Registrar Training Research Articles

John Emile Cosnett

John Emile Cosnett did his registrar training in medicine at the University of Natal and then moved to Edendale Hospital in Pietermaritzburg as head of the medicine department. He stayed...

The National Database of Hospital-based Cancer Registries: A Nationwide Infrastructure to Support Evidence-based Cancer Care and Cancer Control Policy in Japan

Monitoring the current status of cancer care is essential for effective cancer control and high-quality cancer care. To address the information needs of patients and physicians in Japan, hospital-based cancer registries are operated in 397 hospitals designated as cancer care hospitals by the national government. These hospitals collect information on all cancer cases encountered in each hospital according to precisely defined coding rules. The Center for Cancer Control and Information Services at the National Cancer Center supports the management of the hospital-based cancer registry by providing training for tumor registrars and by developing and maintaining the standard software and continuing communication, which includes mailing lists, a customizable web site and site visits. Data from the cancer care hospitals are submitted annually to the Center, compiled, and distributed as the National Cancer Statistics Report. The report reveals the national profiles of patient characteristics, route to discovery, stage distribution, and first-course treatments of the five major cancers in Japan. A system designed to follow up on patient survival will soon be established. Findings from the analyses will reveal characteristics of designated cancer care hospitals nationwide and will show how characteristics of patients with cancer in Japan differ from those of patients with cancer in other countries. The database will provide an infrastructure for future clinical and health services research and will support quality measurement and improvement of cancer care. Researchers and policy-makers in Japan are encouraged to take advantage of this powerful tool to enhance cancer control and their clinical practice.

John Emile Cosnett

John Emile Cosnett did his registrar training in medicine at the University of Natal and then moved to Edendale Hospital in Pietermaritzburg as head of the medicine department. He stayed for some 20 years, providing both high level service and valuable guidance and training for aspiring physicians. John then decided to concentrate on …

Squaring the Circle: Registrar Training and Experience in an EWTR - Compliant Rota

The European WorkingTime Regulations (EWTR) have been introduced over the past five years despite opposition from the surgical community. The stated aim of EWTR-compliant rotas for all staff is to reduce fatigue by having adequate rest periods and shorter working time, thereby improving patient safety as well as work–life balance. Concerns have been voiced that reduction in working periods for trainee surgeons will impair surgical experience and continuity of care for patients.

Pre-operative testing for pregnancy in Dublin Day Surgery Units

The safety of anaesthetic agents in early pregnancy cannot be guaranteed. Certain types of surgery, particularly gynaecological, may also be dangerous. It is therefore important to ensure that, female patients are not inadvertently pregnant when undergoing elective surgery. Different hospitals have different policies and guidelines in place to determine female patients' pregnancy status prior to elective surgery. This study aims to evaluate practices in Ireland with regard to methods used to exclude pregnancy in premenopausal women attending for day surgery. Postal questionnaires were sent to all consultants in Gynaecology and General Surgery. E-mail questionnaires were sent to all registrar trainees in both specialties. Letters were sent to nine Dublin teaching hospital day surgery units and followed up by telephone consultations. The overall response rate was poor at 34.3 %. Eighty per cent of respondents in the gynaecology specialty have encountered a preoperative patient with a positive pregnancy test at least once during their career versus 28.6 % in the surgical specialty. Only 35 % of gynaecology respondents would routinely inform female reproductive age patients of the need to avoid pregnancy prior to surgery versus 14.3 % in the surgical specialty. On the day of elective surgery, 90 % of gynaecologists would determine the LMP (last menstrual period) versus 35.7 % of surgeons. The policy at all nine Dublin teaching hospitals is to perform a urinary HCG preoperatively but, their policies vary as to whether the patient's LMP, age and medical history are considered when performing a urinary HCG test. It is important that, female patients are counselled appropriately regarding the importance of using adequate contraception or, abstinence in order to avoid pregnancy prior to elective surgical procedures. Our survey shows that, gynaecologists are more likely to give this advice compared to our surgical colleagues. Nevertheless, the number of gynaecologists who do this is surprisingly low (35 %). Urinary HCG is still the standard test used in most units to exclude pregnancy.

Integrating recovery-oriented practice into psychiatric registrar training

This paper describes a new initiative in training for psychiatry trainees in the 'recovery' paradigm. Supporting patients in their personal recovery and promoting wellbeing has become a key principle in the delivery of specialist mental health services. This requires psychiatrists to develop (or perhaps return to) a worldview that promotes a hopeful stance and acknowledges the importance of relationships when working with people experiencing mental ill health. In 2011, the authors developed and trialed training about personal recovery and wellbeing within psychiatry. A crucial factor was that the training was delivered by a person who has expertise both as a result of their own recovery journey and their experience in peer support work. The feedback from participants has supported further national and international developments and there are plans to extend this component of the program.

Impact of introducing consultant resident on-call in a District General Hospital

Introduction of structured competency-based training for specialty registrars and implementation of European Working Time Directives (EWTD) have affected the quality of maternity care. In York District Hospital, consultant resident on-call (CRO) without registrar cover was introduced in July 2010 to address the long-standing problem of middle-grade out-of-hours coverage. To examine the impact of introducing out-of-hours consultant resident on-call on maternity care, data from 486 deliveries including 59 CRO and 59 registrar shifts were collected retrospectively, from July 2010 to April 2011. Main outcome measures include mode of delivery, second-stage management, maternal and neonatal outcomes. Feedback from consultants, junior trainees and midwives on the impact of CRO were collated through semi-structured interviews. More normal vaginal deliveries (71.8% vs 63.0%) and fewer emergency caesarean sections (12.5% vs 20.6%) were performed in the CRO shifts compared with registrar on-call. Instrumental delivery rates in labour rooms vs theatre were higher when compared with the registrar group. Overall, good patient and staff experience was reflected during interviews. Our work shows that introduction of CRO in out-of-hours settings is acceptable among staff and is associated with fewer obstetric interventions. However, improved job descriptions may be needed in order to make the CRO post more attractive.

Capacity building in emergency care: An example from Madang, Papua New Guinea

Divine Word University (DWU) is an emerging national university of Papua New Guinea (PNG) based in the provincial capital of Madang, providing training for Health Extension Officers (HEOs). HEOs form the backbone of healthcare delivery in PNG as clinicians, public health officers and health centre managers. Both campus-based and clinical teaching at the nearby Modilon Hospital is limited because of significant resource constraints. This article describes a visiting clinical lecturer programme in which Australasian emergency physicians and emergency registrars deliver teaching to HEO students at DWU and Modilon Hospital. Volunteer doctors are briefed pre-departure and given prepared educational tools. Visits are from 2 weeks to 3 months, and include the possibility of accredited training for emergency registrars through the Australasian College for Emergency Medicine. DWU provides secure accommodation and assistance with travel and visa logistics. Tasks for visiting lecturers include delivering campus-based teaching on emergency medicine (EM) topics, structured and opportunistic bedside tutorials, and clinical teaching and assistance with ED care alongside local EM clinicians. Programme evaluation has relied on qualitative feedback, which has been positive from all stakeholders. Visiting lecturers gain teaching skills and insights into the challenges of emergency healthcare delivery in an international, resource-constrained setting. Local staff receive assistance and support as well as learning new teaching skills. Students receive increased interactive learning opportunities. This programme provides positive models of both emergency care capacity building in a resource-constrained setting and training in international EM for Australasian clinicians.

It's all changed

In conversation with colleagues at the 2012 Family Practitioners Conference, I learned that in South Africa, family medicine has been completely transformed and is now aligned with the needs of the people of sub-Saharan Africa. The family physician is now the African family physician (AFP) 1 and has a job description in accordance with the primary healthcare approach. My colleagues were keen to impress on me just how different things are now: “It’s all changed,” said one. “It’s different now,” said another, referring to registrar training, while in a workshop, a third declared that “Family medicine got it wrong”. Affronted by such summary relegation to family medicine’s Jurassic Park, I looked into some of these changes. 2

General practitioner registrars’ experiences of multisource feedback: a qualitative study

To explore the experiences of general practitioner (GP) specialty training registrars, thereby generating more understanding of the ways in which multisource feedback impacts upon their self-perceptions and professional behaviour, and provide information that might guide its use in the revalidation process of practising GPs. Complete transcripts of semi-structured, audio-taped qualitative interviews were analysed using the constant comparative method, to describe the experiences of multisource feedback for individual registrars. Five GP registrars participated. The first theme to emerge was the importance of the educational supervisor in encouraging the registrar through the emotional response, then facilitating interpretation of feedback and personal development. The second was the differing attitudes to learning and development, which may be in conflict with threats to self-image. The current RCGP format for obtaining multisource feedback for GP registrars may not always be achieving its purpose of challenging self-perceptions and motivating improved performance. An enhanced qualitative approach, through personal interviews rather than anonymous questionnaires, may provide a more accurate picture. This would address the concerns of some registrars by reducing their logistical burden and may facilitate more constructive feedback. The educational supervisor has an important role in promoting personal development, once this feedback is shared. The challenge for teaching organisations is to create a climate of comfort for learning, yet encourage learning beyond a 'comfort zone'.

Need for training in clinical research for postgraduate trainees

Objectives: Postgraduate training programme leading to MD (Medicine) encourages trainees to do research during their training period and a research project is a mandatory component for senior registrar training period in General Medicine. Postgraduate trainees’ perceptions towards clinical research and factors associated with their enthusiasm to participate in research were assessed in the present study. Method: A self administered questionnaire was sent to 110 trainees between March 2011 and June 2011 to collect descriptive data on resources available for research, perceptions and research productivity. Results: Response rate was 72%. Of the senior registrars, 71% were of the view that the research should be a mandatory component in training programme. Non availability of a research curriculum and lack of financial support were the two main institutional barriers to undertaking research identified by the trainees. Lack of time due to heavy clinical commitments and inadequacy of research training were identified as the two main personal obstacles. The opportunities for trainees to receive formal training and the research productivity were found to be inadequate. Conclusions: In order to achieve maximum benefits from the research component, it should be supported with a formal training in research, research curriculum, protected time and good mentorship. DOI: http://dx.doi.org/10.4038/jccp.v42i1-2.4549 Journal of the Ceylon College of Physicians, 2011, 42 , 16-20

King’s Fund management course for specialist trainee registrars in diabetes and endocrinology

The King’s Fund management course for specialist trainee registrars in diabetes and endocrinology is considered the gold standard for diabetologists because it is designed to cover management and leadership issues specific to the specialty. It was introduced three years ago with the blessing and positive feedback of diabetes and endocrinology consultants. The course is intended for diabetes and endocrinology specialist trainee registrars in their final year of training to equip them with leadership and management skills before they become consultants. I attended the course to develop the leadership and management skills that will be expected of me as a consultant in the health service. I was also interested to know more about personality types, team working, and microfinance …

Experience of a trainee in palliative medicine in a resource limited hospital PC setting

IntroductionPalliative Care was introduced to Uganda in 1993, with the development of Hospice Africa Uganda providing a clinical service together with education and research. Palliative medicine Specialist Registrars have been...

Editorial introductions

Editorial introductions

Editorial introductions

Editorial introductions

Training and assessment in practice (TAIP)

The training and assessment in practice (TAIP) course has been developed by the Royal College of Surgeons of England for trainers, including programme directors, assigned educational supervisors, and clinical supervisors, to understand the current training and assessment of trainee specialty registrars (such as core surgical trainees and foundation year doctors). The course is designed to integrate the changes in the training and assessment system into everyday practice. Surgical specialty registrars level 5 to 8 and consultant surgeons. It was a unique opportunity for me to learn about the training and assessment tools used to assess surgical specialty trainees in my daily practice, at the same time as fulfilling my daily duties. In addition it taught me how to use these tools for my own benefit. The faculty consisted of Stella Vig (consultant vascular surgeon and foundation programme director at Mayday University Hospital NHS Trust) and Hayley Allan (course convenor …

Hammersmith interview course

With core medical interviews coming up, I decided to invest in an interview skills course to boost my chances of success. One course that is often talked about is the Hammersmith interview course in London. The testimonials of previous attendants posted on its website, along with the claim that “we are the most experienced interview trainers in the UK,” were enough to persuade me to sign up and pay up. The Hammersmith interview course runs two sessions side by side on the day, one for candidates preparing for consultant interviews and the other for more junior doctors hoping for success at core trainee, specialty trainee, or specialty registrar interviews. The course is held in a …

Skin excisions: Not so simple for the regionally based general surgical trainee

In the regional setting, general practitioners often refer complicated skin excisions to general surgery, whereas in larger centres this is the domain of plastic surgery. General surgical trainees often do not have adequate exposure to complex skin excisions prior to placement in regional centres. To explore what factors affected positive margin rates in surgical registrars in a regional setting. Retrospective audit. Large teaching hospital (referral centre). All skin lesions excised under local anaesthetic by registrars at a single referral centre over a 30-month period from 2007 to mid 2009, of these only basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) were analysed. Registrars excised a total of 703 skin lesions, 314 (43.4%) were BCC or SCC, and of these 50 (15.9%) had positive margins. Repeated measures multivariable logistic regression was performed on relevant data. Surgical registrars had significantly higher positive margin rates when operating unsupervised (P=0.014). Although not significant, there was a tendency for BCC excisions to have positive margins (P=0.059). There was no statistical difference when comparing lesions excised on the head compared to body, use of a graft/flap or registrar training level. This study's positive margin rate of 15.9% falls within the range reported in the literature (0.7% to 20.7%); however, this has the potential to be further reduced. Surgical registrars excising skin lesions in regional centres, regardless of level of training, should have closer supervision. Regular surgical audit should be done so registrars can have early feedback on performance.

CONTENT VALIDATION OF A NOVEL ROBOTIC SURGICAL SIMULATOR

Sir, The article by Seixas-Mikelus et al. [1], regarding content validation of a novel robotic surgical simulator is a timely publication, which has a significant relevance to the training of Specialist Registrars within the UK. Currently in England, there are 22 centres (including private sector) offering Urological Procedures using the da Vinci® Robotic System with at least four more centres in the process of acquiring within the end of this year [2]. Most of these centres are located around the M25 corridor (in and around London), having acquired the da Vinci® system within the last 5 years. Although the urology trainee was exposed to robotic prostatectomy, this was at a price of being the first assistant to the ‘consultant in the learning curve’. Except for a couple, who are in robotic fellowship posts, most of the trainees have hardly had any time on the console. This is despite available evidence that trainees do not negatively impact the institutional learning curve in robot-assisted radical prostatectomy [3]. The lack of console time has been mainly due to absence of robotic surgical simulators or da Vinci® console training programmes available within the teaching curriculum. The lack of a structured teaching programme in the UK to train surgeons to use the robotic system safely and effectively in the treatment of prostate, bladder and renal cancer has recently been highlighted [4]. In the past, consultants and trainees have travelled over-seas for console training and a few have been successful in obtaining a recognised fellowship programme, often supported by charitable organizations [5, 6]. Introduction of robotic surgical simulators such as the Robotic Surgical Simulator (RoSS) described by the authors and locally available Robotically Assisted Surgery Preceptorship Programme, into the curriculum of the higher surgical trainees within the UK will ensure that the future generation of Junior Consultants would be able to confront the technological advances in delivering a world-class service within the NHS [7].

Focused ultrasound training for speciality registrars: a simple solution to curriculum difficulties

It has been recognised that trainees often have difficulty in developing skills in ultrasound scanning additionally there is no established RCOG regime for hands-on training in ultrasonography. Ultrasound skills are...