Global paediatric surgery: meeting an unmet need-the response of the British Association of Paediatric Surgeons.

AIM: Outline the response from an organisation regarding the unmet needs in global children's surgery METHOD: The burden of global surgical disease, whilst daunting, is becoming increasingly better defined as agencies, surgical colleges and professional specialty associations all attempt to increase capacity in terms of manpower, support education and find sustainable solutions to the deficit of health in treating women and children. However, definition of the problem does not in itself create change and similarly, humanitarian activities including volunteering by established surgical practitioners and other non-governmental organisations (NGOs) make only marginal improvement in the standards of care on offer at a global level. RESULTS: The International Affairs Committee, British Association of Paediatric Surgeons (BAPS) has had its target firmly set on investing in potential leaders within paediatric surgery in low- and middle-income countries (LMICs), and sharing elements of the educational programme made available for training within the UK and Ireland with the aim of contributing to the solutions of inequity in the surgical standards available to the world's children. CONCLUSION: This article outlines some of the practical steps that have been deployed by BAPS by way of sharing the responsibility for problem-solving at a global level. It also highlights the need for clarity in advocacy and the route through which effective communication can translate into wider and more effective delivery of surgical care for children.

Nontechnical skills in pediatric surgery: Factors influencing operative performance.

Technical competence is an essential aspect of intraoperative performance but is in itself insufficient to ensure an optimal surgical outcome. A list of other skills complement technical ability and these relate, among others, to surgical judgment and intraoperative decision-making processes as well as the role of the operating surgeon as leader of the surgical team. This article outlines the composite set of nontechnical skills (NTS) and the factors which influence surgical performance by virtue of this skill set. A framework has been developed to allow identification, teaching, and assessment of NTS known as Nontechnical Skills for Surgeons (NOTSS), and the relevance and influence of NOTSS during the intraoperative performance of pediatric surgery is presented.

Competence assurance - who cares?

The provision of clinical care in the United Kingdom now requires the acquisition of a licence to practise from the regulatory authority. A review process-revalidation has been put in place to ensure that standards of care are maintained by the medical workforce, and that all doctors remain up-to-date and fit for purpose so that this licence can be retained. This article outlines how this new statutory requirement pertains to paediatric surgery and highlights those areas where adjudication of competence remains imprecise and where progress in this process of revalidation needs to be made.

Medical error and disclosure - a view from the U.K.

Whilst the steps for reacting to and communicating following a surgical error should be clear to all, actual practice is punctuated by a range of failures which lead to the harm done by the error being compounded by inadequacies in the disclosure and subsequent processes. This article outlines best practice at the current time within the United Kingdom when responding to a surgical error and it also reports the type of behaviours which result in poor levels of satisfaction from the patients' perspective - often resulting in litigation being invoked.

Teaching and assessing non-technical skills.

The terms human factors and non-technical skills have recently been introduced to the language of surgical education. Both tend to be used interchangeably and yet each has a specific definition. More importantly, however, is the fact that the attributes and qualities contained within these headings relate to behaviours, attitudes and cognitive skills. They are recognised as crucially important in the practice of surgery, but are often poorly articulated during surgical performance, during training, during any assessment process and, indeed, seldom measured with reference to any metric in any of these activities. Most research in this area addresses non-technical skills in the operating theatre and it remains to be seen whether the same attributes and skills are used outwith theatre, particularly in the ward setting. However, the contribution that these aspects of performance make to a safe and successful outcome following surgery is being increasingly appreciated and there is increasing recognition of the need to train and assess.

Patient safety in surgery: non-technical aspects of safe surgical performance.

The performance of operative surgery has an understandable focus placed on dexterity, technical precision, as well as the choice of procedure. There is less appreciation of the cognitive and social skills of the individual surgeon and the effect that these have on the surgical team and on patient outcome. This article highlights that impact and explores the contribution of non-technical skills to safe practice within the operating room.

The UK proposals for revalidation of physicians: Implications for the recertification of surgeons.

The editorial titled "For the Protection of the Public and the Good of the Specialty: Maintenance of Certification" (published in the February 2009 issue of the Archives of Surgery) has prompted us to offer the following article to inform the debate about how assessing surgical care and sorting out the variables to be included in maintenance of certification may develop worldwide. The proposals for revalidation of UK physicians involve the relicensing of all physicians and recertification of all specialists on the specialist register of the General Medical Council. The process will be on a 5-year cycle and is currently under development by the General Medical Council. The Royal Colleges have been charged with creating the standards for recertification, and the responsibility will fall on the Royal Colleges to support their fellows and members as the new regulation is introduced and as it develops. This article outlines developments so far, with particular reference to surgeons.

Therapeutic intussusception in necrotizing enterocolitis: a novel surgical strategy.

The optimal operative management of babies with necrotizing enterocolitis (NEC) remains uncertain. We report the case of a premature neonate with advanced NEC where areas of necrotic small bowel were successfully managed by intussusception into adjacent distal intestine and we discuss the merits of therapeutic intussusception as an option in the surgical management of advanced NEC.

The use of PET/CT in evaluating disease recurrence following Ewing's tumour resection of the chest wall.

Limitations exist with the use of computer tomography (CT) in evaluating tumour recurrence at the site of previous chest wall reconstruction due to poor differentiation between inflammatory change and tumour recurrence. This case highlights the value of combined positron emission tomography and CT, which generates detailed anatomical and metabolic profiles in this diagnostic dilemma.