Training In UK Research Articles

The consequences of limited training in disorders of gut-brain interaction: Results from a national survey of gastroenterology trainees in the United Kingdom.

Despite their high prevalence and burden, disorders of gut-brain interaction (DGBI) are undertaught and underrepresented in medical curricula. We evaluated the exposure of UK gastroenterology trainees to DGBI and their comfort managing these conditions. An electronic survey was distributed to trainees via UK training program directors. The survey included questions on stage of training; subspecialty interest; access to DGBI training opportunities, and comfort levels with DGBI diagnosis and management. Responses were compared between junior and senior trainees, by subspecialty interest (luminal and non-luminal), by geographical region, and training program size. One hundred twelve trainees from across the UK participated (21.4% of national training post holders). Exposure to DGBI lectures (32.8% junior vs. 73.3% senior trainees, p = 0.00003) and clinics (9.0% junior vs. 42.2% senior trainees, p = 0.00003), increased with seniority. Regardless of seniority, most trainees were rarely comfortable making a DGBI diagnosis (39.5% senior vs. 33.9% junior trainees, p = 0.69), and were not comfortable initiating neuromodulators (50% senior vs. 25.8% junior trainees, p = 0.08). Trainees without a luminal subspecialty interest (50%) accessed fewer DGBI clinics (p = 0.04), had less communication skills training (p = 0.04) and were less likely to have been observed during DGBI consultations (p = 0.002). Responses were similar across UK regions and did not differ between smaller and larger programs. DGBI training opportunities are limited in UK gastroenterology training across training grades. Most trainees lack confidence with DGBI diagnosis and management. Urgent interventions need to be targeted at all stages of training to ensure DGBI competencies for future gastroenterologists and improve patient outcomes.

Early Years leadership development during workforce crisis: perspectives of 24 UK training providers

ABSTRACT There is growing global recognition of the contribution that leadership development can make to improving quality and outcomes in the Early Years (EY) education sector. UK governments are responding to such evidence through the creation of new national qualifications for EY professionals across the sector and the expansion of publicly funded digitally mediated leadership development. At the same time, the sector is experiencing an acute workforce crisis with a majority of English providers self-reporting that they are struggling to recruit the staff they need. In this article, we explore how diverse training providers across the UK conceptualise their offer of leadership development in the context of a workforce crisis. Based on interviews and focus groups with a total of 24 organisations, we present three needs that guide leadership development in the sector going forward. These are the needs to: (1) embed leadership development in a coherent workforce strategy, (2) build capacity in EY settings to support engagement with leadership development and (3) emphasise collaboration over competition in the design of leadership development programmes. These findings have implications for the next steps that governments and training providers take to support EY leadership as part of a healthy workforce across the sector.

Modifiable risk factors for post-operative delirium in older adults undergoing major non-cardiac elective surgery: a multi-centre, trainee delivered observational cohort feasibility study and trainee survey

BackgroundPost-operative delirium (POD) is an acute brain failure which may occur following major surgery, with serious implications for participants and caregivers. Evidence regarding optimal anaesthetic management for older participants at higher risk of POD is conflicting. We conducted a feasibility study of our protocol in 5 centres to guide sample size estimation and inform future recruitment strategies for a larger cohort study.MethodsParticipants aged over 65 and scheduled for major surgery were recruited. They were assessed pre-operatively for delirium, cognitive impairment, depression, comorbidity, activity levels and alcohol use. Details of management during surgery, all medications and complications were recorded by a trainee-led research team. Participants were assessed for delirium in the immediate recovery period and then on post-operative days 1–4 using the 4 question attention test (4AT) with complications assessed at day 4 using the post-operative morbidity survey (POMS). Primary outcomes were the incident rates of POD. Secondary outcomes were number of eligible patients, recruitment rates and retention rates throughout the study, time required for data collection, preoperative risk factors assessment and daily postoperative delirium assessments. Also to assess the added value of employing the regional trainee research network (INCARNNET) to deliver the study. Specifically, what proportion of patient consent, data collection and post-operative testing is performed by anaesthesia trainees from this group, especially the success of weekend delirium assessment by trainees? A survey was completed at the end of the study by the trainees involved regarding their involvement in the study.ResultsNinety-five participants were recruited, of whom 93 completed the study. Overall, POD occurred in 9 patients. Of these, three were detected in recovery and six on post-op days 1–4. Median length of stay was 6 days. Recruitment rates were high in all but one site. 59 (62%) participants were consented by trainees and 189 (63%) of post op delirium assessments were performed by trainees. A total of six patients declined the study (in a follow up survey of trainees). Pre-existing cognitive impairment, depression and problem drinking were detected in 4(4.3%), 3(3.2%) and 5(5.37%) participants, respectively. Co-morbidity was common with 55(59%) in class three or four of the geriatric index of morbidity. Overall, from a total of 641 data points, levels of missing data were as follows, site A = 9.3%, B = 13.5%, C = 15.4%, D = 10.9%, E = 11.1% (data could not be completed retrospectively).ConclusionsA multi-centre observational cohort study of delirium carried out by UK trainee anaesthetists is feasible. Patients are content to undergo day of surgery consent and multiple short questionnaires pre-operatively. Proposed data, especially pharmacological, should be carefully considered for their relevance to modifiable mechanisms that can lead to POD. Future research to enable prognostic modelling of POD should involve large scale cohort studies of enriched populations to capture a higher POD incidence. POD remains a common complication in older persons undergoing major surgery in the UK and studies of interventions are urgently needed.Trial registrationAll methods were carried out in accordance with relevant guidelines and regulations. The study was retrospectively registered with ISRCTN94663125 on 07/02/2018.

‘It’s not in my job description’: An exploration of trainee clinical psychologists’ attitudes towards research and perceptions of DClinPsy research culture

This project aimed to investigate attitudes towards research and perceived research culture among trainee clinical psychologists across the UK. This was achieved by exploring factors such as: research training environment, research attitudes, research self-efficacy, and professional identity. An online survey was completed by 44 trainee clinical psychologists who started training in 2020. The findings showed that UK trainee clinical psychologists did not perceive a strong research training environment, they did not hold strong attitudes towards research, or have positive research self-efficacy as indicated in previous research. It is of some concern that the role of researcher, as part of the identity of a clinical psychologist, was not seen to be instrumental by most trainees. Important differences in the results of this research compared to previous published literature are discussed, in addition to a consideration of the implications of these findings for training and the post-qualification role of clinical psychologists.

The Royal College of Surgeons of England Damage Control Orthopaedic Trauma Skills course (DCOTS): resuscitative knowledge and confidence in surgical skills are reliably maintained at six months post course.

Since 2012, the Damage Control Orthopaedic Trauma Skills course (DCOTS) has trained more than 250 surgeons in the principles and practice of damage control orthopaedics and early appropriate care. This Royal College of Surgeons of England (RCS England) course takes place at the RCS England Partner cadaver laboratory at Brighton and Sussex Medical School. Trauma is a leading cause of morbidity and mortality in the UK, and the course has tried to pass on the lessons of war and conflict from its military faculty and hard-won lessons of "developed world" trauma from its experienced civilian faculty. Participating surgeons were invited to score their self-reported confidence before attending the DCOTS course, immediately afterwards and again 6 months later. A modified four-point Likert scale was used, with responses from 1 = No Confidence to 4 = Very Confident. Damage control resuscitation principles with damage control surgery showed the greatest retained increase at 6 months - 100% - which is extremely satisfying. Self-reported confidence in pelvic external fixation was initially 93% dropping to 85%, which is also considered good to excellent. For pelvic packing, confidence was 90% at the end of the course, up from 19% precourse. This dropped to 62%, which was still considered good but low for the high standards of the course. This may relate to UK trainees' lack of familiarity with the concept. Three of the main skills taught on the DCOTS are effectively retained at 6 months post course.

UK training academy launched.

UK training academy launched.

THE RISK OF EARLY REVISION SURGERY AFTER TRAINEE-LED PRIMARY TOTAL HIP ARTHROPLASTY

Primary total hip replacement (THR) is a successful and common operation which orthopaedic trainees must demonstrate competence in prior to completion of training. This study aimed to determine the impact of operating surgeon grade and level of supervision on the incidence of 1-year patient mortality and all-cause revision following elective primary THR in a large UK training centre.National Joint Registry (NJR) data for all elective primary THR performed in a single University Teaching Hospital from 2005–2020 were used, with analysis performed on the 15-year dataset divided into 5-year temporal periods (B1 2005–2010, B2 2010–2015, B3 2015–2020). Outcome measures were mortality and revision surgery at one year, in relation to lead surgeon grade, and level of supervision for trainee-led operations.9999 eligible primary THR were undertaken, of which 5526 (55.3%) were consultant led (CL), and 4473 (44.7%) trainees led (TL). Of TL, 2404 (53.7%) were non-consultant supervised (TU), and 2069 (46.3%) consultant supervised (TS). The incidence of 1-year patient mortality was 2.05% (n=205), and all-cause revision was 1.11% (n=111). There was no difference in 1-year mortality between TL (n=82, 1.8%) and CL (n=123, 2.2%) operations (p=0.20, OR 0.78, CI 0.55–1.10). The incidence of 1-year revision was not different for TL (n=56, 1.3%) and CL (n=55, 1.0%) operations (p=0.15, OR 1.37, CI 0.89–2.09). Overall, there was no temporal change for either outcome measure between TL or CL operations. A significant increase in revision within 1-year was observed in B3 between TU (n=17, 2.7%) compared to CL (n=17, 1.0%) operations (p=0.005, OR 2.81, CI 1.35–5.87).We found no difference in 1-year mortality or 1-year all-cause revision rate between trainee-led primary THR and consultant-led operations over the entire fifteen-year period. However, unsupervised trainee led THR in the most recent 5-year block (2015–2020) has a significantly increased risk of early revision, mainly due to instability and prosthetic joint infection. This suggests that modern surgical training is having a detrimental effect on THR patient outcomes. More research is needed to understand the reasons if this trend is to be reversed.

Community Occupational Therapy in Dementia intervention for people with mild to moderate dementia and their family carers in the UK: the VALID research programme including RCT

Community Occupational Therapy in Dementia intervention for people with mild to moderate dementia and their family carers in the UK: the VALID research programme including RCT

Virtual induction for new doctors in a district general hospital

Background: Staff induction is an opportunity and an obligation for organisations to welcome their new trainees and familiarise them with their new workplace. It is well known that UK trainees rotate regularly between hospitals during their career; we, therefore, believed that an online platform for virtual induction of trainees would aid traditional face-to-face induction. This novel virtual tour induction allows trainees to complete part of their induction at a time convenient for them, and familiarise themselves with their new workplace. Swerdlow and colleagues1 highlighted the advantages of screen-based simulation as ‘cost, availability, simplicity, repeatability and scorability’. Methods: For our virtual induction programme, we took 360 degree pictures and videos of our theatre complex. These videos included a complete tour of the theatre complex, the locations of key equipment such as the difficult airway trolley and familiarisation with anaesthetic equipment and the electronic medical record system used in our trust. We then created a website https://wsheducation.co.uk and uploaded these photos and videos on to our website. This link would be shared with all new trainees as part of their induction pack. Results: We sent out a survey of our virtual induction programme to 10 new trainees, seven of whom responded. All seven of them felt that the online virtual induction platform was user friendly, easy to access, and aided induction and familiarisation with the department. In addition, all seven trainees felt more confident with the use of equipment available in our hospital after watching these videos. Conclusion: We received very positive feedback for this novel method of induction and have shown that this high-fidelity induction programme could be used to help with familiarisation of the working environment for new trainees. The platform provides an easy and convenient form of induction and aids continuous reinforced learning through video-based material which could be used alongside face-to-face induction. 1)Swerdlow B, Soelberg J, Osborne-Smith L. Adv Med Educ Pract 2020; 11: 563–7

The implementation of a national online teaching platform for UK trainee otolaryngologists

Disruption to face-to-face postgraduate surgical teaching during the COVID-19 pandemic exposed the need for a virtual learning platform for UK otolaryngology trainees. With this impetus, the Association of Otolaryngologists in Training (AOT) created an educational platform on YouTube™ on which to assemble all official online teaching occurring in the UK alongside teaching from international sources that reliably reflected the UK Intercollegiate Surgical Curriculum Programme (ISCP) in otolaryngology. Since its commencement in April 2020, contributions have come from UK regional deaneries, the National Association of Programme Directors in ENT, and UK and international ear, nose and throat subspecialist organisations. The AOT has edited and annotated webinars, produced transcripts, mapped each individual webinar to the ISCP, maintained a calendar of events and recorded usage data for platform content.

A question of credibility: A focus group study examining the experiences of workers attending counter-terrorism training in UK crowded places

The UK authorities have exponentially increased the number of counter-terrorism (CT) training activities being delivered by the Police Service to workers in crowded places. Counter-terrorism training events are designed to help prevent attacks by raising awareness to hostile reconnaissance, assist workers to cope at the time of an incident, and aid recovery after an attack. This focus group study provided a reality check of what is happening on the ground in sessions. Eight focus groups were conducted in significant crowded places ( N = 55) and targeted workers who had already been in receipt of CT training. It found a paucity of evidence to indicate the effectiveness of CT training activities in improving the resilience of the public realm. Respondents supported the benefits of realistic and experiential training events closely related to their places of work. At the same time, they recounted how events were often poorly organised and delivered, with some CT practitioners lacking credibility. Sessions were often not based on learning need and were seldom evaluated. A series of recommendations are made to improve the credibility of CT products and their delivery, coupled with strategies to potentially aide evaluation and embedded organisational learning from events.

Improving access to forensic psychology education and training for learners with Attention Deficit Hyperactivity Disorder (ADHD)

Neurodiversity within education and the workplace has sparked interest as part of the wider Equality, Diversity and Inclusion (EDI) movement. Attention Deficit Hyperactivity Disorder (ADHD) is one aspect of neurodiversity, traits of which can feature as both barriers and strengths within education and training. Current support for learners with ADHD from institutions varies and is often limited. The purpose of this paper will be to re-dress the attendance to deficits in ADHD and to consider some of the strengths that people with ADHD may bring, and specifically how these may apply to forensic psychology. This paper will also consider how the UK training route for forensic psychology provides barriers and opportunities for people with ADHD and make suggestions for ways in which education, training and supervision could be improved to attract and retain a population of learners who could bring value to the profession.

A survey of liver ablation amongst UK interventional radiologists

To characterise training for, and conduct of, image-guided liver tumour ablation amongst UK interventional radiologists. A web-based survey of British Society of Interventional Radiology members was carried out between 31 August to 1 October 2022. Twenty-eight questions were designed, covering four domains: (1) respondent background, (2) training, (3) current practice, and (4) operator technique. One hundred and six responses were received, with an 87% completion rate and an approximate response rate of 13% of society members. All UK regions were represented, with the majority from London (22/105, 21%). Seventy-two out of 98 (73%) were either extremely or very interested in learning about liver ablation during training, although levels of exposure varied widely, and 37/103 (36%) had no exposure. Performed numbers of cases also varied widely, between 1-10 cases and >100 cases per operator annually. All (53/53) used microwave energy, and most routinely used general anaesthesia (47/53, 89%). Most 33/53 (62%) did not have stereotactic navigation system, and 25/51(49%) always, 18/51 (35%) never, and 8/51(16%) sometimes gave contrast medium (mean 40, SD 32%) after procedures. Fusion software to judge ablation completeness was never used by 86% (43/55), sometimes used by 9% (5/55), and always used by 13% (7/55) of respondents. Although there are high levels of interest in image-guided liver ablation amongst UK interventional radiologists, training arrangements, operator experience, and procedural technique vary widely. As image-guided liver ablation evolves, there is a growing need to standardise training and techniques, and develop the evidence base to ensure high-quality oncological outcomes.

Breaking the unspoken rules of UK training in gastroenterology and hepatology

Breaking the unspoken rules of UK training in gastroenterology and hepatology

Artificial intelligence in radiology: trainees want more

To understand the attitudes of UK radiology trainees towards artificial intelligence (AI) in Radiology, in particular, assessing the demand for AI education. A survey, which ran over a period of 2 months, was created using the Google Forms platform and distributed via email to all UK training programmes. The survey was completed by 149 trainee radiologists with at least one response from all UK training programmes. Of the responses, 83.7% were interested in AI use in radiology but 71.4% had no experience of working with AI and 79.9% would like to be involved in AI-based projects. Almost all (98.7%) felt that AI should be taught during their training, yet only one respondent stated that their training programme had implemented AI teaching. Respondents indicated that basic understanding, implementation, and critical appraisal of AI software should be prioritized in teaching. Of the trainees, 74.2% agreed that AI would enhance the job of diagnostic radiologists over the next 20 years. The main concerns raised were information technology/implementation and ethical/regulatory issues. Despite the current limited availability of AI-based activities and teaching within UK training programmes, UK trainees' attitudes towards AI are mostly positive with many showing interest in being involved with AI-based projects, activities, and teaching.

Colonoscopy Colorectal Cancer Screening Programme in Southern Iraq: Challenges, Knowledge Gaps and Future Potential.

Data on current colorectal cancer screening practices in Iraq are limited. This study aimed to better understand the current colorectal cancer screening practice and perceived barriers. The project also aimed to use UK expertise to introduce Bowel Cancer Screening Programme (BCSP) in Basra, Iraq. The study consisted of two parts: A pre-visit online survey of clinicians to test the project's feasibility. A public survey was conducted to understand and gauge the general knowledge and perceived barriers to having colorectal cancer screening. The second phase included a short visit to Basra and the delivery of a multidisciplinary meeting for bowel screening colonoscopists. Fifty healthcare providers completed the survey. Basra has no established bowel cancer screening programme, let alone the country. Opportunistic colonoscopy surveillance is done on an ad hoc base. A total of 350 individuals completed the public survey. The survey showed that more than 50% of participants were not familiar with the concept of a BCSP and less than 25% were aware of "red flag" symptoms of bowel cancer. The short visit to Basra included a roundtable discussion and delivered a training workshop for screening colonoscopists using UK training materials in conjunction with the Iraqi Medical Association. Feedback from the course was extremely positive. Several potential barriers were identified to participate in BCSP. The study highlighted potential barriers, including a lack of public awareness and insufficient training resources to be addressed in future screening programmes. The study has identified several potential areas for future collaboration to support the development of a BCSP centre in Basra.

Solving the inverse problem of post-mortem interval estimation using Bayesian Belief Networks

Bayesian Belief Networks (BBNs) can be applied to solve inverse problems such as the post-mortem interval (PMI) by a simple and logical graphical representation of conditional dependencies between multiple taphonomic variables and the observable decomposition effect. This study is the first cross-comparison retrospective study of human decomposition across three different geographical regions. To assess the effect of the most influential taphonomic variables on the decomposition rate (as measured by the Total Decomposition Score (TDS)), decomposition data was examined from the Forensic Anthropology Research Facility at the University of Tennessee (n = 312), the Allegheny County Office of the Medical Examiner in Pittsburgh, US (n = 250), and the Crime Scene Investigation department at Southwest Forensics in the UK (n = 81). Two different BBNs for PMI estimations were created from the US and the UK training data. Sensitivity analysis was performed to identify the most influential parameters of TDS variance, with weaker variables (e.g., age, sex, clothing) being excluded during model refinement. The accuracy of the BBNs was then compared by additional validation cases: US (n = 28) and UK (n = 10). Both models conferred predictive power of the PMI and accounted for the unique combination of taphonomic variables affecting decomposition. Both models had a mean posterior probability of 86% (US) and 81% (UK) in favor of the experimental hypothesis (that the PMI was on, or less than, the prior last known alive date). Neither the US nor the UK datasets represented any cases below 'moderate' support for the value of PMI evidence. By applying coherent probabilistic reasoning to PMI estimations, one logical solution is provided to model the complexities of human decomposition that can quantify the combined effect of several uncertainties surrounding the PMI estimation. This approach communicates the PMI with an associated degree of confidence and provides predictive power on unknown PMI cases.

Less than full-time training (LTFT), is this the new norm? A cross-sectional study using a UK-wide online survey to evaluate trainees’ views and intentions for LTFT

ObjectivesInterest in less than full-time training (LTFT) is growing among doctors in training. LTFT applications have previously been limited to fulfilment of specific criteria such as childcare or health reasons,...

Telepractice parent-implemented training and coaching in a rural area in the UK: Impact on mothers and their children with autism

BackgroundParent-implemented interventions are reported to have positive outcomes for both children with autism and their parents. Online parent training and coaching have been increasingly used as an effective alternative or supplemental to traditional face-to-face services, especially after the start of the Covid-19 pandemic. The purpose of this study was to examine the extent to which parents of children with autism can implement a set of newly acquired strategies and the impact these had on their children’s communication skills. MethodFour mother–child dyads from a rural area in the UK participated in the study following a multiple-baseline design across strategies. Asynchronous training and synchronous coaching were provided, all online. ResultsThe present study extended the results of the original US based study it replicated (Meadan et al., 2016). Mothers learned to use the targeted naturalistic teaching strategies they were trained and coached in (i.e., i-PiCS- internet-based Parent-implemented Communication Strategies) and their children’s responsiveness and initiations of communication increased and were mostly maintained after the end of the study. Changes in the mothers’ use of strategies were observed in many cases even after training only, and the strategy of time delay was linked to increases in the children’s initiations of communication. ConclusionsThis replication study showed that i-PiCS is an appropriate intervention to use with mothers of children with autism in the UK and telepractice training and coaching can be a feasible and effective service delivery method.

A national survey investigating the impact of the COVID-19 pandemic on core and higher breast radiology training in the UK

AIMTo investigate the impact of the COVID-19 pandemic on core and higher breast radiology training in the UK from the perspective of trainees and new consultants.MATERIALS AND METHODSA survey comprising 25 questions was distributed to UK radiology trainees via the regional Junior Radiologists Forum representatives under the auspices of the British Society of Breast Radiology (BSBR).RESULTSSixty-nine eligible responses were received representing all UK training regions. Fifty-five per cent of respondents completing either a core or higher breast rotation felt that the pandemic had a negative effect on their breast training. There was an overall reduction in exposure to the key breast imaging methods when rotations took place during the pandemic. Completing a core breast rotation during the pandemic was less likely to attract trainees to higher breast training. Three out of four breast radiology consultants in their first year after receiving their Certificate of Completion of Training (CCT) felt the pandemic reduced their preparedness for becoming consultants. Positive outcomes included the increased use of online educational resources and remote multidisciplinary meetings.CONCLUSIONSAs well as having a negative impact on breast radiology training overall, the pandemic has had a detrimental effect on attracting trainees to breast radiology as a future career. It is of key importance that trainees have a positive core breast rotation as this experience appears central to many trainees' decisions to pursue higher breast training. Increased use of online learning resources has also been positively received and is a valuable approach to learning that can be maintained in the longer term.