Foundation Doctors Research Articles

186 Reflections on Remote Simulation: What Does This Mean That Candidates Miss?

Our organization has been running some courses remotely since autumn 2020. Sessions for medical students and foundation doctors have taken place, allowing those who are isolating or shielding to participate, and facilitating the training of those who are outside our organization. We are now writing many courses with remote learning in mind and creating our course materials in digital format. This means that we are not starting from scratch if changes in circumstance prevent face-to-face training in the future. The remote format involves candidates controlling an ‘avatar’ in-centre, supported by a confederate (in nursing or junior doctor role), with access to a digital notes bundle. The screen on Microsoft Teams has a relatively fixed room view taking up the majority of the screen, with a change in feed to a different camera if appropriate to the flow of the scenario – to focus on the defibrillator, for example, with observations in a corner, and results popping up when requested. There is no option for candidates to alter this view. During a dry-run of a scenario involving a simulated patient (played by a faculty member) with hallucinations due to delirium, the candidate struggled in their appreciation of how abnormal the patient’s behaviours were, as they were unable to see all the small movements that were evident to those of us in the room, and low volume speech and muttering might have been difficult to hear, despite the faculty member wearing a microphone, though may have been easier through headphones. We sought feedback on the format and the feasibility for the scenario from the candidate, and the phrase ‘I didn’t see/hear that’ was used a lot. This has led me to wonder how much detail our candidates are dialling in from home, particularly those who are using a tablet, phone or laptop with a small screen, and have been missing, and how that might have affected their behaviour and clinical reasoning. Submitted feedback makes little reference to missing things in the course of the scenarios, but some candidates seem to have had more issues than others. This may have been due to technical or connectivity problems but could be viewed as a limitation of the set-up in its current format. Reviewing the feedback, while some expressed frustration about technical issues, there are many more comments about how they had enjoyed the experience and hoped it will continue. The jury seems to be out, but there is much to work on as we move forward.

122 Adapting Foundation Programme Simulation in Response to a Pandemic: Has it Diminished Learning?

A human factor-based simulation course is run for foundation doctors and nurses annually at a London teaching hospital. Simulation helps to improve technical and non-technical skills in a supportive environment The aim of the study was to evaluate the impact of the course adaptations on the participants’ learning experience, delivery of learning objectives and quality of teaching.The course comprises simulated scenarios with facilitated debrief sessions. Post-COVID-19 changes comprised: moving to a half-day format, reducing the number of scenarios from five to three, reducing the number of participants per session, running multiple courses on 1 day and reducing debriefing time. Feedback was gathered pre- and post-course using SurveyMonkey. The questionnaires utilized free-text answers and Likert scales based on the Human Factors Skills for Healthcare Instrument Despite changes made, participants reported an improvement in clinical skills (Percentage of participants who reported feeling confident in clinical skillsPercentage of participants who reported that they could adequately do the following Human Factors Skills for Healthcare Instrument skillsCommon themes arising from participants’ feedbackThis course demonstrates that simulation can be delivered safely throughout a pandemic while maintaining education value. Participants continued to find simulation useful; the use of PPE did not affect debriefing and learning processes. Changes did arise as a result of the changes: increased workload on staff (multiple sessions), timing issues, repetition in scenarios delivered and ward pressures on participants. Moving forwards, some adaptations such as the use of PPE will remain, but the course will return to a full day. To further evaluate the impact of the changes made. We are currently obtaining feedback from faculty.

167 Evaluating the Effectiveness of a Redesigned Simulation Programme for Final-Year Medical Students During their Assistantship Placement

The transition to a foundation doctor is often a daunting process for medical students and, to prepare for this, students attend an assistantship placement in the final months of medical school. The transition to foundation year 1 (TTF1) programme is an 8-week placement where students shadow a junior doctor, taking on a vocational role, and attend various teaching activities including high-fidelity simulation. Evidence suggests that medical students transitioning to clinical practice feel unprepared for working on-call, managing acutely unwell patients and task prioritization, and are often unprepared for scenarios requiring expert communication techniques We aimed to evaluate the effectiveness of a redesigned simulation programme for TTF1 students, focussing on student satisfaction, confidence and attitudes across key domains.Fifty-three TTF1 students attended a 1-day high-fidelity simulation training day, separated into cohorts of 10 students. Students completed a pre-course (In terms of confidence, there was an improvement across all core domains, namely diagnosing and managing acute medical emergencies (2.8 vs. 3.8), performing cardiopulmonary resuscitation (3.0 vs. 3.6) and working effectively with colleagues in the interests of the patient (3.3 vs. 4.2). 96% of students found that simulation was a valuable learning experience, allowing them to integrate theory with practice. 94% of students felt that the simulation allowed them to analyse their behaviours and actions and 88% found that scenarios resembled real-world situations. Attitudes towards simulation were positive, with 92% of students agreeing that simulation is a good way of learning technical and non-technical skills. Qualitative themes focussed on the real-world applicability of the scenarios, increased confidence in task prioritization, closed-loop communication and early escalation.We have demonstrated the benefit of integrating simulation training within the assistantship period and the value of creating novel scenarios directly related to future practice as a junior doctor.

Responsibility with a Safety Net: Exploring the Medical Student to Junior Doctor Transition During COVID-19

IntroductionThe Foundation Interim Year-one (FiY1) Programme was part of a UK strategy to increase the medical workforce in response to the COVID-19 pandemic. However, the strategy was introduced urgently without evidence. We sought to explore the transition experience of medical student to FiY1 to foundation doctor, with a view to inform future undergraduate education.MethodsIn this hermeneutic phenomenology study, semi-structured individual interviews were completed with nine foundation doctors who had experience of an FiY1 placement. A template analysis approach was taken, and themes reported.ResultsParticipants reported that FiY1 tended to offer a positive experience of transition as a stepping stone to becoming a foundation doctor. Having a degree of clinical responsibility including the right to prescribe medication with supervision was highly valued, as was feeling a core member of the healthcare team. Participants perceived that FiY1 made them more prepared for the foundation transition, and more resilient to the challenges they faced during their first foundation job.DiscussionThe FiY1 fostered many opportunities for junior doctors to bridge the transition to foundation doctor. Aspects of the FiY1 programme, such as early licencing and increased team membership, should be considered for final-year students in the future.

Changes in the provision of undergraduate ENT clinical placements across the UK in response to the coronavirus disease 2019 pandemic.

This study aimed to report the changes made to ENT placements across the UK in response to the pandemic and their impact on student experience. A questionnaire eliciting how ENT placements were provided before and after coronavirus disease 2019 was disseminated amongst Student and Foundation Doctors in Otolaryngology representatives. Thirty-eight respondents from 27 medical schools across the UK completed the survey (response rate of 90 per cent). Twenty-nine of the 38 respondents (76 per cent) reported a change in ENT placements in response to the pandemic. Six of the 38 students (16 per cent) remained satisfied with their ENT placements, as compared to 12 students prior to the pandemic (32 per cent). There is considerable variability in how medical schools responded to the pandemic. Most medical schools placed students into smaller groups, with less direct contact in the hospital. These changes resulted in lower student satisfaction. The increased emphasis on e-learning underscores the need for high quality e-learning materials to promote learning throughout the pandemic and in the future.

TP8.2.26 A new simulation-based course to improve trauma management by junior doctors

Abstract Aims Trauma calls at small hospitals are often attended by small and/or junior teams, especially overnight. The quality of primary surveys was subjectively observed to be extremely variable, sufficient to cause concern about patient safety. In addition, the introduction of the ‘ward trauma call’ for falls was generating anxiety amongst juniors. I recognised an unmet need and gained permission from the Director of Medical Education to create a half-day ‘Introduction to Trauma’ simulation-based course. Method A sample group of Foundation doctors attended a pilot course. Confidence in aspects of trauma management was assessed using Likert scales. Results Pre-course results indicated doctors were reasonably confident with their A-E assessments (63% moderately or very confident) but lacked confidence in trauma skills such as using a scoop. After the course 100% reported increased confidence about what will happen in a trauma call, and 63% reported increased confidence in their A-E assessments. Increased confidence was also widely reported in trauma skills (e.g. log roll 88%), how to manage a ward trauma call (100%), and where to find further guidance (100%). Conclusions This pilot demonstrated that a small group simulation-based teaching intervention can significantly increase the confidence of foundation doctors in all aspects of their role in trauma management. The most notable increases were in trauma equipment use and in managing ward trauma, suggesting these are areas where foundation doctors lack guidance or experience. The course is now part of trust induction for new foundation doctors.

EP.TU.569Improving Confidence and Technique When Preparing Nipple Smears for Cytology

Abstract Aims To create a sustainable means of educating breast surgeons on how to prepare nipple smears for cytology when investigating nipple discharge. Methods A nation-wide questionnaire of 51 doctors conducted in 2020 identified low confidence and competency in preparing a nipple smear slide. A 3-minute training video was subsequently created and published to the Association of Breast Surgery (ABS) website for universal access. Doctors were prompted to complete a questionnaire after watching the video to assess understanding, confidence, and obtain video feedback. Results were collected and analysed using Qualtrics software. Results 31 doctors completed the survey (10% foundation doctors, 77% specialist trainees, 13% consultants). The mean±StD nipple smears prepared per year was 1.74±0.95. The percentage of doctors who felt confident in their technique increased from 44% to 100%. Ninety-seven per cent correctly identified how to store and label the sample, previously 45%. The percentage of doctors aware of where to place the sample on the slide increased from 37% to 100%. Eighty-seven per cent were aware of the optimal fluid volume in comparison to 10% previously. All respondents felt the video was valuable and 71% of respondents indicated they would also benefit from a written list of instructions. Conclusions The preparation of nipple smear slides has historically been an area of clinical uncertainty. An educational video was successfully created to educate all grades of doctors and made universally accessible through the ABS website.

EP.TU.317Assessing the competency of foundation doctors in urethral catheterisation

Abstract Aim Our aim was to assess FY1/FY2 doctors’ experiences and confidence in performing urethral catheterisation in a teaching hospital. Methods This was a single centre, survey based study. An anonymous online questionnaire was circulated to all foundation doctors at the trust. The survey contained 18 questions. The domains included the number of catheterisations performed, confidence levels and whether they had been signed off as competent. This was followed by a series of knowledge questions. Results The survey was sent to 71 email addresses and the response rate was 53%. The results showed that respondents’ lacked experience and confidence in urethral catheterisation. We also found that 32% trainees had not inserted a female catheter during foundation training, and 55% had failed to insert a catheter in the last year. The vast majority (71%) of respondents did not feel confident in female catheterisation. Conclusions This study shows that knowledge and competency in urethral catheterisation (which is an essential GMC requirement) amongst junior doctors is still inadequate.

EP.FRI.886 Clinicians’ compliance and diagnostic utility of digital rectal examination in acute abdominal emergencies: a prospective, blinded study

Abstract Aims One hundred years ago, Sir Zachary Cope described digital rectal examination (DRE) as ‘extremely important and informative’ in the assessment of the acute abdomen. Medical students have always been taught of the importance of including a DRE as part of the abdominal examination. It has however been observed that DRE is often omitted in clinical practice. The aims of the study are to determine how frequently DRE is carried out in acute abdominal emergencies and also to determine the diagnostic utility of DRE in this setting. Methods Patients over the age of 18 presenting to the on-call general surgeons in a teaching general hospital with any acute abdominal symptoms over a 15 day period were assessed prospectively. The performance of a DRE by any clinician at any point up to 24 hours post-admission was recorded, and the findings of DRE were analysed with respect to the final diagnosis. Results Out of the 168 patients presenting with an abdominal emergency, 41 (24.4%) had a rectal examination. 70.7% of DRE were done by surgical trainees and foundation doctors. Most DREs were performed when the presenting complaints were constipation, rectal bleeding, and suprapubic pain. The findings on DRE directly contributed to the final diagnosis in 11 patients. Conclusions DRE is only preformed selectively during the initial evaluation of surgical patients presenting with acute abdominal symptoms. However DRE remains a key part of clinical examination. The theoretical and practical skills in the performance of DRE should be safeguarded via continuing education and training.

EP.TU.590Making the cut – Tailoring an undergraduate surgical teaching programme a QI project

Abstract Aims This project set out to improve the quality of surgical teaching for final year students on a DGH placement. A four-week programme was introduced and regular modification was undertaken through systematic gathering of feedback. The sessions developed were interactive question-based tutorials, suturing, and on-call simulation with common F1 scenarios. Methods Material was developed and piloted based on topics the facilitators felt were poorly taught as students. Feedback was gathered by questionnaire after each session comparing the student’s confidence before and after, along with suggestions for improvement. This process was repeated through all six rotations. Results A total of 95 questionnaires were completed. Average confidence increased from 52% to 77%. The programme was expanded based on suggestions to include orthopaedic examinations and plastic surgery. The tutor pool was increased to include more foundation doctors to ensure sustainable weekly delivery. Examples of how suggestions were implemented include: Conclusions The success of the teaching programme was evident through positive feedback and good student attendance. By playing to the strength of foundation trainees as recent graduates, the programme complemented content-based teaching from more senior colleagues with sessions targeting practical F1 skills and exam specific needs of students. Early piloting also meant ability to constantly adapt the programme to enhance its benefit to the students.

EP.TU.480Novel virtual near-peer surgical teaching for foundation doctors

AimsStudies have shown that new medical graduates feel unprepared for their role as clinicians. Courses and teachings have been cancelled due to COVID-19. Our aim was to assess demand for surgical teaching and provide a new surgical course delivered virtually to fill this gap.MethodsFY1 doctors from a large teaching hospital were invited to fill in a questionnaire to assess their preparedness for surgical specialties and subsequent appetite for near-peer teaching. The findings were used to create a virtual surgical teaching course. A post-course questionnaire was distributed to assess the success of the course.ResultsFifteen FY1 doctors completed the questionnaire. 73% (11) felt they had not had sufficient teaching on surgical specialties during medical school. 93% (14) felt they did not have sufficient teaching on managing surgical patients in foundation training. None felt ‘very confident’ managing patients peri-operatively. None felt ‘very confident’ managing surgical complications. 66.7% (10) and 53.3% (8) said they had not had any teaching from SHOs or SpRs respectively. Of those who had, 66.7% (4) and 85.7% (6) found it ‘very useful’. 100% (15) said they would be interested in surgical teaching delivered by CSTs. Twelve FY1 doctors completed the post-course feedback. 83% (10) found the course ‘extremely useful’ and relevant to their surgical ward based jobs.ConclusionFY1s are not confident in managing surgical patients on the wards. There is a demand for surgical teaching for FY1s. Virtual lunch-time teaching is an effective way to encourage and continue surgical teaching throughout the pandemic.

EP.TU.833The F2 Cohort of COVID19: The impact on Career development – a survey analysis

Abstract In March 2020 the coronavirus outbreak was announced as a global pandemic by WHO, in response to the pandemic the NHS underwent huge changes. This included recalling foundation doctors and cancelling the changeover into their final rotations. There have been studies into the impact of the pandemic on junior doctor training and wellbeing, however none looking specifically at their career development. An online survey was distributed to a cohort of Foundation Year 2 Doctors (F2s) in one NHS trust. This specifically asked about the impact of not rotating, specialty tasters, courses and the overall impact of the pandemic. The results of this study show that F2 doctors report weaker specialty applications alongside missed career development opportunities. However, the main influence of COVID-19 was reported to be on the cohort’s personal lives. This study concluded that the COVID-19 pandemic negatively affected both F2 doctor’s professional and personal lives, and it would be useful to follow up the cohort’s career development in the long-term as well as investigate the impacts in other NHS foundation trusts in the country.

448 Foundation Doctor Local Peer-Led and Organised Basic Surgical Skills in General Surgery and Plastic Surgery

Abstract Aim Foundation doctors are under pressure early in their careers to attend highly subscribed and expensive surgical courses. We assessed the feasibility of a foundation doctor led and locally organised basic surgical skills introduction. Method The lead foundation doctor organised a basic surgical skills introduction for foundation year doctors at Salisbury District Hospital liaising with the postgraduate centre and local surgical consultants. This training was supervised by local consultants and registrars. This teaching delivered theory and practise in suturing, knot tying and laparoscopy by local and familiar trainers. Feedback was collected using the Likert scale. Results 12 foundation doctors attended. 100% either agreed or strongly agreed the introduction was helpful and well organised. 25% either agreed or strongly agreed feeling confident with suturing and knot tying before the teaching which increased to 92% after teaching. Only 8.3% either agreed or strongly agreed feeling confident with the principles of basic laparoscopy before teaching which increased to 83% after teaching. 100% either agreed or strongly agreed the teaching will improve their clinical practise and enhance their interest in surgery. 92% strongly agreed or agreed that the teaching improved their knowledge in basic surgical skills, and the peer led and organised structure was an effective teaching method. Conclusions Foundation doctor locally peer led teaching organised with supervision by local consultants is an effective method of delivering basic surgical skills with improvement especially marked in basic laparoscopy and help enhance interest in surgical training.

10 COVID-19 and Changing Perceptions Towards Postgraduate Surgical Training in United Kingdom

Abstract Aim The evolution of the current coronavirus disease-2019 (COVID-19) pandemic continues to impact global healthcare systems on an unprecedented scale. Here, we use data from a local NHS trust within the United Kingdom (UK) to examine the perception of medical students and foundation doctors towards postgraduate surgical training. Method This tri-centric cross-sectional study was carried out via a survey disseminated within the East Sussex Healthcare NHS trust, King’s College Hospital, and King’s College London Medical School. The survey was active for 14 days (from 15th March 2020 to 28th March 2020), comprising a total of 40 foundation doctors and 10 medical students. Results A total of 50 responses were received across five hospitals and their associated medical school. A decrease of 10% and 25% was observed in interest to pursue surgery in medical students and foundation doctors, respectively, following the outbreak of COVID-19. Over 40% of foundation doctors holding postgraduate surgical training offers were not accepting them, and of those, over 40% would not consider reapplying to surgery. There was a drop in interest across a select set of specialities, and this was more obvious where aerosol-generating-procedures was a common occurrence. Conclusions These results highlight the need for a more efficient and effective response to address the immediate situation, as well as a robust contingency plan to avert the repercussions the surgical field could face.

1004 Student Perspectives on Surgical Careers

Abstract Aim To investigate medical students’ understanding of skills needed as surgeons and how prepared they feel to pursue surgical careers, and to identify methods to support and prepare medical students who want to pursue surgical careers. Method A student-led National Surgical Conference (Cardiff, 2018) ran a consensus and debate session entitled ‘Are students adequately prepared for a career in surgery at medical school?’, including a questionnaire addressing elements of medical school curriculums relevant to surgery and the importance of developing technical skills and non-technical skills (NTS). Results 60 delegates completed the questionnaire: Year1-3 (n = 38), Year4-6 (n = 15), intercalating (n = 4), foundation doctors (n = 3). Delegates most frequently stated specific surgical skills (20.1%), broader surgical skills (20.1%) and interpersonal skills (17.2%) as the most important skills to be a surgeon. 75% rated technical skills and NTS as equally important, 25% rated technical skills as more important. 12.5% felt unconfident in their NTS to be an efficient surgical team-member, 37.5% felt between confident and unconfident, and 50% were confident. 26.3% felt unprepared to pursue surgical careers following medical school, 70.2% felt between prepared and unprepared, and 3.5% felt prepared. More practical surgical skills sessions (35%), career pathway sessions (15%), surgically relevant teaching (16%) and theatre or surgical placements (19%) were the most frequently wanted improvements. Conclusions Prospective surgeons highly valued developing surgical skills and overall do not feel prepared to pursue surgery. Medical students would benefit from education on the surgical career pathway and the importance of the non-practical components of surgery, including patient safety and NTS.

1496 Building Inclusivity and Diversity from our Foundations: A Cross-Sectional Study Identifying Barriers to Theatre Based Training for Foundation Doctors

Abstract Aim Theatre experience is a powerful factor enabling trainees to determine whether they possess the enthusiasm and aptitude to undertake a surgical career. Removing barriers to theatre learning should allow a more meritorious and diverse cohort of surgical trainees. Method An 18 -point open and closed question Likert scale survey was distributed to Foundation Doctors in three hospitals within the Northern Deanery. The survey was designed via focus group and literature review, ascertaining perceived levels of preparedness, acceptance, enjoyment, and barriers to theatre access. Results The survey dichotomized respondents (n = 54) into those who attended theatre (n = 40) and those who did not (n = 14). Of those attending 38% (n = 15) reported intimidation and 15% (n = 6) cited a cultural barrier to attendance. Of those who did not attend 79% (n = 11) were interested in surgery. These respondents predominantly reported concerns around prohibitive ward workload and unfamiliarity with protocols. Covid restricted surgical rotations for some. There was a statistically significant difference (p fishers exact test = 0.001) between 83% of respondents who felt welcomed by the surgeons compared to just 45% made to feel welcome by the wider theatre team. Only 20% (n = 11) of respondents felt prepared for theatre by medical school. 50% (n = 27) were confident with theatre protocols. Conclusions The study raises concerns around apprehension surrounding the theatre environment and ward workload which appear to impede access to theatre. Adequate undergraduate surgical teaching, appropriate induction and allocation of theatre time are crucial to improve safety, diversity of applicants, confidence for trainees and compliance within the team.

1668 Buying Your Way into A Run-Through Surgical Training Post: The Way Forward?

Abstract Introduction Competition for core surgical training (CST) applications has increased significantly over the last few years. This has been largely attributable to the introduction of limited run-through surgical posts which avoids the bottleneck at ST3 applications. We sought to assess how financial factors may affect current or potential future surgical trainees in their pursuit for run-through posts. Method A 10-point questionnaire was designed to assess various financial considerations for surgical trainees applying to the 2021 CST cycle who had the sole goal of securing a run-through post. Results were analysed using Chi-squared test. Results Of the 40 respondents, 95% were foundation doctors and 5% were core trainees. There was a significant association between willingness to achieve full marks in the CST interview and attending an interview course and obtaining 1-1 coaching sessions (p < 0.05). Familial income was not found to be a significant barrier to spending money on interview courses and coaching sessions (p < 0.05). Conclusions Applicants are willing to pay a significant premium to secure a run-through surgical post. Further research is required to fully understand the reasons behind this phenomenon and the impact on those from widening participation backgrounds.

375 Points Mean Prizes, The Impact of Portfolio Points and Clinical Specialty on The Engagement of Trainees in Research

Abstract Aim Research and scholarship are key outcomes for medical education in order to learn transferable skills outside of the core curriculum as highlighted in 2018 by the General Medical Council. We have provided a historical snapshot of the key factors influencing medical undergraduates and trainees engaging in research. We distributed an anonymous survey to all UK Foundation Trusts and medical schools, which covered simple demographic information, factors influencing involvement in research and intended clinical specialty. Descriptive statistics were calculated for the responses. Results There were 264 responses to the survey, 119 (45.1%) from women. The strongest motivating factor for respondents was points for future applications, which accounted for 138 (52.2%) of responses, and became increasingly important with seniority of respondent. Time accounted for the largest obstacle to engagement in research, with 151 (57.3%) votes. For the 83 responses from aspiring surgeons, the mean number of PubMed citable publications was 2.52 compared to 1.28 for the respondents who listed a non-surgical specialty as their intended career path. Conclusions The UK Foundation Programme recently decided to remove additional educational achievement points (including two points for publications) for the 2023 intake of Foundation doctors. Such a decision, combined with our finding of point-driven reasoning for engagement in research, could result in fewer juniors conducting research. However, given our results highlighting increased engagement in research of aspiring surgeons, it is hoped that this decision will not affect the field of surgical research, but further qualitative analysis is required to explore this.

633 Improving the Quality of AKI Management Within a District General Surgery Department

Abstract Introduction Acute kidney injuries (AKI) affect 1/5 patients requiring acute hospital admission. The NCEPOD report (2009) described only 50% of AKI care as “good”. Swift identification and appropriate management of AKI is vital. We aimed to assess and improve our adherence to NICE guidance(QS76, NG48) on managing AKI. Method Retrospective review of paper notes was conducted in patients admitted under general surgery at Royal Alexandra Hospital found to have a > 50% increase in the serum creatinine. We assessed the completion of a urinalysis and withholding of nephrotoxic medications within 24 hours of AKI identification, and duration of AKI. First cycle was conducted in August 2020. An AKI alert card was introduced outlining the identification of an AKI and initial management. This provided an effective method of recording interventions in patient notes and accessible education on current guidelines to foundation doctors. The second cycle commenced mid-December and is ongoing. Results First cycle included 30 patients; median age was 77(IQR:67-85). Adherence to urinalysis and nephrotoxic guidance was completed in 9/30(30%) and 13/30(43%) respectively. Median duration of AKI was 7(IQR:5-12) days. Second cycle has identified 17 patients so far; median age is 75(IQR:68-91). Adherence to urine dip and nephrotoxic guidance improved to 11/17(65%)(p < 0.05) and 16/17(94%)(p < 0.05) respectively. Median duration of AKI also improved to 3(IQR:2-7) days (p < 0.05). Conclusions Our interim results show a positive effect to the management of AKI following the introduction of our AKI Alert Cards. Reduction in overall duration of AKI highlights patient benefit.

1636 Improving Plastics SHO Induction: A Three-Cycle QI Project and National Survey

Abstract Aim Burns and Plastic Surgery is a wide-ranging exciting field that is rarely taught well in undergraduate medical curriculums. As such, it is imperative that we design and deliver a safe and effective induction programme for Foundation doctors and core trainees who are new to this specialty. Method Plastics SHOs rotating to our unit from December 2019 to December 2021 completed quantitative and qualitative questionnaires on the departmental induction they received. Statistical analysis and thematic analysis of their quantitative and qualitative responses were performed respectively. We aimed to describe the process of modifying our induction programme to the modern learner's learning needs. In addition, we surveyed Plastics SHOs in all Plastics units in the UK to compare and assimilate best practice. Results A combination of didactic and practical workshops resulted in significantly improved learner satisfaction, SHO preparedness for oncalls and knowledge of departmental policies in our unit. SHO shadowing was the most preferred and effective method of SHO induction nationally but rarely used. SHO handbooks were useful but employed by less than 40% of Plastics units nationally. Conclusions Through a multi-cycle QI project and national survey, we look forward to presenting the ideal design of an SHO induction programme for a specialty that requires structured clinical assessment and procedural skills. In summary, the ideal SHO induction programme consists of a combination of didactic tutorials, practical workshops, and peer shadowing. This is crucial in maintaining patient safety and junior doctor well-being when tackling the often-busy plastic surgery oncalls.