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David A K Watters

Publications and source records attributed to David A K Watters.

7 recordsLinked to original sources
PubMed2006

Requirements for trainee logbooks.

All trainees are required to keep a logbook as a record of the procedures they have carried out during their surgical training. However, the current logbook is only a record of work carried out and not of the outcome of the operations. It does not prepare the trainee for either a lifetime practice of surgical audit or for a lifetime of learning from the audit process. The logbook requirements of different training boards vary and consequently, trainees find the keeping of a logbook an inconsistent process with ill-defined learning objectives. The Royal Australasian College of Surgeons should define what needs to be collected, how data should be verified and how experience and learning should be reported, and should approve electronic databases that meet logbook standards. The choice of database software and format can then be left to the trainee. Although there are good examples of electronic logbooks being developed, there is, at present, no perfect logbook available. We recommend that all trainees, from the commencement of basic surgical training, should keep a logbook that contains the minimum and expanded datasets in addition to specific trainee data on supervision and learning. In addition to the current reporting format focused on procedural casemix and supervision level, quality/outcome reports and a record of learning are recommended.

Clinical Competence↗
PubMed2006

The surgical trainee log we need: minimum of work, maximum of output.

BACKGROUND: The objective of this study was to design a trainee logbook suitable for both surgical training and surgical audit. The fields of the logbook should conform to both the current requirements for surgical trainee logbooks and the minimum and recommended datasets for surgical audit. The database should be able to share information with other databases including hospital information systems. The current logbook requirements do not include much outcome data. Therefore, keeping the logbook does not train the young surgeon to collect all the information necessary for surgical audit, particularly the recently promoted minimum (12 fields) and recommended (22 fields) datasets. METHODS: An electronic logbook was developed as part of the hospital's clinical information system (CORDis). Patient identifier information was available in the system and did not need to be re-entered (e.g. name, number, date of birth and sex). The trainee only input the necessary fields for his/her logbook and was able to derive information already available from CORDis on complications, outcome and final diagnosis of the patient. RESULTS: Thirteen of 16 trainees used the program over a period of 2.5 years, and more than 4600 operative procedures were recorded. Information on outcome and complications was included in the logbook, regardless of who in the team entered the data. This also facilitated surgical audit presentations. Logbook reports for the Advanced Training Board were produced with the click of a mouse rather than by spending a whole weekend counting items in the operation register at the end of a 6-month rotation. This system could be used at different hospitals or the data can be exported to another database including databases on a hand-held device. CONCLUSION: The logbook contains all the data for reporting to the Specialty Training Board and Surgical Audit. Duplication of data entry was reduced, and presentation of unit/trainee surgical audits was facilitated. The data can be exchanged with other common databases when the trainee rotates out of Geelong.

Confidentiality↗
PubMed2006

Influence of training on the family.

BACKGROUND: There is currently a shortage of surgeons working in rural Australia. This may be due to partner dissatisfaction with rural placements during training. METHODS: A questionnaire encompassing logistic, financial and emotional aspects of peripheral placements was distributed to trainees and their partners. A similar questionnaire was also distributed to 25 rural surgical consultants. RESULTS: Seventy-four per cent of trainees were either married or in long-term relationships. A further 24% had children. The average number of residential moves per year of training was 0.74. Respondents reported difficulties that included accommodation suitability, general practitioner availability, financial burden and finding amenities such as school and crèches. Many (66%) partners had experienced high levels of isolation or loneliness, whereas some reported the development of a stress-related disorder, depression or anxiety. Most respondents indicated that their partner would influence their decision to work in a given location. Furthermore, 20% of consultant surgeons had either moved town or had seriously considered moving town because of their spouse or children's dissatisfaction. CONCLUSION: Training in peripheral locations causes significant stress to the trainee and their families. These experiences dissuade trainees from working in rural locations as consultants.

Australia↗
PubMed2006

Specialist surgical training in Papua New Guinea: the outcomes after 10 years.

Surgical training commenced in 1975, the year that Papua New Guinea (PNG) gained independence. The training involves a 4-year programme leading to a Master of Medicine (MMed), awarded by the University of Papua New Guinea. In the past 30 years just over 50 general surgeons have graduated. There have also been 9 graduates in the area of ear nose and throat, 10 in ophthalmology and 2 in oral surgery. The subspecialization of general surgeons began in 1994 with four trainees, two orthopaedic, one head and neck and one urological. The model used was to develop specialist skills over 2-3 years only qualified (MMed) general surgeons so that their ability to carry out general surgical procedures and work in a remote hospital was not lost. The different specialties required different balances of in-country and out-of-country training depending on the local ability to provide training in PNG. An important sponsor has been the PNG National Department of Health, which has funded the training posts by using existing general surgical positions and covering the loss of manpower while surgeons are training overseas, sometimes for up to 2 years. Medical education and tertiary health service projects, funded by Aus-Aid, have also contributed significantly to the teaching and training. These projects have provided visiting specialists to teach and hospital attachments for national surgeons to train in Australasia. Various individual surgeons and their specialist societies in Australasia have also provided invaluable support. Three surgeons have been recipients of the Rowan Nicks scholarship. Twelve surgeons have been awarded a specialist diploma and a further five are in training. The posting of national specialist surgeons to Port Moresby has resulted in all modules of the General surgery MMed programme being taught by Papua New Guineans, which would have been hard to imagine back in 1993. The MMed is now a sustainable programme and can be provided without external support. National surgeons carry out a wide range of specialist procedures, formerly carried out only by visiting teams. They are also able to make outreach visits within PNG and specialist visits to neighbouring Pacific Island countries.

Australia↗
PubMed2005

Electronic medical handover: towards safer medical care.

As the working hours of junior doctors decrease, adequate handover of patients becomes more important to maintain continuity of care and avoid errors caused by information gaps. A minimum dataset for surgical handover should include the patient's name, location (ward and bed number), date of admission, diagnosis, procedure (with date), complications and progress, management plan, resuscitation plan, consultant availability (and instructions if not available), expected need for review, and name of doctor completing handover and date to confirm that information is current. An electronic handover system is a potential solution, but our survey shows that free-text entry into such systems may be inadequate; prompts or predefined fields for handover content are possible solutions.

Consumer Behavior↗
PubMedDate not supplied

Guidelines for surgical audit in Australia and New Zealand.

Surgical audit is an important part of the process to measure performance, reduce clinical risk and improve quality of care. Recognizing this, the Royal Australasian College of Surgeons established a Surgical Audit Taskforce as a subcommittee of the Board of Continuing Professional Standards. This study aims to review the recommendations of the Taskforce for data collection and peer review. The minimum data for whole-practice, continuing audit have been defined. The method of data collection, devices and databases are personal choices for the individual surgeon. However, there are many benefits of developing an electronic surgical audit, and these include facilitating comparison and sharing of audit data between units. Surgical audits should not only report on work carried out but also ensure that outcomes include key performance indicators such as major complications, readmissions, reoperations, transfers, incident reports, complaints and mortalities. Effective clinical governance demands that issues raised by audit need to be documented and reported together with recommendations for improvement. Surgeons should be proactive in helping to find and implement solutions to the issues arising from surgical audit.

Australia↗