Specialty Trainees Research Articles

Does the early bird catch the worm? Tick box culture and precocious teaching qualifications for aspiring specialty trainees

Progression up the dental career ladder into dental specialty training is notoriously tough, with rising numbers of applicants and the introduction of national recruitment creating fierce competition for training places. This paper explores the emerging tick-box culture surrounding specialty recruitment applications and the issues accompanying precocious portfolio point-seeking, with a particular focus on recognised postgraduate teaching courses.

Informing ENT training bootcamps - Operating Out-of-hours: A Multicentre Prospective Evaluation.

ENT specialty trainees are invited to national bootcamps to prepare for critical events to which they may have never been exposed. Here, we evaluate the frequency of out-of-hours ENT operations and the level of supervision provided to inform aspiring trainees and the national bootcamps. Information on all ENT operations performed out-of-hours was prospectively recorded by trainees in Kent, Surrey and Sussex over seven months. There was a 100 per cent response rate. The trainee was the most senior surgeon present for 48.4 per cent of out-of-hours operations. Four of the six most frequently performed out-of-hours operations are not included in the ENT indicator procedures, and two are not included in the national ENT bootcamps. Trainees should be aware of the most common procedures they may be expected to perform out-of-hours. Training in these should be provided prior to the commencement of specialty training. The audit design can be replicated across surgical specialties.

The need for a course to complete urological education for consultant practice using a simulated ‘boot camp’ structure at the end of specialist training: A survey-based study

To obtain opinions from urology trainees and consultants regarding the need for, and structure of, a post-specialty training Urology Simulation Boot Camp (USBC) for consultant practice. A survey-based study was conducted, and 'Google Forms' were distributed electronically via social media. Urology specialist trainees (ST) in years 5-7 (ST5-ST7), post-certification of completion of training (CCT) fellows and ST3 boot camp faculty consultants in practice for ≤5 years and >5 years were included. One hundred and seven responses were received. 97.2% of responders thought a pre-consultant USBC was worthwhile; 55.1% selected the course duration to be 2 days. 47.7% felt that the USBC should be delivered post-exam in ST7. 91.6%, 43.9%, 73.8%, 87.9% and 74.8% considered that modules in emergency operative procedures, novel uro-technologies, delivering multidisciplinary team (MDT) meetings, non-clinical consultant roles and responsibilities, stress and burnout to be important, respectively. 62.6% and 31.8% felt that the course should be wholly or part-funded by Health Education England (HEE). A post-specialty training, pre-consultant, USBC delivered post-exam in ST7, is worthwhile and should include modules on emergency operative procedures, leading MDTs, non-clinical roles and responsibilities and managing stress and burnout in consultant careers. Ideally, it should be fully/part-funded by HEE.

A national qualitative investigation of the impact of service change on doctors’ training during Covid-19

BackgroundThe Covid-19 crisis sparked service reconfigurations in healthcare systems worldwide. With postgraduate medical education sitting within these systems, service reconfigurations substantially impact trainees and their training environment. This study aims to provide an in-depth qualitative understanding of the impact of service reconfiguration on doctors’ training during the pandemic, identifying opportunities for the future as well as factors that pose risks to education and training and how these might be mitigated.MethodsQualitative parallel multi-centre case studies examined three Trusts/Health Boards in two countries in the United Kingdom. Data were collected from online focus groups and interviews with trainees and supervisors using semi-structured interview guides (September to December 2020). A socio-cultural model of workplace learning, the expansive-restrictive continuum, informed data gathering, analysis of focus groups and coding.ResultsSixty-six doctors participated, representing 25 specialties/subspecialties. Thirty-four participants were male, 26 were supervisors, 17 were specialty trainees and 23 were foundation doctors. Four themes described the impact of pandemic-related service reconfigurations on training: (1) Development of skills and job design, (2) Supervision and assessments, (3) Teamwork and communication, and (4) Workload and wellbeing. Service changes were found to both facilitate and hinder education and training, varying across sites, specialties, and trainees’ grades. Trainees’ jobs were redesigned extensively, and many trainees were redeployed to specialties requiring extra workforce during the pandemic.ConclusionsThe rapid and unplanned service reconfigurations during the pandemic caused unique challenges and opportunities to doctors’ training. This impaired trainees’ development in their specialty of interest, but also presented new opportunities such as cross-boundary working and networking.

First person – Sarah Escuin and Saba Raza-Knight

ABSTRACT First Person is a series of interviews with the first authors of a selection of papers published in Disease Models & Mechanisms, helping researchers promote themselves alongside their papers. Sarah Escuin and Saba Raza-Knight are co-first authors on ‘ Dual mechanism underlying failure of neural tube closure in the Zic2 mutant mouse’, published in DMM. Sarah conducted the research described in this article while a research associate in the lab of Prof. Andrew Copp at University College London, London, UK, investigating the mechanisms of neurulation and identifying the causes underlying neural tube defects. Saba conducted the research described in this article while an MB PhD student in the lab of Prof. Andrew Copp and Prof. Nicholas Greene at University College London, London, UK. She is now a specialty trainee in neurosurgery at Salford Royal Hospital, Salford, UK, and an honorary clinical lecturer at the University of Manchester, Manchester, UK, investigating neurovascular disorders, cancer biology and genetics, and hydrocephalus, with an active role in medical education.

When the illness speaks

SUMMARYThe nature of culpability and agency in patients with a variety of psychiatric diagnoses is complex. In this article, a psychiatry resident (specialty trainee in psychiatry) reflects on a clinical encounter in medical school to demonstrate some of the benefits (including the removal of stigma) and dangers (including the threat to patients’ agency) of using the medical model to conceptualise psychiatric illness.

Does simulation training result in improved on-call outcomes among newly appointed radiology registrars?

To quantify the impact of a marked increase in radiology trainee numbers and the compensatory introduction of formal simulation on-call training by investigating the discrepancy rates among on-call radiologists in training before and after the introduction of structured simulation training. The first 100 cases reported by a cohort of Specialty Trainee Year 2 doctors (ST2), having commenced on-call reporting, were analysed. This included registrars working in two major tertiary centres. Two groups of registrars were compared directly: those who undertook the simulation training and those who did not. Discrepancies were divided by severity into minor, moderate, and major categories. The criteria for each category were based on previously published literature. Twelve registrars from 2017 were compared with 12 from previous years (two in 2013, four in 2014, and six in 2015); 2,320 cases were analysed. There was a statistically significant reduction in the total number of discrepancies (p=0.01) made by registrars who underwent simulation training. A similar improvement was observed in the number of major discrepancies; however, this was not statistically significant. The present study shows that simulation training successfully increases competency in on-call work. Despite doubling the number of doctors in training, discrepancy rates did not worsen and in fact improved.

Propofol waste and the aggregation of marginal gains in green anaesthesia

AnaesthesiaVolume 78, Issue 3 p. 282-287 Editorial Propofol waste and the aggregation of marginal gains in green anaesthesia S. White, Corresponding Author S. White Consultant stuart.white6@nhs.net Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK Correspondence to: S. White Email: stuart.white6@nhs.netSearch for more papers by this authorL. Fang, L. Fang Specialty Trainee North West School of Anaesthesia, Health Education England North West, Manchester, UKSearch for more papers by this authorC. Shelton, C. Shelton Consultant, Senior Clinical Lecturer in Anaesthesia @@DrCliffShelton Department of Anaesthesia, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK Lancaster Medical School, Lancaster University, Lancaster, UKSearch for more papers by this author S. White, Corresponding Author S. White Consultant stuart.white6@nhs.net Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK Correspondence to: S. White Email: stuart.white6@nhs.netSearch for more papers by this authorL. Fang, L. Fang Specialty Trainee North West School of Anaesthesia, Health Education England North West, Manchester, UKSearch for more papers by this authorC. Shelton, C. Shelton Consultant, Senior Clinical Lecturer in Anaesthesia @@DrCliffShelton Department of Anaesthesia, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK Lancaster Medical School, Lancaster University, Lancaster, UKSearch for more papers by this author First published: 25 January 2023 https://doi.org/10.1111/anae.15905 This editorial accompanies an article by Waspe and Orr. Anaesthesia 2023; 78: 337–42. Read 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 Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume78, Issue3March 2023Pages 282-287 RelatedInformation

Exposure and awareness of oral and maxillofacial surgery for first degree medical undergraduates in the United Kingdom

Most of the current oral and maxillofacial surgery (OMFS) specialty trainees in the United Kingdom (UK) remain as those who first undertook a degree in dentistry. However, OMFS is an increasingly popular career choice amongst ‘first degree’ medical school graduates. The UK medical school curriculum should reflect this trend by ensuring that there is sufficient teaching and exposure to allow medical students to make informed career choices. The purpose of this study was to evaluate levels of awareness of, exposure to, and teaching on, oral and maxillofacial surgery amongst undergraduate medical students in the UK. An online survey was distributed via university representatives and responded to by 76 final year medical students from 15 medical schools across the United Kingdom. No OMFS-related clinical exposure was reported by 69 respondents throughout their time at medical school. Of the seven who did report exposure, the mean length of that exposure was four days. Sixty-three respondents believed that medical students would benefit from more guidance and information on OMFS. Clinical exposure to OMFS by medical undergraduates is low therefore awareness of the specialty is limited. With many dissatisfied with the OMFS exposure and teaching provided by their medical school it shows that there is no lack of interest in OMFS amongst medical undergraduates, rather a lack of opportunity for them.

Education and Mentoring of Specialist Pediatric Palliative Care Medical and Nursing Trainees: The Quality of Care Collaborative Australia.

The Quality of Care Collaborative Australia (QuoCCA) builds capability in the generalist and specialist paediatric palliative care (PPC) workforce throughout Australia. It supports regional and community services to provide care close to families' homes, as well as building expertise in tertiary centers. Medical Fellows and Nurse Practitioner candidates (specialist trainees) were funded by QuoCCA at four tertiary hospitals throughout Australia supported by an education and mentoring framework. This study explored the activity and experiences of clinicians who had occupied these roles to evaluate their effectiveness to build PPC capability. Online surveys recorded the monthly activity of Medical Fellows, with a point in time check of knowledge, skills and confidence in 2019. Discovery Interview methodology was used to collect detailed experiences of 11 trainees employed between 2018 to 2022 in Queensland. A combination of mentoring and formal and informal education, peer support and practical experience was valuable for trainees. They found the support of the whole interdisciplinary team advantageous to learning. Shadowing experienced team members gave them the opportunity to learn practical skills, especially regarding communication with families. Practicing clinical skills was beneficial, through being on call, attending home visits, supporting families, prescribing medications and developing treatment plans in collaboration with the team.The trainee experience was optimised through learning from families, personal reflection, involvement in research projects and delivering QuoCCA education. The QuoCCA trainee roles for Medical Fellows and Nurse Practitioner candidates exhibit a valuable and effective education and mentorship framework that could be applied to other specialties. The service leadership and collaborative interdisciplinary team support various modes of education and mentoring. The roles not only develop the trainees' specialised PPC clinical skills, they also improve their general clinical practice, including communication, empathy and holistic care. A structured curriculum of education is recommended to protect these positive outcomes.

Utilisation of in-consultation supervisor assistance in general practice training and personal cost to trainees: a cross-sectional study.

Aim The aim of the study was to establish whether two previously described barriers to effective in-consultation assistance-seeking by general practice (GP) vocational specialist trainees (ie concern about patient impressions of their competence, and discomfort presenting to supervisors in front of patients) influenced the frequency of trainee in-consultation assistance-seeking from their supervisor. Methods This was a cross-sectional study nested in the Registrar Clinical Encounters in Clinical Training ongoing cohort study of Australian GP trainees. Trainee participants completed contemporaneous records of 60 consecutive patient consultations, including whether supervisory assistance was sought. Trainees also completed a cross-sectional survey including items eliciting their beliefs about patient impressions and their own discomfort in seeking in-consultation supervisory assistance. These were factors of interest in multivariable logistic regression analyses; the outcome factor in both regression models was the seeking of in-consultation supervisory assistance. Results In 2018, 778 trainees (778/876, response rate 89%) completed the cross-sectional survey. No association was found between the odds of in-consultation help-seeking and perceived decrease in patient impressions of trainee competence (OR = 1.09; 95% CI: 0.91, 1.31; P = 0.36) or higher comfort presenting outside patients' hearing (OR = 0.9; 95% CI: 0.77, 1.05; P = 0.19). Discussion Contrary to expected utility models of help-seeking, trainees may not consider personal discomfort or impression management to be important enough, compared to patient safety and other considerations, to influence decisions regarding in-consultation help-seeking. Clinical supervisors should, nevertheless, consider the potential personal costs to trainees and maintain trainee self-esteem and confidence by providing in-consultation assistance in front of patients as comfortably and effectively as possible.

Current Trends in Mini-Clinical Evaluation Exercise in Medical Education: A Bibliometric Analysis.

There has been emerging evidence supporting the mini-clinical evaluation exercise (mini-CEX) in various clinical specialties and settings. However, we need more clarity regarding theapplicability of mini-CEX as an optimal assessment tool. Consequently, it has not been implemented on a wider scale, and several clinical specialties are yet to explore the benefits of mini-CEX. Therefore, we conducted a bibliometric analysis to investigate the publication trends of mini-CEX. We searched the Web of Science database for mini-CEX-related original and review articles. The search results were analyzed for year-wise contribution, citation trends, contributing journals, contributing institutions, countries, authors, distribution of original/review articles, retrospective/prospective/laboratory/other types of studies, specialties covered, nature of medical education (undergraduate vs. specialty trainees), and clinical settings involved in the studies (single/multiple). A total of 59 eligible articles (53 original and six review articles) were published between 1995 and 2022 in 35 different journals. The mean citations per year were 65.96 per year, and the mean citations per article per year were 2.34 citations per article per year. The articles published in BMC Medical Education and Medical Teacher were the highest in number. In total, 97 institutes contributed to the mini-CEX-related research, mostly from the University of Bern, Switzerland. There were 238 contributing authors, with Norcini JJ contributing the most number of articles. The remaining articles were 15 retrospective studies, one developmental study, six review articles, and three laboratory-based studies. The 50 non-laboratory studies involved students/trainees in medical and allied fields. Medicine was the most frequently covered specialty. The participants were mostly specialty trainees, followed by undergraduate medical students. Multiple settings were used in 38% of the reviewed studies and single in 16%. The published articles have reduced impact and growth, as evidenced by low annual growth rates and citation trends. However, the available evidence was of reasonable quality considering the contribution from mostly prospective studies. Furthermore, it suggests considerable potential for further investigating the role of mini-CEX in clinical teaching.

Gender and Race Demographics of Fellowships After General Surgery Training in the United States: A Five-Year Analysis in Applicant and Resident Trends.

The gender and minority gap in general surgery residency is narrowing; however, literature lacks comprehensive data regarding the demographics of fellowship programs following general surgery training. Data from 2017 to 2021 for gender, ethnicity, and surgical subspecialty are publicly available from the ERAS database and ACGME yearly data reports. Cochran-Armitage trend tests were used to determine statistical significance in trends for female and minority applicants and trainees. The overall trend of female applicants to surgical specialties remained stagnant. However, female applicants to vascular surgery increased significantly from 25% to 35% (P = .045). There was no significant increase in female trainees in any surgical specialties evaluated. Furthermore, the overall trend of minority applicants to surgical specialties also remained stagnant, except for pediatric surgery, which showed significantly fewer minority applicants. Despite pediatric surgery having fewer applicants, minority trainees in this specialty increased significantly from 8% to 19% (P = .008). Several current initiatives, such as intentional mentorship, are being reported to promote diverse and equal representation among female and minority applicants and trainees. However, the current overall margin of increase in diversity among surgical specialty applicants and trainees is minimal, indicating that continued efforts are needed to diversify surgical specialty training programs.

Identifying Core Competencies for Remote Delivery of Psychological Interventions: A Rapid Review.

The COVID-19 pandemic led to a rapid shift toward remote delivery of psychological interventions and transition to voice-only and video communication platforms. However, agreement is lacking on key competencies that are aligned with equitable approaches for standardized training and supervision of remote psychological intervention delivery. A rapid review was conducted to identify and describe competencies that could inform best practices of remote services delivery during and after the COVID-19 pandemic. Scopus, MEDLINE, and PsycINFO were searched for literature published in English (2015-2021) on competencies for synchronous, remote psychological interventions that can be measured through observation. Of 135 articles identified, 12 met inclusion criteria. Studies targeted populations in high-income countries (11 in the United States and Canada, one in Saudi Arabia) and focused on specialist practitioners, professionals, or trainees in professional or prelicensure programs working with adult populations. Ten skill categories were identified: emergency and safety protocols for remote services, facilitating communication over remote platforms, remote consent procedures, technological literacy, practitioner-client identification for remote services, confidentiality during remote services, communication skills during remote services, engagement and interpersonal skills for remote services, establishing professional boundaries during remote services, and encouraging continuity of care during remote services. These 10 skills domains can offer a foundation for refinement of discrete, individual-level competencies that can be aligned with global initiatives promoting use of observational competency assessment during training and supervision programs for psychological interventions. More research is needed on identification of and agreement on remote competencies and on their evaluation.

148. Proportion of UK OMFS Consultant and Specialty Trainees registered with the General Dental Council (GDC) is unchanged in 2022

First published in December 2019 https://www.baoms.org.uk/professionals/gdc_and_gmc.aspx titled “GDC confirms position on dual registration” it says “The GDC is currently reviewing the need for dual registration with the GMC and GDC, including the need for oral and maxillofacial surgeons (OMFS) to maintain GDC registration”. It has not been updated since then.

67. Reasons UK OMFS Consultant and Specialty Trainees remain registered with the General Dental Council (GDC) or let their dental registration lapse

67. Reasons UK OMFS Consultant and Specialty Trainees remain registered with the General Dental Council (GDC) or let their dental registration lapse

Using simulation-based interprofessional education to change attitudes towards collaboration among higher specialty trainee physicians and registered nurses: a mixed methods pilot study

ABSTRACT Interprofessional collaboration (IPC) is important for delivering safe patient care and can be enhanced through interprofessional education (IPE). In postgraduate medical education, the most effective model for delivering IPE remains unclear. A multi-site non-randomized mixed methods study was undertaken to investigate the effectiveness of a simulation-based IPE (SB-IPE) intervention on changing attitudes among higher specialty trainee (HST) physicians in general internal medicine and registered nurses (RNs). The intervention, underpinned by intergroup contact theory, is comprised of paired participants (HSTs:RNs) undertaking six simulated scenarios. The Jefferson Scale of Attitudes toward Interprofessional Collaboration (JeffSATIC) was administered pre-and-post intervention. Focus groups were conducted to explore participants’ perceptions of IPC and the SB-IPE intervention. Fifty-six participants attended the SB-IPE intervention and 37 completed focus group interviews. Overall, attitudes toward IPC changed positively (p < .001), with greater change among HSTs (p = .001) compared to RNs (p = .12). Attitudes to “working relationships” significantly increased for HSTs (p < .001) but not RNs (p = .047). Focus group analysis identified three processes by which SB-IPE led to attitudinal change: 1) Shared vulnerability, 2) Positive affirmation, and 3) Negotiating professional hierarchies, mainly through relationship building. Further research is needed to investigate the long-term impact of attitudinal change, including the extent to which benefits transfer into practice.

Benefits and challenges to ophthalmology training via the Specialist Training Program.

The Specialist Training Program (STP) is a commonwealth funding initiative to support specialist medical training positions in regional, rural and remote areas, and in private settings. The program helps to improve the skills and distribution of the specialist medical workforce by providing trainees experience of a broader range of healthcare settings. To examine the benefits and challenges of ophthalmology training delivered by the STP in regional, rural, remote, and/or private settings across Australia. Qualitative design involving semi-structured in-depth interviews with thirty-two participants experienced in the delivery of ophthalmology training at STP posts including ophthalmology trainees (n=8), STP supervisors and clinical tutors (n=16), and other stakeholders (n=8). Training delivered at STP posts was reportedly beneficial for ophthalmology trainees, their supervisors and the broader community given it enabled exposure to regional, rural, remote and private settings, access to unique learning opportunities, provided workforce support and renewal, and affordable ophthalmic care. However, all participants also reported challenges including difficulties achieving work/life balance, unmet training expectations, a lack of professional support, and financial and administrative burden. Malalignment between trainee preferences for STP posts, low STP literacy and limited regional, rural and remote training experiences were also seen as missed opportunities to foster future rural ophthalmic workforce development. The STP improves access to ophthalmic care in underserved populations while enabling valuable rural and/or private practice exposure for medical specialist trainees and workforce support for supervising ophthalmologists. Efforts are needed to improve the quality of training experiences provided at STP posts and post sustainability. Although research is needed to investigate the longer-term benefits of the STP to rural and/or private workforce recruitment and retention, RANZCO should develop further regional, rural and remote STP posts to help realise future rural practice intention amongst ophthalmology trainees.

Engagement in research during specialist geriatric medicine training: results of a national trainee survey

Meaningful ageing research across the UK is dependent on a network of engaged geriatricians. The research in geriatric specialty training (RGST) survey aimed to establish current research opportunities available to geriatric medicine specialty trainees in the UK. The RGST survey was disseminated to UK higher specialist trainees in geriatric medicine in 2019 via the Geriatric Medicine Research Collaborative network. Among the 36.9% (192/521) of respondents, 44% (83/188) reported previous research involvement and 7% (n=8) held a PhD or MD. Of the respondents with no research experience to date, 59.0% (n=49) reported a desire to undertake a period of research. One-third (31%) of geriatric registrars surveyed felt that they had gained sufficient research experience during their training. Perceived encouragement and support to undertake research was low (30.7%). Enablers and barriers to research engagement were identified. Research opportunity and engagement in geriatric medicine training is lacking. This could jeopardise the future workforce of research-active geriatricians in the UK and limit patient access to emerging research and innovation. Interventions to promote research engagement among geriatric medicine trainees are needed to facilitate integration of research into routine clinical practice to improve the health and care of older people.

The case of need for image-guided radiotherapy training for clinical oncology specialist trainees: Impact assessment post-COVID

The case of need for image-guided radiotherapy training for clinical oncology specialist trainees: Impact assessment post-COVID