Clin Med
-
There has been significant progress in the management of venous thromboembolism in recent years, with increased awareness and adequate thromboprophylaxis proving successful in reducing the morbidity and mortality associated with this condition. Most hospitals in the UK have specialists who run an anticoagulation clinic and ensure the adequate monitoring of, and compliance with, agents such as warfarin. In this Lesson of the Month, we describe an individual with treated congenital heart disease who developed extensive thrombosis while his warfarin control was considered to be in the therapeutic range.
-
The two-year Foundation Programme was introduced in the UK as a structured way to deal with the lack of training, support and difficulties with career progression associated with the old senior house office (SHO) grade. Although it provides a clear curriculum and structure for career progression, there is growing dissatisfaction among participants about the difference between the aspirations of the Foundation Programme and the realities of working as a foundation doctor. In particular, the erosion of the traditional team structure, difficulties with the system of assessment and a feeling that the career structure is now too rigid has led to a situation where doctors are being forced to choose their specialty training too early and often with little experience in the specialty. To what extent is the Foundation Programme fit for purpose? This will be considered together with suggestions for future reform.