Training In London Research Articles

The Life and Contributions of Dr. Abraham Colles: A Pioneer in Orthopaedics.

Abraham Colles (1773-1843) was a pioneering Irish surgeon whose contributions significantly advanced the fields of anatomy and surgery. Best known for describing the "Colles' fracture" of the distal radius, Colles' meticulous clinical observations and innovative treatment methods remain influential in modern orthopaedic practice. Born in Kilkenny, Ireland, Colles pursued medical education at Trinity College Dublin and the University of Edinburgh before training in London under the renowned surgeon Astley Cooper. Upon his return to Dublin, Colles was appointed resident surgeon at Steevens' Hospital, where he spent the majority of his career. Beyond his work on fractures, Colles made notable contributions to the understanding and treatment of syphilis, leading to the formulation of "Colles' law," and he introduced new surgical techniques for treating vascular conditions, including aneurysms. A dedicated educator, Colles played a central role in shaping Irish surgical practice through his teaching and leadership at the Royal College of Surgeons in Ireland. His legacy endures not only through his clinical innovations but also through his impact on medical education and public health in Ireland and beyond.

Towards inclusive healthcare: evaluating knowledge, confidence and awareness of LGBTQ + health among Internal Medicine Trainees in London

BackgroundPatients from the lesbian, gay, bisexual, transgender, queer plus (LGBTQ +) community face various health inequalities and report poor healthcare experiences. Little is known about how knowledgeable and confident UK doctors are around LGBTQ + health, and previous research demonstrates that UK medical schools rarely deliver teaching in this area. This research evaluated the level of knowledge, awareness and confidence of LGBTQ + health among Internal Medical Trainees (IMTs) in London.MethodsLondon IMTs were invited to complete an online questionnaire evaluating knowledge, awareness and confidence in LGBTQ + health. Stratified analysis of results by demographics was performed.ResultsThree hundred and fifteen surveys were analysed from 796 eligible trainees (40%). Confidence in caring for LGBTQ + patients was variable. Confidence in discussing gender identity was lower than for sexual orientation. Knowledge of health issues affecting LGBTQ + patients varied. Most participants had never received training on LGBTQ + health at undergraduate (n = 201, 64%) or postgraduate level (n = 252, 80%), but the majority of participants felt that training would be useful (n = 233, 74%). Stratified analysis revealed that IMTs who received previous LGBTQ + teaching at undergraduate or postgraduate level were considerably more confident discussing sexual orientation with patients, compared to those who received no previous teaching.ConclusionsThere is a clear need for education on LGBTQ + health, given the varied levels of knowledge and confidence identified. A significant majority of IMTs in London have never received teaching on LGBTQ + health, although there exists a strong desire for this. LGBTQ + health topics should be integrated into undergraduate and postgraduate training and examinations for IMTs. This would support IMTs in delivering high quality and inclusive care for all patients, particularly those of sexual orientation and gender identity minorities. There are relatively few published studies exploring competency in LGBTQ + health among doctors, and this is the first among UK Internal Medicine Trainees.

Redefining the Professional Identity of the Surgeon by Reflecting on Critical Incidents in London, United Kingdom

INTRODUCTION: Critical incidents are increasingly prevalent documented events in National Health Service (NHS) hospitals in the United Kingdom. Claims are made against the NHS in cases of medical negligence, with Obstetrics and Gynaecology accounting for 15% of the total claims, the second highest among all specialties.  OBJECTIVE: To understand the impact of critical incidents on the developing surgical identity of Obstetric and Gynaecological trainees in London, United Kingdom. METHODS: A Qualitative study using semi-structured styled interviews. The interviews were audio-recorded and subsequently transcribed. The data was then analysed. Six trainees, of specialist trainee level three to seven were interviewed separately. This consisted of five female and one male doctors. This is within the current gender ratio difference in London. RESULTS: Undergoing a critical incident was felt to be a traumatic experience for all trainees involved. The incident itself and its management by the department, hospital or deanery had a significant impact on the psycho-social well-being of the doctor involved. Critical incidents can negatively affect the professional development of the surgeon. Surgical identity is an area that appears to be in the hidden curriculum, however many trainees struggled to define what their surgical identity was and how it may have been affected. CONCLUSION: Critical incidents cause significant psycho-social distress for the developing surgeon. Surgical identity should be implicitly understood within medical education. This study highlights the urgent need for those writing medical curricula; both undergraduate and postgraduate to make the implicit explicit. Surgical identity discourse must be a priority for the new curriculum. Professionalism and an ability to endure the psychological stress caused by undergoing critical incidents is likely to be enhanced, by creating a strong sense of belonging within the surgical profession. The loss of the traditional apprenticeship model and its mentors must be considered within the new design. 

To stay or go? A mixed methods study of psychiatry trainees’ intentions to leave training

This mixed methods research study aimed to test a tailored version of the job demands-resources (JD-R) model to uncover what factors contribute to psychiatry trainees’ intentions to leave their training and how. A Web-based survey measured psychiatry trainees’ work conditions, well-being, occupational commitment, and intentions to leave training. The results were analyzed using structural equation modeling featuring validated constructs. Narrative interviews were analyzed using thematic analysis following the tailored JD-R model. Of 159 current London trainees who completed the questionnaire, 22.1% were thinking a lot about leaving training. Trainees with higher job demands, fewer resources, and less ability to detach from their work experienced higher burnout levels. More engaged and less burned-out trainees were more committed to their occupation and less inclined to leave training. The interviews identified that trainees’ decision to leave was not linear and took time to make. Trainees found their work environment challenging and reported reduced well-being and rethinking their career paths. The JD-R model is a useful tool to understand how medical trainees’ job demands and resources need to be balanced to maintain their well-being and, in turn, how this affects their commitment to the occupation and training.

VALIDATION OF A VIRTUAL REALITY SIMULATOR FOR INTRAMEDULLARY FEMORAL NAIL APPLICATION DURING AN ORTHOPAEDIC SURGICAL COURSE

To investigate the utility of virtual reality (VR) simulators in improving surgical proficiency in Orthopaedic trainees for complex procedures and techniques.Fifteen specialty surgeons attending a London Orthopaedic training course were randomised to either the VR (n = 7) or control group (n = 8). All participants were provided a study pack comprising an application manual and instructional video for the Trochanteric Femoral Nail Advanced (TFNA) procedure. The VR group underwent additional training for TFNA using the DePuy Synthes (Johnson and Johnson) VR simulator. All surgeons were then observed applying the TFNA in a Sawbones model and assessed by a blinded senior consultant using three metrics: time to completion, 22-item procedure checklist and 5-point global assessment scale.Participant demographics for the VR and control groups were similar in context of age (mean [SD]: VR group, 31.0 [2.38] years; control group, 30.6 [2.39] years), gender (VR group, 5 [71%] men; control group, 8 [100%] men) and prior experience with TFNA (had applied TFNA as primary surgeon: VR group, 6 [86%]; control group, 7 [88%]). Although statistical significance was not reached, the VR group, on average, outperformed the control group on all three metrics. They completed the TFNA procedure faster (mean [SD]: 18.2 [2.16] minutes versus 19.78 [1.32] minutes; p<0.189), performed a greater percentage of steps correctly (79% versus 66%; p<0.189) and scored a higher percentage on the global assessment scale (75% versus 65%; p<0.232).VR simulators offer a safe and accessible means for Orthopaedic trainees to prepare for and supplement their theatre-based experience. It is vital, therefore, to review and validate novel simulation-based systems and in turn facilitate their improvement. We intend to increase our sample size and expand this preliminary study through a second upcoming surgical course for Orthopaedic trainees in London.

South East London Training Hub’s student nurse placement process

The shortage of general practice nurses is predicted to get worse in the coming years. One way of attracting new nurses to general practice is through education programmes. However, most nursing degrees do not provide enough primary care experience to students and there are barriers to general practice offering placements. South East London Training Hub has aimed to increase the number of placements on offer. The training hub aims to alleviate as much of the extra workload and pressure brought on by hosting a student as possible. This article covers some of the things being trialled, including improving training, simplifying documentation and keeping records. Nurses and managers experience barriers to hosting student nurse placements. South East London Training Hub are trialling a new placement process to overcome these barriers

An Exploration of ‘Married Love’ by Tessa Hadley

One of the most accomplished fiction writers of the twenty-first century, the British writer Tessa Hadley (1956-till present), is known for her exceptional power of seizing the familiar moments in our life that we would normally not think of highlighting. She is the author of several acclaimed novels and short stories such as Accidents in the Home, Everything Will Be All Right, The Master Bedroom, The London Train, Clever Girl, The Past, Late in the Day, Free Love, Married Love and Other Stories, Bad Dreams, etc. Capturing the beauty of ordinary lives, she writes about the drama of everyday life: complicated family relationships, love affairs, marriages, divorces, and betrayal.

Professor Marc R. de Leval in 100 words (as articulated by his London trainees and surgical colleagues).

Professor Marc R. de Leval in 100 words (as articulated by his London trainees and surgical colleagues).

Professor Marc R. de Leval in 100 words (as articulated by his London trainees and surgical colleagues).

Professor Marc R. de Leval in 100 words (as articulated by his London trainees and surgical colleagues).

Trevor Mann (1916-1996): Paediatrician responsible for the development of hospital services for children in Brighton, England.

Trevor Philip Mann (1916-1996) was the first consultant paediatrician at the Royal Alexandra Children's Hospital (RACH) in Brighton, since its foundation in 1881. Here, he was responsible for significant service developments, including establishing a department of paediatric surgery and the first neonatal unit in England outside of London. Mann grew up in South London, and aged 14 had a lengthy admission to hospital with tuberculosis. He studied medicine at St Mary's Hospital, London. During World War II he was a Royal Navy Surgeon-Lieutenant, aboard the Atlantic destroyer, HMS Georgetown, and with the Russian convoys, before completing paediatric training in London. Here, he was involved in treating paediatric tuberculous meningitis; clinical work that formed part of one of the earliest randomised controlled trials. In 1951 Mann moved to the RACH where he researched infantile infectious gastroenteritis and introduced (now commonplace) practices at the hospital, including barrier nursing. He lived in Rottingdean, Sussex, and enjoyed sailing, gardening and wood turning. Mann's impact on paediatric care in Brighton was recognised by the hospital, naming the Trevor Mann Baby Unit in his honour, upon his retirement in 1981. This article seeks to record his contributions and reconnect local clinicians with his memory.

Thomas Michael Jessell. 2 August 1951—28 April 2019

Tom Jessell was a British neuroscientist who made pioneering discoveries in developmental neurobiology. Beginning with a neuropharmacology training in London and Cambridge, Tom moved to Harvard and finally Columbia University. There, Tom embraced the dramatic late twentieth-century developments in molecular biology to unravel the genetic basis of spinal cord neuronal diversity and developmental mechanisms of circuit formation. Combining encyclopaedic knowledge of the classical neurobiology literature with virtuoso molecular genetic, anatomical and electrophysiological techniques, exploited by his team of gifted students, post-docs and collaborators, Tom made seminal contributions to broad areas of neuroscience. Notable contributions included the discovery of extracellular factors that induce distinct neuronal cell types and guide their connectivity, as well as the identification of the transcriptional repertoires that led to neuronal complexity in the developing spinal cord. Important insights into circuitry and behaviour followed these defining studies. At the same time, Tom was heavily involved in neuroscience education and the development of new neuroscience research institutes. For all his Herculean energy for research, he still found great pleasure in fine art, cricket and jazz, and his life was greatly enriched by his partner Jane Dodd, also a Cambridge-trained neuroscientist, and their three daughters. Tom's wit, energy and incisive intelligence will be sorely missed. His legacy is not only a paradigm-shifting body of papers, but also his educational and institutional achievements and the remarkable group of scientists, once his trainees, who, in their turn, continue to advance neuroscience research around the world.

Did the COVID-19 pandemic affect mental health, training progression, and fertility planning of obstetrics and gynecology trainees? A survey of London trainees.

Purpose of StudyTo assess impact of COVID‐19 pandemic on mental wellbeing, workload, training progression, and fertility planning among London Obstetrics and Gynecology trainees.DesignAn anonymous survey comprising 41 peer‐validated questions was sent to London trainees. Anxiety and depression were screened using Generalized Anxiety Disorder Questionnaire 7 (GAD 7) and Patient Health Questionnaire‐9 (PHQ‐9).ResultsOne hundred and seventy‐seven trainees completed the questionnaire, of whom 54% were aged 25–34 years, 43% were senior trainees (ST6‐7), and 51% classified themselves as Black, Asian, and Minority Asian (BAME). Although the percentage of respondents with “moderate”/“severe” GAD 7 and PHQ‐9 scores was two to three times that of UK population estimates, median GAD 7 and PHQ‐9 scores were 7 and 6 (“mild”). Sixteen percent deferred their fertility plans and 26% of ST6‐7 trainees changed their Advanced Training Skills Modules. Other issues raised ranged from lack of assistance with electronic portfolio, postponement of examinations, poor senior input for mental health, lack of debriefing for redeployed trainees and requests for deferment of annual reviews.ConclusionsThe pandemic has incurred an impact on mental health, training progression, and fertility planning of London trainees. With recommencement of nonemergency consultations and elective gynecology theater, alongside Royal College of Obstetricians and Gynecologists' Recovery Blueprint to optimize learning opportunities, there is optimism that these challenges can be overcome. Trainers and trainees need to safeguard training opportunities and consider innovative forms of future learning, while anticipating potential effects of subsequent waves.

61 Burnout in Core Surgical Trainees and Potential Use of Mindfulness

Abstract Aim Surgical trainees deal with long hours and stressful work content. We aimed to assess the burnout levels in London trainees, and trial a mindfulness intervention. Method London core surgical trainees (CST1) were asked to complete an online survey including validated burnout scoring system (Oldenburg Inventory). 54 of a possible 78 trainees responded (69%). We then asked them to take part in a 2-week mindfulness intervention (approximately 5 minutes a day using the app Headspace). We later resurveyed. Results 60% of trainees who answered the survey feel ‘somewhat’ or ‘completely’ burnt out. Oldenburg burnout inventory calculates 85% of trainees to be ‘disengaged’ and 93% ‘exhausted’. 13/54 trainees completed the mindfulness training. 10 out of 13 trainees found this to be ‘somewhat’ or ‘massively’ helpful for burnout. Conclusions A high percentage of year one surgical trainees can be categorised as burnt out. The low uptake of mindfulness may speak to lack of capacity trainees have to invest in resources that will self-resolve this. We cannot say with significance whether mindfulness helped burnout (and length of trial could be too short) but the majority who did trial report positive experience with mindfulness.

Unearthing a provincial medical school and its students - A history of the 1834 'School of Practical Medicine and Surgery' at the Sussex County Hospital, Brighton, England.

The 19th century was a period of rapid change in English medical education. Little is known about the important contribution of smaller, hospital-based, provincial medical schools which sprang up to provide important practical training opportunities for students, typically as a foundation for further training and examination in London. One such example is the 1834 Brighton 'School of Practical Medicine and Surgery', which was based at the Sussex County Hospital and recognised by the Royal College of Surgeons and Worshipful Society of Apothecaries. Unlike many other 19th century medical schools, the history of the Brighton school is largely undocumented. Although it remained dependent upon London through the 'College and Hall' examination system, this article shows that the school's pragmatic and adaptive educational approach allowed it to play an important role in educating future doctors in Brighton from 1834 into at least the early 20th century.

Dermot O’Brien Hourihane (1933–2020)

Dermot Hourihane was born in Ballina, County Mayo, but his family soon moved to Dublin where he was educated. He studied medicine at University College Dublin and interned at St...

“Migration Is Not a Crime”: Migrant Justice and the Creative Uses of Paddington Bear

Created in 1957, the well-known English children’s book character Paddington Bear is the product of a dizzying number of displacements. Author Michael Bond (1926–2017) was inspired to make Paddington an undocumented migrant by World War II and Cold War mass evacuations in Europe, but he transposed Paddington’s origins to the troped space of “Darkest Africa” only to relocate them to “Darkest Peru.” Fleeing earthquake for England, Bond’s ursine protagonist assumes the name of the London train station where he is “found.” The story’s literary and film critics have challenged its elevation to universality, arguing that it extends colonial discourse and idealizes Paddington as a nonthreatening, assimilated migrant. This article complicates those claims by tracing the character’s emergence as an icon of migrant justice movements in the United Kingdom and Europe, turning to object relations psychoanalysis to examine Paddington’s complex affective pull. Drawing on archival work in Bond’s papers and interviews with his contacts, including migrant justice activists, I contend that although Paddington’s literary construction reflects imperial imaginaries, his reception also attests to the transformative, solidaristic, and creative uses of cultural objects.

James Alan McKinna

James Alan McKinna was the youngest son of two GPs. He was educated at West Bridgford Grammar School, Nottinghamshire. He did his surgical training in London and was consultant surgeon...

171 Surgical Trainee Suggestions to Improve Surgical Training and the Surgical Recruitment Process in View of the COVID-19 Pandemic

IntroductionThe COVID-19 pandemic has had a significant impact on medical education and surgical training. The experiences of surgical trainees were sought to seek feedback on how both training and recruitment can be adapted to reflect these changes.MethodA survey was circulated amongst surgical trainees, to ask what changes to the recruitment process and surgical training they would suggest, in view of the changes related to the COVID-19 pandemic. Circulated amongst surgical trainees in London. 25 surgical trainees from London responded. Results were analysed and tabulated.ResultsSuggestions for the recruitment process include an appreciation by the recruitment panel about reduced academic achievement, relaxation of requirements, clinically oriented interviews and extension of training. Suggestions for surgical training include resumption of educational activities, ensured surgical activities and protected theatre time, mentorship and run through training.ConclusionsThe effects on surgical training due to COVID-19 must be appreciated, and trainees’ experience and feedback should be considered when adapting training and recruitment to this.

Roger Allum Hobdell

Roger Allum Hobdell grew up in north London and with his twin brother attended Mill Hill School. He then enrolled at the London Hospital, where he studied medicine; his twin,...

Public health surveillance of infectious diseases: beyond point mutations

The COVID-19 pandemic has once again brought the concept of viral mutations into the spotlight. The latest impetus is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) N501Y, associated with an increase in case numbers in parts of the UK1 and bringing concerning images of packed platforms at London train stations. This comes on the heels of the Y453F variant, which gained tremendous media attention as it was proposed to evade the long-awaited vaccine; accompanied in this case by disturbing images of mink being hurriedly culled and purportedly rising from their graves.