Is it time for integration of surgical skills simulation into the United Kingdom undergraduate medical curriculum? A perspective from King’s College London School of Medicine

PURPOSE: Changes in undergraduate medical curricula, combined with reforms in postgraduate education, have training implications for surgical skills acquisition in a climate of reduced clinical exposure. Confidence and prior experience influences the educational impact of learning. Currently there is no basic surgical skills (BSS) programme integrated into undergraduate curricula in the United Kingdom. We explored the role of a dedicated BSS programme for undergraduates in improving confidence and influencing careers in King's College London School of Medicine, and the programme was evaluated. METHODS: A programme was designed in-line with the established Royal College of Surgeons course. Undergraduates were taught four key skills over four weeks: knot-tying, basic-suturing, tying-at-depth and chest-drain insertion, using low-fidelity bench-top models. A Likert-style questionnaire was designed to determine educational value and influence on career choice. Qualitative data was collected. RESULTS: Only 29% and 42% of students had undertaken previous practice in knot-tying and basic suturing, respectively. 96% agreed that skills exposure prior to starting surgical rotations was essential and felt a dedicated course would augment undergraduate training. There was a significant increase in confidence in the practice and knowledge of all skills taught (p<0.01), with a greater motivation to be actively involved in the surgical firm and theatres. CONCLUSION: A simple, structured BSS programme can increase the confidence and motivation of students. Early surgical skills targeting is valuable for students entering surgical, related allied, and even traditionally non-surgical specialties such as general practice. Such experience can increase the confidence of future junior doctors and trainees. We advocate the introduction of a BSS programme into United Kingdom undergraduate curricula

Microtopographic refuges enhance recruitment and survival, but inhibit growth of propagules of the tropical macroalga Sargassum swartzii

For organisms with discrete life-histories, any mechanism that enhances growth and/or survival at critical life-history transitions may significantly influence adult population size. On coral reefs, structurally complex microhabitats enhance the early post-settlement growth and/or survival of fishes and corals; however, the importance of such microhabitats to the early life stages of tropical macroalgae is largely unknown. Here, we investigate the effect of crevices on the recruitment, growth and survival of propagules of a common coral reef macroalga, Sargassum swartzii. We settled S. swartzii propagules onto terracotta settlement tiles that had a series of 3 mm deep crevices evenly spaced on their top (exposed) surface. Recruitment of S. swartzii was 21% greater, but propagules were 18% shorter, 18-days post-settlement within crevices than on adjacent exposed surfaces. Exposing tiles to local fish assemblages for five days showed that survival of propagules was 90% greater in crevices than on exposed areas of the tiles on the reef crest, but not on the reef flat. Underwater video footage revealed that few fishes fed from within the crevices (18% of all bites) with the majority of feeding being concentrated on the exposed surface of tiles. Interestingly, small-bodied fishes from the family Blenniidae (predominantly Ecsenius spp.) accounted for the majority of the feeding activity on the tiles, and likely contributed to the mortality of propagules. Structurally complex microhabitats, such as crevices, that shelter vulnerable early post-settlement propagules from herbivory may therefore be important for the persistence of macroalgae on coral reefs

Biology of Parrotfishes

Parrotfish are found on almost every coral reef in the world. This ubiquity and uniqueness of their feeding action make them one of the most important groups of fishes within coral reef ecosystems. But why, exactly, are parrotfish so important to reefs? Can the evolution of a particular jaw morphology and feeding action really have had such a large impact on the health and functioning of the world's coral reefs? This book introduces the reader to this fascinating group of fishes (Labridae, Scarinae), from the morphological innovation of a jaw that has the power to bite through solid calcium carbonate, to the threats currently faced by parrotfish populations around the world. It contains new insights into their diet and food processing ability, and lifehistories, and concludes with an overview of emerging and future research directions

Variation in the parasite communities of three co-occurring herbivorous coral reef fishes

Parasites are important, diverse, and abundant components of natural ecosystems and can influence the behaviour and health of their hosts, inter- and intraspecific interactions, and ultimately community structure. Coral reefs are one of the world's most biodiverse ecosystems, yet our understanding of the abundance, diversity, and composition of parasite communities of coral reef fishes is limited. Here, the authors aimed to compare the abundance, richness and composition of parasite communities among three co-occurring herbivorous coral reef fishes (the barred rabbitfish Siganus doliatus, Ward's damsel Pomacentrus wardi and the obscure damsel Pomacentrus adelus) from an inshore reef of the Great Barrier Reef (GBR). In total, 3978 parasites (3869 endoparasites and 109 ectoparasites) from 17 families were recovered from 30 individuals of each of the three fish species (mean = 44 ± 22 s.e. parasites per fish; range = 0–1947 parasites per fish). The parasite communities of P. wardi and P. adelus were characterised by pennellid copepods, derogenid and lecithasterid digeneans and were distinct from those of S. doliatus that were characterised by a higher abundance of atractotrematid and gyliauchenid digeneans. The abundance and family richness of all parasites were greatest in S. doliatus (abundance: 22.1 ± 5.0 parasites per fish; richness: 3.2 ± 0.3 families per fish), intermediate in P. wardi (abundance: 4.8 ± 1.1 parasites per fish; richness: 2.3 ± 0.3 families per fish) and lowest in P. adelus (abundance: 1.4 ± 0.4 parasites per fish; richness: 0.9 ± 0.2 families per fish). Similarly, the abundance of endoparasites was greatest in S. doliatus (19.7 ± 5.1 endoparasites per fish), intermediate in P. wardi (2.6 ± 0.7 endoparasites per fish) and lowest in P. adelus (1.2 ± 0.4 endoparasites per fish). Ectoparasite abundances were also lowest for P. adelus (0.2 ± 0.1 ectoparasites per fish), and S. doliatus and P. wardi had comparable abundances of ectoparasites (1.3 ± 0.3 and 2.1 ± 0.5 parasites per fish, respectively). Similarities between the parasite assemblages of the two pomacentrids may be related to their similar behaviours and/or diets vs. those of the larger-bodied and more mobile rabbitfish. Investigating the causes and consequences of variation in parasite communities across a broader range of fish species will be critical to understand the potential role of parasites in coral reef ecosystems

Long-term variability in the <i>Abra alba</i> community: importance of physical and biological causes

The macrobenthic communities in temperate, shallow coastal waters are characterized by strong seasonal and year-to-year variations in community characteristics. These patterns are investigated in the Abra alba community on the Belgian Continental Shelf during nine years (1995 - 2003). During this investigation period, the community tended to return to its orginal state, but it never reached this point. This can be related to the replacement of Spisula subtruncata by Donax vittatus as dominant bivalve after 1997, and possibly as a result of the climatic shift of 1998. The devision of the study period in an unstable (1995-1997) and a more stable period (1999-2003) coincide with the year 1998.Different causes are believed to be responsible for shifts in the community structure during the unstable period, such as mass recruitment of the bivalve Spisula subtruncata (biological cause) and some direct physical causes, like a strong increase of the mud content and temperature fluctuations. All these causes have an effect on the macrobenthic density, diversity and species composition. The mass recruitment of S. subtruncata caused a decrease in the density and diversity of the macrobenthos, whereas the increase of mud content was responsible for a crash of the species richness and macrobenthic density. The cold winter could have been responsible for the slow recovery of the A. alba community after those disturbances. The unstable period was followed by a few years of higher stability (1999 - 2003), characterized by a cyclic seasonal pattern and the dominance of the tube building polychaete Lanice conchilega. The overall seasonal pattern in the study at hand was characterized by high macrobenthic densities in spring and summer, with a decline in autumn towards the end of the winter. Although this cycle differed quantitatively from year-to-year, the general features have been repeated throughout the stable period. The dominance of L. conchilega during the stable period probably had a positive influence on the benthos, due to its habitat structuring characteristics.This study indicates that natural causes could have a drastic impact on the normal year-to-year variability and cyclic seasonal patterns in the marine ecosystem and its ability to recover

Macrobenthic community structure of soft-bottom sediments at the Belgian Continental Shelf

Within the frame of different research projects, a large number of sites at the Belgian Continental Shelf (BCS) have been sampled for the macrobenthos between 1994 and 2000. These samples cover a diverse range of habitats: from the sandy beaches to the open sea, from the gullies between the sandbanks to the tops of the sandbanks, and from clay to coarse sandy sediments. To investigate the large-scale spatial distribution of the macrobenthos of the Belgian Continental Shelf, the data of all these research projects -728 samples- were combined and analysed. By means of several multivariate techniques, 10 sample groups with similar macrobenthic assemblage structure were distinguished. Each sample group is found in a particular physico-chemical environment and has a specific species composition. Four sample groups differ drastically, both in habitat and species composition, and are considered to represent four macrobenthic communities: (1) the muddy fine sand Abra alba-Mysella bidentata community is characterized by high densities and diversity; (2) the Nephtys cirrosa community occurs in well-sorted sandy sediments and is characterized by low densities and diversity; (3) very low densities and diversity typify the Ophelia limacine-Glycera lapidum community, which is found in coarse sandy sediments and (4) the Eurydice pulchra-Scolelepis squamata community is typical for the upper intertidal zone of sandy beaches. These macrobenthic communities are not isolated from each other, but are linked through six transitional species assemblages. The transition between the A. alba-M. bidentata community and the N. cirrosa community is characterized by a reduction in the mud content and is dominated by Magelona johnstoni. The transition between the N. cirrosa and the O. limacine-G. lapidum community is distinctive by decreasing densities and coincides with a gradual transition between medium and coarse sandy sediments. From the N. cirrosa to the E. pulchra-S. squamata community, transitional species assemblages related to the transition from the subtidal to the intertidal environment were found. Each community or transitional species assemblages was found over a specific range along the onshore-offshore gradient, four types can be discerned: (1) almost restricted to the nearshore area, but possible wider distribution; (2) distributed over the full onshore-offshore gradient; (3) restricted to the near-shore area and (4) restricted to the sandy beach environment. The diversity pattern on the BCS follows this division, with species rich and poor assemblages in the near-shore area to only species poor assemblages more offshore. The distribution and diversity patterns are linked to the habitat type, distinguished by median grain size and mud content

The ecological importance of the tube building polychaete <i>Lanice conchilega</i> in the <i>Abra alba-Mysella bidentata</i> community (poster)

The Abra alba - Mysella bidentata community is the most diverse (average: 31 spp. 0.1 m-2) and dense (average: 6500 ind. m-2) macrobenthic community on the Belgian Continental Shelf (BCS), in which densities are dominated by polychaetes and bivalves. Numerous species of the community are an important food resource for demersal fish (e.g. cod Gadus morhua) and sea birds (e.g. common scoter Melanitta nigra). This community is mainly found in fine muddy sediments (median grain size: + 200 µm; mud content: 5-10 %) of the swales and slopes of the Western Coastal Banks and Middelkerke Bank and at some local spots along the eastern coast.Because of their ecological importance within the community, three macrobenthic species were selected for a detailed autecological investigation: (1) the bivalve Spisula subtruncata, important as a food resource for seaducks, (2) Abra alba, a highly dominant bivalve, and (3) Lanice conchilega, a habitat structuring polychaete. At this moment only information about L. conchilega is available.Lanice conchilega (family: Terebellidae) typically occurs within the A. alba - M. bidentata community (Indicator Value: 62). Its fringed tubes, with a length of up to 40 cm and extending up to about 3 cm above the sediment, are built from fine to coarse sand grains and shell fragments. When found in high densities (up to 3000 ind. m-2), the patches of tubes create a hydrodynamically benign microclimate in which suspended material is trapped. Consequently, local and patchy sediment elevations of up to 10 cm with a relatively high organic matter content are formed. The fringed tubes, stabilized sediment and increased organic matter content are illustrating the habitat structuring capacity of L. conchilega. The increased habitat complexity in dense patches of L. conchilega are believed to be responsible for the high macrobenthic diversity and density of the community. A relatively low macrobenthic density (2447 ind. m-2) and diversity (22 spp. 0.1 m-2) is found if L. conchilega is present in low densities (-2). If present in high densities, a much higher macrobenthic density (8000 ind. m-2) and diversity (36 spp. 0.1 m-2) occurs. Furthermore, the occurrence of some species (e.g. Eumida sanguinea, Anaitides mucosa, and Pariambus typicus) is almost exclusively linked to the presence of L. conchilega.At present, some information about the life history of L. conchilega is available through the ongoing macrobenthos and hyperbenthos research. Very high densities of the hyperbenthic aulophora larvae are found early May (670 ind. m-3 on average on the BCS). Settlement of L. conchilega takes place in May and is immediately followed by a fast growth till June-July. Within the framework of a PhD research, the ecological importance of L. conchilega will further be evaluated through detailed spatial and temporal investigations of all life stages (planktonic and hyperbenthic larvae and benthic juveniles and adults) from March 2002 till October 2003