Basic Specialist Training Research Articles

An exploratory study of obstetrics trainees' experiences of breaking bad news.

Breaking bad news is one of the hardest tasks performed by doctors. The news can significantly impact on the patient's life; however, the process also generates stress for the doctor. The aim of this study was to explore the lived experiences of breaking bad news for obstetrics trainees in Ireland. A qualitative study using interpretative phenomenological analysis (IPA) was performed to capture the experience of breaking bad news for the trainees. Semi-structured interviews were conducted with trainees over Zoom. The transcripts were analysed in line with the IPA framework with the assistance of NVivo software. Seven trainees were interviewed, five at Basic Specialist Training (BST) level and two at Higher Specialist Training (HST) level. Four superordinate themes were identified from the analysis: "the reality of working in obstetrics," "the role of the doctor," "development of communication skills" and "the importance of the patient experience." The trainees described breaking bad news in a variety of clinical contexts. This task could be emotionally draining; however, only two trainees mentioned ways of coping with this. Their formal training was limited with the majority of learning occurring "on the job." This study provides an insight into factors that influence trainees experiences of breaking bad news. The results complemented existing literature and raised questions about how to better support trainees through increased training and psychological support.

Perspectives of psychiatric trainees and examiners on the assessment of communication skills during an online clinical examination: a qualitative study.

Effective doctor-patient communication is a core competency for healthcare professionals. With the pivot to online clinical education and assessment due to the COVID-19 pandemic, there was a need to explore the views of psychiatric trainees and examiners on assessment of communication skills during online high stakes postgraduate examinations. The study was designed as descriptive qualitative research. All candidates and examiners of the September and November 2020 sitting of online Basic Specialist Training exam (a clinical Objective Structured Clinical Examination exam completed in the first 4 years of psychiatry training) were invited to participate. The respondents were interviewed by Zoom which was transcribed verbatim. Data were analyzed by NVivo20 pro and various themes and subthemes were drawn using Braun and Clarke thematic analysis. A total of seven candidates and seven examiners were interviewed with an average duration of 30 minutes and 25 minutes, respectively. Four main themes emerged: Communication, Screen optimization, Continuation postpandemic and Overall experience. All candidates preferred to continue an online format post pandemic for practical reasons e.g., avoiding travel and overnight stay, while all examiners preferred to go back to in-person Objective Structured Clinical Examination. However, continuation of online Clinical Formulation and Management Examination was agreed by both groups. The participants were largely satisfied with the online examination but did not consider it equal to face-to-face for picking up nonverbal cues. Overall minimal technical issues were reported. These findings may be helpful to modify current psychiatry membership examinations or similar assessments in other countries and specialties.

The retention of training doctors in the Irish health system

BackgroundThere is limited quantitative evidence on the migration patterns of training doctors in Ireland. The aim of this study is to estimate the number of trainee doctors leaving the Irish health system and the numbers returning.MethodsThis study uses administrative data to track the migration patterns of Irish trained doctors at various career stages.ResultsEighty-four percent of interns who commenced intern training in 2015 subsequently commenced a basic specialist training (BST) or general practice (GP) training programme in subsequent years (2016–2021). Of those who completed BST training in 2017, 75% went on to higher specialist training (HST) in Ireland. In 2021, of the 2016 cohort of doctors awarded Certificates of Satisfactory Completion of Specialist Training (CSCST), 68% are employed in Ireland and 32% are abroad or unknown. Of the 2016 group that are abroad, the UK is the main country of practice. There are variations in the retention rate across disciplines; from the 2016 cohort, 52% of anaesthesiology CSCSTs were working in Ireland in 2021 compared to 88% of psychiatry CSCSTs.ConclusionPrevious research has highlighted Irish doctor’s intentions to migrate and intentions to return to Ireland. This study documents for the first time the extent to which Irish doctors are leaving and returning to the Irish health system from 2015 to 2021. The paper also gives a picture of variations across medical disciplines and the location of emigration of qualified specialists.

Welfare practices for anaesthesiology trainees in Europe: A descriptive cross-sectional survey study.

Current regulations of anaesthesiology training programmes may affect gender equity, female representation and leadership. To describe the work regulations of anaesthesiology training programs and working conditions during the early period of child-rearing in European countries. Cross-sectional survey. National Anesthesiologists Societies Committee (NASC) representatives of the European Society of Anesthesiology and Intensive Care. Thirty-eight NASC representatives. Basic specialist training working conditions, gender-related data, return to work after childbirth and workplace policies against discrimination during anaesthesiology specialist training. A 48-item questionnaire to explore the work patterns and conditions for trainees especially for new parents, professional development opportunities and work discrimination regulations in each representative country was distributed to NASC representatives of 44 European countries. We collected the replies of each representative (38 representatives from 44 invited countries' representatives, 86% response rate). The median [IQR] proportion of female trainees was 60% [50 to 68]. There were no reported pay differences between sexes. In eight European countries, pregnant trainees worked fewer hours and were excused from night shifts. Women could not be laid off during pregnancy in all 38 countries (100%). The countries offered a median of 18 weeks of paid (total or partial) maternity leave (range, 13 to 60 weeks). Most countries (89%) accommodate paid paternity leaves. A significant proportion of parental leave was unpaid ( n =18, 42%). Twenty-one (55%) countries allowed part-time work after delivery. The UK was the only country with clear recommendations to formally complain after harassment. European countries have a wide variety of regulations. On paper, numerous countries have various paid maternal, paternal and parental leave; however, it remains to be determined if such leave takes place in practice. The practical consequences of these regulations on female trainees during the child-rearing period need to be explored further. None.

Perspectives of trainees and examiners on communication skills assessment during online postgraduate psychiatry examination in Ireland

IntroductionCovid-19 pandemic caused a pivot to online clinical education and assessment across the globe.ObjectivesTo explore the views of psychiatric trainees and examiners on assessment of communication skills during online high stakes postgraduate examination.MethodsThis study was designed as interpretive descriptive qualitative research. All candidates and examiners of the online Irish Basic Specialist Training exam in September and November 2020 were included. The respondents were interviewed by Zoom which were transcribed verbatim. Data was coded using NVivo20 pro and Braun and Clarke thematic analysis was used to draw various themes and subthemes.ResultsA total of seven candidates and seven examiners from different training deaneries and specialties were interviewed with average duration of 29m 45s and 24m 20s respectively. The participants were largely satisfied with the online examination but did not consider it equal to face-to-face for picking nonverbal cues. The candidates were very conscious of eye contact while examiners placed more emphasis on overall professional behavior and patient engagement. All candidates preferred to continue online format post pandemic for practical reasons e.g., avoiding travel and overnight stay, while all examiners preferred to go back to in-person Objective Structured Clinical Examination due to some limitations in assessing physical and cognitive examination. However, continuation of online Clinical Formulation and Management Examination was agreed by both groups.ConclusionsThe results of the study have shown different insights of two important stakeholders in a professional postgraduate psychiatry examination which can be useful to improve same exam and design similar assessments in other settings.DisclosureNo significant relationships.

Changes in operative experience after the introduction of residency: an objective comparison of surgical and endoscopic volumes.

The SingHealth Residency General Surgery Programme replaced the basic and advanced specialist training (AST) system in Singapore in 2010. The relative merits of both systems continue to be debated, especially the operational readiness of graduating residents. We set out to compare the operative and endoscopic volumes of graduates from the AST system with those from the first graduating batch of the residency programme during their registrar (or equivalent) years, as a reflection of procedural experience gained during traineeship. Operative and endoscopic records of four graduating residents and seven AST system trainees were extracted from the cluster-wide Operating Theatre Management system and compared. Surgeries were analysed as registrar-level operations and their corresponding subspecialties. Registrars and senior residents performed a mean of 1,182 and 533 general surgical operations, respectively. Median percentage loss in operative volume was 50.6% (range 9.6%-75.5%). The mean number of total gastroscopies and colonoscopies performed by registrars (total gastroscopy, n = 819; total colonoscopy, n = 743) and senior residents (total gastroscopy, n = 376; total colonoscopy, n = 412) indicated a mean loss of 54.1% and 44.6%, respectively, in gastroscopic and colonoscopic experience. The residency programme aims to provide robust and complete surgical training. The operational readiness of its graduates is often scrutinised against that from the old system. Although a significant difference in surgical and endoscopic volumes was observed between the two trainee groups, this is only one marker of surgical experience and technical competence.

What influences postgraduate psychiatric trainees' attitudes to clinical audit?

Clinical audit is an important component of safe and ethical practice but many clinicians cite barriers to engagement in audit. A total of 81 basic specialist trainees in psychiatry were surveyed in terms of their basic demographic details and their knowledge, direct experience and attitudes in relation to clinical audit. Among the 49 (60.5%) who responded, 57.1% had received formal training in audit, but only 20.4% had received more than four hours of training in their whole career. The median positivity score was 30 out of a possible 54 (range 12-40), suggesting that participating trainees were barely more than 'undecided' overall when it comes to positive attitudes to clinical audit. Age, nationality and specific training did not predict attitudes to clinical audit. Gender, years of clinical experience and direct experience of clinical audit did not significantly predict attitudes to clinical audit, but these findings are at odds with some previous research. Much work is needed in improving postgraduate trainees' attitudes to clinical audit, given that clinical audit is essential for good medical practice. Ours is an initial study of this area of training limited by sample size and the narrowness of the group tested. Further study of other specialities, higher trainees and consultant trainers would further enhance our understanding.

Implementing Residency Programs and its Challenges

The exponential growth of Singapore’s population from the influx of migrants over recent years, coupled with an aging population, has resulted in a need to increase the number of doctors and, in addition, raise their expertise. The British-based system of specialist training was inherited by Singapore and it consisted of two time-based phases: Basic Specialist Training and Advanced Specialist Training. However, in June 2010, the United States-based Residency system was adapted because it was curriculum-based with a more structured framework. This change in systems has resulted in a number of problems such as: (a) additional faculty to train; (b) adequate manpower backfill; (c) adequate resources for residents, including new infrastructure to facilitate learning, and (d) the usual anxiety associated with such a major change, especially from those who did not see the need to change the current system. Since manpower backfill was a key issue, overseas specialist staff and non-specialist doctors were recruited to facilitate protected training time for residents. In addition, there was a redesign of service work for healthcare personnel. Although these solutions have helped to alleviate many of the problems, the challenge facing the program now is its sustainability since it has proven to be resource intensive.

Exodus? The training paths and plans of postgraduate medical trainees, under the Royal College of Physicians of Ireland

In 2006, the Buttimer report highlighted the paucity of demographic data on those applying for and entering postgraduate medical education and training (PGMET) in Ireland. Today, concerns that there is an "exodus" of graduates of Irish medical schools are at the forefront of national discussion, however, published data on PGMET remains inadequate. The objectives of this study were to collate existing data relating to trainees and training programmes at three stages of training and to examine the career plans of junior trainees. Data from application forms for training programmes, commencing July 2012, under the Royal College of Physicians of Ireland (n = 870), were integrated with data from other existing sources. Candidates entering basic specialist training were surveyed with regard to career plans. Descriptive and comparative analysis was performed in SPSS version 18. Graduates of Irish medical schools made up over 70 % of appointees. Over 80 % of BST trainees aspired to work as consultants in Ireland, but 92.5 % planned to spend time working abroad (response rate 77 %). Decisions to leave the Irish system were linked to lifestyle, but also to failure to be appointed to higher specialist training. Significant numbers of trainees return to Ireland after a period abroad. The trainee "exodus" is more complex than is often portrayed. The desire to spend time working outside Ireland must be accounted for in workforce planning and configuration of training programmes. Expansion of HST is a potential solution to reduce the numbers of graduates leaving Ireland post-BST.

Postgraduate training in Ireland: expectations and experience

Postgraduate medical training in Ireland has been compared unfavourably with training abroad and blamed for an "exodus" of graduates of Irish medical schools. Exploration of features of a good training environment and development of tools to measure it have been the focus of much published research. There have been no Irish studies examining training environment using such validated tools. The aim of this study was to use a validated tool, to examine the expectations and experience of training, amongst those training under the Royal College of Physicians of Ireland (RCPI). The Dutch Residency Education Climate Test (D-RECT) is a 50 item tool to measure postgraduate learning environments. D-RECT was sent to all new entrants to RCPI training programmes in July 2012 (n = 527) and completed in regard to expectations of training (response rate 80.6 %). In March 2013, D-RECT was sent to all RCPI trainees (n = 1,246) to complete in relation to the post held on 1 March (response rate 32.6 %). Data were analysed in SPSS version 18. Experience fell short of expectations for basic specialist training, however, scores for experience rose with greater seniority to match expectations. Positive aspects were teamwork, consultant willingness to discuss patients and respectful treatment of trainees. Areas of weakness were provision of feedback and time to learn new skills. Measurement of learning environment at a national level using a quantitative tool provides useful information for quality assurance and improvement of training.

Knowledge and Attitude of Basic Psychiatric Trainees in Ireland to the Clinical Indemnity Scheme.

To assess the knowledge of basic psychiatric trainees in Ireland of the Clinical Indemnity Scheme (CIS) and to ascertain how many basic specialist trainees in psychiatry had obtained additional medical indemnity cover and reasons for obtaining additional cover. A structured questionnaire was distributed by post to 300 basic specialist trainees in psychiatric training schemes in Ireland. The questionnaire enquired about demographic details and examined the level of trainees' knowledge of the clinical indemnity scheme. Results were compiled and analysed using descriptive statistics and SPSS version 14. The response rate was 49%. The bulk of respondents were male (65.5%), aged between 30-35 years of age (44.6%). The majority of the respondents were aware of the CIS, with approximately half of the respondents having acquired additional medical indemnity cover. The level of awareness of the CIS was proportionately more amongst male respondents (69.1%), compared with females (58.5%). However, more females (61.5%) had additional medical indemnity cover compared with males (45.5%). Irish national trainees were more aware (72.9%) and had additional medical indemnity (80%), compared with non-Irish national trainees of whom approximately 61% were aware of the CIS and only 40% had an additional cover. The level of knowledge regarding details of what the CIS provided coverage for was quite poor. Respondents who had obtained additional indemnity were unsure what cover their additional indemnity provided. Only 10 respondents had been involved in medico-legal cases and of these, five had medical indemnity at the time of the case, stating that the legal advice and support was helpful. Our survey has highlighted that a considerable number of basic specialist trainees in psychiatry in Ireland had no detailed knowledge of what the CIS indemnifies them for and what situations were not covered by the scheme. Additionally, it revealed a clear split in favour of Irish national trainees in comparison to non-Irish national trainees in terms of awareness of the CIS and the procurement of additional medical indemnity. There needs to be an educational drive to provide more information to psychiatric trainees regarding the CIS and other medical insurance schemes. Furthermore, it would be important to examine factors that influence trainees in obtaining/not obtaining additional cover.

487 Virtual Patients: An Effective Educational Intervention to Improve Senior House Officers' Education and Training in the Management of Child Abuse?

As a junior doctor is often the only doctor to assess children presenting with an injury or illness to the A&E department, it is crucial that they are skilled in the identification of possible child abuse or neglect.Aim: To evaluate an interactive computer based Virtual Patient (VP) (using videos to simulate real life clinical scenarios) developed to teach paediatric Senior House Officers about the management of suspected child abuse.Methods: The VP was used to facilitate a child abuse case discussion for Paediatric Basic Specialist Trainees in Ireland. A questionnaire was developed to determine SHOs' perception of the value of the VP as an educational tool. Respondents were asked to rate their agreement with each statement on a 1 to 4 likert scale.Results: All participants (N=25) completed the questionnaire. 100% of participants agreed or strongly agreed that the case was enjoyable, interactive and appropriate for their level of training and a valuable use of their time. Upon completion of the case, most participants reported greater self confidence in their ability to recognize (23/25) and report (24/25) cases of suspected child abuse. All participants felt that the VP helped raise their awareness of the difficulties surrounding the diagnosis and management of child abuse and enabled them to identify deficits in their knowledge.Conclusion: There was an overwhelmingly positive response to the VP. The vast majority of participants reported improvements in their knowledge, confidence and attitude towards the management of child abuse.

Educational supervision and the impact of workplace-based assessments: a survey of psychiatry trainees and their supervisors

BackgroundEducational supervision (ES) is considered to be an essential component of basic specialist training in psychiatry in the UK. However, previous studies have indicated variation in its provision, and uncertainty about structure and content. Workplace-based assessments (WPBAs) were introduced in 2007 as part of major postgraduate medical training reform. Placing considerable time demands on trainees and supervisors alike, the extent to which WPBAs should utilise ES time has not been specified. As ES and WPBAs have discrete (although complementary) functions, there is the potential for this increased emphasis on assessment to displace other educational needs.MethodsAll junior doctors and their educational supervisors in one UK psychiatry training scheme were surveyed both before and after the introduction of WPBAs. Frequency and duration of ES were established, and structure, content and process were ascertained. Opinions on usefulness and responsibility were sought. The usage of ES for WPBAs was also assessed.ResultsThe response rate of 70% showed general agreement between trainees and supervisors, but some significant discrepancies. Around 60% reported 1 hour of ES taking place weekly or 3 times per month. Most agreed that responsibility for ES should be shared equally between trainees and supervisors, and ES was largely seen as useful. Around 50% of trainees and supervisors used 25–50% of ES time for WPBAs, and this did not appear to affect the usefulness of ES or the range of issues covered.ConclusionES continues to be an important component of psychiatric training. However, using ES for WPBAs introduces the potential for tension between trainees' education and their assessment by emphasising certain training issues at the expense of others. The impact of reduced training time, WPBAs and uncertainties over ES structure and content should be monitored to ensure that its benefits are maximised by remaining tailored to individual trainees' needs.

Diploma in Clinical Psychiatry (DCP) conducted by the Royal College of Physicians of Ireland

Although the purpose of the diploma exam is to recognise competence in psychiatric care for doctors working in primary care, it is also suitable for psychiatry trainees who are interested in taking the exam for membership of the Royal College of Psychiatrists (MRCPsych). I did the diploma in October 2005. I was in my second year of basic specialist training as a senior house officer in psychiatry. I did it as practice for my part one MRCPsych exam and to gain an extra qualification. I studied textbooks seriously for three months and did lots of multiple choice questions (MCQs). …

Psychotherapy requirements as recommended by the College: awareness and achievement by senior house officers

Aims and MethodWe questioned 141 senior house officers (SHOs) across three training schemes in order to ascertain the awareness and achievement of psychotherapy requirements as recommended by the College. A structured questionnaire was used and administered either in person or over the telephone to all SHOs. Of all the trainees surveyed, 32 were eligible for MRCPsych part II.ResultsOnly 9% of the SHOs eligible for MRCPsych part II were able to meet the requirements. Less than a third of all trainees were aware of the College guidelines.Clinical ImplicationsTrainees face a number of practical problems in meeting the College guidelines. Psychotherapy training for basic specialist trainees is in need of urgent review and steps need to be taken to ensure that SHOs are gaining basic psychotherapeutic skills.

66. Innovation in the academic half-day CanMEDS medical expert competency for residency educations

Over the past decade we have attempted various iterations of the academic half-day, but recurring trainee complaints of only didactic sessions, a parallel resident-directed “Nelsons” rounds, and low attendance necessitated a reconsideration of the approach.
 After discussion with the postgraduate trainees we divided the academic year into two blocks. An initial 8 week “summer program” with 24 student contact hours, focuses on the introduction to and review of common, critical care and emergency pediatric issues. The following 40 weeks has 120 student contact hours. Two thirds of the time is directed at the CanMEDS Medical Expert Core Competency. The postgraduate trainees have developed a three year core knowledge curriculum. The 200 “core” topics are mapped onto four international curricula; the RCPSC’s Objectives of Training and Specialty Training Requirements in Pediatrics using the Systems-Based Educational Objectives in the Core Program in Pediatrics, the American Board of Pediatrics – General Pediatrics Outline, and the Royal College of Pediatrics & Child Health (RCPCH) Framework of Competencies for Basic Specialist Training, and Core Higher Specialist Training in Paediatrics.
 The two hour Medical Expert session is divided equally into a postgraduate trainee didactic presentation, and a collaborator case-based learning session. Six weeks prior to the scheduled session the trainee and the assigned faculty collaborator receive the core Medical Expert topic mapped to the four international curricula. The pediatric trainee develops a didactic presentation along with a two page summary. The collaborator, a resource for the trainee’s didactic presentation, develops three clinical cases that emphasize core knowledge, and attends as a Medical Expert resource person.
 We are currently surveying the postgraduate trainees and faculty about this international-based core medical expert program of study.

SE18 A TALE OF TWO COLLEGES: DO SPECIALIST TRAINEES RECEIVE ADEQUATE HOSPITAL‐BASED TRAINING?

Purpose Both medical and surgical trainees have a dual reliance on their specialist training college and their respective teaching hospitals to maintain standards in teaching and training. Although guidelines are in place for the administration of this teaching, hospital‐based teaching has been minimally regulated. A review of trainee satisfaction with current levels of hospital‐based training was performed, both to reflect the thoughts of trainees themselves and to highlight specific areas requiring improvement.Methodology Sixty‐four basic specialist trainees (44 surgical [BSTs] and 20 physician [BPTs]) were recruited from all of the major Melbourne metropolitan teaching hospitals and were each given an anonymous survey for completion.Results Surgical trainees considered all areas of hospital‐based training to be deficient, with overall dissatisfaction significantly greater for BSTs compared to BPTs (P = 0.046). A requirement for increased hospital‐based training was similarly greater for BSTs (P = 0.0072).Conclusion The present study confirms the need for a change in the regulation and administration of hospital‐based teaching, particularly for surgical trainees.

A tale of two colleges: do specialist trainees receive adequate hospital-based training?

Both medical and surgical trainees have a dual reliance on their specialist training college and their respective teaching hospitals to maintain standards in teaching and training. Although guidelines are in place for the administration of this teaching, hospital-based teaching has been minimally regulated. A review of trainee satisfaction with current levels of hospital-based training was performed, both to reflect the thoughts of trainees themselves and to highlight specific areas requiring improvement. Sixty-four basic specialist trainees (44 surgical [BSTs] and 20 physician [BPTs]) from all of the major Melbourne metropolitan teaching hospitals completed an anonymous survey. Surgical trainees considered all areas of hospital-based training to be deficient, with overall dissatisfaction significantly greater for BSTs compared with BPTs (P=0.046). A requirement for increased hospital-based training was similarly greater for BSTs (P=0.0072). The study confirms the need for a change in the regulation and administration of hospital-based teaching for surgical trainees.

Service user involvement in training: the trainees' view

Aims and MethodA questionnaire survey was conducted of trainees across the South-West London and St George's Basic Specialist Training Scheme in Psychiatry to explore their attitudes towards service user involvement in training.ResultsFifty-two completed questionnaires were received; 20 trainees (38%) had not attended teaching sessions where a user was present; 35 trainees (67%) were agreeable to service user involvement in examinations. Reservations concerned the objectivity of service users in examination rating and their role as an expert on assessing the trainee's skill. Awareness of user involvement strategies and policies in their trusts were not matched with actual participation.Clinical ImplicationsService users should be involved in teaching in an expert capacity and also in examinations, with safeguards regarding transparency and objectivity of the marking schemes in place.

I have come to the United Kingdom after finishing my residency in internal medicine in the United States to join my husband, who is a specialist registrar in obstetrics and gynaecology. I finally had my training approved by the Joint Commission on Higher Medical Training as equivalent to basic specialist training in the UK, and I am therefore eligible for

I have come to the United Kingdom after finishing my residency in internal medicine in the United States to join my husband, who is a specialist registrar in obstetrics and gynaecology. I finally had my training approved by the Joint Commission on Higher Medical Training as equivalent to basic specialist training in the UK, and I am therefore eligible for