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Acad Med ; 95(2): 175, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31990723
Ann R Coll Surg Engl ; 102(1): 49-53, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31755741


INTRODUCTION: Testicular torsion treatment rests on the horns of a dilemma, with widespread national variation in whether the responsible surgical specialty is general surgery or urology, even in hospitals with both general surgery and urology emergency service assets. This study aimed to quantify higher surgical trainee operative experience and confidence in managing suspected testicular torsion in a single UK deanery (Wales). MATERIALS AND METHODS: Anonymised logbook data were obtained via the Intercollegiate Surgical Curriculum Programme version 10 using the head of school report function for all general surgery (n=53) and urology (n=15) higher surgical trainees, which were combined with the distribution of an electronic self-administered questionnaire. RESULTS: Median operative scrotal explorations recorded for all general surgery higher surgical trainees and senior general surgery higher surgical trainees (ST7+) was 7 (range 1-22) and 10 (range 1-22), compared with 21 (range 9-64, p=0.00104) and 24 (19-64, p<0.001) for urology higher surgical trainees. The questionnaire response rate was 64.6% (general surgery 31/50, urology 11/15). Confidence levels in assessing adult and paediatric patients were lower in general surgery when compared with urology higher surgical trainees: median adult confidence rate 7/10 compared with 9/10, and paediatric confidence rate 7/10 compared with 8/10 (p<0.001 and p=0.053, respectively). All higher surgical trainees preferred urology as the accountable hospital specialty when both assets were available. DISCUSSION AND CONCLUSION: General surgery higher surgical trainees receive less than 50% of the operative exposure of urology higher surgical trainees in emergency scrotal surgery, which has important implications for curriculum competence development and patient safety.

Cirurgia Geral/educação , Torção do Cordão Espermático/cirurgia , Urologia/educação , Adulto , Atitude do Pessoal de Saúde , Criança , Competência Clínica/normas , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Cirurgia Geral/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Pediatria/educação , Pediatria/estatística & dados numéricos , Inquéritos e Questionários , Urologistas/educação , Urologistas/normas , Urologia/estatística & dados numéricos , País de Gales
Ann R Coll Surg Engl ; 102(1): 36-42, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31660752


INTRODUCTION: The temporal patterns and unit-based distributions of trauma patients requiring surgical intervention are poorly described in the UK. We describe the distribution of trauma patients in the UK and assess whether changes in working patterns could provide greater exposure for operative trauma training. METHODS: We searched the Trauma Audit and Research Network database to identify all patients between 1 January 2014 to 31 December 2016. Operative cases were defined as all patients who underwent laparotomy, thoracotomy or open vascular intervention. We assessed time of arrival, correlations between mechanism of injury and surgery, and the effect of changing shift patterns on exposure to trauma patients by reference to a standard 10-hour shift assuming a dedicated trauma rotation or fellowship. RESULTS: There were 159,719 patients from 194 hospitals submitted to the Network between 2014 and 2016. The busiest 20 centres accounted for 57,568 (36.0%) of cases in total. Of these 2147/57,568 patients (3.7%) required a general surgical operation; 43% of penetrating admissions (925 cases) and 2.2% of blunt admissions (1222 cases). The number of operations correlated more closely with the number of penetrating rather than blunt admissions (r = 0.89 vs r = 0.51). A diurnal pattern in trauma admissions enabled significant increases in trauma exposure with later start times. CONCLUSIONS: Centres with high volume and high penetrating rates are likely to require more general surgical input and should be identified as locations for operative trauma training. It is possible to improve the number of trauma patients seen in a shift by optimising shift start time.

Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Admissão do Paciente/estatística & dados numéricos , Traumatologia/educação , Ferimentos e Lesões/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Inglaterra , Feminino , Hospitais com Alto Volume de Atendimentos , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal/organização & administração , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Estudos Retrospectivos , Jornada de Trabalho em Turnos/estatística & dados numéricos , Fatores de Tempo , Centros de Traumatologia/organização & administração , Centros de Traumatologia/estatística & dados numéricos , País de Gales , Local de Trabalho/organização & administração , Local de Trabalho/estatística & dados numéricos , Ferimentos e Lesões/cirurgia
Br J Radiol ; 93(1105): 20190340, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31596121


OBJECTIVE: To compare key characteristics of interventional radiology (IR) training in the UK with four other English-speaking countries (USA, Canada, Australia and New Zealand) and summarise requirements for training. METHODS: Main features examined were career pathway and requirements, examinations required, specific competition for IR and the process of applying for training as an international medical graduate. Data were collected from official governing body publications, literature and personal experience. RESULTS: Several differences were highlighted, including length of training (ranging from 6 to 9 years after medical school), length of IR-specific training (ranging from 1 to 3 years) and examinations required (USA and Canada have additional IR-specific examinations). The level of competition is generally high, in all countries. CONCLUSIONS: With the demand for IR services set to increase over the next few years, it is crucial that more IR specialists are trained to meet this demand. Awareness of training structures in other countries can highlight opportunity and pitfalls, and help ensure the number of highly trained interventional radiologists in the UK continues to grow.

Educação de Pós-Graduação em Medicina/tendências , Radiologia Intervencionista/educação , Austrália , Canadá , Escolha da Profissão , Avaliação Educacional , Humanos , Nova Zelândia , Reino Unido , Estados Unidos
Curr Opin Ophthalmol ; 31(1): 74-79, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31770166


PURPOSE OF REVIEW: To review various techniques of manual small incision cataract surgery (MSICS), updates on training residents and fellows, and cost-effectiveness of the surgery. RECENT FINDINGS: Recent population studies estimate that there are 53 million people blind worldwide from cataracts, up from previous figures. This is in part because of population growth and increased life expectancy worldwide. MSICS continues to play a significant role in addressing cataract burden and there is an increasing need to train surgeons in the technique. In response to this need, several modules and rubrics have been developed to assist in the training process. SUMMARY: MSICS has been refined over recent decades with overall outcomes comparable to phacoemulsification (phaco) in certain settings. MSICS cost and efficiency advantages support its ongoing essential role in addressing global cataract blindness.

Extração de Catarata/métodos , Microcirurgia/métodos , Extração de Catarata/economia , Extração de Catarata/educação , Análise Custo-Benefício , Educação de Pós-Graduação em Medicina , Humanos , Internato e Residência , Microcirurgia/economia , Microcirurgia/educação , Ferida Cirúrgica
Bone Joint J ; 101-B(12): 1585-1592, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31786991


AIMS: Arthroplasty skills need to be acquired safely during training, yet operative experience is increasingly hard to acquire by trainees. Virtual reality (VR) training using headsets and motion-tracked controllers can simulate complex open procedures in a fully immersive operating theatre. The present study aimed to determine if trainees trained using VR perform better than those using conventional preparation for performing total hip arthroplasty (THA). PATIENTS AND METHODS: A total of 24 surgical trainees (seven female, 17 male; mean age 29 years (28 to 31)) volunteered to participate in this observer-blinded 1:1 randomized controlled trial. They had no prior experience of anterior approach THA. Of these 24 trainees, 12 completed a six-week VR training programme in a simulation laboratory, while the other 12 received only conventional preparatory materials for learning THA. All trainees then performed a cadaveric THA, assessed independently by two hip surgeons. The primary outcome was technical and non-technical surgical performance measured by a THA-specific procedure-based assessment (PBA). Secondary outcomes were step completion measured by a task-specific checklist, error in acetabular component orientation, and procedure duration. RESULTS: VR-trained surgeons performed at a higher level than controls, with a median PBA of Level 3a (procedure performed with minimal guidance or intervention) versus Level 2a (guidance required for most/all of the procedure or part performed). VR-trained surgeons completed 33% more key steps than controls (mean 22 (sd 3) vs 12 (sd 3)), were 12° more accurate in component orientation (mean error 4° (sd 6°) vs 16° (sd 17°)), and were 18% faster (mean 42 minutes (sd 7) vs 51 minutes (sd 9)). CONCLUSION: Procedural knowledge and psychomotor skills for THA learned in VR were transferred to cadaveric performance. Basic preparatory materials had limited value for trainees learning a new technique. VR training advanced trainees further up the learning curve, enabling highly precise component orientation and more efficient surgery. VR could augment traditional surgical training to improve how surgeons learn complex open procedures. Cite this article: Bone Joint J 2019;101-B:1585-1592.

Artroplastia de Quadril/educação , Educação de Pós-Graduação em Medicina/métodos , Ortopedia/educação , Treinamento por Simulação/métodos , Realidade Virtual , Adulto , Competência Clínica , Feminino , Seguimentos , Humanos , Curva de Aprendizado , Londres , Masculino , Desempenho Psicomotor , Método Simples-Cego
Medicine (Baltimore) ; 98(49): e18201, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804343


BACKGROUND: Leadership and teamwork are important contributory factors in determining cardiac resuscitation performance and clinical outcome. We aimed to determine whether fixed positioning of the resuscitation team leader (RTL) relative to the patient influences leadership qualities during cardiac resuscitation using simulation. METHODS: A cross-sectional randomized intervention study over 12 months' duration was conducted in university hospital simulation lab. ACLS-certified medical doctors were assigned to run 2 standardized simulated resuscitation code as RTL from a head-end position (HEP) and leg-end position (LEP). They were evaluated on leadership qualities including situational attentiveness (SA), errors detection (ED), and decision making (DM) using a standardized validated resuscitation-code-checklist (RCC). Performance was assessed live by 2 independent raters and was simultaneously recorded. RTL self-perceived performance was compared to measured performance. RESULTS: Thirty-four participants completed the study. Mean marks for SA were 3.74 (SD ±â€Š0.96) at HEP and 3.54 (SD ±â€Š0.92) at LEP, P = .48. Mean marks for ED were 2.43 (SD ±â€Š1.24) at HEP and 2.21 (SD ±â€Š1.14) at LEP, P = .40. Mean marks for DM were 4.53 (SD ±â€Š0.98) at HEP and 4.47 (SD ±â€Š0.73) at LEP, P = .70. The mean total marks were 10.69 (SD ±â€Š1.82) versus 10.22 (SD ±â€Š1.93) at HEP and LEP respectively, P = .29 which shows no significance difference in all parameters. Twenty-four participants (71%) preferred LEP for the following reasons, better visualization (75% of participants); more room for movement (12.5% of participants); and better communication (12.5% of participants). RTL's perceived performance did not correlate with actual performance CONCLUSION:: The physical position either HEP or LEP appears to have no influence on performance of RTL in simulated cardiac resuscitation. RTL should be aware of the advantages and limitations of each position.

Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/normas , Liderança , Equipe de Assistência ao Paciente/normas , Postura , Melhoria de Qualidade , Adulto , Lista de Checagem , Estudos Transversais , Tomada de Decisões , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Malásia , Masculino , Projetos Piloto , Treinamento por Simulação , Inquéritos e Questionários , Gravação em Vídeo
Rev. méd. Urug ; 35(4): 298-301, dic. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1026158


La formación de cirujanos generales es responsabilidad de las clínicas quirúrgicas de la Facultad de Medicina. Su programa de formación de tres años presentaba carencias en cuanto al volumen y complejidad de la cirugía que cada residente realizaba. Objetivo: presentar los resultados de la producción quirúrgica de los residentes de Cirugía General luego de la implementación del cuarto año curricular del posgrado en la Clínica Quirúrgica 3 del Hospital Maciel y compararlos con los del período previo cuya duración era de tres años. Material y método: estudio observacional, descriptivo y retrospectivo de la producción quirúrgica de los residentes de la Clínica Quirúrgica 3 que cursaron en el período 2011-2015. Las variables consideradas fueron: número total de cirugías realizadas por todos los residentes, promedio de cirugías totales y por año por residente, número máximo y mínimo de cirugías realizadas por un residente, porcentaje total de cirugías de coordinación y urgencia, y promedio de cirugías por residente de acuerdo a la categorización en altas, mayores, corrientes y menores. Los datos se extrajeron del sistema de descripciones operatorias de la Administración de los Servicios de Salud del Estado, Hospital Maciel. Conclusiones: el incremento de un año en la duración de la residencia de Cirugía General determinó un aumento en el número y complejidad de la cirugía realizada por los residentes en la Clínica Quirúrgica 3 del Hospital Maciel, así como un incremento de las cirugías de coordinación en relación con las de urgencia y emergencia.

The general surgeons training program is under the responsibility of the Surgical Clinics of the School of Medicine. The 3-year training program evidenced deficiencies in terms of the volume and complexity of the surgeries carried out by the different residents. Objective: to present the surgical outcome of the General Surgery residents after the implementation of the fourth year in the curriculum of graduate studies of the Surgical Clinic 3 at Maciel Hospital and to compare it to that of the residents trained in the previous 3-year studies plan. Method: observational, descriptive and retrospective study of the surgical outcome of residents of the Surgical Clinic 3 who studied in the 2011-2015 period. Below follow the variables considered: total number of surgeries carried out by all residents, average number of surgeries per year and per resident, maximum and minimum number of surgeries by a resident, total percentage of coordination and urgent surgeries and average number of surgeries by resident according to the classification into high complexity, complex, regular and minor. Data were taken from the ASSE surgery description system - Maciel Hospital. Conclusions: increasing one year the duration of the general surgery residence resulted in a higher number and complexity of surgeries carried out by the residents of Surgical Clinic 3 at Maciel Hospital, as well as an increase in the coordination surgeries when compared to urgency and emergency surgeries.

A formação de cirurgiões gerais é responsabilidade das Clínicas Quirúrgicas da Facultad de Medicina. O programa de formação de 3 anos apresentava carências tanto em relação ao volume como também à complexidade da cirurgia que cada residente realizava. Objetivo: apresentar os resultados da produção cirúrgica dos Residentes de Cirurgia Geral depois da implementação do quarto ano curricular da pós-graduação na Clínica Quirúrgica 3 do Hospital Maciel e compará-los com os do período prévio cuja duração era de 3 anos. Material e método: estudo observacional, descritivo e retrospectivo da produção cirúrgica dos Residentes da Clínica Quirúrgica 3 que cursaram no período 2011 ­ 2015. As variáveis estudadas foram: número total de cirurgias realizadas por todos os residentes, média de cirurgias totais e por ano por residente, número máximo e mínimo de cirurgias realizadas por residente, porcentagem total de cirurgias eletivas e de urgência e média de cirurgias por residente segundo a classificação como de grande, meio e pequeno porte e corrente. Os dados foram obtidos do sistema de descrições operatórias de ASSE - Hospital Maciel. Conclusões: o incremento de um ano na duração da residência de cirurgia geral levou a um aumento no número e na complexidade das cirurgias realizadas pelos residentes na Clínica Quirúrgica 3 del Hospital Maciel, bem como uma aumento das cirurgias eletivas em relação às de urgência e emergência.

Cirurgia Geral/educação , Educação de Pós-Graduação em Medicina , Educação Médica , Internato e Residência
Rev Assoc Med Bras (1992) ; 65(10): 1241-1248, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31721955


OBJECTIVES: To investigate how many Brazilian medical and physical therapy schools have initiatives and courses related to IPE in their curricula, assessing the barriers and factors associated with their implementation and comparing the differences between both programs. METHODS: This nationwide survey was carried out in 2017 and included representatives of all physical therapy and medical schools in Brasil. Offers of interprofessional activities and related opinions and barriers were evaluated. RESULTS: A total of 76 (33.9%) of the medical and 159 (41.4%) of the physical therapy schools answered the questionnaires. At least 68.4% of the medical schools and 79.2% of the physical therapy schools have IPE initiatives, although the number of mandatory courses and clerkships is still low. Despite recognizing IPE's importance in health education, school representatives see the lack of integration of programs, conflicting schedules, and the lack of institutional support as barriers. In physical therapy, there is a smaller perception of barriers and greater incorporation of mandatory programs in the curriculum. CONCLUSION: These results will help in the development of future interventions that can enhance IPE in curricula in developing countries.

Educação de Pós-Graduação em Medicina/métodos , Relações Interprofissionais , Faculdades de Medicina/estatística & dados numéricos , Brasil , Comportamento Cooperativo , Currículo , Humanos , Medicina , Modalidades de Fisioterapia , Inquéritos e Questionários