Audit of neurosurgery senior house officer training in the United Kingdom and Eire: a postal survey

An audit was performed to describe the current training conditions of senior house officers in neurosurgery in the UK and Eire. A postal questionnaire was sent to all neurosurgery senior house officers in a 6-month training period between February and August 2003. The questionnaire covered most aspects of working pattern, training and job satisfaction by the end of the 6-month post. The results from the audit showed that there are deficiencies in certain areas of the current system being employed for senior house officer training. Improvements to this training system in line with the establishment of a generic neurosciences training programme will benefit future surgical trainees.     

Square pegs in round holes: has psychometric testing a place in choosing a surgical career? A preliminary report of work in progress.

Methods of selection of candidates for training in surgery has long been regarded as lacking explicit criteria and objectivity. Our purpose was to discover the aptitudes and personality types of applicants for surgical posts at the outset, in order to discover which were most likely to result in a satisfactory progression through training and which were associated with career difficulties. This longitudinal predictive validation study has been undertaken in a London Teaching Hospital since 1994. After short-listing, but immediately before interview, all candidates for senior house officer posts in basic surgical training and in geriatric medicine were asked to undertake psychometric tests of numerical (GMA) and spatial (SIT7) reasoning, personality type (MBTI), and self-rating of competency. There were no differences in ability scores between surgeons or geriatricians. Personality differences were revealed between the surgeons and the geriatricians, and between male and female surgeons. This study suggests that while there are no differences in ability between surgeons and geriatricians at the start of training, there are differences in personality. Long-term follow-up of the career development of this cohort of surgical SHOs is required to determine whether the psychometric measures described correlate with achievements of milestones in their surgical careers.     

Reducing medication errors in a surgical residency training program

Medication errors contribute to in-hospital morbidity and mortality. Teaching hospitals and the surgical residency training programs they support should take proactive steps to reduce error frequency. In order to accomplish meaningful error reduction, we must first define the scope and nature of the problem. Pharmacists at the Monmouth Medical Center prospectively recorded medication prescribing errors made by surgical residents during 2 years. These data were reviewed to determine the types of medication errors made most frequently by surgical house officers. Seventy-five medication-prescribing errors were made by surgical house staff in the years 2001 and 2002. Thirty-three of these errors involved orders for antibiotic therapy. Errors that could not be directly attributed to knowledge deficits were responsible for 36 of the 75 errors (48%), whereas specific knowledge deficits were responsible for 39 of the 75 errors (52%). Twentyeight of the 36 errors not directly attributable to knowledge deficits (78%) were made at the postgraduate year one level, whereas only 15 of the 39 knowledge deficit errors (38%) were made at the postgraduate year one level. Though targeted education to address specific knowledge deficits may substantially reduce the occurrence of "knowledge deficit" medication errors within surgical residency training programs, more costly measures such as the implementation of physician computerized order entry will likely be needed to reduce maximally the frequency of medication ordering errors. Many prescribing errors cannot be attributed to specific knowledge deficits.     

The modernisation of the surgical house officer

INTRODUCTION: There have been considerable changes in the junior doctors'' hours and working patterns over the last 4 years. The aim of this study was to assess the effect of these changes on the house officers'' surgical experience and to obtain their opinions on the ''Hospital at Night'' system, which has recently been introduced at our large teaching hospital. METHODS: A questionnaire was filled out by surgical house officers at the end of their surgical posts in 2001. The same questionnaire was then repeated for house officers completing the same posts in 2005. RESULTS: Pre-registration house officers now see less acute surgical admissions (mean 5 patients in 3 months in 2005 compared with 35 in 2001; P < 0.0001) and spend less time attending theatre than four years ago (mean 12 sessions in 3 months in 2001 compared with 6 in 2005). Despite the reduction in hours, they are still managing to attend educational sessions. Nine out of ten house officers felt that the ''Hospital at Night'' system was unsatisfactory. They were unable to see and clerk acute surgical admissions or go to theatre because they were providing cross cover for other specialties. CONCLUSIONS: The full shift system and the introduction of the ''Hospital at Night'' team have led to a reduction in acute surgical experience for surgical house officers. The General Medical Council recommendations for reducing non-educational tasks have not been fulfilled despite the evolving role of nurse practitioners.     

Recruitment of house staff into anesthesiology: a re-evaluation of factors responsible for house staff selecting anesthesiology as a career and individual training program

STUDY OBJECTIVE: To reexamine, in a follow-up to our first study, those factors responsible for house staff (i.e., residents and clinical fellows) selecting anesthesiology as a career and a specific training program, as well as house staff satisfaction with various educational aspects of our training program, and their perceptions of the future for graduating anesthesiology trainees. DESIGN: Survey questionnaire of 77 house staff at the Mayo Clinic during the 2000 to 2001 academic year. SETTING: Academic medical center. MEASUREMENTS: A cross-sectional analysis was conducted using a questionnaire to survey 77 house staff enrolled in the anesthesiology training program at Mayo Clinic, Rochester, MN during the 2000 to 01 academic year. All responses were anonymous. Data were compared between time epochs using an f-exact test. A p-value 相似文献   

Einrichtung eines chirurgischen Trainingslabors an einer Ausbildungsklinik

The improvement of surgical skills of trainees in Germany often occurs solely in the operating room. In recent years, several countries have established surgical skills labs as an essential part of surgical education, with the goal of improving and refining surgical skills before clinical application. Several years ago, training units were established by the industry wherein the curricula focused on products of the respective company. Selected training courses are still offered in a few clinics. Presently, laboratories which train the surgical skills of novices in an individually adapted form are lacking. A surgical skills lab with a comprehensive curriculum of training courses was introduced at the University Hospital of Marburg in 2005. The present article describes the development and introduction of such facilities. The authors are convinced that surgical skills labs will become increasingly important in German surgical education for improving patient safety in the operating room.     

Needlesticks and Surgical Residents: Who Is Most at Risk?

OBJECTIVE: Exposure to blood-borne diseases remains an occupational risk. Mandates have improved training in how to report exposures for all health-care workers. How exposure rates of surgical residents correlate with experience and mandatory training to reduce risk is not known. It was hypothesized that enhanced training would result in an increased reporting of exposures by surgical trainees and that risk would be greater in the first years of training. DESIGN: Retrospective review of occupational health records and operative case logs, prospective survey. METHODS: Occupational Health Services provides both initial and annual training to General Surgery house staff at the Medical College of Wisconsin. Initial training consists of a blood-borne pathogen review and a detailed explanation of exposure reporting. Mandatory annual training is provided during Surgical Grand Rounds. Training was enhanced beginning June 2005 using a videotape outlining surgical risks and specific countermeasures. The numbers of reported exposures per year before and after enhanced training were compared. Exposures were self-reported. As most exposures occurred in the operating room, rate of exposure was calculated for each year of training using the total number of cases done each year reported by the general surgical residents. RESULTS: Surgical residents reported 118 needlestick injuries over 6 years. Senior and chief residents demonstrated a significantly lower exposure rate than junior residents (nonparametric Mood's median test, p < 0.0001). No significant difference in the injury rate was found per 1000 cases after enhanced training. CONCLUSIONS: Increasing surgical experience lowered the needlestick injury rate. Assuming no change in self-reporting rates by year, enhanced training and reporting guidelines did not seem to change risk. More specific training for junior residents, as well as passive prevention solutions, may be necessary to positively impact their exposure risk.     

Traumatic near amputation secondary to hippopotamus attack: lessons for surgeons

A 34-y-old man presented to Naivasha District Hospital (NDH) in Naivasha Town, Kenya, with near-complete below-knee amputation and hemorrhage after a hippopotamus attack. Residents from the University of Washington (UW), Departments of Surgery, Anesthesia, and Medicine, were rotating at NDH with the Clinical Education Partnership Initiative, a joint venture of UW and University of Nairobi. These providers met the patient in the operating theater. The leg was mangled with severely traumatized soft tissues and tibia–fibula fractures. The visiting UW Surgery resident (R3) and an NDH medical officer (second-year house officer) performed emergency below-knee completion amputation—the first time either had performed this operation. The three major vessel groups were identified and ligated. Sufficient gastrocnemius and soleus were preserved for future stump construction. The wound was washed out, packed with betadine-soaked gauze, and wrapped in an elasticized bandage. Broad-spectrum antibiotics were initiated. Unfortunately, the patient suffered infection and was revised above the knee. After a prolonged course, the patient recovered well and was discharged home. NDH house officers and UW trainees collaborated successfully in an emergency and conducted the postoperative care of a patient with a serious and challenging injury. Their experience highlights the importance of preparedness, command of surgical basics, humility, learning from mistakes, the expertise of others, a digitally connected surgical community, and the role of surgery in global health. These lessons will be increasingly pertinent as surgical training programs create opportunities for their residents to work in developing countries; many of these lessons are equally applicable to surgical practice in the developed world.     

The surgical high dependency unit: an educational resource for surgical trainees

BACKGROUND: Learning to recognise the seriously ill patient and developing the ability to manage them is a very important part of the education and training of surgeons. A general surgical senior house officer (SHO) spends 4 months on our surgically-led high dependency unit (HDU), as part of their basic surgical training programme. AIM: To assess a surgical high dependency unit as an educational resource. METHODS: We interrogated our specifically designed database for a 5-year period (April 1997 to March 2002) to look at what a 4-month attachment offered SHOs in respect of: the number of patients treated; their modes of presentation; the specialty; the physiological and operative scores as determined by the POSSUM scoring system; and the interventions that occurred. DISCUSSION: We have demonstrated that a 4-month attachment to a surgical HDU provides a consistent and valuable clinical resource for teaching and learning in surgical education and training.     

The Simulated Ward: ideal for Training Clinical Clerks in an Era of Patient Safety

IntroductionWork rules have changed medical education. Knowledge previously acquired by experience must now be actively taught to avoid prolonging the training period. We report the feasibility of and clinical clerk opinions regarding a novel simulated floor management course to teach patient care concepts required on the surgical wards.MethodsWe created a hospital ward with simulators exhibiting physical exam findings and active vital signs. Surgical clerks gathered data during “morning rounds,” wrote notes, and provided care. An acute event allowed students to participate in active evaluation and treatment. Findings and plans were communicated to their “chief resident,” a surgical attending. We distributed a survey to participants to determine attitudes and opinions about the course.ResultsThe course required five faculty, two medical educators, four surgical house staff, and 2.5 h to accommodate 40–50 students. Faculty and surgical house staff provided guidance and feedback on clinical skills. Fifty students completed the survey (56% response rate). Most clinical clerks thought that the simulated floor management course improved their understanding of medical management of surgical issues (66%) and their documentation skills (78%). Clinical clerks reported that attending involvement made the experience more valuable (89%) and was not intimidating (66%). Most expressed an interest in participating in more clinical scenarios (72%).ConclusionsA simulation course for teaching patient care concepts is feasible and regarded positively by clinical clerk participants. Further development and use of such simulated patient care exercises may be an effective adjunct for training future house staff and hospital staff in patient care in a time of shifting work hour paradigms.     

The European Working Time Directive: One for all and all for one?

BACKGROUND: The European Working Time Directive (EWTD) became law in Britain on October 1, 1998. As a result, the maximum period that may be spent as a resident in hospitals is 56 hours per week and after August 2009, 48 hours per week. The aim of this study was to determine the views of senior house officers (SHOs), specialist registrars (SpRs), and general consultant surgeons (CONs) in Wales on the influence of the EWTD on surgical training and clinical experience. METHODS: In this cohort study, a postal questionnaire was sent to 150 SHOs in surgical specialties, 50 general surgical SpRs, and all 84 CONs in the Welsh Deanery. RESULTS: The response rates were 81%, 78%, and 71% for SHOs, SpRs, and CONs, respectively. The vast majorities at all grades (88% SHOs, 100% SpRs, and 96% CONs) were unhappy with the introduction of EWTD legislation to clinical medicine. Most felt that EWTD legislation will have a negative effect on clinical experience (96% SHOs, 97% SpRs, 96% CONs); patient care (83% SHOs, 85% SpRs, 96% CONs); and training (94% SHOs, 100% SpRs, 93% CONs). Furthermore, a large proportion felt surgical training should be exempt from EWTD regulations (76% SHOs, 87% SpRs, 89% CONs). A significant proportion at each grade was opposed to the introduction of shifts in order to comply with regulations (78% SHOs, 87% SpRs, 89% CONs), and an alarming number have considered leaving the National Health Service when the regulations are enforced (29% SHOs, 41% SpRs, 33% CONs). CONCLUSION: This study shows that, in Wales at least, a vast majority of surgical trainees and consultants alike are opposed to the introduction of the EWTD and believe it will have a detrimental effect on training, patient care, and doctors' lives outside of medicine.     

The training and utilization of surgical physician assistants. A retrospective study

A community hospital's search for qualified surgical house staff in 1975 led to the development of a postgraduate residency program in surgery for physician assistants. Eleven years after its inception, the program's purpose and structure were reviewed, and its alumni, goals, and contributions were evaluated. A 1987 alumni survey provided data to assess the value of residency training to current employment and job satisfaction.     

Training protocol for intracranial pressure monitor placement by nonneurosurgeons: 5-year experience

BACKGROUND: This report evaluates a protocol for training nonneurosurgeon medical staff to perform ventricular catheter placement for ICP monitoring in traumatic brain injury and other appropriate patients under the guidance of neurosurgeons. METHODS: Eleven neurosurgery house officers were enrolled in the program to be certified for ventricular catheter placement. The training program using the Ghajar Guide is described as well as the preprocedural checklist. The results of these certified house officers were tracked over a 5-year period. RESULTS: Ten house officers successfully completed the certification process for ventricular catheter placement in a total of 106 patients. The majority of ventricular catheters were placed at the bedside. The reported results and the complication rates of catheter-related infections and intracranial hemorrhage are similar to that of neurosurgeons or neurosurgeons in training. CONCLUSION: House officers under the guidance of neurosurgeons can be trained to successfully and safely place ventricular catheters for ICP monitoring in patients needing ICP monitoring.     

Recruitment of house staff into anesthesiology: factors responsible for house staff selecting anesthesiology as a career and individual training program.

STUDY OBJECTIVE: To identify factors responsible in the selection of anesthesiology as a career by Mayo Clinic house staff (i.e., residents and clinical fellows); to evaluate their level of satisfaction with their choice of career and training program, and their perceptions of the future for anesthesiology trainees. DESIGN: Cross-sectional analysis using a questionnaire survey of 67 house staff enrolled in the anesthesiology training program during the 1995-1996 academic year. SETTING: Mayo Clinic, Rochester, MN. MEASUREMENTS AND MAIN RESULTS: Forty-eight (72%) of those surveyed responded to the questionnaire. Data were analyzed using the Chi-square and Mann-Whitney rank sum tests. A p-value less than or equal to 0.05 was considered statistically significant. The most frequently cited reasons for selecting anesthesiology as a career included the following: it is a "hands-on" specialty, it involves clinical application of physiology and pharmacology, and it provides immediate gratification in one's work. The most frequently cited reasons for selecting our training program were the diversity of training experience, prestige associated with Mayo Clinic, and employment opportunities following training. Forty-four (92%) felt downsizing of anesthesiology training programs was a national trend, 26 (54%) anticipated difficulty obtaining a job following training, and 16 (33%) felt they had future job security. Overall, 47 (98%) were happy with their career choice, and 40 (83%) would choose anesthesiology as a career if they were now graduating from medical school. All 1996 graduates found suitable employment without difficulty. CONCLUSIONS: Our data indicate that selection of a career in anesthesiology and training program are strongly associated with concerns regarding educational experiences and postgraduate employment opportunities.     

Sim one, do one, teach one: considerations in designing training curricula for surgical simulation

Although there is considerable interest in the use of simulation for the acquisition of fundamental surgical skills through goal-directed practice in a safe environment, there is little evidence guiding educators on how best to implement simulation within surgical skills curricula. This article reviews the application of the expert performance model in surgery and the role of simulation in surgical skills acquisition. The focus is on implementation of deliberate practice, highlighting the principles of part-task training, proficiency-based training and overtraining. With resident and educator time at a premium, the identification of an optimally effective and efficient training strategy has significant implications for how surgical skills training is incorporated into residency programs, which is critical in today's environment.     

Use of suturing as a measure of technical competence

There is an ongoing demand for surgeons to demonstrate that they can operate well, maintain their performance, and deliver acceptable results. Currently, surgeons are assessed by a series of subjective and peer-reviewed interviews, but at no stage is the objective assessment of surgical competence measured. The authors have introduced an objective test of suturing skill as one of an array of tests used to assess technical ability. A range of surgeons with differing surgical skill was tested. The candidates were asked to suture a 4-cm wound on a latex skin pad. They were videotaped during the procedure and were scored by four independent observers using the Objective Structured Assessment of Technical Skill scoring system. Their movements were also monitored using an electromagnetic tracking system. Forty-three plastic surgeons and 46 general surgeons were divided into four groups, depending on grade, and were assessed. The difference in scores among the plastic surgeons gave a value of p < 0.001, whereas the general surgeons gave a value of p = 0.001. However, when similar grade but different specialties were compared, plastic surgeons scored significantly higher (down to senior house officer [resident year 1-2] level; mean p value = 0.019). Interrater reliability was also high (Cronbach alpha = 0.89). This task has shown that technical ability can be assessed objectively. The task has also been shown to exhibit face, construct, and concurrent validity. This has important implications for the future of surgical training in that it allows one to identify whether the fundamentals of surgical technique have been passed on to the trainee and to monitor their progress continually. It also may be used in revalidation of surgeons.     

Initial experiences with RoSS surgical simulator in residency training: a validity and model analysis

Robotic surgery is an important new tool in many surgical procedures, and training curriculums must adapt to this new technology. Robotic surgical simulators have been developed as a means of providing training without the inherent risks of actual surgery. The purpose of this study is to evaluate the construct validity of the RoSS surgical simulator by correlating simulator performance with amount of time in training and to create a performance model in which time in training is a parameter. A total of eight residents with varying amounts of training were given access to the RoSS surgical simulator and were evaluated on performance of a simulated surgical task. This data was then used to create Akaike information criteria to compare goodness of fit. Participants were also given a questionnaire as to their experience with the simulator and their feelings about the use of simulators in training. Training time and performance within the simulator were shown to have a linear relationship. Correlations were high, with R ² values of 0.95, 0.94, and 0.86 for each of the three performance metrics. Likelihood ratios were similarly high at 4.25 × 10⁹, 10,950, and 362. Participant opinion showed that residents feel that robotic training is an important part of their education and that the simulator is an effective supplement. The RoSS surgical simulator accurately corresponds to training level and is a valid evaluation tool of training experience. These findings are encouraging for the use of robotic simulators in surgical training.     

Is day case surgery the key to basic surgical training?

The logbooks of 5 senior house officers (SHOs) were audited to determine progression of surgical skills on a single vascular firm. Total surgical experience and, in particular, experience in varicose vein and arterio-venous fistula surgery, performed in the day-case unit (DCU), were examined. Trainees were divided into those undertaking their first surgical SHO post (group 1, n = 2) and those who had had previous surgical exposure (group 2, n = 3) on the basic surgical training rotation. SHOs were exposed to a mean of 273 (+/- 41 SD) operative cases in 6 months. Emergency work comprised 15% (+/- 7%) of workload. Day cases accounted for 35% (+/- 3%) of elective workload. A mean of 66 (+/- 5) varicose vein and AVF cases were undertaken in the DCU. This represented 82% (+/- 6%) of day-case operative experience for the firm. SHOs undertook 12 (+/- 6) VV/AVF cases unassisted, 35 (+/- 5) cases with senior assistance, and 20 (+/- 11) as first assistance in the DCU. All SHOs progressed to being able to perform arterial bypass and amputation (with senior assistance) during their time on the firm. There was no significant difference in experience or progression to major vascular surgery between group 1 and group 2 in this study except in lower limb amputation procedures. It is concluded that vascular surgical firms can provide a good introduction to surgical skills. Most experience as first operator was gained in the DCU and we suggest that those undergoing basic surgical training might benefit from an attachment to the DCU early in their rotations.     

Basic microsurgery training: comments and proposal

Microsurgical techniques have been applied in many surgical specialties and have also a broad application in surgical research. It demands high technical skills and continued training. The microsurgical training is lengthy, very expensive and demands high commitment. The microsurgical skills should be first mastered in the lab and only then applied in the clinic. Here, we propose a model of a training course in microsurgery. We also suggest that surgical societies involved with microsurgery promote training courses on a regular basis.