All licensed doctors are required to revalidate from June 2012. The GMC states that patient feedback should form part of doctors provided evidence. A standardised GMC PSS has been shown to offer a reliable basis for the assessment of professionalism among UK doctors and has been suggested as a tool for revalidation. We aim to show its use in the secondary care setting to be simple and effective, offering further evidence for doctors undergoing revalidation. Having sought permission from the Trust the GMC PSS was used in the manner directed for 3 doctors in a Trauma and Orthopaedic fracture clinic. The data was analysed using an automated system and the results made available to individual clinicians in a simple to present format. 3 clinicians used the survey across 13 clinic sessions. The mean number of clinics it took to generate sufficient responses was 3.25 (range 2–5). We found the survey easy to use, HCAs handed forms to patients before consultation. Survey results were collected as patients left clinic and analysed by the Patient Services Department. The GMC PSS, although designed principally for use in Primary care appears to be a useful tool in secondary care

Quality Improvement (QI) is of increasing importance with its inclusion on training curricula and requirement for it in revalidation. Junior Doctors are a valuable, yet under utilised resource for NHS Trusts in patient safety/Quality Improvement activity. A Trainee led QI Academy, supported and administered by Medical Education was launched in our Trust. It offered education on Leadership and Management and support for projects from the Trust Service and Development teams. The QI Academy launch evening attracted over 60 Trainees and 17 QI projects were adopted. Subsequently a further 9 projects have been started and a number published in peer reviewed journals and presented internationally. The Academy was an attractive and supportive method of engaging new groups of doctors. QI is not as constrained as simple audit, and as such, engaging trainees has proven to be easier. Collaboration between a Core Faculty, Trainees and Trust Management ensured adequate and sustainable support for all projects, avoided duplication and fostered a closer relationship. We highly recommend Trust support of QI in junior doctors through Medical Education. Trusts benefit from improvements in patient care and quality whilst trainees learn valuable skills and benefit from presentations and publications

The Royal College of Surgeons of England (RCS) recently issued guidance regarding the use of re-operation rates in the re-validation of UK based orthopaedic surgeons. Currently, little has been published concerning acceptable rates of re-operation following primary surgical management of orthopaedic trauma, particularly with reference to re-validation. We conducted a retrospective review of patients undergoing a clearly defined re-operation following primary surgical management of trauma between 1. st. January 2010 and 31. st. December 2011. 3688 patients underwent primary procedures while 83 (2.25%; 99%CI = 1.69 to 2.96%) required an unplanned re-operation. The mean age of patients was 46 years (range 2–98) with 46 (55%) males and a median time to re-operation of 34 days (IQR 12–134). Potentially avoidable re-operations occurred in 47 patients (56.6%; 99%CI = 42.6 to 69.8%) largely due to technical errors (46 patients; 55.4%; 99%CI = 41.4 to 68.7%), representing 1.27% (99%CI = 0.87 to 1.83%) of the total trauma workload. Within RCS guidelines 28 day re-operation rates for hip fractures, wrist fractures and ankle fractures were 1.4% (99%CI = 0.5 to 3.3%), 3.5% (99%CI = 0.8% to 12.1%) and 2.48% (99%CI = 0.7 to 7.6%) respectively. We present novel work that has established baseline re-operation rates for index procedures required for revalidation of orthopaedic surgeons

Background. A recent Cochrane review has shown that total shoulder arthroplasty (TSA) seems to offer an advantage in terms of shoulder function over hemiarthroplasty, with no other obvious clinical benefits. This is the first study to compare complication rates on a national scale. Methods. All patients (9804 patients) who underwent either TSA or shoulder hemiarthroplasty as a planned procedure between 2005 and 2008 in the English NHS were identified using the hospital episodes statistic database. Data was extracted on 30-day rates of readmission, wound complications, reoperation and medical complications (myocardial infarction (MI) and chest infection (LRTI)), and inpatient 90-day DVT, PE and mortality rates (MR). Revision rate at 18 months was analysed for the whole cohort and, for a subset of 939 patients, 5-year revision rate. Odds ratio (OR) was used to compare groups. Results. Mean age was 70.6 years for the TSA group and 69.3 for hemiarthroaplasty. There were no significant differences in 30-day readmission (0.82% vs. 0.83%, OR 0.99 (95% CI 0.63–1.55)), wound complication (0.57% vs. 0.51%, OR 1.11 (0.63–1.94)), and reoperation rates (0.20% vs. 0.22%, OR 0.89 (0.36–2.19)). 18-month revision was significantly higher in the TSA groups (3.03% vs. 1.76%, OR 1.75 (1.33–2.28), but at 5-years no difference was seen (3.85% vs. 3.67%, OR 0.95 (0.46–1.91). The overall 90-day MR was 0.43% (42 patients). 0.58% had a LRTI and 0.29% had an MI. There were 13 DVTs (0.13%) and 22 PEs (0.22%, 5 fatal). Discussion. Despite concerns regarding osteolysis around the glenoid peg after TSA, revision rates at 5 years were not significantly different to hemiarthroplasty. Except for 18-month revision rates, there were no differences in any of the outcome measures in this study. Methods of national data analysis described in this study can provide benchmark values for future subspecialty revalidation

The use of journal clubs and, more recently, case-based discussions in order to stimulate debate among orthopaedic surgeons lies at the heart of orthopaedic training and education. A virtual learning environment can be used as a platform to host virtual journal clubs and case-based discussions. This has many advantages in the current climate of constrained time and diminishing trainee and consultant participation in such activities. The virtual environment model opens up participation and improves access to journal clubs and case-based discussions, provides reusable educational content, establishes an electronic record of participation for individuals, makes use of multimedia material (including clinical imaging and photographs) for discussion, and finally, allows participants to link case-based discussions with relevant papers in the journal club.

The Leicester experience highlights the many advantages and some of the potential difficulties in setting up such a virtual system and provides useful guidance for those considering such a system in their own training programme. As a result of the virtual learning environment, trainee participation has increased and there is a trend for increased consultant input in the virtual journal club and case-based discussions.

It is likely that the use of virtual environments will expand to encompass newer technological approaches to personal learning and professional development.