Difficulties and Problematic Steps in Teaching the Onstep Technique for Inguinal Hernia Repair, Results from a Focus Group Interview

Background. When a new surgical technique is brought into a department, it is often experienced surgeons that learn it first and then pass it on to younger surgeons in training. This study seeks to clarify the problems and positive experiences when teaching and training surgeons in the Onstep technique for inguinal hernia repair, seen from the instructor’s point of view. Methods. We designed a qualitative study using a focus group to allow participants to elaborate freely and facilitate a discussion. Participants were surgeons with extensive experience in performing the Onstep technique from Germany, UK, France, Belgium, Italy, Greece, and Sweden. Results. Four main themes were found, with one theme covering three subthemes: instruction of others (experience, patient selection, and tailored teaching), comfort, concerns/fear, and anatomy. Conclusion. Surgeons receiving a one-day training course should preferably have experience with other types of hernia repairs. If trainees are inexperienced, the training setup should be a traditional step-by-step programme. A training setup should consist of an explanation of the technique with emphasis on anatomy and difficult parts of the procedure and then a training day should follow. Surgeons teaching surgery can use these findings to improve their everyday practice

Young Scientists Need Emotional Support and a Framework When Drafting Scientific Articles

Introduction. When teaching young scientists to write scientific articles, it is important to consider several aspects of learning including intrinsic motivation, since the scientific work can be demanding in a different way than routine clinical work. The aim of this study was to investigate young scientists’ experience of the process of writing research articles with focus on motivating factors and the feeling of success, in order to improve the process. Methods. This was a qualitative study using focus groups to explore young scientists’ feelings and motivations regarding the process of writing scientific articles. Participants were young scientists including young medical doctors and medical students spending dedicated time on research. Content analysis was used to analyze the focus group interviews. Results. Sixteen informants participated in the study in three groups. Two major themes were identified: emotional support and setting and framework. Emotional support covered three subthemes: support from peers and supervisors, appearances, and motivation. The setting and framework theme covered four subthemes: deadlines, retreats, consciousness, and expectations. Conclusion. We found emotional support, frame-setting, and the avoidance of failures to be important factors for the feeling of success when young scientists are in the process of learning how to write scientific articles

General Practitioners' Barriers Toward Medication Reviews in Polymedicated Multimorbid Patients:How can a Focus on the Pharmacotherapy in an Outpatient Clinic Support GPs?

Purpose: The aim of this study was to explore whether general practitioners (GPs) experienced barriers toward medication reviews in polymedicated, multimorbid patients, and how a clinical pharmacologist with a focus on pharmacotherapy can support the GPs in an outpatient clinic. Design: The study was descriptive and exploratory and had a qualitative design with a phenomenological/hermeneutic orientation for the interviews. Participants: The study comprised 14 interviews with 14 different GPs from the Capital Region of Denmark. Results: Three themes emerged from the interviews: (1) The care of patients With polypharmacy is challenged by the lack of professional dialogue and collaboration between GPs and hospital-based clinical pharmacologists, (2) the relationship between the patients with polypharmacy and the GP is characterized by care and individual considerations, and (3) the culture encourages adding medication and inhibits dialogue about medication withdrawal even for patients with polypharmacy. Conclusion and implications for practice: This study found that the primary barriers toward multimorbid patients with polypharmacy were the need for communication and teamwork with specialists (cardiologists, neurologists, endocrinologists, etc). Often, GPs felt that the specialists at the hospitals were more concerned about following standards and guidelines regarding specific diseases instead of a more holistic patient approach. To improve management of polypharmacy patients, the GPs suggest that a joint force is necessary, a partner-like relationship with greater transparency regarding information transfer, feedback, and shared decision-making, but also more education in the pharmacological field is essential

Team Training (Training at Own Facility) versus Individual Surgeon’s Training (Training at Trainer’s Facility) When Implementing a New Surgical Technique:Example from the ONSTEP Inguinal Hernia Repair

Background. When implementing a new surgical technique, the best method for didactic learning has not been settled. There are basically two scenarios: the trainee goes to the teacher’s clinic and learns the new technique hands-on, or the teacher goes to the trainee’s clinic and performs the teaching there. Methods. An informal literature review was conducted to provide a basis for discussing pros and cons. We also wanted to discuss how many surgeons can be trained in a day and the importance of the demand for a new surgical procedure to ensure a high adoption rate and finally to apply these issues on a discussion of barriers for adoption of the new ONSTEP technique for inguinal hernia repair after initial training. Results and Conclusions. The optimal training method would include moving the teacher to the trainee’s department to obtain team-training effects simultaneous with surgical technical training of the trainee surgeon. The training should also include a theoretical presentation and discussion along with the practical training. Importantly, the training visit should probably be followed by a scheduled visit to clear misunderstandings and fine-tune the technique after an initial self-learning period

Relatives to Critically Ill Patients Have No Sense of Coherence: A Quality Improvement Article Using Mixed Methods

Aims and Objective. To investigate the relatives’ satisfaction and involvement on a general surgery ward regarding the critically ill patient. Introduction. Relatives to critically ill patients are affected both physically and mentally during the hospitalization of a family member. Research has shown that relatives do not always receive the attention they need from health professionals. There is a lack of studies that focus on relatives’ satisfaction and involvement during their family members’ hospitalization. Design. A mixed methods design was chosen. Methods. A quantitative study was conducted with 27 relatives to critically ill patients. All participated in a questionnaire and out of the 27 relatives, six participated in qualitative in-depth interviews. Results. The questionnaire revealed that relatives were dissatisfied with care and involvement. For further exploration of the dissatisfaction, a qualitative approach was used and the in-depth interviews revealed three themes: lack of continuity and structure, responsibility of coordination, and relatives feeling left on their own with no guiding and support. Conclusion. Health professionals’ key role in relation to relatives must be guidance and support. Thereby, relatives can gain a sense of coherence during the hospitalization of a critically ill patient, which can lead to a greater satisfaction and thereby better support for the patient

Outlining and dictating scientific manuscripts is a useful method for health researchers: A focus group interview

Background: Young researchers may experience difficulties when writing scientific articles for publication in biomedical journals. Various methods may facilitate the writing process including outlining the paper before the actual writing and using dictation instead of writing the first draft. The aim of this study was to investigate the experiences and difficulties for young, experienced researchers when writing articles using a detailed outline and dictation of the first draft. Methods: We used qualitative focus group interviews and the study was reported according to the COnsolidated criteria for REporting Qualitative research guideline. Participants were sampled from a group of researchers participating in a writing retreat/course. The interviews were recorded on a digital recorder and transcribed. The text was analyzed according to content analysis and coded and condensed into themes and subthemes. Groups of participants were added until data saturation was reached. Results: A total of 14 researchers participated (9 women and 5 men). Their clinical experience was median (range) of 6 (1–11) years since graduation from medical school. Two themes arose during the analyses of the data: “Process guidance with the outline as the map” and “arrival at dictation.” The outline was used in the preparation phase leading up to the day of dictation and was used in collaboration with co-authors and supervisors. The participants found it to be a useful tool for preparing the manuscript and dictating their initial first full draft. Conclusion: Experienced young researchers found beneficial effects of using a structured outline to prepare for dictation of scientific articles. The outline was a tool that would develop in close collaboration with co-authors and mentors. With dictation, a full first draft of a manuscript can be produced in a few hours. Participants positively evaluated this structured and reproducible way of producing scientific articles