Formal Teaching Sessions Research Articles

Procedures Group Chat: A Resident-Driven Approach to Increase Procedural Competency

Introduction: In 2007, the American Board of Internal Medicine (ABIM) shifted away from requiring completion of procedures during residency training and towards emphasizing common procedural indications, contraindications, and complications. As a result, many procedures are now referred to consulting services such as critical care and interventional radiology (IR). Our aim was to address this training gap through a resident-driven initiative that provided daily opportunities to collaborate on procedures in a supervised clinical setting. Methodology: In January 2023, we created a secure group chat and invited Internal Medicine (IM) residents to voluntarily join if they were interested in learning or teaching bedside procedures such as thoracenteses, paracenteses, lumbar punctures, and line placement. Residents who identified a need for a non-emergent bedside procedure would reach out in the group chat to see if a resident certified to perform and supervise that procedure would be available and could subsequently coordinate availability. A two-question survey was sent to the entire residency program asking residents whether they were a part of the group chat and whether they found the chat helpful in advancing their medical knowledge. The impact of the initiative was measured through procedures logged in to New Innovations, a website used by graduate medical education to log completed procedures. We chose five procedures (paracenteses, thoracenteses, central lines, arterial lines, and lumbar punctures) to compare changes in procedure volume performed by IM residents one year before and after the group chat was set up. Results: 64 out of 108 residents responded to the survey (59% response rate). 90% of respondents stated that they were part of the group chat and 76.6% responded they “agree/strongly agree” that the procedures group chat has been helpful. Objective measures of the group chat’s impact revealed a 93% increase in the number of procedures performed by residents. IM Residents logged 122 procedures in 2022, the year prior to the initiation of the group chat, compared to 235 procedures logged in 2023, the year after. There was a 96% increase in paracentesis and 387% change in thoracenteses completed after the group chat was established. Conclusions: The procedures group chat nearly doubled the number of procedures completed and logged by residents. This group chat has fostered enthusiasm for patient care by helping us overcome some of the barriers and delays in health care due to factors out of our control, such as limited resources or staffing. Due to the inexpensive nature of this initiative, it can be easily replicated at other IM programs across the country, especially those without resources such as simulation centers. Future goals include creating formal teaching sessions including cadaver lab simulations and a proceduralist elective for procedures to be taught and supervised by certified residents, attendings, and subspeciality services for a multidisciplinary education.

Development of Tailored Teaching Model for Beginning Piano Level Among Visually Impaired Students

Music education for visually impaired individuals faces significant challenges due to traditional methods relying heavily on visual cues. This study addresses this gap by developing a tailored teaching model for beginning piano instruction among visually impaired students. Through a multi-phase methodology, including pilot teaching, expert interviews, and formal teaching sessions, the study integrates innovative pedagogical strategies and adaptive technologies to create an inclusive learning environment. The pilot teaching phase was conducted at a specialized school for the blind and deaf in Jiangsu, China, involving six visually impaired students with varying levels of piano learning experience. Expert interviews were conducted with three individuals with expertise in music education for visually impaired individuals. The formal teaching phase comprised six new visually impaired students and spanned three months, with assessments conducted after the 5th and 10th lessons to evaluate learning progress. Results demonstrate the effectiveness of the tailored teaching model in fostering meaningful musical experiences and promoting musical proficiency among visually impaired students. Suggestions for further research and implementation of tailored teaching models are provided to enhance access to music education for visually impaired individuals.

Reducing Improper and Missed Peri-Procedure Antibiotics Prescriptions in a Regional Oncology Centre.

Background In the realm of oncology care, patients undergoing invasive procedures are particularly vulnerable to infections due to their compromised immune systems. Antibiotics play a pivotal role in preventing such infections. However, inappropriate or missed administration of peri-procedure antibiotics poses a significant risk in the form of treatment complications, contributing to antibiotic resistanceand increased healthcare costs. Methods The study was a two-cycle, closed-loop quality improvement project utilizing both retrospective and prospective data analysis of peri-procedure antibiotics prescription in a regional oncology centre. Two audit cycles were carried out in total; the first cycle was carried out in November 2023 where six-week data were collected retrospectively. As a result, formal and informal teaching sessions about the importance of correct peri-procedure antibiotics and the availability of complete institutional peri-procedure antibiotics guidelines in clinical areas were ensured. The second cycle was carried out prospectively for two weeks in January 2024. Patients were included if they underwent selected procedures performed by interventional radiology or gastroenterology while the patients operated on by the general surgeons and any day case procedures were excluded. Results We identified a total of 82 interventional procedures during the first cycle that fulfilled the inclusion criteria. Six out of 82 patients (7.3%) did not receive the correct peri-procedural antibiotics as per hospital antibiotics guidelines. A prospective two-week data after implementing the change revealed that 25 patients had documented interventional procedures done during this period using electronic patient records. Out of 25 patients, only one patient (4%) did not receive the peri-procedural antibiotics as per guidelines. We were able to demonstrate increased adherence to the peri-procedural guidelines (from 93% to 96%) during the two cycles. However, this change was not statistically significant (p = 0.50). Conclusion By educating and engaging healthcare professionals in adhering to evidence-based guidelines and best practices, we have observed notable, although statistically significant improvement in peri-procedure antibiotics prescription practices. Continued educational efforts and reinforcement strategies will be vital in further improvements over time. By providing ongoing support and resources, healthcare providers can be empowered to consistently make informed decisions regarding peri-procedure antibiotic administration. This commitment to maintaining high standards of antibiotic prescribing practices is expected to result in improved patient outcomes, including reduced rates of surgical site infections and antibiotic resistance. It is imperative to recognize the critical role that accurate peri-procedure antibiotic prescriptions play in patient safety and overall healthcare quality. By fostering a culture of continuous improvement and adherence to established guidelines, we can ensure that patients receive optimal care while minimizing the risks associated with antibiotic overuse or misuse.

Informal peer-assisted learning amongst medical students: A qualitative perspective.

Peer-assisted learning (PAL) can occur informally as part of a medical programme and complements the formal curriculum. However, little is known about the mechanisms and processes of how informal peer-assisted learning (IPAL) is enacted. This paper presents data from an ethnographic and semi-structured interview study with Year 1 and 2 undergraduate medical students at a UK university. Peers were observed assisting each other informally: a process that developed as part of the integrated, group-based approach to undergraduate medical education at a UK university. IPAL took place both within and outside of formal teaching sessions and included explanation/clarification of particular points, sharing resources, guiding pronunciation and demonstrating skills. Students placed a high value on IPAL and believed that it was beneficial. When IPAL broke down, this led to negative emotions that presented obstacles to learning, such as resentment. IPAL is an important part of academic support for medical students, and this work shows both its scope, extending from formal to informal teaching, and how it is enacted. This understanding can help educators situate IPAL within student education.

Association Between Educational Resources and Pediatric Fellows' Mental Health Attitudes and Self-Reported Competence.

Children with chronic medical conditions (CCMC) have high rates of mental health (MH) conditions. This study examines associations between MH educational resources during fellowship and 3 dependent variables: fellows' interest, perceived responsibility, and self-reported competence in assessing MH concerns of CCMC. Subspecialty fellows taking the American Board of Pediatrics in-training examinations in February 2020 were invited to participate in a survey inquiring about MH educational resources. Logistic regression examined associations between MH educational resources and the 3 dependent variables, adjusting for demographics and program-level characteristics. Of the 97.7% (4216) fellows who responded, 3870 were included in analyses. About 37.5% reported formal MH teaching sessions; 36.7% reported on-site MH professionals engaged in teaching; 41.6% reported co-assessing patients with MH specialists; and 28.3% reported performance evaluation of their MH skills. All 4 resources were significantly and positively associated with self-reported competence in adjusted analyses, with odds ratios (OR) ranging from 1.28 (95% confidence interval (95% CI): 1.03-1.58) for formal teaching sessions to 2.14 (95% CI: 1.73-2.65) for performance evaluation. Resources were positively associated with the dependent variables in a "dose-response" pattern. Respondents who reported having all 4 educational resources compared to zero resources had an OR of 2.20 (95% CI: 1.74-2.78)for high MH interest, 3.18 (95% CI: 2.45-4.12)for high perceived responsibility, and 4.38 (95% CI: 3.43-5.60)for high self-reported competence CONCLUSIONS: Access to mental health educational resources was associated with higher interest, perceived responsibility, and self-reported competence; investing in these resources may improve fellows' skills in addressing the emotional needs of CCMC.

P22 A multifaceted staff-focused approach to improve urinary tract infection management in our Trust

Abstract Background Urinary tract infection (UTI) is a common diagnostic label given to patients across all medical and surgical specialties. Despite this, there is a great degree of misconception on diagnostic and management aspects of this condition. Following our Trust performance in the NHS UTI CQUIN 2022/2023, where overall compliance was 41% and 48% for quarter 1 and 2, respectively, we embarked on a project to enhance our performance by identifying gaps in knowledge that resulted in over-diagnosis and inappropriate antibiotic treatment. Objectives To optimize clinical diagnosis of UTI, reduce reliance on dipsticks in elderly and catheterized patients, and improve antibiotic stewardship. Methods We surveyed 76 healthcare workers including doctors, nurses, advanced nurse practitioners and healthcare assistants to understand baseline knowledge and explore areas that required targeted intervention. Based on the survey results, we implemented an educational awareness campaign employing formal teaching sessions on specific wards, informal interactions, UTI flow charts and posters, new antibiotic guidelines and posts on the hospital communications and social media pages Results From our survey, we identified 45% believed dipsticks were part of routine investigations, 47% performed dipsticks for catheterized patients and 79% believed that a positive dipstick in elderly patients indicated UTI. The CQUIN data involves five key parameters; including diagnosing UTIs and CA-UTI based on clinical signs and symptoms, establishing the diagnosis without reliance on dipsticks in elderly and catheterized patients, sending urine for culture and microscopy, changing or removing catheters where applicable and treating with an appropriate antibiotic. The individual compliance for each parameter was >60% but our overall compliance was poor. Our survey finding corroborated the initial CQUIN data in demonstrating that the major problem areas were dipstick use in elderly patients and catheterized patients and the use of inappropriate antibiotics for treatment. Following the first wave of our improvement strategies, we recorded a significant improvement in overall Trust CQUIN compliance of 51% and 58% for quarters 3 and 4, respectively, and on the wards where specific implementation strategies were carried out, an overall compliance score of 64%. Conclusions The significant improvement we have made so far highlights what can be achieved with staff-focused interventions and the impact on patient care. We intend to continue to involve various specialities across the Trust to optimize UTI management.

Pediatric Delirium: An Overlooked Diagnosis?

BackgroundDelirium is well-recognized in adult inpatient care. However, it is often overlooked in children, being mistaken for pain, anxiety, or age-appropriate agitation. MethodsTo assess the impact of a formal teaching session on the diagnostic rates and management of pediatric delirium (PD) in a tertiary care center, we conducted a retrospective chart review of all hospitalized children diagnosed with PD between August 2003 and August 2018 at the CHU Sainte-Justine (Montreal, Canada). Diagnostic incidence and management were compared before (2003 to 2014) and after (2015 to 2018) a formal teaching session provided to pediatric residents, staff pediatricians, and intensive care physicians in December 2014. ResultsThe two cohorts displayed similar demographics, PD symptomatology, PD duration (median: 2 days), and hospital stay duration (median: 11.0 and 10.5 days). However, we saw a major increase in diagnosis frequency after 2014 (from 1.84 to 7.09 cases/year). This increased diagnostic rate was most striking in the pediatric intensive care unit setting. Although symptomatic treatment with antipsychotics and alpha-2 agonists was similar between the two cohorts, patients diagnosed after 2014 were more often weaned from offending medications (benzodiazepines, anesthetics, and anticholinergics). All patients recovered fully. ConclusionsFormal teaching on the symptoms and management of PD was associated with an increase in diagnostic rate and an improved management of PD in our institution. Larger studies are required to assess standardized screening tools that may further enhance diagnostic rates and improve care for children with PD.

Use of high-fidelity simulation to ensure inclusivity and equality of international medical graduates

The UK medical profession is becoming increasingly diverse as the number of international medical graduates (IMGs) joining the UK medical workforce increases every year. However, IMGs face a number of significant sociocultural and educational challenges. Recent studies show that IMGs lack insight into the system and lack clarity in relation to the role of a supervisor, career pathways, and medico-legal and ethical issues [1,2]. They exhibit differences in clinical practices and team dynamics. Recent studies suggest the introduction of dedicated induction programs in the form of formal teaching sessions, or tailored online induction for IMGs prior to their first job [1–3]. Most IMGs have minimal exposure to simulation and human factors training with international medical schools favouring more didactic methods of education. We have designed a high-fidelity simulation course with frequently encountered clinical scenarios to improve inclusion and a harmonious transition for the IMGs. This provides an opportunity to familiarise themselves with the healthcare system and team dynamics within the NHS and instils confidence to perform to the best of their ability in their respective roles. The course has been designed specifically tailored to the needs of IMGs who may find it daunting at first to make their place in a completely new system. We employ high-fidelity simulation encompassing multiple frequently encountered clinical scenarios. The scenarios are followed by a debriefing, with a special focus on human factors, interpersonal and communication skills, and understanding of authority gradients. The attendees are also encouraged to reflect on their performance and to participate in the discussion, share their professional opinions, experiences, and cultural influences. The attendees are asked to fill a pre-course and post-course questionnaire. Two pilot courses were conducted with a total of 22 attendees. Pre- and post-course feedback with reflective questions about various aspects of the course was obtained. The scenarios assessed 5 categories, which the IMGs graded on a Likert scale. Pairwise comparison was performed between pre- and post-course feedback, showing a statistically significant increase in confidence levels related to all assessed categories; basic management skills (p <0.001), clinical skills (p=0.006), communication skills (p<0.001), teamwork (p<0.001), and leadership (p<0.001). Based on the positive feedback from attendees we believe that this induction simulation course can greatly help IMGs have a smooth transition into the NHS, and ensure inclusivity by equipping them with confidence, a knowledge of the system, and human factors. 1. Rasquinha M. Difficulties and educational challenges faced by international medical graduates in trust grade roles in the UK. British Journal of Hospital Medicine. 2022;83(4):1–7. 2. Hashim A. Educational challenges faced by international medical graduates in the UK. Advances in Medical Education and Practice. 2017;8:441–445. 3. Emery L, Jackson B, Oliver P, Mitchell C. International graduates’ experiences of reflection in postgraduate training: a cross-sectional survey. BJGP open. 2022.

538 Peer MRCS Teaching Among Surgical Trainees in the East Midlands Deanery, UK

BackgroundDuring the covid-19 pandemic, the East Midlands South Deanery ran virtual peer-MRCS OSCE teaching. We analysed two surveys to understand the impact of peer-MRCS teaching on surgical trainees in this region.MethodOne survey was completed by peer-MRCS teachers who delivered sessions in 2020–2021. The second survey was completed by prospective MRCS OSCE candidates. Responses were anonymised.Results7 / 8 peer teachers and 13/17 prospective learners completed the surveys. 6/7 peer-teachers had previous experience and prior teacher-training ranged from day courses to university degrees. All peer-teachers felt that peer-MRCS teaching enabled them to refresh their anatomy knowledge. 0/7 peer-teachers preferred to deliver practical-skills teaching.Passion for teaching was identified as a motivating factor by all peer teachers. This was further supported by the general consensus (5/7) for peer teachers preferring feedback that is focused on self-development rather than conveying appreciation. Majority (12/13) of peer learners also preferred to give feedback focused on teacher development and felt they were more likely (7/13) to provide accurate feedback for peer-sessions when compared to formal teaching sessions run by the deanery.Majority of participating prospective MRCS OSCE candidates (12/13) expressed an interest in peer-MRCS teaching. Low stress environment and cost effectiveness were the top reasons why prospective peer learners preferred virtual peer MRCS teaching.ConclusionsOverall peer-MRCS teaching in this cohort suggests advantages to both peer-teachers and learners with the potential to improve teaching skills and clinical knowledge among surgical trainees.

Knowledge, attitudes and practices regarding patient safety among surgical trainees in Sri Lanka

IntroductionSurgical trainees play an integral role in the perioperative workup and safety of patients undergoing surgery. This study was aimed to assess surgical trainees’ knowledge, attitudes and practices on perioperative surgical patient safety. MethodsA descriptive cross-sectional study among 105 surgical trainees (males 96%, mean age 33 years, range 30-40 years) was performed using self-administered validated questionnaires on knowledge, attitudes (Safety Attitude Questionnaire-SAQ) and practices (Questionnaire on evidence-based safety practices and reporting of medical errors). Responses were marked on a 5-point Likert scale and were analysed.ResultsApproximately two thirds (n=72, 69%) were junior registrars and the rest (n=33, 31%) were senior registrars. The median knowledge score was 60 (range 10-90). The Median SAQ score was 74 (151/205, range 57-95). Approximately 65% (n=68) claimed they were aware of the protocols of marking the surgical site. Nearly three quarters (n=78, 74%) have read the WHO safe surgery guidelines. Eighty-seven participants (84%) had not attended a formal risk management course/ teaching activity. Only 53% (n=56) believed that medical errors were handled appropriately and less than a third (31%, n=33) believed that the work environment was favourable to discuss errors. Only 54% (n=57) had received appropriate feedback about their performances. ConclusionOverall, the patient safety culture among surgical trainees was found to be suboptimal. Formal teaching sessions, workshops and local guidelines may help improve knowledge and attitudes on patient safety among surgical trainees. Furthermore, working conditions need to be improved to encourage discussion of medical errors and allow frequent feedback.

Online Learning Process from the Perspective of Communication Strategy and Politeness

Today, online teaching and learning is widely accepted in institutions of higher learning. Although there were various problems in the beginning, all parties were receptive to thislearning approach after many improvements were made to ensure that students could followthe online teaching learning activities even during the lockdowns. The objective of the study was to identify the elements of communication strategy and politeness factors and describe the use of these elements during online learning. This study was conducted through observation and recorded sessions of Google Meet (chat room). The respondents of the study consisted of 35 students of various races who took a Malay language course (MPU3201 National Language A) for one semester at Multimedia University, Melaka campus. Data recordings were analysed according to the approach of Asmah Omar and Hymes where the use of language through direct communication strategies is often expressed in the form of statements and direct questions. In addition, communication strategies that mark politeness are examined based on the factors of adherence to social rules and factors in maintaining face. The results show the importance of selecting effective communication strategies even in a formal but friendly atmosphere during teaching and learning as this can build harmonious relationships. Therefore, it is highly recommended that instructors or lecturers use communication strategies, especially in the aspect of opening expressions and appropriate language behaviour expressions by emphasizing the politeness factor so that the formal teaching and learning sessions in a formal atmosphere is appealing to students.

KNOWLEDGE OF BEDSIDE ETHICS AND ITS IMPLEMENTATION IN A PUBLIC SECTOR UNIVERSITY HOSPITAL

Background: Medical ethics have always been considered as fundamentally important and bedside ethics are challenging to teach due to lack of formal teaching sessions. This study aimed to identify the knowledge, attitude and misconceptions among medical students about bedside ethics in hospital and its implementation in their routine practice. Methods: The cross-sectional study was conducted in medical students from 3rd, 4th, and 5th year from public sector medical colleges from June to August 2020. Results: Out of 400 Medical students, 90% had knowledge about bedside ethics and 64% knew the principle of bedside ethics. Sixty-four of medical students believed that they lived in an environment that was inappropriate for an ethical evaluation of the doctor-patient relation. Three-hundred-forty-one (84%) opted to recognize the patient and address them in a sophisticated reserved manner when approaching the patient at bedside. Two-hundred eleven (52%) preferred to inform bad news to patients in front of their attendants. Two-hundred ninety-eight (73%) of medical students believed that ethics were required for moral values. Three-hundred-five (75%) selected the option to tell the patients honestly when they make a mistake while treatment. Moreover, 259 (64%) of students preferred to ask patients to expose the target body part but 131 (32%) of students preferred to do it by themselves. Conclusion: Majority of the undergraduate medical students had knowledge about bedside ethics and its principle. Inculcation of ethics as a subject into the curriculum of MBBS students is suggested. Pak J Physiol 2021;17(4):59–62

EP.TU.642An ANTTiclimax for Antiseptic Non-Touch Technique? A Survey of Junior Doctor Awareness

Abstract Aim Hospital acquired infections are a significant problem, costing the NHS an estimated £1 billion per year and impact on the health and safety of patients. Antiseptic non-touch technique (ANTT) has repeatedly been demonstrated as a method to reduce this burden but there is often a lack of understanding of this topic. We investigated the extent of junior doctors’ knowledge of ANTT during invasive procedures and the precautions that are taken in practice. Method This study utilised information from the World Health Organisation (WHO) Guidelines on Hand Hygiene in Healthcare, NICE guidelines on Infection Prevention and Control and local protocols to create a questionnaire assessing the following domains; general knowledge, hand washing, procedural and post-procedure actions. This was distributed to junior doctors in the ICU. Results A total of 20 participants were assessed from foundation trainees to registrar level. 55% understood the acronym ANTT, whilst 45% did not. A staggering 85% of participants were not aware of Trust ANTT key principles. 70% of respondents were not aware of WHO and local guidelines relating to ANTT for invasive procedures. 95% of participants did wash their hands prior to invasive procedures and 90% post-procedure. 95% of participants stated they would benefit from a formal teaching session on ANTT. Conclusion These results indicate little comprehension of ANTT with reference to both national and local guidelines. Mandatory online and formal education should be integrated into compulsory induction sessions of new staff Trust-wide.

EP.TU.281Mind the Gap: Improving the Quality of Neurosurgical Discharge Summaries

Abstract Aims A discharge summary is a permanent record of a patient’s hospital visit and the primary means of handover between care providers. Studies show they often lack precision and omit important information. This may compromise quality and continuity of care yet they are frequently written by the most junior clinicians on a ward with little guidance or formal education on how to write one. The aim of this study was to develop some specific guidelines to improve the quality of discharge summaries in a busy neurosurgical unit. Methods A survey was designed to identify the challenges faced by junior medical staff in writing discharge summaries. The essential components of a good neurosurgical discharge summary were identified by group of senior neurosurgeons. Summaries were retrospectively audited against these components. We then designed a simple visual aid and placed it above computer stations in the junior doctors’ offices. Formal departmental teaching session followed. After three months we re-audited the discharge summaries retrospectively to measure any effect of our intervention. Results Half of the neurosurgical team rated summaries as below expectations. Challenges included poor ward round documentation and a lack of clear expectations regarding structure and essential components. After the intervention, ward round documentation and discharge summary quality improved dramatically. Conclusions Although various recommendations about writing good discharge summaries exist, they are generally vague and not specific to neurosurgical practice. The development of a simple specialty specific discharge summary guide can improve discharge summary quality and should be encouraged in all specialties.

731 Operation Notes: Is Informal Training Enough?

Abstract Aim Operation notes are essential for continuity of patient care, communication between colleagues, medicolegal records and for coding and remuneration. This study aims to assess core surgical trainees (CST’s) understanding of completing accurate and detailed operation notes and their awareness of the RCS England Good Surgical Practice document (GSP 2014). Method Current CST’s who attended regional teaching were surveyed on their knowledge of what an adequate operation notes entails. Trainees then attended a 40-minute lecture on this topic and were then re-surveyed. Results Thirty trainees completed both questionnaires. No trainees had previously received formal teaching on how to complete operation notes. Most had received informal training in the clinical setting, usually by a registrar (93.3%). Operation notes were considered important for medicolegal reasons (53.3%), continuity of care (96.6%) and communication (53.3%). No one identified their importance for coding. Initial assessment showed only 26.6% of CST’s were aware of RCS GSP document. Responses regarding relevant information to be included in operation notes were variable: patient demographics (23.3%), procedure (93.3%) and post-operative instructions (90%). Improvements, between 3 - 70% increase, were noted in all questionnaire domains post teaching session. All trainees found a more formal session to be beneficial. Conclusions Although a small study, this demonstrates global improvements in knowledge after formal teaching session over informal clinical training. We believe this topic should be included in boot camp training at the start of core surgical training. It should include education in coding to ensure CST’s appreciate the significance of health information management.

131 Perioperative Management of Warfarin on Surgical Wards at District General Hospital

Abstract Introduction Many patients admitted to surgical wards are on warfarin. Poor knowledge of guidelines regarding reversal and restarting of anticoagulant medications can delay surgery, lead to poor outcomes and delay the discharge of patients. The aim of this audit was to establish whether junior doctors are confident in managing warfarin according to local guidelines and to improve their knowledge and confidence. Method A questionnaire was used to assess confidence of junior doctors currently working in general surgical departments. An educational poster was placed in the junior doctors’ office and the questionnaire was repeated. We then conducted a teaching session on the perioperative management of warfarin and repeated the questionnaire again. Results Confidence in reversing and restarting warfarin was significantly higher following the teaching session (p = 0.017 and p < 0.001 respectively). No significant difference was seen following the introduction of educational posters. Confidence in applying the guidelines on perioperative warfarin management was significantly higher following the teaching session (p < 0.001). Following the introduction of educational posters and the formal teaching session doctors felt they knew better how to access the guidelines (not statistically significant for either guideline) and referred to them more (p = 0.0178 for warfarin reversing and p = 0.0940 for warfarin restarting guideline). Conclusions Having doctors who are confident in managing warfarin is crucial to avoid delays in treatment and discharge. This audit showed that a teaching session indeed improved doctors’ knowledge and confidence. Regular formal teaching is essential, and a repeat audit is planned to be performed during the next rotation.

Resident-Reported Impact of a Novel Oncology Curriculum for Internal Medicine Residents.

The Accreditation Council of Graduate Medical Education mandates that all internal medicine residents gain exposure to internal medicine subspecialties including hematology and oncology. While many residents meet this criterion through inpatient oncology rotations, the current structure of many inpatient oncology rotations leaves little opportunity for formal education. We therefore designed a novel oncology curriculum consisting of one-page oncology teaching sheets to increase the number, breadth, and quality of formal teaching sessions on our resident inpatient oncology services. In order to evaluate the curriculum, we conducted pre- and post-intervention surveys of residents. From these surveys, we found that 72.2% of residents used the teaching sheets on their inpatient oncology rotation and that the teaching sheets led to an increase in the number of formal oncology teaching sessions (mean 3.4 ± 2.1 post-implementation vs 2.6 ± 2.0 pre-implementation, p = 0.008), the breadth of oncology topics taught (% reporting ≥ 5 topics; 26.1% vs 16.3%, p = 0.035), the proportion of residents reporting improvement in overall oncology knowledge (80.2% vs 62.4%, p = 0.012), and the proportion of residents reporting improvement in their ability to care for patients (70.8% vs 48.9%, p = 0.013). These results demonstrate that formal oncology teaching can be improved on inpatient oncology rotations through a simple and easily replicable oncology curriculum.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13187-021-02055-6.

Riding the waves: the ongoing impact of COVID-19 on a national surgical training cohort

BackgroundThe World Health Organisation declared a global pandemic on the 11 March 2020 resulting in implementation of methods to contain viral spread, including curtailment of all elective and non-emergent interventions. Many institutions have experienced changes in rostering practices and redeployment of trainees to non-surgical services. Examinations, study days, courses, and conferences have been cancelled. These changes have the potential to significantly impact the education and training of surgical trainees.AimTo investigate the impact of the COVID-19 pandemic on training, educational, and operative experiences of Irish surgical trainees.MethodsSurgical trainees were surveyed anonymously regarding changes in working and educational practices since the declaration of the COVID-19 pandemic on 11 March 2020. The survey was circulated in May 2020 to both core and higher RCSI surgical trainees, when restrictions were at level five. Questions included previous and current access to operative sessions as well as operative cases, previous and current educational activities, access to senior-led training, and access to simulation-/practical-based training methods. A repeat survey was carried out in October 2020 when restrictions were at level two.ResultsOverall, primary and secondary survey response rates were 29% (n = 98/340) and 19.1% (n = 65/340), respectively. At the time of circulation of the second survey, the number of operative sessions attended and cases performed had significantly improved to numbers experienced pre-pandemic (p < 0.0001). Exposure to formal teaching and education sessions returned to pre-COVID levels (p < 0.0001). Initially, 23% of trainees had an examination cancelled; 53% of these trainees have subsequently sat these examinations. Of note 27.7% had courses cancelled, and 97% of these had not been rescheduled.ConclusionSurgical training and education have been significantly impacted in light of COVID-19. This is likely to continue to fluctuate in line with subsequent waves. Significant efforts have to be made to enable trainees to meet educational and operative targets.

GP Trainees' perceptions and experiences of the training placement in Psychiatry - A qualitative study

AimsThis qualitative study aims to explore the leaning needs of the GP trainees for their psychiatry placements.MethodIn this qualitative study, semi-structured interviews of eight former GP trainees were conducted. Data were transcribed and analysed using thematic analysis. Triangulation through multiple analysts” was used to improve the validity of the studyResultThis study identified six key areas of learning needs for GP trainees during their psychiatry placement. i) the on-call experience which enabled the participants to learn how to manage acutely unwell patients in psychiatry, ii) learning the self-harm and suicidal risk assessment which is an important skill for a GP practising in primary care, iii) training in relation to psychiatric medication which enabled GPs to prescribe more confidently in the community, iv) exposure to the community psychiatry which was helpful in getting exposure to community-based clinical practice, v) learning from formal teaching activities which can be tailored to cover the relevant primary care related clinical topics and finally, vi) getting the opportunity to improve the communications skills during the psychiatry placement which is useful for all doctor in training.ConclusionWe recommend that detailed induction of the service setup is required before GP trainees start on-calls and a well-defined support network should be provided and explained to the training doctors. Risk assessment teaching should be delivered by formal training, regular supervision and discussions. Training on psychiatric medication especially in the context of GP prescribing should be considered as part of formal teaching experience. Opportunities to work with community mental health teams and outpatient clinics should be generated and offered to the trainees. Formal teaching sessions should be set up with an understanding of the GP training curriculum and their learning needs. Improvement of communications skills with exposure to difficult communication scenarios under supervision during psychiatric placement should be identified as an important area of learning for the GP trainees.

Using Videos to Teach Medical Learners How to Address Common Breastfeeding Problems.

IntroductionThough breast milk is the recommended first food, only 84% of mothers try breastfeeding, and 19% of those babies are supplemented with formula by the second day of life. Mothers often fall short of their breastfeeding goals, which has been traced in part to primary care physicians’ discomfort and lack of confidence in assisting breastfeeding mothers. A video-based educational intervention was developed to enhance learner comfort and confidence in supporting breastfeeding.MethodsPrior to watching the videos, two separate groups of learners (25 primary care residents and 40 medical students) were given two assessments to assess their baseline knowledge and self-perceived comfort and confidence with breastfeeding based on the American Academy of Pediatrics residency breastfeeding curriculum. We gave the learners a checklist to guide their observations while watching the videos. The learners repeated the assessments after watching the videos.ResultsStudents who participated showed a statistically significant increase in breastfeeding knowledge and self-perceived comfort and confidence in assisting mothers with common breastfeeding problems. Additionally, residents increased their knowledge and confidence, but not their comfort with breastfeeding.DiscussionThe videos seem to have been most helpful in assisting learners with confidence with helping breastfeeding mothers and knowledge of breastfeeding. The videos also improved student comfort but were less effective in increasing residents’ comfort as residents generally self-rated their comfort level as high preceding the video curriculum. These videos provide an effective way to begin sensitizing learners to the importance of breastfeeding, common challenges, and potential solutions for new mothers.