Foundation Skills in Surgery: Handbook
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About this ebook
The book is written in simple format that can be easily digested by novices and is a must read for all who wish to pursue a career in surgery.
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Book preview
Foundation Skills in Surgery - Devender Mittapalli
9)
Chapter 1
Introduction and Overview
Rhiannon L Harries
The Association of Surgeons in Training (ASiT) is a professional body and registered charity working to promote excellence in surgical training for the benefit of junior doctors and patients alike. With a membership of over 2700 surgical trainees from all 10 surgical specialties, the Association provides support at both regional and national levels throughout the United Kingdom and Republic of Ireland. Originally founded in 1976, ASiT is independent of the National Health Service (NHS), Surgical Royal Colleges, and specialty associations. Governed by an elected Executive and Council, the Association is run by trainees for trainees.
ASiT’s Foundation Skills in Surgery course has been running throughout the UK and Republic of Ireland since its successful introduction in 2008. The course was initially developed because it was noted that foundation doctors were often neglected compared to Core Surgical Trainees in terms of surgical courses. It aims to provide a taster of surgery for both medical students and foundation doctors. The course should introduce you to specific skills and knowledge ready for the early stages of surgery and address both technical and non-technical areas of development. This book provides an overview of the syllabus covered on the course, and after reading the prudent student should:
•have knowledge of safe surgical practice
•be able to perform hand and instrument knot-tying
•be able to perform sterile hand-washing, gloving and gowning
•safely handle and dispose of sharps
•be able to choose the correct surgical instruments, suture and needle
•be able to make an incision in skin and subcutaneous tissue based on Langer’s lines
•practice safe tissue handling
•be able to excise a skin lesion
•have knowledge of different skin closure methods and when to choose each one
•be able to perform basic suturing techniques including interrupted, continuous, mattress and subcuticular
•have knowledge of the indication for and management of surgical drains
•understand the principles of incision and drainage of an abscess
•recognise the importance of good medical record keeping
•understand the principles of audit and research
•have knowledge of the surgical career pathway
•understand the principles of CV writing
Most importantly I hope you are able to practise and develop the skills and techniques you read about in this book. Remember practise makes perfect!
‘Actual operative skill cannot be gained by observation, any more than skill in playing the violin can be had by hearing and seeing a virtuoso performing on that instrument.’
Allen O. Whipple (1881–1963)
I wish you every success for a long and prosperous career in surgery.
Miss Rhiannon L Harries,
ASiT President, 2015-16.
Chapter 2
Good medical record keeping
Jonathan RL Wild
Aims
By the end of the chapter you will be able to:
•write in medical records appropriately
•understand how effective written communication ensures good patient care
•understand the medico-legal issues regarding medical records
•construct a clear clinic letter
•construct a clear operation note
Introduction
As important members of the surgical team, surgeons in training should ensure they maintain a high standard of medical record keeping, which is a key component of safe patient care. There are various reasons why good medical record keeping is an important generic skill to master. While the different functions of medical records are outlined in box 2.1, the primary aim of medical record keeping is to support patient care and it should authentically represent each patient interaction.¹ Despite this importance, medical record keeping is often given a low priority, and notes can be poorly maintained, not available, illegible, incomplete, inconsistent and even contain offensive comments.²
This chapter will focus on areas of medical record keeping relevant to surgical trainees including how to write effective clinic letters, operation notes and inpatient clinical note entries, whilst also highlighting the importance of good documentation for medico-legal purposes.
Guidelines on medical record keeping
National guidelines on medical record keeping have been in existence for some time with every NHS hospital also having their own local guidance. As outlined in Good Medical Practice³ it is a requirement of the General Medical Council (GMC) that documentation in medical records should be:
•clear, accurate and legible
•made at the same time as the events you are recording or as soon as possible afterwards
•in line with any data protection requirements
The GMC also states that clinical records should include:
•relevant clinical findings
•decisions made and actions agreed
•information given to patients
•any drugs prescribed or other investigation or treatment
•who is making the record and when
In order to standardise and improve the quality of medical recording keeping the Royal College of Physicians (RCP) have developed 12 generic medical record keeping standards, and an audit tool, to compare these standards against medical record keeping in practice.⁴ In addition further guidance exists from medical defence unions.⁵,⁶
NHS hospitals are slowly moving towards a paperless system. As outlined in Good Surgical Practice,⁷ it is therefore essential that surgeons in training are fully versed in the use of their organisation’s electronic health care systems. They must take part in mandatory training on information governance, and ensure they are familiar and fully compliant with the guidelines of the Data Protection Act 1998 regarding the use and storage of all patient identifiable information.
Medico-legal issues regarding medical record keeping
If you didn’t document it, it didn’t happen
Medical records can be used to help protect a doctor against future claims or complaints, or can support or refute a patient’s claim. Typically complaints or claims occur months or even years after the event. Therefore accurate and legible records with precise dates and times are invaluable in order to clarify the sequence of events and provide a window on the clinical judgement. The medical records are the first, and may often be the only, piece of evidence examined in a malpractice case. Even if everything was done at the time of an incident, if it was not documented then it did not happen
and poor record keeping can make it difficult to defend even the best