scholarly journals Maintaining training progression in remote-working junior doctors

2021 ◽  
pp. fhj.2021-0124
Author(s):  
Anna-Marie C Parr ◽  
Bridget MacDonald ◽  
Anthony C Pereira
Keyword(s):  
Junior Doctors

Assessing the diagnostic capabilities of the app DemDx in an acute care setting (Preprint)

2018 ◽  
Author(s):  
Cian Murphy
Keyword(s):  
Differential Diagnosis ◽  
Care Setting ◽  
Medical Student Education ◽  
Initial Assessment ◽  
Junior Doctors ◽  
Doctor Who ◽  
Clinical Accuracy ◽  
Education Tool ◽  
Clinical Records ◽  
Diagnostic Capabilities

UNSTRUCTURED DemDx is a differential diagnosis app for students and junior doctors. Starting with a patient’s presenting complaint the app goes through a step-by-process through history, examination and investigation findings to an increasingly refined differential diagnosis list until a single most likely diagnosis is reached. The aim of this project was to assess the accuracy of DemDx in an Emergency Department (ED) setting. Anonymised clinical records for 100 patients were retrospectively obtained from the ED in Beth Israel, Boston, USA. This contained the differential diagnoses from the clerking doctor, who performed the initial assessment (D1). The discharge diagnosis was used as the gold standard diagnosis (D2). D1 agreed with D2 in 74.44% of cases while DemDx agreed with D2 in 85.56% of cases (p=0.0003716). When the first, and thus most likely, differential was taken from D1 and DemDx, they agreed with D2 in 20 and 18.8% of cases, respectively (p=0.1428). This demonstration of the clinical accuracy of the app highlights how it can be a useful medical student education tool.

Development of the Shift Smartphone App to Support the Emotional Wellbeing of Junior Doctors: Design of a Prototype and Results of Usability and Acceptability Testing (Preprint)

2020 ◽  
Author(s):  
Isabelle Counson ◽  
Alexandra Bartholomew ◽  
Joanna Crawford ◽  
Katherine Petrie ◽  
Geetanjali Basarkod ◽  
...  
Keyword(s):  
Mental Health ◽  
User Experience ◽  
Help Seeking ◽  
Pilot Trial ◽  
User Involvement ◽  
Health Behaviours ◽  
Junior Doctors ◽  
User Centered Design ◽  
Emotional Wellbeing ◽  
Prototype Development

BACKGROUND Junior doctors report higher levels of psychological distress than more senior doctors and report several barriers to seeking professional mental health support, including concerns about confidentiality and career progression. Mobile health applications (mHealth apps) may be utilised to help overcome these barriers to assist the emotional wellbeing of this population and encourage help-seeking. OBJECTIVE We describe the development and pilot trial of the Shift mHealth app to provide an unobtrusive avenue for junior doctors to seek information about, and help for, wellbeing and mental health concerns that is sensitive to workplace settings. METHODS A 4-phase iterative development process was undertaken to create the content and features of Shift involving junior doctors, using principles of user-centered design. These four phases were: I) Needs assessment, based on interviews with 12 junior doctors; II) Prototype development with user experience feedback from two junior doctors; III) Evaluation, consisting of a pilot trial with 22 junior doctors to assess usability and acceptability of the initial prototype; and IV) Redesign, including user experience workshops with 51 junior doctors. RESULTS Qualitative results informed the content and design of Shift to ensure the app was tailored to junior doctors’ needs. The Shift app prototype contained cognitive-behavioural, mindfulness, value-based actions, and psychoeducational modules, as well as a tracking function visualising patterns of daily variations in mood and health behaviours. Pilot testing revealed possible issues with the organisation of the app content, which were addressed in a thorough restructuring and redesign of Shift with the help of junior doctors across three user experience workshops. CONCLUSIONS The current research demonstrates the importance of ongoing end-user involvement in the creation of a specialised mHealth app for a unique working population experiencing profession-specific stressors and barriers to help-seeking. The development and pilot trial of this novel Shift mHealth app are first steps in addressing the mental health and support-seeking needs of junior doctors, although further research is required to validate its effectiveness and appropriateness on a larger scale.

102 Peer Teaching in Hip Fracture: Responding to the Medical Needs of Surgical Patients and Educational Needs of Junior Doctors

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
N Jones ◽  
J Francis ◽  
R Parikh ◽  
M Shaath
Keyword(s):  
Metastatic Cancer ◽  
Vascular Complications ◽  
Educational Programme ◽  
Junior Doctors ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Teaching Programme ◽  
Medical Needs ◽  
Strongly Agree ◽  
Case Based

Abstract Introduction Fractured Neck of Femur (FNOF) patients are complex. A mortality project identified topics for a peer-led teaching programme. Method Eight bite-sized case-based sessions were devised, to provide a framework to approach the following topics: Anaemia, delirium/dementia, ECG abnormalities, metastatic cancer, osteoporosis, renal disease, respiratory disease, and vascular complications. Attendees were asked to complete pre- and post- teaching programme questionnaires using a Likert Scale to indicate agreement with statements relating to the topic areas chosen (1=strongly disagree and 5=strongly agree). Result Pre-programme questionnaire: respondents were neutral (average 3.04) when asked whether topic areas were currently “well managed”. Attendees lacked confidence, indicating preparedness as neutral (average 3.35). Trainees agreed that they would benefit from teaching (average 4.56). Post-programme questionnaire: increased confidence was reported when considering preparedness (average 4.3). Attendees felt the teaching programme was “accessible” and the “topics well-chosen”. 100% of attendees regarded the teaching as ‘excellent’ or ‘very-good’. Conclusions Matching patient needs to an educational programme is important. The “bite-sized” nature of the programme paired with case-based learning increased confidence. A peer-led teaching programme is a positive response to themes emerging from morbidity and mortality reviews.

scholarly journals Wrist fracture management and the role of surgical care practitioner through the patient’s journey

2021 ◽  
pp. 175045892097607
Author(s):  
Rojas Moya Desiree ◽  
Russell Kabir
Keyword(s):  
Emergency Services ◽  
Surgical Care ◽  
Wrist Fracture ◽  
Junior Doctors ◽  
Examination Technique ◽  
Legal Implications ◽  
Fracture Management ◽  
Surgical Options

The presentation of this case study involves an exploration of the patient's journey in detail after having a traumatic wrist fracture, which is recognised as one of the most common fractures encountered daily in emergency services by junior doctors and practitioners. However, this article not only analyses the medical guidance for this type of case, but also the importance of the surgical care practitioner role in trauma and orthopaedics. All practitioners attending patients in emergency services are required to develop a good knowledge of anatomy, physiology, patient’s examination technique, classifications and consequently being aware of the possible surgical options for treatment of the fracture. They will also need to fully understand the legal implications of consent to ensure safe practice.

scholarly journals 187 Improving Awareness of Managing Post-Operative Haemorrhage in Patients Undergoing Thyroid and Parathyroid Surgery: The SCOOP Protocol

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Bhattacharya ◽  
J Jegadeeson ◽  
J Ramsingh ◽  
P Truran
Keyword(s):  
Nursing Staff ◽  
Simulation Training ◽  
Clinical Signs ◽  
Skin Wound ◽  
Junior Doctors ◽  
Parathyroid Surgery ◽  
Surgical Department ◽  
Life Threatening ◽  
Clinical Questions ◽  
Life Threatening Complication

Abstract Introduction Post-operative haemorrhage is a rare but potentially life-threatening complication of thyroid surgery and occurs in 1 in 100 patients. Our aim was to assess current levels of awareness of post-operative haemorrhage in the surgical department and to improve confidence in managing this. Method Questionnaires with a combination of clinical questions were distributed amongst nurses, foundation doctors, senior house officers and registrars in the surgical department. Results There was a clear gap in awareness in all grades. The British Association of Endocrine and Thyroid surgeons (BAETS) have guidance on the management of these patients and in particular the acronym SCOOP (Steristrips removed, Cut subcuticular sutures, Open skin wound, Open strap muscles, Pack wound). 18/24 of participants had not heard of the SCOOP protocol. Most nurses (6/12) all junior doctors (8/8) showed lack of confidence in managing patients with suspected bleeding. Conclusions An informative poster was created for relevant clinical areas as per the BAETS recommendation. These posters outlined the steps in the SCOOP acronymas well as the main clinical signs of haemorrhage. BAETS recommend that all first responders, including nursing staff, junior doctors and the crash team should be aware of the SCOOP protocol. Simulation training sessions are in progress for these members of staff.

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

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.

scholarly journals 139 Efficacy of Implementation of a Junior Doctors' Teaching Program on The Secondary Prevention of Peripheral Arterial Disease in Vascular Patients

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Daketsey ◽  
M Elkawafi ◽  
A Khallaf ◽  
R Makar
Keyword(s):  
Peripheral Arterial Disease ◽  
Secondary Prevention ◽  
Statin Therapy ◽  
Arterial Disease ◽  
Evidence Base ◽  
Junior Doctors ◽  
Teaching Session ◽  
Prescription Practices ◽  
Best Medical Therapy ◽  
Peripheral Arterial

Abstract Introduction According to NICE Guidelines, the Best medical therapy (BMT) for secondary prevention of peripheral arterial disease includes antiplatelet and statin therapy unless contraindicated. Junior Doctors are usually allocated the job of prescribing patients’ medications. Due to discrepancies in their exposure to vascular surgery in earlier training, we implemented an introductory teaching session for them regarding this BMT and audited the efficacy of this intervention. Method A retrospective review of admission and discharge medications of all vascular ward patients from August 12th to 30th September 2019 was done, and the data was analysed via Excel. Results Out of 127 patients (median age 70), 67% and 64% had antiplatelet and statin medications respectively,while on admission. 1 in each patient cohort was found discharged without either medication. The GP of the patient discharged without antiplatelets was contacted to ensure this was rectified. The other patient had refused statin therapy and thus a discharge note to their GP was conducted to reflect this. Conclusions A teaching session as part of a vascular departmental induction emphasising the evidence base for antiplatelet and statin therapy can contribute to improving prescription practices of junior doctors starting in the department.

scholarly journals Adult Learning Principles and Peer Delivery Improve Satisfaction of Electronic Medical Record Onboarding Education

ACI Open ◽  
2020 ◽  
Vol 04 (02) ◽  
pp. e114-e118
Author(s):  
Joanna Lawrence ◽  
Sharman Tan Tanny ◽  
Victoria Heaton ◽  
Lauren Andrew
Keyword(s):  
Adult Learning ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Junior Doctors ◽  
Free Text ◽  
Organizational Safety ◽  
Adult Learning Principles ◽  
Learning Practices ◽  
Learning Principles ◽  
The Impact

Abstract Objectives Given the importance of onboarding education in ensuring the safety and efficiency of medical users in the electronic medical record (EMR), we re-designed our EMR curriculum to incorporate adult learning principles, informed and delivered by peers. We aimed to evaluate the impact of these changes based on their satisfaction with the training. Methods A single site pre- and post-observational study measured satisfaction scores (four questions) from junior doctors attending EMR onboarding education in 2018 (pre-implementation) compared with 2019 (post-implementation). An additional four questions were asked in the post-implementation survey. All questions employed a Likert scale (1–5) with an opportunity for free-text. Raw data were used to calculate averages, standard deviations and the student t-test was used to compare the two cohorts where applicable. Results There were a total of 98 respondents in 2018 (pre-implementation) and 119 in 2019 (post-implementation). Satisfaction increased from 3.8/5 to 4.5/5 (p < 0.0001) following implementation of a peer-delivered curriculum in line with adult learning practices. The highest-rated factors were being taught by other doctors (4.9/5) and doctors having the appropriate knowledge to deliver training (4.9/5). Ninety-two percent of junior doctors were motivated to engage in further EMR education and 90% felt classroom support was adequate. Conclusion EMR onboarding education for medical users is a critical ingredient to organizational safety and efficiency. An improvement in satisfaction ratings by junior doctors was demonstrated after significant re-design of the curriculum was informed and delivered by peers, in line with adult learning principles.

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