Optimising frontline learning and engagement between consultant-led neonatal teams in the West Midlands: a survey on the utility of an augmented simulation training technique (2021)

Type of publication:
Journal article

Author(s):
Pillay, Thillagavathie; Clarke, Lynsey; Abbott, Lee; Surana, Pinki; Shenvi, Asha; *Deshpande, Sanjeev; Cookson, Joanne; Nash, Matthew; Fawke, Joe; Rasiah, Vishna; Cusack, Jonathan

Citation:
Advances in Simulation; Aug 2021; vol. 6 (no. 1); p. 29

Abstract:
BACKGROUND In England, neonatal care is delivered in operational delivery networks, comprising a combination of the Neonatal Intensive Care (NICU), Local-Neonatal (LNU) or Special-Care Units (SCU), based on their ability to care for babies with different degrees of illness or prematurity. With the development of network care pathways, the most premature and sickest are mostly triaged for delivery in services linked to NICU. This has created anxiety for teams in LNU and SCU. Less exposure to sicker babies has resulted in limited opportunities to maintain expertise for when these babies unexpectedly deliver at their centre and thereafter require transfer for care, to NICU. Simultaneously, LNU and SCU teams develop skills in the care of the less ill and premature baby which would also be of benefit to NICU teams. A need for mutual learning through inter-unit multidirectional collaborative learning and engagement (hereafter also called neonatal networking) between teams of different designations emerged. Here, neonatal networking is defined as collaboration, shared clinical learning and developing an understanding of local systems strengths and challenges between units of different and similar designations. We describe the responses to the development of a clinical and systems focussed platform for this engagement between different teams within our neonatal ODN. METHOD An interactive 1-day programme was developed in the West Midlands, focussing on a non-hierarchical, equal partnership between neonatal teams from different unit designations. It utilised simulation around clinical scenarios, with a slant towards consultant engagement. Four groups rotating through four clinical simulation scenarios were developed. Each group participated in a clinical simulation scenario, led by a consultant and supported by nurses and doctors in training together with facilitators, with a further ~two consultants, as observers within the group. All were considered learners. Consultant candidates took turns to be participants and observers in the simulation scenarios so that at the end of the day all had led a scenario. Each simulation-clinical debrief session was lengthened by a further ~ 20 min, during which freestyle discussion with all learners occurred. This was to promote further bonding, through multidirectional sharing, and with a systems focus on understanding the strengths and challenges of practices in different units. A consultant focus was adopted to promote a long-term engagement between units around shared care. There were four time points for this neonatal networking during the course of the day. Qualitative assessment and a Likert scale were used to assess this initiative over 4 years. RESULTS One hundred fifty-five individuals involved in frontline neonatal care participated. Seventy-seven were consultants, supported by neonatal trainees, staff grade doctors, clinical fellows, advanced neonatal nurse practitioners and nurses in training. All were invited to participate in the survey. The survey response rate was 80.6%. Seventy-nine percent felt that this learning strategy was highly relevant; 96% agreed that for consultants this was appropriate adult learning. Ninety-eight percent agreed that consultant training encompassed more than bedside clinical management, including forging communication links between teams. Thematic responses suggested that this was a highly useful method for multi-directional learning around shared care between neonatal units. CONCLUSION Simulation, enhanced with systems focussed debrief, appeared to be an acceptable method of promoting multidirectional learning within neonatal teams of differing designations within the WMNODN.

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Survey of Foundation Year 1 doctors in managing and preparing patients for anaesthesia (2021)

Type of publication:
Conference abstract

Author(s):
Cheng Y.; *Noakes A.

Citation:
Anaesthesia; Jul 2021; vol. 76 ; p. 95

Abstract:
Introduction Good management of surgical patients on the ward before surgery has a significant impact on postoperative outcome. Foundation Year 1 (FY1) doctors are fundamental in ensuring all patients are managed and prepared for anaesthesia and surgery appropriately. Our initial survey showed FY1 doctors lacked confidence in managing patients pre-operatively and preparing them for anaesthesia. Therefore, a teaching session was organised, which all FY1 doctors found useful. Methods An online survey was sent to all FY1 doctors in Royal Shrewsbury and Telford hospital asking about their confidence level in managing pre-operative conditions using five scales ranging from no confidence to very confident. After the teaching session, feedback was collected to assess the usefulness of the teaching. Results In our survey, 22 responses were collected. Only 31.8% of respondents were confident in fasting guidelines and pre-procedure cessation regime for warfarin, anticoagulants and anti-platelets and bridging therapy for anticoagulants. Of the respondents, 18.2% were confident in managing peri-operative medications (e.g. withholding certain medications), 27.3% of respondents were confident in managing pre-operative anaemia and 72.7% of respondents had little or no confidence in preparing patients with cardiac implantable electronic devices for surgery. In feedback that was collected after the teaching (n = 25), 90% of attendees found it extremely and very useful. Discussion The survey results showed low confidence in FY1 doctors in preparing patients for surgery and anaesthesia. This led to a teaching session facilitated by anaesthetic registrars and consultants. They were introduced to local hospital guidelines, which all of them found useful. Topics covered in the teaching session included fasting guidelines, management of perioperative medications, management of pre-operative anaemia, pre-procedure cessation for anticoagulants and bridging therapies and pre-operative management of diabetic, hypertensive, cardiac and renal patients. With good feedback, this teaching will be incorporated into their weekly teaching and will be taught yearly to all FY1 doctors. Feedback was also collected to improve our delivery of the teaching sessions

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First impressions of the foundation interim year 1 postings: positives, pitfalls, and perils (2020)

Type of publication:
Journal article

Author(s):
Youssef S.; Zaidi S.; Varghese C.; Rajagopalan S.; *Shrestha S.

Citation:
Medical Education Online; Dec 2020; vol. 25 (no. 1)

Abstract:
COVID-19 has placed an increased burden on the NHS. Changes were made to expand patient capacity including hospital restructuring, cancellation of most elective surgeries and early graduation of final year medical students. 1 The UK foundation programme (UKFP) curated a new training position for graduates as foundation interim year 1 (FiY1) doctors, where they voluntarily work in paid positions prior to entering formal foundation year 1 (FY1) roles. 2 Expediting the process of fulfilling these positions, the General Medical Council facilitated early provisional registration of doctors. We discuss the positives, pitfalls, and perils of the new roles and the first impressions of three newly qualified FiY1 s in medical, obstetrics and gynaecology and surgical posts, a surgical FY1 doctor and a clinical supervisor in surgery.

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How can we make renal medicine careers more appealing to UK trainees? (2019)

Type of publication:
Journal article

Author(s):
Karangizi A.H.K.; Chanouzas D.; Foggensteiner L.; *Mahdi A.

Citation:
Clinical Kidney Journal; Feb 2019; vol. 12 (no. 5); p. 756-759

Abstract:
Background: There is a global decline in interest in careers in renal medicine. This is concerning given the increasing global burden of kidney disease. Previous studies in the USA and Australia have identified factors such as a poor work-life balance, lack of role models and the challenging nature of the speciality as possible reasons behind recruitment struggles. This study aimed to identify factors associated with declining interest among trainees in the UK.
Method(s): We conducted a survey of 150 National Health Service Foundation trainees (interns) and Core Medical Trainees in Health Education West Midlands. Participants completed a 14-part paper-based questionnaire capturing data on trainee demographics, medical school and postgraduate exposure to renal medicine and perceptions of a career in renal medicine.
Result(s): There was limited early clinical exposure to renal medicine both in terms of time spent in the speciality and perceived exposure to the range of domains of the speciality. Trainees perceived the speciality as complex with a heavy workload. Very few trainees considered the speciality to be lifestyle oriented. There was also disinterest in taking on the associated general medicine commitments of the training programme. Job experience and identification of role models increased the likelihood of consideration of the speciality.
Conclusion(s): This survey has identified key areas to drive interest in the speciality, including early engagement, enthusiastic supervision and increased training flexibility. Urgent attention is required to address these areas and make renal medicine careers more appealing.

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Are local, speciality specific career days beneficial for medical students and foundation doctors? (2016)

Type of publication:
Conference abstract

Author(s):
*Barker V., *Godden M., *Jones C., *Panikkar J.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, December 2016, vol./is. 123/(6-7)

Abstract:
The Health Education Midlands holds an annual career day for all specialities to attend, allowing all medical students and foundation doctors to explore different specialities within the local area. The Royal College of Obstetricians and Gynaecologists also provide a careers day, for anyone to attend. Both of these are useful resources however do have some limitations due to number of delegates attending and also number of specialities in attendance. Our local obstetrics and gynaecology school held a pilot, local, careers days to allow any medical student from 4th year and above and any foundation doctor within the region, the opportunity to attend. The day consisted of a variety informal presentations about the ‘day in a life’ and was given by a variety of trainees across the school. The deputy head of school also came and provided more specific information on training pathways. The day also included several workshops covering resilience, CV building, and practical skills. The informal nature meant that the delegates could feel free to ask any of us any questions they wish to do so during the process. The delegates were asked to provide feedback at the end of the day. We had a total of 42 delegates, of which the majority found the day useful, we did not receive any negative feedback. We hope that the delegates can use this experience when deciding on future careers. We are intending on repeating the careers day again.

Link to full-text: http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14447/epdf

A dedicated undergraduate gynaecology teaching clinic: The Keele experience (2016)

Type of publication:
Journal article

Author(s):
Katali H.M., *Parry-Smith W.R., Eliot R.L., Omahony F.

Citation:
Journal of Obstetrics and Gynaecology, February 2016, vol./is. 36/2(227-229)

Abstract:
Much discussion in the literature centres on how best to teach medical students the intricacies of gynaecological assessment and the subsequent formulation of a management plan. At Keele University skills are initially developed in a simulated setting and then transferred to the workplace where students continue to develop their skills. A dedicated undergraduate gynaecology teaching clinic has been developed and comprises of 2-3 students and a tutor. All 38 students rotating through the department between January and June 2013 were invited to complete an anonymous questionnaire to evaluate this clinic and 36 (95%) of them responded. Respondents felt significantly more comfortable taking a gynaecology history, ensuring privacy during examination and formulating a management plan post-clinic (all p < 0.001), with female students feeling significantly more comfortable than their male counterparts (p = 0.04). The use of this clinic shows great promise to help students learn an unfamiliar and challenging skill.

Major trauma training for emergency nurses (2014)

Type of publication:
Journal article

Author(s):
*Fenwick R

Citation:
Emergency Nurse, 04 2014, vol./is. 22/1(12-6), 1354-5752;1354-5752 (2014 Apr)

Abstract:
The Midlands regional trauma network was established in March 2012 to improve and standardise the care offered to patients with major trauma. This article discusses the results of a survey of formal training in, and self-assessed knowledge of, trauma management among emergency department nurses working in the network. Less than one third of the nurses had received formal training against which standards can be benchmarked, and the article recommends that nurse education standards are reinstated as key performance indicators in the region.

Link to more details or full-text: http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2012531636&authtype=athens&site=ehost-live