SP10.2.2 Improving undergraduate surgical education: Comparing findings from the ASiT consensus report with the RCS Undergraduate Surgical Curriculum and GMC Outcomes for Graduates

Abstract Aims Previous work by ASiT has shown that undergraduate years can have a significant impact on the decision to pursue a surgical career. The Royal College of Surgeons England launched their recommendations in the undergraduate surgical curriculum in 2015. Our aim was to ascertain whether any additional areas of importance could be highlighted. Methods A consensus document was developed, using the RCS undergraduate surgical curriculum and GMC Outcomes for Graduates as baseline guides. An external advisory group made additional recommendations for inclusion which was then presented and discussed at a face-to-face consensus session at the 2019 ASiT International Surgical Conference. A consensus threshold of 80% was accepted. Results A total of 69 ‘core’ topics were reviewed and discussed, of which 10 did not reach consensus. These topics were predominantly considered to be ‘specialist’ in nature, and were under the domains of Head and Neck/ENT, neurosurgery, paediatric or vascular surgery. Of note, knot tying, which is included in the GMC guidance, was considered beyond the required level of a graduate and more suitable for those with the interest or intent to pursue a career in surgery. Conclusions Our consensus meeting and subsequent report has highlighted differences between the current available guidance and what medical students and junior doctors consider to be ‘core’ undergraduate surgical knowledge and skills. Topics that did not meet consensus may form areas of need in early postgraduate training. Our findings should be used in addition to the RCS and GMC guidance for undergraduate surgical education.

Download Full-text

“Intellectual developmental disorders”: reflections on the international consensus document for redefining “mental retardation-intellectual disability” in ICD-11

Advances in Mental Health and Intellectual Disabilities ◽

10.1108/amhid-10-2015-0050 ◽

2016 ◽

Vol 10 (1) ◽

pp. 36-58 ◽

Cited By ~ 10

Author(s):

Marco O. Bertelli ◽

Kerim Munir ◽

James Harris ◽

Luis Salvador-Carulla

Keyword(s):

Intellectual Disability ◽

Developmental Disorders ◽

Health Condition ◽

World Health ◽

Advisory Group ◽

Content Type ◽

Consensus Document ◽

Single Construct ◽

Consensus Report

Purpose – The debate as to whether intellectual disability (ID) should be conceptualized as a health condition or as a disability has intensified as the revision of World Health Organization’s (WHO’s) International Classification of Diseases (ICD) is being finalized. Defining ID as a health condition is central to retaining it in ICD, with significant implications for health policy and access to health services. The purpose of this paper is to include some reflections on the consensus document produced by the first WHO Working Group on the Classification of MR (WHO WG-MR) and on the process that was followed to realize it. The consensus report was the basis for the development of official recommendations sent to the WHO Advisory Group for ICD-11. Design/methodology/approach – A mixed qualitative approach was followed in a series of meetings leading to the final consensus report submitted to the WHO Advisory group. These recommendations combined prior expert knowledge with available evidence; a nominal approach was followed throughout with face-to-face conferences. Findings – The WG recommended a synonym set (“synset”) ontological approach to the conceptualisation of this health condition underlying a clinical rationale for its diagnosis. It proposed replacing MR with Intellectual Developmental Disorders (IDD) in ICD-11, defined as “a group of developmental conditions characterized by a significant impairment of cognitive functions, which are associated with limitations of learning, adaptive behaviour and skills”. The WG further advised that IDD be included under the parent category of neurodevelopmental disorders, that current distinctions (mild, moderate, severe and profound) be continued as severity qualifiers, and that problem behaviours removed from its core classification structure and instead described as associated features. Originality/value – Within the ID/IDD synset two different names combine distinct aspects under a single construct that describes its clinical as well as social, educational and policy utilities. The single construct incorporates IDD as a clinical meta-syndrome, and ID as its functioning and disability counterpart. IDD and ID are not synonymous or mirror concepts as they have different scientific, social and policy applications. New diagnostic criteria for IDD should be based on a developmental approach, which accounts for the complex causal factors known to impact the acquisition of specific cognitive abilities and adaptive behaviours. The paper focuses on a new clinical framework for the diagnosis of IDD that also includes and complements the existing social, educational and policy components inherent in ID.

Download Full-text

Undergraduate Anatomy Teaching: Are we Failing a Generation of Future Surgeons?

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363511x545456 ◽

2011 ◽

Vol 93 (1) ◽

pp. 26-28 ◽

Cited By ~ 11

Author(s):

Caroline HM Bagley ◽

Elizabeth Gillott ◽

Ayanthi Gunasekera

Keyword(s):

Postgraduate Training ◽

Good Clinical Practice ◽

Undergraduate Curriculum ◽

Human Anatomy ◽

Junior Doctors ◽

Applied Anatomy ◽

Important Concern ◽

Anatomical Knowledge ◽

Surgical Career ◽

New Generation

A sound knowledge of human anatomy underpins good clinical practice. However, changes to the undergraduate curriculum in recent years, in particular a reduced emphasis on applied anatomy, have raised concerns among clinicians that a new generation of doctors are qualifying from medical school with insufficient anatomical knowledge. This is a particularly important concern for those junior doctors wishing to pursue a surgical career and has implications for their early postgraduate training.

Download Full-text

145 Point of care lung ultrasound in patient triage: integration of ultrasound into a streaming pathway for COVID-19

Emergency Medicine Journal ◽

10.1136/emj-2020-rcemabstracts.27 ◽

2020 ◽

Vol 37 (12) ◽

pp. 839.1-839

Author(s):

Dominic Craver ◽

Aminah Ahmad ◽

Anna Colclough

Keyword(s):

Point Of Care ◽

District General Hospital ◽

Training Programme ◽

Service Evaluation ◽

University Hospital ◽

Junior Doctors ◽

Point Of Care Ultrasound ◽

Face To Face ◽

Point Of Care Diagnostics ◽

Audit Data

Aims/Objectives/BackgroundRapid risk stratification of patients is vital for Emergency Department (ED) streaming during the COVID-19 pandemic. Ideally, patients should be split into red (suspected/confirmed COVID-19) and green (non COVID-19) zones in order to minimise the risk of patient-to-patient and patient-to-staff transmission. A robust yet rapid streaming system combining clinician impression with point-of-care diagnostics is therefore necessary.Point of care ultrasound (POCUS) findings in COVID-19 have been shown to correlate well with computed tomography (CT) findings, and it therefore has value as a front-door diagnostic tool. At University Hospital Lewisham (a district general hospital in south London), we recognised the value of early POCUS and its potential for use in patient streaming.Methods/DesignWe developed a training programme, ‘POCUS for COVID’ and subsequently integrated POCUS into streaming of our ED patients. The training involved Zoom lectures, a face to face practical, a 10 scan sign off process followed by a final triggered assessment. Patient outcomes were reviewed in conjunction with their scan reports.Results/ConclusionsCurrently, we have 21 ED junior doctors performing ultrasound scans independently, and all patients presenting to our department are scanned either in triage or in the ambulance. A combination of clinical judgement and scan findings are used to stream the patient to an appropriate area.Service evaluation with analysis of audit data has found our streaming to be 94% sensitive and 79% specific as an indicator of COVID 19. Further analysis is ongoing.Here we present both the structure of our training programme and our integrated streaming pathway along with preliminary analysis results.

Download Full-text

Assessment and management of disease burden and quality of life in patients with hereditary angioedema: a consensus report

Allergy Asthma & Clinical Immunology ◽

10.1186/s13223-021-00537-2 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Konrad Bork ◽

John T. Anderson ◽

Teresa Caballero ◽

Timothy Craig ◽

Douglas T. Johnston ◽

...

Keyword(s):

Quality Of Life ◽

Hereditary Angioedema ◽

Clinical Management ◽

Disease Burden ◽

The United States ◽

Consensus Meeting ◽

Consensus Statements ◽

Consensus Report

Abstract Background Hereditary angioedema (HAE) is a rare disease characterized by unpredictable, potentially life-threatening attacks, resulting in significant physical and emotional burdens for patients and families. To optimize care for patients with HAE, an individualized management plan should be considered in partnership with the physician, requiring comprehensive assessment of the patient’s frequency and severity of attacks, disease burden, and therapeutic control. Although several guidelines and consensus papers have been published concerning the diagnosis and treatment of HAE, there has been limited specific clinical guidance on the assessment of disease burden and quality of life (QoL) in this patient population. Practical guidance is critical in supporting effective long-term clinical management of HAE and improving patient outcomes. The objective of this review is to provide evidence-based guidelines for an individualized assessment of disease burden and QoL in patients with HAE. Methods A consensus meeting was held on February 29, 2020, consisting of 9 HAE experts from the United States and Europe with extensive clinical experience in the treatment of HAE. Consensus statements were developed based on a preliminary literature review and discussions from the consensus meeting. Results Final statements reflect the consensus of the expert panel and include the assessment of attack severity, evaluation of disease burden, and long-term clinical management of HAE caused by C1-esterase inhibitor deficiency. Patient-reported outcome measures for assessing HAE attack severity and frequency are available and valuable tools; however, attack frequency and severity are insufficient markers of disease severity unless they are evaluated in the broader context of the effect on an individual patient’s QoL. QoL assessments should be individualized for each patient and minimally, they should address the interference of HAE with work, school, social, family, and physical activity, along with access to and burden of HAE treatment. Advances in HAE therapies offer the opportunity for comprehensive, individualized treatment plans, allowing patients to achieve minimal attack burden with reduced disease and treatment burden. Conclusion This consensus report builds on existing guidelines by expanding the assessment of disease burden and QoL measures for patients with HAE.

Download Full-text

How do junior doctors spend their time in an Acute Medical Unit?

Acute Medicine Journal ◽

10.52964/amja.0415 ◽

2015 ◽

Vol 14 (2) ◽

pp. 57-60

Author(s):

Eirini V Kasfiki ◽

◽

Mamoon Yusaf ◽

Jivendra Gosai ◽

Makani Purva ◽

...

Keyword(s):

General Practice ◽

Hospital Admission ◽

Postgraduate Training ◽

Junior Doctors ◽

Bed Occupancy ◽

Medical Unit ◽

Admission Rates ◽

The Past ◽

Acute Medical Unit ◽

The Uk

In the UK, postgraduate training for doctors has undergone significant changes over the past decade general practice, etc. During this period, hospital admission rates and bed occupancy have also increased.

Download Full-text

Handover among junior doctors: a quality improvement study

British Journal of Healthcare Management ◽

10.12968/bjhc.2018.0064 ◽

2019 ◽

Vol 25 (6) ◽

pp. 1-7

Author(s):

Aamer Sarfraz ◽

Yvonne Igunma ◽

Ben Harman-Jones

Keyword(s):

Length Of Hospital Stay ◽

Clinical Information ◽

Junior Doctors ◽

Face To Face ◽

Handover Procedure ◽

Before And After ◽

Communications Skills ◽

Positive Experiences ◽

Area Of Concern ◽

Efficient Transfer

Background/Aims Handover is a procedure that ensures efficient transfer of clinical information across teams. It is also an opportunity for junior doctors to develop clinical competencies, communications skills and leadership. Poor handovers can result in delays, clinical errors, duplication of work, poor morale, increased length of hospital stay, and risk of harm to patients. Poor handovers were identified as an area of concern for two successive years in the General Medical Council's survey. Methods Measures were undertaken to address this by updating their handover policy, developing a new handover protocol and instigating rota monitoring by involving junior doctors and consultants through focus groups. A survey was conducted among the same cohort of junior doctors before and after the interventions. Findings There was a remarkable improvement in junior doctors' attitudes towards safety, frequency of face-to-face handover, use of a handover book, and overall positive experiences of the handover procedure. Conclusions It is worth examining the approach to handover among other health professionals and perhaps between professions regarding the same patients.

Download Full-text

What are the most important unanswered research questions in trial retention? A James Lind Alliance Priority Setting Partnership: the PRioRiTy II (Prioritising Retention in Randomised Trials) study

Trials ◽

10.1186/s13063-019-3687-7 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 5

Author(s):

Dan Brunsdon ◽

Linda Biesty ◽

Peter Brocklehurst ◽

Valerie Brueton ◽

Declan Devane ◽

...

Keyword(s):

Clinical Trial ◽

Priority Setting ◽

Online Survey ◽

Consensus Meeting ◽

Randomised Trials ◽

Face To Face ◽

Key Stakeholders ◽

James Lind Alliance ◽

Research Questions ◽

Priority Setting Partnership

Abstract Background One of the top three research priorities for the UK clinical trial community is to address the gap in evidence-based approaches to improving participant retention in randomised trials. Despite this, there is little evidence supporting methods to improve retention. This paper reports the PRioRiTy II project, a Priority Setting Partnership (PSP) that identified and prioritised unanswered questions and uncertainties around trial retention in collaboration with key stakeholders. Methods This PSP was conducted in collaboration with the James Lind Alliance, a non-profit making initiative, to support key stakeholders (researchers, patients, and the public) in jointly identifying and agreeing on priority research questions. There were three stages. (1) First an initial online survey was conducted consisting of six open-ended questions about retention in randomised trials. Responses were coded into thematic groups to create a longlist of questions. The longlist of questions was checked against existing evidence to ensure that they had not been answered by existing research. (2) An interim stage involved a further online survey where stakeholders were asked to select questions of key importance from the longlist. (3) A face-to-face consensus meeting was held, where key stakeholder representatives agreed on an ordered list of 21 unanswered research questions for methods of improving retention in randomised trials. Results A total of 456 respondents yielded 2431 answers to six open-ended questions, from which 372 questions specifically about retention were identified. Further analysis included thematically grouping all data items within answers and merging questions in consultation with the Steering Group. This produced 27 questions for further rating during the interim survey. The top 21 questions from the interim online survey were brought to a face-to-face consensus meeting in which key stakeholder representatives prioritised the order. The ‘Top 10’ of these are reported in this paper. The number one ranked question was ’What motivates a participant’s decision to complete a clinical trial?’ The entire list will be available at www.priorityresearch.ie. Conclusion The Top 10 list can inform the direction of future research on trial methods and be used by funders to guide projects aiming to address and improve retention in randomised trials.

Download Full-text

Does UK medical education provide doctors with sufficient skills and knowledge to manage patients with eating disorders safely?

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2018-135658 ◽

2018 ◽

Vol 94 (1113) ◽

pp. 374-380 ◽

Cited By ~ 7

Author(s):

Agnes Ayton ◽

Ali Ibrahim

Keyword(s):

Eating Disorders ◽

Patient Safety ◽

Eating Disorder ◽

Postgraduate Training ◽

Medical Training ◽

Improve Patient Safety ◽

Medical Schools ◽

Junior Doctors ◽

The Uk ◽

Improve Patient

BackgroundEating disorders affect 1%–4% of the population and they are associated with an increased rate of mortality and multimorbidity. Following the avoidable deaths of three people the parliamentary ombudsman called for a review of training for all junior doctors to improve patient safety.ObjectiveTo review the teaching and assessment relating to eating disorders at all levels of medical training in the UK.MethodWe surveyed all the UK medical schools about their curricula, teaching and examinations related to eating disorders in 2017. Furthermore, we reviewed curricula and requirements for annual progression (Annual Review of Competence Progression (ARCP)) for all relevant postgraduate training programmes, including foundation training, general practice and 33 specialties.Main outcome measuresInclusion of eating disorders in curricula, time dedicated to teaching, assessment methods and ARCP requirements.ResultsThe medical school response rate was 93%. The total number of hours spent on eating disorder teaching in medical schools is <2 hours. Postgraduate training adds little more, with the exception of child and adolescent psychiatry. The majority of doctors are never assessed on their knowledge of eating disorders during their entire training, and only a few medical students and trainees have the opportunity to choose a specialist placement to develop their clinical skills.ConclusionsEating disorder teaching is minimal during the 10–16 years of undergraduate and postgraduate medical training in the UK. Given the risk of mortality and multimorbidity associated with these disorders, this needs to be urgently reviewed to improve patient safety.

Download Full-text