Who is teaching and supervising our junior residents' central venous catheterizations?

Article deposited according to agreement with BMC, December 6, 2010.YesFunding provided by the Open Access Authors Fund

Medical Leadership and Management in the United Kingdom

Objective: This article aims to outline the historical development of medical leadership in the United Kingdom (UK), present recent advances, discuss professional development and future prospects. Conclusions: With increasing involvement of medical professionals in top managerial roles in the UK over the last 30 years, leadership development initiatives have been growing steadily and there is increasing recognition of the need for leadership and management skills for doctors. Such skills can help to greatly improve patient care as well as enhance organisational effectiveness and productivity. The central involvement of professional bodies such as the UK Faculty of Medical Leadership and Management, and the establishment of medical fellowship schemes, have provided a solid foundation for a new generation of aspiring medical leaders but there is still a long way to go to achieve a higher degree of professionalism for clinical leadership in the UK. The evidence base is weak such that integrated efforts by clinicians and management academics have much to offer in achieving the vision of socially responsible, clinically relevant and research-informed medical leadership training

Complexity of case mix in a regional allergy service

<p>Abstract</p> <p>Background</p> <p>Currently in the United Kingdom (UK), there is a mismatch between limited financial resources and the large proportion of patients with suspected allergies actually being referred to specialist allergy clinics. To better understand the case mix of patients being referred, we audited referrals to a regional allergy service over an 8 year period.</p> <p>The main source of data was consultant letters to General Practitioners (GP) summarising the diagnosis of patients, archived from January 2002 to September 2009. Letters were reviewed, extracting the clinic date, doctor seen, gender, date of birth, postcode, GP, and diagnoses. Diagnoses were classified into seven groups and illustrative cases for each group noted.</p> <p>Findings</p> <p>Data from 2,028 new referrals with suspected allergy were analysed. The largest group of patients (43%) were diagnosed with a type I hypersensitivity. The other diagnostic groups were chronic idiopathic (spontaneous) urticaria (35%), suspected type I hypersensitivity but no allergen identified (8%), idiopathic (spontaneous) angioedema (8%), physical urticaria (2.5%), non-allergic symptoms (1.6%), type IV hypersensitivity (0.8%) and ACE inhibitor sensitivity (0.5%). Two thirds of patients seen were female with a higher percentage of female patients in the non type-I hypersensitivity group (71%) than the type 1 hypersensitivity (66%) (χ²= 5.1, 1df, <it>p = 0.024</it>). The type 1 hypersensitivity patients were younger than other patients (38 Vs 46 years, t = -10.8, <it>p < 0.001</it>)</p> <p>Conclusions</p> <p>This study highlights the complexity of specialist allergy practice and the large proportion of patients referred with non-type I hypersensitivities, chronic idiopathic (spontaneous) urticaria being by far the largest group. Such information is critical to inform commissioning decisions, define referral pathways and in primary care education.</p

Palliative curriculum re-imagined: A critical evaluation of the UK Palliative Medicine Syllabus

YesThe UK Palliative Medicine Syllabus is critically evaluated to assess its relationship and relevance to contemporary palliative care policy and direction. Three criteria are employed for this review: (1) relevance to non-cancer dying, ageing, caregivers, and bereaved populations; (2) uptake and adoption of well-being models of public health alongside traditional illness and disease models of clinical understanding; and (3) uptake and integration of public health insights and methodologies for social support. We conclude that the current syllabus falls dramatically short on all 3 criteria. Suggestions are made for future consultation and revision

An evaluation of the performance in the UK Royal College of Anaesthetists primary examination by UK medical school and gender

<p>Abstract</p> <p>Background</p> <p>There has been comparatively little consideration of the impact that the changes to undergraduate curricula might have on postgraduate academic performance. This study compares the performance of graduates by UK medical school and gender in the Multiple Choice Question (MCQ) section of the first part of the Fellowship of the Royal College of Anaesthetists (FRCA) examination.</p> <p>Methods</p> <p>Data from each sitting of the MCQ section of the primary FRCA examination from June 1999 to May 2008 were analysed for performance by medical school and gender.</p> <p>Results</p> <p>There were 4983 attempts at the MCQ part of the examination by 3303 graduates from the 19 United Kingdom medical schools. Using the standardised overall mark minus the pass mark graduates from five medical schools performed significantly better than the mean for the group and five schools performed significantly worse than the mean for the group. Males performed significantly better than females in all aspects of the MCQ – physiology, mean difference = 3.0% (95% CI 2.3, 3.7), p < 0.001; pharmacology, mean difference = 1.7% (95% CI 1.0, 2.3), p < 0.001; physics with clinical measurement, mean difference = 3.5% (95% CI 2.8, 4.1), p < 0.001; overall mark, mean difference = 2.7% (95% CI 2.1, 3.3), p < 0.001; and standardised overall mark minus the pass mark, mean difference = 2.5% (95% CI 1.9, 3.1), p < 0.001. Graduates from three medical schools that have undergone the change from Traditional to Problem Based Learning curricula did not show any change in performance in any aspects of the MCQ pre and post curriculum change.</p> <p>Conclusion</p> <p>Graduates from each of the medical schools in the UK do show differences in performance in the MCQ section of the primary FRCA, but significant curriculum change does not lead to deterioration in post graduate examination performance. Whilst females now outnumber males taking the MCQ, they are not performing as well as the males.</p

Raising the topic of weight in general practice:perspectives of GPs and primary care nurses

OBJECTIVE: To explore general practitioners’ (GPs) and primary care nurses’ perceived barriers to raising the topic of weight in general practice. DESIGN: A qualitative study using the Theoretical Domains Framework (TDF). 34 semistructured interviews were conducted to explore views, opinions and experiences of initiating a discussion about weight. Content and thematic analyses were used to analyse the interview transcripts. SETTING: General practices located in one primary care trust in the South West of England. PARTICIPANTS: 17 GPs and 17 nurses aged between 32 and 66 years. The modal age range for GPs was 30–39 years and for nurses, 40–49 years. RESULTS: Barriers were synthesised into three main themes: (1) limited understanding about obesity care, (2) concern about negative consequences, and (3) having time and resources to raise a sensitive topic. Most barriers were related to raising the topic in more routine settings, rather than when dealing with an associated medical condition. GPs were particularly worried about damaging their relationship with patients and emphasised the need to follow their patient's agenda. CONCLUSIONS: Uncertainty about obesity, concerns about alienating patients and feeling unable to raise the topic within the constraints of a 10 min consultation, is adding to the reluctance of GPs and nurses to broach the topic of weight. Addressing these concerns through training or by providing evidence of effective interventions that are feasible to deliver within consultations may lead to greater practitioner engagement and willingness to raise the topic

Is the routine health information system ready to support the planned national health insurance scheme in South Africa?

Implementation of a National Health Insurance (NHI) in South Africa requires a reliable, standardized health information system that supports Diagnosis-Related Groupers for reimbursements and resource management. We assessed the quality of inpatient health records, the availability of standard discharge summaries and coded clinical data and the congruence between inpatient health records and discharge summaries in public-sector hospitals to support the NHI implementation in terms of reimbursement and resource management. We undertook a cross-sectional healthrecords review from 45 representative public hospitals consisting of seven tertiary, 10 regional and 28 district hospitals in 10 NHI pilot districts representing all nine provinces. Data were abstracted from a randomly selected sample of 5795 inpatient health records from the surgical, medical, obstetrics and gynaecology, paediatrics and psychiatry departments. Quality was assessed for 10 pre-defined data elements relevant to NHI reimbursements, by comparing information in source registers, patient folders and discharge summaries for patients admitted in March and July 2015