INTRODUCTIONTo 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.PATIENTS AND METHODS The programme was evaluated using a stakeholder approach, considering the impact on patients, the trainees and the host institution, including costs. Forty-two operations were performed during the 6-month evaluation period and the patients were compared with control patients undergoing the same procedure during a consultant-run operating list within 4 weeks.RESULTS There was no difference in the patients' experience or overall satisfaction when comparing the trainees' patients with controls. Senior house officers performed only six other supervised operations on routine lists during the period; the programme increased their experience by 700%. Costs were increased by 12% per patient.CONCLUSIONS 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.
INDEX 399 m M1G8543 What happens, of course, in such a case is that the interpreter has to write a new book, and that is what Nasmyth has done. This book has to do with one or two of the few really fundamental questions which concern men condemned to live together in society-as all men are. Yet a book of this character is more likely to be read about and talked about than read ; just as vi says the average social critic, " Don't let us trouble about seeing it at all. Speaking broadly, social amelioration in the widest and deepest sense (such sense not being limited, that is, to municipal wash-houses and straight streets) depends upon viii the hands of men who don't realize in the least how it should be used. Men are at bottom illogical, unseeing, incapable of weighing the result of their acts; in that case don't worry with sobering and rationalizing influences ; the practical thing is to place unrestrictedly at their disposal force of immeasurable destructiveness. Civilization will then be secure. standing in the field of human relationship, in our conception of human right and obligation, the laws of the social world, the nature of the social organism, the mechanism of human society. In all that we are hardly more advanced than the Greeks or the Romans,, or, for that matter, the Egyptians and the Chaldeans. We have covered the earth with a marvellous mechanism which will carry our thought and understanding to the utmost corners; with the invisible waves of wireless telegraphy, with post-offices, railroads, hotels de luxe, and cinematograph shows, but we cannot cover it with a system of law. We can analyse those who have already too much and to render the underworld still more dependent, their lives still more precarious? What should we say, asks Shaw, of the starving man who, on being given a dollar, forthwith spends it all on a bottle of scent for his handkerchief? Yet that is what the modern world does, and it is, we are told, incapable of doing anything else, so intellectually bankrupt are we to assume it. So immense is the failure on this side that responsible students of the comparative condition of men seriously question xiv It is probably the unconscious application on the part of the boy, of the inductive method of reasoning (of which he has never heard, and could not define), and the general attitude of mind towards phenomiena which comes of that habit.Again, to quote myself: "He forms by reasoning correctly (on the prompting of parents, nurses, and teachers) about a few simple facts-which impress xviii strictest sense of the word.* Ernst Haeckel, Freedom in Science and Teaching, p. 93. "Social Darwinism" 7 This view of the theory of selection is not an isolated interpretation ; on the contrary it is the view held by the great majority of the authorities on the Darwinian theory, with a few exceptions, as well as by the immense body of popular opinion which follows the view of these authorities. We live in a world of struggle, and man is a fighting animal, say the adherents of this view.We must therefore...
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