Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Aug 2006
Historical ArticleABMS' Maintenance of Certification: the challenge of continuing competence.
The American Board of Medical Specialties, since its inception in 1933 as the Advisory Board for Medical Specialties, is concerned with the education, training and certification of physician specialists. Although not perfect, the initial certification process is quite good and accomplishes its intended purpose. However, initial certification is based on a primarily knowledge-based "snapshot." The newly developed Maintenance of Certification Program will evaluate the competencies, medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement and systems-based practices believed to be necessary and sufficient for certified physicians to have and maintain throughout their entire professional career. Furthermore, the process will focus on education and assessment to encourage continuous quality improvement in clinical practice.
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Clin. Orthop. Relat. Res. · Aug 2006
ReviewProfessionalism and medicine's social contract with society.
Medicine's relationship with society has been described as a social contract: an "as if" contract with obligations and expectations on the part of both society and medicine, "each of the other". The term is often used without elaboration by those writing on professionalism in medicine. ⋯ The recognition of these expectations is important as they serve as the basis of a series of obligations which are necessary for the maintenance of medicine as a profession. Mutual trust and reasonable demands are required of both parties to the contract.
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Clin. Orthop. Relat. Res. · Aug 2006
Effect of duty hour standards on burnout among orthopaedic surgery residents.
We surveyed orthopaedic surgery residents and faculty from two university training programs to quantify quality of life measures including burnout, general health, and relationship issues. Residents exhibited high levels of burnout and emotional exhaustion but only average levels of personal achievement, while faculty showed lower levels of burnout and emotional exhaustion with above average scores for personal achievement. ⋯ At this time resident scores for personal accomplishment had improved, while scores for emotional exhaustion showed a strong trend towards decreasing, and depersonalization scores also showed a possible trend towards decreasing. Resident duty hour limitation was associated with improvement in objective measures of burnout.
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We analyzed the relationship between knee pain after tibial nailing and nail prominence. We identified 70 patients in our trauma registry with healed fractures initially treated with intramedullary nails. Subjective pain and function were measured with visual analog pain scales and Lysholm knee scores at a mean of 20 months after fracture. These scores were compared with nail prominence measured on postoperative radiographs. More than 49% of patients had knee pain. Subjective knee pain was more common in women and patients with a smaller plateau width. Anterior nail prominence was associated with increased pain at rest. Patients with superior nail prominence had increased pain with kneeling and walking. Nail prominence correlated with increased knee pain. We think surgeons can decrease, but not eliminate, the severity of knee pain after tibial nailing by burying the tip of the nail as reflected on lateral radiographs. ⋯ Prognostic Study, Level II-1 (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.