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The role of the surgical trainer is critical in the development and training of surgeons of the future. Despite this, the majority of research in this area focuses on the views of the trainees. There is very little, or in some cases no research, into which practices make good surgical training, or what good modern surgical training looks like according to the trainers. This research looked to fill this gap. A constructivist exploratory approach was used. Semi structured interviews were conducted. Interviews continued until it was felt that sufficient information power had been achieved. Reflective thematic analysis was then applied using Braun and Clarke's 6 step technique. Ninety-minute interviews were conducted over Microsoft teams, over a 3-month period General Surgery Consultants who self-identified as trainers from Yorkshire and Humber School of Surgery were recruited on a voluntary basis. Four main themes were identified, "Trainees are responsible for their own training," "The best training happens in positive relationships," "Learning to operate is the easy bit" and "Trainers are not empowered to train." Participants emphasized trainee responsibility for proactive learning whilst simultaneously describing structural constraints limiting their capacity to deliver desired training. This tension may reflect broader contradictions in how training responsibilities are understood within current systems. Participants identified resource limitations, particularly time and access to training funding, as barriers beyond their control. However, perceptions that training produces "reasonable" consultants may reduce urgency for systemic change. Findings suggest that meaningful improvement in surgical training may require both institutional changes-such as formal recognition and resourcing of training activities-and collective advocacy by trainers themselves to address structural barriers. Given this study's single-region focus, further research across multiple regions and specialties would strengthen understanding of whether these perspectives reflect wider patterns in UK surgical training.

We appraised the findings of the study by Bindal et al. [1] at CRAMSurg (www.cramsurg.org), an online journal club based in the United Kingdom. We commend the authors for publishing a well-written paper relevant to current practice in general surgery with well-described surgical techniques. We raised the following queries and would value the authors' response. The study does not report a clear selection criterion for deciding one approach against the other and shows a tendency toward larger sized hernias being treated with the robotic approach. Furthermore, there is no mention of the site of the hernias in the abdominal wall, whether midline or off midline, and if that influenced the approach or the requirement of performing unilateral of bilateral TARs. Did the authors consider using a classification system incorporating the location and size of defects so the readers could have a better understanding of the patient population [2]? In the literature, TAR has been reported to be indicated for large ventral hernias (> 10 cm) [3] or those which are complex, with multiple defects, laterally placed in the abdominal wall or in case of previous anterior component separation [4]. All the patients in the laparoscopic group had hernias < 10 cm in the greatest dimension; however, more than 60% of the laparoscopic group was reported to have a unilateral or a bilateral TAR. In comparison, 38% of the robotic group had unilateral or bilateral TARs. The indication for doing a TAR was reported to be the tension on the posterior rectus sheath during closure, and no other objective criteria was set. The preponderance of TAR in the laparoscopic group might explain the greater operative time, worse pain scores, and QoL score in the laparoscopic group as it is a more extensive operation. Were any preoperative adjuncts like botulinum toxin injection or progressive pneumoperitoneum [5] used in any group of these patients? This may influence the ease of fascial closure. It would have been useful to report any open conversion even if there was none. One of the drawbacks of the robotic approach remains its high cost and unavailability in many centers across the world, making it difficult to generalize these results. A cost analysis of the two approaches would have been useful. Finally, from a methodological standpoint, we noticed that the univariate analysis of continuous variables was conducted using Student's t-test. Such a test becomes unreliable when applied to a nonnormally distributed dataset. Was normality tested before using it? Was consideration given to use a nonparametric test instead? We hope our feedback is useful and await in anticipation a response from the authors. Pratik Bhattacharya: conceptualization, writing – original draft, writing – review and editing. JiaXuan Tan: conceptualization, writing – original draft. Constantine Ezeme: conceptualization, writing – original draft. Giordano Perin: conceptualization, supervision, writing – original draft. The authors declare no conflicts of interest.

PurposeThis paper aims to focus on concerns unique to international medical graduates (IMGs) and doctors from global majority groups pursuing a career in psychiatry in the UK. It specifically addresses challenges affecting the differential attainment of IMGs in passing the Clinical Assessment of Skills and Competencies (CASC) examination – the final assessment for attaining Membership of the Royal College of Psychiatrists, affording entry to specialty training programmes.Design/methodology/approachReflections are provided on learning from a CASC examination preparatory course specifically developed for IMGs in psychiatry, particularly those from global majority groups. The rationale for the course is set out as well as some of the challenges in designing and developing the course.FindingsBy reflecting on the experience of developing the course, the intersection of medical education, differential attainment and cultural disparities in training is addressed, alongside the role of group practice in exam preparation and support tailored to the needs of IMGs from global majority groups.Originality/valueThe reflections provided illuminate possible means of innovation to support the progression of IMGs and doctors from global majority backgrounds in the CASC, as a high stakes examination in medical training, and to support action to improve overall outcomes for this community in the field of psychiatry.

Abstract Background Higher surgical training (HST) focuses on delivery of clinical knowledge to pass FRCS exams, technical skills to fulfil CCT requirements, and clinical preparedness in the UK. The lack of good quality evidence to characterise the non-clinical challenges during transition from HST to consultant surgical practice, makes it challenging to develop a well-structured intervention to address this gap. Aim To identify the gap in current literature, methodologies and analysis of inventions trialled to address the transition from surgical trainee to consultant surgeon. Method PRISMA-ScR structured scoping review of literature. Search terms were wider than the specific research question of surgery in the UK. Other medical specialities and overseas healthcare training programmes were included to focus the gap analysis for translatable content and sub analysis to highlight the paucity of literature in surgery. Results Databases interrogated: Medline, HMIC, Pubmed, Google Scholar. Papers: identified n = 434, screened n = 276, eligible n = 105, included n = 50. Majority of papers were of poor to moderate quality. The moderate-quality papers included those adopting a mixed methods approach to both characterise the gap in training and utilised this to structure interventional programmes. Conclusions This review highlights the need for a mixed methods approach alongside a stakeholder analysis to identify target population for qualitative semi-structured interview (most likely to be newly appointed consultants) for characterising the gap in HST for trainees making the transition to UK NHS consultant practice. The topic guide for interviews would be informed by the deficiencies in training identified in this scoping review.

IntroductionAdequacy of postoperative hip and knee radiographs has a direct impact on its interpretation. We undertook a quality improvement project by creating local standards to meet the arthroplasty team expectations for a satisfactory radiograph. The purposes of the study are 1. Assessment of the adequacy of radiographs according to defined criteria, and 2. Correlation of system and patient factors with inadequate radiographs.MethodsStage I: We conducted a single centre, retrospective audit to check the adequacy of a postoperative radiography following a total hip or knee replacement. A total of 100 radiographs were assessed against the nine criteria laid out with the consensus of orthopaedic surgeons and radiologists.Stage II: We created a quality improvement proforma for use in the radiology department. We re-assessed 100 radiographs during the second cycle against the nine criteria to check the adequacy of hip and knee arthroplasty radiographs,ResultsStage I: Of 100 radiographs, 51 were from the knee and 49 from the hip arthroplasty group. Sixty-nine radiographs were adequate considering overall criteria, and 31 radiographs were inadequate. The inadequacy in radiographs was related to the visibility of prosthesis, cement or relevant anatomy.Stage II: We created a quality improvement performa for use in radiology department, highlighting the nine initial criteria. One hundred radiographs of hip and knee arthroplasty were re-assessed. Overall, 84 radiographs fulfilled the criteria of being adequate.ConclusionAdequacy of knee and hip arthroplasty radiographs is essential in picking up pathologies that can be missed otherwise. We present simple criteria to improve the adequacy of x-ray and prevent repetition of radiographs.

Participating in continuing professional development (CPD) activities is a requirement for dental practitioners to keep their skills and knowledge up to date. Understanding the ways dental practitioners engage with professional development and the impact on practice is not fully known (Eaton et al. 2011, http://www.gdc-uk.org/Aboutus/policy/Documents/Impact%20Of%20CPD%20In%20Dentistry.pdf). The aim of this study was to gain insights into the ways that dentists reflect on their professional development and what may be influencing their choices. Empirical qualitative data were collected by semi-structured interviewing of five mid-career dentists. Using grounded theory, the data were analysed for themes about CPD choice and participation. Three themes were identified as influences to dentists' choices of CPD with pragmatic considerations of how new learning could benefit their patients and their practices. Dental practitioners were influenced by the requirements of external regulatory bodies which they did not consider to necessarily improve practice. Dentists working in primary care in the UK are undertaking CPD which is influenced by the pragmatic requirements of running a small business and to meet regulatory requirements. In this sample, dentists are not critically reflecting on their education needs when choosing their CPD activity. Protected learning time and organisational feedback and support are recommended as a way to promote more meaningful reflection on learning and to improve professional development.

&lt;p&gt;Bearings connecting the 1410 m main span deck box to the towers of the Humber were heavily worn. A challenging £4m (US$6.3m) replacement scheme including significant temporary works was implemented. All works to this landmark structure took place with the bridge open to traffic.&lt;/p&gt;