Core Trainees Research Articles

Resilience of dental core trainees in oral and maxillofacial surgery

Introduction & aims: Resilience may be defined as a process of “bouncing back” from the inevitable stresses encountered in life. Higher self-reported resilience has been associated with lower levels of anxiety, depression and psychological distress. Resilience is therefore highly important and should be cultivated where possible.

Are dental core trainees confident performing biopsies during their training post?

Are dental core trainees confident performing biopsies during their training post?

An audit of the quantity and appropriateness of incoming bleeps to the OMFS Dental Core Trainee on-call at Leeds General Infirmary

An audit of the quantity and appropriateness of incoming bleeps to the OMFS Dental Core Trainee on-call at Leeds General Infirmary

OMFS Dental Core Trainees: Who Nose how to manage epistaxis?

Introduction: 60% of the UK population have reported to experience an episode of epistaxis, of these 6% have sought medical attention. King's College Hospital does not have a on call ENT service, by default Epistaxis management on site falls under the OMFS remit. Additionally, epistaxis is a common Le fort 1 osteotomy post-operative complication. In our experience, SHO's are not entirely confident in Epistaxis management, which is compounded by limitations on the ease of access to appropriate equipment. At KCH we have implemented a teaching session and created an easy to access bag of equipment which can be used to manage Epistaxis on the ward or in an emergency setting.

Dentist on the ward 2019 (9th edition): an introduction to oral and maxillofacial surgery and medicine for core trainees in dentistry

Dentist on the ward 2019 (9th edition): an introduction to oral and maxillofacial surgery and medicine for core trainees in dentistry

A CLINICAL AUDIT TO ASSESS THE QUALITY OF DENTAL RADIOGRAPHIC REPORTS

<h3>Background</h3> Radiography forms an integral part of dental and maxillofacial practice, but its reporting continues to pose a variety of problems for practitioners. Chief among these are medicolegal complications and the detriment to patient care that arises from a lack of comprehensive record keeping. <h3>Objective(s)</h3> This audit objectively assessed the completeness and variation of radiographic reports written by undergraduate dental students from year 2 to year 5, including dental core trainees (DCTs) and consultants. We aimed to provide recommendations enabling higher-quality reporting. <h3>Study Design</h3> Conducted at the Royal London Dental Hospital (UK), 100 radiographic reports were randomly selected for each of the chosen groups, and the data were collected retrospectively using clinical case notes. Based on national and international guidelines, we compiled a list of 10 criteria, against which all reports were judged. The data were recorded in a dichotomous manner for each criterion to minimize ambiguity. Each report was subsequently scored of ten (with equal weighting of each criterion) and the average for the group calculated. <h3>Results</h3> Data analysis revealed that less than 1% of reports met all criteria. On average, 5 criteria were met; however, there exists considerable variation between groups. A slight tendency for more comprehensive reporting with undergraduate seniority was noted, in opposition to a substantial drop at the DCT level and again at the consultant level. <h3>Discussion/Conclusions</h3> The data demonstrate a concerning lack of comprehensive reporting across all groups, especially at the higher-ranking levels. Possible explanations include a reduction in senior input and feedback; awareness of the importance of record keeping; time available for each patient encounter; and knowledge of current guidance and policy. Following these results, we recommend regular auditing of radiographic reports by every department and local publication of updates to guidelines and legislation. Raising awareness of this issue will help improve reporting standards, thereby allowing greater patient care and protection from litigation.

A retrospective analysis of case-load and supervision from a large anaesthetic logbook database.

The recent development of electronic logbooks with secure off-device data storage provides a rich resource for research. We present the largest analysis of anaesthetic logbooks to date, with data from 494,235 cases logged by 964 anaesthetists over a 4-year period. Our analysis describes and compares the annual case-load and supervision levels of different grades of anaesthetists across the UK and Republic of Ireland. We calculated the number of cases undertaken per year by grade (median (IQR [range]) core trainees=388 (252-512 [52-1204]); specialist trainees=344 (228-480 [52-1144]); and consultants=328 (204-500 [52-1316]). Overall, the proportion of cases undertaken with direct consultant supervision was 56.7% and 41.6% for core trainees and specialist trainees, respectively. The proportion of supervised cases reduced out-of-hours, for both core trainees (day 93.5%, evening 86.3%, night 78.6%) and specialist trainees (day 81.0%, evening 67.7%, night 56.4%).

Otoplasty: The Belfast Experience. A 10-year Review

PURPOSE: Prominent ear is a common congenital anomaly with an estimated incidence of 5%. Otoplasty aims to address the abnormal shape of the auricular cartilage framework. The vast range of operative techniques and refinements belies a lack of consensus as to the proper surgical approach to this common condition. Recent publications favor cartilage suturing techniques over cartilage scoring methods. The Belfast experience of different otoplasty techniques of 1,199 patients over a 10-year period is reviewed. METHODS AND MATERIALS: All pediatric cases undergoing correction of prominent ear/ears from 2005 to 2015 were included in this retrospective case note analysis and follow-up study. Data collected included age, sex, age at referral, age at outpatient clinic, indication for referral, laterality, family history, and cause of prominence. Also collected was age at surgery, time on waiting list, method of anesthesia, surgeon grade/supervision, surgical technique utilized, hospital stay, duration and compliance with head bandage, and complication rate associated with each technique. Experience including number of cases and follow-up. Over a 10-year period, 1,199 otoplasties were performed: 1,134 bilateral and 65 unilateral (a total of 2,333 ears corrected). Of these, 707 (59%) cases were male and 494 (41%) were female. Patient review was at 1 week and 3 months postoperatively. SUMMARY OF RESULTS: Mean age at surgery was 9 years, median 9 years, and range 2–14 years. Surgery under combined general and local anesthetic in 94% cases, general anesthetic-only 4%, and local anesthetic-only 2%. Surgery performed by a consultant in 29%, registrar 68%, and a core trainee in 3% of cases. Surgical technique: conventional anterior cartilage scoring in 1,575 (68%) cases, suture-only technique in 215 cases (9%), conchal/cartilage reduction in 82 cases (3%), combined conventional cartilage scoring and suturing in 444 cases (19%), and combined suturing and conchal reduction in 17 cases (1%). Complication rates for: Anterior scoring (1,575 ears) 16 ears (1.01%) bleeding requiring early redressing 25 ears (1.58%) developed hematoma requiring theater for evacuation 8 ears (0.32%) infection requiring antibiotics 5 ears (0.32%) wound dehiscence 27 ears (1.715%) developed pressure necrosis 3 ears (0.63%) developed keloid scars 11 ears (0.69%) deemed to have a residual asymmetry deformity Suture-only otoplasty (215 ears) 0 ears (0%) bleeding requiring redressing 0 ears (0%) hematoma requiring evacuation 4 ears (1.39%) infection requiring antibiotics 1 ear (0.47%) wound dehiscence 0 ears (0%) developed pressure necrosis 0 ears (0%) developed keloid scarring 0 ears (0%) were deemed to have a residual asymmetry deformity The remaining ears underwent combination procedures, again with low associated complication rates. For all patients, satisfaction based on an objective questionnaire was found to be 96% postoperatively. CONCLUSIONS: Otoplasty with anterior scoring is a safe procedure, and overall, our results highlight it to be a reliable, reproducible technique with high patient satisfaction. We feel that our institution presents results that are comparable to other studies that rely only on suture correction otoplasty, with a complication rate that is similar if not superior to this technique.

Stress and Burnout in Training; Requiem for the Surgical Dream

Burnout among trainee doctors is common with as many as two-thirds reporting poor health. This study aimed to assess burnout in a cohort of UK core and higher general surgical trainees. The Maslach Burnout Inventory for Medical Personnel was distributed to 158 surgical trainees to evaluate emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). High EE (≥27) and DP (≥10), low PA (≤33) scores were taken to indicate burnout. A single UK (Wales) Deanery. One hundred responses were received; 65 core surgical trainees, 31 Higher Surgical Trainees (HST), and 4 not specified. Median EE, DP, and PA scores were 22.0 (range 2-50), 7.5 (0-25), and 36.0 (19-47), respectively. High burnout by domain was: EE (n = 33), DP (n = 39), PA (n = 34), with 59% of trainees demonstrating burnout in ≥1 one domain, with strong interdomain correlation (EE:DP r = 0.351, p < 0.001; EE:PA r = -0.455, p < 0.001; DP:PA r = -0.446, p < 0.001). Female gender (p = 0.020), core surgical training grade (p = 0.012), and being childless (p = 0.033) were independently associated with higher levels of EE; whereas HST grade (p = 0.007), age >30 years (p = 0.010), married/partner status (p = 0.001), and parenthood (p = 0.015), were associated with lower levels of burnout with regard to DP. Binary logistic regression revealed lower burnout in all domains to be associated with HST status (hazard ratio 0.116, 95% confidence interval 0.014-0.980, p = 0.048) and male gender (hazard ratio 4.365, (1.246-15.293), p = 0.021). Burnout among surgical trainees was common in at least 1 Maslach Burnout Inventory domain. Urgent counter measures are required to protect the health and wellbeing of trainees at risk, which ought to be associated with commensurate improvement in patient safety.

Improving clinic attendances for core medical trainees at a busy district general hospital.

Attending clinics is large part of completing the core medical training competencies. The minimum number of clinics required has now increased from 12 to 20 per annum. Core medical trainees (CMTs) often struggle to attend owing to busy medical wards, on-calls and staff shortages. This quality improvement project aimed to improve attendance with simple measures. We collected data to assess the number of CMTs attending clinic during their time off. A clinic rota …

Training in psychiatry: making person-centred care a reality

The RCPsych curriculum for core trainees is currently undergoing review and revision. The Person-Centred Training and Curriculum Scoping Group, which fed into the revision, reported in 2018. This paper shares key findings from the report and offers suggestions on implementing person-centred care in postgraduate psychiatric training and assessment. The scoping group recommended that training and the curriculum should be explicitly person-centred. Among its other recommendations was that skills relating to person-centred practice should be assessed, and the planning, development and delivery of local MRCPsych courses should be co-produced alongside people with lived experience of mental health conditions.Declaration of interestAll authors contributed to the development and writing of College Report CR215.

Barts omfs induction app: using a mobile phone web application during the induction of new oral and maxillofacial surgery dental core trainees

Barts omfs induction app: using a mobile phone web application during the induction of new oral and maxillofacial surgery dental core trainees

A retrospective analysis of an oral and maxillofacial dental core trainee clinical induction programme a 15 year project

A retrospective analysis of an oral and maxillofacial dental core trainee clinical induction programme a 15 year project

Dental core training for the future GDP: is it worth it?

In this article I highlight the benefits and shortfalls of the dental core trainee year for one who has no interest in specialising and sees their eventual future as a general dental practitioner (GDP). I conclude that the dental core trainee year has great advantages and adds value to the future GDP.

Medical education innovation: the advent of social media

Within our day-to-day lives, social media is playing an ever-expanding role. However, postgraduate training, clinical practice and research has yet to take advantage of this. With ever-developing innovations in social technologies and access to international networks, could social education be the future of postgraduate training? This study aimed to review the current literature relating to social media in postgraduate training, and establish core trainees perceived value and role of social media as an educational tool. …

How can we make renal medicine careers more appealing to UK trainees?

BackgroundThere is a global decline in interest in careers in renal medicine. This is concerning given the increasing global burden of kidney disease. Previous studies in the USA and Australia have identified factors such as a poor work–life balance, lack of role models and the challenging nature of the speciality as possible reasons behind recruitment struggles. This study aimed to identify factors associated with declining interest among trainees in the UK.Methods We conducted a survey of 150 National Health Service Foundation trainees (interns) and Core Medical Trainees in Health Education West Midlands. Participants completed a 14-part paper-based questionnaire capturing data on trainee demographics, medical school and postgraduate exposure to renal medicine and perceptions of a career in renal medicine.Results There was limited early clinical exposure to renal medicine both in terms of time spent in the speciality and perceived exposure to the range of domains of the speciality. Trainees perceived the speciality as complex with a heavy workload. Very few trainees considered the speciality to be lifestyle oriented. There was also disinterest in taking on the associated general medicine commitments of the training programme. Job experience and identification of role models increased the likelihood of consideration of the speciality.Conclusion This survey has identified key areas to drive interest in the speciality, including early engagement, enthusiastic supervision and increased training flexibility. Urgent attention is required to address these areas and make renal medicine careers more appealing.

Recruitment into old age psychiatry

This research aimed to explore the trainee perspective on factors affecting recruitment into old age psychiatry higher training in the UK. A qualitative survey was created by the Faculty of Old Age Psychiatry and distributed to current higher trainees in all psychiatric subspecialties. A total of 324 higher trainees responded to the survey, representing a broad demographic range. Thematic analysis was carried out, with sufficient responses to achieve saturation. Key themes included concerns about the future of the specialty, issues with social care, lack of support with patients’ physical health needs, issues with training posts, and workload. The need to improve core trainees’ experience of the specialty was highlighted. Many positive themes arose from the data; however, a number of barriers to recruitment were also identified. The findings have implications for recruitment to the specialty and should be used to inform recruitment strategy moving forward.Declaration of interestNone.

Improving the working environment for the delivery of safe surgical care in the UK: a qualitative cross-sectional analysis

ObjectivesThe aim of this study was to identify current problems and potential solutions to improve the working environment for the delivery of safe surgical care in the UK.DesignProspective, questionnaire-based cross-sectional...

'Mentoring the Gap' for Junior Doctors: Promoting an under-utilised resource back to centre-stage.

This article was migrated. The article was marked as recommended. Mentoring in medicine is not a new concept. However in recent years it has been sadly neglected and consigned to the wings of the medical education theatre. In this age of disparate clinical teams, disillusionment and shift working, the NHS needs to proactively nurture and develop junior doctors to support them on their career path. In this paper, we argue that effective mentoring is key to achieving this goal. Context and methods: The researcher is a Core Medical Trainee (CMT) and set up a near-peer mentoring programme between Foundation Year (FY) doctors and CMTs. A focus group was conducted and inductive thematic analysis was used to analyse the resulting transcript. Thematic maps demonstrating the benefits and barriers to mentoring were produced. Results: Results demonstrated that mentoring was useful for mentees' personal development in terms of networking opportunities, pastoral support and the sharing of experiences. Positivity and camaraderie were key to an effective mentoring partnership, whilst rota clashes posed a significant barrier. Dangers identified included mentors adhering too tightly to a 'mentoring formula' and encouraging mentees to become 'carbon copies' of themselves. Conclusions: This study has provided a valuable insight into the benefits of mentoring for junior doctors. Recommendations include promotion and active creation of formal mentoring programmes, and integration of formal mentoring training into the CMT curriculum.

Awareness among dental students and dental core trainees of benign and oral potentially malignant disorders and lesions

Awareness among dental students and dental core trainees of benign and oral potentially malignant disorders and lesions