"Specialists' action may cancel med school year"

[Guest Unknown </username> <dateline>1118448240</dateline> <title>Unknown</title> <pagetext>(This]

(This post is missing and can not be restored)</pagetext>

</post>

<post>

<thread>Y</thread>

<threadtitle>"Surgeons swear when operating: fact or myth?"</threadtitle>

<threadviews>0</threadviews>

<threadsticky>0</threadsticky>

<poll></poll>

<username>Ian Wong</username>

<dateline>1043710500</dateline>

<title>"Surgeons swear when operating: fact or myth?"</title>

<pagetext>Here's a funny article published by the British Medical Journal a few years back, studying the rates of swearing between different surgical specialties. Good ol' ENT ranked as the classiest specialty by a long shot...

 

Ian

UBC, Med 4

 

 

Surgeons swear when operating: fact or myth? BMJ 1999; 319: 1611

 

Surgeons swear when operating: fact or myth?

F Fausto Palazzo, surgical research fellow a, Orlando J Warner, specialist registrar b.

 

a Department of Immunology, St Bartholomew's and Royal London Hospitals Medical School, London EC1A 7BE

b Anaesthetics, Oxford Deanery, 20 East Street, Oxford OX2 OAU

 

The medical profession is rich with anecdotes about surgeons, many of national and international repute, using colourful language in the operating theatre. Legend has it that the language of the mildest mannered and pious surgeon, once he or she is gowned and gloved, undergoes a transformation. However, a Medline search of the past 20 years using the search words "swear," "swearing," "foul language," and "blasphemy" produced no relevant articles on the subject.

 

We therefore assessed to what extent the use of foul language by surgeons is a myth. We also tried to identify the surgical specialties where swearing is most common.

 

Materials, methods, and results

 

One hundred consecutive elective operations under general anaesthesia performed at a single hospital were assessed for the incidence of swearing by the operating surgeon. Without the surgeon's knowledge a swearing score was kept during surgery. The scoring was always undertaken by the same person (OJW). Other data recorded comprised the specialty of the surgeon, the length of the operation, and the type of foul language used. The swear words were classified into three groups, with points assigned to each swear word to reflect its strength: heaven and hell (such as "God," "bloody hell," "bugger"), 1 point; bodily products (such as "sh*t," "p*ss"), 2 points; so called four letter words (such as "f***," "c***," "b***ard") 3 points.

 

For strings of swear words, the highest scoring obscenity alone was counted. To guarantee the anonymity of surgeons, no distinction was made between their grade and sex. The swear rate was calculated from the total operating time and total scores for each specialty.

 

The 100 operations from five surgical specialties totalled 80 hours 30 minutes' operating time. Ninety four swearing points were scored, with an average of one point scored every 51.4 minutes. Different surgical specialties had different swearing rates (figure). Rates for a typical eight hour operating day were 16.5 swearing points from the orthopaedic surgeons and 10.6, 10, and 3.1 from the general surgeons, gynaecologists, and urologists respectively. In contrast, during eight hours of ear, nose, and throat surgery, little more than one "bugger!" is likely (figure).

 

Comment

 

Surgeons do swear when operating but the rate differs by specialty. Orthopaedic surgeons on average register one swear point every 29 minutes, almost twice as often as surgeons overall. Although orthopaedic surgeons triumph in the field of foul language, general surgeons are by no means without sin, being only slightly less foul mouthed than their orthopaedic colleagues. Gynaecologists also seem anything but angelic but may have been penalised by a small sample size of operating time. The 95% confidence interval shows that gynaecologists may actually use more foul language than general surgeons. Meanwhile the mild mannered ear, nose, and throat surgeons contribute little, with nearly five hours of operating time on average without any obscenity.

 

The reasons for the differential swearing pattern is difficult to establish. The brevity of the operations in some specialties may be a determinant. The orthopaedic operations lasted an average of 51.7 minutes, compared with 34.4 minutes per ear, nose, and throat operation. However, the average gynaecological procedure lasted just 37.2 minutesduring which time there was nevertheless a good chance of hearing an expletive. Does the use of complicated orthopaedic tools encourage bad language in the theatre? Does the good or bad language of a surgeon lead to a greater or lesser chance of career progression, depending on the specialty? Unanswered questions for the next millennium.

 

Given that the operations were elective, this may be the tip of the iceberg as even more foul language might occur in out of hours operating. However, the increasing practice of routine surgery under local and regional anaesthesia may already be enforcing some restraint of the surgical tongue. Is perhaps 1 January 2000 a good time for surgeons to resolve to stop swearing in theatre, or should we not surrender one of the last bastions of surgical tradition and privilege?

 

Acknowledgments

 

We thank the surgeons of the Royal Berkshire Hospital, Reading, for their good natured participation in this study.

 

Contributors: Both authors collaborated in the design of the study. The data were collected by OJW and analysed by FFP. The paper was written by FFP and revised by OJW. Both authors will act as guarantors.

 

Replies to above article:

[Guest jmh2005]

The last time I was in the OR, with some orthopods...they didn't swear, but got into a very heated debate (throughout a whole TKR) on whether it was chlorine or bromine that was better for their pools! Needless to say, I didn't get any of my questions answered!!

[Guest Ian Wong]

Wow! Just read about this on Medicalpost.com. Apparently there's a risk of U of Montreal cancelling an entire year of medical students?!?!

 

Specialists' action may cancel med school year

In a worst-case scenario, Quebec specialists' work-to-rule and "days of action" could result in the cancellation of the medical student year at the province's largest medical school, and a "disastrous" loss of 200 new doctors four years from now, according to the medical school's dean.

Has anyone else heard about this, or has any more insight to share?

 

Ian

UBC, Med 4

[Guest Unknown </username> <dateline>1118448240</dateline> <title>Unknown</title> <pagetext>(This]

(This post is missing and can not be restored)</pagetext>

</post>

<post>

<thread>Y</thread>

<threadtitle>What happens in 4th year?</threadtitle>

<threadviews>0</threadviews>

<threadsticky>0</threadsticky>

<poll></poll>

<username>Kirsteen</username>

<dateline>1043674380</dateline>

<title>What happens in 4th year?</title>

<pagetext>Hi guys,

 

Given that some of the denizens of the board are roaming around Canada at the moment interviewing for various residency spots (and good luck to you all!) I was wondering about a few things... How is the second "half" of the fourth year of medical school structured so that it will allow for all the interviewing and shuttling around from airport to airport and city to city? Do the medical schools essentially give the med students a lot of time off during that time; is it considered elective time; are rotations optional, etc.? I'm just wondering how that is juggled.

 

Also, after Match Day, I'd be interested in hearing what the different schools across the country offer their newly-minted-doctors-to-be in terms of classes, lectures, activities, rotations, etc.? I understand that UBC offers a "Back to Basics" program for a wee while to help refresh some skills, but I'd imagine that it may be tough to fill classes at that point given that many folk will already be preoccupied with finding living quarters in new cities, etc.

 

Cheers,

Kirsteen

[Guest Unknown </username> <dateline>1118448240</dateline> <title>Unknown</title> <pagetext>(This]

(This post is missing and can not be restored)</pagetext>

</post>

<post>

<thread>N</thread>

<threadtitle>What happens in 4th year?</threadtitle>

<threadviews>0</threadviews>

<threadsticky>0</threadsticky>

<poll></poll>

<username>

 

Unknown

 

 

</username>

<dateline>1118448240</dateline>

<title>Unknown</title>

<pagetext>(This post is missing and can not be restored)

[Guest Unknown </username> <dateline>1118448240</dateline> <title>Unknown</title> <pagetext>(This]

(This post is missing and can not be restored)</pagetext>

</post>

<post>

<thread>N</thread>

<threadtitle>What happens in 4th year?</threadtitle>

<threadviews>0</threadviews>

<threadsticky>0</threadsticky>

<poll></poll>

<username>

 

Unknown

 

 

</username>

<dateline>1118448240</dateline>

<title>Unknown</title>

<pagetext>(This post is missing and can not be restored)

[Guest Unknown </username> <dateline>1118448240</dateline> <title>Unknown</title> <pagetext>(This]

(This post is missing and can not be restored)</pagetext>

</post>

<post>

<thread>N</thread>

<threadtitle>What happens in 4th year?</threadtitle>

<threadviews>0</threadviews>

<threadsticky>0</threadsticky>

<poll></poll>

<username>

 

Unknown

 

 

</username>

<dateline>1118448240</dateline>

<title>Unknown</title>

<pagetext>(This post is missing and can not be restored)

[Guest Unknown </username> <dateline>1118448240</dateline> <title>Unknown</title> <pagetext>(This]

(This post is missing and can not be restored)</pagetext>

</post>

<post>

<thread>Y</thread>

<threadtitle>"Med students and provincial tuition-repayment programs</threadtitle>

<threadviews>0</threadviews>

<threadsticky>0</threadsticky>

<poll></poll>

<username>Ian Wong</username>

<dateline>1039391040</dateline>

<title>"Med students and provincial tuition-repayment programs</title>

<pagetext>Here's an interesting article by the Globe and Mail regarding the concept of "return-of-service" (ROS) agreements. These are projects that offer incentives for new physicians to establish practices in underserved (and often rural) communities.

 

Many of these ROS agreements involve paying an additional sum of money towards a physician's debt load, which is often pretty sizeable after previous undergraduate and medical school degrees.

 

With the recent increases to tuition following government deregulation of fees, one criticism of these programs is that they are coercive, in that a student with a very high debt load may feel that he/she has no other mechanism with which to repay this debt, other than by accepting to work in an underserved area. This also does a disservice to the community, which expends a sizeable amount of money to recruit this doctor, only to have him/her leave once the debt is repaid.

 

Anyway, here's the Globe and Mail article, and below it, a commentary published by the OMA, and written by Danielle Martin, the current president of the Canadian Federation of Medical Students.

 

Ian

UBC, Med 4

 

 

 

www.canada.com/news/story.asp?id={3207EFB0-AF83-4281-B6AC-853C6DB319F1}

 

Med students, doctors put provincial tuition-return programs under microscope

 

MARLENE HABIB

 

Saturday, December 07, 2002

 

TORONTO (CP) - It cost Dr. Eric Labelle about $80,000 in tuition and other expenses to get him where he is today - performing surgical magic like removing diseased portions of a cancer patient's colon.

 

But by the time he's completed four years at Timmins and District Hospital, he'll have reduced his debt - racked up during 11 years of medical schooling and surgical training - by about half.

 

Labelle went to the northern Ontario community of about 50,000 in the summer of 2001, lured by a special Ontario government program that offers tuition kickbacks to medical residents and new doctors if they work in areas of the province in need of physicians.

 

Labelle, 30, says being single meant more flexibility in deciding where he wanted to practise. He says he likely wouldn't have applied to work at the Timmins hospital, which serves about 100,000 people, including in surrounding communities like Hearst and Kirkland Lake, if it weren't for the incentive program.

 

"But even without this program, I may very well have ended up here; I had friends working here already, and family in the area, so I was a little bit spoiled that way," said Labelle, who graduated from medical school at the University of Ottawa and started his surgical training in Montreal before settling in Timmins.

 

Getting huge tuition breaks in exchange for helping underserviced communities across Ontario may seem like a win-win situation for everyone involved, especially considering the spiralling costs of tuition.

 

The number of enrollees in the program - 138 for family practices and 73 for specialists - since its inception in 2000 shows much-needed medical help is making its way into northern communities like Timmins, Algoma, Kenora, Muskoka and Sudbury, as well as other areas that don't easily attract promising young doctors.

 

"It's another form of assistance (for those in the medical profession) and we feel it's a good deal," said David Jensen, spokesman with the Ontario Ministry of Health and Long-Term Care. "Whenever you get a loan of anything like that, you always have to pay back in some form, and this (working in an underserviced area) is how we're asking them to pay back."

 

However, some members of the medical community want improvements to the Underserviced Area Program - one of numerous financial-incentive strategies offered by various provinces to boost medical care in areas of the country that aren't as glitzy as big centres like Toronto and Vancouver.

 

Danielle Martin, a fourth-year medical student at the University of Western Ontario, says the prospect of being $100,000 in debt by the time she can practise as a full-fledged doctor is "frightening."

 

But Martin, 27, says she won't be applying to Ontario's assistance program "out of principle."

 

"I haven't decided where I'm going to practise - I may end up in a rural community or I may not," Martin says on her cellphone during one of her many drives to visit family in Toronto. "I just don't feel comfortable with the way the program has been put in place."

 

The program is "coercive" because many lower-income students may feel they have no choice but to move to regions they have little interest in because of financial need, said Martin, president of the Canadian Federation of Medical Students.

 

In a biting editorial in a recent issue of the Ontario Medical Association's Ontario Medical Review magazine, she also said the return-of-service program "offers an attractive incentive to some medical students and residents who are interested in working in underserviced areas.

 

"However," her article continues, "the broad issues of accessibility to medical education, flexibility for new physicians and long-term solutions for underserviced areas remain a concern."

 

Dr. Dana Hanson, president of the Canadian Medical Association, says there are various financial assistance programs, with the goal of getting doctors into needy communities, offered across Canada.

 

Yet more and more, said the Fredericton dermatologist, students who are facing daunting costs are "feeling this is coersion."

 

A recent study in the Canadian Medical Association Journal, in fact, found students in medical schools are increasingly being drawn in disproportionate numbers from affluent, highly educated homes.

 

Martin says she has other concerns with the return-of-service program in Ontario, where deregulation of tuition fees has resulted in them doubling and tripling in some instances in the last few years.

 

The $10,000 maximum tuition reimbursement annually to a maximum of four years (which is currently under evaluation by the province) is insufficient, says Martin, who pays about $14,000 each year at Western. That's well above the provincial medical tuition-fee average of $11,500 and the national average of about $8,000.

 

There are other concerns that a committee looking into the program - which includes representatives from the OMA's students' section and the Professional Association of Interns and Resident of Ontario - hopes the province will address.

 

They include a penalty of $5,000, on top of repaying the sum awarded for tuition plus interest, if a program enrollee can't complete the return-of-service obligation; the funds provided through the program are subject to federal and provincial tax (which can reduce annual allotment by up to $3,500 annually); and the fact enrollees in the program must complete their return-of-service times on a full-time basis.

 

Martin says some positive changes to the program since its inception is that enrollees are now given six months - instead of three - to choose where they want to do their return of service, and they can change the community they're working in instead of staying in one place.

 

But Martin says she's still more impressed with the financial offerings and flexibility of the incentive programs in Manitoba and Saskatchewan, for instance.

 

Fourth-year medical undergraduates at the University of Manitoba can apply for $15,000 annually, with a commitment to work in underserviced areas upon completion of their residency programs.

 

In Saskatchewan, where the university charges about $6,000 a year in medical tuition fees, thousands of dollars in bursaries are offered to medical students and residents, who can do their return-of-service work in bits and pieces and in various communities.

 

"Saskatchewan is an example of the way return-of-service programs should operate," says Martin, adding that students can either work in an underserviced community upon graduation, or repay their bursary without penalty.

 

Still, lofty tuition costs don't seem to be deterring Ontarians from fulfilling their dreams of becoming doctors.

 

A record 4,469 students have applied to medical schools this fall, 17.6 per cent more than last year's 3,800 applicants and the biggest increase since 1975.

 

Dr. Elliot Halparin, president of the Ontario Medical Association, sees promise in Ontario's assistance plan.

 

"It's a new program, and like any other new program, it needs to be evaluated as we go through the process."

 

With more than two years to go before completing his four-year return-of-service commitment, Labelle says settling into a small community has given him rewards that may motivate him to stay there longer.

 

His advice to other medical students and new doctors: Don't knock moving into a rural community until you try it.

 

 

 

www.oma.org/pcomm/OMR/oct/02returnservice.htm

 

Ontario Return of Service/Free Tuition Program update: the SSOMA perspective

 

by Danielle Martin

 

In July 2000, the Ontario government unveiled its Return of Service (Free Tuition) Program, which is intended to reimburse residents for their medical school tuition costs in return for a commitment to practise in underserviced communities.

 

To date, the program has received 196 applications - 131 for family practice/general practice and 65 for specialty positions.

 

An ROS Implementation Committee has been working toward tailoring the program to best meet the needs of students and residents, as well as those of Ontario's underserviced communities. The Committee includes representation from the Students' Section of the OMA (SSOMA) and the Professional Association of Internes and Residents of Ontario (PAIRO).

 

Progress has been made on a number of issues, and we are continuing to work collaboratively to initiate ongoing improvements.

 

The current program offers an attractive incentive to some medical students and residents who are interested in working in underserviced areas. However, the broader issues of accessibility to medical education, flexibility for new physicians, and long-term solutions for underserviced areas remain a concern.

 

Our goal is to ensure that medical students and residents are provided with accurate information about the advantages and potential disadvantages of the current program.

 

The position of the SSOMA on Return of Service is as follows:

 

Return of Service should not be viewed as a solution to excessive tuition and high debt-loads. An accessible medical education requires a return of tuition fees to more reasonable levels, restriction of any further increases, and adjustment of Ontario Student Assistance Plan regulations to cover the true cost of a medical education.

 

In the context of tuition deregulation and excessive tuition, any ROS program will discriminate against those students who cannot afford the rapidly rising, excessive costs of medical school. Medical students who have a high debt-load are much more likely to sign up for this program than those who have the personal and family support to avoid incurring large education-related debts.

 

Return of Service programs should not be offered to students before they finish medical school. While some individual students would obviously be happy to avoid the stress of paying for their education up front, from a policy perspective, this is a very dangerous option. Students from lower-income backgrounds would be locked into an option that excludes a number of career choices before having any exposure to medicine, while wealthier students would have much more career flexibility.

 

Early career decision-making is an enormous problem for today's medical students. We are being pushed to make vital decisions about specialty and location of practice earlier and earlier - often before even getting exposure to our full range of choices. This leads to a lot of student stress and, in many cases, poor choices and unhappy residents and doctors.

 

To have first-year medical students signing up for the ROS or an equivalent program would only exacerbate this problem. The government, SSOMA and PAIRO have agreed that earlier sign up would ultimately lead to fewer successful contract completions, which would unfairly reflect negatively on the program and its participants. We hope that this will continue to be the position of the Implementation Committee.

 

Physicians should have flexibility in repaying their Return of Service. This would ideally include the option to repay the ROS obligation on a locum or part-time basis. This does not yet exist in the current program, and is a major concern for medical students and residents. By contrast, for example, in Saskatchewan, time spent as a locum is counted as double the ROS commitment time.

 

On a positive note, the application and Return of Service dates have increased to six months from the date of completing residency, rather than the previous three months. This allows residents extra time to select a practice location.

 

In addition, applicants are now allowed to change their ROS community, providing all parties agree. Options for conflict resolution have also been added to the agreement, which is an important step forward.

 

Excessive penalties for physicians who are unable to complete their ROS obligation are counterproductive. If an individual is unable to fulfil an ROS obligation, he or she must repay the sum, along with interest based on the prime rate plus one per cent. We accept that this is reasonable, but we believe that the additional $5,000 penalty is excessive and inappropriate.

 

In addition, the current contract does not have an explicit provision to protect individuals if they are sick or disabled, nor is there any humanitarian/compassionate exemption.

 

Finally, there are no provisions to allow individuals to defer their ROS obligation at any point during their service (for example, for personal or family reasons, or should they become sick or disabled).

 

However, the Ministry of Health and Long-Term Care has added an appeal process which can make non-binding recommendations in these areas to the minister. Maternity leave has also been added to the agreement.

 

The incentive offered should mirror the cost of a medical education. Currently, the ROS contract offers $10,000 per year. The annual tuition charged at Ontario medical schools exceeds this amount.

 

Fortunately, the government has indicated that it is committed to increasing the annual payment to match increasing tuition amounts. However, this is only on a pre-tax basis. As such, when one takes into account the fact that the money is taxable, even a $10,000 payment results in a net of only $6,500 to $7,000 in the hands of most residents.

 

The SSOMA will continue to work with the members of the Implementation Committee to improve the effectiveness and flexibility of the program. We are committed to finding fair and effective ways to address the difficulties faced by so many of Ontario's communities with respect to physician human resources.