Doctoral Training Research Articles

Example of simplest bifurcation diagram for a monotone family of vector fields on a torus**M H-D. was supported by ‘la Caixa’ Foundation (ID 100010434) with fellowship code LCF/BQ/EU20/11810061, and by the Warwick Mathematics Institute Centre for Doctoral Training with funding from the University of Warwick.

Abstract We present an example of a monotone two-parameter family of vector fields on a torus whose bifurcation diagram we demonstrate to be in the class of ‘simplest’ diagrams proposed by Baesens and MacKay (2018 Nonlinearity 31 2928–81). This shows that the proposed class is realisable.

The Future of Doctoral Training in Nonprofit Studies: New Students and New Challenges

The past decade has witnessed important shifts affecting the training of doctoral students studying nonprofits. The student body has become larger and more diverse as more students gain access to graduate school, more universities introduce doctoral programs, and the increasing use of the PhD or the Doctorate in Public Administration (DPA) as a professional qualification drives practitioners to seek these degrees. At the same time, academic hiring has not kept pace with the number of graduates, while non-academic employers are increasingly interested in hiring PhDs and DPAs. How should educators respond to these challenges? Combining market data with our experiences as teachers and pracademics from several different disciplines, we offer a roadmap for the evolution of doctoral training. We argue that doctoral programs must focus on meeting employer needs ahead of boosting recruitment. This includes focusing on training students for practitioner jobs and moving away from defining student success as an academic job offer. Programs must embrace the diversity of their students and attend to the needs of the whole student by developing peer support structures, encouraging faculty mentorship, adopting new teaching practices, including interdisciplinary perspectives, and creating resources that orient students to both doctoral study and post-graduation employment.

Foreign studies of simulation training in professional teacher education: literature review

Simulation teaching methods are actively used in the training of doctors and in clinical practice, but in the context of higher pedagogical education, their large-scale consideration began relatively recently. It is important to integrate the experience of business and role-playing games, the potential of the case method and the capabilities of virtual spaces to create a cognitive and communicative learning environment for teachers working with different student populations. The article presents foreign publications devoted to these problems.

Introducing patient stories in health sciences education: the learning experiences of students

BackgroundIt has been advocated that the development of medical school curricula must be informed by students, doctors in training, educators, employers, other health and social care professionals and patients, families and carers. Patients are widely employed to teach clinical and interpersonal skills, and while recognised as crucial in health education, they have mostly been offered a passive role. We assessed the impact of patients contributing personal illness narratives in the master curriculum of allied health care professionals on students’ learning experiences.MethodsWe designed a module (Patient and Society) for a master’s degree programme in Health Sciences at the University of Southern Denmark in collaboration with six patients. The patients contributed to the teaching by sharing and discussing their personal illness narrative. At the end of the module, as part of the exam, we asked the students to reflect on the patients’ contribution to the module and how this affected their learning experiences. The 500-word exam responses of 29 students were analysed, in collaboration with six patients, using thematic analysis.ResultsIncluding patients’ illness narratives lifted students’ academic learning, and their personal and professional development. The stories brought theoretical concepts to life; it helped the students to obtain, retain, and apply academic knowledge. Actively and uninterrupted listening to patients’ illness experiences promoted empathy and critical reflection on clinical practice. Faced with the impact of a disease on a person’s life, seeing the healthcare system through a patient’s lens made students reflect critically on the medical positivist model ruling the health care system focused on just fixing the medical problem with very little room for the illness experience.ConclusionOur analyses support previous findings indicating that patient narratives are a powerful tool to achieve academic and professional development. Working with patients in health education has the potential to work towards a more inclusive epistemological stance in the health care system and health research.

Future Hospital Commission, 10 years on — Lessons learned and next steps: The Chief Registrar Programme — what has been achieved?

The Royal College of Physicians (RCP) Chief Registrar Programme (CRP) emerged from the RCP Future Hospital Commission Report (2013) and aimed to address development of clinical leadership and quality improvement to maintain high standards of patient safety and experience. The 2016 pilot created a new senior leadership role recruiting doctors in training committed to quality improvement and leadership development to champion delivering change in trusts, supported by a year-long bespoke development programme designed and delivered by the RCP. Following validation of the pilot's impact, the CRP has evolved to become a ‘flagship’ programme for the RCP with increasing penetrance across the UK to maximise impact for chief registrars to lead and deliver quality improvement in trusts. The longer-term goal is that enthusiastic early leaders will deliver sustainable and impactful change regionally and in the wider NHS. This article seeks to explore the CRP development themes and reflects on the learning from the programme and the experiences of chief registrars. The CRP has evolved during a time of significant healthcare challenge with the programme delivering a future generation of medical leaders to navigate these challenges, deliver improvement and innovation across the health sector. We show how chief registrars and alumni can continue to drive forward widespread impact on individuals, organisations and the wider NHS, providing a strategic solution to meet current and future challenges in the NHS.

Experience of Conducting Debriefing in the Process of Mastering Standard Operating Procedures Among Students of Kazan State Medical University

Standard operating procedures (SOPs) are documents that contain step-by-step instructions for performing a particular procedure (manipulation). Undoubtedly, the quality of training of doctors must meet the requirements of the healthcare system in order to provide medical care of the proper quality. At the same time, the precise implementation of nursing manipulations in accordance with SOPs is a very urgent task. In this regard, the debriefing technique used in classes in a simulation center can improve the existing skills and knowledge of students

Pattern of enuresis diagnosis and management by general practitioner in Indonesia

Background:General practitioners (GP) have a major role in diagnosing bedwetting, especially in primary care. Despite the high prevalence, the professional training of doctors in diagnosing and managing enuresis is often minimal, which can make patient care to be not optimal. This study aimed to describe the pattern of enuresis diagnosis and management at primary level by GPs In Indonesia. Methods:This study is a cross-sectional study conducted using an online survey distributed from March 2021 until September 2021. The inclusion criteria in this study are general practitioners registered in the Indonesian Doctor Association. The survey contains several questions describing the general practitioners’ general experience in treating pediatric patients and treating enuresis. The data was then compiled and presented as descriptive data. Result:Out of 584 GPs contacted, 183 responses were analyzed. The majority (70.49%) had less than five years of experience. Most GPs (95.08%) treated pediatric patients, with 44.26% having experience treating enuresis. Diagnosis primarily involved history taking and physical examination (70.37%). Only a minority used special questionnaires or bladder diaries. Treatment often involved lifestyle changes (42.05%), alarm therapy (23.86%), or referrals to specialists (50.82%). Conclusion:There are gaps in the diagnosis and management of enuresis among Indonesian GPs. Enhanced training and adherence to standardized guidelines could improve care for children with enuresis in Indonesia.

Organization of abdominal emergency surgical care across healthcare services in Senegal: a cross-sectional nationwide survey

IntroductionStudying surgical services and the workforce in sub-Saharan Africa is crucial for enhancing access to quality surgical care in the region. Despite many recommendations to produce evidence based on reliable data on this subject to guide policymakers, there is still a knowledge gap on this topic. The aim of this nationwide survey was to describe the organization of abdominal emergency surgical care across healthcare services in Senegal.MethodologyThis was a cross-sectional nationwide survey. The study period was between October 1st, 2023, and January 20th, 2024. The target population included all registered healthcare facilities in Senegal offering emergency surgical services. A structured questionnaire was designed to gather infrastructure-related data, surgical activities, and human resources.ResultsAll 33 identified healthcare facilities responded to the survey (100%). Emergency abdominal surgery services were available for 96.7% of the surveyed structures. The teams were mainly composed of surgeons and residents (45.2%) or surgeons and medical trainees (48.8%). The average bed capacity of the services was 21.9, with a standard deviation of 13.9. The absence of a dedicated hospitalization section for patients requiring special monitoring was found in 69.6% of the facilities. Operating rooms dedicated to emergency abdominal digestive surgery were present in 54.6% of the services. On average, the services performed 17.6 scheduled surgical interventions with a standard deviation of 11.5 and 29.7 emergency surgical interventions with a standard deviation of 16.8 per month. Morbidity and mortality conferences were not routinely held in the majority of departments (only 27.3%). Professional development programmes were present only in 24.2% of departments. Most of the departments did not have adequate human resources (69.6%). A total of 70 surgeons were identified, resulting in a national ratio of 0.39 general surgeons per 100,000 inhabitants. The strategies employed to address staff shortages included additional working hour by staff (54.5%), temporary workers (30.3%) or the use of trainee doctors or nurses (12.1%).ConclusionThis research shows that significant deficiencies are present in the essential physical and human resources needed to conduct fundamental life-saving surgical procedures. These findings suggest potential areas for improvement in the delivery of emergency surgical care in the region.

Identification, mapping, and self-reported practice patterns of village doctors in Sitakunda subdistrict, Bangladesh.

Informally trained health care providers, such as village doctors in Bangladesh, are crucial in providing health care services to the rural poor in low- and middle-income countries. Despite being one of the primary vendors of antibiotics in rural Bangladesh, village doctors often have limited knowledge about appropriate antibiotic use, leading to varied and potentially inappropriate dispensing and treatment practices. In this study, we aimed to identify, map, and survey village doctors in the Sitakunda subdistrict of Bangladesh to understand their distribution, practice characteristics, clinical behaviours, access to technologies, and use of these technologies for clinical decision-making. Using a 'snowball' sampling method, we identified and mapped 411 village doctors, with 371 agreeing to complete a structured survey. The median distance between a residential household and the closest village doctor practice was 0.37 km, and over half of the practices (51.2%) were within 100 m of the major highway. Village doctors were predominately male (98.7%), with a median age of 39. After completing village doctor training, 39.4% had completed an internship, with a median of 15 years of practice experience. Village doctors reported seeing a median of 84 patients per week, including a median of five paediatric diarrhoea cases per week. They stocked a range of antibiotics, with ciprofloxacin and metronidazole being the most prescribed for diarrhoea. Most had access to phones with an internet connection and used online resources for clinical decision-making and guidance. The findings provide insights into the characteristics and practices of village doctors and point to the potential for internet and phone-based interventions to improve patient care and reduce inappropriate antibiotic use in this health care provider group.

Rate of Diagnostic Change in Surgical Pathology Reports after Mandatory Intradepartmental Peer Review in a Tertiary Hospital in the Philippines: A Retrospective Study.

There is a mandatory intradepartmental peer review algorithm in the University of the Philippines - Philippine General Hospital (UP-PGH) Department of Laboratories wherein specific cases are required to be reviewed by another pathologist before the release of results. The main objective of this study was to determine the rate of diagnostic change in surgical pathology reports after undergoing the said review. All surgical pathology cases which underwent the review from 2015 to 2018 were retrieved from the records of the Section of Surgical Pathology. The cases were classified as concordant or discordant. A case was considered concordant if the reviewing pathologist had agreed with the primary pathologist's diagnosis. A case was considered discordant if the reviewing pathologist had disagreed with the primary pathologist's diagnosis. Out of 5,377 cases included in this study, there were 5,209 concordant cases and 168 discordant cases, with the rate of discordance computed to be 3.1%. Out of the 168 discordant cases, 107 were revised for diagnostic change. Rate of diagnostic change was computed to be 2.0% (107 out of 5,377 cases for review). The most common criterion satisfied for meriting a mandatory review is being under the category of biopsies or cytology cases with malignant or borderline diagnoses (49.4%). The most common category of diagnostic change is change in immunohistochemistry recommendations (24.3%). Most of the discordant cases and cases revised for diagnostic change fall under the categories of gastrointestinal, gynecology, and head & neck pathology. The low rate of diagnostic change in our institution might be attributed to good diagnostic accuracy. However, it is also possible that reviewing pathologists tended to agree with the diagnosis made by their colleagues because of the element of peer pressure. Data from the study may imply that special courses/ lectures or institutional standard practice guidelines on interpreting biopsy and cytology cases as well as on the utility of immunohistochemistry studies, especially those focused on gastrointestinal, gynecology, and head & neck pathology are needed by the pathologists and the doctors training to become pathologists in our institution.

Exploring how starting work during COVID-19 impacted post-foundation career decisions of new doctors: a mixed methods study

ObjectivesThis study addressed two research questions: What factors do doctors in training describe as influencing their choices to apply (or not apply) for specialty training during their Foundation Year 2?...

Discovering down's syndrome: An account from A low middle income country.

This study aims to establish the frequency of Down's syndrome which will enhance the knowledge of our local population as well to understand our genotypic patterns and variations. Electronic Medical Records of inborn babies at the Department of Neonatology, Sheikh Saeed Memorial Campus of The Indus Hospital Karachi during the study period from 1st January 2021 to 31st December 2022 were retrieved. Chromosomal karyotyping was done for all babies with suspicious clinical features identified on routine new born examination by consultant neonatologists, trainee doctors and experienced nurses. There was a total of 7,433 live births during the study period, out of which 14 babies had features suggestive of DS. repetition of sentence. What about karyotyping result?? The frequency of DS in our study is slightly higher than the incidence reported within South East Asia. It is high time to perform effective antenatal screening and efficient prenatal diagnostic services for early detection of chromosomal numerical aberration such as Down syndrome for better management of upcoming pregnancies.

Exploring considerations of equality, diversity and inclusion in selection for a doctorate in clinical psychology programme: A qualitative study

Diverse and inclusive healthcare workforces are important to optimise patient access and outcomes. Various attempts have been made to promote equality, diversity and inclusion (EDI) in clinical psychology; however, clinical psychology doctoral training programmes (DClinPsy) frequently fail to reflect the population demographics of the communities that they serve within the make-up of their trainees. Some research indicates that the lack of diversity might be linked to potential biases within the selection process.This study seeks to qualitatively explore how application screeners and interview panellists for a DClinPsy programme consider EDI in the selection process. Content analysis of seven semi-structured interviews suggests that participants think broadly about EDI, considering differences between marginalised groups and the provision of equal access for members of these groups. Content analysis of discussions of protected characteristics suggests that, when considering EDI, race, sex, disability, sexual orientation, and socio-economic status prove more salient than other factors such as age, and religion or belief.Barriers and facilitators to accessing the DClinPsy are discussed. Participants discuss the perceived inadequacy of EDI training for their roles in selection, and conflicts related to different EDI measures such as positive action and standardisation. The findings are discussed with reference to existing literature. Future research should seek to examine the EDI training needs of those involved in the selection process and examine the efficacy of EDI initiatives to improve equity and inclusion for underrepresented groups.

EP525 - A Survey of Medical Students’ Attitudes Towards Sustainable Healthcare

Abstract Aims As the climate crisis becomes increasingly prevalent, so does emphasis on environmental sustainability. The healthcare sector (a significant contributor to environmental impact) is particularly of interest: sustainable healthcare and awareness within the NHS is crucial. However, few medical schools include environmental teaching in their curricula. We undertook this survey to assess environmental awareness and perspectives amongst medical students. Methods An online questionnaire was distributed to London medical students. Participants were asked demographic data, questions concerning the environmental impact of products and practices in the NHS, and methods to reduce healthcare’s environmental impact. Results 87% of students stated that healthcare’s environmental impact is of concern to them, 97% agreed that the environmental impact of products should be considered during development. 65% agreed that the environmental impact of a product should influence its use, but 95% agreed that a device being recyclable/reusable would influence their practice. Students felt the factor most negatively impacting the environmental burden of healthcare was ‘disposable plastic items’, in 57% of responses, and ‘general waste’ in 44%. Conclusions Most medical students found healthcare's environmental impact concerning, expressing a desire to choose the most sustainable options. Whilst the distribution of academic year and the London demographic limited this study, we believe it is the first of its kind assessing medical student's attitudes towards the environmental impact of healthcare. With this initial benchmark, we hope future surveys will assess and improve the environmental awareness of doctors in training, as well as the inclusion of environmental teaching in medical school.

SP8.5 - Enhancing the confidence of FY1 Doctors in managing General Surgical Patients through the introduction of an online handbook– A quality improvement project

Abstract Background Emerging as a Foundation Year 1 (FY1) doctor from undergraduate training can be daunting. Furthermore, working in Colorectal Surgery can pose challenges: managing both elective and acute surgical patients with complex needs. We designed a General Surgery and Colorectal Surgery handbook to help FY1 doctors navigate training. This Quality Improvement Project aimed to assess the impact of and alleviate some of the uncertainty experienced by FY1 doctors during this transitional phase. Methods An electronic handbook was compiled with contributions from across the Multidisciplinary Team which was reviewed and approved for distribution within our Trust. An online questionnaire was distributed to assess pre-placement confidence in key domains on a 10-point Likert scale. This was sent to FY1 doctors who had previously completed a rotation within colorectal surgery without the handbook. The handbook was distributed to new cohort of FY1 doctors a week prior to the start of their rotation in Colorectal Surgery. An identical questionnaire was sent to the new cohort of FY1s within a month of their rotation and results were compared with previous cohort. Results In all surveyed areas, there was an improvement in confidence in the post-intervention group compared to that shown in the pre-intervention group. The average improvement in median score across all areas was 3.8 points. Conclusion This project demonstrated an overwhelmingly positive response to a formalised handbook by FY1 doctors in training. This intervention has helped FY1 doctors manage colorectal and general surgery patients with enhanced confidence thus paving way for safer patient care.

WP6.15 - A dedicated teaching programme in Colorectal Surgery: continuing education beyond medical school

Abstract Background The UK Foundation Programme (UKFP) Curriculum illustrates the need for educational progression for doctors in their first two years of work. Although UKFP recommends use of departmental teaching for this, there is limited guidance on structured and learning-objective focussed training. We designed a colorectal surgery lecture series to create a reproducible teaching programme with defined learning outcomes. Methods We developed a 6-part lecture series aimed at FY1 doctors working in General Surgery at our Teaching Hospital. Teaching was in the form of 30-minute powerpoint presentations, with 15 minutes for questions, at weekly departmental teaching meetings. Lectures were delivered by FY2 doctors and members of colorectal multidisciplinary team (Enhanced Recovery CNS, Stoma Care CNS). Each session was supervised by a Colorectal Consultant. Feedback was obtained using a 10-point Likert scale questionnaire, assessing various domains. Results FY1 trainees indicated an increase in their knowledge with each lecture. Furthermore, the domains of relevance (mean score 9.53±0.80); teaching style (mean score 9.66±0.94); and audiovisual aid (mean score 9.68±0.70) were all rated highly. Lecture duration was rated as perfect length (mean score 5.86±1.80). Conclusion We have demonstrated that weekly departmental teaching can be utilised to enhance training for FY1 doctors within a challenging surgical subspecialty. Feedback revealed high satisfaction, facilitating improvement in knowledge and thus empowerment in undertaking clinical duties. Strengthened by this positive outcome work is in progress to introduce this format of structured teaching into departmental teaching meetings in all disciplines of medicine and surgery across our Trust.

FP5.12 - Write what you know: A retrospective documentation audit

Abstract Aims The Royal College of Physicians (RCP) stipulates that every patient entry in the notes should be; dated, timed and signed by the author (name and designation included). Additionally, the content should have a standardised structure and layout with a chronological order to reflect a continuum of patient care. This audit aimed to assess the percentage of patient documentations that were compliant with these standards. Methods We retrospectively evaluated inpatient documentations for general, colorectal and vascular surgery for one week within a district general hospital setting. The data was obtained from electronic documentations. We assessed inpatient documentation for all relevant criteria as per RCP guidelines. Inpatient documentation included; the admission notes, post take ward round, daily ward rounds and inter-speciality discussions. Results A total of 88 patient related entries were reviewed. Of these 89.8% were dated. 42.0% of the entries were timed, with inter-specialty discussion having the highest percentage of recorded times. 93.2% had a standardised structure. The structure of admission entries was the most consistent with standards. 6.8% and 3.4% had the authors designation and signature respectively. Conclusion Clear informative documentation is pivotal for safe and effective patient care. Failure of patient documentation to meet the stipulated standards was established in this audit. Factors including inadequate junior doctor training, pace of ward rounds and reliance on electronic noting systems are potential reasons for poor compliance. Capitalising on opportunities to educate junior doctors is paramount in improving patient care.

Experience of Implementing the Innovative Educational Program "Virtual Propaedeutics" for Training Doctors

The article presents the experience of developing and implementing a 4-month (from February to May 2024) course "Virtual Propaedeutics" by 2nd-year students of the Faculty of Medicine of I. I. Mechnikov North-West State Medical University, St. Petersburg, based on the S. M. Ryss Department of Propaedeutics of Internal Medicine, Gastroenterology and Dietetics. A large-scale scientific and practical project for implementation in a digital environment — interactive lessons and clinical cases for examining virtual patients, has no analogues in domestic and world educational practice.

Contribution of the Link with society in the training of doctors in the Medicine degree at the San Gregorio de Portoviejo University

Introduction: In Latin America, university extension, today called in Ecuador, connection with society, emerges irreverently with the movement of Córdova, Argentina; It constitutes the historical reason of the university, the engine that provides the basic inputs to Research and Teaching. It is recognized as an academic, dynamic, participatory, dialogic and contextual process that determines social and curricular relevance. It is a real challenge to train responsible professionals committed to solving the problems in their environment, and this is where the contribution of Linkage in the comprehensive training of man is shown, especially in the field of Health Sciences and Medicine particularly. Objective: To assess the contribution of the connection with society in the training of doctors in the Medicine degree at the San Gregorio de Portoviejo University (USGP). Methods: It was a qualitative research, analysis-synthesis, induction-deduction and systemic methods were used, bibliographic sources that regulate the policies of this function in Ecuador, in the USGP and in the Medicine career were also reviewed, and of other materials related to Linkage with society, its contribution to the training of professionals in the field of Health Sciences and specifically in Medicine. Results: It was identified that the policy of linkage with society contained in the training program for doctors in the Medicine career meets the external demands and the premises raised by the CES and the USGP. Conclusions: The Medicine degree implements in its links a comprehensive approach, which is exhibited from the dimension of curricular actions, goes through research and is brought together in university extension, for responsible, committed and highly qualified professionals.

Assessment of Doctors' Readiness to Provide Emergency and Urgent Care

A doctor of any specialty must be able to provide medical care to a patient in urgent and emergency situations. The abstract presents the results of a study that compared groups of specialists who had and had not undergone accreditation, who had and had not been trained in specialized cycles. Knowledge of algorithms and organizational issues of providing these types of care in institutions was revealed. Based on the results obtained, measures were proposed to improve the quality of training doctors to provide urgent and emergency medical care.