Northern Deanery Research Articles

A quality improvement project developing a specific induction programme for International medical graduates (IMG) starting Respiratory Higher specialty training in the Northern Deanery

A quality improvement project developing a specific induction programme for International medical graduates (IMG) starting Respiratory Higher specialty training in the Northern Deanery

A42A palliative care skills study day is an effective way of meeting palliative care registrar curriculum Direct Observation of Procedural Skills (DOPs) requirements

The new Speciality Training curriculum for Palliative Medicine from August 2022 identifies key procedural skills that, for the first time, can be performed in a simulation (SIM) skills lab to demonstrate proficiency [1]. These include tracheostomy care, managing non-invasive ventilation (NIV) and the management of indwelling ascitic drains. These skills can be difficult to acquire in non-hospital settings like hospices and in the community. A bespoke, pilot palliative care skills day was organized to assess the suitability for theory, skills training and subsequent opportunity to demonstrate proficiency by sign off against curriculum competencies. A total of 11 palliative care trainees from the Northern Deanery attended a pilot SIM study day in March 2023. Three parallel workshops were planned – tracheostomy care, the insertion and management of ascitic drains and managing NIV. Each workshop was delivered by local experts in the area (non- palliative care professionals) with experience of teaching and training other professionals. assessing internal medicine trainees. Trainers were briefed on learning outcomes prior to the session by two palliative care consultants, and the clinical context of each session was set within relevant palliative care environments for e.g. the care of a patient in a hospice, in the community or in a hospital. Trainee confidence was assessed before and after SIM training with the use of 10-point Likert scales and free text comments. Overall self-reported trainee confidence and competence scores increased for all three workshops (Paracentesis 7 to 8.8 out of 10, NIV 4.5 to 8.6, tracheostomy care 3.8 to 8.9). All trainees agreed it was an effective and educational way of addressing curriculum objectives; and agreed it should be a rolling programme offered regionally. Trainees commented on the positive learning environment, the small group sizes, the benefit of being taught by experts and having the opportunity to be assessed for curriculum requirements. Trainees who had previously achieved competencies commented on the benefit of refreshing skills. One area for development identified was the lack of standardization on DOPs forms about the level of proficiency required. This will be fed back to the regional training committee for the future. Trainees identified further clinical skills that could be addressed in a skills lab and hence, a second skills day will be organized. SIM training is an effective tool for delivering training around procedural skills for palliative care registrars. It also brings opportunity to demonstrate proficiency in specific practical skills. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

1496 Building Inclusivity and Diversity from our Foundations: A Cross-Sectional Study Identifying Barriers to Theatre Based Training for Foundation Doctors

Abstract Aim Theatre experience is a powerful factor enabling trainees to determine whether they possess the enthusiasm and aptitude to undertake a surgical career. Removing barriers to theatre learning should allow a more meritorious and diverse cohort of surgical trainees. Method An 18 -point open and closed question Likert scale survey was distributed to Foundation Doctors in three hospitals within the Northern Deanery. The survey was designed via focus group and literature review, ascertaining perceived levels of preparedness, acceptance, enjoyment, and barriers to theatre access. Results The survey dichotomized respondents (n = 54) into those who attended theatre (n = 40) and those who did not (n = 14). Of those attending 38% (n = 15) reported intimidation and 15% (n = 6) cited a cultural barrier to attendance. Of those who did not attend 79% (n = 11) were interested in surgery. These respondents predominantly reported concerns around prohibitive ward workload and unfamiliarity with protocols. Covid restricted surgical rotations for some. There was a statistically significant difference (p fishers exact test = 0.001) between 83% of respondents who felt welcomed by the surgeons compared to just 45% made to feel welcome by the wider theatre team. Only 20% (n = 11) of respondents felt prepared for theatre by medical school. 50% (n = 27) were confident with theatre protocols. Conclusions The study raises concerns around apprehension surrounding the theatre environment and ward workload which appear to impede access to theatre. Adequate undergraduate surgical teaching, appropriate induction and allocation of theatre time are crucial to improve safety, diversity of applicants, confidence for trainees and compliance within the team.

Is Meckel’s cave routinely evaluated by Northern Deanery radiology trainees?

Category: Neuro.

A near-peer regional surgical teaching programme designed by medical students, delivered by junior doctors

ABSTRACTBackground: Near-peer teaching initiatives has been shown to be a highly successful method of improving student learning. There has been little data on surgical teaching initiatives of this kind and little data to show if this improves student confidence in surgical topics. This study was designed to show whether a regional surgical teaching programme, delivered by junior doctors, improves confidence levels of students prior to their final examinations. Method: Final year medical students were invited from four hospitals in the Northern deanery of England to participate in a voluntary surgical teaching day. Junior doctors were then recruited to present on various surgical topics based on their own knowledge and experience of finals examinations and working on the wards. A pre and post-course questionnaire was designed, validated and distributed to the students to assess their confidence on a five-point Likert scale of 1–5 (1- most confidence, 5- least confidence) levels in each of the 11 chosen topics. Other variables were also measured relating to the topics including visual material, enthusiasm, content relevance and communication. Results: 53 students completed the questionnaire (n = 53). There were 31 females and 22 males with a mean age of 24.7. A mean level of confidence of 2.7 pre-course and 1.6 post-course showed an increase in confidence by 68.8%. All eleven topics covered showed improvement in confidence. General Surgical Principles showed the lowest improvement in confidence from 2.683 to 1.917 (p = <0.001) compared to endocrine which showed the maximum increased in confidence from 3.650 to 1.694 (p = <0.0001). Orthopedics showed an increased in confidence from 3.010 to 1.62 (p = <0.0001). Conclusion: Near-peer education designed by medical students and delivered by junior doctors is an effective way for improving confidence levels and test results prior to finals examination and is also valuable for junior doctors.

THUR 156 Safe prescribing of immunosuppression: quality improvement project

BackgroundThe use of immunosuppression therapies in Neurology has extended exponentially since they were first used in the 1970s for myasthenia gravis. However there are no NICE or neurology specific guidelines in this area for Neurologists to refer to in their clinical practice.Method and resultsThis 2014 retrospective case notes audit compared medical documentation to ‘10 key statements’ pertaining to the safe use and monitoring of immunosuppression therapies. This is a framework for clinical practice that was first published by The British Association of Rheumatology and The British Association of Dermatology in 2008.A number of key areas of poor documentation around drug safety, pregnancy and vaccinations were identified and in response generic and drug specific safety ‘check-lists’ and guidelines were produced, to be filled out with all patients, prior to starting therapies.In 2016 following the implementation of the quality improvement project, a repeat audit of patient’s medical notes showed a clear improvement in documentation.ConclusionsDrug specific guidelines led to an improvement in documentation and we believe that this also reflects safer prescribing and improved clinical practice. We are now in the process of developing guidelines to be used throughout the entire Northern Deanery.

Evaluation of feedback given to trainees in medical specialties

The aim of this study was to evaluate the quality of feedback provided to specialty trainees (ST3 or higher) in medical specialties during their workplace-based assessments (WBAs). The feedback given in WBAs was examined in detail in a group of 50 ST3 or higher trainees randomly selected from those taking part in a pilot study of changes to the WBA system conducted by the Joint Royal Colleges of Physicians Training Board. They were based in Health Education Northeast (Northern Deanery) and Health Education East of England (Eastern Deanery). Thematic analysis was used to identify commonly occurring themes. Feedback was mainly positive but there were differences in quality between specialties. Problems with feedback included insufficient detail, such that it was not possible to map the progression of the trainee, insufficient action plans made and the timing of feedback not being contemporaneous (feedback not being given at the time of assessment). Recommendations included feedback should be more specific; there need to be more options in the feedback forms for the supervisor to compare the trainee's performance to what is expected and action plans need to be made.

A STUDY OF HEAD INJURY ADVICE ON RETURN TO SPORT IN ACCIDENT AND EMERGENCY

Return to play (RTP) post head injury is a controversial yet important topic in sport. Repeated head injuries have been linked to long-term neurological conditions such as Chronic Traumatic Encephalopathy...

Retrospective analysis of 30-day mortality for emergency general surgery admissions evaluating the weekend effect.

The weekend effect describes excess mortality associated with hospital admission on Saturday or Sunday. This study assessed whether a weekend effect exists for patients admitted for emergency general surgery. Data for emergency general surgical admissions to National Health Service hospitals in the Northern Deanery in England between 2000 and 2014 were collected, including demographics, co-morbidities, diagnoses, operations undertaken and outcomes. The primary outcome of interest was in-hospital death within 30 days of admission. Cox regression analysis was undertaken with adjustment for co-variables. There were 12 100 in-hospital deaths within 30 days of admission (3·3 per cent). The overall 30-day mortality rate reduced significantly during the 15-year interval studied, from 5·4 per cent (2000-2004) to 4·0 per cent (2005-2009) and 2·9 per cent during 2010-2014 (P < 0·001). There was no significant mortality difference for patients admitted at the weekend in adjusted Cox models (hazard ratio (HR) 1·00 for Saturday and 0·90 for Sunday, versus Wednesday). There was a significantly higher mortality for operations undertaken at the weekend (HR 1·15 for Saturday and 1·40 for Sunday; P = 0·021 and P < 0·001 respectively). The significantly increased mortality that was evident for emergency surgery at the weekend compared with weekdays in 2000-2004 (HR 1·46 for Saturday and 1·55 for Sunday; both P < 0·001); had reduced by 2010-2014, when the adjusted mortality risk was not significant (HR 1·18 for Saturday and 1·12 for Sunday). During the past 15 years there has been a weekend effect in patients undergoing emergency general surgery based on day of operation, but not day of admission. Overall mortality for emergency general surgery has improved significantly, and in the past 5 years the increased mortality risk of weekend surgery has reduced.

Where's the antidote? The dangers of local anaesthetic toxicity knowledge of management of local anaesthetic toxicity in orthopaedic specialty trainees in the Northern Deanery

Where's the antidote? The dangers of local anaesthetic toxicity knowledge of management of local anaesthetic toxicity in orthopaedic specialty trainees in the Northern Deanery

Consenting Practice of ENT Trainees: To What Extent Is Trainee Involvement Disclosed?

To assess to what extent ENT trainees disclose their involvement in operations to their patients when obtaining consent. It is not clear how the trainees are conducting the consenting process, although it could lead to a medico-legal conflict. A 6-question questionnaire was sent via email to 22 ENT trainees in Northern Deanery, and 14 ENT registrars in Yorkshire Deanery. Seniority of the participants. Disclosure of the main operating surgeon and trainee involvement in the consenting process. Influence of operation complexity in trainee involvement disclosure. The response rate was 69%. Of the respondents, 46% consistently informed patients about trainee involvement in operations. Only 28% felt the complexity of operations influenced their decision to disclose trainee involvement. Subgroup analysis showed there was no statistically significant difference between junior and senior trainees in trainee involvement disclosure. If the trainees informed patients about who the operator would be, it was more likely for them to also disclose their own involvement. Many trainees also felt that the 'no guarantee of a particular surgeon' clause in the National Health Service consent form implied possible trainee involvement even if they did not specify it verbally. The rate of trainee involvement disclosure is not related to the seniority of trainee or complexity of operations, but is related to operator disclosure. This may suggest trainee involvement disclosure is not dependent on the level of confidence of trainees but on the approach and attitude towards the consenting process.

PTU-113 A Regional Audit Of The Management Of Patients With Decompensated Liver Disease

IntroductionThe recent National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report ‘Measuring the Units’ found that hospitals are missing opportunities to save the lives of people with alcohol-related liver...

Psychiatry for medical students: need for a more holistic approach to teaching?

We are two medical students who wish to offer a perspective on undergraduate education and psychiatry. During our student placement, we attended the old age psychiatry module at the Northern Deanery MRCPsych programme focusing on dementia and ethics. This was aimed at trainees and not specifically

The ageing anaesthetist

The ageing anaesthetist

Developing criminal justice liaison and diversion services: Research priorities and international learning

Criminal Behaviour and Mental HealthVolume 23, Issue 5 p. 315-320 Invited Editorial Developing criminal justice liaison and diversion services: Research priorities and international learning Samir Srivastava, Corresponding Author Samir Srivastava Forensic Psychiatry, Tees, Esk and Wear Valleys NHS Foundation Trust, Northern Deanery, UKAddress correspondence to: Samir Srivastava, Forensic Psychiatry, Tees, Esk and Wear Valleys NHS Foundation Trust, Northern Deanery, UK. Email: samirsrivastava@nhs.netSearch for more papers by this authorAndrew Forrester, Andrew Forrester Forensic Psychiatry, Institute of Psychiatry/King's College, London, UKSearch for more papers by this authorSteffan Davies, Steffan Davies Forensic Psychiatry, Northamptonshire Healthcare NHS Trust, UKSearch for more papers by this authorRajesh Nadkarni, Rajesh Nadkarni Forensic Psychiatry, Northumberland, Tyne and Wear NHS Trust, UKSearch for more papers by this author Samir Srivastava, Corresponding Author Samir Srivastava Forensic Psychiatry, Tees, Esk and Wear Valleys NHS Foundation Trust, Northern Deanery, UKAddress correspondence to: Samir Srivastava, Forensic Psychiatry, Tees, Esk and Wear Valleys NHS Foundation Trust, Northern Deanery, UK. Email: samirsrivastava@nhs.netSearch for more papers by this authorAndrew Forrester, Andrew Forrester Forensic Psychiatry, Institute of Psychiatry/King's College, London, UKSearch for more papers by this authorSteffan Davies, Steffan Davies Forensic Psychiatry, Northamptonshire Healthcare NHS Trust, UKSearch for more papers by this authorRajesh Nadkarni, Rajesh Nadkarni Forensic Psychiatry, Northumberland, Tyne and Wear NHS Trust, UKSearch for more papers by this author First published: 06 December 2013 https://doi.org/10.1002/cbm.1888Citations: 22Read 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 Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume23, Issue5December 2013Pages 315-320 RelatedInformation

Comparing pain and analgesia requirements in different procedures for the treatment of hip fractures

Comparing pain and analgesia requirements in different procedures for the treatment of hip fractures

Training in endoscopy: The northern deanery higher surgical trainees perspective

Training in endoscopy: The northern deanery higher surgical trainees perspective

An evaluation of orthopaedic research publications between 2007-2011 from the Northern Deanery hospital trusts

An evaluation of orthopaedic research publications between 2007-2011 from the Northern Deanery hospital trusts

A northern deanery survey on the consent, prevention and treatment of shivering under neuraxial blockade

Royal Victoria Infirmary, Dept of Anaesthesiology & Intensive Care, Newcastle upon Tyne, United Kingdom

Evaluation of an established learning portfolio

The trainee-held learning portfolio is integral to the foundation programme in the UK. In the Northern Deanery, portfolio assessment is standardised through the Annual Review of Competence Progression (ARCP) process. In this study we aimed to establish how current trainees evaluate portfolio-based learning and ARCP, and how these attitudes may have changed since the foundation programme was first introduced. Deanery-wide trainee attitudes were surveyed by an electronic questionnaire in 2009 and compared with perceptions recorded during the pilot phase (2004-2005). Many trainees continue to view the e-portfolio negatively. Indeed, significantly fewer trainees in 2009 thought that the e-portfolio was a 'good idea' or a 'worthwhile investment of time' than in 2005. Trainees remain unconvinced about the educational value of the e-portfolio: fewer trainees in 2009 regarded it as a tool that might help focus on training or recognise individual strengths and weaknesses. Issues around unnecessary bureaucracy persist. Current trainees tend to understand how to use the e-portfolio, but many did not know how much, or what evidence to collect. Few supervisors were reported to provide useful guidance on the portfolio. ARCP encouraged portfolio completion but did not give meaningful feedback to drive future learning. Continued support is needed for both trainees and supervisors in portfolio-building skills and in using the e-portfolio as an educational tool. Trainee-tailored feedback is needed to ensure that portfolio-based assessment promotes lifelong, self-directed and reflective learners.