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1.
Br J Surg ; 102(10): 1156-66, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26122269

RESUMEN

BACKGROUND: The number of surgeons entering fellowship training before independent practice is increasing. This may have a negative impact on surgeons in training. The impact of fellowship training on patient outcomes is not yet known. This review aimed to investigate the impact of fellowship training in surgery on patient outcomes. METHODS: A systematic review of the literature was conducted to identify studies exploring the structural and surgeon-specific characteristics of fellowship training on patient outcomes. Data from these studies were extracted, synthesized and reported qualitatively, or quantitatively through meta-analysis. RESULTS: Twenty-three studies were included. The mortality rate for patients in centres with an affiliated fellowship programme was lower than that for centres without (odds ratio 0.86, 95 per cent c.i. 0.84 to 0.88), as was the rate of complications (odds ratio 0.90, 0.78 to 1.02). Surgeons without fellowship training converted more laparoscopic operations to open surgery than those with fellowship training (risk ratio (RR) 1.04, 95 per cent c.i. 1.03 to 1.05). Comparison of outcomes for senior surgeons versus current fellows showed no differences in rates of mortality (RR 1.00, 1.00 to 1.01), complications (RR 1.03, 0.98 to 1.08) or conversion to open surgery (RR 1.01, 1.00 to 1.01). CONCLUSION: Fellowship training appears to have a positive impact on patient outcomes.


Asunto(s)
Competencia Clínica , Educación Médica Continua/métodos , Cirugía General/educación , Internado y Residencia/normas , Evaluación del Resultado de la Atención al Paciente , Procedimientos Quirúrgicos Operativos/educación , Humanos
2.
Br J Surg ; 102(8): 965-71, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25970743

RESUMEN

BACKGROUND: Gastrointestinal stromal tumours (GISTs) of the rectum often require radical surgery to achieve complete resection. This study investigated the management and outcome of surgery for rectal GISTs and the role of imatinib. METHODS: A cohort study was undertaken of patients identified from a database at one tertiary sarcoma referral centre over a continuous period, from January 2001 to January 2013. RESULTS: Over 12 years, 19 patients presented with a primary rectal GIST. Median age was 57 (range 30-77) years. Neoadjuvant imatinib was used in 15 patients, significantly reducing mean tumour size from 7·6 (95 per cent c.i. 6·1 to 9·0) to 4·1 (2·8 to 5·3) cm (P < 0·001). Nine of these patients underwent surgical resection. Imatinib therapy enabled sphincter-preserving surgery to be undertaken in seven patients who would otherwise have required abdominoperineal resection or pelvic exenteration for tumour clearance. Neoadjuvant imatinib treatment also led to a significant reduction in mean(s.d.) tumour mitotic count from 16(16) to 4(9) per 50 high-power fields (P = 0·015). Imatinib was used only as adjuvant treatment in two patients. There were three deaths, all from unrelated causes. Eleven of the 13 patients who underwent resection were alive without evidence of recurrence at latest follow-up, with a median disease-free survival of 38 (range 20-129) months and overall survival of 62 (39-162) months. CONCLUSION: The use of neoadjuvant imatinib for rectal GISTs significantly decreased both tumour size and mitotic activity, which permitted less radical sphincter-preserving surgery.


Asunto(s)
Antineoplásicos/uso terapéutico , Benzamidas/uso terapéutico , Tumores del Estroma Gastrointestinal/tratamiento farmacológico , Tumores del Estroma Gastrointestinal/cirugía , Terapia Neoadyuvante , Piperazinas/uso terapéutico , Pirimidinas/uso terapéutico , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/cirugía , Adulto , Anciano , Supervivencia sin Enfermedad , Tumores del Estroma Gastrointestinal/patología , Humanos , Mesilato de Imatinib , Masculino , Persona de Mediana Edad , Índice Mitótico , Neoplasias del Recto/patología
3.
World J Surg ; 39(2): 303-13; discussion 314, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25315087

RESUMEN

AIMS: Mentoring has been used extensively in the business world to enhance performance and maximise potential. Despite this, there is currently a paucity of literature describing mentoring for surgical trainees. This study examined the current extent of mentoring and investigated future needs to support this. METHODS: An electronic, 47-item, self-administered questionnaire survey was distributed via national and regional surgical mailing lists and websites through the Association of Surgeons in Training and Specialty Associations in the UK and Republic of Ireland. RESULTS: Overall, 565 fully completed responses were received from trainees in all specialties, grades and training regions. A total of 48.7 % of respondents reported that they have a surgical mentor, with no significant gender difference (p = 0.65). Of respondents, 52.5 % considered their educational supervisor and 45.5 % their current consultant as mentors. Modal duration of mentoring relationships was 1-2 years (24.4 %). A total of 90.2 % of mentors were in the same specialty, 60.7 % in the same hospital, and 88.7 % in the same training region. Mentors covered clinical and professional matters (99.3 %) versus pastoral and non-clinical matters (41.1 %). Mentoring was commonly face to face or via email and not documented (64.7 %). Of the 51.3 % without a mentor, 89.7 % would like a clinical mentor and 51.0 % a pastoral mentor (p < 0.001). Priority mentoring areas included career progression (94.9 %), research (75.2 %), clinical skills (66.9 %) and clinical confidence (58.4 %). A total of 94.3 % would be willing to act as a peer mentor. Only 8.7 % had received mentoring training; 83 % wish to undertake this. CONCLUSIONS: Less than half of surgical trainees identified a mentor. The majority want mentoring on professional topics during their training and would additionally be willing to peer-mentor colleagues, although few have received training for this. Despite an identified need, there is currently no structure for organising this and little national provision for mentoring.


Asunto(s)
Mentores/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/educación , Adulto , Investigación Biomédica , Movilidad Laboral , Competencia Clínica , Femenino , Humanos , Masculino , Mentores/educación , Persona de Mediana Edad , Evaluación de Necesidades , Autoeficacia , Encuestas y Cuestionarios , Adulto Joven
5.
Br J Surg ; 101(7): 750-9, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24760684

RESUMEN

BACKGROUND: The aim of this meta-analysis was to compare short-term and oncological outcomes following colorectal resection performed by surgical trainees and expert surgeons. METHODS: Systematic literature searches were made to identify articles on colorectal resection for benign or malignant disease published until April 2013. The primary outcome was the rate of anastomotic leak. Secondary outcomes were intraoperative variables, postoperative adverse event rates, and early and late oncological outcomes. Odds ratios (ORs), weighted mean differences (WMDs) and hazard ratios (HRs) for outcomes were calculated using meta-analytical techniques. RESULTS: The final analysis included 19 non-randomized, observational studies of 14,344 colorectal resections, of which 8845 (61.7 per cent) were performed by experts and 5499 (38.3 per cent) by trainees. The overall rate of anastomotic leak was 2.6 per cent. Compared with experts, trainees had a lower leak rate (3.0 versus 2.0 per cent; OR 0.72, P = 0.010), but there was no difference between experts and expert-supervised trainees (3.2 versus 2.5 per cent; OR 0.77, P = 0.080). A subgroup of expert-supervised trainees had a significantly longer operating time for laparoscopic procedures (WMD 10.00 min, P < 0.001), lower 30-day mortality (OR 0.70, P = 0.001) and lower wound infection rate (OR 0.67, P = 0.040) than experts. No difference was observed in laparoscopic conversion, R0 resection or local recurrence rates. For oncological resection, there was no significant difference in cancer-specific survival between trainees and consultants (3 studies, 533 patients; hazard ratio 0.76, P = 0.130). CONCLUSION: In selected patients, it is appropriate for supervised trainees to perform colorectal resection.


Asunto(s)
Enfermedades del Colon/cirugía , Cirugía Colorrectal/normas , Enfermedades del Recto/cirugía , Fuga Anastomótica/epidemiología , Fuga Anastomótica/etiología , Cirugía Colorrectal/educación , Cirugía Colorrectal/estadística & datos numéricos , Grupos Diagnósticos Relacionados , Humanos , Internado y Residencia/normas , Internado y Residencia/estadística & datos numéricos , Laparoscopía/normas , Laparoscopía/estadística & datos numéricos
6.
Tech Coloproctol ; 18(10): 887-93, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24890577

RESUMEN

BACKGROUND: This study aimed to prospectively quantify the frequency of serious bleeding during pelvic surgery for locally advanced or recurrent rectal cancer and review the surgical methods used to control this. METHODS: Consecutive cases of pelvic surgery for curative resection of locally advanced or recurrent rectal cancer were prospectively evaluated over a nine-month period. The procedures undertaken included multivisceral resections, sacrectomies or ultra-low anterior resections. Multivisceral resections were defined as pelvic exenterations, extra-levator abdominoperineal resections (ELAPER) and recurrent anterior resections. The primary endpoint was the proportion of patients sustaining major blood loss, defined as ≥1,000 ml. The secondary endpoint was the blood transfusion rate. Haemostatic adjunct use was recorded. RESULTS: Twenty-six patients underwent surgery, comprising 11 pelvic exenterations, 3 ELAPERs, 1 recurrent anterior resection, 5 abdominosacral resections and 6 ultra-low anterior resections. The median intraoperative blood loss was 1,250 ml with 53.8 % of the patients sustaining a loss ≥1,000 ml. Fifty per cent of patients required a blood transfusion within 24 h, and one or more haemostatic adjuncts were necessary in 50 % of the cases. Adjuncts used included a fibrinogen/thrombin haemostatic agent in 38.5 % of patients, temporary intraoperative pelvic packing in 11.5 % of patients and preoperative internal iliac artery embolization in 7.7 % of patients. CONCLUSIONS: This patient group is at a high risk of intraoperative haemorrhage, and such patients are high consumers of blood products. Haemostatic adjunct use is often necessary to minimize blood loss. We describe our local algorithm to assist in the assessment and intraoperative management of these challenging cases.


Asunto(s)
Pérdida de Sangre Quirúrgica , Hemostasis Quirúrgica/métodos , Recurrencia Local de Neoplasia/cirugía , Neoplasias del Recto/cirugía , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Transfusión Sanguínea/estadística & datos numéricos , Femenino , Hemostasis Quirúrgica/estadística & datos numéricos , Humanos , Cuidados Intraoperatorios/métodos , Masculino , Persona de Mediana Edad , Pelvis/cirugía , Estudios Prospectivos , Tampones Quirúrgicos/estadística & datos numéricos
7.
Colorectal Dis ; 15(11): e665-71, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24103008

RESUMEN

AIM: Extramural vascular invasion (EMVI) has been proposed as an adverse prognostic indicator in colorectal cancer, although its use remains both variable and controversial. This study aimed to determine the survival effect of EMVI in T4 rectal cancer. METHOD: Patients undergoing surgery with curative intent for primary T4 rectal cancer between 1971 and 2011 were included from two prospectively collected rectal cancer databases. The main end-point was 3-year survival. RESULTS: From 1142 patients undergoing resection of rectal cancer during the study period, 126 (11.0%) had T4 rectal cancer and were included in the study group. Sphincter preservation was performed in 61 (48%) and a pathologically negative resection margin (R0) was achieved in 104 patients (82.5%). EMVI was present in 51 patients (40.5%) and was an independent predictor of positive lymph node status (adjusted odds ratio 2.66, P = 0.013). Considering all patients, EMVI was associated with reduced overall survival (P = 0.007) and disease-free survival (P = 0.002), but not local recurrence-free survival (P = 0.198). In only those undergoing R0 resection, EMVI predicted reduced disease-free survival with positive nodal status (P = 0.021); it did not predict survival with negative nodal status. CONCLUSION: Overall, EMVI was a strong prognostic marker of survival. However, after complete surgical resection in patients with node-negative disease, EMVI did not predict local recurrence.


Asunto(s)
Vasos Sanguíneos/patología , Recurrencia Local de Neoplasia/patología , Neoplasias del Recto/patología , Adulto , Anciano , Anciano de 80 o más Años , Canal Anal , Supervivencia sin Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , Metástasis Linfática , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Neoplasia Residual , Tratamientos Conservadores del Órgano , Modelos de Riesgos Proporcionales , Neoplasias del Recto/cirugía , Adulto Joven
8.
World J Surg ; 37(5): 945-52, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23423449

RESUMEN

BACKGROUND: Fellowship posts are increasingly common and offer targeted opportunities for training and personal development. Despite international demand, there is little objective information quantifying this effect or the motivations behind undertaking such a post. The present study investigated surgical trainees' fellowship aims and intentions. METHODS: An electronic, 38-item, self-administered questionnaire survey was distributed in the United Kingdom via national and regional surgical mailing lists and websites via the Association of Surgeons in Training, Royal Surgical Colleges, and Specialty Associations. RESULTS: In all, 1,581 fully completed surveys were received, and 1,365 were included in the analysis. These represented trainees in core or higher training programs or research from all specialties and training regions: 66 % were male; the mean age was 32 years; 77.6 % intended to or had already completed a fellowship. Plastic surgery (95.2 %) and cardiothoracic (88.6 %) trainees were most likely to undertake a fellowship, with pediatrics (51.2 %), and urology (54.3 %) the least likely. Fellowship uptake increased with seniority (p < 0.01) and was positively correlated (p = 0.016, r = 0.767) with increasing belief that fellowships are necessary to the attainment of clinical competence, agreed by 73.1 %. Fellowship aims were ranked in descending order of importance as attaining competence, increasing confidence, and attaining subspecialist skills. CONCLUSIONS: Over three-quarters of trainees have or will undertake a clinical fellowship, varying with gender, specialty, and seniority. Competence, confidence, and subspecialty skills development are the main aims. The findings will influence workforce planning, and perceptions that current training does not deliver sufficient levels of competence and confidence merit further investigation.


Asunto(s)
Actitud del Personal de Salud , Educación de Postgrado en Medicina/métodos , Becas , Motivación , Médicos/psicología , Especialidades Quirúrgicas/educación , Adulto , Competencia Clínica , Educación de Postgrado en Medicina/estadística & datos numéricos , Becas/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Reino Unido
9.
Br J Surg ; 99(5): 706-13, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-22359346

RESUMEN

BACKGROUND: Intra-abdominal fibromatosis (IAF) in the context of familial adenomatosis polyposis (FAP) is associated with significant morbidity and high recurrence rates after surgical resection. Non-surgical treatments are therefore advocated. This study explored outcomes in patients with IAF not associated with FAP who underwent surgical resection. METHODS: Data were analysed from a prospectively collected database at a sarcoma tertiary referral centre. RESULTS: From 2001 to 2011, 15 patients without FAP underwent primary curative surgical resection of IAF. Their median (range) age was 42 (19-64) years. Median tumour size was 18 (8.5-25) cm and weight 1306 (236-2228) g. Complete macroscopic clearance was obtained in all patients. There were no deaths in hospital or within 30 days and only one patient developed a major complication. Median follow-up was 40 (6-119) months. During follow-up two patients developed a recurrence after a disease-free interval of 12 and 16 months. CONCLUSION: In contrast to FAP-associated IAF, non-FAP-associated IAF has a very low recurrence rate after surgical resection. Surgical resection is therefore advocated as first-line treatment in patients with non-FAP-associated IAF when resection can be performed with low morbidity.


Asunto(s)
Pólipos Adenomatosos/complicaciones , Fibromatosis Abdominal/cirugía , Adulto , Pérdida de Sangre Quirúrgica , Femenino , Fibromatosis Abdominal/diagnóstico por imagen , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/etiología , Cuidados Preoperatorios , Estudios Prospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vísceras/cirugía , Adulto Joven
10.
Colorectal Dis ; 14(8): 1020-6, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21910819

RESUMEN

AIM: The BLEED criterion is a triaging model for lower gastrointestinal bleeding (LGIB), which was developed and validated in the USA. We assessed the BLEED criteria in a UK population and aimed to elucidate factors that can be implemented for early risk stratification. METHOD: Patients were identified from a prospectively maintained surgical admission database at a central London teaching hospital. Data were collected on 26 clinical factors available on initial presentation. The primary-outcome end-points included severe bleeding (persistent bleeding within the first 24 h, blood transfusion, a decrease in haematocrit of ≥ 20% or recurrent bleeding after ≥ 24 hours of stability) and adverse outcome (emergency surgery to control bleeding, intensive care unit [ITU] admission or death). RESULTS: One hundred and eighty-four clinical episodes were identified, representing 3% of all surgical referrals. Twelve patients with upper gastrointestinal bleeding were excluded. Severe bleeding occurred in 110 (64%) patients. An adverse outcome was recorded in 20 (11.6%) patients, and 10 (5.4%) patients died during admission. The commonest aetiologies were diverticular disease, haemorrhoids and malignancy. Four prognosticators of adverse outcome were identified, these being: creatinine > 150 µm (P = 0.002); age > 60 years (P = 0.001); abnormal haemodynamic parameters on presentation (P = 0.05); persistent bleeding within the first 24 h (P = 0.05); and area under the receiver-operating characteristics curve (AUC) = 0.79. The BLEED criteria were shown to be nonpredictive (AUC = 0.60). CONCLUSION: The BLEED criterion was not shown to have any predictive value in this patient cohort. Our study has determined an independent set of prognostic factors that could be incorporated into initial triaging of patients presenting with LGIB. This may facilitate the early identification of patients requiring more aggressive resuscitation, admission to a monitored bed and consideration for early radiological or surgical intervention.


Asunto(s)
Hemorragia Gastrointestinal/cirugía , Evaluación de Resultado en la Atención de Salud , Área Bajo la Curva , Comorbilidad , Femenino , Hemorragia Gastrointestinal/epidemiología , Hemodinámica , Humanos , Tiempo de Internación/estadística & datos numéricos , Modelos Logísticos , Masculino , Valor Predictivo de las Pruebas , Estudios Prospectivos , Recto , Derivación y Consulta , Factores de Riesgo , Triaje , Reino Unido/epidemiología
11.
World J Surg ; 35(4): 704-9, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21312036

RESUMEN

BACKGROUND: Positive encounters with surgeons have previously been shown to influence perceptions of surgical careers. Despite this, negative perceptions persist. We investigated whether identifying role models in surgery influences career choice and defined the ideal qualities of a surgical role model as perceived by newly qualified doctors. METHODS: A 36-item questionnaire was distributed to newly qualified graduates from a large UK medical school. Results were analysed using GraphPad Prism 5.00. RESULTS: Questionnaires were returned by 208 of 320 graduates (65%). Median age was 24 years (range = 23-51); 63% female, 37% male; 71% standard undergraduate course, 28% graduate-entry course. Overall, 131 respondents (63%) felt they were able to identify a surgical role model; there were no statistically significant differences between gender or course type. There was a significant difference between identification of a surgical role model and interest in pursuing surgical careers (P = 0.0006), with 41% of those who identified a role model interested compared with 17% of those who did not. Overall, 564 key qualities for a surgical role model were suggested by respondents. These were grouped by theme, with common attributes including good teacher, enthusiastic, and approachable. CONCLUSIONS: Junior doctors were twice as likely to express interest in pursuing a surgical career if they identified a positive surgical role model. Changes in medical school demographics are occurring, with increasing proportions of female and graduate-entry doctors. These groups are less likely to choose a surgical career, so promoting interest in surgery will become increasingly important to maintain high-quality applicants. Defining and promoting perceptions of surgical role models to the wider surgical community may be one way of addressing this.


Asunto(s)
Selección de Profesión , Cirugía General/educación , Rol Profesional , Adulto , Educación de Postgrado en Medicina , Educación de Pregrado en Medicina , Femenino , Humanos , Relaciones Interprofesionales , Masculino , Mentores , Estudiantes de Medicina/psicología , Encuestas y Cuestionarios , Reino Unido
12.
Int J Surg ; 84: 199-206, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32169575

RESUMEN

INTRODUCTION: Accurate recording of operative cases is essential during training to demonstrate experience. However, indicative numbers delineating minimum desirable experience may incentivise exaggeration or misrepresentation of experience. This study aimed to determine perceptions of real-world eLogbook use among UK surgeons in training. MATERIAL AND METHODS: An anonymous online questionnaire was disseminated electronically using a pre-planned yield-maximisation strategy, incorporating regional champions, email and social media. Evaluation employed mixed methods in a combined interpretation of quantitative and qualitative data from the questionnaire. Recommendations for development of the eLogbook were itemised from respondents' free text items and a modified Delphi process, conducted within the Council of the UK national trainee representative body, the Association of Surgeons in Training, determined the strength of each recommendation. RESULTS: Analysis included 906 complete responses from training-grade surgeons (34.8% female) from all UK recognised specialties and all grades of training. More than two-thirds (68.5%) believed that overstatement or misrepresentation of case involvement occurs. A fifth (20.8%) reported witnessing trainees logging cases they had not actually participated in and almost a third (32.7%) had witnessed overstatement, yet few (15.1%) had raised such an issue with a supervisor. Most (85.2%) respondents had few or no eLogbook entries validated. More than a quarter of respondents felt pressure to overstate their involvement in cases (28.6%) and the number recorded (28.1%). Almost a third (31.5%) felt the required case number for completion of training was not achievable. Female trainees were less likely to feel well supervised (p = 0.022) and to perceive targets for completion of training were achievable (p = 0.005). Thematic analysis identified four key themes to explain logbook misuse: Pressure to achieve training milestones; eLogbook functionality issues; training deficiencies and probity. CONCLUSIONS: Inaccurate operative recording was widely reported, primarily in response to perceived pressure to achieve targets for career progression. Operative logbooks may not be as accurate as intended. Consensus recommendations are made for improvement in the eLogbook and its use.


Asunto(s)
Evaluación Educacional/métodos , Registros , Estudiantes de Medicina/psicología , Cirujanos/educación , Cirujanos/psicología , Adulto , Competencia Clínica/normas , Consenso , Educación de Postgrado en Medicina/normas , Evaluación Educacional/normas , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Reino Unido
13.
BMC Med Educ ; 9: 14, 2009 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-19284564

RESUMEN

BACKGROUND: Observing surgical procedures is a beneficial educational experience for medical students during their surgical placements. Anecdotal evidence suggests that operating theatre related syncope may have detrimental effects on students' views of this. Our study examines the frequency and causes of such syncope, together with effects on career intentions, and practical steps to avoid its occurrence. METHODS: All penultimate and final year students at a large UK medical school were surveyed using the University IT system supplemented by personal approach. A 20-item anonymous questionnaire was distributed and results were analysed using the Statistical Package for Social Sciences, version 15.0 (Chicago, Illinois, USA). RESULTS: Of the 630 clinical students surveyed, 77 responded with details of at least one near or actual operating theatre syncope (12%). A statistically significant gender difference existed for syncopal/near-syncopal episodes (male 12%; female 88%), p < 0.05. Twenty-two percent of those affected were graduate entry medical course students with the remaining 78% undergraduate. Mean age was 23-years (range 20 - 45). Of the 77 reactors, 44 (57%) reported an intention to pursue a surgical career. Of this group, 7 (9%) reported being discouraged by syncopal episodes in the operating theatre. The most prevalent contributory factors were reported as hot temperature (n = 61, 79%), prolonged standing (n = 56, 73%), wearing a surgical mask (n = 36, 47%) and the smell of diathermy (n = 18, 23%). The most frequently reported measures that students found helpful in reducing the occurrence of syncopal episodes were eating and drinking prior to attending theatre (n = 47, 61%), and moving their legs whilst standing (n = 14, 18%). CONCLUSION: Our study shows that operating theatre related syncope among medical students is common, and we establish useful risk factors and practical steps that have been used to prevent its occurrence. Our study also highlights the detrimental effect of this on the career intentions of medical students interested in surgery. Based on these findings, we recommend that dedicated time should be set aside in surgical teaching to address this issue prior to students attending the operating theatre.


Asunto(s)
Prácticas Clínicas/métodos , Cirugía General/educación , Quirófanos , Estudiantes de Medicina/psicología , Procedimientos Quirúrgicos Operativos , Síncope/etiología , Adulto , Ansiedad , Selección de Profesión , Estudios Transversales , Miedo , Femenino , Humanos , Intención , Masculino , Facultades de Medicina , Estudiantes de Medicina/estadística & datos numéricos , Encuestas y Cuestionarios , Síncope/epidemiología , Síncope/psicología , Reino Unido/epidemiología
15.
Clin Anat ; 21(7): 718-24, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-18773486

RESUMEN

In recent decades wide-ranging changes have occurred in medical school curricula. Time spent studying gross anatomy has declined amidst controversy as to how, what, and when teaching is best delivered. This reduced emphasis has led to concerns amongst clinicians that a new generation of doctors are leaving medical school with insufficient anatomical knowledge. Previous studies have established that medical students value their anatomy teaching during medical school. None have sought to establish views on the sufficiency of this teaching. We investigate the opinions of newly qualified doctors at a UK medical school and relate these opinions to career intentions and academic performance in the setting of a traditional dissection and prosection-based course. Overall nearly half of respondents believe they received insufficient anatomy teaching. A substantial proportion called for the integration of anatomy teaching throughout the medical school course. Trainees intent on pursuing a surgical career were more likely to believe anatomy teaching was insufficient than those pursuing a nonsurgical career; however, overall there was no statistical difference in relation to the mean for any individual career group. This study adds to the current debates in anatomical sciences education, indicating that overall, regardless of career intentions, new doctors perceive the need for greater emphasis on anatomical teaching.


Asunto(s)
Anatomía/educación , Curriculum/tendencias , Educación de Postgrado en Medicina/tendencias , Educación de Pregrado en Medicina/tendencias , Selección de Profesión , Medicina Clínica/tendencias , Recolección de Datos , Humanos , Reino Unido
16.
Int J Surg ; 52: 349-354, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29428432

RESUMEN

BACKGROUND: As front-line healthcare staff, doctors in surgical training occupy a unique organisational space rotating through hospitals and services in which they witness first hand both good and bad practice. This puts trainees in a clear position to identify and raise patient safety issues, and to contribute to discussions regarding quality and safety improvement. However, there are a number of real and perceived barriers to trainees doing so. These include concerns about the impact on training assessments and career progression, and uncertainty about the appropriate route. METHODS: Paper-based survey of delegates attending the Association of Surgeons in Training (ASiT) conference (response rate 73%; 479/652). RESULTS: 288 (60%) of trainees reported previous concerns over practices and behaviour of colleagues that might pose risks to patient care including concerns over poor performance (n = 243; 84%), bullying (n = 45; 16%), alcohol and drug abuse (n = 15; 5%) and mental health problems (n = 8; 3%). However, 53% (n = 153) did not escalate these concerns. 178 (37%) of trainees also reported concerns over hospital policies, protocols or systems that might pose a risk to patient care, with 46% (n = 82) not escalating such concerns. Respondents highlighted fear of personal vilification or reprisal (n = 224; 47%), fear of impact on career (n = 206; 43%) and a lack of confidence in the process (n = 170; 36%) as barriers to whistleblowing. More senior trainees were significantly more likely to raise concerns than more junior grades (p < 0.0001). CONCLUSION: These results highlight worrying issues around reporting concerns, with trainees often "silent witnesses" to poor performance in healthcare. Adverse events must provide opportunities for learning to improve future outcomes. Herein, ASiT proposes 14 recommendations to improve protection for trainees in raising patient safety concerns. These include the creation of a positive workplace culture, promoting the active involvement of trainees in quality improvement discussions, with clear mechanisms for trainees to raise concerns.


Asunto(s)
Seguridad del Paciente/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Denuncia de Irregularidades/psicología , Femenino , Humanos , Internado y Residencia/estadística & datos numéricos , Masculino , Cirujanos , Encuestas y Cuestionarios , Lugar de Trabajo
17.
BMJ Open ; 5(4): e007677, 2015 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-25854975

RESUMEN

OBJECTIVES: Increasing numbers of minor surgical procedures are being performed in the community. In the UK, general practitioners (family medicine physicians) with a specialist interest (GPwSI) in surgery frequently undertake them. This shift has caused decreases in available cases for junior surgeons to gain and consolidate operative skills. This study evaluated GPwSI's case-load, procedural training and perceptions of offering formalised operative training experience to surgical trainees. DESIGN: Prospective, questionnaire-based cross-sectional study. SETTING/PARTICIPANTS: A novel, 13-item, self-administered questionnaire was distributed to members of the Association of Surgeons in Primary Care (ASPC). A total 113 of 120 ASPC members completed the questionnaire, representing a 94% response rate. Respondents were general practitioners practising or intending to practice surgery in the community. RESULTS: Respondents performed a mean of 38 (range 5-150) surgical procedures per month in primary care. 37% (42/113) of respondents had previously been awarded Membership or Fellowship of a Surgical Royal College; 22% (25/113) had completed a surgical certificate or diploma or undertaken a course of less than 1 year duration. 41% (46/113) had no formal British surgical qualifications. All respondents believed that surgical training in primary care could be valuable for surgical trainees, and the majority (71/113, 63%) felt that both general practice and surgical trainees could benefit equally from such training. CONCLUSIONS: There is a significant volume of surgical procedures being undertaken in the community by general practitioners, with the capacity and appetite for training of prospective surgeons in this setting, providing appropriate standards are achieved and maintained, commensurate with current standards in secondary care. Surgical experience and training of GPwSI's in surgery is highly varied, and does not yet benefit from the quality assurance secondary care surgical training in the UK undergoes. The Royal Colleges of Surgery and General Practice are well placed to invest in such infrastructure to provide long-term, high-quality service and training in the community.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Educación de Postgrado en Medicina/estadística & datos numéricos , Medicina Familiar y Comunitaria/estadística & datos numéricos , Medicina General/estadística & datos numéricos , Cirugía General/educación , Pautas de la Práctica en Medicina/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Procedimientos Quirúrgicos Ambulatorios/educación , Estudios Transversales , Educación de Postgrado en Medicina/organización & administración , Medicina Familiar y Comunitaria/métodos , Medicina General/métodos , Humanos , Estudios Prospectivos , Procedimientos Quirúrgicos Operativos/educación , Encuestas y Cuestionarios , Reino Unido
18.
Int J Surg ; 13: 211-216, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25498494

RESUMEN

Government-mandated publication of named surgeon-specific outcome data (SSD) has recently been introduced across nine surgical speciality areas in England. This move is the first time that such national data has been released in any country, and it promises to provide a significant advancement in health service transparency. Data is derived from nine preexisting national surgical audit databases. However, eight of these were not originally designed for this purpose, and there is considerable controversy surrounding data quality, risk adjustment, patient use and interpretation, and surgeons' subsequent case selection. Concerns also surround the degree to which these results truly reflect the individual consultant, or the wider hospital team and accompanying resources. The potential impact on surgical training has largely been overlooked. This paper investigated the background to SSD publication and controversies surrounding this, the potential impact on surgical training and the response to these concerns from medical and surgical leaders. As SSD collection continues to be refined, the most appropriate outcomes measurements need to be established, and risk adjustment requires ongoing improvement and validation. Prospective evaluation of changes in surgical training should be undertaken, as any degradation of will have both short and long-term consequences for patients and surgeons alike. It is important that the literature supporting the safety of supervised trainee practice is also promoted in order to counterbalance any potential concerns that might detract from trainee operating opportunities. Finally, it is important that outcomes data is communicated to patients in the most meaningful way in order to facilitate their understanding and interpretation given the complexities of the data and analysis involved.


Asunto(s)
Evaluación de Resultado en la Atención de Salud , Cirujanos/estadística & datos numéricos , Inglaterra , Hospitales , Humanos , Masculino , Estudios Prospectivos , Cirujanos/educación
19.
Int J Surg ; 12 Suppl 3: S9-12, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25150022

RESUMEN

The Association of Surgeons in Training (ASiT) is a professional body and registered charity working to promote excellence in surgical training for the benefit of junior doctors and patients alike. ASiT is independent of the National Health Service (NHS), Surgical Royal Colleges, and specialty associations and represents trainees in all ten surgical specialties. ASiT was delighted to welcome all four surgical Royal College Presidents and over 650 delegates to Belfast for ASiT 2014. With a theme of Marginal Gains, the conference programme explored collaboration, simulation training and human factors, complimented by debates including the Shape of Training Review (ShOT), several focussed parallel sessions and ten subsidised pre-conference training courses. Almost £4000 was awarded by the incoming President, Mr Vimal Gokani, to delegates across more than 30 prizes for delegates who presented the highest scoring academic work from over 1200 submitted abstracts.


Asunto(s)
Organizaciones de Beneficencia , Cirugía General/educación , Sociedades Médicas , Humanos , Reino Unido
20.
Int J Surg ; 12 Suppl 3: S5-8, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25174790

RESUMEN

Mentoring has been present within surgical training for many years, albeit in different forms. There is evidence that formal mentoring can improve patient outcomes and facilitate learning and personal growth in the mentee. The Association of Surgeons in Training (ASiT) is an independent educational charity working to promote excellence in surgical training. This document recommends the introduction of a structured mentoring programme, which is readily accessible to all surgical trainees. A review of the available evidence--including an ASiT-led survey of its membership--highlights the desire of surgical trainees to have a mentor, whilst the majority do not have access to one. There is also limited training for those in mentoring roles. In response, ASiT have implemented a pilot mentoring scheme, with surgical trainees acting both as mentors and mentees. Based on the existing literature, survey data and pilot experience, ASiT formalises in this document consensus recommendations for mentoring in surgical training.


Asunto(s)
Cirugía General/educación , Mentores , Organizaciones de Beneficencia , Humanos , Sociedades Médicas , Reino Unido
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