EP.FRI.500 Establishing a protocol of management of acute bowel obstruction in a tertiary hospital in the Middle East

Aim To establish a protocol of management of acute bowel obstruction in a tertiary hospital in the Middle East. Method An online search in PubMed, Cochrane reviews and Google Scholar for the period between 2010 and 2020 was performed to identify all published guidelines and recommendations for the management of acute bowel obstruction including the keywords small/large bowel or intestinal obstruction, adhesive obstruction, complete/ partial obstruction and conservative/ surgical management of bowel obstruction. Results A protocol of management of acute bowel obstruction has been developed, reviewed and approved by different concerned departments in the hospital. The indicators to monitor the implementation of the protocol had been approved by the Quality and Risk Management Committee of the hospital. The protocol is divided into 7 sections. These sections include:1) ER assessment with all essential clinical, laboratory and radiological investigations required going hand in hand with resuscitation, hydration, pain control and antibiotic prophylaxis.2) Surgical assessment by senior trainee who will liaise with consultant surgery on call. 3) Radiological assessment guidelines done by senior Radiologist to review the CT scan. 4) Admission criteria. 5) Risk prediction scorings with involvement of critical care team if indicated. 6) Surgical management guidelines with rapid access to operating theatre if indicated. 7) Non- surgical management guidelines including conservative, radiological and endoscopic management. Conclusion Multidisciplinary team approach is essential for the management of acute bowel obstruction. Hospital agreed guidelines and protocols can reduce the significant morbidity and mortality associated with common clinical conditions hence improving patient’s care.

Effecting a national implementation project through distributed leadership in the West Midlands: rising to the spread challenge

We describe the utility and impact of a distributed leadership model to implement a National Health Service (NHS) England Academic Health Sciences national quality improvement programme, in the West Midlands. This model was adopted to address the inherent difficulties of implementing change in practice in a large geographical region with a diverse population of health service personnel. We report on the inclusion of a senior trainee as part of the implementation team, supported by a multidisciplinary clinical consultant team, with equal agency in decision making, acting as mentors and activators in the background.

Job satisfaction, engagement, and burnout in the population of orthopedic surgeon and neurosurgeon trainees in mainland China

OBJECTIVEIn China, orthopedics and neurosurgery are among the most desired majors for medical students. However, little is known about the working and living status of specialists in these two fields. This study was aimed at evaluating job satisfaction, engagement, and burnout in the population of Chinese orthopedist and neurosurgeon trainees.METHODSA nationwide online survey was administered in mainland China. Questionnaires were answered anonymously. Job satisfaction, engagement, and burnout were assessed using the Job Descriptive Index, the Utrecht Work Engagement Scale, and the Maslach Burnout Inventory, respectively.RESULTSData were collected from 643 orthopedist trainees and 690 neurosurgeon trainees. Orthopedists and neurosurgeons showed no statistical difference in terms of age, sex, job titles, and preference for working in tertiary hospitals. Orthopedists had a higher marriage rate (p < 0.01), a lower divorce rate (p = 0.017), relatively shorter working hours (p < 0.01), and a higher annual income (p = 0.023) than neurosurgeons. Approximately 40% of respondents experienced workplace violence in the last 5 years. Less than 10% of respondents were satisfied with their pay, and over 70% would not encourage their offspring to become a doctor. Orthopedists were more satisfied with their careers than neurosurgeons (p < 0.01) and had a higher level of work engagement (p < 0.01). In addition, a higher proportion of orthopedists were burnt out (p < 0.01) than neurosurgeons, though the difference between the two groups was not significant (p = 0.088). Multivariate regressions suggested that younger age (≤ 25 years old), being a senior trainee, getting divorced, working in a regional hospital, long working hours (≥ 71 hrs/wk), a low annual income (<¥100,000), sleeping < 6 hrs/day, and experience with workplace violence were significantly related to burnout for both groups.CONCLUSIONSChinese orthopedic surgical and neurosurgical trainees are under significant stress. Orthopedic surgeons showed relatively optimistic data in their assessments of job satisfaction, engagement, and burnout. This study may provide valuable information for orthopedic and neurosurgical candidates considering either specialty as a career.

‘Having a mentor helped me with difficult times’: a trainee-run mentoring project

Objective: A mentoring programme was established in South Australia in 2014 by psychiatry trainees, with the goal of reducing stress and burnout amongst first-year trainees. All first-year trainees are offered the opportunity to have a senior trainee as a mentor. This article describes the mentoring programme, presents feedback from participants and identifies areas for further development. Method: The majority (72/76) of first-year trainees entering psychiatry training in South Australia from 2014–2018 were allocated a mentor. Surveys were sent out in 2014, 2015 and 2017. Twenty of 42 (48%) mentors and 17 of 42 (40%) of mentees completed a 10-item questionnaire, with free text responses. Results: Mentee feedback was mostly positive, reporting that mentors offered them reassurance and support. The most common challenges were advice about training, managing work-life balance and issues with supervision. The main barrier to the mentoring programme was lack of time to meet. Mentors identified that they would have liked more training in mentoring. Conclusion: The trainee mentoring programme has been a useful initiative. As consultant psychiatrists are likely to provide mentoring for more junior colleagues, the authors propose that training in mentoring should be part of the Royal Australian and New Zealand College of Psychiatrists education programme.

Organising an overseas fellowship in Australia

You may be in the middle of the nightmare segment of your life that is the exit exam or you may be revelling in the well-deserved lubrications of the celebrations after passing it. You suddenly realise that the end of your training rotation is nearing. Should you stay with it to the end in the familiar, safe realms of being a senior trainee in hospitals you now know well, with supervising consultants whose idiosyncrasies you have come to understand and perhaps even emulate? Or should you go on a fellowship?

College approval visits – a perspective on trainee participation

This text discusses whether senior trainees should endeavour to Join a College Approval Panel as one of the visiting team, what the advantages would be to the trainees being visited of having a senior trainee representative as a member of the assessing group and what the benefits are to senior trainees in terms of training and broadening their own curriculum vitae.