The dawn of a new competency-based training era

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

Karen Barnett, Stewart W Mercer, Michael Norbury … (2012)

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

A M Williamson (2000)

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

Hannah K. James:

ORCID: https://orcid.org/0000-0002-0535-3062

Role: Specialist Registrar

Robert J. H. Gregory: Role: Consultant Orthopaedic SurgeonRole: Chair of the Specialist Advisory Committee for Trauma & Orthopaedic Surgery

Journal

Journal ID (nlm-ta): Bone Jt Open

Journal ID (iso-abbrev): Bone Jt Open

Journal ID (publisher-id): bjo

Title: Bone & Joint Open

Publisher: The British Editorial Society of Bone & Joint Surgery (London )

ISSN (Electronic): 2633-1462

Publication date (Electronic): 19 March 2021

Publication date Collection: March 2021

Volume: 2

Issue: 3

Pages: 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

Hannah K. James https://orcid.org/0000-0002-0535-3062

Article

Publisher ID: BJO-2-181

DOI: 10.1302/2633-1462.23.BJO-2020-0155.R1

PMC ID: 8009901

PubMed ID: 33739137

SO-VID: 54a33c95-2e48-481d-9593-29270cb48e70

License:

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/

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principal-institution Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK

article-type General Orthopaedics

coi-statement H. K. James reports a doctoral research fellowship (grant ID 20845) from Versus Arthritis, directly related to this article.

Keywords: surgical training,postgraduate education

Data availability:

Keywords: surgical training, postgraduate education

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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

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Most cited references 69

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

Teaching surgical skills--changes in the wind.

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

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