Objective: To explore the factors that may influence the progress of doctors who come from the Indian subcontinent to train in paediatrics in the UK. Methods: Overseas doctors training in paediatrics in Rotherham, Sheffield and Doncaster participated in the study. Focus groups were used to collect data; two focus groups, each with 4-5 participants, were conducted at 6-week intervals. Semistructured, one-to-one interviews were conducted to add more understanding and depth to issues highlighted in the focus groups. The focus groups and interviews were audiotaped; the tapes were transcribed and data were analysed using the Grounded Theory; open codes were formed and concepts identified using microanalysis, and initial theories were built. Results: Lack of information about the National Health Service (NHS)/Royal Colleges, inappropriate communication skills, difficulties in team working, difficulties in preparing for Royal College examinations, visa and job hunting, and social and cultural isolation were identified as major barriers. Problems arose not only from difficulties with language but also from use of local and colloquial words, different accents and difficulty in communicating sensitive issues. Lack of understanding of role in teams and difficulties in working in multiprofessional setting all contributed to the problems. Cultural differences inside and outside the workplace, and social isolation were also highlighted. Induction programmes, mentoring, awareness of the issues within the teams, and courses in communication specifically directed at overseas doctors were identified as means to overcome these barriers. Conclusions: Several intercultural factors were identified that could act as barriers to the progress of overseas doctors training in paediatrics in the UK. Increased awareness of these factors within the teams would be the first step in resolving some of the issues.
Hypospadias is considered as second most common birth defect in children with 1 in every 250 male births worldwide and 1 in every 150 boys in India. Urethroplasty is only mode of hypospadias repair which is associated with wide range of complications like urethrocutaneous fistula, meatal stenosis, narrow urethra. Rising incidence of these complications demands judicious postoperative care and urethral calibration. Objective: To develop and operationalize protocol on urethral calibration for children undergone urethroplasty among caregivers and nursing personnel. Method: An operational study was conducted on caregivers and nursing personnel at pediatric surgery OPD. Total of 40 study subjects i.e. 32 caregivers and 8 nursing personnel included by total enumeration sampling. Study was conducted in three phases. In 1st phase, current practices of urethral calibration were assessed.10 observations were taken to identify lacunae regarding procedure. Protocol on urethral calibration was developed by extensive literature review, expert opinions using Delphi technique. In 2nd phase, training sessions were conducted using lecture cum discussion, demonstration and return demonstrations, booklets and posters. In 3rd phase, assessment of effectiveness of urethral calibration was done by evaluating occurrence of complications related to urethroplasty. Results: Significant (p < 0.001) increase in mean performance score of urethral calibration of caregivers and nursing personnel was achieved up to 22.75 ±1.10 and 23.50 ± 0.92 after four and three subsequent return demonstrations respectively. Conclusion: Protocol on urethral calibration is effective in developing skills among caregivers and nursing personnel related to procedure and improving surgical outcome of urethroplasty among children.
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