Training Of Junior Doctors Research Articles

Improving junior doctor experience at Sheffield Teaching Hospitals

Sheffield Teaching Hospitals Foundation Trust (STHFT) is one of the largest UK foundation trusts with 17,000 staff, approximately 1,000 junior doctors (JDs) in training and around 700 career grade doctors. The previous chief executive officer and medical director had a vision to improve the relationship between junior doctors and senior management in the trust. By fostering this relationship, the ultimate goal was to make the JD cohort feel connected, involved and valued …

Smartphones in orthopaedics: a decade of innovation.

Smartphones have become a mainstream feature in medicine since the introduction of the Apple iPhone in 2007. Over the last decade they have taken on increasing prominence with multiple uses in daily practice. They have long been used for group messaging and accessing patient's electronic records while mobile. More recently, however, smartphones have allowed clinicians to improve patient assessment in clinic and manage follow-up appointments remotely. Furthermore they have been used to aid procedural tasks in surgery and provide a medium for simulation training for junior doctors. The role of smartphones in the future is predicted to increase exponentially and there will no doubt be countless further roles for them in the ever-expanding field of orthopaedics.

Should UK specialty trainee doctors in Obstetrics and Gynaecology have more opportunities to work in global women's health?

The Royal College of Obstetricians and Gynaecologists (RCOG) has a long history of advocacy for women's health, nationally and internationally. There is a demand and interest in global women's health among a sample of junior doctors training in obstetrics and gynaecology in the UK. There is ongoing debate regarding whether this desire should be nurtured, opportunities created and barriers addressed, both in the interest of training and as a means of addressing global health inequity. Global health work needs to be a mutually beneficial partnership for all involved, with work carried out sensitively and sustainably.

Accuracy of appendicular radiographic image interpretation by radiographers and junior doctors in Ghana: Can this be improved by training?

IntroductionAccess to image interpretation in Ghana remains a challenge with the limited number of radiologists. Radiographers with the right skills and knowledge in image interpretation could help address this challenge. The aims of the study were to determine and compare the ability (accuracy, sensitivity and specificity) of radiographers and junior doctors in interpreting appendicular trauma radiographs both before and after training. MethodsAn action research study involving a pre and post training test was carried out to determine the level of accuracy, sensitivity and specificity in abnormality detection by radiographers after undergoing training when compared to junior doctors. Eight radiographers and twelve junior doctors were invited to interpret an image bank of 30 skeletal radiographs, both before and upon completion of an educational program. The participants’ tests were scored against a reference standard provided by an experienced radiologist. Pre and post-test analysis were carried out for comparison. ResultsPost training mean accuracy (radiographers 83.3% vs 68.8%, p = 0.017; doctors 81.9% vs 71.6%, p = 0.003), sensitivity (radiographers 83.3% vs 69.2%, p = 0.042; doctors 77.2% vs 67.8% p = 0.025) and specificity (radiographers 83.3% vs 68.3%, p = 0.011; doctors 86.7% vs 75.6% p = 0.005) of both groups significantly improved. No significant differences were recorded between the radiographers and doctors after the training event. ConclusionThe study revealed that, with a well-structured training program, radiographers and junior doctors could improve on their accuracies in radiographic abnormality detection and commenting on trauma radiographs.

Hospital at Night

We aim to introduce a Hospital at Night service to improve patient safety and junior doctor training at Great Western Hospital (GWH) in Swindon by winter 2018. We will do this by improving efficiency of overnight clinical work, with additional staffing and different ways of utilising clinical staff and information technology (IT) systems. We also aim to improve nursing training, development and retention by providing opportunity for nursing progression within the advanced …

Rota changes in acute and general internal medicine: delivering improved patient care and junior doctor training at the front and back door – acute medical unit placement blocks the way forward for Midland Met!

Introduction of a rota to provide consistency of care for patients and improved training for junior doctors. Initial meetings were held with stakeholders from medical staffing, consultant and junior doctors. Following consultation, a prototype rota was agreed for foundation doctors and ‘senior house officer’ grades whereby doctors rotate into acute medicine for 5 or 6-week blocks once every 4 months. Within this block is two sets of nights, three to four weekends, late shifts and some normal working days. The remainder of the 4-month block would be spent back in their specialty rotation mostly working weekdays 9am–5pm. Two 9am–5pm ward cover doctors were added to support the …

Building an island in the storm: enhancing the junior doctor experience

To understand the level of satisfaction among junior doctors in our organisation and their priority areas for improvement, and develop a sustainable programme of improvement to enhance their wellbeing and experience. We surveyed the junior doctors (both training and non-training grades) in our organisation, asking them to rate their satisfaction with their experience, identify positive and negative aspects of their working lives, and suggest priority areas for improvement. We combined this with information from the General …

P55 The neurosurgical physician: a new role in the UK

ObjectivesWith reduction in numbers of junior doctors and strict deanery requirements for training opportunities, the provision of ward cover and continuity has consistently fallen. Various methods of addressing this have been implemented in the UK, including increased nurse practitioners and physician associates. We introduced a new position of GP with a specialist neuroscience interest in line with the North American model of hospitalist and review the impact on patients and trainees.DesignQualitative descriptive study.Subjects14 core and speciality trainees.MethodsRetrospective review of the impact of a permanent neurosurgical physician on ward care and provision of training with a qualitative study of trainee experience. Saturation was reached at 14 interviews.ResultsA neurosurgical physician role was instituted in 2013, enabling a formal training rota to fulfil deanery requirements for core training and provide continuity of care at senior medical level, reducing medical ward consults to zero, improved communication with relatives and reduced the need for ST ward rounds. Qualitative assessment revealed a senior medical presence aided trainees own knowledge, resulted in better rapport and communication with patients and improved patient care through knowledge of best medical practice guidelines.ConclusionsThe addition of the neurosurgical physician role has positively impacted on the quality of patient care and junior doctor training. Senior medical care is provided with continuity, in contrast to other models.

Antimicrobial stewardship: an evaluation of structure and process and their association with antimicrobial prescribing in NHS hospitals in England.

Rigorous antimicrobial stewardship programmes (ASPs) are an essential strategy against antimicrobial resistance. To evaluate and score ASPs in acute English NHS hospitals and determine association of ASP scores with antimicrobial prescribing. ASP structure and process were evaluated through an online survey in 148/152 acute hospitals in 2017. Scores were assigned to quality indicators based on resource- and labour-intensiveness, and their association with total and modified WHO-categorized 'Access', 'Watch' and 'Reserve' (AwaRe) prescribing was analysed. The survey response rate was 97% with 78% of trusts submitting antimicrobial prescribing data. Over 80% of ASPs contained stewardship teams, policies and access to outpatient parenteral antimicrobial therapy, whilst less than 50% scored well for leadership or funding. High process performance was observed for antimicrobial pre-authorization, prescribing review and feedback, restricted susceptibility reporting, antimicrobial consumption monitoring, adherence to guidelines and junior doctor training. Low process attainment included education of senior prescribers and lack of resistance surveillance data distribution. Between 2016 and 2017, there was no difference in total trust prescribing (P = 0.117) although carbapenem prescribing fell (incidence rate ratio = 0.93, 95% CI 0.88-0.98) in non-teaching hospitals; 'Watch' prescribing also increased for specialist hospitals (OR = 1.10, 95% CI 1.01-1.20), as did 'Reserve' category prescribing in teaching (OR = 1.58, 95% CI 1.23-3.02) and specialist hospitals (OR = 3.09, 95% CI 2.02-4.74). A high process score was associated with lower 'Reserve' prescribing (OR = 0.82, 95% CI 0.67-1.01). All responding trusts had established ASPs. The association of a scoring system with total and 'AWaRe' prescribing to assess effectiveness of ASPs merits further study.

Simulation-based training of junior doctors in handling critically ill patients facilitates the transition to clinical practice: an interview study

BackgroundJunior doctors lack confidence and competence in handling the critically ill patient including diagnostic skills, decision-making and team working with other health care professionals. Simulation-based training on managing emergency situations can have substantial effects on satisfaction and learning. However, there are indications of problems when applying learned skills to practice. Our aim was to identify first-year doctors’ perceptions, reflections and experiences on transfer of skills to a clinical setting after simulation-based training in handling critically ill patients.MethodsWe used a qualitative approach and conducted semi-structured telephone interviews with a sample of twenty first-year doctors six months after a 4-day simulation-based training course in handling critically ill patients. Interviews were transcribed verbatim. A content-analysis approach was used to analyse the data.ResultsThe following main themes were identified from the interviews: preparedness for clinical practice, organisational readiness, use of algorithms, communication, teamwork, situational awareness and decision making. The doctors gave several examples of simulation-based training increasing their preparedness for clinical practice and handling the critically ill patient. The usefulness of algorithms and the appreciation of non-technical skills were highlighted and found to be helpful in managing clinical difficulties. Concern was expressed related to staff willingness and preparedness in using these tools.ConclusionsOverall, the simulation-based training seemed to facilitate the transition from being a medical student to become a junior doctor. The doctors experienced an ability to transfer the use of algorithms and non-technical skills trained in the simulated environment to the clinical environment. However, the application of these skills was more difficult if these skills were unfamiliar to the surrounding clinical staff.Trial registrationNot applicable.

Risk Factors for Wound Infection Following Caesarean Section: A Case Control Study from Sir Salimullah Medical College & Mitford Hospital in Dhaka, Bangladesh

Background: Post caesarean section (CS) wound infection or surgical site infection is a leading cause of prolonged hospital stay or readmission. An understanding of its risk factors is important. Methods: A case control study was conducted in the Department of Obstetrics and Gynecology of Sir Salimullah Medical College & Mitford Hospital, in Dhaka, Bangladesh from January to June 2014 to evaluate the risk factors of postoperative surgical site infection following CS. One hundred patients were studied. Results: Fifty patients of post CS wound infection (surgical site infection: SSI) were selected as cases. Body mass index > 25 (kg/m2), anemia (p = 0.001), prolonged rupture of membrane (p = 0.005), prolonged operation time (p = 0.019), and junior surgeons performing the operation (p = 0.011) were the risk factors for CS-SSI. Conclusions: Pre- and postoperative care and surgical training of junior doctors should be directed to these risk factors.

An Interpretable and Expandable Deep Learning Diagnostic System for Multiple Ocular Diseases: Qualitative Study.

BackgroundAlthough artificial intelligence performs promisingly in medicine, few automatic disease diagnosis platforms can clearly explain why a specific medical decision is made.ObjectiveWe aimed to devise and develop an interpretable and expandable diagnosis framework for automatically diagnosing multiple ocular diseases and providing treatment recommendations for the particular illness of a specific patient.MethodsAs the diagnosis of ocular diseases highly depends on observing medical images, we chose ophthalmic images as research material. All medical images were labeled to 4 types of diseases or normal (total 5 classes); each image was decomposed into different parts according to the anatomical knowledge and then annotated. This process yields the positions and primary information on different anatomical parts and foci observed in medical images, thereby bridging the gap between medical image and diagnostic process. Next, we applied images and the information produced during the annotation process to implement an interpretable and expandable automatic diagnostic framework with deep learning.ResultsThis diagnosis framework comprises 4 stages. The first stage identifies the type of disease (identification accuracy, 93%). The second stage localizes the anatomical parts and foci of the eye (localization accuracy: images under natural light without fluorescein sodium eye drops, 82%; images under cobalt blue light or natural light with fluorescein sodium eye drops, 90%). The third stage carefully classifies the specific condition of each anatomical part or focus with the result from the second stage (average accuracy for multiple classification problems, 79%-98%). The last stage provides treatment advice according to medical experience and artificial intelligence, which is merely involved with pterygium (accuracy, >95%). Based on this, we developed a telemedical system that can show detailed reasons for a particular diagnosis to doctors and patients to help doctors with medical decision making. This system can carefully analyze medical images and provide treatment advices according to the analysis results and consultation between a doctor and a patient.ConclusionsThe interpretable and expandable medical artificial intelligence platform was successfully built; this system can identify the disease, distinguish different anatomical parts and foci, discern the diagnostic information relevant to the diagnosis of diseases, and provide treatment suggestions. During this process, the whole diagnostic flow becomes clear and understandable to both doctors and their patients. Moreover, other diseases can be seamlessly integrated into this system without any influence on existing modules or diseases. Furthermore, this framework can assist in the clinical training of junior doctors. Owing to the rare high-grade medical resource, it is impossible that everyone receives high-quality professional diagnosis and treatment service. This framework can not only be applied in hospitals with insufficient medical resources to decrease the pressure on experienced doctors but also deployed in remote areas to help doctors diagnose common ocular diseases.

A novel simulator for training junior doctors in breast surgery –a model for the future?

Introduction: The availability of breast surgery training for junior doctors in UK and Ireland is becoming ever more limited, due to a reduction in the number of hours available for practice since the introduction of the European Working Time Directive (EWTD), and other service provision commitments.

The Educational and Clinical Benefits of a “Consultant-Speciality Trainee” ENT Shared Clinic

Introduction and Aims. The European Working Time Regulations (EWTR) of 48-hour working week limit have raised concerns regarding the quality of medical training for junior doctors. Our study has looked to improve junior doctors training without impairing patients’ care with the introduction of one-to-one “consultant with specialty trainee” doctor teaching in the outpatient clinic setting. Methodology. In this study, an ENT specialty trainee conducted a 3-month block of solo clinics seeing new patients. After that, the same specialty trainee shared the clinic with an ENT consultant for 3 months and subsequently the same trainee reconducted solo clinics. Outcomes of the specialty trainee performance were measured clinically by completed patient episodes (CPE) (i.e., patient discharged from clinic or placed on surgical operation waiting list) and ongoing patient episodes (OPE) (i.e., patient given follow-up appointment to ENT clinic) and educationally by workplace based assessments (WBA) completed in the trainee’s e-portfolio. Results. 271 patients were recruited in this research: 24% being in the preintervention group, 47% during the intervention, and 29% in the postintervention. The intervention of one-to-one outpatient clinic teaching increased the specialty trainees CPE rate (60% to 67.5%, p>0.1) and reduced their OPE rate (40% to 32.5%, p=0.001). Educationally these trainees completed with the consultant statistically significant WBA (17 assessments) during the one-to-one clinics compared to solo clinics (2.3 on average). Discussion and Conclusion. In this study, a positive trend in the clinical outcomes was obtained in terms of CPE, while a statistically significant reduction of the total OPE was achieved giving an indicator to consider this concept for further research in terms of patient’s clinical outcomes. Nevertheless, it showed a new way of supporting the trainee’s education supported by more WBA being filled.

Implementing blended learning in emergency airway management training: a randomized controlled trial

BackgroundWhile emergency airway management training is conventionally conducted via face-to-face learning (F2FL) workshops, there are inherent cost, time, place and manpower limitations in running such workshops. Blended learning (BL) refers to the systematic integration of online and face-to-face learning aimed to facilitate complex thinking skills and flexible participation at a reduced financial, time and manpower cost. This study was conducted to evaluate its effectiveness in emergency airway management training.MethodsA single-center prospective randomised controlled trial involving 30 doctors from Sarawak General Hospital, Malaysia was conducted from September 2016 to February 2017 to compare the effectiveness of BL versus F2FL for emergency airway management training. Participants in the BL arm were given a period of 12 days to go through the online materials in a learning management system while those in the F2FL arm attended a-day of face-to-face lectures (8 h). Participants from both arms then attended a day of hands-on session consisting of simulation skills training with airway manikins. Pre- and post-tests in knowledge and practical skills were administered. E-learning experience and the perception towards BL among participants in the BL arm were also assessed.ResultsSignificant improvements in post-test scores as compared to pre-test scores were noted for participants in both BL and F2FL arms for knowledge, practical, and total scores. The degree of increment between the BL group and the F2FL arms for all categories were not significantly different (total scores: 35 marks, inter-quartile range (IQR) 15.0 – 41.0 vs. 31 marks, IQR 24.0 – 41.0, p = 0.690; theory scores: 18 marks, IQR 9 – 24 vs. 19 marks, IQR 15 – 20, p = 0.992; practical scores: 11 marks, IQR 5 -18 vs. 10 marks, IQR 9 – 20, p = 0.461 respectively). The overall perception towards BL was positive.ConclusionsBlended learning is as effective as face-to-face learning for emergency airway management training of junior doctors, suggesting that blended learning may be a feasible alternative to face-to-face learning for such skill training in emergency departments.Trial registrationMalaysian National Medical Research NMRR-16-696-30190. Registered 28 April 2016.

Junior doctor teaching delivered by near peers.

Near-peer teaching - trainees teaching more juniortrainee colleagues - hasbeenwidely described inundergraduate medical education. Several benefits havebeen reported, including a more comfortable learning environment for learners and the development of tutors' teaching skills. Near-peer teaching programmes in postgraduate training are less commonly described in the existing literature, however. This article outlines a pilot study of a postgraduate near-peer teaching programme implemented at the Royal Victoria Infirmary, Newcastle, UK. A 16-week teaching programme was developed in which core medical trainees delivered teaching sessions to their more junior Foundation Year-2 colleagues. The teaching was based on cases that the Foundation Year-2 doctors frequently manage during clinical practice. Evaluation questionnaires were completed and learners were asked to rate their confidence in managing the cases before and after each session. Furthermore, each tutor underwent a standardised teaching assessment during their first and final sessions. Fifteen sessions were delivered by four tutors. All sessions received positive feedback from learners with nine sessions receiving a five out of five rating. In addition, the confidence ratings of the learners increased following each session. The tutors improved in all items of the teaching assessments and the overall rating of their teaching. Near-peer teaching could enhance the training of junior doctors DISCUSSION: The results of this pilot study suggest that the benefits described in undergraduate near-peer teaching programmes may also be seen in postgraduate medical education. Thus near-peer teaching could enhance the training of junior doctors, and we encourage the proliferation of such programmes to further evaluate their benefits in this setting.

An audit of clinical training exposure amongst junior doctors working in Trauma & Orthopaedic Surgery in 101 hospitals in the United Kingdom

BackgroundThere are concerns regarding early years’ training for junior doctors in Trauma & Orthopaedic Surgery (T&O) in the United Kingdom. Our primary objective was to audit the clinical activities undertaken by junior doctors working in Trauma & Orthopaedic (T&O) surgery in the National Health Service (NHS) in a typical workweek. A secondary objective was to audit the clinical exposure of junior surgeons in training to the Joint Committee on Surgical Training (JCST) standards for minimum weekly clinical exposure in T&O surgery.MethodsWe recruited collaborators in 101 T&O surgery departments in NHS hospitals to participate in this study. Clinical activity diaries from 935 doctors working in T&O surgery in the 101 participating NHS hospitals were involved. All junior doctors covering the junior on call tier were included. Collaborators collected clinical activity data from 08:00 18/01/2015 to 20:00 22/01/2015. Clinical activities recorded in sessions (morning, afternoon, evening) depending on what activity that doctor undertook for the majority of that session. Clinical activities were grouped into operating theatre/room, outpatient clinic, on call, “not in work” (i.e. leave, sickness), teaching, and ward cover sessions. The weekly clinical activity of Core Surgical Trainees (CSTs) were analyzed in accordance to two JCST standards for minimum weekly clinical exposure.ResultsOverall, junior doctors working in T&O surgery attended a theatre list session 8.5% of the time, an outpatient clinic 3.2%, were on call 14.8%, a teaching session 1.7%, providing ward cover 34.6%, and on a zero session 20.7% of the time. Only 5% of core surgical trainees (n = 200) met both the JCST standards for minimum weekly clinical exposure in the specialty.ConclusionsJunior surgeons in training, working in Trauma & Orthopaedic surgery in the United Kingdom are not meeting the minimum weekly clinical sessions laid out by the JCST. Further work to develop models allowing for enhanced training experiences and improved clinical exposure to operating lists and outpatient clinics would be beneficial.

Burnout in Chinese medical students and residents: an exploratory cross-sectional study

BackgroundChinese medical doctors have experienced unprecedented challenges over the past 10 years, including but not limited to heavy workload and violence against doctors. In the meantime, the National Health and Family Planning Commission issued guidelines for standardised medical training that include an additional 2–4 years of specialist training for junior doctors. Few studies have explored the relationship between burnout and associated factors at Chinese medical schools and hospitals. MethodsThe study population consisted of 3387 medical students (n=2097) and residents (n=1290) from all over China. In 2016, 85 medical schools and their teaching hospitals participated in this study. We used the following questionnaires: Chinese version of the Maslach Burnout Inventory; Job Content Questionnaire; Professionalism Assessment Scale; Moral Distress Questionnaire; Jefferson Scale of Physician Empathy—Student Version; Chinese version of the General Health Questionnaire; Center for Epidemiologic Studies Depression Scale (CES-D); Professional Role Formation Inventory including sections related to lifelong learning, humanism, social learning, and research advancement; and other social demographic questions to collect cross-sectional data. Statistical analyses were conducted using SPSS 20. Ethical approval was obtained by the Institutional Review Board of the principal investigator's institution. FindingsThe burnout mean scores were 11·42 (SD 6·25) for emotional exhaustion, 8·10 (4·85) for cynicism, and 21·08 (8·70) for reduced personal accomplishment. Statistically significant increases were found as age increased and between residents and medical students (p<0·001). Higher burnout scores were significantly associated with lower empathy (p<0·001), lower professionalism (p<0·001), lower general health (p<0·001), depression (p<0·001), lower humanism (p<0·001), lower social learning (p<0·001), and lower research advancement (p<0·001)). InterpretationBurnout affects not only the physical and mental health of future Chinese doctors but also their empathy, professional role formation, and professionalism. Given China's aging population and high disease burden, educators and policy makers should not ignore burnout, wellbeing, and their effects on future doctors. FundingROC Ministry of Science and Technology Grant MOST 105-2511-S-010-002-MY2. The funding source had no involvement in study design, data collection and analysis, interpretation of the results, writing of the report, and the decision to submit the paper for publication.

Teach junior doctors how to combat bullying, say surgeons

Junior doctors in foundation training should receive compulsory training on how to challenge bullying behaviour, the Royal College of Surgeons of Edinburgh (RCSEd) has said. As part its #LetsRemoveIt campaign against bullying and undermining, the college called on deaneries, Health Education England, and NHS Education for Scotland to introduce relevant compulsory training for foundation year doctors. This training would embed culture change, the college said, to “encourage people to challenge poor behaviour and …

‘You do not cross them’: Hierarchy and emotion in doctors' narratives of power relations in specialist training

Studies of medical education often focus on experiences and socialisation processes among undergraduate students, with fewer examining emotionality among postgraduate trainees. This article explores the relationship between power and emotion, questioning how affective relations between senior and junior doctors are patterned on the hierarchical structure of medicine. The study employs qualitative methods of in-depth, face-to-face and telephone interviews with fifty doctors at initial and advanced stages of specialist postgraduate training in teaching hospitals across Ireland, conducted between May and July, 2015. The study found that respect for hierarchy, anger and fear, intimidation, and disillusion were key themes in participants' narratives of relationships with senior staff who oversaw their postgraduate training. The implications of these emotional subjectivities for quality of training, patient care and willingness of junior doctors to pursue careers in Ireland, are discussed and recommendations and areas for further research proposed.