Is current surgical training efficient? A national survey.

OBJECTIVES: Evaluation of surgical training in Denmark is competency based with no requirement for a specific number of procedures. This may affect monitoring of surgical progress adversely and cause an underestimation of the time needed to acquire surgical competencies. We investigated the number of common surgical procedures performed by trainees. Trainees' and consultants' expectations from the training program were also investigated. DESIGN AND PARTICIPANTS: A questionnaire was sent to all 115 surgical trainees in Denmark. We asked how many common surgical procedures the trainees had performed during their postgraduate training, whether self-reported procedural confidence was achieved during their training, and whether their training expectations were met. Another questionnaire dealt with the consultants' expectations of the surgical training. RESULTS: The total number of common surgical procedures (Lichtenstein hernia repair, appendectomy, laparoscopic appendectomy, and laparoscopic cholecystectomy) that were performed varied between trainees. One group performed few common procedures during training. A low number in 1 procedure correlated with a similar pattern in other procedures. Approximately one-third did not perform common elective procedures independently until their fifth year. Consultants and trainees viewed training differently. CONCLUSIONS: Our study reveals no common trend in the numbers and types of procedures performed during training. The number of procedures seems to reflect the individual trainee and a local tradition rather than the particular training program. An informal competency-based assessment system with lack of quantitative requirements evidently involves a risk of skewness in training.

Measures of educational effort: what is essential to clinical faculty?

PURPOSE: To enhance the recognition of educational effort and thereby support faculty vitality, the authors aimed to identify essential categories of educational effort from the perspective of clinical faculty and determine whether the emerging categories were in concordance with an organizational perspective. METHOD: The authors performed nominal group processes in four groups in 2008, with the participation of 24 clinical faculty members, 6 in each group, representing 18 (medical, surgical, paraclinical, and psychiatric) specialties at 14 hospitals in Denmark. Subsequently, the authors performed a comparative analysis of the emerging essential categories and the organizational work by the national panel on medical education, appointed by the Association of American Medical Colleges (AAMC). RESULTS: The four groups of clinical faculty members agreed on categories of educational effort. This quantitative consistency in prioritization was supported by qualitative consistency, as the authors observed similar uses of words and phrases among all four groups. The top priority in essential categories of educational effort was "Visibility of planned educational activities on the work schedule," which received 39% of all votes. The comparative analysis showed that the essential categories of educational effort suggested by clinical faculty were in concordance with the steps developed by the AAMC. CONCLUSIONS: The high degree of consistency among clinical faculty from different locations and specialties and the high concordance with the organizational work of the AAMC suggest that it is possible to develop standardized measurements of educational effort. Clinical faculty emphasized that a good starting point for educational measurements is the work schedule.

The three-hour meeting: a socio-cultural approach to engage junior doctors in education.

BACKGROUND: Learning in a socio-cultural context, in contrast to an individual context, has been highlighted in recent years. The 3-hour meeting concept presents a socio-cultural framework for collaborative educational opportunities; it has run successfully for 6 years at 129 meetings for junior doctors (JDs) in an 850-bed Danish university hospital. AIM: This concept improved the educational environment and activities by engaging JDs in educational initiatives. METHOD: The concept began with annual meetings that featured self-reflection and plenary discussions regarding all aspects of education. The meetings concluded with the Top 3 of 'educational issues of concern' and an action plan for education initiated by junior doctors. This written material on educational matters from each department provided updated knowledge to department and hospital management and resulted in the development of 'blue prints for educational action'. RESULTS: The compiled actions resulted in the implementation of 76 educational initiatives in the first year, after just one 3-hour meeting and managerial follow-up. CONCLUSION: The junior doctors' increased engagement in education reinforced educational relationships with senior doctors and management, and this collaboration markedly improved the educational environment and the number of educational activities. Therefore, the 3-hour meeting concept supported the socio-cultural perception of education in the hospital.

[The 3-hour meeting concept: an organisational approach for involvement of junior doctors in education]. / 3-timers-møder i yngre laegers kliniske uddannelse.

In an 850-bed Danish University hospital, "3-hour meetings" provide junior doctors with three hours within normal working hours for discussing training with an innovative purpose. The meetings are followed-up by dialogue and action throughout the organisation. The junior doctors get many of their training initiatives implemented. The Head of Department obtains information, which is used for prioritisation of educational initiatives. At hospital level, an overview of education as well as sharing of knowledge and educational vision is achieved.

[Feedback in postgraduate medical training]. / Feedback i den laegelige postgraduate uddannelse.

Feedback may be described as a process comprising communication of information and reactions to such communication. It has been defined as specific information about the difference between a trainee's observed performance and a given standard with the intent of achieving performance improvement. Feedback is essential in medical education and has great implications for the educational climate. It has been shown that a common language regarding the principles of feedback has a sustained effect on quality and frequency of feedback. Further research is needed on feedback and educational climate, and on how to motivate trainees to improve future learning through feedback.

Changes from 1992 to 2002 in the pretreatment delay for patients with squamous cell carcinoma of larynx or pharynx: a Danish nationwide survey from DAHANCA.

In Denmark, a general impression of prolonged pretreatment delay for patients with head and neck cancer led to a nationwide study of time spans from symptom debut over first health care contact to start of treatment. Charts of consecutive new patients with squamous cell carcinoma of the pharynx and larynx, seen at the five Danish oncology centers in January-April 1992 and 2002, respectively, were reviewed. Of the 288 patients identified, definitive treatment was radiotherapy in 264 cases, surgery in one case. Twenty-three patients had neither surgery nor radiotherapy. Total time from first health care contact to start of definitive treatment was significantly longer in 2002 than in 1992 (median 70 versus 50 days, p<0.001). There was no significantly difference in time used for diagnosis. Time for treatment preparation and planning was 46 days in 2002 versus 31 days in 1992 (p<0.001). Significantly more diagnostic procedures (CT, MR, US, PET) were done in 2002. In conclusion, this nationwide study showed that waiting time before start of radiotherapy was significantly longer in 2002 compared to 1992. An increasing number of imaging procedures including CT-based dose planning was observed. The prolongation was mainly related to shortage of radiotherapy capacity. The three weeks extra pretreatment delay could theoretically lead to a 10% lower tumor control probability in 2002 compared to 1992.