Monday, 27 October 2014

Mind what you wish for!

Cardiothoracic Surgery in the UK is, as far as the General Medical Council and the Colleges of Surgery are concerned, a single specialty.

Saturday, 25 October 2014

UK Falls Behind in Genomic Medicine Race.

The great Norman Shumway, the true father of heart transplantation, had many witty sayings. One that particularly appealed to me was 'the future of transplantation is xenotransplantation and always will be' reflecting his belief that the interspecies immune hurdles would never be conquered in a clinically meaningful way. The reason this famous Shumwayism appealed to me was the fact that he often visited me in the lab when I was working in the lab at Stanford Universiity in the early 1990s on a xenotransplantation project!

The future of medicine IS genomic medicine - and will become the present long before xenotransplantation ever will. This paper published recently in the JAMA, describes the findings of 2 recent studies and speculates how genomic or more accurately exomic medicine may be used in every day practice in the near future.

Both of these studies come from the U.S. and this should surprise no-one. This contrasts with the protracted and top heavy way genomic medicine is still being organised within the NHS in England as described in this painfully long document published by NHS England - another example if ever we need one of how the UK is falling behind its competitors in the hi tech world of specialist services.

 

Saturday, 18 October 2014

How An Engineer designed his own insides and saved his own Life - Ultimate Shared Care




Amazing story. Patient deciding and designing his own treatment is the purest of all shared care decision making. 

Patient Centredness, Ethics and Why You can' have them.

Two articles in a recent issue of the British Medical Journal illustrate different ways hospitals and healthcare institutions can introduce interventions to improve patient outcomes. The need for a response to poor cardiac surgery outcomes in one hospital in the Netherlands proved to be the impetus to radically change the way the institute and its employees deals with patients is described in the first.

Saturday, 27 September 2014

The Effect of Feminisation of Medical Training

As honorary senior lecturer at the University of Sheffield,  I am often involved in the assessment and examination of medical students.
I was recently attending a refresher course on OSCE (Observed Structured Clinical Examination) assessment of medical undergraduates.  This formal instruction for examiners is, we were told, now mandated by the General Medical Council .
The talk together with demonstration videos of how to and how not to carry out a proper valid OSCE assessment was very helpful and informative.
The speaker was a medical education specialist from the medical school. Many of her senior colleagues are also women. It struck me as I listened to her presentation that, in addition to a steep increase in the number of female medical graduates, there has been a gradual feminisation of medical training in the UK. I suppose that this should hold no surprise to anyone as the number of academic medical women involved in designing curricula and assessments has inevitably increased. This, I hasten to add,  is no bad thing. On the contrary, it is to be welcomed. Feminisation of undergraduate medical training has led to an increase in patient centredness of what is expected from modern doctors  (what old timers used to call the touchy feely bits!) - a quality hitherto lacking in medical training.
Whether this approach to medical training occurs in all of the countries of origin of the large numbers of foreign graduates who work in the NHS is debatable. This should be a matter of some concern if the predominance of foreign born doctors who fall foul of the General Medical Council is to be reversed. There is no doubt that this new approach to undergraduate training is extended into postgraduate training and foreign graduates who come to the UK for their postgraduate training learn fast. The doctors who are at risk are those who do all their training elsewhere and come to the UK for their tenured job. It is this group who require an intensive and prolonged induction prior to entering medical life in the UK with all that British society expects from its doctors.

Saturday, 20 September 2014

High Fidelity Surgical Training

This is an excellent example of high fidelity simulation of a difficult surgical procedure.
As one surgeon in the video says it is now unacceptable for a surgeon to go through a learning curve whilst operating on patients. A smart device like this not only recreates the procedure but cleverly, is able to give feedback to the surgeon.
Much more of this is required. Surgeons are clever and resourceful. Colleges of surgeons should be encouraging and incentivising young surgeons to do what this clever chap from Holland has achieved.