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Completion of foundation doctors' assessments by hospital consultants is viewed as a low priority. These assessments are being completed to a large extent by fellow doctors in training. The learning opportunities are consequently less educationally productive. F2 doctors want more opportunities for valued consultant interaction with timely feedback. Suggestions are proposed to improve WPBA implementation. The present WPBA process lacks integrity and a change in approach is urgently required.

Background-Resection is the treatment of choice for lung cancer, but may cause impaired cardiopulmonary function with an adverse eVect on quality of life. Few studies have considered the eVects of thoracotomy alone on lung function, and whether the operation itself can impair subsequent exercise capacity. Methods-Patients being considered for lung resection (n = 106) underwent full static and dynamic pulmonary function testing which was repeated 3-6 months after surgery (n = 53). Results-Thoracotomy alone (n = 13) produced a reduction in forced expiratory volume in one second (FEV 1 ; mean (SE) 2.10 (0.16) versus 1.87 (0.15) l; p<0.05). Wedge resection (n = 13) produced a nonsignificant reduction in total lung capacity (TLC) only. Lobectomy (n = 14) reduced forced vital capacity (FVC), TLC, and carbon monoxide transfer factor but exercise capacity was unchanged. Only pneumonectomy (n = 13) reduced exercise capacity by 28% (PṼ O 2 23.9 (1.5) versus 17.2 (1.7) ml/min/kg; diVerence (95% CI) 6.72 (3.15 to 10.28); p<0.01) and three patients changed from a cardiac limitation to exercise before pneumonectomy to pulmonary limitation afterwards. Conclusions-Neither thoracotomy alone nor limited lung resection has a significant eVect on exercise capacity. Only pneumonectomy is associated with impaired exercise performance, and then perhaps not as much as might be expected.

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