Residents' readiness for out-of-hours service: a Dutch national survey.

BACKGROUND: Residents play a crucial role in out-of-hours service. Their perceived readiness for out-of-hours service, however, remains underexposed. This national exploratory study assesses whether or not Dutch residents feel sufficiently prepared to provide out-of-hours service at the time of their first shift, and aims to identify factors influencing perceived readiness. METHODS: An online questionnaire focussing on residents' working conditions was accessible from 21 September to 10 November 2015. Questions targeting perceived readiness for out-of-hours service were presented to all responding medical residents actively involved in out-of-hours service. Residents who felt sufficiently prepared were compared with residents who did not, exploring both individual characteristics and environmental factors. RESULTS: A total of 960 residents (mean age 32.5 years ±; 3.5, 72.4% female) from over 30 different medical specialties were included. Thirty-six percent of responding residents felt insufficiently prepared to provide out-of-hours service at the time of their first shift. Current junior status (p = 0.020), prolonged clinical experience prior to the first shift (p < 0.001), targeted training (p < 0.001), assessment of relevant skills and competencies (p < 0.001), and formal consequences following negative assessment (p = 0.001) were positively associated with perceived readiness. CONCLUSION: One-third of responding residents felt insufficiently prepared for their first out-of-hours shift. Our results emphasise the need for sufficient time to gain clinical experience as a new graduate, and underline the positive contribution of targeted training and assessment of skills and competencies relevant to out-of-hours service.

Psoas hitch ureteral reimplantation after surgery for locally advanced and locally recurrent colorectal cancer: Complications and oncological outcome.

INTRODUCTION: The most important prognostic factor for oncological outcome of rectal cancer is radical surgical resection. In patients with locally advanced T4 rectal cancer (LARC) or locally recurrent rectal cancer (LRRC) (partial) resection of the urinary tract is frequently required to achieve radical resection. The psoas bladder hitch (PBH) technique is the first choice for reconstruction of the ureter after partial resection and this bladder-preserving technique should not influence the oncological outcome. METHODS: Demographic and clinical data were collected prospectively for all patients operated on for LARC or LRRC between 1996 and 2014 who also underwent a psoas hitch ureter reconstruction. Urological complications and oncological outcome were assessed. RESULTS: The sample comprised 70 patients, 30 with LARC and 40 with LRRC. The mean age was 62 years (range: 39-86). Postoperative complications occurred in 38.6% of patients, the most frequent were urinary leakage (22.9%), ureteral stricture with hydronephrosis (8.6%) and urosepsis (4.3%). Surgical re-intervention was required in 4 cases (5.7%), resulting in permanent loss of bladder function and construction of a ureter-ileo-cutaneostomy in 3 cases (4.3%). Oncological outcome was not influenced by postoperative complications. CONCLUSION: The rate of complications associated with the PBH procedure was higher in our sample than in previous samples with benign conditions, but most complications were temporary and did not require surgical intervention. We conclude that the bladder-sparing PBH technique of ureter reconstruction is feasible in locally advanced and recurrent rectal cancer with invasion of the urinary tract after pelvic radiotherapy.