UK-wide study of the opinions of gastroenterology trainees: COVID-19, Shape of Training and the future workforce

IntroductionThe COVID-19 pandemic has disrupted training. Gastroenterology higher specialty training is soon to be reduced from 5 years to 4. The British Society of Gastroenterology Trainees Section biennial survey aims to delineate the impact of COVID-19 on training and the opinions on changes to training.MethodsAn electronic survey allowing for anonymised responses at the point of completion was distributed to all gastroenterology trainees from September to November 2020.ResultsDuring the first wave of the COVID-19 pandemic, 71.0% of the respondents stated that more than 50% of their clinical time was mostly within general internal medicine. Trainees reported a significant impact on all aspects of their gastroenterology training due to lost training opportunities and increasing service commitments. During the first wave, 88.5% of the respondents reported no access to endoscopy training lists. Since this time, 66.2% of the respondents stated that their endoscopy training lists had restarted. This has resulted in fewer respondents achieving endoscopy accreditation. The COVID-19 pandemic has caused 42.2% of the respondents to consider extending their training to obtain the skills required to complete training. Furthermore, 10.0% of the respondents reported concerns of a delay to completion of training. The majority of respondents (84.2%) reported that they would not feel ready to be a consultant after 4 years of training.ConclusionsReductions in all aspects of gastroenterology training were reported. This is mirrored in anticipated concerns about completion of training in a shorter training programme as proposed in the new curriculum. Work is now required to ensure training is restored following the pandemic.

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Drug-related problems identification in general internal medicine: The impact and role of the clinical pharmacist and pharmacologist

European Journal of Internal Medicine ◽

10.1016/j.ejim.2015.05.012 ◽

2015 ◽

Vol 26 (6) ◽

pp. 399-406 ◽

Cited By ~ 27

Author(s):

Bertrand Guignard ◽

Pascal Bonnabry ◽

Arnaud Perrier ◽

Pierre Dayer ◽

Jules Desmeules ◽

...

Keyword(s):

Internal Medicine ◽

General Internal Medicine ◽

Clinical Pharmacist ◽

Drug Related Problems ◽

General Internal ◽

The Impact

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P080 BSR national training survey results for rheumatology and GIM dual-accreditation

Rheumatology ◽

10.1093/rheumatology/keab247.078 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Sameena Khalid ◽

Mithun Chakravorty ◽

Cattleya Godsave ◽

Shahid Yaqub ◽

Emma Davies ◽

...

Keyword(s):

High Intensity ◽

Training Programme ◽

British Society ◽

Free Text ◽

Training Time ◽

General Internal ◽

Time Required ◽

National Training ◽

The Impact ◽

Expected Duration

Abstract Background/Aims Following the Shape of Training Report, all Rheumatology registrars commencing training from August 2017 are required to obtain dual-accreditation with General Internal Medicine (GIM). Training time increased from 4 to 5 years. Current trainees have expressed concerns regarding the lack of clarity and standardisation of the structure and duration of GIM training, and the impact on Rheumatology experience. Surveys were developed and disseminated by the British Society for Rheumatology (BSR) Trainees' Committee to explore the national GIM experience and expectations of trainees and Training Programme Directors (TPDs). Methods Two surveys were created by trainees, with support from the BSR. Web links were emailed to all UK Rheumatology trainees and TPDs in February 2020, and remained open for three weeks. The surveys covered: Duration of dedicated rheumatology trainingDuration of 'high intensity' GIM training (defined as night shifts with at least 1 in 8 on-calls)Weekly number of GIM clinics and ward roundsGuidance provided to trainees and TPDs on the expected duration and structure of GIM training. Results 73 responses were analysed from dual-accrediting trainees across the UK. 73% of trainees expected 1.5-3 years of dedicated rheumatology training however, 12% of trainees did not expect any dedicated rheumatology years. Similarly, the expected duration of ‘high intensity’ GIM training varied widely from up to 1 year (10%) to 2.5-3 years (30%). 37% of trainees expected to do more than 3.5 years of 'high intensity' GIM training. During a ‘high intensity’ GIM year, 58% of trainees did not do any GIM clinics (some Deaneries count general rheumatology clinics towards GIM), 34% had one GIM clinic and 8% of trainees had three or more GIM clinics per week. Similarly, the number of average weekly GIM ward rounds varied from none (11%) to 3 or more (55%). Only 62% of trainees confirmed they were aware of the number and 'intensity' of GIM years required during their training. Twelve TPDs completed the survey. 72% of TPDs were able to provide specific guidance on the expected duration and structure of GIM training for ST3 applicants in 2020. Despite this, 83% of TPDs felt that further guidance is required on the length of dedicated rheumatology and GIM training. Free-text comments suggested a move away from describing GIM training as ‘low', 'medium' or 'high intensity’. Conclusion The surveys identified a wide national variation in GIM training structure and duration, and dedicated Rheumatology training for dual-accrediting trainees. This inequality has proved concerning for many trainees. TPDs and trainees felt that further information and standardisation is needed regarding the dedicated time required in Rheumatology and GIM. The results will be discussed at the next Joint Royal College of Physician’s Board (JRCPTB) Specialty Advisory Committee meeting. Disclosure S. Khalid: None. M. Chakravorty: None. C. Godsave: None. S. Yaqub: None. E. Davies: None. M. Rutter: None. S. Shabbir: None. E. Reilly: None.

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Does Reducing Inpatient Length of Stay Have Upstream Effects on the Emergency Room: Exploring the Impact of the General Internal Medicine Care Transformation Initiative

Academic Emergency Medicine ◽

10.1111/acem.12935 ◽

2016 ◽

Vol 23 (6) ◽

pp. 711-717 ◽

Cited By ~ 6

Author(s):

Finlay A. McAlister ◽

Jeffrey A. Bakal ◽

Rhonda J. Rosychuk ◽

Brian H. Rowe

Keyword(s):

Internal Medicine ◽

Length Of Stay ◽

Emergency Room ◽

General Internal Medicine ◽

General Internal ◽

The Impact ◽

Inpatient Length Of Stay

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1057. The Impact of Temporary Suspensions of an Antimicrobial Stewardship Audit and Feedback Program on Antimicrobial Utilization of General Internal Medicine Inpatients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.921 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S373-S374

Author(s):

Cynthia Wong ◽

Linda R Taggart ◽

Elizabeth Leung

Keyword(s):

Internal Medicine ◽

General Internal Medicine ◽

Antimicrobial Stewardship ◽

Audit And Feedback ◽

Patient Specific ◽

Antimicrobial Use ◽

Patient Acuity ◽

General Internal ◽

Antimicrobial Utilization ◽

The Impact

Abstract Background A goal of Antimicrobial Stewardship Programs (ASP) is to optimize antimicrobial use; many using audit and feedback (AAF). Although AAF decreases unnecessary target antimicrobial use, it is resource-intensive. As a result, temporary suspensions in AAF activity may occur from human resource limitations or other factors. We describe the impact of these temporary suspensions and intensity of care on antimicrobial utilization trends. Methods This retrospective study describes the initiation and temporary suspensions of AAF in the General Internal Medicine (GIM) unit at an urban teaching hospital. Data were collected over 65 months. During active-AAF, a dedicated ID trained clinical pharmacist and ID physician-reviewed antimicrobial use for all GIM patients and provided patient-specific advice to physicians. Antimicrobial use was measured by Defined Daily Doses (DDD) normalized per 1,000 patient-days. To assess the impact of temporary suspensions, data were compared in two ways: 1. All nonactive-AAF time-frames were compared with active AAF 2. Pre-ASP was compared with Post-ASP Initiation which includes suspension periods. To determine whether differences in trends were seen based on acuity level of the patients (identified at admission as benefiting from frequent monitoring), analyses were repeated after stratification of patients admitted to the Step-Up unit (GIM-SU) and the regular ward (GIM-W). Results Comparing nonactive AAF vs. active-AAF, significant changes (P < 0.05) in mean normalized DDD were observed for total antimicrobials (-19%), antipseudomonals (-21%) fluoroquinolones (−41%) and first-generation β lactams (−30%). Pre ASP vs. Post ASP comparisons showed similar but less pronounced trends. Following stratification to GIM-SU and GIM-W, greater variation in significant changes to targeted antimicrobials between comparisons was observed. Different significant antimicrobial changes were seen in SU vs. W. Conclusion Our results show that the temporary suspension of ASP AAF impacts antimicrobial utilization trends. Greater sustained decreases in targeted antimicrobials utilization were associated with active AAF. Stratification by patient acuity lead to increased variation in the impact on target antimicrobials and increased the impact of suspension. Disclosures All authors: No reported disclosures.

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Effect of an Intervention to Improve Team Coordination on Patients Who are Likely to be Discharged by General Internal Medicine

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v10i1.21 ◽

1970 ◽

Vol 10 (1) ◽

Author(s):

Lina Pham BA ◽

Teri Arany ◽

William Coke MD ◽

Vivian Lo ◽

Robert C. Wu MD

Keyword(s):

Internal Medicine ◽

Emergency Department ◽

Length Of Stay ◽

General Internal Medicine ◽

Discharge Planning ◽

Teaching Hospitals ◽

Post Discharge ◽

General Internal ◽

Effective Discharge ◽

The Impact

Effective discharge planning is important to ensuring a high quality of patient care and operational efficiency. The general internal medicine (GIM) environment is very complex and fluid, with multiple health professions providing care for patients. This makes coordination of discharges difficult, even with structured daily interprofessional rounds.The purpose of this case-control study was to evaluate a discharge notification form that predicts next-day discharges. The main measures of the study, which took place in GIM wards at two academic teaching hospitals, were the completion and accuracy of the discharge forms, length of stay, discharge times, post-discharge admissions, and emergency department visits.Seventy-six of 200 patients studied had information completed on the discharge notification form. The overall effect appeared to move discharges earlier in the day, while having no effect on length of stay.Patients whose information was completed on the discharge notification form were less likely to have an emergency department visit within 30 days post-discharge.The use of a discharge notification form appears to move discharges earlier in the day, without increasing length of stay. Further refinement and evaluation is necessary to increase usage and assess the impact onoutcomes of care.

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Impact of a medical scribe on clinical efficiency and quality in an academic general internal medicine practice

BMC Health Services Research ◽

10.1186/s12913-021-06710-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anastasia Pozdnyakova Piersa ◽

Neda Laiteerapong ◽

Sandra A. Ham ◽

Felipe Fernandez del Castillo ◽

Sachin Shah ◽

...

Keyword(s):

Internal Medicine ◽

General Internal Medicine ◽

Close Encounter ◽

General Internal ◽

Clinical Efficiency ◽

Preventative Health ◽

Academic General Internal Medicine ◽

Number Of Visits ◽

Internal Medicine Clinic ◽

The Impact

Abstract Background Scribes have been proposed as an intervention to decrease physician electronic health record (EHR) workload and improve clinical quality. We aimed to assess the impact of a scribe on clinical efficiency and quality in an academic internal medicine practice. Methods Six faculty physicians worked with one scribe at an urban academic general internal medicine clinic April through June 2017. Patient visits during the 3 months prior to intervention (baseline, n = 789), unscribed visits during the intervention (concurrent control, n = 605), and scribed visits (n = 579) were included in the study. Clinical efficiency outcomes included time to close encounter, patient time in clinic, and number of visits per clinic session. Quality outcomes included EHR note quality, rates of medication and immunization review, population of patient instructions, reconciliation of outside information, and completion of preventative health recommendations. Results Median time to close encounter (IQR) was lower for scribed visits [0.4 (4.8) days] compared to baseline and unscribed visits [1.2 (5.9) and 2.9 (5.4) days, both p < 0.001]. Scribed notes were more likely to have a clear history of present illness (HPI) [OR = 7.30 (2.35–22.7), p = 0.001] and sufficient HPI information [OR = 2.21 (1.13–4.35), p = 0.02] compared to unscribed notes. Physicians were more likely to review the medication list during scribed vs. baseline visits [OR = 1.70 (1.22–2.35), p = 0.002]. No differences were found in the number of visits per clinic session, patient time in clinic, completion of preventative health recommendations, or other outcomes. Conclusions Working with a scribe in an academic internal medicine practice was associated with more timely documentation.

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The balancing act: the variation among deaneries across Great Britain regarding provision of focus on diabetes and endocrinology training

British Journal of Diabetes ◽

10.15277/bjd.2018.158 ◽

2018 ◽

Vol 18 (1) ◽

pp. 22-24

Author(s):

Adnan Agha ◽

Baldev Singh ◽

Wasim Hanif

Keyword(s):

Internal Medicine ◽

Great Britain ◽

General Internal Medicine ◽

Medical Specialty ◽

Training Programme ◽

Internal Medicine Training ◽

Accreditation Training Programme ◽

General Internal ◽

Accreditation Programme ◽

Training Programmes

Diabetes and endocrinology is a medical specialty, and a five-year dual accreditation training programme in diabetes and endocrinology and general internal medicine is offered, with active participation in medical on-call rota. Some deaneries offer some respite from the ever-increasing general medical workload by offering a few months of training focusing only on specialty work in diabetes and endocrinology. The authors wanted to see if this experience is available uniformly to all the trainees in diabetes and endocrinology/ general internal medicine across Great Britain. To assess this, a survey of specialist training registrars on a dual accreditation programme for diabetes and general internal medicine from all deaneries in England, Scotland and Wales was performed by directly interviewing and asking them about any relaxation in either their on-call or ward commitments to focus on diabetes and endocrine specialty during their five years of training. The results showed that the acute take/general medical commitment-free training periodfocusing only on diabetes and endocrinology ranges from zero in some deaneries to nearly three years in others. This simple survey highlights the extent of variability that exists in dual diabetes/endocrinology and general internal medicine training programmes across deaneries in England, Scotland and Wales, which may increase further once the training programme is reduced to four years after new changes from Shape of Training.

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