Flying solo in Myanmar: case study on challenges and important lessons learned by an early career psychiatrist in a district setting

The transition from trainee early career psychiatrist (ECP) to independent practitioner can be challenging. Upon completion of training in well-equipped academic settings, an ECP from Myanmar is required to serve in a divisional hospital for at least 3 years. Significant challenges are faced by ECPs practising solo in divisional hospitals, including inexperience in administrative aspects, lack of future-proof training, scarcity of resources and facilities, struggles in the provision of holistic biopsychosocial treatment, work–life imbalance, and limited career advancement and access to continuous training. The solutions tried thus far include the incorporation of information and communication technology in training, gathering support and distant supervision from both local and international settings, and task shifting. Bigger challenges are often rewarded by faster growth, and difficult times stimulate creative solutions. The sacrifice of these solo ECPs has significantly improved the mental health service of Myanmar district regions.

Pediatric Neurosurgery

The ABNS Oral Examination evaluates an applicant’s knowledge and judgment in clinical neurosurgical practice after an applicant has been an independent practitioner. With the new format, the oral exam is divided into 3 sessions, each consisting of 5 questions. Questions in the first session deal with general neurosurgery, questions in the second session focus on the preidentified area of practice chosen by the applicant (e.g., pediatric neurosurgery), and questions in the third session are based on cases submitted by the applicant. Common pediatric neurosurgical problems treated by neurosurgeons may be included on the American Board of Neurological Surgery Oral Examination in the general neurosurgery session. Therefore, one should be familiar with the neurosurgical management of pediatric cases, including disorders of cerebrospinal fluid dynamics, congenital cranial and spinal malformations, tumors, vascular congenital and acquired disorders, intracranial and spinal infections, and intractable epilepsy. In this chapter, clinical vignettes of common pediatric neurosurgical conditions will be presented including (a) myelomeningocele, (b) craniosynostosis, (c) hydrocephalus, (d) posterior fossa tumors, and (e) moyamoya disease, with the cases subdivided into those that may be seen in the general session (1 to 3) and those more likely to be seen in the subspecialty specific session (4 and 5). The applicant will be given the history, physical examination, pertinent imaging studies, and test results and will then be expected to provide a rational differential diagnosis and plan of management, outline the risks of surgery, and describe the operation, if proposed, and handle intraoperative and postoperative complications that occur.

A-06 The Culturally Expressive and Responsive (CER) Supervision Model in Neuropsychology

Objective The competency-based movement within neuropsychology training programs has done much to create uniform standards of training and identify the “readiness” of trainees to progress to the next level. However, there is little research regarding best practices for development of a supervisory style. The successful progression from trainee to independent practitioner requires a training model that evolves, allowing for independence and collegiality, which includes knowledge expansion, changes in professional relationships and successful institutional navigation. Culture mediates interactions in the patient-doctor relationship, case conceptualization, and also within and between institutional frameworks; therefore, a supervision model should include a multicultural perspective at its core. Data Selection: An otherwise unrestricted multi-database search for “Neuropsychology Supervision” within the title of peer-reviewed journals yielded six results with publication years spanning 1999-2017. Only three specifically address models of supervision and only one is US-based (Stucky et al., 2010). Given then demographic shift estimated for 2050 (Passel & Cohn, 2008), there is a call to action to increase culturally competent neuropsychological services, including training and strengthening the student pipeline (Mindt Rivera et al., 2010). Data Synthesis: The proposed Model for Neuropsychology Supervision (Stucky et al., 2010) recommends supervision to be individually tailored, with both process-based and developmental approaches. Conclusions There is a strong need for clear supervision models designed specifically for neuropsychology that integrate culture at all levels of training. Authors propose the Culturally Expressive and Responsive (CER) Supervision Model in Neuropsychology. This is a framework for both trainees and professionals that provides a developmental approach integrating culture and the competency-based standards.

What are junior doctors for? The work of Foundation doctors in the UK: a mixed methods study

ObjectivesTo examine what activities constitute the work of Foundation doctors and understand the factors that determine how that work is constructed.DesignCross-sectional mixed methods study. Questionnaire survey of the frequency with which activities specified in curricular documents are performed. Semistructured interviews and focus groups.SettingPostgraduate medical training in the UK.ParticipantsDoctors in their first 2 years of postgraduate practice (Foundation Programme). Staff who work with Foundation doctors—supervisors, nurses and employers (clinical; non-clinical).ResultsSurvey data from 3697 Foundation doctors identified curricular activities (41/103, 42%) that are carried out routinely (performed at least once or twice per week by >75% of respondents). However, another 30 activities (29%) were carried out rarely (at least once or twice per week by <25% respondents), largely because they are routinely part of nurses’, and not doctors’, work. Junior doctors indicated their work constituted three roles: ‘support’ of ward and team, ‘independent practitioner’ and ‘learner’. The support function dominated work, but conflicted with stereotyped expectations of what ‘being a doctor’ would be. It was, however, valued by the other staff groups. The learner role was felt to be incidental to practice, but was couched in a limited definition of learning that related to new skills, rather than consolidation and practice. Activities and perceived role were shaped by the organisational context, medical hierarchies and through relationships with nurses, which could change unpredictably and cause tension. Training progression did not affect what activities were done, but supported greater autonomy in how they were carried out.ConclusionsNew doctors must be fit for multiple roles. Strategies for transition should manage graduates’ expectations of real-world work, and encourage teams and organisations to better accommodate graduates. These strategies may help ensure that new doctors can adapt to the variable demands of the evolving multiprofessional workforce.

Romañach, J. Mario (1917–1984)

Based on the quality of design in his projects both built and unbuilt, the significant output of work during his relatively short career in Cuba (over seventy built during his eight years in the partnership Bosch y Romañach (1948–1955) with architect Silverio Bosch and five years as an independent practitioner), and a consensus among critics both contemporary and current, Mario Romañach is generally regarded as Cuba’s most talented modern architect. A creative individual passionately dedicated to rational architectonic experimentation as well as a designer with a sensible interest in traditional spatial systems and formal composition, both local as well as foreign, he generated a body of work that reflected a careful balance between an international modernity and Cuba’s colonial past.