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Introduced in 2017, the reform of the 3rd cycle has modified the organization of the residency in all specialties, and in particular radiation oncology. The residency was thus divided into 3 phases with increasing knowledge and responsibilities. The latter, carried out under the status of "junior doctor", created and defined by decree n°2018-571 of July 3, 2018 and the decree of January 16, 2020, is a phase of supervised autonomy of the resident. Radiotherapy is a singular specialty, with multiple and complex activities, and requires multiple skills. A guide defining the status of the "Junior Doctor" in radiation oncology therefore appears necessary, defining each resident's role and obligations. This guide is of an advisory nature and must be adapted to the particularities of each department. This guide aims to help the implementation of the reform of the 3rd cycle in radiation oncology and especially the final year called the consolidation phase. It is destined to evolve, expanded by individual and collective feedback and the constant renewal of our speciality., (Copyright © 2021 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

Aims: Much has been written about the use of the Mental Health Act in psychiatric settings. There is, however, little written on its use to detain patients with mental disorder in general hospitals., Method and Results: We therefore carried out a survey of the use of the Mental Health Act in general hospital settings in Aberdeen, and also posted a questionnaire to Scottish Liaison Psychiatrists, asking about their experience of the use of the Mental Health Act in general hospitals. Over a six-month period in Aberdeen Royal Infirmary, we identified 39 detentions. Out of hours, the use of Emergency Detention Certificates was more common than use of Short Term Detention Certificates - the latter is recommended by the Mental Welfare Commission, as patients are afforded more rights. When psychiatric staff were not directly involved, procedural and administrative errors were more likely to occur. Liaison psychiatrists elsewhere in Scotland reported similar observations., Conclusion: General hospital clinicians are unfamiliar with the Mental Health Act and its use. Errors in its application therefore arise, and are more common when psychiatric staff is not involved. Better education, including the provision of written information and consideration of an electronic system, may improve current practice.

Competing Interests: Competing interests: RA: the NZ perspective is through the lens of unintentional error and does not address other challenges faced by the NZ health system such as inequitable access to healthcare. JC is Bawa Garba’s educational supervisor and has supported her throughout the criminal and regulatory process. He does not work in the Children’s hospital and was not involved in Jack’s clinical care or the UHL Trust investigations. JV was the medical lead in the successful appeal against conviction of David Sellu (FRCS) and a supporter of Bawa-Garba. HK is a frontline NHS consultant who served for over 15 years on the national clinical advisory group for Paediatric Intensive Care Audit, is involved in training for healthcare professionals at multiple levels and has set up groups for the active participation of service users in healthcare development. Her knowledge of this case is through personal contact and mentorship of some of the individuals. She co-wrote a blog used by Team Hadiza to fund raise for an independent legal opinion. AM is an anaesthetist whose research and writing addresses the safety and regulation of healthcare. He chairs the Board of the Health Quality and Safety Commission in New Zealand. He has studied and reported through books, book chapters and papers in peer-reviewed journals on patient safety, human factors in healthcare and legal responses to negligence in healthcare.

Background and Goal: According to § 136a (2) SGB V (volume V of the German Social Security Code) the German legislator instructed the Federal Joint Committee (G-BA) to specify binding minimum standards for the staff needed for the treatment in inpatient psychiatric and psychosomatic facilities. This induced the expert associations/organizations to develop their own conceptional approach as to the future organization of staffing., Method: Organization of regular expert workshops, the results of which were systematically documented and validated by the experts., Results: The essential elements of the concept are: the starting points for the calculation are the needs of all patients treated in the institution. The need for treatment has three dimensions: (a) psychiatric psychotherapeutic/psychosomatic psychotherapeutic/pediatric and adolescent psychiatric-psychotherapeutic, (b) somatic and (c) psychosocial needs. The model developed by the platform distinguishes between staff requirements being directly related to the treatment of the individual patient, staff requirements caused by the treatment setting and such staff requirements arising at an institutional level. Minimum staff requirement is understood as the staff structure which is, among others, needed to guarantee the multiprofessional, physician-led treatment and the required medical care services for all patients specified by the existing guidelines or an expert consensus as well as to ensure the protection of the patient, fellow patients and the employees working in the facility against hazards., Conclusion: This model considers the medical progress within the meaning of the evidence-based guidelines and the modified healthcare practice including sociopolitical standards aimed at the patients' self-determination.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

(1) Background: An analysis of work-related sharp injuries in Healthcare Workers (HCWs) based at a selected hospital in Central Poland by presenting the frequency of accidents, injury rates, and identifying circumstances of Needle Sticks and Sharp Injuries (NSSI) and giving Post-Exposure Procedures (PEP). (2) Methods: A retrospective analysis of medical documentation regarding work-related NSSI at a district hospital located in central Poland; over the period 2010⁻2017. The study group included HCWs who had an accident while on duty. (3) Results: Most injuries were reported by nurses and staff over 40, on the morning shift. The most common injuries were using a needle. The most exposed part of the body were fingers. The average annual injury rates were: 1.22/100 Nurses; 2.02/100 doctors; 1.34/100 hospital beds; and 8.59/100,000 inpatient days. The rates for 3-year periods, after the implementation of legal regulations were higher than before., Conclusion: Injuries rates are more reliable for comparison than frequency. Legislation on the need to register injuries seems to be necessary. In the supervision of work safety of personnel, reliable reporting of all injuries by the respective HCWs plays a key role.

Emeritus Professor Alan Glasper, University of Southampton, dissects the case of paediatrician Dr Hadiza Bawa-Garba and registered nurse Isabel Amaro, and how their convictions might affect the duty of candour legislation.

Background: Undergraduate medical education in Germany takes place in the medical faculties of universities, whereas postgraduate medical education takes place in nearly all hospitals under the aegis of medical associations. Both phases of the medical qualification process live on their own; the communication between the two responsible bodies is negligible. Previous reforms have always tackled undergraduate education only, whereas postgraduate education takes place without public attention., Objective: This position paper discusses the origins and consequences of the complete separation between undergraduate and postgraduate medical education in Germany with regard to responsible bodies, learning objectives, and didactical concepts. On the basis of this critical analysis, proposals are presented to narrow the gap between the two phases., Materials and Methods: This paper is based on several sources: data from historical documents, information retrieved from the internet on educational concepts in other OECD countries as well as intensive discussions among the authors., Results and Discussion: The dissociation between under- and postgraduate education has historical reasons. Over a longer period of time the German Federal States reduced their responsibility for postgraduate education in favor of medical associations. The authors propose steps towards a better integration of both sequences, towards seeing the educational process as a continuum. In such a concept, medical associations would have a greater influence on undergraduate education and - vice versa - medical faculties on the postgraduate phase.

Objectives: The aim of the study has been to analyze the epidemiological data on sharp injuries among health care workers before and after the implementation of regulations related to the conduct of the register of sharp injuries., Material and Methods: We hypothesized that the introduction of legislation would change the existing low reportability of sharp injuries and reporting incidents would increase. In Poland the binding regulations, dating back to 2013, require the employer to keep a record of sharp injuries. Therefore, we compared the data from before and after the entry regulations. Data was collected from the records of occupational exposure/accidents at work in hospitals in the Łódź Province during 2010-2014. The feedback came from 36 hospitals (return index = 51.5%), representing a total annual average of 13 211 medical workers., Results: The incidence of injuries did not change significantly over the period 2010-2014, and the number of reported injuries in 2014 (the year when the Regulation had already been effective) was even lower than in the previous years. The average annual injury index was 12.31 injuries per 1000 employees (95% confidence interval: 11.48-13.16/1000). The incidence of injuries among nurses was significantly higher than in other groups of medical professionals (p < 0.05). These injuries most often occur while using needles (p < 0.05)., Conclusions: The obligation to record occupational exposures set forth in current regulations is not likely to improve the reliability of reporting the incidents actually taking place. Further research should focus on identifying barriers to reporting cases of exposure to potentially infectious material. Action should be taken to raise awareness of medical personnel about the possible effects of exposure to infectious material, in particular, the benefits of the implementation of early post-exposure procedures. Perhaps it will increase the reporting frequency of sharp injuries of medical personnel. Int J Occup Med Environ Health 2018;31(1):37-46., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Background: Surgical training requires exposure to clinical decision-making and operative experience in a supervised environment. It is recognised that learning ability is compromised when fatigued. The European Working Time Directive requires a decrease in working hours, but compliance reduces trainees' clinical exposure, which has profound implications for plastic surgery training. The aim of this study was to evaluate plastic surgery registrars' experience of an EWTD-compliant rota, and to examine its impact on patient care, education, and logbook activity., Methods: An electronic survey was distributed to plastic surgery registrars in a university teaching hospital. Registrars were asked to rate 31 items on a five-point Likert scale, including statements on patient care, clinical and operative duties, training, and quality-of-life. Interquartile deviations explored consensus among responses. Operative caseload was objectively evaluated using eLogbook data to compare activity at equal time points before and after implementation of the EWTD rota., Results: Highest levels of consensus among respondents were found in positive statements addressing alertness and preparation for theatre, as well as time to read and study for exams. Registrars agreed that EWTD compliance improved their quality-of-life. However, it was felt that continuity of patient care was compromised by work hours restriction. Registrars were concerned about their operative experience. eLogbook data confirmed a fall-off in mean caseload of 31.8% compared to activity prior to EWTD rota implementation., Conclusion: While EWTD compliant rotas promote trainee quality-of-life and satisfaction with training, attention needs to be paid to optimising operative opportunities.

Although several studies described the experience of doctors in their first postgraduate years, few shed the light on the ethical issues encountered by them. These doctors face a broad range of 'everyday' ethical challenges, from breach of confidentiality to truth-telling or improper informed consent. The daily ethical issues faced by junior doctors are not as dramatic as the major issues learned at medical school. Junior doctors have to make the best ethical decisions within the time limits available. Undergraduate medical ethics curricula should give priority to the real-life issues that doctors will face in their first years of practice., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objectives: To describe the characteristics of top-rated Internal Medicine attendings and whether they changed after implementation of the 2004 work-hour restrictions., Methods: Mixed methods study of resident ratings of medicine attendings (Period 1: 1994-1996, n = 250 and Period 2: 2007-2009, n = 152). Residents evaluated 17 attending characteristics. The top 25% of "overall" ratings were classified as "highly rated." Two free-text questions included "What was your attending's best characteristic?" and "How could your attending best improve?" and were coded in duplicate, using grounded qualitative methods., Results: There were no differences in the characteristics of highly rated attendings in the two time periods. Characteristics associated with being a top-rated attending included enthusiasm (odds ratio [OR]: 5.69, 2.78-11.67), balanced teaching style (OR: 3.63, 1.64-8.02), promoting independent thinking (OR: 2.90, 0.96-8.74), fund of knowledge (OR: 2.73, 1.13-6.58), and time management (OR: 1.78, 1.14-2.80). Among the 1,410 utterances, valued attending attributes included helpfulness, promoting independent thinking, and having strong medical knowledge., Conclusions: The characteristics valued by residents in attendings did not change over time despite a major structural change in work hours and patterns of teaching. These valued characteristics continue to be a strong general fund of knowledge, enthusiasm for teaching, and balance between didactic and bedside approaches., (Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.)

The Mexican Medical Movement from 1964-1965 constitutes an important event from the rising urban middle-class, besides it was the first time medical doctors claimed for fair working conditions. The background of this movement is the so-called Crisis of 1958, which included the Movements from the educators union, oil workers union, telegraph workers union and the railroad workers union. The conflict began because interns and residents from the "Hospital 20 de Noviembre" would not get a payment at the end of the year, so on November 26th, 1964, the movement started. The Asociación Mexicana de Médicos Residentes e Internos (AMMRI) was created and their demands were the following: 1) Full working site restitution without retaliations, 2) Legal examination of the scholarship-contract terms, in order to get annual, renewable and progressive contracts, and a fixed salary with the usual working-hours and characteristics of each institution, 3) To have preference to get an adscription at the hospital where the resident studied, 4) Active participation from the resident in the elaboration of the academic plans, and 5) Resolution of each hospital's problems. This movement had social impact for Mexico's contemporary life, nevertheless some of the demands are still unchanged among medical residents.