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

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.

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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

British Journal of Surgery ◽

10.1093/bjs/znab361.184 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Praveena Deekonda ◽

Daniel Baker ◽

Deirdre Nally ◽

Nisaharan Srikandararajah ◽

Gemma Humm ◽

...

Keyword(s):

Surgical Education ◽

Postgraduate Training ◽

Consensus Meeting ◽

Advisory Group ◽

Junior Doctors ◽

Knot Tying ◽

Face To Face ◽

Consensus Document ◽

Surgical Career ◽

Consensus Report

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.

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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.

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The Eagle Project – something for everyone

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363507x204567 ◽

2007 ◽

Vol 89 (6) ◽

pp. 194-195 ◽

Cited By ~ 1

Author(s):

Dick Rainsbury

Keyword(s):

Undergraduate Curriculum ◽

Surgical Anatomy ◽

Central Importance ◽

Surgical Practice ◽

Anatomical Knowledge ◽

Real Progress ◽

High Standards ◽

Anatomy Teaching

Real progress is being made with the Eagle Project – the multimillion-pound scheme to convert the education facilities on the fourth floor of the College. The recent highly successful College conference Anatomy Teaching – the Cruellest Cut of All (see page 194), reconfirmed the central importance of the Eagle Project in teaching surgical anatomy and in maintaining high standards in surgical practice. The conference highlighted the stark and worrying effects of a changing undergraduate curriculum on levels of basic anatomical knowledge. This in turn impacts on postgraduate examination results and on levels of litigation in the NHS. The capacity and diversity of the Eagle Project's facilities provide the College with a unique resource to tackle these problems at every level – undergraduate, postgraduate and consultant.

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The Introduction of An Intravenous Fluid Bundle to Improve the Prescribing of Intravenous Fluids Within a District General Hospital (Preprint)

10.2196/preprints.36304 ◽

2022 ◽

Author(s):

Abdul-Rahman Gomaa ◽

Sharan Sambhwani ◽

Jonathan Wilkinson

Keyword(s):

Point Of Care ◽

Kidney Injury ◽

District General Hospital ◽

Good Clinical Practice ◽

Point Prevalence ◽

Grand Round ◽

Junior Doctors ◽

Improvement Project ◽

Increased Risk ◽

The Impact

BACKGROUND Intravenous (IV) fluids are some of the most commonly prescribed day-to-day drugs. Evidence suggests that such prescriptions are rarely ever done correctly despite the presence of clear guidelines (NICE CG174). This is believed to be due to lack of knowledge and experience, which often breeds confusion and places patients at increased risk of harm. It also incurs avoidable costs to hospitals. OBJECTIVE This quality improvement project (QIP) aims to ensure that IV fluid prescriptions are: safe, appropriate and adhere to evidence-based NICE guidance. The project’s aims will be achieved through implementing multiple interventions that are categorised under: educational, changing prescribing habits and raising awareness. METHODS Review and improve the prescribing process of “IV fluid prescribing” via three simultaneous approaches. Teaching sessions were delivered to all junior doctors in order to improve knowledge and awareness of appropriate IV fluid prescribing and promote familiarity with the current NICE IV fluid guidelines. This included a ‘feature session’ at our local hospital Grand Round. A point-of-care aide-memoire containing a summary of the information needed for correct prescription was designed and printed. This complimented the teaching sessions and supported good clinical practice. Using serial Plan-Do-Study-Act (PDSA) cycles, a novel “IV fluid bundle” was developed, fine-tuned and trialled on five wards, (three surgical, two medical). The aim of the bundle was to ensure that patients were clinically reviewed in order to assess their volaemic status in order that appropriate IV fluids could then be selected and prescribed safely. The impact of these interventions was assessed on the trial wards via a weekly point prevalence audit of the IV fluid bundles for the duration of the trial. Parameters looked at were: incidence of deranged U&E’s, incidence of AKI and the number of days between the latest U&E’s and the patient’s IV fluid prescription. RESULTS These interventions were assessed on trial wards via a weekly point prevalence audit of the new IV fluid prescription chart (bundle; IFB) for the duration of the trial. Parameters monitored were: incidence of deranged U&E’s, incidence of acute kidney injury (AKI) and the number of days between the latest U&E’s and the patient’s IV fluid prescription. Of all of the patients on the IV fluid bundle, 100% had a documented weight, review of both fluid status and balance. The incidence of deranged U&E’s decreased from 48% to 35%. Incidence of AKI decreased from 24% to 10%. The average number of days between the latest U&E’s and a fluid prescription decreased from 2.2 days to 0.6 day. CONCLUSIONS Prescribing IV fluids is a complex task that requires significant improvement both locally and nationally. With 85% uptake of the IFB, we were able to significantly improve all measured outcomes. Through carefully structured interventions geared towards tackling the confounding issues identified from previous audits and process mapping we have shown that prescribing IV fluids can be made safer.

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Clinical Anatomy: Applied Anatomy for Students and Junior Doctors

Journal of Perioperative Practice ◽

10.1177/1750458919877625 ◽

2019 ◽

Vol 29 (12) ◽

pp. 389-390

Author(s):

Carolina Britton

Keyword(s):

Junior Doctors ◽

Clinical Anatomy ◽

Applied Anatomy

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Empowering junior doctors: a qualitative study of a QI programme in South West England

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2018-136059 ◽

2018 ◽

Vol 94 (1116) ◽

pp. 571-577 ◽

Cited By ~ 2

Author(s):

Natasha J Doran ◽

Rob Bethune ◽

Joanne Watson ◽

Katherine Finucane ◽

Andrew Carson-Stevens

Keyword(s):

Patient Safety ◽

Improve Patient Safety ◽

Qualitative Interviews ◽

Working Environment ◽

Junior Doctors ◽

Effect Change ◽

Medical Careers ◽

South West ◽

Before And After ◽

New Generation

AimTo explore how the South-West Foundation Doctor Quality Improvement programme affected foundation year 1 (F1) doctors’ attitudes and ability to implement change in healthcare.MethodsTwenty-two qualitative interviews were carried out with two cohorts of doctors. The first F1 group before and after their participation in the QI programme; the second group comprised those who had completed the programme between 1 and 5 years earlier. Qualitative data were analysed using thematic analysis techniques.Results Prior to taking part in the QI programme, junior doctors’ attitudes towards QI were mixed. Although there was agreement on the importance of QI in terms of patient safety, not all shared enthusiasm for engaging in QI, while some were sceptical that they could bring about any change. Following participation in the programme, attitudes towards QI and the ability to effect change were significantly transformed. Whether their projects were considered a success or not, all juniors reported that they valued the skills learnt and the overall experience they gained through carrying out QI projects. Participants reported feeling more empowered in their role as junior doctors, with several describing how they felt ‘listened to’ and able to ‘have a voice’, that they were beginning to see things ‘at systems level’ and learning to ‘engage more critically’ in their working environment.Conclusions Junior doctors are ideally placed to engage in QI. Training in QI at the start of their medical careers may enable a new generation of doctors to acquire the skills necessary to improve patient safety and quality of care.

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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.

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