Foundation Doctors Research Articles

How to pass the Part 1 FRCOphth in foundation training

The Part 1 FRCOphth (hereafter referred to as Part 1) is the first of four examinations required for a Fellowship in Ophthalmology (FRCOphth) awarded by the Royal College of Ophthalmologists...

Empowering junior doctors: a qualitative study of a QI programme in South West England

AimTo explore how the South-West Foundation Doctor Quality Improvement programme affected foundation year 1 (F1) doctors’ attitudes and ability to implement change in healthcare.MethodsTwenty-two qualitative interviews were carried out with...

Paracentesis Model for Junior Doctors.

Paracentesis Model for Junior Doctors.

A Foundation Programme educational placement in peri-operative medicine for older people: mixed methods evaluation.

We established an innovative Foundation placement in peri-operative medicine for older patients in response to the need for training in 'whole patient' medicine and the challenge of fewer Foundation doctors in acute surgical roles. The placement and underpinning curriculum were co-designed with junior doctors and other clinical stakeholders. This resulted in a modular design offering acute and community experience and dedicated quality improvement project time. To evaluate the placement we used a mixed methods study based on Kirkpatrick's model of workplace learning. Level 1 (trainee reaction) was evaluated using Job Evaluation Study Tool questionnaires and nominal group technique. Levels 2 and 3 (trainee learning/behaviour) were assessed using a Likert-style survey mapped to curriculum objectives, e-portfolio completion, nominal group technique and documentation of completed quality improvement projects and oral/poster presentations. Sixty-eight foundation trainees underwent the new placement. A similar-sized 'control' sample (n = 57) of surgical Foundation trainees within the same Trust was recruited. The trainees in the peri-operative placement attained both generic Foundation and specific peri-operative curriculum competencies, and gave higher job satisfaction scores than trainees in standard surgical placements. The top three ranked advantages from the nominal group sessions were senior support, clinical variety and project opportunities. Universal project completion resulted in high rates of poster and platform presentations, and in sustained service changes at hospital level.

KNOWLEDGE AMONG GYNECOLOGISTS AND PAEDIATRICIANS.

Objective: To assess the knowledge of Zika virus infection in gynecologistsand pediatricians Study Design: Cross sectional. Setting: Tertiary care public hospitalsincluding Sardar Begam, and Allama Iqbal Memorial Hospitals, Sialkot; Services Institute ofMedical Sciences and Jinnah Hospital, Lahore; and Pakistan Air Force Hospital, Islamabad(Pakistan). Period: July to December, 2016. Method: Calculation of sample size using p =0.5 (inavailability of secondary data) in n = z2pq/d2 was followed by convenience samplingbasedrecruitment of the specialists. An indigenously developed questionnaire (Cronbach’s α= 0.79) was administrated to each subject for recording sociodemographic and professionalinformation; and self-reporting to 12 close-ended items on Zika virus infection (ZVI) in women;and microcephaly in newborns. The knowledge was categorized as adequate/inadequate.Results: Overall 172 respondents included (response rate = 97.2%); and substantially higherrate i.e. ≥ 91.9% was found against each of the correct options. Consequently, 94.8% (n= 163) of them showed adequate knowledge (score 10-12 out of possible total = 12) onthe infection and microcephaly. The knowledge had insignificant association with any of thesociodemographic/professional variables e.g. specialty (p ˃ 0.05; χ2 test). Similarly, post hocmultiple comparisons using Tukey’s HSD test revealed insignificant difference among themean values of score (p ˃ 0.05) in 3 occupational positions viz. Foundation doctors (M =11.29, SD = 1.13), trainee doctors (M = 11.26, SD = 0.81), and consultants (M = 11.40, SD= 0.82). Conclusion: Gynecologists and pediatricians had adequate level of the infection andmicrocephaly-related knowledge; though lack disease-oriented attitude and practical handling.

Foundation doctors’ experience of training and preparedness in pre-operative assessment in the United Kingdom: A qualitative study

IntroductionUK medical school graduates report feeling unprepared to perform pre-operative assessment. This study aimed to explore foundation doctors’ experiences and opinions of the current pre-operative assessment service in the United Kingdom, their preparedness to perform the task and the training they receive. MethodsA qualitative study, which utilized focus groups. Participants were foundation doctors in the South West England Region. Inductive thematic analysis was performed. ResultsSixteen participants were recruited to four focus groups. Following changes to staff and resource utilization, foundation doctors’ exposure to routine cases and training in pre-operative assessment was reported as inadequate, resulting in concerns for patient safety. Participants reported that training as a medical student may best prepare them for their responsibilities as a newly qualified doctor. DiscussionAlthough a nurse-led elective pre-operative service may improve staff and resource utilization within the NHS, this should not be at the expense of reducing doctors’ skill in this vital area. Inadequate training leads to over-reliance on guidelines, which can reduce iterative thinking, increase physician anxiety and service inefficiencies. ConclusionsSafety and efficiency of pre-operative assessment services may be improved by the training of medical students in this area, but the teaching methodology that best facilitates this competency warrants investigation.

ZIKA VIRUS INFECTION;

Objective: To assess the knowledge of Zika virus infection in gynecologistsand pediatricians Study Design: Cross sectional. Setting: Tertiary care public hospitalsincluding Sardar Begam, and Allama Iqbal Memorial Hospitals, Sialkot; Services Institute ofMedical Sciences and Jinnah Hospital, Lahore; and Pakistan Air Force Hospital, Islamabad(Pakistan). Period: July to December, 2016. Method: Calculation of sample size using p =0.5 (inavailability of secondary data) in n = z2pq/d2 was followed by convenience samplingbasedrecruitment of the specialists. An indigenously developed questionnaire (Cronbach’s α= 0.79) was administrated to each subject for recording sociodemographic and professionalinformation; and self-reporting to 12 close-ended items on Zika virus infection (ZVI) in women;and microcephaly in newborns. The knowledge was categorized as adequate/inadequate.Results: Overall 172 respondents included (response rate = 97.2%); and substantially higherrate i.e. ≥ 91.9% was found against each of the correct options. Consequently, 94.8% (n= 163) of them showed adequate knowledge (score 10-12 out of possible total = 12) onthe infection and microcephaly. The knowledge had insignificant association with any of thesociodemographic/professional variables e.g. specialty (p ˃ 0.05; χ2 test). Similarly, post hocmultiple comparisons using Tukey’s HSD test revealed insignificant difference among themean values of score (p ˃ 0.05) in 3 occupational positions viz. Foundation doctors (M =11.29, SD = 1.13), trainee doctors (M = 11.26, SD = 0.81), and consultants (M = 11.40, SD= 0.82). Conclusion: Gynecologists and pediatricians had adequate level of the infection andmicrocephaly-related knowledge; though lack disease-oriented attitude and practical handling.

Is undergraduate urology teaching fit for practice: A cross-sectional study of foundation doctors

Is undergraduate urology teaching fit for practice: A cross-sectional study of foundation doctors

A peer-education intervention improves foundation doctors' knowledge on antibiotic prophylaxis for percutaneous transhepatic cholangiography at a tertiary referral centre

A peer-education intervention improves foundation doctors' knowledge on antibiotic prophylaxis for percutaneous transhepatic cholangiography at a tertiary referral centre

Pre-op medication management – Audit of foundation doctors knowledge

Pre-op medication management – Audit of foundation doctors knowledge

Outcomes of a surgical skills course for foundation doctors to enhance confidence and increase an interest in surgery as a career choice

Outcomes of a surgical skills course for foundation doctors to enhance confidence and increase an interest in surgery as a career choice

Global Echoes: reflection on the use of interpretation in consultations in the UK.

Working as a foundation doctor in psychiatry I quickly noted the value of two things: the development of a strong therapeutic relationship and the importance of a detailed history. These two things are made much harder when your patient does not speak English and you do not speak their language. I present a reflection on my experiences with two patients who did not speak English, the role of interpreters and some common pitfalls when working with them.

A direct-to-patient telemedicine abortion service in Australia: Retrospective analysis of the first 18 months.

In 2015, the Tabbot Foundation launched a nationwide direct-to-patient telemedicine service to enable women to obtain medical abortion without visiting an abortion provider. We aimed to describe results from the first 18months of this service. To have an abortion through the Foundation, a woman obtained screening tests locally and had a telephone consultation with a Foundation doctor. If she was eligible, mifepristone, misoprostol and other medications were sent to her by mail. After taking the drugs, the woman obtained follow-up tests at local facilities and had a consultation with Foundation professionals. The Foundation charged $250 to patients with Medicare eligibility and $600 otherwise. We summarised clinical data collected by the service. Between June 2015 and December 2016, 1010 women received medications, of whom 56% lived outside of major cities. Ninety-five percent of packages were sent within 15days after registration. Of the 965 women who took misoprostol, outcomes were definitively documented for 754 (78%), of whom 96% had a complete abortion without surgical intervention, and 95% had no face-to-face clinical encounter after treatment. Of women with Medicare cards, 72% paid no out-of-pocket charges other than to the Foundation. Nearly all women (781/802; 97%) were highly satisfied. The direct-to-patient telemedicine medical abortion service was effective, safe, inexpensive and satisfactory. It disproportionately served women in parts of Australia with limited access to abortion facilities. This experience may be instructive for others desiring to use telemedicine to enhance access to abortion.

General practice tasters for foundation doctors.

General practice (GP) is currently not viewed positively as a career choice, compared with other specialties, with GP training programmes struggling to fill posts. Opportunities to change this mindset in the early years of training are limited. Trainees may find themselves applying for entry into GP specialty training just 3-4months after completing Foundation Year1 (FY1), yet there are few GP attachments during FY1 that can provide experience of primary care and positively inform career choice. To help ameliorate the current crisis in GP, recruitment and retention initiatives are needed to provide relevant experience of GP early in medical careers so that more doctors can make an informed decision to choose GP as a career. FY1 doctors have been given the opportunity to shadow final-year GP specialty trainees (GPST3) in clinical practice (for between 3 and 5days). The voluntary scheme has run successfully since 2014. This paper describes the taster programme and its evaluation. The programme has been positively received by both FY1s and GPST3 mentors. The GPST3s are enthusiastic about GP, which appeared to 'rub off' on the FY1s. FY1s find it helpful to have a trainee's perspective, gaining an overview of what to expect, including the opportunities available to them. General practice is currently notviewed positively as a career choice IMPLICATIONS: Using GPST3 trainees as mentors for FY1 doctors is educational for both groups and can have a positive impact on GP recruitment. The taster demonstrated how varied GP is, and challenged some negative perceptions of primary care. GPST3s gained confidence in their knowledge about GP and greater insight into educational roles.

What factors are critical to attracting NHS foundation doctors into specialty or core training? A discrete choice experiment

ObjectivesMultiple personal and work-related factors influence medical trainees’ career decision-making. The relative value of these diverse factors is under-researched, yet this intelligence is crucially important for informing medical workforce planning...

Variability in the prescribing of intravenous fluids: A cross sectional multicentre analysis of clinical practice

AimsIntravenous (IV) fluid administration continues to be a mainstay of care in General Surgery. Yet if they are prescribed incorrectly significant morbidity including electrolyte abnormalities, renal impairment and cardiac failure can develop. Despite this, it is frequently the responsibility of the most junior staff to prescribe IV fluids. We aim to analyse the understanding of IV fluid prescribing amongst junior doctors and to describe variability in clinical practice. MethodsWe undertook a multicentre questionnaire study. Foundation doctors and specialty trainees were invited to undertake a two part paper-based questionnaire. Part one analysed baseline knowledge of the concentration of commonly prescribed fluids. Part two consisted of four clinical vignettes requiring a IV fluid prescribing decision by the surveyed doctor. ResultsA total of 143 Doctors working in 8 hospitals were recruited. 65 (45.5%) doctors correctly stated the daily maintenance fluid requirements of water for an adult (25–30 mls/kg/day), while only 54 (37.8%) knew the sodium concentration of 0.9% NaCl. Lack of postgraduate experience (p = 0.011), qualifying from a medical school outside the United Kingdom (p < 0.0001) and working in one of the eight hospitals in this study (p < 0.0001) were associated with a lower knowledge level. There was limited consensus in prescribing in the responses to the 4 clinical scenarios, with 69 unique combinations of fluid choice, rate and volume prescribed. ConclusionsKnowledge of the constituents of common IV fluids and routine requirement for fluid and common electrolytes is poor across junior doctors of all grades, driving large variation in clinical practice.

The impact of medical school assessment on preparedness for practice

Purpose: As assessment is known to drive learning, this paper looks at the relationship between assessment practice across UK medical schools and graduates preparedness for practice.Materials and methods: It uses data on written and practical assessment at each medical school and the association with students’ self-reported preparedness for working as a foundation doctor on graduation, and in particular the preparation related to clinical skills.Results and conclusions: A negative correlation (β= −0.003, p < 0.001) was observed between total duration of written assessment and preparedness, while a positive relationship (β = 0.461, p < 0.001) was seen between “adequately prepared” and the proportion of all assessment time focusing on practical skills. This suggests that graduates from medical schools with a greater emphasis on practical skills in their assessment plan are better prepared to practice as a junior doctor on gradation; something that may be of relevance when designing a national licensing examination.

The Impact of a one day Undergraduate Radiology Course on Confidence and Performance of Medical Students in Interpreting commonly encountered Radiographs

This article was migrated. The article was not marked as recommended. IntroductionResearch into undergraduate radiology teaching suggests that medical students feel their radiology training is currently inadequate. Radiology, as a specialty, is generally not taught formally at medical school; rather, it is integrated inconsistently into various other specialties. This study aimed to investigate whether a one day course could help medical students with both confidence and performance.MethodsParticipants consisted of third and fourth year medical students from Barts and The London School of Medicine and Dentistry. The course consisted of morning lectures delivered by radiology registrars and afternoon small group interactive tutorials led by foundation doctors. The topics were chest (CXR), abdominal (AXR), musculoskeletal radiographs and computed-tomography (CT) of the head. The learning outcomes were created in accordance with the Royal College of Radiologists undergraduate curriculum. There was a pre and post course assessment consisting of 15 multiple-choice questions. Additionally a questionnaire was given evaluating their confidence in interpretation (rated from 1= not confident to 10=completely confident). A paired T-test was performed to investigate the significance of the results.Results7 students completed the quiz and questionnaires. The mean assessment scores were 10.43 pre-course and 14.33 post-course. This demonstrated a statistically significant improvement of 4.43 marks or 27% (p=0.0004 95% CI 2.59 to 5.41). Likewise, students demonstrated a significant increase in confidence in all four areas. Confidence in CXR interpretation increased by 21%, or 2.1 points (p=0.0113 95% CI 0.69 to 3.60); AXR increased by 31%, or 3.14 points (p=0.0008 95% CI 1.90 to 4.39); CT Head increased by 44%, or 4.43 points (p=0.0002 95% CI 3.03 to 5.83) and Musculoskeletal X-ray increased by 37%, or 3.71 points (p=0.002 95% CI 1.97 to 5.46).ConclusionOur results demonstrate that a one-day intensive course statistically raised both confidence and knowledge in interpreting common radiographs. The combination of lectures and interactive small group teaching sessions seemed to allow students to consolidate their knowledge and apply it more successfully when tested in the post-course assessment. Additional research is required to further explore the impact of the course and the plan is to run a second course at the start of the next academic year.

The influence of early research experience in medical school on the decision to intercalate and future career in clinical academia: a questionnaire study

BackgroundCurrently, only one in three UK medical students undertake an intercalated degree. This has often been implicated as a result of financial obstacles or a lack of interest in research due to inadequate exposure to academic medicine. The aims of this study were to determine whether exposure to research early in medical school, through the initiation of an early years clinical academic training programme has a positive influence on the decision-making related to intercalating and a career long interest in research. This study also aims to evaluate the perceived views of the recipients of such a scholarship programme.MethodsAll previous recipients of the Aberdeen Summer Research Scholarship (ASRS) (n = 117) since its inception in 2010 until 2015 were invited via email in June 2016, to take part in the survey. Data were analysed using SPSS for quantitative data and a thematic approach was used to derive themes from free text.ResultsThe overall response rate was 56% (66/117). Of the respondents, seven received the scholarship twice. Seventy-three percent were still at medical school and 26% were foundation doctors. One respondent indicated that they were currently not in training. Seventy percent of respondents have continued to be involved in research since completing the scholarship. Fifty percent embarked on an intercalated degree following the ASRS. Furthermore, two thirds of the respondents who were undecided about undertaking an intercalated degree before the scholarship, chose to intercalate after completing the programme. ASRS was generally thought of as a positive, influential programme, yet the success of individual ASRS projects was dependent on the allocated supervisors and the resources available for specific projects.ConclusionsOur findings indicate that early research exposure in medical school can provide students with a positive influence on involvement in research and allows students to make an informed decision about embarking on an intercalated degree. We therefore recommend the encouragement of similar programmes in medical schools to promote clinical academia at an early stage for medical students.

‘Just a GP’: a mixed method study of undermining of general practice as a career choice in the UK

ObjectivesFailure to recruit sufficient applicants to general practice (GP) training has been a problem both nationally and internationally for many years and undermining of GP is one possible contributing factor....