NHS advice and guidance - improving outpatient flow and patient care in general surgery.

INTRODUCTION: Advice and Guidance (A&G) is a digital communication tool that allows primary care physicians to seek advice from secondary care clinicians prior to, or instead of, direct referrals. Its effectiveness in general surgery has not been robustly evaluated. AIMS: To analyse the number of A&G e-referrals to General Surgery at the Queen Elizabeth Hospital Birmingham and evaluate the outcomes of these requests including response times and changes to outpatient clinic appointment requirements. METHODS: A retrospective analysis of all A&G requests to General Surgery between July 2020 and September 2021. The responses were categorised into 7 different outcomes and the time taken to reply to requests was recorded. An analysis of outpatient appointments (both 'new' and 'follow-up' appointments) pre- and post-introduction of A&G was performed. RESULTS: A total of 2244 A&G requests were made during the study period: 61% requests resulted in outpatient clinic appointments; 18% direct organisation of investigations; 10% advice was provided; 8% were redirected to a different specialty. Median time take to reply to a referral was the same day. The proportion of outpatient appointments that were 'new' appointments was reduced by 16.3% following introduction of A&G (P < 0.001). CONCLUSION: A&G requests to General Surgery potentially diverts patients away from the outpatient clinic. Responses are rapid. A longer term evaluation of the service is necessary to determine its beneficial and detrimental effects on patients, primary care and secondary care.

A live term intra-abdominal pregnancy in a Field Hospital: a case report.

Abdominal pregnancy is a rare form of ectopic pregnancy with high morbidity and mortality for both the mother and the fetus. Diagnosis can be challenging, especially in a resource-limited setting. We report a case of abdominal pregnancy that presented to Médecins Sans Frontières field hospital in Agok, South Sudan, with abdominal pain. Examination revealed a term pregnancy and a live fetus in transverse lie. The diagnosis of abdominal pregnancy was made intraoperatively, with successful management and delivery of a healthy baby.

Efficacy and Feasibility of Objective Structured Clinical Examination in the Internal Assessment for Surgery Postgraduates.

INTRODUCTION: Traditionally assessment in medical training programs has been through subjective faculty evaluations or multiple choice questions. Conventional examinations provide assessment of the global performance rather than individual competencies thus making the final feedback less meaningful. The objective structured clinical examination (OSCE) is a relatively new multidimensional tool for evaluating training. This study was carried out to determine the efficacy and feasibility of OSCE as a tool for the internal assessment of surgery residents. METHODS: This study was carried out on the marks obtained by surgery residents at different levels of training in a single tertiary center in India over the 4 OSCEs conducted in the years 2015 and 2016. The marks of the OSCE were collected from the departmental records and analyzed. Reliability was calculated using internal consistency using Cronbach's α. Validity was calculated by item total correlation. Content validation was done by obtaining expert reviews from 5 experts using a proforma, to assess the content and checklist of each station of the OSCE. RESULTS: A total of 49 surgery residents were assessed in small batches during the above mentioned period. Of the 4 OSCEs conducted by us, 3 had a high value of Cronbach's α of greater than 0.9, as opposed to the set standard of 0.7. Out of 23 stations used in the 4 examinations separately, only 3 stations were found to have a low correlation coefficient (item total correlation), and hence, a low validity. The remaining 20 stations were found to have a high validity. Expert review showed unanimous validation of the content of 17 out of the 23 stations, with few suggestions for change in the remaining 6 stations. The material and manpower used was minimal and easy to obtain, thus making the OSCE feasible to conduct. CONCLUSION: OSCE is a reliable, valid. and feasible method for evaluating surgery residents at various levels of training.