The erosive effects of saliva following chewing gum on enamel and dentine: an ex vivo study.

OBJECTIVES: The primary objective was to determine the erosive effect of expectorated saliva, following chewing acidic gum, on enamel and dentine samples, using a non-acidic gum as a negative control. Secondary objectives were to determine the effect of brushing enamel and dentine samples and the effect of individual saliva pH and buffering. DESIGN: A single-centre, single-blind, placebo-controlled, two-way crossover study. SETTING: A clinical trial, involving healthy participants, undertaken at Bristol Dental School and Hospital. METHODS: Eight healthy participants expectorated saliva onto prepared enamel and dentine samples while chewing gum (strawberry flavoured acidic gum [active] or peppermint flavoured non-acidic gum [control]). Half of the enamel and dentine samples were brushed before measurement by contact profilometry. MAIN OUTCOME MEASURES: Mean enamel and dentine erosion, with and without brushing and the relationship to salivary buffering.Results At 10 days, mean depth of surface loss from dentine samples (95% CI), following chewing of acid-containing gum and subsequent brushing, was -11.34 µm (2.22 µm) and from un-brushed dentine samples was -11.02 µm (1.71 µm). No significant erosion was noted for other groups. CONCLUSIONS: Frequent chewers of acid-containing gums are susceptible to dentine erosion even in the presence of good salivary buffering. Enamel erosion was insignificant within the time constraints of the present study but warrants further investigation.

Stress, burnout and doctors' attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates.

BACKGROUND: The study investigated the extent to which approaches to work, workplace climate, stress, burnout and satisfaction with medicine as a career in doctors aged about thirty are predicted by measures of learning style and personality measured five to twelve years earlier when the doctors were applicants to medical school or were medical students. METHODS: Prospective study of a large cohort of doctors. The participants were first studied when they applied to any of five UK medical schools in 1990. Postal questionnaires were sent to all doctors with a traceable address on the current or a previous Medical Register. The current questionnaire included measures of Approaches to Work, Workplace Climate, stress (General Health Questionnaire), burnout (Maslach Burnout Inventory), and satisfaction with medicine as a career and personality (Big Five). Previous questionnaires had included measures of learning style (Study Process Questionnaire) and personality. RESULTS: Doctors' approaches to work were predicted by study habits and learning styles, both at application to medical school and in the final year. How doctors perceive their workplace climate and workload is predicted both by approaches to work and by measures of stress, burnout and satisfaction with medicine. These characteristics are partially predicted by trait measures of personality taken five years earlier. Stress, burnout and satisfaction also correlate with trait measures of personality taken five years earlier. CONCLUSIONS: Differences in approach to work and perceived workplace climate seem mainly to reflect stable, long-term individual differences in doctors themselves, reflected in measures of personality and learning style.

How to write a peer review.

The peer review process is a quality control for scientific publication. Well done, it helps editors to improve their journals and protects readers from wasting time on ill-conceived, redundant, irrelevant or erroneous literature. Badly done it can act as an obstacle to innovation. This article tells you how to be a first rate peer reviewer.

Informed consent and the preregistration house officer.

A survey of preregistration house officers demonstrated that less than a third had never felt compelled to obtain consent from patients for procedures they themselves did not understand. This had occurred frequently for over a fifth of respondents. Learning how to obtain informed consent is an important part of the education and training of a doctor. The wrong lessons will be learned if they feel compelled to do this when ill-equipped with relevant information about risks and alternatives.

Job sharing in medical training: an evaluation of a 3-year project.

Job sharing has been introduced on a major scale in one deanery to help accommodate increasing demand for flexible (part-time) training. We arranged 37 job shares for 74 trainees between 1996 and 1999. Job shares lasted from 6 months to 2 years. Trainees in job shares were as satisfied with their training as those in supernumerary posts or in full-time training.

Trainee satisfaction before and after the Calman reforms of specialist training: questionnaire survey.

OBJECTIVES: To evaluate the impact of the Calman reforms of higher specialist training on trainee satisfaction. DESIGN: Questionnaire surveys using portable electronic survey units, two years apart. SETTING: Postgraduate, teaching, district general, and community NHS trusts in North Thames. North Thames deanery includes London north of the Thames, Essex, and Hertfordshire. PARTICIPANTS: Trainees in all grades and all specialties: 3078 took part in the first survey and 3517 in the second survey. MAIN OUTCOME MEASURES: Trainees' satisfaction with training in their current post, including educational objectives, training agreements, induction, consultant feedback, hands on experience acquired, use of log books, consultant supervision, and overall satisfaction with the post. RESULTS: In the second survey respondents were more likely to have discussed educational objectives with their consultant, used a log book, and had useful feedback from their consultant. They were more likely to give high ratings to induction, consultant supervision, and hands on experience acquired in the post. Each of these elements was associated with increased satisfaction with the post overall. Improvements were most noticeable at the level of specialist registrar, but changes in the same direction were also seen in more junior grades. CONCLUSIONS: After the reforms of specialist training, trainees in all grades reported greater satisfaction with their current posts. The changes required extra training time and effort from consultants.

The effect of 1-year rotations on stress in preregistration house officers.

A comparison of stress levels in preregistration house officers demonstrated lower levels in those completing 1-year rotations compared with those completing 6-month posts in two different hospitals. One-year rotations provide a more stable environment, allow new doctors to become familiar with the workings of an organization from several viewpoints and permit a better sense of working within a multiprofessional team than the traditional arrangements.

Flexible specialist training compared with full-time training.

The educational and training quality of flexible training posts compared very well and in some instances was better than that obtained in full-time training. The hours of work were fewer, but as a proportion not as small as is sometimes recognized by the Colleges and is comparable with many full-time training programmes in other European Union countries.

Managing trainee doctors in difficulty.

When the conduct, performance or health of a doctor in training is called into question, there is often confusion about the roles and responsibilities of the parties involved. Where does training stop and employment begin? When should poor performance trigger intensified training, and when should it lead to dismissal? How much information should be transferred from employer to employer as a trainee moves around a training programme? This article describes one Deanery's approach.

Specialist registrar training and the generalist: views of trusts and health authorities.

As a results of the introduction of structured training in postgraduate medical education we undertook a survey of North Thames stakeholders in health authorities and trusts to ascertain views on the implications of the specialist registrar grade on the future shape of the clinical workforce. Trusts and health authorities expressed concern over the training of specialist doctors at the expense of training generalists to provide patient care.

Is the new deal compatible with good training? A survey of senior house officers.

A survey of senior house officers revealed that the New Deal on junior doctors' hours had not been fully achieved, and that education and training was variable. The report explores the relationship between hours and intensity of work, experience gained, and the educational quality of posts. It suggests that the acquisition of experience has more to do with working in a well-organized, well-supervised educational environment than with putting in long hours or doing without sleep. It concludes that the New Deal is compatible with good training.

Association of use of a log book and experience as a preregistration house officer: interview survey.

OBJECTIVE: To determine whether use of a log book improved the experiences of preregistration house officers. DESIGN: Confidential questionnaire and interview survey of preregistration house officers carried out as part of University of London inspection process. MEASURES: Preregistration house officers were asked to rate educational and pastoral elements of their posts and about the use made of previously distributed log books. SUBJECTS AND SETTING: Preregistration house officers in North Thames. RESULTS: The incumbents of 535 of 560 (95%) preregistration house officer posts in the region were surveyed between June 1994 and July 1995, 490 by questionnaire and interview, 45 by questionnaire alone. House officers who had discussed the log book with their consultant expressed more satisfaction with their induction, consultant supervision and feedback, and formal and informal education and were more likely to recommend their job to a friend. CONCLUSION: Preregistration house officers who had discussed the log book with their consultant expressed more satisfaction with the educational elements of their jobs. The structured discussion with their consultant about the job and their performance seemed to make the difference.

New approaches to job-sharing of training posts in the North Thames region.

This paper proposes a new way of managing the provision of flexible training opportunities by job-sharing. It shows how the difficulties of implementing job-sharing can be overcome, and gives an example of implementation of job-sharing in the context of flexible training.