The Basic Surgical Skills Course in Sub-Saharan Africa: An Observational Study of Effectiveness.

BACKGROUND: The Basic Surgical Skills (BSS) course is a common component of postgraduate surgical training programmes in sub-Saharan Africa, but was originally designed in a UK context, and its efficacy and relevance have not been formally assessed in Africa. METHODS: An observational study was carried out during a BSS course delivered to early-stage surgical trainees from Rwanda and the Democratic Republic of the Congo. Technical skill in a basic wound closure task was assessed in a formal Objective Structured Assessment of Technical Skills (OSAT) before and after course completion. Participants completed a pre-course questionnaire documenting existing surgical experience and self-perceived confidence levels in surgical skills which were to be taught during the course. Participants repeated confidence ratings and completed course evaluation following course delivery. RESULTS: A cohort of 17 participants had completed a pre-course median of 150 Caesarean sections as primary operator. Performance on the OSAT improved from a mean of 10.5/17 pre-course to 14.2/17 post-course (mean of paired differences 3.7, p < 0.001). Improvements were seen in 15/17 components of wound closure. Pre-course, only 47% of candidates were forming hand-tied knots correctly and 38% were appropriately crossing hands with each throw, improving to 88 and 76%, respectively, following the course (p = 0.01 for both components). Confidence levels improved significantly in all technical skills taught, and the course was assessed as highly relevant by trainees. CONCLUSION: The Basic Surgical Skills course is effective in improving the basic surgical technique of surgical trainees from sub-Saharan Africa and their confidence in key technical skills.

On integrating Jungian and other theories.

This paper consists of reflections on some of the processes, subtleties, and 'eros' involved in attempting to integrate Jungian and other analytic perspectives. Assimilation of other theoretical viewpoints has a long history in analytical psychology, beginning when Jung met Freud. Since its inception, the Journal of Analytical Psychology has provided a forum for theoretical syntheses and comparative psychoanalysis. Such attempts at synthesizing other theories represent analytical psychology itself trying to individuate.

Winnicott's dream: some reflections on D. W. Winnicott and C. G. Jung.

The author discusses D. W. Winnicott's 1964 review of C. G. Jung's autobiography, Memories, Dreams, Reflections, emphasizing the psychological effect the reviewing process had on Winnicott himself. Writing the review constellated Winnicott's unconscious, and he reported having a healing dream 'for Jung and for some of my patients, as well as for myself'. Winnicott's 'countertransference' to Jung helped him personally, and the review was Winnicott's first written formulation of his theory on 'The use of an object'.