F1 Doctors Research Articles

'From scared to prepared': targeted structured induction training during the transition from medical school to foundation doctor.

The risks to patients at August handover time are well known, yet there is no national consensus on the best way to deliver induction programmes for Foundation Year One (F1). The aim of this study was to design, deliver and assess a targeted structured induction programme for new F1 doctors. The induction training programme was designed using educational models of topic analysis informed by results of a survey of F1s and medical students, and the F1 curriculum. Data regarding serious untoward incidents and self-reported preparedness were collected between 2008 and 2010, and rates were compared between those receiving optional (2008) and compulsory (2009 and 2010) training. By delivering targeted education and spending time with the outgoing F1 doctors, 97 % of our new doctors felt adequately prepared for practice. The incidence of self-reported mistakes made by F1s in the first 4 months of their practice fell by 45 % and serious untoward incidents also decreased. Targeted structured induction training addresses final-year medical students’ concerns about their preparedness for practice as junior doctors, and improves patient safety. This study supports the General Medical Council recommendation that targeted structured induction training should be mandatory for all new doctors.

BME doctors less likely to be offered postgraduate training posts than white doctors, says GMC

Black and minority ethnic (BME) doctors are less likely to be offered a place on a specialty training programme than white applicants, research carried out by the General Medical Council has found. The GMC has published a report on its investigation into how doctors progress through training.1 As part of the investigation the GMC studied recruitment data concerning doctors who applied for specialty and general practice training programmes after completing the second year of foundation training (F2). It also looked at data on examination pass rates for doctors in specialty and GP training. The GMC found that BME doctors were less likely than white applicants to be offered a place on a training programme. “Of F2 doctors with a UK primary medical qualification, 72% of BME applicants received an offer compared with 81% of white applicants,” the report said. The GMC also found that BME doctors from UK medical schools were less likely to pass their postgraduate exams than white doctors from UK medical schools. “Pass rates were 63.5% and 76% respectively,” the …

Compliance with GMC guidelines for chaperone use in intimate examinations and the influence of junior doctor education on practice

Compliance with GMC guidelines for chaperone use in intimate examinations and the influence of junior doctor education on practice

Cadaveric simulation in surgical training: A high-fidelity model to increase trainee confidence

Cadaveric simulation in surgical training: A high-fidelity model to increase trainee confidence

Junior doctors are better prepared than before, says GMC

Foundation doctors are better prepared to start treating patients than they have been in the past, a report from the General Medical Council has found. The report, which includes data from the regulator’s annual national training surveys, said that doctors in the first year of their foundation training (F1) were less likely to think that they had been forced to cope with clinical problems beyond their competence or experience than in the past. In 2009 around half (51%) of the 5175 F1 doctors who responded to the national training survey said that they felt they …

QUALITY END OF LIFE CARE FOR ALL (QELCA) IMPLEMENTATION AND EVALUATION

Innovation within the NHS is vital to achieve two aims: firstly and most importantly: improving patient care; secondly saving money, to sustain our healthcare system.A “good death” was defined in...

Improving handover of patient care using a new weekend proforma with a focus on ceiling of care.

Patient handover is paramount for effective patient care and is often poorly documented or incomplete. North Bristol NHS Trust weekend handover proformas identify medical patients requiring weekend review. Many patients seen during on-call shifts are not handed over. Our aim was to develop Friday ward round proforma sheets for medical patients, to encourage clear documentation of management plans in order to improve handover of important information, particularly ceiling of care decisions.Questionnaires were completed by F1 doctors regarding current handover systems. Baseline data collected by on-call F1s included time of understanding a patient's ceiling of care decision, and difficulty of comprehension of medical notes. Repeat data were collected with novel proformas in situ. Multiple cycles were performed to refine the sheets and target problems arising in their use.Ninety-three percent of F1s wanted improved patient handover, with ceiling of care (87%) and management plans (73%) being the most difficult areas to understand. Time taken to ascertain ceiling of care decisions improved with the introduction of Friday handover proformas; mean time 153 seconds before and 5 seconds after. Clarity and documentation of management plans improved, with 50% improvement in ease of understanding medical notes.Results demonstrate that introducing Friday ward round proformas for medical patients improves communication between weekday and on-call teams, highlights current escalation of care plans, and leads to faster decision-making. Future plans include the introduction of a short educational session to the new F1 doctors and continued progress with introduction into hospital stationary.

HOW DOES CONFIDENCE IN PRACTICAL AND CLINICAL MANAGEMENT CHANGE FOLLOWING FOUR MONTHS WORKING IN THE EMERGENCY DEPARTMENT?

Objectives & BackgroundThere is a lack of information available about how the skills of Foundation Doctors develop over their time spent working in the Emergency Department (ED). Knowing this could...

‘You're certainly relatively competent’: assessor bias due to recent experiences

A recent study has suggested that assessors judge performance comparatively rather than against fixed standards. Ratings assigned to borderline trainees were found to be biased by previously seen candidates' performances. We extended that programme of investigation by examining these effects across a range of performance levels. Furthermore, we investigated whether confidence in the rating assigned predicts susceptibility to manipulation and whether prompting consideration of typical performance lessens the influence of recent experience. Consultant doctors were randomised to groups within an internet experiment. The descending performance group judged videos of Foundation Year 1 (F1; postgraduate Year 1) doctors in descending order of proficiency; the ascending performance group judged the same videos in ascending order. For all videos, participants rated: (i) trainee competence; (ii) rater confidence and (iii) percentage better (the percentage of other F1 doctors who would perform better on the same task). Overall, the descending performance group assigned lower scores than the ascending performance group (2.97 [95% confidence interval 2.73-3.20] versus 3.50 [95% confidence interval 3.25-3.74]; F(1,47)=9.80, p=0.003, d=0.52). Pairwise comparisons showed differences were significant for good and borderline performances. The percentage better ratings showed a similar pattern (descending performance mean=57.4 [95% confidence interval 52.5-62.3], ascending performance mean=43.4 [95% confidence interval 38.4-48.5]; F(1, 46)=16.0, p<0.001, d=0.67). Confidence ratings did not vary by level of performance and showed no relationship with the effect of group. Assessors' judgements showed contrast effects at both good and borderline performance levels. Findings suggest that assessors use normative rather than criterion-referenced decision making while judging, and that the norms referenced are weakly represented in memory and easily influenced. Confidence ratings suggested a lack of insight into this phenomenon. Raters' judgements could be importantly influenced in ways that are unfair to candidates.

Assessing transfusion competency in junior doctors: a retrospective cohort study

There is scope to further improve the safety of transfusion practice within the United Kingdom. This study aims to identify the current role of junior doctors in the transfusion process and to assess their competency to appropriately prescribe blood and blood products to patients. Transfusion competency in junior doctors training in a single region was addressed through anonymized questionnaires assessing factual knowledge, personal reflection, and documented evidence of competency. Factual knowledge comprised 33 true-false questions (competency score) covering indications for transfusion, special requirements, risks of transfusion, and guidelines for testing in transfusion. Background data on current practice and education in transfusion medicine were addressed using multiple-choice and single-response questions. A total of 787 newly qualified doctors, comprising 79% of first-year (F1) and 62% of second-year (F2) Foundation doctors, completed the assessment over a 3-week period. There was no improvement in competency score between F1 and F2 doctors (p = 0.1). Competency scores correlated most strongly with undergraduate education in transfusion medicine and attendance at hospital induction (p < 0.01). Junior doctors had a high confidence level with regard to prescribing blood, although only 78% were aware they had been competency assessed against national standards. Junior doctors are involved in sampling, prescribing, consenting, and documenting transfusion practice frequently enough to maintain competency. They are rarely involved in the collection, bedside checking, or administration of blood despite current curriculum requirements. There is scope to significantly improve both the training and the assessment of transfusion competency in doctors.

Intravenous Fluid Prescribing Knowledge and Confidence in F1 Doctors

Rach year in the UK, 7,500 F1 doctors take up post. Most are new graduates from UK medical schools. Teaching in the 33 medical schools in the UK is reviewed by the General Medical Council (GMC). Tomorrow's Doctors, published by the GMC, defines the knowledge, skills and behaviours that UK medical graduates should possess after completion of their undergraduate training.

Is Foundation training producing competent doctors? What do Foundation trainees, educational supervisors and nurses in Scotland have to say?

The aim of this paper is to examine perceptions of Foundation Year trainees, consultants and senior nurses about the introduction of the Foundation Programme. Specifically, to examine whether Foundation trainees acquire appropriate skills, experience and responsibility. Semi-structured interviews were conducted with 23 F1 doctors, 22 F2 doctors, 23 consultants and 25 nurses from across Scotland in a broad range of specialties. In the summer of 2007 trainees, consultants and nurses broadly agreed that Foundation offers good experience but some issues were highlighted. Certain specialties were seen as offering insufficiently generic experience and consultants, in particular, were concerned that four-month rotations are too short. Frequent moving around for trainees was seen as detrimental for seeing cases through and continuity of care was now perceived to be provided by nurses and consultants rather than junior doctors. Levels of responsibility could vary widely from post to post and tended to be specialty-dependent. As a result, some F2s reported frustration that they were not given sufficient responsibility for their stage of training. Nights were recognized as a valuable learning opportunity and most trainees were supportive of night work being made available in F1 and F2. In conclusion, in order to maximize the possibilities of the Foundation years and ensure that trainees can meet the required Foundation competencies, specialties that offer narrow experience need to be matched with 'busy' specialties that can offer broader experience. Night work should be retained, but perhaps not introduced right at the start of F1. Trainees feeling that they are being given insufficient experience, particularly in the F2 year, need to be proactive in addressing this if possible. There is a perception among some consultants and nurses that a process of 'delayed skilling' is taking place, attributable more to reduced hours than Foundation per se. There is a need to follow trainees through to specialty training to ascertain if Foundation has adequately prepared them for run-through training.

Use of abbreviations by healthcare professionals: what is the way forward?

ObjectiveTo assess the understanding of commonly used abbreviations in the medical records among healthcare professionals.MethodsA selection of abbreviations from surgical inpatient admissions (gathered over a 10 day period in October...

Medical students experience of paediatric deaths

<h3>Aims</h3> To investigate medical students experience of paediatric deaths. <h3>Methods</h3> An anonymous online questionnaire was distributed to all final year medical students at the University of Bristol. This study was approved by the Faculty of Medicine and Dentistry Committee for Ethics. <h3>Results</h3> 220 students were contacted, 60% responded and 27% had witnessed a paediatric death. 89% of paediatric deaths were abroad on elective. Students have had mixed initial feelings following patient death. Many students abroad were angry or frustrated after their patient died: “angry at myself, worried that I didn9t do enough”; they also reported feeling patient death was an “injustice”. In the UK, students witnessed more “expected” deaths and appreciated the concept of “a good death”. In both elective and UK placements, the majority (80% and 76%, respectively) of students found talking to people beneficial—“I think if I was left alone I9d have fallen apart”. In the UK, students often had formal support with 75% turning to doctors for support—“the F1 doctor and lead tutor talked to me which I found comforting”. When students looked for emotional support on elective, they turned to friends globally using email and Facebook rather than talking to local doctors and nurses. Only 13% of medical students thought the medical course had prepared them sufficiently to deal with death—“I think we aren9t supported, we might be prepared in terms of medical knowledge but we need support of the more senior medical team”. “Although the palliative care/oncology module in 5th year does help prepare you, many witness deaths before then”. Of those who did feel prepared many said they had gained this knowledge through working as healthcare assistant. <h3>Conclusion</h3> Students feel that although they may have “medical knowledge” they are still lacking in emotional support and are often inadequately supported around the time of a patient9s death, especially a child. Medical schools need to address these deficiencies within their curricula and doctors need to be aware that medical students require senior support at this time along with advice on obtaining appropriate support while abroad.

Attitudes and beliefs to seasonal influenza vaccination among junior doctors and the impact of a targeted campaign on vaccine uptake

The Department of Health recommends that health care workers (HCWs) with direct patient contact are vaccinated against seasonal influenza. A survey of acute hospital NHS trusts in 2008 reported that doctors had the lowest vaccine uptake of all HCWs. At the University Hospital of North Staffordshire, vaccination coverage in doctors was 7% in 2007/2008 and only 2% in foundation year 1 (F1) doctors. During this year (2008/2009), as part of a programme to improve uptake, we carried out a questionnaire survey among junior doctors to assess barriers to vaccination. We targeted F1 doctors by organising vaccination sessions at the same time and location as two mandatory training days. Fifty-four questionnaires were analysed. 68.5% of foundation doctors were in favour of vaccination of HCWs and 3.7% opposed it. 50% believed vaccination to be a professional responsibility; 46.3% believed it should be mandatory. Greater accessibility of vaccination, peer pressure and the example of seniors were viewed to be the most important factors in improving uptake. In 2008/2009 uptake of influenza immunisation in F1 doctors rose to 62% (31/50) from 2% in 2007/2008. Among F2 doctors (who had no vaccination sessions at training days) there was a 16% (9/56) uptake. Among foundation doctors in our Trust, most favour vaccination; barriers appear to be related to accessibility. By arranging vaccination sessions at training days, we dramatically increased uptake. We believe that increasing accessibility and peer pressure and senior example contributed to this effect.

New focus on anatomy for surgical trainees

The demise of anatomy teaching in the undergraduate medical curriculum has inevitably reduced the general level of applied anatomical knowledge displayed by junior doctors. Initiatives such as the European Working Time Directive have exacerbated the problem by reducing trainees' opportunities to acquire appropriate anatomical knowledge and clinical skills through workplace training. Medical Schools and postgraduate Colleges and Schools of Surgery must work together to design and deliver quality-assured courses in core and non-core anatomy, that cross the undergraduate/postgraduate interface. All medical students should learn a core syllabus of anatomy, agreed by a panel of clinicians and anatomists but delivered according to the pedagogic style favoured by individual Medical Schools. This core will define the anatomy, that all F1 doctors should know, particularly the anatomy associated with clinical procedures: it will be assessed across all years of the undergraduate medical programme. Medical Schools should also offer modules in non-core surgical and/or radiological anatomy, some of which may be designed and delivered in partnership with Colleges of Surgery and Radiology: these modules would be particularly attractive to students contemplating a career in surgery or interventional radiology, but would not be offered exclusively to this cohort. At present, the inadequate anatomical knowledge of Foundation doctors must be addressed by ensuring that early postgraduate training programmes include explicit, formal teaching in anatomy, for example, the Core Surgical Anatomy course currently being piloted at the Royal College of Surgeons of England.

How to insert a temporary pacing wire

Temporary pacing is indicated in emergency situations for treatment of bradyand tachyarrhythmias. Frequently these patients are haemodynamically unstable and so competency in temporary wire insertion is vital as immediate intervention is frequently required. Temporary pacing should form part of the procedural capabilities of any medical specialist registrar undertaking acute medical on call, especially those working in emergency medicine. F1 and F2 doctors should have be able to recognize a patient with indications for temporary pacing (Table 1) and diagnose complications of the procedure.

Developing a virtual learning course in emergency medicine for F2 doctors

Changes in the regulation of junior doctors’ hours and in the design of medical career pathways have rendered the traditional weekly tutorial ineffective for teaching the core knowledge of emergency...

Foundation year 2 in public health

Karl Botham and Sundhar Rajhan Shunmugam Kanagasabapathy describe their experience as F2 doctors in public health

Exploring the views of second-year Foundation Programme doctors and their educational supervisors during a deanery-wide pilot Foundation Programme

Aim: To explore the views of second-year Foundation Programme doctors (F2s) and their educational supervisors taking part in a deanery-wide pilot Foundation Programme, in order to gain an understanding of...