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Over the past 5 years, there has been a groundswell of support in Canada for the development of organized, focused and multidisciplinary approaches to caring for acutely ill general surgical patients. Newly forged acute care surgery (ACS) services are beginning to provide prompt, evidence-based and goal-directed care to acutely ill general surgical patients who often present with a diverse range of complex pathologies and little or no pre- or postoperative planning. Through a team-based structure with attention to processes of care and information sharing, ACS services are well positioned to improve outcomes, while finding and developing efficiencies and reducing costs of surgical and emergency health care delivery. The ACS model also offers enhanced opportunities for surgical education for students, residents and practicing surgeons, and it will provide avenues to strengthen clinical and academic bonds between the community and academic surgical centres. In the near future, cooperation of ACS services from community and academic hospitals across the country will lead to the formation of systems of acute surgical care whose development will be informed by rigorous data collection and research and evidence-based quality-improvement initiatives. In an era of increasing subspecialization, ACS is a strong unifying force in general surgery and a platform for collective advocacy for an important patient population., General surgical emergencies represent a major challenge to the Canadian health care system. They account for a substantial proportion of general surgical operations, and almost every general surgeon, regardless of [...]

Background: In July 2007, a large Canadian teaching hospital realigned its general surgery services into elective general surgery subspecialty-based services (SUBS) and a new urgent surgical care (USC) service (also know in the literature as an acute care surgery service). The residents on SUBS had their number of on-call days reduced to enable them to focus on activities related to SUBS. Our aim was to examine the effect of the creation of the USC service on the educational experiences of SUBS residents. Methods: We enrolled residents who were on SUBS for the 6 months before and after the introduction of the USC service. We collected data by use of a survey, WEB eVAL and recorded attendance at academic half days. Our 2 primary outcomes were residents' attendance at ambulatory clinics and compliance with the reduction in the number of on-call days. Our secondary outcomes included residents' time for independent study, attendance at academic half days, operative experience, attendance at multidisciplinary rounds and overall satisfaction with SUBS. Results: Residents on SUBS had a decrease in the mean number of on-call days per resident per month from 6.28 to 1.84 (p = 0.006), an increase in mean attendance at academic half days from 65% to 87% (p = 0.02 8), at multidisciplinary rounds (p = 0.002) and at ambulatory clinics and an increase in independent reading time (p = 0.015), and they reported an improvement in their work environment. There was no change in the amount of time residents spent in the operating room or in their overall satisfaction with SUBS. Conclusion: Residents' education in the SUBS structure was positively affected by the creation of a USC service. Compliance with the readjustment of on-call duties was high and was identified as the single most significant factor in enabling residents to take full advantage of the unique educational opportunities available only while on SUBS. Contexte: En juillet 2007, un grand centre hospitalier universitaire canadien a reorganise ses services de chirurgie generale en les subdivisant en deux elements : un service de chirurgie generale elective (SCGE) base sur les surspecialites et un nouveau service de chirurgie d'urgence (SCU) (qui porte dans la litterature l'appellation de service de chirurgie de soins actifs). On a reduit le nombre de jours de garde des residents assignes au SCGE afin de leur permettre de se consacrer aux activites de ce service. Notre but etait de mesurer l'effet de la mise sur pied d'un SCU sur l'experience d'apprentissage des residents assignes au SCGE. Methodes: Notre etude a porte sur les residents assignes au SCGE pendant les six mois precedant et suivant la creation du SCU. Nous avons recueilli les donnees au moyen du questionnaire WEB eVAL et nous avons enregistre les presences aux demijournees de formation. Nos deux principaux parametres etaient la participation des residents aux cliniques ambulatoires et leur conformite a la reduction du nombre de leurs jours de garde. Nos parametres secondaires incluaient le temps consacre par les residents a la formation autonome, la participation aux demi-journees de formation, l'experience chirurgicale, la participation aux tournees pluridisciplinaires et le degre general de satisfaction a l'endroit du SCGE. Resultats: Chez les residents assignes au SCGE, on a enregistre une baisse du nombre moyen de jours de garde par resident par mois, soit de 6,28 a 1,84 (p = 0,006), une augmentation de 65 % a 87 % de la participation moyenne aux demi-journees de formation (p = 0,028), aux tournees pluridisciplinaires (p = 0,002) et aux cliniques ambulatoires, de meme qu'une augmentation du temps consacre a la formation autonome (p = 0,015); les residents ont de plus fait mention d'une amelioration de leur environnement de travail. On n'a note aucun changement quant au temps passe par les residents au bloc operatoire ou quant a leur satisfaction globale a l'endroit du SCGE. Conclusion: La mise sur pied du SCU a exerce un effet positif sur les residents assignes au SCGE. Leur conformite a la reorganisation des taches de garde a ete elevee et s'est revelee etre le facteur le plus significatif leur ayant permis de profiter au maximum de l'experience didactique unique offerte exclusivement au SCGE., Teaching hospitals across North America must deliver highly specialized elective surgical care and timely interventions in acute surgical illness while providing a supportive and high-quality learning environment for surgical residents. [...]

Communication and information technologies can reduce the barriers of distance and space that disadvantage communities in Australia's underserved rural areas, where the health status of residents is often worse than [...]

Communication and information technologies can reduce the barriers of distance and space that disadvantage communities in Australia’s underserved rural areas, where the health status of residents is often worse than that of their urban counterparts. ACROSSnet (Australians Creating Rural Online Support Systems) is a 3 year collaborative action research project that aims to design and develop an online support system that will assist rural communities in accessing information, education and support regarding suicide and its prevention, whilst considering the challenges of Internet speed, cost and availability that can impede the delivery of online services. The site provides three distinct levels of access: one level for community members, and two further levels for appropriately credentialled mental health workers. In creating this environment, the ACROSSnet team hopes that online communities of practice will develop, engaging participants of different ages, income and education levels, location, and socioeconomic backgrounds. [ABSTRACT FROM PUBLISHER]