Predictors of ophthalmology career success (POCS) study

ObjectiveOphthalmology is the busiest outpatient specialty with demand predicted to rise over 40% in the next 20 years. A significant increase in the number of trainee ophthalmologists is required to fill currently vacant consultant posts and meet the UK’s workforce demands by 2038. Our aim was to understand what determines success in ophthalmology training, in order to inform future ophthalmologists, refine recruitment and facilitate workforce planning.Methods and AnalysisThis was a retrospective longitudinal cohort study using routinely collected data available from UK Medical Education Database (UKMED) (https://www.ukmed.ac.uk/). Data were analysed on 1350 candidates who had applied for ophthalmology specialty training (OST) between 2012 and 2018, as well as 495 candidates who had attempted Fellow of the Royal College of Ophthalmologists (FRCOphth) Part 1 between 2013 and 2018. Participants who had not obtained their primary medical qualification from the UK medical schools were excluded. Primary outcome measures included gaining a place on the OST programme and passing the FRCOphth Part 1 examination on first attempt.ResultsHigher education performance measure decile scores at medical school are strongly predictive in securing an OST post and passing the part 1 examination first time (p<0.001). Candidates who attempt FRCOphth Part 1 prior to their ST1 application are more likely to get a place on OST on first attempt. Socioeconomic factors, gender and ethnicity do not influence success in OST entry. Male trainees are more likely to pass FRCOphth Part 1 on their first attempt.ConclusionThis study is the first quantitative assessment of the factors that determine success in OST recruitment and ophthalmology postgraduate examinations in the UK. Similar studies should be undertaken in all other medical and surgical specialties to understand what factors predict success.

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To bee or not to beet with neonicotinoids

Environmental Law Review ◽

10.1177/14614529211021194 ◽

2021 ◽

Vol 23 (2) ◽

pp. 103-109

Author(s):

Lynda M. Warren

Keyword(s):

Sugar Beet ◽

Weather Conditions ◽

The European Union ◽

Environmental Standards ◽

Economic Interests ◽

Precautionary Approach ◽

The United Kingdom ◽

Commercial Sugar ◽

The Uk ◽

First Time

In January 2021 the UK government granted an application for authorisation to use thiamethoxam, a neonicotinoid pesticide, to protect commercial sugar beet crops from attack by viruses transmitted by aphids. This was the first time such an authorisation had been granted in the United Kingdom (UK) and there were concerns that it signalled a weakening of environmental standards now that the UK was no longer part of the European Union. In fact, similar authorisations had been granted by several European Member States in the last 2 years, despite the ban on the use of neonicotinoids introduced in 2018. Nevertheless, the reasons for granting the authorisation do suggest that the balance between adopting a precautionary approach to environmental protection and taking emergency action to protect economic interests may have shifted. It was acknowledged that the proposed mitigation to safeguard bees and other wildlife was not entirely satisfactory. In the end, due to unforeseen weather conditions it meant that the pesticide is not necessary, which in itself demonstrates that short-term emergency measures are unsuitable for dealing with the problem. If the sugar beet industry is to continue to prosper in the UK, it will need to be managed in a way that provides resistance to virus infection without the use of controversial chemicals.

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Using population-based routinely collected data from the Sentinel Stroke National Audit Programme to investigate factors associated with discharge to care home after rehabilitation

Clinical Rehabilitation ◽

10.1177/0269215517748715 ◽

2017 ◽

Vol 32 (8) ◽

pp. 1108-1118 ◽

Cited By ~ 7

Author(s):

Dipankar Dutta ◽

Daniel Thornton ◽

Emily Bowen

Keyword(s):

Care Home ◽

Univariate Analysis ◽

Population Based ◽

National Institutes Of Health ◽

National Audit ◽

Factors Associated ◽

Routinely Collected Data ◽

Early Supported Discharge ◽

Research Findings ◽

First Time

Objectives: We investigated factors associated with Care Home (CH) discharge following stroke using routinely collected data in unselected patients and assessed the relevance of previous research findings to such patients seen in routine clinical practice. Design: Retrospective analysis of data from the Sentinel Stroke National Audit Programme using univariate analysis and logistic regression. Setting: A large acute and rehabilitation UK stroke unit with access to early supported discharge. Subjects: All patients with stroke treated from 1 January 2014 to 1 January 2017. Main measures: National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Results: Of 2584 patients (median age 78 years, interquartile range (IQR) 69–86; 50.6% male; 86.7% infarcts; median admission NIHSS 4, IQR 2–9), 401 (15.5%) died in hospital and 203 patients (7.9%) were permanently discharged to CH for the first time. Most had pre-discharge mRS scores of 4/5. Factors (odds ratios; 95% confidence intervals) associated with CH discharge included age (1.07; 1.05–1.10), incontinence (11.5; 7.13–19.25), dysphagia (2.13; 1.39–3.29), severe weakness (1.93; 1.28–2.92), pneumonia (1.68; 1.13–2.50), urinary tract infection (UTI) (1.70; 1.04–2.75) and depression (1.65; 1.00–2.72). In a subgroup of all patients with a pre-discharge mRS of 4/5, age (1.04; 1.02–1.06), incontinence (4.87; 2.39–11.02), UTI (2.0; 1.09–3.71) and pneumonia (1.59; 1.02–2.50) were the only factors associated with CH discharge. Conclusion: Potentially modifiable variables like incontinence, UTI and pneumonia were associated with CH discharge, particularly in the severely disabled.

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The duties of impartiality, disclosure, and confidentiality: lessons from a London-seated arbitration

Arbitration International ◽

10.1093/arbint/aiab013 ◽

2021 ◽

Author(s):

Samuel Yee Ching Leung ◽

Alex Chun Hei Chan

Keyword(s):

United Kingdom ◽

Important Case ◽

Careful Examination ◽

International Arbitration ◽

The United Kingdom ◽

Key Concepts ◽

The Uk ◽

First Time

Abstract Halliburton Company v Chubb Bermuda Insurance Ltd (formerly known as Ace Bermuda Insurance Ltd [2020] UKSC 48 is an important case not only to the UK but also to the international arbitration community for several reasons: first, it examines indispensable duties in international arbitration and for the first time recognises and explicates upon the duty of disclosure at the highest court of the United Kingdom; secondly, it addresses and clarifies key concepts in international arbitration; thirdly, it confirms the objective nature of the test of justifiable doubts which has wider implications for other arbitral forums; fourthly, it illustrates how the duties of impartiality, disclosure, and confidentiality interact with and affect each other and how the key concepts should be applied to this interaction; and finally, it lays down useful guidance for arbitrators. For these reasons, this case deserves close and careful examination. This article aims to explain the significance of the aforesaid and suggests that, in addition to what has been addressed, further judicial explanations are warranted in what other aspects.

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Defence Medical Services’ REBOA training course

BMJ Military Health ◽

10.1136/bmjmilitary-2021-001926 ◽

2021 ◽

pp. bmjmilitary-2021-001926

Author(s):

Max E R Marsden ◽

C Park ◽

J Barratt ◽

N Tai ◽

P Rees

Keyword(s):

Training Programme ◽

Balloon Occlusion ◽

Medical Services ◽

Skill Retention ◽

Training Course ◽

Challenges And Opportunities ◽

Haemorrhage Control ◽

Surgical Teams ◽

The Uk ◽

First Time

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) enables temporary haemorrhage control and physiological stabilisation. This article describes the bespoke Defence Medical Services (DMS) training package for effectively using REBOA. The article covers how the course was designed, how the key learning objectives are taught, participant feedback and the authors’ perceptions of future training challenges and opportunities. Since the inaugural training course in April 2019, the authors have delivered six courses, training over 100 clinicians. For the first time in the UK DMS, we designed and delivered a robust specialist endovascular training programme, with demonstrable, significant increases in confidence and competence. As a result of this course, the first DMS REBOA-equipped forward surgical teams deployed in June 2019. Looking to the future, there is a requirement to develop an assessment of skill retention and the potential need for revalidation.

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Are there differences between those doctors who apply for a training post in Foundation Year 2 and those who take time out of the training pathway? A UK multicohort study

BMJ Open ◽

10.1136/bmjopen-2019-032021 ◽

2019 ◽

Vol 9 (11) ◽

pp. e032021 ◽

Cited By ~ 3

Author(s):

Jennifer Cleland ◽

Gordon Prescott ◽

Kim Walker ◽

Peter Johnston ◽

Ben Kumwenda

Keyword(s):

Medical School ◽

Workforce Planning ◽

Sociodemographic Factors ◽

Specialty Training ◽

Time Out ◽

Foundation Programme ◽

Training Post ◽

Multivariable Regression ◽

The Uk ◽

Participation In Higher Education

IntroductionKnowledge about the career decisions of doctors in relation to specialty (residency) training is essential in terms of UK workforce planning. However, little is known about which doctors elect to progress directly from Foundation Year 2 (F2) into core/specialty/general practice training and those who instead opt for an alternative next career step.ObjectiveTo identify if there were any individual differences between these two groups of doctors.DesignThis was a longitudinal, cohort study of ‘home’ students who graduated from UK medical schools between 2010 and 2015 and completed the Foundation Programme (FP) between 2012 and 2017.We used the UK Medical Education Database (UKMED) to access linked data from different sources, including medical school performance, specialty training applications and career preferences. Multivariable regression analyses were used to predict the odds of taking time out of training based on various sociodemographic factors.Results18 380/38 905 (47.2%) of F2 doctors applied for, and accepted, a training post offer immediately after completing F2. The most common pattern for doctors taking time out of the training pathway after FP was to have a 1-year (7155: 38.8%) or a 2-year break (2605: 14.0%) from training. The odds of not proceeding directly into core or specialty training were higher for those who were male, white, entered medical school as (high) school leavers and whose parents were educated to degree level. Doctors from areas of low participation in higher education were significantly (0.001) more likely to proceed directly into core or specialty training.ConclusionThe results show that UK doctors from higher socioeconomic groups are less likely to choose to progress directly from the FP into specialty training. The data suggest that widening access and encouraging more socioeconomic diversity in our medical students may be helpful in terms of attracting F2s into core/specialty training posts.

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Do we need medical leadership or medical engagement?

Leadership in Health Services ◽

10.1108/lhs-03-2014-0029 ◽

2015 ◽

Vol 28 (3) ◽

pp. 173-184 ◽

Cited By ~ 22

Author(s):

Peter Spurgeon ◽

Paul Long ◽

John Clark ◽

Frank Daly

Keyword(s):

Care Quality ◽

Current Evidence ◽

Organisational Performance ◽

Content Type ◽

Care Quality Commission ◽

The Uk ◽

Medical Leadership ◽

First Time ◽

Practical Implications ◽

A Current

Purpose – The purpose of this paper is to address issues of medical leadership within health systems and to clarify the associated conceptual issues, for example, leadership versus management and medical versus clinical leadership. However, its principle contribution is to raise the issue of the purpose or outcome of medical leadership, and, in this respect, it argues that it is to promote medical engagement. Design/methodology/approach – The approach is to provide evidence, both from the literature and empirically, to suggest that enhanced medical engagement leads to improved organisational performance and, in doing so, to review the associated concepts. Findings – Building on current evidence from the UK and Australia, the authors strengthen previous findings that effective medical leadership underpins the effective organisational performance. Research limitations/implications – There is a current imbalance between the size of the databases on medical engagement between the UK (very large) and Australia (small but developing). Practical implications – The authors aim to equip medical leaders with the appropriate skill set to promote and enhance greater medical engagement. The focus of leaders in organisations should be in creating a culture that fosters and supports medical engagement. Social implications – This paper provides empowerment of medical professionals to have greater influence in the running of the organisation in which they deliver care. Originality/value – The paper contains, for the first time, linked performance data from the Care Quality Commission in the UK and from Australia with the new set of medical engagement findings.

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The Society for Acute Medicine (UK) Acute Medicine Training Survey 2007

Acute Medicine Journal ◽

10.52964/amja.0195 ◽

2008 ◽

Vol 7 (1) ◽

pp. 50-54

Author(s):

Hannah Skene ◽

◽

David K Ward ◽

Keyword(s):

Online Survey ◽

Workforce Planning ◽

Skills Training ◽

Training Programme ◽

Current Situation ◽

Acute Medicine ◽

Part Time ◽

The Uk

An online survey of training in Acute Medicine was conducted to assemble a true picture of the current situation in the UK. The specialty is flourishing, with over 60 trainees having predicted CCT dates in Acute Medicine in 2010 and 2011 alone. 128 respondents highlighted a multitude of issues, including the need for improvements in management and special skills training and part time opportunities. We have used the results of this survey to suggest action points for Deaneries, Training Programme Directors, the Society for Acute Medicine (UK) and those involved in workforce planning.

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The growth of interest for astronomical X-ray polarimetry

10.20944/preprints201802.0062.v1 ◽

2018 ◽

Author(s):

Frédéric Marin

Keyword(s):

Quantitative Assessment ◽

Supernova Remnant ◽

Scientific Literature ◽

High Energy ◽

X Ray ◽

Highly Sensitive ◽

In The Beginning ◽

First Time

Astronomical X-ray polarimetry was first explored in the end of the 60's by pioneering rocket instruments. The craze arising from the first discoveries on stellar and supernova remnant X-ray polarization led to the addition of X-ray polarimeters on-board of early satellites. Unfortunately, the inadequacy of the diffraction and scattering technologies required to measure polarization with respect to the constraints driven by X-ray mirrors and detectors, coupled to long integration times, slowed down the field for almost 40 years. Thanks to the development of new, highly sensitive, compact X-ray polarimeters in the beginning of the 2000's, the possibility to observe astronomical X-ray polarization is rising again and scientists are now ready to explore the high energy sky thanks to modern X-ray polarimeters. In the forthcoming years, several X-ray missions (both rockets, balloons and satellites) will open a new observational windows. A wind of renewal blows over the area of X-ray polarimetry and this paper presents for the first time a quantitative assessment, all based on scientific literature, of the growth of interest for astronomical X-ray polarimetry.

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Quantifying the prevalence of assortative mating in a human population

10.1101/848911 ◽

2019 ◽

Author(s):

Klaus Jaffe

Keyword(s):

Assortative Mating ◽

Genetic Relatedness ◽

Random Mating ◽

Human Populations ◽

Genetic Composition ◽

Genetic Studies ◽

Maintenance Of Sex ◽

Animal Populations ◽

The Uk ◽

First Time

AbstractFor the first time, empirical evidence allowed to construct the frequency distribution of a genetic relatedness index between the parents of about half a million individuals living in the UK. The results suggest that over 30% of the population is the product of parents mating assortatively. The rest is probably the offspring of parents matching the genetic composition of their partners randomly. High degrees of genetic relatedness between parents, i.e. extreme inbreeding, was rare. This result shows that assortative mating is likely to be highly prevalent in human populations. Thus, assuming only random mating among humans, as widely done in ecology and population genetic studies, is not an appropriate approximation to reality. The existence of assortative mating has to be accounted for. The results suggest the conclusion that both, assortative and random mating, are evolutionary stable strategies. This improved insight allows to better understand complex evolutionary phenomena, such as the emergence and maintenance of sex, the speed of adaptation, runaway adaptation, maintenance of cooperation, and many others in human and animal populations.

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Treatment of first-time traumatic anterior shoulder dislocation: the UK TASH-D cohort study

Health Technology Assessment ◽

10.3310/hta23180 ◽

2019 ◽

Vol 23 (18) ◽

pp. 1-104

Author(s):

Jonathan L Rees ◽

Anjali Shah ◽

Katherine Edwards ◽

Maria T Sanchez-Santos ◽

Danielle E Robinson ◽

...

Keyword(s):

Risk Factors ◽

Shoulder Dislocation ◽

Recurrent Dislocation ◽

Incidence Rates ◽

Anterior Shoulder Dislocation ◽

Traumatic Anterior Shoulder Dislocation ◽

The Uk ◽

First Time ◽

Residual Confounding ◽

Age And Sex

Background Shoulder dislocations are the most common joint dislocations seen in emergency departments. Most traumatic cases are anterior and cause recurrent dislocations. Management options include surgical and conservative treatments. There is a lack of evidence about which method is most effective after the first traumatic anterior shoulder dislocation (TASD). Objectives To produce UK age- and sex-specific incidence rates for TASD. To assess whether or not surgery within 6 months of a first-time TASD decreases re-dislocation rates compared with no surgery. To identify clinical predictors of recurrent dislocation. Design A population-based cohort study of first-time TASD patients in the UK. An initial validation study and subsequent propensity-score-matched analysis to compare re-dislocation rates between surgery and no surgery after a first-time TASD. Prediction modelling was used to identify potential predictors of recurrent dislocation. Setting UK primary and secondary care data. Participants Patients with a first-time TASD between 1997 and 2015. Interventions Stabilisation surgery within 6 months of a first-time TASD (compared with no surgery). Stabilisation surgery within 12 months of a first-time TASD was also carried out as a sensitivity analysis. Main outcome measure Re-dislocation rate up to 2 years after the first TASD. Methods Eligible patients were identified from the Clinical Practice Research Datalink (CPRD) (1997–2015). Accuracy of shoulder dislocation coding was internally validated using the CPRD General Practitioner questionnaire service. UK age- and sex-specific incidence rates for TASD were externally validated against rates from the USA and Canada. A propensity-score-matched analysis using linked CPRD and Hospital Episode Statistics (HES) data compared re-dislocation rates for patients aged 16–35 years, comparing surgery with no surgery. Multivariable Cox regression models for predicting re-dislocation were developed for the surgical and non-surgical cohorts. Results Shoulder dislocation was coded correctly for 89% of cases in the CPRD [95% confidence interval (CI) 83% to 95%], with a ‘primary’ dislocation confirmed for 76% of cases (95% CI 67% to 85%). Far fewer patients than expected received stabilisation surgery within 6 months of a first TASD, leading to an underpowered study. Around 20% of re-dislocation rates were observed for both surgical and non-surgical patients. The sensitivity analysis at 12 months also showed little difference in re-dislocation rates. Missing data on risk factors limited the value of the prediction modelling; however, younger age, epilepsy and sex (male) were identified as statistically significant predictors of re-dislocation. Limitations Far fewer than the expected number of patients had surgery after a first-time TASD, resulting in an underpowered study. This and residual confounding from missing risk factors mean that it is not possible to draw valid conclusions. Conclusions This study provides, for the first time, UK data on the age- and sex-specific incidence rates for TASD. Most TASD occurs in men, but an unexpected increased incidence was observed in women aged > 50 years. Surgery after a first-time TASD is uncommon in the NHS. Re-dislocation rates for patients receiving surgery after their first TASD are higher than previously expected; however, important residual confounding risk factors were not recorded in NHS primary and secondary care databases, thus preventing useful recommendations. Future work The high incidence of TASD justifies investigation into preventative measures for young men participating in contact sports, as well as investigating the risk factors in women aged > 50 years. A randomised controlled trial would account for key confounders missing from CPRD and HES data. A national TASD registry would allow for a more relevant data capture for this patient group. Study registration Independent Scientific Advisory Committee (ISAC) for the Medicines and Healthcare Products Regulatory Agency (ISAC protocol 15_0260). Funding The National Institute for Health Research Health Technology Assessment programme.

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