1307 Linking Pre-ST Trainees into The Surgical Profession - An Example from OMFS Of A Structured Introduction to The Speciality

Introduction Inspiration and support are two of the key principles that enthuse junior trainees to pursue a career in surgery. Exposure to Oral and Maxillofacial Surgery (OMFS) is minimal at undergraduate level and can present a challenge for those postgraduate individuals who wish to gain more experience before applying to further training. This has prompted the formation of a support programme comprised of two stages: Taste of OMFS and Mentoring and Support Programme (MSP). Method Feedback was captured from OMFS junior trainees and educational supervisors on the existing junior trainee programme. It was concluded that a new programme was required to create a more structured system to help support trainees achieve their goals within OMFS. Taste in OMFS aims to provoke intrigue in the specialty. Individuals who are inspired to experience more can advance on to the MSP which consists of checklists, carefully designed to help the trainee obtain adequate exposure and achieve the recommended requirements for second-degree and specialty training applications. Results The new programme was trialed by existing junior trainee programme members over a six-month period. The results were encouraging with positive feedback on the structure of both sections. This, in combination with ideas generated from a focus group has helped create the final version, now published and accessible on the British Association of Oral and Maxillofacial Surgeons website. Conclusions We hope to raise awareness of this dynamic programme which can be tailored to each individual, in the hope that more junior trainees pursue a career within OMFS.

On-call medical seclusion reviews: are we meeting MHA code of practice (COP) requirements?

AimsAre Junior Trainee, Medical Seclusion Reviews complaint with MHA COP Criteria?ObjectivesAre we seeing newly secluded patients on time?Are we documenting these reviews in clinical notes?Do documented reviews meet criteria stated by the MHA COP 26.133?Are we informing Higher Trainees of the need for MDT reviews?BackgroundSeclusion is an important aspect of inpatient care. MHA COP Chapter 26 provides guidance for documenting seclusion reviews, ensuring safeguards are in place to protect patient's safety and human rights. Secluded patients require a medical review within 1 hour, and four hourly thereafter, until a higher trainee or Consultant undertake an MDT Review. In our Trust, LYPFT, trainees undertake these reviews. There is noted discrepancy in seclusion review documentation. This audit identifies our compliance with time limits, and whether documentation meets the required criteria in the MHA Code of PracticeMethodOur Sample includes all Out-of-Hour Junior Trainee Medical Seclusion Reviews between 01/01/20 and 01/04/20 at LYPFT. Seclusions were identified from on call logs, and clinical notes were reviewed for a documented seclusion review. The date and time of seclusion are recorded, whether a 1 or 4 hourly review, and the time of review. We recorded any mention of: physical health; mental state; observation levels; recent medication; medication side effects; risk to others; risk to self and the need for ongoing seclusion.Result56 episodes of seclusion were identified; all 56 had a documented medical seclusion review. 49 reviews were on time, 4 were late with a documented reason, and 3 were late without. There was documentation of the Higher Trainee being informed in 53 reviews.No seclusion reviews mentioned all MHA COP criteria. We more frequently mentioned patients’ physical health (51), psychiatric health (52) and need for seclusion (54). 46 seclusion reviews mentioned risk of harm to others; only 3 mentioned risk of self-harm. 25 seclusion reviews mentioned medication, and 5 mentioned review for side effects. 5 seclusion reviews mentioned observation levels.ConclusionOur Junior Doctor Seclusion Reviews were not meeting the MHA Code of Practice Criteria, and we believe this to largely be due to lack of awareness of the standards. As such, results have been disseminated to Junior trainees in weekly teaching. We created a medical seclusion review template, adopted by the Trust, to ensure documentation compliance with the MHA COP. Junior doctor inductions now include a presentation regarding Seclusion, the reviews and documentation. We will re-audit in 12 months.

A survey of the level of knowledge and understanding of members of the inpatient team on the role of the physician associate on the general adult psychiatric wards

AimsPhysician Associates (PAs) are healthcare professionals with a general medical education background, having completed a two-year postgraduate degree. Whilst the number of PAs employed in healthcare trusts continues to increase, the number working in mental health settings remains small.Mersey Care NHS Foundation Trust employed two PAs two years ago. In August 2019, a third PA was recruited to work at Clock View Hospital, a general adult inpatient unit.This survey aims to establish what level of understanding different members of the inpatient teams across the inpatient wards have of the tasks PAs are permitted to undertake and those they are not.MethodA survey was designed, listing 37 tasks, e.g. completing an admission clerking. For each task, the participant was asked whether a PA is allowed to complete it or not, with three options provided – “can carry out the task”, “cannot carry out the task” and “do not know.” A score of + 1 was awarded if the correct answer was provided, –1 for an incorrect answer and 0 if the respondent didn't know. The highest possible score for a completed survey was + 37 points; the lowest possible score was –37 points.A sample of survey respondents was identified from the three general adult inpatient wards at Clock View Hospital and the Psychiatric Intensive Care Unit (PICU), comprising: senior doctors, junior trainees, Ward Manager, Deputy Ward Manager, Band 5 nurse and Assistant Practitioner.ResultTwenty-four members of staff completed the survey – 3 senior doctors, 4 junior trainees, 4 Ward Managers, 4 Deputy Ward Managers, 5 Band 5 nurses and 4 Assistant Practitioners. The respondents were distributed equally across the three general adult wards and the PICU. The highest survey score was 36 out of 37 (a Consultant); the lowest was 18 (a junior trainee). The lowest mean score was variable across the different grades of staff, with Consultants scoring highest at 29 and Assistant Practitioners and Ward Managers both scoring lowest at 25. There was little variability in mean score (only 2 points) across the three wards and PICU.ConclusionThe results from this survey demonstrate that different members of the inpatient team have a good understanding of what tasks PAs are and are not permitted to. There is still a need to provide further education to inpatient staff to ensure they utilise the PA at Clock View Hospital appropriately and that the PA is able to develop his skill set.

MODIFIED V-Y VOLAR FLAP(ATASOY) TO COVER THE FINGER TIP AMPUTATION

Purpose: Inadequate mobility of Atasoy and Kutler V-Y ap Method: Prospective clinical study Result: Adequate mobility was achieved to cover the stumps of terminal amputation of ngers Conclusion: Modied V-Y volar ap which is reliable and can be easily executed by junior reconstructive surgeons with good postoperative outcome in terms of sensation, length and appearance Summary: Inadequate mobility of Atasoy's V-Y advancement ap to cover the nger tip raw area prompted us to modify the Atasoy's technique. Both the digital neurovascular bundles are identied and included in this modication, thereby, increasing the mobility and reliability with good recovery of function, sensation and appearance. None of aps was lost out of twenty two nger amputations treated by this modied technique. This technique can be easily executed by junior trainee doctors as we incorporate the relatively larger vessels(unlike the digital perforators)which are easily identied by simple loupe magnication.

Common operations

This chapter describes and illustrates key common operations in the paediatric patient. These include circumcision, the drainage of soft tissue abscesses, common nerve injuries, open and laparoscopic inguinal hernia repair, orchidopexy and scrotal exploration, laparotomy, minimally invasive access, pyloromyotomy, laparoscopic fundoplication, appendicectomy, intestinal anastomosis and stomas, and thoracotomy and thoracoscopy. The aim was to include a structured approach to guide the junior trainee in their performance—given that all operations no matter how complex they appear initially are simply a series of steps which when taken together lead to a logical whole. Though obviously not common, the principles behind robotic surgery are described.

Safety of tympanoplasty and ossiculoplasty performed by otorhinolaryngology trainees

ObjectiveThis study aimed to examine the impact of trainee involvement in performing tympanoplasty or tympano-ossiculoplasty on outcomes.MethodsA retrospective analysis was performed of a prospective database of all patients undergoing tympanoplasty and tympano-ossiculoplasty in a single centre during a three-year period. Patients were divided into three primary surgeon groups: consultants, fellows and residents. The outcomes of operative time, surgical complications, length of hospital stay, and air–bone gap improvement were compared among the groups.ResultsThe study included 398 tympanoplasty and tympano-ossiculoplasty surgical procedures, 71 per cent of which were performed by junior trainees (residents). The junior trainee group was associated with a significantly longer surgical time, without adverse impact on outcomes.ConclusionTrainee participation in tympanoplasty and tympano-ossiculoplasty surgery was associated with longer surgical time, but did not negatively affect the peri-operative course or hearing outcome. Therefore, resident involvement in these types of surgery is safe.

Cicatricial ectropion after wound closure of facial laceration†

Patients presenting to the emergency department with facial lacerations are commonplace and often sutured by a junior trainee. Cicatricial ectropion can occur after trauma, surgery and actinic/other dermatological conditions. It can make the eye dry, irritated and vulnerable to infection and water excessively. A 71-year-old man presented to the emergency department after falling off his bike. He had lacerations on his right forehead and right lower eyelid, amongst other injuries. His lacerations were sutured in the emergency department but 2 months later, he presented with scar contracture and was diagnosed with cicatricial ectropion of lower eyelid. This case highlights the risk of ectropion after closure of lacerations which involve the eyelid. Ectropion and how to reduce the risk involved surgically are discussed in this case report. Both diagnosing and operating clinicians should be aware of these risks and inform the patient appropriately.