The modernisation of the surgical house officer

Gossage, James; Modarai, Bijan; McGuinness, C L; Burnand, K. G.

doi:10.1308/003588405x51218

Cited by 7 publications

(3 citation statements)

References 6 publications

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“…Several studies have examined the effects of the New Deal, European Working Time Directive (EWTD) and Hospital at Night on junior doctors' training. [1][2][3][4][5][6][7] Our study showed ad ramatic decline in the number of appendicectomies performed by SHOs over a1-year period, between February 2002 and February 2003. Prior to this time, doctors worked an average of 61.2 h/week as part of a 1i n6o n-call rota.…”

Section: Discussionmentioning

confidence: 99%

Whose Appendicectomy? – Do Laparoscopic Appendicectomies Impair SHO Training?

Owais

Wilson

Sethi

et al. 2008

annals

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Ann RC oll Surg Engl 2008; 90:5 77-580 577Open appendicectomy is an ideal procedure for junior surgical trainees to develop their operative skills. However, we have noticed ad ecline in the number of appendicectomies performed by basic surgical trainees over recent years. An umber of studies published after the implementation of the New Deal in 1993 have demonstrated adramatic effect of changing in shift patterns of working on junior doctors. 1,2One of these studies found that the number of appendicectomies performed by SHOs might have fallen by 40% between 1985 and 1999.More recently,w eh ave also witnessed as hift towards increasing use of laparoscopic appendicectomy,a tt he possible expense of SHO training. One study,e xamining a structured approach to training registrars in laparoscopic appendicectomy,f ound that the number of open appendicectomies performed by the SHOs after the introduction of the programme fell by 50%. 3 We hypothesised that the growing popularity of laparoscopic appendicectomy is having ad eleterious effect on the operative experience of SHOs. The aim of this study was to test this hypothesis by examining recent trends with respect to the use of laparoscopic appendicectomy and SHO appendicectomies at one district training hospital. Patients and MethodsWe undertook ar etrospective review of all cases of appendicectomies performed in one district hospital over a 7-year period from August 1999 to August 2006. The operation details for all the patients are entered into a computerised data collection system at the day of the operation. These data were downloaded and used to obtain GENERAL Ann RC oll Surg Engl 2008; 90:5 77-580

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Section: Discussionmentioning

confidence: 99%

Whose Appendicectomy? – Do Laparoscopic Appendicectomies Impair SHO Training?

Owais

Wilson

Sethi

et al. 2008

annals

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“…Involvement of FY1s in acute surgical admissions has been sacrificed to ensure that routine tasks for existing ward patients are completed. ( 1 ) The assessment and management of acute referrals have been left to more senior members of the team, although management of emergencies should remain a key part of the training of junior doctors. ( 2 ) FY1s informally reported reduced confidence in dealing with acutely unwell surgical patients and dissatisfaction with their role, with the perception that they are less valued as part of the surgical team.…”

Section: Problemmentioning

confidence: 99%

Improving the education and experience of foundation doctors in general surgery

Martel¹,

Magee²

2014

BMJ Qual Improv Report

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Reduced working hours and fragmentation of the surgical firm has resulted in a gradual change in FY1 duties. Locally, FY1 doctors were no longer routinely seeing surgical emergency admissions, while FY1s informally reported reduced confidence in dealing with surgical emergencies. The goal of this project was to assess the current training of FY1 doctors within the unit, and to attempt to improve this by increasing exposure to surgical emergencies.Two months into their four month surgical rotation, FY1s completed an anonymous online survey that focused on their confidence in dealing with emergency surgical admissions. Working practice was then changed by the creation of a formal emergency foundation year one (FY1) rota, and the introduction of a baton bleep. The expectation was that all emergency admissions would be clerked by an FY1 doctor. The cohort were asked to repeat the survey after implementation of change.Across all areas assessed, the confidence and experience of the junior doctors was improved. Initially 70% of FY1s felt exposure to emergency surgical cases was inadequate, falling to 0% after the intervention. This was associated with a rise in the average number of acute cases clerked by each FY1 per week from 1.2 to 4.0. At baseline, only 30% of those surveyed felt that they were gaining the skills and experience necessary to prepare them for an FY2 job in general surgery, and after the intervention this increased to 100%.The increased pressures of service provision within reduced working hours does not necessitate the exclusion FY1 doctors from the assessment and management of surgical emergencies. We have demonstrated that preserving this exposure is a priority in the training of junior doctors, resulting in more experienced and confident medical staff.

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“…This is a DoH initiative which involves the creation of a single, multi‐disciplinary overnight team, the aim of which is to improve patient care by ensuring that tasks are carried out by the most appropriately trained individual. Critics of H@N argue that this is simply a cost‐cutting exercise in that it reduces the number of medical staff available overnight, which, in turn, jeopardises training 5 and possibly patient care 6,7 . In addition, the introduction of clinical support workers and extended‐role nurse practitioners further limits trainee opportunities to achieve clinical Foundation Training competencies and, indeed, some UK hospitals do not include FY1 trainees in night‐time hospital care 8…”

Section: Introductionmentioning

confidence: 99%