Training Of Junior Doctors Research Articles

Trial of an Inexpensive Training Simulation Model for Laparoscopic Appendicectomy.

Introduction Laparoscopic surgery is now the gold standard for many common procedures; however, there has been a lack of emphasis on laparoscopic training at the junior level. Simulation is an effective form of training in surgery, but surgical simulation models and courses can be expensive and inaccessible to medical students and foundation doctors. With procedures becoming more minimally invasive, it is key that we train laparoscopic skills at an earlier stage; and to do so, we need to remove the barriers of cost and accessibility. Our study aims to develop and assess the effectiveness of a simulated laparoscopic appendicectomy training model in developing laparoscopic knowledge, skills, and confidence in a cohort of foundation doctors. Methods A simulated mesoappendix model was fashioned from supermarket chicken wings with the bone removed, and it was put inside a laparoscopic box trainer with laparoscopic tools and equipment. This was trialed in a surgical-themed hub day for foundation doctors in the East of England Deanery, UK, and the simulated model was set up as a workshop following a teaching session detailing the steps of a laparoscopic appendicectomy. Participants completed questionnaires pre- and post-session to assess perceived skills, experience, and confidence in laparoscopic surgery, laparoscopic skills, and the usefulness of this training model. Results A total of 29 foundation doctors with limited formal surgical training completed the survey. The model is quick to prepare and assemble, costing around £0.30 ($0.40). Trainees found the model acceptable and helpful in developing their laparoscopic skills and knowledge of laparoscopic surgery. There was also an increase in self-perceived confidence in performing laparoscopic procedures under supervision. Discussion This modification to the model allows the dissection and division of a simulated mesoappendix using only laparoscopic scissors and forceps in a box trainer. This simulation model is a promising and inexpensive tool which can be used for early-stage laparoscopic training for medical students and junior doctors.

FP5.12 - Write what you know: A retrospective documentation audit

Abstract Aims The Royal College of Physicians (RCP) stipulates that every patient entry in the notes should be; dated, timed and signed by the author (name and designation included). Additionally, the content should have a standardised structure and layout with a chronological order to reflect a continuum of patient care. This audit aimed to assess the percentage of patient documentations that were compliant with these standards. Methods We retrospectively evaluated inpatient documentations for general, colorectal and vascular surgery for one week within a district general hospital setting. The data was obtained from electronic documentations. We assessed inpatient documentation for all relevant criteria as per RCP guidelines. Inpatient documentation included; the admission notes, post take ward round, daily ward rounds and inter-speciality discussions. Results A total of 88 patient related entries were reviewed. Of these 89.8% were dated. 42.0% of the entries were timed, with inter-specialty discussion having the highest percentage of recorded times. 93.2% had a standardised structure. The structure of admission entries was the most consistent with standards. 6.8% and 3.4% had the authors designation and signature respectively. Conclusion Clear informative documentation is pivotal for safe and effective patient care. Failure of patient documentation to meet the stipulated standards was established in this audit. Factors including inadequate junior doctor training, pace of ward rounds and reliance on electronic noting systems are potential reasons for poor compliance. Capitalising on opportunities to educate junior doctors is paramount in improving patient care.

2303 Improving the assessment and management of osteoporosis in a district general hospital

Abstract Introduction Over 500,000 fragility fractures occur in the UK each year (1). NICE guidelines state that all women aged ≥65 and all men aged ≥75 should be considered for a fracture risk assessment. It was recognised that locally these guidelines were not being met. The aim of this quality improvement project was to improve the number of patients being assessed for osteoporosis across two medical wards. Method This quality improvement project followed two ‘Plan Do Study Act’ (PDSA) cycles. The first cycle involved teaching sessions for junior doctors on using the FRAX tool—a tool recommended by NICE guidelines to estimate 10-year predicted absolute fracture risk. Posters and visual reminders were placed around the wards. The second cycle involved creating a sticker which was placed in patients’ medical records prompting doctors to calculate FRAX scores and document the results. Patients deemed inappropriate for bone protection and patients already receiving bone protection prior to admission were excluded. Results A baseline set of data showed that 0% of patients had undergone fracture risk assessment, therefore resulting in no patients being prescribed bone protection or being referred to osteoporosis clinic. Repeat assessment after the first intervention showed 29.7% of patients had undergone fracture risk assessment, 13.5% were prescribed bone protection and 16.2% referred to osteoporosis clinic. After the second intervention, 80% of patients had undergone fracture risk assessment, 10% were prescribed bone protection and 55% referred to osteoporosis clinic. Conclusion Use of the FRAX tool was moderately increased by the targeted training of junior doctors and markedly increased by using a visual memorandum in the patient records. This led to an increase in treatment for osteoporosis, reducing patients’ future risk of fragility fractures.

Comparing virtual reality and simulation to teach the assessment and management of acute surgical scenarios: A pilot study.

Traditional apprenticeship-based surgical training presents with challenges, especially in acute scenarios. Simulation provides the current standard of facilitating surgical training in a low-risk environment but is restricted by limited accessibility and high costs. Virtual reality (VR) offers immersive three-dimensional computer-generated training scenarios and can connect users from various locations. We aimed to compare the performance of junior doctors to manage an acute surgical scenario using VR and mannequin-based simulation. We hypothesised that VR would be as effective as mannequin-based simulation in performance outcomes. This multicentre, randomised controlled pilot study was conducted with eighteen junior doctor volunteers (Foundation and Core Trainee Year 1). Ten were randomly allocated to VR and eight to mannequin-based simulation. Participants completed questionnaires and a 15-min pneumothorax scenario. Quantitative metrics included overall score, time-to-critical decisions, and academic buoyancy scores (ABS). Qualitative metrics included participants' likes and dislikes of their allocated simulation modality. VR participants scored significantly higher than mannequin-based simulation participants in overall scores (74.30% (SD ± 5.08%) vs. 59.75% (SD ± 10.14) (p = 0.04)), and technical skills aspects (77.20% (SD ± 8.01%) vs. 65.00% (SD ± 8.21%) (p = 0.01)). Mannequin-based simulation participants initiated critical decisions faster and demonstrated a trend towards a faster mean time-to-completion (p = 0.06). ABS scores increased for both study groups, though was only significant for VR participants (p ≤ 0.01). VR participants liked how VR fostered independent learning but disliked the formulaic content and impaired communication-learning compared to mannequin-based simulation. Both VR and mannequin-based simulation training are effective in training junior doctors in acute surgical scenarios but present different educational benefits. Future research should recruit a larger sample size for a full comparative randomised controlled trial.

Deep learning-based anatomical position recognition for gastroscopic examination.

The gastroscopic examination is a preferred method for the detection of upper gastrointestinal lesions. However, gastroscopic examination has high requirements for doctors, especially for the strict position and quantity of the archived images. These requirements are challenging for the education and training of junior doctors. The purpose of this study is to use deep learning to develop automatic position recognition technology for gastroscopic examination. A total of 17182 gastroscopic images in eight anatomical position categories are collected. Convolutional neural network model MogaNet is used to identify all the anatomical positions of the stomach for gastroscopic examination The performance of four models is evaluated by sensitivity, precision, and F1 score. The average sensitivity of the method proposed is 0.963, which is 0.074, 0.066 and 0.065 higher than ResNet, GoogleNet and SqueezeNet, respectively. The average precision of the method proposed is 0.964, which is 0.072, 0.067 and 0.068 higher than ResNet, GoogleNet, and SqueezeNet, respectively. And the average F1-Score of the method proposed is 0.964, which is 0.074, 0.067 and 0.067 higher than ResNet, GoogleNet, and SqueezeNet, respectively. The results of the t-test show that the method proposed is significantly different from other methods (p< 0.05). The method proposed exhibits the best performance for anatomical positions recognition. And the method proposed can help junior doctors meet the requirements of completeness of gastroscopic examination and the number and position of archived images quickly.

Views of assistant professors on digital transformation in otorhinolaryngology education : Current status and perspectives in undergraduate and advanced training

Digital transformation in curricular teaching in medicine comprises the use of digital teaching and learning formats as well as the transfer of digital skills for medical staff. Concepts of knowledge transfer and competency profiles also have to be adapted and transferred in advanced training due to necessary changes. The aim of this study was an evaluation of the current state of digital transformation in otorhinolaryngology teaching in undergraduate and advanced training at otorhinolaryngology departments of university medical centers in Germany. Aquestionnaire with nine questions on digital transformation was sent to the assistant professors of 37national university ENT departments. The anonymous survey was conducted online via the online platform SurveyMonkey®. Of the contacted assistant professors, 86.5% participated in the survey. Teaching sessions on digital skills for medical students are part of the curriculum in only 25% of ENT departments. Digital teaching formats are used by half of the departments in undergraduate training. Only 56.25% of the assistant professors receive support to realize the changes required by digital transformation. In 40.62% of departments, the issue of digital transformation is broached during advanced training, but only 28.12% use digital teaching methods to train junior doctors. Aspects of digital transformation are implemented mainly in undergraduate education, partly driven by the COVID19 pandemic. Overall, there is still considerable backlog in undergraduate and advanced training in ENT.

O116: Comparing Virtual Reality versus Simulation to teach the assessment and management of acute surgical scenarios

Abstract Introduction Traditional apprenticeship-based surgical training presents with challenges, especially in acute scenarios. Simulation is the current gold standard but has its drawbacks. Virtual reality (VR) offers immersive three-dimensional computer-generated training scenarios and can connect users from various locations. We aimed to compare the performance of junior doctors to manage an acute surgical scenario using VR and mannequin-based simulation. We hypothesised that VR would be as effective as mannequin-based simulation in performance outcomes. Method This multicentre, randomised controlled pilot study was conducted with eighteen junior doctor volunteers (Foundation and Core Trainee Year 1). Ten were randomly allocated to VR and eight to mannequin-based simulation. Participants completed questionnaires and a 15-minute pneumothorax scenario. Quantitative metrics included overall score, time-to-critical decisions, and academic buoyancy scores (ABS). Qualitative metrics included participants’ likes and dislikes of their allocated simulation modality. Results VR participants scored significantly higher than simulation participants in overall scores (74.30% (SD±5.08%) versus 59.75% (SD±10.14) (p=0.04)), and technical skills (77.20% (SD±8.01%) versus 65.00% (SD±8.21%) (p=0.01)). Mannequin-based simulation participants initiated critical decisions faster and demonstrated a trend towards a faster mean time-to-completion (p=0.06). ABS scores increased for both study groups, though was only significant for VR participants (p≤0.01). Participants liked how VR fostered independent learning but disliked the formulaic content and impaired communication-learning compared to mannequin-based simulation. Conclusion VR can be as effective as mannequin-based simulation in training junior doctors in acute surgical scenarios. Future research should recruit a larger sample size for a full comparative randomised controlled trial.

1945 Hospital at Home - developing a novel simulation induction programme through quality improvement

Abstract Introduction The UK is expanding provision of acute medical care in people’s own homes through Hospital at Home (H@H) and virtual wards. Our H@H service is training junior doctors to meet the growing clinical need in this environment. We describe the use of simulation training to improve the H@H induction process. Methods From their experiences in H@H, junior doctors identified specific training needs to build relevant competencies. From this feedback, PDSA cycle one involved junior doctors designing a dedicated simulation training (H@H-SIM). Stations addressed clinical, practical and advanced communication skills required in H@H using high- and low-fidelity simulation. PDSA cycle two used post-course evaluation to refine H@H-SIM through introduction of FP10 prescribing stations, point-of-care testing (POCT) and greater emphasis on practical skills. Revisions were evaluated via participant questionnaire before and after the H@H-SIM. Results Cycle two of H@H-SIM involved twenty doctors. The clinical scenarios, prescribing and practical skills stations, including POCT and IV administration, were perceived as the most useful parts of training. Overall self-rated confidence in knowledge and skills to work in H@H improved from a mean of 6.9 to 7.7/10. Before H@H-SIM, 60% were ‘not confident’ with recognising end of life (EOL), IV administration or decision-making around remaining at home; 10% with advance care planning (ACP). After H@H-SIM, 10% felt ‘not confident’ with recognising EOL or ACP and 5% with IV administration. Concerns persisted with using equipment, prescribing and availability of senior support. An additional station on recording ECGs was suggested. Conclusions Working in a H@H context and seeing patients in their homes can be daunting for junior doctors. H@H-SIM embedded into induction is one way to prepare doctors for this role, improve their confidence and has potential for wider replication.

Clinical Simulation for Procedural Expertise: State of Education and Application

Procedural skills are a core component in the health care practice that extends across all medical practitioners, from novice trainees to specialists. Medical institutions have widely adopted simulation to develop the clinical and procedural skills of health profession students. This review evaluates the evidence regarding simulation-based training for developing procedural expertise among medical students and junior doctors. For this purpose, Google Scholar and MEDLINE/PubMed databases were searched for articles published on simulation-based procedural training between January 2000 and October 2023. Reviews or studies published in languages other than English and research that showed evidence on communication, critical thinking, teamwork, decision-making, and cognitive skills were excluded from the search. The focus was placed on clinical and psychomotor skills as this review intends to inform clinical skills teaching and research practice. The results reveal that simulation-based training has been utilized increasingly to train medical students and junior doctors in procedural skills. Varying levels of fidelity have been incorporated to train psychomotor skills about a multitude of common and rare procedures. The evidence supports the acquisition of knowledge and procedural skills via simulation. Evidence also supports the transfer of skills from the simulated environment to clinical practice and live patients. However, resource intensiveness has limited the implementation of this method of education in developing countries. When used consciously, simulation can complement clinical training to produce competent doctors capable of effective patient care.

Educating Medical Students on How to Prescribe Anti-Hyperglycaemic Drugs: A Practical Guide

In the light of the rapidly increasing global incidence of, and therapeutic arsenal for, diabetes type 2, this brief report underscores the need for advancements in clinical pharmacology and therapeutics (CPT) education with regard to diabetes type 2. We advocate for the comprehensive training of medical students and junior doctors in line with current guidelines, and emphasize the importance of teaching how to draw up individualized treatment plans based on patients’ specific risk factors and conditions, such as cardiovascular risks, weight, and risk of hypoglycaemia. Within the curriculum, traditional teaching approaches should be replaced by innovative methods such as problem-based learning, which has been shown to be more effective in developing prescribing knowledge and skills. The inclusion of real-world experience and interprofessional learning via so-called student-run clinics is also recommended. Subsequently, innovative assessment methods like the European Prescribing Exam and objective structured clinical examinations (OSCE) are highlighted as essential for evaluating knowledge and practical skills. By adopting these educational advances, medical education can better equip future practitioners to adequately manage the complex pharmacological treatment of diabetes.

Evaluation of junior doctors’ retention of knowledge and skills after simulation training in shockable rhythm cardiac arrest in a low-resource setting in Nepal

AimsTo test junior doctors’ abilities to retain advanced life support psychomotor skills and theoretical knowledge in management of shockable rhythm cardiac arrest. MethodsA repeated measure pre-post study design was used with 43 junior doctors, recruited after notifying them with robust method of attraction through flyers, brochures, email and phone calls. Written and performance tests, initial pre-test, immediate post-training, 30-days post-training and 60-days post-training, using simulation-based scenarios with a low-fidelity manikin were used with recording performance of ALS. InstrumentationResuscitation Council UK ALS algorithms and guidelines1 were used in a simulated testing environment. ResultsThere was a highly significant improvement in knowledge immediately after training (p < 0.00), with a net gain of marks from a mean value of 63.2% before training to 87.7% after training by 24.5% (95% CI 19.4, 29.6).There was a gradual decline of retained knowledge with time from immediate post-training over, 30-days and 60-days post-training (p < 0.00). The simulation pre-training assessments and immediate post-training assessments results were statistically significant (p < .00). The mean difference was 44.1% (95% CI 50.11, 38.10). There was a statistically significant decline of the competency with time (p < .00). Unlike for the knowledge test, the drop was significant on the 30th day (p < .00) with a mean difference of −10.5% (95% CI −13.55, −7.40). ConclusionThe training of junior doctors in shockable rhythm cardiac arrest in a low resource setting, improved knowledge and skills in the participants after training. However, retention of knowledge declined at 30 days and more significantly after 60 days and retention of skill was declined more significantly at 30 days.

Designing for digital transformation of residency education – a post-pandemic pedagogical response

BackgroundThe forced transition to emergency remote teaching (ERT) during the COVID-19 pandemic has significantly impacted health professions education worldwide. In Sweden, the need for alternative solutions for the training of junior doctors became urgent, as many of the mandatory onsite courses required for residents to qualify as specialists were canceled. The purpose of this study was to understand course leaders' perceptions and experiences of using digital technologies, such as video conferencing, to teach medical residents (ST) during the pandemic and beyond.MethodsA qualitative study using semi-structured interviews was conducted with seven course leaders responsible for residency courses during the first year of the pandemic to capture their perceptions and experiences. The interviews were transcribed verbatim and analyzed using thematic analysis, drawing on the technology affordances and constraints theory (TACT) as a framework to explore pedagogical strategies and new teaching practices emerging from the forced use of digital technologies for remote teaching.ResultsThe data analysis revealed affordances of, as well as constraints to, teaching specialist medical training during the pandemic. The findings show that the use of digital conference technologies for ERT can both enable and inhibit social interactions, the interactive learning environment and the utilization of technological features, depending on the individual course leaders’ goals of using the technology and the situated context of the teaching.ConclusionsThe study reflects the course leaders' pedagogical response to the pandemic, as remote teaching became the only way to provide residency education. Initially, the sudden shift was perceived as constraining, but over time they found new affordances through the enforced use of digital technology that helped them not only to cope with the transition but also to innovate their pedagogical methods. After a rapid, forced shift from on-site to digital courses, it is crucial to utilize experiences to create better preconditions for digital technology to facilitate learning in the future.

Comparing the attitudes of junior doctors towards mental and physical ill-health: a survey of trainees in North London

PurposeDoctors are more likely to suffer from mental illness in comparison to the wider population. This is particularly true for junior doctors, who are at increased risk in comparison to their senior colleagues. This study aims to identify whether junior doctors in North London are comfortable discussing mental health problems with their peers and supervisors and to compare how comfortable they are discussing mental and physical health problems.Design/methodology/approachAn anonymous online questionnaire was designed with demographic data, multiple-choice questions and free-text boxes. This was distributed via email to core psychiatry trainees and foundation doctors in North London. Drug- and alcohol-related disorders were excluded from our definition of mental illness in this survey, as these are reportable to the General Medical Council.FindingsA total of 51 junior doctors responded to the survey. The respondents were significantly more likely to discuss mental health problems with their peers in comparison to their supervisors. They were also less likely to discuss mental health problems in comparison to physical health problems with their peers, supervisors or general practitioner. Qualitative analysis of the free-text comments elucidated several themes including the stigmatisation of mental health.Originality/valueTo the best of the authors’ knowledge, there has been no prior research in the UK comparing the attitudes of junior doctors towards physical and mental ill-health. The questionnaire highlights the continued stigma towards mental health within the medical profession. The difference in attitudes towards physical and mental ill-health has important implications for the training and well-being of junior doctors.

Evaluation of rural general practice experiences for pre-vocational medical graduates.

Despite substantial investment in rural workforce support, sustaining the necessary recruitment and retention of general practitioners (GPs) in rural areas remains a challenge. Insufficient medical graduates are choosing a general/rural practice career. Medical training at postgraduate level, particularly for those 'between' undergraduate medical education and specialty training, remains strongly reliant on hospital experience in larger hospitals, potentially diverting interest away from general/rural practice. The Rural Junior Doctor Training Innovation Fund (RJDTIF) program offered junior hospital doctors (interns) an experience of 10 weeks in a rural general practice, aiming to increase their consideration of general/rural practice careers This study aimed to evaluate the educational and potential workforce impact of the RJDTIF program. Up to 110 places were established during 2019-2020 for Queensland's interns to undertake an 8-12-week rotation (depending on individual hospital rosters) out of regional hospitals to work in a rural general practice. Participants were surveyed before and after the placement, although only 86 were invited due to the disruption caused by the COVID-19 pandemic. Descriptive quantitative statistics were applied to the survey data. Four semi-structured interviews were conducted to further explore the experiences post-placement, with audio-recordings transcribed verbatim. Semi-structured interview data were analysed using inductive, reflexive thematic analysis. In total, 60 interns completed either survey, although only 25 were matched as completing both surveys. About half (48%) indicated they had preferenced the rural GP term and 48% indicated strong enthusiasm for the experience. General practice was indicated as the most likely career option for 50%, other general specialty 28% and subspecialty 22%. Likelihood to be working in a regional/rural location in 10 years was indicated as 'likely' or 'very likely' for 40%, 'unlikely' for 24% and 'unsure' for 36%. The two most common reasons for preferencing a rural GP term were experiencing training in a primary care setting (50%) and gaining more clinical skills through increased patient exposure (22%). The overall impact on pursuing a primary care career was self-assessed as much more likely by 41%, but much less by 15%. Interest in a rural location was less influenced. Those rating the term poor or average had low pre-placement enthusiasm for the term. The qualitative analysis of interview data produced two themes: importance of the rural GP term for interns (hands-on learning, skills improvement, influence on future career choice and engagement with the local community), and potential improvements to rural intern GP rotations. Most participants reported a positive experience from their rural GP rotation, which was recognised as a sound learning experience at an important time with respect to choosing a specialty. Despite the challenges posed by the pandemic, this evidence supports the investment in programs that provide opportunities for junior doctors to experience rural general practice in these formative postgraduate years to stimulate interest in this much-needed career pathway. Focusing resources on those who have at least some interest and enthusiasm may improve its workforce impact.

1324 DEVELOPMENT OF A M&amp;M MEETING INTEGRATING THE SITUATIONAL JUDGEMENT REVIEW (SJR) FRAMEWORK IN A GERIATRIC DEPARTMENT

Abstract Introduction The National Mortality Case Record Review Programme commissioned in 2016 aimed to improve the learning from deaths process. As part of this aim, several reports were published, which identified barriers in implementing the mortality review process. Mortality and Morbidity (M&amp;M) meetings can be an important mechanism for removing these barriers, and while have been in place for a long time in surgical specialties, are only recently becoming more common in medical specialties. We have developed an innovative M&amp;M meeting in our geriatric department to integrate Mortality case reviews with teaching and QI development. Methods We created a standardised mortality data collection proforma, using the (SJR) framework as a template. During the development, feedback was obtained from consultants and juniors. Data was then collected using the proforma by trainees, and all mortality cases were then reviewed with consultant supervision, and specific cases were chosen for their educational benefit or requiring areas of improvement. Cases were then presented at the meeting. At the end of the meetings, an action plan was then created in collaboration with the consultant and juniors in the meeting to create a teaching plan or develop a QI project to help improve service. Results From feedback gained, the M&amp;M was well received, and has already helped improve training and delivery of end of life care and recognising the dying patient. There were several difficulties identified during the process such as incomplete medical records, time and lack of engagement from other team members due to work pressures. Conclusion Mortality meetings are an essential part of junior doctor training and hospital clinical governance, often times underutilised. They can support quality improvement and professional learning, especially when facilitated by a standardised mortality review process.

In-situ obstetric simulation – ticking all the boxes

Simulation is increasingly valued as a versatile and effective tool for medical education [1]. This is even timelier with the recent release of the Ockenden Report which recommends in-situ simulation in obstetric units to promote safety [2]. With the recent change of speciality training curricula, especially in anaesthetics, there has been an increased requirement for simulation-based training. However, the COVID-19 pandemic has had a significant negative impact on medical training, both in terms of clinical breadth and opportunities for educational activities [3]. In order to tackle all these requirements, we developed an in-situ multidisciplinary obstetric simulation programme. This was supported by the anaesthetic simulation fellow, obstetric anaesthetic lead and fellow and obstetric safety fellow, together with senior midwifery input. This allowed simulation development, running and debriefing to benefit from the skill and experience of a multidisciplinary team. The local simulation centre provided technical support which allowed us to take the simulation to multiple locations on the labour ward. Learners were from anaesthetic, midwifery, theatre, and operating department practitioner backgrounds and we conducted this simulation programme as three-monthly sessions corresponding with trainees’ rotations. The scenarios were based around previous critical incidents while ensuring the psychological safety of the candidates. This demonstrates an open learning culture where lessons learnt can be shared and patient safety prioritised. It was also be useful in applying a systems approach to understanding how errors occurred. Feedback confirmed the in-situ aspect of this session provided experiential learning and improved familiarity of the environment. This was especially pertinent as the sessions were conducted with trainees new to the department. It also allowed midwifery and theatre staff to take part in the session who otherwise may not have. A multidisciplinary approach allowed flattening of team hierarchy as shown by feedback. We ensured challenges associated with in-situ simulation were met with the team ready to respond to clinical needs in the department. No simulated equipment or medication was used and all documentation was labelled appropriately. Obstetric emergencies can be life changing and can significantly affect those involved. This simulation session addressed several learning needs while rising to the challenges of in-situ simulations. We hope to continue developing this programme with more specialities represented and integrating learning from critical incidents while ensuring psychological safety. 1. Higham H, Baxendale B. To err is human: use of simulation to enhance training and patient safety in anaesthesia. BJA: British Journal of Anaesthesia. 2017;119(suppl_1):i106–14. 2. Ockenden D. Emerging findings and recommendations from the independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust. House of Commons. 2020 Dec 10. 3. Seifman MA, Fuzzard SK, To H, Nestel D. COVID-19 impact on junior doctor education and training: a scoping review. Postgraduate medical journal. 2022;98(1160):466–76.

Improving and Sustaining the Quality of Discharge Summaries.

High quality discharge information communication has been linked to a reduction in the incidence of adverse events, decreasing the risk of prescription errors and lost follow up. In this paper we describe how our trust-wide quality improvement project, led by acute physicians, successfully improved discharge documentation. We demonstrate how we identified obstacles to continued success, and the interventions we implemented. We recommend how discharge summary quality can be optimised through training of junior doctors, recruitment of local champions, and use of novel methods to preserve engagement, such as gamification.

Electrocardiography Interpretation Proficiency Among Medical Doctors of Different Grades in the United Kingdom.

Electrocardiography interpretation is a core clinical skill for all doctors participating in emergency medical services. Given the majority ofECGsinitially performed in hospital on admission are reviewed by junior doctors, and the need for life-threatening pathology to be diagnosed or excluded, further understanding of the level of competency in interpretation and factors associated with this are needed. This was a cross-sectional, descriptive, analytical study. The data were collected using a structured questionnaire. This was comprised of two sections; the first section contained questions related to confidence, previous ECG learning and factors thought to be associated with ECG interpretation competence. The second section was an ECG quiz of 10 12-lead ECGs of varying complexity for interpretation assessment. Descriptive and inferential statistics were utilized for data analysis. Sixty-twodoctors from foundation year 1 to registrar level working in acute medicine across three hospitals participated. The mean overall percentage score for the ECG quiz was 45%. No association was found between junior doctor training grade and overall score on the ECG assessment. Undergraduate and postgraduate teaching strategies also did not impact competence. Only 9.7% reported themselves as "confident" interpreting ECGs. There was a trend towards higher levels of competency among those who felt they had undergone sufficient ECG teaching and those who sought regular feedback from other clinicians. This study demonstrated low overall levels of ECG interpretation competency among junior doctors in a large acute teaching NHS trust regardless of grade. Factors associated with competency remain unclear.

WE3.10 The Impact of Simulation Training on Junior Doctors Managing Surgical Emergencies

Abstract Aim The use of simulation for the training of junior doctors in surgery usually involves either practicing technical skills or exercising communication skills. We have identified a gap in crisis resource management training of junior surgical trainees with scenario-based simulation. We have developed a one-day simulation course on general surgical emergencies and evaluated its impact. Methods The course included a human factors presentation and several scenarios of acute surgical emergencies. It was aimed at core surgical trainees, but other junior doctors were invited. High fidelity human simulator (SimMan®) was used and controlled by faculty. Surgical scenarios were selected in order to provide insight for the appropriate resuscitation for acute surgical patients. The impact of the course was evaluated with a post course questionnaire. Results Ten courses were completed between 2015 and 2021. A total of 58 doctors attended, 45 were core surgical trainees. All 51 participants who responded to the questionnaire rated the course “Good (4/5)” or “Excellent (5/5)”. Following the course, of 51 participants, 50 felt better prepared and 51 were confident in recognising unwell surgical patients; 42 felt better prepared and 50 confident in providing resuscitation; 46 felt better prepared and 51 confident in escalating care. During debriefs and on free text feedback, participants frequently reported the course helped develop their non-technical skills. Conclusion The General Surgical Emergencies simulation courses were rated useful by the learners. The course has positively impacted on the preparedness and confidence of junior surgical trainees in recognising unwell surgical patients, providing initial resuscitation and escalating care.

Perceptions and expectations of medical students and junior doctors in training: blended learning approach for medical education initiatives

Perceptions and expectations of medical students and junior doctors in training: blended learning approach for medical education initiatives