Foundation Year 1 Doctors Research Articles

'Virtual Mentorship is a No-Brainer': The Application of a Virtual Mentorship Programme for Prospective Plastic Surgery Trainees.

Aims This study aimed to evaluate the effectiveness of a virtual mentorship programme in plastic surgery designed for medical students and foundation doctors in the United Kingdom. The programme sought to enhance understanding of common and emergency conditions, provide guidance on the application process for speciality training, and facilitate networking opportunities. Materials and methods The programme consisted of six sessions delivered via Microsoft Teams (Microsoft® Corporation, Redmond, WA) over a four-month period from May to August 2024. Participants completed online pre- and post-mentoring questionnaires. Wilcoxon signed-rank test was used to compare paired data responses. Results Ten participants completed both questionnaires; 90% were medical students, and 10% were foundation-year doctors. There was a significant increase in the understanding of common plastic surgery conditions and emergencies (p < 0.05), as well as improved knowledge of the application processes for core surgical training (p < 0.05) and higher speciality training (p < 0.05). Interest in the speciality significantly increased (p < 0.05), and participants were more likely to seek in-person mentorship (p < 0.05). The programme was well-received, with 100% rating it as 'excellent' or 'very good'. Conclusions The virtual mentorship programme effectively enhanced foundational knowledge, career preparation, and mentor-mentee relationships. Its implementation is recommended both alone and in combination with traditional face-to-face mentorship.

Exploring the Plastic Surgery Related Experiences, Needs, Confidence and Knowledge Gaps of Foundation Year Doctors

Plastic surgery is a diverse speciality relevant to non-plastic doctors, as plastic surgeons frequently collaborate with other specialities and its basic principles are transferable across multiple specialities. Foundation-year (FY) doctors are the most junior doctors in the workforce and may need to apply plastic surgery knowledge and principles during their clinical duties. Despite this, formal plastic surgery education for junior doctors is limited, resulting in an educational gap. This study gains insight into the perceived confidence, knowledge gaps, skills, educational activities and needs related to plastic surgery. This qualitative study uses phenomenology through semi-structured individual interviews with eight FY doctors. Data was analysed using reflexive thematic analysis. This study revealed that plastic surgery features diversely in the work life of FYs, who often manage patients with a lack of knowledge and confidence, influencing patient care and FY wellbeing. FYs primarily acquire knowledge and confidence through experiential learning and individual initiative. A need for curriculum improvements was expressed. FYs are an essential part of the workforce who exhibited educational gaps and a lack of confidence in plastic surgery knowledge. We suggest improved integration of plastic surgery into the FY curriculum for improved FY knowledge and patient care.

SP8.5 - Enhancing the confidence of FY1 Doctors in managing General Surgical Patients through the introduction of an online handbook– A quality improvement project

Abstract Background Emerging as a Foundation Year 1 (FY1) doctor from undergraduate training can be daunting. Furthermore, working in Colorectal Surgery can pose challenges: managing both elective and acute surgical patients with complex needs. We designed a General Surgery and Colorectal Surgery handbook to help FY1 doctors navigate training. This Quality Improvement Project aimed to assess the impact of and alleviate some of the uncertainty experienced by FY1 doctors during this transitional phase. Methods An electronic handbook was compiled with contributions from across the Multidisciplinary Team which was reviewed and approved for distribution within our Trust. An online questionnaire was distributed to assess pre-placement confidence in key domains on a 10-point Likert scale. This was sent to FY1 doctors who had previously completed a rotation within colorectal surgery without the handbook. The handbook was distributed to new cohort of FY1 doctors a week prior to the start of their rotation in Colorectal Surgery. An identical questionnaire was sent to the new cohort of FY1s within a month of their rotation and results were compared with previous cohort. Results In all surveyed areas, there was an improvement in confidence in the post-intervention group compared to that shown in the pre-intervention group. The average improvement in median score across all areas was 3.8 points. Conclusion This project demonstrated an overwhelmingly positive response to a formalised handbook by FY1 doctors in training. This intervention has helped FY1 doctors manage colorectal and general surgery patients with enhanced confidence thus paving way for safer patient care.

The role of mindfulness in stress, productivity and wellbeing of foundation year doctors: a mixed-methods feasibility study of the mindful resilience and effectiveness training programme

BackgroundMedical Foundation Year (FY) doctors demonstrate greater psychological distress compared with the general population and other student groups. This feasibility study investigated FY doctors’ perceptions of mindfulness and the impact of a mindful resilience and effectiveness training (MRET) programme on stress, wellbeing, and performance.MethodsMixed-methods study utilising a questionnaire (study 1, N = 144) and a pre-post analysis design of MRET programme (study 2, N = 13), along with focus groups (N = 7).ResultsIn study 1 28.5% of FY’s reported using mindfulness. All five mindfulness facets were significantly, and positively, associated with mental wellbeing (p < 0.05). Acting with awareness (AA) and non-reactivity (NR) were significantly, positively associated with a challenge responses to stress (p < 0.05). Threat and loss appraisals were negatively associated with AA, NR, and non-judging (p < 0.01). Perceived productivity was positively associated with mindfulness facets: describing, AA, and NR (p < 0.001). In study 2, there were significant increases in wellbeing and mindfulness facets observing, describing, AA, and NR, and threat appraisals decreased (p < 0.05). The main themes identified across the focus group included Reframed Mindset, Values-Based Action, Embodied Leadership and Pedagogy.ConclusionsThere exists a relationship between mindfulness, psychological wellbeing, and performance in FYs. The MRET prorgamme improved psychological wellbeing and reduced threat appraisals. Future work could focus resources on enhancing the skills of AA and NR, as this may be sufficient to bring about meaningful improvements in wellbeing, percieved productivity and cognitive reappraisal of stressful life events.

Can compassionate leadership of senior hospital leaders help retain trainee doctors?

BackgroundHigh burnout and low retention rates among trainee doctors threaten the future viability of the UK medical workforce. This study empirically examined factors that can sustain trainee doctors.MethodA total of...

Out-of-hours decision-making in deteriorating patients by foundation year doctors: Relationship to moral distress.

Moral distress (MD) refers to psychological unease when healthcare professionals identify morally correct actions to take but are constrained in their ability to take those actions. This study evaluated the relationship between out-of-hours decisions and MD among 40 Foundation Year 2 (FY2) doctors. They were asked to choose the 'expected' and the 'right' management options for five out-of-hours scenarios and complete an adapted Measure of Moral Distress for Health Professionals (MMD-HP) questionnaire. 28/40 (70%) reported discordance between 'expected' and 'right' options more frequently than concordance. The mean total MMD-HP score was low: 64.9 (SD = 26.9), range 13-143, maximum 288. The association between decision-making discordance and MMD-HP score was weak. Out-of-hours decisions by FY2 doctors were characterised by doing what is 'expected' rather than what is perceived to be 'right'. Providing guidance regarding decision-making in deteriorating patients is needed for patient safety and staff well-being.

SP9.17 Adherence to fluid guidelines in surgical patients and impact on complication rate

Abstract Aims Up to 95% of intravenous fluid prescription requests for surgical patients are executed by Foundation Year-1(FY1) doctors. This, notwithstanding the plethora of studies suggesting FY1 doctors are inadequately equipped to be prescribing fluids unsupervised. Poor intravenous fluid therapy is associated with an approximate 20% complication rate, including electrolyte abnormalities, dysrhythmia and fluid overload. Methods A closed-loop audit was performed at a large teaching hospital to examine compliance with fluid prescribing guidelines and associated complications. This involved a 4-week retrospective review of drug prescription charts against NICE guidelines followed by a targeted intervention that involved a dedicated teaching session on fluid management in the surgical patient, alongside posters and crib sheets of fluid management on surgical wards. The re-audit using the same criteria compared proportion of prescription errors, over- or under-hydration, and total complications before and after intervention. Results 308 patient records were reviewed (pre-intervention n=185; post-intervention n=123). Documentation of fluids indication (31% vs 46%(p&amp;lt;0.0414)), contingency plans (3% vs 38%(p&amp;lt;0.0001)) and glucose prescription for nil per os patients on maintenance fluids (10% vs 25% (p=0.0029)) improved post-intervention. Fluid balance monitoring (29% vs 9%(p=0.0001)) worsened. The proportion of patients receiving insufficient potassium (91% both rounds), excess sodium (90% vs 92% (p=0.6212)), and the average rate of complications (1 in 1.67 vs 1 in 1.54, p=0.4652) remained unchanged. Conclusion Didactic educational intervention for FY1 doctors on fluid therapy improved documentation on fluids indication, but failed to resolve significant prescription failures and resulted in similar complication rates pre-and post-intervention.

The prescribing safety assessment: Looking to the future.

The prescribing safety assessment: Looking to the future.

Out-of-hours task allocation: implications for foundation training and practice

The role of foundation year-1 (FY1) doctors during the out-of-hours (OOHs) period was explored, identifying areas to improve their training. Data were retrospectively collected for 1 year of foundation training (2018-2019) from an electronic task system between 17:00 to 08:00, Monday to Sunday, in a 798-bed teaching hospital in Exeter, UK. Thirty-two thousand, two hundred and sixty OOHs jobs were requested with 21,816 (67.6%) assigned to FY1 doctors and the clinical site practitioner. Jobs were distributed with 12,044 (55.2%) for FY1 medicine, 5,739 (26.3%) for FY1 surgery and 4,033 (18.5%) for the clinical site practitioner. The three most common jobs requested were prescribing (31.1%), patient reviews (17.9%), and interpreting or taking bloods (11.6%). Procedural jobs accounted for 22.2% of all jobs. Prescribing and patient review jobs were further categorised into commonly encountered themes. This study describes the nature of jobs performed by FY1 doctors working OOHs and identifies three areas to focus foundation doctor training. First, improving the preparedness of new graduates as guided by commonly identified jobs. Second, monitoring the appropriateness of performed jobs. Third, ensuring the evolving roles of allied health professionals and foundation doctors are clearly understood in relation to one another.

SP7.4 Near-peer surgical simulation &amp; teaching day for newly qualified FY1 doctors

Abstract Aims The aims of this study were to ascertain how prepared newly qualified Foundation Year 1 (FY1) doctors felt for their surgical rotation and to evaluate the effectiveness of a surgical-themed teaching day for new FY1 doctors. Methods A near-peer surgery-themed teaching day was delivered to 44 newly qualified FY1 doctors and delivered by clinical teaching fellows (FY3 doctors). The day involved four surgical-themed simulation scenarios: (i) haemodynamically unstable pancreatitis, (ii) anastomotic leak following ileocaecal resection, (iii) septic shower post ureteric stent and (iv) post-operative pulmonary embolism. Classroom-based teaching included: (i) microbiology and antibiotic prescribing (ii) interpreting abdominal films and (iii) insulin prescribing (including for nil by mouth patients). FY1s were randomly allocated a participant number and completed pre- and post-session anonymised questionnaires. Results Only 31.7% (13/41) agreed that Medical School had adequately prepared them for their surgical foundation job and 46.3% (19/41) felt less prepared for surgical rotations compared with medical rotations. When compared with the pre-session scores: 93% (58% pre-session) felt prepared to manage acutely unwell surgical patients and 84% (43.9% pre-session) were confident with escalating patients to level 2/3 care. Confidence improved across the board for classroom-based sessions. Conclusion This study has highlighted a need to ensure newly qualified FY1 doctors feel better prepared for their surgical rotations. The introduction of a mixed simulation and classroom teaching day has, in this instance, improved confidence across a number of important domains. Teaching delivered in the near-peer style may be the key to imparting relevant knowledge to new FY1s.

Stress and burnout amongst foundation year doctors during COVID- 19 pandemic lockdown

Context: Foundation Year Doctors (FYD) have been immensely impacted by the COVID-19 pandemic because of its effect on their academic training, uncertainties about the novel coronavirus, specific pandemic issues around patients and personal safety. Aims: This study examined the effect of the COVID-19 pandemic first national lockdown in the United Kingdom on FYD stress and burnout levels. Method: Quantitative study was conducted to compare Foundation Year doctors (FYD) level of stress and burnout pre and during the first national lockdown of the COVID 19 pandemic in the UK using the Maslach Burnout Inventory (MBI) scale. Descriptive analysis was used to present background information of participants and the effect of COVID-19 on participants. Furthermore, Wilcoxon-signed ranked test was used to identify any significant increase in stress and burnout levels during COVID-19 pandemic. Bivariate Pearson Chi-square test was used to assess any association between categorical variables and burnout levels. Multinomial regression was conducted to identify the predictor of high stress andburnout levels. A p-value of &lt; 0.05 was considered of statistical significance.

1066 INCREASING CONFIDENCE OF FOUNDATION DOCTORS IN MAKING AND DISCUSSING ESCALATION DECISIONS

IntroductionThe Covid-19 pandemic has resulted in renewed emphasis on escalation decisions and discussions, often conducted by junior doctors without any training. Our local Foundation Year (FY) teaching does not address these topics. The distress caused by poor communication regarding escalation is well recognised. Our goal was to improve FY doctors’ confidence in this area and consequently improve quality of patient care.MethodIn PDSA cycle one, email questionnaires established a lack of confidence amongst FY1 doctors. This cycle resulted in the design of a one-hour workshop by middle-grade trainees interested in geriatrics or acute medicine. This workshop included an interactive teaching session, followed by demonstrative and participant role play. Feedback from the first workshop closed cycle two. In cycle three, a subsequent workshop was amended according to feedback. Workshop participants completed anonymous feedback, rating the impact on their confidence.ResultsThirteen FY1 doctors responded positively to the initial questionnaire, with nine able to attend a workshop. Pre- and post-workshop questionnaires asked respondents to rate their confidence from 1 (low) to 5 (high). Comparison demonstrated an increase in confidence making decisions from an average of 1.8 to 3.7 and discussing decisions with patients from 2 to 3.1. Qualitative feedback emphasised benefit from participant role play and the need for longer workshops.ConclusionOur project highlighted the need and desire for FY training in making and discussing escalation decisions. A one-hour workshop increased confidence in this group, though we acknowledge this is a surrogate marker of improved care. Workshop uptake was limited by a small local FY1 cohort, leave and clinical commitments. Though convenient, a one-hour session did not provide adequate time to realise full benefit. We hope to address these issues by integrating longer sessions into the protected teaching for all FY doctors in our health board.

A qualitative study of the psychological impact of COVID-19 pandemic on foundation year doctors

Globally, COVID-19 pandemic has immensely affected medical education including postgraduate medical education. This study used a qualitative approach to explore the psychological impact of the COVID-19 pandemic on Foundation Year Doctors (FYD). Ten semistructured interviews were conducted. FYDs highlighted the changes in their academic training and working life that occurred during the COVID-19 pandemic and the psychological impact of these changes. This study may be helpful for key stakeholders of foundation training in developing evidence based policies and strategies that improve the wellbeing during and after the COVID-19 pandemic. Keywords: foundation year doctors; COVID-19 pandemic; psychological impact; qualitative study.

115 On-Call Bleep Simulation for Final-Year Medical Students

A common concern amongst final-year medical students is the on-call shifts as a Foundation Year 1 (FY1) doctor. With a large focus on knowledge, clinical and communication skills, and practical procedures, there is little in the medical curriculum to cover the non-technical skills required whilst on-call such as prioritization. A novel teaching programme was devised to help develop students’ confidence and preparedness for these shifts. This The aim of this course was to prepare final-year medical students for their on-call duties as FY1 doctors. This includes developing confidence with the technical aspects of on-calls such as managing the acutely unwell patient, as well as the non-technical skills expected from bleep-related tasks such as responding, prioritization and escalation.A total of five sessions were delivered from September to December 2020 for final-year medical students. Twelve simulated on-call ‘activities’ were designed mirroring real tasks commonly encountered as an FY1 on-call. These activities were spread across the hospital involving the medical wards as part of the A total of 17 students completed the on-call bleep simulation. Only a third of the candidates had used a bleep prior to the session. Pre-course, 66.6% of candidates responded feeling not confident about being on-call as an FY1. Encouragingly, following the simulation, 100% felt more confident about being on-call. During the open feedback sessions, students valued the use of hospital wards, practicing procedures under time pressure, and performing handovers. This on-call bleep simulation was very well received and improved students’ confidence and preparedness for being on-call as an FY1 from August 2021. Students commented on how invaluable this training was. This on-call bleep simulation will continue to be implemented as part of the final-year teaching provided at the trust.

TP8.2.16 A survey to assess the confidence and knowledge of Foundation Year one doctors to perform a Digital Rectal Examination

Abstract Aims Digital Rectal Examination (DRE) is an essential component of comprehensive assessment of a surgical patients, both in acute and elective settings. Due to the intimate nature of the examination, this important examination is often not well taught. This study aims to assess the confidence and knowledge of the Foundation Year 1 (FY1) doctors in performing DRE. Methods FY1 doctors were invited for online voluntary anonymous survey via Google forms. The survey consisted of 16 questions on the indications, findings and interpretation of DRE. The purpose and aims of the study were explained in an invitation email and participants provided a declaration of consent, giving permission for their anonymous results to be used in the study. Results There were 24 responses, 79% had performed DRE (including on mannequins and simulations) less than 10 times. Two thirds of DRE were performed during the FY1 rotation and two thirds in the elective wards. Majority of respondents (83%) were moderately confident in performing and appreciating DRE findings. 63% respondents though that a chaperone is not mandatory if the gender of the doctor and patient was same. 58% respondents thought that hematuria is not an indication to preform DRE. Interpretation of DRE findings - approximately 80% respondents correctly interpreted the findings, however only 45% could formulate the correct initial management plan. Conclusions This study illustrates that FY1 doctors receive inadequate exposure to performing and interpreting DRE. Their teaching should be enhanced by providing them with more opportunities through simulation and dedicated teaching sessions.

734 Evaluation of A Webinar Based Surgical Teaching Course (EDUCATE) - A Prospective Cohort Study

Abstract Aim Anecdotal evidence suggests Foundation Year (FY) doctors start surgical rotations with less confidence than medical rotations. The study aimed to determine the effect of a national webinar-based surgical teaching course on participants’ confidence, and to assess attitudes surrounding undergraduate surgical education. Method This prospective cohort study is reported with reference to STROBE guidelines and received ethical approval. A series of 15 free-access webinars was developed based on the Royal College of Surgeons Undergraduate Curriculum. An expert-validated questionnaire was used to collect data before and after the course. Inclusion criteria were UK-based medical students and FY doctors who attended at least one webinar. The primary outcome was confidence in completing common tasks during surgical rotations. Results Completed pre-course (484) and post-course (352) questionnaires yielded 92 paired samples (63% female). 85% were medical students, representing 29 UK universities, and 15% FY doctors. Mean confidence in assessing, investigating, and implementing initial management of surgical conditions was greater after the intervention (p ≤ 0.001). Mean confidence in managing on-call tasks and starting a surgical FY job was also higher post-course greater (p ≤ 0.001). These improvements correlated with webinar attendance (p ≤ 0.05). 27.1% of participants were satisfied with the quality of undergraduate surgical education. 22.9% agreed that surgical placements prepared them well to manage surgical tasks. Conclusions Medical students and FY doctors report low confidence and feel unprepared in managing surgical tasks. Additionally, they report poor satisfaction with undergraduate surgical education. This shortfall may be improved through delivery of a national, accessible, targeted online webinar series and curriculum.

1034 A Survey to Assess the Confidence and Knowledge of Foundation Year One Doctors to Perform A Digital Rectal Examination

Abstract Aim Digital Rectal Examination (DRE) is an essential component of comprehensive assessment of a surgical patient, both in acute and elective settings. Due to the intimate nature of the examination, this important examination is often not well taught. This study aims to assess the confidence and knowledge of the Foundation Year 1 (FY1) doctors in performing DRE. Method FY1 doctors were invited for online voluntary anonymous survey via Google forms. The survey consisted of 16 questions on the indications, findings, and interpretation of DRE. The purpose and aims of the study were explained in an invitation email and participants provided a declaration of consent, giving permission for their anonymous results to be used in the study. Results There were 24 responses, 79% had performed DRE (including on mannequins and simulations) less than 10 times. Two thirds of DRE were performed during the FY1 rotation and two thirds in the elective wards. Majority of respondents (83%) were moderately confident in performing and appreciating DRE findings. 63% respondents though that a chaperone is not mandatory if the gender of the doctor and patient was same. 58% respondents thought that hematuria is not an indication to preform DRE. Interpretation of DRE findings - approximately 80% respondents correctly interpreted the findings, however only 45% could formulate the correct initial management plan. Conclusions This study illustrates that FY1 doctors receive inadequate exposure to performing and interpreting DRE. Their teaching should be enhanced by providing them with more opportunities through simulation and dedicated teaching sessions.

Sins of Omission: Are junior doctors failing to report clinical incidents, and if so, how can we better support them to do so?

Objectives University Hospitals Birmingham's (UHB) Foundation Doctors should log clinical incidents via the Trust's incident reporting system. Anecdotal reports suggest under-reporting is commonplace. It is therefore important to identify the proportion of Foundation Year 1 (FY1s) who witnessed but did not report incidents and identify and weigh perceived barriers to reporting. We can then suggest strategies to address these barriers and repeat our data collection. Methodology We performed an analysis of anonymised data from the Trust's Datix Incident Reporting system alongside an anonymised survey to determine the proportion of FY1s witnessing reportable clinical incidents, and the proportion successfully reporting an incident in the 2017/18 academic year. The survey also gathered data on FY1 perceptions of barriers to reporting. We went on to discuss our results with UHB management and suggested several strategies to improve reporting, prior to repeating data collection for the 2019–20 academic year. Results 36.4% FY1 doctors surveyed in 2017–18 reported witnessing at least one clinical incident that they did not report. 37.0% FY1 doctors surveyed in 2019–20 reported the same. Respondents felt time taken to complete forms and system complexity were the key barriers to reporting. Conclusion Results show that over a third of FY1s at UHB had witnessed but not reported at least one clinical incident each year. The evidence-based strategies suggested to the trust in 2018 and 2020 included FY1 education on incident reporting, early senior clinician involvement in the reporting pathway, and a streamlined reporting system integrated with existing infrastructure. These have not been implemented.

429 National Evaluation of Confidence and Preparedness for Surgical Rotations in Medical Students and Foundation Year Doctors

Abstract Introduction Limited published and anecdotal evidence suggests foundation year (FY) doctors start their surgical rotations with lower confidence than medical rotations. This may be due to insufficient undergraduate practical teaching related to common surgical rotations. This study aimed to evaluate the confidence and preparedness for surgical rotations of medical students and FY doctors. Method An expert-validated questionnaire was distributed nationally to UK medical students and FY doctors. The primary outcome was confidence in completing common tasks during surgical rotations. Results 491 participants (84% medical students, 16% FYs) were recruited from 36 UK medical schools. 80% were likely to pursue a career in surgery however only 7% felt confident about starting a surgical FY job. 66% felt neutral or unsatisfied about the quality of medical school surgical teaching, and 80% indicated that placements did not prepare them well to manage common FY surgical tasks. The internal reliability of the questionnaire was high (=0.939). Conclusions Medical students and FY doctors lack confidence and preparation for surgical jobs. High-quality, practically grounded educational courses such as the National Surgical Teaching Society (NSTS) webinar curriculum could improve confidence and preparedness for surgical rotations. Further research evaluating the benefits of such courses is warranted.

154 Enhancing Communication Between Foundation Doctors and Radiologists

Abstract Introduction Facilitating radiological imaging for patients is an essential task for all Foundation Year (FY) doctors. Achieving competence in this task can expedite patient management. We evaluated the confidence and skills of FYs in facilitating radiological imaging before and after introduction of formal training. Method Surgical FYs working at a teaching hospital were surveyed to evaluate their baseline level of competence in booking and discussing imaging with radiology colleagues. Parameters were measured on a Likert scale, including confidence in discussing requests and satisfaction of their own performance following discussions. Eight radiology consultants were surveyed to evaluate their opinions on FYs’ communication and established areas for improvement. A teaching session was then delivered to improve communication skills. Furthermore, PACCSS poster was introduced to remind the FYs of the salient information required when discussing imaging. Results One month after the intervention, the participants were re-surveyed. This demonstrated a statistically significant improvement in self-reported confidence from 5.3/10 to 7.3/10 (p &amp;lt; 0.001), and in satisfaction of own performance from 5.4/10 to 7.0/10 (p &amp;lt; 0.001). Conclusions We identified deficiencies in surgical FY doctors’ confidence and skills in facilitating radiological imaging. There was a demonstrable benefit with focused training. Inter-specialty communication should be introduced into under- and post-graduate educational curriculum.