Preregistration House Officers Research Articles

Microlearning and online simulation-based virtual consultation training module for the undergraduate medical curriculum – a preliminary evaluation

BackgroundVirtual consultation is a synchronous mode of telemedicine provided remotely via information and communication technology. The projected growth of digitalization in healthcare delivery, however, necessitates medical student training in virtual consultation (VC) to ensure safe and effective patient care. This study describes the implementation and preliminary evaluation of a competency-based VC training module for undergraduate medical students.MethodsA newly developed six-week VC module was implemented online through asynchronous microlearning and synchronous simulation-based experiential learning modalities. Clinical students in years 4 and 5 and fresh graduates, who had not started pre-registration house officer or residency programmes, were invited to participate. Training outcomes using checklist-based video-recorded assessments of VC encounters between medical students and simulated patients were compared. Each video was independently assessed by two facilitators trained in VC teaching and assessment, using a direct observed virtual consultation skills checklist derived from established VC competencies. The participants completed course evaluations electronically as additional outcome measures.ResultsFifty-two clinical phase medical students and alumni completed both the instructional and practical phases of this module. Altogether, 45 (95.7%) students found the module beneficial, and 46 (95.9%) reported increased self-efficacy for conducting VC. In total, 46 (95.9%) students would recommend the course to others. Post-test results showed a significant increase in the students’ abilities to conduct a VC (t-test = 16.33, p < 0.05).ConclusionMicrolearning and simulation-based sessions were effective instructional delivery modalities for undergraduate medical students in their attainment of VC competencies.

Personal reflections on shift work, sleep and fatigue

From 1st August 1974 I worked as a Pre-registration House Officer in a Scottish hospital whose routine business was general and respiratory medicine, and infectious disease. Like my contemporaries, I quickly settled into the alternate nights and weekends on call, the weekends starting at 8 a.m. on Friday, and although the hospital returned to normal at 8 a.m. on Monday, it would likely be 5–6 p.m. before the on-call resident could leave. We also did a lot of our own emergency lab work—haemoglobins, total and differential white cell counts in blood and cerebrospinal fluid (CSF), and staining urine, CSF and sputum with Gram’s and Ziehl–Neilsen’s stain. An alarm bell would periodically ring to remind us to check the ESRs set up an hour earlier. We cheerfully grumbled, our consultants would nod sympathetically, then point out that our conditions were positively Elysian, compared to what they had endured when at our...

Evaluation of an Interprofessional Course on Leadership and Management for Medical and Nursing Pre-registration House Officers

Interprofessional education is about two or more professions learning from, with, and about each other, for the aim of better working together in the future. The aim of this study is to evaluate the outcomes of an interprofessional course on management and leadership for medical and nursing pre-registration house officers. Thirty eight house officers were enrolled in the course on an elective basis. The course comprised three workshops in addition to a collaborative project. Evaluation of the outcomes of the course followed Hammick’s four-level model for evaluation of interprofessional education. The participants completed course evaluation questionnaires in addition to a readiness questionnaire administered before and after the implementation of the course. Knowledge acquisition was measured by a paper and pencil test. Acquisition of skills in leadership and management was assessed by the evaluation of the projects. Changes in participants’ behaviour towards interprofessional collaboration were evaluated by supervisors, nurses, and colleagues. The t -test was used to compare between the results of the pre- and post-tests for assessment of knowledge. It was also used to compare the readiness of the participants, as well as the multi-source feedback about their collaborative attitude before and after the course. Statistical significant improvement was observed in the participants’ readiness for interprofessional education, their knowledge in leadership and management, their application of leadership and management skills, as well as their collaborative behaviour at the workplace. The study concluded that the interprofessional course improved the participants’ readiness towards interprofessional education, as well as their knowledge, skills, attitudes and behaviours.

Pre-registration house officer training in psychiatry: the London experience

AIMS AND METHOD To evaluate whether new pre-registration house officer posts in psychiatry deliver training leading to increased confidence in target skills, based on General Medical Council requirements, and to evaluate trainees9 satisfaction with these posts. A structured questionnaire was filled out by the first nine incumbents of the PRHO posts before and after the placements. RESULTS Trainees9 confidence improved in all the target skills and the posts were all rated as good or excellent. The posts attracted trainees who were potentially interested in a career in psychiatry or general practice. CLINICAL IMPLICATIONS PRHO posts in psychiatry deliver training that meets General Medical Council objectives, and trainees9 confidence with core psychiatric skills improves after undertaking the placements.

Academic Misconduct in Nigerian Medical Schools-A Report from Focus Group Discussions among House Officers

Concern is growing as research continues to find evidence of academic misconduct among medical students. There is, however, paucity of information on this issue among medical students and medical graduates in Africa. We determined the perceptions and attitude of house officers on academic misconduct within Nigerian medical schools. We conducted 7 focus group discussions (FGDs) among pre-registration house-officers (PRHOs) working in a Nigerian Teaching hospital between October and November 2013. A FGD guide containing 7 broad questions related to their perception and attitude on academic misconduct was employed. Ethnographic content analysis and manual coding were adopted in identifying themes, issues and representative quotations. A total of 58 participants out of an eligible pool of 76 PRHOs were recruited. All the groups associated academic misconduct chiefly with cheating in examinations, and perceived it as a commonplace problem. “It is a part of school life”, admitted one PRHO. Copying during exam appeared to be the commonest form of cheating. Another respondent opined that “The lecturers should be more concerned with helping students understand better. They should not make passing an exam a do-or-die affair.” The perception and attitudes towards academic misconduct may be a reflection of the prevailing moral decline in the contemporary Nigerian society. Underlying the reasons adduced by the participants for getting involved in academic misconduct is the fear of failure in examinations. Apart from consolidating formal and informal medical ethics education, the medical schools should ensure that the opportunities and pressures to indulge in academic misconduct are minimized.

Ansiedad de los estudiantes de una facultad de medicina mexicana, antes de iniciar el internado

IntroductionPre-registration medical graduates demonstrate their skills in a hospital as rotation house-officers, which can cause anxiety. The aim of this study is to quantify anxiety (state and trait) in students before starting their pre-registration posts in a public medical school in Mexico, and also to determine if their mean examination grades (GPA) are related to anxiety. MethodA descriptive, cross-sectional study was conducted using the IDARE questionnaire, which assesses Trait anxiety (STAI R) and state (STAI E). It was completed, before starting the pre-registration house officer rotation in 2014, by students of the Faculty of Medicine, UNAM, 2009 course. Statistical analysis was performed using Student t test for independent samples, and Pearson correlation index. ResultsOut of a total number of 1,023 students in 2014, the sampled population was 479 (46.82%), of whom 332 (32.45%) were women and 147 (14.36%) were men. There were 105 (21.82%) students with trait anxiety trait, with a GPA of 84.1, 132 (27.55%) with anxiety state, with a GPA of 84.0. There were 374 (78.07%) with no anxiety trait, and 347 (72.44%) with no state anxiety. On comparing state anxiety, the Student t-test p=.3 (95% CI -1474 to 0.494); the Pearson correlation index was -0.009, p=.043. On comparing anxiety state, the Student t-test p=.236 reported (95% CI -1.46 to 0.360); the Pearson correlation index was -0.08, with a p=.047. As for the GPA, there was no difference between the different levels of state and trait anxiety. ConclusionsThe trait anxiety level and state is often greater than that reported in the general population. There was no correlation between the presence of anxiety and mean examination grades (GPA).

Newly Qualified Doctors’ Views of Medical School Training and Its Adequacy in Making Them “Fit for Purpose” as First Year Doctors

Aim: To assess whether the medical graduates from one medical school felt “fit for purpose” to work as intern doctors in the Health Service in Ireland. In the early nineties documents like “Tomorrow’s Doctors” emphasised the direction and change that undergraduate medical training had to take. It stated that “students must be properly prepared for their first day as Pre-Registration House Officer”. There are current arguments that junior doctors are not fully prepared for working life when they finish university. This study aims to analyse this perceived truth. Methods: I employed use of semi-structured interviews with a purposive sample of medical school’s qualified interns. A grounded theory thematic analysis approach was used. Results: The interviews confirmed the participants’ sense of being ill-prepared for the complexities of being a doctor. Issues such as managing professional relationships, navigating hospital politics, building support networks, knowing when to seek help and dealing with ethically challenging situations were all highlighted. Conclusions: The study has established that the medical school in which the study was situated is teaching its graduates to an acceptable standard with regard to their medical knowledge base, communication skill abilities and the basic tenets of history taking and examination, but it needs to prepare graduates in a more concrete way for working in complex multi-professional clinical environments and for participating effectively in the context of acute medical emergencies. It is arguable that all medical schools should follow up their graduates to assess how well the medical school curriculum has prepared their graduates for practice.

Team-based versus ward-based junior doctors: Where do the differences lie?

Foundation Year 1 doctors (or pre-registration house officers) are the most junior members on the medical or surgical team. They provide secretarial and clinical services under supervision of more senior clinicians. With the increasing demand on health services in the United Kingdom, employers and educators are searching for ways to maximise their productivity without detriment to their training. One such method was trialled at our Trust. We changed from a team-based system to a ward-based system for Foundation Year 1 doctors on general surgical firms. Following the change we assessed the impact on junior doctor training using qualitative and quantitative methods. We believe that our study and the results will be of great interest to your readers. This project has been presented regionally and nationally and has been met with great interest.

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].

Training Foundation Year Doctors in the Operating Theatre: A Missed Opportunity?

Foundation trainees replaced the pre-registration house officers in August 2005 after Modernising Medical Careers was set up to 'drive up the quality of care for patients through reform and improvement in postgraduate medical education and training'. Doctors qualifying from UK medical schools entered into the foundation years, which consisted of two years of training designed to form a bridge between medical school and specialty training. All doctors wanting to apply for specialty training in the UK must complete their foundation programme or equivalent.

Reactive interventions by pharmacists to prescribing decisions by house officers: an audit with support implications

Abstract Focal points

Factors Influencing Foundation Programme Choice among Medical Students

ObjectivesThe advent of Modernising Medical Careers has replaced the traditional pre-registration house officer (PRHO) year and first year of senior house officer (SHO) training with a combined foundation programme. The aim of this study was to find out the factors influencing choice of foundation programme among medical students.DesignProspective survey.SettingThree medical schools based in England.Main outcome measuresA questionnaire was formulated containing the reasons for choosing a foundation programme with students asked to rank their choices.ResultsThere were 46 replies. The most important factors identified were geographical location (score 154) and combination of specialties (score 178). The least important factors was the reputation of consultants (score 525) and opportunities for research (score 530).ConclusionsThe factors influencing choice of foundation programme are not dissimilar to the choice of PRHO year despite the different emphasis in training which it offers.

Career choices in dermatology

Reforms to both undergraduate and postgraduate training have resulted in limited exposure to clinical dermatology, and therefore we need to target advice and clinical attachments to the most appropriate stages of training to ensure that dermatology is considered as a career option by medical students. A questionnaire survey was undertaken to determine when and how doctors chose their career in dermatology. An electronic questionnaire was sent to 709 dermatologists (response rate 44%). Of the respondents, 49% considered dermatology after medical school attachment and 61% were influenced by the jobs they had done as a pre-registration house officer (PRHO) or senior house officer (SHO). Careers advice was lacking, with only 11% receiving it while at medical school and 29% during their PRHO/SHO years. Contact with an inspiring clinician was the most influential factor in choosing dermatology. Both medical students and junior doctors, should have opportunities to learn from and work with clinical dermatologists.

An exploration into physiological and self-report measures of stress in pre-registration doctors at the beginning and end of a clinical rotation

The first year practising medicine, pre-registration, is considered to be a stressful time for junior doctors. The aims of this study were to explore how levels of psychological distress were affected by changes in the working environment and to examine these effects across subjective (i.e. self-report) and objective (i.e. stress hormone cortisol) indices of psychological distress. A cohort of 36 pre-registration house officers (males = 15) completed a battery of psychosocial measures and collected salivary samples for the measurement of diurnal cortisol at the beginning and end of a 3–4-month clinical rotation with the assumption that the end of a rotation would be less stressful than the beginning. Results from the self-report measures remained constant over the two-time points suggesting no perceived change in emotional well-being on a subjective level. However, there is some evidence of neuro-endocrine changes across the two time points suggestive of hypothalamic–pituitary–adrenal axis dysregulation. In particular, there was a significant difference between the cortisol awakening rise with the greatest rise seen at the beginning of a rotation. In addition, the daily cortisol decline (diurnal slope) was also significantly less at this test time. These findings have implications for the discord apparent between self-report and physiological measures of psychological stress.

How do UK medical graduates rate their knowledge and skills in sexual health and HIV medicine? A national survey

The objectives of this study are to determine self-assessed knowledge and skills in sexual health and HIV medicine in preregistration house officers and to explore undergraduate experiences of teaching and assessment in these subjects prior to the launch of National Core Learning Outcomes in Sexual and Reproductive Health and HIV. The study was designed as a postal questionnaire survey. The participants were all UK medical graduates of August 2004. The response rate 1737/4746 (36%). The main outcome measures were Doctors' views on their preparedness to manage patients with sexual health and HIV-related problems. Since graduation, 90% of respondents had seen at least one patient with a sexually transmitted infection or HIV-related issue. Seventy-six percent felt confident to take a sexual history. In all, 63% and 53% felt competent in male and female genital examination, respectively. Forty-three percent felt they could conduct an appropriate HIV pretest discussion and 59% felt they could recognize clinical indicators suggestive of HIV. Seventy-eight percent had been formally assessed in sexual health and 55% in HIV medicine. Increased confidence in sexual history taking, HIV pretest discussion and recognition of HIV indicators was associated with a longer duration of teaching and formal examination. In conclusion, although the proportion of recent graduates confident in sexual history taking is encouraging, their lack of skill in discussing HIV testing, risk assessment and recognition of possible HIV presentations must be addressed. Integration of National Core Learning Outcomes into all undergraduate curricula is a key step in reducing inconsistencies in undergraduate training.

Education, education, education: postgraduate assessments and the consultant contract

Recent changes in medical training have involved the introduction of a number of different tools for the assessment of trainees at all levels. These are completed by all doctors ranging from the level of foundation year 1 (FY1) trainees (previously pre-registration house officers) to final year specialty trainees (STs). While consultants are required to be an integral part of this assessment process, no formal time has been set aside and protected for these sessions. We propose the correct number of sessions for this activity be part of a new consultant contract, especially given the significant increase in the quantity of assessment and appraisals in the current training system. But how many hours are required?

Assessment of Psychometric Properties of a Modified PHEEM Questionnaire

An effective tool in analysing the learning environment, customised to the Sri Lankan setting, is vital for the assessment and delivery of quality healthcare training of preregistration house officers. Such a tool should be reliable and valid. We assessed psychometric properties such as internal reliability and construct validity of a modified version of the Postgraduate Hospital Educational Environment Measure (PHEEM). A modified PHEEM questionnaire customised to the Sri Lankan context was developed in accordance to the Sri Lanka Medical Council guidelines. The questionnaire was distributed to all interns at the National Hospital of Sri Lanka, Colombo North Teaching Hospital and Wathupitiwala Base Hospital during a calendar year (n = 100, response rate = 86%). Internal reliability and construct validity of the inventory were assessed by using Cronbach's alpha and exploratory factor analysis respectively as statistical methods. PHEEM consists of 3 subscales: perceptions of autonomy, social support and teaching, which are factors perceived to be influencing the educational environment. This administration demonstrated high internal reliability as reflected by a Cronbach's alpha value of 0.84. Exploratory factor analysis identified 12 factors with eigenvalue >1. However, the first factor had an eigenvalue of 6.7 (accounting for 19.7% of variance), while the rest had eigenvalues < 2.5. These results suggest a single predictive factor and thus a one-dimensional scale as opposed to the three-dimensional scale which is used in the current questionnaire. The psychometric properties of this tool reflect a high degree of internal reliability in assessing the educational environment of intern doctors in Sri Lanka. It is possible that the clinical educational environment is collectively represented as a single dimension. This may be due to the complex interplay between individual items in the questionnaire. Therefore the psychometric properties do not justify the interpretation of the educational environment through specified subscales.

Diploma of the Royal College of Ophthalmologists, London (DRCOphth)

The DRCOphth examination is open to any medically qualified persons with a medical degree which is approved by the General Medical Council. They must have done one year in a preregistration house officer post (or equivalent) acceptable by the GMC and have some ophthalmology experience at postgraduate level (no minimum time specified). It is intended mainly for medical doctors with an interest in ophthalmology who do not wish to practise as a consultant ophthalmologist in the United Kingdom. I did it in July 2007. This sitting was …

Learning not to take it seriously: junior doctors’ accounts of error

We aimed to investigate experiences of, and responses to, medical error amongst junior doctors and to examine the challenges junior doctors face and the support they receive. We carried out a qualitative study of 38 randomly selected pre-registration house officers (PRHOs) in 10 hospitals. All 38 had graduated in 2000 or 2001 from a single medical school. Errors were common and sometimes serious. In relation to disclosure and learning from error, four main themes emerged: a norm of selective disclosure; the effects of the team; individualised blame and responsibility, and the 'learning moment'. Trainees reported disclosing errors informally, particularly when teams were seen as supportive, but were reluctant to criticize colleagues. Formal reports and disclosure to patients were very rare. Patient care was compromised when juniors did not access senior help, often when working outside their usual team environment. Lack of cooperation between teams and poor continuity of care also contributed to errors. Learning was maximised when errors were formally discussed and constructive feedback offered. However, both blame and the prioritization of reassurance over learning and structured feedback appeared to inhibit reflection on the experience of error. Junior doctors need help to reflect on their experiences and to recognise where they may have made mistakes, particularly in the contexts of shift-work and fragmented teams. Formal reporting systems alone will not facilitate learning from error. Juniors require individual clinical supervision from seniors with appropriate training. Such expertise may benefit the whole team and the training environment.

To call or not to call: a judgement of risk by pre-registration house officers

This study set out to answer the following questions. What influences a junior doctor's response to a judgement call within a clinical setting? What, if any, are the relationships between these influences? This paper describes an interpretivist study based on a grounded theory approach to data analysis. This involved a phased approach to data collection using semi-structured interviews. Analysis was facilitated by observations and group presentations. Participants were doctors in their first year of postgraduate practice who were purposively selected from a range of hospitals in the Northern Deanery. The data demonstrated a number of influences on whether junior doctors chose to seek senior assistance. These included the upholding and balancing of tenets that were necessary for ensuring safe practice, and estimating the chance and severity of potential negative consequences to patients, themselves and their teams. In order to make these judgements, junior doctors drew on different forms of knowledge, especially knowledge gained from previous clinical experiences. In judging whether or not to contact a senior, pre-registration house officers (PRHOs) were practising essential clinical attributes, that of independent yet co-operative and discerning practitioners who are able to balance multiple considerations while ensuring patient care. This particular judgement of risk, as it was described by those interviewed, was a dynamic process exemplified by the need to create counterbalances between multiple consequences. As a result, no prescriptive action could have allowed PRHOs to deal with the numerous configurations they faced and took into account.