Training medical assistants for surgery. (25/965)

A successful programme is reported from Mozambique for training middle-level health workers to perform fairly advanced surgical procedures in remote areas where the services of consultants are virtually unobtainable. Manpower and financial constraints obliged Mozambique to train medical assistants to perform surgical work in rural areas, where three broad priorities were identified: pregnancy-related complications, trauma-related complications, and emergency inflammatory conditions. Since 1984, 20 health workers have emerged from three-year courses to become tecnicos de cirurgia (assistant medical officers), and it is expected that there will be 46 by 1999. The training comprises two years of lectures and practical sessions in the Maputo Central Hospital, and a practical internship lasting a year at a provincial hospital. Three workshops organized since 1989 suggest that the upgraded personnel are performing well. More detailed evaluation and follow-up are in progress. Throughout 1995 a follow-up was conducted on 14 assistant medical officers. They performed 10,258 surgical operations, some 70% of which were emergency interventions. Low rates of complication occurred and postoperative mortality amounted to 0.4% and 0.1% in emergency and elective interventions respectively.  (+info)

Work loads and practice patterns of general surgeons in the United States, 1995-1997: a report from the American Board of Surgery. (26/965)

OBJECTIVE: To characterize the work loads and practice patterns of general surgeons in the United States over a 3-year period (1995 to 1997). METHODS: The surgical operative logs of 2434 "generalist" general surgeons recertifying in surgery form the basis of this report. Selected demographics of the group are as follows: location: 50% Northeast and Southeast, 21 % Midwest, 29% West and Southwest; practice type: 45% solo, 40% group, 9% academics; size of practice community: 46% highly urban, 19% rural. Parameters evaluated were the average number of procedures and their distribution by category related to geographic area, practice type, community size, and other parameters. Statistical analysis was accomplished using analysis of variance. RESULTS: No significant year-to-year differences were observed between cohorts. The average numbers of procedures per surgeon per year was 398, distributed as follows: abdomen 102, alimentary tract 63, breast 54, endoscopic 51, vascular 39, trauma 6, endocrine 4, and head and neck, 3. Eleven percent of the 398 procedures were performed laparoscopically. Major index cases were largely concentrated with small groups of surgeons representing 5% to 10% of the total. Significant differences were as follows: surgeons in the Northeast and West performed far fewer procedures than those elsewhere. Urban surgeons performed a few more tertiary-type procedures than did rural ones; however, rural surgeons performed many more total procedures, especially in endoscopy, laparoscopy, gynecology, genitourinary, and orthopedics. Academic surgeons performed substantially fewer total procedures as a group than did nonacademic ones and in all categories except liver, transplant, and pancreas. Male surgeons performed more procedures than did female surgeons, except those involving the breast. More procedures were done by surgeons in group practice than by those in solo practice. U.S. medical graduates and international medical graduates had similar work loads but with a different distribution. CONCLUSIONS: This unique database will be useful in tracking trends over time. More importantly, it demonstrates that general surgery practice in the United States is extremely heterogeneous, a fact that must be acknowledged in any future workforce deliberations.  (+info)

Resident continuity of care experience in a Canadian general surgery training program. (27/965)

OBJECTIVES: To provide baseline data on resident continuity of care experience, to describe the effect of ambulatory centre surgery on continuity of care, to analyse continuity of care by level of resident training and to assess a resident-run preadmission clinic's effect on continuity of care. DESIGN: Data were prospectively collected for 4 weeks. All patients who underwent a general surgical procedure were included if a resident was present at operation. SETTING: The Division of General Surgery, Queen's University, Kingston, Ont. OUTCOME MEASURES: Preoperative, operative and inhospital postoperative involvement of each resident with each case was recorded. RESULTS: Residents assessed preoperatively (before entering the operating room) 52% of patients overall, 20% of patients at the ambulatory centre and 83% of patients who required emergency surgery. Of patients assessed by the chief resident, 94% were assessed preoperatively compared with 32% of patients assessed by other residents (p < 0.001). Of the admitted patients, 40% had complete resident continuity of care (preoperative, operative and postoperative). There was no statistical difference between this rate and that for emergency, chief-resident and non-chief-resident subgroups. Of the eligible patients, 58% were seen preoperatively by the resident on the preadmission clinic service compared with 54% on other services (p < 0.1). CONCLUSIONS: This study serves as a reference for the continuity of care experience in Canadian surgical programs. Residents assessed only 52% of patients preoperatively, and only 40% of patients had complete continuity of care. Factors such as ambulatory surgery and junior level of training negatively affected continuity experience. Such factors must be taken into account in planning surgical education.  (+info)

French survey of anesthesia in 1996. (28/965)

BACKGROUND: To identify the growth in the number of anesthetic procedures since 1980 and the changes in the practice of anesthesia, the present survey was designed to collect and analyze the anesthetic activity performed in France in 1996, from a representative sample collected in all French hospitals and clinics. METHODS: This study, initiated by the French Society of Anesthesia and Intensive Care, collected information that included the characteristics of patients (age, sex, American Society of Anesthesiologists status), the techniques of anesthesia, and the nature of the procedure for which anesthesia was required. All French private, public, and military hospitals were asked to participate in the survey. In each hospital in the country, all anesthetic procedures were documented and collected during 3 consecutive days, chosen at random during a 12-month period, to obtain a representative sample of the annual activity. All data were analyzed at the INSERM (National Institute of Health and MEDICAL RESEARCH: At the conclusion of the study, 5% of hospitals were randomly assigned to be audited to check for missing data and errors. The rate of anesthetic activity was calculated as the ratio between the annual number of anesthetic procedures and the number of the general population in the same age group. RESULTS: The participation rate of hospitals was 98%. The analysis of the 62,415 collected questionnaires allowed extrapolation of the anesthetic activity to 7,937,000 anesthetic procedures (95% confidence interval, +/- 387,000) performed in France in 1996. Thus, the annual rate of anesthetic procedures was 13.5 per 100 population, varying between 5.4 per 100 in girls aged 5-14 yr and 30.2 per 100 in men aged 75-84 yr. Surgery was involved in 71% of anesthesia cases. Regional anesthesia alone was performed in 20% of all surgical cases and was combined with general anesthesia in 3% of additional cases. Anesthesia for obstetric procedures represented 9% of all cases. Seventy-six percent of all anesthetic procedures started between 12:00 A.M. and 7:00 A.M. were related to obstetric activities. CONCLUSION: In comparison with a previous study, the present survey shows that the number of anesthetic procedures has increased by 120% since 1980, and the rate of anesthetic procedures increased from 6.6 to 13.5 per 100 population, the major changes being observed in patients aged > or = 75 yr and in those with an American Society of Anesthesiologists physical status of 3. In the same time period, the number of regional anesthetic procedures increased 14-fold. In obstetrics, the practice of epidural analgesia extended from 1.5% to 51% of all deliveries of the country.  (+info)

The usefulness of handheld computers in a surgical group practice. (29/965)

We designed a system using hand-held computers allowing physicians in the hospital setting to access their surgical schedules, to track patients in multiple hospitals, and to quickly enter billing information. The physicians would then update their schedules and pass billing information electronically when they returned to the office. The system was successfully implemented, it was well accepted by clinicians and staff users, and it showed an increased capture of charges. Whether an economically important effect on the number of days to post hospital charges will be evident after follow-up data has been collected.  (+info)

Role of surgical residents in undergraduate surgical education. (30/965)

OBJECTIVES: To identify the role and impact of surgical residents on the various activities of a senior (4th year) surgical clerkship, and to explore students' perceptions of differences between the teaching behaviours of attending physicians and residents. DESIGN: A survey by questionnaire. SETTING: McGill University, Montreal. METHOD: A 67-item questionnaire was administered to fourth-year medical students at the end of their 8-week surgical clerkship. Analysis of the data was performed using the Wilcoxon signed-rank test, Dunn's multiple comparison test and mean average. MAIN OUTCOME MEASURES: Overall satisfaction with the clerkship, teaching behaviours and teaching of clinical skills and basic principles. RESULTS: Overall satisfaction with the clerkship was 6.31 out of 10. Surgical residents were perceived as being significantly more active than the attending staff in 14 out of 15 teaching behaviours. They were also seen as important in teaching certain clinical skills such as suturing, assisting in the operating room and managing emergency situations. They also contributed significantly to teaching the basic principles of surgery such as infections, surgical bleeding and fluid and electrolytes. On a 10-point scale, students felt that more learning was achieved by independent reading, tutorials and residents' teaching than by other teaching modalities, including attending physicians' and nurses' teaching. CONCLUSIONS: Medical students perceive surgical residents as being significantly more active in their education process than the attending staff. Residents appear to be responsible for teaching various technical and patient management skills necessary for patient care. Along with independent reading and tutorials, resident teaching contributes a significant portion of the medical student's acquisition of knowledge and appears to contribute to the students' choice of surgery as a career.  (+info)

Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study. (31/965)

The present randomized study was undertaken in order to compare the short-term results between total laparoscopic hysterectomy and abdominal hysterectomy in a centre with experience in laparoscopic surgery. From January 1997 to September 1998 inclusive, 102 women aged 44-71 years were randomly assigned to either total laparoscopic hysterectomy (n = 51 patients) or abdominal hysterectomy (n = 51 patients). The patients' demographic characteristics were similar in both groups. Average intra-operative blood loss was lower in laparoscopic hysterectomy than in abdominal hysterectomy (P +info)

Learning rate for laparoscopic surgical skills on MIST VR, a virtual reality simulator: quality of human-computer interface. (32/965)

Acquiring laparoscopic surgical skills involves initial learning of cognitive and motor skills followed by refinement of those skills. The successful use of a virtual reality simulator depends on the quality of the interface for the human-computer interaction and this can be determined by the initial learning rate. MIST VR, a part-task virtual reality laparoscopic simulator, provides objective assessment of psychomotor skills and can generate an overall score for performance, based upon errors made and time taken for six different tasks. This study analysed the rate of early task/instrument/computer familiarization on consecutive scores achieved by surgically experienced and naive individuals. Eleven surgeons, 18 medical students and seven non-medical personnel were tested on the simulator up to ten consecutive times, within a 2-week period. Performance data from every task and repetition were analysed to obtain individual scores of task performance. The calculation of overall score penalized errors far more heavily than total time taken, with high scores indicating poor performance. The surgeon-computer interface generated a rapid and significant early familiarization curve up to the third session on the simulator, with significant reductions in both time taken and total contact errors made. These results suggest that MIST VR represents a high quality interface. Surgeons scored consistently and significantly better than other subjects on all tasks. For surgically naive individuals, it was possible to predict the level of laparoscopic skills performance that would be attained after overcoming initial simulator learning curve, by studying their initial score. Overall scores reflected surgical experience and suggest that the simulator is measuring surgically relevant parameters. MIST VR provides a validated and much needed method for objective assessment of laparoscopic skills, for a variety of surgical disciplines.  (+info)