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Essay: Neil Singh On a wing and a prayer: surgeons learning from the aviation industry J R Soc Med 2009; 102: 360-364 [Full text] [PDF]

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Comparisons with the past

Mark R Savage   (2 October 2009)

Surgeons and Safety

William G Notcutt   (2 October 2009)

D. Warren and the black box.

J. Clifford Jones, University of Aberdeen.   (22 September 2009)

Comparisons with the past 2 October 2009
Mark R Savage, Doctor - Emergency Medicine Send letter to journal: Re: Comparisons with the past savagehaus{at}gmail.com Mark R Savage	A very interesting article. I am interested by the potential lessons medicine can learn about safety and teamwork from aviation. In this time of EWTD angst, I am also interested in the debates regarding hours of experience and quality of consultant at the other end. One thing that stands out to me is that we have, as far as I am aware, no scientific evidence regarding the training of the past, to which so many refer currently. Doctors worked many hours and performed much more surgery, but it is not simply a matter of number of hours, rather what happens during those hours. There is no substitute for clinical experience, yet one must be able to learn properly from that experience. Hospitals are, I am informed, busier now than in the past, with sicker patients. Surgeons specialise much more than previously. Upper GI, lower GI, Vascular etc., etc. I wonder if the actual range of operations performed now by a trainee is less, and therefore experience is more concentrated than before? The opposite problem occurs In my specialty. Patient attendances have risen dramatically since the earliest casualty departments. So, whilst I may work less hours than previously, the chances may be that I am seeing a similar number of patients. With this, though, comes less opportunity to follow- up patients and learn from a case, particularly with the four-hour limit. EWTD/MMC are here for the forseeable. It is up to the medical profession to seize the initiative in making sure that training is relevant and provides sufficient experience at the same time as optimising the outcomes for patients.
Surgeons and Safety 2 October 2009
William G Notcutt, Anaesthetist James Paget University Hospital, Great Yarmouth NR31 6LA Send letter to journal: Re: Surgeons and Safety willy{at}tucton.demon.co.uk William G Notcutt	So surgeons are looking to the Airline Industry now for guidance on safety. What a pity they don't glance over the screen at the top of the operating table to the Anaesthetist. We have been doing "Cockpit Drills" for 30 years or more. The parallels between the processes of flying and anaesthesia are closer than with surgery. Over the years I have observed that Anaesthetists in general spend far more time than the surgeon in undertaking pre- assessment, both of the patient and of the work environment. How long have I waited in theatre for the X-Rays or a favoured surgical tool to be found, which a little forethought would have made available when needed. Learn about preparation by all means but don't bother to go to the hangar, ask on the other side of the screen.
D. Warren and the black box. 22 September 2009
J. Clifford Jones, Reader School of Engineering, University of Aberdeen. Send letter to journal: Re: D. Warren and the black box. j.c.jones{at}eng.abdn.ac.uk J. Clifford Jones, et al.	I was almost galvanised when I saw the reference to Dr. Dave Warren in the article by N. Singh in the September issue of JRSM. This is because over the period 1979-1990 I knew him well, and was an occasional visitor to his home in the Melbourne suburb of Glenhuntly. The association was through the Australian Section of the Combustion Institute. I have spent time with Dave Warren in three countries: Australia (as noted), the USA and New Zealand. Our most recent encounter was in 1990, at a Combustion Institute function at the University of Sydney. I do not want to say very much about his invention of the black box beyond that an article about it appeared in the Melbourne daily newspaper (‘The Age’) in about 1985 which at the time attracted interest and comment. There has been much said and written about this matter since. Dave is, as Singh has pointed out, a chemist. Having graduated from the University if Sydney at about the time of the end of WW2 he travelled to England to do a PhD at Imperial College under the supervision of Sir Alfred Egerton. On his return to Australia he worked at the Aeronautical Research Laboratories in Melbourne. A major undertaking there was development of a gas turbine for use with locally mined low-rank coal. His training as a chemist would have suited him to such a project. I do not know the circumstances which led to his involvement with the black box. I might be permitted to slip in a personal anecdote here. Dave always drove a Morris Minor and, when he lived in Melbourne, would be in possession of several at any one time. In early 2006 I was driving a hired car in rural Victoria when I observed that the car in front of me was a very well preserved Morris Minor. Let it be noted that the most recent Morris Minors in Australia are well over 40 years old by now, so the only ones left are those belonging to enthusiasts. Recalling having heard that Dave had moved to ‘the country’ from Melbourne I felt almost sure that he must be at the wheel of the car I was following, and overtook it in an attempt to attract his attention and signal him to stop so that I could identify myself as his erstwhile associate in the Combustion Institute. In fact the Minor was not being driven by Dave. I did however reason that over the decades of its existence it had probably passed through Dave’s hands at some stage! J.C. Jones DSc FIChemE FRSC MAIChE, Fellow RSM. School of Engineering, University of Aberdeen.