Foundation Doctors Research Articles

Do junior doctors have the knowledge to safely prescribe antibiotics in the context of known penicillin allergy?

The drug class most frequently associated with allergic reactions are the penicillins. Yet penicillins have a vital role in being important treatment options for many common and uncommon infections. Junior doctors undertake the majority of hospital-based prescribing. Evidence suggests foundation doctors make the most prescribing-based errors. A questionnaire was designed to ascertain whether junior doctors displayed an adequate level of knowledge regarding individual and antibiotic class identification, use of trade names, beta lactam cross sensitivity and symptoms of type I and IV hypersensitivity reactions. Three quarters of respondents stated they had received allergy/non-allergic drug reaction teaching as an undergraduate but only just over a half had as a postgraduate. The Junior doctor responded group demonstrated adequate knowledge of correct identification of individual penicillins and non-penicillins and symptoms of a type I hypersensitivity reaction. There was inadequate knowledge of cephalosporin and carbapenem prescribing in the context of penicillin-associated anaphylaxis and of type IV hypersensitivity reaction symptoms. More core and higher specialty trainees correctly chose to prescribe in generic name form than foundation doctors. This survey suggests that there may be key elements of knowledge required to safely prescribe antibiotics in the context of penicillin that, overall, as a group, junior doctors may lack adequate knowledge of, with this inadequacy being most pronounced in foundation doctors. This suggests that junior doctors, and foundation trainees in particular, may need more education and training early in their careers to help support safe prescribing in the context of penicillin allergies.

What does a good prescribing induction for the newly qualified doctor look like?

Foundation year 1 doctors (F1s) are expected to prescribe from their first day in clinical practice. Prescribing involves a complex series of steps involving integration of theoretical and experiential knowledge, patient information, communication skills, mathematics and awareness of human factors that undermine safe prescribing. It has been suggested that prescribing should routinely be viewed and treated as a high-risk procedural skill. The majority of prescriptions within secondary care are written by foundation doctors (FDs).1,2 FDs also make the most prescribing errors.2,3 An important part of the transition to prescriber is F1 induction. Since 2012, trusts and health boards must provide an induction and at least …

Learning to prescribe antimicrobials in Northern Ireland

Background: The appropriate use of antimicrobials has implications on individual patient care, drug resistance and worldwide public health. Learning to prescribe antimicrobials is therefore an important part of medical education. The aim of this study was to evaluate novice prescribers’ readiness to use antimicrobials, in order to design valid educational activities. Methods: A mixed methods study was carried out amongst final year students at Queen’s University Belfast and foundation year 1 (FY1) doctors working in a Northern Ireland hospital. Data was initially collected using a survey, comprised of quantitative and qualitative elements. This was supplemented by semi-structured interviews. Results: One hundred and fifty-eight students and eighteen doctors participated in the survey. Two students and two doctors were interviewed. Both groups appeared to feel only moderately prepared to prescribe antimicrobials. Agreement with survey statements relating to knowledge and confidence was 61% and 73% for students and FY1 doctors respectively. More focused contextual teaching and practical learning opportunities were felt to be required. Students perceived a long time gap between teaching and clinical exposure. Both groups conveyed the strong influence of the working environment and local prescribing culture. These were sometimes seen as barriers to optimal prescribing. Feedback on prescribing was felt to be useful but lacking. Conclusion: This study suggests that medical students and foundation doctors do not feel adequately prepared to prescribe antimicrobials, which may lead them to be overly influenced by suboptimal prescribing cultures. A number of curriculum development and quality improvement initiatives are suggested as a result.

Induction for foundation doctors: to what extent can face-to-face induction be replaced by Health Education England's national Doctors in Training induction e-learning?

The Doctors in Training (DiT) induction e-learning programme was launched by Health Education England in 2018. This covers eight topics: blood transfusion, consent, death certification, the Mental Capacity Act, record keeping, risk management, safe prescribing, and VTE thromboprophylaxis in three clinical scenarios. The certification is valid for 3 years. Within the East Kent Hospitals University NHS Foundation Trust (EKHUFT), a 2-day induction …

Who wants to be a psychiatrist? Northern Ireland foundation doctors (2006-2018) are positive toward psychiatry as career choice.

Northern Ireland presents itself as an anomaly - a region in which only 31.8% of doctors enter into any training programme after completion of the Foundation Programme, but where Core Psychiatry has been consistently oversubscribed. Here, we aim to find what other regions can learn from this success. All doctors of any grade, working in psychiatry, who had been though the Foundation Programme were questioned on their motivations for becoming a psychiatry trainee. Sixty-two doctors currently working in psychiatry responded, including over 60% of current trainees, and 45% stated they had not considered a career in psychiatry before their foundation attachment. Over 80% preferred foundation placements in FY2 only, rather than in either foundation year 1 or FY2. This survey identifies that for the majority of people who ultimately chose to train in psychiatry, in a region that has consistently attracted candidates to core and higher level training, completion of a foundation psychiatry post was an influencing factor in this decision. A strong majority of doctors prefer the foundation psychiatry placement to be offered in FY2.

Ten tips for foundation doctors when making inpatient referrals to surgical specialties

Making referrals to another specialty is an underemphasised skill in the undergraduate medical curriculum. As a result, many new foundation doctors find themselves ill-equipped to make effective referrals to other...

Do foundation doctors meet the mental health competencies in the foundation programme curriculum?

Do foundation doctors meet the mental health competencies in the foundation programme curriculum?

Foundation doctor knowledge of wounds and dressings is improved by a simple intervention: An audit cycle-based quality improvement study.

BackgroundMany foundation year 1 and 2 doctors (FYs) have limited knowledge experience in wound management. Wound dressing formularies exist in many NHS Trusts, though awareness of and adherence to them by FYs is not known. This quality improvement study described baseline FY knowledge of wound management, and investigated whether this could be improved through educational intervention.MethodsA single-centre, prospective, baseline audit was conducted following local approval. This assessed knowledge of wound types and appropriate dressings alongside individual confidence providing wound care. The educational intervention involved the distribution of an ID-badge sized quick reference guide that could be attached to the FYs' lanyards, and an introduction to the formulary during routine teaching. The audit loop was closed by repeating the questionnaire.ResultsPre- (n = 43) and post- (n = 35) intervention questions were completed by FYs. The mean score post-intervention was significantly higher than the pre-intervention score across all knowledge questions (from 32% correct to 71% correct, p < 0.0001). There was no change in participant confidence, which remained low.ConclusionFYs lack confidence and knowledge about wounds and dressings. The latter can be improved through a simple and practical educational intervention that could be deployed nationally.

Medical education, simulation and uncertainty.

Foundation doctors often feel underprepared to cope with uncertainty, particularly in an acute setting. Simulation is an established method for teaching about the management of acutely unwell patients, yet simulated cases are often simplified to ensure that a given learning outcome is reached. This approach may present learners with challenges in clinical practice when more complex nuanced cases are encountered. We explored final-year medical students' perceptions of clinical uncertainty when facing an 'authentically' complex simulated patient. We adapted a simulation scenario in an attempt to replicate clinical uncertainty. The simulated patient had a confused history, only mildly deranged physiology, no current clear diagnosis and no diagnostic investigations yet available. Students engaged in debriefs facilitated by the researchers, which employed advocacy and enquiry to help students to reflect on their simulations (the 'Diamond Approach'). These were transcribed, coded and analysed thematically. Students found the 'uncertainty' simulation more challenging than a 'typical' simulation. Students found it disheartening when the patient had no clear diagnosis and expected 'an answer'. Students described task fixation and/or inaction in the face of uncertainty, struggled to identify appropriate times to seek senior support and were confused about their role in managing complex cases. We propose that this session prompted valuable discussion amongst students about how to react to clinical uncertainty. Students generally perceived the simulation as being useful. Affording space for reflection and allowing students to consider strategies for coping with uncertainty may help them when managing complex cases as Foundation doctors.

Quantitative analysis of medical students’ and physicians’ knowledge of degenerative cervical myelopathy

ObjectivesWe have previously identified a delay in general practitioner (GP) referrals for patients with degenerative cervical myelopathy (DCM). The aim of this study was to evaluate whether an education gap...

An Introduction to Surgical Instruments in the Operating Theatre

The operating theatre can be an intimidating environment for Foundation Doctors and Medical Students, even if they are interested in surgery. A pre-requisite level of knowledge is required before active participation is possible, which is crucial to access learning opportunities. Initially, junior assistants are often tasked with retraction using a Langenbeck, but good performance here often leads to more substantial contributions later in the operating list. Therefore, it is crucial to be familiar surgical instruments and their function to facilitate active assistance of the primary operator. Below we have compiled the 17 most frequently used surgical instruments and five top tips.

An investigation into the career thinking of foundation doctors in Wales

An investigation into the career thinking of foundation doctors in Wales

National survey of the management of eye emergencies in the accident and emergency department by foundation doctors: has anything changed over the past 15 years?

Ophthalmic emergencies comprise a significant portion of junior doctors' workload in accident and emergency (A&E). However, previous studies have demonstrated a lack of training and confidence in the management of such emergencies. This study assessed changes in basic ophthalmic training that A&E junior doctors received in dealing with eye emergencies, their perceived level of confidence and the availability of appropriate ophthalmic equipment in A&E over the last 15 years. A prospective, national, combined online and telephone survey using a previously published questionnaire was performed. Foundation year two doctors (FY2s) from each A&E department in the UK listed on the official NHS directory were contacted for participation. Two hundred and ten A&E departments were contacted and 202 responded (response rate of 96.2%). There was no significant change in the number of A&E departments equipped with slit lamps (82.5% in 2003 vs 79.7% in 2018; p = 0.26). However, the prevalence of training in its use has decreased significantly (68.4% in 2003 vs 52% in 2018; p = 0.005). There was also a significant reduction in the prevalence of training in the management of eye emergencies (77.4% in 2003 vs 45.5% in 2018; p < 0.001) and the proportion of FY2s who felt confident in dealing with such cases (36.1% in 2003 vs 6% in 2018; p < 0.001). There is a concerning decline in basic ophthalmic training for A&E FY2s, reflected by the alarmingly low level of confidence in the management of eye emergencies. This highlights an urgent need to improve ophthalmic training for junior doctors in A&E.

Exploring the perceived medical ethics and law training needs of UK foundation doctors

Foundation doctors (FDs) encounter a wide range of ethical and legal issues during their first two years of work. Despite ethics being a key part of most modern undergraduate curricula, FDs can struggle with the issues they see. This study is based on results from an on-line survey answered by 479 UK FDs regarding their medical law and ethics learning needs, and their undergraduate training in this area. Over two-thirds stated they would wish to receive MEL training as an FD on self-discharge against medical advice (∼71%), sedating patients (∼70%), decision making in emergency medicine (∼67%), and withholding and withdrawing treatment (∼66%). Over half of all respondents want MEL training during their Foundation Programme on DNACPR orders (∼63%), dealing with patients with suicidal intent (∼59%), Mental Health Act (∼55%), Deprivation of Liberty Safeguards (∼54%), and end of life care (∼53%). We therefore propose a minimum curriculum for ethics and law training for FDs based on these topics, as well as cases brought by the FDs themselves.

Does initial postgraduate career intention and social demographics predict perceived career behaviour? A national cross-sectional survey of UK postgraduate doctors

ObjectiveStudies indicate that initial career intentions and personal characteristics (eg, gender) can influence medical career decision-making. However, little is known about how personal characteristics and intention interact with career decision-making....

Improving patient safety through an emergency call safety huddle.

Communication among members of the emergency team is integrally linked to patient safety.1 The need to promptly identify and manage the acutely unwell patients is key towards preventing harm to patients. A short daily meeting can help save lives by helping emergency teams to work together more effectively. At Surrey and Sussex NHS Trust (SASH) we have approximately five to eight emergency calls in a 24-hour period. These are composed of medical emergency team (MET), which is composed of the medical registrar, senior house officer, foundation doctor and a critical care outreach nurse (CCOT). A cardiac arrest team is composed of the MET team as well as an anaesthetist. In the past the emergency team would initially meet over an unwell patient unaware of who each other was, what role they played and what was expected of them. It is known that there is a 1 in 400 million chance of the same team working together again.2 The Safety Huddle has been a part of the culture of improving patient care at SASH since October 2016. Members of the cardiac arrest and medical emergency teams meet each other, roles are allocated every morning and learning from previous emergencies is discussed. Roles and training needs are documented through a standardised checklist on a daily basis. This is in order to create effective teamworking and improve patient safety.

It's all fun and games until somebody gets hurt: using a scavenger hunt game to teach human factors to junior doctors.

Human factors are extremely important in healthcare. It is now a requirement that all junior doctors demonstrate understanding of human factors in medical error.1 Feedback from previous teaching to foundation doctors on human factors in South Tyneside NHS Foundation Trust included comments such as ‘just not relevant to us at this level of our training’. A session entitled ‘Introduction to human factors’ aimed to meet the outcome as expected in junior doctors’ Foundation Programme curriculum: ‘Describes the role of human factors in medical errors and takes steps to minimise these’. The foundation doctors were divided into teams. …

What are the perceptions of interventional radiology amongst foundation doctors and how can awareness be improved?

To assess perceptions of interventional radiology (IR) amongst foundation trainees (FYs) and to explore how awareness can be improved. Seventy-nine FYs completed a survey developed by the Radiology Department. Forty-five percent of FYs were introduced to IR throughout their training posts, whereas 38% learnt more via self-directed reading. Fifty-nine of the 79 FYs would not consider a career in IR with 53/59 lacking interest in radiology and 13/59 lacking enough information. The majority were aware that interventional radiologists have on-call commitments; however, 55% realised that they attend clinics. Just over 85% were familiar that ultrasound-guided biopsy was performed by IR closely followed by inferior vena cava (IVC) filter and nephrostomy insertions (81% and 72% respectively). Around one-third of FYs thought that interventional radiologists come from a surgical background while 64% knew that juniors are able to apply directly for radiology. Sixty-five percent rejected the notion of learning more about IR; however, the most preferred methods to raise awareness were elective placements and teaching throughout foundation years. FYs perception of IR is generally poor due to lack of adequate knowledge. This may dissuade them from selecting radiology as a career. Efforts need to be exerted to raise awareness with the aim of attracting more juniors to IR in order to address the significant shortage of interventional radiologists in the UK.

It’s all fun and games until somebody gets hurt: using a scavenger hunt game to teach human factors to junior doctors

Human factors are extremely important in healthcare. It is now a requirement that all junior doctors demonstrate understanding of human factors in medical error.1 Feedback from previous teaching to foundation doctors on human factors in South Tyneside NHS Foundation Trust included comments such as ‘just not relevant to us at this level of our training’. A session entitled ‘Introduction to human factors’ aimed to meet the outcome as expected in junior doctors’ Foundation Programme curriculum: ‘Describes the role of human factors in medical errors and takes steps to minimise these’. The foundation doctors were divided into teams. …

Exploring the Physical Activity Counselling Practices of Foundation Doctors: A Qualitative Study

Exploring the Physical Activity Counselling Practices of Foundation Doctors: A Qualitative Study