Newly-qualified Doctors Research Articles

P037 Rheum for more? A systematic literature review on undergraduate exposure to rheumatology

Abstract Background/Aims Since the introduction of Modernising Medical Careers by the General Medical Council in the United Kingdom (UK) in 2007, newly-qualified doctors are expected to choose their specialty much sooner than previously. A recent report published by the British Society of Rheumatology (BSR) in 2021 demonstrated a lack of exposure to the specialty for medical students. We conducted a systematic literature review on the quantity and quality of rheumatology teaching amongst undergraduate medical students. Methods Articles published until June 2023 were included. Eligible articles were: case reports and series, observational studies, qualitative studies and randomised control trials. Medline, Embase, PyscINFO, Cochrane library and WHO international clinical trial registry were searched, restricted to English language articles only. Articles including postgraduate trainees and those pertaining to a single intervention or single student cohort were excluded. Information was extracted on demographics, method of teaching, hours dedicated to rheumatology and students’ and educators’ feedback where mentioned. Results After deduplication, 1195 article were identified. After screening title and abstract, 1156 papers were excluded, with 39 proceeding to full text screening. Ultimately, seven articles (all cross-sectional surveys) were included. Publication year of included articles ranged from 1981 to 2018. The countries of included studies were UK (3), USA (2), Australian (1) and Pan-European (1). Year of rheumatology teaching at medical school was reported in four studies (3 UK and 1 USA). The three UK studies were all taught in the latter years (4-6), whereas in the USA study the students were taught at every single year. Where reported, data on the number of hours of exposure to rheumatology were variable, ranging from 15 to 96 hours per medical student. Reported method of teaching included lecture-based, rheumatology inpatient service and shadowing consultations. Student feedback was only provided in one (UK-based) study, from 49 students of whom two regarded rheumatology as “fascinating”, four felt that they had limited exposure and eight considered it as “a niche specialty of no interest”. No feedback from educators were collected in any of the included studies. Factors identified by the included studies for overall poor exposure to rheumatology included: lack of having full-time rheumatologists on the school’s faculty, lack of specialty training programme in their local teaching hospital and greater emphasis on general medical/ acute specialties (e.g. general practice and emergency medicine). Conclusion Overall, there are significant limitations in recording the amount and quality of rheumatology teaching amongst undergraduate medical students. Exposure to clinical rheumatology has markedly decreased over time, with variable student awareness of the speciality. Given the ageing UK population and increase in multimorbidity, there is a need to increase exposure and entry to the specialty, which may be partly facilitated by improved incorporation of rheumatology in the undergraduate curriculum. Disclosure K. Kouranloo: None. N. Myall: None. J. Christie: None.

A systematic review of interventions aiming to improve newly-qualified doctors’ wellbeing in the United Kingdom

BackgroundNewly-qualified doctors in the United Kingdom experience a great deal of stress and have poor wellbeing when compared to more senior counterparts. A number of interventions have been put in place to boost healthcare professionals’ wellbeing, but little is known about interventions aimed to improve the wellbeing of newly-qualified doctors in the United Kingdom. This study aims to systematically review current evidence of interventions which improved the wellbeing of newly-qualified junior doctors in the United Kingdom.MethodsFive key electronic databases were searched. Subsequently, reference scanning and citation search was performed. Studies were included if they were conducted from the commencement of the Foundation Programme in 2004, until 2019. In addition, studies had to be performed on junior doctors: working in the United Kingdom and within their first five years post-qualification and have a quantitative outcome. Studies which did not meet these criteria were excluded. Quality was assessed using the modified Newcastle-Ottawa scale. Bias was not formally assessed using a standardised tool.ResultsSeven papers met the inclusion criteria and identified three main types of interventions: mentorship, mindfulness and clinical preparation interventions. The majority of included studies reported a positive result from the performed intervention, suggesting these to be beneficial in improving junior doctor wellbeing, and thereby reducing anxiety and stress levels. However, most of the studies used small sample sizes.ConclusionsThis review reveals that there is dearth of evidence on the effectiveness of intervention to improve the wellbeing of newly-qualified doctors in the United Kingdom. Most of the identified interventions focused on relieving stress and anxiety inherent within newly-qualified doctors’ training programmes. However, wellbeing interventions need to take into cognisance all the factors which impact on wellbeing, particularly job-related factors. We recommend that future researchers implement large-scale holistic interventions using appropriate research methods.Systematic review registration: PROSPERO CRD42019127341.

Adult social care training for newly-qualified doctors from general medical practice: A pilot project, doctors and social workers learning together

ABSTRACT This article reports findings from a pilot project evaluation, involving workshops for newly qualified doctors training as general practitioners (GPs). The learning project, designed as part of GP training programmes in one English city, focused on strengthening newly qualified doctors’ knowledge of social work practice in adult social care. The evaluation reported here used pre- and post-workshop questionnaires and GP and social worker participants’ discussions, presenting quantitative questionnaire data (from Phase one) and qualitative discussion data (from Phase Two). GP trainees from eight programme sites (n = 221) took part in Phase One; in Phase two, GP trainees were joined by 13 social workers from local adult social care teams. We gathered data about trainees’ prior experience and training, pre- and post-workshop levels of knowledge confidence and attitudes towards working with social workers/others in adult social care, including knowledge of the Care Act 2014 requirements (including prevention and reduction of the need for care where this is possible and safe). Overall findings demonstrate that this workshop training impacted positively on knowledge and understanding gained by trainee GPs in key areas including knowledge of social care referral routes, adult safeguarding and reciprocal roles of adult social workers and GPs.

An ethically-motivated, Bayesian, adaptive design clinical trial bringing hope to women with menorrhagia…and warmth to statisticians' hearts.

An ethically-motivated, Bayesian, adaptive design clinical trial bringing hope to women with menorrhagia…and warmth to statisticians' hearts.

Foundation doctor preparedness for treating mental health conditions: results from a national survey

AimsPrevious research suggests the prevalence of mental health conditions among medical inpatients may be as high as 38%. Anecdotally, junior doctors report lacking the confidence, knowledge and skills to assess and treat patients with psychiatric conditions. Identifying this unmet need offers potential to improve standards of care and achieve parity of esteem between psychiatric and medical conditions within the general hospital. Aims:To assess self-reported preparedness of newly-qualified Foundation Doctors to care for patients with acute or chronic psychiatric symptoms in comparison to physical health conditions.MethodIn September of each year (2017, 2018, 2019), a survey was cascaded to all incoming Foundation Year 1 Doctors. For each respective year there were 1673, 961 & 1301 respondents. Respondents were asked to rate their agreement with statements on a Likert scale. Statements pertaining to mental health included “a) I am competent in acute mental health care provision, b) I am competent in chronic mental health care provision” and “I feel confident in prescribing the following drugs; c) drugs for mental health problems”. Comparison statements assessed confidence caring for medically unwell patients, performing practical procedures and prescribing drugs for physical health conditions.ResultPreparedness for acute and chronic mental health were lower than both physical health comparison items; preparedness to care for patients with critical illness (acute: r = 0.794, p < 0.001, chronic: r = 0.556, p < 0.001) and preparedness to perform practical procedures (acute: r = 0.724, p < 0.001, chronic: r = 0.433, p < 0.001).Confidence prescribing mental health drugs was lower than all other comparison items (simple analgesia: r = 0.854, bronchodilators: r = 0.789, antimicrobials: r = 0.772, inhaled steroids: r = 0.720, intravenous fluids: r = 0.702, oral anti-diabetics: r = 0.611, anticoagulants: r = 0.515, narcotics: r = 0.514, insulin: r = 0.206; p < 0.001)ConclusionThese results identify a disparity in foundation doctors’ self-reported preparedness to treat acute and chronic mental health conditions and prescribe psychotropic medications, compared to a variety of physical health domains. To our knowledge this is the first large-scale study to empirically test a potential discrepancy between newly-qualified doctors’ preparedness to treat patients’ mental and physical health needs. Medical school education and foundation training may therefore present a fruitful opportunity to improve care for patients with psychiatric conditions within general hospital settings.

Undergraduate urology – does this adequately prepare junior doctors?

Introduction: Junior doctors commonly encounter patients with urological issues regardless of the specialty they work in. Previous surveys of newly-qualified doctors have shown a lack of confidence in managing basic urological issues.

Dispositions of newly qualified doctors encountering a language-related dilemma in South Africa

The overarching goal of medical internship is to provide newly qualified doctors (NQDs) with work-based learning opportunities to gain experience of clinical practice under supervision, while gradually assuming greater independent responsibility. In South Africa, this often stressful period of potentially transformative learning is additionally complicated by issues of language. This article, based on a narrative study that explored NQDs’ experiences, focuses on two of the NQDs’ responses to multilingual learning environments encountered in clinical practice. We report on the journeys of these doctors as they faced a similar language-related dilemma on transitioning to internship, to which each responded very differently due to their individual habitus. In the context of eleven official languages in South Africa, learning opportunities for medical interns are likely to be influenced by linguistic dispositions and capability to communicate in the prevalent language of medical practice in a specific region. The study found that the trajectories of the two NQDs had also been profoundly influenced by the collective sociocultural dispositions in clinical practice environments. This article argues that, in addition to gaining medical knowledge, in order to construct positive identities as doctors, graduates should be better prepared for the contextual, cultural and linguistic aspects of medical practice.

Anxiety among newly-qualified doctors: An eight-year analysis

Background: Stressed and anxious doctors are more likely to make errors, take time off work and to leave medicine. This study aims to quantify the prevalence of anxiety among newly-qualified Foundation Year 1 doctors (FY1s), identify high risk groups and determine workplace factors associated with anxiety.Methods: We investigated self-reported anxiety among eight cohorts of FY1s between 2010 and 2017. Participants completed an online survey after their first week of work (n = 11,839), with a follow-up survey later in the year (n = 3502). Surveys included questions about the workplace and a validated screening tool for pathological anxiety.Results: Overall, a large proportion of doctors screened positive for pathological anxiety at the start of their FY1 year (27.3%) and after 4 months of work (21.0%). Year-on-year, we found a growing burden of anxiety at the start of FY1 (22.8% in 2010 vs. 29.6% in 2017, p < 0.01) and at follow-up. Anxiety was significantly higher among females (p < 0.01), those aged 21–25 (p < 0.05) and those who did not feel part of a team (p < 0.01).Conclusion: We found a growing burden of anxiety among FY1s associated with a perceived lack of support. We hope our findings will inform interventions to support newly-qualified doctors as they transition into the workplace.

Newly qualified doctors’ perceived effects of assistantship alignment with first post: a longitudinal questionnaire study

PurposeGrowing evidence supports the role of student assistantships in enhancing graduates’ preparedness for practice. However, there is limited evidence concerning the impact of aligning assistantships with graduates’ first doctor post....

How do newly-qualified doctors perceive empathy in medical training and practice?

Objective: Evidence exists of an apparent decline in empathy during medical training which may be detrimental to patient care. This qualitative study explores the reflections of a group of newly-qualified foundation doctors with regard to empathy in medical training and practice. Methods: Doctors in a UK Foundation Training Programme were invited to reflect on the subject of empathy in medical training and practice. Researchers obtained consent to access their anonymous reflective statements and analyze for recurring themes using framework analysis. Results: Coding of 65 trainees’ reflective statements resulted in identification of two thematic categories: (i) preparedness for empathic patient care and (ii) therapeutic effect of empathy. Conclusions: Trainees are aware of the value of empathy as a therapeutic tool. Many use it instinctively but not systematically. Clinical pressures can impact negatively on empathic dealings with patients and relatives. Targeted educational interventions and positive role modeling may assist foundation doctors enhance their skills in patient-centered care.

Does Access to Role Models Influence Future Career Choice? Impact of Psychiatry Teaching on Recently Graduated Doctors in the United Kingdom

The authors determined who provides formal psychiatry teaching to newly-qualified doctors and whether the amount of such teaching correlates to a later career preference for psychiatry. Data were collected on the cohort starting work in 2010 until applying to a specialty training program 16 months later. Total hours of psychiatry teaching was compared with the number choosing a residency in the same specialty. A total of 19 hospitals in northwest England provided teaching programs for their interns and first-year residents (U.K. foundation doctors); 15 provided information on doctors' later specialty choice. Only 2.3% of teaching was dedicated to psychiatry. Doctors led a higher proportion of medicine or surgery sessions (63%) than those on psychiatry (48%). Provision of psychiatry teaching was associated with entering psychiatry residency. Hospitals providing the most formal psychiatry training have the highest proportions matriculating into a psychiatry residency.

Chronic acalculous cholecystitis on hida scan: Is laparoscopic cholecystectomy indicated?

Chronic acalculous cholecystitis on hida scan: Is laparoscopic cholecystectomy indicated?

P238 Competence in, and Safety of, Oxygen Prescribing by Medical Students Taking Final MBBS as Assessed by Objective Structured Clinical Examination

Introduction and ObjectivesNational audits show oxygen prescribing is still not consistently safe and appropriate, despite the 2008 BTS Emergency Oxygen Guidelines. The aim of this study was to assess whether...

P0756 ASSESSMENT OF KNOWLEDGE AND ATTITUDES OF NEWLY-QUALIFIED DOCTORS TOWARDS AIDS INFECTION

Background: Health-care professionals are at a high risk of AIDS infection, among hospitalized HIV infected patients. Proper training and knowledge accompanied by necessary preventive measures are by all means, the most significant factors which ensure low accident rates and furthermore lower contamination rates of the health-care personnel. Objective: Screening and assessment of knowledge and attitudes of newly-qualified doctors towards AIDS infection. Methodology: We conducted a cohort study with a screening questionnaire, which included demographic data and 16 questions associated with AIDS infection. 51 forms were filled in by specializing and rural doctors. The statistical analysis was conducted using the statistical program SPSS 13. Results: 25,5% (n=13) of the participants in this reserch have treated at least one patient for HIV infection, 19% (n=10), of them would willingly specialize in intense care of HIV patients and lastly 90.2%(n=46) believe that we should preserve the medical confidential for HIV patients. 96.1% (n=49) of the participants doctors knew that AIDS disease is caused by Human Immunodeficiency Virus (HIV), 88.2%(n=45) is aware that HIV virus damages the immune system and finally 92% (n=47) recognize HIV symptomatology.The vast majority of the doctors (98%,n=50) is aware that HIV infection is spread through sexual intercourse, blood contact and by sharing needles or syringes. Nevertheless, a percentage of 13.7% (n=7) believe that HIV transmission is feasible through kissing and 7.8% (n=15) through insects’ bites. At last 85-98% of the personnel refer that it’s familiar with the general preventive measures, which are usually applied to all HIV positive inpatients. Conclusions: Knowledge and attitude of new doctors towards AIDS infection is, in general terms satisfactory. Nevertheless, it’s imperative that we constantly inform and update newly-qualified doctors about AIDS infection, in order to minimize their inhibitions and compensate for the lack of knowledge, which is commonly observed in new doctors.

'It gives you an understanding you can't get from any book.' The relationship between medical students' and doctors' personal illness experiences and their performance: a qualitative and quantitative study.

BackgroundAnecdotes abound about doctors' personal illness experiences and the effect they have on their empathy and care of patients. We formally investigated the relationship between doctors' and medical students' personal illness experiences, their examination results, preparedness for clinical practice, learning and professional attitudes and behaviour towards patients.MethodsNewly-qualified UK doctors in 2005 (n = 2062/4784), and two cohorts of students at one London medical school (n = 640/749) participated in the quantitative arm of the study. 37 Consultants, 1 Specialist Registrar, 2 Clinical Skills Tutors and 25 newly-qualified doctors participated in the qualitative arm. Newly-qualified doctors and medical students reported their personal illness experiences in a questionnaire. Doctors' experiences were correlated with self-reported preparedness for their new clinical jobs. Students' experiences were correlated with their examination results, and self-reported anxiety and depression. Interviews with clinical teachers, newly-qualified doctors and senior doctors qualitatively investigated how personal illness experiences affect learning, professional attitudes, and behaviour.Results85.5% of newly-qualified doctors and 54.4% of medical students reported personal illness experiences. Newly-qualified doctors who had been ill felt less prepared for starting work (p < 0.001), but those who had only experienced illness in a relative or friend felt more prepared (p = 0.02). Clinical medical students who had been ill were more anxious (p = 0.01) and had lower examination scores (p = 0.006). Doctors felt their personal illness experiences helped them empathise and communicate with patients. Medical students with more life experience were perceived as more mature, empathetic, and better learners; but illness at medical school was recognised to impede learning.ConclusionThe majority of the medical students and newly qualified doctors we studied reported personal illness experiences, and these experiences were associated with lower undergraduate examination results, higher anxiety, and lower preparedness. However reflection on such experiences may have improved professional attitudes such as empathy and compassion for patients. Future research is warranted in this area.

Dealing with colleagues: a guide for the foundation year doctor

Learning science and medicine are the main priorities for medical students, along with patient communication. However, less time has traditionally been devoted to preparing newly-qualified doctors for getting on with colleagues.

Reflections on foundation year 1

As I approach the end of my foundation year 1 (FY1) I look back on what has been an interesting but at times difficult year. August 2005 heralded the start of working as a junior doctor, but along with many others I was now classed as an FY1 junior doctor. I was now one of many newly-qualified doctors becoming part of history as the first set of doctors embarking on the reformed postgraduate medical education and training programme as encompassed in Modernising Medical Careers (MMC) (Department of Health, 2005).

Cardio-pulmonary resuscitation training, knowledge and attitudes of newly-qualified doctors in New Zealand in 2003

To assess the resuscitation knowledge and confidence of newly-qualified doctors in New Zealand (NZ) in 2003. Anonymous questionnaires were distributed to all newly-qualified doctors in NZ (n=279). Two hundred and thirty-three respondents from hospitals throughout NZ (84% response rate). Resuscitation training received during medical school and use of recommended text (Level 7 of NZ resuscitation manual), confidence in resuscitation skills and core knowledge of basic and advanced resuscitation. 98.3% of doctors received advanced resuscitation training during their final year of medical school, of these 64.6% had received training in the previous 6 months. The mean knowledge score was 56.6% and 45% of doctors made 'fatal errors'. Eighty-four percentage of doctors had read the Level 7 manual and 72.6% found it very or extremely useful. Those who had read the manual had higher scores and were less likely to make a 'fatal error'. Having attended a cardiac arrest and having received training within the last 6 months improved doctor confidence in resuscitation. The resuscitation knowledge and confidence of newly-qualified doctors in NZ are sub-optimal, with some doctors displaying dangerous deficiencies. Our results suggest mandatory attainment of an advanced resuscitation certificate, six-monthly practical resuscitation sessions and increased exposure to real resuscitation situations should be implemented to improve undergraduate resuscitation training.

Doctors and State Medicine: A Study of the British Health Service

Dr. Forsyth, an authority on the problems of state medicine in England, concisely presents the complexities and politics surrounding the historical development and effectiveness of the British Health Service. He stresses, that the British Medical Association's leadership has not been representative of the main body of medical practitioners. "To exert weight in medical politics, one must have money, and above all, time. Representative medical bodies are, therefore, inevitably weighed in favor of age, affluence, private practice, and the suburb." He points out that "the workload of medical administrators, newly-qualified doctors, and those working in urban working-class areas does not allow them time to participate in medical politics at the local level, and it is usually only through participation at this level, that influence can be exerted nationally." By emphasizing the conflict between specialist and general practitioners in England, he demonstrates that the physicians' drive for personal gain adversely affects the