Registrar Level Research Articles

WP3.9 - Characteristics and outcomes of an emergency hot clinic in a district general hospital - are they still a useful resource?

Abstract Introduction Hot clinics with ambulatory imaging have become integral to service provision in emergency general surgery, reducing admissions and expediting diagnoses. However they can come under criticism over a lack of senior decision making and perceived unnecessary reviews. Aims We aimed to evaluate the service in our department, by characterising the seniority level of the decision makers and assessors in the hot clinic, and outcomes of patients seen. Methods Retrospective analysis over a 3 month period of patients seen in the hot clinic of a district general hospital was performed. Results Total number of patients seen was 128. Median time from referral to appointment was 1 day. Abdominal pain formed 70.3% original presenting complaints. Over half of patients (52.3%, n=67) had review arranged by a registrar, and 46.9% (n=60) of patients were seen by a registrar at their appointment. 7% (n=9) had their hot clinic review arranged by a consultant. 63.3% (n=81) of patients had imaging performed as part of their review, and 53.1% (n =43) of these patients had pathology identified. 13.3% (n=17) of patients seen at the clinic required admission, and 43.0% (n=55) were discharged. 21.4% (n=3) of those brought back for a further hot clinic review had been seen by a consultant, versus 64.3% (n=9) seen by a registrar. Discussion Hot clinics are a valuable resource, and in our department a senior decision maker at a registrar level is involved in majority of decision making. The admission rate is low, demonstrating that the service is effective in helping to avoid admissions. Consultant input can help avoid repeated reviews.

WP6.4 - General Surgery Bootcamp: Improving Induction for Higher General Surgery Training

Abstract Aim To create an introductory course or “bootcamp” to assist new ST3s transition from working at core trainee to General Surgical Registrar level. Method Using previous expertise of “bootcamps” delivered in the region in similar specialities, a 3-day programme was designed to offer training in areas aligned to the curriculum and considered useful to newly starting higher surgical trainees. The course involved a mix of simulation-based workshops, lectures and skill-based labs. The programme was delivered by a senior faculty directing activity with support from industry partners and medical education/simulation expertise. A range of skills were targeted using animal, virtual and augmented reality models, low and high-fidelity simulation, and non-operative technical skills (NOTSS) in simulated ward and theatre environments. Results 26 trainees (23 new General Surgery ST3s, 3 returning to training) completed the bootcamp. Feedback questionnaires using a likert scale demonstrated clear improvements in trainees’ own skill perception in endoscopy, laparoscopy, open surgery and NOTSS. 100% of responding trainees’ were confident or strongly confident post course, compared to 69% before. We also showed an increase in confidence in laparoscopic suturing (77%), duodenal ulcer repair (69%) and operating in a stressful environment. Conclusions A transitional “bootcamp” can provide both tangible and intangible benefits. This project showed clear improvement in trainee confidence both in key practical and non-practical skills such as communication. It also enabled registrars to familiarise themselves with new colleagues, facilitating an early welcome from the region and embedded support network.

Development of entrustable professional activities for family medicine in South Africa.

South Africa is undergoing a significant shift towards implementing enhanced workplace-based assessment methodologies across various specialist training programmes, including family medicine. This paradigm involves the evaluation of Entrustable Professional Activities (EPAs) through comprehensive portfolios of evidence, which a local and national clinical competency committee then assesses. The initial phase of this transformative journey entails the meticulous development of EPAs rooted in discrete units of work. Each EPA delineates the registrar's level of entrustment for autonomous practice, along with the specific supervision requirements. This concise report details the collaborative effort within the discipline of family medicine in South Africa, culminating in the consensus formation of 22 meticulously crafted EPAs for postgraduate family medicine training. The article intricately outlines the systematic structuring and rationale behind the EPAs, elucidating the iterative process employed in their development. Notably, this marks a groundbreaking milestone as the first comprehensive documentation of EPAs nationally for family medicine training in Africa.

Management of Traumatic Cerebral Venous Sinus Thrombosis: A United Kingdom and Ireland Survey on Practice Variation.

Traumatic cerebral venous sinus thrombosis (tCVST) is an increasingly recognized sequela of traumatic brain injury (TBI), with skull fractures and extradural hematomas overlying venous sinuses recognized as risk factors. Although it may be treated with anticoagulation, the decision to treat tCVST is nuanced by the risk of new or worsening hemorrhage. Presently, there are no guidelines on the investigation and management of tCVST. Therefore, we conducted a UK- and Ireland-wide practice variation survey. A 17-question survey was sent via Google Forms to neurosurgeons and intensive care doctors of at least ST3 (registrar) level and above in the UK and Ireland and distributed by the Society of British Neurological Surgeons and investigators of the Sugar or Salt trial between May 9, 2023, and September 15, 2023. Data were extracted from the survey for both qualitative and quantitative analyses. There were 41 respondents to the survey, 18 (43.9%) of whom were consultant neurosurgeons. Fifty-four percent of the respondents performed a computed tomography intracranial venogram to investigate for tCVST where there was a skull fracture overlying or adjacent to a venous sinus, whereas 43.9% performed these at the time of TBI diagnosis. Around three-fourth of the respondents anticoagulate for tCVST, largely within 3 days post-TBI. A range of hemorrhagic and thrombotic complications have been observed following decisions to treat and withhold treatment of tCVST, respectively. Around two-third of the respondents conducted follow-up imaging in confirmed tCVST. None of the respondents had an established departmental protocol for the management of tCVST. This UK- and Ireland-wide survey on the management of tCVST revealed a variation in its diagnosis, treatment, and follow-up with no departmental protocol established. The optimal diagnostic pathway, management protocol, and follow-up of patients with tCVST remain unknown and should be the subject of future studies.

Hospital dental staff attitudes to guide education and training in patient safety: a study with a focus on qualitative data.

Objectives This study aimed to determine attitudes of current NHS dental hospital trainees at dental core trainee and speciality registrar level, plus consultant trainers, to guide shaping the direction of education and training in patient safety. The study was a locally based project in a single dental hospital setting at an acute NHS London Trust.Methods This study employed a survey and interviews, with emphasis on qualitative data utilised. Interviews were aimed at hospital clinical dental staff. The survey and focus groups were aimed at trainees. The one-on-one interview sessions were aimed at trainers.Results Findings demonstrated that both trainers and trainees see patient safety as a priority and there are gaps in education and training. Four overarching themes were seen as important to trainees and trainers to support education and training in patient safety: culture, knowledge, time to train and engagement.Conclusions Recommendations in this dental hospital setting focused on culture change and dental-specific experiential learning based on spiral curricula. Education and training in patient safety should be introduced at undergraduate level, with regular team training acknowledging the need for consistent engagement of all key stakeholders.

Benefits of Mentoring in Oncology Education for Mentors and Mentees: Pre-Post Interventional Study of the British Oncology Network for Undergraduate Societies' National Oncology Mentorship Scheme.

Formal education of oncology is lacking in many undergraduate medical curricula. Mentoring schemes can expose participants to specific areas of medicine and may address the shortfalls in oncology education. Few mentoring schemes have been designed within the United Kingdom, especially within oncology. There is a need to understand reasons for mentor and mentee participation in such schemes and to identify ways to minimize barriers to engagement. This study identifies motivations for participation in an oncology mentoring scheme and its benefits and limitations to both the mentee and the mentor. The British Oncology Network for Undergraduate Societies launched a National Oncology Mentorship Scheme (NOMS) on September 1, 2021. Mentees (medical student or foundation doctor) were paired with mentors (specialty registrar or consultant), for 6 months of mentoring. In total, 86 mentors and 112 mentees were recruited to the scheme. The mentees and mentors were asked to meet at least 3 times during this period and suggestions were provided on the content of mentoring. Mentees and mentors were invited to complete a prescheme questionnaire, exploring motivations for involvement in the scheme, current experiences within oncology, and knowledge and interests in the field. At the end of the scheme, mentors and mentees were asked to complete a postscheme questionnaire exploring experiences and benefits or limitations of participation. Paired analysis was performed using the Wilcoxon signed-rank test. For free text data, content analysis was applied to summarize the main themes in the data. Of the 66 (59%) mentees who completed the prescheme questionnaire, 41 (62%) were clinical, 21 (32%) preclinical medical students, and the remainder were junior doctors. For mentees, networking was the primary reason for joining the scheme (n=25, 38%). Mentees ranked experience of oncology at medical school at 3 on 10 (IQR 2-5). In this, 46 (53%) mentors completed the prescheme questionnaire, 35 (76%) were registrar level, and the remainder were consultant level (n=11). The most common reason for mentor participation was to increase awareness and interest in the field (n=29, 63%). Of those who completed the prescheme questionnaire, 23 (35%) mentees and 25 (54%) mentors completed the postscheme questionnaire. Knowledge in all areas of oncology assessed significantly increased during the scheme (P<.001). Most mentees (n=21, 91%) and mentors (n=18, 72%) felt they had benefited from the scheme. Mentees cited gaining insights into oncology as most beneficial; and mentors, opportunities to develop professionally. Whilst mentees did not report any barriers to participating in the scheme, mentors stated lack of time as the greatest barrier to mentoring. British Oncology Network for Undergraduate Societies' NOMS is expanding and is beneficial for mentees through increasing knowledge, providing exposure, and career advice in oncology. Mentors benefit from improving their mentoring skills and personal satisfaction.

Surgical Training in the United Kingdom's National Health Service: The Challenges for International Medical Graduates.

The UK's National Health Service (NHS) is a hub that trainees from all over the world want to join. However, there are many challenges for International Medical Graduates (IMGs). The aim of this study is to raise awareness of these challenges and to attempt to identify areas for improvement in the surgical training experience for international graduates wishing to join the NHS and obtain a National Training Number (NTN). A 33-question survey was designed and distributed to the surgical community via The Upper Gastrointestinal Surgery Society (TUGSS) and social media. Eighty-fiverespondents, IMGs from 25 countries, participated. The results showed that 43.5% of doctors had a Master's degree (MSc). Most IMGs joined as locally employed doctors at the senior house officer or registrar level. They all faced many challenges in the UK, including difficulties finding a job in the NHS, obtaining an NTN, and adapting to the differences between UK surgical practice and their home country. More than 50% of doctors did not have a named educational/clinical supervisor, and 63.2% of them felt that the supervisor helped them to become more familiar with the system. The support doctors received from the human resources department of the hospital they joined was poor. In addition, more than half of the IMGs changed their career plans after joining the NHS (56.4%) and would like to stay in the UK (52.9%). The majority of them (43.9%) plan to obtain an NTN. This study showed that there is a need to support international doctors who wish to start or continue their training in the UK. Furthermore, IMGs should expect to face several challenges when applying to work in the UK NHS.

1209 Comparison of Competition in Recruitment into Surgical and Non-Surgical Specialties

Abstract Aim Despite notoriety for strenuous training with significant out of hours commitments, surgical specialties maintain a reputation for competitive entry with rigorous portfolio requirements. This study aimed to compare recruitment data between surgical and non-surgical specialties to examine whether surgical specialties are more competitive for entry. Method Recruitment data from 2022 published by Health Education England was collated. Specialties included were those recruiting for registrar level training post (ST3/ST4 depending on specialty). Fill rates and competition ratios for all surgical specialties (with an ST3 entry-point) were compared with all non-surgical specialties for which there was data. Statistical analysis was completed using the Mann-Whitney U test. Results Median fill rates were 94.99% (IQR 23.81%) for non-surgical specialties and 100% (IQR 0%) for surgical specialties (p &amp;lt; 0.05). Median competition ratios were 3.17 (IQR 2.86) for non-surgical specialties and 3.92 (IQR 1.58) for surgical specialties (p &amp;lt; 0.05). Highest competition ratio overall was in immunology (46), with cardiothoracics having the highest surgical competitions ratio (23.5). Only genitourinary medicine and diagnostic neuropathology had a competition ratio &amp;lt;1. Conclusions All specialties at registrar level training had high fill rates and competition ratios, however this varied greatly between specialties perhaps due to lifestyle factors and exposure as students. Surgical sub-specialties demonstrated significantly higher competition ratios and fill rates, suggesting that despite discussion around quality of life and burnout in recent years, surgery continues to be an attractive career. It would be interesting to compare the rates of those leaving training posts with recruitment data.

Consenting surgical patients for the risk of contracting COVID-19 during the hospital stay.

Postoperative pulmonary complications occur in half of patients with perioperative COVID-19 and are associated with high mortality. The Royal College of Surgeons of England published guidance on recovery of surgical services during and after the COVID-19 pandemic. One part of this toolkit looked at unique considerations during the COVID-19 pandemic, in particular the risk of contracting COVID-19 while in the hospital. This quality improvement project sought to assess consent forms from the authors' surgical department to see if patients were being consented for the risks associated with COVID-19 during their stay in the hospital. Over an 8-week period in October and November 2020, consent forms for patients under the general surgery department were audited four times against the Royal College of Surgeons of England's standards. Patients were included in the study if they were deemed to have capacity to consent to a procedure. Posters in the hospital, generic emails and teaching sessions were used as the interventions after each cycle of the audit. Baseline measurement showed that fewer than 37% of patients were consented for the risk of contracting COVID-19; this rose to almost 61%, 71% and 85% in the second, third and fourth parts of the project respectively. Year 1 and 2 core surgical trainees and clinical fellows below registrar level showed the greatest improvement, from consenting only 8% of patients up to 100% of patients, while specialty registrars showed improvement in consenting from 52% to 73%. The change was sustained 2 years after the initial interventions, with almost 60% of patients consented for the risk associated with in-hospital COVID-19 infection in March 2023. Errors or omission of important elements in documentation of patient consent can delay operations, expose hospital trusts to medicolegal risk and ultimately may represent a failure to fully respect patient autonomy. This project sought to evaluate consenting practice during the presence of COVID-19 in society. While the teaching session showed some improvement in the consenting for the risk of COVID-19, emails and visual posters increased the consent rates further.

Electrocardiography Interpretation Proficiency Among Medical Doctors of Different Grades in the United Kingdom.

Electrocardiography interpretation is a core clinical skill for all doctors participating in emergency medical services. Given the majority ofECGsinitially performed in hospital on admission are reviewed by junior doctors, and the need for life-threatening pathology to be diagnosed or excluded, further understanding of the level of competency in interpretation and factors associated with this are needed. This was a cross-sectional, descriptive, analytical study. The data were collected using a structured questionnaire. This was comprised of two sections; the first section contained questions related to confidence, previous ECG learning and factors thought to be associated with ECG interpretation competence. The second section was an ECG quiz of 10 12-lead ECGs of varying complexity for interpretation assessment. Descriptive and inferential statistics were utilized for data analysis. Sixty-twodoctors from foundation year 1 to registrar level working in acute medicine across three hospitals participated. The mean overall percentage score for the ECG quiz was 45%. No association was found between junior doctor training grade and overall score on the ECG assessment. Undergraduate and postgraduate teaching strategies also did not impact competence. Only 9.7% reported themselves as "confident" interpreting ECGs. There was a trend towards higher levels of competency among those who felt they had undergone sufficient ECG teaching and those who sought regular feedback from other clinicians. This study demonstrated low overall levels of ECG interpretation competency among junior doctors in a large acute teaching NHS trust regardless of grade. Factors associated with competency remain unclear.

P58 YOUNG PERSONS' PERSPECTIVES ON THE RESULTS OF A UK MULTI-CENTRE SURVEY ON VARIATIONS IN CLINICAL PRACTICE IN PAEDIATRIC RHEUMATOLOGY UNITS DURING THE COVID-19 PANDEMIC

Introduction/BackgroundA paediatric rheumatology multi-centre survey was conducted to understand the impact of COVID-19 on services and provide useful learning points that could change future practice. The survey focused on clinicians' views of the pandemic. The aim of this study was to gather the perspectives of young people regarding the results of the initial survey. This was done via a group discussion with members of the national youth advisory panel for adolescent rheumatology – Your Rheum. It is important when evaluating service provision that not only the clinician’s perspective but the patient’s voice is heard.Description/MethodThe initial survey was sent, in August 2021, to Consultants in all UK paediatric rheumatology centres, to the paediatric rheumatology trainees network and to the JIA topic specific group members via email. 20 staff responded (17 consultants and 3 trainees at registrar level) across the 4 UK nations. Results of the survey showed changes to the frequency of blood monitoring (n = 17), an increase in disease flares (n = 4) with all respondents reporting changes to the type of consultation used with a large increase in the use of virtual consultations. Increases in clinic waiting lists due to capacity issues were also reported (n = 7). 15 respondents reported changes in steroid usage for flare management with more ward based steroid injections performed and an increase in the use of oral steroids due to theatre unavailability.The online discussion group held with ‘Your Rheum’ members consisted of 9 Young People (YP) aged between 12-24 years. The discussion group was facilitated by a research assistant, paediatric rheumatology trainee and a consultant paediatric rheumatologist. A number of statements with Agree/Disagree/Unsure options were provided with an opportunity to vote on each statement. A follow up discussion was held after each statement around the issues raised. The online tool Mentimeter was used to form a word cloud on YP experiences of the pandemic which was followed by breakout rooms to facilitate further small group discussions.Discussion/ResultsIn contrast to the survey results which revealed that clinicians perceived that YP preferred virtual (telephone or video or combination of both) consultations, young people in ‘Your Rheum’ varied in their responses with the majority of comments describing that it depended on the clinical context (if unstable or stable disease) with virtual appointments being preferable when their disease was stable. YP also reported issues with virtual appointments including difficulties with phone signal, not being able to obtain a specific time for appointments (varied time slots), issues for YP with hearing difficulties as well as one YP commenting it is “easier to lie to the doctor and just say everything is going really well”. Negative points raised with face-face appointments included longer waiting times and the time spent travelling to appointments.The majority of young people agreed that changes to the normal pattern of blood monitoring was concerning as this could lead to a possible increase in flare of conditions. Specific comments including accessibility to appointments was difficult during the pandemic with the additional fear of getting COVID-19 if attending the hospital for blood monitoring.YP used a variety of words to explain their experiences of rheumatology services during the pandemic including: ‘rushed’, ‘frustrating’, ‘stressful’, ‘virtual’, ‘chaotic’, ‘poor communication’, ‘inaccessible’ but also ‘COVID safe’.Key learning points/ConclusionYoung people with rheumatic diseases offered different insights to the initial clinician survey findings highlighting the importance of considering their opinion as well as that of professionals when considering service provision and evaluation.Flexibility is essential for young people and a hybrid approach with virtual/face to face appointments is key. Overall YP prefer face-face but are willing to have virtual consultations depending on the nature of issues needing addressed and the stability of disease.Experiences of poor communication between YP and health professionals/hospital has always been a theme in their experiences to date but has worsened since COVID-19.YP within this group discussion preferred to have blood monitoring performed at regular frequencies (similar to pre-pandemic) but did have concerns about getting COVID-19 by attending these appointments during the pandemic. It is important that YP are encouraged and reassured about attending appointments whilst ensuring COVID-19 safe precautions.

National Emergency Resuscitation Airway Audit (NERAA): a pilot multicentre analysis of emergency intubations in Irish emergency departments

BackgroundThere is paucity of literature on why and how patients are intubated, and by whom, in Irish Emergency Departments (EDs). The aim of this pilot study was to characterise emergency airway management (EAM) of critically unwell patients presenting to Irish EDs.MethodsA multisite prospective pilot study was undertaken from February 10 to May 10, 2020. This project was facilitated through the Irish Trainee Emergency Research Network (ITERN). All patients over 16 years of age requiring EAM were included. Eleven EDs participated in the project. Data recorded included patients’ demographics, indication for intubation, technique of airway management, medications used to facilitate intubation, level of training and specialty of the intubating clinician, number of attempts, success/complications rates and variation across centres.ResultsOver a 3-month period, 118 patients underwent 131 intubation attempts across 11 EDs. The median age was 57 years (IQR: 40–70). Medical indications were reported in 83% of patients compared to 17% for trauma. Of the 118 patients intubated, Emergency Medicine (EM) doctors performed 54% of initial intubations, while anaesthesiology/intensive care medicine (ICM) doctors performed 46%. The majority (90%) of intubating clinicians were at registrar level. Emergency intubation check lists, video laryngoscopy and bougie were used in 55, 53 and 64% of first attempts, respectively. The first pass success rate was 89%. Intubation complications occurred in 19% of patients. EM doctors undertook a greater proportion of intubations in EDs with > 50,000 attendance (65%) compared to EDs with < 50,000 attendances (16%) (p < 0.000).ConclusionThis is the first study to describe EAM in Irish EDs, and demonstrates comparable first pass success and complication rates to international studies. This study highlights the need for continuous EAM surveillance and could provide a vector for developing national standards for EAM and EAM training in Irish EDs.

P017 Variations in clinical practice in paediatric rheumatology units as a result of the COVID-19 pandemic: Initial findings of a UK wide Multi-Centre Survey

Background/AimsTo understand the impact of COVID-19 on UK paediatric rheumatology services, to determine the learning points that could change future practice and provide information for trainees to plan further quality improvement projects.MethodsSurvey details with a Microsoft forms link were emailed to consultants in each UK paediatric rheumatology centre. Consultants were asked to forward the survey onto any regional units linked. The survey was also sent to the paediatric rheumatology trainee’s network. The questionnaires covered blood monitoring, joint injections, oral corticosteroid use, modes of consultations, positive and negative impacts and what changes should be carried forward.Results20 staff responded to the survey; 17 consultants and three trainees (registrar level). 85% (17) reported changes had occurred to the frequency of blood monitoring to rheumatology patients on Disease Modifying Anti-Rheumatic Drugs (DMARDs) and/or biologics during the pandemic. 60% (12) reported this was due to patient/family reluctance to attend or due to unavailability of appointments. 75% (15) recorded no complications following changes of blood frequency on disease activity or flare. Of those that did have a flare, a number of factors were described including: parents not contacting their service, patient/family discontinuation of treatment, lack of clinic attendance, running out of treatment and safety concerns re prescribing from primary care or local department. One patient on methotrexate experienced significantly deranged liver function tests.75% (15) reported changes with provision of joint injections due to theatre unavailability. As a consequence, 60% (12) reported an increase in the use of oral corticosteroids with 20% (4) performing more ward-based injections with local anaesthetic or Entonox on younger children. 100% (20) changed their mode of consultation. Between 5 and 40% of all appointments are now virtual (telephone or video) and 60-95% are face-face. 60% (12) report that frequency of review appointments has now returned to normal. Major disruption has occurred in seeing new patients due to a backlog of patients created by the pandemic. Some patients have been referred to units with possible arthritis that haven’t been examined or seen face-face in primary care prior to referral.ConclusionCOVID-19 caused significant changes to UK paediatric rheumatology services. The results highlighted the use of virtual consultations where appropriate, consideration of joint injections without general anaesthetic as much as possible, enabling virtual teaching/conferences and also raising the need to review blood monitoring frequency for patients on DMARDs/biologics. Longer waiting lists, increased anxiety amongst children and young people, increase in disease activity and the impact on learning opportunities for trainees were concerning negative aspects of the pandemic. It is likely the impact of these negative consequences will continue to be experienced for some time. Future planning and consideration is required to minimise the negative impact of these aspects on our patients and colleagues.Disclosure D. McLaughlin: None. S. Deepak: None.

287 A Sigma Six Approach to Improving Nephrostomy and Antegrade Stent Services After a Trust Merger – a Quality Improvement Project

Abstract Introduction As hospitals merge into larger trusts there becomes a centralisation of some services. Urology relies on Interventional Radiology (IR) for Nephrostomy insertions and Anterograde stents in particular. Two lR lists run at Broomfield after centralisation. We aimed to innovate, through improving communication and appropriate prioritization of patients, to ensure patient safety and maximum utilisation of these lists. Method We used a sigma six, DMAIC approach. Data was collected over a 30-week period. Analysis was multifaceted, focused interviews with a thematic and stakeholder analysis. Value stream maps were created to assess waste, fishbone analysis to evaluate delayed cases, and a future state map was created, implemented, and controlled. Results Prior to the intervention, the average wait for IR was 3.66 (n = 74) days above the agreed standard of 3.5 days. Thematic analysis outlined lack of standardisation. Bottlenecks in the mapping process resulted from lack of communication. The fishbone analysis outlined organisational factors, such as rota publishing issues and task factors, such as lack of protocols and escalation clarity. The intervention was a standardised proforma, a new consultant to consultant communication channel, scan discussions at a registrar level and a point of escalation. Post intervention showed patient wait to be 1.22 day and staff satisfaction to increase 3-fold. Conclusions The DMAIC method proved for a comprehensive assessment of improvement. Patient waiting times can be reduced in hospitals with similar experience using such methods. Future Plan-Do-Study-Act can be used to continually improve once special cause variation has been eliminated – as it likely has in this case.

95 Striving to Thrive: Developing an Innovative Region-Wide Medical Registrar Preparation Simulation-Based Course

The COVID-19 pandemic has led to disruption and missed educational opportunities for Internal Medicine (IM) Year 2 trainees who shall progress to the second stage of their training in August 2021, stepping up to the medical registrar role. It had become apparent that some of these trainees may not be currently performing at the level expected for this stage of their training and may encounter some difficulties during this transition period.We were tasked by Health Education England (West Midlands) to design and implement an innovative region-wide medical registrar preparation course, utilizing simulation-based education. The courses required standardized content that could be delivered by either face-to-face or virtual modalities across multiple centres in the region.Two separate high-fidelity simulation courses were designed to deliver key aspects of the IM training curriculum with a clear focus on the behaviours, attitudes and skills required to perform as a junior medical registrar: ‘Thrive’. A 1-day course designed for trainees who are expected to be able to progress to IM year 3 without any concern. These courses were planned to be run by other regional centres to their local trainees using either a face-to-face or virtual format. ‘Strive’. A 2-day course designed for those trainees who have been identified as needing extra support to be able to progress to IM year 3. These courses were planned to be run via a face-to-face format at our SimWard to trainees from across the region. Course content included a mix of high-fidelity simulation scenarios as well as workshops focussing on key areas for medical registrar preparation as identified by IM trainees: Leading cardiac arrestsDebriefingBreaking bad newsPrioritization and delegationGiving adviceEscalating careAll content was designed and produced in house to then be provided electronically to region-wide centres facilitating standardized delivery, including pre-recorded simulation scenarios to allow virtual delivery. A webinar was held to aid roll out and provide training on course delivery and content to participating centres. Courses were delivered during the spring and summer of 2021. Initial feedback has shown an increase in perceived trainee confidence in dealing with all topic areas at the registrar level and has illustrated that learning has already been utilized in clinical practice. Courses are ongoing until the end of July 2021, after which a full analysis of region-wide impact can be made.

SP2.1.7Navigating surgical training: a game of trust

Abstract Introduction One premise of the Improved Surgical Training (IST) pilot is delivery of better quality of early years surgical training. However, the quality of the trainee-trainer relationship can positively or negatively impact trainees’ experiences of the specialty. Trust is a key determinant of the relationship, which is influenced by trainers’ level of risk aversion and trainees’ motivation. Game theory provides a framework to understand cooperation amongst rational ‘players’. This study explores how trainee-trainer relationships impact trainees’ experiences through the IST curricular reform. Methods Using a qualitative case study approach, data were obtained from interviews with core surgical trainees across Scotland. Data coding and inductive thematic analysis were undertaken. Results Forty-six trainees participated. Trainees and trainers regularly interacting in clinical activities demonstrated growing levels of trust, aided by: specialty rotations of 6 months or more duration, working at junior registrar level with structured weekly clinical activities and direct consultant supervision, individual goal-setting and regular progress check, and meaningful and timely feedback. Cooperative relationships led to individual fulfilment, growth, and trainee autonomy. Factors hindering development of trust included: temporal and/or geographical distance between trainee-trainer, poor communication and understanding of expectations and training needs, and lack of interest and enthusiasm from either party. Conclusion Cohesive trainee-trainer relationships demonstrated cooperative equilibrium; both trainees and trainers met each other’s expectations and positively impacted on trainees’ experiences. On the contrary, ‘players’ in relationships deficient in trust achieved the minimum to ensure trainee progression. Addressing factors fostering a cooperative trainee-trainer relationship positively impacts trainees’ experiences.

639 ENT Telephone Follow Up in The Era of Covid-19: A Retrospective Qualitative Analysis Utilising Semi structured focus groups

IntroductionCovid-19 and social distancing has triggered a seismic shift in clinical work especially during the first part of lockdown. This work looks to evaluate the experience and opinions of key stakeholders who took part in the process and use this to improve follow up in the future.Method3 Focus groups following the same semi structured format discussed key considerations in follow up in general, telephone follow up, key aspects in its delivery and how this could benefit the service provided to patients. The focus groups involved Juniors (registrar level doctors), Consultants and support staff (clinical and non-clinical).ResultsSeveral themes and subthemes were identified. Key points were that patients were universally in favour of telephone consultations; they find them convenient and enjoy not attending the hospital. All clinicians agreed that although Covid-19 lead us to review New patients via telephone this increased workload as they needed to attend later for an examination and felt it did not provide safe care.ConclusionsThere is certainly an increasing role for telephone follow ups in the wake of Covid-19 which can benefit ongoing patient care and aid in managing the departments follow up capacity. Further work is needed to review this.

Intubation practices for children in emergency departments and intensive care units across Australia and New Zealand: A survey of medical staff.

Intubation of children in the emergency setting is a high-risk, low incidence event. Standardisation of clinical practice has been hampered by a lack of high-quality evidence to support one technique over another. The aim of the present study is to determine clinician preference in intubation practice of children in EDs and ICUs in Australia and New Zealand to provide baseline information to allow future targeted research focused on improving the safety and efficacy of paediatric emergency airway management. The present study was a voluntary questionnaire undertaken by medical staff at registrar level or above in EDs and ICUs associated with the Paediatric Research in Emergency Departments International Collaborative (PREDICT) and Australia and New Zealand Intensive Care Society Paediatric Study Group (ANZICS PSG) research networks. Respondents reported on their individual intubation practices, with a focus on pre-oxygenation and apnoeic oxygenation techniques, and the use of video laryngoscopy. A total of 502 clinicians were invited to complete the survey between May and October 2018 with 336 (66.9%) responded. There was marked variation in practice between ED clinicians and ICU clinicians in the techniques used for pre-oxygenation, the frequency of use of apnoeic oxygenation and the reported use of video laryngoscopy. Within Australia and New Zealand there is considerable variation in paediatric emergency airway clinical practice, in particular with respect to pre-oxygenation, apnoeic oxygenation and use of video laryngoscopy. Definitive clinical trials are required to best inform clinical practice in this area.

Management of hospitalised osteoporotic vertebral fractures.

To explore the management of hospitalised vertebral fragility fracture (VFF) patients in Ireland. A cross-sectional survey of orthopaedic doctors (specialist registrar level) and physiotherapists was conducted across all hospitals with major orthopaedic trauma units in Ireland. Data were analysed using descriptive statistics in SPSS (V24). Responses were achieved from 100% (n = 16) of the hospitals (42 individual physiotherapists and 47 orthopaedic doctors). Conservative management was usual with both orthopaedic doctors (n = 37, 79%) and physiotherapists (n = 40, 96%) reporting prescription of bracing as common practice despite a lack of underpinning evidence. A majority (87%) of the doctors believed osteoporosis medications should commence prior to discharge from the acute setting, but 68% did not agree that responsibility for coordination and delivery of bone health assessment and fracture risk management rested with them. A majority (72%) of physiotherapists reported an absence or were unsure regarding existence of fracture liaison services. 73% of physiotherapists reported prescribing an inpatient or home (78%) exercise programme, including mobility, strength and balance exercise though detail on dose and adherence remain unknown. Wide variance in referral patterns to multi-disciplinary team (MDT) members existed although 79% of orthopaedic doctors supported an MDT approach. Clinical care pathways for the hospitalised VFF population lack standardisation in Ireland. Key challenges reported by orthopaedic doctors and physiotherapists relate to pain management, osteoporosis medication prescription, clarity on indications for bracing and a lack of fracture liaison services. Clinical guidelines, defined clinical care pathways and high-quality clinical research trials are required for VFF management.

David Gwyn Seymour

David Gwyn Seymour (“Gwyn”) was born in Ynysybwl near Pontypridd in south Wales and qualified from Birmingham University in 1973. After rapid acquisition of his MRCP (UK) in 1975, he...