Senior House Officer Research Articles

Cost awareness in urology: A nationwide survey

Introduction: In the current economic climate with continuous expenditure reviews and financial constraints, clinicians should remain conscious of making cost-effective choices on consumables and medications. In this survey, we evaluated the cost awareness amongst UK urologists. This is an observational study in which urology clinicians were asked to estimate the cost of 10 commonly used medications and consumables in urology by completing a questionnaire. Methodology: The survey was primarily conducted at the BAUS Annual Meeting 2017 with subsequent responders at local hospitals and urological courses. The costs of consumables and medications were verified with the relevant companies and the 73rd edition of the British National Formulary. Result: There were 139 responders from across the UK (46 consultants, 64 training registrars, 13 trust grades doctors and 16 senior house officers (SHOs)). In total, 16 and 60% of all estimates were within ± 25% and ± 100% of the true cost of the items respectively. Approximately 97.1, 95.7 and 97.1% overestimated the cost of a 14Ch urethral catheter, Ciprofloxacin and Sildenafil, respectively; while 78.4 and 84.9% of responders underestimated the cost of a JJ ureteric stent and Solifenacin, respectively. On multivariate analysis, SHOs significantly overestimated the cost of urethral catheters, suprapubic catheterization kits and JJ ureteric stents compared to other clinician grades. Conclusion: Cost awareness among UK urologists is poor. Expensive items (e.g. JJ ureteric stent, Solifenacin) tend to be underestimated while inexpensive items (e.g. catheter, Ciprofloxacin, Sildenafil) tend to be overestimated. This lack of appreciation of value may have an impact on drug and consumable expenditure. Level of Evidence: Level 3

Soad Abdalla Bosseri (1958-2019)

Dr. Soad Bosseri passed away on 14.2.2019 following a long struggle with cancer. Soad was born on 21.7.1958. She graduated from the Medical School of Tripoli University in 1982. After her internship, Soad joined the endocrine department working under the supervision of Professor Ibrahim Sherif in Tripoli Central Hospital for several years. Following this, she moved to the United Kingdom for further training. She started as a senior house officer and progressed to a registrar in the Merseyside and Midlands where she acquired her MRCP (UK), Diploma of Tropical Medicine, Diploma of Geriatric Medicine, and MSc in Endocrinology. Dr. Bosseri moved to Brunei working in diabetes for a few years before returning home till her retirement due to ill health.

Can simulation-based education and precision teaching improve paediatric trainees\u2019 behavioural fluency in performing lumbar puncture? A pilot study

BackgroundLow levels of success in performing lumbar puncture have been observed among paediatric trainees. This study assessed the efficacy of simulation-based education with frequency building and precision teaching for training lumbar puncture to behavioural fluency.MethodsThe intervention group was assessed at baseline, at the final training trial, in the presence of distraction, and a minimum of one month after the cessation of the intervention in order to ascertain whether behavioural fluency in lumbar puncture was obtained. Subsequently, the performance of this intervention group (10 paediatric senior house officers) was compared to the performance of a comparator group of 10 more senior colleagues (paediatric registrars) who had not received the intervention. Retrospective chart audit was utilised to examine performance in the clinical setting.ResultsIntervention group participants required a mean of 5 trials to achieve fluency. Performance accuracy was significantly higher in the intervention group than the comparator group. Learning was retained at follow-up and persisted during distraction. Retrospective chart audit revealed no significant difference between the performance of the intervention group and a comparator group, comprised of more senior physicians, in the clinical setting, although the interpretation of these analyses are limited by a low number of lumbar punctures performed in the clinical setting.ConclusionsThe programme of simulation-based education with frequency building and precision teaching delivered produced behavioural fluency in lumbar puncture among paediatric trainees. Following the intervention, the performance of these participants was equivalent to, or greater than, that of senior paediatricians. This study supports the need for further research exploring the effectiveness of simulation-based education with precision teaching to train procedural skills to fluency, and the consideration of how best to explore the impact of these on patient outcomes.

Rota changes in acute and general internal medicine: delivering improved patient care and junior doctor training at the front and back door – acute medical unit placement blocks the way forward for Midland Met!

Introduction of a rota to provide consistency of care for patients and improved training for junior doctors. Initial meetings were held with stakeholders from medical staffing, consultant and junior doctors. Following consultation, a prototype rota was agreed for foundation doctors and ‘senior house officer’ grades whereby doctors rotate into acute medicine for 5 or 6-week blocks once every 4 months. Within this block is two sets of nights, three to four weekends, late shifts and some normal working days. The remainder of the 4-month block would be spent back in their specialty rotation mostly working weekdays 9am–5pm. Two 9am–5pm ward cover doctors were added to support the …

Pilot programme to support a skills and competencies-based workforce in medicine

The aim in creating this innovative degree programme is to find a sustainable solution to medical workforce planning in hospitals reliant on ‘middle grade’ temporary staff to cover medical rotas such as those in remote and rural areas. The local university hospital trust has been investing in the training of advanced clinical practitioners (ACPs) to cover house officer (HO) and senior house officer (SHO) rotas at the hospital. This has led to a composite workforce model based upon a team …

Preoperative Patient Preparation Audit: Completed Loop Cycle.

IntroductionNurses usually check patients scheduled for surgery while the patients are still in the ward. A lack of complete preoperative patient preparation can cause delayed care and disastrous outcomes. The objective of this study was to assess the number of patients en route to surgery who had been fully preoperatively prepared and evaluate any change in that number once a proforma was introduced as part of the preparation protocol.MethodsWe conducted a two-part audit of preoperative preparedness to assess factors such as up-to-date blood work, group and save, cross-match, and surgical site marking, among others. We then devised a proforma to be signed and checked by the ward doctor (e.g., intern or senior house officer). We compared the number of patients marked completely ready for surgery in the six weeks prior to use of the proforma with the number of patients marked completely ready for surgery for six weeks after implementation of the proforma.ResultsThe study included the preoperative audit of 35 patients prior to the use of the proforma and 30 patients after the implementation of the proforma. Use of the proforma improved preoperative patient preparation by 50% compared to the level of preparedness when no proforma was used.ConclusionHealth care facilities may benefit from a similar proforma for supplementing standardized, widely accepted preoperative protocols as an additional safety measure.

Peter J B Hubner

Peter Hubner was born in London in 1942, the third son of a Czech antiques dealer who emigrated to England after the first world war. Peter developed an interest in...

GP who worked as obstetrics and gynaecology locum is struck off after risky caesarean.

A GP who sought to pursue a career in obstetrics and gynaecology despite lacking the training or qualifications has been struck off after he undertook a risky caesarean section that left a patient in intensive care and with “significant and ongoing problems.” A medical practitioners tribunal found that David Nzegbulem took on a locum post as a specialist registrar in obstetrics and gynaecology at Watford Hospital in November 2015 knowing that he lacked the experience to undertake trials of operative vaginal delivery and caesarean sections unsupervised. He had undertaken only locum sessions over a 10 month period in 2015 and worked as a senior house officer in the specialty 20 years before. He had never been recruited into a formal training programme either in …

Alan Edward Andrew Ridgway

Alan Edward Andrew Ridgway attended Downside School, from where he won a place to study medicine at Jesus College, Cambridge, in 1958. He qualified in 1964 after undertaking his clinical...

Fluid and electrolyte balance-establishing the knowledge base of Foundation Year One doctors.

Fluid and electrolyte management for hospital inpatients has been identified by multiple reports to be suboptimal, with delegation of this task to the most junior members of a medical team, Foundation Year One (FY1) doctors, also known as interns or house officers, being identified as a contributing factor. An online survey was distributed nationally via social media to FY1 doctors between 21st August 2018 and 19th September 2018. Questions focused around cohort characteristics, team behaviours around fluid and electrolyte prescribing, as well as teaching and knowledge. Two hundred eighty-six doctors participated. 67.13% knew the daily water requirement of a healthy adult. 58.39 and 79.72% knew the daily requirements of potassium and sodium, respectively. 41.26 and 33.57% knew the potassium and sodium composition of Hartmann's solution (1L), respectively, with only 31.12% of candidates knowing the correct sodium content of 1L of normal saline 0.9%. FY1 doctors were the principle prescribers of fluid therapy (97.55%); senior house officers, registrars, and consultants were only actively involved in the process 51.75, 20.98, and 5.59% of the time, respectively. 30.77 and 23.43% of FY1s received guidelines and/or teaching on the topic within their firms or as part of their foundation teaching, respectively. At undergraduate level, 52.44% of doctors reported the teaching to be "neither poor or good," "poor," or "very poor." The principle knowledge base underlying fluid and electrolyte management is still poorly understood by FY1 doctors, with poor teaching of the subject at both undergraduate and post-graduate level potentially contributing.

Anthony Victor Hirsh

Anthony Victor Hirsh (“Tony”) was one of the leading andrologists in the UK and a general practitioner in central London. He did his preclinical training at King’s College London and...

Disturbing and distressing: a mixed methods study on the psychological impact of end of life care on junior doctors.

The Irish Medical Council has identified gaps in knowledge and communications skills of new-entrant doctors in legal, ethical and practical aspects of end of life care. To determine the frequency with which junior doctors deal with end of life care and patient death and to evaluate the impact this has on their psychological wellbeing. A questionnaire was distributed to junior doctors to determine the frequency with which the participants had managed a patient at end of life. An abbreviated Posttraumatic Stress Disorder Checklist-Civilian version was used to evaluate psychological distress. Critical incident technique interviews explored the challenges of caring for patients at end of life. A total of 110 junior doctors in two teaching hospitals in Ireland completed the questionnaire: 39 (35.5%) interns and 71 (64.5%) senior house officers. In addition, 31 interviews were carried out with interns, senior house officers and registrars. The majority (81.8%) had pronounced a death with 39.4% of senior house officers doing so more than 10 times. Three quarters (75.5%) had discussed end of life with a patient's family. Of the 110 respondents that completed the posttraumatic stress disorder checklist, 11.8% screened positively for posttraumatic stress disorder. Challenges identified at interview included lack of knowledge and preparedness, difficulty communicating with family members, a lack of support and a feeling of failure. Junior doctors are regularly carrying out tasks related to end of life care, resulting in high levels of psychological distress. Further training and a change in culture are required.

William Dewi Rees

After national service, William Dewi Rees (who was always known as “Dewi”), met his future wife, Valerie, while a medical student in London. She was a biochemist at the Hammersmith...

Olivia Marie-Virginie Mine Schofield

Olivia Marie-Virginie Mine Schofield was a dedicated and well respected consultant dermatologist who enhanced dermatology services in Scotland, particularly in paediatric dermatology. She was appointed as a consultant dermatologist to...

Gordon Francis Falconer

Gordon Francis Falconer was the oldest of fiven children born to Dr Eric Falconer and Margaret Falconer. He trained in London at Guy’s Hospital and became a house officer in...

Begoña Anne Bovill

An article about leprosy in the World of Wonder children’s magazine triggered Begona Anne Bovill’s early interest in medicine and infectious disease. She went to the Royal Free Hospital School...

Teaching obstetric ultrasound at Mulago Hospital - Kampala, Uganda.

Mulago Hospital is a high volume referral hospital under the Makerere University School of Medicine and Health Sciences. Basic obstetric ultrasound is a useful skill that can aid patient care. The purpose of the study was to assess the effectiveness of an intervention implemented to teach basic ultrasound skills to medical students and house officers at Mulago Hosptial, Kampala, Uganda. Forty participants, including medical students, junior house officers (JHOs), and senior house officers (SHOs) were enrolled in the study. A didactic and practical hands-on teaching session was evaluated using a pre- and post-test that was administered to all participants. Participants included 12 medical students, 23 JHOs, and 5 SHOs. A significant difference in pre- and post-test scores was demonstrated in the medical students and JHOs (34% to 76%, p <0.0001) and this was retained when the results were stratified into the basic definitions and practical sections of the survey (33% to 71%, p<0.0001). The scores for the senior house officers had a mean increase of 2.3 points. This original teaching intervention is an effective method to improve knowledge and skills for medical students and house officers at Mulago Hospital in the area of basic obstetric ultrasound.

Medical referrals: introducing a GP-priority clerking shift to ensure equitable patient care

The Society of Acute Medicine (SAM) guidelines indicate that all medical patients should be assessed within 4 hours of referral. Our initial audit cycle revealed that in our institution, significantly less patients referred via their GP were seen within recommended time, when compared with patients referred via the Emergency Department (ED). We undertook a targeted educational intervention, improved the communication process for referrals and modified the senior house officer (SHO) clerking rota, and re-audited the service to determine the effect of these changes. Subsequently, the proportion of GP-referred patients reviewed within recommended time significantly improved for both initial clerking (from 60% to 95.5%, p=0.011) and consultant review (from 50% to 90.5%, p=0.009), with no detrimental effect on waiting times for ED-referred patients. This is likely to be clinically important, impacting on best practice and patient safety.

Engaging patients as teachers of clinical interview skills

AIMS AND METHOD To engage patients as teachers of psychiatrists in training and non-consultant career grades, for the purpose of enhancing doctors’ understanding of the patient point of view and of the complexity of the doctor-patient relationship. Patients have been engaged as teachers in a recurrent cycle of ‘Basic Interview Skills’ workshops and the views of the doctors about this initiative have been elicited through a brief anonymous and confidential questionnaire. RESULTS Thirty-six psychiatric senior house officers (SHOs), general practitioners, Vocational Training Scheme SHOs in psychiatry, and staff grade and trust doctors in psychiatry have participated in four cycles of workshops. Five patients have engaged in the workshops as teachers, alongside the clinical tutor. Questionnaire feedback indicated some specific criticisms of a number of participants and dissatisfaction by a small minority of doctors, but the overall evaluation of the experience was positive. CLINICAL IMPLICATIONS Engagement of patients as teachers of psychiatrists in training and other new doctors in mental health services is desirable, feasible and welcomed by most doctors. With due attention to the legitimate sensitivities of participants, the practice of engaging patients as teachers of doctors working in psychiatry could be generalised in training schemes and services across the country.

MRCPsych exam visa considerations

I want to thank Dr Lucas ( Psychiatric Bulletin , March 2003, 27 , 115) for taking the initiative to voice Senior House Officers' views. As an overseas trainee, I would like to draw the College's attention to one more point. There is enough anxiety about the MRCpsych exam and one could do without