Support Junior Doctors Research Articles

Medication errors

Nurse PrescribingVol. 16, No. 8 Calculation SkillsMedication errorsDilyse NuttallDilyse NuttallSearch for more papers by this authorDilyse NuttallPublished Online:8 Aug 2018https://doi.org/10.12968/npre.2018.16.8.364AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Department of Health and Social Care. The Report of the Short Life Working Group on reducing medication-related harm. 2018. https://www.gov.uk/government/publications/medication-errors-short-life-working-group-report (accessed 19 July 2018) Google ScholarDornan TAD, Ashcroft D, Heathfield H et al.. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. London: General Medical Council; 2009 Google ScholarKongkaew C, Noyce PR, Ashcroft DM. Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Ann Pharmacother. 2008;42(7):1017-25. https://doi.org/https://doi.org/10.1345/aph.1L037 Crossref, Google ScholarRoyal College of Physicians. Supporting junior doctors in safe prescribing. 2017. https://www.rcplondon.ac.uk/projects/outputs/supporting-junior-doctors-safe-prescribing (accessed 19 July 2018) Google ScholarRyan C, Ross S, Davey P et al.. Prevalence and causes of prescribing errors: the PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) study. PLoS One. 2014;9(1):e79802. https://doi.org/https://doi.org10.1371/journal.pone.0079802 Crossref, Google ScholarWorld Health Organization. Medication Without Harm: WHO's Third Global Patient Safety Challenge. 2017. http://www.who.int/patientsafety/medication-safety/en/ (accessed 30 July 2018) Google Scholar FiguresReferencesRelatedDetails 2 August 2018Volume 16Issue 8ISSN (print): 1479-9189ISSN (online): 2052-2924 Metrics History Published online 8 August 2018 Published in print 2 August 2018 Information© MA Healthcare LimitedPDF download

Supporting junior doctors: The sad saga of Dr Bawa-Garba.

Supporting junior doctors: The sad saga of Dr Bawa-Garba.

An ENT smartphone handbook: Adopting new practice for induction.

There should be continued support and drive for innovation and implementation of smartphone-based access to local guidelines. This is the first study, that we're aware of, assessing the use of a smartphone-based clinical handbook in ENT surgery. Use of a smartphone-based handbook is superior to printed or intranet-based guidelines. Use of smartphone apps can support junior doctors with delivery of care. Smartphone-based access to guidelines encourage learning and education to improve the induction process for new doctors. This article is protected by copyright. All rights reserved.

Improving preparedness of junior doctors to manage patients with diabetes: a pilot educational programme from ward-based pharmacists

Background: Diabetes is a complex condition and junior doctors can feel underprepared when tasked with safely prescribing insulin. Hyperglycaemia is known to increase mortality and morbidity, yet a British study in 2008 demonstrated that a quarter of doctors responding to the survey did not feel confident enough to take the main initiative to control blood glucose for a patient under their care in hospital. Diabetes learning resources are widely available, yet few offer the opportunity to link undergraduate theory with practical prescribing tasks. Clinical pharmacists can play an important role in providing this type of practical support and in the formative development of safe prescribing for junior doctors. This paper describes an initiative from a hospital pharmacy team to support Foundation Year doctors (FY1s) with safe insulin prescribing.Methods: The team from the Belfast Trust designed a ward-based teaching session which could be used by clinical pharmacists to help newly qualified doctors on their wards. These sessions, known as SIPS (Safe Insulin Prescribing Sessions), focused on three key areas: documentation, insulin product range and resources. The aim was to assess if SIPS had an impact on confidence levels for different aspects of insulin prescribing. This pilot educational intervention was carried out with 19 junior doctors. After the session each doctor was contacted to complete a short online questionnaire ranking their confidence and knowledge levels in managing inpatients prescribed insulin before and after the pharmacist SIPS.Results: After completing the ward-based teaching there were statistically significant increases in the self-ranked confidence and knowledge levels of junior doctors regarding insulin prescribing.Conclusions: This pilot demonstrates that ward-based teaching from a pharmacist can support junior doctors in managing diabetes. A larger study would be needed to confirm whether this translates into better management of inpatients with diabetes.

Imbuing medical professionalism in relation to safety: a study protocol for a mixed-methods intervention focused on trialling an embedded learning approach that centres on the use of a custom designed board game

IntroductionHealthcare organisations have a responsibility for ensuring that the governance of workplace settings creates a culture that supports good professional practice. Encouraging such a culture needs to start from an...

“That was a good shift”

PurposeThe purpose of this paper is to investigate a boundary spanning, interprofessional collaboration between advanced practice nurses (APNs) and junior doctors to support junior doctors’ learning and improve patient management during the overtime shift.Design/methodology/approachA mixed methods evaluation of an intervention in an adult tertiary referral hospital, to enhance interprofessional collaboration on overtime shifts. Phase 1 compared tasks and ward rounds on 86 intervention shifts with 106 “regular” shifts, and examined the effect on junior doctor patient management testing a model using regression techniques. Phase 2 explored the experience of the intervention for stakeholders. 91 junior doctors participated (89 percent response rate) on 192 overtime shifts. Junior doctors, APNs and senior medical professionals/administrators participated in interviews.FindingsThe intervention was associated with an increase in self-initiated ward rounds by junior doctors, partially explained by junior doctors completing fewer tasks skilled nurses could also complete. The intervention significantly reduced doctors’ engagement in tasks carried over from day shifts as well as first year (but not more experienced) junior doctors’ total tasks. Interviews suggested the initiative reduced junior doctors’ work pressure and promoted a safe team climate, situation awareness, skills, confidence, and well-being.Originality/valueJunior doctors overtime shifts (5 p.m. to 11 p.m.) are important, both for hospitals to maintain patient care after hours and for junior doctors to learn and develop independent clinical decision making skills. However, junior doctors frequently report finding overtime shifts challenging and stressful. Redesigning overtime shifts to facilitate interprofessional collaboration can improve patient management and junior doctors’ learning and well-being.

Pharmacists can support junior doctors' safe prescribing, says RCP

Pharmacists can support junior doctors' safe prescribing, says RCP

Consultants support junior doctors’ “principled stance” over contract negotiations

Consultants have supported junior doctors’ “principled stance” over contract negotiations and their decision to take further industrial action. Delegates at the BMA’s annual UK consultants’ conference in London on 3 March unanimously passed a series of motions that expressed support for junior doctors. One motion, which was passed unanimously, supported “the junior doctors’ principled stance in their dispute over their NHS contract negotiations.” Proposing the motion Nick Platt, …

Two thirds of public support junior doctors in contract dispute, poll finds

Two thirds (66%) of the public support the junior doctors’ strike on Wednesday 10 February, a survey by Ipsos MORI and the Health Service Journal has found. The survey of 847 adults in England also found that support for the planned strike was at the same level as it was when junior doctors last took action on Tuesday 12 January, while the proportion strongly supporting junior doctors rose by …

Discharge communication from inpatient care: an audit of written medical discharge summary procedure against the new National Health Service Standard for clinical handover.

To audit written medical discharge summary procedure and practice against Standard Six (clinical handover) of the Australian National Safety and Quality Health Service Standards at a major regional Victorian health service. Department heads were invited to complete a questionnaire about departmental discharge summary practices. Twenty-seven (82%) department heads completed the questionnaire. Seven (26%) departments had a documented discharge summary procedure. Fourteen (52%) departments monitored discharge summary completion and 13 (48%) departments monitored the timeliness of completion. Seven (26%) departments informed the patient of the content of the discharge summary and six (22%) departments provided the patient with a copy. Seven (26%) departments provided training for staff members on how to complete discharge summaries. Completing discharge summaries was usually delegated to the medical intern. The introduction of the National Service Standards prompted an organisation-wide audit of discharge summary practices against the external criterion. There was substantial variation in the organisation's practices. The Standards and the current audit results highlight an opportunity for the organisation to enhance and standardise discharge summary practices and improve communication with general practice.

P92 Improving Diagnosis And Management Of Patients With Copd In The Acute Medical Admission Unit: A "right Care" Approach

Introduction COPD is the second most common cause of emergency admission and 5th cause of readmission to hospital. Appropriate identification and treatment is crucial to make every bed day count and reduce the burden of COPD. Characterising COPD exacerbations (ECOPD) and excluding differential diagnoses in acutely unwell co-morbid patients can be challenging. This study aimed to evaluate the accuracy of diagnoses/management of patients on the acute medical unit (AMU) in an inner London teaching hospital with 300 ECOPD admissions/yr, and to develop an improvement plan. Methods Admission records for COPD patients admitted acutely with increased shortness of breath, cough and/or wheeze over 6 weeks (Jan/Feb 2014) were reviewed. Diagnostic criteria and treatment were compared to national standards. 21 AMU junior staff completed a COPD knowledge questionnaire. An ECOPD pathway was developed, highlighting diagnostic and treatment differences between infective (IECOPD), non-infective COPD exacerbations (NIECOPD) and community acquired pneumonia (CAP), supported by electronic prescribing order sets. An online learning module was developed to support junior doctors. Results 44 COPD patients (26M, 18F) were admitted to AMU. 20% had an incorrect diagnosis. Of NIECOPD patients (20%): 66% received antibiotics; 11% did not receive prednisolone. Of IECOPD patients (47%): 65% received iv or incorrect oral antibiotics; 14% did not receive prednisolone. Of CAP patients (32%): in CURB Conclusion COPD patients commonly present acutely with ECOPD, NIECOPD or CAP. This can cause diagnostic uncertainty in an AMU setting. A right care approach focusing on accurate diagnosis first time and guideline based therapy, supported by joint working, education and electronic prescribing can improve staff knowledge and patient management.

Nutrition education and leadership for improved clinical outcomes: training and supporting junior doctors to run 'Nutrition Awareness Weeks' in three NHS hospitals across England.

BackgroundOne in four adults are estimated to be at medium to high risk of malnutrition when screened using the ‘Malnutrition Universal Screening Tool’ upon admission to hospital in the United Kingdom. The Need for Nutrition Education/Education Programme (NNEdPro) Group was developed to address this issue and the Nutrition Education and Leadership for Improved Clinical Outcomes (NELICO) is a project within this group.The objective of NELICO was to assess whether an intensive training intervention combining clinical and public health nutrition, organisational management and leadership strategies, could equip junior doctors to contribute to improvement in nutrition awareness among healthcare professionals in the National Health Service in England.MethodsThree junior doctors were self-selected from the NNEdPro Group original training. Each junior doctor recruited three additional team members to attend an intensive training weekend incorporating nutrition, change management and leadership. This equipped them to run nutrition awareness weeks in their respective hospitals. Knowledge, attitudes and practices were evaluated at baseline as well as one and four months post-training as a quality assurance measure. The number and type of educational events held, pre-awareness week Online Hospital Survey results, attendance and qualitative feedback from training sessions, effectiveness of dissemination methods such as awareness stalls, Hospital Nutrition Attitude Survey results and overall feedback were also used to determine impact.ResultsWhen the weighted average score for knowledge, attitudes and practices at baseline was compared with four months post-intervention scores, there was a significant increase in the overall score (p = 0.03). All three hospital teams conducted an effective nutrition awareness week, as determined by qualitative data collected from interviews and feedback from educational sessions.ConclusionThe NELICO project and its resulting nutrition awareness weeks were considered innovative in terms of concept and content. It was considered useful, both for the junior doctors who showed improvement in their nutrition knowledge and reported enthusiasm and for the hospital setting, increasing awareness of clinical and public health nutrition among healthcare professionals. The NELICO project is one innovative method to promote nutrition awareness in tomorrow’s doctors and shows they have the enthusiasm and drive to be nutrition champions.

Synthetic Hair Implantation and Squamous Cell Carcinoma of the Scalp

Level of Evidence V This journal requires that authorsassign a level of evidence to each article. For a fulldescription of these Evidence-Based Medicine ratings,please refer to the Table of Contents or the onlineInstructions to Authors www.springer.com/00266.We read with interest the comments of M. Agrawal [1]regarding our recent article, a case of squamous cell car-cinoma of the scalp after several synthetic hair grafts,because this means that the case report achieved our pur-pose to stimulate a fruitful clinical discussion on the topic[2]. Even so, we disagree with the prospective of thecomments. We believe the aim and clinical message of thearticle were misunderstood.The main purpose of a case report is to provide medicaldoctors an original point of view on the clinical features,investigation, and treatment of patients with unusual clin-ical problems. A case report may not provide statisticalsignificance but should clearly illustrate uncommon casesand support junior doctors in their daily clinical activity.As a matter of fact, a case report represents an ‘‘alarm bell’’for addressing misdiagnosed clinical conditions and forstimulating future investigations. In conclusion, each caseis unique and conveys a precise message to the reader.Indeed, the clinical messages of our report are that clini-cians should not underestimate an ulcerative lesion on thescalp of a patient who has undergone multiple surgeries forartificialhairimplantation,shouldnotleavethepatienttothecare of nonlicensed medical doctors, and should considerdiagnostic biopsies related to clinical suspicion and prompttherapeutic management fundamental to the treatment of apatient affected by cutaneous ulcerated lesion of the scalp.We absolutely do not condemn synthetic hair grafting.Instead, we clearly stated in our discussion that the latencyof degeneration (the chronic variant of Marjolin’s ulceronset is reported to have an average lag of 35–46 years),the affected area, the typical clinical history characterizedby repetitive local irritation and microtrauma, the occa-sional presence of bacterial sovra infection, and the pro-longed actinic damage all may represent concomitantfeatures strongly suggesting a clear pathophysiologic pro-cess that finally led to cancer degeneration [2–7].References

Work Stressors, Social Support, and Burnout in Junior Doctors: Exploring Direct and Indirect Pathways

The study tested a pathway model linking different occupational stressors, different sources of social support, and burnout. A sample of 184 junior medical doctors was used. Pathway analysis suggested that doctors who experienced increased time demands, organizational constraints, and a lack of personal confidence perceived their consultants as less supportive, whereas those who experienced greater clinical responsibility perceived their supervisors as more supportive. A lack of support from coworkers was linked with a lack of support from consultants, top management, and family. The perception of consultant support was linked with lower burnout, whereas the perception of coworker support was linked with higher burnout. The present findings may inform interventions aimed to support junior doctors experiencing burnout.

Distressed doctors: a hospital‐based support program for poorly performing and “at‐risk” junior medical staff

Despite "safe-hours" campaigns and doctors health programs, "at-risk" behaviour and suicides still occur in junior doctors. A recent national survey found that 46% of junior doctors believed that their hospital administration was not supportive. The Royal Melbourne Hospital has developed a comprehensive program for preventing and identifying at-risk behaviour and supporting junior doctors, tailored to the individual's needs. Patient and individual doctor safety is paramount, and confidential collaboration between medical workforce and medical education structures, clinical supervisors and the Victorian Doctors Health Program is required. The boundaries of the hospital's "duty of care" for those who do not want assistance is unclear, and balancing increased supervision within a limited workforce is challenging.

Medical leadership: competencies in action

SummaryThe engagement of the medical profession in management and leadership activities has become a priority for the UK's National Health Service (NHS). It makes sense to develop these leadership competencies as early as possible, inculcating leadership skills in junior doctors. The recent core and specialist curriculum competencies address this and, together with the Medical Leadership Competency Framework developed by the Academy of Medical Royal Colleges and the NHS, sets out a blueprint for personal development plans for junior doctors. A culture shift is called for, such that doctors in training prioritise their leadership development alongside their medical training. This article is of particular relevance to educational supervisors, as it describes how they can support junior doctors in achieving the leadership and management competencies outlined in the 2009 core and specialty psychiatry curriculum.

Paediatric respiratory medicine Jeremy Hull Paediatric respiratory medicine,JulianForton andAnneThompson Year/Edition:2008/1stOxford University PressNo of pages: 880£34.95978 0 19 920484 70199204845

This addition to the ‘Oxford Handbooks’ series is focused on the clinical presentation, diagnosis and management of the child/young person with a respiratory condition. Written by two consultants and a clinical lecturer, the handbook is aimed primarily at general paediatricians, specialist trainees and consultants in paediatric respiratory medicine. It would also be of great use to specialist nurses or advanced nurse practitioners in this specialty and children’s nurses who support junior doctors treating children with respiratory conditions.

Can a ward simulation exercise achieve the realism that reflects the complexity of everyday practice junior doctors encounter?

Recent changes in medical education have resulted in an increased focus on patient safety. It is vital that new doctors can recognize and manage acutely-ill patients, as well as work safely and effectively as a member of a multi-professional team. A ward simulation exercise has been developed to provide a safe, but authentic setting to support junior doctors with further practice and feedback. In developing such an exercise realism is important in recreating the complex climate in which the junior doctor has to function as part of the healthcare team in the hospital ward. This paper shares the design methodology of a ward simulation exercise and the views on its authenticity from both the junior doctors and the observers.

Accidents don’t happen any more: junior doctors’ experience of fatal accident inquiries in Scotland

Objective: To determine the experience of junior doctors cited as witnesses at fatal accident inquiries (FAIs). Design: Retrospective questionnaire study. Setting and subjects: 40 junior doctors who had been involved...