Medical Senior House Officers Research Articles

‘Step up’: utilising simulation to assist in the transition from medical senior house officer to registrar

Core medical training was replaced by Internal Medicine Training (IMT) in August 2019. One of the more notable changes was the introduction of a 3 We created an in-person teaching day, entitled ‘Step up’, which consisted of four 20-minute, IM3 specific, high-fidelity scenario-based simulations. In each scenario, a computerised full-body manikin (SimMan Essential) was used. The manikin could be programmed to provide physiological response to scenario participants’ actions. The participants were each tasked to assess an acutely deteriorating patient (the manikin), whilst managing a demanding bleep to add realistic distractions and human factor issues to the scenario. Each participant completed one scenario and watched their peers complete the others from a separate room. Following this, participants were debriefed by qualified member of staff and then taught by a speciality registrar or consultant. Feedback forms were collected. The participants were tasked to rate the simulation day, using a nominal Likert scale from 1 to 10, for usefulness, relevance, clarity, and overall quality. 1 represented strong disagreement and 10 strong agreements with a particular domain. Across 4 full days, we had 11 IM3 doctors take part in the ‘step up’ scenario-based simulations. 9 of the 11 participants completed feedback forms. Scores ranged from 8 to 10. Median scores for all domains were 10. We have demonstrated that ‘step up’ scenarios are a useful and relevant aid for those transitioning into IM3. Further research utilising comparative data will provide more meaningful conclusions. We will be repeating the simulation programme for the next cohort. We will have baseline, one and three-month follow up questionnaires to assess these scenarios further. 1. Buist N, Webster CS. Simulation training to improve the ability of first-year doctors to assess and manage deteriorating patients: a systematic review and meta-analysis. Medical Science Educator. 2019;29(3):749–761.

108 COMBATTING CONFUSION: SIMULATION-BASED MEDICAL EDUCATION FOR DEALING WITH DELIRIUM

Abstract Background Delirium is a complex, costly, and common clinical syndrome. Simulation-based medical education has been shown to be effective in enhancing the confidence, knowledge and skills of healthcare professionals in the management of delirium. We piloted an inter-professional education simulation on delirium in an acute hospital setting. The session’s design was informed by participating in ‘Sim Stars’, a regional simulation development competition. Methods We iteratively developed a low-fidelity simulation scenario on the recognition, prevention and management of delirium. The resulting simulation was piloted during an hour-long multidisciplinary departmental teaching session in a lecture hall setting. A candidate was asked to review an acutely confused patient (played by a ‘confederate’) on call. The candidate was expected to screen for delirium using the 4AT tool; assess for possible causes of delirium; and implement an appropriate management plan. After the session, qualitative feedback from the participants and audience was sought. Results This pilot simulation included one candidate (medical Senior House Officer); two confederates (Consultant Geriatrician, Advanced Nurse Practitioner); two facilitators (Consultant Geriatrician, Advanced Nurse Practitioner); and an audience of 17 members. Feedback indicated that learners and trainers found this a helpful and enjoyable pedagogical method. Areas for improvement were highlighted, including providing advance notice for learners of the topic to be simulated; a more structured introduction defining the learning outcomes and declaring a ‘blame free’ environment; improved script for the patient confederate; and that having a team of learners (rather than specialists) to play ‘confederates’ may help improve team-building and reduce learner anxiety. Conclusion This pilot simulation received positive appraisals from the team, and plans are underway to incorporate simulation more regularly into departmental teaching. Suggestions to improve future simulations were welcomed. Given its low-fidelity, this scenario can easily be used at any site for simulation-based training.

William Smith Mitchell

William Smith Mitchell (“Bill”) was a consultant general physician and rheumatologist at Furness General Hospital in Barrow for over 30 years. He did his initial medical training, including an intercalated...

Singly-qualified medical senior house officer in oral and maxillofacial surgery: perspectives from a unit

Despite constituting a minority of senior house officers (SHO) in oral and maxillofacial surgery (OMFS), the number of singly-qualified medical trainees is growing. We describe the experience of a singly qualified medical trainee in OMFS and the unique benefits and opportunities for potential trainees and the department. Overall, the advantages of synergistic training outweigh any deficiencies in knowledge, and in our experience, having both medical and dental trainees in our unit has maximised training opportunities and provided a more holistic approach to patient care. Increased exposure to conditions in the head and neck also benefits trainees who wish to pursue careers in other specialties such as ear, nose, and throat (ENT), neurosurgery, ophthalmology, and plastic surgery.

A quality improvement comparative audit on theimpact of competency based basic intensive care medicine (ICM) training on the confidence levels of medical senior house officers registrars dealing with intensive care procedures in acutely ill patients

Medical training in the UK has now changed with the development of Foundation Programmes (which includes the pre-registration House Officer year plus one additional year) providing two years of experience in a range of disciplines that may include acute medicine and 3 months Basic training in ICM [1]. The ICM training programme, being competency based, can inter link well with these developments [2]. Intensive care has been described as a horizontal specialty cutting across the traditional vertical specialties of medicine, surgery, paediatrics etc [3]. Several studies have demonstrated the need for all medical postgraduates to undergo Intensive care Medicine training [4].

Contribution of medical senior house officers to a medical referral in the emergency department

In Irish hospitals, the medical senior house officer (SHO) is the most junior fully qualified doctor on the medical on-call team. After a patient has been seen by an emergency department doctor of any level, they are almost always referred directly to the medical SHO. This process has been shown to delay a patient's ward admission by 3 hours 30 minutes [1]. We attempted to quantify the additional benefit for the patient of being seen by the on-call medical SHO, in terms of patients discharged, new diagnoses reached, and new treatments initiated.

PB6 Antimicrobial stewardship education and effect on prescribing in the emergency department of an irish teaching hospital

Objectives and BackgroundCareful selection of antimicrobials is imperative in preventing adverse events and resistant organisms. Guidelines and their availability encourage appropriate prescribing. In our centre, the microbiology team present bi-annually...

Call screening by hospital switchboard operators

This study aimed to determine whether screening of telephone calls occurs in hospitals acrossEngland. Eighteen hospitals were selected at random. The caller requested connection to a namedconsultant and to the on-call medical Senior House Officer (SHO). The results of this study highlight a variation in policies between hospitals. All calls were connected to the on-call SHO, with 39% of switchboard operators asking the caller to identify themselves. In the case of calls toconsultants, 67% of callers were asked for identification; 28% of callers were connected to the consultant's mobile telephone-12% of which had not been asked for identification. This study demonstrates the need for local trusts to protect their staff, either by implementing training sessions on how to manage inappropriate calls or by participating in the development of national guidelines to aid switchboard operators to screen calls effectively.

A professor in Old Age Psychiatry

Robin Jacoby is professor emeritus of old age psychiatry at the University of Oxford. He is coeditor of the Oxford Textbook of Old Age Psychiatry and chairman of the Global Initiative on Psychiatry. Initially I did a language degree in Russian and French at Oxford, and then I did one term towards a PhD before deciding to study medicine. My preclinicals were at Oxford and my clinicals at Guy’s. After my house jobs I went to Southampton, where I worked as a medical senior house officer and medical registrar. For various reasons I decided to go into psychiatry, so I went to talk to the vice dean at the Maudsley. I then applied and stayed there about 20 years. It’s been renamed the Global Initiative on Psychiatry (www.gip-global.org), and it grew out of a group of people who were opposed to the political abuse of psychiatry in the former Soviet Union. I got involved because Jim Birley, who had …

Women in neurology

The medical profession has traditionally been dominated by men but, with over 60% of medical students in the UK possessing two X chromosomes, this imbalance is likely to change. The UK is not alone in training more female medical students than men, but it is unclear whether this change in demographics, and the associated need to take time out for child-care, will alter the provision of neurological services in richer nations. A paper due to be published in the August issue of Clinical Medicine begins to answer this question. The authors of the study, led by Camille Carroll at the University Hospitals Coventry and Warwickshire, UK, used a questionnaire to examine the life choices made by neurology consultants and trainees, general medical senior house officers, and medical students. The investigators received 344 responses, including replies from 30% of the neurology trainees and consultants who were contacted. The findings, although preliminary and possibly unrepresentative because of the poor response rate and small sample size, are interesting and potentially relevant for planning the provision of neurological services in developed countries. Carroll's team found that more female than male consultant neurologists were childless (20% of 35, compared with 8% of 91). Additionally, female neurologists had on average fewer children than did male neurologists (1·9 vs 2·4), and had their first child later, at an average age of 33·4 years. The female neurologists were also more likely to relocate geographically because of their partner's work: 49% of female consultants had done so, compared with just 10% of male consultants. But perhaps the most important issue, in terms of service provision, to come out of the study is that both sexes would like to do more part-time work or have a career break. Around 87% of women at all four levels of experience were planning to work part-time at some point, primarily for child-care reasons. By comparison, 25% of working male doctors wanted to work part-time or take a career break to pursue sporting ambitions, to travel, or for semi-retirement. As the Profile on page 760 shows, women can reach the upper levels of academic neurology while being mothers. However, this involves sacrifices that many people will be unwilling to make. Because clinical neurology has a large outpatient component, it could offer more opportunities for part-time work than medical specialties that have greater out-of-hours commitments. But for this potential to be realised, many more neurologists will need to be trained, and employers will need to develop strategies to accommodate part-time workers. Karen Roos: treating neuroinfections in IndianaThe state of Indiana in the USA has undergone a huge demographic change, with around 200 000 immigrants, from all over the world, settling there in the past 5 years. Some of these people have brought with them infections of the nervous system that were uncommon in Indiana in the not too distant past. “We see a lot of tuberculosis, we see a lot of neurocysticercosis, that sort of thing”, explains Karen Roos, a professor of neurology at the Indiana University School of Medicine. “The immigrants are from all over the world. Full-Text PDF

The feminisation of British neurology: implications for workforce planning

As in other hospital specialties, an increasing proportion of neurology trainees are female. To predict the workforce implications it is necessary to determine what life choices future neurologists will make. A questionnaire survey of life choices was administered to neurology consultants and trainees, general medical senior house officers, and medical students. Of the 344 respondents, 3% of specialist registrars (SpRs) and 4.6% of consultants work part time. Eighty-seven per cent of female and 22% of male junior doctors plan to work part time for, on average, 7.5 and 1.5 years respectively. Thirty percent of consultants also plan to work part time. A number of SpRs (14.3%) and consultants (6%) have taken a career break while 37.5% of SpRs and 18.2% of consultants are planning a career break. The changing demands of both sexes will have a greater impact on the neurology workforce than the increasing proportion of women alone. Increased part-time working will require additional trainees to ensure service requirements are met.

It's Getting Better: Progress in Medical Senior House Officer Training in Scotland

To identify factors which influence the quality of education and training for medical senior house officers (SHOs) in Scotland compared to a study in 1995. Postal questionnaire to collect both qualitative and quantitative data. All 640 SHOs in hospital general medicine and medical specialty posts were identified; 395 (62%) responded. Working patterns, experience of education and training, career choice, and an "attitudes to work" scale. Sixty seven percent of SHOs had been in post for 2 years or less. Seventy three percent work some form of shift pattern compared to 28% in 1995. There were improvements in on the job feedback (92% v 27%), and awareness of educational supervisors (96% v 48%). SHO specific teaching was only available to 49% and was rarely bleep-free. Sixty eight percent had made career decisions. There was a statistically significant improvement in 20/25 components of an attitudes to work scale. Overall medical SHOs have more positive attitudes to their work in 2003 than in 1995, mirroring educational improvements in the work place and changes in working patterns. There remain challenges particularly in provision of formal educational activities.

Diabetes and endocrinology as a career? A questionnaire survey of medical senior house officers

Diabetic MedicineVolume 22, Issue 7 p. 955-956 Diabetes and endocrinology as a career? A questionnaire survey of medical senior house officers K. S. Higgins, K. S. Higgins SpR Diabetes & Endocrinology, Leicester General Hospital, Leicester, UKSearch for more papers by this author K. S. Higgins, K. S. Higgins SpR Diabetes & Endocrinology, Leicester General Hospital, Leicester, UKSearch for more papers by this author First published: 23 June 2005 https://doi.org/10.1111/j.1464-5491.2005.01561.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume22, Issue7July 2005Pages 955-956 RelatedInformation

CORRESPONDENCE

In their article Scott et al (vol 64(7), 2003, p. 425) show that nearly 50% of trainee physicians and surgeons do not feel adequately trained in cardiopulmonary resuscitation (CPR). We were intrigued that they included both surgeons and physicians as very few cardiac arrest teams include members of the surgical team. In contrast nearly all medical senior house officers (SHOs) and registrars are or have been members of the cardiac arrest team. One would expect them to have had more training and be more comfortable in the arrest situation than their surgical colleagues.

Nuclear medicine and radionuclide imaging: a survey of recruitment issues in the United Kingdom.

This wide ranging survey has highlighted difficulties in recruiting trained and committed individuals into nuclear medicine and radionuclide radiology. Several key factors have been recognised that reduce the attractiveness of the training. Recommendations include the rotation of medical senior house officers through nuclear medicine, reconsideration of dual accreditation in nuclear medicine and medicine, an increase in the number of consultant posts in nuclear medicine, parity of remuneration for nuclear medicine trainees and finally, an appropriate sessional provision for those providing radionuclide radiology services.

Communication between members of the cardiac arrest team — a postal survey

Aims: Effective communication enhances team building and is perceived to improve the quality of team performance. A recent publication from the Resuscitation Council (UK) has highlighted this fact and recommended that cardiac arrest team members make contact daily. We wished to identify how often members of this team communicate prior to a cardiopulmonary arrest. Method: A questionnaire on cardiac arrest team composition, leadership, communication and debriefing was distributed nationally to Resuscitation Training Officers (RTOs) and their responses analysed. Results: One hundred and thirty (55%) RTOs replied. Physicians and anaesthetists were the most prominent members of the team. The Medical Senior House Officer is usually nominated as the team leader. Eighty-seven centres (67%) have no communication between team members prior to attending a cardiopulmonary arrest. In 33%, communication occurs but is either informal or fortuitous. The RTOs felt that communication is important to enhance team dynamics and optimise task allocation. Only 7% achieve a formal debrief following a cardiac arrest. Conclusion: Communication between members of the cardiac arrest team before and after a cardiac arrest is poor. Training and development of these skills may improve performance and should be prioritised. Team leadership does not necessarily reflect experience or training.

Teaching the management of medical emergencies

NO. 8 Training students and doctors to deal with medical emergencies is problematic. Patients present sporadically at uncontrolled times. Learning by trial and error is unacceptable. In Anaesthesia and Surgery many of the core skills and emergency routines can be learned under direct senior supervision but the same is often not the case in Medicine. There is also a distinct gap between possession of knowledge and skills and their application: adequate knowledge in theory may not be translated into effective patient management. In order to address these issues a Medical Emergencies Teaching Programme has been developed for final year Medical Students and new-start Medical Senior House Officers (SHO). This consists of a series of tutorials, skills stations and simulated acutely ill patient management scenarios which are filmed and used for debriefing. A Medical Emergencies Hand-book has been written and provides the core materials for the course. Tutorials are all interactive and based on real cases. They are organized through the seven weeks of the student course and are condensed in the SHO 2-day course. They include 'Initial Assessment and Management of the Acutely III Adult', LVF, shock, haemorrhage, anaphylaxis, acute coronary syndromes, respiratory emergencies, basic and advanced life support, prescribing drugs and talking to bereaved relatives. Practical skill stations run in the 2nd and 3rd weeks of the student course. These cover airway support, how to administer oxygen and nebulisers, rapid infusion, using monitoring (ECG, pulse oximetry, cuff BP), the cardiac arrest trolley, basic and advanced life support and defibrillation. Simulated patient management. Once the above skills have been learned the students then manage emergencies in real-time as a team of four, with access to all of the equipment and communications they would have in an acute clinical area, working on a 'low-tech' simulator. This is video-recorded and a debriefing teaching session immediately follows the case. Scottish Clinical Simulation Centre. The final full day of the course involves real-time emergency patient management in teams using a high fidelity clinical simulator with video-recording and debriefing. Summary This course combines cognitive and practical training early. The core philosophy of the management of the acutely ill patient is emphasized and standard core material issued from the start. There is early inclusion of real-time, hands-on patient management using a 'low-tech' system with video recording. These structured, sequential elements ensure that the students are familiar with the management of the acutely ill and with the teaching processes such that they gain maximally from the exposure to the high tech simulator. Feedback from the first 140 students completing the course has been unanimously positive. The next step is to evaluate the influence this teaching has on clinical management.

Teaching the management of medical emergencies

Training students and doctors to deal with medical emergencies is problematic. Patients present sporadically at uncontrolled times. Learning by trial and error is unacceptable. In Anaesthesia and Surgery many of the core skills and emergency routines can be learned under direct senior supervision but the same is often not the case in Medicine. There is also a distinct gap between possession of knowledge and skills and their application: adequate knowledge in theory may not be translated into effective patient management. In order to address these issues a Medical Emergencies Teaching Programme has been developed for final year Medical Students and new-start Medical Senior House Officers (SHO). This consists of a series of tutorials, skills stations and simulated acutely ill patient management scenarios which are filmed and used for debriefing. A Medical Emergencies Handbook has been written and provides the core materials for the course. Tutorials are all interactive and based on real cases. They are organized through the seven weeks of the student course and are condensed in the SHO 2-day course. They include ‘Initial Assessment and Management of the Acutely Ill Adult’, LVF, shock, haemorrhage, anaphylaxis, acute coronary syndromes, respiratory emergencies, basic and advanced life support, prescribing drugs and talking to bereaved relatives. Practical skill stations run in the 2nd and 3rd weeks of the student course. These cover airway support, how to administer oxygen and nebulisers, rapid infusion, using monitoring (ECG, pulse oximetry, cuff BP), the cardiac arrest trolley, basic and advanced life support and defibrillation. Simulated patient management. Once the above skills have been learned the students then manage emergencies in real-time as a team of four, with access to all of the equipment and communications they would have in an acute clinical area, working on a ‘low-tech’ simulator. This is video-recorded and a debriefing teaching session immediately follows the case. Scottish Clinical Simulation Centre. The final full day of the course involves real-time emergency patient management in teams using a high fidelity clinical simulator with video-recording and debriefing. Summary This course combines cognitive and practical training early. The core philosophy of the management of the acutely ill patient is emphasized and standard core material issued from the start. There is early inclusion of real-time, hands-on patient management using a ‘low-tech’ system with video recording. These structured, sequential elements ensure that the students are familiar with the management of the acutely ill and with the teaching processes such that they gain maximally from the exposure to the high tech simulator. Feedback from the first 140 students completing the course has been unanimously positive. The next step is to evaluate the influence this teaching has on clinical management.

Experience of medical senior house officers in preparing discharge summaries

The discharge summary communicates information about a patient's stay in hospital and follows the hand written summary that accompanies the patient on discharge. Previous studies have indicated dissatis-faction among general practitioners with the quality of discharge summaries.1 2 Most are done by senior house officers, and this survey assesses their experience in preparing them. A medical senior house officer from each of 100 acute hospitals in England replied to a telephoned questionnaire about teaching they had received on preparing discharge summaries and arrangements for doing summaries in their hospital. Ninety two of the doctors prepared summaries in their present post. On six firms the house physician was responsible, while a consultant and registrar were responsible in the other two. Six senior house …

Experience of medical senior house officers in preparing discharge summaries.

The discharge summary communicates information about a patient's stay in hospital and follows the hand written summary that accompanies the patient on discharge. Previous studies have indicated dissatis-faction among general practitioners with the quality of discharge summaries.1 2 Most are done by senior house officers, and this survey assesses their experience in preparing them. A medical senior house officer from each of 100 acute hospitals in England replied to a telephoned questionnaire about teaching they had received on preparing discharge summaries and arrangements for doing summaries in their hospital. Ninety two of the doctors prepared summaries in their present post. On six firms the house physician was responsible, while a consultant and registrar were responsible in the other two. Six senior house …