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      The dawn of a new competency-based training era : a 70-year perspective on post-graduate training reform in trauma and orthopaedic surgery

      research-article
      , PhD, MRCS 1 , 2 , , MBBS, FRCSEd 3
      Bone & Joint Open
      The British Editorial Society of Bone & Joint Surgery
      Surgical training, Postgraduate education

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          Abstract

          The imminent introduction of the new Trauma & Orthopaedic (T&O) curriculum, and the implementation of the Improving Surgical Training initiative, reflect yet another paradigm shift in the recent history of trauma and orthopaedic training. The move to outcome-based training without time constraints is a radical departure from the traditional time-based structure and represents an exciting new training frontier. This paper summarizes the history of T&O training reform, explains the rationale for change, and reflects on lessons learnt from the past.

          Cite this article: Bone Jt Open 2021;2-3:181–190.

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          Most cited references69

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          Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.

          Long-term disorders are the main challenge facing health-care systems worldwide, but health systems are largely configured for individual diseases rather than multimorbidity. We examined the distribution of multimorbidity, and of comorbidity of physical and mental health disorders, in relation to age and socioeconomic deprivation. In a cross-sectional study we extracted data on 40 morbidities from a database of 1,751,841 people registered with 314 medical practices in Scotland as of March, 2007. We analysed the data according to the number of morbidities, disorder type (physical or mental), sex, age, and socioeconomic status. We defined multimorbidity as the presence of two or more disorders. 42·2% (95% CI 42·1-42·3) of all patients had one or more morbidities, and 23·2% (23·08-23·21) were multimorbid. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged 65 years and older, the absolute number of people with multimorbidity was higher in those younger than 65 years (210,500 vs 194,996). Onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with multimorbidity that included mental health disorders (prevalence of both physical and mental health disorder 11·0%, 95% CI 10·9-11·2% in most deprived area vs 5·9%, 5·8%-6·0% in least deprived). The presence of a mental health disorder increased as the number of physical morbidities increased (adjusted odds ratio 6·74, 95% CI 6·59-6·90 for five or more disorders vs 1·95, 1·93-1·98 for one disorder), and was much greater in more deprived than in less deprived people (2·28, 2·21-2·32 vs 1·08, 1·05-1·11). Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas. Scottish Government Chief Scientist Office. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Teaching surgical skills--changes in the wind.

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              Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication.

              To compare the relative effects on performance of sleep deprivation and alcohol. Performance effects were studied in the same subjects over a period of 28 hours of sleep deprivation and after measured doses of alcohol up to about 0.1% blood alcohol concentration (BAC). There were 39 subjects, 30 employees from the transport industry and nine from the army. After 17-19 hours without sleep, corresponding to 2230 and 0100, performance on some tests was equivalent or worse than that at a BAC of 0.05%. Response speeds were up to 50% slower for some tests and accuracy measures were significantly poorer than at this level of alcohol. After longer periods without sleep, performance reached levels equivalent to the maximum alcohol dose given to subjects (BAC of 0. 1%). These findings reinforce the evidence that the fatigue of sleep deprivation is an important factor likely to compromise performance of speed and accuracy of the kind needed for safety on the road and in other industrial settings.
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                Author and article information

                Contributors
                Role: Specialist Registrar
                Role: Consultant Orthopaedic SurgeonRole: Chair of the Specialist Advisory Committee for Trauma & Orthopaedic Surgery
                Journal
                Bone Jt Open
                Bone Jt Open
                bjo
                Bone & Joint Open
                The British Editorial Society of Bone & Joint Surgery (London )
                2633-1462
                19 March 2021
                March 2021
                : 2
                : 3
                : 181-190
                Affiliations
                [1 ]org-divisionClinical Trials Unit , org-divisionWarwick Medical School , Coventry, UK
                [2 ]org-divisionDepartment of Trauma and Orthopaedic Surgery , org-divisionUniversity Hospitals Coventry & Warwickshire , Coventry, UK
                [3 ]org-divisionDepartment of Trauma and Orthopaedic Surgery , org-divisionUniversity Hospital of North Durham , Durham, UK
                Author notes
                Correspondence should be sent to Hannah K. James. E-mail: hsmith22@ 123456doctors.org.uk
                Author information
                https://orcid.org/0000-0002-0535-3062
                Article
                BJO-2-181
                10.1302/2633-1462.23.BJO-2020-0155.R1
                8009901
                33739137
                54a33c95-2e48-481d-9593-29270cb48e70
                © 2021 Author(s) et al.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/

                History
                Categories
                General Orthopaedics
                Glucose
                Glucose Variability
                Complications
                Glycemic Control
                Glycated Haemoglobin
                General Orthopaedics, general-orthopaedics
                Custom metadata
                Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
                General Orthopaedics
                H. K. James reports a doctoral research fellowship (grant ID 20845) from Versus Arthritis, directly related to this article.

                surgical training,postgraduate education
                surgical training, postgraduate education

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