Percent Of Training Research Articles

An assessment of burnout in New Zealand orthopaedic resident medical officers.

Burnout and fatigue are common in the medical profession. The primary aim was to assess rates of burnout in trainee and non-trainee orthopaedic registrars in New Zealand. A secondary aim was to establish which specific factors are associated with burnout. In 2021, a 53-question online survey was sent to New Zealand trainee and non-trainee orthopaedic registrars. The survey included questions addressing demographics, modifiable factors known to lead to burnout, information on respective orthopaedic departments, and how respondents had fared with COVID-19. Registrars also completed the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS MP), a 22-question validated survey that is designed to assess the frequency and intensity of perceived burnout among medical personnel. Fifty of 62 (80.6%) trainees and 66 of 70 (estimated number) (94.3%) of non-trainees completed the survey. Trainees and non-trainees both exhibited moderate levels of burnout. The trainee mean score emotional exhaustion (EE) 22.5, depersonalisation (DP) 8.8, personal achievement (PA) 35.9; non-trainee mean score EE 22.4, DP 8.9, PA 35.9. Fifty-two point two percent of trainees and 50% of non-trainees scored in the severe range for at least one of EE or DP. Factors shown to reduce burnout are the presence of a senior colleague (P<0.001), participation in professional assistance (P=0.049), working in a department with a full complement of staff (P=0.020) and being able to attend health maintenance appointments (P=0.050). Our study shows that approximately half of both trainee and non-trainee orthopaedic registrars are exhibiting signs of burnout. This is comparable to other developed nations with a similar healthcare system.

A state-by-state and regional analysis of the direct medical costs of treating musculoskeletal injuries among US Army trainees

IntroductionLow physical activity (PA) and physical fitness (PF) are well-known factors for chronic diseases generally and cardiovascular diseases specifically. The economic burden from these chronic diseases is also well documented, as is their disproportionate prevalence among states in the Southern region of the U.S. Low PA and PF have also become recognized factors impacting military readiness and national security. Specifically, low PA and PF are highly correlated with musculoskeletal injures (MSKIs), now considered the greatest medical impediment to military readiness. Prior research shows low PF and MSKI incidence are greater among Army recruits from Southern states, however no previous research has investigated the economic impact of MSKIs at the state- and regional-level. The aim of this study was to determine the economic impact of MSKIs among U.S. Army initial military trainees on a state- and regional-basis. MethodsRosters for recruits entering U.S. Army Initial Military Training (IMT) for fiscal year 2017 were obtained (n = 103,487). Roster data included the unique personal identifier, demographics with postal zip code, training start/end dates, and height and weight and were subsequently linked to medical encounters and cost data from the Military Health System Data Repository. Trainees with one or more MSKIs were considered injury cases (n = 33,509) and were stratified by gender. The percent of trainee MSKI cases was calculated as number of injury cases divided by total number of trainees. For each injury case, the direct medical cost for MSKIs was calculated. The percent of trainees and direct medical costs for MSKIs were aggregated to home-state and regional-levels for the four U.S. Census tract regions. A test for equality of proportions was performed at state- and regional-levels to investigate differences in percent of trainees with MSKIs by state/region. A one-way ANOVA was used to investigate possible differences in medical cost/trainee by region. Results34% (n = 33,509) of all trainees sustained at least one MSKI. State-specific MSKI percentages showed ten states having the greatest percentage of trainees with at least one MSKI, eight of which were from the South region (AL, FL, GA, LA, MS, NC, SC, TN). The South was the only region to have a statistically significantly higher percentage of trainees with MSKIs at 34% (p < 0.001), as compared to all other regions. The total direct medical cost of treating MSKIs among all trainees was $14,891,563. The South was the costliest region ($7,168,997), accounted for nearly 50 % of the total national cost, and had the highest mean MSKI cost/trainee. DiscussionThis study was the first in demonstrating the disproportionate economic burden Southern states pose to the U.S. Department of Defense resulting from its significantly higher MSKI cost. PA and PF are known to ameliorate chronic disease and MSKI burden among general and military populations. Therefore, increasing PA and PF among all young Americans, and specifically those living in Southern states, is imperative for improving public health and reducing the economic and practical burden of MSKIs on military readiness and national security.

Pengaruh Pelatihan terhadap Kinerja Pegawai Pada Kantor Pertanahan Kabupaten Kerinci

Human resource management is a part of management or in other words it can be said that human resource management is a field of management that specifically studies human relationships and roles in organizations. Human resource management focuses its discussion on regulating the role of humans in realizing optimal goals. It is clear that human resource management regulates human labor in such a way that organizational goals are realized. Training must be job-specific. Related training by increasing the knowledge, skills and abilities to perform certain job. The term training is used to refer to any process skills or abilities and abilities of employees, so that they are more well adapted to the work environment they are involved in. Training is a process of teaching certain knowledge and skills and attitudes so that employees are increasingly skilled and able to carry out their responsibilities with the better, according to the standard .Performance is how an employee carry out his work or for his work. The Kerinci District Land Office has the task of assisting The Regent carries out government affairs and co-administration tasks in the land and spatial planning sector, and part of the privileges assigned to the land and spatial planning sector. The Kerinci Regency Land Office was first established in 1990, located at JL. Prof. Dr. Sri Sudewi Maschun Sofwan,SH, Koto Renah Village, but in 2019 the Kerinci District Land Office created a new office in the Sebukar Village area, Silihat Laut District The results of the estimation of the effect of training (X) on performance (Y) using the Software Statistical Product and Service Solution (SPSS) 20, the regression equation is obtained as follows: Y = 0.286 + 0.560X In other words, the regression equation above can be said that the regression coefficient of the training variable has a positive influence on employee performance at the Kerinci District Land Office. There is a significant effect of training on employee performance at the Kerinci Regency Land Office, as evidenced by the t count of 43,587&gt; t table of 3,180. From the estimation results 0.631 or 63.1 percent of training (X) is able to explain the Y variable (performance) by 63.1%. Meanwhile 36.9% was explained by other variables not included in the model. Not only education and training affect performance, but there are other variables of 36.9 percent that affect performance.

Contemporary trends for urological training and management of stress urinary incontinence in Ireland

Introduction and hypothesisThe aim of this study is to evaluate the trends in stress urinary incontinence (SUI) surgery since the 2018 pause on use of the polypropylene (PP) mid-urethral sling (MUS) and to quantify the effect this has had on surgical training.MethodsTwo anonymous surveys were sent to all current urology trainees and to all consultant surgeons who specialise in stress urinary incontinence surgery.ResultsPrior to the pause, 86% (6 out of 7) of consultant urologists and 73% (11 out of 15) of consultant gynaecologists would “always”/“often” perform MUS for SUI. After that, 100% (22 out of 22) of consultants reported that they “never” perform MUS. There has been a modest increase in the use of urethral bulking agent (UBA) procedures among urologists, with 43% (3 out of 7) now “often” performing this, compared with 71% (5 out of 7) “never” performing it pre-2018. Trainee exposure to SUI surgery reduced by 75% between 2016 and 2020. Despite a ten-fold increase in UBA procedures logged by trainees, the decline in MUS has resulted in a major reduction in total SUI surgeries. Coinciding with this decrease in surgeries, there was a 56% reduction in trainees’ self-assessed competence at SUI surgery. Thirteen percent of trainees are interested in specialising in Female Urology and those trainees had significantly greater exposure to SUI procedures during their training than those who did not (p = 0.0072).ConclusionsThis study has identified a downward trend in SUI surgery, which is concerning for the undertreatment of females with SUI. A decline in SUI surgery training has resulted in reduced trainee confidence and interest in this subspecialty.

Status of minimally invasive HPB surgery in the UK from consultant and trainee perspectives

Introduction: This survey took a snapshot of current attitudes towards minimally invasive HPB surgery from a consultant and trainee perspective. Methods: Two google surveys were emailed to all identified HPB centres in the UK to consultants and trainees (ST5+). The questionnaire contained 33 and 31 questions respectively regarding minimally invasive HPB practice and training. Results: Thirty-five HPB consultants completed the survey. The most common indications for conversion to open surgery were failure to progress in 91.4% (n=32), excessive intraoperative blood loss in 85.7% (n=30) and access issues in 85.7% (n=30). The majority (78.8%, n=26) of HPB surgeons surveyed undertook MIDP while 21.2% (n=7) did not as they deferred them to other surgeon(s) who regularly performed them. Only one consultant undertook minimally invasive pancreaticoduodenectomy (MIPD), robotically; 48.4% (n=15) declared not performing MIPDs as they were not convinced MIS is superior to an open approach. Eighty-five-point seven percent (n=30) performed minimally invasive minor liver resection and segmentectomy (MImLRS), 70.6% (n=24) reported better outcomes with an MIS approach, 23.5% (n=8) reported no difference in outcomes between the MIS and open approaches. Seventy percent (n= 5) performed minimally invasive major liver resection (MIMLR) laparoscopically and 30% (n=3) robotically; 56.3% (n=17) reported equivalent or better outcomes with an open approach while 23.3% (n=7) reported better outcomes with MIMLR. Half of polled HPB trainees did not have access to laparoscopic HPB procedures (excluding laparoscopic cholecystectomy); 22.2% (n=4) of trainees had a mentor in laparoscopic HPB procedures. Forty-four-point four percent of trainees (n=8) reported going to laparoscopic courses on cadaveric/live models while 44.4% (n=8) used internet-based media to improve their laparoscopic skills; 72.2% (n=13) desired an extension to training (or fellowship) to consolidate their laparoscopic training. Conclusion: MImLRS and MIDP would appear to be accepted approaches by most HPB consultants which correlates with a perception that outcomes are better/comparable to open approaches. This is less clear for MIPD and MIMLR. HPB trainees suffer from a lack of laparoscopic HPB exposure leading to seek further laparoscopic HPB experience with fellowships post certificate of completion of training.

Assessing the Key Predictors of an Academic Career after Craniofacial Surgery Fellowship.

As craniofacial fellowship positions outnumber the availability of academic craniofacial jobs, it is important to understand the factors associated with securing an academic position after fellowship. The purpose of this study was to evaluate the impact of bibliometric indices and trainee demographics on the ability to obtain a full-time academic plastic surgery position on completion of a craniofacial fellowship. Craniofacial fellowship graduates between 2009 and 2018 (n = 182) were identified. Initial job placement and demographic data were collected; bibliometric indices at fellowship completion were calculated. Chi-square and Fisher's exact tests and multivariable logistic regression were used to assess the association of select factors with job placement. Of the 48.9 percent of fellows that secured academic positions, 39.3 percent trained at five fellowship institutions. The majority of those completing residency at top institutions for academic surgery and research entered academic positions at fellowship completion. Geography influenced academic placement, as 72.7 percent of trainees in the Northeast secured academic positions. Only 20.3 percent of fellows completed dedicated postgraduate research time, but among these, 70.3 percent entered academic jobs. The h-index (OR, 1.14; p = 0.01) and total manuscripts (OR, 1.04; p = 0.02) were significantly associated with academic practice while adjusting for other covariates. Although residency training institution, geographic location, and postgraduate research may influence academic placement, the h-index and total manuscripts represent the best predictors of academic careers after craniofacial fellowship. This information is valuable for applicants who aspire to be academic craniofacial surgeons, and for programs and educators who can use these data to identify applicants with a propensity for academics.

Economic Benefits of Protected Vegetable Cultivation by the Farmers Trained by KVK Jalandhar

The study was undertaken to examine the economic benefits of protected vegetable cultivation. A total sample of 200 respondents practicing protected vegetable cultivation was selected from Jalandhar district from which 150 respondents were trained by KVK Jalandhar and the remaining 50 respondents were non-trainees. The findings concluded that 42.0 percent of trainees and 38.0 percent of non-trainees were in the age group of 39-52 years. It was revealed that 19.3 percent of trainees had a graduate level of education while 20.0 percent of non-trainees had a middle level of education. It was found that 66.0 percent of trainees and 54.0 percent of non-trainees had medium landholding. The majority of trainees (78.6 percent) and non-trainees (86 percent) had farming as an occupation. Most of the trainees and non-trainees contacted horticulture development officers. It was concluded that 32.6 percent of trainees procured seed or seedling from private firms whereas 40.0 percent of non-trainees procured seed or seedling from fellow farmers. The trainees obtained higher yield and net profit than non-trainees from all sample vegetable crops.

Role of vocational and technical training in achieving gender equality and empowering all women and girls: An empirical study of Sindh, Pakistan

Trained and technically equipped human resources are the nations’ assets and an essential requirement for sustainable national development. The skilled labor force required for the industrial revolution can never be undermined while it can be used as a powerful weapon for poverty reduction. Women presenting almost half of the world population can be economically empowered through vocational and technical training and the fifth sustainable development goal “achieving gender equality and empowering all women and girls with disabilities” can be achieved through this training. Different vocational and technical training programs have been proven to produce technically skilled human resources in different developing countries. However, such programs also have the limitations of accommodating a high percent of trainees in jobs or self-employment. The study aimed to sort out the determinants of these training programs’ low success rates in Sindh province of Pakistan. A total of 128 surveys were filled from randomly selected women who have completed their trainings in the last two years. Data were analyzed through cross-tabulation analysis on SPSS and AMOS. It is used to establish the relationship between training trades and employability, age group and employability and income group of the beneficiaries’ households, and their employability after completing the different technical and vocational training pieces. Results showed that around 35% of the selected women were ever employed after getting the training while significant relationships among the variables also resulted. It has been proven that the importance of technical and vocational training programs cannot be falsified. However, proper selection criteria must be followed, and only severe and needy beneficiaries should be selected through proper assessment. Need assessments for the training programs should be carried out while efforts for achieving employment as an outcome of such training programs are mandatory.

The Impact of Plastic Surgery Training on Family Planning and Prenatal Health.

Plastic surgery trainees who wish to start a family face challenges. This is the first study to collect data directly from residents and fellows to understand issues surrounding childbearing and to propose solutions. Following institutional review board approval, an anonymous survey was distributed to all current plastic surgery residents and fellows in the United States. Data regarding demographics, obstetrical complications, parental leave, breastfeeding, and use of assisted reproductive technology were collected. The survey was completed by 307 trainees, for a resident response rate of 27.0 percent. Mean age of the respondents was 31.7 ± 3.8 years, 58.6 percent were married, and 35.3 percent reported at least one pregnancy for themselves or for their partner. Both male (67.4 percent) and female (76.5 percent) respondents intentionally postponed having children because of career. Women were significantly more likely to report negative stigma attached to pregnancy (70.4 percent versus 51.1 percent; p = 0.003) and plan to delay childbearing until after training. Fifty-six percent of female trainees reported an obstetrical complication. Assisted reproductive technology was used by 19.6 percent of trainees. Mean maternity leave was 5.5 weeks, with 44.4 percent taking less than 6 weeks. Mean paternity leave was 1.2 weeks. Sixty-two percent of women and 51.4 percent of men reported dissatisfaction with leave. Sixty-one percent of female trainees breastfed for 6 months and 19.5 percent continued for 12 months. Lactation facilities were available near operating rooms for 29.4 percent of respondents. Plastic surgery training may negatively impact fertility, obstetrical health, and breastfeeding practices. The data presented in this article provide the groundwork for identifying areas of concern and potential solutions.

Integrated Markov chains and uncertainty analysis techniques to more accurately forecast floods using satellite signals

Utilizing the readily available, inexpensive, remotely-sensed satellite data products in combination with Markov Chain methods for estimating water levels and discharge anywhere along the vast river networks around the world is one of the most interesting and promising fields in hydrology. This study presents two new extensions of Markov Chain (MC) methods, namely the Online-Markov Chains (O-MC) and Extreme Online-Markov Chains (EO-MC) methods to improve the prediction accuracy. The O-MC method has the advantage of the online implementation of the correct variable states, and the EO-MC method has the advantage of online updating the Markov Matrix (MM) along with the online implementation of the correct variable states. The new O-MC and the EO-MC methods were evaluated using short-term satellites signal predictions for six different case study rivers. The Monte Carlo uncertainty analysis was used to measure the reliability of the new MC-based methods. Each model was developed 1000 times to calculate two indices, namely the 95 Percent Predicted Uncertainties (95PPU) and average distance factor (d-factor). The performances of MC and two extensions of O-MC and EO-MC were also examined for cases where we lack the training data. The Training Percent (TrPr) of the entire dataset gradually decreased from 90% to 1%, and the performance of the models in producing accurate future signals in the non-observed dataset is calculated. The Input Variable Imitation (IVI) problem was considered for the MC-based methods, and the results were compared with the Linear Regression (LR), Multi-Layer Perceptron (MLP), Extreme Learning Machine (ELM), and Radial Basis Function (RBF) regression methods. The results showed that the performance of EO-MC and O-MC are better than the simple MC method. In addition, it is concluded that EO-MC and O-MC have very similar performance in the uncertainty analysis and both methods are robust techniques. The main advantage of EO-MC compared with the O-MC method is highlighted when the number of training samples are very low. Finally, considering the IVI problem, the new O-MC and EO-MC methods significantly outperformed the LR, MLP, ELM, and RBF methods.

Satisfaction of the Irish Trauma and Orthopaedic training programme with the Intercollegiate Surgical Curriculum Programme

Surgical training has undergone extensive changes in recent years. The Intercollegiate Surgical Curriculum Programme (ISCP) has been utilised in the UK for many years to facilitate the education and assessment of trainees. It was adopted by the Irish Trauma and Orthopaedics (T&O) training programme in July 2015. This study sought to evaluate the use satisfaction with ISCP in the Irish context. A total of 58 T&O trainers and trainees undertook a paper-based survey during national training days in March and April2017. Eighty-nine percent of trainees responded to the survey along with 85% of trainers. Seventy-nine percent of respondents had been using ISCP for over a year. Most aspects of ISPC were rated as average, with the induction process, online multi-source feedback (MSF) and overall user friendliness rating poorly amongst respondents. Seventeen percent felt that ISCP had a positive impact on training, while 66% felt that it did not adversely affect their training opportunities. Forty-three percent reported a negative impact on the trainer-trainee relationship with adoption of ISCP and only 24% felt that the educational feedback was improved with the new system. Forty-two percent agreed that ISCP created a more structured and supervised framework to the training scheme. Our survey demonstrated significant concerns and reservations amongst the Irish users of ISCP. The demonstrable level of trainee dissatisfaction with ISCP may represent a frustration that key problems such as the regulated training content of jobs remains unaddressed while ISCP does little to improve meaningful formative feedback.

Landslide susceptibility delineation in the Ar-Rayth area, Jizan, Kingdom of Saudi Arabia, using analytical hierarchy process, frequency ratio, and logistic regression models

Mountain areas in the southern western corner of the Kingdom of Saudi Arabia (KSA) frequently suffer from various types of landsides induced by rainstorms and anthropogenic activities. To mitigate these problems, landslide susceptibility mapping and classification is important to develop quick and safe mitigation or remediation measures and to help the decision making in future planning by identifying the most vulnerable areas. This paper summarizes the findings of a landslide susceptibility analysis in the Ar-Rayth area, Jizan, KSA, using an analytical hierarchy process (AHP), frequency ratio (FR), and logistic regression (LR) models with the aid of GIS tools and remote sensing data. The landslide inventory map was prepared according to historical data, interpretation of high-resolution satellite images (Geo-Eye 0.5 m resolution and QuickBird 0.6 m resolution), topographic maps (1:10,000), and verified by field investigations. An inventory map with 253 landslides locations was extracted from many sources. The landslide inventory was randomly divided into two datasets: 75 % for training the models and 25 % for validation. An enhanced thematic mapper plus 15 m satellite image acquired in 2006 was used for determining the Normalized Difference Vegetation Index. A contour map (1:10,000 with a 10 m contour interval) was converted to digital elevation model 10 m resolution and subsequently converted to slope, slope aspect, curvature, elevation, and drainage networks. Geological data obtained with the help of satellite images were used to prepare lithological units and lineaments. Roads were digitized from the high-resolution image and a rainfall map was prepared from the rainfall gauges distributed throughout the study area. All these data were used to construct a spatial database using GIS and image processing. Three landslide susceptibility maps were constructed; one on the basis of a heuristic method using an AHP, the other two on the basis of landslide inventories and causative factors, using FR and LR. Furthermore, each causative factor’s weight was determined according to these three models and landslide susceptibility indices were calculated. For verification, receiver operating characteristic curves were calculated and the areas under the curve (AUC) for success rate are 0.755, 0.828, and 0.749 and for prediction rate are 0.708, 0.781, and 0.727 for the AHP, FR, and LR, respectively. In addition, the percentage of existing training landslides data in high and very high zones of the susceptibility maps is of 73.2, 85.31, and 88.59 % and for the validation landslides data is 73.2, 85.31, and 88.59 % for the AHP, FR, and LR, respectively. The findings indicated that the values of AUC are above 0.7 for both success and prediction rate which indicate these three models are suitable for susceptibility analysis. Also, percent of training and validation landslides data of high and very high zones indicate that LR model is more accurate followed by FR model and AHP model.

Board 243 - Program Innovations Abstract Acute Blood Loss - Hemorrhagic Shock

Introduction/Background Despite the fact that the modern 3D simulators have basic scenarios of acute blood loss, adaptation of the scenarios to specialization of trainees and increase of realism are necessary. Methods “Acute blood loss- hemorrhagic shock” is developed and used by trainees at MSC of Siberian State Medical University. The scenario consists of sections such as: 1) Skills - collection of information (documents, personnel of ambulance and hospital department, other information source); patient assessment; monitoring (heart rate, pulse, blood pressure, auscultation of the lungs etc.) diagnosis; sequence of actions, efficiency assessment of therapy; 2) Information for an assistant: a) preparation of manikins (Susie S2000, Hal S3000 or Noelle S575, choice of manikin depends on specialization of trainees). The assistant has to fill the venue system and bladder, to lubricate the manikin’s airway and urethra; b) preparation of medical equipment and instruments for the scenario (stethoscope, blood pressure cuff, sets for airway management, ventilators, oxygen and ways of delivery, patient monitors, perfusors, vacuum suction, etc.); c) preparation of special materials (bandages, gloves, antiseptic, systems for intravenous infusion, nasogastric probe, Blackmor’s probe, urinary catheters, syringes, infusion solutions, containers with blood, albumin, epinephrine and other drugs). Vials of distilled water are used instead of real drugs. To achieve maximum realism during simulations colorants are added into the vials (if necessary) and labels are stuck; 3) Guide for operator (description of simulation process): a) stages of the scenario (the physiological parameters of a patient-simulator: respiratory pattern and rate, rhythm, heart rate, temperature, blood pressure, cyanosis and other); b) duration of stages; c) the variety of transition to next stage. Clinical parameters of the simulator, described by qualified doctors (expert), are based on guidelines. Scenario consists of several clinical stages: 1 = Normal state, 2 = Acute blood loss (Hypovolemya), 3 = Shock Compensation, 4 = Shock Decompensation, 5 = Agony, 6 = Asistolia, 7 = Stabilization of the state (level 1), 8 = Stabilization of the state (level 2), 9 = Persistently stabilized patients state or patient’s death. Correct conducting of diagnosis and therapy leads to stabilization on any stages of the scenario. Number of required actions to help depends on the patient state (scenario stage). Incorrect conducting of diagnosis and therapy leads to death of the patient (robot simulator). Variants of scenario development: a) preoperative preparation and examination; b) postoperative intensive care; c) conservative therapy, if there is no indication for surgery. Transition to the next stage is implemented automatically or by operator (according to manipulations of trainees). Therefore, an operator has to know the clinical pattern of diseases and to be able to evaluate trainees manipulations; 4) Information for trainees (briefing). To motivate trainees, three variants of the scenarios are developed (for surgeons, internists and obstetricians); 5) Additional information (analysis Results, X-ray and ultrasound investigations, etc.) is given to trainees on request. During simulation audio video control is conducted. Moreove,r there is a checklist for every trainees group wherethe trainer notes duration of decision making, performing of manipulations, drugs and its doses (in obedience to National Standards). The checklist is used for debriefing, then trainees have opportunities of retraining. Results: Conclusion Basic scenarios require adaptation to trainee’s specialization. It is necessary to describe participant’s duties in details for preparation of simulation. Use of real medical equipment of ICU and drug imitation are provided to add realism of simulation training. Special clinical training of simulation operator (engineer) is necessary. Scenarios should be created by qualified doctors (expert). Audio-video control and checklist make debriefing more reasonable. Ninety two percent of trainees that studied at MSC of Siberian State Medical University in 2012 (n=458), gave a positive assessment of scenarios. Disclosures None.

What do surgical trainees think about patient safety culture, and is this different from their consultants?

Introduction Little is known about the patient safety culture within surgical departments in UK hospitals. What has been done to date is to survey only permanent senior staff opinion of the safety culture in their institution. This study surveyed both consultant and trainee views on perceived patient safety and compared the results between these two groups. Material and methods The previously validated Team Work and Safety Climate Questionnaire was configured in Survey Monkey format and sent to all surgical trainees and consultant surgeons in the South West Strategic Health Authority. Two reminders were sent to achieve as high a return rate as possible. Results Two hundred and ninety-six replies were received. Forty-four percent of trainees and 30% of consultants responded to the survey. Consultants consistently rated a higher safety culture than surgical trainees. Only 2.9% of trainees believe their patient safety concerns would be acted upon by hospital management. There is notable variation in perceived patient safety culture between hospitals. Conclusion This study has suggested that the patient safety culture in hospitals, within a Strategic Health Authority, is variable and sub-optimal when viewed by surgical trainees and their consultants. This study also provides some evidence that the perception of patient safety in an organization varies according to clinical experience. As trainees deliver a great deal of clinical care, surveys of safety culture should include this group. As perceived patient safety culture is correlated to clinical outcomes, validated safety surveys might form part of the assessment of a hospital's performance, along with outcome and patient satisfaction.

The attitudes of British surgical trainees about the treatment of HIV-infected patients

As the incidence of HIV increases, the occupational risk of human immuno deficiency virus (HIV) infection also increases, leading to heightened anxiety within surgical practice. This study assessed the attitudes of surgeons treating HIV-infected patients. Seventy surgical trainees working in two district general hospitals were requested to complete a survey assessing their attitudes regarding the surgical management of HIV-infected patients. A needle-stick injury was reported by 64% of the trainees. Fifty-four percent of trainees were concerned about acquiring HIV from patients when performing a surgical procedure. There was a significant difference between the number of trainees worried about treating a patient with HIV and the number of trainees wearing eye protection when performing invasive procedures (p < 0.002). Eighty-six percent of trainees were confident they could treat HIV patients safely, but only 63% were aware of the hospital protocol for needle-stick injuries. There appears to be increasing concern among surgical trainees about carrying out surgical procedures on HIV-infected patients. Despite equipment being fully available, many trainees are not considering the full use of protective theatre garments to minimize the risk of HIV contamination. Further education and training is required to stress the importance of the increasing HIV prevalence and the need for safety during surgical practice.

Unexpected Collateral Effects of Simulation-Based Medical Education

Internal medicine residents who complete simulation-based education (SBE) in central venous catheter (CVC) insertion acquire improved skills that yield better patient care outcomes. The collateral effects of SBE on the skills of residents who have not yet experienced SBE are unknown. In this retrospective, observational study, the authors used a checklist to test the internal jugular and subclavian CVC insertion skills of 102 Northwestern University second- and third-year internal medicine residents before they received simulation training. The authors compared, across consecutive academic years (2007-2008, 2008-2009, 2009-2010), mean pretraining scores and the percent of trainees who met or surpassed a minimum passing score (MPS). Mean internal jugular pretest scores improved from 46.7% (standard deviation = 20.8%) in 2007 to 55.7% (±22.5%) in 2008 and 70.8% (±22.4%) in 2009 (P < .001). Mean subclavian pretest scores changed from 48.3% (±25.5%) in 2007 to 45.6% (±31.0%) in 2008 and 63.6% (±27.3%) in 2009 (P = .04). The percentage of residents who met or surpassed the MPS before training for internal jugular insertion was 7% in 2007, 16% in 2008, and 38% in 2009 (P = .004); for subclavian insertion, the percentage was 11% in 2007, 19% in 2008, and 38% in 2009 (P = .028). SBE for senior residents had an effect on junior trainees, as evidenced by pretraining CVC insertion skill improvement across three consecutive years. SBE for a targeted group of residents has implications for skill acquisition among other trainees.

Associations between quality indicators of internal medicine residency training programs.

BackgroundSeveral residency program characteristics have been suggested as measures of program quality, but associations between these measures are unknown. We set out to determine associations between these potential measures of program quality.MethodsSurvey of internal medicine residency programs that shared an online ambulatory curriculum on hospital type, faculty size, number of trainees, proportion of international medical graduate (IMG) trainees, Internal Medicine In-Training Examination (IM-ITE) scores, three-year American Board of Internal Medicine Certifying Examination (ABIM-CE) first-try pass rates, Residency Review Committee-Internal Medicine (RRC-IM) certification length, program director clinical duties, and use of pharmaceutical funding to support education. Associations assessed using Chi-square, Spearman rank correlation, univariate and multivariable linear regression.ResultsFifty one of 67 programs responded (response rate 76.1%), including 29 (56.9%) community teaching and 17 (33.3%) university hospitals, with a mean of 68 trainees and 101 faculty. Forty four percent of trainees were IMGs. The average post-graduate year (PGY)-2 IM-ITE raw score was 63.1, which was 66.8 for PGY3s. Average 3-year ABIM-CE pass rate was 95.8%; average RRC-IM certification was 4.3 years. ABIM-CE results, IM-ITE results, and length of RRC-IM certification were strongly associated with each other (p < 0.05). PGY3 IM-ITE scores were higher in programs with more IMGs and in programs that accepted pharmaceutical support (p < 0.05). RRC-IM certification was shorter in programs with higher numbers of IMGs. In multivariable analysis, a higher proportion of IMGs was associated with 1.17 years shorter RRC accreditation.ConclusionsAssociations between quality indicators are complex, but suggest that the presence of IMGs is associated with better performance on standardized tests but decreased duration of RRC-IM certification.

Electroconvulsive Therapy Training and Confidence in Administration

: As the lack of on-site electroconvulsive therapy (ECT) facilities in many psychiatric hospitals in Ireland may impact negatively on ECT training, we conducted a national survey of trainees with the aims of establishing the current standard of ECT training and to assess trainees' confidence in their abilities in ECT administration. : A national postal survey of 415 trainees was conducted in September 2008 using a self-designed 15-item questionnaire for the purpose of the study, containing no identification data and incorporating relevant questionnaire items from similar published trainee survey. Reminders were distributed to the entire study sample 4 weeks afterward within a sampling time frame of 3 months. Trainee responses were coded and converted to anonymized data, which the lead author held. : The overall response rate was 61%. Ninety-one percent of trainees had worked in ECT centers, of which 36% had given ECT on an occasion without direct consultant supervision. Overall, 12% of trainees had never administered or observed ECT, which includes 2 trainees on the national senior registrar scheme, and 19% of trainees had nil or minimal confidence in their ability to administer ECT. : Our findings indicate deficiencies in training and supervision, which is reflected in the proportion of trainees reporting nil or minimal confidence in their ability to administer ECT. Greater collaboration between training scheme coordinators, clinical tutors, and the College of Psychiatry of Ireland is essential to ensure ongoing monitoring and implementation of standards.

Gastroenterology trainees' views on educational supervisors: do they fulfil their role?

IntroductionSince January 2010 all educational supervisors in London must be accredited for their role against a set of mandatory requirements developed by the London Deanery. The aim of this study...

Clinical psychology trainees' research productivity and publications: An initial survey and contributing factors

AbstractClinical psychology research productivity is an issue of great professional concern. The current paper explores the rate and nature of trainee publication of research projects in peer‐reviewed journals, together with reasons likely to be relevant to its success and failure. Twenty‐one out of 28 courses responded to a survey composed of closed and open‐ended questions. Data were analysed using inferential statistics and content analysis. Twenty‐four percent of trainees in any one cohort during the period 1999–2004 successfully wrote up their research for publication. Most publications were in psychology journals with modest but respectable impact factors. The most important theme thought to be related to success was supervisor factors, followed by trainee factors, general course factors, study characteristics and the demands of a new job following qualification. Recommendations to enhance publication success are made within the context of a broader discussion of the importance of facilitating the development of the new generation of clinical psychology researchers. Copyright © 2007 John Wiley &amp; Sons, Ltd.