The future of surgery--Santayana or Ford.
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The Canadian health care system is currently in an era of reform and restructuring. Economic and political forces, changes in licensing and educational system as well as public expectations all influence change in this evolving health care delivery system. In contemplating change it is useful to remember the lessons of our rich surgical history so that the mistakes of the past will not be repeated. The Canadian Association of General Surgeons is well positioned to exert a leadership role in the evolution of surgical care in Canada. The role of the Association in the promotion of evidence-based surgery, continuing professional development and the provision of surgical services in rural areas is discussed in this paper. (+info)
Canadian Network for International Surgery: development activities and strategies.
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The Canadian Network for International Surgery (CNIS) is a surgical development and research organization, whose objective is to reduce death and disability from surgical disorders in low income countries. The organization has 4 main activities: (1) the Essential Surgical Skills (ESS) program teaches surgery to general practitioners and is predicated on the assumption that there will not be enough surgeons in Africa in the foreseeable future and therefore nonsurgeons must do surgery; (2) the injury control program, which is predicated on the conclusion that the incidence of injury in Africa is unacceptably high, therefore injury prevention is an imperative surgical strategy; (3) the library project, which sends new and recent books and journals to the surgical libraries of our African partners; and (4) the members' projects, which encourage individual or organization members to use their own creativity in meeting CNIS objectives. The CNIS has direct activity in 4 African countries and presents its project check list as a means to help others succeed. Canadian surgical and allied specialists can help in the reduction of needless suffering by supporting the CNIS. (+info)
Laparoscopic appendicectomy: safe and useful for training.
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Debate exists about the benefits of laparoscopic appendicectomy when compared to a conventional open procedure. The majority of appendices are removed by the open route in the UK. We report a series of 132 cases of suspected appendicitis managed laparoscopically: 112 (85%) of the patients had acute appendicitis, the remaining 20 (15%) had non-appendiceal pathology. The median operative time was 30 min and there were no conversions to an open operative procedure. The median postoperative stay was two days. Complications were seen in two patients. The published evidence comparing laparoscopic and open appendicectomy is contradictory. Our series shows that laparoscopic appendicectomy is a safe procedure with low morbidity; it is also an excellent training tool in laparoscopic technique and, with sufficient experience, takes no longer than an open procedure. Negative appendicocecotomies are most common in women of fertile age and can be associated with significant morbidity; therefore, laparoscopy should be used to make the diagnosis and, if appendicitis is the cause, the appendix could safely be removed laparoscopically. However, the choice between open and laparoscopic procedure is a subjective decision for the patient and their surgeon. Laparoscopic appendicectomy cannot be regarded as the gold standard. (+info)
Examination of the Distinctive Awards System.
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When they stopped secrecy, the consultants of an internationally-famous postgraduate teaching centre in psychiatry--not a designated teaching hospital--discovered that they had one-tenth the national average of distinction awards. Subsequent investigation of the whole system suggests that this is not an isolated case. Moreover, official figures are scanty and misleading. This paper explores the difficulties in understanding, investigating, and influencing the system. The composition of the committees involved, the de facto quota system, the method of collecting information, and the convention of secrecy are examined and critized. (+info)
Improving continuing medical education for surgical techniques: applying the lessons learned in the first decade of minimal access surgery.
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OBJECTIVE: To examine the first decade of experience with minimal access surgery, with particular attention to issues of training surgeons already in practice, and to provide a set of recommendations to improve technical training for surgeons in practice. SUMMARY BACKGROUND DATA: Concerns about the adequacy of training in new techniques for practicing surgeons began almost immediately after the introduction of laparoscopic cholecystectomy. The concern was restated throughout the following decade with seemingly little progress in addressing it. METHODS: A preliminary search of the medical literature revealed no systematic review of continuing medical education for technical skills. The search was broadened to include educational, medical, and psychological databases in four general areas: surgical training curricula, continuing medical education, learning curve, and general motor skills theory. RESULTS: The introduction and the evolution of minimal access surgery have helped to focus attention on technical skills training. The experience in the first decade has provided evidence that surgical skills training shares many characteristics with general motor skills training, thus suggesting several ways of improving continuing medical education in technical skills. CONCLUSIONS: The educational effectiveness of the short-course type of continuing medical education currently offered for training in new surgical techniques should be established, or this type of training should be abandoned. At present, short courses offer a means of introducing technical innovation, and so recommendations for improving the educational effectiveness of the short-course format are offered. These recommendations are followed by suggestions for research. (+info)
Efficient evaluation of thyroid nodules by primary care providers and thyroid specialists.
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OBJECTIVE: To determine whether primary care providers and thyroid specialists at Gundersen Lutheran Medical Center are evaluating thyroid nodules efficiently by following recently published clinical guidelines. STUDY DESIGN: One-year retrospective chart review. PATIENTS AND METHODS: We reviewed patient records from 1996 and tabulated the use of fine-needle aspiration cytology, radionuclide scanning, and thyroid ultrasonography by 49 primary care physicians evaluating 81 thyroid nodules and by 5 thyroid specialists evaluating 29 thyroid nodules. The results were compared with our previous findings and those recently reported by others. RESULTS: Fine-needle aspiration cytology was widely used by both groups of Gundersen Lutheran healthcare providers. Primary care physicians used imaging studies modestly and generated $106 per patient in unnecessary costs. Thyroid specialists occasionally used radionuclide scanning but did not use thyroid ultrasonography; they generated $41 per patient in unnecessary costs. Overall, the introduction of fine-needle aspiration cytology at our institution has reduced the use of radionuclide scanning from 90% to 12% and the use of thyroid ultrasonography from 30% to 10%. We also found that the frequency of surgery in patients with thyroid nodules fell substantially, yet detection of thyroid cancer in the operative specimens increased from 16% to 43% while the cost of removing a thyroid carcinoma decreased from $64,000 to $25,000. CONCLUSIONS: Fine-needle aspiration cytology, adopted as the initial test for diagnosing thyroid nodules by most of our healthcare providers, has reduced the use of imaging studies far below the frequency reported by others and has substantially decreased the cost of thyroid nodule management. (+info)
The impact of trauma teams on basic surgical training.
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An analysis of the number of trauma teams and the extent of involvement of basic surgical trainees in these teams in the South-West region is presented. (+info)
All basic surgical trainees should rotate through an accident and emergency post.
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A 6-month post in accident and emergency is no longer compulsory for basic surgical training. Meanwhile, trauma teams have emerged in many UK hospitals to receive seriously injured patients, often with no involvement of basic surgical trainees (BSTs). This may lead to the appointment of surgical specialist registrars (SpRs) who have had little exposure to the initial management of seriously injured patients. This study documents the experience of a senior house officer undertaking a 6-month post in the accident and emergency department of a district general hospital. METHODS: Data concerning the nature of cases seen were collected retrospectively from all patient record cards signed by the author during the placement. RESULTS: During the period studied, the author was present in the resuscitation room on 41 occasions, of which 10 episodes involved the management of a multiply injured patient. A total of 159 fractures and significant soft tissue injuries in the upper limb and 122 such cases in the lower limb were seen. There were 25 head injuries, 17 spinal injuries, 5 significant cases of chest trauma, 4 of abdominal trauma and 5 significant urinary tract injuries. Some 86 practical procedures were carried out during the placement. DISCUSSION: The 6-month post in accident and emergency provided the BST with significant exposure to the care of seriously injured patients. Such a post should be compulsory to ensure that SpRs on appointment have already received exposure to managing the seriously injured. The post provided additional benefit in terms of performing practical procedures and exposure to other acute surgical conditions. (+info)