Surgical training derailed: The view from the tracks

Howell, Robert D.; Scott, Noel

doi:10.1308/147363504x2285

Cited by 4 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Assessment of patients with acute abdominal pain is complex. Clinical evaluation of the acute abdomen will continue to have a central role, albeit within a climate of uncertain surgical experience and expertise (12). A significant reduction in hospital surgical admissions may also require expenditure on the development of community services to support patients sent home with significant symptoms but no cause for surgical intervention (13–15).…”

Section: Discussionmentioning

confidence: 99%

Hotel NHS and the acute abdomen - admit first, investigate later

Aryal¹,

Bhowmick²,

Beveridge³

et al. 2009

International Journal of Clinical Practice

View full text Add to dashboard Cite

Summary Aim: To determine the financial consequences of a policy of admission first, followed by definitive investigation for patients with an admission diagnosis of suspected acute abdomen. Results: Over a 1‐month period, 122 patients were admitted with a suspected surgical diagnosis of acute abdomen (55 men, 67 women); age range 16–95 years (median: 56.5). Based on surgical operation required (n = 36), death after admission (n = 6, three postoperative deaths) and/or severe surgical illness (n = 17), 56 required surgical inpatient admission, while 66 did not. The patients who did not require admission spent significantly shorter time in hospital than those who required admission (median: 5 days vs. 8.5 days; p = 0.0000). Total hospital hotel and investigation cost (not including ITU or theatre costs) for all 122 patients was £330,468. Overall, £205,468 was consumed by these 56 patients who required admission, while £125,000 was spent on 66 patients whose clinical course did not justify admission; 92% of which was spent on hospital hotel costs and 8% on the cost of imaging and/or endoscopy. Discussion and conclusion: On a national basis, emergency General Surgery admissions account for 1000 Finished Consultant Episodes per 100,000 population. The findings of this study suggest that this equates to a national NHS spend of £650 million each year, for the hotel costs of patients that could arguably avoid surgical admission altogether. Continuing to admit patients with a suspected acute abdomen first and then requesting definitive investigation makes neither clinical nor economic sense.

show abstract

Section: Discussionmentioning

confidence: 99%

Hotel NHS and the acute abdomen - admit first, investigate later

Aryal¹,

Bhowmick²,

Beveridge³

et al. 2009

International Journal of Clinical Practice

View full text Add to dashboard Cite

show abstract

“…Based on its applied nature, surgery has been referred to as “a craft”,33,34 but expertise in highly technical professions is more complex than such a term communicates. Depending on the precise nature of the work, and its process and products, expertise is defined in a number of ways 9,10.…”

Section: Introductionmentioning

confidence: 99%

Developing expertise in gynecologic surgery: reflective perspectives of international experts on learning environments and processes

Hardré

Nihira

LeClaire

2017

PRBM

View full text Add to dashboard Cite

Research in medical education does not provide a clear understanding of how professional expertise develops among surgeons and what experiential factors contribute to that development. To address this gap, the researchers interviewed 16 international experts in female pelvic medicine and reconstructive surgery to assess their reflective perceptions of what specific opportunities and experiences initiated and supported their development toward expertise in their field. Characteristics and influences explaining the speed and quality of expertise development were sorted into the following themes: the dynamic process of expertise development, internal and personal characteristics, general aptitudes and preparatory skills, role modeling and interpersonal influences, opportunities to learn and practice, and roles and reference points. Across the narratives and perspectives of these expert surgeons, both individual characteristics and choices, and contextual activities and opportunities were necessary and important. Experiences with greatest impact on quality of expertise development included those provided by the environment and mentors, as well as those sought out by learners themselves, to elaborate and supplement existing opportunities. The ideal combination across experts was interaction and integration of individual characteristics with experiential opportunities. Grounded in theory and research in expertise development, these findings can support improvement of medical education, both for individual mentors and strategic program development. As surgery evolves at a continuously increasing pace, effective mentoring of promising surgical trainees will be critical to ensure that future generations of gynecologic surgeons will remain excellent. Effective, efficient surgical expertise development requires identifying trainees with the appropriate characteristics and providing them with the best development opportunities.

show abstract

“…The increase in staff‐grade doctors and nurse specialists, both with an emphasis on increased provision of service, is diluting many training opportunities. In addition, the development of ‘treatment centres’ as part of the government's waiting‐list initiative is also removing the prospect of vital training [3]. With the additional problems that the EWTD brings, even more care must be taken to ensure that remaining compliant with the EWTD is not at the expense of developing competently trained consultants.…”

Section: Introductionmentioning

confidence: 99%