Training In London Research Articles

Peter J Gormley

Peter J Gormley pioneered day case cataract surgery in Northern Ireland in 1984. He was at the heart of initiatives that led to the creation of the Civil Rights Association....

A remarkable surgical training opportunity in Nigeria

Awojobi Clinic is a hospital deep in rural Nigeria. I visited for two weeks before starting my core surgical training in London, as part of a team led by Professor Andrew Kingsnorth from Derriford Hospital in Plymouth, representing the charity Operation Hernia, which aims to treat and teach groin hernia surgery in Africa.

Commonwealth Update

Kenya sent troops into Somalia in what has been seen as an attempt to carve out a sphere of influence in the war-torn country. The Islamist militant group Boko Haram killed more than 100 people in Nigeria. Attempts to reform the Commonwealth largely failed after the Chogm summit in Perth rejected proposals of the Eminent Persons Group. Despite calls at Chogm to decriminalise homosexuality in Commonwealth countries, two Malaysian states are set to increase penalties. As Australia was named as host of the 2018 Commonwealth Games, it emerged that 30 foreign contractors are still owed $80m for the recent Delhi games, which were marred by corruption. Hopes of campaigners that Uganda was finally acting on corruption were dashed. Michael Sata, a former cleaner at a London train station, became president of Zambia. The African National Congress suspended Julius Malema, firebrand leader of its Youth League and seen as a future president of South Africa, for five years.

Re: Clinical Leadership and Management in the NHS

We were interested to read your article about the leadership challenges faced by managers and clinicians in the NHS.1 As two trainees, one a manager and one a clinician, we have spent much time considering how to prepare ourselves for our future careers. We both wish to preserve our primary roles while being able to make a difference to patient care at every level. We have each been fortunate to have been offered leadership development opportunities, through the London ‘Darzi Fellowship’ programme and the NHS Graduate Management Training Scheme. The challenge for us has been translating the theoretical learning and personal development into the ‘live’ environment of a Hospital Trust. We very much agree that there is a need for training opportunities to help managers and clinicians develop meaningful working relationships. Efforts to improve clinical leadership through enabling clinicians to develop management competencies need to be balanced by helping managers to better understand clinical medicine. This will enable real dialogue between managers and clinicians at all levels so that services are developed with appreciation of clinical variation as well as wider resource constraints. Based on the experiences of an innovative Paired Learning Scheme in Imperial College Healthcare NHS Trust, we have developed a programme to link new NHS Graduate Management Training Scheme trainees and Foundation Year Two trainees in London through a buddy scheme. From September 2011, trainees will be encouraged to learn about each others' role through conversations, workshops and shadowing. They will work on small projects that encourage reflection on what joint working can deliver. Our own experience of working together has been incredibly positive. We are able to complement each other's work and as a pair have more credibility when approaching senior staff with ideas. Inspired by our successful partnership and developing friendship, we hope to inspire a future generation of medical and management trainees to learn to lead together from the very start of their careers.

Letter to the editor: The electronic learning habits of radiology trainees in London and South East England.

The Editor, An extensive variety of learning resources are available to current radiology trainees [1,2] and in addition to traditional books and journals there now exists a wide range of electronic resources to promote further clinical education [1,2]. Use of electronic and internet applications have increased greatly over recent years and now provide a valuable information resource for radiologists in training. Online resources include websites such as Aunt Minnie, emedicine/Medscape, RSNA online and Imaging consult, as well as more exam focused subscription multiple choice question website such as PasTest and OnExamination. Online books and journals are now available and the Royal College also provides its own Radiology Integrated Training Initiative resource. We designed and distributed an anonymous online questionnaire to all London, Kent, Surrey and Sussex radiology trainees to examine the use of various online/electronic learning resources, including use of Radiology Integrated Training Initiative, for radiology trainees versus more traditional learning methods. We also set out to assess access to information technology (IT) resources within the Deanery. We received 136 compete responses from a total of 302 trainees (an overall response rate of 45%). 18% of respondents were preparing for FRCR Part 1, 28% for Part 2A, 22% for Part 2B and 32% had completed their exams. Despite such a wide range of electronic resources being available the single most popular learning format remained the traditional book (42), followed by Radiology Integrated Training Initiative online (24), paper journals (20) and electronic journals (14). Less popular resources included Emedicine (6), Aunt Minnie Online (6), RSNA Online (6), Online MCQ sites (6) and electronic books (4) (Figure 1). Figure 1 Single most preferred resource among respondents. Regarding online resources 39% of trainees used Emedicine/ Medscape weekly and 34% on a monthly basis. Only 18% had ever used Imaging Consult and two-thirds of these hardly ever used this resource. 75% had used Aunt Minnie online, with 51% using this resource monthly or more frequently. 66% had used RSNA online, with 43% using this monthly or more frequently. 46% had never used online MCQ resources (e.g. PasTest and OnExamination) and 38% had prepared for exams using MCQs passed on from other trainees. 64% used electronic books. 76% of respondents felt easier access to electronic journals would encourage online learning. 76 answered that less restrictive IT policies at their institution would encourage use of online resources. 66 felt that more time should be dedicated to online learning and 76 believed there should be more computers. Interestingly our data correlates with that of Rowell et al [1] who reported in their cohort of respondents that for reading journal articles, 67% prefer hard copy. They noted that the results of their survey indicated that, despite an increase in internet use and the perception that web based information is reliable, most radiologists still prefer traditional resources for radiological information and radiology education [1]. This is consistent with the London/KSS respondents who despite demonstrating use of a wide range of electronic and online learning resources, traditional methods, such as paper books remained the most popular. Yours etc., C J Burke R H Thomas D Fascia D Howlett S Heenan

Importance of incorporation of personal communication devices in evacuation simulators

The importance of the incorporation of personal communication devices in emergency evacuation simulators will be discussed. Four case studies are examined to identify usage statistics and human behavior when using the devices in an emergency. The case studies are: 9/11 World Trade Center Attacks, London train bombings, Virginia Tech shooting and United Flight #93. The case studies’ findings are implemented into the Vacate evacuation simulator, which uses particle swarm optimization to mimic human pedestrian behavior. The physical actions of using a device, as well as the reaction to the information transmitted during usage, are examined. Findings show that the effects of the personal communication devices can affect individuals that are close to the user of the device, as well as those not in the local vicinity of the user. These effects, combined with the rapid mainstream acceptance of communication technologies, justify the implementation of personal communication devices into evacuation simulators.

Afolabi Michael Sawyerr

After house jobs in Wales, Afolabi Michael Sawyerr (“Af”) undertook specialist training in London and Edinburgh. This included research for his MD, at the Royal Free Hospital, and working as...

Comic Crisis

Comic Crisis Heather Houser (bio) Solar. Ian McEwan. Nan A. Talese/Doubleday. http://nan-a-talese.knopfdoubleday.com. 287 pages; cloth, $26.95. "Now, increasingly, we are one vast civilization, and we sense that it is the whole laboratory, the whole glorious human experiment, that is at risk. And what do we have on our side to avert that risk?… [A]bove all, we have our rationality, which finds its highest expression and formalization in good science…. Pessimism is intellectually delicious, even thrilling, but the matter before us non-scientists is too serious for mere self-pleasuring." Penned by British novelist Ian McEwan in a 2007 essay, these observations about the obstacles to and tools for averting climate change motivate his fictional foray into the topic with Solar. In his tenth novel, rationality and pleasure are no longer Manichaean choices. The dictates of reason and the allures of pleasure—particularly in its carnal and gustatory forms—both pull on physicist Michael Beard, a late-middle-aged Nobel laureate who falls into a second career of environmental entrepreneurship. The easy coexistence of rationality and sensuality in Beard pushes readers to doubt whether hormonally complex humans can possibly take action against large-scale threats whose solutions threaten self-interest. Solar strives to ignite wonder, an emotion that defines much environmentally concerned literature. Rather than the imperiled marvels of the nonhuman world, however, McEwan proffers Beard as the specimen toward which we direct our amazement. Solar thus approaches climate change through a study in character that hews to the conventions of literary realism. More precisely, the novel is a study in motivation, a subject familiar to McEwan devotees. We see Beard at three points in time—2000, 2005, and 2009—as he first feels shame, longing, and misery; as he struggles to resuscitate a ruined marriage and a waning career; as he heads a renewable energy project despite his tepid interest in "the course of a catastrophe"; and as his stomach gurgles anticipating the deep-fried cheese, American-sized breakfasts, and potato chips that lead him to obesity, heart disease, and inadvertent food theft on a London train. Inconsequential and momentous decisions alike bend his life's path and the path of others in his orbit. The novel asks: Given the human nature we see exaggerated in Beard, why should we ever expect to overcome our "wild success" as proliferative, consuming creatures, akin to "a ravaging bloom of algae, a mold enveloping a soft fruit," to stem climate change and preserve a wider nature? Solar opens with a man's deterioration rather than flourishing. The fifty-three-year-old Londoner Beard stumbles on rich emotion only when his nubile wife, Patrice, leaves him for the "help," a builder named Rodney Tarpin. The paunchy Beard uses his status as Nobel winner and head of various centers and academic departments to bed several women, but Patrice's adultery undoes him. The novel's perspective is largely Beard's despite the third-person narration, yet McEwan deftly balances the reader's incredulity toward and recognition of—if not sympathy for—a once thriving, now senescing man whose personal plight echoes his species': his success is his undoing. The narrative strikes this balance as Beard moves between home and workplace. His latest sinecure is as head of the National Center for Renewable Energy, which is developing the "Wind turbine for Urban Domestic Use," an unadventurous project that wastes tax dollars. Tom Aldous, a young postdoctoral researcher, dogs his boss with another proposal: by building on Beard's Nobel-worthy discovery—the vaguely sketched "Beard-Einstein Conflation"—the Center can generate energy through artificial photosynthesis and make its members true environmental saviors and moguls. When the elder researcher finds that Patrice is also cuckolding him with Aldous, he chances upon a way to snatch credit for the young man's scientific innovation. This comes about through a plot twist that's worth not spoiling. It's Solar's decisive moment and displays McEwan's talent for narrative pacing. The two cases of cuckoldry bookend the "2000" portion of the novel while the centerpiece is Beard's trip to the Arctic Circle, which the author visited with the Cape...

Stock Market Reaction to Terrorist Attacks: Empirical Evidence from Front Line State

Since the hijacked airliner attacks in the United States on Sept. 11, 2001, to the suicide blasts at night clubs in Bali in 2002 and the Madrid and London train bombings of 2004 and 2005 and a series of blast and attack in Pakistan, financial markets have reacted in a highly consistent pattern. In this study, we examined the effect of terrorist attack news on returns and volatility for the KSE100, oil and gas, financial and industry sector indexes. We employ the EGARCH model proposed by Engle and Victor (1993) as it allows good and bad news to have a different impact on volatility. Our results show that terrorist attack news has negative impact on the returns of all the sector indexes including the sector indexes. Such results are consistent with Karolyi and Martell (2005). However, these news increased the volatility of KSE100 index and financial sector index. We also find that the results of other sectors (oil and gas, industry) are not statistically significantly in respond to terrorist attack news, indicating that these type of news does not affect the volatility. Moreover, volatility asymmetry is negative in all of the sectors including KSE100 confirming leverage effect. Furthermore, persistence parameter beta is large for the sectors those are not affected by the terrorist attack news such as oil and gas and industry sector, indicating that the variance move slowly through time.

Necroethics of Terrorism

This essay is an attempt to begin to think through the complex interlacing of Levinasian ethics, violence, terror and war. The question driving this essay is: in the midst of the harrowing debris of body parts that followed the synchronised explosions of bombs in a number of London train carriages and a bus, what can possibly remain of the ethical? This question will be examined in the context of what remains unspeakable in the face of such acts of violence. Framed by the authorising rubric of declarations of law—as ‘that which speaks in the language of legislation and promises certainty in the anxious aftermath of the loss of certainty’, and the attendant concerns with the question of the ‘enemy’ (as clandestine operative of terror and as object of fantasies)—this essay seeks to examine the ‘unspeakable remainder’ of declarations of law, as that which unsettles (legislated) promises of certainty in the anxious aftermath of a terrorist explosion and its ongoing trauma. In the course of this essay, I proceed to think through the contentious relation between violence and ethics in the context of a Levinasian framework, arguing for a Levinas that challenges and unsettles pietistic views of his ethical philosophy. In deploying the neologism necroethics, I attempt to examine anachronic and necrological violence and its relation to the ethical injunction to own responsibility for the dead.

D. Evans (1919–2010)

David Evans who died quietly at home in March of this year was a remarkable man. He was our longest serving Chairman, being Chairman of the Council of Management of the JBJS(B) from 1975 to 1992. He held many other high offices in our specialty. He had a very distinct, quiet and persuasive style of

MEMORIES OF ISABEL MENZIES LYTH

I undertook analysis with Isabel Menzies Lyth in the course of my training in London as a child psychotherapist. This contribution is about my memories of her as my analyst, and in my long and friendly relationship with her after my analysis ended.

Abstracts from the North London trainees' presentation day

Abstracts from the North London trainees' presentation day

Evaluating changes in gastrointestinal endoscopy training over 5 years: closing the audit loop

An audit in 2002 showed that colonoscopy training in a large London training region was poorly structured, with the quality of supervision below recommendations and high reported complication rates. In 2004, the UK National Endoscopy Training Programme introduced centrally funded, accredited courses and new assessment tools to standardize training and raise the quality of colonoscopy by improving the skills of practicing endoscopists. To evaluate the changes in the standard of colonoscopy training over the last 5 years. Questionnaires used in the earlier study were updated and e-mailed to all gastroenterology trainees in the region and those who participated in the earlier study. Trainees completed and returned the forms electronically. Twenty-six out of 37 gastroenterology trainees responded (70.3%). Significantly more trainees said that they had been formally taught the principles of colonoscopy (91 vs. 65%; P = 0.02), polypectomy (81 vs. 52%; P = 0.02) and extubation (88 vs. 56%; P = 0.01) than in 2002, and reported that complication rates were lower. Trainers displayed more appropriate teaching strategies and course attendance had significantly increased (84 vs. 48%, P = 0.003). Eighty-seven percent of the trainees thought that their training had been adequate or better than adequate, compared with 25% in 2002. In the 2007 survey, trainees reported a significant improvement both in colonoscopy training at base hospitals and in access to specialist courses compared with those in the 2002 survey. The centrally funded training programme has made a significantly positive impact in this large training region that is likely to be reflected elsewhere in England. The loss of such investment may have a detrimental effect on future colonoscopy training and the quality of service provision.

Training of Assistant Forensic Medical Examiners in London, UK

The overall aim of this pilot study was to evaluate the quality of current practical training in London with a view to improving future training as part of faculty development. New trainees in clinical forensic medicine (CFM), Assistant Forensic Medical Examiners (AFMEs), were interviewed to gather their views of their recent training experience and to attempt to identify problems with implementing the training as it stands. An overwhelming theme emerged that there should be a more formal structure to the training of newly appointed FMEs. Each trainee should have a named clinical and educational supervisor during the training period. Furthermore it should be mandatory for educational supervisors to undergo training and review of performance.

Mary Elizabeth Lennox (née Smith)

After medical training in London during the war years, Mary was briefly a general practitioner before marrying Bernard (a pathologist) and moving to Glasgow. After raising a …

Robin Francis McNab Jones

Robin McNab Jones moved to Manchester as a child and was educated at Manchester Grammar School and Dulwich College. He graduated from Barts in 1945 and served in the Royal...

Peter Vincent Scott

After graduating in 1962 from Cambridge and University College Hospital, London, Peter Vincent Scott undertook surgical training in Cambridge, London, Bristol, and Wales, before taking up anaesthesia in Swansea and...

Personal psychotherapy in psychiatric training: study of four London training schemes

Aims and MethodWe carried out a web-based survey to establish the proportion of London psychiatry senior house officers who undertake personal psychotherapy. Demographics, training characteristics and psychotherapy experience were examined using descriptive statistics. Predictors of personal psychotherapy status were examined using logistic regression.ResultsThe majority of trainees who undertook personal psychotherapy included training as a reason for doing so. of the participants, 16% had undergone personal psychotherapy and of the remainder, 73% reported that they would consider it in the future. Ethnicity was the only predictor of psychotherapy status, with White British trainees nearly four times more likely to pursue it.Clinical ImplicationsPersonal psychotherapy appeared to have relevance to training from both a pastoral and a learning perspective. If training schemes wish to support this practice they will need to address difficulties trainees may face in accessing therapy. Trainees might also be encouraged to think about the effect of cultural factors on their attitudes towards psychological therapies.

Using Standardized Patients' Marks in Scoring Postgraduate Psychiatry OSCEs

Standardized patients (SPs) do not contribute scores in postgraduate psychiatry objective structured clinical examinations (OSCEs) in the United Kingdom. However, this may change in the near future. The primary aim of this study was to measure the degree of agreement between scores given by examiners and those given by SPs in an OSCE. The authors measured the degree of agreement in two consecutive postgraduate OSCEs for psychiatric residents on a London training scheme. Fifty-five candidates participated in the two OSCEs. There was a moderate degree of agreement between examiner and SP scores for communication and for the overall mark. However, there was a stronger relationship between the examiner score for communication and the candidates' overall mark. Examiners and SPs scored candidates differently. Therefore, the decision to include SP scores in the marking scheme for postgraduate OSCEs would be a significant development.