¹. Previous surgical curricula have included recognition and management of frailty². Updated versions have deviated from such specifics, and surgical training lacks education on frailty. The "Surgical Frailty Journey" is a novel, one-day training course designed for resident surgeons, using the fictitious case of "Mrs B" to simulate the challenges of managing surgical patients with frailty and hospital-acquired harms.

Methods: 
The course consists of lectures and discussions delivered by consultants from Geriatric and Palliative medicine. It follows a fictitious patient with small bowel obstruction as she becomes progressively frailer. Sessions included the clinical frailty scale (CFS)³, recognition and management of delirium, de-prescribing, treatment escalation plans, and advance care planning. In May 2025, training was delivered to core surgical trainees across London. Pre- and post-course surveys were used to assess knowledge and confidence in key domains.

Results: 
Complete familiarity with the CFS increased (23.3% to 71%). Confidence in application of CFS (10% to 71%), recognition of delirium (16.7% to 67.7%), de-prescribing (20% to 71%), and the identification of patients unsuitable for full escalation all improved significantly. Trainees described the course as “relevant”, “informative” and “thought-provoking”. Residents expressed a desire for the training to be available for their senior colleagues.

Conclusions: 
The “Surgical Frailty Journey” addresses a gap in surgical training. It equips doctors with skills to manage frail and complex co-morbid patients. Surgical residents recognised the evolving demographic needs of their services and were keen for the embedding of geriatric principles into surgical education. This supports better patient-centred care and aligns with national audit findings. Expansion of frailty training is warranted across surgical training programmes.

References

1. NELA Project Team (2024). The National Emergency Laparotomy Audit: Seventh Patient Report. London: Royal College of Anaesthetists. [Accessed 26/05/2025]. Available via https://www.nela.org.uk/reports
2. Brecknell J, Lintott P (2021). Core Surgical Training Curriculum 4 August 2021 (version 2 / July 2023). The intercollegiate surgical curriculum programme. [Accessed 29/05/2025]. Available via https://www.iscp.ac.uk/media/1371/core-surgical-training-curriculum-aug…
3. Rockwood K, Song X, MacKnight C, Bergman H, Hogan D B, McDowell I, Mitnitski A (2005). A global clinical measure of fitness and frailty in elderly people. CMAJ, 173(5), 489–495