Clinical medicine (London, England)
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Comment Letter
Surgical approaches for lung volume reduction in emphysema.
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Patient safety in hospital is dependent on a multitude of factors. Recent reports into the failings of healthcare organisations in the UK have highlighted low staffing levels as a significant factor. There is research into the impact of nurse-to-patient ratios on patient safety, but our literature search found little published data that would allow healthcare providers to define a minimum number of physician staff and skills mix that would assure safety in the largest hospital specialty: unscheduled (acute) medicine. Future work should focus on the evaluation of existing data on hospital mortality rates and physician staffing levels as well as on empirical time and motion studies to ascertain the resources required to undertake safe medical care at times of peak demand.
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Life as a medical registrar presents many challenges and concern is growing that a downwards trend in recruitment to General Medicine is the direct result of a perception by junior doctors that the role of the medical registrar is excessively demanding and results in poor work-life balance. A solution-focused approach (SFA) can be used successfully to find a satisfying outcome for both registrar and patient in many of the situations encountered during an on-call, as well as carrying over benefits into life outside of work. We explore the origins of SFA and the ways in which it can be successfully applied to clinical medicine, providing case studies from the author's own experience to illustrate the principles of this way of thinking.
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Since the introduction of Modernising Medical Careers in 2005, the electronic portfolio (ePortfolio) and workplace based assessments (WPBAs) have become integral, yet anecdotally controversial, components of postgraduate medical training. In this multi-centre, survey-based study, we looked at core medical trainees and trainers in the Northwest London region and their opinions of the ePortfolio and WPBAs. ⋯ Overall, if implemented correctly, the ePortfolio and WPBAs are potentially powerful tools in the education and development of trainee doctors. However, improvements in mentoring and feedback may be needed to experience the full benefits of this system.