Formal Training Courses Research Articles

The Evolution of Training in Brain Stereotactic Radiosurgery: A Growing Part of Intracranial Neurosurgery

Stereotactic radiosurgery (SRS) has evolved to become an established, well-studied treatment modality for intracranial pathologies traditionally treated with more invasive neurosurgical management. As the field expands, among neurosurgeons and across multiple disciplines, resident training will become increasingly crucial. In this review, we reflect on 25 years of SRS at the University of Pittsburgh Medical Center and the development of formal training in this area at our institution. We describe the formal resident rotation, fellowship opportunities, and training courses for multidisciplinary physician teams and allied health professionals. The number of SRS cases performed annually has significantly increased in recent years and indeed surpassed caseloads for certain more traditional surgeries. Residents report high rates of expectation for including SRS in future practice, yet participate in only a small fraction of annual cases. The formal postgraduate year 3 rotation established at the University of Pittsburgh Medical Center provides a way to expose and educate residents in this growing subspecialty within the confines of duty hour regulations. In combination with extended clinical elective opportunities and postresidency fellowships, this rotation prepares residents at our institution for the use of SRS in future clinical practice. SRS is a rapidly expanding field that requires a unique skill set and current neurosurgical resident training often does not fully prepare trainees for its use in clinical practice. Focused resident training is necessary to ensure trainees are proficient in this specialty and well equipped to become leaders in the field.

Implementation of validated pharmacodynamic assays in multiple laboratories: challenges, successes, and limitations.

There is a "life cycle" of pharmacodynamic (PD) biomarker assays that guides the development and clinical implementation in our laboratories. The well-recognized elements of analytical assay validation and demonstration of fitness-for-purpose of the biomarker, specimen collection, handling, and assay methods are only a part of the required activities. Assay transfer across laboratories and testing on actual human clinical specimens are vital for understanding assay performance and robustness. In our experience, this patient specimen-centered approach has required assay method modifications, some unexpected, but which were critical to successful implementation in clinical trials. In addition, dispersing assays throughout the National Cancer Institute's clinical trials network has required the development of calibrator and control materials as well as formal training courses for smooth implementation. One measure of success of this approach has been that a number of the assays developed at NCI's Frederick National Laboratory have ultimately reached the stage of commercialization, enabling wide accessibility of the PD biomarker assays by the research community. See all articles in this ccr focus section, "Progress in pharmacodynamic endpoints."

Are Physicians Performing Neonatal Circumcisions Well Trained?

Notwithstanding the recommendations from the Canadian Pediatric Association and the American Academy of Pediatrics on the indications for neonatal circumcision, this procedure is still common in North America and throughout the world. Our purpose is not to argue whether this procedure should be done, but rather to examine who is doing it, their training, how it is performed and how can we prevent unsatisfactory results and complications. The objective is to identify what fields of knowledge require improvement and then design a teaching module to improve the outcomes of neonatal circumcision. A 19-question cross-sectional survey, including a visual identification item, was submitted to 87 physicians who perform neonatal circumcisions in Southwestern Ontario, Canada. To improve our response rate, study subjects were contacted in a variety of ways, including mail and fax and telephone. Once the survey was completed, we produced a surgical technique training video on using the Gomco clamp and the Plastibell techiques. A knowledge dissemination workshop was held with survey participants to discuss contraindications and the use of anesthesia and management of complications of neonatal circumcision and to evaluate the surgical technique training video. A 6-month follow-up questionnaire was completed to determine the impact of the teaching course on participants' daily practice. In total, we received 54 responses (62% response rate). From these, 46 (85%) were family doctors and pediatricians, while the remaining 8 (15%) were pediatric general surgeons and urologists. The circumcisions were carried out with the Gomco clamp 35 (63%) and the Plastibell 21 (37%). No respondent admitted to learning the procedure through a structured training course. Of the non-surgeons, 19 (43%) learned to perform a circumcision from a non-surgeon colleague. A little over a third of the participants (17, 31%) were happy to perform a circumcision in a child born with a concealed penis, where circumcision is contraindicated. With respect to the early complications post-circumcision, 8 (100%) surgeons versus 29 (63%) non-surgeons felt comfortable dealing with bleeding (p = 0.046). In total, 7 (88%) surgeons versus 16 (35%) non-surgeons were comfortable dealing with urinary retention (p = 0.01). Also, 8 (100%) surgeons versus 24 (52%) non-surgeons were comfortable dealing with a wound dehiscence (p = 0.02). Moreover, 6 (75%) surgeons and 5 (10%) non-surgeons were comfortable managing meatal stenosis (p < 0.01). Five (63%) surgeons versus 15 (33%) non-surgeons were confident in dealing with a trapped penis post-circumcision (p = 0.24). Our survey findings indicate that most physicians performing neonatal circumcisions in our community have received informal and unstructured training. This lack of formal instruction may explain the complications and unsatisfactory results witnessed in our pediatric urology practice. Many practitioners are not aware of the contraindications to neonatal circumcision and most non-surgeons perform the procedure without being able to handle common post-surgical complications. Based on our survey findings, we planned and carried out a formal training course to address these issues.

Assessment of Robotic Simulation by Trainees in Residency Programs of the Southeastern Section of the American Urologic Association

To assess the Southeast Section of the American Urological Association (SESAUA) trainee exposure to and thoughts on robotic simulation. Questionnaire-based study of SESAUA residency trainees to determine their access to robotic simulation, live robotic experience to date, and opinion regarding the adequacy of current robotic training. Three trainees from each SESAUA training program were invited to Orlando, Florida for a formal 2-day robotic training course. Day 1 was a 3-component didactic session. Day 2 involved faculty directing the trainees in set tasks on a live porcine model for 4 hours and another 4 hours on the Mimic dV-Trainer (Mimic Technologies, Inc, Seattle, WA) for directed exercises. Thirty-two trainees from 14 programs in the SESAUA participated in the course and filled out a 1-page, 8-item questionnaire following their simulator exposure. Seventeen (53.1%) trainees, including 5 urology year-3 trainees, reported never having had robotic console time. Of the trainees, 65.6% (21 of 32) had access to the Mimic dV-Trainer or Mimic "backpack" whereas 10 had no exposure to robotic simulation; 84.4% (27 of 32) felt that the simulator replicated real-life robotic console surgery and 90.6% (29 of 32) felt the simulator was helpful or would be helpful for training in their program. Trainees felt the "tubes 2" drill, which mimics a vesicourethral anastomosis, was the most difficult drill to perform. A majority of trainees in the SESAUA have had limited to no robotic console time. A high number of resident trainees in the SESAUA have exposure to virtual reality robotic simulation. Trainees believe that the simulator replicates real-life robotic console movements and almost all believe they would be benefit from having access to robotic simulation.

Palliative Care Knowledge and Attitudes Among Oncology Nurses in Qatar

Formal palliative care (PC) education is lacking in the middle eastern state of Qatar. This study was done to assess the need for PC education among oncology nurses in Qatar. In March 2012, a self-constructed questionnaire was distributed to 115 nurses at the Qatar National Center for Cancer Care and Research. A total of 115 nurses responded to the questionnaire. The majority (87.8%) were female. Although 60% had more than 10 years of work experience, only 31% had received formal training in PC, with only 6.1% having completed postgraduate training. The majority (63%) of responders attributed this issue to unavailability of PC courses rather than lack of time, interest, or financial issues. Currently, only 16.7% did not express interest in the field, with 56% showing some kind of interest. In terms of knowledge, 54% of the responders were familiar with the World Health Organization ladder for pain relief. Only 43.6% know about Palliative Performance Scale, and half of the nurses know the Edmonton Symptom Assessment System. Overall, 56% of the nurses indicated a need for training in more than 1 aspect. These aspects included training in care of the dying patients (14.6%), communication strategies (22%), caregiver support (10.6%), psychosocial care (15%), pain management (10.2%), other symptom management (13%), and other ethical/spiritual issues (14.2%). There is a clear deficiency in formal PC education among the nurses at the National Center for Cancer Care and Research, in Qatar. This is reflected by their lack of experience and exposure to PC and their mediocre knowledge in the field. This could be attributed to the fact that formal PC service was established only recently in Qatar (2008). Formal training courses in PC nursing are required.

An Independent Learning Method for Orthopaedic Surgeons Performing Shoulder Ultrasound to Identify Full-Thickness Tears of the Rotator Cuff

There is an evolving interest in shoulder ultrasound performed by orthopaedic surgeons as part of routine clinical assessment of the rotator cuff in a so-called one-stop clinic. This study investigated the accuracy of ultrasound assessment of rotator cuff integrity performed by orthopaedic surgeons without prior experience of ultrasound who were following our proposed learning protocol. We studied four surgeons without previous experience with shoulder ultrasound and monitored their ability to evaluate rotator cuff integrity using ultrasound compared with findings at arthroscopy. The surgeons attended a formal training course and were taught a protocol to identify and size full-thickness tears of the rotator cuff. The surgeons performed preoperative scans on the day that patients underwent shoulder arthroscopy. This allowed the surgeons to receive same-day feedback with comparison of arthroscopic images and ultrasound images. One hundred and fifty-nine shoulders were scanned by the surgeons in the study. In the initial training period, surgeons who performed >100 scans demonstrated a sensitivity of 94% and a specificity of 88% (a positive predictive value of 79% and a negative predictive value of 97%) for the identification of a full-thickness tear and agreed with intraoperative sizing of the defect in 84% of the scans. In the later training period, the predictive values showed a sensitivity of 90% and a specificity of 97% (a positive predictive value of 95% and a negative predictive value of 94%) for the identification of a full-thickness tear and agreement with intraoperative sizing for 95% of the scans. The predictive values obtained in this study for the evaluation of rotator cuff integrity were comparable with published results from experienced radiologists. This study demonstrates the capacity of our proposed learning protocol to train surgeons without previous ultrasound experience to reliably evaluate rotator cuff integrity using ultrasound within fifty to 100 scans.

The Value of Care Provided by Student Doulas: An Examination of the Perceptions of Women in Their Care

This study provides an examination of women's perceptions of care provided by student doulas undertaking a formal qualification in doula support services. Feedback forms completed by women attended by student doulas undertaking a formal qualification in doula support services were analyzed. The women (N = 160) consistently rated the student doulas' contribution to their experience of birth favorably. Qualitative analysis revealed that women value the presence of their student doulas highly with reference to the student doulas' demeanor, support provided to family, interface with other health professionals, and learned skills. Within the Australian context, this study suggests that the support provided by student doulas that have completed a formal training course is held in positive regard by the women receiving their care.

Reply to Letter to the Editor: Critically Assessing the Haiti Earthquake Response and the Barriers to Quality Orthopaedic Care

We thank Dr. Moyad for his constructive criticism and service to the Haitian people. His positive experience providing care in the wake of this natural disaster is testament to the power of volunteerism in resource-poor countries. After the earthquake, many medical and surgical volunteers sacrificed to provide the highest quality care to disaster casualties. These stories and tremendous worldwide response should give all of us hope regarding our international capacity for relief. Nevertheless, the intention of the publication was to provide our readership with a perspective that has remained largely elusive. Although many publications regarding the orthopaedic response to the Haiti earthquake document the quantity of procedures performed and the personal stories of the volunteers, there are few systematic documentations of the failures. Our systematic method of data collection and analysis has many weaknesses highlighted in the publication, but it provides an important window into potential ways in which we can improve and devise measures of disaster care. Many of the anecdotes associated with poor-quality care, we believe, were preventable with training. From our interviews, for example, we discovered that ill-prepared physicians such as ophthalmologists and pediatricians were performing orthopaedic surgeries without adequate training. In addition, to address Dr. Moyad’s specific point regarding fasciotomies, there is documentation to suggest that this procedure should be reconsidered in the acute muscle-crush compartment syndromes commonly found in earthquake zones. The muscle in these limbs usually is already dead and in these resource-poor settings, when damage-control orthopaedics is necessary, there is limited time for repeated operations that risk limb-threatening infection [2]. Although we will never know the specific nature of every injury treated, there clearly is room for debate and greater need for better documentation and further study of disaster response. A substantial report from the Pan American Health Organization (PAHO) discusses the overall lack of organization and chaotic pattern of the relief effort [1]. The foreword of the report states that the response, “included a number of wholly unprepared or even incompetent health actors who bypassed the overburdened coordination mechanisms”. For these reasons, the PAHO report highlights the need for accreditation and training in disaster response, a matter about which we disagree with Dr. Moyad. Regardless of the outcome, training courses provide volunteers with the opportunity to share stories, exchange knowledge, build expert opinion, and prepare for a variety of patient-care possibilities. We hope that formal training courses are cultivated to continue to improve the care provided to patients most in need.

Knowledge and attitude of primary health care doctors towards obesity management, Kuwait

Background: Obesity is a significant public health issue constituting an independent risk factor for morbidity and mortality as well as complicating the management of other medical conditions. Objectives: The objective of this study was to reveal knowledge, attitude and practice of PHC physicians as regarding overweight and obesity management. Methods: This study was a cross sectional descriptive survey that was conducted in all PHC centers in Kuwait. All physicians currently working in these centers during the study period were invited to participate in the study. Data was collected through a specially designed, self-administered questionnaire. Results: More than 4 fifths of participants (84.1%) declared that they didn't receive any obesity specialized courses or training, 61.8% thought they have limited knowledge about obesity management while 25.8% thought that they have good knowledge, while the rest (12.2%) have no knowledge. Regarding health risks related to obesity, the score of correct knowledge showed a mean score of 66.49+16.12%. Knowledge concerning diseases which could be controlled by weight reduction, showed an overall mean % score of 63.01+14.08. It was found that 26.6% of them believed that obesity is a health problem in Kuwait and 37.4% believed that they have limited role in obesity control. The vast majority of the sample agreed that normal body weight or even small weight reduction should be encouraged (86.4% & 84.7% respectively). However 63.2% agreed that few people can reduce their weight. Just less than one third of the sample agreed that different lines of management of obesity are needed. The majority used dietary or physical activity advice or both (90.9%, 94.9% respectively). The most frequent, major limitation agreed upon by physicians was short consultation time and work overload (85.8%). Conclusions: knowledge and attitudes of physicians are acceptable. However, there is, room for improvement and could be done through formal training courses and distribution of guidelines. As a final point, major limitations in weight management should be taken into consideration

The bridges and barriers to ‘good’ urodynamic practice: a regional perspective

ABSTRACTThe translation of clinical guidelines into practice is a complex process, primarily because it is a ‘top down’ approach to disseminating information. The aim of this study was to determine whether current guidelines and standards have been applied to everyday urodynamic practice, and establish how health care professionals have interpreted the terminology. It was also an ideal opportunity to explore the systems in place that support personal and professional development, and identify factors that can contribute to, or obstruct, ‘good’ urodynamic practice. A descriptive exploratory research design was adopted using a mixed methodological approach. A purposive sample (n = 60) of doctors, nurses and technicians who currently undertake urodynamic investigations within one NHS region were identified. Most of the participants were familiar with the International Continence Society guidelines; with over half routinely using them in their current practice. Although there was a comprehensive uptake of formal urodynamic training courses, there was limited evidence of formal assessment either before or after training/education. This was also reflected in some of the themes that emerged during the semi‐structured interviews; access to supervision, multidisciplinary team meetings, team working, networking, isolation, attitudes and time, were all identified as factors that could have either a positive or negative effect on urodynamic practice. These findings confirm that guidelines, in one NHS region, are reaching their target population. However, the translation of training and assessment into practice is a complex issue to address, as it requires skills in reflective practice, self‐assessment and critical analysis. Although guidelines/recommendations exist, a more robust framework may be required; incorporating structured mentoring and clinical assessment with experienced practitioners, in order to address the barriers that clearly exist.

Prevalence of training in addiction psychology and treatment in APA-accredited clinical and counseling psychology doctoral programs

Clinical and counseling psychologists trained in the United States have reported receiving little or no formal education in substance use disorders (SUD). We, therefore, sought to determine the extent to which American Psychological Association (APA) accredited doctoral programs in clinical and counseling psychology provide education in addictive disorders., Based on past research, we predicted that (a) most doctoral programs would not offer formal SUD training courses; (b) the available courses would more likely be elective than required; (c) Psy.D. (Doctor of Psychology) programs would be more likely to offer required SUD courses than Ph.D. (Doctor of Philosophy in Clinical and Counseling Psychology) programs; and (d) Psy.D. programs would have a higher number of faculty members who include SUD in the topics of their research interests than Ph.D. programs. We thoroughly surveyed curriculum webpages of all APA-accredited clinical and counseling psychology programs. We tallied the number of programs that offered courses in SUD (required and elective courses) and the number of faculty members who listed SUD (or an addiction) as one of their clinical and/or research interests. In general, our hypotheses were supported. We found that 30.8% of all surveyed programs offered SUD courses, supporting past research and our hypotheses that SUD training is scant among clinical and counseling psychology programs. While psychologists are increasingly required to provide addiction services in clinical practice, too many psychologists finish graduate school with no formal training to understand, assess, and treat individuals with an SUD.

Participation in Learning and Depressive Symptoms

This paper reports the findings of research on relationships between depression and participation in learning using data from a large sample of older adults. The objective was to establish whether learning can reduce the risk of depression. Data were obtained from the English Longitudinal Study of Ageing, a nationally-representative sample of adults aged 50 and above. The eight-item Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure depressive symptoms. Participation in learning covered the acquisition of qualifications; taking formal training courses, learning at arts, music or evening classes; and participation in gym/exercise classes. Multiple regression analyses were conducted with the change in the measure of depressive symptoms between two waves of the longitudinal survey as the response variable. There was limited evidence that participation in learning reduced the risk of depression in later life. Only learning leading to qualifications was significantly associated with the outcome after controlling other factors. But learning leading to qualifications was undertaken only by a small minority of the sample, mainly the youngest and most highly educated. Other types of learning were not significantly associated with depression. It appears that learning has, at best, a small role to play in addressing the risk of depression in later life.

1445 - Level of Palliative Care Education Among Oncology Nurses in the State of Qatar

ABSTRACT Objectives Formal Palliative Care (PC) education is lacking in the Middle Eastern state of Qatar. This study was done to assess the need for PC education among oncology nurses in Qatar. Methods A self-constructed questionnaire was distributed to 115 nurses at the Qatar National Center for Cancer Care and Research in March 2012. Results One hundred fifteen nurses responded to the questionnaire. The majority (87.8%) were female. While 60% had more than ten years of work experience, only 31% had received formal training in PC with only 6.1% having completed postgraduate training. The majority of responders (75%) attributed this issue to unavailability of PC courses rather than lack of time, interest or financial issues. Currently, only 16.7% did not express interest in the field, with 56% showing some kind of interest. In terms of knowledge, 54% of responders were familiar with the WHO ladder for pain relief. Only 43.6% know about Palliative Performance Scale and half of all nurses know the Edmonton Symptom Assesment System. Overall, 56% of the nurses indicated a need for training in more than one aspect. These aspects included training in care of the dying patients (14.6 %), communication strategies (22%), caregiver support (10.6%), psycho-social care (15%), pain management (10.2%), other symptom management (13%) and other ethical/spiritual issues (14.2%). Conclusions There is a clear deficiency in formal PC education among the nurses at the NCCCR in Qatar. This is reflected by their lack of experience and exposure to PC, and their mediocre knowledge in the field. This could be attributed to the fact that formal PC service was introduced only recently in Qatar (2008). Formal training courses in PC nursing are required. Disclosure All authors have declared no conflicts of interest.

ICT Proficiency of Dental Students in Sri Lanka

The Faculty of Dental Sciences, University of Peradeniya has been conducting formal introductory courses in ICT for undergraduates at their entry level. Although senior students do not get an opportunity for ICT education they will be required to perform tasks such as assignments, reports, referencing using ICT tools. Dental undergraduate students’ proficiency in ICT was tested on randomly selected groups from three senior batches. Total performance of all students tested showed that the MCQ score (53.4, SD 8.0) has exceeded the pass mark and practical test (44.0, SD 7.2) has recorded well below. Individual tests on the Practical components also showed that students were extremely weak in Excel (8.1, SD 2.2) and well below passmark in Word (16.9, SD 2.9) and Powerpoint (19.0, SD 5.3) tasks. This indicates that considering the basic nature of the questions in this ICT proficiency test, students have displayed a low level of skill in the practical component. However the total aggregate for the overall student performance (48.8, SD 5.4) has recorded just below the pass mark of 50%. These results reiterate the need for development of a formal supplementary training course in ICT for students in senior batches in the Faculty of Dental Sciences. DOI: http://dx.doi.org/10.4038/sljbmi.v2i3.3796 Sri Lanka Journal of Bio-Medical Informatics 2011;2(3):107-111

The Bockus International Society of Gastroenterology: Historical Review

The Bockus International Society of Gastroenterology was founded in 1958 in honour of Dr Henry L Bockus (1894-1982) by his former students, residents and fellows at the Graduate School of Medicine of the University of Pennsylvania, Philadelphia, USA. It was a celebrated tribute to Dr Bockus' outstanding leadership in the development and teaching of clinical gastroenterology as a subspecialty, which was in its infancy in the post-World War II era. He established the first formal training course in clinical gastroenterology in America. His department of gastroenterology became the leading graduate school of clinical gastroenterology in the world, training many clinical gastroenterologists in America and from many regions around the world. For many years, Dr Bockus was the most prominent American in world gastroenterology. The Bockus Society holds biennial scientific congresses in different continents, thus continuing to foster Dr Bockus' lifelong interest and vision to promote international medical friendship, and excellence in education and research collaboration.

A Cohort Study to Evaluate Emergency Medicine Ultrasound by Non-Sonographers in Clinical Practice

Previous research has evaluated the sensitivity and specificity of emergency medicine ultrasound (EMU); however, the literature on clinical governance issues such as the quality of training, competence of the operator, development of clinical guidelines or standard setting within individual trusts is very limited. Although national guidelines have been issued regarding governance of non-radiology performed ultrasound, it is unclear whether the expectations provided within the guidance are being implemented in clinical practice. The aim of this study was to explore the clinical governance and service provision of emergency medicine practitioners who had attended a two-day formal training course on EMU. The method used was a prospective non-randomized study using an electronic questionnaire to 160 clinicians who had attended a two-day EMU course. The questions investigated the clinicians’ EMU clinical practice in their departments including profession, grade, number of scans, types of examinations, equipment used and clinical governance arrangements such as scope of practice, audit, guidelines, support, archiving of reports and images. Responses were obtained from 59 of 160 (37%) delegates. The mean time they had been involved in emergency medicine was 8.31 years. Most (73%) were performing EMU in their current roles. Nearly all (86%) felt that the two-day course had given them adequate training and over half were performing extra examinations to those taught on the course. Only 23 (39%) respondents had supervision in their workplace after the course. Less than half (46%) were aware of national EMU guidelines, and only 22% of respondents indicated there were local clinical guidelines in place. A significant proportion of departments (37%) do not undertake audit. In conclusion, most of the respondents were not aware of the national guidelines around EMU and there was a lack of evidence that clinical governance issues were being enforced by all trusts. Many departments showed a limited use of clinical guidelines, audit regimes or competency assessment.

The Hong Kong infection control nurses’ association (HKICNA) – small establishment big impact

In Hong Kong, the importance of infection prevention and control is recognized indubitably after an outbreak of MRSA with 6 neonatal deaths in 1985. The same year 24 infection control nurses were deployed full-time and formal training course was initiated. In 1989, HKICNA was inaugurated with 44 members and advisers. The followings are the milestones on how HKICNA, developed from a very small establishment, to have significant impacts on healthcare professionals in Hong Kong.

Pediatric residents experience a significant decline in their response capabilities to simulated life-threatening events as their training frequency in cardiopulmonary resuscitation decreases*

To determine the frequency of cardiopulmonary resuscitation education using high-fidelity patient simulators during pediatric residency training. Randomized controlled trial. Suburban tertiary care children's hospital residency training program. Twenty-four second year pediatric residents. Twenty-four second year pediatric residents were randomized into two study groups, 12 residents in each. Both groups completed a formal resuscitation training course utilizing lectures, skill stations, and six scenarios on high-fidelity patient stimulators. Group A was retested on three scenarios 4 months after training and group B was similarly retested 8 months after training. Time intervals from induction of a clinical problem to its definitive management were recorded for each resident. Residents were also asked to complete surveys following each episode of training and testing. The mean time intervals, for group A, to start effective bag mask ventilation and chest compressions in response to apnea and cardiac arrest were 17.75 secs (± 3.39 secs) and 23.42 secs (± 9.33 secs), respectively. These were significantly shorter than 32.7 secs (± 18.6 secs) and 81.2 secs (± 74.9 secs), for group B, respectively (p < .05). Residents in group A provided higher survey scores for their level of confidence in using cardiopulmonary resuscitation pharmacology than residents in group B did (p < .05). The two groups were no different in their response time to defibrillate or to start anti-arrhythmia medications for life-threatening arrhythmias and in their endotracheal intubation skills. Pediatric residents show a significantly slower response time to effectively manage episodes of apnea and cardiac arrest 8 months after their initial resuscitation training, when compared to 4 months after training. These results may indicate that residents require more frequent training than currently recommended.

Deficiencies in venous experience in UK vascular trainees: a survey of Rouleaux Club members

The aim of this study was to evaluate the training experience of current UK vascular trainees in the modern management of venous disease. A web-based questionnaire of the 145 members of the Rouleaux Club (www.rouleauxclub.com), which represents UK vascular trainees. Members were asked to complete the survey between June and October 2009 with regular email reminders being sent out to non-responders. One hundred and twenty-three trainees (85% response rate) representing all 17 UK training Deaneries responded. Seventy-eight per cent reported having received no formal venous duplex training either for diagnosis of venous disease or to guide endovenous therapy. Operative experience of great and small saphenous vein surgery improved with years of training. Surgical experience for recurrent varicose veins was poor. Experience with endovenous techniques was limited and variable. No experience of endovenous laser ablation or radiofrequency ablation was reported by 39% and 67% of trainees, respectively. Experience and/or training with foam sclerotherapy was limited to <40%. Many of those reporting no experience with endovenous ablation techniques were within the final two years of their training. Less than 25% of trainees reported having had any experience (assisted/performed) of advanced venous interventions such as thrombolysis techniques for deep venous thrombosis, inferior vena cava filter placement/removal, venous stenting or deep venous reconstruction. Less than a quarter of trainees are currently involved in the acute management of deep venous thrombosis. The majority (76%) of current trainees would like a formal approved UK venous training course to be offered. The current level of training in the management of venous disease will not allow UK vascular trainees to become the competent all round vascular specialists of the future.

Supporting informal learning by traders in investment banks

PurposeThe main aims of this paper are to determine the extent to which experienced traders in investment banks based in London are learning by informal methods, which methods are to the fore, and whether HRD staff are providing support for informal learning. It also seeks to find evidence that such investment banks were attempting to become learning organisations.Design/methodology/approachEmpirical research was conducted involving in‐depth semi‐structured interviews with experienced traders, line managers of traders, and HRD professionals involved in the training of traders in London based investment banks.FindingsMost of the ongoing learning conducted by traders was informal, and on‐the‐job in nature. This informal learning was ad hoc, poorly recorded, and limited in scope. Support of line managers to learning by their subordinate traders was patchy, with little accountability. HRD professionals were almost entirely concerned with organising formal training courses, and had little knowledge of, or involvement with, informal learning by traders. There was very little evidence of investment banks striving to become learning organisations.Research limitations/implicationsThe research study was limited to those investment banks willing to take part in the study, and by the banks selecting those to be interviewed.Practical implicationsInvestment banks have become a powerful component of the UK economy, and the ways in which their traders learn, or could learn, effectively in terms of competence improvement is key to the performance of these banks.Originality/valueInformal learning by traders in investment banks in the UK has been little researched to date. This paper addresses this inadequacy.