{"title":"Training young adult hip surgeons for the future: the Cambridge vision","authors":"K. Kumar, J. Lawrence, V. Khanduja","doi":"10.1302/2048-0105.56.360485","DOIUrl":"https://doi.org/10.1302/2048-0105.56.360485","url":null,"abstract":"Surgery is a form of art which has transformed over the last six centuries from an individual’s craftsmanship to a team-based approach to ensure patient safety.1 Surgical training has also seen a compelling change from being a primarily apprentice-based training to a competency-based model.2,3 Although the traditional model of apprentice-based training is still valid in modern surgical training, there has been a gradual shift over the last two decades towards achieving specific competencies in an objective manner to deliver safe surgical care.2,3 There are several reasons for this change. A reduction in working hours in the UK and Europe, as dictated by the European Working Time Directive (EWTD), has reduced the total training time between qualification and becoming a consultant (specialist) from 30 000 hours to 6000 hours.4 This five-fold reduction in hours has not only reduced the amount of surgical exposure gained by the resident during training, but has also resulted in significant variability in the orthopaedic caseload for the trainee.5⇓⇓-8 In parallel with this, the introduction of consultant-delivered care in an effort to improve patient outcomes may have an indirect effect on surgical training by reducing the number of cases a resident performs as primary surgeon.9 A final driving force for the shift in curriculum is the continued evolution of technically demanding surgery with steep learning curves, such as arthroscopy, which is now increasingly performed in orthopaedic practice due to several technical advances.10⇓-12\u0000\u0000The current orthopaedic curriculum in the UK is based around three core themes: applied clinical knowledge, applied clinical skills and professional and management skills.13 Competency-based training encompasses several work-based assessments, of which procedure-based assessment (PBA) is one. PBAs provide the opportunity for a detailed assessment of …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"5 1","pages":"8-12"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85023609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Is there life after Montgomery? Medico-legal implications","authors":"M. Foy","doi":"10.1302/2048-0105.56.360481","DOIUrl":"https://doi.org/10.1302/2048-0105.56.360481","url":null,"abstract":"We had two interesting sessions on consent issues at the recent Congress in Belfast. The first comprised presentations on what the patient should be told before an operation with opinions from a senior orthopaedic surgeon and experienced negligence barrister, together with the perspective of the defence organisations. The second consisted of a great exposition on Montgomery1 and the decline of Bolam from James Badenoch, the lead/senior counsel who presented the Montgomery appeal to the Supreme Court in 2015.2 We followed this with a debate on ‘This house believes that the Montgomery judgement is a step too far’. For those of you who were unable to attend, some of the issues that were raised in those sessions are worthy of repetition. It is also worth reassessing the situation regarding Montgomery and informed consent 18 months on, to see if there has been any major fallout from the ruling in our day-to-day clinical practice.\u0000\u0000First of all, let’s be clear, there were no dissenting voices in any quarter that opposed the GMC guidelines on consent published in 2008.3 What the Montgomery judgement has done is to articulate in law what we should all already have been practicing. The concerns that many of us have are twofold:\u0000\u00001. That the publicity surrounding the case would lead to a large number of retrospective negligence claims when patients who developed an uncommon or rare complication of surgery retrospectively decide that they would not have consented to the surgery had they been made aware of the ‘material risk’ of the complication that occurred.\u0000\u00002. That the views expressed by some leading figures in the legal profession (including James Badenoch) that the Bolam principle should be removed from medical practice altogether would lead to an erosion of power/responsibility in the profession, with courts …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"7 1","pages":"41-42"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88103023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Online learning resources: a creator’s perspective","authors":"T. Coughlin","doi":"10.1302/2048-0105.56.360487","DOIUrl":"https://doi.org/10.1302/2048-0105.56.360487","url":null,"abstract":"For the last two decades, computers and the internet have been central to education. They are essential tools which allow educators to be creative and collaborative with their teaching, and to enable students an instant and ‘always-on’ access to content (Fig. 1). As a learning tool they are indispensable and at times frustrating, but increasingly they will provide the greater proportion of students’ total quantum of learning. With changes in the way information is accessed and courses are delivered, as well as the omnipresent nature of the internet, education bodies need to be cognisant of newer ways to deliver information, and the ways in which contemporary technologies may be used to address some of the difficulties the modern surgical trainee faces in gaining knowledge and proficiency.\u0000\u0000\u0000\u0000Fig. 1 \u0000Access to online resources has changed dramatically over the last 20 years.\u0000\u0000\u0000\u0000While the benefits of digital education are clear, there are a number of prominent potential issues:\u0000\u00001. Inconsistent content with a lack of peer review.\u0000\u00002. Excess volume of content, making it hard to distinguish which will provide the ‘best’ resources.\u0000\u00003. Content which is made inaccessible due to cost.\u0000\u00004. Content which is made inaccessible by institutional firewalls or by platform incompatibility.\u0000\u00005. Confusion and consternation over the risk of infringing copyright.\u0000\u0000These issues are in varying stages of resolution, but each provides a potential bar to the delivery of consistent, quality education. However, the trend in each is very much towards improvement.\u0000\u0000The modern internet is based on the early protocols devised by Tim Berners-Lee in 1989 to communicate between academic institutions. From the mid-1990s onwards, personal access to the internet has increased exponentially to become an almost universal tool for learning. Access to the internet for students has been essential for more than two decades, and its uses have increased in parallel with its …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"11 1","pages":"2-6"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73722546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Education, Education, Education","authors":"B. Ollivere","doi":"10.1302/2048-0105.56.360493","DOIUrl":"https://doi.org/10.1302/2048-0105.56.360493","url":null,"abstract":"The development and training of the next generation of orthopaedic surgeons is becoming more and more difficult. The problems are somewhat multifactorial – the limitation of working time and moves to a full shift system have limited ‘contact time’ somewhat, with the trainee often spending much less time with their trainer. This lack of exposure has been compounded with dramatic changes in working life. With morale perhaps at its lowest ebb in the time I have been in medicine, doctors and medical students at every level are becoming increasingly disenfranchised, which inevitably impacts on willingness to learn …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"3 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82596174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Forward, B. Ollivere, J. Ng, T. Coughlin, K. Rollins
{"title":"Current concepts in rib fracture fixation","authors":"D. Forward, B. Ollivere, J. Ng, T. Coughlin, K. Rollins","doi":"10.1302/2048-0105.55.360464","DOIUrl":"https://doi.org/10.1302/2048-0105.55.360464","url":null,"abstract":"Rib fracture fixation by orthopaedic and cardiothoracic surgeons has become increasingly popular for the treatment of chest injuries in trauma. The literature, though mainly limited to Level II and III evidence, shows favourable results for operative fixation. In this paper we review the literature and discuss the indications for rib fracture fixation, surgical approaches, choice of implants and the future direction for management. With the advent of NICE guidance and new British Orthopaedic Association Standards for Trauma (BOAST) guidelines in production, the management of rib fractures is going to become more and more commonplace.","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"751 1","pages":"2-7"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76869203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Assessing quality in emergency health care","authors":"B. Ollivere","doi":"10.1302/2048-0105.55.360475","DOIUrl":"https://doi.org/10.1302/2048-0105.55.360475","url":null,"abstract":"We as a family were recently the receivers of health care, with the birth of our firstborn son who arrived a little early. It is always a learning experience to be the receiver of health care, and it certainly focuses the mind as to what is important in its delivery.\u0000\u0000We were fortunate and I am pleased to say that despite the urgent nature of the situation, both mother and baby are well. However for me — usually the consultant in charge — being admitted for emergency surgery was an eye-opening experience. I have nothing but admiration for Miss Wallace who expertly performed the caesarean section and safely brought both mother and baby through the whole experience. The entire undertaking set me thinking about quality assessment in health care and, in particular, the emergency setting.\u0000\u0000The PROMs revolution has happened and is the next step in the evidence-based medicine movement focussing outcomes …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"104 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88104689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"New expert witness guidance? Kennedy v Cordia 2016","authors":"M. Solon","doi":"10.1302/2048-0105.55.360476","DOIUrl":"https://doi.org/10.1302/2048-0105.55.360476","url":null,"abstract":"Expert evidence forms the basis of almost every claim that comes before the courts in personal injury and clinical negligence litigation. The experts instructed will be of fundamental importance to the success or failure of the case. The legal profession are increasingly aware of the responsibility when instructing an expert to ensure that the expert is aware of their duty to the court. Following the case of Jones v Kaney (2011),1 it is important that experts know that their evidence no longer carries immunity from an action in contract or negligence if it is found to be wanting.\u0000\u0000In light of this, it is worth reading the judgement in the Kennedy v Cordia case.2 Who would have thought that a bruised wrist from a fall on an icy footpath in 20103 would lead to the Supreme Court giving useful guidance on when expert evidence would be allowed in a civil court? The claimant (Ms Kennedy) was employed as a home carer by the defendant. Her work involved visiting clients in their homes and providing personal care. One wintry December evening, she was required to visit an elderly lady. She slipped and fell, injuring her wrist. She sued the company, and called Lenford Greasly as part of her case, a consulting engineer and former factory inspector. Mr Greasley opined that as part of the risk assessment for her role Ms Kennedy should have been provided with some form of anti-slip overshoe which, if worn, would probably have prevented her injury.\u0000\u0000The defendant objected to his evidence on the basis that he did not have any special skill, learning or experience. This objection was rejected initially by the court. At first appeal (motivated partly by concerns about the unnecessary proliferation of experts in civil cases which is seen to …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"21 1","pages":"39-40"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83279502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Key opinion leaders","authors":"B. Ollivere","doi":"10.1302/2048-0105.54.360456","DOIUrl":"https://doi.org/10.1302/2048-0105.54.360456","url":null,"abstract":"Mohammed Ali died on June 3 2016. Perhaps one of the most successful sportsmen of all time, Ali was widely regarded as a strong political force and human rights activist. A fearsome fighter, he was also known for his love of poetry (sometimes of dubious quality) and support for the black emancipation movement in the USA, conversion to Islam and continuous presence on the world stage throughout a long and difficult fight with Parkinson’s disease. Despite his reportedly low IQ, having scored 78 on a US army recruitment test, Ali remarked “I said I was the greatest, not the smartest”. An amazing insight into one of the world’s most colourful, successful and inspirational people.\u0000\u0000Human beings are not good at separating personality traits and physical characteristics. Just because an individual is able to run 100 m faster than anyone ever before does not make them more insightful …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"44 1 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82689080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Total knee arthroplasty at a crossroads: Choosing the middle way","authors":"K. Sehat","doi":"10.1302/2048-0105.54.360451","DOIUrl":"https://doi.org/10.1302/2048-0105.54.360451","url":null,"abstract":"Anatomical total knee arthroplasty alignment versus conventional mechanical alignment; or a combination?","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"22 1","pages":"4-15"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91221612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical guidelines: Must we follow them?","authors":"M. Foy","doi":"10.1302/2048-0105.54.360450","DOIUrl":"https://doi.org/10.1302/2048-0105.54.360450","url":null,"abstract":"Controversy about clinical guidelines is not new. Hurwitz (1999)1 described how, in the fourth century BC, Plato explored the difference between skills grounded in practical expertise and those based solely on following instructions or obeying rules. Plato was of the opinion that flexible responsiveness and ‘improvisatory ability’ were endangered by the use of guidelines. Plato’s view was that the ritual following of guidelines debased medical practice because guidelines presuppose an average patient rather than the particular patient that the doctor is treating. He also believed that the knowledge/analysis that goes into the development of guidelines is not with the treating clinician, but with guideline developers distant from the clinical situation.\u0000\u0000The legal profession seem to like guidelines and protocols; it gives them something to judge us by. The question we need to ask in clinical practice is, how do we stand legally if we don’t follow NICE guidelines or hospital/departmental protocols? Is it a mandatory requirement that we do so? If not, why have they been drafted in the first place? Gupta and Warner2 helpfully summarise the rubric of the NICE guidelines, pointing out that NICE concede that they are not a replacement for clinical knowledge and judgement, and do not take the place of the individual responsibility of healthcare professionals to make appropriate decisions.\u0000\u0000NICE itself indicates that clinical guidelines recommend the ways in which healthcare professionals should care for people with specific conditionsand encourage best practice. However, Tingle3 describes how, in 1996, the Department of Health4 indicated that the guidelines should be constructed in such a way that permits deviation and initiative, which has the potential to result in improvements. The point is also made by Tingle that clinical guidelines are not a cookery book and clinical judgement is not suspended when they are …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"112 1","pages":"42-43"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77917581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}