Can day case elective operating lists provide efficient training opportunities for general surgical trainees?

Introduction: During the COVID-19 pandemic there has been a reduction in trainee hands-on learning opportunities due to curtailment of elective workload. Our study aims to assess the impact of non-consultant led operating on theatre list efficiency. Methods: Prospective data collection over an eight week period of consecutive elective day case hernia lists at a newly established regional centre of excellence for day surgery. Specifically recording of key time points in surgical cases including time ready, knife to skin, last suture and exit theatre. This was achieved using the Theatre Management System (TMS). Results: 46 patients underwent open unilateral elective inguinal hernia repair. 54% (N=25) of cases were trainee led. Median trainee time was 53 minutes, vs 51 minutes for consultant led procedures;no significant difference (p>0.05). Conclusion: Day case elective hernia lists can be efficient training opportunities for general surgical trainees. Our results demonstrate that trainee-led operating in this setting have not resulted in significantly increased surgical time or operative theatre inefficiency. It is widely acknowledged there is benefit to training in performing the same technical skill within a short time frame.

A student technologist's perspective regarding theincrease in pharmacological stress testing due to theSARS-CoV-2pandemic in a large urban area

Objectives: Nuclear Medicine Technology (NMT) students quickly learn procedures and different protocols areutilized dependent on a variety of different factors. Recently, the SARS- CoV-2 pandemic has severely impacted theway modern-day medicine is being practiced in all modalities, and specifically altering the way nuclear medicineprocedures are performed, according to a survey conducted in nuclear medicine departments throughout 72countries.[1] Student technologists have been able to adapt and analyze the impacts the pandemic is having bychanging procedure protocols. Nuclear cardiology studies, specifically Myocardial Perfusion Imaging (MPI), arepreformed to correctly analyze blood flow to the myocardium of the heart at both a rested and stressed heart-stateto detect Coronary artery Disease (CAD). A standard stress test follows Bruce protocol in which patients physicallystress their heart via indoor exercise, but a study from the Mayo Clinic explains when to use specific protocols.[2]SARS-CoV-2, however, the coronavirus responsible for the global pandemic, is highly transmissible via airborne particles and respiratory droplets allowing for a patient and occupational health hazard. If Bruce protocol for MPIstress testing purposes a substantial health hazard, is this forcing nuclear medicine departments to convert allstress tests from exercise to pharmacological regardless of specified order, and will the stress test protocolperformed yield a same diagnosis? As a student technologist it is detrimental to adapt quickly to change due touncontrollable circumstances and to understand if/how different protocols affect diagnostics. Methods: Equal, randomized MPI study data was collected from studies completed in the year 2019 (pre-pandemic)and 2020 (intra-pandemic) including indication for study, type of stress test conducted, triaged exercise tests, andstudy outcome were collected from two nuclear cardiology departments located within a large urban city. Studies and outcomes were compared to one another and reviewed to determine a percentage difference on exercise stresstests for diagnosing CAD converted to pharmacological stress tests due to the global pandemic. Results: The SARS-CoV-2 pandemic has increased pharmacological stress testing and decreased exercise stresstests performed in urban departments. Performing a pharmacological stress test compared to an exercise stress testhas minimal effect on correctly diagnosing CAD and provides decreased exposure to SARS-CoV-2. Conclusion: MPI studies, in large urban areas, has increased triage from exercise to pharmacological protocol, because of theoccupational and patient health hazard of exercise protocols due to the SARS-CoV-2 pandemic. Patientsundergoing either an exercise or to the pandemic in a large urban area. Pharmacological stress test, regardless of the original order, will be assessed and correctly diagnosed for CAD, if present, with consistent findings using either of these two stresses protocols for MPI. As a student technologist, it is important to consider all aspects of procedures and the effect different protocols can have on images and diagnostics, while also being cognizant of extrinsic factors.

Co-Teaching in Nuclear Medicine Technology

Objectives: Like most everything in 2020, COVID-19 suddenly changed teaching and learning in higher education. With each passing month, it became clear that online learning was going to become mainstream in education. There are several NMT programs around the country that were already conducting a portion or all of the program via distance learning prior to the pandemic;however, for the majority of the programs this was a new endeavor. The challenge for many educators was learning how to make the switch from face-to-face teaching to online learning. This not only included the logistics of online learning, but also the how to teach online. Clinical placements, labs, graduation and completion of the program dates, and certification board eligibility was all in question. There was never a better time for educators to collaborate with one another in order to provide the highest quality of education for the future technologists of our profession. Co-teaching is not a new concept or idea in education1 , 2 . Co-teaching allows the faculty members to greatly expand their individual skills and knowledge to a greater audience2 . In the New England region, the geographic locations of programs are close so the idea to collaborate and co-teach across programs was ideal. This study explored the views of two program directors in the overall outcome of a class that was co-taught by them from different programs with a senior class in both programs. Methods: Two programs in New England within 60 miles of each other co-taught a high-level comprehension procedures course together in the fall 2020 semester. Between the two programs, there was 17 students in the course. The two program directors have a strong professional working relationship and extremely involved in the professional organizations. When the decision was made by both programs' institutions that the fall semester 2020 would remain online, the two program directors begin talking in how to enhance their online teaching. After reviewing the curricula together, it was clear that each program had a course in their final year that was directed toward the boards and more specifically, centered on procedures review. In the summer 2020, the PDs began developing and planning for the course together. This included aligning the course objectives, materials to be used, the syllabi, organization of the course and content, assignments, and examinations. Both schools used the same learning management system, which assisted with the online course structure. Zoom was used to facilitate the synchronized sessions. Results: Both program directors felt that the overall outcome was positive. It allowed for the strengths of both PDs to be utilized. The students gained experience from others that they do not work or learn with understanding different methods for performing the procedures or to learn from other's experiences in less seen procedures. In the first few weeks there were some obstacles to overcome, especially with connecting the students from both programs. However, the students were divided into four groups mixed from the two programs to develop case studies and eventually made strong connections which was demonstrated during the groups' presentations. The course evaluations completed by the students were positive. The PDs' perceptions were that they learned more about the various topics versus if the course was taught individually. Conclusions: There is research on co-teaching, but usually resides within the same department or same institutions. This study, from the perceptions of the PDs, demonstrates the need to look co-teaching from multiple programs specific to NMT to continue to expand and enhance learning for the students. Incorporating different strategies into the curriculum allows the students to potentially achieve higher learning expectations. Additional research beyond just one semester and one course between two programs should be completed in NMT education.

Alternative Values and Stigmatized Agents: Communicating Legitimacy in the Creative Industries

This paper explores the UK’s subsidized creative industries sector through the lens of organizational stigma literature. We argue that this theoretical lens contributes nuance and depth to an underexplored yet imperative aspect of the creative industries within the UK at a time when it needs to recover and reconfigure its value-based assessment system as it emerges into the post Covid-19 “new normal.” We bring together two separate, but interlinking studies of a national arts funder’s key stakeholders and its recipient organizations to explore the legitimacy of the funder’s value-based judgements, and the impact of these on subsidized arts organizations. © 2021 Taylor & Francis Group, LLC.