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"ABSTRACTPurpose To evaluate the status of surgical training in Japan through a national level needs assessment. Methods A survey was sent to all 909 graduating residents (GRs) and their 611 program directors (PDs) for the year 2016. A working group of surgical educators from around the country was formed under the education committee of the Japan Surgical Society. The survey items were developed by consensus of this working group. The survey investigated the knowledge and problems of the current curriculum, and the status of the current residency training.ResultsThe response rates were 56,3% of the GRs and 76,8% of the PDs. Among the participants, 47,6% of the GRs and 29,4% of the PDs believed that the residency curriculum did not match the clinical experience. Over 80% of the GRs and PDs agreed on the importance of training outside of the OR, whereas only 13% of the GRs had received such training regularly. Trainees also reported a lower satisfaction rate about the opportunity to train outside of the OR.ConclusionThis national level needs assessment of surgical training in Japan identified several gaps in the curriculum. These results provide valuable data to assist the ongoing efforts for surgical residency curriculum improvement."

"Pendahuluan: Derajat supervisi yang tepat tidak hanya mendorong pencapaian kompetensi peserta didik namun juga menjamin pelayanan kesehatan yang aman dan berkualitas. Namun demikian, hingga saat ini masih ditemukan berbagai kendala dalam penerapannya. Penelitian ini bertujuan memperoleh pemahaman mendalam mengenai kebutuhan, kondisi dan tantangan yang dihadapi terkait pentahapan kompetensi dan supervisi dalam pendidikan profesi dokter spesialis, sebagai masukan dalam pengembangan kurikulum. Metode: Penelitian dijalankan menggunakan desain kualitatif dengan pendekatan fenomenologi untuk mempelajari secara mendalam pentahapan kompetensi dan kewenangan sebagai suatu fenomena berdasarkan pengalaman pihak-pihak yang terlibat secara langsung dalam pendidikan profesi dokter spesialis. Peneliti menggunakan metode pengumpulan data berupa wawancara semi-terstruktur dan focus group discussion untuk mendalami pandangan stakeholder, pengelola, pelaksana pendidikan dan peserta didik mengenai konsep kompetensi, kewenangan dan pentahapan, kebutuhan akan pentahapan kompetensi dan kewenangan, faktor-faktor yang mempengaruhi, pola implementasi, masalah dan tantangan yang dihadapi dalam implementasi, serta bentuk implementasi yang diharapkan. Hasil: Telah dilakukan wawancara dan FGD terhadap 26 narasumber, yang mewakili pihak fakultas, pengelola program studi, staf dan peserta didik dari kelompok keilmuan surgikal, medikal dan penunjang. Pandangan mengenai kompetensi erat kaitannya dengan sistem pentahapan, pemberian kewenangan dan supervisi yang dilakukan. Faktor penentu keberhasilan implementasi meliputi perumusan kompetensi dan unit kewenangan yang jelas, dukungan staf, sistem evaluasi yang valid dan terpercaya, serta sudut pandang yang integratif. Sistem asesmen konvensional masih belum memadai sebagai sumber informasi pengambilan keputusan terkait pentahapan dan supervisi. Beban kerja yang tinggi, khususnya administratif, disadari sebagai tantangan terbesar dalam penerapan supervisi yang efektif pada saat ini. Kemandirian disadari sebagai unsur penting dalam pencapaian kompetensi peserta didik, tingkat kemandirian dalam pendidikan perlu disesuaikan dengan regulasi dan sistem pelayanan kesehatan saat ini. Kesimpulan: Sistem supervisi yang lebih baik dibutuhkan untuk menyeimbangkan antara keselamatan pasien dengan kebutuhan pencapaian kompetensi selaras dengan sistem pendidikan di universitas dan regulasi rumah sakit.

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Introduction: Proper supervision not only promotes the competency development of residents but also the delivery of safe medical care. However, challenges have frequently been identified in its implementation. In this study we attempted to explore the needs, patterns and challenges in the implementation of competency leveling, as inputs for future curriculum development. Methods: This is a qualitative study with phenomenological approach to explore in depth the issue of competency levels and supervision as a phenomenon from the perspectives of the parties directly involved in residency training. Through semi-structured interviews and focus group discussions, we explored the view on the concept of competencies, supervision and leveling; the expressed needs regarding supervision and leveling; factors affecting implementation patters; challenges in its implementation; and the ideal form according to the perspectives of the parties involved. Results: Through interview and FGD with 26 respondents representing the faculty, program directors, staffs and residents from surgical, medical and diagnostic disciplines, we identified that the concept of competencies were closely related to how training programs implement their system of leveling and supervision. Success factors included properly defined competencies and units of supervision, support from staff members, availability of valid and reliable system of assessment, and an integrative view of the system. Conventional assessment methods were inadequate in supporting entrustment decision making. Excessive workload, mainly administrative, were identified as the biggest challenge in implementing effective supervision. Independence was identified as an important part in the development of resident's competence, but the most appropriate system which incorporates demands from regulations and existing healthcare system still needs to be developed. Conclusion: Further curriculum development will need to find the best fit between the current university-based course organization and the unique needs of competency based postgraduate medical education with its characteristics as a workplace-based training."

"Biomaterials for surgical operation offers a review of the latest advances made in developing bioabsorbable devices for surgical operations which include surgical adhesives (sealants), barriers for the prevention of tissue adhesion, polymers for fractured bone fixation, growth factors for the promotion of wound healing, and sutures. Over the years, many descriptions of biomaterials have appeared in academic journals and books, but most of them have been devoted to limited clinical areas. This is in marked contrast with this volume which covers a wide range of bioabsorbable devices used in surgery from a practical point of view. The currently applied polymeric devices are critical in surgery, but all involve serious problems due to their poor performance. For instance, fibrin glue, the most widely used surgical sealant, can produce only a weak gel with low adhesive strength to tissues, accentuating the limited effectiveness of current treatment options. Likewise, the currently available barrier membranes cannot fully prevent tissue adhesion at the acceptable level and are, moreover, not easy to handle with endoscopes due to their poor mechanical properties"