Ward simulation to improve surgical ward round performance: A randomized controlled trial of a simulation-based curriculum

Objective: This study aimed to investigate the effects of a simulation-based curriculum for ward-based care on ward round (WR) performance. Background: Variability in surgical outcomes does not relate to surgical skill alone. Prevention, diagnosis, and treatment of peri- and postoperative morbidity are dependent on provision of high-quality ward-based care. The focal point of this is the surgical WR. Although WR conduct is learned primarily through experience, a simulated environment and validated assessment tools may enable measurement and enhancement of WR quality. Methods: Junior surgical residents were randomized either to a half-day educational intervention with lectures, structured feedback, and debriefing, or to standard practice (control). All conducted a standardized, validated, simulated WR of 3 patients. Surgical Ward Care Assessment Tool and W-NOTECHS rating scales were used for technical and nontechnical skills assessment, respectively, and compared between groups. Subjects completed pre- and posttest confidence questionnaires and feedback forms. Results: Twenty-nine trainees were randomized to intervention (n = 14) or control (n = 15). Baseline confidence and demographics were equal between groups. Intervention group demonstrated better patient assessment: 63.5 ± 8.1% (control) versus 79.8 ± 11.9% (P = 0.002), management 56.0% ± 19.7% versus 72.2 ± 10.3% (P = 0.014), and nontechnical skills: W-NOTECHS 17.75 ± 2.06 versus 23.33 ± 1.21 (P < 0.001). Hundred percent of subjects felt that the curriculum improved their practice. Conclusions: Conducting WRs is a crucial skill but not currently subject to formal training. Implementation of a comprehensive curriculum for surgical WRs led to significant improvement in quality of patient assessment, management, and nontechnical skills. Improved WR performance may lead to earlier identification and amelioration of complications and improve patient outcomes

The Wittenoom Legacy

Introduction/Aim: In the fifty years since the Wittenoom crocidolite (blue asbestos) industry ceased operating, the epidemic of asbestos‐related diseases in Australia has intensified. Use of the employment records of the Australian Blue Asbestos Company and records of the Wittenoom township residents has permitted two cohorts of people with virtually exclusive exposure to blue asbestos to be assembled. Methods: Exposure data have been analysed and follow‐up of these two cohorts has been conducted through all available public records including mortality records in all states of Australia and in Italy, cancer registries of Western Australia (WA) and Federal mesothelioma registries. Results: Although the pattern of occurrence of asbestos‐related diseases in the Wittenoom cohorts has changed, there has been an ongoing epidemic of mortality from lung cancer and malignant mesothelioma and also from asbestosis. Benign pleural diseases continue to be seen. Quantitative exposure‐response relationships have been established. Conclusion: The industrial disaster that was Wittenoom has been directly responsible for many deaths as well as ongoing disease and social issues in people who worked in the mine and mill, who lived in the town, were involved in the transport of asbestos or were exposed to the product occupationally, domestically or environmentally subsequently. The legacy continues. It has prompted the establishment of epidemiological, clinical and scientific research groups in order to understand the biology and behaviour of the various asbestos‐related diseases and improve their diagnosis and clinical management, thereby contributing significantly to scientific knowledge