scholarly journals Induction shouldn't be painful: improving psychiatry local induction for junior doctors across the South West

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S16-S16
Author(s):  
Bethany Cole ◽  
Harriet Greenstone
Keyword(s):  
Medical Education ◽  
Vital Role ◽  
Junior Doctors ◽  
Specific Information ◽  
Post Intervention ◽  
High Quality ◽  
Face To Face ◽  
Start Date ◽  
Exception Reporting ◽  
Job Role

AimsThe GMC recommends that organisations ensure learners have an induction in preparation for each placement. We aimed to ensure that high quality induction was being delivered in psychiatry posts across the whole of the Severn Deanery. This included multiple localities (Bristol, Bath, Swindon, Devizes, Weston-Super-Mare, Gloucester, Cheltenham, Taunton and Yeovil) across three NHS trusts.BackgroundInduction plays a vital role in preparing doctors for their new roles. Crucially, some doctors are not only new to the specific role and site, but also new to the specialty (for example, Foundation Doctors and GP Trainees). In Severn, each locality takes responsibility for providing Junior Doctors with a locality-specific induction; these occur four times per year. Previous feedback from trainees in Severn was poor; as demonstrated by informal feedback and the August 2018's GMC survey results, showing some localities ‘required improvement’.MethodPre- and post-intervention measurements were ascertained by written questionnaires for Foundation Doctors, GP Trainees and Core Trainees in Psychiatry. Baseline questionnaires were completed in August/September 2019. Five ‘Plan, Do, Study, Act’ Cycles were completed over the following eighteen months. Examples of the changes made included incorporating ‘missed’ topics (such as wellbeing, seclusion reviews and exception reporting) and specific information to on-call responsibilities, reducing replicated information, and touring clinical sites. These changes were coordinated via monthly meetings between Locality Trainee Leads (LTLs).ResultThere was an overall improvement in trainee's satisfaction with induction. Outcomes also included the development of an induction checklist specific to each locality and a ‘gold standard’ list for what local induction should involve. This is hopefully soon to be ratified by the Medical Education department and Severn Deanery.ConclusionHaving worked on this project for over 18 months, sustainability of change remains a crucial issue. In response to this, we have established several recommendations: the LTL job role needs to be revised to include updating the written induction handbook in each locality and delivering face-to-face induction. Outgoing and incoming LTLs will plan each induction together, at least 4 to 8 weeks before the start date. Support from Medical Education regarding attendees at each induction is to be put in place. Handbooks will be shared across localities, so that the ‘core’ information is consistent. Ongoing feedback will ensure that Junior Doctors continue to receive a high quality and relevant induction.

scholarly journals Constructing high-quality rest facilities to maximise performance and ensure patient safety

2021 ◽  
Vol 10 (3) ◽  
pp. e001403
Author(s):  
Geeth Silva ◽  
Aiken Yam ◽  
Jessica Court ◽  
Rabia Imtiaz ◽  
Cath Chisholm
Keyword(s):  
Patient Safety ◽  
Well Being ◽  
Recovery Phase ◽  
Alternative Methods ◽  
Junior Doctors ◽  
High Quality ◽  
Ensure Patient Safety ◽  
Being There ◽  
Exception Reporting

IntroductionJunior doctors are working in an increasingly overstretched National Health Service. In 2018, Kettering General Hospital (KGH) was awarded £60 800 of government funds to create high-quality rest facilities and improve junior doctor well-being.MethodsAn audit and survey in KGH identified the structural and functional improvements needed. From November 2019 to June 2020, £47 841.24 was spent on creating new rest facilities. On completion, a postaction review assessed how the changes impacted morale, well-being and quality of patient care.ResultsThe majority of doctors were happy with the new rest areas (60%), a majority felt that they would use the on-call room area (63%) and the renovation improved morale and well-being. There was an increased ability to take breaks. However, the majority of doctors are not exception-reporting missing breaks: 79% (2019), 74% (2020).Conclusions and ImplicationsThis report recommends the maintenance of increased staffing levels and rest facilities during the recovery phase of COVID-19. The remaining £12 958.76 should be directed at sustaining the quality of KGH rest facilities. Lastly, the rate of exception-reporting must be increased through improving awareness, exploring alternative methods and supporting the action when necessary. The continual investment into rest facilities ensures workforce well-being and translates into patient safety.

Generating publicly available progress notes of authentic quality: A crowdsourcing-based approach (Preprint)

2020 ◽  
Author(s):  
Rina Kagawa ◽  
Yukino Baba ◽  
Hideo Tsurushima
Keyword(s):  
Social Capital ◽  
Medical Education ◽  
Medical Practice ◽  
Patient Privacy ◽  
Patient Anxiety ◽  
Physical Status ◽  
High Quality ◽  
Privacy Concerns ◽  
Progress Notes ◽  
Research And Education

BACKGROUND Sharing progress notes as a common social capital is essential in research and education, but the content of progress notes is sensitive and needs to be kept confidential. Publishing actual progress notes are difficult due to privacy concerns. OBJECTIVE This study aims to generate a large repository of pseudo-progress notes of authentic quality. We focused on two requirements for authentic quality: the validity and consistency of the data, from the perspective of medical practice, and the empirical and semantic characteristics of progress notes, such as shorthand styles used for reporting changes in a patient's physical status, long narrative sentences detailing patient anxiety, and interprofessional communications. METHODS We proposed a practical framework that consists of a simulation of the notes and evaluation of the simulated notes. The framework utilized two human cognitive traits: (1) the ability to use imitation to simulate objects with diverse characteristics without background knowledge and (2) the use of comparison as a strategy for deep thinking. This enabled crowd workers to generate a large number of progress notes. Our framework involved three steps. In step 1, crowd workers imitated actual progress notes decomposed into subject data (S), object data (O), and assessment and plan (A/P). These imitated texts were then shuffled and recomposed in S, O, and A/P in order to create simulated progress notes. In step 2, crowd workers identified the characteristics of actual progress notes based on comparisons between actual and dummy progress notes. These characteristics were clustered based on their similarities. Each cluster exhibited the empirical and semantic characteristics of the actual progress notes. Finally, in step 3, the texts from step 1 that exhibited the identified characteristics from step 2 were evaluated as quality-guaranteed progress notes that met the two requirements. All data were preprocessed to protect patient privacy. RESULTS Step 1: By recomposing the 700 imitated texts, 9,856 simulated progress notes were generated. Step 2: 3,938 differences between actual progress notes and dummy progress notes were identified. After clustering, 166 characteristics were evaluated to be appropriate as empirical and semantic characteristics of the actual progress notes. Step 3: 500 crowd workers demonstrated that 83.0% of the simulated progress notes satisfied at least one of the characteristics obtained in step 2. The crowd workers' artificially-reproduced progress notes were evaluated to determine the most realistic, based on four metrics: disease, morpheme, readability, and reality. CONCLUSIONS Our results demonstrated that crowd workers could generate and evaluate highly professional documents. We have made our large repository of high-quality crowdsourced progress notes publicly available, and we encourage their use in the development of medical education and research.

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 Medical Education and Training Within Congenital Cardiology: Current Global Status and Future Directions in A Post COVID-19 World

2021 ◽  
pp. 1-40
Author(s):  
Colin J. McMahon ◽  
Justin T. Tretter ◽  
Andrew N. Redington ◽  
Frances Bu’Lock ◽  
Liesl Zühlke ◽  
...  
Keyword(s):  
Medical Education ◽  
Vital Role ◽  
Current Status ◽  
Technology Enhanced Learning ◽  
Middle Income ◽  
Critical Reasoning ◽  
Professional Activities ◽  
Competency Frameworks ◽  
Medical Education And Training ◽  
Global Status

Abstract Despite enormous strides in our field with respect to patient care, there has been surprisingly limited dialogue on how to train and educate the next generation of congenital cardiologists. This paper reviews the current status of training and evolving developments in medical education pertinent to congenital cardiology. The adoption of competency-based medical education has been lauded as a robust framework for contemporary medical education over the last two decades. However, inconsistencies in frameworks across different jurisdictions remain, and bridging gaps between competency frameworks and clinical practice has proved challenging. Entrustable professional activities have been proposed as a solution but integration of such activities into busy clinical cardiology practices will present its own challenges. Consequently, this pivot toward a more structured approach to medical education necessitates the widespread availability of appropriately trained medical educationalists; a development that will better inform curriculum development, instructional design, and assessment. Differentiation between superficial and deep learning, the vital role of rich formative feedback and coaching, should guide our trainees to become self-regulated learners, capable of critical reasoning yet retaining an awareness of uncertainty and ambiguity. Furthermore, disruptive innovations such as ‘technology enhanced learning’ may be leveraged to improve education, especially for trainees from low- and middle-income countries. Each of these initiatives will require resources, widespread advocacy and raised awareness, and publication of supporting data, and so it is especially gratifying that Cardiology in The Young has fostered a progressive approach, agreeing to publish one or two articles in each journal issue in this domain.

scholarly journals European List of Essential Medicines for Medical Education: a protocol for a modified Delphi study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045635
Author(s):  
Erik Donker ◽  
David Brinkman ◽  
Milan Richir ◽  
Paraskevi Papaioannidou ◽  
Robert Likic ◽  
...  
Keyword(s):  
Medical Education ◽  
Delphi Study ◽  
Medical Training ◽  
Medical Center ◽  
European Countries ◽  
Essential Medicines ◽  
Ethical Review ◽  
Junior Doctors ◽  
Direct Supervision ◽  
Modified Delphi

IntroductionJunior doctors are responsible for a substantial number of prescribing errors, and final-year medical students lack sufficient prescribing knowledge and skills just before they graduate. Various national and international projects have been initiated to reform the teaching of clinical pharmacology and therapeutics (CP&T) during undergraduate medical training. However, there is as yet no list of commonly prescribed and available medicines that European doctors should be able to independently prescribe safely and effectively without direct supervision. Such a list could form the basis for a European Prescribing Exam and would harmonise European CP&T education. Therefore, the aim of this study is to reach consensus on a list of widely prescribed medicines, available in most European countries, that European junior doctors should be able to independently prescribe safely and effectively without direct supervision: the European List of Essential Medicines for Medical Education.Methods and analysisThis modified Delphi study will recruit European CP&T teachers (expert group). Two Delphi rounds will be carried out to enable a list to be drawn up of medicines that are available in ≥80% of European countries, which are considered standard prescribing practice, and which junior doctors should be able to prescribe safely and effectively without supervision.Ethics and disseminationThe study has been approved by the Medical Ethics Review Committee of VU University Medical Center (no. 2020.335) and by the Ethical Review Board of the Netherlands Association for Medical Education (approved project no. NVMO‐ERB 2020.4.8). The European List of Essential Medicines for Medical Education will be presented at national and international conferences and will be submitted to international peer-reviewed journals. It will also be used to develop and implement the European Prescribing Exam.

Kids and Diabetes in Schools (KiDS) intervention in India: Participants’ perspectives

2021 ◽  
pp. 001789692110054
Author(s):  
Tina Rawal ◽  
Soumyadeep Bhaumik ◽  
Radhika Shrivastav ◽  
Gaurang P Nazar ◽  
Nikhil Tandon ◽  
...  
Keyword(s):  
School Environment ◽  
Diabetes Management ◽  
Technical Information ◽  
Qualitative Evaluation ◽  
Visual Aids ◽  
Management Skills ◽  
Post Intervention ◽  
Total N ◽  
Face To Face ◽  
Teachers And Parents

Objectives: The purpose of this study was to assess the experience and satisfaction of teachers and parents of children with and without diabetes, with the Kids and Diabetes in School (KiDS) intervention. Project KiDS aimed to foster a safe and supportive school environment to encourage the management of type 1 diabetes and prevention of type 2 diabetes. Design: This qualitative evaluation involved semi-structured, face-to-face, in-depth interviews with a purposive sample of 35 respondents, including teachers and parents of children with and without diabetes attending the selected schools at 1 and 3 months post-intervention implementation. In total, n = 5 schools (3 government and 2 private) were selected out of 15 schools in which the KiDS project was implemented. Methods: In total, 65 interviews were conducted in two rounds. The sample comprised teachers ( n = 20 in round 1; n = 18 in round 2), parents of children with diabetes ( n = 3 in both the rounds) and parents of children without diabetes ( n = 15 in round 1; n = 6 in round 2) attending five schools. Data were analysed using the thematic framework method. Results: Teachers reported gaining new knowledge as a result of the KiDS intervention. They felt more confident in assisting children with diabetes. Suggestions to strengthen the KiDS resource pack were the inclusion of case studies and audio-visual aids. Parents of children with diabetes reported that the project reinforced information and improved diabetes management skills. Their suggestions for strengthening KiDS materials included the provision of additional technical information. The parents of children without diabetes reported that the resource pack aided a better understanding of diabetes and clarified myths and misconceptions. Suggestions for strengthening the pack included the regular reinforcement of information on diabetes among children. Conclusion: Findings support the upscaling of KiDS work elsewhere in India through the engagement of multiple stakeholders to promote the management and prevention of diabetes in school.

scholarly journals Feasibility and acceptability of a culturally tailored physical activity intervention for Arab-Australian women

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aymen El Masri ◽  
Gregory S. Kolt ◽  
Emma S. George
Keyword(s):  
Physical Activity ◽  
Physical Activity Intervention ◽  
Short Form ◽  
Trial Registration ◽  
Post Intervention ◽  
Face To Face ◽  
Physical Activity Interventions ◽  
Culturally Tailored ◽  
Session Attendance ◽  
Australian Community

Abstract Background Despite being one of the largest migrant groups in Australia, few physical activity interventions exist for Arab-Australians. The primary aim of this study was to test the feasibility and acceptability of a 12-week culturally tailored physical activity intervention for Arab-Australian women. Methods This study used a single-group pretest–posttest design, and was informed by extensive formative research and consultation involving the Arab-Australian community. Participants were insufficiently active Arab-Australian women aged 35–64 with no current illness or injury that would limit physical activity participation. The intervention comprised 6 face-to-face physical activity and education sessions over 12 weeks. The intervention was conducted at 2 separate intervention sites in Western Sydney, Australia. Feasibility outcomes included recruitment, session attendance, and retention. The acceptability of the intervention was assessed through a process evaluation questionnaire completed post-intervention. Accelerometers and the short-form International Physical Activity Questionnaire were used to measure physical activity at baseline and post-intervention. Descriptive statistics were used for feasibility and acceptability outcomes, and changes in physical activity were examined using Wilcoxon signed-rank tests. Results Of the 53 women who were contacted or expressed interest, 22 were eligible and enrolled in the study. Participants were primarily recruited through direct contact by Arab-Australian community workers and by word-of-mouth. Average session attendance was 63% and the retention rate post-intervention was 68%. The culturally-related intervention components, such as the appropriateness of content, and women-only setting, were rated highly favourably (4.33 to 4.87/5). General intervention elements, such as the face-to-face delivery, knowledge and approachability of facilitators, and session structure, were also rated favourably (4.33 to 4.93/5), and the lowest scored item was the intervention session frequency (3.2/5). There were no statistically significant changes in physical activity post-intervention. Conclusions The findings from this study highlighted factors related to recruitment and delivery that need to be considered when developing physical activity interventions for Arab-Australian women. Further research is required using a larger sample and a randomised controlled trial design to examine the longer-term impact on physical activity, and to also examine ways of increasing intervention engagement and retention among Arab-Australian women. Trial Registration: ANZCTR, ACTRN12618001392257. Registered 20 August 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375636.

Increasing Home Health Face-to-Face Certification: Impact of a Hospital-Based Intervention

2018 ◽  
Vol 30 (3) ◽  
pp. 110-115
Author(s):  
Kimberly Pelland ◽  
Emily Cooper ◽  
Alyssa DaCunha ◽  
Kathleen Calandra ◽  
Rebekah Gardner
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Home Health ◽  
Hospitalized Patients ◽  
Post Intervention ◽  
Face To Face ◽  
Hospital Physicians ◽  
Health Agencies ◽  
Community Physician ◽  
Home Health Agencies

Medicare requires that home health patients have a face-to-face visit with a physician when services are initiated and that physicians provide certification of this encounter before home health agencies (HHAs) can be reimbursed. We assessed an intervention to increase completion of face-to-face certification by hospital physicians at discharge using a retrospective chart review. We found a shift in the source and timeliness of certification among intervention hospitals. Pre-intervention, hospital physicians completed face-to-face certifications for 18.7% of patients and community physicians completed certifications for 47.2% ( p < .001), compared with 44.4% and 24.3% ( p < .001) post-intervention. Shifting the source of certification from community to hospital physicians helped HHAs by reducing the burden of tracking down certification from community physician offices and facilitating timely care for recently hospitalized patients.

Cross-disciplinary perspectives on the transition to remote education

2021 ◽  
pp. bmjstel-2020-000814
Author(s):  
Natasha Houghton ◽  
Will Houstoun ◽  
Sophie Yates ◽  
Bill Badley ◽  
Roger Kneebone
Keyword(s):  
Medical Education ◽  
Performing Arts ◽  
Procedural Knowledge ◽  
Clinical Skills ◽  
Technology Enhanced Learning ◽  
Practical Skills ◽  
Digital Resources ◽  
Face To Face ◽  
Direct Patient Contact ◽  
Enhanced Learning

The COVID-19 pandemic has prompted the cancellation of clinical attachments and face-to-face teaching at medical schools across the world. Experiential learning—through simulation or direct patient contact—is essential for the development of clinical skills and procedural knowledge. Adapting this type of teaching for remote delivery is a major challenge for undergraduate medical education. It is also an opportunity for innovation in technology enhanced learning and prompts educators to embrace new ways of thinking. In this article, the authors explored how educators from different disciplines (medicine, music and performing arts) are using technology to enhance practical skills-based learning remotely.The authors, five experienced educators from different fields (surgery, medicine, music and magic), jointly documented the transition to technology enhanced remote teaching through a series of five structured conversations. Drawing from literature on distance learning in medicine and professional experience in education, the authors identified seven practice-enhancing recommendations for optimising teaching of procedural knowledge and skills. These are: (1) make a virtue out of necessity; (2) actively manage your environment; (3) make expectations clear; (4) embrace purposeful communication; (5) use digital resources; (6) be prepared for things to go wrong and (7) personalise the approach. The authors argue that widening the discourse in technology enhanced learning to include cross-disciplinary perspectives adds richness and depth to discussions. This article demonstrates a cross-disciplinary approach to addressing challenges in technology-enhanced medical education.

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