Recruitment of medical graduates from Prague to foundation programme jobs in a UK hospital: results of a 6-year project.

Introduction: International medical graduates (IMGs) are required to fill foundation-level posts in the NHS. Recruiting for these posts is difficult and time consuming. In 2016, we created a link between the Great Western Hospital, Swindon and Charles University, Prague to recruit to these posts. Here, we describe in detail the recruitment process, level of support and outcomes after 6 years, including the success rate of completion of foundation training and their career progression. Methods: Formal structured interviews occurred in Prague or online. Support included tailored educational/clinical supervision and additional simulation sessions. Data collected included exception reports and sick leave records. In 2022, a survey established satisfaction levels with the project and subsequent career progression. Results: All 51 doctors (100%) recruited as IMGs completed foundation training. Exception reporting and sick leave were below the Trust average. Of those doctors, 39 (76%) replied to the survey. All reported that the appointments helped them progress in their careers and 23 (45%) have subsequently been appointed successfully to a national Specialty Training Scheme. Conclusions: This project improved recruitment of non-deanery foundation doctors, prevented rota gaps and provided adequate staffing of junior doctors in our hospital. Concerns around employment of IMGs can be offset by providing a supportive and developmental environment.

Concurrent development of encapsulating peritoneal sclerosis and calciphylaxis in a patient with peritoneal dialysis for end-stage renal disease.

Both encapsulating peritoneal sclerosis (EPS) and calciphylaxis are rare but severe complications involving patients with end-stage renal disease. In this report, we discuss a unique case of a 73-year-old female patient who had undergone 8 years of peritoneal dialysis for IgA nephropathy and concurrently developed these two synchronous complications within 3 months of each other. Diagnosis and management of both conditions were discussed in detail as well as the possible association between the two. With surgical treatment for EPS and measures to minimise bone mineral disorder abnormalities, both complications have been successfully managed to date.

A Soft- Tissue Injury Diagnosis in Knee Replacement Patients cannot be made without a Plain Radiograph.

INTRODUCTION: The design of some knee replacements includes the use of a mobile polyethylene bearing which can potentially dislocate away from the main bearing surfaces. This is particularly the case in unicompartmental or partial knee replacements (UKRs), and the most widely used UKR currently has this feature. Bearing dislocations are typically very painful and disabling, but not always, as in the case we present. CASE REPORT: We report the case of a patient presenting at a 1 -year follow- up following a mobile bearing UKR. At this consultation, the patient reported a smooth initial recovery but with on-going pain and swelling in the posterior aspect of his knee for 3 months, diagnosed as a soft- tissue strain. RESULTS: Radiographs at 1 year follow-up appointment showed that the polyethylene insert was dislocated posteriorly towards the popliteal fossa with metal components in direct contact. At revision surgery, this was confirmed as a chronic dislocation with severe metallosis requiring revision to a total knee replacement. CONCLUSION: We report a case of a posterior dislocation of a mobile polyethylene bearing of a partial / unicompartmental knee replacement UKR with delayed definitive treatment due to mis-diagnosis at the time of onset of symptoms and signs. The key lesson is that plain radiographs should be obtained promptly for any local issue in knee replacement patients.

Celiac artery aneurysm causing an acute abdomen.

Abdominal pain is a very common presentation in the accident and emergency department. However, vasculitis is not the usual first differential diagnosis. This paper discusses a case of polyarteritis nodosa presenting with acute abdominal pain alone. Common surgical conditions were obviously considered, but they were not found to cause the patient's problems. We describe how investigations led to this diagnosis discussed in detail in this paper. It is important to remember that prompt recognition of unusual life-threatening conditions can lead to timely intervention.