Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Sep 2005
What impact will shortened training have on urological service delivery?
Modernisation of Medical Careers dictates a shortening of the training required to achieve consultant status. Precisely what type of work these consultants could be expected to accomplish, and be trained to do, is not clear. The objective of this study was to demonstrate a method of stratifying urological workload so as to determine what a urological trainee, undergoing shortened training, might be expected to do as a consultant and to use this stratification to help manpower planning within the specialty. ⋯ Shortened training seems able to satisfy the service delivery needs of the majority of out-patient and day-case urological activity. It will not, however, fulfil the need for subspecialty-based training required to cope with the large minority of patients necessitating complex surgical intervention. Specialist training programmes, promoting advanced operative skills, need to be evolved in parallel to shortened training so as to ensure global urological service provision for the future.
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Ann R Coll Surg Engl · Jul 2005
ReviewDoes earlier detection of critically ill patients on surgical wards lead to better outcomes?
Patients at risk of catastrophic deterioration are often identified too late. Delayed identification of sick patients and delayed referral to intensive care units might be associated with poor outcomes. The goal of the review is to assess the potential impact of systems that enable early detection of critically ill surgical patients. ⋯ The literature about Critical Care Outreach and Medical Emergency teams is characterised by methodological weaknesses. However there is a common suggestion that early detection might improve outcome of critically ill surgical patients.
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Ann R Coll Surg Engl · Jul 2005
An evaluation of operative training lists for senior house officers in a district general hospital.
To address concerns about reduced opportunities for operative training, a programme of training operating lists for senior house officers was established. The entire patient pathway was used as a learning resource so that training was offered in a range of areas including development of knowledge, communication skills and attitudes as well as operative technique. ⋯ There is an imperative to find new, efficient ways to train surgeons. Dedicated training operating lists with an appropriately controlled case-mix can both address a service need and provide a high intensity learning experience.
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Ann R Coll Surg Engl · Jul 2005
A maximally sensitive clinical decision rule to reduce the need for radiography in mandibular trauma.
To identify clinical symptoms and signs that exclude the presence of mandibular fracture in patients presenting with mandibular trauma and thus devise a clinical decision rule that will rule out the need for radiography in some patients. ⋯ A simple decision rule is presented that can be used to exclude the need for radiography in a subset of patients with mandibular trauma.
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Surgical practice must be driven by wise professional judgements, involving complex deliberation, in the interests of ensuring the safe care of patients. Large amounts of energy are now being concentrated in training doctors in skills (competencies) in the belief that this will reduce risk to patients. Little thought is being given to developing in the young, wise professional judgement which is at the heart of being a good doctor and a good surgeon.