Hospital Doctors Research Articles

Development and validation of situational judgement test for assessment of behavioural competencies required for effective medical practice in Nigeria.

The personal qualities of health workers determine the way health services are provided to clients. Some key personal qualities (also called behavioural competencies) of physicians that contribute to quality healthcare delivery include ethical responsibility, empathy, patient-centeredness, diligence, good judgment, respectful, teamwork, team leadership/conflict management, ability to take correction and tolerance. In this study, we developed and validated clinical scenarios (dilemmas) for assessing priority behavioural competencies for medical practice in Nigeria. Drawing on prioritized competencies generated via a scoping review and nominal group technique (NGT) exercises in a previous study in the study series, Faculty members from the University of Nigeria Teaching Hospital were consulted to develop or adapt clinical scenarios that could be used to assess these competencies in a physician. The clinical scenarios and options were framed as situational judgement tests (SJTs) and these tests were administered to a random sample of 192 undergraduate and 111 postgraduate medical doctors in a tertiary hospital in Enugu State. Using Kane's validity argument framework, we assessed scoring and generalization inferences of situational judgment tests (SJT) based on the developed scenarios. Scoring inference - difficulty and discrimination index - shows that most of the SJT items are good test items and can differentiate between high and low performers. The corrected point biserial correlations show positive correlation for most of the items. Generalization inference shows the items represent the domains of interest and are internally consistent. However, few items that show poor difficulty and discrimination index were subjected to re-evaluation and possible elimination. This study has produced a set of valid clinical scenarios that can be used to evaluate specific behavioural competencies among trainee medical doctors. It demonstrates that SJTs can be used to assess behavioural competencies for medical practice. However, further research is needed to establish the applicability of SJT beyond the immediate context, such as the medical school, in which it is developed.

Emotional resilience and sense of danger among doctors in hospitals during periods of heightened tensions and warfare in Israel.

The "Iron Swords" War beginning in October 2023 led to unprecedented levels of shock and trauma across Israel, significantly impacting the Israeli population and medical personnel. This study aimed to evaluate and compare the perceived personal resilience and sense of danger among physicians in hospitals located in different conflict zone proximities in Israel during this period. A quantitative, cross-sectional study was conducted from March to August 2024, during an active phase of the war, using a structured anonymous questionnaire. Participants were 161 physicians from three hospitals: one in southern Israel near the Gaza Strip, another in northern Israel near the borders with Lebanon, Syria, and Jordan, and a third in central Israel near Tel Aviv. The survey measured personal resilience using the Connor-Davidson Resilience Scale (CD-RISC-10) and sense of danger using the Solomon & Prager scale. Statistical analyses included Kruskal-Wallis H test, multiple linear regression, two-way analysis of variance (ANOVA), and Sobel test for mediation effects. The final sample included 161 physicians (54 southern, 56 central, 51 northern). The mean resilience score was 31.14 ± 5.77, and the mean sense of danger score was 8.36 ± 4.15 (scales 0-40 and 0-20, respectively). Physicians in the southern hospital reported significantly higher sense of danger scores (p = 0.005). A trend towards lower resilience scores was noted among southern hospital physicians (p = 0.068) (p = 0.068). Two-way ANOVA revealed significant main effects of hospital location and gender on resilience (p = 0.046 and p = 0.003, respectively) and sense of danger (p = 0.005 and p = 0.062, respectively). Multiple regression analysis identified hospital location (β = -0.178, p = 0.023) and gender (β = 0.229, p = 0.004) as significant predictors of resilience. Mediation analysis indicated that personal resilience partially mediated the relationship between hospital location and sense of danger (indirect effect = 0.2896, p < 0.001). Physicians working near conflict zones report higher levels of perceived danger, though their resilience is comparable to peers in less threatened regions. Enhancing personal resilience is crucial to mitigate the heightened sense of danger. This could include regular resilience training, psychological support, and specific programs for single and childless physicians to improve safety perceptions. Additionally, fostering a supportive community with clear communication and robust emergency protocols is essential for enhancing staff resilience and safety in hospitals.

Examining mobile medical supplies in supply chain: Exploring the impact of intention to use mobile medical apps

All sectors have an increasing interest in smart phone applications based on their many advantages that support business, especially the medical sector, which is constantly competing to develop the medical services provided, and accordingly in this research study we industrialized a mobile medical supplies and equipment ordering application (mobile medical app) classic and make an effort to authenticate it factually. When clients (hospitals doctors) create consumptions on the application, three dimensions can be identified: platform emotion stage, fear effect, and familiarity with product. This research designed to reinforce and brighten the most important magnitudes that improve a physician’s judgment of mobile medical app and the purpose to usage. Furthermore, this study inspected the availability of the model between hospital physicians in UAE. The classic ideal was observed by means of a model of 340 UAE clinic physicians and their personal assistant who utilize mobiles facilities in overall. The review technique, a calculable method, was applied; the fractional smallest cubes organizational calculation exhibiting systems was owned to inspect the planned agenda. The platform emotion dimension, especially fear and resistance to change, and the familiarity with the products were evaluated, and it was discovered that these factors positively influenced the objective to use the application. And the other side, the first dimension of emotion, fear, manifested as “apparent threat”, had no outcome on the purpose to using. These discoveries recommended that scholars should emphasis more on the facilities, merchandises, and the key task of the mobile medical app to control their inspirations on clients’ ordering purpose. This will progress the purchasing ways associated to acquiring medicinal materials utilizing mobile medical app and/or on other operational stages in unambiguously in UAE and the Central East at great.

25-year experience of surgical treatment of thyroid diseases in a multidisciplinary hospital

BACKGROUND: Every year there is an increase in the number of patients with thyroid diseases, thus improving surgical treatment methods with decreased traumatic effect and postoperative complications, remains relevant. AIM: To summarize the results of 25-year work of the team (surgeons and endocrinologists) of specialists from the multidisciplinary hospital of Saint Petersburg and the departments of the North-Western State medical university named after I.I. Mechnikov on the diagnosis and treatment of patients with surgical pathology of the thyroid gland. MATERIALS AND METHODS: The results of surgical treatment of 3977 patients with thyroid diseases operated accoding to the traditional Kocher approach, asymmetric “floating” mini-approach and video-assisted mini-approach were analyzed. RESULTS: In the analyzed time period, a rapid increase in the number of minimally invasive techniques for surgical operations on the thyroid gland is characteristic, which are used for nodular euthyroid goiter, multi-nodular euthyroid goiter and toxic thyroid adenoma. With the help of traditional approach, surgical intervention was performed mainly for diffuse toxic goiter and multinodular toxic goiter. The introduction of new techniques and approaches in the provision of medical care to patients with surgical diseases of the thyroid gland can significantly improve the results of treatment. CONCLUSIONS: 25-year experience of the endocrinological center of the Elizabethan Hospital demonstrates that collaboration of departments and doctors of a multidisciplinary hospital allows to introduce new approaches to treating surgical thyroid diseases and improve its results without increasing the number of postoperative complications.

The lifestyle factors of medical doctors in academic hospitals, Bloemfontein, Free State.

Lifestyle factors of medical doctors are essential to their health and well-being. Previous studies omitted factors that constituted a healthy lifestyle and did not differentiate between various medical specialties or level of seniority which may expose doctors to different stress levels, workload and responsibility. The study assessed the lifestyle factors of medical doctors and compared them between departments, levels of seniority, years of experience and gender according to globally recognised health standards. This descriptive cross-sectional study collected data using a questionnaire created by the researchers based on healthy lifestyle factors and was administered online. Access was given to all doctors from four large departments, employed at two academic hospitals in Bloemfontein, Free State who agreed to participate in the study. Consultants from paediatrics, with 6+ years in medical practice, had the healthiest lifestyles. Registrars and interns from surgical disciplines such as obstetrics and gynaecology and surgery, with 1-5 years of medical practice, showed unhealthy lifestyles with inadequate sleep and exercise. The challenge remains how medical doctors can live a healthy lifestyle while managing a demanding schedule. This may impact on the management of their patients and the doctors' overall health and well-being. We recommend improving the working conditions by providing healthy meals on-site at hospitals with adequate breaks, reducing the heavy workload and providing exercise facilities.Contribution:The findings from this article may help improve the lifestyles of the identified groups of at-risk doctors and assist them in seeking ways to improve upon this.

Fostering Nurses’ Support in the Workplace: Addressing Job Burnout Among Malaysian Medical Doctors Working in Public Hospitals

Job burnout in employees is caused by individual factors, including demographic characteristics and nurses’ support. This study analyzed the relationship between nurses’ support and job burnout among medical doctors in Malaysian public hospitals. This research was a correlational study with a cross-sectional design. The research sample was 471 employees, using the non-probability sampling method with the purposive and quota sampling techniques. Data collection used the Abbreviated Maslach Burnout Inventory (aMBI) and nurses’ support items. The data in this study were analyzed using the Statistical Package Social Science (SPSS) and Partial Least Squares Structural Equation Modelling (PLS-SEM) software. Findings suggest that 77 medical doctors who participated in the study were from Hospital Pulau Pinang, from the Emergency Department, mostly female, ranging from 24-56 years old, single, and have an MBBS education level. The study assessed the measurement model’s loading, average variance extracted (AVE), and composite reliability (CR) where the loadings were above 0.60. AVEs were greater than 0.50 and CRs were greater than 0.708. Additionally, the bootstrap BCI LL (-0.079) and UL (-0.002) for nurses’ support and job burnout were not straddled a 0 in between. Job burnout had a negative association with nurses’ support. In particular, nurses’ support towards medical doctors lowers their risk of job burnout, which has a substantial impact on medical doctors’ overall well-being. The findings indicated that medical doctors who had complete support from their nurses performed their jobs more efficiently, displayed good task performance, and experienced less job burnout.

Policies, Progress, and Prospects for Internet Telemedicine in China

ABSTRACT Around the world, the adoption of digital technologies in health care has accelerated considerably in the wake of the COVID-19 pandemic. Prior to the emergence of the pandemic, China had already embarked on a private sector, technology enterprise-led creation of an innovative internet health care ecosystem, which has dramatically transformed China’s health care landscape. In this article, we describe the evolution of China’s internet health market, focusing on internet telemedicine. We trace its early origins with the establishment of information networks in the 1980s, to the emergence of a fast-growing internet health market in the 2010s that leveraged the capabilities of technology enterprises in e-commerce, logistics, and payment systems. Private health care platforms have played a central role throughout this transformative process. The supplyside of the market has a unique public-private mix structure, with the coexistence of public and private internet hospitals, and with the majority of telemedicine services provided by public hospital doctors working on private platforms in a dual practice capacity. We conclude with a discussion of the prospects of internet telemedicine, including how it should be optimized and harnessed to improve China’s health system. Finally, we set out areas where more research is needed.

Patient-centered lean healthcare management from a humanistic perspective

BackgroundHealthcare organizations are under pressure to improve services because of an aging population and increasing healthcare demands. Lean healthcare management focuses on improving service quality and efficiency under the condition of limited resources, but it may overlook patients’ emotional needs and experiences, especially in developing countries. This study advocates integrating medical humanities with lean healthcare to develop a patient-centered service model.MethodsThe study employs literature review to discuss the critical role of medical humanities in lean healthcare frameworks, both theoretical and practical. Additionally, it conducts a qualitative study through semi-structured interviews to explore strategies for developing a humanistic lean healthcare model. The study conducts semi - structured interviews with eight management staff members and doctors in a tertiary hospital in China that actively adopts this approach.ResultsEight managers and doctors (five female and three male) were interviewed between January and March 2024 at their chosen locations. Firstly, the study identifies key benefits of integrating medical humanities into lean healthcare, which are as follows: (1) Enhancing the personalization and comprehensiveness of services. (2) Building trust in doctor-patient relationships. (3) Boosting the satisfaction of healthcare teams. Secondly, it highlights strategies for a humanistic approach, namely: (1) Conducting comprehensive patient assessments and providing personalized treatments. (2) Enhancing doctor - patient communication for emotional resonance. (3) Optimizing the medical environment for humanized services. (4) Developing humanistic qualities among healthcare professionals. (5) Using information technology effectively. Additionally, the study also addresses potential issues regarding lean healthcare’s focus on profitability and proposes preventive measures: (1) Implementing a scientific evaluation and incentive mechanism. (2) Enhancing transparency and oversight in healthcare. (3) Cultivating a patient - centric medical culture.ConclusionsThis research proposes a patient-centered lean healthcare model integrating medical humanities, providing a novel framework for improving service quality and efficiency while ensuring compassionate care. This management framework can support the reform of public hospitals in China and also serve as a reference for other countries.

Impact of telehealth implementation on medical non-consultant hospital doctors training experience

Telehealth is defined as the provision of health care services over a distance. Major health systems, including outpatient clinics and check-ups alike, turned to telehealth and teleconsultation amid the COVID19 pandemic. There are many recognized advantages of telehealth and its increasing implementation, however, not much is known about the specific impact of remote consultation on the quality of non-consultant hospital doctors (NCHD) training experiences in medicine. This study aimed to gain rich descriptive insights into the specific impact of remote consultation on the quality of medical NCHD training experiences and their perceptions, through purposeful sampling. Data was collected via semi-structured virtual interviews of fifteen NCHD participants. The interviews were recorded, transcribed and analysed using thematic analysis. The collective transcripts were analysed using NVIVO data software for common themes. The themes identified suggested that there were both advantages and disadvantages to telehealth and its impact on training across a spectrum of entities including; doctor-patient relationships, peer relationships, service provision, work morale, working hours, clinical skills experience and general feedback as a trainee. NCHD perspectives expressed were mixed across all themes. Further research is recommended to advance understanding of the potential impact of telehealth on current and prospective doctors in training. With a greater understanding of general insights, future changes, including telehealth training programmes, could be implemented to build confidence and familiarity with telehealth utilization and potentiate its conceivable benefits.

Health Care Worker Usage of Large-Scale Health Information Exchanges in Japan: User-Level Audit Log Analysis Study.

Over 200 health information exchanges (HIEs) are currently operational in Japan. The most common feature of HIEs is remote on-demand viewing or searching of aggregated patient health data from multiple institutions. However, the usage of this feature by individual users and institutions remains unknown. This study aims to understand usage of the on-demand patient data viewing feature of large-scale HIEs by individual health care workers and institutions in Japan. We conducted audit log analyses of large-scale HIEs. The research subjects were HIEs connected to over 100 institutions and with over 10,000 patients. Each health care worker's profile and audit log data for HIEs were collected. We conducted four types of analyses on the extracted audit log. First, we calculated the ratio of the number of days of active HIE use for each hospital-affiliated doctor account. Second, we calculated cumulative monthly usage days of HIEs by each institution in financial year (FY) 2021/22. Third, we calculated each facility type's monthly active institution ratio in FY2021/22. Fourth, we compared the monthly active institution ratio by medical institution for each HIE and the proportion of cumulative usage days by user type for each HIE. We identified 24 HIEs as candidates for data collection and we analyzed data from 7 HIEs. Among hospital doctors, 93.5% (7326/7833) had never used HIEs during the available period in FY2021/22, while 19 doctors used them at least 30% of days. The median (IQR) monthly active institution ratios were 0.482 (0.470-0.487) for hospitals, 0.243 (0.230-0.247) for medical clinics, and 0.030 (0.024-0.048) for dental clinics. In 51.9% (1781/3434) of hospitals, the cumulative monthly usage days of HIEs was 0, while in 26.8% (921/3434) of hospitals, it was between 1 and 10, and in 3% (103/3434) of hospitals, it was 100 or more. The median (IQR) monthly active institution ratio in medical institutions was 0.511 (0.487-0.529) for the most used HIE and 0.109 (0.0927-0.117) for the least used. The proportion of cumulative usage days of HIE by user type was complex for each HIE, and no consistent trends could be discerned. In the large-scale HIEs surveyed in this study, the overall usage of the on-demand patient data viewing feature was low, consistent with past official reports. User-level analyses of audit logs revealed large disparities in the number of days of HIE use among health care workers and institutions. There were also large disparities in HIE use by facility type or HIE; the percentage of cumulative HIE usage days by user type also differed by HIE. This study indicates the need for further research into why there are large disparities in demand for HIEs in Japan as well as the need to design comprehensive audit logs that can be matched with other official datasets.

An evaluation of knowledge, attitudes, practice, and associated factors regarding oxygen therapy among resident doctors in a tertiary care teaching hospital: A mixed-methods study

BACKGROUND: Despite oxygen therapy guidelines, suboptimal practices prevail among front-line resident doctors, highlighting knowledge and attitudinal barriers. Mixed-methods research can inform tailored quality improvements. This study aimed to assess the knowledge, attitudes, and practices of resident doctors regarding oxygen therapy, determine associated factors quantitatively, and explore experiences, barriers, and enablers qualitatively. MATERIALS AND METHODS: This was a convergent parallel mixed-methods study conducted at a tertiary teaching hospital. An analytical cross-sectional survey of 410 resident doctors assessed knowledge, attitudes, and practices using a questionnaire. Qualitative phenomenology entailed in-depth interviews with 30 participants analyzing experiences and perspectives. Integration enabled corroborating and complementing findings. Logistic regression analysis and thematic analysis were used to make themes and subthemes. RESULTS: Most demonstrated suboptimal knowledge (78% or 320/410 good), attitudes (61.7% or 253/410 positive), and practices (47.8% or 196/410 good). Significant factors were gender, experience, workload perceptions, and device familiarity. Males had 5.5 times higher odds of good knowledge (adjusted odds ratio (AOR) 5.5, 95% confidence interval (CI) 3.25–10). Those perceiving workload impact had 13 times higher odds of positive attitudes (AOR 13, 95% CI 9.4–20.9). Qualitative themes highlighted inadequate skills and time constraints as barriers and protocolization and decision tools as enablers. CONCLUSION: Gaps exist in knowledge, attitudes, and practices regarding oxygen therapy among resident doctors attributable to varied factors. Tailored quality improvement strategies addressing demonstrated barriers, such as enablement workshops, order set integration, and pulse oximetry audits, are recommended based on mixed-methods insights.

Competencies Required By All Hospital Doctors Caring for Older Adults: A Group Concept Mapping Study

Abstract Background The number of older adults accessing the healthcare service far exceeds the available geriatric specialist services. It is recognised that for the foreseeable future most hospital inpatient contacts with older adults will be completed by doctors not specifically trained in geriatric medicine. To ensure the provision of adequate healthcare, it is imperative that that all hospital doctors are trained in the minimum geriatric competencies. Allowing for the broad, complex, and multidisciplinary nature of geriatric medicine, we conducted a group concept mapping (GCM) study to permit multiple stakeholders with various expertise to convey their thoughts on the competencies required by all hospital doctors caring for older adults. Methods GCM is a mixed methods approach utilising six phases to generate expert group consensus, enabling participants to organise and represent their ideas. We invited healthcare professionals, patient advocacy groups and clinical educators to participate in GCM via an online platform. Hierarchical cluster analysis and multi-dimensional scaling were utilised to analyse participant input regarding competencies required by doctors caring for older adults. Results Forty-eight participants completed the brainstorming stage, generating eighty-eight statements, and twenty-two participants took part in the subsequent sorting stage. Participants included hospital doctors, general practitioners, allied health professionals and patient advocacy groups. Nine competency domains were identified as integral for all hospital doctors to care for older adults. Domains rated most important related to interpersonal communication skills, ethical and legal matters relating to older adults, recognition and management of delirium and medication management. Conclusion The twelve competency domains indicate the diverse skillset required by all doctors to provide comprehensive care to older adults within a hospital setting. This study identifies competencies that may serve as a foundational framework for ensuring quality healthcare for the ageing population. Future initiatives should consider incorporating these competencies to improve inpatient care provided by hospital doctors to older adults.

Bridging the Gap: A Competency Framework for Hospital Doctors Caring for Older Adults

Abstract Background Our ageing population has resulted in an increasing number of older adults requiring healthcare services. This growing demand within a population of varying needs requires that all hospital doctors, regardless of specialty, possess fundamental Geriatric Medicine competencies. However, a consensus on these competencies is lacking with no overarching competency framework available. We aimed to address this gap by synthesising a competency framework for all hospital doctors caring for older adults. Methods Our first step involved a comprehensive scoping review of international literature identifying the proposed competencies for hospital doctors caring for older adults. These findings were validated and expanded through a national group concept mapping study inviting multiple stakeholders. An iterative process refined the identified competencies, categorising them into domains, and synthesising a final competency framework using Microsoft Excel. Results This study synthesised 110 Geriatric medicine competencies within seventeen competency domains. The scoping review highlighted medication, cognitive, and chronic disease management and the group concept mapping identified interpersonal communication, medicolegal, and delirium management as most critical. The iterative process further refined the framework, emphasising competencies pertaining to cognitive impairment, depression, falls, and acute inpatient management of older adults. Conclusion This synthesis highlights the broad range of competencies necessary for effective care of older adults by all hospital doctors. The identified competencies reflect the heterogeneous nature of the older adult population, encompassing both fundamental but also specialised skills. Further research is now essential to determine the optimal educational interventions for ensuring all hospital doctors are equipped with these essential competencies.

Creating a Guidance Template for NCHDs to Evaluate Cognition in Geriatric Medicine Clinics

Abstract Background Non-Consultant hospital doctors (NCHDs), when rotating through geriatric medicine, often take a comprehensive cognitive history for the first time. Graduate clinical exams often overlook this complex assessment, and knowledge of cognitive disorders amongst NCHDs is often limited. We aimed to create a template to guide NCHDs in taking this history, including investigations and management options. Methods We developed a 9-question survey, administered to a sample of representative NCHDs and specialist nurses who have rotated through our department, to gauge their confidence in assessing cognition. We examined their understanding of cognitive assessments and if a template would be useful. With consultants, we subsequently drafted an agreed guidance template for use at clinics. Results We included 35 respondents who rotated through geriatric medicine clinics this year; 8 registrars, 18 SHOs, 5 interns, 1 ANP. 10(31.25%) felt very confident completing a cognitive history, 17(53.13%) felt just somewhat confident and 5(15.65%) did not feel confident. Regarding investigating a new cognitive impairment (CI) n=10 (31.25%) felt very confident, 12(37.5%) felt somewhat confident and 10(31.25%) did not feel confident. Management of CI - 12(37.5%) felt very confident, 11(34.38%) felt somewhat confident and n=9 (28.13%) did not feel confident. MMSE, MOCA, clock drawing test, Addenbrooks and RUDAS were listed as cognitive assessments. Regarding investigations, CT/MRI Brain were mentioned in all but just n=12 mentioned a PET scan. Services listed included Occupational Therapy (20), Social Work (6), Dublin Alzheimer’s Society (6), psychology (6). Almost all 96.87% (31) felt a guide would be helpful and 100% of participants said that they would use it. Conclusion We identified gaps in confidence and knowledge amongst NCHDs regarding assessment of cognition. Consequently, we designed a guidance template to ensure rotating junior staff are more confident and informed during cognitive assessments at clinics in our department.

Enhancing Discharge Letter Completeness: Consultant Review via Encrypted Medical App

Abstract Background Ensuring comprehensive discharge letters is crucial for safe transitions from acute hospitals to community care. The 2013 National Standard for Patient Discharge Summary Information of the Health Information and Quality Authority (HIQA) 2013 outlines what items of information ought to be included in discharge summaries. On the wards, junior doctors often complete discharge documentation without consultant review. With technological advancements, tools like encrypted chat apps for medical care offer potential solution to improve communication and access to specialized reviews. We aimed to evaluate whether a specific app to access Consultant review could enhance discharge letter completeness. Methods We conducted a retrospective audit of discharge letters for inpatients admitted and discharged under a geriatric team between September 1st and December 23rd, 2023. The letters were divided in two groups: intervention, reviewed by a medical consultant, and control, including letters only signed off by non-consultant hospital doctors. Data access and approval were obtained from the hospital's Clinical Audit Committee; data collection utilized hospital information systems and Excel database, with minimal demographic data collected. SPSS facilitated data analysis. Each discharge letter was assessed for various items outlined in the HIQA guideline. The prevalence of inclusion of each item in each group was compared using non-paired Student t-test. Results We analysed 89 discharge letters, with 34 (38.2%) in the intervention group and 55 (61.7%) in the control group. Although most items showed no statistically significant difference between groups, the inclusion of investigation results significantly differed (91% in the intervention group versus 23% in the control group). Conclusion Our audit observed improved completeness of inclusion of investigation results in the intervention group. Future research should involve a larger sample from various teams to assess whether access to senior letter review via an encrypted app can consistently enhance discharge letter completeness.

DNAR: All or Nothing: Impact of Education Sessions Re-Audit in a Model 3 Hospital

Abstract Background Do Not Attempt Resuscitation (DNAR) orders are implemented to obviate inappropriate Cardio-Pulmonary Resuscitation (CPR) in patients with low chances of survival post-CPR. However, ambiguity regarding ceilings of care for patients with a DNAR order can arise. This re-audit aimed to review DNAR and ceilings of care documentation according to national HSE guidelines after education sessions, comparing results with the pre-education audit in a Model 3 Hospital. Methods A point-prevalence chart review of thirty-one adult medical inpatients with a DNAR order was conducted after two education sessions were held for Non-Consultant Hospital Doctors (NCHDs) and Consultants. Results Of all thirty-one charts, 35% documented DNAR status in the medical notes, with 32% documenting the reasoning for DNAR status, both of which were unchanged from the first audit cycle. There was an increase in documentation of patient discussion (61% versus 45%) and reasons if this was excluded (66% versus 41%). There was no change in documentation of patient relatives’ discussion (48%) but there was an increase in the reasons if this was excluded (25% versus 18%). There was an overall increase in ceilings of care documentation for ICU admission (three-fold increase), intubation (two-fold increase), inotropic support, and comfort measures, but rates of documentation were still less than 15%. This elucidates the efficacy of education sessions in improving DNAR documentation adherence. Recent studies have highlighted uncertainty among NCHDs regarding treatment escalation in acutely unwell patients in the absence of adequately filled DNAR orders and clear documentation of ceilings of care. Therefore, we posit the introduction of a Ceilings of Care document, akin to the United Kingdom’s Medical Advance Plan. Conclusion Accurate recording of DNAR status and ceilings of care is essential for quality care and treatment escalation. While simple education strategies have proven beneficial in enhancing compliance, additional efforts are needed to enhance ceilings of care documentation.

Prevalence of work place violence and its impact on doctors in some Iraqi hospitals.

To estimate the prevalence of workplace violence and its impact on doctors in hospitals. The cross-sectional study was conducted from August 2021 to January 2022 in Baghdad and Karbala governorates of Iraq, and comprised resident doctors at a number of hospitals. Data was collected using a selfadministered questionnaire that focussed on the frequency of exposure to violence, type, source, most common time, and other details about violence as well as its impact on doctors and their careers. Data was analysed using SPSS 23. Of the 1,079 subjects working at 18 participating hospitals and having a mean age 30.0±5.72 years, 567(52.5%) were females and 512(47.5%) were males, while 570(52.8%) were aged <30 years and 509(47.2%) were aged >30 years. Overall, violence exposure was reported by 811(75.2%) subjects; 427(52.6%) females and 384(47.4%) males. Gender was not significantly associated with exposure to violence (p>0.05). Due to missing data, further analysis was limited to 792(97.6%) subjects who faced exposure to workplace violence. In 671(85%) cases, the assaults were nonphysical. However, 110(14%) doctors reported physical attacks and severe consequences. There were 673(85%) doctors with exposure to violence who expressed their intention to change their job, workplace, or leave the country because of violence. The problem of violence against Iraqi doctors was found to be highly prevalent with a seriously negative impact on the medical professionals.

A quality improvement project for the ECG interpretation skills of junior doctors in West Suffolk Hospital

A quality improvement project for the ECG interpretation skills of junior doctors in West Suffolk Hospital

EP160 - A comparison of pre-rotation confidence levels over a year of surgical foundation year one doctors in a busy district general hospital

Abstract Aims Assess the confidence levels of foundation year one (FY1) doctors in managing surgical patients pre-rotation. Identify areas where further support could be given to improve confidence levels. Methods Ten questions used Likert scales (1 to 5: not at all confident to very confident) to assess general surgical patient management. One question focused on education methods and one open question. Cohort One (August 2022) were asked to reflect in December 2022. Cohort Two (December 2022) and Cohort 3 (April 2023) were surveyed at the start of their general surgical rotation. Data was initially inputted using Google Docs and analysed in Microsoft Excel. Results 100% (10/10) cohort one, 75% (6/8) cohort two and 100% (10/10) cohort three completed the survey. Pre-rotation confidence levels mostly improved between the first cohort and last cohort. Areas where modal scores were below three in the last cohort were in managing the acutely unwell general surgical patient, managing biliary disease and managing non-specific abdominal pain. Common concerns of FY1 doctors were not being able to contact a senior in theatre and the busyness of the specialty. Most FY1 doctors felt that group teaching would be the preferred method to increase understanding of general surgery. Conclusions Confidence levels were higher in the final cohort. This suggests core skills are picked up in different specialties which are transferrable to aspects of general surgery. Further work needs to be done to target improvement in areas of lower confidence.

WP6.16 - A comparison of post-rotation confidence levels over a year of surgical foundation year one doctors in a busy district general hospital

Abstract Aims Assess the confidence levels of foundation year one (FY1) doctors in managing surgical patients post-rotation. Identify areas where further support could be given to improve confidence levels. Methods August 2022, December 2022 and April 2023 cohorts were surveyed following the end of their four-month rotation. Ten questions used Likert scales (1 to 5: not at all confident to very confident) to assess general surgical patient management. One question focused on education methods and one was an open question. Data was initially inputted using Google Docs and analysed in Microsoft Excel. Results 100% (10/10) August 2022 cohort, 38% (3/8) December 2022 and 80% (8/10) April 2023 cohort completed the survey. Modal post-rotation confidence levels were mostly four and five across all cohorts. August 2022 and December 2022 cohorts had a modal value of three for confidence in speaking with a patient’s family when a patient was dying. August 2022 cohort had a modal value of three for confidence in speaking to a patient when their condition was unknown. Common concerns of FY1 doctors were managing a deteriorating patient and being unable to contact a senior. Most FY1 doctors felt that case-based discussion would be the preferred method to increase understanding of general surgery. Conclusions Confidence levels were high post-rotation and increased throughout the year. This could suggest that FY1 doctors are receiving a good understanding of general surgery by the end of their rotation. Further work needs to be done to target improvement in areas of lower confidence.