Trainees' evaluation of the Foundation Programme

There are currently 15,000 junior doctors in the foundation programme (FP). The programme's purpose is to bridge medical school and specialty training, and it replaced the Pre-Registration House Officer year (PRHO) and the first Senior House Officer (SHO) year: it is made up of three-to six-month placements in primary and secondary care specialities that will allow trainees to experience a wide range of specialities, allow greater general experience and form a clear career direction. This two-year internship programme was introduced in 2005, as part of the process of modernising postgraduate medical training in the United Kingdom. This was in response to the problems identified in the consultation document entitled the "Unfinished Business" There were problems highlighted in the old SHO training which included lack of supervision, career direction and an ever-increasing workload.peer-reviewe

Acute abdomen due to spontaneous splenic rupture as the first presentation of lung malignancy: a case report

Abstract Introduction Spontaneous splenic rupture is well recognized in the context of hematological malignancies (lymphoproliferative and myeloproliferative disorders); a few case reports have also linked solid tumors, such as pancreatic and liver cancer, with the occurrence of spontaneous splenic rupture. This is the first case report of lung cancer as a likely cause of spontaneous splenic rupture. Case presentation A 61-year-old Caucasian woman presented to our hospital with non-specific symptoms. She developed an 'acute' abdomen and went into a state of shock within twelve hours of her presentation. She was diagnosed with spontaneous splenic rupture with radiology and following a laparotomy. She made an uneventful recovery postoperatively and was simultaneously found to have a bronchial adenocarcinoma. Conclusion Spontaneous splenic rupture is a potentially fatal but often unrecognized cause of acute abdomen. It should be routinely considered in the differential diagnosis of acute ('surgical') abdomen and when present it should be promptly dealt with, most commonly with a laparotomy. Once the diagnosis is confirmed there should be an aggressive drive to identify an underlying etiology; malignancy is the commonest culprit. Solid tumors should be considered as underlying causes despite being less common than hematological neoplasms. This case report demonstrates lung malignancy as an underlying precipitating cause of spontaneous splenic rupture.</p