Establishing a generic training programme for future junior doctors: a role for neurosurgery within the framework of clinical neurosciences (original) (raw)
2005, Annals of The Royal College of Surgeons of England
INTRODUCTION To describe the opinion of junior doctors in neurosurgery in the UK and Eire about future reforms to training, and to relate this to the establishment of a generic neurosciences training programme. METHODS A postal questionnaire survey of neurosurgery units in UK and Eire (36 units). All senior house officers (SHOs) taking part in a neurosurgery on-call rota during the 6 months between February and August 2003 (n = 236); 190 respondents (response rate 81% overall, 90% neurosurgery SHOs and 55% neurology SHOs. The questionnaire covered most aspects of provision of training, working pattern and job satisfaction gained from the post. Also included were questions on future reforms for training. RESULTS There is an overwhelming acceptance amongst SHOs for training to be centred on generic programmes. The audit also identified that there are many aspects of neurosurgical training which will be very suitable for trainees from other fields, thus supporting the establishment of a generic neurosciences training programme. CONCLUSIONS The establishment of a generic training programme would encourage an improvement in training standards for the whole SHO grade. To ensure the success of this proposed generic training programme, support from junior doctors and all those involved in postgraduate education is required. Neurosciences teaching has the excellent potential to move towards the planning and formation of a generic neurosciences training programme in-line with the proposed reforms. Coll Surg Engl 2005; 87: 264-8 266 Question Useful knowledge/ Suitable for Training should be part understanding gained generic training of SHO or PRHO rotation Basic science of the nervous system, e.g. anatomy, Yes -133(70%) Yes -150 (79%) PRHO -76 (40%) physiology, pathology, etc. No -57(30%) No -40 (21%) SHO -114 (60%) Taking history relevant to neurosurgery Yes -171 (90%) Yes -171 (90%) PRHO -133 (70%) No -19 (10%) No -19 (10%) SHO -57 (30%) Clinical examination skills of the nervous system Yes -177 (93%) Yes -179 (94%) PRHO -150 (79%) No -13 (7%) No -11 (6%) SHO -40 (21%) Clinical pharmacology and prescribing as relevant Yes -146 (77%) Yes -146 (77%) PRHO -105 (55%) to neurosurgery No -44 (23%) No -44 (23%) SHO -85 (45%) Pre-operative preparation of a patient for a major life Yes -156 (82%) Yes -167 (88%) PRHO -150 (79%) threatening procedure No -34 (18%) No -23 (12%) SHO -40 (21%) Documentation of neurological observations, Yes -177 (93%) Yes -177 (93%) PRHO -140 (74%) e.g. GCS, AVPU No -13 (7%) No -13 (7%) SHO -50 (26%) Basic interventional procedures, e.g. lumbar puncture, Yes -163 (86%) Yes -173 (91%) PRHO -112 (59%) central venous access, arterial access No -27 (14%) No -17 (9%) SHO -78 (41%) Managing the unconscious person Yes -160 (84%) Yes -179 (94%) PRHO -116 (61%) No -30 (26%) No -11 (6%) SHO -74 (39%) Managing epilepsy and its complications Yes -101 (53%) Yes -160 (84%) PRHO -135 (71%) No -89 (47%) No -30 (26%) SHO -55 (29%) Managing the spectrum of head injured patients Yes -162 (85%) Yes -173 (91%) PRHO -97 (51%) No -28 (15%) No -17 (9%) SHO -93 (49%) Managing the spectrum of acute spinal conditions Yes -141 (74%) Yes -158 (83%) PRHO -25 (15%) and injuries No -49 (26%) No -37 (27%) SHO -161 (85%) Management of a space occupying lesion and assessment Yes -175 (92%) Yes -167 (88%) PRHO -25 (15%) of urgency of its treatment No -15 (8%) No -23 (12%) SHO -161 (85%) Management of acute cerebral haemorrhage Yes -173 (91%) Yes -171 (90%) PRHO -38 (20%) No -17 (9%) No -19 (10%) SHO -152 (80%) Management of back/neck pain with or without sciatica/ Yes -150 (79%) Yes -165 (85%) PRHO -29 (15%) brachalgia and assessment of urgency of its treatment No -40 (21%) No -25 (15%) SHO -161 (85%) Breaking bad news to the patient/relatives Yes -131 (69%) Yes -169 (89%) PRHO -144 (76%) No -59 (31%) No -21 (11%) SHO -46 (24%) Managing an emotional, confused, distressed patient Yes -150 (79%) Yes -175 (92%) PRHO -124 (65%) and/or relative No -50 (21%) No -15 (8%) SHO -66 (35%) Managing an angry patient and/or relative Yes -146 (77%) Yes -161 (85%) PRHO -129 (68%) No -44 (23%) No -29 (15%) SHO -61 (32%) Explaining the risk-benefit of an intended life threatening Yes -135 (71%) Yes -146 (77%) PRHO -40 (21%) procedure to a patient/relative in an acute setting No -55 (29%) No -44 (23%) SHO -150 (79%) Conveying issues and explaining reasons related to withdrawal Yes -131 (69%) Yes -158 (83%) PRHO -51 (27%) of life-saving treatment or Do Not Resuscitate Order to the No -59 (31%) No -37 (17%) SHO -139 (73%) relatives of a patient who is gravely unwell with a very poor prognosis Effective communication skills and ability to relay information Yes -171 (90%) Yes -180 (95%) PRHO -144 (76%) to others No -19 (10%) No -10 (5%) SHO -46 (24%) Working as part of a team to achieve effective patient care Yes -165 (87%) Yes -179 (94%) PRHO -131 (69%) No -25 (13%) No -11 (6%) SHO -59 (31%) Issues surrounding clinical governance and audit Yes -65(34%) Yes -131 (69%) PRHO -59 (31%) No -125 (66%) No -59 (31%) SHO -131 (69%)
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