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PubMed1995

Educating tomorrow's cardiac and thoracic surgeons: a Canadian initiative.

Societal, technologic, organizational and educational developments during the past 10 years have brought about increasing promises for change in the graduate medical education of cardiac and thoracic surgeons. These changes effectively lengthened training to 8'years and created a double standard for the education of a thoracic surgeon. A task force mandated by the Royal College of Physicians and Surgeons of Canada nucleus committees in both cardiac and thoracic surgery and with the support of the Canadian Society of Cardiovascular and Thoracic Surgeons studied the problem and made the following recommendation: cardiac surgery and thoracic surgery should each become a primary specialty with its own nucleus committee. Each specialty would require 6'years' training, with the possibility of obtaining certification in both specialties after an additional 18'months training. Each specialty could also be entered after completion of full training in general surgery. The task force also urged the development of a curriculum to guide educational objectives in each specialty. These changes will produce a flexible, shorter, more focused program for cardiac and thoracic surgeons for both university and community settings.

Canada↗
PubMed1995

[Do Danish surgeons have problems of conscience and responsibility? Results of a preliminary questionnaire survey].

A survey among Danish surgeons was conducted in order to elucidate whether Danish surgeons have problems of conscience related to their operative activity, especially when the results of the latter are unsatisfactory or lead to the death of the patient. Forty-three surgeons returned a questionnaire. All surgeons agreed that the problem that was raised was a significant one. The majority of the surgeons were aware of a patient, whom they had operated on and where the result of surgery was unsatisfactory or even caused the death of the patient. These problems are only to a limited extent discussed at work, whereas they are more frequently dealt with at home.

Denmark↗
PubMed1995

Reported use of strategies by surgeons to prevent transmission of bloodborne diseases.

OBJECTIVE: To determine how often surgeons use strategies to prevent the transmission of bloodborne diseases and what factors are associated with the use of these strategies. DESIGN: Cross-sectional mail survey. SETTING: Secondary and tertiary care teaching hospitals affiliated with the University of Toronto. PARTICIPANTS: Of 539 active surgical staff and residents who were eligible, 503 (93.3%) responded. OUTCOME MEASURES: Current preventive practices, attitudes toward transmission of bloodborne diseases, perceived risk of infection and willingness to adopt preventive strategies. RESULTS: On average, surgeons reported using double- or triple-gloving in 32.2% of procedures, facial protection (including regular corrective eyewear) in 74.2% and goggles or face shields in 19.4%. Use of strategies to prevent sharp injuries, in addition to barrier precautions, was reported by 259 (51.5%) of the respondents. Factors associated with greater use of preventive strategies included resident position, subspecialty, greater number of years in surgical practice and a high perceived risk. Most of the respondents thought that patients should be routinely screened for HIV antibodies before surgery (68.2% [343/503]), that there was too little research into ways to reduce the risk of transmission of bloodborne diseases (55.3% [278/503]) and that there was too little effort on the part of organizations to reduce the risk of transmission (58.8% [296/503]). The perceived lifetime risk was reported to be moderate or high by 191 (38.0%) of the respondents and low or insignificant by 308 (61.2%). In all, 463 (92.0%) indicated a willingness to change the way they performed surgery to prevent transmission of bloodborne diseases. CONCLUSION: Surgeons expressed varying degrees of concern about the transmission of bloodborne diseases and reported infrequent use of preventive strategies. Efforts to reduce the risk of transmission between patients and surgeons will need to include informing surgeons of their personal risk and the availability of preventive strategies, improving the comfort of barrier precautions and minimizing how preventive strategies interfere with surgery.

Adult↗
PubMed1995

Which surgeons in a district general hospital should treat patients with carcinoma of the rectum?

There has recently been considerable media and medical interest in the apparent differences of the results of the surgical treatment of colorectal cancer by specialist and non-specialist colorectal surgeons. We have therefore audited and compared the results of the elective treatment of cancers of the rectum and distal sigmoid colon undertaken by two surgeons working in the same hospital, one a general surgeon with a vascular special interest and the other a colorectal specialist. Although our results demonstrate no difference in overall survival, the higher clinical leak rate and higher rate of palliative diversional surgery in the general surgeon's group lends some support to the argument that carcinoma of the rectum should be treated by surgeons with a special interest in colorectal surgery.

Clinical Competence↗
PubMed1995

Crossover trial of partial shift working and a one in six rota system for house surgeons in two teaching hospitals.

The objective of this study was to compare an on call rota and partial shift working pattern for house surgeons in two hospitals. The study was conducted using a crossover trial of working both systems for 6 weeks each in two groups of newly appointed house surgeons. Assessment was by questionnaire to house surgeons, consultants, registrars, nursing staff and patients. The study took place at the departments of general surgery at Guy's and Lewisham Hospitals, London. A total of 12 house surgeons attached to four surgical firms and their consultants and registrars were the subject of our study. In addition the permanent nursing staff on designated general surgical wards and those patients of greater than 48 h stay on those wards on the day of assessment took part. Expectations of reduced fatigue levels using the partial shift system were not fulfilled. In contrast, this working pattern led to perceived disruption of the running of the surgical firms and demoralization of the house surgeons. Standards of patient care were, however, equally high using a rota or partial shift system. This comparison of a partial shift working pattern to an on call rota of similar average weekly hours demonstrated a marked preference for an on call rota from both medical and nursing staff although patients found both systems acceptable.

Cross-Over Studies↗
PubMed1994

The general surgeon through the looking glass: bright reflections from a tarnished image.

The image of the general surgeon is suffering in the eyes of trainees, peers, the public and even general surgeons themselves. The magnitude and importance of this to the future of the specialty is reviewed. A diminishing number of graduates are entering general surgical training, and only one-quarter ultimately complete their training and remain in general surgery practice. A lack of suitable academic role models and the dichotomy that exists between traditional insistence on uniform broad-based training for all and the realities of clinical practice are important parts of the image problem. This is particularly evident in small communities where the general surgeon may be ill prepared for the surgical needs of the community, or conversely where the present generation of general practitioners fails to recognize the capabilities of the general surgeon. The public does not know the meaning of the term general surgeon and fails fails to recognize and reward its highly specialist nature. Solutions to this image problem include the following: acceptance of and emphasis on the generalist nature of the specialty of general surgery; innovation and emulation of technologic advances but with careful evaluation; and reorganization of training programs with emphasis on core training in "surgery in general," flexibility tailored to ultimate career goals and preservation of in-depth general surgical experience for those who ultimately intend to serve its practice.

Canada↗
PubMed1996

Satisfaction with penile appearance after hypospadias surgery: the patient and surgeon view.

PURPOSE: We studied the degree of agreement between hypospadias patient and surgeon satisfaction with the cosmetic surgical result, and the relation between penile length, meatal position and patient satisfaction. MATERIALS AND METHODS: Cosmetic and functional results in 35 boys with hypospadias were assessed, and a standardized questionnaire was completed by patients and surgeon. RESULTS: There was hardly any agreement between patient and surgeon satisfaction with patient penile appearance. Patients were less satisfied than the surgeon. No significant correlation was noted between penile satisfaction and penile length. Patients with a retracted meatus were less satisfied with the meatal position than those with a glanular meatus. Of the 35 patients 4 underwent repeat surgery after our study. CONCLUSIONS: Hypospadias surgeons should explicitly asked if patients are satisfied and they should follow patients through adolescence.

Adolescent↗
PubMedDate not supplied

XXXII Wherry Memorial Lecture. The ear surgeon of tomorrow. Tympanomastoidectomy techniques and classification.

The ear surgery of the past 40 years (1936-1976) has been reviewed to demonstrate how this has influenced the development of modern microsurgery and the ear surgery of the future. The ear surgeon of tomorrow must have complete knowledge of the surgical anatomy and surgical pathology of the temporal bone, that pathology which has been produced by my generation of ear surgeons, and all techniques of all surgeons, for there is no single approach to surgery of the temporal bone. Only with complete and total knowledge of the temporal bone obtained by personal dissection can the surgeon succeed in the first operation. In unsheltered private practice, the patient will rarely give the surgeon a second chance. Residual postoperative cholesteatoma is divided into two types, encapsulated and exfoliative. In carcinoma of the external auditory canal, parotidectomy is advocated in continuity with the block resection of the external auditory canal. The classification of tympanoplasty is presented. Fenestration of the horizontal semicircular canal remains the operation of choice in bilateral congenital conductive deafness with stenosis of the external auditory canal, particularly in adult Treacher Collins syndrome. The evolution of the stapes techniques is presented with a view toward the diagnosis of future complications, and the postauricular transcanal approach is recommended for the removal of glomus tumors in the hypotympanum and removal of the jugular bulb.

Cholesteatoma↗
PubMed1995

Acute leg ischaemia--a case for the junior surgeon?

OBJECTIVE: To evaluate the change in the type of acute leg ischaemia and the outcome of its treatment in relation to the experience of the surgeon responsible for the treatment. DESIGN: A 12-year (1980-1991) retrospective study based on hospital records and population vital statistics. SETTING: A defined population of 165,000 served by one central hospital (CH) and two district hospitals (DH). SUBJECTS: 282 interventions performed for acute leg ischaemia. MAIN OUTCOME MEASURES: Type of leg ischaemia, reintervention, amputation and survival rates in relation to the type of ischaemia, treatment and surgical expertise. RESULTS: Thrombotic acute ischaemia increased by 91% and graft occlusions by 130% while embolisation numbers remained unchanged during the period. With junior, general and vascular surgeons operating on acute ischaemia, the respective 30-day amputation rates were 25%, 18% and 9%. Postoperative mortality was 29%, 33% and 8% respectively. The reconstruction rate for the vascular surgeon was 67% with 33% thrombectomies, while the figures for junior surgeons were 2% and 98% and for senior surgeons 6% and 94%. CONCLUSION: Mortality and amputation rates in acute ischaemia are high. By judicious use of different treatment modalities, as judged by vascular surgical experience, better limb salvage rates may be achieved especially in patients with acute on chronic ischaemia.

Acute Disease↗
PubMed1996

Surgical skills of pre-registration house surgeons.

As demands on house surgeons increase and junior doctors' hours are reduced, the opportunity for learning surgical skills during the pre-registration period is threatened. An increasing number of medical specialties, including general practice, now require a proficiency in these skills. For many doctors the pre-registration period may be the last occasion when formal training from experienced surgeons is available. Fifteen house surgeons were tested and asked to perform three basic surgical drills on artificial skin and answer 10 questions relevant to minor surgery during the final week of their house surgical post. Four (27 per cent) house surgeons were unable to complete any of the surgical drills, no one could calculate the dose of lignocaine in 10 ml of a 1% solution, and only two (13 per cent) knew the safe maximum dose of subcutaneous plain lignocaine. This study highlights deficiencies in basic surgical skills amongst house surgeons and suggests that this opportunity for training is being missed.

Clinical Competence↗
PubMed1996

Description and evaluation of the Surgeons as Educators course.

BACKGROUND: Since 1993, the American College of Surgeons has sponsored an annual 6-day course entitled the Surgeons as Educators. The course was designed to provide academic surgeons with the knowledge and skills necessary to enhance the surgical education curriculum, teaching strategies, educational program administration, and performance evaluation. This article describes the development, implementation, and effect of the course on the classes graduating in 1993 and 1994. STUDY DESIGN: The effect of the course was studied by using a longitudinal survey approach. A survey was mailed to participants 3 to 6 months after they completed the course. Graduates were asked to describe any education-related actions taken attributable to attending the Surgeons as Educators course. The quality of course content and presentations were evaluated by using end-of-course evaluation forms and daily feedback forms and by an external reviewer. RESULTS: Within 6 months of returning from the course, more than one half of the graduates initiated actions related to curriculum development, teaching strategies, or educational administration. One third or more of the graduates modified their performance and program evaluation systems. Using a five-point scale, ratings of the course content ranged from 3.78 to 4.64 for "value of topic" and from 3.77 to 4.76 for "quality of presentation." Items evaluated by the graduates on the end-of-course evaluation forms ranged from 7.8 to 8.7 on a nine-point scale. CONCLUSIONS: The Surgeons as Educators course offered an opportunity for participants to interact among themselves and with course faculty about educational issues and to practice teaching skills. The course was highly rated for educational quality and value. The retreat environment and the length of the program helped attendees become immersed during this "protected time" to analyze strengths and weaknesses of their programs and devise achievable plans to improve their abilities as educators and the effectiveness of their programs.

Clinical Competence↗
PubMed1996

[Forgotten Dresden Surgeons (I)].

This article describes problems some surgeons of Dresden were confronted with in the time between 1750 and 1850. These surgeons present the transition of the 'Age of Enlightment' and the period of sciences. Special achievements are mentioned: Hedenus as the founder of the modern surgery in Dresden and as a pioneer in practising the operations of glandula thyreoidea, Ohle, Meding, Pech and Graeffe mainly as military surgeons and surgery teachers, Ammon as a plastic surgeon and Andrée as a dental surgeon.

General Surgery↗
PubMed1997

Ionising radiation: are orthopaedic surgeons' offspring at risk?

The hazards of exposure to ionising radiation are well documented. Fears have been raised that occupational exposure to ionising radiation by orthopaedic surgeons may have detrimental effects on the future health of their unborn offspring. The current members of the British Orthopaedic Trainees' Association and orthopaedic consultants appointed during the last 5 years in the United Kingdom were contacted using a postal questionnaire. Obstetricians and gynaecologists of a similar age group were also contacted to act as the control group. The collected data were compared with the latest national data as published by the Office of Population Censuses and Surveys for England and Wales (OPCS, 1991). In all, 504 questionnaires were posted to orthopaedic surgeons and 1597 to obstetricians and gynaecologists. Reply rates were 334 (66%) and 986 (62%), respectively. Our data reveal a higher rate of congenital abnormalities as compared with the normal population in both groups (P < 0.001). However, there were no statistically significant differences in the rate of congenital abnormalities between the offspring of orthopaedic surgeons and obstetricians and gynaecologists (P = 0.78). These findings suggest that the increased rate of congenital abnormalities observed in both groups is more likely to be associated with factors other than exposure to X-rays. In this study, male surgeons had a higher incidence of female children compared with the normal population (P = 0.01). The incidence of childhood malignancies does not appear to be raised in either group. These findings suggest that the current levels of occupational exposure to X-rays by orthopaedic surgeons is unlikely to be associated with an increased risk of congenital abnormalities or childhood malignancies in their children.

Adult↗
PubMed1997

Medicine on the margins: perspectives of abortion operating surgeons in southern New Zealand.

AIMS: This research surveys operating surgeon perspectives on their work with a view to providing information relevant to improving access to abortion services. METHODS: In depth interviews were held with 14 abortion operating surgeons in the southern region. Interviews were transcribed and analysed according to emergent themes. RESULTS: Operating surgeons reported their work as technically uninteresting but felt an obligation to provide a safe service and derived important satisfaction from helping patients. They valued peer support in the workplace and did not feel isolated from colleagues or lacking professional status. They noted that the introduction of medical abortions would provide opportunities to improve access. DISCUSSION: Mainstreaming abortions into other gynaecology services might improve the work environment for operating surgeons and training opportunities for doctors. Increased use of medical abortion techniques, may encourage doctors to become operating surgeons and improve access to services in some localities.

Abortion, Induced↗
PubMed1997

Training of surgeons for primary health care.

It has been the view of the Association of Surgeons of East Africa (ASEA) that, like primary health care, there is primary surgery. The unit of provision of primary surgery is the district hospital. The training of surgeons for district hospitals starts at the undergraduate level, leading to the attainment of Bachelor of Medicine and Bachelor of Surgery (M.B. Ch.B.) degree. After internship the doctor works in a district or provincial hospital for 2-3 years, then trains for the degree of Master of Medicine (M. Med. (Surg.)) for a period of 3 years. The training involves rotation through all branches of surgery, so that the surgeon should be able to handle all aspects of routine surgery in a district hospital. To equip the surgeon further, a period in an outside setting is considered advisable. There are arrangements for regional surgical colleges to standardise the form of surgical training in the ASEA region. To keep surgeons in touch with the outside world, specialist training is done outside the region, but arrangements are being made for localised specialised units to offer this training.

Africa, Eastern↗
PubMed1998

Job analysis, appraisal and performance assessments of a surgeon--a multifaceted approach.

The role of a surgeon is a complex one. A variety of skills and abilities in a different array of performance tasks is required before he can be competent in his job. As such, there is no simple rule of thumb that can be used to assess a surgeon's performance. As performance assessment and appraisal become increasingly important both for manpower decisions and personal development, it is important that we recognise the different roles a surgeon plays. Only then are we able to subdivide a surgeon's job demands into small manageable portions for analysis. This paper examines the multi-faceted aspects of a surgeon's job, and how each facet should be individually assessed and appraised.

Attitude of Health Personnel↗
PubMed1998

[Quality assessment indicators of cardiac surgeons' work; the validity of mortality rates].

OBJECTIVE: To determine the possibility of comparing the mortality rates of patients operated by different heart surgeons with each other. DESIGN: Retrospective cohort study. SETTING: Academic Medical Centre, Amsterdam, the Netherlands. PATIENTS AND METHODS: Clinical information, operation data and follow-up data on 783 patients who had undergone cardiac valve replacement, were collected from the clinical records. Aortic valve replacement had been performed in 446 patients (1979-1986) and mitral valve replacement in 337 patients (1980-1990). RESULTS: The one-year mortality rate was higher among patients operated on by heart surgeon A than among patients operated on by the other heart surgeons from the same team, viz. 16.4% and 9.5%, respectively, an absolute difference of 6.9%. The 95% confidence interval of the difference was 1.7-12.9. However, it was also found that the risk profiles of these patients of surgeon A differed from those of the other patients. After multivariate correction for this difference in risk profile, the difference in mortality was no longer statistically significant. CONCLUSION: The differences in mortality observed in our study could not be attributed to difference in quality of the heart surgeons, but were related with the risk profiles of the patients operated by one of them. Thorough analysis with correction for risks is necessary for the assessment of the quality of care, if the conclusions are not to be misleading.

Adult↗
PubMed2006

The future of academic surgery--a consensus conference held at the Royal College of Surgeons of England, 2 September 2005.

A consensus conference organised by the Association of Surgeons of Great Britain and Ireland (ASGBI) and the Association of Surgeons of Training (ASIT) was held at the Royal College of Surgeons of England on 2 September 2005. All Specialist Advisory Committees and specialist associations were represented, except for orthopaedic surgery. The future of both academic surgery and training were discussed. We concluded that the European Working Time Directive, and Modernising Medical Careers are likely to have an adverse effect on future of research in oral and maxillofacial surgery. Most surgeons were concerned about the future of training and the development of surgery in general.

Academic Medical Centers↗