How do junior doctors spend their time in an Acute Medical Unit?

2015 ◽  
Vol 14 (2) ◽  
pp. 57-60
Author(s):  
Eirini V Kasfiki ◽  
◽  
Mamoon Yusaf ◽  
Jivendra Gosai ◽  
Makani Purva ◽  
...  
Keyword(s):  
General Practice ◽  
Hospital Admission ◽  
Postgraduate Training ◽  
Junior Doctors ◽  
Bed Occupancy ◽  
Medical Unit ◽  
Admission Rates ◽  
The Past ◽  
Acute Medical Unit ◽  
The Uk

In the UK, postgraduate training for doctors has undergone significant changes over the past decade general practice, etc. During this period, hospital admission rates and bed occupancy have also increased.

Editorial

2006 ◽  
Vol 5 (3) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Medical Training ◽  
Case Reports ◽  
Junior Doctors ◽  
Acute Medicine ◽  
The Past ◽  
Acute Medical Unit ◽  
Application Service ◽  
Public House ◽  
The Uk

They say time flies when you’re having fun – and the 5 years since Paul Jenkins convinced me to take over as editor of this journal have certainly flown by. This period has seen a dramatic expansion in the numbers of physicians specialising in Acute Medicine, the confirmation of subspeciality status and development of a training curriculum. Addressing over 300 delegates at the recent Society for Acute Medicine meeting at the Royal College of Physicians, President Mike Jones reminded us that only seven years earlier the Society’s entire membership had sat around a small table in a public house just a few hundred yards from that spot. At that time many were predicting that recruitment to the speciality would be a major challenge. ‘Why would anyone choose to specialise in acute medicine?’ was a question, sometimes whispered in the corridors of St Andrew’s Place. And yet many have made this choice, and many more continue to do so. The Society for Acute Medicine now has upwards of 400 members, a figure which has doubled in the past 12 months. Even more encouraging was the large number of trainees who visited the Acute Medicine stand at the recent BMJ careers fair. Many junior doctors clearly view Acute Medicine as a positive career choice, not the ‘last resort’ which some predicted it may become. However, challenges remain. By the time this edition hits the press the Medical Training Application Service (MTAS) will be swinging into action to produce the first applicants for ‘post MMC’ training positions across the UK. For those of us who are involved in the shortlisting and interview process, the enormity of the task is rapidly becoming apparent. In Wessex, the Deanery has suggested that Acute Medicine shortlisting may take as much as a week, with a further week set aside for interviews of the hopeful candidates. Then comes ‘round two’, later in the year, when potentially we do it all over again. Suddenly the prospect of annual leave in the months of March or April looks like a forlorn hope. But before I break this news to my wife and family, I should spare a thought for those readers who find themselves on the opposite side of the process. To be part of the first cohort of trainees to be involved in this must be a daunting prospect. Many of those enthusiastic potential recruits to the speciality are clearly struggling to know where to turn to for advice on the process, confused by often contradictory messages and unanswered questions. Hopefully all will become clearer as the deadlines approach. A smaller ‘Reviews’ section in this edition reflects a dramatic increase in the number of articles submitted for consideration of publication in this journal over the past 6 months. As a result we have accommodated more case reports than normal, along with two papers in our new section for research and audit. I would encourage similar submissions in the future; case reports need not be rare or esoteric, provided they contain a clear teaching message clinicians involved in the acute ‘take’. Completed audits will be considered if they demonstrate clear evidence of how to improve practice in an acute medical unit. Owing to some software problems, Rila has temporarily suspended their submissions website which, until recently, had been the mechanism for submission of articles to this journal. Until these problems are resolved, I would be grateful if any articles could be e-mailed directly to me at the address shown on this page, so that I can arrange for peer review. Finally, a reminder that this edition concludes the cycle of reviews which started in 2002 and has now covered the majority of conditions presenting as emergencies on the acute medical ‘take’. The new cycle, starting in 2007 with volume 6 issue 1 will follow a modified pattern, with different authors hopefully providing a fresh perspective in their updated reviews. My thanks go to all of the authors who have produced material over the past 5 years as well as to the editorial board for their ongoing hard work in commissioning articles for the past and future cycles.

scholarly journals Current Practice in Paediatric Orthopaedic Trauma Care: A Retrospective Comparison Study

2013 ◽  
Vol 95 (8) ◽  
pp. 1-6
Author(s):  
JW Penn ◽  
NMP Clarke
Keyword(s):  
Hospital Admission ◽  
Current Practice ◽  
Comparison Study ◽  
Accidental Injury ◽  
Admission Rates ◽  
The Past ◽  
Retrospective Comparison ◽  
Paediatric Fracture ◽  
Paediatric Orthopaedic ◽  
The Uk

Accidental injury has been demonstrated repeatedly to be the leading cause of morbidity, mortality and hospital admission in children aged 5–16 years in the UK, with an estimated annual cost of £200 million. The past 40 years have seen an increase in paediatric fracture rates by at least 30 per cent, as reflected by increased hospital admission rates. This illustrates the continuation of a trend identified by a large swedish study of more than 8,000 paediatric fractures between the years 1950 and 1979, which showed a doubling of the incidence of fractures for boys and girls below the age of 16 during the course of this 30-year period.

scholarly journals Rhythmicity of patient flow in an acute medical unit: relationship to hospital occupancy, seven-day working, and the effect of COVID-19

QJM ◽  
2021 ◽  
Author(s):  
S J Dauncey ◽  
P A Kelly ◽  
D Baykov ◽  
A C Skeldon ◽  
M B Whyte
Keyword(s):  
Hospital Admissions ◽  
Fourier Transforms ◽  
Patient Flow ◽  
Cohort Analysis ◽  
Information Management System ◽  
Hospital Performance ◽  
Bed Occupancy ◽  
Urban Hospital ◽  
Medical Unit ◽  
Acute Medical Unit

Abstract Background The Acute Medical Unit (AMU) provides care for unscheduled hospital admissions. Seven-day Consultant presence and morning AMU discharges have been advocated to improve hospital bed management. Aims To determine whether a later time of daily peak AMU occupancy correlates with measures of hospital stress; whether seven-day Consultant presence, for COVID-19, abolished weekly periodicity of discharges. Design Retrospective cohort analysis Methods Anonymised AMU admission and discharge times were retrieved from the Profile Information Management System (PIMS), at a large, urban hospital from 14th April 2014—31st December 2018 and 20th March—2nd May 2020 (COVID-19 peak). Minute-by-minute admission and discharge times were combined to construct a running total of AMU bed occupancy. Fourier transforms were used to determine periodicity. We tested association between i) average AMU occupancy and ii) time of peak AMU occupancy, with measures of hospital stress (total medical bed occupancy and ‘medical outliers’ on non-medical wards). Results Daily, weekly and seasonal patterns of AMU bed occupancy were evident. Timing of AMU peak occupancy was unrelated to each measure of hospital stress: total medical inpatients (Spearman’s rho, rs=0.04, P = 0.24); number of medical outliers (rs=-0.06, P = 0.05). During COVID-19, daily bed occupancy was similar, with continuation of greater Friday and Monday discharges than the weekend. Conclusions Timing of peak AMU occupancy did not alter with hospital stress. Efforts to increase morning AMU discharges are likely to have little effect on hospital performance. Seven-day Consultant presence did not abolish weekly periodicity of discharges – other factors influence weekend discharges.

Does UK medical education provide doctors with sufficient skills and knowledge to manage patients with eating disorders safely?

2018 ◽  
Vol 94 (1113) ◽  
pp. 374-380 ◽  
Author(s):  
Agnes Ayton ◽  
Ali Ibrahim
Keyword(s):  
Eating Disorders ◽  
Patient Safety ◽  
Eating Disorder ◽  
Postgraduate Training ◽  
Medical Training ◽  
Improve Patient Safety ◽  
Medical Schools ◽  
Junior Doctors ◽  
The Uk ◽  
Improve Patient

BackgroundEating disorders affect 1%–4% of the population and they are associated with an increased rate of mortality and multimorbidity. Following the avoidable deaths of three people the parliamentary ombudsman called for a review of training for all junior doctors to improve patient safety.ObjectiveTo review the teaching and assessment relating to eating disorders at all levels of medical training in the UK.MethodWe surveyed all the UK medical schools about their curricula, teaching and examinations related to eating disorders in 2017. Furthermore, we reviewed curricula and requirements for annual progression (Annual Review of Competence Progression (ARCP)) for all relevant postgraduate training programmes, including foundation training, general practice and 33 specialties.Main outcome measuresInclusion of eating disorders in curricula, time dedicated to teaching, assessment methods and ARCP requirements.ResultsThe medical school response rate was 93%. The total number of hours spent on eating disorder teaching in medical schools is <2 hours. Postgraduate training adds little more, with the exception of child and adolescent psychiatry. The majority of doctors are never assessed on their knowledge of eating disorders during their entire training, and only a few medical students and trainees have the opportunity to choose a specialist placement to develop their clinical skills.ConclusionsEating disorder teaching is minimal during the 10–16 years of undergraduate and postgraduate medical training in the UK. Given the risk of mortality and multimorbidity associated with these disorders, this needs to be urgently reviewed to improve patient safety.

scholarly journals Anaesthetic Higher Specialty Training Recruitment in the United Kingdom During the COVID-19 Pandemic: A National Survey

2021 ◽  
Author(s):  
Fionnuala Durrant ◽  
Stuart Edwardson ◽  
Sally El-Ghazali ◽  
Christopher Holt ◽  
Roopa McCrossan ◽  
...  
Keyword(s):  
Postgraduate Training ◽  
Medical Profession ◽  
Medical Specialty ◽  
Further Education ◽  
Similar Proportion ◽  
Junior Doctors ◽  
Free Text ◽  
Recruitment Process ◽  
Training Requirements ◽  
The Uk

The most recent ST3 Anaesthetic recruitment for posts commencing in August 2021 saw larger numbers of applicants (n = 1,056) compared to previous years, with approximately 700 applicants failing to secure an ST3 post. We surveyed 536 anaesthetic junior doctors who applied for ST3 posts during this application round with the aim of investigating their experience of the recruitment process this year (response rate 536/1,056 = 51%). Approximately 61% were not offered ST3 posts (n = 326), a similar proportion to that previously reported. We asked all respondents what their potential career plans were for the next 12 to 24 months. The majority expressed intentions to take up either CT3 top-up posts or non-training fellow posts from August 2021 (79%). Other options considered by respondents included: pursuing work abroad (17%), embarking on a career break (16%), taking up an ST3 post in intensive care medicine instead of anaesthetics (15%) and permanently leaving the medical profession (9%). A number of respondents expressed a desire to pursue training in a different medical specialty (9%). Some respondents expressed an intention to pursue further education or research (10%). A large proportion of respondents (42%) expressed a lack of confidence in being able to achieve the necessary training requirements to later apply for ST4 in August 2023. The majority of respondents reported not feeling confident in achieving GMC Specialty Registration in Anaesthesia in the future without a training number (75%), and that their wider life plans have been disrupted due to the impending time out of training (78%). We received a total of 384 free-text responses to a question asking about general concerns regarding the ST3 applications process. Sentiment analysis of these free-text responses indicated that respondents felt generally negatively about the ST3 recruitment process. Some themes that were elicited from the responses included: respondents feeling the recruitment process lacked fairness, respondents suffering burnout and negative impacts on their wellbeing, difficulties in making plans for their personal lives, and feeling undervalued and abandoned despite having made personal sacrifices to support the health service during the COVID-19 pandemic. These results suggest that junior anaesthetic doctors in the UK currently have a negative perception towards postgraduate training structures, which has been exacerbated by the COVID-19 pandemic, changes to the postgraduate training curriculum and difficulties in securing higher training posts.

Junior doctors and fitness to practice procedures in the UK: analysis of factors prompting tribunal referrals and outcomes

2021 ◽  
pp. postgradmedj-2021-140284
Author(s):  
Helen Grote ◽  
Flora Greig
Keyword(s):  
Postgraduate Training ◽  
Postgraduate Education ◽  
Medical Practitioner ◽  
Male Gender ◽  
Junior Doctors ◽  
Legal Representation ◽  
Academic Achievements ◽  
Qualitative Thematic Analysis ◽  
Foundation Programme ◽  
The Uk

Purpose of the studyTo ascertain factors influencing referral to, and outcomes from medical tribunals for junior doctors with less than 7 years of postgraduate training.Study designA mixed methods analysis of 49 publicly available determinations from the UK Medical Practitioner Tribunal Service (MPTS) between 2014 and 2020 was undertaken. Data on demographics, training grade, type of case and outcomes from the tribunal were recorded. A qualitative thematic analysis of the determinations was also undertaken, with themes being identified based on frequency and pertinence to the process of determination.ResultsThe largest group of junior doctors referred to an MPTS tribunal (38%) was those on the foundation programme; in their first 2 years postgraduation. Fifty-three per cent of all junior doctors referred to a tribunal were erased from the medical register. Erasure from the register was significantly associated with male gender, less than 4 years postqualification, non-attendance at the tribunal hearing, lack of legal representation and lack of insight or remorse at the tribunal hearing. Several cases involved dishonesty in relation to academic achievements and workplace-based assessments.ConclusionConsideration should be given as to how best to support the transition in professional identity from student to doctor. Teaching medical professionalism should be a priority in undergraduate and early postgraduate education, with lessons from fitness to practice tribunals shared for educational purposes.

Psychiatric Hospital Admission Rates in Jamaica, 1971 and 1988

1991 ◽  
Vol 159 (6) ◽  
pp. 817-821 ◽  
Author(s):  
Frederick W. Hickling
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Hospital Admission ◽  
Psychiatric Hospital ◽  
Admission Rate ◽  
Community Mental Health Service ◽  
Psychiatric Admission ◽  
Admission Rates ◽  
The Uk ◽  
Wide Community

The overall psychiatric hospital admission rates in Jamaica were 136 per 100 000 in 1971 and 69 per 100 000 in 1988. The admission rate for schizophrenia was 69 per 100 000 in 1971 and 35 per 100 000 in 1988. The 49% reduction in admission rates over these 17 years is attributed to the introduction of an island-wide community mental health service with psychiatric admission to general parish hospitals in 1972. This admission rate for schizophrenia is five to six times lower than the rate reported for Afro-Caribbeans in the UK by a number of studies, and is more in keeping with the admission rate for schizophrenia reported for the general population in England.

scholarly journals A patient with palpitations

2014 ◽  
Vol 13 (4) ◽  
pp. 182-182
Author(s):  
Legate Philip ◽  
◽  
Kristel Longman ◽  
Neil Andrews ◽  
◽  
...  
Keyword(s):  
Chest Pain ◽  
Exercise Tolerance ◽  
Medical Unit ◽  
The Past ◽  
Acute Medical Unit

A 52 year old woman presented to the Acute Medical Unit with her 4th episode of palpitations in the past four weeks. Each episode was similar in nature and described as being acute in onset, fast and regular, associated with pre-syncope but never syncope or chest pain. The episodes lasted for 30 – 45 minutes and would self terminate. Of particular note, the episodes were not associated with exertion and she had a normal exercise tolerance.

scholarly journals Trainee Update September 2014

2014 ◽  
Vol 13 (3) ◽  
pp. 131-131
Author(s):  
Nerys Conway
Keyword(s):  
Internal Medicine ◽  
Chief Executive ◽  
Important Work ◽  
Acute Medicine ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
The Family ◽  
The Uk ◽  
Southmead Hospital ◽  
New Jobs

I hope you have all settled well into your new jobs and a very warm welcome to those that have recently joined the ‘family’ of acute medicine. I would first of all like to thank Ruth Johnson for all her hard work as trainee representative over the last 18 months and wish her all the best as she ventures into consultant territory: her replacement will be announced later in the autumn. July was a busy month, dominated by our Acute Medicine Awareness Week, during which AMUs across the UK undertook events to raise the profile of the speciality and the important work they were doing locally. Barnsley completed a 25 mile virtual marathon, Crosshouse Hospital made £350 in a cake sale, Salford Royal staff walked around every acute medical unit in Greater Manchester, North Staffordshire staff ran a half marathon and there was more cake on sale in Kings College and Leicester Royal. The AMU staff at Southampton raised over £400 with their cake sale and cycle challenge, during which they were joined by the Trust Chief Executive for a ‘virtual’ 120 miles on an exercise bike situated outside the hospital entrance. The highlight, however was the contribution of Dr Nigel Lane, an acute medicine trainee from Southmead Hospital in North Bristol, who put together an outstanding weekly programme of events. This included a visit from the Chief Executive of the trust, visit from local GPs to the unit, daily MDT teaching, daily ‘messages of the day’ located on the trust website and lots of screensavers, banners and information scattered throughout the hospital. I am delighted to announce that Nigel has received the SAM awareness week prize. This involves the opportunity to join the European School of Internal Medicine and attend the winter EFIM school camp in Latvia. Nigel will also be joining us as one of the speakers in the trainee session at SAM Brighton. He will be speaking on “Preparing for your PYA”. There will also be talks in the trainee session on “Keeping your e-portfolio updated”, “Choosing your specialist skill” and “Preparing for your consultant job”. The session will be aimed at both junior and senior trainees. The trainee that has produced the best poster at Brighton will also have a chance to win a place to attend the summer EFIM school camp. The day before the conference starts there will be a SCE revision session. I attended last year and found it extremely helpful! Looking forward to seeing you all in Brighton. In the meantime if you have any problems or suggestions please tweet or email me at the addresses below.

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