Specialist Registrars Research Articles

Variation between countries for routine transvaginal cervical length measurement and interventions to prevent preterm birth

ObjectiveTo assess the variation between countries for routine transvaginal ultrasound assessment of the cervical length and interventions offered to prevent preterm birth (PTB). Study DesignAn anonymous digital questionnaire was sent out between August and October 2023 to delegates of the European Spontaneous Preterm Birth Congress. Outcomes assessed included method, indications (i.e. singleton pregnancy in women with or without a history of PTB, or a multiple pregnancy), timing and frequency of routine cervical length measurement, interventions offered to pregnant women with a short cervix or a history of PTB, and advice on physical- and sexual activity. ResultsIn total, 247 visitors of the European Spontaneous Preterm Birth Congress were approached for this study and 103 (42 %) participants completed the questionnaire representing 15 countries. Most participants worked in a Public/University hospital (n = 54, 53 %) and worked as a specialist (registrar or consultant; n = 84, 82 %). In most countries, the cervix was measured via a straight-line method without the cervical isthmus, but variety existed also within countries. Routine cervical length measurement in women with no prior PTB or a multiple pregnancy is rarely performed in the first trimester. For women with a history of PTB, 39 (38 %) respondents from six countries reported to start serial cervical measurement in the first trimester and 99 (96 %) from 14 countries in the second trimester. Follow-up for women at risk for PTB mainly occurs fortnightly (n = 40, 39 %) or monthly (n = 14, 14 %). However, follow-up is often individualized according to patient’s history and/or cervical length. In women with a history of PTB or a short cervix progesterone is administered vaginally (n = 99, 96 %), however dosage vary between 100 mg and 400 mg daily. The timing and gestational age at which a (primary/secondary/tertiary) vaginal cerclage is offered widely differ between countries (e.g. up to 24–28 weeks of gestation for a secondary cerclage). Advice on restrictions regarding sexual activity in pregnancy is frequently prescribed for women with a short cervix (n = 38, 37 %). ConclusionSubstantial variation exist between and within countries regarding the indications and timing of cervical length measurement and interventions offered. There is a need for a more universal approach to manage patients at risk for PTB based on the existing evidence.

Perceptions of undertaking a higher degree alongside dental specialty training: A cross-sectional survey of UK dental specialty trainees.

The curricula for UK dental specialty training have recently been under review and until 2024, completion of a research component during training in Dental Public Health, Oral Microbiology and Orthodontics has been mandatory (with an alternative route for Orthodontics involving the submission of two scientific papers for those trainees not wishing to undertake a higher degree). Anecdotally, some trainees in other dental specialties choose to undertake higher degrees alongside specialty training. The aims were to investigate how many dental specialty registrars study for higher degrees alongside specialty training, and whether undertaking a higher degree alongside specialty training has an impact on completion of training, research skills, research experience, patient care and career opportunities. This was a cross-sectional study design, involving the distribution of an online, anonymous questionnaire-based survey to UK dental specialty registrars in November and December 2022. In total, 38 questionnaires were completed, representing a 7.7% response rate of the entire dental specialty registrar cohort in the UK and 42% of those who received it. Most respondents (76.3%) were either studying or had completed a clinically relevant higher degree prior to specialty training. Most respondents (76.3%) reported that the higher degree increased career opportunities and gave them additional skills. Dental specialty trainees who responded to this survey perceived the higher degree to be beneficial in terms of preparing for exams, gaining skills in critical appraisal and for increasing future career opportunities.

Introduction to round table panel discussion and audience quiz

Abstract Dr. John Gannon is a Public Health Specialist Registrar with HSE Ireland. He has a background working in clinical paediatrics in Ireland, Australia and Zambia. John will introduce the workshop and begin by quizzing the audience using an interactive online tool, to evaluate their perceptions and understanding of the current landscape of screen usage and social media among children and adolescents. In this presentation, he will relay statistics on these metrics and the dramatic upsurge in recent years. He will also touch on the financial implications of these trends for global tech giants.

What does current diabetes and endocrine speciality outpatient training look like and what will change? Observations from a single training region in England

Introduction: Diabetes and endocrine speciality training in the UK has traditionally been lasted five years but moved to a four- year model in 2021 with the introduction of the Internal Medical Training (IMT)3 year programme. Here we aim to review the case mix of outpatients seen by a single diabetes and endocrinology Specialty Registrar (SpR) during clinical training and offer insights into the range of patients seen. We will also review the NHS ePortfolio entries for Diabetes and Endocrinology and for General Internal Medicine to establish how many self-entered forms, assessments (completed and expired) and summary assessments are typically undertaken before certification of completion of training (CCT). Methods: A diabetes and endocrinology registrar (JD) kept an anonymised log of all outpatient consultations from starting speciality training as an ST3 in August 2017 up until his CCT was awarded in May 2023. Duration of training was extended because JD was a less than full time trainee (LFTT), with a period of shared parental leave. Non-patient-identifiable data included diagnosis or presenting complaint of patient seen, type of clinic and date of clinic between August 2017 and May 2023. Following CCT, NHS ePortfolio data were reviewed to establish NHS ePortfolio entries, including the number of requested assessments and number of completions. Results: For the last 18 months of training, approximately 40% of JD’s working time was spent on general medicine and 60% on diabetes and endocrinology. Over the total time of training from 2017 to 2023 JD had a total of 4,150 consultations in outpatient clinics. There were 1,347 consultations in the endocrine clinic and 2,803 consultations in the diabetes clinic. There were 472 ePortfolio entries: 158 of these were self-entered, 284 requested assessments completed and 30 summary or progression assessments. 130 requested assessments expired before completion, giving a response rate of 68.5%. Conclusion: Observations from a single training region in England show that five years of diabetes and endocrinology registrar training provided a broad mix and depth of outpatient experience. The greater number of patients seen in diabetes clinic represents the requirement for service delivery in the area and subspecialist interest being developed. The change to four years’ speciality training is likely to represent around 800 fewer consultations as a speciality trainee in diabetes and endocrinology. The reduction in training opportunities could be addressed through having more protected time for specialist teaching clinics, particularly pump and technology clinics. A large amount of evidence from both the trainee and assessors is required in NHS ePortfolio to achieve CCT in diabetes and endocrinology and general internal medicine. Although the data come only from one trainee and one region, they can provide a point of reference for future analysis of the effect of four years’ speciality specific training on the breadth of training and a stimulus for other trainees and other region to reflect and analyse their rota and data.

Evaluating the Effectiveness of an Online Targeted Education Programme on Vascular Surgery Aimed at Early Postgraduate Doctors.

Introduction Mind The Bleep (MTB) is a junior doctor-led online education organisation that produces free open-access medical education (FOAMed) resources. This paper describes MTB vascular surgery online education programme. The target audience was early postgraduate doctors completing a rotation in vascular surgery. The aims were to increase participant confidence in basic vascular surgery topics and better prepare them for their role in vascular surgery. Methods Speakers included foundation doctors, vascular speciality registrars, consultant vascular surgeons, and a vascular nurse specialist. Post-webinar feedback surveys presented as a five-point Likert scale were used to assess the effectiveness of the course. Wilcoxon signed-rank tests were used to analyse the data. Results Over three months, from March to June 2022, nine one-hour targeted education sessions were conducted, with a total of 564 participants. Post-session feedback was obtained from 364 participants (64.6%). There was a significant increase in the participants' level of confidence in the topic seen across all sessions (p <0.05). The participants rated webinars highly in the domains of engagement (mean 4.31), helpfulness of the content (mean 4.50), and interest (mean 4.39). From the cohort, 200 participants provided feedback on whether attending the webinar better prepared them for a vascular surgery rotation, with 66.5% (n = 133) reporting yes. Conclusion The MTB vascular surgery online education program successfully increased participants' confidence and their preparedness for a role in vascular surgery. As a result, it is a useful adjunct to undergraduate surgical education.

Implementing a Pilot Geriatric Oncology Service at a National Cancer Centre in Dublin

Abstract Background The American Society of Clinical Oncology and International Society of Geriatric Oncology recommend comprehensive geriatric assessment (CGA) for older adults commencing systemic anti-cancer treatments (SACTs) (1, 2). Routine CGA is lacking in cancer centres nationally. Methods A pilot, interdisciplinary geriatric-oncology (GO) clinic comprising a geriatric medicine consultant and specialist registrar, medical oncology fellow, physiotherapist and occupational therapist was established Dec 2023. New oncology patient referrals were screened applying the G8 tool; a score of ≤14 triggering referral. Polypharmacy was defined as ≥5 regular medications. Frailty was assessed using Clinical Frailty Scale (CFS) and cognition using Montreal Cognitive Assessment (MoCA). Results To date, 30 patients have attended the clinic; mean age 77.2 (SD5) years (range 68-85); 73% female, 50% with a CFS score of ≥4. Sixty-percent (n=18) were due to commence chemotherapy, the remainder hormonal or targeted treatment. Polypharmacy was identified in 66.6% (n=20), with 13.3% (n=4) having an anti-cholinergic burden score of ≥3, MoCAs were completed in 60% (n=18), of whom 77.8% (n=14) had an abnormal result (&amp;lt;26/30 MoCA or &amp;lt;18/22 MoCA blind). Twenty-six percent (n=8) reported ≥1 fall in the preceding six-months. Deprescribing interventions were completed in 40% (n=12); 58.3% (n=7) had ≥2 medications stopped. Medications most commonly deprescribed included opioids (n=2), antihypertensives (n=2), statins (n=2). Ambulatory blood pressure monitors were arranged for 33.3% (n=10) and DEXAs for 40% (n=12) and appropriately actioned. Follow up was arranged in the Falls and Syncope Unit for 7%, day hospital 10%, geriatric outpatients 10%, group psycho-oncology sessions 20%, specialist cancer rehabilitation physiotherapy service 17%. Parkinsons disease and dementia were diagnosed in 1 and 1 patients, respectively. Each patient had a detailed assessment and plan forwarded to their treating oncologist. Conclusion The development of a dedicated GO service is in line with international standards. By undergoing CGA, geriatric syndromes amenable to intervention were identified in patients.

Unenhanced computed tomography as a diagnostic tool in suspected pulmonary hypertension: a retrospective cross-sectional pilot study.

Computed tomography pulmonary angiography (CTPA) has been proposed to be diagnostic for pulmonary hypertension (PH) in multiple studies. However, the utility of the unenhanced CT measurements diagnosing PH has not been fully assessed. This study aimed to assess the diagnostic utility and reproducibility of cardiac and great vessel parameters on unenhanced computed tomography (CT) in suspected pulmonary hypertension (PH). In total, 42 patients with suspected PH who underwent unenhanced CT thorax and right heart catheterization (RHC) were included in the study. Three observers (a consultant radiologist, a specialist registrar in radiology, and a medical student) measured the parameters by using unenhanced CT. Diagnostic accuracy of the parameters was assessed by area under the receiver operating characteristic curve (AUC). Inter-observer variability between the consultant radiologist (primary observer) and the two secondary observers was determined by intra-class correlation analysis (ICC). Overall, 35 patients were diagnosed with PH by RHC while 7 patients were not. Main pulmonary arterial (MPA) diameter was the strongest (AUC 0.79 to 0.87) and the most reproducible great vessel parameter. ICC comparing the MPA diameter measurement of the consultant radiologist to the specialist registrar's and the medical student's were 0.96 and 0.92, respectively. Right atrial area was the cardiac measurement with highest accuracy and reproducibility (AUC 0.76 to 0.79; ICC 0.980, 0.950) followed by tricuspid annulus diameter (AUC 0.76 to 0.79; ICC 0.790, 0.800). MPA diameter and right atrial areas showed high reproducibility. Diagnostic accuracies of these were within the range of acceptable to excellent, and might have clinical value. Tricuspid annular diameter was less reliable and less diagnostic and was therefore not a recommended diagnostic measurement.

Multidisciplinary approach to obstetric disseminated intravascular coagulopathy management in low-income country: A survey.

To assess the uptake of a multidisciplinary team approach in obstetric disseminated intravascular coagulopathy (DIC) management in a low- to middle-income country. A cross-sectional observational study, in which a semi-structured and pre-tested questionnaire was used to collect data on the uptake by Nigerian obstetricians of the multidisciplinary team approach to obstetric DIC management. A total of 171 obstetricians responded, 82 (48.0%) were consultants and 89 (52.0%) were specialist registrars. Most (165; 96.5%) practiced in tertiary healthcare facilities and the multidisciplinary team approach was the most preferred (162; 94.7%) management approach. In all, 142 (83.0%) supported the invitation of hematologists always in the management whereas 115 (67.3%) participants recommended that involvement of specialists in the treatment should be when clinical presentation was suggestive of DIC. No significant association existed between years of obstetric practice and adoption of a multidisciplinary team-based approach (χ2 = 9.590; P = 0.252). A multidisciplinary approach is widely adopted in the management of obstetric DIC, with hematologists being a key member of the team.

The Student Grand Round: A Peer Teaching Initiative.

Introduction Oral presentation and public speaking skills are poorly emphasised in the medical school curriculum. The student grand round was created to tackle this deficiency by changing the way in which students are taught, from traditional lecture-based learning to interactive small-group peer-to-peer teaching. This approach encourages students to become responsible for their own learning, develop their public speaking and teaching skills, as well as identify and address gaps in their knowledge. Aims The primary aims of this study were to determine the understanding of students before and after peer teaching, including retention of concepts via quiz scores and confidence of students in giving SBAR (Situation, Background, Assessment, Recommendation) handovers. The secondary aim is to determine the place of student-led grand round teaching in the medical curriculum as a means of developing teaching skills and encouraging active learning. Methods A cohort of 21 third-year medical students from Leicester University attended a weekly peer teaching programme where students presented a case they had encountered during their clinical attachment. Peer teachers were required to research some background and pathophysiology regarding the topic and teach in an interactive manner and create discussion regarding the topic. The students then summarised the case and practised the skill of concise handovers using the SBAR format.Knowledge and understanding were assessed with an interactive quiz, and feedback via a survey was gathered before and after sessions. Each student engaged in case discussion and received input from a specialty registrar regarding their presentation skills, case knowledge, and SBAR handover. Results Individual and combined session analysis demonstrated a significant improvement in scores across understanding the topic and confidence in SBAR. Student recommendation for the session cumulatively was significant (p=0.02); however, comparison of medical student recommendations of individual sessions did not yield statistically significant results. There was a significant improvement in the overall quiz score (p=0.045), and average scores improved from 51% to 70% (p=0.043). There was a significant increase in the mean quiz result after the first two sessions (28-55% (p=0.002) and 56-85% (p=0.0001), respectively). Summary The student grand round is a promising teaching initiative that capitalises on peer teaching, a valuable learning theory that centres around students taking on the role of teachers to instruct their peers. Results from this study have shown that this method of collaborative teaching is effective in improving the understanding of medical topics, increases confidence in public speaking and precise handover skills, and therefore better prepares medical students for their career as future clinicians.

Demystifying the MRCP exams for IMGs: the impact of five Nigerian Specialist Registrars through a virtual medical academy

‘There is a loftier ambition than to stand tall in theworld, it is to stoop down and raise mankind higher’ – Henry Van Dyke. The MRCP PACES exam is the last hurdle to climb for internal medicine registrars before they become a prestigious Member of the Royal College of Physicians United Kingdom. However, most International Medical Graduates (IMGs) do shy away from the medical specialty because of the failure rate of these exams. According to the Paces Spring Performance Report 2023, the failure rate of IMG in Paces was alarming compared with British Medical Graduates; Around 60% of IMGs failed the exam-700 IMGs in comparison to approximately 30–200% UK graduates [1, 2]. These disparities invigorated five Nigerian IMG registrars to bridge this gap through a free weekly virtual PACES exam for the last 40 weeks. We also started monthly MRCP Courses and PACES-centred MRCP Masterclasses to support International Medical Graduates to ace their PACE exams. Furthermore, through the power of representation, we are inspiring and attracting IMG doctors to the physician specialty [3]. Five Nigerian IMG registrars – ST4 to ST5, trainees of HEE in Acute Medicine, Neurology, Cardiology, and Stroke Medicine across diverse regions in England facilitated weekly tutorials up to three times weekly since June 2023 through the Zoom Platform. The success of the free tutorials led to the development of the Virtual PACES and created a need to start a Virtual MRCP PACES Course. We have facilitated more than 10 PACES courses, 15 Paces Mocks, 4 Neurology Masterclasses, and 4 Communication Master Classes. To the best of our knowledge, we are the first group to conduct a Successful Virtual PACES Mock exam. We have more than 500 International Medical Graduates on our social media platform who participate actively in all our educational courses. The majority of them live in the United Kingdom and completed their medical school in Asia, Africa, or Europe. To rate the impacts of our weekly IMG Paces tutorials, we decided to conduct an anonymous online survey. More than 50 doctors responded. More than 96% of the respondents were IMGs. A third of the respondents were Internal Medicine Trainees (IMTs) in the UK. About a third were trainee registrars and a third were in a non-training role. A third of our respondents have attempted paces before. More than about half of the respondents had attended more than five weekly sessions. When asked to ‘rate their strength in the paces content before attending Free PACES teaching’; more than half of respondents rated themselves as either poor or fair across all pace components, especially in Neurology, Communication, and Consultation [4]. When asked to rate their improvement in the PACES content after attending our free PACES teaching. More than 90% rated improvement across all the paces and approximately 60% of respondents said they ‘improved a lot’ in Communication, Consultation, and Neurology. When asked ‘how do you feel seeing fellow IMG Registrars taking you through the Sessions? More than 90% of respondents feel more confident, more supported, inspired, and more included to pass paces. Almost all respondents now have a more positive perception of IMG registrars following the tutorials [5]. Finally, for people who attend our courses and mocks, we have a success rate of more than 50% in the MRCP exams which is higher than the national average for IMGs. This bold and altruistic step taken by five Nigerian Specialist Registrars has bridged the gap to improve the success rates of IMGs in completing the MRCP PACES exam. We hope to extend this innovative platform to other specialties who are willing to collaborate with us in our quest to empower IMGs. Beyond that, we believe we are changing narratives and shaping the perception of Nigerian doctors, Nigeria, and Africa as a whole. That to us, becomes an ‘icing on the cake’.

Specialist palliative care professionals’ views on access to their services for people with dementia

Background In Ireland and around the world populations are ageing, contributing to an increase in the number of people living with dementia. Dementia is a life-limiting condition and evidence suggests that people with dementia would benefit from specialist palliative care (SPC) input. There is ongoing investigation into how people with dementia access the services they need at the right time. Aim The aim of this study was to explore how people with dementia access SPC services in a region in the Mid-West of Ireland, from the perspectives of key healthcare workers linked to the service. Methods Semi-structured qualitative interviews (n=10) were conducted with healthcare professionals involved in the referral process of accessing SPC input, including consultants, specialist registrars, clinical nurse managers and an assistant director of nursing. The data was analysed using thematic analysis. Results Overall four main themes were identified from the data: Capacity for providing SPC services to people with dementia; Appropriate Referrals and Recognising Need; Inadequate volume and inequitable geographical distribution of dementia services; Service integration and inter-professional collaboration. The underlying premise was the disease trajectory of dementia and a changing model of care. Conclusion A needs assessment rather than a diagnosis is the referral process that underpins access to SPC for people with dementia. However, there is little consensus on ‘grey’ areas within this process and some SPC professionals may be less comfortable with treating patients with dementia. A different model of care is needed.

Burnout among diabetes specialist registrars across the United Kingdom in the post-pandemic era.

Burnout syndrome is a condition resulting from chronic work-related stress exposure and can be identified by the presence of one or more of the three classic dimensions of burnout, i.e., emotional exhaustion, depersonalization, and lack of personal accomplishment, which negatively impact physician health and productivity. This study aimed to identify burnout among Diabetes and Endocrinology Specialty Training Registrars (DStRs) across the United Kingdom. It was a Cross-sectional observational study after ethical approval ERSC_2022_1166, utilizing the gold standard Maslach Burnout Inventory to measure burnout syndrome, and to determine self-reported stressors and compare them with the results of our previous survey in 2018. Over 430 DStRs across the United Kingdom were invited electronically through their deanery representatives and specialty training bodies. Using Google Forms™ to gather data, we were able to collect 104 completed surveys. Results revealed that 62.5% (n = 65) of participants have burnout (5% increase from the previous survey in 2018), 38.6% (n = 40) have high emotional exhaustion, and 44.2% (n = 46) feel a lack of personal accomplishment. "General Internal Medicine specific workload" was the most common self-reported stressor reported by 87.5% (n = 91) of participants, whereas bullying/harassment and discrimination at work were reported by 35.6% (n = 37) and 30.77% (n = 32) of participants, respectively. Using multivariable logistic regression model, personal stress (OR, 4.00; 95% CI, 1.48-10.86; p = 0.006) had significant, while Bullying/harassment (OR, 3.75; 95% CI, 0.93-15.12; p = 0.063) had marginal impact on the presence of burnout. Diabetes and Endocrinology Specialty Training Registrars frequently experience burnout syndrome, which has increased over the last 4 years. However, organizational changes can help identify, prevent, and treat physician burnout. NCT05481021 available at https://ichgcp.net/clinical-trials-registry/NCT05481021.

How do we review coronectomies? A national survey

AbstractIntroductionCoronectomy of a mandibular third molar is a surgical procedure which aims to protect the inferior alveolar nerve (IAN) by removing the crown of the tooth, whilst leaving the roots in‐situ. There is an anecdotal variation in practice regarding the post‐operative clinical and radiographic review of patients who have undergone this procedure, which may be attributable to a lack of high‐quality evidence or guidance. The aim of this study was to establish current practice within the United Kingdom (UK) for a post‐operative review following a coronectomy.Materials and MethodsAn online survey was distributed to 50 Oral Surgery speciality registrars working within Oral Surgery and Oral and Maxillofacial departments across the UK during June 2022. Two reminder emails were sent, and participants were asked to respond on behalf of their departments.ResultsTwenty responses were received from trainees, on behalf of 20 separate departments. Fifty percent (n = 10) of the responding departments discharged patients without intra‐operative complications immediately following the procedure. The remaining 50% of departments discharged patients at points ranging from 2 weeks to 12 months. Departments who review patients who have undergone a coronectomy without intra‐operative complications do so between 1 and 3 times, with the most common time for the first review being at 1‐month post‐procedure (n = 3). When reviewing these patients, 54.5% (n = 6) of departments utilise face‐to‐face only reviews, whereas 36.4% (n = 4) of departments utilise a combination of face‐to‐face and remote reviews. Sixty‐five percent (n = 13) of departments do not routinely take postoperative imaging for these patients. Many departments also reported variation in practice within their departments, regarding discharge timing, clinical review and radiographic review.ConclusionThis survey has suggested that there is variation in practice within the secondary and tertiary care Oral Surgery and Oral and Maxillofacial Surgery centres within the United Kingdom in relation to the post‐operative clinical and radiographic coronectomy review. Consideration should be given to further high‐quality research into these areas, including the merits of patient‐initiated reviews and the development of guidelines for post‐operative management of coronectomy patients.

Can you name that tablet? A cross-sectional study on recognition of common urology medications.

Clinicians frequently rely on patients to accurately tell them what prescription medications and doses they are taking in outpatient visits. This information is essential to monitor the efficacy of a medication and to determine any adverse interactions. This study aimed to assess urologist and urology trainee's visual recognition of common urology medications. An online survey was distributed to urologists and urology trainees in Ireland. Images of 11 commonly prescribed urological medications were presented with free text options for answering. Information was gathered on respondent's role and experience. Data was analysed using STATA version 17. The survey had a 90% response rate from 50 distributions. Respondents' roles were consultant (31.1%), specialist registrar (33.3%), registrar (22.2%), senior house officer (11.1%) and intern (2.2%). Forty six percenthad more than six years urology experience. Average rate of correct responses was 39.4% ± 23.9. The most accurate group were consultants (46.1% ± 22.1), followed by specialist registrars (41.2% ± 24.9), registrars (39.1% ± 26.8), senior house officers (21.8% ± 10.4) and interns (9.1% ± 0). The most and least recognised medications were sildenafil (Viagra©) (84.4%) and fesoterodine (Toviaz©) (11.1%), respectively. Just 28.9% of respondents had previously handled any of the medications listed. Patients often do not reliably know their own medications other than to describe them or show an unpackaged tablet. Prescribing safety is paramount to ensuring patient safety and reducing the risk of adverse drug reactions. This study shows that even experienced clinicians do not recognise the medications they regularly prescribe, and decisions should not be made without accurate medication reconciliation.

Simulation as an effective means of preparing trainees for active participation in MDT meetings

IntroductionCancer multi-disciplinary team (MDT) meetings are an important component of consultant workload, however previous literature has suggested trainees are not satisfied with their current curriculum in preparing for MDT working. MethodsThis educational pilot assessed whether multi-speciality simulated scenarios with pre-defined learning objectives, could prepare specialist registrars for interacting within an MDT. Participants completed pre- and post-questionnaires assessing a number of areas including: current experience of training, confidence presenting patients and whether the course would alter future practice. ResultsTrainee confidence increased significantly from a mean of 5 to 7 (mean to nearest whole number, p < 0.01). Trainees rated the session highly for utility and altering their future practice (mean scores of 9 for both respectively, out of 10). ConclusionSimulation has shown success in other multidisciplinary teaching, however to our knowledge there are no cancer specific training programmes. Our results highlight a potential gap in UK specialist training, and suggest simulation may be beneficial in preparing trainees to present in MDT meetings.

Does Virtual Video Endoscopy simulation training aid postgraduate endoscopy trainee learning of pathology in the era of COVID-19?- A single centre experience in a Dublin Teaching Hospital

COVID-19 has had a significant impact on post-graduate gastrointestinal endoscopy education in Ireland. The signature pedagogy of endoscopy education is the hands-on apprenticeship model however this was impeded during the restrictions imposed by the pandemic. To progress endoscopy learning at a time when exposure was reduced, we, as consultant trainers, focused on teaching pathology recognition, a known deficit in the current endoscopy curriculum. A series of five virtual endoscopy simulation sessions consisting of endoscopic videos and pictures demonstrating upper gastrointestinal pathology were taught to six endoscopy trainee specialist registrars in a single Dublin teaching hospital. Pathology quizzes were administered to trainees pre and post undertaking the sessions to measure learning. Semi-structured interviews were used to assess the utility of the sessions and a qualitative analysis of responses was undertaken. Amongst the six trainees, virtual video endoscopy simulation training led to a statistically significant increase in endoscopy trainees’ pathology recognition scores in the post-intervention quiz. All trainees found the virtual video simulation sessions to be useful and relevant to their stage of training, with demonstration of active learning after the teaching sessions. However, the personal and professional effect of the pandemic on trainees was profound, with senior trainees being disproportionally affected. Trainees also identified that the current apprenticeship model for endoscopy learning is no longer fit for purpose. Given the effect of the pandemic on trainee learning it is important that we take a systematic approach to analyse teaching tools that were used during the pandemic to ensure that they are helping trainees reach their learning goals.

EGS P14 Improving Management of Obstructive Jaundice: A Single-Centre Experience

Abstract Background Timely management is essential in preventing recurrence of gallstone disease and The National Institute for Clinical Excellence (NICE) recommends that laparoscopic cholecystectomy (LC) should be performed within seven days of admission. However, there remains wide variation between NHS Trusts in managing gallstone disease. As part of an ongoing surgical quality improvement project, a restructured Upper Gastrointestinal Surgery (UGI) firm was created (with three dedicated UGI consultant surgeons, one specialist registrar, one foundation doctor), in close collaboration with interventional gastroenterologists and radiologists. The impact of this new service on gallstone disease management has been closely monitored. Methods A prospective database was maintained including patients presenting emergently with obstructive jaundice and/or common bile duct stones at our district general hospital (DGH) in the 6-month timeframe before (September 2021 to February 2022) and after (September 2022 to February 2023) implementation of the new UGI service. Outcomes included time from presentation to magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP) and LC. Results 26 and 38 patients with obstructive jaundice were admitted in the 6-month periods before and after UGI firm implementation, respectively. There were significant reductions in time from admission to receiving ERCP (6.6 days versus 40.2 days, p&amp;lt;.001), and outpatient LC (61.8 days versus 194 days, p=.02). There was also marked improvement in obtaining MRCP (2.5 days versus 5.2 days). After UGI firm implementation, 35% of eligible patients were offered an inpatient LC which were all performed within seven days (mean 6.3 days), versus none previously. Conclusions A dedicated UGI service significantly improved the treatment process for patients presenting with obstructive jaundice at our DGH. As part of ongoing quality improvement work, solutions such as introducing a ‘golden patient’ to the NCEPOD list, a ‘hot slot’ on the elective gallbladder list or a dedicated weekly ‘hot’ gallbladder list are currently being investigated. Equipment for laparoscopic transcystic common bile duct exploration is also being considered to alleviate the need for ERCP prior to surgery.

'Experience days': promoting interprofessional collaboration and understanding for postgraduate doctors in training.

An 'experience day' is a novel concept in medical education, targeted at postgraduate doctors in training. In this article, the term postgraduate doctors in training includes all junior doctors, ranging from foundation year level to junior specialist doctors to higher specialist registrars. Experience days offer postgraduate doctors in training the opportunity to shadow other healthcare professionals in their working environment, to enhance their perspective of their role as a clinician and their understanding of the complex interplay of services. The aim is to promote interprofessional collaboration and to encourage consideration of the expectations placed upon members of the multidisciplinary team and reflection on whether these are realistic. Taster days are a well-established educational opportunity for junior doctors, supported by Health Education England. However, there is a paucity of literature concerning shadowing for doctors who have already qualified, or those who wish to shadow services that they work alongside. This article introduces the concept of experience days for postgraduate doctors in training.

Developing the workforce to deliver perioperative medicine for older people undergoing surgery: a transdisciplinary education programme

Patients who are older, frail and medically complex are increasingly presenting for elective and emergency surgical interventions. Comprehensive Geriatric Assessment (CGA) and optimisation methodology improve morbidity and mortality in older surgical patients. However, there is a need to develop an extended and flexible workforce to provide patient-centred quality perioperative care and to simultaneously tackle the growing backlog of planned surgery following the Coronavirus 2019 (COVID-19) pandemic. At Guy's and St Thomas' NHS Foundation Trust, Perioperative Medicine for Older People (POPS) delivers a transdisciplinary education programme for foundation doctors, specialty registrars and advanced clinical practitioners to develop a blended team with shared capabilities and goals in perioperative care. This case study outlines the framework of how the education programme was developed and its evaluation, and the ongoing work of POPS to disseminate knowledge and promote national innovation and collaboration.

A92Sustained Quality in Simulation Training – ‘Step-Up’ to IMT3

Following the introduction of the ‘IMT3’ year as part of Internal Medicine Training in 2019, a ‘Step-Up’ simulation day was developed in 2021. Positive feedback from candidates reflected its usefulness in preparing to work as a medical registrar [1]. The scenarios were conducted with the subsequent cohort of IMT3 doctors and feedback assessed for sustained quality of training. Simulation is recognized as an important tool in medical education [2]. It is now specified by the Royal College of Physicians that trainees participate in simulation inclusive of human factors and scenario training [3]. The ‘Step-Up’ simulation day continues to consist of four progressive, high-fidelity scenarios that replicate a day in the life of a medical registrar. Each scenario occurs in the simulation lab for individual candidates, with peers observing via video-link in the debrief room. Each scenario requires the candidate to perform a medical assessment of an acutely unwell patient, facilitated by use of the computerized manikin (SimMan Essential), whilst simultaneously tackling difficult conversations with a live actor and managing interruptions from a bleep. Participants also had the opportunity to lead simulated cardiac arrests with peers forming the cardiac arrest team. Debrief and teaching continued to be provided by a qualified simulation facilitator alongside a specialist registrar or consultant. Feedback provision was moved to an online format and accessed via a QR code to be more environmentally conscious and to readily allow analysis and storage for future comparison. In order to assess sustained quality, the same five aspects of the day were assessed by participants on a ten-point Likert scale: relevance, pitch, clarity, usefulness and overall quality. Scores of 1 reflected strong disagreement and 10 of strong agreement. Free text feedback allowed candidates to suggest topics for future sessions or identify valuable learning points. Thirteen IMT3 or equivalent doctors participated in this round of ‘Step-Up’ simulation with 100% feedback rate. As in previous rounds median and modal scores were 10 in all 5 domains, ranging from 7 to 10. Free text feedback recorded multiple requests for further simulation sessions. ‘Step-Up’ simulation was demonstrated previously to be a useful tool in progression to IMT3. Overall quality and usefulness were sustained year-on-year and simulated challenging discussions were highly valued by participants. Therefore, this programme will continue for future cohorts, with ongoing monitoring of sustained quality and development of new scenarios to provide increased frequency of simulation training. 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.