Systems and technologies for objective evaluation of technical skills in laparoscopic surgery

Minimally invasive surgery is a highly demanding surgical approach regarding technical requirements for the surgeon, who must be trained in order to perform a safe surgical intervention. Traditional surgical education in minimally invasive surgery is commonly based on subjective criteria to quantify and evaluate surgical abilities, which could be potentially unsafe for the patient. Authors, surgeons and associations are increasingly demanding the development of more objective assessment tools that can accredit surgeons as technically competent. This paper describes the state of the art in objective assessment methods of surgical skills. It gives an overview on assessment systems based on structured checklists and rating scales, surgical simulators, and instrument motion analysis. As a future work, an objective and automatic assessment method of surgical skills should be standardized as a means towards proficiency-based curricula for training in laparoscopic surgery and its certification

Untangling approaches to management and leadership across systems of medical education

Aims: How future doctors might be educated and trained in order to meet the population and system needs of countries is currently being debated. Incorporation of a broad range of capabilities, encompassed within categories of management and, increasingly, leadership, form part of this discussion. The purpose of this paper is to outline a framework by which countries’ progress in this area might be assessed and compared. Methods: Key databases and journals related to this area were reviewed. From relevant articles potential factors impacting on the incorporation of aspects of management and leadership within medical education and training were identified. These factors were tested via an online survey during 2013 with six members of a European Association of doctors who promote medical involvement in hospital management, including members from countries less represented in the health management literature. Results: A framework for analysing how management and leadership education is being approached within different systems of healthcare is developed and presented. Conclusions: More systematic work across a wider range of countries is needed if we are to have a better understanding of how countries within and beyond Europe are approaching and progressing the education of doctors in management and leadership. Keywords: Medical education, Management, Leadership, Competency framework

CRITICAL SUCCESS FACTORS AND THEIR IMPACT ON KNOWLEDGE MANAGEMENT IN MEDIUM SIZED MANUFACTURING COMPANIES

ABSTRACT Globalization has turned competition in businesses int

Power and physician leadership

Power and leadership are intimately related. While physician leadership is widely discussed in healthcare, power has received less attention. Formal organisational leadership by physicians is increasingly common even though the evidence for the effectiveness of physician leadership is still evolving. There is an expectation of leadership by all physicians for resource stewardship. The impact of power on interprofessional education and practice needs further study. Power also shapes the profession's attempts to address physician and learner well-being with its implications for patient care. Unfortunately, the profession is not exempt from inappropriate use of power. These observations led the authors to explore the concept and impact of power in physician leadership. Drawing from a range of conceptualisations including structuralist (French and Raven), feminist (Allen) and poststructuralist (Foucault) conceptualisations of power, we explore how power is acquired and exercised in healthcare systems and enacted in leadership praxis by individual physician leaders (PL). Judicious use of power will benefit from consideration and application of a range of concepts including liminality, power mediation, power distance, inter-related use of power bases, intergroup and shared leadership, inclusive leadership, empowerment, transformational leadership and discourse for meaning-making. Avoiding abuse of power requires moral courage, and those who seek to become accountable leaders may benefit from adaptive reflection. Reframing 'followers' as 'constituents or citizens' is one way to interrupt discourses and narratives that reinforce traditional power imbalances. Applying these concepts can enhance creativity, cocreation and citizenship-strengthening commitment to improved healthcare. PLs can contribute greatly in this regard to further transform healthcare

Molecular Diffusion in Hierarchical Zeolites with Ordered Mesoporosity: Pulsed Field Gradient Nuclear Magnetic Resonance Combined with Thermodynamic Modeling

International audienceThe dynamics of fluids confined in hierarchical porous materials is gaining increasing attention. Here, using pulsed field gradient nuclear magnetic resonance, we report an experimental study of the self-diffusivity of cyclohexane confined at different temperatures in the bi-porous structure of hierarchical faujasite zeolites (i.e., combining the intrinsic zeolite microporosity of < 2 nm diameter and an ordered MCM-41-like mesoporosity of 4 nm diameter). For different mesoporous volumes, we consider cyclohexane self-diffusivity at chemical potentials where the porosity is either totally or only partially filled (in the latter case, the microporosity is completely filled, while the mesoporous surface is only covered by a molecular thin film). On one hand, in completely filled materials, as expected, the effective cyclohexane self-diffusivity is found to increase as the mesoporous volume increases. Moreover, in this regime, the self-diffusivity follows an Arrhenius behavior with an activation energy that is close to─although slightly smaller than─that for bulk cyclohexane. On the other hand, for partially filled materials, a striking behavior is observed as the measured self-diffusivity decreases upon increasing the loading and remains nearly constant upon increasing the temperature. We propose here that such a behavior can be rationalized by considering (1) the population redistribution between the microporosity and mesoporosity (including the gas phase in the mesopores) and (2) the effective number of molecules that contribute to spin echo attenuation upon increasing the temperature. In particular, while molecules diffuse faster overall with the increasing temperature, we show here that our measurements rely at each temperature on a slower and slower population (therefore leading to unexpected temperature variations)