Editorial

2005 ◽  
Vol 4 (3) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Night Shift ◽  
Hospital Medicine ◽  
Phone Call ◽  
Junior Doctors ◽  
Exact Nature ◽  
Text Book ◽  
Acute Medicine ◽  
Junior Staff ◽  
Training Programmes ◽  
The Uk

The challenges and uncertainties of working in the developing field of Acute Medicine have been a regular theme for editorial comment in this journal since I took the helm in 2002. Almost four years on, with sub-specialty status confirmed, over 200 consultants and many SpRs enrolled in higher specialist training programmes throughout the UK, Acute Medicine finds itself in a much stronger position than any could have predicted at that time. Enthusiasm for the field is clear from the numbers of applicants for training programmes at SpR level, as well as the dramatic rise in attendances at acute medicine meetings across the country in the last year. However, on-going challenges remain. Eighteen months from now, Modernising Medical Careers will send shockwaves throughout hospital medicine. The exact nature of the change to our training programmes remains unclear, and will probably have changed again between my writing this and its publication. However it is essential that Acute Medicine is ready for whatever comes our way. We must work closely with our colleagues in Emergency Medicine and Critical Care to develop common stem training schemes which allow doctors to choose the area of ‘front door’ medicine which suits them best. Where possible we should seek to encourage dual accreditation in two or more of these areas. But most of all we need to maintain the momentum which has carried us so far in such a short space of time, and which has the potential to make Acute Medicine one of the largest hospital specialties. This edition’s review articles cover a varied mix of common and less common conditions on the acute medical ‘take’. Most medical admission units will be faced with at least one patient presenting with a seizure in each 24 hour period. Dr Kinton emphasises the importance of a good history in the management of this problem, but also provides some useful tips to help distinguish seizures from other causes of blackout. Distinction from syncope can be a particular challenge, not least because of the differing implications for driving, the loss of which can have devastating consequences. Acute ischaemic stroke is another common problem, the management of which is comprehensively reviewed by David Jarrett and Hemang Dave. As well as summarising some of the major trial data for thrombolytic and antiplatelet therapy, this review includes some advice on some of the common clinical challenges which don’t usually feature in text book descriptions of this condition. Less common, but no less important, Acute liver failure must be distinguished from decompensated chronic liver disease – the former often requiring discussion with a regional liver unit. Phil Berry has included a useful checklist to have to hand before making this phone call. Headache, palpitations and sweating is a common problem on the post-take ward round – particularly amongst the junior staff completing a night shift. Fortunately most junior doctors do not have a phaeochromocytoma – in common with every patient for whom I have ever requested 24 hour urinary catecholamine measurement. Having read Dr Solomon’s thorough review of the acute management of this condition I will now feel equipped to manage this condition when I finally get a positive result back from the laboratory! Apologies that this edition has been a little delayed – I hope you consider it to have been worth waiting for….

Editorial

2004 ◽  
Vol 3 (2) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Bacterial Meningitis ◽  
Medical Staff ◽  
Case Reports ◽  
Rapid Development ◽  
Working Party ◽  
Significant Shift ◽  
Multiple Choice Questions ◽  
Acute Medicine ◽  
Junior Staff ◽  
The Uk

Over the past three years it has become apparent to me that referring to ‘current affairs’ in these columns can be a mistake, serving only to highlight inevitable printing delays. By the time this edition arrives on your doormat Euro 2004, ‘Big Brother’ and the early summer heat wave will be nothing but a distant memory. However the ‘recent’ publication of the Royal College of Physicians document ‘Acute Medicine – making it work for patients’ cannot be allowed to pass without a mention. This report represents a significant shift in the position of the College in relation to Acute Medicine since the previous working party reported its findings in 2000. The value of consultants specialising in Acute Medicine is now clearly recognised and supported – every trust should now have one, with the minimum figure of three per hospital being proposed by 2008. Whether this is achievable will depend on the rapid development of training schemes across the UK, as well as the generation of enthusiasm for the specialty amongst junior staff. The number of applicants for our Wessex programme indicates no shortage of the latter. Although developing a training scheme takes a lot of hard work, it is vital that those already working in the specialty make this a high priority. We have already seen benefits from the appointment of high quality middle grade staff and are looking forward to a ‘flood’ of future applicants for local consultant posts, 4 years from now. This edition comprises four more important review papers on aspects of acute medicine, along with the first in our ‘Controversies in acute medicine’ series. The latter was designed to try to stir up some correspondence, for future publication. The confusion over oxygen delivery in the acute setting seems to reign fairly widely amongst junior, and indeed some more senior medical staff. Hopefully Dr Cooper’s well-written paper will serve to dismiss some of the misconceptions in this area. Our reviews cover relatively uncommon, but nonetheless important aspects of acute medicine. Tuberculosis and HIV are both on the increase in the UK. The success of anti-retroviral therapy will undoubtedly lead HIVrelated illness to be a significant part of our practice over the next decade. An understanding of the range of conditions specific to this group of immunocompromised patients is therefore crucial for physicians involved in the acute take. Hypoglycaemia and suspected bacterial meningitis are both conditions which require immediate action by medical staff. Both of these reviews comprehensively cover their respective topics with a combination of well written text, illustrations tables and algorithms. Dr Hartman highlights recent evidence supporting the use of dexamethosone in bacterial meningitis and re-iterates some of the points made in an earlier edition regarding the use (and abuse) of CT scanning prior to lumbar puncture. For a change we have no case reports this time, although Dr Macdonald’s audit of the innovative review clinic in the Emergency Assessment Area of Heartlands hospital provides a worthy substitute. Submission of similar articles in future would be most welcome. Once again, a reminder that multiple choice questions are for self assessment and ‘personal’ CPD only; I hope you will find this edition helpful in your clinical practice.

scholarly journals Modernising Medical Careers: a urological workforce perspective

2008 ◽  
Vol 90 (1) ◽  
pp. 22-26
Author(s):  
GO Hellawell ◽  
SS Kommu ◽  
F Mumtaz
Keyword(s):  
Junior Doctors ◽  
Specialty Training ◽  
Medical Careers ◽  
Foundation Programme ◽  
The Future ◽  
Training Programmes ◽  
The Uk ◽  
And Training

The training of junior doctors in the UK is undergoing an evolution to ensure that those concerned are adequately trained and specialised for current and future consultant practice. The implementation of this training evolution is currently widespread at the foundation level (SHO-equivalent) and will expand to specialty training programmes as foundation programme trainees complete their training in 2007. Urology has led the change to the specialty training, with three-year trainees having entered the specialty in 2005. The emergence of urology as the lead specialty for change originated in part from a meeting in 1998 that addressed the future of urology and training, the summary of which was published later that year.

scholarly journals Acute hospital medical staffing during the night shift

1998 ◽  
Vol 21 (4) ◽  
pp. 163 ◽  
Author(s):  
Ken Hillman ◽  
Sean Beehan
Keyword(s):  
Night Shift ◽  
Acute Hospital ◽  
Junior Doctors ◽  
Great Cost ◽  
Acute Medicine ◽  
Acute Hospitals ◽  
High Level ◽  
General Wards ◽  
Cost Implications

There has been little or no attempt to define the need for 24-hour medical cover, norits appropriateness in acute hospitals, despite the great cost implications and thequestion of the quality of that care. This study examined the medical activity duringthe ?night shift? in an acute hospital. There were an average of 2.59 calls per night,most from the emergency department (247/475) and general wards (108/475). Manycalls were related to active resuscitation (88/475) and immediate treatment (83/475).Over 40% (81/286) of patients had to be transferred to a higher level of care, suchas an intensive care unit within the hospital. By collecting data on the demands ofhealth care during what amounts to over a third of the hospital?s time, it wasestablished that a high level of medical care was required. Appropriate levels ofstaffing, using junior doctors trained in acute medicine, was able to be provided tomatch need as determined by these data, and extra staff at higher costs were avoided.

Editorial

2006 ◽  
Vol 5 (3) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Medical Training ◽  
Case Reports ◽  
Junior Doctors ◽  
Acute Medicine ◽  
The Past ◽  
Acute Medical Unit ◽  
Application Service ◽  
Public House ◽  
The Uk

They say time flies when you’re having fun – and the 5 years since Paul Jenkins convinced me to take over as editor of this journal have certainly flown by. This period has seen a dramatic expansion in the numbers of physicians specialising in Acute Medicine, the confirmation of subspeciality status and development of a training curriculum. Addressing over 300 delegates at the recent Society for Acute Medicine meeting at the Royal College of Physicians, President Mike Jones reminded us that only seven years earlier the Society’s entire membership had sat around a small table in a public house just a few hundred yards from that spot. At that time many were predicting that recruitment to the speciality would be a major challenge. ‘Why would anyone choose to specialise in acute medicine?’ was a question, sometimes whispered in the corridors of St Andrew’s Place. And yet many have made this choice, and many more continue to do so. The Society for Acute Medicine now has upwards of 400 members, a figure which has doubled in the past 12 months. Even more encouraging was the large number of trainees who visited the Acute Medicine stand at the recent BMJ careers fair. Many junior doctors clearly view Acute Medicine as a positive career choice, not the ‘last resort’ which some predicted it may become. However, challenges remain. By the time this edition hits the press the Medical Training Application Service (MTAS) will be swinging into action to produce the first applicants for ‘post MMC’ training positions across the UK. For those of us who are involved in the shortlisting and interview process, the enormity of the task is rapidly becoming apparent. In Wessex, the Deanery has suggested that Acute Medicine shortlisting may take as much as a week, with a further week set aside for interviews of the hopeful candidates. Then comes ‘round two’, later in the year, when potentially we do it all over again. Suddenly the prospect of annual leave in the months of March or April looks like a forlorn hope. But before I break this news to my wife and family, I should spare a thought for those readers who find themselves on the opposite side of the process. To be part of the first cohort of trainees to be involved in this must be a daunting prospect. Many of those enthusiastic potential recruits to the speciality are clearly struggling to know where to turn to for advice on the process, confused by often contradictory messages and unanswered questions. Hopefully all will become clearer as the deadlines approach. A smaller ‘Reviews’ section in this edition reflects a dramatic increase in the number of articles submitted for consideration of publication in this journal over the past 6 months. As a result we have accommodated more case reports than normal, along with two papers in our new section for research and audit. I would encourage similar submissions in the future; case reports need not be rare or esoteric, provided they contain a clear teaching message clinicians involved in the acute ‘take’. Completed audits will be considered if they demonstrate clear evidence of how to improve practice in an acute medical unit. Owing to some software problems, Rila has temporarily suspended their submissions website which, until recently, had been the mechanism for submission of articles to this journal. Until these problems are resolved, I would be grateful if any articles could be e-mailed directly to me at the address shown on this page, so that I can arrange for peer review. Finally, a reminder that this edition concludes the cycle of reviews which started in 2002 and has now covered the majority of conditions presenting as emergencies on the acute medical ‘take’. The new cycle, starting in 2007 with volume 6 issue 1 will follow a modified pattern, with different authors hopefully providing a fresh perspective in their updated reviews. My thanks go to all of the authors who have produced material over the past 5 years as well as to the editorial board for their ongoing hard work in commissioning articles for the past and future cycles.

Junior doctor engagement: what is it, why does it matter and what the workplace can do to improve it

BMJ Leader ◽  
2019 ◽  
Vol 3 (2) ◽  
pp. 62-64
Author(s):  
Emily Ward
Keyword(s):  
Employee Engagement ◽  
Patient Outcomes ◽  
Healthcare Professionals ◽  
New Technologies ◽  
Junior Doctors ◽  
Workplace Engagement ◽  
Junior Staff ◽  
Increasing Demand ◽  
Staff Research ◽  
The Uk

Background Across the world, there is a struggle to balance the provision of adequate healthcare with trained healthcare professionals. In the UK, the National Health Service (NHS) is struggling with increasing demand coupled with a reduction in funding, an older multimorbid population and rising patient expectations.Objectives The landscape within which doctors practise is constantly changing with increasing devolution, changing political priorities and new technologies, and as a result, we cannot afford to have disengaged staff.Methods Employee engagement is a process, a description of how a business or workplace interacts with its staff. Research has demonstrated that while engagement can improve certain patient outcomes, the manner in which Junior Doctors are employed in the NHS can create many barriers to organisational workplace engagement.Results This discussion focuses on how workplace engagement is being developed across healthcare; and some of the challenges to workplace engagement with Junior Doctors with a focus on issues such as placement durations, demanding workloads and lack of basic provisions for junior staff. It gives simple suggestions for how these barriers can be overcome and how Junior Doctors can be incorporated into teams, resulting in increased workplace engagement and improved patient outcomes.

scholarly journals Trainee Update January 2014

2014 ◽  
Vol 13 (1) ◽  
pp. 32-32
Author(s):  
Nerys Conway ◽  
◽  
R Johnson ◽  
Keyword(s):  
Medical Education ◽  
Education And Training ◽  
Medical Society ◽  
Junior Doctors ◽  
Hospital Workers ◽  
Acute Medicine ◽  
The Public ◽  
Medical Education And Training ◽  
The Uk ◽  
And Training

We hope you all had a lovely Christmas and New Year. Apart from making all the usual resolutions, New Year is always a time to think about our careers, look at our CV’s and strive to improve ourselves towards our ARCP or CCT. Our spring conference will take place in Amsterdam this May on 1st-2nd May and there is plenty of opportunity for you to get involved! This year we will be joined by the Dutch Medical Society (DAM). The SAM conferences always provides us with an opportunity for networking, presenting our hard work and meeting other trainees throughout the UK (and in this case Holland). It will be interesting to hear what the Dutch trainees think about their training and how it is structured. There is a dedicated session on acute medical education and training. It will be useful to certainly combine and share ideas with our Dutch colleagues. We certainly could learn a lot from each other and therefore improve our training. Our acute awareness week will take place on 14th-20th July. This is a huge chance for us to raise awareness of our speciality to the public and other hospital workers. You often find that people don’t understand what acute medicine actually is or what an acute medical registrar or consultant actually does. This is an opportunity for us to ‘celebrate’ our speciality and enjoy team bonding. The junior doctors enjoy getting involved and this often encourages them to think about a career in acute medicine. Full details and information packs will be available via our website shortly. We will be interested to hear what you are all planning as we both have a huge part to play in this year’s acute awareness week. Perhaps one day we could have a training awareness day? It would be great if you got in touch with us to let us know your plans or suggestions! We hope to see as many of you in Amsterdam. Please feel free to contact us with any suggestions, ideas or concerns

scholarly journals An interview study to determine the experiences of cellulitis diagnosis amongst health care professionals in the UK

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e034692
Author(s):  
Mitesh Patel ◽  
Siang Ing Lee ◽  
Nick J Levell ◽  
Peter Smart ◽  
Joe Kai ◽  
...  
Keyword(s):  
Clinical Features ◽  
Clinical Experience ◽  
Lower Limb ◽  
Health Care Professionals ◽  
Secondary Outcome ◽  
Snowball Sampling ◽  
Acute Medicine ◽  
Common Diagnosis ◽  
The Uk ◽  
National Networks

ObjectivesTo explore healthcare professionals (HCPs) experiences and challenges in diagnosing suspected lower limb cellulitis.SettingUK nationwide.Participants20 qualified HCPs, who had a minimum of 2 years clinical experience as an HCP in the national health service and had managed a clinical case of suspected cellulitis of the lower limb in the UK. HCPs were recruited from departments of dermatology (including a specialist cellulitis clinic), general practice, tissue viability, lymphoedema services, general surgery, emergency care and acute medicine. Purposive sampling was employed to ensure that participants included consultant doctors, trainee doctors and nurses across the specialties listed above. Participants were recruited through national networks, HCPs who contributed to the cellulitis priority setting partnership, UK Dermatology Clinical Trials Network, snowball sampling where participants helped recruit other participants and personal networks of the authors.Primary and secondary outcomesPrimary outcome was to describe the key clinical features which inform the diagnosis of lower limb cellulitis. Secondary outcome was to explore the difficulties in making a diagnosis of lower limb cellulitis.ResultsThe presentation of lower limb cellulitis changes as the episode runs its course. Therefore, different specialties see clinical features at varying stages of cellulitis. Clinical experience is essential to being confident in making a diagnosis, but even among experienced HCPs, there were differences in the clinical rationale of diagnosis. A group of core clinical features were suggested, many of which overlapped with alternative diagnoses. This emphasises how the diagnosis is challenging, with objective aids and a greater understanding of the mimics of cellulitis required.ConclusionCellulitis is a complex diagnosis and has a variable clinical presentation at different stages. Although cellulitis is a common diagnosis to make, HCPs need to be mindful of alternative diagnoses.

Individual patient—doctor contact in a mental hospital

1978 ◽  
Vol 8 (4) ◽  
pp. 705-710 ◽  
Author(s):  
David Pitcher ◽  
Howard Sergeant
Keyword(s):  
Clinical Practice ◽  
Relative Efficiency ◽  
Mental Hospital ◽  
Professional Standards ◽  
Junior Doctors ◽  
Discharge Rates ◽  
Training Programmes ◽  
And Training

SynopsisPatients admitted to Friern Hospital in 1972 stayed on average for about 5 weeks and spent a total of less than 2 hours individually with senior and junior doctors. Long-stay patients (1 year or more) saw their doctors for an average of less than 1 hour a year. These findings, which in the case of junior doctors were corroborated in 1974, refer only to the time doctors spent with patients alone. The admission, and long-stay discharge rates were greater in the Islington than in the Camden division, and probably reflect differences in clinical practice. It is argued that more psychiatrists are needed – precisely how many will depend on studies of the relative efficiency of different services and training programmes, and on agreement among psychiatrists about minimum professional standards.

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