Uniform experience and assessment during a multisite surgical clerkship.

Major changes in health care delivery and the increased number of clerkship sites used for teaching by many medical schools has resulted in significant implications for medical education. Methods have become necessary to achieve and maintain a comparable clinical experience and a uniform assessment process at each teaching site. Following a review of existing practices, a new core curriculum, a problem-based approach and the Objective Structured Clinical Examination (OSCE) were introduced into this department. Over 1200 students have passed through this revised surgical clerkship over the past 8 years. The introduction of the OSCE has helped to direct student learning, provide an objective assessment to complement the ward grade, and enabled an audit of teaching and learning to be carried out. In one group of 103 students no significant correlation was found between the OSCE and ward grades. Performance at different hospitals was similar and those carrying out their clerkship later in the academic year benefited from their previous other attachments. The OSCE has enabled immediate feedback to be given to learners as well as providing teachers with an opportunity to see for themselves the outcome of their tuition. A clinical performance record card has now been introduced to improve the monitoring of students' clinical experience.

Chymopapain versus conventional surgery for lumbar disc herniation. 10-year results of treatment.

We reviewed two comparable groups of patients who had been treated for lumbar disc herniation by chymopapain chemonucleolysis (145) or conventional surgical discectomy (91). They were reviewed 10 years after treatment by questionnaire, followed by a personal interview by an independent observer. The results of the surgically treated groups were slightly better than those treated with chymopapain. In particular, there was significantly better early relief of leg and low back pain, and fewer patients needed a second procedure. Complications were few in both groups.

Orthopaedic training in private practice.

The background philosophy, structure and training experience offered by a new free-standing clinic set up purely to facilitate orthopaedic post-graduate training is described. Emphasis is placed on the ethical issues involved. The educational programme, which includes involvement in all local and national activities, is summarized. The registrars' operative experience is recorded using log-sheet criteria. This venture has predated the major restructuring of the health care system in Auckland, which is anticipated in the next few years, and will therefore allow the training programme to evolve appropriately, employing the educational opportunities of all sectors of health care.

Upper limb replantation: a 3-year follow-up.

A case report of an upper limb replantation is presented detailing the initial treatment and the functional results three years later. Although wasted in appearance, the limb is very useful and the patient has been able to successfully adapt to his resulting residual disability.

Denervation of spinal facet joints for treatment of chronic low back pain.

This paper describes a neurolytic technique for the denervation of the posterior lumbar spinal facet joints for the treatment of chronic low back pain. Results are reported of a pilot study, using a simple outpatient procedure and achieved relief of pain in 80% of cases. No major complications were encountered.