The Doctor in Literature. Volume 4. Gender and Sex

This book is the fourth of four volumes in the series The Doctor in Literature. Like the first three it is intended to serve as an indexed, annotated anthology and to bring together a total of some 1500 extracts from approximately 600 works of fiction where medical doctors appear as major or minor characters. The citations in volume 4 relate to sex and gender as these issues affect physicians and medical practice, There is a lengthy chapter discussing fictional female doctors and the perceived differences between these women and their male colleagues. Nurses (generally female) and their interactions with doctors (generally male) are discussed in three chapters. Sexual encounters between patients and doctors form the subject of the last chapter

The effect of distractions in the operating room during endourological procedures

Contains fulltext : 98421.pdf (publisher's version ) (Closed access)BACKGROUND: Professionals working in the operating room (OR) are subject to various distractions that can be detrimental to their task performance and the quality of their work. This study aimed to quantify the frequency, nature, and effect on performance of (potentially) distracting events occurring during endourological procedures and additionally explored urologists' and residents' perspectives on experienced ill effects due to distracting factors. METHODS: First, observational data were collected prospectively during endourological procedures in one OR of a teaching hospital. A seven-point ordinal scale was used to measure the level of observed interference with the main task of the surgical team. Second, semistructured interviews were conducted with eight urologists and seven urology residents in two hospitals to obtain their perspectives on the impact of distracting factors. RESULTS: Seventy-eight procedures were observed. A median of 20 distracting events occurred per procedure, which corresponds to an overall rate of one distracting event every 1.8 min. Equipment problems and procedure-related and medically irrelevant communication were the most frequently observed causes of interruptions and identified as the most distracting factors in the interviews. Occurrence of distracting factors in difficult situations requiring high levels of concentration was perceived by all interviewees as disturbing and negatively impacting performance. The majority of interviewees (13/15) thought distracting factors impacted more strongly on residents' compared to urologists' performance due to their different levels of experience. CONCLUSION: Distracting events occur frequently in the OR. Equipment problems and communication, the latter both procedure-related and medically irrelevant, have the largest impact on the sterile team and regularly interrupt procedures. Distracting stimuli can influence performance negatively and should therefore be minimized. Further research is required to determine the direct effect of distraction on patient safety

High acceptability of a newly developed urological practical skills training program

BACKGROUND: Benefits of simulation training are widely recognized, but its structural implementation into urological curricula remains challenging. This study aims to gain insight into current and ideal urological practical skills training and presents the outline of a newly developed skills training program, including an assessment of the design characteristics that may increase its acceptability. METHODS: A questionnaire was sent to the urology residents (n = 87) and program directors (n = 45) of all Dutch teaching hospitals. Open- and close-ended questions were used to determine the views on current and ideal skills training and the newly developed skills training program. Eight semi-structured interviews were conducted with 39 residents and 15 program directors. All interviews were audiotaped, fully transcribed, and thereafter analyzed. RESULTS: Response was 87.4 % for residents and 86.7 % for program directors. Residents appeared to be still predominantly trained ‘by doing’. Structured practical skills training in local hospitals takes place according to 12 % of the residents versus 44 % of the program directors (p < 0.001). Ideally, residents prefer to practice certain procedures on simulation models first, especially in endourology. The majority of residents (92 %) and program directors (87 %) approved of implementing the newly developed skills training program (p = 0.51). ‘Structured scheduling’, ‘use of peer teaching’ and ‘high fidelity models’ were indicated as design characteristics that increase its acceptability. CONCLUSIONS: Current urological residency training consists of patient-related ‘learning by doing’, although more practice on simulation models is desired. The acceptability of implementing the presented skills-training program is high. Design characteristics that increase its acceptability are structured scheduling, the use of peer teaching and high fidelity models. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12894-015-0084-8) contains supplementary material, which is available to authorized users

Program for laparoscopic urological skills assessment: Setting certification standards for residents

Aim: There is growing pressure from the government and the public to define proficiency standards for surgical skills. Aim of this study was to estimate the reliability of the Program for Laparoscopic Urological Skills (PLUS) assessment and to set a certification standard for second-year urological residents. Methods: Fifty participants were assessed on performance time and performance quality to investigate the reliability of the PLUS assessment. Generalisability coefficient of 0.8, on a scale of 0 to 1.0, was considered to indicate good reliability for assessment purposes. Pass/fail standards were based on laparoscopic experience: Novices, intermediates, and experts (&gt;100 procedures). The pass/fail standards were investigated for the PLUS performances of 33 second-year urological residents. Results: Fifteen novices, twenty-three intermediates and twelve experts were included. An inter-trial reliability of &gt;0.80 was reached with two trials for each task. Inter-rater reliability of the quality measurements was 0.79 for two judges. Pass/fail scores were determined for the novice/intermediate boundary and the intermediate/expert boundary. Pass rates for second-year residents were 63.64% and 9.09%, respectively. Conclusion: The PLUS assessment is reliable for setting a certification standard for second-year urological residents that serves as a starting point for residents to proceed to the next level of laparoscopic competency

Transfer of cysto-urethroscopy skills from a virtual-reality simulator to the operating room:a randomized controlled trial

OBJECTIVE To assess whether real-time cysto-urethroscopy (CUS) performance improves by simulator-based training (criterion or predictive validity), addressing the research question 'Does practical skills training on the URO Mentor (UM, Simbionix USA Corp., Cleveland, OH, USA) virtual-reality simulator improve the performance of flexible CUS in patients'. SUBJECTS AND METHODS Participants (71 interns from Catharina Hospital Eindhoven, CHE, and 29 from University Medical Centre Groningen, UMCG) were randomized to carry out CUS in a patient after training on the UM (UM-trained, 50) or without training on UM (control, 50). The assessment of real-time performance consisted of scoring on a Global Rating Scale (GRS) by supervisors unaware of training status. Data were analysed using stepwise multiple linear regression. The effect size (ES) indication for correlations was used to interpret the magnitude of a standard regression coefficient (beta); an ES of 0.10, 0.30 and 0.50 were considered small, moderate and large, respectively. The study was approved by the Medical Review Ethics Committees of the participating hospitals. RESULTS Overall, the group that received training performed significantly better than the controls (P <0.003, beta range 0.30-0.47). There was no effect of training for participants with a specific preference for a surgical speciality in two of five GRS scores. Participants from CHE obtained higher GRS 3 scores than those from UMCG. Significantly more UMCG trainees indicated having had stress than those from CHE (P <0.001). CONCLUSIONS The results showed that interns who had trained on UM outperformed controls for a CUS procedure in a patient. Training for CUS on the UM is to be recommended for learning to respect tissue, procedural knowledge, flow of procedure and forward planning. Use of the UM to train interns with a specific interest in a surgical speciality in handling instruments, and time and motion, seems to be of limited value