Junior Clinicians Research Articles

Are central hospitals ready for National Health Insurance? ICD coding quality from an electronic patient discharge record for clinicians.

South Africa (SA)'s planned National Health Insurance reforms require the use of International Statistical Classification of Diseases (ICD) codes for hospitals to purchase services from the proposed National Health Authority. However, compliance with coding at public hospitals in the Western Cape Province has been challenging. A computer application was developed to aid clinicians in integrating ICD coding into the patient hospital discharge process. To evaluate the quality of ICD codes captured using the application and predictors thereof in a single hospital department. After 6 months, the quality of ICD codes was determined by comparing ICD code descriptors with medical concepts in a random sample of original patient records selected over a 6-week period. Patient and personnel characteristics influencing quality of coding, derived from a theoretical framework, were collected. Of 223 patient records, 45.3% (95% confidence interval (CI) 38.8 - 51.9) had complete ICD codes. Primary ICD code accuracy was 74.0% (95% CI 67.8 - 79.5). Patient characteristics such as female gender, younger age group and fewer comorbidities, as well as seniority of clinician rank, were significantly associated with ICD coding being complete on adjusted analysis. The results of this study describe ICD coding quality at a central hospital in SA supported by a computer application and the factors influencing this. More interventions are required to achieve reliable coding data, such as additional ICD coding validation tools, training and oversight of junior clinicians.

Simplifying the upper limb peripheral motor screen: Proposing the "K" sign.

The well-recognized erosion of pathoanatomic correlations in basic medical training, combined with the increasing everyday pressures of time-efficacy in patient examination, continue to place strain on junior clinicians. Over the years, many refinements to tried-and-true basic physical examination techniques have been described, allowing improvement in diagnostic yield. A multitude of “screening” techniques are available for physical assessment; however, such approaches are often nonstandardized and inconsistently taught and applied in the clinical realm. Great interexaminer inconsistency in the documentation of many forms of screening techniques also substantively undermines their respective clinical value. The current work presents a novel refinement/combination of previously described examination approaches for the assessment of peripheral upper limb (UL) motor function — the “K” sign. Having been successfully applied in both the acute and ambulatory clinical settings for several years, we feel that the technique has a useful role as a rapid and specific screening technique that is easily taught, learnt, and applied. Arguably, its employment serves to improve time efficacy in the screening examination, and may even improve diagnostic yield through its reliable reproducibility and provision of direct bilateral comparison. Its inherent simplicity also lends itself well to high levels of uptake (and retention) by medical students and junior clinicians alike. On top of presenting the simple screening test itself, we offer a simple means of subsequent notation for the patient's case note record, again in the hope of standardization and endurance of clinical value beyond the time of patient examination.

Do “trainee-centered ward rounds” help overcome barriers to learning and improve the learning satisfaction of junior doctors in the workplace?

Ward rounds are widely considered an underutilized resource with regard to medical education, and therefore, a project was undertaken to assess if the initiation of “trainee-centered ward rounds” would help improve the confidence, knowledge acquisition, and workplace satisfaction of junior doctors in the clinical environment. Data were collated from junior doctors, registrar grade doctors, and consultants working in the delivery suite at Luton and Dunstable University Hospital in Luton over a 4-week period in March–April 2013. A review of the relevant literature was also undertaken. This pilot study found that despite the reservations around time constraints held by both junior and senior clinicians alike, feedback following the intervention was largely positive. The junior doctors enjoyed having a defined role and responsibility during the ward round and felt they benefited from their senior colleagues’ feedback. Both seniors and junior colleagues agreed that discussing learning objectives prior to commencing the round was beneficial and made the round more learner-orientated; this enabled maximal learner-focused outcomes to be addressed and met. The juniors were generally encouraged to participate more during the round and the consultants endeavored to narrate their decision-making, both were measures that led to greater satisfaction of both parties. This was in keeping with the concept of “Legitimate peripheral participation” as described by Lave and Wenger. Overall, trainee-centered ward rounds did appear to be effective in overcoming some of the traditional barriers to teaching in the ward environment, although further work to formalize and quantify these findings, as well as using greater sample sizes from different hospital departments and the inclusion of a control group, is needed.

How to teach the fundamentals of meta-analyses

PurposeConducting meta-analyses is an exciting and rewarding way of summarizing and quantifying the current knowledge, which is also becoming increasingly important in clinical research. There are many articles published on interpreting meta-analysis and specific statistical methods, which makes it challenging to obtain an overview, also for teachers and supervisors. The aim of this article is to provide a guide for teaching the fundamentals of meta-analysis, with as goal to improve the quality of published meta-analyses. MethodsThis article provides tips and key references on how to conduct meta-analyses, based on own research, supervising and teaching experience, mainly working with junior clinical researchers. ResultsThis article contains up-to-date guidelines, practical examples and recommendations to improve the identification and selection of relevant articles, data-extraction, quality assessment, statistical analyses and presentation and publication of results. Time-saving tips and commonly encountered problems such as heterogeneity and publication bias are also discussed. This article is based on recommendations from world renowned organizations and authors, and covers practical examples and pitfalls. ConclusionsAlthough conducting meta-analysis may seem complex and difficult, it is also achievable for junior researchers and clinicians. Expert guidance is however recommended to achieve high-quality research.

A clinical decision support system for diagnosis of Allergic Rhinitis based on intradermal skin tests

Backgrounds and objectivesAllergic Rhinitis is a universal common disease, especially in populated cities and urban areas. Diagnosis and treatment of Allergic Rhinitis will improve the quality of life of allergic patients. Though skin tests remain the gold standard test for diagnosis of allergic disorders, clinical experts are required for accurate interpretation of test outcomes. This work presents a clinical decision support system (CDSS) to assist junior clinicians in the diagnosis of Allergic Rhinitis. MethodsIntradermal Skin tests were performed on patients who had plausible allergic symptoms. Based on patient׳s history, 40 clinically relevant allergens were tested. 872 patients who had allergic symptoms were considered for this study. The rule based classification approach and the clinical test results were used to develop and validate the CDSS. Clinical relevance of the CDSS was compared with the Score for Allergic Rhinitis (SFAR). Tests were conducted for junior clinicians to assess their diagnostic capability in the absence of an expert. ResultsThe class based Association rule generation approach provides a concise set of rules that is further validated by clinical experts. The interpretations of the experts are considered as the gold standard. The CDSS diagnoses the presence or absence of rhinitis with an accuracy of 88.31%. The allergy specialist and the junior clinicians prefer the rule based approach for its comprehendible knowledge model. ConclusionThe Clinical Decision Support Systems with rule based classification approach assists junior doctors and clinicians in the diagnosis of Allergic Rhinitis to make reliable decisions based on the reports of intradermal skin tests.

Does elderberry benefit intercontinental air travellers?

Discussion: Junior doctors face enormous stress and are often reluctant to seek help. Some key stressors to which junior doctors are exposed, including medical error and negative workplace culture will be explored. Barriers to junior doctors ensuring the priority of their own wellness will be examined. The importance of ‘healthy’ specialty training programs and ‘healthy’ workplace for our junior clinicians will be critically discussed. Conclusion: Evidence suggests that Specialty Colleges, hospitals, medical schools and all clinical workplaces need to examine their processes to ensure struggling clinicians are identified and are helped to access self care. Furthermore, junior doctors need to be able to find joy and meaning in their work. Efforts are needed to proactively instil in trainees the importance of their own self care. The curriculum of Specialty Colleges and hospital education programs should include wellness and healthy workplace culture.

CoDiagnose: Interactive software to harness collaborative diagnoses and to increase diagnostic accuracy amongst junior physicians

Many studies have been conducted that highlight the prevalence of misdiagnoses within the medical profession and the statistically poor diagnostic accuracy rates associated with junior clinicians. There is evidence that crowdsourcing and multiple medical opinions can improve the veracity of a diagnosis. This paper proposes a cloud based prototype that makes use of interactive web technologies along with the concepts of crowdsourcing and e-learning to improve diagnostic accuracy rates amongst junior doctors. Existing approaches in this field are analysed to identify potential gaps and opportunities. Sample representations of both junior and senior clinicians are surveyed to establish the feasibility of adopting collaborative diagnostics. It is theorised that the prototype developed in this work will harness the experience and knowledge of expert clinicians. The prototype is a fully responsive web-based and feature-rich interactive system that has been developed using the latest Internet technologies. It has been evaluated using usability tests and a one month long trial involving a sample of end-users. Crowdsourcing is an innovative process in its infancy but the results being produced indicate a promising future for its use within medicine. The results offer an inclination that the prototype's usage could be attributed to improved diagnostic ability. However the findings need to be replicated in larger, independent samples.

Reducing dosing errors and increasing clinical efficiency in Guatemala: first report of a novel mHealth medication dosing app in a developing country

BackgroundMedication errors are known to be a widespread problem affecting patient safety and treatment efficacy. We were approached by a Guatemalan clinic interested in piloting an app to aid their...

A comparison of mental state examination documentation by junior clinicians in electronic health records before and after the introduction of a semi-structured assessment template (OPCRIT+)

ObjectivesThe mental state examination (MSE) provides crucial information for healthcare professionals in the assessment and treatment of psychiatric patients as well as potentially providing valuable data for mental health researchers accessing electronic health records (EHRs). We wished to establish if improvements could be achieved in the documenting of MSEs by junior doctors within a large United Kingdom mental health trust following the introduction of an EHR based semi-structured MSE assessment template (OPCRIT+). MethodsFirst, three consultant psychiatrists using a modified version of the Physician Documentation Quality Instrument-9 (PDQI-9) blindly rated fifty MSEs written using OPCRIT+ and fifty normal MSEs written with no template. Second, we conducted an audit to compare the frequency with which individual components of the MSE were documented in the normal MSEs compared with the OPCRIT+MSEs. ResultsPDQI-9 ratings indicated that the OPCRIT+MSEs were more ‘Thorough’, ‘Organized’, ‘Useful’ and ‘Comprehensible’ as well as being of an overall higher quality than the normal MSEs. The audit identified that the normal MSEs contained fewer mentions of the individual components of ‘Thought content’, ‘Anxiety’ and ‘Cognition & Insight’. ConclusionsThese results indicate that a semi-structured assessment template significantly improves the quality of MSE recording by junior doctors within EHRs. Future work should focus on whether such improvements translate into better patient outcomes and have the ability to improve the quality of information available on EHRs to researchers.

Organizing the 15th International Thyroid Congress: Junior Scientists and Clinicians to Be Highlighted

Organizing the 15^th International Thyroid Congress: Junior Scientists and Clinicians to Be Highlighted

Ebola virus disease: awareness among junior doctors in England

The current Ebola virus epidemic continues to pose a threat to the UK. Junior clinicians are often at the frontline of medical care in hospitals and their awareness of the clinical features and management of the Ebola virus disease (EVD) may significantly influence the timely implementation of infection control measures. In view of this, we carried out a cross-sectional survey of 119 junior doctors across four different hospitals in England in order to assess their level of knowledge of EVD. We demonstrate that there is currently a deficiency of knowledge about critical aspects of EVD in this population.

Pyogenic iliopsoas abscess: An uncommon presentation of nonspecific leg pain

Psoas abscesses can have a high mortality rate, particularly when left untreated. Diagnosis is commonly delayed owing to the relative paucity of cases and its varied clinical presentation. We describe a patient with psoas abscess who presented to the emergency department at Milton Keynes General Hospital, illustrating how psoas abscesses are still misdiagnosed by junior and senior clinicians, even when patients present with the classical signs of fever, leg pain, and antalgic gait. This highlights the need for an increased emphasis on training at all levels, to increase the index of suspicion for a psoas abscess in those presenting with leg, hip, or back pain with a fever.

Contemporary Surgical Trends in the Management of Upper Tract Calculi

Upper tract nephrolithiasis is a common surgical condition that is treated with multiple surgical techniques, including shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy. We analyzed case logs submitted to the ABU by candidates for initial certification and recertification to help elucidate the trends in management of upper tract urinary calculi. Annualized case logs from 2003 to 2012 were analyzed. We used logistic regression models to assess how surgeon specific attributes affected the way that upper tract stones were treated. Cases were identified by the CPT code of the corresponding procedure. A total of 6,620 urologists in 3 certification groups recorded case logs, including 2,275 for initial certification, 2,381 for first recertification and 1,964 for second recertification. A total of 441,162 procedures were logged, of which 54.2% were ureteroscopy, 41.3% were shock wave lithotripsy and 4.5% were percutaneous nephrolithotomy. From 2003 to 2013 there was an increase in ureteroscopy from 40.9% to 59.6% and a corresponding decrease in shock wave lithotripsy from 54% to 36.3%. For new urologists ureteroscopy increased from 47.6% to 70.9% of all stones cases logged and for senior clinicians ureteroscopy increased from 40% to 55%. Endourologists performed a significantly higher proportion of percutaneous nephrolithotomies than nonendourologists (10.6% vs 3.69%, p <0.0001) and a significantly smaller proportion of shock wave lithotripsies (34.2% vs 42.2%, p = 0.001). Junior and senior clinicians showed a dramatic adoption of endoscopic techniques. Treatment of upper tract calculi is an evolving field and provider specific attributes affect how these stones are treated.

Can we improve the delivery of bedside teaching?

Bedside teaching is a vital component of clinical training in the medical curriculum. There is growing dissatisfaction among students regarding its delivery, and the main obstacles identified are: the availability of clinical tutors and access to suitable patients. We sought to evaluate Sydney University medical students' perceptions and satisfaction with two structured bedside teaching methods. We compared two strategies of bedside teaching. In the old, traditional method an experienced clinician was formally allocated to a group, and was 'responsible' for regular (usually weekly) bedside teaching for that group. In the new method a specified, protected clinical teaching time was chosen, during which time any tutor available (mainly Junior Medical Officers, JMOs) performed clinical bedside teaching for that student group. The strengths and weaknesses of the two methods were evaluated. A total of 104 students out of a possible 128 (81% participation rate) took part in this study. In the new method, 100 per cent of students had their scheduled bedside tutorial delivered every week, compared with 20 per cent in the old system, 70 per cent of tutors had patients prepared every week, compared with 25 per cent in the old system, and 64 per cent of students had 'no frustration' with clinical bedside tutorials, compared with 27 per cent in the old system. The new method, using protected clinical teaching time at a specific scheduled weekly time, and using opportunistically available junior clinicians, is perceived by students as superior to the old method of one constant, experienced tutor allocated to a group. The main obstacles [to bedside teaching] are: the availability of clinical tutors and access to suitable patients.

Application of Computer System Based on Artificial Neural Network and Artificial Intelligence in Diagnosing Child Attention Deficit/Hyperactivity Disorder (AD/HD)

This paper used computer to simulate thinking modes of human brain, to establish an artificial intelligence expert system for diagnosis and treatment of child AD/HD based on artificial neural network. The diagnosis system involves expert knowledge database, artificial neural network and the relational database. The clinical data were obtained from 10 epidemiological and outpatient department, and 1125 valid data were harvested for the system compilation. The diagnosis of 627 cases adopting the man-machine double-blind controlled trial, the Kappa value was 0.98 (P &lt; 0.001). The research can help junior clinicians to learn abundant clinical experiences of senior child psychiatrists, and can help children of AD/HD throughout the country.

Young Talent Group launches actions for young gastroenterologists by introducing the UEG Young GI Network.

There are eight of us and we are all working in the field of gastroenterology. It would be almost natural to call us G8, but this acronym was already taken by the Group of Eight, which is the forum for the governments of leading industrialised countries. Whether we will have a similar powerful impact on the European milieu of gastroenterologists – that we do not know yet. However, we hope that our actions focusing on young clinical fellows and junior basic scientists, supported by UEG, will help develop and shape their careers, gain expertise in the domain and create a vast network of collaborations and simply friendships. It all started in 2013, when the National Societies Committee appointed me as a Young Member of this well-esteemed body within the UEG structure. Step by step, other candidates for this position joined me to form the assembly later called the “Young Talent Group” and hence the work began. An enormous support was provided from the members of UEG and the UEG Secretariat, for whom actions addressed at junior clinicians and basic scientists is one of the priority tasks for the future. Up to this date, UEG has been actively focusing and promoting actions oriented towards young gastroenterologists at various stages of their career. Young Investigators Meetings, Prague Summer Schools, Basic Science Courses, to name just a few, attract young talents from all corners of the world and give them excellent opportunities not only to gain a better understanding of the field, but also teach practical skills, related to both, clinical and scientific work. There is also an important social aspect for these events and it is not an overstatement to say that several successful collaborations began in one of the pubs located in Vienna or Prague. Now, the Young Talent Group aims further. Our first goal is to make UEG Week an attractive meeting place for young gastroenterologists. We focus already on this year’s congress in Vienna, where a Young GI Network Lounge will be operating. This will be a space where (finally) young attendees can meet and mingle, charge their devices and check on their mails, have a drink or lunch in an area dedicated just for them. We do not want to distract young people from the main scientific programme, which is – as each and every year – getting more and more attractive, but to create a junior gastroenterologist-friendly environment. Another initiative of the Young Talent Group for UEG Week in Vienna is a mentoring program, which was again established based on the needs of the young clinicians and scientists. We will offer them a chance to spend one day of the congress with a mentor. Small groups of five to ten mentees will be formed based on their experience and area of expertise. These groups will be guided through the scientific program of the day by senior gastroenterologists. This exciting activity will also include a visit to a poster session and mingling with other experts in the field. There are no limits to the plans crafted by your mentors! Finally, a reception allowing for informal networking among the young attendees, called “Let’s meet” will be held in “Wolke 19”, a venue close to the congress center, with a great view over Vienna and the Danube river. Young congress delegates, as well as mentors and UEG committee members are invited to participate and mingle; light drinks and snacks will be served and lounge music will be played for the good atmosphere. A right start and excellent occasion for networking just before the scientific program of the congress begins. We hope you will enjoy it! If you wish to participate in our attractions for young gastroenterologists at the UEG Week Vienna 2014, please follow the UEG newsletters and special announcements. We look forward to your feedback on our initiatives, so that we can make them even better in the following years. And if you think you have good ideas focusing on junior clinicians and basic scientists in the field of gastroenterology and you would like to develop them, do join us at Young Talent Group. A new call for applications is coming up soon. Jakub Fichna UEG Young Committee Member on the National Societies Committee On behalf of the Young Talent Group Get to know the members of the Young Talent Group visit: http://www.ueg.eu/about-ueg/structure/boards-committees/young-talent-group/ Find out more about Young GI Network activities during UEG Week Vienna 2014: https://www.ueg.eu/week/programme/young-gi-network/

Influence of Surgeon Behavior on Trainee Willingness to Speak Up: A Randomized Controlled Trial

Our aim was to determine if a surgeon's behaviors can encourage or discourage trainees from speaking up when they witness a surgical mistake. A randomized clinical trial in which medical students (n= 55) were randomly assigned to an "encouraged" (n= 28) or "discouraged" (n= 27) group. Participants underwent personality tests to assess decision-making styles, and were then trained on basic tasks ("burn" then "cut") on a laparoscopic surgery simulator. After randomization, students assisted at a simulated laparoscopic salpingectomy. The senior surgeon used either an "encourage" script (eg, "Your opinion is important.") or a "discourage" script (eg, "Do what I say. Save questions for next time."). Otherwise, the surgery was conducted identically. Subsequently, a surgical mistake was made by the senior surgeon when he instructed students to cut without burning. Students were considered to have spoken up if they questioned the instruction and did not cut. Potential personality bias was assessed with two validated personality tests before simulation. Data were processed with Mann-Whitney and Fisher exact tests. The students in the encouraged group were significantly more likely to speak up (23 of 28[82%] vs 8 of 27 [30%]; p < 0.001). There was no statistically significant difference between the two groups in personality traits, student training level (p= 1.0), or sex (p= 0.53). A discouraging environment decreases the frequency with which trainees speak up when witnessing a surgical error. The senior surgeon plays an important role in improving intraoperative communication between junior and senior clinicians and can enhance patient safety.

Becoming a medical educator: motivation, socialisation and navigation.

BackgroundDespite an increasing concern about a future shortage of medical educators, little published research exists on career choices in medical education nor the impact of specific training posts in medical education (e.g. academic registrar/resident positions). Medical educators at all levels, from both medical and non-medical backgrounds, are crucial for the training of medical students, junior doctors and in continuing professional development. We explored the motivations and experiences of junior doctors considering an education career and undertaking a medical education registrar (MER) post.MethodsData were collected through semi-structured interviews with junior doctors and clinicians across Queensland Health. Framework analysis was used to identify themes in the data, based on our defined research questions and the medical education workforce issues prompting the study. We applied socio-cognitive career theory to guide our analysis and to explore the experience of junior doctors in medical education registrar posts as they enter, navigate and fulfil the role.ResultsWe identified six key themes in the data: motivation for career choice and wanting to provide better education; personal goals, expectations and the need for self-direction; the influence of role models; defining one’s identity; support networks and the need for research as a potential barrier to pursuing a career in/with education. We also identified the similarities and differences between the MERs’ experiences to develop a composite of an MER’s journey through career choice, experience in role and outcomes.ConclusionsThere is growing interest from junior doctors in pursuing education pathways in a clinical environment. They want to enhance clinical teaching in the hospitals and become specialists with an interest in education, and have no particular interest in research or academia. This has implications for the recruitment and training of the next generation of clinical educators.

The Lung Corps’ Approach to Reducing Health Disparities in Respiratory Disease

Health disparities are prevalent across diseases of the respiratory system, and are major sources of morbidity and mortality among disadvantaged populations in the United States. The American Thoracic Society (ATS) aims to reduce disparities that are both avoidable and unjust. In meeting this goal, the ATS is committed to creating the Lung Corps, a diverse group of senior, mid-level, and junior clinicians, trainees, researchers, and public health practitioners to help achieve health equality. This will be achieved through the following mechanisms: (1) increase awareness of health disparities; (2) empower health professionals with the knowledge and tools to address disparities; (3) shape research agendas to focus on the root causes, to identify modifiable targets, and to promote innovative approaches to reduce disparities; and (4) develop and advocate for health-related policies and regulations that improve the respiratory health of the population. To ensure success, the Lung Corps will interact with other societies, agencies, and organizations to effect elimination of disparities in respiratory health. The ATS is committed to identifying and addressing health disparities to improve the overall health of individuals affected by respiratory diseases.

G175(P) Doctors Attitudes Regarding Safeguarding Children: An Anonymous Survey of Doctors in a Large Hospital Trust

BackgroundPrevious study has revealed that many doctors consider the identification of abuse as being their primary responsibility in the management of child safeguarding cases. However, a doctor’s role extends further;...