Training Grades Research Articles

Active vs passive haptic feedback technology in virtual reality arthroscopy simulation: Which is most realistic?

BackgroundVirtual Reality (VR) simulators are playing an increasingly prominent role in orthopaedic training and education. Face-validity - the degree to which reality is accurately represented - underpins the value of a VR simulator as a learning tool for trainees. Despite the importance of tactile feedback in arthroscopy, there is a paucity for evidence regarding the role of haptics in VR arthroscopy simulator realism. PurposeTo assess the difference in face validity between two high fidelity VR simulators employing passive and active haptic feedback technology respectively. Method38 participants were recruited and divided into intermediate and expert groups based on orthopaedic training grade. Each participant completed a 12-point diagnostic knee arthroscopy VR module using the active haptic Simbionix ARTHRO Mentor and passive haptic VirtaMed ArthroS simulators. Subsequently, each participant completed a validated simulator face validity questionnaire. ResultsThe ARTHRO Mentor active haptic system failed to achieve face validity with mean scores for external appearance (6.61), intra-articular appearance (4.78) and instrumentation (4.36) falling below the acceptable threshold (≥7.0). The ArthroS passive haptic simulator demonstrated satisfactory scores in all domains: external appearance (8.42), intra-articular appearance (7.65), instrumentation (7.21) and was significantly (p < 0.001) more realistic than ARTHRO Mentor for all metrics. 61% of participants gave scores ≥7.0 for questions pertaining to haptic feedback realism from intra-articular structures such as menisci and ACL/PCL for the ArthroS vs. 12% for ARTHRO Mentor. There was no difference in face-validity perception between intermediate and expert groups for either simulator (p > 0.05). ConclusionCurrent active haptic technology which employs motors to simulate tactile feedback fails to demonstrate sufficient face-validity or match the sophistication of passive haptic systems in high fidelity arthroscopy simulators. Textured rubber phantoms that mirror the anatomy and haptic properties of the knee joint provide a significantly more realistic training experience for both intermediate and expert arthroscopists.

Choroidal Thickness by Handheld Swept-Source Optical Coherence Tomography in Term Newborns.

PurposeTo describe normative values for choroidal thickness in newborns and characterize their relationship to vitreoretinal features.MethodsTerm newborns underwent awake, handheld swept-source optical coherence tomography (SS-OCT) in this prospective cohort study. An automated segmentation algorithm followed by manual adjustments measured choroidal thickness at the fovea and five perifoveal locations. Two masked, trained graders, with a third mediating disagreements, analyzed scans for vitreoretinal findings. OCT vitreoretinal findings, including dome-shaped macula, subretinal fluid, punctate hyperreflective vitreous opacities, persistent inner retinal layers, foveal ellipsoid zone, tractional and non-tractional vitreous bands, epiretinal membrane, cystoid macular edema, vessel elevation, scalloped retinal layers, hyporeflective vessels, and retinal spaces, were assessed and correlated with foveal choroidal thickness using a generalized linear mixed model.ResultsFifty-nine eyes of 39 infants (mean gestational age, 39.5 weeks; 18 male, 46%) were included. Mean foveal choroidal thickness was 455.5 ± 93.9 µm. Choroid was thinner inferonasally (343.6 ± 106.2 µm) compared to superonasally (368.4 ± 92.9 µm; P = 0.03) and superotemporally (369.6 ± 100.6 µm; P = 0.02). Thinner foveal choroidal thickness was associated with absence of a foveal ellipsoid zone (437.1 ± 78.5 µm vs. 553.7 ± 93.9 µm; P = 0.02). Choroidal thickness was not significantly associated with other OCT findings.ConclusionsWe identified an association between thinner choroid and foveal immaturity. Additional study is needed to determine whether choroidal development impacts visual outcomes.Translational RelevanceHandheld SS-OCT achieved normative measurements for choroidal thickness across the macula in term newborns, providing a foundation for future investigations into the role of choroidal development in infancy.

Polypoidal Choroidal Vasculopathy in Caucasians: Morphological Findings from Multimodal Retinal Imaging

Purpose: The aim of the study was to characterize the morphological features of polypoidal choroidal vasculopathy (PCV) in a large Caucasian population. Methods: We conducteda multicenter, cross-sectional study of treatment-naïve patients with PCV. Baseline fundus photography, spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA) were assessed by trained medical graders. Typical PCV features were explored, and retinal thickness (RT) and choroidal thickness (CT) measurements were performed. Results: Seventy-nine eyes of 73 patients (mean age, 72.6 ± 11.9 years) were included. ICGA identified macular polyps in 89.9% of cases. SD-OCT revealed mostly subretinal fluid (93.6%) and a retinal pigment epithelium (RPE) detachment in 91.4%, with sharp protrusion in 67.0% of cases. Polyp-like structures were seen in 74.3% of cases, mostly adherent to an elevated RPE (69.6%). Type 1 neovascularization (NV) was identified in 74.7% of patients, while 16.5% had a mixed NV. The mean macular CT was 220.9 ± 83.2 μm (range, 67.9–403.6). Diffuse and focal pachychoroid were observed in 26.6 and 30.4% of patients, respectively. Soft drusen were reported in 62.0% of cases, but retinal hemorrhage occurred in only 19.0% of cases. Conclusion: The morphological features of PCV in Caucasians are similar to those reported in Asians. Pachychoroid signs were found in nearly half of our cohort. However, the mean age at presentation, high prevalence of soft drusen, and low prevalence of large subretinal hemorrhages make PCV closer to age-related macular degeneration in this ethnic group.

Exposure to Porphyromonas gingivalis and Modifiable Risk Factors Modulate Risk for Early Diabetic Retinopathy.

PurposeWe hypothesized that exposure to Porphyromonas gingivalis (Pg) increases the risk for early diabetic retinopathy (DR) and that the risk can be modulated.MethodsWe identified 116 early DR cases, and 116 non-DR controls were selected randomly by frequency matching for age, sex, race, and education from the US Third National Health and Nutrition Examination Survey. DR was assessed using non-mydriatic fundus photographs and graded by trained graders using the Modified Airlie House Classification scheme and the Early Treatment for Diabetic Retinopathy Study severity scale. Serum Pg immunoglobulin G (IgG) antibody (Ab) was measured in enzyme-linked immunosorbent assay units. Logistic regression was used to relate serum Pg IgG Ab levels to the risk for early DR.ResultsPer tenfold increase in Pg IgG Ab levels, there was an over 60% increased risk for early DR (odds ratio = 1.64; 95% confidence interval, 1.36–1.97), and a linear trend was noted for the estimated probabilities of early DR at various Pg IgG Ab levels (P for trend = 0.0053). The analysis also suggested that moderate alcohol consumption (less than 12 drinks in the past 12 months; P for interaction = 0.0003) and maintaining a normal serum glycated hemoglobulin level (HbA1c ≤ 5.7%; P for interaction < 0.0001) helped reduce the Pg-related DR risk.ConclusionsThe increased Pg-related DR risk could be alleviated by managing alcohol consumption and maintaining a normal blood glucose level.Translational RelevanceFindings from this study provide new directions for developing novel therapeutics and prevention strategies for DR.

Radiation Safety Knowledge and Practice in Urology Theaters: A Collaborative Multicenter Survey.

Objective: To evaluate the knowledge and current radiation safety practice among health care professionals undertaking fluoroscopic procedures in urology. Materials and Methods: A 14-question survey was disseminated to multidisciplinary urology theater staff. Questions included demographic data, usual radiation safety practice, and knowledge. The questions were selected based on guidelines from the International Commission of Radiological Protection and Health and Safety Executive. The survey was disseminated through regional collaborators and social media. Results: The survey received a total of 309 completed responses, including 272 from the United Kingdom. Responses from the United Kingdom multidisciplinary team included 164 (60.3%) urologic surgeons, 68 (25.0%) theater nurses, 27 (9.9%) from the anesthetic team, and 13 (4.7%) radiographers. Results from the United Kingdom demonstrated use of lead aprons and thyroid shields as 99.3% and 52.2%, respectively. Lead glasses and lead glove use were 7.4% and 0.7%, respectively. Lack of availability was cited as a reason for noncompliance with shielding guidelines in 208 (76.5%) of the respondents. No form of training in radiation safety was reported by 120 (44.1%) respondents. However, there was no association between answering knowledge questions correctly and having completed some form of radiation safety training (p = 0.41). There was an association between dosimeter use and those who had received radiation safety training (p = 0.02). Consultant urologists were also more likely to use a dosimeter than training grade urologists (p = 0.035). Conclusion: Suboptimal compliance with radiation safety guidelines is prevalent in contemporary urologic practice, and presents a significant occupational health concern. Availability of protective equipment needs to be urgently addressed.

Accuracy of bolt external ventricular drain insertion by neurosurgeons of different experience.

The accuracy of tunneled external ventricular drain (EVD) placement has been shown to be similar among practitioners of varying experience, but this has not yet been investigated for bolt EVDs. Tunneled and bolt EVDs are distinct techniques, and it is unclear if conclusions regarding accuracy can be inferred from one method to the other. The goal of this study was to determine whether neurosurgical experience influences the accuracy of bolt EVD placement. We performed a single-center retrospective analysis of accuracy of bolt EVD placement between 1st December 2018 and 31st May 2020, comparing the accuracy outcomes between three levels of training (junior trainees (JT); mid-grade trainees (MT); senior trainees/fellows (ST)). Accuracy was determined radiologically by two methods: Kakarla grade and by measuring the distance of the catheter tip to its optimal position (DTOP) at the foramen of Monro. Eighty-seven patients underwent insertion of bolt EVDs, of which n = 19 by JT, n = 40 by MT and n = 28 by ST, with a significant difference found between training grades in the median Kakarla grade (p = 0.0055) and in the accuracy of placement as per DTOP (p = 0.0168). In contrast to previous published results on tunneled EVDs, we demonstrate that the accuracy of bolt EVD placement is dependent on neurosurgical experience. Our results draw awareness to the fact that the bolt EVD technique can represent a challenge for less experienced practitioners and underline the importance of dedicated training to support the safe insertion of bolt ventricular catheters.

Deep Learning-Based Cataract Detection and Grading from Slit-Lamp and Retro-Illumination Photographs: Model Development and Validation Study

Backgroud: Accurate detection and grading of cataract is pivotal in providing personalized precision treatment strategies for preventing visual loss. We develop and validate an automated deep learning (DL)-based artificial intelligence (AI) platform for diagnosing and grading cataracts, using slit-lamp and retro-illumination lens photographs based on the Lens Opacities Classification System-Ⅲ (LOCS-Ⅲ). Methods: Slit-lamp and retro-illumination lens photographs were graded by two trained graders using LOCS-III. Image datasets were labeled and divided into training, validation, and test datasets. We trained and validated AI platforms with four key strategies in the AI domain: (1) region detection network for redundant information inside data, (2) data augmentation and transfer learning for the small dataset size problem, (3) generalized cross entropy loss for dataset bias, and (4) class balanced loss for class imbalance problems. The performance of the AI platform was reinforced with an ensemble of three AI algorithms (ResNet18, WideResNet50-2, and ResNext50). Finding: The AI platform showed robust diagnostic performance (AUC of 0.9992 [0.9986-0.9998], 0.9994 [0.9989-0.9998]; accuracy of 98.82% [97.7-99.9], 98.51% [97.4-99.6]) and grading prediction performance (AUC of 0.9567 [0.9501-0.9633], 0.9650 [0.9509-0.9792]; accuracy of 91.22% [89.4-93.0], 90.26% [88.6-91.9]) for nuclear opalescence (NO) and nuclear color (NC) using slit-lamp photographs. For cortical opacity (CO) and posterior subcapsular opacity (PSC), the system achieved high diagnostic performance (AUC of 0.9680 [0.9579-0.9781], 0.9465 [0.9348-0.9582]; accuracy of 96.21% [94.4-98.0], 92.17% [88.6-95.8]) and good grading prediction performance (AUC of 0.9044 [0.8958-0.9129], 0.9174 [0.9055-0.9295]; accuracy of 91.33% [89.7-93.0], 87.89% [85.6-90.2]) using retro-illumination images. Interpretation: Our DL-based AI platform successfully yielded accurate and precise detection and grading of NO and NC in seven-level classification and CO and PSC in six-level classification, overcoming the limitations of medical databases such as small training data or biased label distribution. Funding: This work was supported by the National Research Foundation of Korea grant funded by the Korean government's Ministry of Education (NRF-2021R1C1C1007795; Seoul, Korea), which was received by D.H.L. Declaration of Interest: The authors declare no conflict of interest Ethical Approval: The study was approved by the Samsung Medical Center Institutional Review Board (IRB file number 2020-08-035)

Scoring Osteoarthritis Reliably in Large Joints and the Spine Using Whole-Body CT: OsteoArthritis Computed Tomography-Score (OACT-Score).

A standardized method to assess structural osteoarthritis (OA) burden thorough the body lacks from literature. Such a method can be valuable in developing personalized treatments for OA. We developed a reliable scoring system to evaluate OA in large joints and the spine—the OsteoArthritis Computed Tomography (OACT) score, using a convenience sample of 197 whole-body low-dose non-contrast CTs. An atlas, containing example images as reference points for training and scoring, are presented. Each joint was graded between 0–3. The total OA burden was calculated by summing scores of individual joints. Intra- and inter-observer reliability was tested 25 randomly selected scans (N = 600 joints). Intra-observer reliability and inter-observer reliability between three observers was assessed using intraclass correlation coefficient (ICC) and square-weighted kappa statistics. The square-weighted kappa for intra-observer reliability for OACT-score at joint-level ranged from 0.79 to 0.95; the ICC for the total OA grade was 0.97 (95%-CI, 0.94 to 0.99). Square-weighted kappa for interobserver reliability ranged from 0.48 to 0.95; the ICC for the total OA grade was 0.95 (95%-CI, 0.90 to 0.98). The OACT score, a new reproducible CT-based grading system reflecting OA burden in large joints and the spine, has a satisfactory reproducibility. The atlas can be used for research purposes, training, educational purposes and systemic grading of OA on CT-scans.

Rates and Risk Factors Associated with COVID-19 Infection Among Myanmar Ethnic Minority Doctors in UK NHS

Background: There is dearth of information on personal and work-related risk factors associated with COVID-19 infection among ethnic healthcare workers in UK NHS.Methods: A questionnaire survey was conducted among Myanmar Ethnic Minority Doctors immediately after the peak of pandemic in UK during June 2020. We aimed to explore real world personal work experience of doctors working in the NHS during the rising phase of the first wave of the pandemic and to provide better understanding and deeper insight into the impact of COVID-19 with regard to susceptibility and risk of poor outcome among doctors.Findings: Of 670 potentially eligible participants from Myanmar ethnic background, a total of 512 responses were received. Majority are training grade doctors and majority of respondents work in acute hospital setting; 42.3% and 46.2% in COVID-ward areas and non-COVID ward areas, respectively. Probable infection rate was extremely high among respondents (N=221 (43.2%)) and 66 (12.9%) had a positive test. The majority, ~70%, who were symptomatic believed they got infection from working in a hospital environment. In multivariate models, controlling for age, sex, body mass index, smoking, hypertension, diabetes mellitus, usage of ACE inhibitors/Angiotensin Receptor Blockers, and vitamin C & D containing supplements, only ‘working in COVID-19 ward area in acute setting’ was significantly less likely to be associated with our primary outcome of being tested positive for COVID-19 (adjusted OR (95% confidence interval) 0.49 (0.28, 0.86; p= 0.014). For ‘probable COVID-19 infection’, being older (aOR 0.97 (0.95, 0.99); p=0.002), using vitamin D containing vitamins (aOR 0.59 (0.36, 0.98); p=0.043) and working in COVID-ward area in acute setting (aOR 0.47 (0.31, 0.70); pInterpretation: Given that COVID-19 testing is not instituted routinely to healthcare staff over the period of survey covering December 2019 to June 2020, the results are likely to be underestimation of the real impact. The high infection rates are most likely related to initial lack of adequate PPEs in so called non-COVID clinical areas and lack of policy on widespread testing of all hospital admissions (especially in older people) for COVID-19. We highlight the need for support to NHS workforce for potential consequences of physical and mental health due to COVID-19.Funding Self-funded.Funding Statement: This project is self-funded.Declaration of Interests: None to declareEthics Approval Statement: The study gained ethical approval from College Ethics Review Board, University of Aberdeen (CERB/2020/5/1955).

Barriers to Post-CCST training in orthodontics: A survey of trainee perceptions.

In order to be eligible for consultant appointments within the NHS, orthodontists can undertake higher specialty training after their Certificate of Completion of Specialist Training (CCST). These training posts are known as Post-CCST positions and orthodontists must be eligible for inclusion on the General Dental Council's (GDC) specialist list for orthodontics before applying. There has been a decline in the number of applicants and the number of filled Post-CCST positions in recent years, leading to concerns over a potential shortage of appropriately trained consultant orthodontists to provide a secondary care service in the near future. This survey was undertaken to identify barriers to applying for Post-CCST training and assess potential options for increasing trainee numbers. An online survey was distributed, by email, to current orthodontic trainees and those that had recently completed training in the last six months via the British Orthodontic Society Training Grades Group. Reminder emails were sent at two and four weeks. A total of 201 trainees were invited to complete the survey. Eighty-nine trainees completed the survey (response rate of 44.3%). Regarding applying to Post-CCST training, 32.6% and 47.7% of respondents, respectively, either wanted to or were considering applying for Post-CCST training. The South East was the most preferred region for Post-CCST training (38.0%). Reasons for not wishing to complete Post-CCST training included salary (71.9%), lack of consultant posts in desired regions (64.1%) and inability/unwillingness to relocate (63.5%). Part-time training (91.0%) and a higher salary during training (86.0%) were most likely to incentivise application for Post-CCST training. Financial, family and geographical concerns appear to be the main reasons why trainees might not consider Post-CCST training. Part-time and run-through training options may encourage trainees to apply for Post-CCST training.

Superficial and Deep Foveal Avascular Zone Area Measurement in Healthy Subjects Using Two Different Spectral Domain Optical Coherence Tomography Angiography Devices.

PurposeTo compare the area of the foveal avascular zone (FAZ) in the superficial and deep retinal layers using two different spectral-domain optical coherence tomography angiography (OCTA) devices.MethodsA cross-sectional comparative study was conducted to obtain macular OCTA images from healthy subjects using Optovue RTVue XR Avanti (Optovue, Inc, Fremont, CA) and Spectralis HRA+OCTA (Heidelberg Engineering, Heidelberg, Germany). Two independent trained graders measured the FAZ area using automated slab segmentation. The FAZ area in the superficial and deep retinal layers were compared.ResultsTwenty-three eyes of 23 subjects were included. The graders agreement was excellent (0.86) for all measurements. The mean FAZ area was significantly larger at the superficial retinal layer as compared to the deep retinal layer on both devices (0.31 0.08 mm vs 0.26 0.08 mm in Optovue and 0.55 0.16 mm vs 0.36 0.13 mm in Spectralis, both P 0.001). The mean FAZ area was significantly greater in the superficial and deep retinal layers using Spectralis as compared to Optovue measurements (P 0.001 for both comparisons).ConclusionIn contrast to previous reports, the FAZ area was larger in the superficial retina as compared to deep retinal layers using updated software versions. Measurements from different devices cannot be used interchangeably.

Quantifying the impact of the COVID-19 pandemic on orthopaedic trainees: a national perspective.

AimsWe aim to objectively assess the impact of COVID-19 on mean total operative cases for all indicative procedures (as outlined by the Joint Committee on Surgical Training (JCST)) experienced by orthopaedic trainees in the deanery of the Republic of Ireland. Subjective experiences were reported for each trainee using questionnaires.MethodsDuring the first four weeks of the nationwide lockdown due to COVID-19, the objective impact of the pandemic on each trainee’s surgical caseload exposure was assessed using data from individual trainee logbook profiles in the deanery of the Republic of Ireland. Independent predictor variables included the trainee grade (ST 3 to 8), the individual trainee, the unit that the logbook was reported from, and the year in which the logbook was recorded. We used the analysis of variance (ANOVA) test to assess for any statistically significant predictor variables. The subjective experience of each trainee was captured using an electronic questionnaire.ResultsThe mean number of total procedures per trainee over four weeks was 36.8 (7 to 99; standard deviation (SD) 19.67) in 2018, 40.6 (6 to 81; SD 17.90) in 2019, and 18.3 (3 to 65; SD 11.70) during the pandemic of 2020 (p = 0.043). Significant reductions were noted for all elective indicative procedures, including arthroplasty (p = 0.019), osteotomy (p = 0.045), nerve decompression (p = 0.024) and arthroscopy (p = 0.024). In contrast, none of the nine indicative procedures for trauma were reduced. There was a significant inter-unit difference in the mean number of total cases (p = 0.029) and indicative cases (p = 0.0005) per trainee. We noted that 7.69% (n = 3) of trainees contracted COVID-19.ConclusionDuring the COVID-19 pandemic, the mean number of operative cases per trainee has been significantly reduced for four of the 13 indicative procedures, as outlined by the JCST. Reassignment of trainees to high-volume institutions in the future may be a plausible approach to mitigate significant training deficits in those trainees worst impacted by the reduction in operative exposure.

SVM Modelling of Agarwood Oil Quality Grading using Radial Basis Function (RBF) and Sequential Minimal Optimization (SMO) Learning Algorithms

Agarwood Oil also known as Gaharu Oil is an expensive oil with extreme demand in the world trading especially in Japan, China and the Middle East countries. Currently, the grading of the agarwood oil quality only can be done by trained human graders by physically checked the color, odour and the resin content. However, this technique is limited due to human body limitation and not too accurate as it is supposed to be. To improve the problem faced by the existing method, the grading technique using Sequential Minimal Optimization (SMO) and Radial Basis Function (RBF) in Support Vector Machine (SVM) was conducted. The works involved of data collection, data pre-processing, SVM model development and testing of the developed SVM model. The finding showed that both RBF and SMO successfully can grade the agarwood oil quality due to their accuracies is above than 80 % and error rate or MSE is close to 0. Thus, the technique presented in this paper proved its capability in overcoming the constraint of human trained grader and benefit as well as contribute to the agarwood oil industry especially its oil quality grading.

Understanding intrinsic challenges to STEM instructional practices for Chinese teachers based on their beliefs and knowledge base

BackgroundChina has great student participation in STEM education. Chinese society has a progressive and positive attitude towards STEM as it is considered to provide more opportunities in life. Teachers play a vital role in the success of any STEM program in K-12 schools. However, teachers are facing instructional challenges because of the interdisciplinary nature of the STEM curriculum and the current typical school structure. The success of the STEM programs depends on teachers’ beliefs and their knowledge in adapting to instructional implementation of STEM concepts.ResultsThe data (n = 216) was collected from STEM primary and secondary teachers from 25 provinces in mainland China. Exploratory factor analysis (EFA) was applied, and Pearson’s correlation analysis was used to examine the correlation between Chinese STEM teachers’ beliefs, knowledge, implementation, and the intrinsic challenges of STEM education; t tests and analysis of variance (ANOVA) were performed to ascertain whether there were differences. The structural equation model (SEM) was applied to identify interrelationships. The results indicated that Chinese STEM teachers encounter higher-level intrinsic challenges to instructional implementations based on their beliefs and knowledge. Teachers who utilize their experience of teaching science as their main discipline and then attempt to integrate STEM using mathematics and engineering are likely to encounter higher-level intrinsic challenges in implementation.ConclusionThe intrinsic challenges perceived by Chinese teachers in the practice of STEM education can be predicted by their beliefs and knowledge base. Teachers who understand the nature and pedagogy of STEM education are more likely to encounter lower-level intrinsic challenges of STEM teaching, while teachers who utilize their main discipline when conducting integrated STEM learning activities through modeling based on science, technology, engineering, and mathematical problem situations are more likely to encounter higher-level intrinsic challenges. This study also reveals that there are some significant differences in the level of STEM teachers’ beliefs, knowledge base, instructional practice, and their intrinsic challenges based on their teaching grade, seniority, and experience of STEM training and teaching.

Knowledge, attitudes and eye health-seeking behaviours in a population-based sample of people with diabetes in rural China

AimsTo assess knowledge of diabetes and acceptance of eye care among people with diabetes in rural China, to improve service uptake.MethodsPopulation-based study of people in Guangdong, China, with glycosylated haemoglobin...

Bullying and undermining behaviours in surgery: A qualitative study of surgical trainee experiences in the United Kingdom (UK) & Republic of Ireland (ROI)

BackgroundBullying and undermining (B/U) behaviours are documented in the international surgical workplace. This study is the largest assessment of prevalence of B/U behaviours within UK & ROI surgical training to date. Materials and methodsUK & ROI surgical trainees were electronically surveyed in July 2017. The survey was open for one month and sent to all registered trainees at Core and Specialty level by the Joint Committee on Surgical Training (JCST) along with email and social media dissemination by the Association of Surgeons in Training (ASiT) and the British Orthopaedic Trainees Association (BOTA). A consensus session on the topic was conducted at the ASiT Conference in Edinburgh in March 2018. Standards for reporting of Qualitative Research were followed. Results1412 responses were received (26.6% response rate). All training regions, grades and specialties were represented. 60% of trainees (n = 837) reported witnessing or experiencing B/U behaviours in the surgical workplace. The most common reports related to sexism; 42% (n = 568) reported witnessing or experiencing sexist language/attitudes in the workplace. This was reported more by female respondents (66% compared to 27% male). 21% (n = 291) and 13% (n = 180) reported witnessing or personally experiencing racist and homophobic language or attitudes respectively. Consultants were identified as the most frequent perpetrators. The surgical wards or theatres were the most frequently reported areas that trainees either witnessed or experienced B/U behaviours. Of those trainees who had reported a personal experience of B/U behaviours (n = 344), 20% described their experiences of reporting as negative or very negative. 48.1% of respondents felt that surgery as a whole had a moderate, high or very high degree of a concern about B/U behaviours. ConclusionB/U behaviours are prevalent in the surgical domain. Urgent action is required to eradicate this unacceptable behaviour. A cross-specialty, intercollegiate response is required to tackle this issue and improve the working culture in surgery for all.

Performance anxiety amongst trauma and orthopaedic surgical trainees

BackgroundThis study aims to assess performance anxiety amongst orthopaedic trainees. Operating is equivalent in its skill level, both dexterous and mental, to that of elite sport. This study uses a slightly altered version of the validated Sports Competition Anxiety Test (SCAT), making it relevant to operating, rather than to sport, to evaluate peri-operative stress and anxiety in orthopaedic surgeons. MethodsThe SCAT questionnaire was sent to trainees across 3 UK. deaneries via email. A score of <17 suggests low-levels of anxiety, 17–24 suggests medium-levels of anxiety and >24 suggest high-levels of anxiety. Data was anonymised except from training grade and sex. Results109 of 273 (40%) responded to the survey, 71% of respondents were male (n = 77). The mean SCAT score amongst Core Surgical Trainees was 16.9 (n = 21, range 12–23), Specialist Trainees years 3–5 was 18.7 (n = 51, range 12–28), Specialist Trainees years 6–8 was 16.8 (n = 26, range 11–24) and consultants was 16 (n = 11, range 11–28). Across all groups, when sub-divided by sex, females had higher mean scores, this was statistically significant for Specialist Trainees years 3–5 (p = 0.029) and Specialist Trainees years 6–8 (p = 0.042) groups. DiscussionSurgical performance anxiety exists amongst orthopaedic surgeons, with females scoring higher than males. Five respondents scored “high-levels of anxiety” including 2 consultants level surgeons, suggesting experience does not entirely eliminate anxiety. Stress and anxiety are known to lead to surgical mistakes and “burnout” amongst surgeons which is highly topical at present. It is important to highlight this significant issue and it could be taken forward as a national survey to evaluate further.

Do Slit-Lamp Shields and Face Masks Protect Ophthalmologists amidst COVID-19?

Do Slit-Lamp Shields and Face Masks Protect Ophthalmologists amidst COVID-19?

Progression of retinopathy and incidence of cardiovascular disease: findings from the Chronic Renal Insufficiency Cohort Study

PurposeChronic kidney disease (CKD) patients often develop cardiovascular disease (CVD) and retinopathy. The purpose of this study was to assess the association between progression of retinopathy and concurrent incidence of...

Proof of surgical publication prowess: prospective observational study of factors associated with surrogate markers of academic reach.

BackgroundIn the UK, general surgery higher surgical trainees (HSTs) must publish at least three peer‐reviewed scientific articles (as first, second or corresponding author) to qualify for certification of completion of training (CCT). This study aimed to identify the factors associated with success in this arena.MethodsDeanery rosters supplemented with data from the Intercollegiate Surgical Curriculum Programme, PubMed and ResearchGate were used to identify the profiles of consecutive HSTs. Primary outcomes were publication numbers at defined points in higher training (speciality training year (ST) 3–8); secondary outcomes were the Hirsch index and ResearchGate scores.ResultsFifty‐nine consecutive HSTs (24 women, 35 men) were studied. The median publication number was 3 (range 0–30). At least three published articles were obtained by 30 HSTs (51 per cent), with 19 (38 per cent) of 50 HSTs achieving this by ST4 (of whom 15 (79 per cent) had undertaken out of programme for research (OOPR) time) and 24 (80 per cent) by ST6. Thirteen HSTs (22 per cent) (ST3, 6; ST4, 4; ST5, 2; ST8, 1) had yet to publish at the time of writing. OOPR was associated with achieving three publications (24 of 35 (69 per cent) versus 6 of 24 (25 per cent) with no formal research time; P = 0·001), higher overall number of publications (median 6 versus 1 respectively; P < 0·001), higher ResearchGate score (median 23·37 versus 5·27; P < 0·001) and higher Hirsch index (median 3 versus 1; P < 0·001). In multivariable analysis, training grade (odds ratio (OR) 1·89, 95 per cent c.i. 0·01 to 3·52; P = 0·045) and OOPR (OR 6·55, 2·04 to 21·04; P = 0·002) were associated with achieving three publications.ConclusionIf CCT credentials are to include publication profiles, HST programmes should incorporate research training in workforce planning.