Supernumerary registrar experience at the University of Cape Town, South Africa.

BACKGROUND: Despite supernumerary registrars (SNRs) being hosted in South African (SA) training programmes, there are no reports of their experience. OBJECTIVES: To evaluate the experience of SNRs at the University of Cape Town, SA, and the experience of SNRs from the perspective of SA registrars (SARs). METHODS: SNRs and SARs completed an online survey in 2012. RESULTS: Seventy-three registrars responded; 42 were SARs and 31 were SNRs. Of the SNRs 47.8% were self-funded, 17.4% were funded through private organisations, and 34.8% were funded by governments. Average annual income was ZAR102 349 (range ZAR680 - 460 000). Funding was considered insufficient by 61.0%. Eighty-seven percent intended to return to their home countries. Personal sacrifices were deemed worthwhile from academic (81.8%) and social (54.5%) perspectives, but not financially (33.3%). Only a small majority were satisfied with the orientation provided and with assimilation into their departments. Almost half experienced challenges relating to cultural and social integration. Almost all SARs supported having SNRs. SNRs reported xenophobia from patients (23.8%) and colleagues (47.8%), and felt disadvantaged in terms of learning opportunities, academic support and on-call allocations. CONCLUSIONS: SNRs are fee-paying students and should enjoy academic and teaching support equal to that received by SARs. Both the university and the teaching hospitals must take steps to improve the integration of SNRs and ensure that they receive equal access to academic support and clinical teaching, and also need to take an interest in their financial wellbeing. Of particular concern are perceptions of xenophobia from SA medical colleagues.

Does academic output correlate with better mortality rates in NHS trusts in England?

OBJECTIVE: To establish whether there is an association between academic output and mortality rates for National Health Service (NHS) trusts. METHODS: Hospital standardized mortality ratios were obtained from Dr Foster hospital report cards. The Medline database of biomedical citations was queried to establish the number of citations credited to each NHS trust and constituent hospitals from 2006 to 2010. Admissions totals for NHS trusts for 2009-2010 were obtained from Hospital Episode Statistics Online. The number of citations per admission was calculated and used as an indicator of academic output as this reflects the workload of the trust. RESULTS: Spearman's rank analysis was performed to identify any correlation between citations per admission and the inverse of four types of mortality rate: high-risk conditions, r = 0.20 (P = 0.01); low-risk conditions, r = -0.06 (P = 0.46); deaths after surgery, r = 0.193 (P = 0.019); and overall mortality, r = 0.291 (P < 0.01). CONCLUSION: The results of this preliminary study demonstrate a significant correlation between academic output and mortality rates. The correlation coefficients are small, but the findings of this study encourage further debate.

Mucocele of a pneumatised uncinate process: first reported case.

OBJECTIVE: We report a unique case of a mucocele of a pneumatised uncinate process. METHOD: Clinical, radiological and intra-operative findings are presented. RESULTS: A 43-year-old woman was referred to our ENT department suffering from persistent symptoms of left-sided sinusitis. Although an initial computed tomography scan suggested a lacrimal duct mass, dacrocystography showed free flow through the nasolacrimal duct. The patient underwent surgery, revealing a mucocele within a pneumatised uncinate process. CONCLUSION: This patient's clinical, radiological and intra-operative findings illustrate how variations in sinus anatomy can pose a diagnostic challenge.