scholarly journals 40 Across the Pond: Why Are Junior Doctors Seeking Surgical Training Abroad?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Irfan ◽  
I Ahmed
Keyword(s):  
Surgical Training ◽  
Training Programme ◽  
Junior Doctors ◽  
Common Time ◽  
Surgical Trainees ◽  
Surgical Workforce ◽  
The Us ◽  
To Receive ◽  
Career Uncertainty

Abstract Introduction The loss of junior doctors from the NHS has been an ongoing issue. A subset are now seeking surgical training in other systems, such as the US. This is a costly and difficult process and many enter into undesignated positions with no guarantee of a job. With so much career uncertainty, why are trainees willing to take the risk? Method We performed a survey of trainees who graduated from British medical schools; all are currently enrolled in a US surgical training programme. They were asked about their experiences and perceptions of Results Nine trainees completed the survey. The most common time for trainees to move was during or after foundation training and the majority initially matched into preliminary positions. The most common reason cited to move was to receive better quality training. Many perceived the US training to be better and felt that they had a reasonable work-life balance. Conclusions The potential loss of the future NHS surgical workforce is worrying. Our survey highlights that surgical trainees place a high value on the quality of their training and were willing to enter an intense and uncertain process to achieve it. This needs to be addressed to retain potential trainees.

Development and implementation of a structured leadership programme for junior doctors

BMJ Leader ◽  
2020 ◽  
pp. leader-2020-000281
Author(s):  
Anum Pervez ◽  
Aaisha Saqib ◽  
Sarah Hare
Keyword(s):  
Leadership Skills ◽  
District General Hospital ◽  
Training Programme ◽  
Junior Doctors ◽  
Leadership Roles ◽  
Self Assessment ◽  
Leadership And Management ◽  
Business Cases ◽  
Do So

IntroductionHealthcare performance and quality of care have been shown to improve when clinicians actively participate in leadership roles. However, the training for junior doctors in leadership and management is either not formally provided or requires out of programme training. In this article, we discuss how we devised a leadership training programme for junior doctors at our district general hospital and reflections on how it can be implemented elsewhere.MethodsA junior doctors leadership programme was developed involving workshops and guidance through delivery of quality improvement projects. A precourse and postcourse questionnaire assessing preparedness to lead was given to trainees to assess the effectiveness of the course.ResultsUsing a Likert Scale, trainees provided quantitative self-assessment for precourse and postcourse changes in their leadership skills. There was an overall increase in confidence across key areas such as communication, preparing business cases and understating hierarchies of management teams.DiscussionThe structure of this leadership programme has provided the opportunity to address gaps in leadership skills that trainees encounter, without the need to extend training. This programme is easily reproducible and offers other trusts a guide on how to do so.

scholarly journals Incomplete Early Childhood Immunization Series and Missing Fourth DTaP Immunizations; Missed Opportunities or Missed Visits?

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Steve G. Robison
Keyword(s):  
Early Childhood ◽  
Early Care ◽  
Childhood Immunization ◽  
Missed Opportunities ◽  
Childhood Immunizations ◽  
The Us ◽  
Oregon Health Plan ◽  
Missed Visits ◽  
To Receive

The successful completion of early childhood immunizations is a proxy for overall quality of early care. Immunization statuses are usually assessed by up-to-date (UTD) rates covering combined series of different immunizations. However, series UTD rates often only bear on which single immunization is missing, rather than the success of all immunizations. In the US, most series UTD rates are limited by missing fourth DTaP-containing immunizations (diphtheria/tetanus/pertussis) due at 15 to 18 months of age. Missing 4th DTaP immunizations are associated either with a lack of visits at 15 to 18 months of age, or to visits without immunizations. Typical immunization data however cannot distinguish between these two reasons. This study compared immunization records from the Oregon ALERT IIS with medical encounter records for two-year olds in the Oregon Health Plan. Among those with 3 valid DTaPs by 9 months of age, 31.6% failed to receive a timely 4th DTaP; of those without a 4th DTaP, 42.1% did not have any provider visits from 15 through 18 months of age, while 57.9% had at least one provider visit. Those with a 4th DTaP averaged 2.45 encounters, while those with encounters but without 4th DTaPs averaged 2.23 encounters.

Aseptic Ingredient Addition: Meeting the Demand for Better-Tasting Orange Juice

2006 ◽  
Author(s):  
Paul P. Brocker
Keyword(s):  
Orange Juice ◽  
Juice Quality ◽  
Storage Tanks ◽  
Bulk Storage ◽  
Naturally Occurring ◽  
The Us ◽  
Enhancement Method ◽  
Market Perception ◽  
To Receive

Since the late 1970’s, Aseptic Not-From-Concentrate Orange Juice (NFCOJ) has been successfully stored in large refrigerated aseptic storage tanks. Aseptic tanks have evolved from 280,000 gallons in volume to now in excess of 1.8 million gallons each. The total bulk storage capacity in Florida has grown to approximately 280 millions of gallons and continues to grow with new installations occurring each year at some facilities. Worldwide, the market is expanding into Brazil, Spain, and markets that are beginning to receive juice shipped in bulk on snips. The aseptic storage methods have been accepted in Brazil and Europe, and aseptic transfer of the juice is occurring via specially outfitted aseptic tanker vessels from Brazil to the US and Europe. The consumer’s demand for NFCOJ has grown steadily throughout these years, and the suppliers of consumer packaged orange juice have developed special processes and methods to maximize the quality and flavor of the juices sent to the market. Fresh juice, light pasteurization, and flavor enhanced products are just some of these methods resulting in very high quality juice availability. Also, cost and price are always under assault, and the juice suppliers are always looking for an edge. Recently, the flavor enhancement method has come under scrutiny by the FDA, and the industry is being reminded that all added flavors must be made from naturally occurring orange derivatives or must be labeled appropriately: such as “with natural (other fruit) flavors” or “with artificial flavors,” both of which may have an undesirable impact on the market perception of the juice quality. At this same time, as the bulk storage technology of NFCOJ has matured in the past 25 years, some processors who package their own juice are investing in special aseptic transfer methods from the aseptic bulk storage tanks without the need to re-pasteurize the juice prior to packaging. Their goal is to provide the highest quality juice to the consumer, and to minimize or eliminate the need to add expensive and special flavor packs to the juice. This is being done commercially in Florida and Spain. This paper explores these methods of aseptic juice transfer direct to packaging and the aseptic addition of natural or otherwise desired and labeled ingredients, and their potential impact on the quality of the juice. Paper published with permission.

Oxford Handbook of Oral and Maxillofacial Surgery

2018 ◽  
Author(s):  
Luke Cascarini ◽  
Clare Schilling ◽  
Ben Gurney ◽  
Peter Brennan
Keyword(s):  
Maxillofacial Surgery ◽  
Dental Materials ◽  
Training Programme ◽  
Dental Students ◽  
Oral And Maxillofacial Surgery ◽  
Junior Doctors ◽  
Reference Guide ◽  
Surgical Trainees ◽  
Specialist Nurses ◽  
Current Guidelines

This new edition of Oxford Handbook of Oral and Maxillofacial Surgery has been fully updated to cover the current guidelines and research in the field of OMFS. Splitting vital knowledge into sections based on clinical areas, this handbook uses bulleted lists and summary boxes to make the information easily searchable. Chapters on ‘in the clinic’, ‘in the theatre’, and ‘on the ward’ cover all common complaints and presentations that the reader can expect to encounter in their daily activities, and a dedicated section to emergencies provides clear advice. Common drugs and dental materials are covered as a quick reference guide. With OMFS now part of the Core Training programme for surgical trainees, the handbook ensures a solid grasp of the basics and fundamentals to help support decision making for junior doctors, dental foundation trainees, specialist nurses, and medical and dental students.

Basic surgical training outcomes in the era of the EWTD

2006 ◽  
Vol 88 (6) ◽  
pp. 206-207 ◽  
Author(s):  
BM Frost ◽  
C Beaton ◽  
AN Hopper ◽  
MR Stephens ◽  
WG Lewis
Keyword(s):  
Surgical Training ◽  
Medical Profession ◽  
Junior Doctors ◽  
Training Outcomes ◽  
Mixed Response ◽  
Surgical Trainees ◽  
European Working ◽  
The Uk ◽  
Working Time Directive ◽  
The New Deal

The European Working Time Directive (EWTD) represents the latest challenge to surgical training in the UK, following Calmanisation and the implementation of the New Deal on junior doctors' hours. Compliance with the EWTD in the UK demands shift working patterns and as such it has received a mixed response from the UK medical profession. While physicians in training are relatively content with the regulations of the EWTD, surgical trainees have voiced concerns regarding the potential impact of an altered working week on their clinical experience and training as well as quality of life.

Ethics, errors and education in surgical operating room

2015 ◽  
Vol 1 (2) ◽  
Author(s):  
Dr. Shashi Shekhar
Keyword(s):  
Patient Safety ◽  
Surgical Training ◽  
Care Delivery ◽  
Surgical Techniques ◽  
Operating Experience ◽  
Skin Grafting ◽  
Surgical Skill ◽  
Surgical Trainees ◽  
Surgical Workforce ◽  
Quality Of Surgery

Patient safety errors in OR may originate from: <italic>surgeon</italic> on account of forgetfulness, inattention, poor motivation, carelessness, negligence and recklessness; <italic>Hospital</italic> system due to understaffing, inadequate equipment, fatigue, time pressure and inexperience. Quality surgical training is crucial for creation of surgical workforce for health care delivery. The surgical trainees during ‘Junior Residency’ need training in both ‘Surgical’ and ‘Communication’ OR skill. The surgical skill learnt in OR is: competence in ‘basic surgical techniques’; skill of ‘assistance and minor surgeries’: hernia repair, appendectomy, skin grafting and laparoscopic skills. During ‘Senior Residency’ independent surgical judgment and performance of advanced surgical procedures to gain extensive operating experience. The non-surgical skill that promotes patient safety in OR are ‘communication skill’ and ‘team skill’. The ’<italic>supervised progressive responsibility model of surgical training</italic>’ has elements embedded for patient safety. Surgical trainer promotes trainee’s skill and ensures patient safety as well the highest quality of surgery, through gradual decreasing levels of supervision in OR, namely <italic>Direct Supervision</italic> where the trainer is physically present; <italic>Indirect supervision</italic> where the trainer becomes available within few minutes; <italic>oversight</italic> where after the surgery review is provided with feedback and progress <italic>monitoring</italic> where progress is monitored and supervision is done only in complex surgeries. Supervised surgical training helps creation of skilled practicing surgeon and ensures patient safety.

Maxillofacial Trauma Experience for OMFS Registrars: A Comparison of Surgical Experience and Aetiology in 1980 and 2010

2012 ◽  
Vol 94 (9) ◽  
pp. 312-314
Author(s):  
BS Nandra ◽  
KK Shah ◽  
AM Felstead ◽  
PJ Revington
Keyword(s):  
Medical Association ◽  
Surgical Training ◽  
Royal College ◽  
Training Programme ◽  
Clinical Governance ◽  
Maxillofacial Trauma ◽  
Junior Doctors ◽  
Surgical Experience ◽  
European Working ◽  
Conclusive Data

Surgical training has undergone considerable reforms in order to emphasise a structured training programme with supervision in a framework of clinical governance. This was following Sir Kenneth Calman's proposed reforms of the registrar grades in 1993. The European Working Time Regulations (EWTR) became part of British law in 1998 and since August 2009 also includes junior doctors, limiting maximum working times to 48 hours per week with specific rest requirements. This has raised concerns from organisations, such as the British Medical Association and the Royal College of Surgeons, regarding the effect on training and whether changes are needed to prevent a loss in competency and confidence. The 2010 report by Professor Sir John Temple found a lack of conclusive data on the effects of the EWTR on training. However, it recommended that fundamental changes must be made to the way training and service are delivered.

scholarly journals O9 The Effects of Coronavirus (COVID-19) on operative and work-based assessment (WBA) activity on surgical training

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
◽  
Joshua Clements
Keyword(s):  
Surgical Training ◽  
Negative Impact ◽  
Training Programme ◽  
Continuous Variables ◽  
Data Governance ◽  
Training Activity ◽  
Surgical Trainees ◽  
Percentage Difference ◽  
The Impact ◽  
And Training

Abstract Background COVID-19 has had a global impact on all aspects of healthcare including surgical teaching and training. The COVID-STAR qualitative study demonstrated a perceived negative impact of COVID-19 on numerous aspects of surgical training across all specialties and training grades. The aim of this study is to investigate how COVID-19 has affected operative case exposure and work-based assessments for surgeons in training. Methods Anonymized data has been sought from the Intercollegiate Surgical Curriculum Programme (ISCP) database for operations and work-based assessments in each specialty, involving surgical trainees on an approved training programme at defined Pre-COVID (16/03/19 – 11/05/19) and COVID (16/03/2020 – 11/05/20) timepoints. Primary outcome measures are the percentage (%) difference in WBA and operative activity between time points respectively. Differences in training activity between time periods will be tested using Pearson χ2 and Kruskal–Wallis tests for categorical and continuous variables respectively. Results This study has been approved by the ISCP Data Analysis, Audit and Research Group, and data will be managed in accordance with ISCP data governance. The hypothesis of this study is that COVID-19 has caused a reduction in the operative and WBA activity of trainees across all specialties. Conclusion This study seeks to quantify the impact of COVID-19 on operative training activity and completion of WBAs in clinical practice. This information will inform major stakeholders involved in optimising surgical training in the COVID-19 recovery phase.

scholarly journals Differences in progression by surgical specialty: a national cohort study

2021 ◽  
Author(s):  
carla hope ◽  
Jon Lund ◽  
gareth griffiths ◽  
david humes
Keyword(s):  
Cohort Study ◽  
Surgical Training ◽  
General Surgery ◽  
Primary Outcome Measure ◽  
Older Age ◽  
Annual Review ◽  
Surgical Specialty ◽  
Surgical Trainees ◽  
National Cohort ◽  
To Receive

The aim of surgical training across the ten surgical specialties is to produce competent day one consultants. Progression through training is assessed by the Annual Review of Competency Progression (ARCP). Objective This study aimed to examine variation in ARCP outcomes within surgical training and identify differences between specialties. Design A national cohort study using data from United Kingdom Medical Education Database (UKMED) was performed. ARCP outcome was the primary outcome measure. Multi-level ordinal regression analyses were performed, with ARCP outcomes nested within trainees. Participants Higher surgical trainees (ST3-ST8) from 9 UK surgical specialties were included (vascular surgery was excluded due to insufficient data). All surgical trainees across the UK with an ARCP outcome between 2010 to 2017 were included. Results Eight thousand two hundred and twenty trainees with an ARCP outcome awarded between 2010 and 2017 were included, comprising 31,788 ARCP outcomes. There was substantial variation in the proportion of non-standard outcomes recorded across specialties with general surgery trainees having the highest proportion of non-standard outcomes (22.5%) and urology trainees the fewest 12.4%. After adjustment, general surgery trainees were 1.3 times more likely to receive a non-standard ARCP outcome compared to trainees in T&O (OR 1.33 95%CI 1.21-1.45). Urology trainees were 36% less likely to receive a non-standard outcome compared to T&O trainees (OR 0.64 95%CI 0.54-0.75). Female trainees and older age were associated with non-standard outcomes (OR 1.11 95%CI 1.02-1.22; OR 1.04 95%CI 1.03-1.05). Conclusion There is wide variation in the training outcome assessments across surgical specialties. General surgery has higher rates of non-standard outcomes compared to other surgical specialities. Across all specialities, female sex and older age were associated with non-standard outcomes.

scholarly journals 1559 Motivations of Medical Students and Doctors Leaving the NHS Explored in a Residency Training Application Webinar Series

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Z Y Ooi ◽  
R Ooi ◽  
A Godoi ◽  
E F Foo ◽  
T Woo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Medical Students ◽  
Medical Training ◽  
Junior Doctors ◽  
Specialty Training ◽  
Motivating Factors ◽  
Surgical Trainees ◽  
The Difference ◽  
The Uk

Abstract Aim Traditionally, the UK has been highly regarded as a place for doctors to pursue undergraduate medical training and postgraduate training. However, recent reports show that more than 40% of UK-graduate doctors leave the country to pursue specialty training elsewhere. This paper aims to identify and evaluate the motivating factors for UK graduates to leave the NHS. Method An anonymised questionnaire was disseminated at a webinar series regarding the application process to pursue residency overseas. The data was independently analysed by two reviewers. A one-way ANOVA (with Tukey’s Post Hoc test) was utilised to compare the difference between motivating factors. Results were considered statistically significant for p-values &lt;0.05. Results 1,118 responses from the UK medical students and doctors were collected; of which, 1,001 (89.5%) were medical students, and 88 (7.9%) were junior doctors. There was a higher preference for leaving after the Foundation Programme compared to the other periods (p &lt; 0.0001). There was no difference between leaving after core surgical/medical training and specialty training (p = 0.549). However, both were significantly higher than leaving the NHS after medical school (p &lt; 0.0001). Quality of life and financial prospects (both P-corrected&lt;0.0001 compared individually and to other groups) were the most agreed reasons to leave the NHS, followed by clinical and academic opportunities and, subsequently, family reasons. Conclusions Future work on the quality of life for doctors in the UK, especially for prospective surgical trainees, should be explored. Policymakers should focus on assessing the difference in working hours, on-call hours or wages that may differ among the healthcare systems.

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