Specialist Registrars Research Articles

P119 Pleural Service Provision and Training Opportunities in a District General Hospital in North East Lincolnshire

IntroductionBTS Pleural disease guidelines in 2010 strongly recommend thoracic ultrasound guidance for all pleural procedures for pleural fluid, and at least level 1 competency is required to safely perform independent...

Leadership excellence for middle grade doctors

This one day course on leadership excellence aims to deal with the practical and theoretical aspects of leadership to enable NHS doctors (of all levels) to lead more effectively. This course is aimed at trainees in any specialty, ideally those who are at specialist registrar level (specialty trainee year 3 and upwards). However, trainees at a more junior level are also encouraged. I was a specialty trainee year 6 in anaesthesia when I did the course; the other participants were at the level of specialist registrar/specialty trainee year 3 or above and from various other specialties. Non-clinical skills are just as important as clinical skills at …

Impact of introducing consultant resident on-call in a District General Hospital

Introduction of structured competency-based training for specialty registrars and implementation of European Working Time Directives (EWTD) have affected the quality of maternity care. In York District Hospital, consultant resident on-call (CRO) without registrar cover was introduced in July 2010 to address the long-standing problem of middle-grade out-of-hours coverage. To examine the impact of introducing out-of-hours consultant resident on-call on maternity care, data from 486 deliveries including 59 CRO and 59 registrar shifts were collected retrospectively, from July 2010 to April 2011. Main outcome measures include mode of delivery, second-stage management, maternal and neonatal outcomes. Feedback from consultants, junior trainees and midwives on the impact of CRO were collated through semi-structured interviews. More normal vaginal deliveries (71.8% vs 63.0%) and fewer emergency caesarean sections (12.5% vs 20.6%) were performed in the CRO shifts compared with registrar on-call. Instrumental delivery rates in labour rooms vs theatre were higher when compared with the registrar group. Overall, good patient and staff experience was reflected during interviews. Our work shows that introduction of CRO in out-of-hours settings is acceptable among staff and is associated with fewer obstetric interventions. However, improved job descriptions may be needed in order to make the CRO post more attractive.

Atypical incisional hernia following Pfannenstiel incision

Herniation following Pfannenstiel incision is rare. Closure of the incision in four layers including the rectii abdominis, is done uncommonly. The authors report five cases of interstitial herniae between the rectus muscles and the anterior rectus sheath, incarcerating omentum and bowel. Four patients underwent repair, two as an emergency. One patient was managed conservatively. Subsequently all consultant and specialist registrars in obstetrics and gynaecology in the Wessex region were sent questionnaires on their methods of closure of Pfannenstiel incisions and rates of associated herniae. Fifty-three of 74 surgeons responded and only three (5.6 %) routinely closed the abdominal recti. The surveyed surgeons felt post-Pfannenstiel incisional hernia rates were low (0-1 %) though the rate was unknown to 33 % of surgeons. Complex incisional interstitial herniae of this type have not previously been described. Closure of the rectii abdominis (as originally described by Pfannenstiel in 1900) could minimise the incidence of incisional herniae.

Scientific methods and research techniques (SMaRT) course

If you have ever wondered what constitutes medical research and how you might establish a project, get ethical approval, organise data collection, analyse your results, or present your findings, the scientific methods and research techniques (SMaRT) course is for you. An understanding of research is essential for all doctors in training. We were both interested in doing some research but wanted to see what it would really be like before taking the plunge. We did this course in November 2011, when we were both year 5 specialty registrars in anaesthesia. Although the SMaRT course has been designed for those who have passed the fellowship of the Royal College of Anaesthetists exam, it is suitable for trainees from all backgrounds. Our group of delegates included a foundation year 2 doctor as well as trainees of various grades from medicine, surgery, and psychiatry. The course is delivered by the University of …

HIV dilemmas day

The HIV dilemmas day, run by the British Infection Association and Hartley Taylor Medical Communications, is designed for any trainees or specialists working in HIV medicine, including those from infectious diseases, genitourinary medicine, microbiology, virology, and pharmacology. I took the course in January 2010 while I was a third year specialist registrar in infectious diseases, and I attended again for the fifth version of the course in January 2012 in Manchester. Although I regularly see complex HIV cases, the sheer breadth of these means I only see some of the conditions once or twice a year. This course allowed me to reacquaint myself with some important HIV related scenarios and update on the latest evidence and current best practice in their management. The workshop covers clinical scenarios that occur frequently enough to be important, but not so regularly that they don’t still present considerable …

Parkinson’s disease masterclass

The Parkinson’s disease masterclasses are run by the movement disorders section of the British Geriatrics Society. The classes aim to provide advanced training for senior healthcare professionals involved in treating patients with Parkinson’s disease and related disorders. Three types of masterclass are run by the British Geriatrics Society. The classic masterclass is for consultants, neurologists, final year specialty registrars, pharmacists, clinical fellows, clinical lecturers, and general practitioners. The registrar masterclass is for specialty trainees who are not in their final year, and the nurse masterclass is for Parkinson’s disease nurse specialists, nurse consultants, and community matrons. I took the registrar masterclass during the second …

Development and implementation of centralized simulation training: evaluation of feasibility, acceptability and construct validity

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: A competent urologist should not only have effective technical skills, but also other attributes that would make him/her a complete surgeon. These include team-working, communication and decision-making skills. Although evidence for effectiveness of simulation exists for individual simulators, there is a paucity of evidence for utility and effectiveness of these simulators in training programmes that aims to combine technical and non-technical skills training. This article explains the process of development and validation of a centrally coordinated simulation program (Participants - South-East Region Specialist Registrars) under the umbrella of the British Association for Urological Surgeons (BAUS) and the London Deanery. This program incorporated training of both technical (synthetic, animal and virtual reality models) and non-technical skills (simulated operating theatres). To establish the feasibility and acceptability of a centralized, simulation-based training-programme. Simulation is increasingly establishing its role in urological training, with two areas that are relevant to urologists: (i) technical skills and (ii) non-technical skills. For this London Deanery supported pilot Simulation and Technology enhanced Learning Initiative (STeLI) project, we developed a structured multimodal simulation training programme. The programme incorporated: (i) technical skills training using virtual-reality simulators (Uro-mentor and Perc-mentor [Symbionix, Cleveland, OH, USA], Procedicus MIST-Nephrectomy [Mentice, Gothenburg, Sweden] and SEP Robotic simulator [Sim Surgery, Oslo, Norway]); bench-top models (synthetic models for cystocopy, transurethral resection of the prostate, transurethral resection of bladder tumour, ureteroscopy); and a European (Aalborg, Denmark) wet-lab training facility; as well as (ii) non-technical skills/crisis resource management (CRM), using SimMan (Laerdal Medical Ltd, Orpington, UK) to teach team-working, decision-making and communication skills. The feasibility, acceptability and construct validity of these training modules were assessed using validated questionnaires, as well as global and procedure/task-specific rating scales. In total 33, three specialist registrars of different grades and five urological nurses participated in the present study. Construct-validity between junior and senior trainees was significant. Of the participants, 90% rated the training models as being realistic and easy to use. In total 95% of the participants recommended the use of simulation during surgical training, 95% approved the format of the teaching by the faculty and 90% rated the sessions as well organized. A significant number of trainees (60%) would like to have easy access to a simulation facility to allow more practice and enhancement of their skills. A centralized simulation programme that provides training in both technical and non-technical skills is feasible. It is expected to improve the performance of future surgeons in a simulated environment and thus improve patient safety.

EDTA and temperature dependent neutrophil aggregation

European Journal of HaematologyVolume 89, Issue 5 p. 435-435 Clinical Picture EDTA and temperature dependent neutrophil aggregation Joseph Padayatty, Corresponding Author Joseph Padayatty Department of Haematology, Box 234, Addenbrooke's Hospital, Cambridge, UKCorrespondence Joseph Padayatty, Speciality Registrar, Haematology Department, Box 234, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK. Tel: 01223245151; Fax: 01223274871; e-mail: [email protected]Search for more papers by this authorRoderick Lynn, Roderick Lynn Department of Haematology, Box 234, Addenbrooke's Hospital, Cambridge, UKSearch for more papers by this authorMike A. Scott, Mike A. Scott Department of Haematology, Box 234, Addenbrooke's Hospital, Cambridge, UKSearch for more papers by this authorMars B. Van't Veer, Mars B. Van't Veer Department of Haematology, Box 234, Addenbrooke's Hospital, Cambridge, UKSearch for more papers by this author Joseph Padayatty, Corresponding Author Joseph Padayatty Department of Haematology, Box 234, Addenbrooke's Hospital, Cambridge, UKCorrespondence Joseph Padayatty, Speciality Registrar, Haematology Department, Box 234, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK. Tel: 01223245151; Fax: 01223274871; e-mail: [email protected]Search for more papers by this authorRoderick Lynn, Roderick Lynn Department of Haematology, Box 234, Addenbrooke's Hospital, Cambridge, UKSearch for more papers by this authorMike A. Scott, Mike A. Scott Department of Haematology, Box 234, Addenbrooke's Hospital, Cambridge, UKSearch for more papers by this authorMars B. Van't Veer, Mars B. Van't Veer Department of Haematology, Box 234, Addenbrooke's Hospital, Cambridge, UKSearch for more papers by this author First published: 16 July 2012 https://doi.org/10.1111/j.1600-0609.2012.01820.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume89, Issue5November 2012Pages 435-435 RelatedInformation

Corrigendum

Diabetic MedicineVolume 29, Issue 9 p. 1216-1216 Free Access Corrigendum This article corrects the following: Diabetes and Endocrinology Specialist Registrars Teaching programmes in the United Kingdom – time to set some quality standards? Results from the Association of British Clinical Diabetologists – Young Diabetologists Forum survey R. Ahulwalia, M. Atkin, I. Gallen, P. Winocour, N. Goenka, Volume 29Issue 4Diabetic Medicine pages: 553-554 First Published online: March 12, 2012 First published: 13 August 2012 https://doi.org/10.1111/j.1464-5491.2012.03736.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat R Ahulwalia, M Atkin, I Gallen, P Winocour, N Goenka. Diabetes and Endocrinology Specialist Registrars Teaching programmes in the United Kingdom – time to set some quality standards? Results from the Association of British Clinical Diabetologists – Young Diabetologists Forum survey. Diabet Med 2012; 29: 553–554. The first author’s surname was misspelt. The correct spelling should be Ahluwalia. Therefore, the correct author list should read as: Ahluwalia R, Atkin M, Gallen I, Winocour P, Goenka N. The authors regret this error. Reference 1 Ahulwalia R, Atkin M, Gallen I, Winocour P, Goenka N. Diabetes and Endocrinology Specialist Registrars Teaching programmes in the United Kingdom – time to set some quality standards? Results from the Association of British Clinical Diabetologists – Young Diabetologists Forum survey. Diabet Med 2012; 29: 553– 554. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar Volume29, Issue9September 2012Pages 1216-1216 ReferencesRelatedInformation

Delay between CCT and consultant appointment in oral and maxillofacial surgery (OMFS) in those appointed between 2006 and 2011

Introduction: In response to concern that those enrolled as Specialist Trainees in OMFS (ST Modernising Medical Careers) in OMFS rather than as Specialty Registrars (SpR Calman Regulations) were not entitled to 6 months grace on the completion of training, we thought there would be value in knowing the time taken for trainees to obtain a consultant post. This confusion has now been clarified, ST trainees are entitled to the same grace period, but the results of our study are still of interest.

Surgical handover in an era of reduced working hours: an audit of current practice.

To examine the current practice of handover and to record trainees' assessment of handover process. An audit study. Department of General Surgery, Scarborough General Hospital, Scarborough, United Kingdom, from January to April 2010. A paper-based questionnaire containing instruments pertaining to handover guidelines was disseminated to trainees on surgical on-call rota at the hospital. Trainees' responses regarding handover process including information transferred, designated location, duration, structure, senior supervision, awareness of guidelines, formal training, and rating of current handover practice were analysed. A total of 42 questionnaires were returned (response rate = 100%). The trainees included were; registrars 21% (n=9), core surgical trainees 38 % (n=16), and foundation trainees 41% (n=17). Satisfactory compliance (> 80% handover sessions) to RCS guidelines was observed for only five out of nine components. Ninety-five percent of hand over sessions took place at a designated place and two-third lasted less than 20-minutes. Computer generated handover sheet 57% (n=24) was the most commonly practised method of handover. Specialist registrar 69 % (n=29) remained the supervising person in majority of handover sessions. None of the respondents received formal teaching or training in handover, whereas only half of them 48% (n=20) were aware of handover guidelines. Twenty-one percent of the trainees expressed dissatisfaction with the current practice of handover. Current practice of surgical handover lacks structure despite a fair degree of compliance to RCS handover guidelines. A computerised-sheet based structured handover process, subjected to regular audit, would ensure patient safety and continuity of care.

PTU-268 The impact of EWTD on gastroenterology training and the inpatient GI referral service at a district general hospital

IntroductionA Specialist Registrar's (SpR) weekly duties include two Consultant and one SpR ward round, two clinics, 1–2 endoscopy training lists along with on-calls for General Medicine (GIM). Ward referrals are...

Too far, too long, too few: workforce planning in dermatology

Conflict of interest: none declared. The 2010 British Association of Dermatologists (BAD) annual workforce survey identified 73 vacant consultant posts in the UK, with 52 consultant posts occupied by locums.1 The UK government agency, the Centre for Workforce Intelligence (CfWI), consults with stakeholders to mathematically model future workforce demands, and has allocated six new dermatology trainees between 2011 and 2013.2 However, workforce calculations are limited by lack of data about trainees’ current career plans relating to part‐time work, academic careers and work abroad. An anecdotal perception exists that many trainees are unwilling to move away from the region in which they have trained, making it difficult to fill consultant posts in regions with lower trainee numbers. We conducted a study to explore the plans of UK dermatology trainees completing training for part‐time work, work abroad and academic work, and to investigate their likely future geographical mobility. All 201 current UK dermatology trainees1 [trainee specialty registrar (StR) grade 3 and higher] were contacted by e‐mail, and asked to complete an anonymous web‐based workforce questionnaire between 28 March and 10 April 2011.

Sonoanaesthesia: ultrasound guided regional anaesthesia

Ultrasound guided regional anaesthesia of upper and lower limb is a two day course run by consultants and senior registrars in anaesthesia who have a strong interest in regional anaesthesia. It is designed to provide anaesthetists with hands on experience of ultrasound anatomy and nerve block techniques. The course is aimed at anaesthetists of all grades who want to perform nerve blocks under ultrasound guidance as part of their practice. It would also be useful for trainees who are preparing for the Final Examination of the Diploma of Fellowship of the Royal College of Anaesthetists. I did the course in September 2011 as a specialty registrar year 5 in anaesthesia. The other delegates included …

A survey of parent experience in a specialist paediatric epilepsy outpatient clinic

Aim To assess the outpatient clinic experience of children with epilepsy and their families under the care of one paediatric neurologist attending a single specialist epilepsy clinic. Methods The survey was undertaken prospectively over 12 months. Families of both new and follow-up patients who attended the clinic were provided with a simple standard questionnaire with eight questions addressing staff courtesy, communication, clinic visits and their overall experience. Each family was requested to anonymously complete only one questionnaire during the audit period irrespective of how many times the child was seen during the 12 months. All children were seen by the same consultant or specialist registrar in paediatric neurology. Data were analysed by the Trust9s Audit Department. Results Two hundred and thirty eight (238) questionnaires were given of which 229 (96.2%) were returned. All were completed anonymously. Courtesy: 100% (229/229) of families reported that the reception, nursing and medical staff were friendly and polite. Communication 100% (229/229) reported that the doctors were easy to talk to and their questions were listened to and adequately answered. 97.4% (223/229) stated that they received enough information about epilepsy during the visit; two replied that this was inadequate. 98.7% (226/229) replied that their child9s epilepsy had been clearly explained. Clinic visits 97.4% (223/229) felt that waiting times were acceptable. 90% (206/229) replied that the frequency of clinic visits was appropriate whilst 7 (3.1%) said they were too infrequent. 92% (211/229) considered that they spent the right amount of time with the doctor. 99.6% (228/229) stated that the clinic visit was useful. Overall impressions 100% (229/229) reported they were happy with their child9s care received during the clinic visit. Conclusion This survey has demonstrated that the vast majority of families found the entire epilepsy clinic experience positive and supportive and were satisfied with the experience. There is little published information on family experience of an entire clinic journey. The results of this survey compares very favourably with two earlier studies undertaken in much smaller populations in a District General Hospital.

Bridging the GAP: efficient usage of pathology services in paediatrics and neonatal medicine

Background In 2005, around 175 million samples were sent for analysis to NHS pathology laboratories in England. Pathology departments in England had a combined gross budget of £1.8 billion in 2005/2006, and on average each Trust spent 5.1% of its total budget on pathology. Audits conducted in a different speciality showed 33% inefficient usage of pathology services. Aim To improve efficiency in the use of pathology services in Paediatrics and Neonatal Medicine. Methods A small project team of senior paediatric specialist registrars (ST6 and above) was formed. We compared two 5 month blocks for pathology tests usage (Retrospective (Jan 2010 - May 2010) and prospective (Jan 2011-May 2011)). Series of measures were undertaken to improve awareness in order to efficiently order pathology requests. These included increased awareness at handover, academic meetings, on the wards, email reports of the number and pattern of tests ordered, use of posters on the wards, increased usage of near patient testing, designing specific pathways for specific disorders and developing guidelines after service evaluation and audits and ongoing review of the project by the project team. In addition, we compared activity in terms of number of admissions and length of stay. Results A 25 % reduction in the number of tests was seen (58,589 (Jan-May 2010) v/s 43,955 (Jan –May 2011) between the two time periods. The most commonly ordered tests included Full Blood Count (12% in both time periods), C reactive Protein (7.2% (Jan-May 2010) v/s 6.5% (Jan - May 2011) Urea and Electrolytes (5% in both time periods). During the 2 time periods Jan 2010-May 2010 v/s Jan 2011- May 2011 activity reported month on month was comparable in terms of number of admissions (3400 v/s3586) and length of stay (elective: 2.6 v/s1.7 (median) non elective: 3.65 v/s 3.725 (median)). Conclusion A combined method of improving awareness, developing new guidelines and pathways can contribute to a reduction in the usage of pathology services.

Diabetes and Endocrinology Specialist Registrars Teaching programmes in the United Kingdom – time to set some quality standards? Results from the Association of British Clinical Diabetologists – Young Diabetologists Forum survey

Diabetes and Endocrinology Specialist Registrars Teaching programmes in the United Kingdom – time to set some quality standards? Results from the Association of British Clinical Diabetologists – Young Diabetologists Forum survey

Emergency management of severe burns

The one day course in emergency management of severe burns is run centrally by the British Burns Association but can be done at a number of hospitals nationwide, including Birmingham, Swansea, and Nottingham. It aims to train you in the emergency assessment, resuscitation, and transfer of patients with severe burns. The course is aimed at medical and nursing healthcare staff involved in the field of burn care, from members of burns units to staff working in isolated rural areas. The session I attended had a good mix of candidates, including foundation year 2 doctors, core surgical trainees and specialist registrars planning a career in plastic surgery, and senior clinical nurses from various burns units. The experience of referring to and receiving patients at a …

Impact of the introduction of emergency ultrasound to one large UK emergency department: the REBUS study

AimFirstly, to detail the experiences of one UK training region in establishing an emergency ultrasound (EU) training programme and secondly, to report the initial 30 months of EU scanning experience.MethodsProspective...