Consultant Supervision Research Articles

Comparison of the Consultative Supervision Implementation among the Metropolitan and Provincial Offices of Education

Comparison of the Consultative Supervision Implementation among the Metropolitan and Provincial Offices of Education

Identifying the Learning Curve for Uterine Artery Embolisation in an Interventional Radiological Training Unit.

A clear understanding of operator experience is important in improving technical success whilst minimising patient risk undergoing endovascular procedures, and there is the need to ensure that trainees have the appropriate skills as primary operators. The aim of the study is to retrospectively analyse uterine artery embolisation (UAE) procedures performed by interventional radiology (IR) trainees at an IR training unit analysing fluoroscopy times and radiation dose as surrogate markers of technical skill. Ten IR fellows were primary operator in 200 UAE procedures over a 5-year period. We compared fluoroscopy times, radiation dose and complications, after having them categorised according to three groups: Group 1, initial five, Group 2, >5 procedures and Group 3, penultimate five UAE procedures. We documented factors that may affect screening time (number of vials employed and use of microcatheters). Mean fluoroscopy time was 18.4 (± 8.1), 17.3 (± 9.0), 16.3 (± 8.4) min in Groups 1, 2 and 3, respectively. There was no statistically significant difference between these groups (p > 0.05) with respect to fluoroscopy time or radiation dose. Analysis after correction for confounding factors showed no statistical significance (p > 0.05). All procedures were technically successful, and total complication rate was 4%. UAE was chosen as a highly standardised procedure followed by IR practitioners. Although there is a non-significant trend for shorter screening times with experience, technical success and safety were not compromised with appropriate Consultant supervision, which illustrates a safe construct for IR training. This is important and reassuring information for patients undergoing a procedure in a training unit.

The Structural Relationship of the Factors that Influence Effectiveness of Consultative Supervision

The Structural Relationship of the Factors that Influence Effectiveness of Consultative Supervision

Features of residency training and psychological distress among residents in a Nigerian teaching hospital

<p><strong>Background.</strong> Resident doctors at University College Hospital (UCH), Ibadan, Nigeria, made a series of complaints about inadequate con­sultant supervision, lack of structure in the training programme and excessive workload. These complaints led to an evaluation of residency training. </p><p><strong>Objective. </strong>To investigate perceptions of the residency training programme and levels of psychological distress among residents.</p><p><strong>Methods.</strong> All 250 resident doctors at UCH were invited to complete questionnaires about their residency training and general health as part of a cross-sectional study. Data were analysed using SPSS 16. </p><p><strong>Results.</strong> A total of 128 residents (51.2%) responded to the questionnaire. Of the respondents, 72% rated their consultant supervision as good and 82.6% rated support from nurses as good; 61.8% had <5 hours of formal educational activities and 65.1% had <5 hours of research or private study per week. There was evidence of psychological distress in 48.4% of the respondents, and there was a significant association between psychological distress and the intensity of work (<em>p</em><0.01). </p><p><strong>Conclusion.</strong> The residency training programme at UCH appears to prioritise service provision over research and education activities. Residents who report high workloads also have high levels of psychological distress. Tackling these issues could improve overall satisfaction with residency training and reduce complaints. </p><div> </div>

Features of residency training and psychological distress among residents in a Nigerian teaching hospital

Background. Resident doctors at University College Hospital (UCH), Ibadan, Nigeria, made a series of complaints about inadequate con­sultant supervision, lack of structure in the training programme and excessive workload. These complaints led to an evaluation of residency training. Objective. To investigate perceptions of the residency training programme and levels of psychological distress among residents. Methods. All 250 resident doctors at UCH were invited to complete questionnaires about their residency training and general health as part of a cross-sectional study. Data were analysed using SPSS 16. Results. A total of 128 residents (51.2%) responded to the questionnaire. Of the respondents, 72% rated their consultant supervision as good and 82.6% rated support from nurses as good; 61.8% had <5 hours of formal educational activities and 65.1% had <5 hours of research or private study per week. There was evidence of psychological distress in 48.4% of the respondents, and there was a significant association between psychological distress and the intensity of work ( p <0.01). Conclusion. The residency training programme at UCH appears to prioritise service provision over research and education activities. Residents who report high workloads also have high levels of psychological distress. Tackling these issues could improve overall satisfaction with residency training and reduce complaints.

Limited weekend cover has led to concerns over junior doctors’ training, says NHS chief

A lack of consultant supervision at weekends has led to concerns about junior doctors’ training, the national medical director of NHS England has said. Addressing junior doctors at an Agents for Change event in London on Friday, Bruce Keogh said that he was concerned about the way the NHS ran at weekends. He said, “Many of you will know that I have raised a debate over the last couple of …

Consultant supervision of trainees seeing inpatient ward referrals – a cause for concern?

The adequate supervision of trainee doctors seeing ward referrals is critical to the quality of patient care and medical training. This survey assessed the level and nature of supervision of trainees in neurology and comparable specialities. 123 neurology specialty registrars from nine deaneries across the UK and 81 dermatology, rheumatology and infectious disease specialty registrars from the London deanery completed the survey. Only 11% of first year neurology and 21% of first year non-neurology registrars reported that the most common method of supervision when seeing ward referrals was for consultants to see ward referrals with them. The remaining first year neurology and non-neurology registrars reported being primarily supervised by discussing cases with consultant (62% and 37% respectively) or being asked to contact a consultant if help was needed (35% and 42% respectively). The lack of adequate supervision of junior trainees seeing ward referrals has significant implications for both patient safety and training.

E learning in surgery.

E learning means use of electronic media and information technologies in education. Virtual learning environment (VLE) provides learning platforms consisting of online tools, databases and managed resources. This article is a review of use of E learning in medical and surgical education including available evidence favouring this approach. E learning has been shown to be more effective, less costly and more satisfying to the students than the traditional methods. E learning cannot however replace direct consultant supervision at their place of work in surgical trainees and a combination of both called blended learning has been shown to be most useful. As an example of university-based qualification, one such programme is presented to clarify the components and the process of E learning. Increasing use of E learning and occasional face to face focussed supervision by the teacher is likely to enhance surgical training in the future.

컨설팅장학 활성화를 위한 세종특별자치시교육청 역할의 중요도-실행도 매트릭스 분석

컨설팅장학 활성화를 위한 세종특별자치시교육청 역할의 중요도-실행도 매트릭스 분석

G199(P) Implementation of a Peer-Led Practice OSCE examination for Paediatric Medical Students at a busy Major Acute Trust

AimsPeer-graded practice examinations can help medical students to achieve higher results in their final exams,1 and peer-led exam revision courses have demonstrated high levels of satisfaction.2,3 Surveys show that the...

G277(P) Implementation of a Peer-Led Practice OSCE examination for Paediatric Medical Students at a busy Major Acute Trust

AimsPeer-graded practice examinations can help medical students to achieve higher results in their final exams (1), and peer-led exam revision courses have demonstrated high levels of satisfaction (2,3). Surveys show...

Evaluating trainee experience of surgical skills teaching

Introduction: Operating theatres are a crucial learning environment for trainee surgeons developing surgical skills. There is no structured framework for teaching during surgery or its evaluation. Objective assessment of the learning experience can assess quality and highlight areas for improvement, maximizing benefit. Methods: A 5-point Likert rating scale was devised to assess surgical teaching experience. Positive and negative teaching attributes were established with a literature review and interviews of trainees and teachers. Sixty surgical trainees at a major London teaching hospital, operating under consultant supervision, evaluated the supervisor teaching using the tool. Significance of test results from the assessment tool was analysed using repeated measures analysis of variance for Likert scoring. A P value 50.05 was considered statistically significant. Results: There was consensus between trainees on the relevance of tool themes, with most ranked important or absolutely essential and no difference across grades (P5 0.05). There was no difference in the overall supervisor scores between trainees with different levels of experience (P5 0.05) or between procedures with different levels of complexity (P5 0.05). Junior supervisors scored more highly overall than senior supervisors (P = 0.024). Discussion: The study demonstrated that the assessment tool is feasible, practical and applicable, with face and content validity. Discrimination between supervisors with different levels of experience shows discriminative validity. The tool facilitates objective assessment of the teaching experience in surgery. We hope this will aid improvements in teaching quality, an area for further study.

P71 Training of junior doctors into thoracic ultrasound and pleural procedures–impact of a dedicated respiratory consultant –supervised advanced nurse practitioner-supported session

The BTS made recommendations on pleural services. In order to stream-line the elective pleural procedures (other than thoracoscopy) a mid-week session was initiated on the pleural unit at a teaching...

ARE NEUROLOGY TRAINEES ADEQUATELY SUPERVISED WHEN SEEING IN–PATIENT WARD REFERRALS?

ObjectivesTo investigate–1. How neurology speciality registrars are supervised when seeing in–patient ward referrals.2. To see if supervision differs in different regions within Great Britain.3. To compare the supervision of neurology...

The Western Australian Audit of Surgical Mortality: outcomes from the first 10 years

The Western Australian Audit of Surgical Mortality (WAASM) is an external, peer-reviewed audit of all deaths that occur in hospital of patients under the care of a surgeon. We conducted a retrospective analysis of prospective audit data collected from 1 January 2002 to 31 December 2011. The annual number of deaths peaked in 2006, then fell 22% by 2011. After correcting for population growth, the overall reduction from 2002 to 2011 was 30% (regression analysis, P = 0.002). Some changes in practice, such as with pancreatic surgery, can be directly attributed to WAASM. There is strong evidence to suggest that WAASM improved other aspects of care, such as thromboembolic prophylaxis, consultant supervision and fluid management. A shift of high-risk patients to teaching hospitals, where there is a greater ability to "rescue" patients after complications, may have been an important factor in improved outcomes. This external, peer-reviewed mortality audit has changed surgical practice and reduced deaths. The same process should be applied to other sentinel events, and the lessons learned can also be extended to non-surgical specialties.

Perioperative compliance with VSGBI quality improvement framework for major limb amputations in a single vascular centre

Perioperative compliance with VSGBI quality improvement framework for major limb amputations in a single vascular centre

SOMATOPHYCHIC DISTURBANCES IN DEPRESSIVE AND ANXIETY DISORDERS

The article presents the clinical analysis of 181 patients with depressive and anxiety disorders associated with pathologic bodily sensations under consultative supervision. It covers the structure of sensopathy, its pathogenetic features, singles out the phenomelogical variants for diagnostical optimization. The conceptual notion about the vital nature of pathologic bodily sensations and its relation to somatopsychic disorders is being specified.

Intraoperative Radiation Use by Trainees During Ankle Fracture Fixation

Orthopedic trainees are assessed during training regarding their use of radiological screening during operative procedures. The authors investigated whether orthopedic trainees' use of fluoroscopic screening during ankle fixation operations varied with the 2 variables of consultant supervision and trainee experience. Data from operative fixation of isolated Weber B ankle fractures were reviewed. The intraoperative radiation dose was retrieved from radiographers' data. Operations performed by consultants were used as a control group (n=25 patients). Trainee supervision was assessed as "trainer in operating room (OR)" and "trainer out of OR." Regarding experience, the patients were divided into those operated on primarily by trainees in their first (n=36 patients) and in their last (n=34 patients) 3 years of formal specialist training. All trainee groups used more radiation than consultants. Supervision did not affect the radiation use of senior trainees (P<.05). Senior trainees used less radiation than their junior peers (P<.02). Junior trainees supervised by a trainer in the OR used less radiation than junior trainees supervised by a trainer outside of the OR (P<.05). During open reduction and internal fixation of ankle fractures, junior orthopedic trainees use less intraoperative radiation when they are supervised by a trainer in the OR. The more experience a surgeon has, the less fluoroscopic screening is used during operative ankle fixation.

세종특별자치시교육청 컨설팅장학 활성화 방안 탐색

세종특별자치시교육청 컨설팅장학 활성화 방안 탐색

Inaccuracy of the AO Expert Lateral Femoral Nail recon jig: A case series

IntroductionIntra-medullary nail fixation is a standard treatment for many proximal femoral fractures. The AO Expert Lateral Femoral Nail (ELFN) is a typical example of such a device and uses a jig to assist the surgeon accurately place the proximal screws. We present a series of six cases where this jig allowed the screws to miss the nail. This serious complication can easily be missed even with intra-operative radiography. Our series highlights the need for accurate radiography and vigilance when using jigs in femoral nails. MethodsBetween November 2011 and August 2012, the AO ELFN was used for eleven patients in a level II trauma centre. In nine cases the indication was a subtrochanteric fracture with two cases of prophylactic nailing for metastatic disease.We retrospectively reviewed the notes of patients identified from our theatre register. Data recorded included – mechanism of injury, indication, grade of operating surgeon and whether or not there was consultant supervision. The radiographic records were also assessed. The cases included seven different surgeons with four different consultants present. More than one ELFN jig was used. ResultsThe Aiming arm for the proximal (recon) screws was found to have missed the nail in six cases (54.5%). All of these cases were discovered during intra-operative radiography. This inaccuracy was only visible on true lateral X-ray screening. AP radiographs appeared normal. ConclusionsIn our series the Aiming arm for the proximal screws of the ELFN was inaccurate in a high proportion of cases. This serious complication can easily be missed even by experienced surgeons. The operating surgeon must recognize the potential for jigs to be inaccurate even for proximal screws. Meticulous bi-planar imaging and experience with this particular implant are important for precise and safe insertion.