Foundation Placements Research Articles

67 Surgical Foundation Doctor Placements: Does Team Structure Alter Training and Support?

Abstract Aim Surgical foundation placements lay the groundwork for a surgical career. Many units run individual teams comprising consultants and trainees in the same subspecialty whilst others have adopted ward-based placements where foundation doctors are responsible for patients belonging to several teams. Belonging to a ‘firm’ is said to increase trainees' access to professional and emotional support. To accommodate for COVID-19 pressures, foundation doctors in our unit became ward-based as opposed to team-based. Our aim was to explore what impact this pandemic-enforced change in team structure had on foundation doctors’ training experiences. Method We conducted a single-center, cross-sectional study. We sent out a questionnaire to foundation doctors who had undergone both pre-COVID and COVID surgical placements. Domains such as training opportunities, support from seniors, and whether their experience impacted their interest in pursuing a surgical career were measured using Likert Scales (1 = low; 5 = high). Statistical analysis was conducted using Microsoft Excel. Results A total of 30 foundation doctors completed the survey. Foundation doctors felt that they were significantly more supported when team-based (p = 0.005) and found they had greater training opportunities (p = 0.002). Despite this, there was no impact on their interest in pursuing a surgical career (p = 0.255). Furthermore, for foundation doctors already interested in surgery, their COVID experience did not impact their career aspirations (p = 0.104). Conclusions Foundation doctors subjectively preferred individual team-based placements. The change to ward-based work led to perceived fewer training opportunities and less support. However, despite this negative impact on training, there was no impact on whether they would pursue a surgical career.

The creation of a novel, targeted liver surgical handbook and complimentary teaching programme utilizing a combination of peer-to-peer and senior-led presentation designs to optimally upskill new foundation trainees

Foundation placements in Liver Surgery at specialist, tertiary centres demand an understanding of initial and long-term management of benign and malignant HPB conditions, procedures and complications, including liver transplantation. The breadth of knowledge required has frequently left trainees feeling overwhelmed and unprepared. This has inevitably resulted in: unnecessary escalation of trivial clinical issues; slowed decision making and, ultimately, sub-optimal teamworking and patient care.

Recruitment and organising 3rd year pharmacy undergraduates into summer placements in primary care in Southwest England

Abstract Introduction Primary care is facing a workforce shortage, especially in Southwest England (SW).1 Funding for clinical pharmacist roles in GP has an impact on community pharmacy with pharmacists leaving to take up PCN positions.2 SW has higher rate of vacancies in than nationally.3 Oriel data showed that fill rate for split foundation training placements in GP is high, however, in SW is significantly low. Aim To increase recruitment of future pharmacists in SW by offering pharmacy undergraduates paid 5-week summer placements in GP or GP/community pharmacy partnership, gaining primary care experience, showcasing benefits of cross-sector working and encouraging development of partnerships for increased cross-sector training placements. Objectives Students enjoy SW area placement, Students recommend placement to other students, Students preference GP foundation placement, Supervisors express interest in a summer placement for 2022, Supervisors express interest in the GP split trainee pharmacist programme. Methods Expressions of interest (EOIs) sought from primary care placements in SW and 16 sites selected. Applicants shortlisted and interviewed online. 16 offered placements based on preference of location. Funding by HEE South reimbursed for student’s wages. Planning booklets provided to GPs, workbooks to students and online induction attended. During the placement, students completed an audit and case-based discussion, shadowed healthcare professionals, assisted administration and pharmacy tasks and practised basic procedural skills. Students attended end-of-placement event to share learning and sent questionnaire focusing on enjoyment of the placement and likelihood of returning to the Southwest and primary care for future employment. Supervisors sent questionnaire separately focusing on likelihood to partake in future. Questionnaires were sent, completed and analysed via Jisc. Ethics approval was not required. Results 10 students and 11 supervisors completed the survey. 60% students enjoyed SW. 90% students would recommend placement to other students and 90% would like to see them in other areas. 70% students very likely to or definitely would apply for GP foundation placement. 63% supervisors benefitted from having a student and 81% would recommend having summer placement student. 55% supervisors would definitely EOI in future summer placement programme and 55% would definitely EOI in GP split foundation programme. 25% students chose GP/Community placements in SW, 18% other placements in SW, 12% GP placements in other regions. Oriel fill rates in SW increased from 36.67% in 2020 to 39.30% in 2021, GP/Community placements remained the same in 2021 at 28.2% and community placements increased in from 18.14% in 2020 to 18.75% in 2021. Discussion/Conclusion The students enjoyed their placements and would recommend to other students. Supervisors found having students useful and would have a student in the future. Although some students were successful in securing a placement in SW for foundation training, due to nature of Oriel it’s not possible to determine how many preferenced SW and GP split programme, this is a limitation to the evaluation. Oriel fill rates didn’t increase for SW community/GP placements as desired, however this was a very small cohort. This pilot will be repeated summer 2022 so fill rates can be evaluated in 2023.

How to make the most of your ophthalmology taster week

Medical students have limited exposure to ophthalmology (1) and foundation placements in the specialty are rare. Taster weeks give applicants a chance to broaden their experience and make an informed career decision, and the recruiting bodies for ophthalmic specialist training (OST) in the UK have hence allocated weight in the application for the completion of an ophthalmology taster week (2). However, OST is highly competitive and, while a taster week itself carries 1 point in the application, applicants can use this experience to unlock more opportunities to strengthen their chances of securing a post. The following article explores how those looking to apply for the specialty can get the most out of their taster weeks.

789 The Impact of a Virtual Orthopaedic On-Call Survival Course on Junior Doctors’ Confidence in Managing an Orthopaedic On-Call

Abstract Aim Junior doctors often feel underprepared for their orthopaedic on-call shifts during their foundation placements. Studies have shown that medical schools are failing to prepare students to manage trauma and orthopaedic patients. The aim of this study was to assess the effects of an orthopaedic on-call survival course on the confidence levels of junior doctors in managing an orthopaedic on-call. Method We developed a one day orthopaedic on-call survival course, designed to provide junior doctors with the relevant knowledge to be able to confidently navigate an orthopaedic on-call shift. We designed a pre-course and post-course questionnaire which were distributed to the participants. Self-assessed confidence levels were recorded in managing an orthopaedic on-call and a number of orthopaedic knowledge domains using visual analogue scale 1–5. The course was delivered over 4 hours using Microsoft Teams. Results We received 47 matched pre- and post-course questionnaires. Overall, 87% of participants reported an increase in confidence in managing an orthopaedic on-call shift. 83% of participants reported an increase in confidence in orthopaedic radiology teaching. 80% of participants reported an increase in confidence in both upper limb emergencies and lower limb emergencies. 91% of participants reported an increase in confidence in spinal trauma. Conclusions An orthopaedic on-call survival course can provide junior doctors with the knowledge to be able to confidently manage trauma and orthopaedic patients during on-call shifts. We recommend that an orthopaedic on-call survival course can be used as an effective teaching method towards preparing junior doctors for their on-calls during foundation training.

Evaluation of near-surface conditions for engineering site characterization using geophysical and geotechnical methods in Lagos, Southwestern Nigeria

ABSTRACT The geological condition of the site in Lagos was investigated using integrated methods. This was necessary following evidence of structural defects prevalent in the area. Against this backdrop, measurements were carried out using in-situ geotechnical and geophysical techniques. The techniques were the Standard Penetration Test, Cone Penetration Test, Electrical Resistivity and seismic refraction surface waves. The various data were collected along eight (8) traverses established strategically in the study area in order to obtain the most desirable results. The results obtained generally show that a low resistive and highly compressive soft soils of organic peats/clays are prevalent in the study area. These geomaterials are characterised with low SPT-N values, low penetrative resistance, low bearing capacities and low electrical resistivity values. The shear (weak) zones have also been identified particularly in the inverted resistivity models. These geomaterials are unfriendly, inimical and severe enough to cause instability in ground conditions. The peat/clay and the weak zones could possibly be responsible for the various degrees of structural defects observed in the study area and should be avoided as foundation placements.

Early career doctors' experiences of psychiatry placements: A qualitative study

Introduction On completion of a medical degree, junior doctors in the UK undergo a 2 year Foundation Programme. Since 2016, 45% of Foundation Programme doctors are required to undertake a psychiatry placement during foundation training. During this time, recruitment to Core Psychiatry Training has fluctuated, dropping to a 69% fill rate in 2017. Methods With the support of the Royal College of Psychiatrists, Health Education England and the UK Foundation Programme Office, a large-scale study was formulated utilising semi-structured focus groups. These exploring participant experiences help to understand how and if the psychiatry foundation placements are valuable, and their potential influence on a trainee choosing psychiatry as a career. A framework analysis was used to analyse data. Results Seventy-four participants across 10 foundation schools in England participated. Experiences and perceptions were split into three broad themes; pre-placement, during placement, and post-placement. Within these, 12 sub-themes emerged. Doctors valued independence and responsibility especially if accompanied by a level of support from seniors. They also enjoyed working as part of a multi-disciplinary team. However, there were clear issues around staffing levels, stigma attached to psychiatry, and out of hours working. Discussion The pre-placement perceptions of psychiatry as a specialty as well as the trainees’ personal priorities for career selection were influenced by psychiatry placement experiences. The results have important implications for the recruitment to the specialty and need to be considered when designing and constructing placement aims.

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

AimsRecruitment into psychiatry remains a major issue nationally despite recent progress with the #choose psychiatry scheme. Here we look to establish why Northern Ireland (NI) has been able to have 100% fill rates by speaking to the people who have work in the frontline of psychiatry. What is done differently in NI and are there lessons that could benefit other regions?BackgroundNI presents itself as an anomaly – In a region that only attracts 31.8% of F2s to enter into any training programme, Core psychiatry has been consistently oversubscribed for many years. One difference is the allocation of trainees in the Foundation programme. NI offers psychiatry placements to 33% of F2 doctors with none in the F1 year.MethodAll doctors of any grade working in psychiatry who had been through the Foundation programme since 2006 were asked to complete a survey on their foundation experience and reasons for choosing a career in psychiatry using SurveyMonkey technology. Qualiative and quantiative data was collected and analysed.Resultin total 67 doctors from CT1 to Consultant and SAS doctors responded, including over 60% of all current trainees, providing a huge amount of information. Remarkably, 45% of psychiatry doctors working in NI surveyed hadn't considered a career in psychiatry until their foundation placement. NI is the only region in the UK that does not have an F1 placement in Psychiatry. Over 80% of doctors here feel that this is a positive. White space answers revealed other aspects of training that positively influenced them to choose psychiatry including a reputation for high quality training, as well as close links between the local medical school, the local brach of the Royal College of Psychiatrists and the NI deanery.ConclusionThis study is the first to examine the reasons behind psychiatry's success in NI. The quality of the training scheme locally and presence of an excellent training to service provision balance were also mentioned. This study supports the presence of psychiatry in the F2 year only.

A qualitative study of foundation year two (F2) doctor's attitudes towards psychiatry carried out in Northern Ireland

AimsRecruitment into psychiatry is a major issue nationally. Northern Ireland (NI) consistently punching above it's weight with psychiatry recruitment - in a region that only attracts 31.8% of F2s to enter into any training programme, Core psychiatry has been consistently oversubscribed. Here we look to examine the experiences of F2s in NI, including those who have had a placement in psychiatry and those who have not - what can we learn from NI?BackgroundThe exposure to psychiatry during the F2 year is a crucial time for recruitment to psychiatry. In NI, where there has been an 100% fill rate at core training level for many years, trainees and consultants have pointed towards a positive experience in the F2 year.MethodQuestionnaires were given out at a sample of F2 Generic Skills sessions, gathering a range of quantitative and qualitative data. A representative sample of over half of current F2s wrote about there preconceptions and experiences of psychiatry, whether they had worked in it or not. An a priori approach was taken towards generating codes as part of a framework analysis from which 4 major themes were identified.Result93/148 F2 doctors who were approached responded to the survey of which 36.6% had experienced a Foundation placement in psychiatry. Major qualitative themes that emerged were exposure to psychiatry, the nature of working in psychiatry, being valued and stigma. Doctors who had an F2 placement were much more likely to be willing to pursue a career in it, regardless of whether they had been allocated a placement with psychiatry by choice or not.ConclusionThis survey adds to the literature that exposure to psychiatry in undergraduate and postgraduate level has a huge role in shaping attitudes towards the specialty of psychiatry, and indeed the likelihood of a foundation doctor going on to become a psychiatry trainee. Stigma in the medical profession towards mental illness and psychiatry remains prevalent.

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.

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.

Foundation trainees and changes in career intentions.

To understand whether foundation trainees change their career intentions during psychiatry placements and explore what factors influence such changes. Over a two-year period, foundation trainees completed questionnaires at the beginning, middle and end of their four-month placement. There were two questions, the first as to how likely they were to pursue a career in psychiatry and the second openly asked them to elaborate on their reasons. Twenty-one out of 41 eligible trainees returned all three questionnaires. The number of trainees 'highly likely' to choose psychiatry increased over the four-month period, from 4.5% to 19%. The number of trainees 'highly unlikely' to choose psychiatry decreased, from 27.3% to 9.5%. An increasingly positive intention towards a psychiatry career appeared to relate to enjoyment of the placement and the quality of supervision. The most common reason for not choosing psychiatry was a pre-existing interest in another specialty. Undertaking a psychiatry placement during the foundation programme continues to increase the likelihood of a positive attitude towards psychiatry as a career. The findings of our study suggest good practice in providing foundation placements in psychiatry includes identifying medical school experience, enjoyment, quality weekly supervision and mindful experiential design of placements.

The Foundation Programme in psychiatry: a qualitative study into the effects of a foundation placement.

Aims and method There is a drive to increase the number of psychiatry foundation placements to ensure that training keeps up with the changing health and social care landscape. This qualitative study aimed to explore, by interview, the experiences of 17 doctors who have completed a foundation placement in psychiatry.Results The study highlights the benefits of foundation psychiatry placements and some of their positive and negative aspects.Clinical implications Those developing foundation placements will need to ensure they are of high quality.

The expansion of the Foundation Programme in psychiatry.

The Broadening the Foundation Programme report has led to an expansion in the number of psychiatry foundation placements. This change will have far-reaching benefits for foundation doctors doing psychiatry, no matter what their future career intentions. Doctors will develop a better understanding of mental illness, they will improve their communication skills and they will gain experience of working within multidisciplinary teams. Recruitment into psychiatry is also likely to improve. The Royal College of Psychiatrists is putting in place a number of measures to ensure that placements are of a high quality so that foundation doctors have a good experience of psychiatry.

Has the Bachelor of Surgery Left Medical School?—A National Undergraduate Assessment

Nearly all trainee doctors would undertake a surgical placement in their clinical training; however, there is anecdotal evidence of variability in undergraduate surgical teaching across the UK. We set out to describe the provision of undergraduate surgery and report graduating students' opinions of aspects of this. We undertook a cross-sectional questionnaire of medical students graduating in 2014 from UK medical schools. An online electronic questionnaire was used to capture demographics, career intentions, and individual's undergraduate experience of surgery. A separate questionnaire was sent to medical schools to assess time devoted to surgical placements and how surgical sciences were taught and assessed. From 483 responses covering 31 UK medical schools, there were 328 completed student questionnaires. A third of respondents felt that teaching of surgical sciences was inadequate. Medical schools reported time allocated to surgical specialties ranging from 4 to 21 weeks (median 13 weeks). Among all, 1 medical school offered a basic surgical skills course and 1 medical school specifically assessed surgical-related skills. Overall, 65% of medical students felt prepared for a surgical foundation placement and 88% felt prepared for a medical foundation placement. In total, 78% felt ready to participate in an acute medicine on-call and 48% felt ready for emergency surgery on-call. There was a positive association between time dedicated to undergraduate surgery and reported preparedness for a foundation surgical job. UK medical students reported uniformly low rates of satisfaction with surgical science teaching. Students studying at medical schools with more time in the curriculum dedicated to surgery reported higher levels of preparedness for surgical foundation jobs. There were differences in the rates of perceived preparedness for surgical posts and for emergency surgery. There is a clear need to review undergraduate surgical provision to ensure that students are equipped for safe practice in junior surgical foundation jobs.

The role of surgical foundation placements in training

The role of surgical foundation placements in training

Safeguarding children awareness amongst foundation trainees

Aims Foundation Trainees occupy frontline positions in reviewing children. The aim of this study was to assess whether they were confident to recognise and respond to suspected cases of child maltreatment and their acquisition and progression of these competencies through the foundation training. Methods A controlled study compared Foundation Trainee year 1 (FY1, n=32) and year 2 (FY2, n=33) with the null hypothesis that there were no significant differences in their confidences in recognising child maltreatment. A 5 point Likert questionnaire in a visual analogue scale with 7 domains was implemented. These domains were recognising history, suspicion from interaction of carers and child, recognising radiological features, suspicion of child sexual abuse (CSA), teaching on child maltreatment and guidance on what to do. Results were statistically analysed using non parametric algorithms with Stats Direct version 2.7.8 at 95% CI. Further, an open ended questionnaire looked at perceived dilemmas/challenges trainees might face in recognition of child maltreatment. Results In all domains in the FY1 group the main response was the ambivalent response. In the FY2 group, notable exceptions included confidence in recognising history, suspicion from interaction of carers, recognising radiology and teaching on child maltreatment. In the Mann Whitney test, there were no statistically significant differences (p >0.05) in confidences between the groups in recognising history, suspecting features from parental or child interaction and teaching received. However, statistically significant differences (p Conclusions In conclusion, this study shows that a Foundation Trainee gains confidence in safeguarding matters with time which in turn is reflective of the training. However, there are uncertainties. Importantly, this study highlights gaps in training delivery in crucial aspects emphasising on relevant history taking and observational skills over Foundation years. These areas necessitate the need for tailored sessions throughout Foundation placement. To our knowledge, this is the first statistical study of its kind.

When and why do doctors decide to become general practitioners? Implications for recruitment into UK general practice specialty training

All applicants to round 1 of national recruitment into the general practice specialty recruitment process were surveyed as to the reasons for, and the timing of their career choices. Most applicants reported decision making after completing undergraduate training citing variety, continuity of care and work-life balance as their main drivers for a career in general practice. Applicants were statistically more likely to have undertaken a Foundation placement in general practice than their peers on a Foundation programme. Reasons for choice of deanery were largely related to location and social ties, rather than to the educational 'reputation' of its programmes.

Postmodernism and psychiatry

have highlighted some of theimportant positive aspects of foundationyear placements in influencing careerchoice into psychiatry.The jubilant articlecarries an optimistic account from trainersand trainees who share the champagne ofsuccessful mentoring. Unfortunately, thedarker side of wider experience whileseeking foundation placements inpsychiatry has been overlooked.The number of places available for FY1and FY2 placements in psychiatry are verylimited, and as of now not representa-tional of subsequent requirements thespecialty has during core training.There isan urgent need for such ‘potentialdemand’ v. supply statistics to be madeclear and compared across variousspecialties.The perennial recruitment issuecould be seen in correct perspective whenlevel playing fields are ensured followingthe implementation of ModernisingMedical Careers.Despite being a trainee with significantinterest in exploring psychiatry as a careerchoice, the placements in my current FY2rotation were ready-made with noelement of choice. On the wake of Boyleet al’s account, it is important to solicitand analyse national data on foundationplacements in psychiatry and rate ofconversion into core psychiatric training.Creating such foundation maps ofpotential psychiatry placements acrossdeaneries may help interested trainees toplan their careers. One could argue thatpsychiatry must be given more foundationslots than some relatively oversubscribedspecialties.If one is allowed to make a deductionfrom personal experience, mostspecialties look at foundation doctors asinconsequential cogs in the churningwheel of hospital machinery.Very fewminutes in the 120 days of a foundationplacement are spent in motivating thetrainee to consider a specific specialtycareer. In addition, the educationalmeetings and professional activities inmost hospital units tend to concentrateeither on core trainees or making a ‘safedoctor’out of foundation trainees.Thereis an immense hidden potential forpsychiatry to convert a substantialnumber of hesitant doctors into promisingand passionate specialists for the future, ifsome collective and timely effort is takento recognise the prospect here.Bearing in mind that at least a quarterof all psychiatrists explore other special-ties before choosing psychiatry as theircareer,

Does a foundation placement in orthopaedics offer learning opportunities for all trainees?

Does a foundation placement in orthopaedics offer learning opportunities for all trainees?