Two sides of the same coin: educational and professional pathway for surgical residents

AIM

To provide a review of medical malpractice cases ruled by the Italian Supreme Court with the aims at identifying lawsuits targeting involved with surgical residents.

MATERIAL AND METHODS

Legal cases ruled by the Italian Supreme Court, from September 2020 to October 2020, pertaining to medical claims involving surgical residents were examined, using the main online databases.

RESULTS

Of a total of eleven (n=11; 100%) cases identified, four (n= 4; 36,4%) cases addressed the standard of care pertaining to the surgical residents' medical activity. The legal reasoning of the Italian Supreme Court does not focus on the manual skill in the resident's medical performance, but rather on the choice to accept to treat the patient, regardless of the participation of the tutor.

CONCLUSIONS

The performance of the surgical residents is made more difficult due to their peculiar nature, characterized by the complex interactions between the directives given by the tutor and the need to guarantee patients' needs.

KEY WORDS

Surgical Residents, Tutor, Educational Pathway, Medical Malpractice, Standard of Care.

An international survey of medical licensing requirements for immigrating physicians, focusing on communication evaluation

OBJECTIVE

To identify current entry requirements set by international medical licensing bodies for immigrating physicians, focusing on postgraduate level communication skills, clinical and technical skill assessments.

METHODS

A standardised, author developed survey was administered to a selection of national, state and provincial licensing institutions across 6 continents. Representative institutions were selected from the most populated regions of each continent. Surveys were administered by email and telephone. The information was also searched by website review. Website information alone was used if no response was received by the targeted institution after 2 phone/2 email attempts. Statistical analysis of the non-parametric data was conducted using SPSS (v.21).

RESULTS

Thirty-seven licensing bodies were contacted from 30 countries; verifiable information was available for 29; twenty-six responded to the communication inquiry. Sixty five 65.4% (n=17) surveyed communication skills, 100% involved language proficiency testing; 11.5% tested other forms of communication skills. For clinical and technical skills, 86.2% (n=25) assessed candidates by credential review, 72.4% (n=21) required both credential review and exam and 62.1% (n=18) used country-specific examination. A mentorship period were required by 37.9% (n=11), ranging from 3 months to 1 year. Only 2 countries identified examinations for recertification. No technical/clinical skills nor communication skill evaluation (beyond language proficiency) are routinely assessed at the postgraduate level.

CONCLUSIONS

International assessments of migrating physicians are heterogeneous. Communication skills, beyond language proficiency, are not routinely assessed in foreign trained physicians seeking entry. The majority of clinical and technical skills are assessed by credential review only. This study highlights the lack of standardisation of assessment internationally and the need for steps toward a global agreement on training schemes and summative assessment.

Experiences in reconciling risk management and restorative justice: how circles of support and accountability work restoratively in the risk society

Circles of Support and Accountability (COSA) is a restorative justice-based model that originated in Canada in the mid-1990s for the postincarceration reintegration of those who have offended sexually. Although the roots of COSA are in restorative justice philosophy, the program has also found favour, to some degree, with organisations such as police services and corrections that are traditionally concerned more with protecting community safety than with the ideals of restorative justice. Informed by the author's research and personal experience as a COSA volunteer, and analysis of recent and historical representations of COSA, this article explores theoretically how the development of the COSA initiative has been influenced by the seemingly disparate concerns of both the restorative justice and community protection movements, and examines the importance of balancing these paradigms in the everyday practices of circles.

Parent representation model in child safety conferences

Child welfare-involved parents are often isolated and lack support and skills to navigate complex systems. Programs using a parent representation service model in child protection can offer an exceptional and critical form of support and empowerment to birthparents, promote parental engagement and cooperation, and teach system navigation skills. While there is a notable emphasis on an overall family-centered and strength-based approach in child welfare, much progress is still needed in giving voice to parents, empowering them, including them in decisionmaking about the case, and seeking their cooperation. Funding should be directed to recruiting more parent representatives to assist birthparents in their communities as well to educating and training child protective services workers by transferring values and strategies implemented by parent representatives. Although additional research is certainly necessary, it appears that programs such as the Child Welfare Organizing Project in New York City may be an important step toward building partnerships with families impacted by the child welfare system in promoting child safety, well-being, and permanency.