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.

The sociodemographic profile, risk categories and prevalence of HIV infection among people attending a London same-day testing clinic, 2000-2001.

The objectives were to determine the sociodemographic profile, risk category, and prevalence of HIV infection amongst people attending a confidential clinic providing counselling, medical advice and results of HIV antibody testing on the same day of consultation. Data were collected on all 1749 individuals attending the same-day HIV testing clinic at the Royal Free Hospital, London and proceeding to HIV testing between June 2000 and May 2001. One thousand, one hundred and forty-eight men and 601 women (mean age 33.3 years) were tested for HIV antibodies. The primary risk for HIV infection was heterosexual contact (69.9%; 1224/1749) and homosexual contact (27.7%; 485/1749). Fifty individuals tested HIV-positive (42 men and eight women). HIV seroprevalence was 2.8% (50/1749) and was highest among men who reported risk through homosexual contact (6.2%; 30/485). The rates for heterosexual men and women were 1.8% (12/648) and 1.4% (8/576), respectively, though they were highest among Black Caribbean (12%; 3/25) and Black African attendees from sub-Saharan African countries (11.2%; 18/160). Of the total number attending the clinic, more than half (56%; 981/1749) had previously been tested and received a negative test result. Of the fifty HIV antibody-positive individuals, 26%, (13) had previously received a negative result and had all reported risk through homosexual contact. Thirty of the HIV antibody-positive individuals were asymptomatic, 14 were symptomatic and three were diagnosed with an AIDS-defining condition. Half of all HIV-positive attendees (51.2%; 22/43) presented at the time of testing with CD4 cell counts below the normal range (>400x10(6)/l). The high HIV seroprevalence among homosexual men, some of whom had previously tested negative, suggests that HIV prevention strategies used within this group may need to be reassessed. The continuing high HIV seroprevalence among individuals from African countries suggests that this population require specific targeting for HIV risk reduction and information on the advantages of early diagnosis and treatment.

The challenges to intimacy and sexual relationships for gay men in HIV serodiscordant relationships: a pilot study.

Human Immunodeficiency Virus (HIV) infection and disease progression create imbalance in long-term, HIV-serodiscordant, gay male relationships, particularly in sexual relations and issues of physical and emotional intimacy. Stage of disease progression and worldview of the couple both affect the relationship and its survival. To redress imbalance, partners employ a range of coping strategies and techniques. This article explores these issues in the context of HIV serodiscordant gay couples and how they preserve their relationships in the face of these unique challenges. For workers who provide psychotherapeutic and community support for people with HIV and for their partners, the results of this study may be helpful in recognizing stress factors for couples, and tailoring support services to the needs of both partners. Overall, this study provides a basis for further work examining the dynamics of serodiscordant relationships.

'I'm not picking up a heart-beat': experiences of sonographers giving bad news to women during ultrasound scans.

This study explores the experiences of obstetric sonographers imparting diagnostic information which may be considered 'bad news' to expectant mothers. Semi-structured interviews were conducted with nine sonographers at two London Hospitals to elicit their experiences of giving bad news. Themes which emerged then formed the basis for a quantitative survey of 180 practising obstetric sonographers in England. Their perception of what constitutes 'bad news' was examined. It was found that sonographers were predominantly concerned with lack of time and the unpredictability of the patient's reaction when giving bad news. Staff working in settings where there was a clear protocol specifying how to proceed following disclosure of bad news experienced less stress than those working without such a protocol. These findings have implications for psychologists working with patients who suffer pregnancy loss who may consider provision of support and counselling skills training for sonographers.

Coping with the disfiguring effects of vitiligo: a preliminary investigation into the effects of cognitive-behavioural therapy.

Vitiligo is a progressive condition involving a loss of pigmentation in the skin; it can be disfiguring and no effective treatment or cure exists. Although vitiligo's medical effects have been studied extensively, little attention has been paid to its psychological impact or to the effects of psychological state on the illness itself. To address these issues, the present study examined the effect of cognitive behavioural therapy on coping with vitiligo and adaptation to the negative effects on body image, quality of life and self-esteem in adult patients. The study also examined whether any psychological gains acquired from psychological therapy would influence the progression of the condition itself. Two matched groups of vitiligo patients were compared, one of which received cognitive-behavioural therapy over a period of 8 weeks, while the other received no changes to their treatment status. All patients were assessed on self-esteem, body image and quality of life, prior to, immediately following and 5 months following the end of therapy. The progression of the condition was assessed by photographing patients prior to the start of counselling and 5 months following counselling. Results suggest that patients can benefit from cognitive behavioural therapy in terms of coping and living with vitiligo. There is also preliminary evidence to suggest that psychological therapy may have a positive effect on the progression of the condition itself. Implications for incorporating psychological counselling into patient care and management are discussed.

Impact of life events on the onset of vitiligo in adults: preliminary evidence for a psychological dimension in aetiology.

The present study retrospectively examines the role of stressful life events in the onset of vitiligo in adults. A matched clinical sample of patients with other forms of disfigurement or skin disease (dystrophic epidermolysis bullosa and naevi, not thought to be associated with stress) served as a control group. Newly diagnosed patients and matched controls were thus asked to complete the 12-month version of the Schedule of Recent Experience, a questionnaire which measures the frequency and number of stressful life events occurring over a specified period. The results suggest that such patients endure a significantly higher number of stressful life events than do controls, suggesting that psychological distress may have contributed to the onset of their condition. The implications of the results are discussed and suggestions made for future research.

Psychological distress among gay men supporting a lover or partner with AIDS: a pilot study.

To date, there has been little research to examine how much psychological distress is caused to people providing care and support to a lover or partner with AIDS. This study aimed to determine the level of psychological distress experienced by a sample of gay men providing care and support to a lover or partner with AIDS. It was conducted as a cross-sectional questionnaire survey. A control group was not enlisted, thus the study was descriptive in nature. The experimental hypothesis proposed that providing care and support would result in a high level of psychological distress. Thirty-eight gay men, some of whom themselves were infected with HIV, who were the primary carer of a lover or partner with an AIDS diagnosis were assessed using a self-report questionnaire. The 28-item General Health Questionnaire was used as a measure of global psychological distress. In addition, Martin's (1988) Traumatic Stress Response Scale was used as a measure of psychological distress arising specifically from AIDS. The sample reported high levels of global and AIDS-specific psychological distress. The levels of distress reported were of such a degree to indicate that the majority of the sample were probably suffering from significant psychiatric problems. The results strongly suggest that providing care and support to a lover or partner with AIDS may have an adverse affect on the carer's own psychological health: however, because of the design of the study it is impossible to state this conclusively.

Nurses' knowledge of and attitudes towards sexuality and the relationship of these with nursing practice.

Issues concerning sex and sexuality are relevant to nursing practice. The objective of this study was to determine the relationship between knowledge of and attitude towards sexuality, and nursing practice. Nursing practice in this case was defined as the discussion of sexuality with the patient, with particular reference to taking a sexual history on admission to the ward. A multi-choice questionnaire with sections establishing demographic details and nursing practice, and including the Sex, Knowledge and Attitude Test (SKAT), was administered to 357 registered general nurses (RGNs). Results show a relationship between knowledge and attitude but no relationship between either of these and the nursing practice scale. However, a slight but significant correlation between receiving teaching about sexual history taking and questioning patients about sexuality on admission suggests that nursing practice and knowledge are weakly related. There is evidence that factors other than those within the scope of this study influence all three independent variables, and these are discussed. The implications of the study suggest the need for an improvement in nurse education regarding sexuality at all stages of training.

HIV seroprevalence in a London same-day testing clinic.

OBJECTIVES: To determine the prevalence of HIV infection among people attending a confidential, non-genitourinary medicine based testing clinic that provides HIV antibody test results on the day of consultation. METHODS: Retrospective analysis of data collected on 2635 individuals attending the Same-Day HIV Testing Clinic at the Royal Free Hospital, London between March 1992 and February 1993. RESULTS: A total of 1612 men and 1023 women were tested for HIV antibody. The primary risk for HIV infection was heterosexual (71.7%; 1889 out of 2635) and homosexual contact (24.5%; 646 out of 2635). Fifty-four individuals were given positive HIV test results (46 men, median age 34 years; eight women, median age 27 years). Overall HIV seroprevalence was 2.0% (95% confidence interval, 1.5-2.5). HIV seroprevalence was highest among homosexual men (6.5%; 41 out of 635) and injecting drug users (5.7%; four out of 70). The rates for heterosexual men and women were 0.2% (two out of 915) and 0.7% (seven out of 974), respectively. Of the 54 individuals who were HIV-antibody-positive, 44 were Centers for Disease Control and Prevention stage II/III, eight stage IV and one was tested at the time of seroconversion (stage I; data were not available for one patient). Of the total numbers attending this clinic 27% (702 out of 2635) had previously been tested and received a negative result. Of a total of 54 HIV-antibody-positive individuals, 40% (21) had previously received a negative test result. CONCLUSIONS: The data suggest that seroprevalence amongst homosexual men attending a designated HIV testing clinic in London is lower than that reported by genitourinary clinic based testing sites. The large number of repeat testers who subsequently became infected with HIV suggests that there is a population requiring specific targetting for HIV risk reduction.

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

Knowledge about HIV and views about HIV testing among students at an inner London university.

Undergraduate students at an inner London university were surveyed at the beginning of 1992 about their basic knowledge regarding HIV/AIDS, HIV transmission and views about the HIV antibody test. Although they demonstrated good knowledge about HIV/AIDS and routes of transmission, a proportion had had unprotected intercourse, but were deterred from seeking an HIV test for a number of reasons. Implications for promoting safer sex and increasing awareness about HIV testing sites on university campuses are discussed.

Talking to patients about sexual matters.

Specific counselling skills that will assist nurses in discussing sexual matters with patients can be learned. The possession of such skills by nurses will enhance the nurse/patient relationship and encourage patients in the era of HIV/AIDS, to discuss their concerns about sexual issues more openly. This article describes the place of conversation about sexual matters with patients.