Cutting edge selection: learning from high reliability organisations for virtual recruitment in surgery during the COVID-19 pandemic.

INTRODUCTION: National selection for higher surgical training (ST3+) recruitment in the UK is competitive. The process must prioritise patient safety while being credible, impartial and fair. During the COVID-19 pandemic, all face-to-face interviews were cancelled. Selection was based on a controversial isolated self-assessment score with no evidence checking taking place. From 2021, selection will take place entirely online. Although this has cost and time advantages, new challenges emerge. METHODS: We review surgical selection as it transitions to an online format and suggest validated methods that could be adapted from High Reliability Organisations (HRO). FINDINGS: Virtual selection methods include video interviewing, online examinations and aptitude testing. These tools have been used in business for many years, but their predictive value in surgery is largely unknown. In healthcare, the established online Multi-Specialty Recruitment Assessment (MSRA) examines generic professional capabilities. Its scope, however, is too limited to be used in isolation. Candidates and interviewers alike may have concerns about the technical aspects of virtual recruitment. The significance of human factors must not be overlooked in the online environment. Surgery can learn from HROs, such as aviation. Pilot and air traffic control selection is integral to ensuring safety. These organisations have already established digital selection methods for psychological aptitude, professional capabilities and manual dexterity. CONCLUSION: National selection for higher surgical training (ST3+) can learn from HROs, using validated methods to prioritise patient safety while being acceptable to candidates, trainers and health service recruiters.

What leads to good counselling?

PIP: Human immunodeficiency virus (HIV) counseling involves advising those who are facing an incurable, stigmatizing disease. The counselor needs to be emotionally stable and have respect for the patient's rights and dignity. The abilities to listen, communicate, keep confidentiality, and maintain a nonjudgemental attitude are all necessary. Institutions need to provide privacy and time for such counseling. Practical items (condoms, soap, bleach, plastic sheets, home care visits, and travel expenses) should also be provided. Training in counseling is useful for anyone involved in the care and support of HIV patients. Skills include the ability to 1) explain HIV testing, prevention of sexually transmitted disease (STD), and family planning methods clearly, simply, and appropriately; 2) speak openly and frankly, encouraging the same in the patient, about sex; 3) listen and to allow time for the patient to talk; 4) ask nonleading questions that encourage patients to express feelings and to think about their life and personal relationships; 5) empathize; 6) give psychological support; 7) assist someone in making realistic decisions and in adjusting to change by drawing upon their resources; and 8) establish trust and to keep confidentiality. A training course should be limited to 20 participants who attend several workshops conducted over a few months. Group exercises, demonstrations, role plays, short talks, and videos should be mixed to allow participants to learn and practice skills. This should include an exercise allowing them to discover their own values, fears, and prejudices. Supervision by an experienced counselor is necessary during and after training. This includes dealing with the counselor's emotional reactions to counseling. A follow up workshop should be held a few months later, where difficult situations could be role played. Regular meetings with colleagues, supervision, and further training should be continued. Training courses should be evaluated through discussion, supervision, and questionnaires.^ieng

Research into HIV and AIDS between 1981 and 1990: the epidemic curve.

The main features of research into HIV and AIDS between 1981 and 1990 were examined using a database of medical, nursing and dental journals [compact disc read-only memory (CD-ROM) version of the Medline database (Silver Platter Information Services, London, UK)]. More than 30,000 papers on HIV and AIDS were indexed by Medline between 1981 and 1990. Of these, only 3% were concerned with African populations although a quarter of AIDS cases worldwide were reported from African countries during the decade. The number of papers on HIV/AIDS increased from 24 in 1982 to an estimated 8300 in 1990. Between 1983 and 1988 the number of indexed papers on HIV/AIDS increased at around 50-60% per year; between 1988 and 1989, however, the rate of growth fell to 6%. The percentage of papers discussing the aetiology of AIDS fell from 25 to 3% between 1983 and 1990. During the same period, papers concerned with HIV increased from 2 to 37% of the HIV/AIDS total. Research into drug therapy also accounted for an increasing proportion of indexed papers during the decade. The percentage of papers dealing with prevention and control rose to 18% in 1988, but had declined to 12% by 1990. Priorities for the 1990s should include a renewed interest in aetiology and a sustained emphasis on prevention. Furthermore, countries that have so far been neglected should be granted priority in future research.