Professionalism and the role of medical colleges.

BACKGROUND: There has been substantial interest and emphasis on medical professionalism over the past twenty years. This speaks to the history of the medical profession, but increasingly to a broader understanding of the importance of socialisation and professional identity formation. METHOD: A literature review was undertaken of professionalism and the role of professions and medical professional organisations. RESULTS: A key outcome has been the recognition that medical professionalism must be actively taught and assessed. Substantial effort is required to improve the educational environment, so that it nurtures the development of professionalism within the work-place. Although medical colleges have been prominent in identifying and progressing the recent developments within professionalism there is still much to be done to deliver fully on the societal contract between the public and the profession. There are key gaps to address, particularly with regards to self-regulation, civil behaviour and effective leadership and advocacy. CONCLUSION: Medical colleges need to take direct responsibility for the professionalism of their members. The expectations of the community are increasingly clear in this regard.

Development of the Australasian vascular surgical audit.

OBJECTIVE: The purpose of this study was to describe the development of the Australasian Vascular Audit that was created to unify audit activities under the umbrella of the Australian and New Zealand Society for Vascular Surgery as a Web-based application. METHODS: Constitutional change in late 2008 deemed participation in this audit compulsory for Society members. The Web-based application was developed and tested during 2009. Data for all open vascular surgery and for all endovascular procedures are collected at two points in the admission episode: at the time of operation and at discharge, and entered into the application. Data are analyzed to produce risk-adjusted outcomes. An algorithm has been developed to deal with outliers according to natural justice and to comply with the requirements of regulatory bodies. The Audit is protected by legislated privilege and is officially endorsed and indemnified by the Royal Australasian College of Surgeons. Confidentiality of surgeons and patients alike is ensured by a legally protected coding system and computer encryption system. Validation is by a verification process of 5% of members per year who are randomly selected. The application is completely funded by the Society. RESULTS: Data entry commenced on January 1, 2010. Over 40,000 vascular procedures were entered in the first year. The Audit application allows instantaneous on-line access to individual data and to deidentified group data and specific reports. It also allows real-time instantaneous production of log books for vascular trainees. The Audit has already gained recognition in the Australasian public arena during its first year of operation as an important benchmark of correct professional surgical behavior. Compliance has been extremely high in public hospitals but less so in private hospitals such that only 60% of members received a certificate of complete participation at the end of its first year of operation. CONCLUSION: An Internet-based compulsory audit of complete surgical practice is possible to create and be maintained by a society of surgeons with a membership of just over 200. The 60% compliance rate for complete data entry has created an immediate constitutional challenge for the Society. Future challenges are to improve total participation to an acceptable level and to ensure accurate data entry via a robust validation system.

Surgical research elective in the United States: an Australian medical student's experience.

The value of surgical research is increasingly recognised by undergraduate medical students interested in pursuing a surgical career. This article describes how an undergraduate medical student from Monash University built upon his surgical research experience from the Eastern Health Surgical Research Group in Australia, by undertaking a 9-week research elective at the Johns Hopkins Center of Surgery Trials and Outcomes Research. Practical issues encountered, such as visa and housing, are outlined. Differing attitudes and trends in surgical research among Australian and American medical students, means of assessing surgical research productivity and the benefits of surgical research are discussed. Surgical research should be encouraged and supported in young trainee surgeons; a short-term surgical research elective can be productive provided the student is focused and realistic about expectations.

Occlusive wrap dressing reduces infection rate in saphenous vein harvest site.

BACKGROUND: Infection in the saphenous vein harvest site is a common problem. We developed an occlusive circumferential wrap dressing technique that reduces skin edge tension, eliminates dead space, and prevents external contamination. We compared the surgical site infection rate using the wrap dressing technique with that of standard longitudinal dressings. METHODS. One hundred fifty-two consecutive patients were randomly assigned to receive either standard dressings or the wrap dressing. Data were collected in the hospital and then 4 to 6 weeks postoperatively. Superficial and deep wound infections were defined by the standard criteria from the Centers for Disease Control and Prevention. RESULTS: The infection rate in the wrap group was 14% compared with 35%, for the standard group (p = 0.006). Multivariate analysis showed that wrap technique was the only significant predictor (negative) of infection (odds ratio, 0.19; p = 0.001). CONCLUSIONS: In saphenous vein harvest wounds, the occlusive wrap dressing technique has the potential to reduce the rate of infection by 50%. This simple and inexpensive technique is also readily applicable to the radial artery harvest site in the arm and may provide similar benefit.

Homocysteine: an aetiological contributor to peripheral vascular arterial disease.

Surgeons are increasingly being exposed to the term 'hyperhomocysteinaemia' but few understand this condition that affects up to 10% of the population, or its pathological sequelae. Hyperhomocysteinaemia has been identified as an important and independent risk factor for atherosclerosis. There is increasing evidence that, in addition to coronary disease, hyperhomocysteinaemia is also associated with an increased risk of developing peripheral arterial disease. Causes of elevated homocysteine levels include inherited enzyme deficiencies and acquired vitamin deficiencies. Detection of hyperhomocysteinaemia is particularly relevant in patients with early onset atherosclerosis. Effective lowering of elevated homocysteine levels is possible with folate, vitamin B6 and B12 supplementation and may reduce the incidence and sequelae of atherosclerotic peripheral arterial disease.