Thinking outside the (tick) box: rescuing professionalism and professional judgement.
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Decision Making↗
Biomedical subjects
Linda de Cossart
Publications and source records attributed to Linda de Cossart.
A question of professionalism: leading forward the surgical team.
Surgical practice must be driven by wise professional judgements, involving complex deliberation, in the interests of ensuring the safe care of patients. Large amounts of energy are now being concentrated in training doctors in skills (competencies) in the belief that this will reduce risk to patients. Little thought is being given to developing in the young, wise professional judgement which is at the heart of being a good doctor and a good surgeon.
Attitude of Health Personnel↗
The surgical high dependency unit: an educational resource for surgical trainees.
BACKGROUND: Learning to recognise the seriously ill patient and developing the ability to manage them is a very important part of the education and training of surgeons. A general surgical senior house officer (SHO) spends 4 months on our surgically-led high dependency unit (HDU), as part of their basic surgical training programme. AIM: To assess a surgical high dependency unit as an educational resource. METHODS: We interrogated our specifically designed database for a 5-year period (April 1997 to March 2002) to look at what a 4-month attachment offered SHOs in respect of: the number of patients treated; their modes of presentation; the specialty; the physiological and operative scores as determined by the POSSUM scoring system; and the interventions that occurred. DISCUSSION: We have demonstrated that a 4-month attachment to a surgical HDU provides a consistent and valuable clinical resource for teaching and learning in surgical education and training.
Critical Illness↗
A first curriculum framework for surgical SHOs designed by the Royal College of Surgeons of England.
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Curriculum↗
Routine beta-blockade in vascular surgery.
We have evaluated the safety and efficacy of routine beta-blockade for the prevention of cardiac complications in a comprehensive series of patients undergoing major vascular surgery and amputation for atherosclerotic arterial disease. From 1 December 2001 to 31 May 2002, patients received perioperative beta-blockade by atenolol. Outcomes in this period were compared to the immediately antecedent 6 months. The main outcome measure was the occurrence of cardiac complications. Fifty-three patients underwent surgery in the first period and 54 in the second. After introduction of routine beta-blockade, only one patient suffered cardiac complications compared to 10 in the first period (P=0.01). There were eight deaths in the first and two in the second period (P=0.052). On multivariate analysis, treatment with beta-blockers was the only variable significantly associated with a decrease in cardiac morbidity (OR=0.12; 95% CI=0.002-0.66; P=0.014). Two patients suffered bronchospasm leading to discontinuation of atenolol. Routine perioperative beta-blockade was safe and reduced the occurrence of cardiac complications after vascular surgery.
Adrenergic beta-Antagonists↗
Exploring the views of basic surgical trainees (senior house officers) on a basic surgical training scheme.
The objective of this study was to explore views of basic surgical trainees on a basic surgical training scheme that complies with college requirements. A postal questionnaire was distributed to 115 basic surgical trainees. Questions focused on career choices, influences on those choices, and self-appraisal. A total of 93 questionnaires were completed and returned (81%). Fifty (54%) were Liverpool Medical School graduates. Forty-nine (53%) respondents came directly onto the Mersey BST scheme from PRHO posts. Job experience and the influence of particular teachers were key factors on trainees' career choice within surgery. This review identified a young, parochial and inexperienced cohort of trainees who have strong convictions to pursue a surgical career. Feedback and advice from consultants was appreciated. Many issues raised have one common denominator: the strong influence of teachers on trainees.
Attitude of Health Personnel↗