Medicine Registrars Research Articles

Ιnternists’ and Endocrinologists’ Knowledge and Attitudes Regarding Periodontal Disease, Caries, Xerostomia and Diabetes Mellitus: A National Survey

Objectives: The present study aims to investigate the current knowledge, attitudes and behaviors of clinicians dealing with diabetes regarding the relationship of Diabetes Mellitus (DM) and odostomatological diseases, such as periodontal disease, xerostomia and caries. Methods: A twenty-four item closed-ended multiple-choice questionnaire was completed by 225 Greek medical doctors. The sample was divided into three groups according to specialty: a) Endocrinologists; b) Internists; c) Internal medicine registrars. Bivarate analysis, Fisher test, and Spearman correlation were used for statistical analysis. Results: Most doctors were aware of the bi-directional relationship between periodontal disease and DM. Regarding the relationship between DM and xerostomia, 50% of doctors were unaware that patients with DM have an increased risk of xerostomia and were unfamiliar with the relevant studies. Nearly 50% of doctors agreed that patients with diabetes are at increased risk of developing caries. Age, specialty, and years of expertise have an impact on the way of doctors' answer. Finally, 78,6% of doctors treating diabetes should cooperate with dentists to reduce their patients' risk of odontostomatological complications. Conclusions: The relationship between diabetes and dental problems is often underestimated. Implementation of medical and dental educational programs oriented in increasing inter-professional education as well as collaboration between dentists and doctors dealing with diabetes, are needed in order to achieve the goal of better care of patients with diabetes.

Mastering your fellowship: Part 3, 2022.

The series, ‘Mastering your Fellowship’, provides examples of the question formats encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP SA) examination. The series is aimed at helping family medicine registrars (and their supervisors) prepare for this examination.

Mastering your fellowship: Part 2, 2022.

The series, ‘Mastering your Fellowship’, provides examples of the question format encountered in the written and clinical examinations, Part A of the Fellow of the College of Family Physicians South Africa (FCFP SA) examination. The series is aimed at helping family medicine registrars prepare for this examination. Model answers are available online.

Mastering your fellowship: Part 1, 2022.

The series, ‘Mastering your Fellowship’, provides examples of the different question formats encountered in the written and clinical examinations, that is, Part A of the Fellowship of the College of Family Physicians South Africa (FCFP SA) examination. The series is aimed at helping family medicine registrars (and their supervisors) prepare for this examination.

The role played by family physicians in providing health services for the sheltered homeless populations during COVID-19 lockdown in the Tshwane district.

This short report describes the role that family physicians (FPs) (and family medicine registrars) played to provide care for the homeless people in shelters (both temporary and permanent) during the coronavirus disease 2019 (COVID-19) lockdown in the City of Tshwane, South Africa. The lockdown resulted in the establishment of a large number of temporary shelters. The FPs took on the task to provide comprehensive and coordinated primary care, whilst extending their activities in terms of data management, quality improvement, capacity building and research. The FPs worked in teams with other healthcare providers and contributed a unique set of skills to the process. This report demonstrates the value of responding quickly and appropriately through communication, cooperation and innovation. It also demonstrates the large number of areas in which FPs can make a difference when engaged appropriately, with the necessary support and collaboration, thus making a positive impact in the already overburdened health services.

The GP crisis: demonised and demoralised.

Frustrated. Exhausted. Burnt out. These are just some of the things our colleagues in primary care are feeling. I’m a GP registrar in the final 6 months of my training. It’s taken me 15 years to get to this stage after starting my medical education in 2006. It’s taken commitment, numerous exams, and countless sacrifices; but it has always been worth it knowing I was making a difference to my patients’ lives and the satisfaction their hard-earned respect and gratitude gleaned. But all that has changed. The recent vitriol aimed at primary care from mainstream and social media is demoralising, soul destroying, and incredibly damaging. Contrary to popular belief, we are and always have been open. Prior to entering GP training, I worked in secondary care as a medical and emergency medicine registrar. Like most of my hospital colleagues, I had little understanding of what actually happened in the mystical land of general practice. I do now. Having been the most senior doctor covering medical wards and emergency departments out of hours in busy inner-city hospitals, I can firmly say I have never been busier. The pressures are different, but the impact is real and …

A junior doctor on the other side of a bone marrow transplantation

As an emergency medicine registrar, I thought I was hardened to the fear of illness. Yet, the words acute myeloid leukaemia hit me as hard as I can imagine they could possibly hit anyone. 2 years later, on the far side of two rounds of induction chemotherapy, a sibling allograft, and the ups-and-downs of chronic graft-versus-host disease, I am privileged to be back working in the bustling energy of the emergency department.

Mastering your fellowship.

The series, ‘Mastering your Fellowship’, provides examples of the question format encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP SA) examination. The series is aimed at helping family medicine registrars to prepare for this examination.

The family physician as a primary care consultant - the Mossel Bay experience.

The South African family physician (FP) is an expert generalist who has a number of roles to strengthen the district health system. A research study on FPs in district hospitals has previously demonstrated an impact; however, more evidence on impact in primary health care (PHC) is needed. By serving as a consultant for the PHC team, the FP may improve access to care, capacitate team members, enhance comprehensiveness of care, and improve coordination and continuity of care. This report narrates the story of how one of the FPs at a rural district hospital recorded his experience of being a consultant to the PHC team and was able to self-audit the experience. A self-designed audit tool analysed 1000 patient consultations with the FP and enabled a reflection on the coronavirus disease 2019 (COVID-19)-related changes to the consultant role. There was a clear need for FPs to consult patients with complex multi-morbidity and multifaceted psychosocial aspects to their illness, in consultation with their team members. Patients were referred to them by medical officers, other specialists, family medicine registrars, allied healthcare professionals and nurse practitioners. The FP’s ability to strengthen the PHC service outside the district hospital may be enhanced by creating more FP posts at a subdistrict level to support high-quality, team-based primary care in line with the PHC policy directions.

Mastering your fellowship.

The series, ‘Mastering your Fellowship’, provides examples of the question format encountered in the written and clinical examinations, Part A of the FCFP (SA) (Fellowship of the College of Family Physicians [SA]) examination. The series is aimed at helping family medicine registrars (and their supervisors) prepare for this examination. Model answers are available online.

Quality of care, resource use and patient outcome by use of emergency response team compared with standard care for critically ill medical patients in the emergency department: a retrospective single-centre cohort study from Norway

ObjectiveThe study aimed to investigate quality of care, resource use and patient outcome in management by an emergency response team versus standard care for critically ill medical patients in the...

Mastering your fellowship.

The series, ‘Mastering your Fellowship’, provides examples of the question format encountered in the written and clinical examinations, Part A of the Family Physicians of South Africa (FCFP SA) examination. The series is aimed at helping Family Medicine registrars prepare for this examination. Model answers are available online.

45 Quality Improvement Project on Delirium Care in Older Patients at Mid Yorkshire Hospitals NHS Trust (MYHT)

Abstract Background To improve delirium care in older patients admitted to a large district general NHS Trust in the UK, a quality improvement project was conducted. Introduction The national NICE guidelines (CG103) and recent SIGN guidelines recommend delirium is diagnosed by a clinical assessment based on DSM criteria (e.g. CAM or 4AT) and managed by identifying and treating the causes alongside multicomponent interventions. The results of MYHT’s 2018 delirium audit showed the use of CAM or 4AT was 32.5% and delirium care plan was 20%. A quality improvement project was developed and implemented for 6 weeks on a frailty admission unit. Method The quality improvement project introduced a delirium care checklist sticker for medical notes in cases of suspected delirium, brief education sessions for ward doctors regarding delirium care and use of the sticker and reminder emails, all implemented by the elderly medicine registrar. The target measures were completion of stickers, 4AT and delirium care plan. Data was collected by the registrar once a week for 6 weeks and entered into a run chart. Feedback was collected from staff on barriers to use. Results 31 patients with suspected delirium has their notes reviewed. The sticker use gradually reduced from 57% of cases in week 1, to 0% in week 6. The 4ATwas completed in 57%, 50% and 100% of cases in the first 3 weeks, but dropped to 40%, 4.2% and 1.3% in the last 3 weeks. A delirium care plan was initiated in 42% and 37% of cases in the first two weeks but ended at 0% by week 6. Barriers included a lack of education sessions from week 2 onwards due to registrar on call shifts. Also junior doctor changeover in week 3. Feedback indicated barriers were time taken to complete, and confusion over ownership of completing 4AT and care plan between medical and nursing teams. Conclusion Although a delirium care checklist sticker and brief education sessions can improve delirium care, sustained improvement requires ongoing education and addressing barriers to completion.

Mastering your fellowship.

The series, ‘Mastering your Fellowship’, provides examples of the question format encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP, SA) examination. The series is aimed at helping family medicine registrars (and their supervisors) prepare for this examination. Model answers are available online.

Quality use of diagnostic imaging in trauma, and the impact on emergency medical practice-a retrospective clinical audit.

The current study aimed to evaluate the appropriateness of the decisions made to order diagnostic imaging for emergency trauma patients. A retrospective audit of 642 clinical decisions for 370 non-consecutive trauma cases was conducted at a level 1 adult trauma centre. Radiographs and computed tomography investigations were compared for compliance with the American College of Radiology/European Society of Radiology (ACR/ESR) imaging guidelines. The non-compliant imaging orders were evaluated for the following medical officer ranks: Junior Medical Officer (JMO), Senior Resident Medical Officer (SRMO), Emergency Medicine Registrar (EMR) and Consultants/Career Medical Officer (CMO). The time of imaging order (day/evening or night shift), whether the imaging led to conservative or surgical patient management, and whether the imaging order decisions led to a change in the clinical management of the patient were also considered. Non-compliance with the ACR/ESR guidelines was low. At least half of non-compliant decisions made by each level of medical officer resulted in a change in patient management. In total, 11 (65%), 25 (53%), 12 (63%) and 11 (52%) of non-compliant imaging orders placed by JMOs, SRMOs, EMRs and Consultants, respectively, resulted in change of patient management. JMOs and SRMOs ordered a significantly higher proportion of non-compliant imaging studies for conservatively managed patients in comparison to surgically managed patients. This study highlighted that most non-compliant imaging orders benefited the patient.

Krishna Korlipara: founder of the National Association of GP Cooperatives and longest serving elected member of the GMC

Krishna Korlipara was born in Denduluru, a rural agricultural village in Andhra Pradesh state, south India. Korlipara grew up in a large family. His father was Laxminarayana Korlipara, his mother...

Mastering your fellowship.

The series, ‘Mastering your Fellowship’, provides examples of the question format encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians, South Africa (FCFP [SA]) examination. The series is aimed at helping family medicine registrars prepare for this examination. Model answers are available online.

Credentialing of emergency medicine trainees in point-of-care ultrasound: An effective, efficient and enjoyable model.

The Australasian College for Emergency Medicine Curriculum Framework contains numerous mentions of point-of-care ultrasound (PoCUS). However, obtaining formal PoCUS credentials is often problematic. The Fiona Stanley Hospital ED PoCUS training programme was devised to assist emergency medicine trainees to meet the credentialing requirements of the Australasian College for Emergency Medicine and the Australasian Society for Ultrasound in Medicine. Six emergency medicine registrars are selected for each 6-month semester. Successful applicants nominate two modules of Australasian Society for Ultrasound in Medicine's Certificate in Clinician Performed Ultrasound and receive dedicated non-clinical time. For 3 h a week, an emergency physician holding formal PoCUS credentials supervises a pair of trainees while they perform scans on ED patients. During these sessions, trainee logbooks can be reviewed and assessments occur as required by the module. Over an 18-month period, 18 emergency registrars were involved, averaging eight 3-h sessions each. All selected the Extended Focused Abdominal Scan for Trauma module, 14 chose Abdominal Aortic Aneurysm and eight chose Basic Echo in Life Support. Overall, 30 (75%) of 40 modules were completed within the trainees' 6-month semester. Just under half of logged scans were obtained during the supervised sessions. Overall, the average number of scans performed exceeded each module's logbook requirements. Trainees perceived that involvement in the programme benefited their ability to manage patients. There was overwhelming support for the structure of the programme. The Fiona Stanley Hospital ED model is effective in assisting emergency medicine trainees to gain formal PoCUS credentials. As it requires relatively little organisation, time and staffing, it could be adopted in many EDs around Australia and New Zealand.

The views and experiences of Zambia's emergency medicine registrars in South Africa: Lessons for the development of emergency care in Zambia.

IntroductionAlthough low- and middle-income countries (LMICs) are beginning to integrate emergency medicine (EM) specialist physicians into their healthcare systems, they must often send these trainees to other countries with established registrar programmes. Given that retention of foreign-trained EM specialist physicians is low following repatriation, there is interest in understanding their expectations and intentions when they return. This study aimed to describe the expectations of Zambia's EM registrars regarding the development of various aspects of emergency care in Zambia.MethodsIn this qualitative, descriptive study, individual telephonic interviews were conducted with current Zambian EM registrars using a semi-structured interview schedule. Recorded interviews were transcribed verbatim, validated by participants, and subjected to inductive content analysis.ResultsFour interviews were completed, representing the entire population of interest. Two key categories emerged from these discussions: that the state of emergency care in Zambia was inadequate, and that there were numerous priority areas for further developing the emergency care system. A lack of recognition of EM as a specialty, resource and training constraints in emergency units, and the lack of a formal prehospital emergency care system were prominently identified as challenges. Priority aspects that registrars hoped to focus on when developing emergency care included expanding local training and knowledge, improving the supply chain for essential medications and equipment, increasing interprofessional collaborative practice, and advocating for emergency care.ConclusionZambian EM registrars characterised the nascent emergency care system by challenges that are common in many LMICs and align with previous in-country assessments of emergency care. In order to ensure that registrars' strategies are ultimately implemented upon their return to Zambia, it is imperative they are communicated with stakeholders in-country. From there, mutual planning can occur between future EM specialists and government stakeholders, to ensure that there are mechanisms in place to facilitate dissemination.

Mastering your fellowship

The series, ‘Mastering your Fellowship’, provides examples of the question format encountered in the written and clinical examinations, Part A of the FCFP (SA) examination. The series is aimed at helping family medicine registrars (and their supervisors) prepare for this examination. Model answers are available online.