Foundation Year 1 Doctors Research Articles

Online professionalism and Facebook – Falling through the generation gap

Background: Facebook is the most popular social networking site (SNS) worldwide. The growing popularity of SNSs brings ‘e-professionalism’ to the forefront.Aims: To assess Facebook use, publicly accessible material and awareness of privacy guidelines and online professionalism by students, foundation year doctors (FYDs) and senior staff grades (SSGs).Methods: It was an ethical risk to access publicly available information online as many users do not appreciate the lack of privacy involved, therefore a cross-sectional survey was undertaken. Participants included 42 students, 20 FYDs and 20 SSGs from the Severn Deanery (UK).Results: All 42 students and 20 FYDs had Facebook compared with 6 (30%) SSGs. Of these, 17 students (41%), 15 FYDs (75%) and 3 SSGs (50%) had public ‘info pages’. 37 students (88%) reported colleagues behaving unprofessionally online with 16 FYDs (80%) but no SSGs. 32 students (76%) felt their professionalism was threatened online, alongside 18 FYDs (90%) and 2 SSGs (33%). Only 11 students (26%), 10 trainees (50%) and no SSGs were aware of guidelines.Conclusions: Professionals lack awareness of their professional vulnerability online. They are not careful in restricting access to their posted information and are not mindful that the principles of professionalism apply to SNSs.

Preparedness of Foundation Year 1 doctors in dermatology

UK medical graduates are required to reach standards defined by the General Medical Council (in Tomorrows Doctors) in all specialties, including dermatology. We assessed the self-reported competence of Foundation Year 1 (FY1) doctors in the diagnosis and management of skin disease correlated against their undergraduate dermatology experience. The FY1 doctors attending a teaching programme were surveyed at six hospital sites throughout the North Western Deanery. Questionnaires were completed on self-reported competence in learning outcomes defined by the British Association of Dermatologists (BAD). Information recorded previous undergraduate teaching (duration and delivery), and whether they felt sufficiently prepared to diagnose and manage patients with skin disease in their clinical practice. Of 174 FY1 doctors, 118 attended the teaching sessions. All of the attendees completed a questionnaire. Trainees who undertook longitudinal placements in dermatology (defined as 10 or more half days of clinical experience) regarded themselves significantly more prepared to practise for their stage of training: 61 per cent compared with 8.9 per cent (χ(2) = 32.8, df = 1, p < 0.05). Furthermore, these trainees rated their abilities in basic history taking, clinical examination, management of dermatological emergencies and diagnosis of skin malignancy as being greater than those who had not experienced longitudinal placements in the specialty. Longitudinal placements in dermatology offer undergraduates experience in the diagnosis and management of skin disease that develops confidence for foundation practice.

Hospital consultants and workplace based assessments: how foundation doctors view these educational interactions?

AimTo determine how foundation year 2 (F2) doctors view the input of hospital consultants into their workplace based assessments (WPBAs).Study designF2 doctors in Northern Ireland participated in an electronic survey...

Junior doctors' reflections on patient safety

AimTo determine whether foundation year 1 (FY1) doctors reflect upon patient safety incidents (PSIs) within their portfolios and the potential value of such reflections for quality of care.MethodsA cross-sectional retrospective...

Foundation Programme doctors as teachers

Teaching is a core competency outlined in the Foundation Programme curriculum in the UK. This article reports data from a larger postal questionnaire study asking general practitioner (GP) trainers and GP programme directors in the Yorkshire & Humber Deanery whether Foundation Year 2 (FY2) doctors were undertaking teaching roles during primary care posts. We also aimed to explore their attitudes towards FY2s as teachers. A questionnaire was designed asking whether FY2s had been present in the practice, and if so what teaching methods they had undertaken. The responder was then asked how comfortable they would feel with an FY2 doctor undertaking certain teaching roles. Responses were prompted using a nine-point Likert scale. The response rate was 74 per cent (216/291). Of the respondents, 37 per cent (80/216) stated that FY2s had been present in their surgery in the last 12 months; 16 per cent (13/80) went on to say that those FY2 doctors had undertaken teaching roles. Respondents felt more comfortable with FY2s undertaking the teaching of practical skills (median score 6, interquartile range 5-7, on the Likert scale) and giving one-to-one tutorials to medical students (median score 6, interquartile range range 4-7), but were uncomfortable with them clinically supervising medical students (median score 3, interquartile range 2-5) and giving one-to-one tutorials to fellow FY2s (median 4, interquartile range 2-5). With reduced hours resulting in a decrease in exposure to teaching experience during hospital rotations, it is important that these doctors are given adequate opportunities during primary care placements to improve skills in this area.

Shadowing a foundation-year doctor: a third-year medical student’s perspective

This paper considers the advantages of shadowing foundation-year doctors (FY1) in the third year of medical school, an opportunity the UK's General Medical Council (UKGMC) recommends to be given to final-year students only. Eighteen students spent 1 day each shadowing an FY1, holding their pager and carrying out their duties under direct supervision. Questionnaires, based on UKGMC expectations of an FY1, were completed assessing students' confidence and experience before and after the shifts. The doctors were interviewed. The questionnaire response rate was 72 per cent (13/18). The overall increase in student experiences in good clinical care (p<0.001), maintaining good medical practice--teaching and learning (p=0.002), and recognition and management of the acutely ill (p<0.001), were statistically significant. The increase in student confidence in answering the pager (p<0.001), prioritising jobs (p=0.002), venepuncture (p=0.008), writing drug charts (p=0.031), writing in patient notes (p=0.002) and developing management plans (p=0.002) were statistically significant. Qualitative results yielded an overwhelming opinion from students and doctors that it should be made a compulsory part of the third-year curriculum. The doctors found it increased their knowledge and teaching skills. This study has implications for the future of medical training. If incorporated into the third-year curriculum, compulsory shadowing would give students a structured one-to-one learning experience during which to learn clinically relevant skills. By shadowing a doctor so closely, they will also learn first-hand how to interact professionally with patients and other health care workers, a skill difficult to teach at medical school.

Junior doctors’ learning and development in foundation year 1 posts in palliative medicine

Background: The ability to provide good palliative care to patients is increasingly recognised as a core clinical skill that all doctors should possess. Few junior doctors, however, feel competent in breaking bad news, pain relief and the care of dying patients by the time they are fully registered to practice. Aim: The aim of this study was to explore doctors’ experiences in foundation year 1 (F1) palliative medicine posts. Design: Participants underwent semi-structured interviews and interview transcripts were analysed using Interpretative Phenomenological Analysis. Setting/participants: The study involved a purposive sample of six F1 doctors matched in 2005-2006 to rotations incorporating palliative medicine posts at two acute hospital National Health Service (NHS) Trusts and one NHS hospice in the UK. Results: F1 doctors were satisfied with the learning opportunities provided by the posts, which achieved the right balance between supported and autonomous working. They described learning through their day-to-day interactions with staff, including specialist nurses, and by practising their skills on the job. Some struggled, however, to make the transition to a more independent learning style in the clinical environment. Trainees felt the post helped them to develop generic skills, such as symptom control, diagnosing dying and breaking bad news. Whilst they found split posts and on-call rotas disrupted their palliative care learning, these offered important opportunities to learn additional F1 skills. Conclusions: F1 posts in palliative medicine in the UK have positive influences on perceived generic skills development and practice. These findings might encourage the development of more rotations incorporating palliative medicine in the future.

The Knowledge of Medical Students and Newly Qualified Doctors concerning the Specialty of Intensive Care Medicine

Current evidence suggests that around the transition from undergraduate to postgraduate training, deficiencies exist in doctors' knowledge of acute care. This study assessed Foundation Year 1 (FY1) doctors and medical students in intensive care/acute medicine with respect to their understanding of ICU practice and identifying critically ill patients. A qualitative questionnaire was formulated focusing on several targeted areas including training experience, broader ICU knowledge, formal assessment of ICU medicine and critically ill patients encountered outside the ICU. After successfully piloting the study, ethics approval was granted. In February 2010, the questionnaires were distributed to 50 final-year medical students at Brighton and Sussex Medical School and 50 FY1 doctors working at Worthing Hospital or the Royal Sussex County Hospital. One hundred percent of participants completed the questionnaires; 12.5% of medical students knew about the Surviving Sepsis Campaign compared to 62% FY1s (p&lt;0.05). Non-significant trends were evident when choosing three most useful observations for identifying sick patients. The study concluded medical students lack knowledge regarding assessment and monitoring of critically ill patients. Undergraduate training and ICU exposure did not differ between groups, however differences existed in understanding of ICU practice. There was a relative paucity in understanding from final year students regarding the Surviving Sepsis Campaign compared to FY1 doctors, which highlights the need for further improvement.

How good are newly qualified doctors at digital rectal examination?

Digital rectal examination (DRE) is an essential skill which all newly qualified doctors should have. There is evidence in the literature that junior doctors lack this important examination technique. The aim of our study was to determine, with the help of a questionnaire, the abilities of foundation year 1 (FY1) doctors to perform DRE. A questionnaire was developed and sent to newly qualified FY1 doctors qualified in two universities (Nottingham and Sheffield) within the first 4 weeks of starting as a FY1 doctor. Ninety (75%) out of 120 questionnaires were completed. Most FY1 doctors had very little experience in performing DRE on a patient, and 68 (76%) had performed less than 10 procedures prior to qualification. Very few of these doctors had their clinical findings on DRE checked by a senior doctor (n = 7, 8%). Comparing DRE with other forms of examination, newly qualified doctors were most confident at groin hernia examination followed by testicular examination. They were least confident with vaginal examination and DRE (ANOVA P = 0.0082). Digital rectal examination is frequently performed by the most inexperienced doctor and may not be verified by a more senior colleague. More training and supervision of junior doctors are required both prior to qualification and during the early stages of their medical career.

Development of a core drug list towards improving prescribing education and reducing errors in the UK

To develop a core list of 100 commonly prescribed drugs to support prescribing education. A retrospective analysis of prescribing data from primary care in England (2006 and 2008) and from two London Teaching Hospitals (2007 and 2009) was performed. A survey of prescribing by foundation year 1 (FY1) doctors in 39 NHS Trusts across London was carried out. A core list of 100 commonly prescribed drugs comprising ≥0.1% prescriptions in primary and/or secondary care was developed in 2006/7. The core list remained stable over 2 years. FY1 doctors prescribed 65% drugs on the list at least monthly. Seventy-six% of FY1 doctors did not regularly prescribe any drugs not on the core list. There was a strong correlation between prescribing frequency (prescriptions for each drug class expressed as percentage of all prescriptions written) and error rate described in the EQUIP study (errors made when prescribing each drug class expressed as a percentage of all errors made), n= 39, r= 0.861, P= 0.000. Our core drug list identifies drugs that are commonly used and associated with error and is stable over at least 2 years. This list can now be used to develop learning resources and training programmes to improve prescribing of drugs in regular use. Complementary skills required for prescribing less familiar drugs must be developed in parallel. Ongoing research is required to monitor the effect of new training initiatives on prescribing error and patient safety.

Portfolio Development for Foundation Doctors – Step® Foundation Day 1

The careers of foundation-year doctors since the advent of Modernising Medical Careers (MMC) have significantly differed from those of our predecessors. Long gone are the days when doctors could spend a few years plying their trade as senior house officers in different subspecialties, taking their time to develop an extensive skill set before finally settling on the area in which they wished to forge their career.

The urological foot soldier: are we equipping our foundation-year doctors?

Tomorrow's Doctors was first published by the General Medical Council (GMC) in 1993. The recommendations provide a framework for UK medical schools to use to design detailed curricula and schemes of assessment in the training of future doctors. They also set out the minimum standards that are used to judge the quality of undergraduate teaching. In 2003 this guidance was revised and a further 2009 version has now been published. A constant feature of these important documents is a list of therapeutic procedures that all graduates are expected be able to perform safely and effectively. These include male and female urethral catheterisation.

Recognition of diabetic retinopathy in retinal photographs can be improved with a basic education programme

AbstractEvery person with diabetes in the United Kingdom should have access to annual digital retinal photographs to screen for diabetic retinopathy. Our experience is that medical students, junior hospital doctors and general practitioners are all concerned that they may not be able to interpret these pictures. We examined several different groups to determine their baseline level of knowledge and to see if minimal education could improve their ability to diagnose diabetic retinopathy in retinal photographs.Twenty‐eight fourth‐year medical students, 16 foundation year 1 (FY1) doctors, 17 core medical trainees/specialist medical registrars and 12 general practitioners were each shown 20 retinal images. All images were 45° macula centred retinal photographs: 10 normal and 10 with diabetic retinopathy. Participants were asked to classify them as normal or abnormal (diabetic retinopathy present) both before and after a five‐minute educational session on the lesions seen in diabetic retinopathy.The results showed that 3.6% (1/28) of medical students pre‐education and 25% (7/28) post‐education achieved a sensitivity &gt;80% and specificity &gt;95%, as per national guidelines. Mean sensitivities improved from 78% to 89% for fourth‐year medical students, 71.9% to 83.1% for FY1 doctors, 88% to 91% for core medical trainees/specialist registrars and 61% to 82% for general practitioners.Health care professionals are increasingly able to access retinal images and are concerned that they may not be able to interpret these images. While the baseline ability of these groups to screen for diabetic retinopathy was variable, their accuracy was significantly improved with a simple and brief intervention. These results suggest that all participants should revise their knowledge on this topic and others should think about doing so. Copyright © 2010 John Wiley &amp; Sons.

The performance of junior doctors in applying clinical pharmacology knowledge and prescribing skills to standardized clinical cases

Recent studies suggest a worryingly high proportion of final year medical students and new doctors feel unprepared for effective and safe prescribing. Little research has been undertaken on UK junior doctors to see if these perceptions translate into unsafe prescribing practice. We aimed to measure the performance of foundation year 1 (FY1) doctors in applying clinical pharmacology and therapeutics (CPT) knowledge and prescribing skills using standardized clinical cases. A subject matter expert (SME) panel constructed a blueprint, and from these, twelve assessments focusing on areas posing high risk to patient safety and deemed as essential for FY1 doctors to know were chosen. Assessments comprised six extended matching questions (EMQs) and six written unobserved structured clinical examinations (WUSCEs) covering seven CPT domains. Two of each assessment types were administered over three time points to 128 FY1 doctors. The twelve assessments were valid and statistically reliable. Across seven CPT areas tested 51-75% of FY1 doctors failed EMQs and 27-70% failed WUSCEs. The WUSCEs showed three performance trends; 30% of FY1 doctors consistently performing poorly, 50% performing around the passing score, and 20% performing consistently well. Categorical rating of the WUSCEs revealed 5% (8/161) of scripts contained errors deemed as potentially lethal. This study showed that a large proportion of FY1 doctors failed to demonstrate the level of CPT knowledge and prescribing ability required at this stage of their careers. We identified areas of performance weakness that posed high risk to patient safety and suggested ways to improve the prescribing by FY1 doctors.

Assessing and improving the knowledge of orthopaedic foundation-year doctors

modernising medical careers has been fully implemented nationally in the UK.(1) The foundation-year programme is the keystone of this plan, and as a consequence a large number of foundation trainees are exposed to specialties (e.g. orthopaedics) previously reserved for aspirant surgeons.(2) When coupled with the undergraduate curriculum changes instigated by the UK registry and accrediting body for medicine, the General Medical Council (GMC),(3,4) it appears self-evident that the type of training now being provided to these juniors is very different from that formerly available. We aimed to assess whether foundation-year doctors are being trained adequately. junior doctors were set an original test at the start of their orthopaedic training to assess their knowledge (this was based on orthopaedic consultants' expectations). After a succinct 2-week training programme aimed at meeting those expectations, the juniors were then retested using a different test to close the audit loop and assess if improvements had been made. we show that set against the basic expectations of orthopaedic consultants, generic foundation-doctor education is inadequate. However, after a focussed teaching programme instigated at the beginning of the job, standards improved significantly. Our results also show that junior doctors' confidence and enjoyment of the speciality also increased.

Attitudes and beliefs to seasonal influenza vaccination among junior doctors and the impact of a targeted campaign on vaccine uptake

The Department of Health recommends that health care workers (HCWs) with direct patient contact are vaccinated against seasonal influenza. A survey of acute hospital NHS trusts in 2008 reported that doctors had the lowest vaccine uptake of all HCWs. At the University Hospital of North Staffordshire, vaccination coverage in doctors was 7% in 2007/2008 and only 2% in foundation year 1 (F1) doctors. During this year (2008/2009), as part of a programme to improve uptake, we carried out a questionnaire survey among junior doctors to assess barriers to vaccination. We targeted F1 doctors by organising vaccination sessions at the same time and location as two mandatory training days. Fifty-four questionnaires were analysed. 68.5% of foundation doctors were in favour of vaccination of HCWs and 3.7% opposed it. 50% believed vaccination to be a professional responsibility; 46.3% believed it should be mandatory. Greater accessibility of vaccination, peer pressure and the example of seniors were viewed to be the most important factors in improving uptake. In 2008/2009 uptake of influenza immunisation in F1 doctors rose to 62% (31/50) from 2% in 2007/2008. Among F2 doctors (who had no vaccination sessions at training days) there was a 16% (9/56) uptake. Among foundation doctors in our Trust, most favour vaccination; barriers appear to be related to accessibility. By arranging vaccination sessions at training days, we dramatically increased uptake. We believe that increasing accessibility and peer pressure and senior example contributed to this effect.

Abstract P76: Assessment of Resuscitation Skills in Foundation Year 1 Hospital Doctors in Northern Ireland

Aims: To assess Foundation Year 1 (F1) doctors’ ability to perform effective cardiopulmonary resuscitation (CPR) using different chest compression:ventilation ratios. Methods: All forty F1 doctors working in a major teaching hospital were asked to participate in the study. Thirty four doctors participated, eighteen male and sixteen female. BMI was recorded in each case. They were asked to perform two, three minute sessions of CPR on a skills reporter manikin separated by a five minute rest period. Half of the doctors started using a ratio of 15:2 and half used 30:2. After a five minute rest the alternate ratio was performed. Their performance was assessed both objectively, by measuring the rate and depth of chest compressions, and subjectively by a panel of five advanced life support (ALS) instructors who reviewed tracings of each CPR session. Results: Mean compression rate per minute was sixty five while performing 15:2 and ninety one at 30:2. Chest compressions were effective if &gt;38mm. Twenty three doctors (67.7%) achieved &gt;80% effective chest compressions at a ratio of 15:2, compared with nineteen doctors (55.9%) at 30:2. At 15:2, males were 89% effective compared to 44% of females. At 30:2 males were 83 % effective compared to 25% of females. At 15:2 82% of compressions were effective in BMI&gt;24 group compared with 50% of BMI&lt;24. At 30:2 BMI&gt;24 achieved 76% effective compared with 35% in BMI&lt;24 group. Outcome measures shown in table 1 show no statistical difference between 15:2 and 30:2. Subjectively, 41% of doctors were deemed effective at 15:2 compared with 35% at 30:2. Conclusions: A significant number of F1 doctors are unable to perform effective CPR. Objectively, F1 doctors performed better at 15:2 than 30:2 but no statistical significance was noted. Subjectively, ALS instructors favoured the 15:2 regieme. CPR was performed better by males and doctors with BMI&gt;24. F1 doctors’ should be carefully assessed before they act as first responders at in-hospital cardiac arrests. Mean difference between 15:2 and 30:2

ALERT course (Acute Life threatening Events—Recognition and Treatment)

Credit: JANHALASKA/ALAMY FURTHER INFORMATION The ALERT course was designed to cater for all types of healthcare professionals, including medical students, doctors, nurses, paramedics, and resuscitation trainers. It is aimed at foundation year 1 (F1) doctors. The course is designed to teach healthcare staff to anticipate, recognise, and improve the quality of care for critically ill patients on general wards who may require subsequent admission to a critical care facility. Being the equivalent of an F1 doctor, I …

Are Medical Students Adequately Trained to Prescribe at the Point of Graduation? Views of First Year Foundation Doctors

Drugs are the major therapeutic intervention provided by most doctors throughout their careers. The General Medical Council expects all medical students to be competent to prescribe at the point of graduation. The aim of this study was to assess the views of Foundation Year 1 (FY1) doctors who had recently graduated from the University of Edinburgh about their training and competence in relation to the use of drugs based on their early clinical experience. A questionnaire was constructed based on Tomorrow's Doctors 2002 and distributed to FY1 doctors who graduated in August 2005. Responses were received from 100 (39.8%) of the doctors who graduated in 2005. Only 32% respondents considered themselves 'competent to prescribe' at the point of graduation. Less than 50% of respondents felt comfortable in providing information about possible treatments to allow patients to make informed decisions about their care. The majority of respondents complained about a lack of formal teaching and practice at basic clinical skills relating to drug therapy. Many graduates feel under-prepared to take on prescribing responsibilities after graduation. These findings emphasise the need to ensure that all medical curricula are able to provide sufficient learning opportunities and robust assessment in this important area of clinical practice.

0050 DEVELOPMENT OF AN EARLY DETECTION NETWORK IN FRANCE

Recent changes to the structure of medical training have placed increasing pressure on foundation year 1 (FY1) doctors to decide upon careers earlier. The deadline for application to core surgical training (CST) at the start of the foundation year 2 (FY2) may deter doctors from pursuing careers in surgery due to insufficient experience and confidence in its practical aspects. We piloted a four-week basic surgical skills (BSS) programme near the start of the FY1 year to a small cohort of FY1s and assessed its impact on confidence in basic surgical competencies and attitudes to a career in surgery.FY1 doctors at Whipps Cross University Hospital (WXUH) were selected to participate in a four week BSS programme within three months of starting their posts. We devised the BSS programme based on relevant key competencies in the Intercollegiate Surgical Curriculum Programme (ISCP). Using questionnaires we assessed confidence in basic surgical skills, competencies and attitudes to surgery before, immediately after and at 8 months after completion of the course and compared this with non-participating FY1s.Out of 31 FY1 doctors, 14 (4 males, 10 females) participated in the BSS programme and 17 (10 males, 7 females) were non-participants (control group). Using the Mann–Whitney test, there was a statistically significant increase in confidence at 8 month follow-up of course participants (versus control group) in tying knots (p = 0.0112), suturing skills (p = 0.0455) performing fine needle aspiration (FNA) cytology (p = 0.0017), obtaining tru-cut biopsy samples (p = 0.0031), suturing lacerations in accident and emergency (A&E) (p = 0.0009), incising and draining abscesses (p = 0.0034), performing skin closure (p = 0.0042), surgical sharps handling (p = 0.0402) and surgical instrument handling (p = 0.0066). Course participants were significantly more likely than non-participants to receive additional training in BSS from senior members of the team (p = 0.0076). Importantly, they also demonstrated a statistically significant increase in interest in a career in surgery at 8 month follow-up in comparison to non-participants (p = 0.0016).A structured, challenging BSS teaching programme early on during the FY1 year increases confidence in key surgical skills and competencies and can increase interest in surgery as a career.