scholarly journals A Near-Peer Surgical Teaching Programme for Junior Doctors

2020 ◽  
Author(s):  
Shoaib Fahad Hussain ◽  
Teri Hsiao Hsui Toi ◽  
Edward Peter Laurent ◽  
Shaikh Sanjid Seraj ◽  
Samer-ul-Haque
Keyword(s):  
Clinical Education ◽  
Education Programme ◽  
Peer Teaching ◽  
University Hospital ◽  
Junior Doctors ◽  
Free Text ◽  
Teaching Programme ◽  
Surgical Teaching ◽  
The Uk

Abstract Background: Surgical departments across the UK are having to mitigate increasing service demands, budget constraints and changes to work patterns, with their statutory duty to provide high-quality training and education. In an overstretched NHS, securing consultant-led teaching for junior doctors has become increasingly difficult leading to the rise of near-peer teaching. We evaluate the long-term effectiveness of a near-peer surgical teaching programme for junior doctors. Methods: We developed a rolling 12-week trainee-led, didactic surgical education programme for junior doctors and incorporated a three-tiered leadership and handover mechanism involving lead junior doctors, registrars and a lead consultant to ensure consistency and programme continuity. Junior doctors delivered presentations to their peers with close supervision and input from registrars. Participants provided session and supervision feedback using 5-point scales and free-text responses. Data was collected using Google Forms™ and analysed using student’s t-test on Microsoft Excel®. Results: 42 junior doctors responded to our end-of-programme feedback surveys covering December 2018 to April 2020. The overall programme (8.83±1.08/10), topic relevance (4.62±0.58/5), presentation quality (4.60±0.50/5) and supervisor knowledge (4.81±0.40/5) were rated highly by respondents. 95.2% (n=40) of respondents had attended more than 3 sessions and 71.4 % (n=30) had delivered teaching. Respondents also reported significant improvements in subject knowledge (3.72±0.92/5 to 4.50±0.56/5, P<0.0001), clinical confidence, presentation and teaching skills following each session. Conclusions: This long-term near-peer teaching programme addressed the educational needs of junior doctors and developed their presentation and organisational skills. Supervision and input from registrars facilitated discussion and reinforced key concepts. Our strategy also facilitated workplace-based assessments and familiarisation with local management protocols for new cohorts of doctors rotating in Surgery at Basildon University Hospital. We also recently adapted this into a virtual programme in response to the COVID-19 pandemic, maintaining clinical education and expanding our audience. The success of this programme highlights the role that trainees can play in designing, developing and coordinating an effective surgical teaching programme.

scholarly journals 643 Near-Peer Surgical Teaching for Junior Doctors: A 16-Month Retrospective Analysis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S F Hussain ◽  
T Toi ◽  
E Laurent ◽  
S S Seraj ◽  
S Haque
Keyword(s):  
Education Programme ◽  
Peer Teaching ◽  
Junior Doctors ◽  
Free Text ◽  
Teaching Programme ◽  
Surgical Trainees ◽  
Statutory Duty ◽  
Surgical Teaching ◽  
Clinical Confidence ◽  
The Uk

Abstract Introduction Surgical departments across the UK are having to mitigate service demands, budget constraints and changes to work patterns with their statutory duty to provide high-quality training and education. Securing consultant-led teaching has also become increasingly difficult leading to the rise of near-peer teaching. We evaluate the long-term effectiveness of near-peer surgical teaching for junior doctors. Method We developed a rolling 12-week trainee-led didactic surgical education programme for Foundation doctors and Core Surgical Trainees. Junior doctors delivered teaching to peers with registrar input; session and supervision feedback was recorded using 5-point scales and free-text responses. Results 42 junior doctors responded to our end-of-programme feedback surveys covering December 2018 to April 2020. The overall programme (8.83±1.08/10), relevance (4.62±0.58/5), presentation quality (4.60±0.50/5) and supervisor knowledge (4.81±0.40/5) were rated highly by respondents. Attendees also reported significant improvements in subject knowledge (3.72±0.92/5 to 4.50±0.56/5, P &lt; 0.0001), clinical confidence, presentation and teaching skills. Conclusions Our near-peer teaching programme addressed the educational needs of junior doctors and developed their presentation and organisational skills. Supervision and input from registrars facilitated discussion and reinforced key concepts. The success of this programme highlights the role that trainees can play in designing, developing, and leading an effective surgical teaching programme.

scholarly journals 913 Near-Peer Teaching for Surgical Foundation Year Doctors During COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Olabisi ◽  
S Choi ◽  
A Hughes ◽  
J Torkington
Keyword(s):  
Medical School ◽  
Peer Education ◽  
Peer Teaching ◽  
University Hospital ◽  
Surgical Patients ◽  
Surgical Trainees ◽  
Initial Questionnaire ◽  
Surgical Teaching ◽  
Virtual Teaching ◽  
Lunch Time

Abstract Introduction Literature has shown near-peer teaching to be an effective method of improving learning. There is little data on surgical teaching initiatives of this kind. Nationally and locally, teaching sessions and courses have been cancelled due to the pandemic. A new surgical lunch-time virtual course was created to fill this gap. Method FY1 doctors from University Hospital Wales were invited to participate in a survey exploring the need and topics for surgical teaching. Results were used to create a surgical teaching course. Near-peer, core surgical trainees were recruited to teach. A post-course questionnaire was distributed to FY1 doctors who attended the teaching to assess the success of the course. Results 15 FY1 doctors completed the initial questionnaire. 33% (5) were currently on a surgical placement. 60% (9) had an upcoming surgical placement. 73% (11) felt they did not have sufficient teaching on surgical specialties during medical school. 93% (14) felt they did not have sufficient teaching on how to manage surgical patients as a FY1. 100% (15) responded they would be interested in surgical teaching delivered by core surgical trainees. Eight topics were suggested, and lunchtime sessions were created. Post-course feedback was completed by 12 FY1 doctors. 88% (10) of respondents found the course ‘extremely useful’ and relevant to their surgical jobs. Conclusions There is a demand for surgical teaching for FY1s. Near-peer education designed by FY1s and delivered by CSTs is an effective way for teaching relevant surgical knowledge. Lunch-time virtual teaching is a good way to continue teaching sessions through the pandemic.

scholarly journals Quality improvement education for medical students: a near-peer pilot study

2020 ◽  
Author(s):  
Elizabeth McGeorge ◽  
Charles Coughlan ◽  
Martha Fawcett ◽  
Robert Klaber
Keyword(s):  
Quality Improvement ◽  
Medical Students ◽  
Peer Teaching ◽  
Junior Doctors ◽  
Teaching Content ◽  
Single Centre Study ◽  
The Uk ◽  
The University ◽  
Competing Priorities ◽  
Future Work

Abstract Background Quality improvement (QI) is an essential component of modern clinical practice. Front-line professionals offer valuable perspectives on areas for improvement and are motivated to deliver change. In the UK, all junior doctors are expected to participate in QI in order to advance to the next stage of their training. However, UK undergraduates receive no standardized training in QI methodology. This is perpetuated within medical schools by a lack of teaching capacity and competing priorities, and may lead to tokenistic engagement with future QI projects. Methods We describe a near-peer teaching programme designed to introduce students to QI methodology. This programme was conceived and delivered in full by junior doctors and used existing resources to ensure high quality teaching content. 111 fifth-year medical students from the University of Cambridge were taught in interactive, participative workshops that encourage them to develop their own QI change ideas and projects. Core topics included the model for improvement, driver diagrams, stakeholder engagement, measurement for improvement and analysing and presenting data. Students completed surveys before and immediately after this intervention to assess their understanding of and confidence in utilizing QI methodology. Questionnaires were also completed by junior doctor tutors. Results Analysis of questionnaires completed before and immediately after the intervention revealed statistically significant improvements in students’ self-reported understanding of QI (p<0.05) and confidence in applying techniques to their own work (p<0.05). Students expressed a preference for QI teaching delivered by junior doctors, citing a relaxed learning environment and greater relevance to their stage of training. Tutors reported increased confidence in using QI techniques and a greater willingness to engage with QI in future. Conclusions In this single-centre study, near-peer teaching produced significant improvements in students’ self-reported understanding of QI and confidence in applying QI methodology. Near-peer teaching may constitute a sustainable means of teaching essential QI skills at undergraduate level. Future work must evaluate objective measures of student engagement with and competence in conducting QI.

scholarly journals Anaesthetic Higher Specialty Training Recruitment in the United Kingdom During the COVID-19 Pandemic: A National Survey

2021 ◽  
Author(s):  
Fionnuala Durrant ◽  
Stuart Edwardson ◽  
Sally El-Ghazali ◽  
Christopher Holt ◽  
Roopa McCrossan ◽  
...  
Keyword(s):  
Postgraduate Training ◽  
Medical Profession ◽  
Medical Specialty ◽  
Further Education ◽  
Similar Proportion ◽  
Junior Doctors ◽  
Free Text ◽  
Recruitment Process ◽  
Training Requirements ◽  
The Uk

The most recent ST3 Anaesthetic recruitment for posts commencing in August 2021 saw larger numbers of applicants (n = 1,056) compared to previous years, with approximately 700 applicants failing to secure an ST3 post. We surveyed 536 anaesthetic junior doctors who applied for ST3 posts during this application round with the aim of investigating their experience of the recruitment process this year (response rate 536/1,056 = 51%). Approximately 61% were not offered ST3 posts (n = 326), a similar proportion to that previously reported. We asked all respondents what their potential career plans were for the next 12 to 24 months. The majority expressed intentions to take up either CT3 top-up posts or non-training fellow posts from August 2021 (79%). Other options considered by respondents included: pursuing work abroad (17%), embarking on a career break (16%), taking up an ST3 post in intensive care medicine instead of anaesthetics (15%) and permanently leaving the medical profession (9%). A number of respondents expressed a desire to pursue training in a different medical specialty (9%). Some respondents expressed an intention to pursue further education or research (10%). A large proportion of respondents (42%) expressed a lack of confidence in being able to achieve the necessary training requirements to later apply for ST4 in August 2023. The majority of respondents reported not feeling confident in achieving GMC Specialty Registration in Anaesthesia in the future without a training number (75%), and that their wider life plans have been disrupted due to the impending time out of training (78%). We received a total of 384 free-text responses to a question asking about general concerns regarding the ST3 applications process. Sentiment analysis of these free-text responses indicated that respondents felt generally negatively about the ST3 recruitment process. Some themes that were elicited from the responses included: respondents feeling the recruitment process lacked fairness, respondents suffering burnout and negative impacts on their wellbeing, difficulties in making plans for their personal lives, and feeling undervalued and abandoned despite having made personal sacrifices to support the health service during the COVID-19 pandemic. These results suggest that junior anaesthetic doctors in the UK currently have a negative perception towards postgraduate training structures, which has been exacerbated by the COVID-19 pandemic, changes to the postgraduate training curriculum and difficulties in securing higher training posts.

scholarly journals GP’s perspectives on laboratory test use for monitoring long-term conditions: an audit of current testing practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Martha M. C. Elwenspoek ◽  
Ed Mann ◽  
Katharine Alsop ◽  
Hannah Clark ◽  
Rita Patel ◽  
...  
Keyword(s):  
Online Survey ◽  
Liver Function Tests ◽  
Free Text ◽  
Negative Consequences ◽  
Patient Harm ◽  
Long Term Conditions ◽  
Current Testing ◽  
The Uk ◽  
Robust Evidence

Abstract Background We have shown previously that current recommendations in UK guidelines for monitoring long-term conditions are largely based on expert opinion. Due to a lack of robust evidence on optimal monitoring strategies and testing intervals, the guidelines are unclear and incomplete. This uncertainty may underly variation in testing that has been observed across the UK between GP practices and regions. Methods Our objective was to audit current testing practices of GPs in the UK; in particular, perspectives on laboratory tests for monitoring long-term conditions, the workload, and how confident GPs are in ordering and interpreting these tests. We designed an online survey consisting of multiple-choice and open-ended questions that was promoted on social media and in newsletters targeting GPs practicing in UK. The survey was live between October–November 2019. The results were analysed using a mixed-methods approach. Results The survey was completed by 550 GPs, of whom 69% had more than 10 years of experience. The majority spent more than 30 min per day on testing (78%), but only half of the respondents felt confident in dealing with abnormal results (53%). There was a high level of disagreement for whether liver function tests and full blood counts should be done ‘routinely’, ‘sometimes’, or ‘never’ in patients with a certain long-term condition. The free text comments revealed three common themes: (1) pressures that promote over-testing, i.e. guidelines or protocols, workload from secondary care, fear of missing something, patient expectations; (2) negative consequences of over-testing, i.e. increased workload and patient harm; and (3) uncertainties due to lack of evidence and unclear guidelines. Conclusion These results confirm the variation that has been observed in test ordering data. The results also show that most GPs spent a significant part of their day ordering and interpreting monitoring tests. The lack of confidence in knowing how to act on abnormal test results underlines the urgent need for robust evidence on optimal testing and the development of clear and unambiguous testing recommendations. Uncertainties surrounding optimal testing has resulted in an over-use of tests, which leads to a waste of resources, increased GP workload and potential patient harm.

scholarly journals Is seniority of emergency physician associated with the weekend mortality effect? An exploratory analysis of electronic health records in the UK

2019 ◽  
pp. emermed-2018-208114
Author(s):  
Larry Han ◽  
Jason Fine ◽  
Susan M Robinson ◽  
Adrian A Boyle ◽  
Michael Freeman ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Admissions ◽  
Severity Of Illness ◽  
Weekend Effect ◽  
University Hospital ◽  
Hospital Death ◽  
Junior Doctors ◽  
Hazards Model ◽  
Mortality Effect ◽  
The Uk

ObjectiveAdmission to hospital over a weekend is associated with increased mortality, but the underlying causes of the weekend effect are poorly understood. We explore to what extent differences in emergency department (ED) admission and discharge processes, severity of illness and the seniority of the treating physician explain the weekend effect.MethodsWe analysed linked ED attendances to hospital admissions to Cambridge University Hospital over a 7-year period from 1 January 2007 to 31 December 2013, with 30-day in-hospital death as the primary outcome and discharge as a competing risk. The primary exposure was day of the week of arrival. Subdistribution hazards models controlled for multiple confounders, including physician seniority, calendar year, mode of arrival, triage category, referral from general practice, sex, arrival time, prior attendances and admissions, diagnosis group and age.Results229 401 patients made 424 845 ED attendances, of which 158 396 (37.3%) were admitted to the hospital. The case-mix of admitted patients was more ill at weekends: 2530 (6.4%) admitted at a weekend required immediate resuscitation compared with 6450 (5.4%) admitted on a weekday (p<0.0001). Senior doctors admitted 24.8% of patients on weekdays and 24.0% at weekends, but junior doctors admitted 61.7% of patients on weekdays and 44.2% at weekends. 3947 (3.3%) patients admitted on a weekday and 1454 (3.7%) patients admitted at a weekend died within 30 days. In the adjusted subdistribution hazards model, the HR of in-hospital death was 1.11 (95% CI 1.04 to 1.18) for weekend arrivals. After controlling for confounders, the in-hospital mortality of patients admitted by junior doctors was greater at the weekend (adjusted HR (aHR) 1.15, 95% CI 1.06 to 1.24). In-hospital mortality for patients admitted by senior doctors was not statistically different at the weekend (aHR 1.08, 95% CI 0.98 to 1.19).ConclusionsOur findings suggest that the weekend effect was driven by a higher proportion of admitted patients requiring immediate resuscitation at the weekend. Junior doctors admitted a lower proportion of relatively healthy patients at the weekend compared with the weekday, thus diluting the risk pool of weekday admissions and contributing to the weekend effect. Senior doctors’ admitting behaviour did not change at the weekend, and the corresponding weekend effect was reduced.

Hopes and fears before opioid tapering: a quantitative and qualitative study of patients with chronic pain and long-term opioids

2020 ◽  
pp. 204946372097405
Author(s):  
Jane Quinlan ◽  
Heather Willson ◽  
Katheryn Grange
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Side Effects ◽  
Phenomenological Approach ◽  
Free Text ◽  
Significant Depression ◽  
Opioid Tapering ◽  
The Uk

Background: It is clear that the risks of opioids in chronic pain outweigh the benefits, creating a drive for clinicians to support patients taper and stop long-term opioids. However, it is not known how patients who have been taking these medicines for months or years feel about reducing them. Using quantitative and qualitative data, this study describes the psychological complexity of these patients and examines their hopes and fears before opioid reduction. Methods: Sixty patients attending the opioid clinic completed psychological and pain questionnaires, providing quantitative data, just before they commenced opioid tapering. They scored the severity of opioid side effects and completed a free text framework to express their beliefs about stopping or continuing opioids. A phenomenological approach was used to identify common qualitative themes. Results: Most patients were taking opioid doses above the UK recommended maximum dose and reported severe pain with high pain interference. Over 80% of patients described significant depression and 60% significant anxiety. Negative themes around stopping opioids were more common than positive ones, with 63% patients fearing increased pain. A quarter of patients referred to addiction and 16% feared withdrawal. Five patients hoped for a better quality of life; seven feared a worse one. Opioid side effects were common and severe. Conclusion: Patients with chronic pain taking long-term opioids demonstrate high psychological distress and low self-efficacy. Their concerns around opioid tapering relate to pain, quality of life and withdrawal. Identifying and addressing patients’ individual concerns should increase the likelihood of successful opioid tapering.

scholarly journals 140 Lessons From the Front Line: Communication is Key

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
B Pyrke ◽  
B Abdalla ◽  
G Cartwright ◽  
K Figg ◽  
E Murphy ◽  
...  
Keyword(s):  
Communication Skills ◽  
Skills Training ◽  
University Hospital ◽  
Junior Doctors ◽  
Teaching Programme ◽  
Successful Communication ◽  
Difficult Conversations ◽  
The Family ◽  
Regular Family ◽  
Learning Points

Abstract Introduction As junior doctors, we very rarely receive formal teaching on communication after medical school, with telephone encounters and difficult conversations over technology being a vital yet missing part of our education. The COVID-19 pandemic has required us to adapt how we communicate with patients’ families due to hospital visiting restrictions. In an era where tragically deterioration and death have been much more commonplace, we looked to identify areas where junior doctors felt their communication skills could be improved, and implemented a teaching programme to deliver this. Methods Pre-teaching questionnaires were distributed to a range of grades of junior doctors working in University Hospital of Llandough, Cardiff. The questionnaires were distributed at the beginning of June 2020, after 3 months of working in pandemic conditions. A teaching session on telephone and video communication skills was delivered by a local palliative care consultant. Post-teaching, a repeat questionnaire was undertaken to assess response and identify key learning points. Results Pre-teaching, 100% of the 22 respondents had had to participate in difficult conversations over the phone, 82% had had no formal phone based communication skills training and 81.82% felt some form of formal teaching would be helpful. Post-teaching, 12 junior doctors provided feedback with an average 37% increase in confidence to undertake difficult conversations. Key learning points from the session highlighted the importance of preparation, regularly updating the family to build trust and rapport, and integrating family updates via tele-communication into daily ward life. Conclusions Education around telephone communication skills is critical to enable us to adapt our skills in accordance with the demands of the pandemic, to continue to support relatives and to engage with technology with confidence. Increased preparation is required to navigate difficult conversations via technology, and successful communication requires clinicians to take responsibility for initiating regular family updates.

scholarly journals Views of UK doctors in training on the timing of choosing a clinical specialty: quantitative and qualitative analysis of surveys 3 years after graduation

2018 ◽  
Vol 94 (1117) ◽  
pp. 621-626 ◽  
Author(s):  
Shelly Lachish ◽  
Michael J Goldacre ◽  
Trevor William Lambert
Keyword(s):  
Qualitative Analysis ◽  
Career Guidance ◽  
Junior Doctors ◽  
Free Text ◽  
Specialist Training ◽  
Clinical Specialty ◽  
Wide Range ◽  
Career Advice ◽  
Career Specialty

BackgroundWorkforce studies show a declining proportion of UK junior doctors proceeding directly to specialist training, with many taking career breaks. Doctors may be choosing to delay this important career decision.AimTo assess doctors’ views on the timing of choosing a clinical specialty.MethodsSurveys of two cohorts of UK-trained doctors 3 years after qualification, in 2011 and 2015.ResultsPresented with the statement ‘I had to choose my career specialty too soon after qualification’, 61% agreed (27% strongly) and 22% disagreed (3% strongly disagreed). Doctors least certain about their choice of specialty were most likely to agree (81%), compared with those who were more confident (72%) or were definite regarding their choice of long-term specialty (54%). Doctors not in higher specialist training were more likely to agree with this statement than those who were (72% vs 59%). Graduate medical school entrants (ie, those who had completed prior degrees) were less likely to agree than non-graduates (56% vs 62%). Qualitative analysis of free text comments identified three themes as reasons why doctors felt rushed into choosing their future career: insufficient exposure to a wide range of specialties; a desire for a greater breadth of experience of medicine in general; and inadequate career advice.ConclusionsMost UK-trained doctors feel rushed into choosing their long-term career specialty. Doctors find this difficult because they lack sufficient medical experience and adequate career advice to make sound choices. Workforce trainers and planners should enable greater flexibility in training pathways and should further improve existing career guidance.

Sign in / Sign up

Export Citation Format

Share Document