SP2.2.8Teams, performance, and trust: a perspective from the vanguard

Aims The aim of this study was to determine surgical trainees’ perspective regarding team environment, function, performance, and trust. Methods A 44-point, anonymous survey was distributed to all doctors working in surgery in a single UK Statutory Education Body with responses received from 116 (n = 17 Foundation Year 1 (FY1), n = 50 Senior House Officer (SHO), n = 49 Specialist Registrar (SpR)). Results Psychological safety was associated with trainee grade; SHO perception of support (60.4%, n = 29), FY1 (88.2%, n = 15), SpR (82.4%, n = 42), p = 0.016; and ability to ask for help: SHO (70.8%, n = 34), FY1 (100.0%, n = 17), SpR (92.2%, n = 47 p = 0.043). Dependability among colleagues was perceived to be poorer by women (69.8%, n = 30) than men (87.5%, n = 63, p = 0.009). Clarity of team structure was associated with grade and perceived to be poor by SHOs (60.4%, n = 29) vs. FY1 (94.1%, n = 16) vs. SpR (78.4%, n = 40), p = 0.014. Meaningfulness and impact of team achievement was associated with grade: SHO (68.8%, n = 33) vs. FY1 (76.5%, n = 13) vs. SpR (94.1%, n = 48), p = 0.005. Inverse correlations were observed between the prevalence of harassment/bullying and markers of psychological safety (rho -0.382, p < 0.001), dependability (rho -0.270, p = 0.003), and clarity of team structure (rho -0.355, p < 0.001). Conclusion Important deficiencies in psychological safety impacted two in five of SHOs adversely. Countermeasures (Enhanced Surgical Resilience Training) are needed to protect morale, patient safety, and clinical outcomes.

TP8.2.30 Bleep paralysis: preventing inefficiency on the general surgical on-call

Aims The demand on surgical services is increasing. In our Trust, all surgical referrals and queries are directed through the Senior House Officer (SHO) on-call. This leads to inefficiency, with many hours spent on the telephone and away from clinical duties. Such constant intensity can cause increased stress and anxiety amongst those involved. Junior doctor burnout and stress-related sickness are increasing concerns amongst the current surgical workforce. In an attempt to alleviate these factors, we instigated an intervention to evenly distribute workload during surgical on-calls. Method The number of bleeps through the surgical SHO on-call were audited for four consecutive thirteen hour shifts. Each call was estimated to take an average of five minutes to resolve. A separate GP referral phone was introduced to reduce the volume of traffic through the SHO bleep. The number of calls through the SHO and referral phone were re-audited following this intervention. Results Before introduction of a referral phone, the mean length of time spent by the SHO per shift answering calls was 232.5 minutes, with a maximum of 330 minutes. Post intervention, the SHO spent an average of 92.5 minutes per shift answering calls and referrals through the GP phone averaged 43.75 minutes. Conclusion The introduction of a single point GP referral system has significantly reduced the volume of calls through the SHO, thus has also minimised time spent away from on-call duties. Not only does this improve efficiency within the on-call team, but also reduces risk of burnout amongst trainees.

EP.TU.304The Role of the Surgical Senior House Officer: A Quality Improvement Project

Aim The role of the surgical Senior House Officer (SHO) is very variable and evidence reports that many surgical SHO posts do not meet national quality standards. SHO is an active training role in which the doctor should be exposed to all aspects of General Surgery to prepare them to become a registrar. However, in a busy surgical department this can be difficult to achieve whilst ensuring that acute inpatient care is not compromised. A quality improvement project was undertaken to increase the quality and quantity of training opportunities available for the surgical SHOs in a district general hospital. Methods All of the SHOs in the general surgery department were asked to complete a survey about their experiences as an SHO. A timetable with personalised allocations to on-call cover, theatre sessions, clinics and ward work was introduced. After one month, further survey data was collected to re-assess. Results Prior to the implementation of the new timetable, the SHOs did not understand their role within the department and had minimal exposure to the elective aspects of General Surgery. One month after implementation, job satisfaction was greatly increased and attendance in clinics and theatres had doubled. Conclusion The implementation of this timetable resulted in a significant improvement in training for the surgical SHOs and clarification of their role within the department. By specifying activities within a formal rota, overcrowding of SHOs in theatre sessions and clinics was avoided and it ensured that all SHOs were provided with equal and adequate training opportunities.

Revamping the Ophthalmic Clinical Practice during Pandemic Covid 19; A Potential New Normal

This paper discusses how COVID-19 affected ophthalmology practices at JPMC and the measures taken to minimize the spread of infection among doctors, nurses, administrative staff, and patients. Staff members and doctors were divided into groups consisting of a consultant, two trainees, a house-officer and eight paramedics. Out of the eight paramedics, three were posted in theatre, two inwards and the remaining in outpatient clinics. These measures helped us in the restoration of our services quickly. All elective surgeries were cancelled. In the ward, social distancing was observed. No one was allowed inside the ward without thermal scanning. Only one attendant was allowed with pediatric patients and all the adults, including patient were required to wear masks. Before admitting patients to the ward, a negative COVID-19 PCR test was compulsory. These precautionary measures helped to reduce the spread of coronavirus among the department staff.

Audit of methods used to contact the duty doctor - Abraham Cowley Unit

AimsThe aim of this audit was to determine whether the duty doctor of a 4 ward inpatient psychiatric unit is contacted safely, effectively and in a manner that can be monitored. This is in line with trust protocol and the method stated is via switchboard. Should a deficit be found it was the aim to make an appropriate intervention.BackgroundIn the Abraham Cowley Unit, there is a Senior House Officer ‘on-call’ duty doctor 24/7. The shifts are 2 x 12.5 hours daily and at all times the duty doctor should be contacted via switchboard. Contacting via switchboard is important to ensure there is an audit trail of calls made. Issues that arise from using other methods of contact, e.g. calling direct extensions, include miscommunication and the doctor not being reached in a timely manner. This had been identified as an issue anecdotally by junior doctors on call and also highlighted following an untoward incident.MethodThe method by which the on call doctor was contacted was recorded in Excel for 5 consecutive 12.5 hour shifts in October 2019. The standard set for calls via switchboard was 80%. Following the initial results and the subsequent intervention, a repeat audit was performed using the same method.ResultInitial OutcomeInitially it was found that only 25% of calls received where through the appropriate channel (5 out of 20 calls). This fell far below the 80% standard and an intervention was therefore devised.InterventionIn order to ensure that all ward staff were aware of the trust policy posters were created and placed above all ward telephones and the telephone in the assessment suite office. This information was also handed over to the nurses in charge directly in order for it to be filtered through to other staff during handover.Post Intervention OutcomeFollowing the intervention 88% of calls received where through the appropriate channels (7 out of 8 calls) and the 80% standard was achieved.ConclusionThere has been a demonstrable improvement in the adherence to trust policy when contacting the duty doctor, with the percentage of calls made through the appropriate channel rising from 25% to 88%. This has now met the agreed standard of 80% and will improve the trust's ability to monitor contact of the duty doctor effectively.

Senior house officer perspectives on the educational benefits of a local teaching programme at a specialist orthopaedic hospital

Background: Delivering local teaching programmes equally relevant to all senior house officer (SHO) equivalent junior doctors within a tertiary level specialist hospital is challenging. This study aimed to establish the views of SHOs within a specialist orthopaedic hospital on the value of the current local teaching programme to their educational needs how it may potentially be improved? Methods: Data was collected via questionnaires of SHOs selected through a combination of convenience and purposive sampling. Responses underwent thematic analysis which utilised a hybrid model of a priori and emergent coding. Results: 12 (50%) of SHOs within the hospital responded. Thematic analysis of completed questionnaires resulted in identification of 4 main themes: quality/utility of teaching, content of teaching, accessibility of teaching and non-educational benefits. Feedback received regarding the existing local teaching programme was largely positive. Opinions on the utility and content of the teaching programme were found to be the most varied. Conclusion: This study highlights the difficulties in delivering a teaching programme to a clinical learner group with diverse educational needs in a specialist hospital setting. Such issues may be minimised by learner survey to identify educational topics of equivalent utility to the majority of the learner group.

Quasi-experimental study on the effectiveness of a house officer preparatory course for medical graduates on self-perceived confidence and readiness: a study protocol

IntroductionBeing a house officer (HO) is said to be associated with high levels of stress, leading to mental health problems and sometimes to quitting the medical profession altogether. In Malaysia, the number of HOs completing training on time is slowly declining, with increasing annual dropout rates. Feeling incompetent is one of the contributors towards this growing problem. This study aimed to evaluate the effectiveness of a 3-day pre-HO intervention module in addressing participants’ confidence, readiness and psychological well-being in preparation for their HO training.Methods and analysisThe pre-HO intervention is the ‘Medicorp’ module that includes clerkship, experience sharing, hands-on skills training, common clinical cases and introduction of the local healthcare system. This is a pre-post quasi-experimental study lasting 1 year, with three assessment time points—at pretraining, immediately after training and 1 month into the participants’ HO-ship. The study is currently ongoing and involves 208 participants who attended the course in Malaysia. Participants with known psychiatric illness, working HOs and medical students are excluded. A pretested, self-administered questionnaire that includes baseline sociodemography, adaptation of the International Medical University (IMU) Student Competency Survey and the Depression Anxiety Stress Scale has been adopted, and 1 month follow-up will be conducted by telephone. Data will be analysed using SPSS V.24. The primary outcome is change in confidence level, while the secondary outcomes are changes in the readiness and psychological well-being of the participants.Ethics and disseminationThis study protocol has received ethics approval from Ethics Committee for Research Involving Human Subjects Universiti Putra Malaysia and the National Medical Research Registry Malaysia. Written informed consent has been obtained from each participant. Results will be disseminated through journals and conferences, especially those involved in medical education specifically looking into the training of medical doctors.Trial registration numberNCT03510195.