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Al Saoudi T, Chawla K, Khasawneh F, Pollard C, Isherwood J, Bhardwaj N, Garcea G, Dennison A. Induction Implications: Shaping the Competence and Confidence of Junior Doctors Within Complex Medical Specialties. Cureus 2023; 15:e50768. [PMID: 38239518 PMCID: PMC10795099 DOI: 10.7759/cureus.50768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction The newly qualified junior doctors in the United Kingdom face challenges due to their limited experience and unfamiliarity with their rotations. We aim to share the experience of establishing a hepato-pancreato-biliary (HPB) surgery-specific induction program at the University Hospitals of Leicester NHS Trust and assess its impact on doctors' knowledge and experience. Methods A booklet was distributed to new junior doctors, and a two-hour structured teaching session was also conducted, with pre- and post-session assessments using multiple-choice questions and a feedback survey. The survey measured understanding of HPB anatomy, interventions, and satisfaction with the teaching methodology. Results The pre-session questionnaire included 22 participants, while the post-session had 20 participants. Regarding HPB anatomy understanding, in the pre-session, six (28.6%) and 11 (52.4%) participants reported levels 2 and 3, respectively, while levels 4 and 5 were reported by three (13.3%) and one (4.8%) participants. In the post-session, levels 4 and 5 were reported by six (30%) and 13 (65%), with only one (5%) reporting level 3 and none at levels 1 or 2. Similar trends were observed in understanding HPB investigation. In the pre-session, levels 2 and 3 were reported by eight (36.4%) and 11 (50%), while levels 4 and 5 were reported by two (9.1%) and one (4%). In the post-session, eight (40%) and 11 (55%) reported levels 4 and 5, with only one (5%) at level 3 and none at levels 1 or 2. For HPB management methods before teaching, levels 2 and 3 were equally reported by eight (36.4%), level 4 by four (22.7%), and none at level 5. After teaching, nine (45%) and 10 (50%) reported levels 4 and 5, with only one (5%) at level 3 and none at levels 1 or 2. Factual knowledge showed a 38% increase, rising from 49% pre-session to 87% post-session. In post-session feedback, 12 (60%) strongly agreed that the session helped augment their medical practice, and six (30%) agreed, with two (10%) neutral. Feedback on the teaching session's organization was positive, with 13 (65%) strongly agreeing that it was structured coherently, and six (30%) agreeing, with only one (5%) neutral regarding the clarity of the structure and delivery method. Conclusion Specialty-specific induction programs are crucial for providing support and ensuring the development of competent doctors. Efforts should be made to create supportive working environments for junior doctors to alleviate stress and improve their well-being.
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Affiliation(s)
- Tareq Al Saoudi
- Hepato-Pancreato-Biliary (HPB) Surgery Department, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Kanika Chawla
- Hepato-Pancreato-Biliary (HPB) Surgery Department, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Farah Khasawneh
- Colorectal Surgery Department, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Cristina Pollard
- Hepato-Pancreato-Biliary (HPB) Surgery Department, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - John Isherwood
- Hepato-Pancreato-Biliary (HPB) Surgery Department, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Neil Bhardwaj
- Hepato-Pancreato-Biliary (HPB) Surgery Department, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Giuseppe Garcea
- Hepato-Pancreato-Biliary (HPB) Surgery Department, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Ashley Dennison
- Hepato-Pancreato-Biliary (HPB) Surgery Department, University Hospitals of Leicester NHS Trust, Leicester, GBR
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Riaz Q, Mitha R, Shamim MS, Virani QUA, Belgaumi A, Khan MR, Roshan R, Zahid N, Haider A. Exploring the 'January effect' at a university hospital in Pakistan: a retrospective cohort study investigating the impact of trainee turnover on patient care quality outcomes. BMC MEDICAL EDUCATION 2023; 23:770. [PMID: 37845631 PMCID: PMC10577952 DOI: 10.1186/s12909-023-04708-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE There are reports of a potential rise in a teaching hospital's morbidity and mortality rates during the trainee turnover period, i.e., with the induction of new residents and house staffs, and the changeover of clinical teams. The published literature displays mixed reports on this topic with lack of reproducible observations. The current study was conducted to explore existence of any such phenomenon (January effect) in Pakistan. METHODS This retrospective cohort study was conducted at Aga Khan University Hospital, Karachi, Pakistan. Five-year (2013-2018) record of all the patients in all age groups related to these outcomes was retrieved and recorded in specifically designed questionnaire. Different outcome measures were used as indicators of patient care and change in these outcomes at the time of new induction was related to possible January effect. RESULTS During the five-year study period, more than 1100 new trainees were inducted into the post graduate medical education program (average of 237 per year) with more than 22,000 inpatient admissions (average of 45,469 per year). Some patterns were observed in frequencies of surgical site infections, medication errors, sentinel events, patient complaints, and adverse drug reactions. However, these were not consistently reproducible and could not be directly attributed to the trainee turnover. All other indicators did not show any pattern and were considered inconclusive. No effect of overlap was observed. CONCLUSIONS Inconsistency in the patient care quality indicators do not favor existence of January effect in our study. Further research is recommended to establish our results.
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Affiliation(s)
- Qamar Riaz
- Department for Educational Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Rida Mitha
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Shahzad Shamim
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Qurat-Ul-Ain Virani
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Rozina Roshan
- Department of Infection Prevention & Hospital Epidemiology (DIPHE), Aga Khan University Hospital (AKUH), Karachi, Pakistan
| | - Nida Zahid
- Aga Khan University Hospital, Karachi, Pakistan
| | - Adil Haider
- Aga Khan University Hospital, Karachi, Pakistan
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Moore CJS, Blencowe NS, Hollén L, van Hamel C. Interim Foundation Year One (FiY1) and preparedness for foundation year 1: A national survey of UK foundation doctors. MEDICAL TEACHER 2022; 44:622-628. [PMID: 34936534 DOI: 10.1080/0142159x.2021.2015065] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Induction programmes aim to ease the transition from medical student to doctor. The interim foundation year 1 (FiY1) placement, introduced in the first COVID-19 wave, provided experience in advance of the Foundation Year 1 (FY1) start in August; providing more time and enhanced responsibilities than traditional induction programmes. This study examines the effects of the FiY1 placement on anxiety levels and preparedness for FY1. METHODS This was a descriptive cross-sectional study using data from four cohorts of FY1s who completed the online National FY1 induction survey from 2017 to 2020 (n = 4766). Questions evaluated self-reported preparedness and anxiety levels. Differences in preparedness and anxiety levels of FiY1 and non-FiY1 participants in 2020, and the 2017-2019 participants (non-FiY1 controls), were evaluated. RESULTS FiY1s in 2020 reported higher self-reported preparedness (79%) than non-FiY1s (54%) in 2020 (p = <0.001) and the control 2017-2019 cohort (63.8%) (p < 0.001). Fewer FiY1s experienced pathological anxiety (29.3% versus 40.8% for non-FiY1s; p = 0.001). CONCLUSION Time spent in an FiY1 role is associated with an increase in self-perceptions of preparedness and a reduction in anxiety. These data indicate that time spent in an FiY1 role may have utility in further improving the transition period from medical school to FY1.
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Affiliation(s)
- Connor J S Moore
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Natalie S Blencowe
- Division of Surgery, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Linda Hollén
- Centre for Academic Child Health, University of Bristol, Bristol, UK
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Cunningham N, O'Neil V, Leng C, Sethia B. Undergraduate medical education at a district general hospital: facilitating the transition from student to medical professional. MEDEDPUBLISH 2022. [DOI: 10.12688/mep.19111.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The transition from student to medical professional represents a major challenge for all medical students. Every intake of newly qualified doctors increases potential risks to patients. In the UK, this is often colloquially referred to as the ‘August Effect’. At one District General Hospital, a ‘Ward-Craft and Bleep Simulation Programme’ was implemented for final year medical students. This aimed to equip students with the procedural knowledge and soft skills to support the transition from undergraduate training to professional working life as a junior doctor. Methods: A series of six, weekly, two-hour workshops which focussed on common clinical problems encountered by newly qualified doctors was delivered to final year medical students (‘Ward-Craft Programme’). Students then participated in a two-hour high fidelity, in-situ, ‘Bleep Simulation Programme. The programme was facilitated by a Clinical Teaching Fellow and evaluated through an anonymous feedback survey Results: 98.9% of students (n=259) agreed, or strongly agreed, that the programme helped them feel more prepared and confident for life as a junior doctor. Participants provided overwhelmingly positive feedback, specifically noting that the programme addressed feelings of confusion, anxiety, and the feeling of being overwhelmed by the work of junior doctor. Conclusions: The Ward-Craft and Bleep Simulation Programme has been positively received by medical students from universities with very different types of learning styles and courses. The replication of similar programmes for final year medical students is a valuable training opportunity for final year medical students and may help mitigate the challenges posed by the ‘August effect’.
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Magola E, Willis SC, Schafheutle EI. The development, feasibility and acceptability of a coach-led intervention to ease novice community pharmacists' transition to practice. Res Social Adm Pharm 2021; 18:2468-2477. [PMID: 33994115 DOI: 10.1016/j.sapharm.2021.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite reported benefits of transition support programmes for other healthcare professionals, no evidence-based support interventions exist to ease newly-registered novice community pharmacists' (NCPs) transition into practice. OBJECTIVES To develop an intervention to provide psychosocial support, support the development of professional behaviours and skills of novice pharmacists in community pharmacy and conduct an evaluation. METHODS The Medical Research Council (MRC) guidance for developing complex interventions was applied to develop a 17-week, pharmacist coach-led intervention, using a social media group, a face-to-face introductory workshop, two webinars, weekly case studies, portfolios (reflective logs and development plans) and a handbook. Twelve newly-registered NCPs participated. A coach log and semi-structured interviews collected data on feasibility, acceptability and perceived impact. RESULTS Findings suggest the intervention was feasible and highly acceptable to NCPs, who perceived the coach and social media group to be the most valuable components. The coach was described as non-judgemental, approachable and collaborative. Provision of guided one-to-one reflection was viewed as useful for debriefing, feedback and meaningful reflection, and supported development of reflection-in-action. The face-to-face workshop was considered important for establishing rapport and trust. The social media group was most valued for providing an accessible, confidential and responsive support network, in which NCPs felt psychologically safe to learn. This component was reported to present opportunities for developmental discourse and shared reflection with peers, thus reducing the sense of professional isolation. NCPs reported that the intervention led to increases in meaningful learning, confidence, critical reasoning, self-awareness and self-reflection. The webinars and handbook were identified as the least valuable components. CONCLUSIONS A transition-support intervention using an experienced pharmacist coach, delivered within a safe, supportive, albeit online facilitated learning environment, appeared feasible and valuable in supporting guided reflection and developmental discourse. This facilitates transformative learning, and supports NCPs to gain proficiency and become independent reflective practitioners.
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Affiliation(s)
- Esnath Magola
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
| | - Sarah C Willis
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
| | - Ellen I Schafheutle
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
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Butt A, Umaskanth N. Reviewing the foundation interim year 1 programme. CLINICAL TEACHER 2020; 18:229-230. [PMID: 33174337 DOI: 10.1111/tct.13305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Aqeel Butt
- Ealing Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Neelan Umaskanth
- Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
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Prescott O, Millar E, Nimmo G, Wales A, Edgar S. 21st century medical education: critical decision-making guidance through smartphone/tablet applications—the Lothian pilot. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2017; 3:60-64. [DOI: 10.1136/bmjstel-2016-000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 11/04/2022]
Abstract
IntroductionIn starting a new clinical placement, doctors in training must become aware of and apply standard operating procedures, as well as learn guidelines, simultaneously adjusting to new patient presentations, environments and personnel. This transition is thought to correlate with increased risk to patient safety, notably during the annual UK changeover. Mobile technologies are increasingly commonplace throughout the National Health Service. Clinicians at all levels are employing medical technology and applications (apps) with minimal local guidance. We set out to test the feasibility and utility of offering medical apps to out-of-hours (OOH) practitioners as an aid to clinical decision-making at point of patient contact. The theorised benefits were threefold: clinical education—real time support for clinical decision-making as one component of deliberate practice to build expert performance; decreased administrative burden–updating and accessing current guidelines; and service development—readily accessible feedback from users.MethodWe provided 32 devices in our emergency departments and OOH environments. The devices were preloaded with apps approved by our medical education department and clinical service leads to be used in support of care delivery.ResultsWe surveyed 123 clinical staff prior to the pilot discovering that 65% had used mobile apps to aid their decision-making. During our project, we saw the number of clinical users expand with our data series, suggesting the apps most useful to care delivery for this group of service providers.Future developmentsThere was huge enthusiasm for the project and we hope to maintain a clinician-led environment.
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Kapur N, Ibrahim S, Hunt IM, Turnbull P, Shaw J, Appleby L. Mental health services, suicide and 7-day working. Br J Psychiatry 2016; 209:334-339. [PMID: 27388571 DOI: 10.1192/bjp.bp.116.184788] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/03/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients admitted to hospital at the weekend appear to be at increased risk of death compared with those admitted at other times. However, a 'weekend effect' has rarely been explored in mental health and there may also be other times of year when patients are vulnerable. AIMS To investigate the timing of suicide in high-risk mental health patients. METHOD We compared the incidence of suicide at the weekend v. during the week, and also in August (the month of junior doctor changeover) v. other months in in-patients, patients within 3 months of discharge and patients under the care of crisis resolution home treatment (CRHT) teams (2001-2013). RESULTS The incidence of suicide was lower at the weekends for each group (incidence rate ratio (IRR) = 0.88 (95% CI 0.79-0.99) for in-patients, IRR = 0.85 (95% CI 0.78-0.92) for post-discharge patients, IRR = 0.87 (95% CI 0.78-0.97) for CRHT patients). Patients who died by suicide were also less likely to have been admitted at weekends than during the week (IRR = 0.52 (95% CI 0.45-0.60)). The incidence of suicide in August was not significantly different from other months. CONCLUSIONS We found evidence of a weekend effect for suicide risk among high-risk mental health patients, but with a 12-15% lower incidence at weekends. Our study does not support the claim that safety is compromised at weekends, at least in mental health services.
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Affiliation(s)
- Nav Kapur
- Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Saied Ibrahim
- Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Isabelle M Hunt
- Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Jenny Shaw
- Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Louis Appleby
- Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
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Brown M, Pinchin J, Valand R, Larkin C, Pattinson J, Benning K, Housley G, Hatton J, Shaw D, Syrysko P, Sharples S, Blakey JD. NightShift simulation to train newly qualified doctors in non-technical skills: a feasibility study. Future Hosp J 2016; 3:94-98. [PMID: 31098195 DOI: 10.7861/futurehosp.3-2-94] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
There is growing evidence of greater rates of morbidity and mortality in hospitals during out-of-hours shifts, which appears to be exacerbated during the period in which newly qualified doctors commence work. In order to combat this issue, an online simulation of a night shift was developed and trialled in order to improve the non-technical skills of newly qualified doctors and, ultimately, improve clinical outcomes. A randomised feasibility trial of the electronic training simulation was performed with medical students (n=30) at the end of their training and in the initial weeks of working at a large teaching hospital. The study showed that participants in the intervention group completed their non-urgent tasks more rapidly than the control group: mean (SD) time to complete a non-urgent task of 85.1 (50.1) versus 157.6 (90.4) minutes, p=0.027. This difference persisted using linear regression analysis, which was undertaken using rota and task volume as independent cofactors (p=0.028). This study shows the potential for simulation technologies to improve non-technical skills.
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Affiliation(s)
- Michael Brown
- Horizon Digital Economy Research, University of Nottingham, Nottingham, UK
| | - James Pinchin
- Horizon Digital Economy Research, University of Nottingham, Nottingham, UK
| | | | | | | | - Kelly Benning
- Acute Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Gemma Housley
- Informatics, Nottingham University Hospitals, Nottingham, UK
| | - Jim Hatton
- Informatics, Nottingham University Hospitals, Nottingham, UK
| | | | | | - Sarah Sharples
- Horizon Digital Economy Research, University of Nottingham, Nottingham, UK
| | - John D Blakey
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, and Respiratory Medicine, Aintree University Hospital, Liverpool, UK
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Hartai M, Nyári TA, McNally RJQ. Trends in mortality rates in female genital organs and breast cancers in Hungary between 1979 and 2013. Eur J Obstet Gynecol Reprod Biol 2015; 194:168-72. [PMID: 26412351 DOI: 10.1016/j.ejogrb.2015.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/04/2015] [Accepted: 08/13/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study investigated annual and seasonal trends in deaths for cancers of the female genital organs and breast in Hungary between 1979 and 2013. STUDY DESIGN Data on the numbers of cancer deaths were obtained from the published nationwide population register. Joinpoint regression was applied to investigate the yearly trends in cancer mortality rates. Cyclic trends were investigated using logistic regression, Edwards' and Walter-Elwood methods. RESULTS The majority of deaths from cancers of the female genital organs and breast occurred in winter but using the observed numbers of deaths a significant seasonal pattern was only revealed for deaths from breast cancer with a peak in January and a nadir in July. However, seasonality in the proportion of deaths from female genital organs and breast cancers out of deaths from all causes detected a different peak and nadir. The proportion of female genital organs and breast cancer deaths out of deaths from all causes was higher around the end of summer and significant seasonal variation with a peak in August and nadir in February was revealed. CONCLUSION This Hungarian study suggests that there was a significant seasonal effect on female genital organs and breast cancer mortality. Both seasonal patterns are interesting and informative to potentiate prevention. Our findings suggest that infectious diseases may increase the risk of the mortality among the immune deficient patents.
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Affiliation(s)
- Margit Hartai
- Department of Medical Physics and Informatics, University of Szeged, Hungary
| | - Tibor András Nyári
- Department of Medical Physics and Informatics, University of Szeged, Hungary.
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Brown M, Shaw D, Sharples S, Jeune IL, Blakey J. A survey-based cross-sectional study of doctors' expectations and experiences of non-technical skills for Out of Hours work. BMJ Open 2015; 5:e006102. [PMID: 25687899 PMCID: PMC4336458 DOI: 10.1136/bmjopen-2014-006102] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The skill set required for junior doctors to work efficiently and safely Out of Hours (OoH) in hospitals has not been established. This is despite the OoH period representing 75% of the year and it being the time of highest mortality. We set out to explore the expectations of medical students and experiences of junior doctors of the non-technical skills needed to work OoH. DESIGN Survey-based cross-sectional study informed by focus groups. SETTING Online survey with participants from five large teaching hospitals across the UK. PARTICIPANTS 300 Medical Students and Doctors OUTCOME MEASURE Participants ranked the importance of non-technical skills, as identified by literature review and focus groups, needed for OoH care. RESULTS The focus groups revealed a total of eight non-technical skills deemed to be important. In the survey 'Task Prioritisation' (mean rank 1.617) was consistently identified as the most important non-technical skill. Stage of training affected the ranking of skills, with significant differences for 'Communication with Senior Doctors', 'Dealing with Clinical Isolation', 'Task Prioritisation' and 'Communication with Patients'. Importantly, there was a significant discrepancy between the medical student expectations and experiences of doctors undertaking work. CONCLUSIONS Our findings suggest that medical staff particularly value task prioritisation skills; however, these are not routinely taught in medical schools. The discrepancy between expectations of students and experience of doctors reinforces the idea that there is a gap in training. Doctors of different grades place different importance on specific non-technical skills with implications for postgraduate training. There is a pressing need for medical schools and deaneries to review non-technical training to include more than communication skills.
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Affiliation(s)
- Michael Brown
- Human Factors Research Group/Horizon Digital Economy Research, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Dominick Shaw
- Department of Respiratory Medicine, University of Nottingham, Nottingham, Nottinghamshire, UK
- East Midlands Academic Health Science Network, Nottingham, Nottinghamshire, UK
| | - Sarah Sharples
- Human Factors Research Group/Horizon Digital Economy Research, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Ivan Le Jeune
- Department of Respiratory Medicine, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - John Blakey
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Nottingham, Nottinghamshire, UK
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Kamau C. Effects of experimental inductions for newly qualified doctors on competence at clinical procedures. Clin Med (Lond) 2014; 14:380-5. [PMID: 25099839 PMCID: PMC4952831 DOI: 10.7861/clinmedicine.14-4-380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Up to 96% of newly qualified doctors fail one or more clinical procedure tests. Their entrance into work in hospitals has been associated with significant reductions in patient safety and an increase in patient mortality. Curriculum changes offer one solution. Another solution is the introduction of clinical skills inductions (orientations) before doctors' first day at work; the failure rate for one or more clinical tests can be reduced from 96% of new doctors to 27% after just a 5-day experimental induction. Experiments reported in the literature showed improvements in new doctors' competence at intravenous line insertion and taking blood after a 5-day or 2-week induction, intravenous drug administration after a 5-day induction, certifying death, prescribing and out-of-hours tasks after a 2-week induction, and lumbar puncture and spirometry after a 1-day induction. Examined performance after a 5-day induction also showed improved objective structured clinical examination (OSCE) scores on blood pressure, cannulation, venepuncture and catheterisation. There is therefore value in scheduling inductions before doctors report for their first day on the job.
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Blakey JD, Brown M, Pinchin J, Barley M, Sharples S. PRO: confronting resistance to rule-based medicine is essential to improving outcomes. Thorax 2014; 70:110-1. [PMID: 25052574 DOI: 10.1136/thoraxjnl-2014-205986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The past 20 years have seen two great changes in the practice of medicine: the widespread adoption of evidence-based medicine, and the increasing challenge of managing complex multimorbid patients. Both these developments have resulted in clinical rules and protocols becoming ever more abundant and increasingly critical to delivering safe and effective patient care. These evidence-based clinical rules perform at least as well as expert opinion, and the increasing volume and quality of available clinical data suggests their performance could continue to improve. This article considers why clinicians deviate from effective rules, highlighting key issues such as the persisting culture of heroism, institutional inertia, deference to authority and personal heuristics. We argue that better rules can be created, and that clinical improvements will follow if there is a 'common knowledge' of these rules. Furthermore, we argue that there is a ceiling to the effectiveness of any rule, even one as simple as ensuring hand hygiene, unless individuals are held accountable for transgressions.
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Affiliation(s)
- John D Blakey
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Michael Brown
- Horizon Digital Economy Research, University of Nottingham, Nottingham, UK Human Factors Research Group, University of Nottingham, Nottingham, UK
| | - James Pinchin
- Horizon Digital Economy Research, University of Nottingham, Nottingham, UK
| | - Mark Barley
- Department of Anaesthetics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sarah Sharples
- Human Factors Research Group, University of Nottingham, Nottingham, UK
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Herrod PJJ, Barclay C, Blakey JD. Can mobile technology improve response times of junior doctors to urgent out-of-hours calls? A prospective observational study. QJM 2014; 107:271-6. [PMID: 24300162 DOI: 10.1093/qjmed/hct242] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Hospital at Night system has been widely adopted to manage Out-of-Hours workload. However, it has the potential to introduce delays and corruption of information. The introduction of newer technologies to replace landlines, pagers and paper may ameliorate these issues. AIM To establish if the introduction of a Hospital at Night system supported by a wireless taskflow system affected the escalation of high Early Warning Scores (EWSs) to medical attention, and the time taken to medical review. DESIGN Prospective 'pre and post' observational study in a teaching hospital in the UK. METHODS Review of observation charts and medical records, and data extraction from the electronic taskflow system. RESULTS The implementation of a technology-supported Hospital at Night system was associated with a significant decrease in time to documentation of initial review in those who were reviewed. However, there was no change in the proportion of those with a high EWS that were reviewed, and throughout the study a majority of patients with high EWSs were not reviewed in accordance with guidelines. CONCLUSION Introduction of a Hospital at Night system supported by mobile technology appeared to improve the transfer of information, but did not affect the nursing decision whether to escalate abnormal findings.
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Affiliation(s)
- P J J Herrod
- Department of Orthopaedic Surgery, King's Mill Hospital, Sutton in Ashfield, Nottinghamshire NG17 4JL, UK.
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