Improve Junior Doctors Research Articles

What drives junior doctors to use clinical practice guidelines? A national cross-sectional survey of foundation doctors in England & Wales.

BackgroundClinical practice guidelines (CPGs) aim to improve patient care, but their use remains variable. We explored attitudes that influence CPG use amongst newly qualified doctors.MethodsA self-completed, anonymous questionnaire was sent to all Foundation Doctors in England and Wales between December 2012 and May 2013. We included questions designed to measure the 11 domains of the validated Theoretical Domains Framework (TDF). We correlated these responses to questions assessing current and future intention to use CPGs.ResultsA total of 13,138 doctors were invited of which 1698 (13 %) responded. 1,035 (62.5 %) reported regular CPG use with 575 (34.4 %) applying CPGs 2–3 times per week. A significant minority of 606 (36.6 %) declared an inability to critically appraise evidence.Despite efforts to design a questionnaire that captured the domains of the TDF, the domain scales created had low internal reliability. Using previously published studies and input from an expert statistical group, an alternative model was sought using exploratory factor analysis. Five alternative domains were identified. These were judged to represent: “confidence”, “familiarity”, “commitment and duty”, “time” and “perceived benefits”.Using regression analyses, the first three were noted as consistent predictors of both current and future intentions to use CPGs in decreasing strength order.ConclusionsIn this large survey of newly qualified doctors, “confidence”, “familiarity” and “commitment and duty” were identified as domains that influence use of CPGs in frontline practice. Additionally, a significant minority were not confident in critically appraising evidence.Our findings suggest a number of approaches that may be taken to improve junior doctors’ commitment to CPGs through processes that increase their confidence and familiarity in using CPGs.Despite limitations of a self-reported survey and potential non-response bias, these findings are from a large representative sample and a review of existing implementation strategies may be warranted based on these findings.

A simple, low cost, practical skills course improves junior doctors’ confidence at managing simple skin wounds

s / International Journal of Surgery 23 (2015) S15eS134 S98 model and many believe that women do not have the same chance to succeed as men. Continued engagement with trainees is needed to improve perceptions of the quality of life in surgical careers to attract the best candidates. 0225: A SIMPLE, LOW COST, PRACTICAL SKILLS COURSE IMPROVES JUNIOR DOCTORS’ CONFIDENCE AT MANAGING SIMPLE SKIN WOUNDS R. Aggarwal, A. Brown, C. Borg. University Hospital Lewisham, UK Aim: Foundation year doctors are required to rotate round different specialties that require basic surgical skills, in particular in the emergency department. Many junior doctors feel that they have insufficient experience or confidence in these skills. We devised a short basic surgical skills course with the aim of improving participants’ confidence at managing and closing simple wounds. Methods: A program was devised incorporating key competencies required for effective and safe wound management and closure. Two courses were run at our hospital. Using questionnaires, we asked participants to rate their confidence in basic surgical skills and competencies before and after the course. A paired t-test was used to compare these. Results: 34 people attended over two dates (13 male, 21 female); 53% had worked in surgical specialty previously. There was a statistically significant increase in confidence after the course in naming instruments (p 1⁄4 < 0.0001), handling instruments (p 1⁄4 < 0.0001), injecting local anaesthetic (p 1⁄4 < 0.0001), suturing (p 1⁄4 < 0.0001), knot tying (p 1⁄4 < 0.0001) and managing lacerations (p 1⁄4 < 0.0001) compared to before the course. Conclusion: Improving Junior Doctors’ skills through a simple, low cost, practical course, could improve their confidence and ability to deal with simple wounds in the Emergency Department, reducing the workload of their much overworked senior colleagues 0251: POST-OPERATIVE FLUID PRESCRIBING: IS TEACHING ADEQUATE IN THE UNDERGRADUATE CURRICULUM? B. Dreyer, S. Dreyer, G. Griffiths. University of Dundee, UK Aim: The aim of this study was to determine whether post-operative fluid prescribing is adequately taught at undergraduate level. Methods: A prospective, qualitative survey of year 3e5 medical students was performed at a single Scottish medical school. A questionnaire assessed each year group’s confidence in fluid prescribing ability, opinion on teaching adequacy, knowledge of applied basic science and approach to clinical applications. Results: 41 participants completed the questionnaire. Confidence in fluid prescribing ability and knowledge improved significantly in the more senior years of study (p 1⁄4 0.002, p 1⁄4 0.006 respectively). Nevertheless, the mean knowledge score of final year students was only 52% and there was poor correlation between confidence levels and knowledge in fluid prescribing (R2 1⁄4 0.11). Senior students rated the adequacy of fluid prescription teaching more highly (p 1⁄4 0.006). Conclusion: This is, to our knowledge, the first study to suggest that student knowledge of fluid prescribing improves during undergraduate training. While views on the quality of teaching, knowledge and confidence increased with seniority, these did not correlate with each other and did not translate into good prescribing practice. This suggests a need to improve undergraduate teaching to reduce post-operative fluid prescribing errors. 0253: PURSUING A CAREER IN SURGERY: WHAT IS HOLDING MEDICAL STUDENTS BACK? M. Bath , L. Jones , R. Harries , V. Gokani . 1 Leicester Medical School, UK; University of Leicester, UK; Cardiff University, UK Aim: In recent years there has been a decline in junior doctors opting for a surgical career. We aimed to ascertain the main factors influencing preclinical medical students' career choice. Methods: An online questionnaire was distributed to 122 pre-clinical medical students. Students were asked to rate separately the importance of commonly viewed limitations towards and possible attractants to a career in surgery. Results: There was a 97.5% (119) response rate. The most important factor limiting a surgical career was strong competition ratios. Female students placed greater importance towards family implications (p 1⁄4 0.0003); students affiliated to a surgical society placed greater importance on career guidance (p 1⁄4 0.001) and mentorship (p 1⁄4 0.0004). More males were considering a career in surgery than females (47.2% vs 18.6%). Earlier exposure to a surgical environment and better career guidance were the highest ranked aspects to encourage this career choice. Conclusion: Strong competition ratios remain an important consideration for medical students perusing a surgical career. Female students view family commitments as a more important issue for a future career, which must be addressed. Increased availability of competition ratios, mentoring, less than-full time training opportunities, and role models at all levels should be priorities to attract more students to surgery. 0260: ELASTICATED RETRACTION METHODS IN OPEN HEAD AND NECK SURGERY: EXPOSING A BENEFIT TO SURGICAL TRAINING R. Gohil, C. Kennedy, R. Mountain. Ninewells Hospital and Medical School,

Quantifying and reducing inhaler prescription errors in secondary care.

Junior doctors commonly prescribe inhaled medication for patients admitted to hospitals, and this may be a potential source of prescription error. Objective To determine the potential type, frequency and cost of prescription errors for inhaled medication, and ascertain if a simple educational intervention can improve junior doctors' knowledge and reduce these. We carried out a prospective study looking at the types and cost of inhaled prescription errors. Simultaneously we tested knowledge of junior doctors' using a quiz. Both the studies were carried out before and after the introduction of inhaler flash cards (pictures of devices with, instructions on use and the medication they contain) on specific wards. This was followed by an electronic feedback survey. Error rates varied greatly (p = 6.8 × 10(-8)) by device, with 23 % of Evohaler and Accuhaler prescriptions being incorrect. The average cost of an erroneously prescribed medication was £45.50. There were 14 % incorrect prescriptions before the intervention. There was no significant improvement in junior doctors' knowledge of inhalers or the rate of prescription error after the intervention. Prescription errors of inhaled medication are common and costly to rectify. There is a need for improved teaching and training of junior doctors and medical students.

P444: An intervention aimed at improving junior doctors’ prescribing in a large geriatric department

Introduction: Many hospitalized patients require enteral feeding and medication administration via nasogastric tube or percutaneous endoscopic gastrostomy; many of them are elderly patients. The right practice for medication administration via enteral tube includes appropriate formulation, adequate tube flushing, and proper nutrition scheduling. Impaired administration may lead to medication ineffectiveness, toxicity or clogged feeding tube [1]. The aim of our study was to evaluate the current practices and knowledge regarding medication administration via enteral feeding tubes. Methods: Pre-intervention assessment evaluated the knowledge and practices of nurses and pharmacists regarding medication administration via enteral feeding tubes using a self-structured questionnaire or oral questioning. After this evaluation, an intervention through a presentation and new guidelines for the improvement of knowledge and practices was performed. Post intervention assessment was later completed. Assessment results were electronically recorded and analyzed (Microsoft Excel 2010). Results: Pre-intervention assessment was completed in 106 nurses and 10 pharmacists. Knowledge and practice among nurses were lacking; 41% did not receive any training, 75% crush all tablets together, 47% do not flush the tubes before administration. In addition, nutrition scheduling is usually not taken into consideration. Pharmacists’ knowledge was also lacking, especially concerning nutrition scheduling and tube flushing. Post intervention assessment demonstrated improved knowledge. Conclusion: Knowledge and practices of nurses and pharmacists regarding medication administration via enteral feeding tubes is lacking without active intervention. Proper education and clear guidelines can improve knowledge and practice.

A simple and effective strategy for improving junior doctors&amp;#39; knowledge of intravenous fluid therapy

A simple and effective strategy for improving junior doctors&amp;#39; knowledge of intravenous fluid therapy

Improving junior doctor handover between jobs.

Patient safety is one of the most important issues in healthcare. In recent years there has been much focus on “Black Wednesday”; the day that Foundation doctors start their first jobs. Great efforts have been made to ensure that patient safety on this day has improved, with the main example being that newly qualified doctors now use some of their free time between medical school and starting their first job to shadow their outgoing counterparts.However, because Foundation doctors start a brand new job approximately every four months for two years, subsequent job changeovers were identified as a time of potential problems and increased patient risk. It is not practical to shadow prior to every job because junior doctors are needed in their current post right up until changeover day, so a simple way to smooth this transition was needed.A handover lunch seemed to be a feasible solution. The day before Foundation doctors change jobs, an hour is dedicated for Foundation Year 1 doctors (F1's) to sit down together over lunch (provided by the mess) and take a formal handover of all relevant information about their forthcoming job and discuss current inpatients.Results showed that 100% of those surveyed mentioned face to face handover as essential, 93.75% said it was either helpful or extremely helpful to have a dedicated time for F1's to handover, and 12.5% said they would not have sought a face to face handover otherwise. Apart from being extremely simple and cheap, it was very popular with the F1's in the trust. It enables effective working from day one and is a great team building activity.

A digital approach to improving junior doctors' diabetes knowledge

A digital approach to improving junior doctors' diabetes knowledge

Introducing a diabetes e‐learning module: a means of improving junior doctors' confidence and ability in managing inpatients with diabetes

AbstractThe aims of this study were to determine whether the introduction of a diabetes management e‐module can increase junior doctors' confidence in managing inpatients with diabetes and contribute to improvements in patient care.A diabetes e‐module was introduced at Barnet and Chase Farm Hospitals NHS Trust in October 2010. Junior doctors completed it and undertook an online exam at the end. Junior doctors were surveyed once, six to eight months after completing the e‐module, and retrospectively ranked their confidence and knowledge levels in managing inpatients with diabetes before and after completing the e‐module. Patient care was assessed by comparing the National Diabetes Inpatient Audit (NaDIA) findings at Barnet Hospital before and at two time points after the introduction of the e‐module.After undertaking the e‐module there were statistically significant increases in the self‐ranked confidence and knowledge levels of junior doctors regarding diabetes management. This included improvements in identifying different types of insulin, making insulin dose adjustments for hypoglycaemia/hyperglycaemia and a reduction in reported prescription errors. The results from the NaDIA also suggest an improvement in ‘good diabetes days’ for insulin‐treated patients with diabetes and a pattern of reduction in prescription and management errors.This study demonstrates that an inpatient diabetes management e‐module increases junior doctors' knowledge and confidence in managing diabetes. A multi‐centre study would be needed to confirm whether this translates into better management of inpatients with diabetes. E‐modules may be used to cover further topics in diabetes, and to support nursing and patient education. Copyright © 2013 John Wiley &amp; Sons. Practical Diabetes 2013; 30(3): 122–127

How can we improve junior doctor prescribing?

The large number of medications available has complicated the learning of drug therapy for medical students at a time when pharmacology training has been substantially reduced. Attempts to remedy this include: improving the pharmaco-therapeutics curriculum; interactive web-based learning and students developing a personal formulary. The approach adopted by the University of Wollongong Medical School is to integrate clinical pharmacology throughout the course, with the Student Preferred-drugs Formulary linking pharmacology and common diseases. Evidence from other countries suggests this should enhance prescribing by medical graduates.

Simulation training: a tool to improve junior doctors' confidence

We read Dr Gordon’s paper[1][1] with great interest as it echoes our own work while surveying the confidence of junior doctors new to psychiatry. Like Dr Gordon, we felt there was a specific need to combat their self-perceived lack of confidence, particularly in the out-of-hours environment, as

PMO-058 A simple and an effective strategy for improving juniors doctors' knowledge of intravenous fluid therapy

IntroductionErroneous intravenous fluid therapy is a source of perioperative morbidity and mortality.1 In most surgical units, junior doctors are given the major responsibility for prescribing intravenous fluids, even though their...

P147 Are video recordings of consultations in HIV and genitourinary medicine (GUM) acceptable to patients and staff?

BackgroundVideo recordings of consultations (VC) are used in general practice to improve junior doctors' training, having been shown to be acceptable to patients.AimsTo determine the acceptability of VC in GUM/HIV,...

Improved junior paediatric prescribing skills after a short e-learning intervention: a randomised controlled trial

ObjectiveMedication errors are common, with junior doctors accounting for the majority in acute healthcare. Paediatrics is uniquely challenging, but the evidence base to guide prescribing education is limited. The authors...

Vital Radiology – Learning from Our Mistakes to Improve Junior Doctors' Interpretation of Radiographs

Following a Never Event in our Trust which involved misinterpretation of a radiograph by a junior doctor, we set out to reduce the risk of recurrence by creating Vital Radiology. Vital Radiology is a new scheme designed to teach junior doctors about important radiological diagnoses that, if missed at the bedside, can have devastating consequences for patients. Although in its infancy, the scheme is receiving positive feedback both from the participants and senior clinicians. Ultimately we aim to extend the scheme throughout our trust and beyond, with the intention to improve junior doctors' confidence in interpreting images and, more importantly, to reduce risk to patients.

Does an ENT Introductory Course Improve Junior Doctors' Confidence in Managing ENT Emergencies?

The implementation of the European Working Time Regulations has resulted in significant changes in working patterns in order to provide an emergency service in ear, nose and throat surgery (ENT). In contrast to many surgical specialties, a large proportion of emergency ENT patients can undergo their definitive treatment in a ward-based setting. These skills were previously acquired as targeted on-the-job training during the first few weeks of the attachment.

The MoLIE project: Enhancing capacity for intern training in the Emergency Department

Introduction: Increasing the number of medical graduates hascreated a challenge for early postgraduate training capacity. AnEmergency Department (ED) term is a core requirement to completethe intern year in Queensland. There is concern that increasingintern numbers in the ED will result in a dilution of their learningexperience, plus a decrease in ED efficiency and safety.Aim: To redesign the emergency medicine learning model forinterns with increased numbers, while maintaining safe clinicalsupervision and an improved educational quality.Methods: A structured learning component comprisingapproximately 20% of rostered intern work hours was included inthe ED term. Sessions covered a case-based curriculum developedand delivered by FACEMs in a small-group learning format. Seniorand junior staff rosters were modified to minimise fluctuations injunior staff numbers ‘on the floor’ from participation in structuredteaching sessions. Participating interns completed feedback surveysat the end of each ED term.Results: Intern numbers were able to be increased 38% from 65 in2007 to 90 in 2008, whilst maintaining unchanged junior staffsupervision ratios in the ED clinical area. Interns reported that theMore Learning in Emergency (MoLIE) teaching sessions wererelevant to their work, and covered the right balance of clinical andprofessional skills. There were high levels of satisfaction withfacilitators’ knowledge and teaching skills. After MoLIE a majorityof interns felt they were more likely to choose emergency medicineas a career.Conclusion: Increased intern numbers represents an opportunity toredesign and improve junior doctor education.

Scottish council elects new chairman Little support for new Scottish manpower body Juniors want payment for work intensity WMA will support former secretary general of Nigerian Medical Association BMA tackles major issues at political fringe meetings

# Scottish council elects new chairman {#article-title-2} The BMA's Scottish council has elected Mr Arthur Morris as its new chairman. Mr Morris, who is a consultant plastic surgeon in Dundee Teaching Hospitals NHS Trust, told the council last week that he foresaw a critical time for the NHS. There was certainly a clearer line of command in the NHS but who, he asked, was pulling the policy strings. “Is it the secretary of state? Is it the NHS chief executive? Is it the civil servants, the purchasers, or the fundholders? It is certainly not the patients.” Working for Patients, Mr Morris said, was supposed to devolve decision making to the periphery. Yet central directives, such as waiting time targets were distorting local strategy planning and cut across clinical priorities in patient care. He referred to conflicts that had been created. For example, the reforms to improve junior doctors' hours had coincided with career restructuring in specialist training and both had increased consultants' workload at a time of increasing patient demands. The new Scottish chairman applauded the move for more treatment to be provided in primary care where appropriate but not bed closures in advance of adequate facilities being provided in the community. Both examples illustrated the strain that health care resources could suffer if changes were not introduced in a planned and coordinated manner. # Little support for new Scottish manpower body {#article-title-3} Representatives of Scottish doctors will take the opportunity at their forthcoming meetings with the Scottish secretary, Mr Michael Forsyth, and the health minister, Lord James Douglas-Hamilton, to express their concerns at the proposal to set up an advisory group for planning …

The 'GALS' locomotor screen.

The locomotor system is complex and difficult to examine. A selective clinical process to detect important locomotor abnormalities and functional disability could prove valuable. A screen based on a tested 'minimal' history and examination system is described, together with a simple method of recording. The screen is fast and easy to perform. As well as providing a useful introduction to examination of the locomotor system, the screen includes objective observation of functional movements relevant to activities of daily living. Its inclusion in the undergraduate clerking repertoire could improve junior doctors' awareness and recognition of rheumatic disease and general disability. It could also provide a valuable screening test for use in general practice.

New living-in rules compared to ‘apartheid’

New rules to improve junior doctors' accommodation are forcing student nurses into costly private housing.