21ĀM NŪṞṞĀṆṬU KAṞṞAL KAṞPITTAL CINTAṈAIT TIṞAṈ VARAIPAṬATTIṈ VAḺI VAḺIKĀṬṬIK KAṬṬURAI EḺUTUM MUṞAI [21ST CENTURY TEACHING EFFECTIVENESS OF USE (I-THINK MAP) IN WRITING TAMIL LANGUAGE]

This article explores the benefits of using the I-Think map to enhance student performance in the Tamil alphabet. Understanding, cognition, and problem-solving skills using the I-Think graphic system will be taught in the form of essays at the end of a teaching session or test for Tamil language lessons. This study looks at how increased training for students' achievement in the essay subject using the I-Think map. Furthermore, this study examines the extent to which students' acceptance towards the I-Think map of the teaching and language learning process and the implications of the use of the map enhance student achievement in fourth year Tamil subjects. 28 students were sampled for the study. The findings of this study show that students can also improve their scores in Tamil by learning the algorithm for using I-Think graphic learning strategies. The writing energy strategy at the end of the study was a useful keyword. Not only the teacher but also the students can get a better learning instruction if used in the lesson in the classroom.

TP8.2.22 Mind the Gap: Overcoming the disruption of surgical teaching during COVID-19 redeployment

Aims Due to the pandemic, surgical FY1s in our trust were re-deployed to cover medical patients. In addition to cancellation of surgery-specific teaching, there was less time spent by FY1s with senior surgical colleagues during the normal working day. Our FY1s appeared less confident in managing unwell surgical patients, and there was dissatisfaction for both FY1s and seniors. This project aimed to identify the particular areas of concern and deliver a tailored teaching session. Methods Surgical FY1s and SpRs were surveyed. We received 10 (83%) FY1 responses and 5 (42%) SpR responses. Management of common surgical presentations, routine administrative and clerical tasks were identified as areas of need. A teaching session was delivered via online conferencing software and uploaded to a video sharing website where it could be viewed at a later date. Seven of 12 (58%) surgical FY1s attended live and completed a post-teaching session feedback survey. Results Seven (100%) FY1s rated the session ‘very useful’, and a majority found the ‘common surgical presentations’ section of most value. All respondents felt more confident with both clerking surgical patients and administrative tasks following the refresher session. Conclusions This project demonstrated the need for additional training sessions to compensate for loss of opportunities due to re-deployment. Utilising remote teaching proved an acceptable alternative to previous in-person options. The tailored refresher session successfully improved confidence in target areas and should be delivered routinely.

EP.WE.617A clinical audit analysing the completion of junior clerking at the Surgical Admissions Unit at an acute District General Hospital, as impacted by short-staffing due to CoViD-19

Aims The quality of junior clerking is essential to patient safety and care; it provides information vital to the management of surgical patients. This audit aimed to evaluate the completion of the General Admission Document (GAD) on the Surgical Admissions Unit to identify the impact of staff absences secondary to CoViD-19. Methods Admissions to the unit over a 5-day period (n = 92) were evaluated against a checklist of the 26 items included on the GAD utilised by the trust, and daily handover sheets were used to identify staff absences. Mean completion was measured alongside thematic analysis of free-text remarks. Results Handover sheets identified staff absences on 3 days. The overall mean completion of the GAD was 50.88% (95%CI: 46.65, 55.11, p < 0.05). This was not significantly (p = 0.074) impacted by staffing; mean completion was 48.47% (95%CI: 42.75, 54.20, p < 0.05) on days with junior doctor absences, and 54.98% (95%CI: 49.14, 60.82, p < 0.05) without. The major theme identified was deferring to the ‘senior review’ section of the GAD, suggesting a lack of awareness among juniors regarding the importance of a full junior clerking. Conclusions Staff shortages secondary to CoViD-19 absences did not significantly impact the quality of junior clerking. However, the baseline completion of the GAD was noted to be poor regardless. Therefore, a teaching session during induction of the next cohort of doctors could be a sensible intervention to reiterate the importance of a full clerking.

EP.TU.201Evaluating and Improving the Management of Tonsilitis in an A+E Department: An Educational Intervention

Aims Tonsilitis is one of the most common presentations to the A+E department. We aimed to assess whether patients presenting with tonsilitis are being managed in-line with current guidance. We then set out to educate A+E staff about tonsilitis management and then assessed for improvement in management. Methods All patients presenting to A+E in one fortnight with a documented diagnosis of tonsilitis were included. We reviewed the notes to assess the choice of treatment in each case and whether a clinical score was used to guide choice of treatment (in accordance with NICE guideline [NG84]). We designed and delivered an educational intervention for A+E staff covering tonsilitis guidelines. The audit was repeated two weeks later. Results Over the study period, 49 patients were included; only 35% (n = 17) had either a clinical score documented or had all components of a score recorded. In total, 39% (n = 19) were treated with antibiotics. Of these, 63% (n = 12) should not have been prescribed an antibiotic and 37% (n = 7) were prescribed an inappropriate antibiotic. At re-audit, (n = 50 cases), 58% (n = 29) had a clinical score documented and 28% (n = 14) were treated with antibiotics. Of these, 29% (n = 4) should not have been prescribed antibiotics and 21% (n = 3) were prescribed an inappropriate antibiotic. Thus, after this teaching session, there was a significant improvement in antibiotic prescribing practices (63% vs 29%, p = 0.026). Conclusions A+E assessment and management of tonsilitis frequently deviated from guidelines, but a single teaching session vastly improved clinical scoring and antibiotic prescribing practices.

EP.WE.628The Challenges of Consent and COVID-19: Analysis of Documentation of Risk of Hospital Acquired COVID-19 Infection in a District General Hospital

Aims The COVID-19 pandemic poses a new material risk to hospital admissions and we must modify consenting practice accordingly. This study assessed documentation of the risk of COVID-19 infection and associated morbidity in consenting practice for patients undergoing general surgical procedures under general anaesthesia at a district general hospital. Methods This is was a two-cycle study design. An initial retrospective case-note analysis of 41 inpatient consent forms and operation notes during April 2020 was performed. Data were gathered on points from the Royal College of Surgeons (RCS) guidance, including documentation of risk of COVID-19 infection. Recommendations were then offered including a teaching session from the departmental lead into the importance of documenting risk of COVID-19 infection. A prospective case-note analysis of 45 inpatient consent forms and operation notes during November to December 2020 was then performed. Results In cycle one, of 41 cases, 39% (16) had risk of chest infection documented. Of these, 16 (63%) specified COVID-19 in risk documentation. Morbidity related to COVID-19 was documented in 4 (25%) of these 16 cases. Following interventions, of 45 cases, 93% had risk of COVID-19 infection and associated morbidity documented (χ2 = 89.3646, p < 0.00001 significant at p < 0.05). Conclusion We initially identified a deviation from RCS consent guidance. The second cycle results show a significant improvement in consenting practice for the risk of contracting COVID-19 for inpatient surgical procedures. We aim to further refine our recommendations to ensure that this material risk is communicated to patients during the initial consent process.

131 Perioperative Management of Warfarin on Surgical Wards at District General Hospital

Introduction Many patients admitted to surgical wards are on warfarin. Poor knowledge of guidelines regarding reversal and restarting of anticoagulant medications can delay surgery, lead to poor outcomes and delay the discharge of patients. The aim of this audit was to establish whether junior doctors are confident in managing warfarin according to local guidelines and to improve their knowledge and confidence. Method A questionnaire was used to assess confidence of junior doctors currently working in general surgical departments. An educational poster was placed in the junior doctors’ office and the questionnaire was repeated. We then conducted a teaching session on the perioperative management of warfarin and repeated the questionnaire again. Results Confidence in reversing and restarting warfarin was significantly higher following the teaching session (p = 0.017 and p < 0.001 respectively). No significant difference was seen following the introduction of educational posters. Confidence in applying the guidelines on perioperative warfarin management was significantly higher following the teaching session (p < 0.001). Following the introduction of educational posters and the formal teaching session doctors felt they knew better how to access the guidelines (not statistically significant for either guideline) and referred to them more (p = 0.0178 for warfarin reversing and p = 0.0940 for warfarin restarting guideline). Conclusions Having doctors who are confident in managing warfarin is crucial to avoid delays in treatment and discharge. This audit showed that a teaching session indeed improved doctors’ knowledge and confidence. Regular formal teaching is essential, and a repeat audit is planned to be performed during the next rotation.

295 Secondary Prevention of Cardiovascular Risk Factors in Patients Admitted Under the Vascular Service - Full Cycle Audit

Aim Peripheral arterial disease (PAD) is strongly associated with general cardiovascular morbidity and mortality. This audit aimed to monitor and improve compliance with NICE guidelines CG147 & TA607 for PAD patients that presented to our vascular service. Method Patients were audited from September to October 2020. The audit reviewed prescription of anticoagulant/antiplatelet agents, lipid modification, optimisation of diabetes control and smoking cessation advice. Our intervention was to conduct a single teaching session for junior doctors that emphasised medication checks, checking HBA1c/ensuring appropriate diabetic referrals, and implementation/documentation of any smoking cessation advice. We also introduced a dedicated computer for conducting the vascular surgery morning ward round. Re-audit was undertaken between November to December 2020. Results The first audit included 32 patients. It revealed 100% compliance with anticoagulant/antiplatelet prescribing. 82% were prescribed appropriate lipid modification. There was 75% compliance with diabetic referrals for patients with high HBA1c results. There was only 19% compliance with smoking cessation advice/documentation. The re-audit process included 27 patients. There was 100% compliance with antiplatelet/anticoagulant prescriptions. 26 (96%) patients were prescribed appropriate lipid modification. There was now 100% compliance with appropriate referral to the diabetic team. There was also 100% compliance with smoking cessation advice/assistance/documentation. Conclusions A single teaching session for junior doctors familiarising them with the current national guidelines, and introduction of a dedicated computer for ward rounds significantly helped improve our compliance with national guidelines for secondary prevention of vascular disease.

731 Operation Notes: Is Informal Training Enough?

Aim Operation notes are essential for continuity of patient care, communication between colleagues, medicolegal records and for coding and remuneration. This study aims to assess core surgical trainees (CST’s) understanding of completing accurate and detailed operation notes and their awareness of the RCS England Good Surgical Practice document (GSP 2014). Method Current CST’s who attended regional teaching were surveyed on their knowledge of what an adequate operation notes entails. Trainees then attended a 40-minute lecture on this topic and were then re-surveyed. Results Thirty trainees completed both questionnaires. No trainees had previously received formal teaching on how to complete operation notes. Most had received informal training in the clinical setting, usually by a registrar (93.3%). Operation notes were considered important for medicolegal reasons (53.3%), continuity of care (96.6%) and communication (53.3%). No one identified their importance for coding. Initial assessment showed only 26.6% of CST’s were aware of RCS GSP document. Responses regarding relevant information to be included in operation notes were variable: patient demographics (23.3%), procedure (93.3%) and post-operative instructions (90%). Improvements, between 3 - 70% increase, were noted in all questionnaire domains post teaching session. All trainees found a more formal session to be beneficial. Conclusions Although a small study, this demonstrates global improvements in knowledge after formal teaching session over informal clinical training. We believe this topic should be included in boot camp training at the start of core surgical training. It should include education in coding to ensure CST’s appreciate the significance of health information management.

57 A Closed Loop Audit of Post-Operative Driving Advice Documentation

Aim The Driving and Vehicle Licensing Agency state post-operatively it is between the patient and doctor to establish when would be safe to resume driving, providing recovery does not exceed three months. This audit aimed to assess and improve the documentation rate of driving advice in the discharge summaries given to patients post abdominal surgery. Method Retrospective data collection from electronic records over the months of August and September 2020. 132 discharge summaries were screened to assess the baseline rate of verbal/documented driving advice given on discharge. Following the 1st cycle, posters encouraging the inclusion of driving advice and demonstrating how to access driving advice to discharge summaries were developed and distributed across the surgical wards. A 2nd cycle re-audit was conducted in October 2020 to measure the effect of change, and a further 3rd cycle audit was conducted in November 2020. Results 1st cycle included 132 patients. 62% had documented advice on their discharge summaries, while 38% had no proof of driving advice. After intervention, 2nd cycle included 30 patients. Results showed a significant increase in advice documentation (80%). A 3rd cycle was carried out with 47 patients. This showed a reduction in advice documentation (66%). Conclusions Driving advice on discharge in post-operative patients is crucial part of patient safety. Implementation of intervention has increased the documentation of driving advice showing enhancing patient safety. However, 3rd cycle after registrar’s changeover showed a decrease in the rate of documentation. A teaching session is planned for new doctors followed by 4th cycle.

Eliciting Idiom Retention through Alliteration in a Classroom Activity

Alliteration comes up as one of the efforts that follow the notion of linguistic motivation in creating language retention and memorization to learners. Idiom is one of the language phenomena where alliteration takes place as part of its non-arbitrariness principle. The claim underlying the effectiveness of alliteration in aiding language retention in idiom is tried to be applied in some classroom activities which may consist of pre, whilst, and post-teaching. All the activities in the teaching session are arranged to be integrated with idiom learning using alliteration. Learners' ability to recall idioms containing aliteration will also be tested in the provided exercises. The success of the expected retention on learners will be measured from the result gained from the activity divided simply into three phases, pre-teaching, whilst-teaching, and post-teaching where it will be conducted for approximately 90 minutes. As some deviations possibly made can influence the result, the teacher should figure out some considerations affecting the effectiveness of the lesson given. Reflection phase should be conducted maximally, so that learners’ response is really fruitful that it can be known whether they are engaged with the activity and gain the material well. In the first activity, they work semi-independently, so that the assessment is expected to be more objective, covering the combination of group and individual work.