The do's, don't and don't knows of supporting transition to more independent practice

Introduction: Transitions are traditionally viewed as challenging for clinicians. Throughout medical career pathways, clinicians need to successfully navigate successive transitions as they become progressively more independent practitioners. In these guidelines, we aim to synthesize the evidence from the literature to provide guidance for supporting clinicians in their development of independence, and highlight areas for further research. Methods: Drawing upon D3 method guidance, four key themes universal to medical career transitions and progressive independence were identified by all authors through discussion and consensus from our own experience and expertise: workplace learning, independence and responsibility, mentoring and coaching, and patient perspectives. A scoping review of the literature was conducted using Medline database searches in addition to the authors’ personal archives and reference snowballing searches. Results: 387 articles were identified and screened. 210 were excluded as not relevant to medical transitions (50 at title screen; 160 at abstract screen). 177 full-text articles were assessed for eligibility; a further 107 were rejected (97 did not include career transitions in their study design; 10 were review articles; the primary references of these were screened for inclusion). 70 articles were included of which 60 provided extractable data for the final qualitative synthesis. Across the four key themes, seven do’s, two don’ts and seven don’t knows were identified, and the strength of evidence was graded for each of these recommendations. Conclusion: The two strongest messages arising from current literature are first, transitions should not be viewed as one moment in time: career trajectories are a continuum with valuable opportunities for personal and professional development throughout. Second, learning needs to be embedded in practice and learners provided with authentic and meaningful learning opportunities. In this paper, we propose evidence-based guidelines aimed at facilitating such transitions through the fostering of progressive independence

Quality assessment of a new surgical simulator for neuroendoscopic training

Object. Ideal surgical training models should be entirely reliable, atoxic, easy to handle, and, if possible, low cost. All available models have their advantages and disadvantages. the choice of one or another will depend on the type of surgery to be performed. the authors created an anatomical model called the S.I.M.O.N.T. (Sinus Model Oto-Rhino Neuro Trainer) Neurosurgical Endotrainer, which can provide reliable neuroendoscopic training. the aim in the present study was to assess both the quality of the model and the development of surgical skills by trainees.Methods. the S.I.M.O.N.T. is built of a synthetic thermoretractable, thermosensible rubber called Neoderma, which, combined with different polymers, produces more than 30 different formulas. Quality assessment of the model was based on qualitative and quantitative data obtained from training sessions with 9 experienced and 13 inexperienced neurosurgeons. the techniques used for evaluation were face validation, retest and interrater reliability, and construct validation.Results. the experts considered the S.I.M.O.N.T. capable of reproducing surgical situations as if they were real and presenting great similarity with the human brain. Surgical results of serial training showed that the model could be considered precise. Finally, development and improvement in surgical skills by the trainees were observed and considered relevant to further training. It was also observed that the probability of any single error was dramatically decreased after each training session, with a mean reduction of 41.65% (range 38.7%-45.6%).Conclusions. Neuroendoscopic training has some specific requirements. A unique set of instruments is required, as is a model that can resemble real-life situations. the S.I.M.O.N.T. is a new alternative model specially designed for this purpose. Validation techniques followed by precision assessments attested to the model's feasibility. (DOI: 10.3171/2011.2.FOCUS10321)Universidade Federal de São Paulo, Discipline Neurosurg, Escola Paulista Med, São Paulo, BrazilCuritiba Neurol Inst, Curitiba, Parana, BrazilUniv Fed Pernambuco, Dept Gynecol, Recife, PE, BrazilUniversidade Federal de São Paulo, Discipline Neurosurg, Escola Paulista Med, São Paulo, BrazilWeb of Scienc

\u27Slowing down When You Should\u27: Initiators and Influences of the Transition from the Routine to the Effortful

BACKGROUND: \u27Slowing down when you should\u27 has been described as marking the transition from \u27automatic\u27 to \u27effortful\u27 functioning in professional practice. The ability to \u27slow down\u27 is hypothesized as an important factor in expert judgment. This study explored the nature of the \u27slowing down\u27 phenomenon intraoperatively and its link to surgical judgment. METHODS: Twenty-eight surgeons across different surgical specialties were interviewed from four hospitals affiliated with a large urban university. In grounded theory tradition, data were collected and analyzed in an iterative design, using a constant comparative approach. Emergent themes were identified and a conceptual framework was developed. RESULTS: Surgeons recognized the \u27slowing down\u27 phenomenon acknowledging its link to judgment and described two main initiators. Proactively planned \u27slowing down\u27 moments were anticipated preoperatively from operation-specific (tying superior thyroid vessels) or patient-specific (imaging abnormality) factors. Surgeons also described situationally responsive \u27slowing down\u27 moments to unexpected events (encountering an adherent tumor). Surgeons described several influencing factors on the slowing down phenomenon (fatigue, confidence). CONCLUSIONS: This framework for \u27slowing down\u27 assists in making tangible the previously elusive construct of surgical judgment, providing a vocabulary for considering the events surrounding these critical moments in surgery, essential for teaching, self-reflection, and patient safety

Benralizumab improves symptoms of patients with severe, eosinophilic asthma with a diagnosis of nasal polyposis

BackgroundClinically meaningful improvement in the Sino‐Nasal Outcome Test‐22 (SNOT‐22) was observed in patients with severe, eosinophilic asthma, and nasal polyposis (NP) treated with benralizumab in the ANDHI trial. A post hoc assessment of the effects of benralizumab on SNOT‐22 response and asthma efficacy measures in these patients was conducted for further characterization of the efficacy and safety of benralizumab for patients with severe asthma and NP.MethodsAdults with severe, eosinophilic asthma who had experienced ≥2 prior‐year exacerbations despite high‐dosage inhaled corticosteroid plus additional controller[s] were randomized to 24 weeks of benralizumab or placebo. Patients with physician‐diagnosed chronic rhinosinusitis with NP of any severity ongoing at baseline who consented to participate were included in the current ANDHI NP substudy population. Effect on NP symptoms was assessed by the SNOT‐22, with an improvement of at least 8.9 defined as clinically significant (responder). Effects on chronic asthma outcomes were assessed by means of annualized asthma exacerbation rate (AER), St. George’s Respiratory Questionnaire (SGRQ) total score, forced expiratory volume in one second (FEV1), and Asthma Control Questionnaire‐6 (ACQ‐6). All p‐values were nominal.ResultsOf the ANDHI population (n = 656), 23% (n = 153) participated in the NP substudy (n = 96 benralizumab; n = 57 placebo). Patients were 50% female, with mean age of 53 years, had prior‐year AER = 3.3; mean pre‐bronchodilator FEV1 = 55% predicted; and median blood eosinophil count ​= 510 cells/µl. For patients with high baseline SNOT‐22 scores (>30), benralizumab treatment improved symptoms of NP as measured by SNOT‐22 from baseline to Week 24 compared with placebo (Week 24: −10.44 [p = .0176]). Percentage of responders to SNOT‐22 was greater for benralizumab vs. placebo (71.3% vs. 45.5%; p = .0036), and effect was enhanced for patients with high baseline SNOT‐22 scores (>30). A 69% reduction vs. placebo in annualized AER (0.77 vs. 2.47; p < .0001) and greater clinically meaningful improvements from baseline in SGRQ total score (−16.7), FEV1 (+0.32 L), and ACQ‐6 (–0.88) were observed (p < .0001). Benralizumab was well‐tolerated. Frequency of adverse events (AEs) was similar for benralizumab (76.0%) and placebo (73.7%) groups. Most common AEs (frequency ≥5%) reported at a greater frequency in benralizumab vs. placebo included headache, sinusitis, pyrexia, and influenza.ConclusionsThese substudy data from ANDHI demonstrated the efficacy profile of benralizumab for patients with severe, eosinophilic asthma and NP, with improvement in SNOT‐22 and asthma outcomes.The combination of asthma and nasal polyposis provides significant treatment challenges and substantial disease burden, including a greater number of asthma exacerbations annually, which negatively impacts quality of life. Clinically meaningful improvement in the SNOT‐22 was observed early and maintained over time for patients with severe, eosinophilic asthma and nasal polyposis treated with benralizumab in the ANDHI trial. This ANDHI substudy demonstrated that benralizumab is safe and efficacious for patients with severe, eosinophilic asthma and nasal polyposis, with improvement in SNOT‐22 total scores and asthma outcomes. Abbreviation: ACQ‐6, Asthma Control Questionnaire‐6; AER, asthma exacerbation rate; CRSwNP, chronic rhinosinusitis with nasal polyposis; FEV1, forced expiratory volume in 1 second; SGRQ, St. George’s Respiratory Questionnaire; SNOT‐22, Sino‐Nasal Outcome TestPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/171162/1/all14902_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/171162/2/all14902.pd