928 The Process of Learning Anatomical Variations among Surgeons: A Journey of Developing Expertise

Aim This qualitative study aimed to develop a theoretical framework that explained the process of learning anatomical variations among surgeons using the constructivist grounded theory methodology. Method Initial purposeful and subsequent theoretical sampling of surgical trainees and consultants was utilised. Semi-structured interviews were conducted with 6 surgical consultants and trainees. Data analysis was informed by the grounded theory methodology. Results The resultant theoretical framework proposed a three-step iterative learning process that represents the journey of developing surgical expertise. The first step of the process is encountering a variant which encourages trainees to identify the variant and establish their understanding of normal anatomy. The next step is to deal with the variant as required by evaluating its clinical impact and using surgical skills to manage it accordingly. In the third step, trainees engage in self-directed learning about the variant. As they progress, trainees develop an increasing awareness of anatomical variations relevant to their surgical sub-specialty and begin to learn how to deal with the variant. Playing a crucial role in a trainee’s learning process at each step is the consultant who provides clinical supervision during the encounter, guidance when dealing with the variant, and encourages reflective practice after the encounter. Conclusions This study is one of the first to explain the process of learning anatomical variations, providing a unique insight into the current standards of surgical training in the United Kingdom. It calls for a greater emphasis on exploring how the learning and teaching of anatomical variations can be integrated within the surgical training curriculum.