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\" All democracies have had to contend with the challenge of tolerating hidden spy services within otherwise relatively transparent governments. Democracies pride themselves on privacy and liberty, but intelligence organizations have secret budgets, gather information surreptitiously around the world, and plan covert action against foreign regimes. Sometimes, they have even targeted the very citizens they were established to protect, as with the COINTELPRO operations in the 1960s and 1970s, carried out by the Federal Bureau of Investigation (FBI) against civil rights and antiwar activists. In this sense, democracy and intelligence have always been a poor match. Yet Americans live in an uncertain and threatening world filled with nuclear warheads, chemical and biological weapons, and terrorists intent on destruction. Without an intelligence apparatus scanning the globe to alert the United States to these threats, the planet would be an even more perilous place. In Spy Watching, Loch K. Johnson explores the United States' travails in its efforts to maintain effective accountability over its spy services. Johnson explores the work of the famous Church Committee, a Senate panel that investigated America's espionage organizations in 1975 and established new protocol for supervising the Central Intelligence Agency (CIA) and the nation's other sixteen secret services. Johnson explores why partisanship has crept into once-neutral intelligence operations, the effect of the 9/11 attacks on the expansion of spying, and the controversies related to CIA rendition and torture programs. He also discusses both the Edward Snowden case and the ongoing investigations into the Russian hack of the 2016 US election. Above all, Spy Watching seeks to find a sensible balance between the twin imperatives in a democracy of liberty and security. Johnson draws on scores of interviews with Directors of Central Intelligence and others in America's secret agencies, making this a uniquely authoritative account. \"-- Provided by publisher.

Research summary: We examine the influence of CEOs' military background on financial misconduct using two distinctive datasets. First, we make use of accounting and auditing enforcement releases (AAER) issued by the U.S. Securities and Exchange Commission (SEC), which contain intentional and substantial cases of financial fraud. Second, we use a dataset of \"lucky grants,\" which provide a measure of the likelihood of grant dates of CEOs' stock options having been manipulated. Results for both datasets indicate that CEOs who served in the military are less inclined to be involved in fraudulent financial reporting and to backdate stock options. In addition, we find that these relationships are moderated by board oversight (CEO duality and independent directors in the board). Managerial summary: CEOs who formerly served in the U.S. military are prevalent among U.S. firms. The military puts strong emphasis on the obedience of its personnel. In this study, we test if time spent in the military leads individuals to be more obedient to rules and regulations in the years after they have left the military and become CEOs. Our findings strongly suggest that CEOs who served in the U.S. military are less likely to be involved in financial misconduct. We also find evidence that tougher board oversight strengthens this relationship. Our findings have implications for regulators, auditors, practitioners, and researchers who are interested in determinants of and mechanisms to prevent fraud and stock option backdating.

An essential responsibility of the U.S. Congress is holding the president accountable for the conduct of foreign policy. In this in-depth look at formal oversight hearings by the Senate Armed Services and Foreign Relations committees, Linda Fowler evaluates how the legislature's most visible and important watchdogs performed from the mid-twentieth century to the present. She finds a noticeable reduction in public and secret hearings since the mid-1990s and establishes that American foreign policy frequently violated basic conditions for democratic accountability. Committee scrutiny of the wars in Iraq and Afghanistan, she notes, fell below levels of oversight in prior major conflicts. Fowler attributes the drop in watchdog activity to growing disinterest among senators in committee work, biases among members who join the Armed Services and Foreign Relations committees, and motives that shield presidents, particularly Republicans, from public inquiry. Her detailed case studies of the Truman Doctrine, Vietnam War, Panama Canal Treaty, humanitarian mission in Somalia, and Iraq War illustrate the importance of oversight in generating the information citizens need to judge the president's national security policies. She argues for a reassessment of congressional war powers and proposes reforms to encourage Senate watchdogs to improve public deliberation about decisions of war and peace. Watchdogs on the Hillinvestigates America's national security oversight and its critical place in the review of congressional and presidential powers in foreign policy.

ObjectivesCivility relates to politeness while showing respect to those around us. Incivility therefore implies unsociable speech or behaviour. In the context of civility in hospitals, this means treating colleagues with the respect needed to ensure effective teamwork for excellent patient care. Civility Saves Lives campaigns have illustrated the detrimental behaviour that incivility can have in the workplace, and frameworks exist to combat this to ensure employee protection. This project aims to identify the current state of civility among paediatric departments to identify areas for improvement and highlight if this impacts patient care.MethodsAn anonymous 30-question survey was created to determine feelings of incivility and sent to medical trainees who had worked within general paediatrics at Noah’s Ark Children’s Hospital (Cardiff, Wales) within the last 3 years. The survey was designed to allow respondents to candidly discuss experiences they had when contacting paediatric departments and if they faced incivility. Using Likert scales, the questionnaire assessed concerns about contacting departments, if staff felt personally victimised and whether this was due to protected characteristics. Trainees were asked if they had or would deviate from normal practice due to concerns and were able to provide evidence using free text.ResultsThe survey was sent to 240 junior doctors who worked at Noah’s Ark for general or speciality paediatrics between 2020–2023 via email. 49 completed the survey (response rate 20.4%). 49% stated they felt personally victimised, with 3 feeling this was due to protected characteristics (2 gender, 1 ethnicity). 32.7% believed feelings about contacting a department have influenced their patient care, and 95.9% agreed care could be improved between departments. Department A caused the most concern, with 34 (69.4%) stating they were concerned (29 (59.2%)), or very concerned (5 (10.2%)) about discussing a patient, with 17 (34.7%) stating this changed patient management. In free text, examples included ‘avoidance’ and ‘delaying contacting’. Other departments, such as B, however, had 0 respondents who were concerned, and 100% hadn’t changed practice.ConclusionA significant number of staff flagged that incivility exists within paediatric departments and that patient care could be improved by improving civility. Several expressed apprehensions about contacting others, most concerningly, 3 feel this is based on protective characteristics. The next step is to approach departments with results and provide opportunities for training to minimise incivility to create a better working atmosphere and safer patient care.

ObjectivesThe paediatric foundation doctor taster scheme based in South Wales was established in 2021. The scheme, which allows participants to experience paediatrics and improves paediatric specialty exposure, has now extended to three healthboards. Doctors select from a 2 or 5 day experience in general paediatrics plus specialities including neonates, cardiology, community paediatrics or palliative care.MethodsThe scheme is managed by a nominated paediatric trainee-led foundation liaison team. Participants contact the liaison team by e-mail expressing interest and avaliability, a taster programme is allocated, and departments are contacted. Questionnaires are sent pre and post taster to capture participant feelings about a career in paediatrics and any previous exposure to paediatrics. A certificate is generated for the foundation doctor and signposting given about mentorship and career guidance. 6–12 months after the scheme participants are contacted and sent an anonymous follow-up questionnaire to capture their onward career decisions.Results23 doctors have taken part since 2021 with a further 8 doctors with tasters planned by December 2023. Majority are foundation year one doctors, and 53% have or will have a paediatric job in their foundation training. Pre taster: the average likelihood of participants to pursue a paediatric career was 6.8/10. After the scheme, this increased to 8.3/10 with an average rating of 9/10 for enjoyment. 78% participants said the scheme has influenced their decision to pursue paediatrics. Participants commended the scheme for its organisation, ease and welcoming nature. 8 doctors responded to the follow-up survey with 2 doctors still in the foundation training. 1 doctor has entered paediatric training and 5 doctors are taking a non-training FY3 year. 62.5% of those who responded were planning to apply for paediatric training.ConclusionThis scheme is an example of a successful, trainee-led initiative which is receiving overwhelming positive feedback. By the end of 2023, we anticipate having over 30 doctors having taken part in the scheme across 3 sites and a variety of specialities.A formal taster scheme encourages junior doctors to consider career options in a structured way and to work directly with role models. It is not yet evidenced whether the scheme has directly impacted on uptake of paediatric training due to the increasing prevelance of foundation year 3 years, but we believe this scheme is transferrable to healthboards across the UK and should be introduced nationwide.

ObjectivesRCPCH Trainee Charter recommends at least 8 hours a month for ST1–3 Postgraduate doctor in training (PGDiT) pro rata for Less Than Full Time (LTFT) PGDiT for Supporting Professional Activity (SPA).1 This has been difficult to implement in Yorkshire and Humber deanery due to staffing concerns and its absence in the Junior Doctor contract. In an audit in the deanery, less than 28% of trainees responded yes to having at least 4 hours per month for SPA.The General paediatrics Tier 1 rota at the tertiary hospital Hull Royal Infirmary (HRI) comprises 11 persons and does not provide SPA time, leaving Lower Specialty Trainee, LST, with personal development time.This abstract aims to demonstrate that with adequate planning, there can be dedicated SPA time allocation in the rota for paediatric PGDIT and that using this model, Paediatric LST can have more exposure to clinics. This will also increase the conversation around trainee-led rota planning.MethodsAn LST was assigned to manage the tier 1 rota between May-August 2023. They identified dates for SPA time and clinics. This data was collated and analysed retrospectively.ResultsFigure 1 Chart Showing SPA hours per Postgraduate Doctor In Training (PGDiT) (PGDiT got an equivalent amount of time for the clinic).A whole day was allocated per person for SPA time and clinic with a plan to attend clinic half of the day. All the Tier 1 got an average of at least 4 hours of SPA time per month. However, the graph above is focused on the Paediatric PGDIT. An added benefit was four clinic hours per month, improving training exposure. Teaching days and leaves were taken into consideration and impacted SPA allocations.Abstract 6494 Figure 1Chart showing SPA hours per postgraduate doctor in training (PGDiT) (PGDiT got an equivalent amount of time for the clinic)ConclusionWith good planning, collaboration with the rota team and support from the college tutor, it is possible to implement SPA time as well as improve clinic attendance. PGDiT must adopt the excellent practice of requesting annual and study leaves at least six weeks in advance to enable planning.There is an ongoing effort to trial this in other regional Trusts. There is a need for further work to focus on increasing SPA time to a minimum of 8 hours per month for LST as per RCPCH recommendation.Trainee-led rotering can lead to an improvement in the training experience, and trainees value getting more outpatient clinic time as per feedback received.ReferenceTrainee Charter by RCPCH available at https://www.rcpch.ac.uk/resources/trainee-charter