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Junior Doctors (junior + doctor)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Medical Professional Development	36%
Nursing General	20%
Surgery & Surgical Specialties	16%
Obstetrics & Gynecology	10%
4 Other Subdomains	18%

Selected Abstracts

CLINICAL ANATOMY: APPLIED ANATOMY FOR STUDENTS AND JUNIOR DOCTORS.

ANZ JOURNAL OF SURGERY, Issue 10 2007
11th EDITION - BY HAROLD ELLIS
No abstract is available for this article. [source]

The capacity of Australian ED to absorb the projected increase in intern numbers

EMERGENCY MEDICINE AUSTRALASIA, Issue 2 2010
Anthony Chong
Abstract As a reaction to the medical workforce shortage in Australia, a large expansion of undergraduate medical education has occurred through the provision of funding of additional medical student places. As a consequence, the number of medical graduates is anticipated to increase by as much as 90% with a peak in numbers anticipated in 2012. With ED already under pressure, this increase has serious implications for ED, particularly the delivery of intern and student teaching. This integrated review describes potential challenges that might arise from the predicted increase in intern numbers working in ED. A structured literature search was conducted from which 44 directly relevant articles were identified. We discuss the possible impact of an increased number of medical graduates on emergency medical staff, education, supervision and feedback to interns, and given the potential impacts on the education of junior doctors; we review the purpose and implementation of the Australian Curriculum framework for Junior Doctors in relation to their learning requirements. Although there is consensus by most postgraduate bodies that the core emergency term in emergency medicine should be retained, the impact of increased intern numbers might dramatically affect the clinical experiences, supervision and educational resources in the ED. This might necessitate cultural changes in medical education and ED function. [source]

A literature review: factors that impact on nurses' effective use of the Medical Emergency Team (MET)

JOURNAL OF CLINICAL NURSING, Issue 24 2009
Lisa Jones
Aims and objectives., The aim of this literature review is to identify factors, both positive and negative, that impact on nurses' effective use of the Medical Emergency Team (MET) in acute care settings. Background., Outcomes for patients are often dependent on nurses' ability to identify and respond to signs of increasing illness and initiate medical intervention. In an attempt to improve patient outcomes, many acute hospitals have implemented a rapid response system known as the Medical Emergency Team (MET) which has improved management of critically ill ward patients. Subsequent research has indicated that the MET system continues to be underused by nurses. Design., A comprehensive thematic literature review. Methods., The review was undertaken using key words and the electronic databases of Cumulative Index to Nursing and Allied Health Literature (CINAHL), OVID/MEDLINE, Blackwell Synergy, Science Direct and Informit. Fifteen primary research reports were relevant and included in the review. Results., Five major themes emerged from the analysis of the literature as the major factors effecting nurses' use of the MET system. They were: education on the MET, expertise, support by medical and nursing staff, nurses' familiarity with and advocacy for the patient and nurses' workload. Conclusions., Ongoing education on all aspects of the MET system is recommended for nursing, medical and MET staff. Bringing MET education into undergraduate programs to prepare new graduates entering the workforce to care for acutely ill patients is also strongly recommended. Further research is also needed to determine other influences on MET activation. Relevance to clinical practice., Strategies that will assist nurses to use the MET system more effectively include recruitment and retention of adequate numbers of permanent skilled staff thereby increasing familiarity with and advocacy for the patient. Junior doctors and nurses should be encouraged to attend ward MET calls to gain skills in management of acutely ill patients. [source]

General competencies of problem-based learning (PBL) and non-PBL graduates

MEDICAL EDUCATION, Issue 4 2005
Katinka J A H Prince
Introduction, Junior doctors have reported shortcomings in their general competencies, such as organisational skills and teamwork. We explored graduates' perceptions of how well their training had prepared them for medical practice and in general competencies in particular. We compared the opinions of graduates from problem-based learning (PBL) and non-PBL schools, because PBL is supposed to enhance general competencies. Method, We analysed the responses of 1159 graduates from 1 PBL and 4 non-PBL schools to a questionnaire survey administered 18 months after graduation. Results, Compared with their non-PBL colleagues, the PBL graduates gave higher ratings for the connection between school and work, their medical training and preparation for practice. According to the graduates, the most frequently used competencies with sufficient coverage during medical training were expert knowledge, profession-specific skills and communication skills. The majority of the PBL graduates, but less than half of the non-PBL graduates, indicated that communication skills had been covered sufficiently. All the graduates called for more curriculum attention on working with computers, planning and organisation, and leadership skills. More PBL graduates than non-PBL graduates indicated that they had learned profession-specific methods, communication skills and teamwork in medical school. Discussion, Overall, the graduates appeared to be satisfied with their knowledge and skills. The results suggest that the PBL school provided better preparation with respect to several of the competencies. However, both PBL and non-PBL graduates identified deficits in their general competencies, such as working with computers and planning and organising work. These competencies should feature more prominently in undergraduate medical education. [source]

Use of Bakri balloon in post-partum haemorrhage: A series of 15 cases

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2009
Srisailesh VITTHALA
Background: Post-partum haemorrhage (PPH) is a major complication of delivery. Hysterectomy is commonly performed when medical treatment of PPH fails. We assessed the effectiveness of Bakri balloon tamponade, a non-surgical technique in the management of PPH. Aim(s): Our objective is to report our experience in the use of Bakri balloon in treating PPH. Method: A retrospective study of 15 patients who underwent Bakri balloon insertion after unsuccessful medical management of PPH. Results: Fifteen cases of PPH were managed with Bakri balloon insertion. It was effective in all cases of PPH after vaginal delivery and in four cases of caesarean section; the overall effectiveness was 80%. Conclusion: Insertion of Bakri balloon is a simple alternative procedure in the management of PPH. It should be consider before any further surgical intervention including hysterectomy. Junior doctors and midwives can effectively apply it. It can be used during transfer or while waiting for a surgical procedure to reduce blood loss. [source]

Educating European (Junior) Doctors for Safe Prescribing

BASIC AND CLINICAL PHARMACOLOGY & TOXICOLOGY, Issue 6 2007
Simon R. J. Maxwell
Junior doctors who have recently graduated are responsible for much of the prescribing that takes place in hospitals and are implicated in many of the adverse medication events. Analysis of such events suggests that lack of knowledge and training underlies many of them and it has been shown that dedicated training can increase prescribing performance. In the context of these problems, it is a matter of increasing concern that recent changes to undergraduate medical education may have reduced exposure to clinical pharmacology, a discipline dedicated to optimal practice in relation to medicines. For this reason, the European Association of Clinical Pharmacology and Therapeutics (EACPT) and British Pharmacological Society (BPS) jointly organized a meeting to explore (i) the state of undergraduate education in clinical pharmacology in Europe, (ii) the knowledge and competencies in relation to medicines that should be expected of a new graduate, (iii) assessments that might demonstrate that this minimum standard had been reached, (iv) a curriculum that might help medical students to achieve this standard and (v) how competence can be developed in the postgraduate phase. It was agreed that the lack of exposure to clinical pharmacology is a cause for concern at a time when the challenges facing junior prescribers have never been greater. The potential for undertaking further research was discussed. [source]

Effects of gynaecological education on interpersonal communication skills

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2001
A.M. van Dulmen
Objective To investigate the effects of an experimental communication course on how gynaecologists handle psychosocial issues in gynaecological consultation. Design Pre-post testing. Multilevel analysis was used to take into account the similarity among encounters with the same gynaecologist. Sample Eighteen gynaecologists (13 consultants and 5 junior doctors) from five different hospitals participated. All gynaecologists videotaped consecutive outpatient encounters before and after attending an intensive training course. Main outcome measures The communicative performance of the gynaecologists at pre-and post measurement. Results The gynaecologists recorded a total of 526 outpatient encounters, 272 before and 254 after the training. As a result of the training, gynaecologists' sensitivity to psychosocial aspects of their patients increased. At post measurement, the gynaecologists gave more signs of agreement, became less directive, asked fewer medical questions and more psychosocial questions. No difference was found in the duration of the outpatient visits. With the trained gynaecologists, patients asked more questions and provided more psychosocial information. Conclusions Junior doctors and clinically experienced gynaecologists can be taught to handle psychosocial issues without lengthening the visit. [source]

Variations in the evaluation of colorectal cancer risk

COLORECTAL DISEASE, Issue 3 2005
R. J. Hodder
Abstract Objectives, To test the variability in estimating cancer risk and demonstrate the consequences that subjectivity has on patient care. Subjects and methods, Forty-three clinicians were each asked to assess 40 symptomatic colorectal referrals. Each clinician was provided with a comprehensive history on the 40 patients. The clinicians graded the referral according to a malignancy risk score, decided on the required first line investigation and the priority of that investigation. The main outcome measures used was accuracy in cancer detection and appropriateness of investigations selected. Results, There was a wide degree of variation among all clinicians grading both benign and malignant disease with the overall correct classification of 54% (P -value of <0.001). On average, the clinicians correctly diagnosed 71.3% of the cancer patients as compared to 44% of the benign patients. Of the cancer patients, 47% were correctly classified as an urgent referral whilst 52% of the benign patients were over classified and graded as an urgent referral. The mean number chosen by clinicians to have a flexible sigmoidoscopy as the appropriate first investigation was 13 (of 40 patients); this was despite the diagnosis being possible in all cases with a flexible sigmoidoscopy. The choice to use full colonic investigation was seen throughout all disciplines. Junior doctors demonstrated the highest tendency choosing full colonic investigation in 92.3%. Consultants and senior grades showed the least tendency to choose full colonic imaging although even here colonoscopy or barium enema represented 48.5%. Conclusion, Subjective assessment of cancer referrals is a significant problem that needs to be confronted. Improvements are needed to resolve the inherent problems of subjectivity and operator bias if uniform quality of patient care and best use of resources is to be achieved. [source]

Junior doctors' working hours: Perspectives on the reforms

INTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 3 2008
Carol Wilkinson MSc BA(Hons) RGN Teacher's Cert Fellow Higher Education AcademyArticle first published online: 5 MAY 200
The European Working Time Directive for junior doctors came into force in Britain in August 2004. The reforms themselves have been a long time in development and implementation since the inception and debates regarding the New Deal, to the current formations under health and safety legislation. This study, undertaken within a hospital trust setting in England, provides an insight into the perspectives of doctors, nurses and human resources managers in relation to the European Working Time Directive. Critical consideration is given to the impact of the reforms upon the National Health Service and more specifically to daily working relationships at the point of implementation. The results demonstrate some ambivalence towards the reforms because of the major shift in culture for the professions per se, but also for the future of health-care delivery where there are considerable tensions. [source]

An evaluation of pharmacist-written hospital discharge prescriptions on general surgical wards

INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 3 2005
Mohamed H. Rahman Principal pharmacist, surgical services
Objective To evaluate the quality of pharmacist-written hospital discharge prescriptions (DPs) in comparison to those written by doctors. Method The study was carried out in two, week-long phases on the general surgical wards in one UK hospital. In phase 1, doctors wrote the DPs, which were then checked by the ward pharmacist. In phase 2, ward pharmacists wrote the DPs which were then checked by the patient's junior doctor. In both phases, the clinical dispensary pharmacist made their routine check of the prescription prior to dispensing. All interventions were recorded on a pre-piloted data collection form. Key findings In phase 1, doctors wrote 128 DPs; in phase 2, pharmacists wrote 133 DPs. There were 755 interventions recorded during phase 1 in comparison to 76 during phase 2. In phase 1, transcription errors accounted for 118 interventions, 149 were due to ambiguity/illegibility; 488 amendments were to facilitate the dispensing process e.g. clarification of patient, medical and drug details, and dosage form discrepancies. In phase 2, transcription errors accounted for one intervention, 50 interventions were due to ambiguities or illegibility; 25 amendments were to facilitate the dispensing process. During phase 2, doctors made 10 minor alterations to pharmacist-written DPs. On 52 occasions during phase 2, the ward pharmacist had to clarify, prior to writing the DP, either the dose of a drug, or, whether a drug should be continued on discharge, and if so, for what duration. Conclusion Pharmacist-written DPs contained considerably fewer errors, omissions and unclear information in comparison to doctor-written DPs. Doctors recorded no significant alterations when validating pharmacist-written DPs. [source]

A pre-employment programme for overseas-trained doctors entering the Australian workforce, 1997,99

MEDICAL EDUCATION, Issue 7 2002
Elizabeth A Sullivan
Objectives Overseas-trained doctors (OTDs) have limited access and formal interaction with the Australian health care system prior to joining the Australian medical workforce. A pre-employment programme was designed to familiarize OTDs with the Australian health care system. Method All OTDs who had passed their Australian Medical Council (AMC) exams and were applying for a pre-registration year in New South Wales were invited to participate in the voluntary, free programme. A 4-week full-time programme was developed consisting of core group teaching and a hospital attachment. The curriculum included communication, health and workplace skills; and sessions on culture shock and the role of junior doctors. A pilot programme was run in 1997. The programme was repeated in 1998 and 1999. The OTDs' confidence regarding the general duties of internship, and attitudes towards hospital workplace skills were examined. Results The 66 OTDs reported greater understanding of staff and communication issues and familiarization with the hospital environment. They reported a more realistic understanding of the role of a junior doctor, the need for separation of workplace and personal responsibilities and knowledge of pathways for future professional development. The course structure, with a focus on hospital attachments, establishment of a peer network, and workplace familiarization facilitated entry into the hospital workforce. Conclusion The pre-employment programme enabled the OTDs to have a more equitable entry into the public hospital system, resulting in a more integrated, confident and functional workforce. [source]

The capacity of Australian ED to absorb the projected increase in intern numbers

The clinical effectiveness of nurse practitioners' management of minor injuries in an adult emergency department: a systematic review

INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 1 2009
Anne Wilson PhD, FRCNA
Abstract Background, The increasing cost of healthcare in Australia demands changes in the way healthcare is delivered. Nurse practitioners have been introduced into specialty areas including emergency departments. Specific interventions are known to include the treatment and management of minor injuries, but little has been reported on their work. Objectives, Examine the best available evidence to determine the clinical effectiveness of emergency department nurse practitioners in the assessment, treatment and management of minor injuries in adults. Inclusion criteria, For inclusion studies had to include adult patients treated for minor injuries by nurse practitioners in emergency departments. All study designs were included. Search strategy, English language articles from 1986 onwards were sought using MEDLINE, CINAHL, Embase and Science Citation Index. Methodological quality, Two independent reviewers critically appraised the quality of the studies and extracted data using standardised tools. Data collection, Two independent reviewers assessed the eligibility of each study for inclusion into the review and the study design used. Where any disagreement occurred, consensus was reached by discussion with an independent researcher. Data synthesis, Studies were assessed for homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format; otherwise a meta-analysis was conducted. For each outcome measure, results were tabulated by intervention type and discussed in a narrative summary. Results from randomised controlled trials were pooled in meta-analyses where appropriate. Results, Nine studies from a total of 55 participants met the inclusion criteria. Two were randomised controlled trials. Metasynthesis of research findings generated five synthesised findings derived from 16 study findings aggregated into seven categories. Evidence comparing the clinical effectiveness of nurse practitioners to mainstream management of minor injuries was fair to poor methodological quality. When comparable data were pooled, there were no significant differences (P < 0.05) between nurse practitioners and junior doctors. Conclusions, The results emphasise the need for more high-quality research using appropriate outcome measures in the area of clinical effectiveness of nurse practitioners, particularly interventions that improve outcomes for presentations to emergency departments and address issues of waiting and congestion. [source]

Junior doctors' working hours: Perspectives on the reforms

Acute Pain Teams in England: current provision and their role in postoperative pain management

JOURNAL OF CLINICAL NURSING, Issue 3 2003
Ann Mcdonnell BSc
Summary ,,This survey describes the current provision of multidisciplinary Acute Pain Teams (APTs) in acute English hospitals performing adult in-patient surgery (excluding maternity). Associations between the presence of an APT and a number of organizational and clinical initiatives for the management of postoperative pain are also explored. ,,Postal questionnaires were sent to the Clinical Director of Anaesthetics or head of the APT at every acute English hospital providing separate anaesthetic services. ,,After written and telephone reminders, the response rate was 86% (n = 226). ,,Eighty-four per cent (n = 190) of respondents had an APT in their hospital. The presence of an APT was associated (P,0.05) with higher estimates of patient controlled analgesia and epidural use, regular in-service training for nurses and junior doctors, written guidelines/protocols for management of postoperative pain, routine use of postoperative pain measurement systems and audit/research in relation to postoperative pain issues. ,,Acute Pain Teams, in which nurses play a major role, have a pivotal influence not only in relation to postoperative analgesia but also in wider service development. Since 1995, the number of hospitals offering in-patient surgery that are covered by an APT has risen. However, despite repeated endorsements from professional bodies, some acute hospitals still have no APT and recent evidence indicates that some APTs face financial problems and provide a ,token' service only. Recent policy recommendations may have little impact on the current situation. [source]

Changes in practice at the nurse,doctor interface.

JOURNAL OF CLINICAL NURSING, Issue 1 2003
Using focus groups to explore the perceptions of first level nurses working in an acute care setting
Summary ,,A unique combination of factors has recently triggered a rapid change in the clinical practice of nurses in the UK. ,,This study was carried out to explore the consequences of changing practice at the nurse,doctor interface, as perceived by first level nurses working in an acute care setting in the UK. ,,Qualitative data were collected using focus group interviews and analysed thematically. ,,Findings suggest that role change to these nurses is represented by a ,shift' in the practice of technical activities from junior doctors and a corresponding delegation of nursing activity to care assistants. ,,It is suggested that the wholesale incorporation of technical interventions into the role of the nurse without an increase in the number of qualified nurses is turning nursing back to a task system of care delivery. ,,This has the potential to depersonalize patients and reduce work satisfaction for nurses. [source]

Some implications for nurses and managers of recent changes to the processing and hearing of medical negligence claims

JOURNAL OF NURSING MANAGEMENT, Issue 3 2000
DIPLAW, Fletcher BA, MPHIL
Aim This paper considers some possible implications for individual nurses and their managers of moves to delegate tasks formerly undertaken by medical practitioners to nurses, in the light of recent changes in the legal process, relating to the funding and the hearing of cases of medical negligence. Background It is suggested that the introduction of a system of conditional fees, under which lawyers will only recover their costs if they win cases, may lead to a more specialist approach to negligence claims and to greater scrutiny of medical evidence. The implications of the recent ,Bolitho' judgement, when judges for the first time subjected expert medical testimony to their own independent analysis, are also explored. Findings It is suggested that in the light of the disparities in the training of medical and nursing personnel and in their disciplinary processes, and in view of the lack of consensus about what training is necessary for those who will substitute for junior doctors, or represent themselves as ,practitioners', ,specialists', or ,consultants', that nurses may in the future find themselves more directly involved in civil proceedings. [source]

Teaching junior doctors to recognise child abuse and neglect

MEDICAL EDUCATION, Issue 11 2003
Calum Macleod
No abstract is available for this article. [source]

The transition from knowing to doing: teaching junior doctors how to use insulin in the management of diabetes mellitus

MEDICAL EDUCATION, Issue 8 2003
Jennifer J Conn
Objective To develop and evaluate a short education programme to improve the skills and confidence of junior doctors in managing the glycaemic control of inpatients with diabetes mellitus. Methods A total of 15 junior doctors completed two 1-hour workshops on the practical skills required to manage the glycaemic control of insulin-treated patients. The workshops were based on simulated case scenarios presented in a workbook format. Pre-workshop performance and levels of confidence were tested, using a set of tasks matched to the learning objectives. Participants were re-tested immediately after the second workshop and again after 3 months. Results There was a significant overall effect for time of testing for performance and confidence considered together, F(4,11) = 12.67, P = 0.000, power = 1.00. The mean score for performance for the intermediate and 3-month post-tests combined was significantly higher than the mean performance score for the pre-test (11.00 < [17.53 + 15.80]), t(56) = ,6.50, P = 0.000 (95% CI ,6.15, ,3.10). The mean score for confidence for the intermediate and 3 month post-tests combined was higher than the mean for the pre-test (13.20 < [15.33 + 15.20]), t(56) = 2.95, P = 0.011 (95% CI 2.19, 0.46), although this result must be treated with caution. Conclusions A brief educational intervention can improve and maintain the performance and confidence of junior doctors in managing patients with insulin-treated diabetes in a simulated environment. [source]

A pre-employment programme for overseas-trained doctors entering the Australian workforce, 1997,99

Cardiopulmonary resuscitation training for undergraduate medical students: a five-year study

MEDICAL EDUCATION, Issue 3 2002
Colin A Graham
Background Cardiopulmonary resuscitation (CPR) training for undergraduate medical students and junior doctors has been noted to be poor in the past. Attempts have been made over the last decade to improve CPR training for all health professionals. Aim This study aimed to determine if CPR training for undergraduate medical students in a single institution improved after initial concerns in 1992, and to observe trends in CPR training over five years. Methods Prospective single centre observational cohort survey by means of a 2-page self completed questionnaire to final year undergraduate medical students at the University of Glasgow (1993,97 inclusive). Results Mean annual response rate 58% (range 48% , 67%). 99% of responders had been trained in basic life support during undergraduate training. The use of simulated arrests for training increased significantly. CPR training was concentrated in the first and final years. Training in all aspects of advanced life support increased, as did the students' confidence in these techniques. Student satisfaction with the amount of basic life support training increased very significantly and there was a small, but significant increase in student satisfaction with advanced life support training. Overall confidence at the prospect of being a member of the resuscitation team on qualification did not increase. Conclusions There has been a sustained improvement in CPR training at this institution since 1993. Improvements in the training of specific advanced life support techniques does not lead to improved overall confidence in using these skills on qualification. Advanced life support training requires further expansion. [source]

Training the ideal hospital doctor: the specialist registrars' perspective

MEDICAL EDUCATION, Issue 10 2001
N Khera
Background When training for junior doctors is being planned, little discussion is focused on what outcomes hospitals are trying to achieve with regard to education/training, i.e. on what makes the ideal hospital doctor. Instead, the primary focus is on the requirements of the syllabi of the Royal Colleges (credentialing) and the requirements of service delivery (job description). Current literature has no qualitative studies of any longitude in which middle-grade doctors are asked about their vision of the ideal hospital doctor, what they feel can be done to help realize this vision, and how they feel about their own training. Methods This study examined data principally collected through a series of semistructured interviews conducted with eight specialist registrars (SpRs), four each from the North Trent and South Thames rotations over a period of 18 months. Additional information was taken from focus groups, interviews with programme directors, and questionnaires. Findings A model was created of the SpRs' perceptions of the key attributes of an ideal hospital doctor and of how these may be achieved in training. Eight broad areas were identified: clinical knowledge and skills; key clinically related generic/non-clinical skills; self-directed learning and medical education; implementing change management; applying strategic and organizational skills in career planning; consultation skills; research; and key personal attributes. Conclusions SpRs are articulate in expressing their own expectations of their training and have considerable insight into the components of good training. Further improvement could be made and will require significant commitment from both trainees and trainers. [source]

Modernising Morning Report: innovation in teaching and learning

THE CLINICAL TEACHER, Issue 2 2010
Kerry Layne
Summary Background:, Over recent years there has been a shift in undergraduate medical education, from predominantly passive, didactic teaching methods to facilitating learning by focusing on the management of common scenarios, through the means of problem- and case-based learning. Context:, Case-based learning and peer-led teaching are often overlooked at postgraduate level, despite the continuing demonstrated success of these methods in fostering independent reasoning and problem-solving skills that are vital for newly qualified doctors to develop. When trying to strike a balance between educational needs and service provision, it is essential to identify and implement efficient, effective approaches to optimise learning opportunities. Innovation:, We have adapted the pre-existing framework of the American ,Morning Report' to suit the needs of today's junior doctors, creating a system of providing case-based learning paired with peer-led teaching. Implications:, We evaluated the educational model through a focus group session, and found that our Morning Report was a unique environment where junior doctors feel comfortable engaging with group case-based teaching, with the support and encouragement of senior consultants, reinforced with online case summaries and blog resources. [source]

Revising the surgical registrar on-call roster

ANZ JOURNAL OF SURGERY, Issue 7-8 2010
A. Peter Wysocki
Abstract Background:, The work hours of junior doctors have been in the spotlight since the mid-1980s. Rostering and the structure of surgical units aim to balance quality and continuity of patient care with reasonable working hours. Methods:, Actual hours worked during two 12-week surgical registrar rosters were compared. Compliance of each roster with fatigue recommendations was assessed with Fatigue Audit InterDyne (FAID, InterDynamics Pty Ltd, Adelaide, Australia) software. Workload was determined from an electronic prospective surgical audit. Impact of the roster change was discussed with consultants and registrars. The traditional roster started on 16 July 2007 and the fatigue-friendly roster on 14 July 2008. Results:, The total number of hours worked reduced by 11% (from 5085.17 h in 2007 to 4530.85 h in 2008). Fatigue was eliminated (from 133.25 h in 2007 to 0 h in 2008). Over the 12-month period, the operative workload for the Department of General Surgery increased by 18%. FAID compliance improved from 67.3 to 91.2%. Consultant and registrar satisfaction with the new roster was high. Conclusions:, Safe working hours have been achieved for surgical registrars by restructuring the surgical units and implementing a new on-call rota without a perceived effect on patient care. [source]

Nurturing of surgical careers by the wellington surgical interest club

ANZ JOURNAL OF SURGERY, Issue 4 2009
Sanket Srinivasa
The Royal Australasian College of Surgeons (RACS) has recently introduced the new Surgical Education and Training programme. The purpose of this was, in part, to help address the anticipated shortage of surgeons in the future, by streamlining the surgical training programme. The formation of the Wellington Surgical Interest Club (WSIC), a student-led initiative, had several complementary goals. These included the desire to identify potential candidates for a career in surgery, promote a surgical career to students especially women, help students acquire basic surgical skills early, inform students about surgical careers, promote student involvement in surgical research and to create an effective mentorship model during undergraduate and junior surgical training. The strengths of WSIC are its goals, which are similar to those of the RACS with regard to promoting surgery as a career option; its easy reproducibility at other medical institutions; its ability to focus on issues of relevance to both students and junior doctors; and being a bridging solution at a time when early exposure to surgical specialties is both desired and necessary. [source]

IS INFORMED CONSENT IN CARDIAC SURGERY AND PERCUTANEOUS CORONARY INTERVENTION ACHIEVABLE?

ANZ JOURNAL OF SURGERY, Issue 7 2007
Marco E. Larobina
Background: Medical and legal published work regularly discusses informed consent and patient autonomy before medical interventions. Recent discussions have suggested that Cardiothoracic surgeons' risk adjusted mortality data should be published to facilitate the informed consent process. However, as to which aspects of medicine, procedures and the associated risks patients understand is unknown. It is also unclear how well the medical profession understands the concepts of informed consent and medical negligence. The aims of this study were to evaluate patients undergoing coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) to assess their understanding of the risks of interventions and baseline level of understanding of medical concepts and to evaluate the medical staff's understanding of medical negligence and informed consent. Methods: Patients undergoing CABG or PCI at a tertiary hospital were interviewed with questionnaires focusing on the consent process, the patient's understanding of CABG or PCI and associated risks and understanding of medical concepts. Medical staff were questioned on the process of obtaining consent and understanding of medicolegal concepts. Results: Fifty CABG patients, 40 PCI patients and 40 medical staff were interviewed over a 6-month period. No patient identified any of the explained risks as a reason to reconsider having CABG or PCI, but 80% of patients wanted to be informed of all risks of surgery. 80% of patients considered doctors obligated to discuss all risks of surgery. One patient (2%) expressed concern at the prospect of a trainee surgeon carrying out the operation. Stroke (40%) rather than mortality (10%) were the important concerns in patients undergoing CABG and PCI. The purpose of interventions was only partially understood by both groups; PCI patients clearly underestimated the subsequent need for repeat PCI or CABG. Knowledge of medical concepts was poor in both groups: less than 50% of patients understood the cause or consequence of an AMI or stroke and less than 20% of patients correctly identified the ratio equal to 0.5%. One doctor (2.5%) correctly identified the four elements of negligence, eight (20%) the meaning of material risk and four (10%) the meaning of causation. Thirty doctors (75%) believed that all complications of a procedure needed to be explained for informed consent. Less than 10% could recognize landmark legal cases. Conclusion: Patients undergoing both CABG and PCI have a poor understanding of their disease, their intervention, and its complications making the attaining of true informed consent difficult, despite their desire to be informed of all risks. PCI patients particularly were highly optimistic regarding the need for reintervention over time, which requires specific attention during the consent process. Medical staff showed a poor knowledge of the concepts of material risk and medical negligence requiring much improved education of both junior doctors and specialists. [source]

Effects of gynaecological education on interpersonal communication skills

Impact of UK academic foundation programmes on aspirations to pursue a career in academia

MEDICAL EDUCATION, Issue 10 2010
Oliver T A Lyons
Medical Education 2010: 44: 996,1005 Objectives, This study aimed to determine the role played by academic foundation programmes in influencing junior doctors' desire to pursue a career in academic medicine. Methods, We conducted an online questionnaire-based study of doctors who were enrolled on or had completed academic foundation programmes in the UK. There were 92 respondents (44 men, 48 women). Of these, 32 (35%) possessed a higher degree and 73 (79%) had undertaken a 4-month academic placement during Foundation Year 2. Outcomes were measured using Likert scale-based ordinal response data. Results, From a cohort of 115 academic foundation trainees directly contacted, 46 replies were obtained (40% response rate). A further 46 responses were obtained via indirect notification through local programme directors. From the combined responses, the majority (77%) wished to pursue a career in academia at the end of the academic Foundation Year (acFY) programme. Feeling well informed about academic careers (odds ratio [OR] 16.9, p = 0.005) and possessing a higher degree (OR 31.1, p = 0.013) were independently associated with an increased desire to continue in academia. Concern about reduced clinical experience whilst in academic training dissuaded from continuing in academia (OR 0.15, p = 0.026). Many respondents expressed concerns about autonomy, the organisation of the programme and the quantity and quality of academic teaching received. However, choice of work carried out during the academic block was the only variable independently associated with increasing the desire of respondents to pursue a career in academia following their experiences in the acFY programme (OR 6.3, p = 0.007). Conclusions, The results support the provision of well-organised academic training programmes that assist junior clinical academics in achieving clinical competencies whilst providing protected academic time, information about further academic training pathways and autonomy in their choice of academic work. [source]