Years Of Postgraduate Experience Research Articles

Physiotherapists' Understanding of Shortwave Diathermy Contraindications: A Questionnaire Survey.

It is known that electromagnetic fields and heat generated by shortwave diathermy (SWD) can have adverse effects on living tissue. The purpose of this research is to evaluate Jordanian physiotherapists' knowledge of pulsed and continuous SWD contraindications. And investigate the potential contraindications about which Jordanian physiotherapists may have limited knowledge. This cross-sectional study investigates Jordanian physiotherapists' knowledge of SWD contraindications. In 38 private and public hospitals, a self-administered questionnaire survey was carried out. Participants were asked to classify 32 conditions as "always, sometime, or never" contraindicated or "I do not know". Participants are physiotherapists with two or more years of postgraduate experience. Two forms comprised the survey. The first consisted of assessing their reaction to the contraindications of pulsed shortwave diathermy (PSWD), while the second consisted of continuous shortwave diathermy (CSWD). Approximately 270 physiotherapists wereeligible to participate in this investigation. Only 150 questionnaires were distributed to the therapists whoagreed to the study. One hundred twenty-eight were returned for an average response rate of 85.3% (128/150). Respondents had good agreement about using SWD for cardiovascular condition, however, 24 respondents (19%) thought PSWD can be used over venous thrombosis. Only 64% of the respondents was aware that pacemakers are contraindicated for PSWD. Approximately 14% to 32% seem unaware that tuberculosis and osteomyelitis are contraindicated for both CSWD and PSWD. About 21% to 28% have been unaware that the use of PSWD is contraindicated for specialized tissues (eg, eyes, gonads, or malignant tissues) and 29% during pregnancy. Jordanian physiotherapists generally agreed on the widely acknowledged contraindications of CSWD for specific conditions. However, there was considerable uncertainty among Jordanian physical therapists about the contraindications of PSWD. This discrepancy highlights the need to improve physiotherapist awareness and for more fact-based research to the contraindication of SWD modality.

Development of a novel behaviourally anchored instrument for the assessment of surgical trainees.

BackgroundThe Royal Australasian College of Surgeons (RACS) created its competency framework in 2003 which initially consisted of nine competencies each regarded as equally important for a practising surgeon. The JDocs Framework is aligned to these competencies and provides guidance for junior doctors working towards the Surgical Education and Training program.MethodsA novel assessment instrument was designed around the JDocs framework using 48 behaviourally anchored questions. The study was completed in 2020 across five public hospitals in the ACT and NSW. Participants were invited to complete the self‐assessment form online.ResultsThirty‐six of 59 (61%) trainees participated in the study, with 67 of 68 (98.5%) supervisors having completed the assessment form. Trainee self‐rating scores were lower than that of supervisor ratings across all competencies except communication. The self‐rating scores were negatively correlated with the seniority of a trainee's level in all nine competencies. The years of post‐graduate experience was positively correlated with seven of the nine competencies. For gender and International Medical Graduate status, correlation was only identified for health advocacy and medical expertise. There was no correlation identified with a trainee's age.ConclusionThis pilot study has provided an opportunity to explore a new assessment instrument for surgical trainees that is aligned to the RACS competency framework using behaviourally anchored questions. Looking ahead, a better understanding of this instrument will potentially be helpful in early identification of underperforming trainees in order to facilitate early intervention, or its use as a selection tool for formal training programs.

Importance of Submental Diversion and Tracheostomy for the Oral and Maxillofacial Surgeon

Surgical airway maintenance in a patient with oral and maxillofacial trauma, pathology, or infection may present a technical challenge to the oral and maxillofacial surgeon. Submental diversion and tracheostomy are effective methods that can be performed with low complication rates.1,2 However, outcomes may be affected by surgeon experience and training; thus, it is important to evaluate the proficiency of graduates in their ability to perform the associated procedures. The purpose of this study was to evaluate the level of exposure to surgical airway management in training programs, assess the level of confidence in performing these procedures following completion of training, and determine the perceived importance of the procedures within the oral and maxillofacial surgeon's armamentarium.Email invitations were sent to 1200 active email addresses listed on the American Association of Oral and Maxillofacial Surgeons directory. The survey contained 18 questions assessing the level of oral and maxillofacial surgery training, current scope of practice, clinical experience with surgical airway management, confidence in performing surgical airway management, and views on the importance of competency in surgical airway management. Survey responses from individuals who had completed a CODA-accredited OMS training program in the United States were included for analysis. Descriptive statistics for all survey responses were computed using SPSS v. 27.0 (IBM Corp., Armonk, NY, USA). Bivariate analyses between survey responses were analyzed using Pearson's Chi-square tests.A total of 286 completed surveys from practicing oral and maxillofacial surgeons were included in this study; 81.1% of respondents had greater than 5 years of experience, 10.5% had 5 years or less of experience, and 8.4% were currently in fellowship training. Most (71%) held the majority of their practice in a private practice setting. Interestingly, 91% of oral surgeons reported tracheostomy as an important procedure for the OMS armamentarium, but 50% felt inadequately prepared. Frequency of exposure to tracheostomy and submental diversion procedures during residency was found to be significantly associated with level of comfort in completing the procedures (P = .001 and P = .000, respectively). However, only 44% of oral and maxillofacial surgeons completed 10 or more tracheostomies during residency training, and 6% completed at least 10 submental diversions. Years of post-graduate experience and practice setting were also found to have significant correlations with comfort level in completing tracheostomy and submental diversion.There is a broad range of experience and comfort among oral and maxillofacial surgeons in performing airway procedures. Almost all oral and maxillofacial surgeons feel that tracheostomy and submental diversion are important procedures for the oral and maxillofacial surgeon's armamentarium, but many do not feel comfortable in performing these procedures. The findings identify a potential need for additional emphasis in the training of these procedures during oral and maxillofacial surgery residency.

Another lost tribe: Quantifying the experience of international medical graduates applying for a national training number (NTN) in the United Kingdom with a cross-sectional study

BackgroundInternational medical graduates (IMGs) have a primary medical qualification obtained from outside their country of practice. In the United Kingdom (UK), postgraduate medical training after foundation years involves obtaining a national training number (NTN) in their specialty of choice by national selection. In this paper, we aim to quantify how IMGs feel to obtain an NTN and what unique obstacles they may face in doing so. Materials and methodsA survey with a combination of closed and open-ended questions was circulated to IMGs via social media and text message. The survey was aimed at those IMGs practising at a middle grade (non-consultant) level, whether they had obtained a training number or not. Data collected included demographics, years of postgraduate experience before UK arrival, number of attempts at obtaining a training number, and the most significant perceived difficulty to obtaining a training number. We also asked whether difficulties in obtaining a training number would cause IMGs to contemplate changing specialty. Data from the survey responses were analysed using SPSS 22. ResultsOut of a total of 203 doctors approached, 197 responded, of which the majority were male. All responders had at least five years of postgraduate experience before relocating to the UK. Only 56 (28.8%) had a training number at the time of the survey. Almost all the responders had made at least one unsuccessful attempt to obtain a training number. In addition, 152 (76.6%) of responders felt that timely career progression in the UK was unlikely without having a training number. 57 (29.6%) of responders considered changing specialty due to inability to obtain a training number. ConclusionObtaining an NTN remains a crucial goal among IMGs in the UK, despite the obstacles and repeated failures in doing so.

Perception of Non-Alcoholic Fatty Liver Disease: Real-Life Experience From Pakistan.

IntroductionNon-alcoholic fatty liver disease (NALFD) has become one of the most pervasive causes of hepatic pathology. Because of its marked association with metabolic syndrome, type II diabetes and cardiovascular disease, NAFLD has gained substantial focus recently. Its prevalence and incidence are on the rise in Pakistan. However, due to its indolent and mostly asymptomatic course, NAFLD is often overlooked. This reckless behavior towards a potentially deadly disease is influenced most notably by disinformation or flawed perception, although there are a number of other complex socioeconomic components to this as well. With respect to NAFLD, the gap between disease understanding and steps for management is growing in the Pakistani society. With this study, we hoped and aimed to evaluate just how far and wide these shortcomings were found and how was NAFLD perceived in the local populace via a self-administered survey.MethodsThis was a cross-sectional observational cohort study undertaken at the Department of Gastroenterology, Jinnah Postgraduate Medical Centre, and Medical Unit II, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan. All patients ≥18 years with a diagnosis of NAFLD were included in the study. NAFLD was diagnosed on the basis of sonographic evidence. All ultrasounds were done by a senior expert radiologist with at least 10 years of postgraduate experience. Ultrasounds were performed twice in all patients to rule out human error and bias. Perceptions regarding the knowledge of NAFLD were assessed using a self-administered survey questionnaire.ResultsThe female-to-male ratio in our cohort was 3:1. The mean age and body mass index (BMI) recorded were 39.85 ± 9.79 years and 31.21 ± 3.6 kg/m2, respectively. Sixty participants (26.4%) knew about their disease (NAFLD) while only 36 (15.9%) knew what NAFLD was and only 33 (14.5%) participants knew about the cardiovascular risk associated with it. Nearly two-thirds of the patients considered themselves overweight, while 180 (79.3%) of them were willing to lose weight. However, just about half of the cohort admitted the need for improved eating habits and increased physical activity/exercise in their daily lives. Fifty-seven (25.1%) patients admitted to using alternative or quack medications and only 45 (19.8%) patients considered them harmful.ConclusionsPatients harboring NAFLD have little to no knowledge about the disease and its nature or the fact that they are suffering from it despite being diagnosed clinically. Furthermore, while the general populace is willing to accept being overweight and having unhealthy eating habits, their willingness in initiating real-life practical steps to manage NAFLD is lacking.

A nationwide survey assessing the satisfaction of dental colleges graduates with their undergraduate experience in Saudi Arabia

ObjectiveTo date, there are no publications on the Saudi graduates’ perceived value of their dental curriculum. The aim of this nation-wide survey was to investigate graduates’ satisfaction with specific disciplines of their dental education and training. The first part of this study addressed findings according to the respondents’ gender and the number of years of postgraduate experience (Graduate-related factors). MethodsAn electronic questionnaire was emailed to registrants of the Saudi Dental Society, specifically dental interns, general dentists, and specialized dentists who graduated from private and governmental dental colleges in Saudi Arabia (n = 2185). ResultsThe response rate was 36.4 %. The number of male respondents was (n = 352, 44.2 %), the remainder being female (n = 444, 55.8 %). The number of recent dentists (≤ 5 years since graduation) was (n = 428, 53.8 %) and experienced dentists (n = 368, 46.2 %). There were statistically significant gender variations in satisfaction levels, and among dentists with different post-graduation experiences. Although male and female dental students are taught similar curriculums and have similar graduation requirements, there were statistically significant differences in various subjects covered. Similarly, recent and experienced dentists reported statistically significant differences in satisfaction in various subjects. ConclusionThis study provides graduates’ perspectives on the strengths and weaknesses of their dental education in Saudi Arabia. The findings help in curriculum reform and collaborations between the dental colleges nationally. Ultimately this can lead to formulating a national dental accreditation and assessment body. Clinical significanceThe findings of this study provide graduates’ perspective on the dental education received in Saudi Arabia. This will help stimulate discussion and collaboration within and amongst the colleges on improving their curriculum in this fast-paced, evolving field of dentistry.

Potential no man’s land for the 4th year dental graduate

The Royal College of Surgeons of England stipulates that to hold a substantive specialty or associate specialist (SAS) grade post a person must be a minimum of 4 years post-graduation and have at least 2 years’ experience in their chosen speciality. We have noticed an increasing number of excellent applications for specialty doctor adverts posted by our trust without the necessary 4 years of post-graduate experience. Many of these applicants who do not comply with the RCS stipulations may be forced to take a job outside of their chosen career path. The reasons for this may be multifactorial, but it could have a worrying impact on their own future career and hospital service provision. We looked at the number of SAS grade adverts placed on NHS jobs in the year 2019 and the type of job advertised. We also considered the possible reasons for a rise in the number of applicants for SAS roles in oral surgery and oral and maxillofacial surgery, and what changes, if any, could be made to support this group of clinicians.

Current assessment of parental and health professional perception of the colour of neonatal vomiting: Results of a scoping survey.

To determine current perceptions of doctors, nurses and parents for the colour of a neonatal vomit which should prompt an urgent surgical review. A voluntary scoping survey of parents/guardians of patients and non-surgical healthcare professionals was conducted with respondents asked to choose from 8 different selections in a colour swatch from pale yellow to dark green. A control group consisted of 13 paediatric surgeons. Data were analysed using the paired t test, Fishers exact test. A p value of < 0.05 was considered to be significant. 365 participants responded: 36% (131/365) parents, 18% (64/365) nurses and 46% (166/365) doctors. 4/365 (1%) did not state their role. 343 participants completed all questions and responses were analysed using total responses for each question. 82% (121/148) of doctors and 78% (50/64) of nurses had more than 3years of post-graduate experience. Overall, 63% (227/361) of participants (100% paediatric surgeons, 78% other doctors, 75% nurses/midwives & 30% parents) considered dark and light green vomits to be a sign of intestinal obstruction. 67% (242/361) of participants (100% paediatric surgeons, 72% other doctors, 56% nurses/midwives and 62% parents) believed dark and light green vomiting needed an urgent surgical referral. There were significant differences between the control group and other groups in terms of whether the neonate could wait until the next day for a review; nursing staff (p = 0.0002), postnatal/midwifery (p = < 0.0001), emergency medicine (p = 0.04), general practice (p = 0.002), neonatal (p = 0.0001) and paediatricians (p = 0.005). Only the neonatologists (p = 0.04), nursing staff (p = 0.001) and postnatal/midwifery (p = 0.004) believed that the neonate could have safe observation. Although the perception that green vomiting is potentially serious is acknowledged by the majority of healthcare professionals surveyed, there is still a requirement for more targeted educational practices in nursing, midwifery and medical staff.

Academic benchmarks for leaders in Otolaryngology - Head & Neck Surgery: a Canadian perspective

BackgroundThe present study summarizes the demographics, subspecialty training, and academic productivity of contemporary leaders in Canadian Otolaryngology – Head & Neck Surgery (OHNS) training programs across Canada.MethodsDemographic data regarding chairpersons (CPs) and program directors (PDs) were obtained from publicly-available faculty listings and online sources, and included employment institution, residency training, fellowship training status, gender, and years of post-graduate experience. Research productivity was measured using the h-index and number of publications, obtained from Scopus. Characteristics of CPs and PDs were compared using statistical analysis.ResultsCross-sectional data was obtained from a total of 27 CPs and PDs from 13 accredited OHNS training programs across Canada active on July 1, 2019. All academic leaders completed at least 1 year of fellowship training. Head and neck oncology represented 77% of CPs and 59% of academic leaders overall, while pediatric otolaryngology represented 43% of PDs. Females represented 11% of academic leaders. There was a significant association between location of residency training and employment, with 56% (15/27) of physicians working where they had trained (p = 0.001, Fisher’s exact test; φ = 2.63, p = 0.001). On average, individuals with a graduate (Master’s) degree had a significantly higher H-index (17.7 vs 7.4, p = 0.001) and greater number of publications (106 vs. 52, p = 0.02). Compared to PDs, CPs had a significantly higher average h-index score (14.5 vs. 8.14, p = 0.04) and accrued more years of post-graduate experience (29.7 vs. 21.3 years, p = 0.008). There were no differences in the proportions of CPs and PDs with graduate degrees. There appeared to be a decline in research productivity beginning 3 years after academic appointment.ConclusionsThis cross-sectional overview of academic leaders in Canadian OHNS programs demonstrates the following key findings: 1) all leaders completed fellowship training; 2) head and neck surgical oncology was the most common fellowship training subspecialty; 3) leaders were likely to be employed at the institution where they trained; 4) a Master’s degree may be associated with increased research productivity; 5) there is a potential risk of decreased productivity after appointment to a leadership position; and 6) women are underrepresented in academic leadership roles.

Cognitive appraisals and team performance under stress: A simulation study.

The present study explored how challenge and threat responses to stress relate to performance, anxiety, confidence, team identity and team characteristics (time spent in training and postgraduate experience) in a medical simulation-based team competition. The study was conducted during a national simulation-based training event for residents, the SIMCUP Italia 2018. The SIMCUP is a simulation competition in which teams of four compete in simulated medical emergency scenarios. Cross-sectional data were collected prior to the 3days of the competition. Subjects included 95 participants on 24 teams. Before the competition on each day, participants completed brief self-report measures that assessed demands and resources (which underpin challenge and threat responses to stress), cognitive and somatic anxiety, self-confidence and team identification. Participants also reported time (hours) spent practising as a team and years of postgraduate experience. A team of referees judged each scenario for performance and assigned a score. A linear mixed model using demands and resources was built to model performance. The data showed that both demands and resources have positive effects on performance (31 [11-50.3] [P<.01] and 54 [25-83.3] [P<.01] percentage points increase for unitary increases in demands and resources, respectively); however, this is balanced by a negative interaction between the two (demands*resources interaction coefficient=-10 [-16 to -4.2]). A high level of resources is associated with better performance until demands become very high. Cognitive and somatic anxieties were found to be correlated with demands (Pearson's r=.51 [P<.01] and Pearson's r=.48 [P<.01], respectively). Time spent training was associated with greater perceptions of resources (Pearson's r=.36 [P<.01]). We describe a model of challenge and threat that allows for the estimation of performance according to perceived demands and resources, and the interaction between the two. Higher levels of resources and lower demands were associated with better performance.

Survey of clinician and student impressions of a synthetic canine model for gastrointestinal surgery training.

To evaluate the perceived efficacy of a high-fidelity synthetic canine model for simulating common gastrointestinal surgical procedures. Survey of students and experienced clinicians. Twelve clinicians with >2 years of postgraduate experience in the field of small animal surgery and 102 senior year veterinary students. The model was subjectively evaluated by 12 clinicians with >2 years of postgraduate experience in the field of small animal surgery. Senior year veterinary students (n = 102) were asked to complete questionnaires before and after a laboratory on common gastrointestinal surgical procedures that included rating of perceived proficiency, anatomical knowledge, and the use of synthetic models compared with live animals. Clinicians assessed most aspects of the model as moderately realistic and unanimously agreed that it would be helpful for students to train on this model prior to live surgery. Student survey response rates were 91% and 99% before and after the laboratory, respectively. The proportion of students that felt moderately-to-highly proficient with the procedures increased from 8% prior to the laboratories to 59% after the laboratories (P < .001). The proportion of students that felt that they had superior-to-excellent knowledge of abdominal surgical anatomy increased from 16% prior to the laboratories to 44% after the laboratories (P < .001). The proportion of students that were satisfied with synthetic models instead of live animals increased from 52% prior to the laboratories to 74% after the laboratories (P = .014). Experienced clinicians considered the model to have moderate realism. A positive shift in the students' self-perceived proficiency with gastrointestinal surgery was evident after the use of the model. This synthetic model should be considered for training of veterinary gastrointestinal surgery. However, comparison studies are recommended to ascertain the relative educational value of this model.

Do Supervised Learning Events reflect clinical competency and support ‘Trainee in Difficulty' identification? Physician Trainees' perceptions.

Objective Training and assessment of postgraduate medical trainees has undergone a process of standardisation in recent years by using Workplace Based Assessments (WPBAs). WPBAs play a pivotal role in assessing competency and ensuring satisfactory training progress. From 2012 onwards, traditional WPBAs in the UK were replaced by Supervised Learning Events (SLEs) that include substantial formative feedback. SLE use are encouraged in identification and monitoring of training difficulties. Trainees’ perceptions of their value in identifying training difficulties and assessment of clinical competency are yet to be explored. Methods A mixed- methods study adopting Grounded Theory methods was conducted with Higher Specialty Trainees across three medical disciplines; individuals with several years of postgraduate experience. Participants completed an online questionnaire utilising both qualitative and quantitative questions (n=25). Subsequently, two focus groups were conducted to explore perceptions of the assessment process (n=14). Grounded Theory methods were used to develop codes for the qualitative data, with quantitative responses recorded using Likert rating scales. Results Multi-rater assessments were rated highest at assessing clinical competency, with directly-observed assessments rated lowest. Five main themes emerged from the data: 1. Trainees attempted to present their ‘best-self’: tension was identified between formative and summative aspects of assessments 2. Assessment process mistrust: concerns regarding the permanency of recording suboptimal performance impaired assessment use 3. Cultural shift of feedback provision: an enhanced feedback culture was identified, with assessments acting as a ‘springboard’ for knowledge development 4. Assessor dependence: pivotal role the assessor plays in training difficulty identification 5. Task-specific nature: narrow remit led to assessments’ limited ability to capture trainee performance Conclusions Physician trainees associate SLE introduction with enhanced identification of training difficulties through an improved feedback culture. Threats to optimal SLE use include fear of repercussions of negative outcomes and trainees masking weaknesses.

Nurse anesthetists' evaluations of anesthesiologists' operating room performance are sensitive to anesthesiologists' years of postgraduate practice

Study objectiveThe first aim of this study was to test whether a 7 item evaluation scale developed by our department's certified registered nurse anesthetists (CRNAs) was psychometrically reliable. The second aim was to test whether anesthesiologists' performance changed with their years of postgraduate experience. Design, setting, measurementsSixty-two University of Iowa CRNAs evaluated 81 anesthesiologists during one weekend. Anesthesiologists' scores were adjusted for CRNA rater leniency. Anesthesiologists' scores were tested for sensitivity to CRNA-anesthesiologist case-specific variables. Scores also were tested against anesthesiologists' years of postgraduate experience. The latter association was tested for sensitivity to case-specific variables, anesthesiologists' clinical supervision scores provided by residents, and anesthesiologist clinical assignment variables. Main resultsThe 7 items demonstrated a single-factor structure, allowing calculation of mean score over the 7 items. Individual anesthesiologist scores were reliable when scores were provided by at least 10 different CRNAs. Anesthesiologists' scores (mean 3.34 [SD 0.41]) were not affected by the interval since last CRNA-anesthesiologist interaction, number of interactions, or case-specific variables. There was a negative association between leniency-adjusted anesthesiologist scores and years of anesthesiologist postgraduate practice (coefficient −0.20 per decade, t = −19.39, P < 0.0001). The association remained robust when accounting for case-specific variables, resident clinical supervision scores, and overall clinical assignment variables. ConclusionsAnesthesiologists' operating room performance can be evaluated reliably by non-physician anesthesia providers (CRNAs). The evaluation process can be done reliably and validly using an assessment scale consisting of only a few (<10) items and with evaluations by only a few individuals (≥10 CRNA raters). There is no indication evaluations provided by CRNAs were significantly influenced by the interval between interaction and evaluation, number of interactions, or other case-specific variables. From CRNAs' perspectives, on average, as anesthesiologists gain experience, anesthesiologists' behaviors in the operating room change, providing CRNAs with less direct assistance in patient care.

Antipsychotic prescribing and its correlates in New Zealand.

Antipsychotics are the cornerstone of schizophrenia management. There is substantial literature on their efficacy and optimal use. Doubts remain, however, regarding the translation of this knowledge into day-to-day practice. This study aimed to investigate antipsychotic prescribing in three New Zealand regions and its relationship to clinical guidelines and patient characteristics. We studied 451 patients discharged from inpatient units with a diagnosis of schizophrenia or a related disorder (International Classification of Disease, version 10) between July 2009 and December 2011. Available information included patient demography, legal status, prescribed medications, duration of index admission and prescriber's country of postgraduate training and years of postgraduate experience. There was a high rate (33.7%) of multiple antipsychotic prescription, and lower than expected clozapine use (20%); Maori were prescribed clozapine more frequently than non-Maori (24% vs. 13%, respectively). Compulsory treatment was associated with more use of injectable medication and increased length of stay in hospital. Clinician characteristics did not significantly influence prescribing. Observed prescribing practice aligned with existing guidelines except for antipsychotic polypharmacy and clozapine under-utilisation.

Physical Therapists' Perceptions and Use of Exercise in the Management of Subacromial Shoulder Impingement Syndrome: Focus Group Study.

Shoulder pain resulting from subacromial impingement syndrome (SAIS) is a common problem with a relatively poor response to treatment. There is little research exploring physical therapists' perspectives on the management of the syndrome. The study objective was to investigate physical therapists' perceptions and experiences regarding the use of exercise in the treatment of patients with SAIS. This was a qualitative focus group study. Three 60- to 90-minute focus group sessions containing 6 to 8 experienced musculoskeletal physical therapists (total number=20) were conducted. Thematic content analysis was used to analyze transcripts and develop core themes and categories. Exercise was seen as key in the management of SAIS. The overarching theme was the need to "gain buy-in to exercise" at an early stage. The main subtheme was patient education. Therapists identified the need to use education about SAIS etiology to foster buy-in and "sell" self-management through exercise to the patient. They consistently mentioned achieving education and buy-in using visual tools, postural advice, and sometimes a "quick fix" of pain control. Furthermore, experienced practitioners reported including educational interventions much earlier in treatment than when they first qualified. Therapists emphasized the need for individually tailored exercises, including: scapular stabilization; rotator cuff, lower trapezius, and serratus anterior muscle strengthening; and anterior shoulder and pectoralis minor muscle stretching. Quality of exercise performance was deemed more important than the number of repetitions that the patients performed. Expanding the geographical area over which the focus groups were conducted and including therapists with less than 5 years of postgraduate experience may have strengthened the findings of this study. Experienced musculoskeletal physical therapists believe that exercise is central in treating patients with SAIS and that gaining patient buy-in to its importance, patient education, promoting self-management, and postural advice are central to the successful treatment of people with SAIS.

Early experience of a virtual journal club.

Traditional journal club models based on didactic presentation sessions followed by group discussion have many limitations. To overcome some of these shortcomings, a virtual journal club (VJC) using social media and e-mail was developed. The aim of this study was to report the initial experience of this novel multimodal e-learning platform to facilitate journal club discussion and promote the development of critical appraisal skills. Journal articles were discussed monthly via e-mail and social media. After a 3-week period of discussion, all comments were collated and group-generated critical appraisal summaries were fed back to participants. In addition, letters to the journal editors based on the group appraisal were submitted. A questionnaire survey to evaluate the VJC concept was also conducted. After eight cycles of the VJC, the mean trainee participation rate was 29.6 per cent (range 21.1-42.1%). Senior trainees (≥4 years of postgraduate experience) were more likely to participate than more junior trainees (75.0 versus 21.1%; p = 0.005). The majority of participants thought that the VJC was educationally valuable, easy to participate in, helpful in keeping up to date with recent papers and useful in developing critical appraisal skills. Barriers to participation were lack of time, motivation and lack of experience in critical appraisal. In addition, the group-generated critical appraisal summaries derived from VJC discussions led to eight published 'letters to the editor'. Traditional journal club models based on didactic presentation sessions followed by group discussion have many limitations This novel VJC model is a feasible and popular method of delivering a journal club in the postgraduate setting.

AN ANALYSIS OF EARLY CAREER TRAINING REQUIREMENTS FOR QUANTITY SURVEYING PROFESSIONALS

Early career experience can play a significant part in lifelong professional capability and the support and knowledge gained during the early years of graduate employment can influence future career direction and success. Whilst there are prescribed models of graduate development relative to the surveying professions, for example, those relating to the APC utilised by the RICS, there has been little evaluation in terms of their relative contribution to career success. Through the use of a questionnaire survey, the issue of learning and development for new graduates in their early career, the extent to which new graduates perceive themselves to be competent in various major quantity surveying activities and, the range of graduate training provided by the employer were explored. The main conclusions drawn from the study are that: new graduates exhibit a high level of self-doubt in professional competence; task competence is influenced by frequency of application, years of postgraduate experience and the mode of study taken by graduates in entering the QS profession. There is a difference between training received by graduates working for consultant and contracting employers. Graduates from full time study mode tend to receive more training from their employers compared to part time graduates.

Undertreatment of acute pain (oligoanalgesia) and medical practice variation in prehospital analgesia of adult trauma patients: a 10 yr retrospective study

Prehospital oligoanalgesia is prevalent among trauma victims, even when the emergency medical services team includes a physician. We investigated if not only patients' characteristics but physicians' practice variations contributed to prehospital oligoanalgesia. Patient records of conscious adult trauma victims transported by our air rescue helicopter service over 10 yr were reviewed retrospectively. Oligoanalgesia was defined as a numeric rating scale (NRS) >3 at hospital admission. Multilevel logistic regression analysis was used to predict oligoanalgesia, accounting first for patient case-mix, and then physician-level clustering. The intraclass correlation was expressed as the median odds ratio (MOR). A total of 1202 patients and 77 physicians were included in the study. NRS at the scene was 6.9 (1.9). The prevalence of oligoanalgesia was 43%. Physicians had a median of 5.7 yr (inter-quartile range: 4.2-7.5) of post-graduate training and 27% were female. In our multilevel analysis, significant predictors of oligoanalgesia were: no analgesia [odds ratio (OR) 8.8], National Advisory Committee for Aeronautics V on site (OR 4.4), NRS on site (OR 1.5 per additional NRS unit >4), female physician (OR 2.0), and years of post-graduate experience [>4.0 to ≤5.0 (OR 1.3), >3.0 to ≤4.0 (OR 1.6), >2.0 to ≤3.0 (OR 2.6), and ≤2.0 yr (OR 16.7)]. The MOR was 2.6, and was statistically significant. Physicians' practice variations contributed to oligoanalgesia, a factor often overlooked in analyses of prehospital pain management. Further exploration of the sources of these variations may provide innovative targets for quality improvement programmes to achieve consistent pain relief for trauma victims.

Development of assessing generic and specific technical skills in laparoscopic surgery

Background Assessing live laparoscopic surgery using structured methodology is still in its infancy; however, it removes bias and subjectivity. We critique a new assessment tool for technical skills in laparoscopic surgery. Methods A hierarchical task analysis was done for laparoscopic cholecystectomy (LC), and a global assessment for generic and specific technical skills for LC was developed. Two experienced surgeons with >12 years of postgraduate experience assessed 50 full-length LC operations blindly and independently. Results Five consultant/attending and 4 registrar/resident surgeons were recruited. Interrater reliability was k = 0.86 and k = 0.84 ( P < .05) for generic and specific technical skills, respectively. Mean time for consultants was 32 minutes (range 15 to 70) and for registrars was 53 minutes (range 20 to 90). Parametric Student t test analysis was significant for time between the 2 groups, P < .05. Nonparametric analysis of variance between the 2 groups for generic and specific technical skills was significant at P < .05. Conclusions This assessment tool for live laparoscopic surgery may have face, content, concurrent, construct, and predictive validities for generic and specific technical skills. We aim to continue the study and expand assessment to other surgical techniques.

Bilevel noninvasive positive pressure ventilation for acute respiratory failure: Survey of Ontario practice*

To determine physicians' stated practices regarding the use of bilevel noninvasive ventilation (NIV) for acute respiratory failure and the predictors of practice variation. Cross-sectional postal survey. Province of Ontario, Canada. Attending physicians and residents in four specialties at 15 teaching hospitals. We used literature searches and focus groups to design questions related to NIV utilization with respect to frequency, location of and indications for use, awareness of supporting literature, and perceived efficacy. We assessed the survey's clinical sensibility and reliability. We used regression analyses to evaluate practice variation among hospitals and specialties and to determine predictors of more frequent NIV use, initiation of and continued use in nonmonitored settings, and use for specific indications. Three hundred eighty-five (48%) of 808 physicians responded; 242 used NIV. The two most common indications for NIV use were chronic obstructive pulmonary disease and congestive heart failure. NIV guidelines, protocols, or policies were available in 12 of 15 hospitals. We found variation in NIV utilization among specialties but not hospitals. Specialty (critical care and respirology versus internal and emergency medicine), fewer years of postgraduate experience, and a greater number of noninvasive ventilators were predictors of more frequent NIV use (all p < or = .001). Only 6% of respondents reported initiation of use and continued use most frequently in nonmonitored settings, which increased with the number of noninvasive ventilators (p = .02). Physician characteristics such as awareness of the literature were predictive of NIV use for exacerbations of chronic obstructive pulmonary disease, whereas perceived NIV efficacy was predictive of use for many indications, including congestive heart failure. Self-reported practice variation for bilevel NIV exists among specialties but not hospitals and differs with respect to frequency, location of use, and use for specific indications. Some factors associated with variation in NIV use may be suitable targets for utilization improvement interventions.