Exploring the Changing Landscape of Surgical Residency Training

Within the past decade, the structure and format of surgical residency training has changed radically by the introduction of competency-based training programs, the progressive fragmentation of general surgery into subspecialties, and the implementation of stringent work hour restrictions. The aim of this thesis was to explore how these developments have transformed the landscape of surgical residency training within the past years. The research described in this thesis has been conducted in a surgical training region located in the Southwest of the Netherlands, consisting of 1 university hospital and 6 affiliated district hospitals. Conclusions resulting from this research may be helpful for stakeholders responsible for the organization of training in general surgery in the Netherlands and could be used for continuous improvement of the surgical residency training program and to guide future directions in surgical training, hence ensuring high-quality training and well-balanced education for the next generation of surgeons

Repairing reforms and transforming professional practices

Although much has been written on changing professionalism, only limited attention has been given to the way in which professionals themselves give shape to new requirements in everyday professional practice. This article investigates the understudied reform of postgraduate medical education. The reform takes in a shift from apprenticeship-based training based on “learning-by-doing” and socialization to time-restricted, streamlined, competency-based training programs based on competency-based training and standardized performance assessment. We deploy a mixed-methods study design of surgical training reform in the Netherlands (2011-2012) to examine how surgeons and surgical residents give shape to changes in education as well as in the wider hospital context, and how this impact on surgical training from a micro perspective. Informed by sociological literatures on medical education and changing professionalism, this article reveals how the reform is repaired in everyday training practice. This repair work, as a form of institutional work, goes beyond restoring disrupted institutional arrangements in order to restore the status quo as is often argued. Instead, it involves acting with the reform; seeking feasible solutions that preserve old values and related practices while adopting new requirements that reconfigure institutionalized arrangements in professional training practices

Identification and carbon isotope composition of a novel branched GDGT isomer in lake sediments: Evidence for lacustrine branched GDGT production

Branched glycerol dialkyl glycerol tetraethers (brGDGTs) are bacterial membrane lipids that occur ubiquitously in soils and lacustrine sediments and have great potential as proxy indicators for paleotemperature and pH reconstructions. Initially, brGDGTs in lakes were thought to originate from soils of the watershed. The composition of the lacustrine brGDGT pool, however, often differs substantially from that in catchment soils, complicating the application of the brGDGT paleothermometer to lake sediments. This suggests that terrigenous brGDGT signals in lacustrine sedimentary archives may be affected by aquatic in situ production. In sediments of a Swiss mountain lake, we detected a novel hexamethylated brGDGT, which elutes between the known 5- and 6-methyl brGDGT isomers during HPLC–MS analysis. This novel isomer accounted for 8.5% of the total brGDGTs. Most remarkably, this brGDGT was not detected in soils collected from the catchment of the lake, providing circumstantial evidence for an in situ brGDGT source in the lake’s water column or sediments. Isolation of the compound by preparative HPLC and subsequent GC–MS analysis of the alkyl chains revealed that the novel brGDGT comprises two structural isomers. One possesses a 5,13,16- and a 6,13,16-trimethyloctacosanyl moiety and constitutes 84% of the new brGDGT; the second contains a 13,16-dimethyloctacosanyl and a 5,13,16,23-tetramethyloctacosanyl moiety. The d13C values of both the alkyl chains derived from the novel brGDGT (-46‰) and all other major brGDGTs (-43‰ to -44‰) were significantly lower than those of brGDGT-derived alkanes in catchment soils (-27‰ to -28‰) further attesting to in situ production of brGDGTs in the studied lak

Impact of the European Working Time Directive (EWTD) on the operative experience of surgery residents

Background In Europe and the United States, work hour restrictions are considered to be particularly burdensome for residents in surgery specialties. The aim of this study was to examine whether reduction of the work week to 48 hours resulting from the implementation of the European Working Time Directive has affected the operative experience of surgery residents. Methods This study was conducted in a general surgery training region in the Netherlands, consisting of 1 university hospital a