Specialty Trainees Research Articles

137 VIRTUAL CONSULTATIONS IN GERIATRIC MEDICINE OUTPATIENT DEPARTMENTS; THE PERSPECTIVE OF GERIATRIC MEDICINE SPECIALIST TRAINEES

Abstract Background Covid-19 social distancing measures restricted access to outpatient services. “Virtual Clinics”(VCs) were introduced in Outpatients Departments (OPDs) to continue service provision. OPD experience is vital to geriatric medicine training. The geriatric medicine Higher Specialist Training (HST) curriculum requires annual OPD participation. This study sought to identify the impact of VCs on geriatric medicine training. Methods An online mixed-method questionnaire was developed and circulated among geriatric medicine specialist trainees. 20 closed-questions collected demographic information and considered opinion of VCs. 5 open-questions enabled respondents to expand views of VCs. Closed-questions responses underwent quantitative descriptive analysis. Open-question responses underwent qualitative thematic analysis. Results Response rate was 61.4%. 86.3% reported VCs were conducted via telephone calls. 58% didn't feel comfortable conducting VCs. 64.7% didn't feel VCs positively contributed to training. 90.2% stated Face-To-Face (FTF) clinics offer greater training opportunities. 74.51% stated they were less likely to discuss VCs with consultants(compared to FTF clinics). 98.04% hadn't received training in conducting VCs. Qualitative analysis revealed four main themes: (1) Patient Selection: certain patient cohorts are unsuitable for VCs. VCs are useful in relaying simple results; not for patients with complex needs; (2) Practical Considerations: there must be access to required technologies for patients and medical staff. Medicolegal concerns were raised by several respondents; (3) Patient Care: the inability to examine patients is a challenge which impacts patient care. The lack of non-verbal cues impeded communication; (4) Training Impact: Respondents felt VCs weren't beneficial to training. There was a sense that training opportunities had been missed. Conclusion This study found high rates of dissatisfaction with VCs among geriatric trainees. This may be due to: (1) Inadequate training/preparation; (2) Inappropriate patient selection or (3) Lack of video-conferencing technologies. There is a sense that VCs have negatively impacted geriatric medicine training. Current policy advocates for the continuation of VCs. If VCs continue, additional resources may be needed to address any accompanying training deficit.

Fertility knowledge and views on egg freezing and family planning among surgical specialty trainees

There are limited studies focusing on resident and fellow attitudes on family planning and egg freezing. Surgical training programs are often longer and more time consuming than other fields. It is important to understand how this training affects family planning decisions. This study aimed to describe fertility knowledge and viewpoints on family planning among US residents or fellows. The Advocate Aurora Health Institutional Review Board approved this study on October 8, 2019 (IRB# AHC-7213-S5500413). A 32-question survey was emailed to trainees across US programs in a variety of specialties (obstetrics/gynecology; ophthalmology; otolaryngology; urology; and neurology, plastic, general, thoracic and orthopedic surgery) to assess fertility knowledge. Pearson chi square tests were conducted to investigate differences in fertility knowledge by groups of interest (trainee specialty, gender, trainee program type). Demographics and viewpoints on family planning and egg freezing are described. All analyses were performed using SAS, version 9.4. A total of 447 surveys were collected from October 2019 to January 2020. Participants included 309 residents, 94 fellows, and 44 with unknown status across the 9 specialties. Participants were mostly female (73%), aged 26 to 30 years (48%), White (69%), married (59%), and heterosexual (95%), with no children (72%). When asked at what age a woman's fertility slightly decreases, obstetrics/gynecology trainees had 39% less likelihood of answering correctly compared with non-obstetrics/gynecology respondents (P=.0207). Female respondents had 18% less likelihood of answering correctly relative to male respondents, and trainees in academic programs were 20% to 60% more likely to answer correctly relative to those in community programs, but these findings were not statistically significant. Interestingly, female respondents had 2.89 times increased odds of having 0 children (P<.0001), 0.42 times increased odds (ie, 58% decreased odds) of being married (P=.0003), and 1.33 times increased odds of postponing childbearing (P=.2438). This study found that despite their sex or focused training in reproductive endocrinology and infertility, female respondents and obstetrics/gynecology trainees were not more well-versed in basic female fertility knowledge than their counterparts. Furthermore, female respondents were less likely to have children or be married, and more likely to report postponing childbearing, highlighting differences in family planning by sex. Fertility-focused educational interventions for obstetrics/gynecology trainees are necessary. More research into barriers to family planning, particularly by sex, are also merited.

A bump in the night: a 15-year retrospective analysis of urgent inpatient and emergency CT reporting out of hours in a tertiary referral centre

To assess the impact on specialty trainee (ST) experience of out-of-hours (OOH) working, focusing on what might be improved with both patient safety and staff wellbeing in mind. The number of acute computed tomography (CT) examinations reported OOH over the last 15 years (2007-2021) at Oxford University Hospitals NHS Foundation Trust was analysed. Qualitative data from the radiology STs participating in the acute OOH rotas were obtained using questionnaires during winter months in 2019 and 2021, before and after the introduction of an OOH CT outsourcing service in 2020. Overnight acute CT has increased over 10-fold over the last decade to almost 50 CT examinations in 2021, and similar increases were observed during evening and weekend shifts. The option to outsource acute CT on an ad hoc basis was introduced in 2020 to manage the increase in demand. This resulted in a statistically significant improvement in the STs' level of reported satisfaction for OOH shifts (p<0.018), despite significantly increased perception of how busy the shifts were (p<0.035). OOH acute CT reporting at Oxford NHS Foundation Trust has increased dramatically over the previous 15 years. Working patterns and resources have changed incrementally to absorb this increase in demand, most recently with the option for outsourcing at times of peak demand. The trend for increasing OOH CT demand has considerable implications for future resource planning.

Major trauma care at a regional trauma centre during the COVID-19 lockdown in England.

The COVID-19 pandemic has changed the presentation of many medical and surgical conditions, including major trauma. We aimed to assess how lockdown changed the presentation, severity and management of major trauma patients at our level 1 trauma centre in England. Data were collected retrospectively from the Trauma Audit and Research Network's database between 23 March and 28 April 2020 and compared with the same period in 2019. Collected data included patient demographics, and the mechanism, severity and management of injuries. We experienced a 56.4% reduction in major trauma admissions during the lockdown period when compared with 2019. In 2020, more patients arrived in haemodynamic shock (25.3% vs 12.2%, p=0.02); however, Glasgow Coma Scale and Injury Severity Score were unchanged. A higher proportion of incidents occurred at home (37.2% vs 53.5%, p=0.018), with no difference in trauma secondary to substance abuse or assault. During lockdown, patients had a significantly shorter hospital (17 vs 10 days, p=0.029) and critical care stay (2 vs 1 day, p=0.033). A higher proportion of major trauma patients were assessed by specialty trainees in the emergency department in 2020 (12.8% vs 53.1%, p=0.0001) with a lower proportion assessed by a consultant (69.8% vs 46.7%, p=0.001). The COVID-19 pandemic and lockdown drastically changed human behaviour, as reflected in the change in presentation of major trauma. Changes in the management of these patients reflect adaptive measures to manage the pressures generated by the worldwide pandemic.

Oral 23 - Has urological run-through training had an impact on specialist trainee presentation and subsequent publication rates in peer-reviewed journals?

Oral 23 - Has urological run-through training had an impact on specialist trainee presentation and subsequent publication rates in peer-reviewed journals?

Cadaver dissection for oculoplastic procedures: A beginner's guide.

The purpose of this article is to form a basic guide for beginning the cadaver dissection training programs focused on oculoplastic surgical procedures. Ours was a collaborative study between the departments of Ophthalmology and Anatomy in a tertiary care teaching institute. We formed a step-wise approach to begin the cadaver dissection focused on the oculoplastic surgical procedures. The basics of cadaver procurement, processing, and preparation for dissections were described. The operative requirements of trainees, surgical handling of cadavers, and basic oculoplastic surgical steps were discussed. The types of embalming (cadaver preservation process) and steps have been described in detail. We have emphasized the preoperative discussion about the proposed dissections using standard teachings and skull models for easier understanding. Additional helping tools like soft embalming and injectable substances for better intra-dissection understanding (intra-arterial, intravenous and orbital injections) have been described. Post-dissection cadaver handing and soft-tissue disposal protocols have also been described. Overall, the cadaver dissections provide holistic surgical learning for the residents, specialty trainees, and practitioners. This article may act as a basic step-wise guide for starting the cadaver-based oculoplastics lab dissection in various institutes and workshops.

947 COVID19 and Its Impact on the North and East of Scotland Orthopaedic Trainees

Abstract Aim We conducted a trainee survey at the first peak of the pandemic to investigate the impact of COVID-19 on the North of Scotland (NoS) and East of Scotland (EoS) orthopaedic trainees. Method An online survey was distributed to all NoS and EoS orthopaedic trainees. All data collection was anonymous. Results Across both Scottish deaneries, 28 trainees had responded: 39% from EoS and 61% from NoS. Trainees at all stages of training responded to the survey, with the most responses received from specialist trainees in third year of training (ST3) (25%). In response to the pandemic, 18% of trainees had been redeployed and they were from NoS. Since the reconfiguration of service, 18% of trainees had done &amp;gt;20 operations in a month and they were senior trainees. If COVID-19 outbreak is likely going to reduce operating opportunities for a long period, only 36% of trainees would be open to the idea of making standard surgical specialty training longer whereas 57% of trainees would be open to longer working hours to achieve certification in Trauma and Orthopaedic surgery within 96 months. Conclusion The outbreak of COVID-19 has impacted both deaneries orthopaedic training and urgent restoration of surgical training is essential for individual trainees. Changes in working practices necessitated by COVID-19 have known to impact theatre efficiency. Actions should be taken to improve the theatre efficiency while prioritizing training opportunities.

315 The Impact of COVID-19 on Training Opportunities and Long-Term Career Aspirations of UK Based Doctors

Abstract Background The onset of the COVID-19 pandemic in November 2019 has witnessed a reactive ‘covidisation’ of NHS care services. Training opportunities for junior doctors have suffered and psycho-social impacts are anticipated. This study will seek to assess these factors and their impact on doctors’ career aspirations. Method A five question survey was disseminated to 350 junior doctors in the Yorkshire and Humber deanery. 115 responses were gained; 78 Foundation doctors (FY1–2), 24 Core/Early specialist trainees (CT 1–2/ST1–2) and 13 Specialist Registrars. Results Negative impacts on training include teaching commitments (61.7%) and work-based assessments (48%). A change in treatment protocols (67%) and acute referrals (58%) were also identified. Concerns regarding personal wellbeing were highlighted by 65%, with a greater willingness to consider taking time out of training (32%) or leave UK medical practice altogether (22%). Discussion The number of doctors immediately progressing into specialist training has almost halved. COVID era practice has impacted on training opportunities, clinical experience, and the ability to meet ARCP requirements. It has also led to high levels of personal concern amongst junior doctors surveyed. These factors may stimulate a greater willingness to take time out of training (1/3) or leave UK based medical practice (1/4). Conclusions It is evident that new and existing concerns amongst junior doctors have been heightened by COVID-19. This data provides a useful snapshot and may be utilised in ensuring the continued health and robustness of the UK's junior doctor workforce and its ability to meet the evolving challenges of global healthcare.

29 The Surgical Trainee Personality: Selected or Shaped?

Abstract Aim This study aims to describe the personality differences between trainees at different stages prior to and during surgical training. Method The Mental Muscle Diagram Indicator was distributed electronically to doctors in training in South West London. A total of 553 trainees completed the personality questionnaire. Specifically, there were general surgery specialty (n = 53), core surgical (n = 254), and foundation trainees (n = 246). 52% of trainees were female. Results Women scored significantly higher in the Extraversion, Sensing and Judging personality domains (p &amp;lt; 0.0001), there were no significant differences between genders for ‘Thinking’. One-way ANOVA only showed a significant difference in the ‘Judging’ domain between grades. Tukey's test was performed showing the difference arose from FT to CST (p = 0.008). Two-way ANOVA showed an interaction between gender and grade for ‘Judging’ and as such simple main effects were performed, with alpha = 0.017 to control for type 1 errors. Significant differences were found in the Judging domain between genders during in FT (p=0.002) and CST (p=0.002), and there was no significant difference for SpRs (p=0.15). Conclusions This study demonstrated differences in personality types between trainee stages and gender. These differences appear to decrease as trainees progress through their training, although the cause of this is unclear.

386 A Comparison of Academic Output of Welsh Plastic Surgery Trainees Pre- and Mid-COVID-19 Pandemic

AimThe COVID-19 pandemic has affected doctors worldwide, with 1.5 million surgeries being postponed or cancelled in England and Wales during 2020. Surgeons in competitive specialties requiring active research portfolios may have used this time to strengthen their academic work. This cross-sectional study provides insight into the academic output of Welsh plastic surgery trainees during the COVID-19 pandemic, which could be used to highlight contributing factors to benefit future training.MethodA cross-sectional study was distributed to all Welsh burns and plastic surgery trainees from specialty trainee levels 3–8. Data was obtained comparing publications achieved, abstracts submitted, and projects undertaken pre-pandemic, March 1st to 31st August 2019 and mid-pandemic, March 1st to 31st August 2020.ResultsOf the 12 Welsh plastic surgery trainees, 75% participated in this survey, with representation from all years of training. Mid-pandemic, an average of 3 publications were achieved per trainee when compared with 1.4 pre-pandemic. 78% submitted abstracts during both periods, increasing from 1.5 to 2.44 mid-pandemic. Although the average number of projects undertaken pre- and mid-pandemic was 3.2 and 3.1 respectively, the number of trainees undertaking projects increased by 22% to 100%. Most commonly, this was attributed to an increase in capacity.ConclusionsOur study demonstrated that overall, academic output increased significantly during the COVID-19 pandemic. Unsurprisingly, this sudden decrease in surgical activity led to trainees in this highly competitive specialty employing their time towards research. Further studies investigating the factors enabling trainees to increase their academic productivity would be beneficial as routine surgical activity resumes.

879 Attitudes to Research and Academic Careers Among Surgical Trainees and Medical Students: A Survey of Attendees at the 2021 Oxford Surgical Innovation Conference

Abstract Introduction Participation in research throughout medical training is essential in developing and implementing evidence-based practice. Increasing competitiveness across many surgical specialties has led to increased desire to participate in research by medical students and surgical trainees of all grades, with the aim of increasing their employability. Method The Oxford surgical innovation conference (OxSI) took place on the 23rd of April. The 121 attendees were surveyed regarding their attitudes to medical research, levels of research experience, and their confidence in seeking out and engaging with research opportunities. Survey respondents included clinical medical students, foundation trainees, core surgical trainees and higher specialist trainees. Results From 121 surveyed attendees at OxSI 2021, we received 88 responses (72%). 90% of respondents were interested in/pursuing a surgical career, with 70% interested in a career in academic surgery specifically. Furthermore, 97.8% agreed that engaging in research and innovation are an important part of surgical training. However only 48.9% were actively engaged in research. Furthermore only 26.2% of respondents were confident in engaging in independent research, with 56.8% stating they would not know how to engage in research or pursue new surgical innovations without outside assistance. Conclusions There is significant interest among medical trainees in research and academic surgical careers. However, many struggle to engage with research due to time constraints, or inadequate exposure to research opportunities. This survey suggests a larger study examining barriers to research exposure and participation could assist in addressing the discrepancy between desire to engage with research and opportunities to do so.

A cross-sectional survey of doctors' views on flexible postgraduate physician training in Ireland.

Recruitment and retention of doctors is a priority for the Irish healthcare service, with many leaving to work in regions with more favourable conditions. Aligning flexible training options with other jurisdictions may be an effective means of improving working conditions. We sought to assess possible improvements to the existing system and to review barriers to flexible training. We carried out a survey using 'Survey Monkey' and disseminated it to 1557 basic specialist (BST) and higher specialist trainee (HST) doctors of the Institute of Medicine, 3500 members of the Irish Medical Organisation (IMO), and across social media. There were 854 respondents; 303 (35.5%) BST, 352 (41.2%) HST, 125 (14.6%) non-training doctors, unknown, n = 74. The response rate was approximately 15-23%. Non-consultant doctors identified a preference for access to flexible training (n = 849, 99.4%), with 82.2 of doctors reporting that they would consider applying (n = 702). Most (92.4%) considered the current provision of 16 whole-time equivalent positions as inadequate (n = 789). Of doctors who would not apply for flexible training, themes identified included a perceived negative impact on their career, not meeting eligibility criteria, prolonged training, and salary implications. Suggestions for improving the system included expanding the number of places available, removing eligibility criteria, job sharing options, and the provision of regional training schemes. Access to flexible training should be a priority for the healthcare service, which may enhance recruitment and retention. A majority of our sample of non-consultant doctors identified a preference for access to flexible training options.

Paediatric dentistry trainee views on training relating to the medically compromised child and oral medicine elements of specialty training curricula.

Paediatric dentists care for children who are medically compromised and with an orofacial disease; therefore, trainees need appropriate training in these areas. The prevalence of congenital and chronic diseases in children is increasing, and future specialists need an understanding of human health and disease and oral medicine. This study aimed to determine if current teaching and assessments were fulfilling these requirements. A survey distributed to the UK and Ireland specialty trainees asked their opinions on whether knowledge gained prior to entering training, and teaching and learning during training equipped them for future management of medically compromised children and those with oral medicine diagnoses. The response rate was 51% (26 trainees). Most were aware of curriculum elements for medically compromised children and oral medicine. The majority felt that knowledge and experience gained as undergraduates and early graduates was insufficient and recognised the need for these topics in speciality training. For medically compromised children, this learning was considered a good use of time by 96% of trainees, and 88% felt that this topic should be given more attention. For oral medicine, this learning was considered a good use of time by 96% of trainees, and 69% felt that this topic should have more attention. Paediatric dentistry specialty trainees recognise that knowledge and experience of managing patients considered medically compromised and those with oral medicine conditions are an important part of training and need greater emphasis, especially in light of changing demographics with congenital and acquired chronic disease, and children with oral medicine disorders.

SP1.2.5 A Prospective Evaluation of Out of Hours Operations: Informing ENT Training Bootcamps

Abstract Introduction All trainees are invited to attend national trainee bootcamps upon commencing ENT speciality training. This induction course uses simulations to teach technical and non-technical skills and includes teaching on various emergency procedures. We aimed to prospectively record which procedures are being performed out of hours by ENT trainees to inform training programmes. Methods We recorded all operations out of hours performed by ENT speciality trainees in Kent Surrey and Sussex over 6 months. In January - February 2020 and August - November 2021 trainees completed data sheets detailing operations they were involved in that took place between 18:00 and 08:00 on weekdays or on weekends. Responses were analysed using Excel. Results Trainee response rate was 92%. In total 89 operations were performed out of hours. The speciality trainee was the most senior surgeon present in 58% of these cases (n=52). 27 different operations were performed. 5 procedures made up 53% of all operations performed: Oesophagoscopy and removal of foreign body (n=23); Tracheostomy (n=10); Removal of foreign body from nose (n=8); Drainage of neck abscess (n=6); and SPA ligation (n=5). Discussion and Conclusions To our knowledge, this is the first study to investigate the frequency of ENT procedures performed out of hours by trainees. Our findings can be used to plan and prioritise teaching of procedural skills in national trainee bootcamps. Oesophagoscopy and removal of foreign body was the most commonly performed out of hours procedure and along with other emergency procedures it should be prioritised in training camps.

EP-524 Implementing Simulation Based Learning (SBL) to Reduce the Gap in Surgical Training, A Theoretical Evaluation Approach

BackgroundThe current surgical training is severely affected by COVID-19 pandemic with redeployment and reduced number of elective procedure across NHS hospitals, this has affected both core and higher surgical trainees, rendering the traditional apprenticeship model obsolete. It became evident that the future of Surgical training and innovation will require a combination of simulation and operative exposure to overcome the obstacle of reduced exposure in surgical education and operative training.DiscussionIn our theoretical analysis, we will discuss the efficacy, safety and impact of relying on SBL to fill the gaps in surgical training.Clinical exposure alone will not be sufficient to train procedure based speciality trainees to their highest proficiency. SBL is one design that is supported by learning theories such as Transformational Learning and Experiential Learning Theory.In a high fidelity simulation, such as laparoscopic simulation courses, all concepts of facilitated learning are fulfilled which strongly supports our hypothesis.On balance, given the complexity of skills learnt, it remains difficult to measure the efficacy of transferring the learnt capabilities into practice and standardise this among learners. SBL also leaves non-technical skills un-assessed in depth.ConclusionThe disruption of training due to COVID-19 affected our procedure based learning, this leaves us with a dilemma to catch-up with these unmet training needs. SBL could be one of the adjuncts that fill in the gaps on the short and medium term. Implementing SBL in surgical training curriculum, should be evaluated for efficacy and cost effectiveness.

Attitude of Iranian medical specialty trainees toward providing health care services to patients with mental disorders.

IntroductionThe stigma of mental illness has a negative impact on the diagnosis and treatment of these disorders. Considering the high prevalence of mental illness, the attitude of medical specialists toward mental disorders, who are front liners in diagnosing and treating these patients, is critical. Therefore, we examined the attitude of Iranian medical specialty trainees toward providing health care services for patients with mental illness.MethodsWe included 143 residents in the fields that have the most interactions with patients with mental disorders, including internal medicine, surgery, neurology, cardiovascular diseases, and psychiatry. A demographic checklist, as well as the opening minds scale for health care providers stigma assessment questionnaire, was provided, which measures five dimensions of improvement, social responsibility, social distance, exposure, and other (such as risk) in health care providers toward delivering the healthcare services to patients with mental disorders.ResultsThe mean score of stigma for mental illness in medical specialty trainees was 61.36 ± 4.83 out of 100. Psychiatric residents have the least stigmatizing attitude (58.38 ± 3.54), and internal medicine and cardiology residents have the highest score, respectively, (62.96 ± 6.05, 62.45 ± 3.80). As for comparing subscales between specialties, only the social responsibility subscale showed a significant difference, with psychiatry having less stigma toward social responsibility (12.93 ± 2.01) than cardiology (15.09 ± 1.50) trainees.ConclusionThe attitude of medical specialty trainees toward providing health care services for patients with mental illness is not uniform; internal medicine and cardiology residents have more stigmatizing attitude, while psychiatric residents have less stigmatizing attitude. It seems that not every contact could be useful in making a better attitude toward mental illness, but it needs preconditions, like a structured contact that leads to positive outcomes. Anti-stigma interventions are needed to improve the attitude of medical specialty trainees toward providing health care services to patients with mental illness.

PD03: Photodermatology training experiences of speciality trainees in the UK

PD03: Photodermatology training experiences of speciality trainees in the <scp>UK</scp>

Educational impact of a novel cleft palate surgical simulator: Improvement in surgical trainees’ knowledge and confidence

Trainees' experience in cleft surgery is limited due to the high-risk nature of the surgery and centralization of cleft care. Simulation training allows trainees to learn complex surgical tasks whilst ensuring patient safety. Existing cleft surgical simulators are over-simplified or prohibitively expensive. In this article, we show the development and application of a high-fidelity yet cost-effective simulator for cleft palate repair. Skeletal elements were obtained through high-resolution scanning of a pathologic specimen, 3-dimensional printed, and then molded in plastic. Soft tissue components were formed through molding layers of silicone. The simulator was tested by 26 United Kingdom (UK) specialty trainees who performed a vomerine mucosal flap and intra-velar veloplasty in a 1-hour workshop. Pre- and post-simulation questionnaires assessing cleft knowledge and surgical confidence were compared for statistical significance. The simulator had high acceptability: 23/26 participants confirmed that the simulation training was a valuable learning experience. Baseline experience of cleft palate surgery was low: 24 participants had never performed any part of the procedure before. Following the workshop, mean knowledge score increased by 38%, and confidence by 53%. The paired T-test demonstrated that observed improvements in both knowledge and confidence were statistically significant (p<0.001). Simulation training is increasingly recognized as a crucial component of improving patient safety. Our new cost-effective cleft palate simulator has high acceptability and is a powerful educational tool that is effective in improving cleft palate surgical knowledge and confidence across all grades of surgical trainees.

PB2192: THE IMPACT OF DENTAL DISEASE ON THE MANAGEMENT OF HAEMATOLOGICAL DISEASE: A REVIEW OF TWO CASES

Background: Significant numbers of haematology patients are seen on a clinic dedicated to the management of patients with medically complex backgrounds within the Dental Institute of King’s College Hospital. Many are referred for dental assessment and treatment prior to haematopoietic stem cell transplant (HSCT), our clinic aims to provide this service in a timely manner in order to avoid dental concerns delaying transplant. The objective of pre-HSCT dental assessment is the identification and elimination of possible source of dental infection which could otherwise cause significant morbidity or mortality during the transplant process. For most of the patients found to require dental treatment this will involve the extraction of teeth which are non-vital, infected or considered to pose a future risk of infection. Our team includes dental consultants, specialty trainees and hospital grade dentists who work closely with haematology colleagues within our hospital and others. We report two cases in which concerns about oral health identified at dental assessment resulted in planned HSCT being significantly delayed or abandoned. The impact on the patients’ haematological management will be discussed with the aim of highlighting the importance of effective pre-transplant dental assessment and the effects of poor dental health on HSCT. Aims: - To identify patients whose medical outcome was directly adversely affected by their dental health. - To discuss the cases in which findings at dental assessment resulted in significant delay to HSCT. Methods: From the dedicated database of patients managed within our medically complex dental clinic over the last five years, those referred for pre-HSCT dental assessment whose oral health contraindicated proceeding with HSCT around the time this was planned were identified and data pertaining to them extracted. Results: Since 2017 our clinic received more than 600 referrals for pre-HSCT dental assessment from haematology colleagues. The vast majority of patients were deemed dentally fit for transplant either at presentation or after the successful completion of dental treatment. Two patients who could not proceed to transplant due to oral contraindications were, however, identified. Patient 1 had been diagnosed with Hodgkin’s lymphoma 2 years earlier, previous treatment included zolendronic acid. Unfortunately, no dental assessment was undertaken before this bisphosphonate therapy was commenced. He presented with a large, spontaneous osteonecrosis of the left maxilla and a neglected dentition; all remaining teeth required extraction. The patient’s haematologist believed that the presence and extent of the necrotic bone contraindicated HSCT so alternative, less effective treatment, was pursued instead. Patient 2 had received chemotherapy to treat his follicular lymphoma. During pre-HSCT dental assessment a squamous cell carcinoma of the right tongue was noted and later confirmed on biopsy; he subsequently underwent hemi-glossectomy and right neck dissection with free flap reconstruction. HSCT had to be postponed but was successfully completed 3 months after his surgery. Summary/Conclusion: The cases presented highlight the value of pre-HSCT dental assessment and how oral health can impact significantly on wider aspects of healthcare. Although a rare occurrence dental assessment may identify patients who should not proceed to transplant as planned and in doing so may help to prevent adverse outcome of this intervention.

1016 USING VIDEO TELEMEDICINE FOR INPATIENT WORKING: A NOVEL APPROACH TO REMOTE WORKING DURING THE COVID-19 PANDEMIC

BackgroundOrthogeriatrics inpatient ward.IntroductionThe COVID-19 pandemic changed working patterns for many trainees. Remote telephone or video outpatient consultations became established practice, with clinically vulnerable staff able to support this provision. We adapted the use of telemedicine to provide remote clinical working for inpatient care and continued speciality training opportunities.MethodMicrosoft Teams video conferencing facilitated interaction between the specialist registrar working remotely and the on-site multidisciplinary team (MDT). Daily activities included virtual handover attendance, inpatient ward round consultations and MDT discussions. A portable computer enabled the clinician to see and interact with inpatients remotely. Access to electronic patient records facilitated timely decision making and enactment of management plans. Anonymous MDT feedback was collected via online questionnaires. This project conformed to service evaluation guidelines and ethical approval was not required.ResultsFourteen staff members completed the feedback survey. Results were overwhelmingly positive, with 78.6% of respondents strongly agreeing that the senior doctor working remotely supported the MDT, facilitated complex clinical decision making and was beneficial to patient care. Feedback noted that some patients praised the ‘clever’ and ‘innovative’ method. Limitations included technical difficulties due to Wi-Fi connection, which contributed to communication not being as fluid as face-to-face consultations and increased ward round duration. Patient factors, namely hearing and cognitive impairment, limited the interaction that patients were able to have with the clinician via video link.ConclusionVideo inpatient ward round consultations offer an effective opportunity for physicians to continue clinical patient-facing roles whilst working remotely. Furthermore, this minimises the impact of COVID-19 on specialty trainees, by providing continued training and assessment opportunities for individuals required to shield. This novel method affords a framework transferrable to clinicians from other hospital specialties who may be required to work remotely. Future reviews of patient and relative satisfaction with this process are required.