Defining the good surgical resident: a resident and registrar perspective.

BACKGROUND: Surgical residency provides insight into the essential skills required to become a successful surgical registrar. However, the role of the surgical resident remains largely undefined. While the Royal Australasian College of Surgeon (RACS) JDocs framework provides a useful guide, no published research explores what defines a highly performing surgical resident. We investigate what constitutes a 'good' surgical resident from the surgical resident and accredited surgical registrar perspectives. We hope this knowledge will improve patient care and assist surgical residents towards becoming valuable team members and successful accredited surgical training candidates. METHODS: A qualitative research approach was utilized employing reflexive thematic analysis. Using semi-structured interviews, 10 surgical residents and 10 accredited surgical registrars across eight surgical specialties were interviewed. RESULTS: Amongst surgical residents five themes were identified: efficiency: mastering the mundane, 'stepping up' to more responsibility, enthusiasm to learn, first do no harm: a safe practitioner, and lastly no resident is an island: a team player. Four themes described by accredited registrars included: somebody you can trust, finding a safe 'balance', a perfect fit: teamwork and communication and finally eagerness to improve. CONCLUSION: Themes correlated well with eight of 10 RACS competencies and the JDocs Framework. Our results reaffirmed the importance of developing early career non-technical skills. Explicit knowledge and understanding of these attributes used in conjunction with the core competency and JDocs frameworks may help those contemplating a career in surgery throughout their early surgical years.

Urgent nephrectomy for rapidly progressive disseminated metastatic Hypermucoid Klebsiella.

Few cases of Hypervirulent Klebsiella Pneumonia (HvKP) have been described. Even fewer cases with renal abscess and metastatic pulmonary spread are reported. Typically, prompt introduction of intravenous antibiotics leads to clinical resolution and more invasive measures of source control are rarely required. To date only one other case of disseminated metastatic HvKP requiring nephrectomy for infective source control is described. Here we present a rare case of metastatic HvKP refractory to intravenous antimicrobial therapy in an immunocompromised newly diagnosed diabetic patient. Specifically, we seek to illustrate the rapid effectiveness of surgical intervention following a poor response to initial treatment.