On July 1, 2003, work-hour reforms were enacted nationally for the roughly 129,000 resident physicians in the United States. The reforms limit weekly work hours (a maximum of eighty per week) and in-hospital call (no more than once every three nights), mandate days free of clinical and educational obligations (one day in seven), and regulate other aspects of resident work life. Why Surgeons Struggle with Work-Hour Reforms focuses on general surgeons, a historically long-hour specialty, who fiercely opposed the reforms and are among the least compliant. Why do surgeons struggle with the reforms? Why do they continue to work long hours and view the act of doing so as reasonable if not quintessentially professional? Although the analysis is situated in the growing scientific literature on the consequences of fatigue, the authors do not adjudicate between the claims of surgeons and reform advocates about the effects of long work hours on patient or provider safety. Rather, the aim is to explore and explain how aspects of the occupational culture of surgeons and the social organization of surgical training and practice interlock to impede the reforms.

An analysis of American surgical residents and their attendings working in the face of restrictions on resident work hours

In 2003, in the face of errors and accidents caused by medical and surgical trainees, the American Council of Graduate Medical Education mandated a reduction in resident work hours to eighty per week. Over the course of two and a half years spent observing residents and staff surgeons trying to implement this new regulation, Katherine C. Kellogg discovered that resistance to it was both strong and successful—in fact, two of the three hospitals she studied failed to make the change. Challenging Operations takes up the apparent paradox of medical professionals resisting reforms designed to help them and their patients. Through vivid anecdotes, interviews, and incisive observation and analysis, Kellogg shows the complex ways that institutional reforms spark resistance when they challenge long-standing beliefs, roles, and systems of authority. At a time when numerous policies have been enacted to address the nation’s soaring medical costs, uneven access to care, and shortage of primary-care physicians, Challenging Operations sheds new light on the difficulty of implementing reforms and offers concrete recommendations for effectively meeting that challenge.

The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and patient safety. Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education. These core competencies include patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics. This book recommends a mix of approaches to health education improvement, including those related to oversight processes, the training environment, research, public reporting, and leadership. Educators, administrators, and health professionals can use this book to help achieve an approach to education that better prepares clinicians to meet both the needs of patients and the requirements of a changing health care system.

Mismanaged by local authority, in the 19th-century, Dublin lacked sufficient industrial development to provide adequate employment. Dublin's charitable workers attempted to improve the lives of the thousands who flocked to the city in search of relief. As a means to examining the hidden incentives of charity, the author offers a discussion of the language of charity in this setting. She notes how contemporary notions of race, class, and religion influenced how Ireland's philanthropists thought of and related to the poor. While much has been written on the perceived racial inferiority of the Celt as compared to the Anglo-Saxon, Preston suggests that the Irish upper classes, in seeking to gain equal footing with the British elite, adopted the same language to describe the poor. Intense sectarian strife marred Irish charities and undermined the smooth operation of social services. Preston offers insight by focusing on two women philanthropists who battled for the souls of Ireland's children. She also explores those who remained above the fray, such as the Religious Society of Friends in Ireland, who offered aid to all regardless of creed. Within the charitable records of this group, Preston contends that one can see how the Society changed over time and that, in Ireland, the industrial revolution as well as the 1798 Rebellion, contributed to the Society adapting to the mainstream. Finally, the women of charity helped to establish a modern nursing system for Ireland, and this work details their efforts at turning nursing into a respectable profession for women.

Scotland offers almost unique opportunities for medical historians. For a conventional history, there is a rich stock of famous doctors and their discoveries. There are also the contributions of four ancient universities and three equally old colleges of physicians and surgeons. For historians of public health there is the famous struggle against the problems of the industrial revolution and the lives and works of the great sanitary reformers in Glasgow and Edinburgh. For the social historian there are equal opportunities in the diversity of the health care in the Highlands and Lowlands, the rich traditions of Scottish folk medicine and the interactions of Scottish and English medical practice. Much else can be learnt in relating Scotland's great innovative periods to her cultural and political state at the time. It is perhaps surprising therefore that there are no up-to-date accounts of any of these aspects of health and health care in Scotland. . . . there are now many new sources available and new questions to be asked. -from the Introduction In this book, author David Hamilton explores new sources and evaluates the rich history of medicinal practices in Scotland. Thus, for historians both of medicine and of Scotland, this study is necessary to more fully understand the country's history.

Patient-centered, high-quality health care relies on the well-being, health, and safety of health care clinicians. However, alarmingly high rates of clinician burnout in the United States are detrimental to the quality of care being provided, harmful to individuals in the workforce, and costly. It is important to take a systemic approach to address burnout that focuses on the structure, organization, and culture of health care. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being builds upon two groundbreaking reports from the past twenty years, To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, which both called attention to the issues around patient safety and quality of care. This report explores the extent, consequences, and contributing factors of clinician burnout and provides a framework for a systems approach to clinician burnout and professional well-being, a research agenda to advance clinician well-being, and recommendations for the field.

A manifesto for a new, democratic left: a political programme poised to transform Europe Since 2011, Pablo Iglesias has led Podemos, a new radical left party in Spain that is reframing the nature of modern politics. Under his guidance, the party has unmasked the ideological motives behind European austerity, revealing the true nature of this power grab conducted on behalf of elites intent on dismantling the welfare state. Here, Iglesias delineates his political vision. He skewers not only the Spanish establishment, but also the anti-democratic bloc comprising the Troika, corporate interests, and the “Wall Street Party.” Politics in a Time of Crisis—which includes an in-depth interview with Iglesias—is an incisive examination of the current situation in Europe as well as a stirring call for international resistance.

Looking for the first time at the cut-price anatomy schools rather than genteel Oxbridge, Desmond winkles out pre-Darwinian evolutionary ideas in reform-minded and politically charged early nineteenth-century London. In the process, he reveals the underside of London intellectual and social life in the generation before Darwin as it has never been seen before. "The Politics of Evolution is intellectual dynamite, and certainly one of the most important books in the history of science published during the past decade."—Jim Secord, Times Literary Supplement "One of those rare books that not only stakes out new territory but demands a radical overhaul of conventional wisdom."—John Hedley Brooke, Times Higher Education Supplement