Biomedical subjects
Publications and source records attributed to S Brearley.
Eighteen cases of rupture of the diaphragm caused by blunt trauma of the trunk were seen over a ten-year period. Nine patients died, all from associated injuries of two or more systems. The ruptured diaphragm did not seem to contribute significantly to the cause of death. An acceptable rate of diagnosis was achieved by simple methods and a moderate delay in diagnosis did not affect the outcome.
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Surgical education in the United Kingdom has evolved to meet the need of the National Health Service (NHS) for a relatively small body of consultants practicing autonomously and carrying ultimate clinical responsibility for their patients. This form of specialist practice is markedly different from that found in most other countries and has necessitated a longer, more comprehensive training program than is usual where hospital specialists work more in teams and under the supervision of a head of department. Because the ratio of specialists to population is low, case loads are high. Trainees obtain excellent experience and rapidly assume clinical responsibility. Service commitments have increasingly conflicted with the need for more formal educational activity, and the financial problems of the NHS have latterly reduced opportunities for clinical training as well. Scientific advances in surgery have removed a range of cases from the operative repertoire of younger trainees. As a result, it is becoming increasingly difficult to provide trainees with opportunities to develop their surgical skills. The duration of surgical training in the United Kingdom is largely dictated by the availability of consultant posts. It could be shortened substantially with no loss of quality, but only if considerable additional funding were made available to the NHS. There seems little prospect of this boost at present and the impoverishment of the NHS is having an increasingly detrimental effect on standards of surgical education.