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Background During the COVID-19 pandemic, limitations were placed on face-to-face encounters in dentistry and oral and maxillofacial surgery (OMFS) in order to promote physical distancing and reduce viral propagation. To facilitate continued assessment of dental, orthodontic, and maxillofacial emergencies, a photographic triage system was initiated at Alder Hey Children's Hospital (AHCH). We will discuss the benefits this system offers at a patient, clinician, departmental, and NHS service level. Aim To share our experience of photographic triage during the first 3 months of COVID-19 lockdown, lessons learned, and recommendations. Design Prospective data collection over 3 months. Results 220 photographic referrals were received, and swelling (30%) and dental trauma (27%) were the most common presenting complaints. 57% of referrals were not seen, 23% were seen semi-urgently, and 20% booked for outpatient review. Of those seen, 7 children were seen elsewhere and 44 were seen face-to-face at AHCH, with 8 being admitted. Conclusion Photographic triage reduced physical encounters and proved useful in training junior staff, assessment of new patient referrals, and first on-call from home. Implementation should be considered throughout dental, orthodontic, and OMFS departments nationwide. In the event of a COVID-19 resurgence or emergence of a new pandemic, photographic triage could facilitate physical distancing and service provision.

Design Cross-sectional, exploratory study collecting photographic referral data over three months. Sample selection Paediatric referrals to the orthodontic and maxillofacial department at Alder Hey Hospital during the COVID-19 pandemic. Data analysis Photographic referrals were analysed using Microsoft Excel to determine treatment outcomes, including 'not to see', 'plan to see' and 'need to see'. Demographic information collected and analysed were patient age, gender, referral source and presenting complaint. Results In total, 220 photographic referrals were received, with swelling (30%) and dental trauma (27%) being the most common presenting complaints. Fifty-seven percent of the referrals were not seen, 23% were seen semi-urgently and 20% booked for outpatient review. Of those seen, seven children were examined elsewhere, with 44 receiving face-to-face consultations at Alder Hey Children's Hospital, with eight being admitted. Conclusions Photographic triage has potential to be a useful adjunctive assessment tool for new patient referrals, with secondary benefits for training junior staff and for populations who already find access to dental services challenging. Feasibility studies on the application should be seriously considered. However, the unique circumstances which resulted in the development of a photographic triage method need to be considered when generalising its use to normal working conditions.

Radiological interventions play an increasingly relevant role in cardiology. Due to the inherent risks of ionizing radiation, proper care must be taken with monitoring and optimizing the dose delivered in angiograms to pose as low risk as possible to staff and patients. Dose optimization is particularly pertinent in teaching hospitals, where longer procedure times are at times necessary to accommodate the teaching needs of junior staff, and thus impart a more significant radiation dose. This study aims to analyze the effects of different protocol settings in routine coronary angiograms, from the perspective of a large tertiary center implementing a rapid dose reduction program. Routine coronary angiograms were chosen to compare baseline levels of radiation, and the dose imparted before and after dose optimization techniques was measured. Such methods included lowering dose per pulse, fluoroscopic pulse rates, and cine acquisition frame rates. The results showed up to 63% reduction in radiation dose without adverse impact on clinical or teaching outcomes. A 10 fps/low and 5 pps/low setting was found to achieve maximum dose optimization, with the caveat that settings require incremental changes to accommodate for patient complexities.

We write this short piece regarding a recently referred case to our oral and maxillofacial surgery (OMFS) unit, which highlights several important learning points for OMFS junior staff. We describe a pertinent case in which the importance of history, examination and relevant investigations during the workup of soft tissue facial injuries is illustrated. Fundamentally, all facial traumatic wounds require a thorough assessment that is performed with a high index of suspicion of foreign body implantation. This case report highlights that all facial traumatic wounds require a thorough assessment performed with a high index of suspicion for foreign body implantation.

Education and training in cytology in Europe is hampered by the fact that there is no homogenous programme across Europe. This can be observed for (Cyto)Pathologists and Cytotechnologists. However, lack of workforce and lack of a pan-European Cytology diploma are decreasing motivation among junior staff to dedicate their professional interests to cytology. Cytology and histology are complementary approaches for the diagnosis or exclusion of disease in patients and there are many individual efforts of National Societies to maintain competencies in cytology by workshops, seminars, tutorials and congresses. Furthermore, professional organizations such as the European Federation of Cytology Societies (EFCS), the European Society of Pathology (ESP) and Union of European Medical Specialists (UEMS) - Section Pathology are working together in order to develop a pan-European Cytology diploma. The EFCS is part supported by EU funding in this endeavour. Activities are ongoing in the fields of training (Eurocytology) and examination (QUATE Aptitude Test - Quality Assurance, Training and Examination) or both (Cy-Test). Modern techniques such as Webatlas with teaching modules in cytology and Tele(cyto)pathology are more and more integrated in daily teaching activities resulting in standardization of cytology in Europe.

Introduction. This study measures the exposure of occupational therapists from a 1.5-T magnetic resonance imaging (MRI) machine. Method. A total of 14 time-series on each of the chest, head and hand were taken before and after different MRI procedures. The peak values were noted in each case together with an average of all data recorded in the time-series. Results. The highest exposure recorded was observed on the hand, followed by the head and the chest. The overall maximum exposure (1479.40 mT) recorded was observed on the hand during a change of coil. It was also observed that the recorded exposure of experienced radiographers working in the MRI environment was less than that of junior staff due to different practices. Conclusion. This study is of significant importance in Malta since it is the first conducted in a MRI environment, especially because the results were compared with limits imposed by EU Directive 2013/35/EU which has to be implemented by July 2016.

Instructional guidance is an essential component of the professional training teachers receive as it assists in the production of efficient and effective teachers. The story of experienced graduate teachers who have no requisite professional qualifications is unique as these teachers join a training programme, the Post Graduate Diploma in Education (PGDE), when they already have some experience in teaching, with some already in instructional leadership positions at their schools. The problem arises when they are the ones to be supervised when they join the training programme. This research study sought to solicit these graduate trainees’ perceptions concerning the effectiveness and usefulness of the programme to them with the aim of establishing how they are guided and who their instructional leaders or mentors are when they are on teaching practice (TP). This was a qualitative multiple case study of five purposively sampled student teachers who are instructional leaders at their schools. Data was collected through interviews with these students and a focus group discussion with five lecturers who went out to supervise them on TP. The study found that these student teachers did not have mentors or did not make use of them and therefore lacked support and guidance when on TP. They, in most cases, did not want the junior staff members to know that they were pursuing a professional programme which then affected their preparations for their supervisors (the college lecturers). The study recommends that graduate teachers be encouraged to join professional programmes immediately after completing their first degrees, before they are engaged as teachers and even given positions of leadership which make them mentors, or instructional leaders, before they attain a professional qualification. The universities can also marry the bachelor’s degrees with an education component. The Ministry of Education should appoint fully qualified teachers to leadership positions in order for them to be able to assist the novice teachers and students deployed to their schools. The university can also deploy these students to other schools where they can get instructional guidance which is essential for their professional growth.

Purpose – The purpose of this paper is to consider design engineers’ perception of health and safety and its impact on their behaviour during design activity. The study presents three types of design engineers each, exhibiting particular tendencies when faced with health and safety considerations during design. The discovery of these tendencies pose important implications for education and professional institutions and practical measures are suggested to help design engineers manage their tendencies to be more conducive to ensuring improved health and safety performance. Design/methodology/approach – An exploratory design method was used – grounded theory, to include 13, in-depth, one-to-one interviews with design engineers, representing junior staff, middle and senior management. Findings – The paper provides empirical insights about how designers think and behave when asked to consider health and safety issues during the design process. It identifies three group types of designers: doers, receivers and givers, who will exhibit their particular tendencies based on how they view and understand the term health and safety. Research limitations/implications – The data obtained were from design engineers only, and therefore the research results may lack generalisability. Therefore, researchers are encouraged to test the proposed propositions. Practical implications – The paper includes implications for those involved in the creation and development of designers e.g., educators and professional bodies. The data forms the basis for helping designers to manage their perceptions towards the term health and safety and thus, their tendencies exhibited in their behaviour. Originality/value – This paper contributes to new understanding of designers’ behaviour and considers the significance of how designers’ views of health and safety will influence their behaviour.

To identify the factors associated with quality decision-making of healthcare professionals in managing complicated labour and delivery in referral hospitals of Burkina Faso.We carried out a six-month observational cross-sectional study among 123 healthcare professionals performing caesareans in 22 hospitals. Clinical decision-making was evaluated using hypothetical patient vignettes framed around four main complications during labour and delivery and developed using guidelines validated by an expert committee. The results were used to generate a quality decision-making score. A multivariate linear regression analysis was used to identify the factors independently associated with the score.Out of 100, the mean ± SD quality decision-making score was 63.84 ± 7.21 for midwives, 65.58 ± 6.90 for general practitioners (GPs), and 71.94 ± 6.70 for gynaecologist-obstetricians (p 0.001). Quality decision-making score was higher among professionals with more than seven years' work experience and those with the highest level of professional qualification. Working in a service where partograms are regularly reviewed by peers dramatically increased the skills of professionals.The simple dissemination of written clinical guidelines is not sufficient to maintain high-quality decision-making among healthcare professionals in Burkina Faso. Midwives may have some better scores than GPs if duly retrained and supervised. Increasing in-service training and supervision of both junior staff and lower-qualified healthcare professionals might help to improve obstetric practices in referral hospitals of Burkina Faso.

The current law on the protection of expectant and nursing mothers largely rules out surgical activities during pregnancy for female doctors who perform surgical roles in hospitals. The proportion of female junior staff in gynaecology amounts to 80 %, and, for many of these women, surgical further training is not possible following official notification of an existing pregnancy. In a Germany-wide survey of female gynaecologists and surgeons using a questionnaire, it was determined to what extent female doctors worked in surgery during pregnancy, whether it led to complications in the pregnancy, when the employer was notified about the pregnancy, and what desire for change there is with regard to the law on the protection of expectant and nursing mothers. The data from 164 female doctors, of which 136 are gynaecologists and 28 surgeons, was evaluated. On average, the pregnancy was announced during the 14th week of pregnancy (WOP), and the doctor was not allowed to perform surgical activities in the 21st WOP. Female doctors in higher professional roles tended to announce the pregnancy later and ended their surgical activities later. There was no link between the time of ceasing surgical activities and an increased occurrence of complaints or complications during the pregnancy. In total, only 53 % of respondents had an appraisal during pregnancy and 75 % wanted a change in the law on the protection of expectant and nursing mothers.Das aktuelle Mutterschutzgesetz schließt eine operative Tätigkeit während der Schwangerschaft für in der Klinik operativ tätige Ärztinnen weitestgehend aus. Der Anteil der Berufseinsteigerinnen liegt in der Gynäkologie bei 80 %, für viele dieser Frauen ist die operative Weiterbildung nach offizieller Mitteilung einer bestehenden Schwangerschaft nicht möglich. In einer deutschlandweiten Umfrage unter Gynäkologinnen und Chirurginnen wurde anhand eines Fragebogens u. a. ermittelt, inwieweit Ärztinnen in der Schwangerschaft operativ tätig waren, ob es zu Komplikationen in der Schwangerschaft kam, wann die Schwangerschaft dem Arbeitgeber mitgeteilt wurde und welche Änderungswünsche bez. des Mutterschutzgesetzes bestehen. Die Daten von 164 Ärztinnen, davon 136 Gynäkologinnen und 28 Chirurginnen, wurden ausgewertet. Die Schwangerschaft wurde im Mittel in der 14. Schwangerschaftswoche (SSW) bekanntgegeben, ein Ausschluss aus der operativen Tätigkeit erfolgte in der 21. SSW. Ärztinnen in höheren beruflichen Positionen gaben tendenziell später die Schwangerschaft bekannt und beendeten später die operative Tätigkeit. Es bestand kein Zusammenhang zwischen dem Zeitpunkt des Ausscheidens aus der operativen Tätigkeit und einem vermehrten Auftreten von Beschwerden oder Komplikationen während der Schwangerschaft. Insgesamt führten nur 53 % der Befragten in der Schwangerschaft ein Personalgespräch und 75 % wünschten sich eine Änderung des Mutterschutzgesetzes.

Purpose: Aimed to evaluate normal volume of the lacrimal gland in patients of different age groups and race. Methods: All MRI studies of the brain that were done between June 2012 and April 2013 were examined. Lacrimal glands were identified using fat-saturated fluid-attenuated inversion recovery (FLAIR) images, and the volumes were calculated using TeraRecon iNtuition viewer. Volumes for the right and left lacrimal glands were recorded for persons of different age groups and race, and the results were compared with those of a randomly selected group of patients who had undergone the same calculation method using CT of the brain, orbit, or paranasal sinuses. Results: The authors included 998 lacrimal glands of 499 patients. The mean volumes for the right and left lacrimal glands were 0.770 and 0.684 cm3, respectively. Lacrimal glands were larger in women; the largest volumes were observed during the second decade of life. Mean volumes also varied with race: 0.840 cm3 in Asians, 0.790 cm3 in Africans, 0.760 cm3 in Indians, and 0.710 cm3 in Middle Easterners. The consultant neuroradiologist and the intern showed excellent agreement for measurements of lacrimal gland volume. No significant difference was observed between lacrimal gland measurements method on MRI and CT. Conclusion: Lacrimal gland volume varies according to age, gender, race, and laterality. Measurements with MRI using fat-saturated FLAIR images and TeraRecon iNtuition viewer software are reliable, accurate, and can be used by junior staff with less radiation exposure to patients.

Acting on their own initiative, junior staff members at a branch office for Akita domain bought a steamship on credit from a Dutch merchant in 1869. They then borrowed so much money that they left Akita with the single largest debt owed to foreigners of any domain in Japan. An analysis of how they did this and why exposes economic and political activity at the middle level of the domains, the difficulties faced by the new national government in gaining control over local administration, and the efforts made by descendants and disciples of Hirata Atsutane to develop Akita’s foreign trade.

Burns are an important cause of mortality and morbidity, with potentially severe local and systemic consequences. An estimated 250 000 burns are treated annually in UK emergency departments and primary care and patients may deteriorate rapidly. Their emergency management is therefore a crucial skill for junior staff in many specialties. This article provides the reader with the theoretical knowledge necessary to undertake this competently.

One of the themes of the recent sociology of higher education has been the globalisation of knowledge and the professional transfer of scientists and researchers. In this paper we show how these transfers of people and knowledge are disproportionately characteristic of: (a) some institutions; and (b) some cost centres. We argue that universities form part of an international labour market for high skilled workers in prestige institutions. However, globalisation also has a second face in relation to labour markets in higher education. This refers to the deployment of overseas junior staff in areas unsupplied by the British system.

Study design: Retrospective prognostic study. Objective: To evaluate whether patients with anatomical deformity due to scoliosis have a higher frequency of inaccurate pedicle screw insertion and related complications using the free-hand technique compared with those whose normal anatomy had been impacted by trauma. Methods: Consecutively treated trauma patients with otherwise normal anatomy (48 patients instrumented with 291 screws, group A) and scoliosis patients (24 patients instrumented with 287 screws, group B) were evaluated. Screw position on CT was evaluated using the classification by Gertzbein and Robbins with modification by Karagoz Guzey. (See web appendix at www.aospine.org/ebsj for complete classification description.) Images were examined by two fellows and one junior staff member none of whom participated in patient management. Screw position was determined by consensus. Results: In group A, five (1.7%) out of 289 screws were severely misplaced and 26 (9%) screws caused either medial (3.8%) or lateral (5.2%) cortical breeches. The other 258 (89.3%) screws were fully contained within the cortical boundaries of the pedicle. In group B, seven (2.8%) out of 256 screws were severely misplaced. Thirty-three (13%) screws caused cortical breeches, either medial (9%), lateral (2%), or anterior (2%), and 216 (84.3%) screws were fully contained within the cortical boundaries of the pedicle and the vertebra. Neurological complications were reported in one patient with scoliosis. No vascular complications were reported in either group. Conclusions: The percentage of incorrectly placed screws was similar in both groups, trauma and deformity patients. The presence of vertebral anatomical changes related to adult scoliosis was not associated with an increase in the screw-related neurological or vascular complications. Methods evaluation and class of evidence (CoE) Methodological principle: Study design: Prospective cohort Retrospective cohort • Case control Case series Methods Patients at similar point in course of treatment Follow-up ≥85% • Similarity of treatment protocols for patient groups • Patients followed for long enough for outcomes to occur • Control for extraneous risk factors Evidence class: III View it in a separate window The definiton of the different classes of evidence is available on page 73.

Aim: To develop and evaluate a novel skills-based education programme for medical students completing a paediatric pre-internship (PrInt) at the Children's Hospital at Westmead (CHW), Sydney which incorporated a mini-clinical evaluation exercise style formative assessment component and was based upon a local needs assessment of junior staff. Methods: We designed a teaching programme which included four interactive tutorials and formative assessment tasks using observed clinical exercises (OCE). The final programme was informed by a local need-based assessment of out-of-hours junior doctors' tasks. Students rated their level of confidence prior to and after the tutorial and following the OCE. Students provided structured and free text feedback on the programme. Results: Of 29 PrInt students (2007–2008), with collectively 85 tutorial attendances, 84% rated the programme excellent (39%) or very good (45%). For each topic students' confidence increased after the tutorial and again after the OCE (P 90%. Diaries from junior doctors during 20 shifts at the CHW recorded 398 out-of-hours activities, the most common of which are ordering intravenous fluids (19.6%), reviewing asthmatics (16.6%) and recharting medications (16.3%). Conclusion: PrInt students value structured teaching incorporating OCE, which allows assessment of clinical skills and direct formative feedback and promotes gains in confidence, knowledge and skills. Addition of OCE to the teaching programme significantly increased the confidence of PrInt students in performing specific tasks compared with an educational session alone. Local needs assessment of junior doctors by out-of-hours survey both confirmed selection of appropriate topics (pain, fluids) and informed additional topics (asthma management and bronchodilator weaning regime) for future PrInt student programmes.

Various aspects of local anesthesia for cataract surgery, such as the anesthetic agents and their interaction with ocular nerve supply, anesthesia requirements, available clinical techniques and their inherent complications are reviewed. A comparative evaluation of clinical techniques in terms of efficacy, akinesia, and patient-perceived pain during both anesthesia administration and intraoperative cataract surgery is presented, along with the prevailing practice patterns of anesthesia techniques among refractive surgeons in the United Kingdom and United States. More randomized clinical trials are needed to facilitate statistical methods of metaanalysis to establish convincingly the overall benefits and efficacy of the various local anesthesia procedures in cataract surgery. The wide scope of the present review is of relevance in structuring ophthalmology and anesthesia specialist training programs for junior staff.

With the ever-changing structure of modern dental teams, it is important for senior nurses to develop formal supervisory management skills, so that they can provide junior staff with guidance and reassurance, and ensure quality standards are consistently being met.

Traditionally, mentoring in higher education institutions has either occurred informally or as a planned program where junior staff members are matched with experienced staff members in a formal one-to-one program. While such programs have reported benefits to participants, many miss out on the opportunity. Further, mentoring dyads do little to enhance a more collaborative atmosphere in higher education settings. Alternative mentoring methods do exist and can provide advantages to the traditional approach. Mentoring circles are an innovative example of these alternative methods. The mentoring activity and subsequent evaluation described in this paper sought to explore the perceived benefits of a group mentoring model for academic staff. Refereed/Peer-reviewed

Advanced nursing roles are one way of encouraging experienced nurses to stay in clinical practice so they can provide expert care, develop practice and be role models for junior staff. A search for literature about advanced nurse practice in paediatric intensive care units in the UK identified just four articles, including one survey, but no reports of empirical research. There is some consensus on the nature and educational requirements for advanced practice but delays in agreeing a regulatory framework and failure to recognise the potential contribution of advanced roles mean that development is hindered. Although several UK units have developed or are developing the role, more insight and better evidence is needed on how nursing can be advanced in paediatric intensive care settings.

This paper is a study of the accounting academic labour market and workplace conditions. Its particular focus is on the pressures, contradictions and dilemmas experienced by junior (Levels A and B) accounting academics at Australian universities. It is argued that, due to work, personal and family pressures, many junior staff members may struggle to complete their PhD within a prescribed time frame. The reasons for this are discussed, as well as the likely effects. The Marxist concept of “alienation” is explored in detail to explain how a junior staff member's work “product” may take on a life of its own which stands up in opposition to her/him, to accuse her/him. The writings of the first-generation critical theorist, Herbert Marcuse, are used to suggest a radical path forward for the junior staff member. She/he is encouraged to take charge of her/his own destiny from within, value personal relationships, and pursue scholarship for its own sake. Opportunities for resistance are also explored in the paper.

Purpose The purpose of this study was to establish the level of occupational stress in UK NHS radiographers, and to examine its causes. A total of more than 1600 radiographers sampled nationally completed a postal questionnaire. Four groups were represented – mammography, diagnostics, radiotherapy, and ultrasound – and both junior staff and superintendents were examined. Method The questionnaire measured role ambiguity, role conflict, work problems, social support from colleagues, and perceived stress. Results Levels of perceived stress were high in all four groups. The mean was significantly lower in the mammography group than the others, however, and junior staff reported lower levels than superintendents. Role ambiguity, role conflict and work problems all contributed significantly to stress, but the effects were sometimes buffered by social support from colleagues. Conclusion The implications of the findings are discussed for theory and for policy and practice: occupational stress was predicted by intrinsic features of the job; the levels were similar to those reported by other NHS professionals; and the pattern of findings suggests possible ways to intervene to reduce it.

This audit explores the use of the Canadian Occupational Performance Measure (COPM) in an independent living centre (ILC) in the UK. Although the COPM is widely used in a variety of situations, the audit setting is currently the only ILC in the UK using this outcome measure. It is used in this setting to prove the effectiveness of occupational therapy in order to secure ongoing funding for the ILC. The audit took place over two years and examined results obtained with the COPM during this period. The findings of the audit were then compared to the findings and analyses of a pilot study carried out by Law et al (1994), which tested the use of the COPM as an outcome measure. The audits highlights the effective use of COPM within this setting, recognizing its challenges and limitations, particularly when used by students and junior staff. It is suggested that this measure can be adopted by other organizations for the purpose of securing funding as well as to prove the value of occupational therapy in similar settings.

Rationale and aims Research suggests that there are problems of communication effectiveness in surgery. Here we describe the content, initiators and recipients of communications that intrude or interfere with individual surgical cases. We also consider the level at which the surgical team and its team members are distracted by these case-irrelevant communications (CICs). Methods Two psychologist observers sampled 48 general surgery procedures and they recorded the initiator and the recipient of CIC events, their content and the level of observable distraction that they caused. Results Irrelevant comments and queries (i.e. ‘small-talk’) accounted for half of the observed CICs. From the remaining CICs that we observed, most were related to the organization and administration of the case-list, to operating theatre provisions and to teaching junior staff. Surgeons initiated a third of the observed CICs, while receiving two thirds of them. External staff visiting the operating theatre initiated the most distracting communications. The CICs addressed to surgeons introduced significantly less distraction to the operating theatre than those addressed to anaesthetists and nurses. Conclusions Some of the observed CICs contributed to the administration of the operating theatre case-list. Nonetheless, this communication can interfere with highly sensitive work. More effectively co-ordinated communication could reduce this interference. More research should assess the communication effectiveness and the impact of CICs on task performance in the operating theatre.

Background: Performing a lumbar puncture in an unwell child can cause anxiety in both the parent and the junior doctor. There is increasing evidence of post-lumbar-puncture complications in this age group. Aims: To improve the documentation, consent for and technical performance of paediatric lumbar punctures to 100% of the required standard within 3 months. Setting: The paediatric emergency department of a the Royal North Shore Hospital (University of Sydney, Sydney, Australia). Participants: Paediatric emergency staff, including residents, registrars and consultants. Methods: Medical records of 40 consecutive children who had undergone a lumbar puncture in the 6 months before the introduction of the lumbar-puncture proforma were reviewed. After introduction of the proforma, the records of 25 consecutive patients were reviewed to assess changes in the outcome measures. Before introduction of the proforma, junior medical staff were instructed in the procedure using specialised lumbar puncture manikins (Baby Stap; Laerdel, USA). Results: Before introduction of the proforma, the median number of documented indicators was 4, out of a maximum of 12. There was almost no documentation of parental consent, patient complications and analgesia. Introduction of the proforma resulted in a highly marked increase to a median of 12 documented indicators per patient (p

Background: Integrated care pathways (ICPs) offer an increasingly common approach to the standardization and integration of health-care practice in hospitals. The questionnaire study reported here was the final phase in a systematic investigation of the attitudes of health-care professionals towards ICPs in one acute UK NHS Trust. Method: A total of 314 health-care professionals working in a medium-sized NHS hospital in the UK completed a survey questionnaire, representing 34% of those approached. Results: Ten dimensions of attitude to ICPs were uncovered. Junior staff had less positive attitudes than senior staff on all dimensions. Across all professional groups (doctors, nurses, professions allied to medicine), staff were more unhappy with the idea of ICPs than with the evidence they are based on or the quality of the documentation itself. Conclusions: The investigation provided information about how widespread the dislike of ICPs was in the Trust and details of what was giving rise to staff unease. This enabled the authors to make recommendations to the Trust about the future development and implementation of ICPs in the Trust. The most central of these was that investing time and effort in changing the presentation of ICPs will not meet with success until more fundamental aspects of staff unease have been addressed. Overall, respondents from this Trust felt uneasy about ICPs because they do not like the idea of being told what to do. Therefore, if the ICP development programme is to continue at this hospital and be successful, the hearts and minds of those expected to use ICPs must be won over.

This is a case study of USA‐Japan intercultural communication, analyzing a one‐hour meeting between a US manager, a Japanese manager and a Japanese junior staff member of a US company operating in Japan. The study focuses on miscommunication caused by pragmatic transfer from Japanese, especially relating to silence, the ambiguity of “yes”, and different strategies of politeness between the US and Japanese managers. It is also discussed how both native and non‐native speakers should make their approach in order to understand each other and co‐construct the conversation in intercultural communication in an age when English is becoming a global language and could be separated from the cultures of English‐speaking countries.

This study aims to uncover some of the reasons for differences in attitudes towards family‐friendly and equal opportunities (EO) policies for women between senior and junior staff and between male and female staff. This in‐depth case study of a multi‐national corporation in Hong Kong that included a survey questionnaire, interviews and participant observation suggests four categories of female employees according to their approach to EO: advocators, supporters, outsiders and rejecters. The approach adopted was dependent on the woman's level of empathy towards the situation of working women and the extent of her career ambition. Four categories of male employees can also be classified depending on their level of empathy towards women's situation (similar to women's case) and their extent of career satisfaction (in contrast to women's career ambition), namely, antagonists, outsiders, fence‐sitters and sympathizers. Women at higher levels were less supportive of EO than women at lower levels. No such clear r...

This study aims to uncover some of the reasons for differences in attitudes towards family‐friendly and equal opportunities (EO) policies for women between senior and junior staff and between male and female staff. This in‐depth case study of a multi‐national corporation in Hong Kong that included a survey questionnaire, interviews and participant observation suggests four categories of female employees according to their approach to EO: advocators, supporters, outsiders and rejecters. The approach adopted was dependent on the woman's level of empathy towards the situation of working women and the extent of her career ambition. Four categories of male employees can also be classified depending on their level of empathy towards women's situation (similar to women's case) and their extent of career satisfaction (in contrast to women's career ambition), namely, antagonists, outsiders, fence‐sitters and sympathizers. Women at higher levels were less supportive of EO than women at lower levels. No such clear r...

This study investigates the effect of mentoring on commitment to job, job satisfaction and gender in the Nigeria Police. The participants, numbering 592, were recruited for the study from three out of six geo‐political zones in Nigeria using a cluster quota random sampling method. They comprised 396 (66.9 per cent) males and 196 (33.1 per cent) females, 179 (30.2 per cent) officers (senior officers) and 413 (69.8 per cent) junior staff. Two hypotheses and two research questions were tested and answered at 0.05 margin of error using Z score and analysis of variance statistics. Results showed that mentored male police are more committed to their job. The mentored female police showed more satisfaction with their job than the mentored male police. Mentoring was also found to predict commitment to job of the police. The implications of these findings are discussed.

The aim of this review was to investigate whether formalized compression bandage training is required for nurses to achieve compression bandaging of high quality, that is bandaging which produces sustained graduation from toe to knee. Medline, CINAHL and Embase databases were used in the search. Randomized controlled trials and quasi-experimental trials were included where (at a minimum) nurses experienced in compression bandaging had their skills reviewed before and after training, and then reviewed once more at a later follow-up session. Three studies matched these criteria. In all three, nurses in general did not achieve sustained graduated compression before training, despite being defined as experienced bandagers. There was a substantial improvement in bandaging skills immediately following training. Two trials found that this improvement was sustained for between 2 and 4 weeks. The results of the third study suggested that improvements might not be sustained in the longer term. This review raises issues for further research including the current standard of compression bandaging, by those individuals who consider themselves competent in this skill. In addition, there needs to be argument on how nurses’ bandaging skills can be improved and maintained, including the depth of role of feedback. In the meantime, nurses need to be as diligent as possible in maintenance of their compression bandaging skills, and the training they give junior staff. The effectiveness of current training cannot be assessed by short-term improvements and must not be assumed.

When I was a medical student in the 1960s it was drummed into me that the diagnosis was made from the history, examination and special investigations, but the most important was the history. Despite the explosion of advances during the past 20 years, this is still true today, at least in clinical neurology, and yet histories are becoming increasingly shorter and they are frequently inadequate and incomplete. We enter medicine for many different reasons but I suspect the two most frequently given are a love of meeting people and a desire to help them, but unfortunately because of the pressures we are under, particularly the junior staff, that joy and satisfaction appear to be disappearing and medicine is becoming more mechanical. Protocols and guidelines proliferate at an alarming rate and the emphasis has switched from the history to multiple screening tests and scans. It is now difficult to be seen

The paper deals with the current efforts of the Austrian government to remodel the university sector. The Rectors’ Conference meddled in the discussion process and asked some experts to evaluate the outline which has been drawn up by the ministerial bureaucracy. Result is the voluminous report “Universitaten im Wettbewerb”. The report stands up for a radical change in the sense of neo-liberalism and centres the question how to make universities more efficient. Its suggestions refer to all aspects of universities: their funding and organisation, employment contracts of scientific staff, regulation of studies and access to university. The ideas presented in the report radicalize the outline the government developed. The analysis shows that a break with the targets of educational and research policy in the past is intended. Efficiency of universities and the interests of the economic sector are moved in the focus of policy at the expense of free access to universities, participation of lecturers and students, academic freedom and independent scientific work, diversity of research, generous furthering of junior staff.

A relative newcomer to the world of scholarly publishing, Theresa Liu offers a ‘junior’ staff member's perspective on that world and, more specifically, on the world of an editorial assistant. The editorial assistant does everything from handling the everyday administrative minutiae, to acting as press diplomat to the outside world – whether by e-mail, post, or telephone – to attending author meetings and carrying out other responsibilities that overlap with those of her senior editor. In the world of an editorial assistant, even the most banal task is essential to the end product – that tangible object of ideas and knowledge, the scholarly book.

Background: Increasing recognition of the need for training in teaching skills for clinical teachers has coincided with data that registrars and residents conduct much ‘on the job’ teaching as part of their routine work. While attention has been devoted to training consultants, support for the teaching role of the junior staff has been relatively neglected. The aim of the present report is to describe the teaching experiences of surgical registrars and the impact of a registrar teaching workshop. Method: A half-day programme combining presentation and discussion of surgical teaching with practical skills sessions was designed for surgical registrars at Prince of Wales Hospital. The programme included observation and feedback of brief teaching simulations at the bedside of volunteer patients to newly commenced clinical students, and small group sessions on clinic and operating theatre teaching. A pre-workshop questionnaire sought information about the registrars’ own teaching, and a survey 3 months after the workshop determined if any changes to teaching practice had occurred. Results: The registrars were generally moderately to very confident with their teaching ability but more than 75% felt that they were more confident after the workshop. Only three of 39 registrars had received any instruction aimed at improving their teaching skills, yet 34/39 had taught either on the ward, in the clinics or in the operating room. Follow-up after 3 months revealed that most registrars were enjoying their teaching tasks more, and half had increased their teaching since the workshop and began discussing teaching with their surgical colleagues. Conclusions: The present project demonstrates that relatively brief interventions focused on skill development may enhance the confidence and enjoyment of junior clinical teachers and increase the frequency of ‘teaching on the run’.

A report is presented on interprofessional study days for final-year medical students and junior staff nurses, providing valuable preparation for transition to the role of house officer. Guided by a view of shared learning as learning with and from members of another profession, a patient scenario pertinent to the nurses' ward experience was presented and developed. Participants planned and revised their responses to the patient's needs, practising pertinent clinical and communication skills at each stage. Students were challenged to integrate existing knowledge in the context of whole-patient care, and were able to clarify roles and responsibilities within the multidisciplinary team. They discussed ward management and patient management. The curriculum design and evaluation were guided by educational theories relating to readiness to learn and disjuncture. Nurse-medical student pairs, to teach each other practical skills and exchange information, were particularly highly valued. Siting the learning exper...

Background. Performance management initiatives, such as the UK’s Patient’s Charter, are creating pressure for patients to be seen earlier at out-patient clinics, thus increasing clinic workloads. There is, however, little information about whether this can be absorbed, either by utilizing spare capacity or by more efficient use of time, or whether it is likely to affect patient care adversely. Methods. Nine surgical clinics, run by four general surgeons, in an English district general hospital were studied during a typical week. Clinic schedules and numbers invited to attend were extracted from clinic records. An observer recorded the actual time each patient spent with the surgeon to the nearest 5 seconds. Scheduled and actual times of commencement and completion of clinics were also recorded. Results. The number of patients booked to attend each clinic varied from 11 to 82 (mean 37). The median consultation for new patients was 4.3 minutes and for follow-up patients it was 3 minutes. Consultants spent a median 2.7 minutes with patients whereas junior staff spent 4.2 minutes. These aggregate results conceal considerable variation between surgeons, even though the scheduled time available was similar. The median time spent with new patients by one consultant was 1.3 minutes and by another 13.1 minutes. Seven of the nine clinics overran their scheduled time (by up to 55 minutes). All doctors, with one exception, arrived late for the clinics (range 10 minutes early to 30 minutes late). The first patient was invariably seen after the scheduled starting time for the clinic (mean 17 minutes, range 5‐50 minutes) and the median interval between a doctor arriving and seeing their first patient was 10.6 minutes. Overall, only 50% of the time spent by doctors at the clinics was with patients. Implications. The amount of time spent by patients with surgeons is already so short as to cause concern about both the appropriateness and value of consultations. It is unreasonable to increase workload further. There is a clear need for outpatient clinics to be managed, with regular examination of what is taking place and how long it takes. Only then will it be possible to tailor schedules to the actual requirements of the service.

Aims and MethodThere are no national standards to evaluate the quality of delivery of in-patient liaison psychiatry services in general hospitals in the UK. In order to benchmark our service against best international practice, we adapted quality indicators from two peer-reviewed studies from Australia and Switzerland and monitored our performance standards over a period of 6 months.ResultsThere were 145 patients assessed over the study period. We set a priori target of 90% achievement on indicators in the areas of timeliness of response to all referrals, timeliness of response to referrals following self-harm and quality of supervision of junior medical staff attaining 93.8, 87.5 and 89.6% respectively.Clinical ImplicationsWe demonstrated that we provided a reasonably responsive consultation–liaison service with high levels of supervision of junior staff. National bodies should develop benchmarks in this area so that services can demonstrate the quality of their service and learn from others' good practice.

Aims and MethodsThis paper describes the development and initial audit of a protocol for the assessment of young people up to the age of 18 years who presented to the accident and emergency department (A&E) with self-harm. A key part of the project was education and training.ResultsRegular training of senior house officers (SHOs) in A&E may have contributed to an increase in young people being admitted to a bed for proper assessment (as per the protocol), but psychosocial assessments undertaken by SHOs in A&E were still only partial, and there was no apparent use of the mental state examination.Clinical ImplicationsChild and adolescent mental health services have an important role to play in liaising with local A&E departments in training of junior staff in psychosocial assessment and the use of the mental state examination. This is especially relevant in the light of the new training requirements of the foundation years.

In our experience, most of the teaching at university level in Denmark is planned and carried out by individuals rather than a group of teachers, and teaching is in some ways a relatively private affair, particularly for junior staff members. “Lesson studies” is a format for instructional change based on a conception of teaching as a collaborative enterprise. In this article, we describe the method, report the outcome of a pilot lesson study cycle, and discuss the merits and potential of the method for instructional and educational change.

The development of an appraisal questionnaire which measures junior doctors' opinions about their hospital experiences is described. The first section of the questionnaire consists of seven reliable subscales which measure opinions about teaching and learning, registrar teaching, consultant teaching, staff support, workload, administration and overall experiences during a period of attachment or term. The second part of the survey contains 11 reliable questions about the hours spent on service and education during the term. The responses to this measure of 257 randomly selected Australian junior doctors are described. The questionnaire may be used to contrast the experiences of junior doctors in different types of terms, different hospitals or varying levels of training. The data generated from the instrument can provide useful information about hospitals, such as the work practices of junior staff and the effectiveness of educational programs.

The research for this article was carried out in the Channel island of Guernsey during 1996-97 and focuses on the remarkable resilience of a small group of nurses as they strove to provide an emergency hospital service to the civilian population of Guernsey between 1940 and 1945, during which time German forces were in occupation. Inslghts are provided into a unique period of nursing history, giving a flavour of the harsh environment in which care was provided. Hospital records at the time described a nurse as ‘someone who earns her living nursing’, therefore the title ‘nurse’ is used collectively to describe both the qualified State Registered Nurse and the unqualified junior staff. The article is part of an ongoing oral history project representing a collaborative venture between the Department of Health Studies at the University of Lincolnshire and Humberside, and the School of Healthcare Studies at the University of Leeds. Data for this study were obtained from a series of semi-structured audio-taped interviews with 13 former nurses who worked at the States of Guernsey Emergency Hospital during the occupation. Supporting data were derived from official archives, news reports and other published literature. The article is based on the author's inaugural lecture delivered at The University of Lincoln Campus, Friday 30 May 1997.

Recent studies of academic work have identified increasing pressures on universities and academics throughout the world. These pressures relate to such factors as diminishing resources available to the higher education sector, widening diversity of the student clientele, moves for increased accountability and tensions between the research and teaching goals of academic work. Among the pressures being placed on the teaching component of academic work are the need for increased accountability of teaching performance and the need to update professional competence related to teaching. This paper reports a study of a selected group of academics — relatively junior staff who have participated in significant professional development activities related to their teaching. The data provided by the interviews with these academics allow a glimpse at their academic lives and how they fit teaching and professional development related to teaching into their working lives. The study highlights how these academic...