Información del libro
Titulo del libro: Bonney’s Gynaecological Surgery
Autor del libro: Tito Lopes, Nick M. Spirtos, Raj Naik, John M. Monaghan
Edición de libro: 11th edition
Formato de libro: EBook
Date published: 2011
Número de páginas: 284
User Review( votes)
Surgical training in gynaecology has seen dramatic changes in both the UK and the USA over the last 20 years.
When the current editors were in training, there were no restrictions to the number of hours that they could be asked to work. It was common to be resident on call every third night in addition to daytime work, which often resulted in a working week in excess of 110 hours.
In the UK, adoption of the European Union Working Time Directive will mean that trainees will legally be allowed to work only 48 hours per week. In the USA, the working week for residents is limited to 80 hours.
Although the reduction in working hours is important for one ’ s work – life balance, it has inevitably had a major impact on surgical training. The concept of the surgical team or fi rm to which a trainee was attached has all but disappeared. The introduction of shift systems has made it diffi cult, and in some cases impossible, for trainees to attend the surgical and clinical sessions of their team.
At the same time, there has been a marked reduction in the number of hysterectomies performed as a result of more conservative management options for dysfunctional uterine bleeding. In the 9 – year period from 1995 to 2004, there was a 46% reduction in the number of hysterectomy operations performed in NHS hospitals in England (Hospital Episode Statistics). In 2003, at the ‘ Fellows ’ ceremony at the Royal College of Gynaecologists, the then President stated that not every specialist gynaecologist would be expected to be able to perform a hysterectomy.
With the increasing use of laparoscopic surgery in elective gynaecology, including for hysterectomy, the ‘open’ approach to gynaecological surgery, the surgical ‘bread and butter’ for trainees, is also on the decline. Equally, a large number of ectopic pregnancies are now managed conservatively so that trainees are lacking exposure to emergency laparoscopic surgery for tubal pregnancies.