[The new continuing education regulations-A challenge for visceral surgery : Results of a survey among DGAV members and solution strategies of the Young Surgeons]. / Die neue Weiterbildungsordnung ­ eine Herausforderung für die Viszeralchirurgie : Ergebnisse einer Umfrage unter DGAV-Mitgliedern und Lösungsstrategien der Jungen Chirurgie.

BACKGROUND: The new competency-based further training regulations (nWBO) for surgical training have been adopted by all German state medical associations. METHODS: From May to June 2023 the Young Surgeons' Working Group (CAJC) conducted an anonymous online survey among the 5896 members of the German Society for General and Visceral Surgery (DGAV). OBJECTIVE: The survey aimed to assess expectations regarding the nWBO and to develop strategies for enhancing surgical training. RESULTS: With 488 participants (response rate 8.3%) the study is representative. The respondents consisted of 107 continuing education assistants (WBA 21.9%), 69 specialist physicians, and 188 senior physicians (specialist physicians 14.1% and senior physicians 38.5%), as well as 107 chief physicians (21.9%). The majority worked in regular care providers (44%), followed by maximum care providers (26.8%) and university clinics (20.1%). Only 22% considered the required operative spectrum of the new medical specialist training regulations (nWBO) to be realistic. Half of the respondents believed that full training in their clinic according to the new catalog will no longer be possible and 54.6% considered achieving the target numbers in 6 years to be impossible or state that they can no longer train the same number of continuing education assistants (WBAs) in the same time frame. Endoscopy (17.1-18.8%), fundoplication (15.4-17.7%) and head and neck procedures (12.1-17.1%) were consistently mentioned as bottlenecks across all levels of care. Rotations for balance were reported to be already established or not necessary in 64.7%. In 48% it was stated that the department had established the partial steps concept. The importance of a structured training concept was considered important by 85% of WBAs, compared to 53.3% of chief physicians (CÄ). If a structured training concept was present in the department, the achievability of the target numbers was significantly assessed more positively in the univariate analysis. In the multivariate analysis, male gender and the status of "habilitated/professor" were independent factors for a more positive assessment of the nWBO. Objective certification of training was considered important by 51.5%. CONCLUSION: Concerns surround the nWBO and the sentiment is pessimistic. Additional requirements and hospital reforms could exacerbate the situation. Collaboration and rotations are crucial but still insufficiently implemented. Quality-oriented certification could enhance the quality of training.

Analysis of forensic medical opinions issued in criminal cases of alleged medical error in obstetrics at the Department of Forensic Medicine, Jagiellonian University Medical College, in 2010-2016.

AIM OF THE STUDY: Analysis of forensic medical opinions in the field of obstetrics prepared at the Department of Forensic Medicine, Jagiellonian University Medical College in Krakow, in 2010-2016, in order to evaluate changes in the number of filed cases involving an alleged medical error over the years, and determine the most common situations where medical errors are suspected by patients, and the most prevalent types of medical errors in obstetrics. MATERIAL AND METHODS: The opinions were divided into two groups. In the first group, the medical management was appropriate, while in the second group medical errors were identified. The medical errors were categorised as diagnostic/therapeutic, technical, and organisational. The effects of medical errors were classified as death, impairment to health, exposure to death, and exposure to impairment to health, by considering them separately for post-natal women, and for foetuses and neonates (during the first days of life). RESULTS: A total of 73 forensic medical opinions were analysed. In 25 cases, a medical error was identified. The most common situations in which a medical error was committed, and in which the suspicion of medical error proved to be unfounded, were listed. Overall, there were 17 diagnostic/therapeutic errors, 7 organisational errors, and 4 technical errors. In cases where a medical error was identified, there were 15 deaths, and in cases without a medical error - 31 deaths. CONCLUSIONS: It was found that 66% of the analysed forensic medical opinions involved no medical errors. In most of these cases, a therapeutic failure occurred, including perinatal haemorrhage, tight wrapping of the umbilical cord around the foetal neck (nuchal cord), premature birth, and septic complications. A few cases involved uncooperative patients. The most prevalent medical error was failure to perform or delaying a caesarean section when it was needed (because of emergency or urgent indications). The second most common medical error was related to incorrect CTG interpretation.

Sistemas de Saúde e Competências do Enfermeiro em Portugal / Health Systems and Nursing Skills in Portugal

Resumo O artigo discorre sobre o Sistema de Saúde em Portugal que possui o modelo de Beverigde, baseado no financiamento dos serviços de saúde pelas receitas, obtidas por impostos sobre o rendimento dos contribuintes, alicerçado num sistema público, em que o direito à saúde é independente do trabalho e do emprego. O ensino de Enfermagem está estruturado em: Formação Pré-Graduada - Licenciatura; Mestrado e Doutorado em Ciências de Enfermagem e Enfermagem. A competência do enfermeiro de cuidados gerais refere-se ao desempenho profissional demonstrador da aplicação efetiva do conhecimento e das capacidades, que lhe permitem o juízo clínico e a tomada de decisão. O exercício das competências baseia-se na relação interpessoal entre o enfermeiro e o cliente individual e/ou grupo; tomada de decisão baseada em evidência científica, juízo clínico fundamentado nas necessidades de cuidados individuais ou do grupo, intervenções de Enfermagem prescritas considerando a segurança dos cuidados e do cliente, detecção precoce dos reais ou potenciais diagnósticos buscando resolução ou minimização das consequências, pelos valores dos clientes, além do respeito e regulamentação profissional que estabelecem a boa prática.

Abstract The paper discusses the Portuguese Health System that has adopted the Beveridge model, which is based on the financing of health services by taxpayers' income, based on a public system, where the right to health is independent of work and employment. Nursing education is structured in Pre-Graduate Education - Degree; Master and Doctorate in Nursing Sciences and Nursing. The competency of the generalist nurses refers to the professional performance showing the effective application of knowledge and skills, which allows them to make a clinical judgment and decide. The exercise of competencies is based on the interpersonal relationship between the nurse and the individual client or group; decision-making based on scientific evidence, clinical judgment based on the needs of individual or group care, prescribed nursing interventions considering the safety of care and the client, early detection of the real or diagnostic potentials seeking resolution or minimization of consequences, by the values of the patients, as well as respect and professional regulation that establish good practice.

Jury verdicts and outcomes of malpractice cases involving arteriovenous hemodialysis access.

OBJECTIVE: To analyze malpractice cases involving hemodialysis access to prevent future litigation and improve physician education. METHODS: Jury verdict reviews from the WESTLAW database from 1 January 2005 to 1 January 2015 were reviewed. The search terms "hemodialysis," "dialysis," "graft," "fistula," "AVG," "AVF," "arteriovenous," "catheter," "permacatheter," and "shiley" were used to compile data on the demographics of the defendant, plaintiff, allegation, complication, and verdict. RESULTS: Sixty-six cases involving the litigation pertaining to hemodialysis catheter, arteriovenous fistula (AVF) or arteriovenous grafts (AVGs) were obtained. Of these, 55% involved catheter-based hemodialysis access, 18% involved AVF, and 27% involved AVG. The most frequent physician defendants were vascular surgeons (36%), internists (14%), nephrologists (14%), general surgeons (9%), and interventional radiologists (6%). Of the patients, 38% involved were male and the average patient age was 56.3 (standard deviation (SD) = 20.1) years. Region of injury was 50% in the neck or chest, 42% in the arm, and 8% in the groin. Injury was listed as death in 79% of cases. Of the deaths, 95% involved bleeding at some point in the chain of events. The most common claims related to the cases were failure to perform the surgery or procedure safely (44%), failure to diagnose and treat in a timely manner (30%), and negligent hemodialysis treatment (11%). The most common complications cited were hemorrhage (62%), loss of function of limb (15%), and ischemia due to steal syndrome (11%). A total of 26 cases (39%) were found for the plaintiff or settled. The median award was US$463,000 with a mean of US$985,299 (SD = US$1,314,557). CONCLUSION: While popular opinion may indicate that steal syndrome is a commonly litigated complication, our data reveal that the most common injury litigated is death which may frequently be the result of a hemorrhagic episode. In addition to hemorrhage, the remaining most common complications included steal syndrome and loss of limb function. Therefore, steps to better prevent, diagnose and treat bleeding, nerve injury, and steal syndrome in a timely manner are critical to preventing hemodialysis-access-associated litigation.

The evaluation of malpractice cases arising from aesthetic intervention in Turkey based on Supreme Court case law.

AIM: The aim of this study is to evaluate medical malpractice cases arising from aesthetic services based on the decisions of the Supreme Court. MATERIAL AND METHODS: In the study, compensation and criminal lawsuits finalized by the civil and penal courts of the Supreme Court were examined retrospectively. All the case law decisions were obtained from the official website of the Supreme Court: www.yargitay.gov.tr. Nine hundred and eighty-one decisions were obtained after performing a keyword search in the website; after duplicates and unrelated cases were removed, 81 decisions (N = 81) were evaluated. RESULTS: The analysis showed that lawsuits related to medical malpractice involving aesthetic interventions are mostly finalized by the civil courts, which decide claims for compensation. Malpractice primarily occurred in private hospitals and beauty centers, and operations were found to be commonly performed by physicians and beauty experts. Malpractice cases were found to be mostly caused by poor medical intervention, a lack of attention/care, and faulty/incorrect treatment. The average compensation amount provided by the civil courts is 55 558 ± 50 014 TL (14 209 ± 12 318 USD). CONCLUSION: On the basis of these results, it is recommended that the awareness and training level of healthcare personnel should be increased, and precautions should be taken at both the institutional and the national levels.

Analysis of the French national evaluation of radiology residents.

PURPOSE: In France, a national evaluation is given annually to radiology residents. The aim of this study was to perform both a docimological analysis of the quality of the questionnaire and a statistical analysis of the results. MATERIALS AND METHODS: This retrospective study, which included French radiology residents from Year 1 to Year 5 of residency, was performed from 2015 to 2017 across 25 medical universities in France. Both qualitative and quantitative docimological analyses were performed as assessed by the Cronbach alpha coefficient, the difficulty of question (PDI), and the coefficient of discrimination (Rir). Results to the questionnaire were compared between years of residency. RESULTS: The results of the analysis confirmed the quality of the questionnaire (Cronbach alpha coefficient=0.71, mean [PDI=0.40]) though the majority of questions could be answered by memory rather than cognitive ability. The mean Rir was 0.02, indicating that students could not be certified using only the questionnaire. The results measuring resident level of knowledge were moderate, with mean results ranging from 9.2/20 at the first year to 11.3/20 at the fifth year of residency (P<0.001). There were no significant differences in results obtained between the third, fourth, and fifth year of residency but results were significantly different among university hospitals. CONCLUSION: Even if close interactions exist between learning and pedagogic environment, our results suggest that it may be useful to further develop an evaluation process in relation with pedagogic instructions in order to provide more optimal training.

[Weighting of Orthopaedics & Trauma Surgery in the Medical State Examination - Comparison of the Written Examination with the National Catalogue of Learning Objectives in Surgery]. / Die Wertigkeit des gemeinsamen Faches Orthopädie-Unfallchirurgie im 2. Staatsexamen ­ Vergleich der schriftlichen 2. Staatsexamina mit dem Nationalen Kompetenzbasierten Lernzielkatalog Chirurgie.

BACKGROUND: The national competence-based catalogue of learning-goals in surgery (NKLC) defines competence levels for each of its 230 goals, including "competence level in 1: factual knowledge" up to "competence level 3: independent action". Aside from the cumulative examinations influencing the learning behaviour of students, those teaching targets do not affect the second state examination. This study analyses the extent to which the questions of the German second medical licensing examination compiled by the IMPP (central German institute for medical and pharmaceutical examinations) are congruent with the trauma-surgical and orthopaedic learning goals in the NKLC, in which this thematic focus is emphasised. MATERIAL AND METHODS: Exam questions from autumn 2009 to autumn 2014 (n = 11) were retrospectively analysed. Orthopaedic and trauma-surgical teaching targets defined in NKLC were identified by five senior orthopaedic physicians and trauma surgery experts. All questions addressing one of these learning goals were identified and analysed (re: the number of learning goals, the number of questions addressing a trauma-surgical, or orthopaedic goal, as well as different competency levels). RESULTS: We found 113 learning goals of NKLC (49.1% of the overall NKLC learning goals) identified as orthopaedic or trauma surgery subjects. During the study period, 543 questions included teaching targets referring to orthopaedic or trauma surgery subjects (15.6% of the total of 3480 questions). Per exam, a mean of 49.36 ± 14.1 questions (minimum 30; maximum 80) was identified that addressed a learning goal referring to these issues. For each exam, 13.45 ± 6.39 (minimum 6; maximum 24) questions referred to learning goals of competence level 3a and b, 21.45 ± 9.94 (minimum 9; maximum 39) questions referred to learning goals of competence level 2, and 14.45 ± 6.36 (minimum 6; maximum 25) questions referred to learning goals of competence level 1. Most questions addressed the topic: "disorders of the rheumatic spectrum" (n = 16 questions in autumn 2009). CONCLUSION: Questions focusing on orthopaedic and trauma surgery appeared sufficiently often during the second state examination. There is a thematic imbalance, and important clinical learning goals tagged with high competence levels were not addressed in a satisfactory manner. This indicates that a clear adjustment between the state examination and NKLC is necessary.

Malpractice litigation in the endovascular era.

OBJECTIVE: The standard of care in the treatment of vascular disease continues to evolve as endovascular therapies develop. Currently, it is unclear how medical malpractice litigation has adapted to the "endovascular era." This retrospective case review is the most comprehensive analysis to date of malpractice actions involving endovascular procedures performed by vascular surgeons (VSs), interventional radiologists (IRs), interventional cardiologists (ICs), and cardiothoracic surgeons (CTSs). METHODS: The legal databases LexisNexis and Westlaw were searched for all published legal cases in the United States involving endovascular procedures. The search was limited to state and federal cases up to and including the year 2016. Keywords included "malpractice," "vascular," "endovascular," "catheter," "catheterization," "stent," "angiogram," "angiography," and "surgery." Cases involving tax revenue, insurance disputes, Social Security Disability, and hospital employment contract disputes were excluded. Data were analyzed using χ2 test. RESULTS: There were 2115 initial search results identified, and 369 cases were included in final analysis. The rate of endovascular procedure-related lawsuits (per 1000 active physicians in the specialty) was highest for ICs (105.56), whereas rates for VSs and IRs were comparable (18.47 and 16.85, respectively); 93% of the IC cases were related to coronary interventions. Overall, 55% (148/271 classifiable cases) of actions were related to elective procedures. For VSs specifically, 46% (25/54) of cases arose from diagnostic angiography and inferior vena cava filter placement, two relatively minor procedure types. Overall, 83% (176/211 finalized cases) of verdicts favored defendants, with no significant differences across the specialties; 43% (157/368) of total cases involved death of the patient. Among the four specialties, there was a significant (P = .0004) difference in the primary allegation (informed consent, preprocedure negligence, intraprocedure complications, or postprocedure complications) underlying the litigation. For CTSs and VSs, there was a predominance of informed consent and preprocedure negligence allegations (70% [7/10] and 52% [28/54], respectively). Intraprocedure negligence was the most common allegation for IRs (59% [23/39]), whereas allegations were more evenly distributed among ICs. CONCLUSIONS: Key issues were identified regarding malpractice litigation involving the specialties that commonly perform endovascular procedures. Despite the increasing number of ICs doing peripheral interventions, a large majority of IC cases were related to coronary treatments. A surprisingly large percentage of VS cases were related to seemingly minor cases. There were significant interspecialty differences in the primary underlying allegations. As the scope of endovascular procedures broadens and deepens, it is important for clinicians to be aware of legal considerations relevant to their practice.