Background: Trainees need to operate under appropriate supervision to become competent. Transit time flow measurement (TTFM) is useful in detecting intraoperative graft failures during coronary artery bypass grafting (CABG). This study aims to compare the intra-and postoperative outcomes, including TTFM, of isolated CABG performed by a single consultant versus trainees and to determine the relationship between the pulsatility index (PI) and postoperative outcomes. Methods: This retrospective study included 155 isolated CABG cases. Intraoperative outcomes included duration of cardiopulmonary bypass (CPB) and aortic cross-clamp and TTFM for arterial and venous grafts.Postoperative outcomes included common postoperative complications and mortality. The odds ratios of postoperative complications and mortality for arterial and venous grafts with PI ≤3 relative to grafts with PI >3 were determined with multiple logistic regression. Results: The duration of CPB and aortic cross-clamp was significantly shorter in the consultant's group.TTFM for both arterial and venous grafts were similar and no significant differences in postoperative complications and mortality were detected between the two groups. Patients with arterial grafts with PI ≤3 were less likely to require an intra-aortic balloon pump (IABP) or be ventilated for a prolonged period. No significant differences in postoperative outcomes and mortality were detected between venous grafts with PI ≤3 and PI >3. Conclusions: Trainees can achieve good results in isolated CABG with appropriate case selection. Patients with arterial grafts with PI ≤3 have better postoperative outcomes.

Breaking bad news is a crucial communication delivered by healthcare professionals. This skill was taught in Management and Science University, Malaysia using lecture previously. Realising the instructional delivery gap, breaking bad news workshops was introduced involving not only the theory of the skills but the hands on experience as well. This workshop incorporated peer-assisted learning method in providing a friendly and conducive environment for the best learning experience for the students. Five workshops were conducted with a total of 204 students. Students (n = 38-42 per session) were given materials a week prior to the session to familiarise themselves with the workshop. Trained peer-assisted tutors (n = 8) guided role-playing sessions as well as giving feedbacks. Students found that the workshop to be useful adjunct to learning communication skills, specifically in breaking bad news. Students considered peer-assisted learning method provided them with a safe environment where mistakes were allowed, corrected and proper skills reiterated. In conclusion, learning breaking bad news is feasible with peer-assistance.

Aorto-bronchial fistula is a rare but potentially fatal condition due to torrential bleeding from erosion of aneurysmal wall into bronchial wall or lung parenchyma. It is usually associated with infection, lung transplantation, pulmonary malignancies, atherosclerotic and mycotic aneurysms, and anastomotic pseudoaneurysms after open or endovascular surgery. The typical presentation usually manifested by haemoptysis, but rarely the patient also can be presented with hematemesis and this will delay the definitive treatment. Surgical or endovascular repair is mandatory because non-operative management will lead to a poor prognosis due to massive bleeding from the fistula.  We would like to present a unique case of an elderly man presented with intermittent haematemesis, in which he later developed profound haemoptysis and diagnosed with ABF. Although in the era of endovascular, the ABF was successfully treated via open thoracotomy, resection of thoracic aorta aneurysm, left lower lobe lobectomy, and completed with aortic repair using Gelweave aortic graft.