About the Network
EMBUS-UKI
Ergonomic and Musculoskeletal BUrden in Surgery: A multi-centre cross-sectional study and audit among surgeons in the United Kingdom and Ireland
CROSS-CHECK STUDY
Study Aim
To investigate the work-related musculoskeletal disorders among surgeons in the United Kingdom and Ireland and explore modifiable lifestyle and workplace factors.
Status: Recruiting Centres
Registration: 11th August 2026 – 11th November 2026
Data Submission Deadline: 1st December 2026
Study Information
Background
Surgeons are often subjected to prolonged static postures, repetitive motions, and poorly designed operating room setups.1 These factors, among others, significantly increase the risk of work-related musculoskeletal disorders (WMSDs).1 The WMSDs affect male and female surgeons, but little is known about gender disparity in WMSDs’ prevalence and ergonomic stressors.2 Despite increased global awareness, ergonomic practices are still inconsistently implemented in surgical healthcare settings.3 Evidence from the UK and Ireland’s surgical healthcare centres is scarce and often confined to selected surgical specialties.4,5
References:
- Catanzarite T, Tan-Kim J, Whitcomb EL, Menefee S. Ergonomics in Surgery: A Review. Urogynecology. 2018;24(1):1. doi:10.1097/SPV.0000000000000456
- Jacovides CL, Guetter CR, Crandall M, et al. Overcoming Barriers: Sex Disparity in Surgeon Ergonomics. Journal of the American College of Surgeons. 2024;238(5):971. doi:10.1097/XCS.0000000000001043
- Restaino S, D’Indinosante M, Perelli F, et al. Ergonomics in the operating room and surgical training: a survey on the Italian scenario. Front Public Health. 2024;12. doi:10.3389/fpubh.2024.1417250
- Morton J, Stewart GD. The burden of performing minimal access surgery: ergonomics survey results from 462 surgeons across Germany, the UK and the USA. J Robotic Surg. 2022;16(6):1347-1354. doi:10.1007/s11701-021-01358-6
- Phoenix E, Canavan C, Kelly L, et al. Ergonomic burden in microsurgery: Real-time quantification of cervical posture using biosensor technology. J Plast Reconstr Aesthet Surg. 2025;113:374-381. doi:10.1016/j.bjps.2025.11.042
About The Study
Aim
Phase 2 will be led by the Human Factors in Surgery Network (HFSN) along with the project steering committee and will utilise a trainee collaborative model for data collection. All UK and Ireland NHS Trusts/Boards in which surgical procedures are undertaken will be eligible for the study.
Study Phases and IP Framework
Phase 1:
This phase has been complete by Mr Hasan Asfour (ST3 trainee in General Surgery at NHS Tayside, Dundee. Honorary Fellow at the University of Leicester) and is under review for publication
Phase 2: Multi-centre audit and study
This phase will be led by the Human Factors in Surgery Network (HFSN) along with the project steering committee and will utilise a trainee collaborative model for data collection. All UK and Ireland NHS Trusts/Boards in which surgical procedures are undertaken will be eligible for the study.
Phase 2A: Multi-centre data collection
A multicentre survey across the UK and Ireland will be conducted under the governance of HFSN/University of Oxford, with participating centres contributing data in accordance with HFSN/University of Oxford ethics approvals and data governance frameworks.
The objective of the multicentre survey is to expand the pilot dataset generated in phase 1A by collecting multi-centre representative data relevant to the initial study aim.
Data collected during Phase 2 will be centrally managed by HFSN. The Phase 2 dataset is independent of the Phase 1 pilot dataset. The Steering Committee will oversee study conduct, data quality, and analysis planning in accordance with HFSN/university of Oxford governance arrangements.
Phase 3: Validation of the prediction model using the multi-centre data
Data collected during Phase 2 will be used for external validation of the prediction model developed in Phase 1B and will be published separately as an external validation and refinement of the model.
Phase 2: Study Protocol and Methods
The study will be led by the Human Factors in Surgery Network (HFSN) and will utilise a trainee collaborative model for data collection. All UK and Ireland NHS Trusts/Boards in which surgical procedures are undertaken will be eligible for the study.
The study will consist of the following components:
- Multi-centre cross-sectional survey assessing WRMD prevalence
- Analysis of ergonomic, workplace, and lifestyle risk factors
- Subgroup analysis including gender, specialty, and grade
Local collaborators will be recruited from participating hospitals and will be required to:
- Distribute a standardised survey to eligible surgeons within their Trust/Board
- Support local participation and completion of surveys
All collected data will be analysed centrally by the steering committee. Collaborators may be provided with an anonymised summary of their local results on request (where responses are >20) to allow local quality improvement and comparison with national results.
Who should be asked to complete the survey?
The target respondents will include surgical trainees (core trainees and registrars), associate specialists and locally employed surgeons, and consultants across all ten surgical specialties defined by the RCS, including: 1) General Surgery, 2) Trauma and Orthopaedics, 3) ENT, 4) Urology, 5) Maxillofacial Surgery, 6) Paediatric Surgery, 7) Plastic Surgery, 8) Neurosurgery, 9) Vascular Surgery, and 10) Cardiothoracic Surgery.
Getting Involved
Registration will open in 11th August 2026 and close in 11th November 2026.
Surveys and checklists must be submitted by 1st December 2026.
Inclusion Criteria
Resident doctors, associate specialists consultants working in UK NHS hospitals/healthcare boards and in the Irish HSE National Health Service are eligible to apply to become EMBUS-UKI local collaborators.
Each local team should consist of up to 5 people:
- A Supervisor/Consultant (Audit Supervisor)
- A Local Collaborator (Audit Lead)
- Up to three further participants (Local Data Collectors)
Collaborators must seek approval of a local consultant supervisor prior to application.
Local collaborators who achieved Collaborator Status will be recognised with Collaborator Author Status on publications. For further information see the Collaborator Guidelines.
Ethics & QIP Registration
As per the University of Oxford research classification committee, ethical approval is not required as this is a quality improvement project, and no patient information will be requested.
Local collaborators are required to register the project as a quality improvement project within their local audit/quality improvement team (Note: not required at the time of application but will be required when submitting data for analysis).
Guidelines
Collaborator Guidelines:
For further information please see the FAQ section below, or email us at humanfactorsnetwork@gmail.com
FAQ
Who can get involved?
Inclusion Criteria
Resident doctors, associate specialists consultants working in UK NHS hospitals/healthcare boards and in the Irish HSE National Health Service are eligible to apply to become EMBUS-UKI local collaborators.
Each local team should consist of up to 5 people:
- A Supervisor/Consultant (Audit Supervisor)
- A Local Collaborator (Audit Lead)
- Up to three further participants (Local Data Collectors)
Collaborators must seek approval of a local consultant supervisor prior to application.
The trust/board must perform surgical and/or invasive procedures.
How many collaborators are allowed per NHS Trust/Board?
Each local team should consist of:
- A Supervisor/Consultant (Consultant Supervisor)
- A Local Collaborator (Audit Lead)
- Up to three participants as Local Data Collectors
Someone has already signed up for my trust, can I still be involved?
We are accepting up to three participants as local data collectors per NHS Trust/Board. If your trust is already signed up, please get in touch with us via email at humanfactorsnetwork@gmail.com and we can put you in touch with the local collaborator for your trust. In cases where local collaborators have failed to collect the required data within 6 weeks of sign-up approval, the local collaborator will be contacted by the steering committee and the role may be offered to others.
What is a Consultant Supervisor?
Any consultant working in the same trust can be a consultant supervisor for a local collaborator.
Whats in it for me?
Local collaborators and additional Local Data Collectors may achieve Collaborator Status according the guidelines below. Those who do not meet this threshold will receive acknowledgement status. Consultant supervisors will be afforded Acknowledgement status.
Local Collaborators, Local Data Collectors and Consultant Supervisors will be recognised as contributors to the EMBUS UKI-Study and provided with certificates of recognition.
Collaborative Authorships Status Requirements:
· Minimum 20 responses for the first local collaborator in each trust, plus 10 for each additional local data collector involved.
· Local collabs must keep a prospective record of how many people they contacted to complete the survey
· Those who meet the above criteria and have a response rate >75% are invited to contribute (review) the main manuscript and may achieve main authorship status
· All others will received collaborator authorship status (or acknowledgement if they don’t reach the number of responses required)
When does the project open?
Registration will open on 11th August 2026 and close on 11th November 2026. Surveys must be submitted by 1st December 2026.
This sounds great! How do I sign up?
Please fill in some basic details using the link below and a member of our team will be in touch with further information. Please read all the information in this document before registration. Further information can be found on the HFSN website.
About
Dedicated to advancing the understanding and application of human factors in surgery, anaesthesia and peri-operative medicine.
