Junior Doctors Research Articles

Clinical application potential of large language model: a study based on thyroid nodules.

Limited data indicated the performance of large language model (LLM) taking on the role of doctors. We aimed to investigate the potential for ChatGPT-3.5 and New Bing Chat acting as doctors using thyroid nodules as an example. A total of 145 patients with thyroid nodules were included for generating questions. Each question was entered into chatbot of ChatGPT-3.5 and New Bing Chat five times and five responses were acquired respectively. These responses were compared with answers given by five junior doctors. Responses from five senior doctors were regarded as gold standard. Accuracy and reproducibility of responses from ChatGPT-3.5 and New Bing Chat were evaluated. The accuracy of ChatGPT-3.5 and New Bing Chat in answering Q2, Q3, Q5 were lower than that of junior doctors (all P < 0.05), while both LLMs were comparable to junior doctors when answering Q4 and Q6. In terms of "high reproducibility and accuracy", ChatGPT-3.5 outperformed New Bing Chat in Q1 and Q5 (P < 0.001 and P = 0.008, respectively), but showed no significant difference in Q2, Q3, Q4, and Q6 (P > 0.05 for all). New Bing Chat generated higher accuracy than ChatGPT-3.5 (72.41% vs 58.62%) (P = 0.003) in decision making of thyroid nodules, and both were less accurate than junior doctors (89.66%, P < 0.001 for both). The exploration of ChatGPT-3.5 and New Bing Chat in the diagnosis and management of thyroid nodules illustrates that LLMs currently demonstrate the potential for medical applications, but do not yet reach the clinical decision-making capacity of doctors.

Robotic-assisted CT-guided percutaneous pulmonary nodules localization by hook-wire needles: a retrospective observational study.

Preoperative computed tomography (CT)-guided localization of small pulmonary nodules (SPNs) is the major approach for accurate intraoperative visualization in video-assisted thoracoscopic surgery (VATS). However, this interventional procedure has certain risks and may challenge to less experienced junior doctors. This study aims to evaluate the feasibility and efficacy of robotic-assisted CT-guided preoperative pulmonary nodules localization with the modified hook-wire needles before VATS. A total of 599 patients with 654 SPNs who preoperatively accepted robotic-assisted CT-guided percutaneous pulmonary localization were respectively enrolled and compared to 90 patients with 94 SPNs who underwent the conventional CT-guided manual localization. The clinical and imaging data including patients' basic information, pulmonary nodule features, location procedure findings, and operation time were analyzed. The localization success rate was 96.64% (632/654). The mean time required for marking was 22.85±10.27 min. Anchor of dislodgement occurred in 2 cases (0.31%). Localization-related complications included pneumothorax in 163 cases (27.21%), parenchymal hemorrhage in 222 cases (33.94%), pleural reaction in 3 cases (0.50%), and intercostal vascular hemorrhage in 5 cases (0.83%). Localization and VATS were performed within 24 hours. All devices were successfully retrieved in VATS. Histopathological examination revealed 166 (25.38%) benign nodules and 488 (74.62%) malignant nodules. For patients who received localizations, VATS spent a significantly shorter time, especially the segmentectomy group (93.61±35.72 vs. 167.50±40.70 min, P<0.001). The proportion of pneumothorax in the robotic-assisted group significantly decreased compared with the conventional manual group (27.21% vs. 43.33%, P=0.002). Robotic-assisted CT-guided percutaneous pulmonary nodules hook-wire localization could be effectively helpful for junior less experienced interventional physicians to master the procedure and potentially increase precision.

Endophthalmitis following intravitreal injections administered by junior medical officers in rural Western Australia.

Patients in rural Australia have limited access to intravitreal treatments due to a maldistribution of the ophthalmology workforce. To improve access, a novel outreach service model was implemented whereby junior medical staff administered intravitreal injections under a supervising ophthalmology consultant. This model involves outreach visits in hospitals, mobile clinics and a remote hub with intravitreal injections administered by junior doctors overseen by an ophthalmologist. The article explores the safety of this approach with respect to the rate of post-injection endophthalmitis. A retrospective audit was conducted by the Lions Outback Vision outreach ophthalmology service from 2017 to mid-2023. The number of injections, locations, diagnoses, intravitreal agents used, designation of administering doctor and cases of endophthalmitis were reviewed. A 12 632 intravitreal injections were administered across 32 locations throughout rural Western Australia in the 6.5-year period. Three cases of endophthalmitis occurred representing a rate of 0.0237%. The rate of endophthalmitis in the outreach service is comparable to other centres. The outreach model with supervising ophthalmology consultant support in person or via telehealth and administration of injections by junior medical staff has improved access for underserved or marginalised populations.

Enabling and inhibiting doctors transitions: introducing the social identity resource and belonginess model (SIRB).

The transition into postgraduate medical training is complex, requiring an integration into the workplace, adjustment to new identities, and understanding of the social and organisational structure of healthcare. Studies suggest that social resources, including a sense of belonging, inclusivity from social groups, and having strong social identities can facilitate positive transitions. However, little is known about the role these resources play in junior doctors' transitions into the healthcare community. This study aimed to explore the implications of having access to social resources for junior doctors. This study undertook secondary analysis from a longitudinal qualitative study which followed 19 junior doctors (residents within two years of qualification) for nine months. Data were thematically analysed using an abductive approach, with the social identity resource and belongingness (SIRB) model as a conceptual lens to explore how social networks of support act as identity resources (IRs) for junior doctors as they experience transitions. The doctors narrated that having accessible IRs in the form of supportive workplace relationships enabled an integration and a sense of belonging into healthcare practice, supported the construction of new professional identities, and strengthened career intentions. Those with inaccessible IRs (i.e. poor workplace relationships) expressed a lack of belonging, and casted doubt on their identity as a doctor and their career intentions. Our study indicates that SIRB model would be beneficial for medical educators, supervisors, and managers to help them understand the importance and implications of having IRs within the workplace environment and the consequences of their accessibility for healthcare staff experiencing transitions.

Comparison of the Quality of Discharge Letters Written by Large Language Models and Junior Clinicians: Single-Blinded Study.

Discharge letters are a critical component in the continuity of care between specialists and primary care providers. However, these letters are time-consuming to write, underprioritized in comparison to direct clinical care, and are often tasked to junior doctors. Prior studies assessing the quality of discharge summaries written for inpatient hospital admissions show inadequacies in many domains. Large language models such as GPT have the ability to summarize large volumes of unstructured free text such as electronic medical records and have the potential to automate such tasks, providing time savings and consistency in quality. The aim of this study was to assess the performance of GPT-4 in generating discharge letters written from urology specialist outpatient clinics to primary care providers and to compare their quality against letters written by junior clinicians. Fictional electronic records were written by physicians simulating 5 common urology outpatient cases with long-term follow-up. Records comprised simulated consultation notes, referral letters and replies, and relevant discharge summaries from inpatient admissions. GPT-4 was tasked to write discharge letters for these cases with a specified target audience of primary care providers who would be continuing the patient's care. Prompts were written for safety, content, and style. Concurrently, junior clinicians were provided with the same case records and instructional prompts. GPT-4 output was assessed for instances of hallucination. A blinded panel of primary care physicians then evaluated the letters using a standardized questionnaire tool. GPT-4 outperformed human counterparts in information provision (mean 4.32, SD 0.95 vs 3.70, SD 1.27; P=.03) and had no instances of hallucination. There were no statistically significant differences in the mean clarity (4.16, SD 0.95 vs 3.68, SD 1.24; P=.12), collegiality (4.36, SD 1.00 vs 3.84, SD 1.22; P=.05), conciseness (3.60, SD 1.12 vs 3.64, SD 1.27; P=.71), follow-up recommendations (4.16, SD 1.03 vs 3.72, SD 1.13; P=.08), and overall satisfaction (3.96, SD 1.14 vs 3.62, SD 1.34; P=.36) between the letters generated by GPT-4 and humans, respectively. Discharge letters written by GPT-4 had equivalent quality to those written by junior clinicians, without any hallucinations. This study provides a proof of concept that large language models can be useful and safe tools in clinical documentation.

Exploring the viability of Virtual Reality as a teaching method for knee aspiration

Knee arthrocentesis is a simple procedure commonly performed by general practitioners and junior doctors. As such, doctors should be competent and comfortable in performing the technique by themselves; however, they need to be adequately trained. The best method to ensure practitioner proficiency is by optimizing teaching at an institutional level, thus, educating all future doctors in the procedure. However, the Coronavirus Disease 19 (COVID-19) pandemic caused significant disruption to hospital teaching for medical students which necessitated investigating the effectiveness of virtual reality (VR) as a platform to emulate hospital teaching of knee arthrocentesis. A workshop was conducted with 100 fourth year medical students divided into three Groups: A, B and C, each receiving a pre-reading online lecture. Group A was placed in an Objective Structured Clinical Examination (OSCE) station where they were assessed by a blinded orthopaedic surgeon using the OSCE assessment rubric. Group B undertook a hands-on practice station prior to assessment, while Group C received a VR video (courtesy of the University of Adelaide’s Health Simulation) in the form of VR headset or 360° surround immersion room and hands-on station followed by the OSCE. Upon completion of the workshop, students completed a questionnaire on their confidence with the procedure and the practicality of the VR station. OSCE scores were compared between Groups B and C to investigate the educational value of VR teaching. On average, students with VR headsets reported higher confidence with the procedure and were more inclined to undertake it on their own. Students in Group C who used the VR station prior to assessment scored higher than the non-VR Groups (Group A, 56%; Group B, 67%; Group C 83%). Students in Group A had statistically significant results on average compared to those in Group B (t(69) = 3.003, p = 0.003), as do students in Group B compared to Group C (t(62) = 5.400, p < 0.001). Within Group C students who were given VR headsets scored higher than immersion room students. The VR headset was beneficial in providing students with a representation of how knee arthrocentesis may be conducted in the hospital setting. While VR will not replace conventional in-hospital teaching, given current technological limitations, it serves as an effective teaching aid for arthrocentesis and has many other potential applications for a wide scope of medicine and surgical training.

Steady undermining of the UK National Health Service underlies industrial action by doctors and other staff.

Erosion of standard of healthcare in the United Kingdom underlies the industrial action taken recently by staff in the publicly provided National Health Service. Underfunding and understaffing, largely as a consequence of neoliberal government "austerity" policies implemented following the 2007-08 banking crisis, together with lack of long-term planning and a drive towards outsourcing, have led to a deterioration in the quality of services. Reduction in bed numbers and neglect of community and social support have compounded problems by making it more difficult both to admit and to discharge patients in a timely fashion. Access to services has been compromised with negative consequences for the sick. Reduction of doctors' real wages together with stress at work, moral injury caused by feelings of not being able to do the best for patients, burnout from the Covid-19 pandemic and uncertainty about the future have led to the longest ever strike action by junior doctors in England.

Peer mentorship amongst junior doctors: is this the solution to improving wellbeing?

Peer mentorship amongst junior doctors: is this the solution to improving wellbeing?

Improve the efficiency and accuracy of ophthalmologists’ clinical decision-making based on AI technology

BackgroundAs global aging intensifies, the prevalence of ocular fundus diseases continues to rise. In China, the tense doctor-patient ratio poses numerous challenges for the early diagnosis and treatment of ocular fundus diseases. To reduce the high risk of missed or misdiagnosed cases, avoid irreversible visual impairment for patients, and ensure good visual prognosis for patients with ocular fundus diseases, it is particularly important to enhance the growth and diagnostic capabilities of junior doctors. This study aims to leverage the value of electronic medical record data to developing a diagnostic intelligent decision support platform. This platform aims to assist junior doctors in diagnosing ocular fundus diseases quickly and accurately, expedite their professional growth, and prevent delays in patient treatment. An empirical evaluation will assess the platform’s effectiveness in enhancing doctors’ diagnostic efficiency and accuracy.MethodsIn this study, eight Chinese Named Entity Recognition (NER) models were compared, and the SoftLexicon-Glove-Word2vec model, achieving a high F1 score of 93.02%, was selected as the optimal recognition tool. This model was then used to extract key information from electronic medical records (EMRs) and generate feature variables based on diagnostic rule templates. Subsequently, an XGBoost algorithm was employed to construct an intelligent decision support platform for diagnosing ocular fundus diseases. The effectiveness of the platform in improving diagnostic efficiency and accuracy was evaluated through a controlled experiment comparing experienced and junior doctors.ResultsThe use of the diagnostic intelligent decision support platform resulted in significant improvements in both diagnostic efficiency and accuracy for both experienced and junior doctors (P < 0.05). Notably, the gap in diagnostic speed and precision between junior doctors and experienced doctors narrowed considerably when the platform was used. Although the platform also provided some benefits to experienced doctors, the improvement was less pronounced compared to junior doctors.ConclusionThe diagnostic intelligent decision support platform established in this study, based on the XGBoost algorithm and NER, effectively enhances the diagnostic efficiency and accuracy of junior doctors in ocular fundus diseases. This has significant implications for optimizing clinical diagnosis and treatment.

Automatic segmentation of knee CT images of tibial plateau fractures based on three-dimensional U-Net: Assisting junior physicians with Schatzker classification

PurposeThis study aimed to automatically segment knee computed tomography (CT) images of tibial plateau fractures using a three-dimensional (3D) U-net-based method, accurately construct 3D maps of tibial plateau fractures, and examine their usefulness for Schatzker classification in clinical practice. MethodsWe retrospectively enrolled 234 cases with tibial plateau fractures from our hospital in this study. The four constituent bones of the knee were manually annotated using ITK-SNAP software. Finally, image features were extracted using deep learning. The usefulness of the results for Schatzker classification was examined by an orthopaedic and a radiology resident. ResultsOn average, our model required < 40 s to process a 3D CT scan of the knee. The average Dice coefficient for all four knee bones was higher than 0.950, and highly accurate 3D maps of the tibia were produced. With the aid of the results of our model, the accuracy, sensitivity, and specificity of the Schatzker classification of both residents improved. ConclusionsThe proposed method can rapidly and accurately segment knee CT images of tibial plateau fractures and assist residents with Schatzker classification, which can help improve diagnostic efficiency and reduce the workload of junior doctors in clinical practice.

821 Impact of a One-Day Conference on Perceptions and Understanding of T&amp;O - Outcomes of the South West Orthopaedic Conference 2023

Abstract Aim This study aimed to evaluate the effects of a student-organised conference on delegates’ motivation and understanding of orthopaedic surgery. Method This was a conference organised by students with the support of consultants from the Princess Elizabeth Orthopaedic Centre in The Royal Devon and Exeter Hospital. Identical questionnaires were completed immediately before and after the conference on google forms. The google forms were distributed to the delegates via their registered email address. The pre- and post-conference questionnaire had three sections comprising of understanding, motivations, and barriers to pursing orthopaedic surgery. Pre- and post-conference responses which were recorded on a Likert scale and were compared using Wilcoxon signed rank test. All data analysis performed was using IBM SPSS (v.28, USA). Results 62 delegates completed the questionnaires, the majority of which were medical students with 4 junior doctors. Understanding of orthopaedics showed a significant increase in the majority of questions (p&amp;lt;0.001), except the intention to pursue orthopaedics which showed no significant difference. Delegates were attracted to orthopaedics due to the work-life balance, prestige and salary (p&amp;lt;0.001), however they showed a reduced interest in case variety and private practice. There was no difference in the barriers to pursuing orthopaedic surgery, except lack of patient contact which showed a significant increase (p&amp;lt;0.001). Conclusions Orthopaedic conferences improve delegates understanding, perceptions and motivations to pursue a career in orthopaedic surgery. We therefore encourage orthopaedic surgeons and educationalists to increase exposure to orthopaedics for undergraduates by supporting more student-led initiatives to promote recruitment into orthopaedic surgery.

An artificial intelligence grading system of apical periodontitis in cone-beam computed tomography data.

In order to assist junior doctors in better diagnosing apical periodontitis (AP), an artificial intelligence AP grading system was developed based on deep learning (DL) and its reliability and accuracy were evaluated. One hundred and twenty cone-beam computed tomography (CBCT) images were selected to construct a classification dataset with four categories, which were divided by CBCT periapical index (CBCTPAI), including normal periapical tissue, CBCTPAI 1-2, CBCTPAI 3-5, and young permanent teeth. Three classic algorithms (ResNet50/101/152) as well as one self-invented algorithm (PAINet) were compared with each other. PAINet were also compared with two recent Transformer-based models and three attention models. Their performance was evaluated by accuracy, precision, recall, balanced F score (F1-score), and the area under the macro-average receiver operating curve (AUC). Reliability was evaluated by Cohen's kappa to compare the consistency of model predicted labels with expert opinions. PAINet performed best among the four algorithms. The accuracy, precision, recall, F1-score, and AUC on the test set were 0.9333, 0.9415, 0.9333, 0.9336, and 0.9972, respectively. Cohen's kappa was 0.911, which represented almost perfect consistency. PAINet can accurately distinguish between normal periapical tissues, CBCTPAI 1-2, CBCTPAI 3-5, and young permanent teeth. Its results were highly consistent with expert opinions. It can help junior doctors diagnose and score AP, reducing the burden. It can also be promoted in areas where experts are lacking to provide professional diagnostic opinions.

1170 Bridging the Gap in Surgical Robotics Education

Abstract Aim Despite rapid evolution of surgical robotics systems, training opportunities are very limited especially for medical students and junior doctors. We organised a free-of-charge regional robotics workshop in collaboration with CMR Surgical with the goal of increasing exposure to surgical robotics technology. We also evaluated the delegates’ perception on current surgical robotics training and the workshop. Method CMR Surgical was invited to exhibit their Versius® robot and Virtual-Reality trainer for a one-day workshop at Glenfield Hospital, Leicester. The workshop was advertised across universities and hospital trusts in East Midlands. Registration form included pre-workshop questionnaire which assessed the motivation and barriers to attending surgical robotics courses, and their familiarity with robotics surgery. After 1-hour hands-on exercise supervised by consultants and CMR Surgical trainers, delegates were asked to complete post-workshop questionnaire to evaluate shift in familiarity, interest, and confidence in basic robotic skills. Results 75 delegates registered with 93% having never attended similar workshop before and the barriers were perceiving that robotics surgery skills are for advanced surgeons only (37%), cost (26%), no accessible courses (24%), time constraints (9%) and others (4%). The primary motivation to attend this workshop were learning basic robotic skills (49%), exploring innovative technology (44%) and networking (7%). 30 delegates were shortlisted for 1-hour hands-on experience into six groups consisting of 18 students and 12 junior doctors. Post-workshop feedback showed a positive shift in familiarity, interest, and confidence in basic robotic skills. Delegates also expressed increased interest in surgical specialties after this workshop. They also found VR station was enjoyable and believed it has potential in training future robotic surgeons. Conclusions These findings highlight the feasibility and importance of creating accessible training opportunities to bridge the gap in surgical robotics education.

1276 Creating Safer Theatres. Tackling Religious Headwear Discrimination Nationally

Abstract Aim To identify and challenge discriminatory EDI practices. To improve adoption of national policies on surgical headwear in theatre. Method Freedom of information requests were sent to 124 hospitals with emergency general surgery theatres. Data requested included total staff number, BAME staff percentage, theatre staff percentage, Muslim theatre staff (including ODPs, porters, medical, nursing staff, surgeons, junior doctors), female Muslim staff number, and copies of uniform policies, especially on religious headwear. Two senior trainees reviewed policies. Results 100 of 124 trusts responded to the FOI request. Percentage of BAME staff ranged from 5% to 47%. 12 trusts had no BAME members of staff working in theatres or could not release this data for risk of their few personal being identified. 97 policies were reviewed. 80% of the policies reviewed adhered or replicated the national guidance. Potentially discriminatory practices included necessitating disposable head wear be always worn, lack of specific guidance on the wearing of hijabs, and one policy which appeared to request they would not be worn. Conclusions This project highlights significant disparities in EDI policies within hospital theatre teams, especially regarding religious headwear. The lack of specific accommodations for religious garments creates an exclusionary environment. This can lead to increased stress and lower sense of belonging amongst minority staff. The findings emphasise the need for hospitals to re-evaluate and reform their policies, those with poor practices have been contacted. We aim to foster a more inclusive, equitable workplace.

854 Bridging the Communication Gap in Surgery: A Quality Improvement Initiative to Improve Surgical Juniors’ Confidence in Navigating Difficult Conversations and Documentation

Abstract Aim In response to the challenges faced by surgical juniors in communicating with critically ill patients and their families, particularly after emergency surgery, we initiated a comprehensive two-pronged QIP. Our aims were 1) to enhance skills and confidence of surgical juniors in navigating difficult conversations, and 2) to improve documentation of post-operative patient and NOK discussions after ITU step-down to ward, in-line with NICE guidelines (CG83-1.13). Method A retrospective analysis of 14 laparotomy patients in September 2023, revealed that only 36% had documented NOK discussions 3-5 days post-operatively, falling short of best practice guidelines recommending documentation within 12 hours. Only 33% of the 10 patients requiring ITU admission, received documented NOK updates post-step-down to the ward. Interventions to address this included developing a communication skills workshop and implementing colored cards in notes folders to visually identify patients needing NOK discussions. Results Pre- and post-workshop surveys, utilizing a 1-to-5 scale, measured confidence levels of junior doctors for difficult discussions, with 13 and 9 respondents, respectively. High confidence scores (4 or 5) for different discussion types showed substantial improvement post-workshop: DNACPR (31% vs. 89%), end-of-life (31% vs. 55%), emotionally charged (31% vs. 78%). Furthermore, 100% of participants post-workshop were highly likely (4 or 5) to utilizing communication frameworks e.g., SPIES. Conclusions Our interventions have demonstrated a significant improvement in the confidence of surgical juniors when navigating challenging conversations. Our ongoing efforts include expanding our ‘communication in surgery’ workshop series, which we hope to present, and a re-audit of NOK discussion documentation to objectively measure positive changes post-intervention.

1234 Optimising Vitamin D and Calcium Management in Thyroidectomy Patients

Abstract Aim The study aimed to investigate the causes of temporary postoperative hypocalcemia and strategies for correction. Objectives included assessing the impact of preoperative trust guidelines on detecting and managing Vitamin D deficiency in thyroidectomy patients and analyzing its correlation with postoperative hypocalcemia at Northampton General Hospital. Method A three-cycle audit analyzed 16, 12, and 8 cases, respectively, encompassing total and completion thyroidectomies at NGH. Collaborative development of standardized trust guidelines involved the ENT Team, Endocrinology, and Pharmacists. Data collection covered various parameters, and departmental teachings were conducted to educate the team on the new guidelines. Results Thyroidectomy indications included Graves's disease, large Multinodular Goitre, and malignancy. In the third cycle, all patients underwent preoperative Vitamin D checks, aligning postoperative hypocalcemia with the national range. Our interventions increased preoperative Vitamin D checks from 56% to 100%, reducing deficiency from 25% to 0%. Postoperative hypocalcemia decreased from 56% in Cycle 1 to 8.3% in Cycle 2 and 12.5% in Cycle 3. Long-term hypoparathyroidism dropped to 0% in Cycle 3, with no correlation between surgeon technique or indication and postoperative hypocalcemia. Conclusions The introduction of preoperative guidelines significantly enhanced Vitamin D deficiency detection, substantially reducing postoperative hypocalcemia. This underscores the positive impact of standardized protocols on patient care. Future efforts involve re-auditing with the involvement of junior doctors to ensure continuous enhancement in clinical practice.

835 FAMiSH: Fasting Prior to Emergency General Surgery in Hospital – Quality Improvement Project Protocol

Abstract Aim This study was conducted to evaluate adherence to preoperative fasting guidelines at the Royal Devon University Hospital, focusing on safety and reducing prolonged fasting particularly in geriatric, diabetic or co-morbid patients. Method Data were gathered anonymously over 2 cycles for 4 weeks through patient records and questionnaires to access patient given instructions for fasting to solids and fluids. All patients with emergency surgeries more than 6 hours later were included, excluding emergency operations (NCEPOD) 1 or 2a/2b classification. Issues such as inadequate communication, excessive fasting and medication mismanagement were addressed. Results Cycle one revealed that 25% of patients fasted for more than 6 hours, 56.25% did not consume liquids for more than 12 hours, and 25% abstained from drinking for more than 8 hours preoperatively. It was noted that guidelines were not thoroughly adhered to. Some patients missed medications, besides diabetics with prolonged hours of fasting. We have provided a session for junior doctors and nurses, educating on ASA guidelines, and encouraging individualised fasting plans for patients. Information leaflets were distributed to patients for surgery. In the second cycle only 20% and 24% of patients didn’t follow fasting guidelines for solids and liquids respectively compared to 68.75% of patients receiving inappropriate instructions in first cycle, showing significant improvement in care. Conclusions In our study we have noted improvement in departmental focus on adherence to fasting guidelines, which advise abstaining from solids up to 6 hours and drinks up to 2 hours prior to surgery, aiding patient safety and improvement of quality of care.

822 Burn Bright, Learn Brighter: Igniting Expertise in Burns Care with Virtual Reality

Abstract Aim To assess the effectiveness of a burns assessment and management course for junior doctors, comparing virtual reality (VR) training with traditional didactic instruction and moulage. Method Foundation doctors (n=36) were divided into two groups: one receiving VR training and the other traditional instruction with in-person moulage practicals covering burns assessment and emergency management. An objective structured clinical examination (OSCEs) and pre, post and 6-weeks post-course questionnaires assessed knowledge retention and performance. Analysis involved paired sample t-tests. Qualitative analysis evaluated post course feedback. Results The VR group exhibited a significant increase in burns assessment accuracy and knowledge (p&amp;lt;0.05) but a decrease in burns management (p&amp;lt;0.05) compared to the control group in the OSCE. Both groups demonstrated significant improvement of 24% (VR, p&amp;lt;0.05) and 21% (control, p&amp;lt;0.05) in knowledge post-course. There was also significant retention at 6-weeks, with mean improvement of 19% (VR, p&amp;lt;0.05) and 17% (control, p&amp;lt;0.05). Qualitative feedback highlighted the VR's superior visualisation in assessment scenarios, while moulage-based practicals were perceived as more realistic for burns management. 33% considered an occupation in burns as a subspecialty, 100% reported increased confidence in burns assessment and management. Conclusions VR training proved effective in enhancing burns assessment skills, but its realism in burns management scenarios was questioned. Integrating VR alongside traditional methods demonstrated a comprehensive improvement in participants' overall burns care competency and a notable boost in confidence levels. Findings underscore the importance of balancing technological advancements with practical realism in plastic surgery education.

1021 Accuracy of Clinical Coding in General Surgery and Its Financial Impact

Abstract Aim To analyse the clinical coding performed at a tertiary centre after patient discharge and compare it with the clinical summary to identify any inconsistency and its financial implications. Method Fifty patient episodes were selected randomly between June 2023 and August 2023 under the general surgery department. Clinical notes, discharge summaries and existing clinical codes were scrutinized by liaison with the clinical coding department. Financial losses were noted, and the summary was later presented at the local clinical governance meeting. Results A total of £38,760 was lost in 50 patients. Loss incurred was primarily due to incomplete information in the discharge summary, related to the patient’s comorbidities, incomplete diagnosis, and procedure/investigations. These results were discussed in a clinical governance meeting and a poster was made to disseminate the conclusion and improve the quality of the discharge summary. Conclusions A total of £38,760 of funding was lost due to discrepancies in the clinical coding. An intervention in the form of a poster and teaching session was conducted for junior doctors and a repeat cycle is planned in the due course of time to improve the quality and minimise the loss of funding.

The Echo Report Understood: Improving Education in Echocardiography for Junior Doctors.

With echocardiography standing as the most widely used cardiac imaging modality, echocardiography report interpretation is a core responsibility of junior doctors. The literature, however, reveals a deficit in echocardiography education. The implications of this for patient care should not be ignored. To address this need, a hybrid teaching session was developed for junior (intern and resident grade) doctors, with the aim to increase understanding of echocardiography and increase confidence in report interpretation. Pre- and post-session data were analysed. Results revealed that the vast majority of respondents received less than an hour of echocardiography teaching at medical school, with over two-thirds receiving less than an hour in the postgraduate setting. A total of 80% of doctors interpreted echocardiography reports weekly, with almost all doctors perceiving this skill as important. Despite this, an overwhelming majority of doctors did not feel confident interpreting reports.The educational intervention achieved significant increases in perceived understanding of echocardiography and confidence with report interpretation. Participants were better able to identify cardiac pathology and understand report terminology. This intervention has the scope to improve patient safety through better management of cardiac patients and recognition of pathology from echocardiography. This work also identifies a need for more echocardiography education, having uncovered a concerning lack of confidence amongst junior doctors and an appetite for further teaching on this important topic.