Surgical training: an objective assessment of recent changes for a single health board

The reduction in doctors' hours and the introduction of specialist training have reduced general surgical training by 60%. This study assessed the implications for a single health board. A questionnaire listing 13 representative operations was sent to 44 trainees and 52 trainers to determine the number of operations a trainee should perform. The total number of operations required for training was compared against the total actually performed across the health board. Operating times for five representative operations were audited prospectively. Trainers and trainees recommended a similar and conservative number of operations. The total number of operations available for training (4913) was 38% less than the number recommended (7946). Trainees required 50-75% more operating time than consultants. To increase the proportion of operations undertaken by trainees from the current 30% to 70% would require an extra 270 theatre days (of pounds 1.3m) yearly. The minimum number of operations required for training must be defined and the proportion of supervised operations undertaken by trainees substantially increased. Service and financial implications will have to be addressed. Action is needed urgently, as the first trainees will become consultants in less than five years.     

A manual on pediatric telephone triage

In 1985 in Zaire, a 12-week training course began in Kasongo district to prepare physicians to use sound management of primary and secondary health services, supervision of health centers, and commitment to team work to operate districts in an integrated way. Only 1 new physician trainee was accepted every 4 weeks. During the first week, trainees observed work at an outpatient clinic for 2-3 hours/day to learn about the links between the primary and secondary levels of health care. During the second week, they observed staff at an urban health center in Kasongo city so they could become familiar with strategies for diagnosis and treatment in curative consultations and with instructions for follow-up. During the third week, the trainees returned to the outpatient clinic to practice interviewing patients. During the fourth week, they observed work in a rural health center and in remote villages. During the second 4-week period, trainees worked in a hospital department of their choice to learn how to use files and to evaluate quality of care. They visited health centers 1-2 times/week to examine supervisory techniques of different resident physicians. Trainees were part of the health team during the third 4-week period. They were responsible for a hospital department and supervised health centers under a resident physician. The trainees also attended management committee meetings addressing quality of care, staff management, and feedback from health center supervisions. The cost for this health district management training was US $100/trainee. Between mid-1985 and mid-1988, 18 physicians underwent this training. 12 of these physicians are now working in health districts in Zaire. A follow-up survey in 1995 showed that most trainees were applying the requisite skills and knowledge acquired during the training. Further supervision or self-training, involving team analysis of problems and possible solutions, are needed. Factors contributing to the course's success include: an integrated health system under the direction of a health team, a large enough team to do student training but small enough to maintain communication, and active participation of trainees.     

A survey of advanced trauma life-support training for trainees in acute surgical specialties

There have been few published data describing the demand for and amount of Advanced Trauma Life Support (ATLS) training received by trainees in acute surgical specialties. We undertook a survey on aspects of ATLS training, questioning all senior house officers in accident and emergency (A & E) medicine, general surgery and orthopaedic surgery in the west of Scotland in January 1995. More general surgical trainees were ATLS trained than orthopaedic or A & E trainees. Ninety-seven per cent of respondents felt ATLS was essential training for FRCS. There were few problems gaining study leave for the courses, but concern was expressed regarding the long waiting lists. ATLS training is therefore thought to be essential for surgical trainees, and the number of ATLS courses needs to be increased to cope with the demand.     

The 60 hour week in surgery: possible or impossible?

The number of hours of work per week by doctors is the subject of great controversy in many countries. This has led to restrictive legislation in several states or countries (New York and Great Britain, for example) which is both cumbersome and restrictive. We have polled the Swiss surgeons (both trained and in training) in teaching hospitals on this subject with a questionnaire which also covered some other aspects of training. A majority wishes that the working week be limited (to 60 h/week). However a real limit of 60 h per 7 day week (including call duty) is not reasonable. Furthermore the other problems are considered to be more important by 84% of respondents. Thus the overall opinion is that there are too many surgeons training in a poorly structured system, both on a personal and institutional basis.     

45Ca exchange in rat cortex slices in conditions of long-term potentiation

OBJECTIVE: An attempt was made to find out how many operations were performed in Europe in 1995 for congenital heart disease. METHODS: Representatives from the 20 most active European countries which could supply reliable information were contacted. They were asked to contact all surgeons performing significant numbers of operations for congenital heart disease in their country. The numbers of operations on children under and over 1 year operated on with and without cardiopulmonary bypass were collected. No attempt was made to collect more detailed information such as operative mortality as it was felt that many surgeons would be reluctant to give their results and the data would be incomplete. RESULTS: A total of 27,976 operations were recorded, of which 20,318 were performed with cardiopulmonary bypass and 7658 without. The total population of the 20 European countries was 448 million and the mean number of operations performed with cardiopulmonary bypass per million was 45.4. However, the rate varied from 9.1 to 70.1. The percentage of operations on cardiopulmonary bypass performed in the first year of life varied from 9.4% to 44.4%. CONCLUSIONS: The total of nearly 28,000 operations in 1995 is probably an underestimate, but it has been difficult to collect this data at all. Obviously many smaller countries have not been included, and some older patients undergoing operations such as atrial septal defect closure in adult units have been missed. The number of open heart operations per million vary in different countries and this presumably represents differing referral patterns. If their numbers are low in some countries, these results may be helpful in persuading their governments that more resources are needed for congenital heart surgery. It is also interesting to see the variation in the number of operations performed in the first year of life. Those countries with a lower rate may have a backlog of older patients who were previously palliated, or their surgeons may still prefer initial palliation and later correction in some conditions rather than early correction. It is hoped that with better prospective data collection, an assessment can be repeated in 2000.     

Mental rotation: Cross-task training and generalization.

It is well established that performance on standard mental rotation tasks improves with training (Peters et al., 1995), but thus far there is little consensus regarding the degree of transfer to other tasks which also involve mental rotation. In Experiment 1, we assessed the effect of mental rotation training on participants' Mental Rotation Test (MRT) scores. Twenty-eight participants were randomly assigned to one of three groups: a “One-Day Training,” “Spaced Training,” or “No Training” group. Participants who received training achieved higher scores on the MRT, an advantage that was still evident after 1 week. Distribution of training did not affect performance. Experiment 2 assessed generalization of mental rotation training to a more complex mental rotation task, laparoscopic surgery. Laparoscopic surgical skills were assessed using Fundamentals of Laparoscopic Surgery (FLS) tasks. Thirty-four participants were randomly assigned to a “Full Mental Rotation Training, MRT and FLS,” “MRT and FLS,” or “FLS-only” group. MRT results from Experiment 1 were replicated and mental rotation training was found to elicit higher scores on the MRT. Further, mental rotation training was found to generalize to certain laparoscopic surgical tasks. Participants who obtained mental rotation training performed significantly better on mental-rotation dependent surgical tasks than participants who did not receive training. Therefore, surgical training programs can use simple computer or paper-based mental rotation training instead of more expensive materials to enhance certain aspects of surgical performance of trainees. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

基于VR技术的矿山冒顶片帮事故教学培训

为了提高非煤矿山冒顶片帮VR培训效率,基于Unity3D、3DMax和Visual Studio 2019软件开发了包括预培训、隐患岩块识别培训和灾害现场逃生培训3个模块的矿山冒顶片帮事故教学培训平台.该平台采用虚拟教练进行示范性教学,指导受训者识别、清理隐患岩块和完成灾害现场逃生,并将虚拟教练培训与传统UI文字培训的...     

Paediatric gynaecology: an overview of current practice

OBJECTIVE: To provide a comprehensive assessment of smoking prevalence and risks for smoking in an entire population of United States Air Force (USAF) military basic trainees (n = 32,144). DESIGN: Population-based survey with every individual entering the USAF enlisted force from August 1995 to August 1996. SETTING: USAF Basic Military Training (BMT) facility at Lackland Air Force Base, Texas. All trainees were assessed during the first week of BMT. MAIN OUTCOME MEASURES: A 53-item questionnaire was developed to assess four domains: demographics, smoking history, risk factors for smoking, and other health behaviours. RESULTS: Approximately 32% of the trainees smoked regularly before basic training and a small percentage of the trainees (7.6%) described themselves as ex-smokers. Men, Euro-Americans, and those from lower educational backgrounds were more likely to smoke than other trainees. On average, smokers had smoked for approximately four years and had low nicotine dependence scores. Individuals who had smoked before BMT were more likely to use other drugs (such as alcohol, binge drinking, smokeless tobacco), and were less physically active than never-smokers. These findings were particularly strong for those who smoked up to basic training but were also evident for ex-smokers. CONCLUSIONS: Smoking is a prevalent risk factor among individuals entering the USAF. Furthermore, smoking was related to other risk factors believed to lower military readiness, including alcohol use and decreased physical activity. Comprehensive tobacco control policies aimed at reducing smoking among military trainees are needed.     

Patellar reconstruction of the condyles in giant cell tumours of the knee

Training in vascular surgery is inevitably going to change radically over the next few years and we no longer have the luxury of an apprenticeship where the trainee matures and develops by prolonged contact with patients and senior colleagues. The EEC and Department of Health are insisting on a more focused training, by reducing the hours to 72 per week and suggesting accreditation as a surgical specialist after 6 years in higher surgical training. These goals, which have already been accepted by the Royal Colleges (and have been welcomed by the trainees), will inevitably lead to an entirely different approach to training, offering vascular surgeons an opportunity to develop coherent and more uniform programmes. To date many trainees have complained that their experience has been patchy, and sometimes poorly supervised. The task of developing a practical scheme is daunting, but we must start with the patient. Clearly, the patients' needs come first so that the training programme must lock on to the best standards of care. Only in this way can we ensure that the trainee is exposed to the best practice and modern techniques.     

Responses of a sample of practicing psychologists to questions about clinical work with trauma and interest in specialized training.

This study reports on selected findings from a survey conducted by the American Psychological Association Practice Organization, which assessed the number of hours per month that practicing psychologists estimated they spent treating trauma survivors and their interest in additional clinical training on trauma-related issues and topics. Respondents reported 14.3 mean number of hours spent working with trauma survivors over the past month. Of the 76% of the sample who treated any trauma patients, the mean was 16.9 hours. Although trauma psychology is not currently an integral component of the standard curricula in graduate-level education, generalist psychology practitioners are treating trauma-related concerns in their clinical practices. It is imperative therefore to ascertain if they are adequately trained in specialized trauma recognition, assessment, and treatment. The fact that almost 64% of survey respondents expressed interest in participating in educational endeavors to learn more about trauma-related clinical topics suggests that such a need exists and that more training opportunities, including ongoing continuing education offerings, should be organized. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

How much is the workload of surgeons in Scandinavia?

According to figures presented at the Bianniul General Meeting of the Scandinavian Surgical Society, the mean number of operations performed per surgeon at some clinics of different sizes in Denmark, Finland, Iceland, Norway and Sweden ranged from 90 to 240 in 1996. This corresponds to 2.6 to 8.5 hours actual operating time, though figures are misleading since time spent assisting at operations, or on endoscopies, minor diagnostics and outpatient procedures, and essential pre- and post-operative tasks is not included. This level of operative activity is considered barely sufficient for training surgeons or for maintaining surgical skills. Surgeons could devote more time to surgery if a greater proportion of their non-surgical workload was taken over by other hospital staff, which would also reduce the number of surgeons required.     

Status quo of plastic surgery education in Austria

Quality is essentially based on excellent training. Therefore, all medical disciplines in Austria, including the Plastic Surgery, have to orientate on EU-standards including efforts to adapt the surgical training. To gain an overall impression of the present training situation in Austria, an anonymous questionnaire was sent to all the 25 trainees in Plastic Surgery in summer 1995. Eight centres were involved throughout the country. The questions covered quality of training, reference departments, rotation in training, and postgraduate studies, 52% of the questionnaires were sent back. The conclusions resulting from the questionnaires are the following: unrestricted passing of plastic surgery know-how, provision of reference departments, implementation of rotation for training, carrying out of all operations listed in the EU-catalogue, regular postgraduate training. Only in this way excellently trained plastic surgeons with a strong self confidence can be a convincing counterpole to other fields of surgery which increasingly lay claim to Plastic Surgery terrain.     

Sj?gren''s syndrome presenting with a minor salivary gland mass

To survey the frequency of Lyme borreliosis (LB) and to evaluate its clinical presentation in Europe, we performed a questionnaire interview of a sample of physicians involved in the care of patients with LB. Reference laboratories in 15 European countries agreed to participate by distributing questionnaires to those clinicians who most frequently requested LB serology for their patients. The mean number of cases of LB per physician per country showed a longitudinal geographical gradient, with a higher number of patients seen in Eastern and Central Europe than in Western Europe. Skin involvement was seen in 58.9% of the patients, neurological involvement in 34.3%, joint involvement in 15.4% and cardiac involvement in 2%. About 30% of the patients had multisystem involvement. The frequency of the different manifestations varied greatly between countries. The frequency of diagnosis of LB and the number of serological tests requested were inversely correlated.     

Psychology Training Directors' Views of Trainees' Readiness to Practice Independently.

When are psychology trainees ready to practice independently? This question has been debated extensively during the past few years. To contribute to this debate, a national survey of training directors of academic programs, predoctoral internships, and postdoctoral fellowships was conducted. The study explored training directors' views regarding the examinations and supervisory hours necessary to become an independent practitioner. The study found that training directors were divided in their opinions of when trainees are competent to practice independently. Academic training directors believed that trainees are ready for independent practice earlier in the training sequence than internship and postdoctoral training directors. The implications for conflicting views are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Time utilization of a population of general surgeons in a prepaid group practice

Seven general surgeons in a prepaid group practice previously shown to have a mean operative work load of 9.2 hernia equivalents (HE) per week were found to have a standardized mean daytime working week of 56.2 hours, exclusive of evening activities of which 50.7 hours were devoted to professional activities. The surgeons also devoted a mean of 6.7 evening hours per week to professional activities for a mean net professional week of 57.4 hours. Comparisons with a population of previously studied community surgeons revealed that the prepaid group surgeons were able to produce a surgical output more than double that of the community surgeons while devoting only one and a half as much time to professional activities. Economies in the utilization of surgical manpower in the prepaid group appear to stem from: 1) restriction of practice setting to a single geographic location, 2) restriction of patients to surgical patients, 3) reduced surgeon waiting time in the office, and 4) the utilization of paraprofessional personnel for selected operative assisting. These economies were achieved while the prepaid group surgeons were observed to average more time per patient visit both on rounds and in the office than the community surgeons.     

Characterization of the tyrosine phosphorylation and distribution of dystrobrevin isoforms

While level of school education has been related to prevalence of cigarette smoking in a number of studies, less information is available on the role of vocational education and related occupational contexts. This study analyses the relative contribution of different types of educational experience to explaining prevalence and intensity of cigarette smoking in a large sample of female and male vocational trainees in Germany. A standardized questionnaire on smoking behaviour and educational performance was applied in 27 educational centers across the country, covering a total of 20,527 respondents (77.3% of the original sample; women: 59.5%, men: 40.5%). Bivariate analysis revealed a high prevalence of current smokers among vocational trainees, both men (51.2%) and women (49.4%). Men were more likely to be heavy smokers, especially with increasing age. In both sexes, prevalence of smoking was particularly high in the following occupational groups: hairdressers, butchers, painters, service personnel (hotels, restaurants), shop assistants/sellers and cooks. Multivariate analysis taking educational level, type of vocational training (occupation), age, sex and urban-rural background into account revealed the highest prevalence odds ratios (POR) of smoking in subjects with the lowest educational level (POR = 5.19 for men and 4.56 for women). Even stronger effects were observed with smoking intensity (> or = 20 cigarettes/day): in men with the lowest educational level the risk of being a heavy smoker was 8.92, and in women 13.54 compared to subjects with a high-school leaving qualification. Poor school education must be considered the relatively strongest predictor of prevalence and intensity of cigarette smoking in a large sample of female and male vocational trainees. Preventive efforts should be directed at specific target groups such as those identified by this study.     

On the elevated plus-maze the anxiolytic-like effects of the 5-HT(1A) agonist, 8-OH-DPAT, but not the anxiogenic-like effects of the 5-HT(1A) partial agonist, buspirone, are blocked by the 5-HT1A antagonist, WAY 100635

A survey of dental schools in the European Union was carried out for two main reasons. Firstly to promote the exchange of information in respect of curriculum objectives in the different countries and secondly to ascertain the differences in the interpretation of the 1978 EU sectoral directives for dental education and training. Out of 127 schools, only 30 responded, yet the information provided is of considerable importance. It demonstrates wide divergence in the interpretation of the 1978 Directives and methods of assessment of clinical competence. There is a considerable difference throughout Europe in hours devoted to the various subjects included in the Dental Directives. There is little evidence of convergence in methods of assessment or quality assurance. The survey demonstrates the difference in resources, levels of staff, availability of clinical training places, output in research and patient treatments throughout the European Union. The results question the effectiveness of the 1978 Dental Directives in promoting convergence of standards. As there is free movement of dentists throughout the European Union, it is concluded that a different approach may be necessary to ensure that all European Union dental graduates achieve comparable standards in their education and training.     

APA-approved group treatment internship training opportunities: Present status and future directions.

Questionnaires were mailed to the clinical training directors of 110 American Psychological Association-approved internship centers. Results from 87 completed and returned questionnaires indicate significant increases in reported trainee interest and program emphasis in group therapy during the past 5 yrs. However, although the number of course offerings reportedly increased significantly, the increase in the number of both staff and supervised practicums in group forms of intervention was not significant. Findings are compared with the results of an earlier survey of training opportunities in group treatment methods among doctoral programs. It is concluded that present training opportunities in group interventions are on the rise, but they still fall far short of providing trainees with all of the clinical skills necessary to meet the increasing demands for service in the area of group interventions. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary care psychologists in the Netherlands: 30 years of experience.

The primary care psychologist (PCP) in the Netherlands has 30 years of experience. The PCP is a generalist who, in close cooperation with the family physician and other providers of primary health care, has a mindset and manner of working that is largely determined by the context in which the PCP works. The specific attitudes and role of the PCP are described. The PCP provides services for a clearly delimited geographic region and is responsible for the provision of brief psychological help from a biopsychosocial perspective. In addition to psychological assessment and the provision of stepped care, the PCP also devotes considerable attention to prevention and health promotion. An orientation toward the community and the empowerment of clients stands central. The various tasks of the PCP are described in detail, and an educational curriculum for the specific 1-year training of the PCP is outlined. Lessons for other European countries and the United States are deduced from the Dutch experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)