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Dineen M, Lazarus MD, Stephens GC. Uncertainty experienced by newly qualified doctors during the transition to internship. MEDICAL EDUCATION 2025. [PMID: 40156179 DOI: 10.1111/medu.15692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Revised: 02/27/2025] [Accepted: 03/17/2025] [Indexed: 04/01/2025]
Abstract
INTRODUCTION Uncertainty is an inherent feature of medical practice. Uncertainty Tolerance (UT) describes how individuals experience and respond to uncertainty, with lower UT associated with negative outcomes, including burnout. Periods of career transition can be particularly uncertain, but there is little research into newly qualified doctors' uncertain experiences during their transition to internship (TTI). Early career doctors have a high incidence of burnout; therefore, understanding how new doctors experience uncertainty could be valuable. We explored the sources of, responses to and moderators of uncertainty during the TTI to inform support of this group. METHODS Engaging social constructionism, we conducted a cross-sectional qualitative study with 13 intern doctors who graduated from a single Australian medical school during their TTI. Participants completed a semi-structured interview within five months of commencing practice in 2021. Data were analysed using framework analysis, informed by the integrative UT model. RESULTS Although participants described clinical uncertainty during the TTI (i.e. unknown aspects of patient care due to ambiguity, complexity or probability), dominant sources of uncertainty related to novel scenarios (e.g. tasks and responsibilities experienced for the first time) and their professional role (e.g. boundaries and expectations). Participants described responding to uncertainty by asking for help from senior colleagues and reported feelings of stress. Key factors that moderated responses to uncertainty included support, time and perceived stakes. DISCUSSION Our results suggest that educators, supervisors and employers should aim to reduce the extraneous uncertainties associated with the TTI. Approaches to achieve this could include orientation programmes that appropriately familiarise interns with workplace environments and systems, reducing role ambiguity by setting clear expectations and facilitating regular feedback, and creating psychologically safe working environments with adequate senior support. These approaches may allow newly qualified doctors the capacity to explore clinical uncertainties and develop their UT through methods such as critical reflection.
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Affiliation(s)
- Molly Dineen
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Michelle D Lazarus
- Centre of Human Anatomy Education (CHAE), Department of Anatomy and Developmental Biology, Biomedical Discovery Institute, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Georgina C Stephens
- Centre of Human Anatomy Education (CHAE), Department of Anatomy and Developmental Biology, Biomedical Discovery Institute, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
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Karsalia R, Borja AJ, Xu E, Gallagher RS, Na J, McClintock SD, Marcotte PJ, Ozturk AK, Schuster JM, Yoon JJW, Malhotra NR. The "July Effect" scrutinized: A coarsened-exact match analysis of lumbar fusion outcomes during resident transition. Clin Neurol Neurosurg 2025; 249:108686. [PMID: 39675151 DOI: 10.1016/j.clineuro.2024.108686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 12/03/2024] [Accepted: 12/07/2024] [Indexed: 12/17/2024]
Abstract
OBJECTIVE The aim of this study was to assess for a "July Effect" by comparing exact matched patients undergoing single-level spinal fusions in July or in the latter half of the academic year. METHODS Data from 2338 patients who underwent single-level, posterior-only lumbar fusion at a single, multicenter university hospital system were retrospectively reviewed. The primary outcomes were 90-day unplanned hospital readmissions, Emergency Department (ED) evaluations, reoperations, non-home discharge, and all-cause mortality. The secondary outcomes assessed include length of hospital stay, main procedure time, procedure closure time, and total surgery duration. Outcomes of surgeries at the beginning (July) of the academic year were compared to those at the end of the year (April-June). RESULTS Across 2338 patients, operative month had no effect on 90-day readmissions, ED visits, reoperations, mortality, or non-home discharge. Patients undergoing surgery in July vs April-June had a significantly longer mean procedure time, procedure closure time, and total duration of surgery, but not hospital length of stay. Among patients whom were exact matched, surgeries in July vs April-June had a significantly longer mean procedure closure time, but no significant differences in primary procedure time, total surgical duration, or length of stay in hospital. CONCLUSIONS Single level spinal fusion wound closure times are longer in July but postoperative morbidity and mortality are unchanged throughout the academic year. These findings support the current literature that teaching hospitals, and senior surgeons, provide adequate safeguards to ensure patient safety at all times.
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Affiliation(s)
- Ritesh Karsalia
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Austin J Borja
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Xu
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan S Gallagher
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jianbo Na
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; McKenna EpiLog Fellowship in Population Health, at the University of Pennsylvania, Philadelphia, PA, USA
| | - Scott D McClintock
- West Chester University, The West Chester Statistical Institute and Department of Mathematics, 25 University Ave., West Chester, PA, USA
| | - Paul J Marcotte
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ali K Ozturk
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - James M Schuster
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jon J W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; McKenna EpiLog Fellowship in Population Health, at the University of Pennsylvania, Philadelphia, PA, USA.
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Gajjar AA, Covell MM, Prem Kumar R, Tang OY, Ranganathan S, Muzyka L, Mualem W, Rehman I, Patel SV, Lavadi RS, Mitha R, Lieber BA, Hamilton DK, Agarwal N. Evidence Against a Traumatic Brain Injury "July Effect": An Analysis of 3 160 452 Patients From the National Inpatient Sample. Neurosurgery 2025; 96:447-453. [PMID: 38990004 DOI: 10.1227/neu.0000000000003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/29/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The "July Effect" hypothesizes increased morbidity and mortality after the addition of inexperienced physicians at the beginning of an academic year. However, the impact of newer members on neurosurgical teams managing patients with traumatic brain injury (TBI) has yet to be examined. This study conducted a nationwide analysis to evaluate the existence of the "July Effect" in the setting of patients with TBI. METHODS The Healthcare Cost and Utilization Project Central Distributor's National Inpatient Sample data set was queried for patients with TBI using International Classification of Diseases (ICD)-9 and ICD-10 codes. Discharges were included for diagnoses of traumatic epidural, subdural, or subarachnoid hemorrhages. Only patients treated at teaching hospitals were included to ensure resident involvement in care. Patients were grouped into July admission and non-July admission cohorts. A subgroup of patients with neurotrauma undergoing any form of cranial surgery was created. Perioperative variables were recorded. Rates of different complications were assayed. Groups were compared using χ 2 tests (qualitative variables) and t -tests or Mann-Whitney U -tests (quantitative variables). Logistic regression was used for binary variables. Gamma log-linked regression was used for continuous variables. RESULTS The National Inpatient Sample database yielded a weighted average of 3 160 452 patients, of which 312 863 (9.9%) underwent surgical management. Patients admitted to the hospital in July had a 5% decreased likelihood of death ( P = .027), and a 5.83% decreased likelihood of developing a complication ( P < .001) compared with other months of the year. July admittance to a hospital showed no significant impact on mean length of stay ( P = .392) or routine discharge ( P = .147). Among patients with TBI who received surgical intervention, July admittance did not significantly affect the likelihood of death ( P = .053), developing a complication ( P = .477), routine discharge ( P = .986), or mean length of stay ( P = .385). CONCLUSION The findings suggested that there is no "July Effect" on patients with TBI treated at teaching hospitals in the United States.
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Affiliation(s)
- Avi A Gajjar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Michael M Covell
- School of Medicine, Georgetown University, Washington , District of Columbia , USA
| | - Rohit Prem Kumar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Oliver Y Tang
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | | | - Logan Muzyka
- Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin , Texas , USA
| | - William Mualem
- Department of General Surgery, Temple University, Philadelphia , Pennsylvania , USA
| | - Inaya Rehman
- Department of Biology, San Jose State University, San Jose , California , USA
| | - Shrey V Patel
- Tufts University School of Medicine, Boston , Massachusetts , USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Bryan A Lieber
- Department of Neurosurgery, Dr. Kiran C. Patel College of Allopathic Medicine Nova Southeastern University Davie, Fort Lauderdale , Florida , USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
- Neurological Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Celdir MG, Wehby G, Prakash S, Tanaka T. July effect in hospitalized cirrhosis patients: A US nationwide study using difference-in-differences analysis. PLoS One 2025; 20:e0316445. [PMID: 39804918 PMCID: PMC11729967 DOI: 10.1371/journal.pone.0316445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 12/11/2024] [Indexed: 01/16/2025] Open
Abstract
BACKGROUND The July effect in US teaching hospitals has been studied with conflicting results. We aimed to evaluate the effect of physician turnover in July on the clinical outcomes of patients hospitalized with cirrhosis. METHODS We utilized the Nationwide Inpatient Sample database (2016-2019) to identify patients hospitalized with cirrhosis and liver-related complications (variceal bleeding, hepatorenal syndrome, acute-on-chronic liver failure). We used difference-in-differences analysis to compare teaching and non-teaching hospital differences in mortality and length of stay (LOS) in May and July, and trends in outcomes in other months before and after July. RESULTS We included 78,371 hospitalizations in teaching and 23,518 in non-teaching hospitals in May and July. Teaching hospital admissions had overall higher complication rates and mortality compared to non-teaching hospitals. We did not find a difference in mortality between teaching and non-teaching hospitals in all cirrhotic patients (adjusted odds ratio 1.01, 95%CI [0.88-1.16]) or in those with severe complications (0.87, [0.72-1.06]). There was greater LOS in July vs. May in teaching hospitals relative to non-teaching hospitals for all patients with cirrhosis (adjusted rate ratio 1.03, 95%CI [1.02-1.05]) and for those with severe complications (1.19, [1.17-1.21]). The months after July were associated with longer LOS in teaching hospitals, with the effect gradually diminishing over the subsequent months. CONCLUSIONS Our study suggests trainee turnover in July did not affect mortality, but lengthened hospital stays for patients with cirrhosis, highlighting the need for effective supervision of new trainees and strategies to mitigate operational disruptions for improved clinical management.
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Affiliation(s)
- Melis Gokce Celdir
- Division of Gastroenterology and Hepatology, University of Iowa, Iowa City, IA, United States of America
| | - George Wehby
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA, United States of America
- National Bureau of Economic Research, Cambridge, Massachusetts, United States of America
| | - Shahana Prakash
- Department of Internal Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Tomohiro Tanaka
- Division of Gastroenterology and Hepatology, University of Iowa, Iowa City, IA, United States of America
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Conway R, Low C, Byrne D, O'Riordan D, Silke B. Reduced 30-day in-hospital but increased long-term mortality for weekend vs weekday acute medical admission. Ir J Med Sci 2024; 193:2139-2145. [PMID: 38861102 PMCID: PMC11449977 DOI: 10.1007/s11845-024-03729-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/30/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Acute medical admission at the weekend has been reported to be associated with increased mortality. We aimed to assess 30-day in-hospital mortality and subsequent follow-up of all community deaths following discharge for acute medical admission to our institution over 21 years. METHODS We employed a database of all acute medical admissions to our institution over 21 years (2002-2023). We compared 30-day in-hospital mortality by weekend (Saturday/Sunday) or weekday (Tuesday/Wednesday) admission. Outcome post-discharge was determined from the National Death Register to December 2021. Predictors of 30-day in-hospital and long-term mortality were analysed by logistic regression or Cox proportional hazards models. RESULTS The study population consisted of 109,232 admissions in 57,059 patients. A weekend admission was associated with a reduced 30-day in-hospital mortality, odds ratio (OR) 0.70 (95%CI 0.65, 0.76). Major predictors of 30-day in-hospital mortality were acute illness severity score (AISS) OR 6.9 (95%CI 5.5, 8.6) and comorbidity score OR 2.4 (95%CI 1.2, 4.6). At a median follow-up of 5.9 years post-discharge, 19.0% had died. The strongest long-term predictor of mortality was admission AISS OR 6.7 (95%CI 4.6, 9.9). The overall survival half-life after hospital discharge was 16.6 years. Survival was significantly worse for weekend admissions at 20.8 years compared to weekday admissions at 13.3 years. CONCLUSION Weekend admission of acute medical patients is associated with reduced 30-day in-hospital mortality but reduced long-term survival.
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Affiliation(s)
- Richard Conway
- Trinity College Dublin, The University of Dublin Trinity College, Dublin, Ireland.
- St. James's Hospital, Dublin, Ireland.
| | - Candice Low
- Trinity College Dublin, The University of Dublin Trinity College, Dublin, Ireland
- St. James's Hospital, Dublin, Ireland
| | - Declan Byrne
- Trinity College Dublin, The University of Dublin Trinity College, Dublin, Ireland
- St. James's Hospital, Dublin, Ireland
| | - Deirdre O'Riordan
- Trinity College Dublin, The University of Dublin Trinity College, Dublin, Ireland
- St. James's Hospital, Dublin, Ireland
| | - Bernard Silke
- Trinity College Dublin, The University of Dublin Trinity College, Dublin, Ireland
- St. James's Hospital, Dublin, Ireland
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Wickramanayake U, Arrayeh A, Arulvasan V, Sarvesh B, Nwankpa C, Hewagamage R, Malik A, Giubileo A. Introducing an Emergency Department Electronic Handbook to Junior Doctors New to Emergency Medicine. Cureus 2024; 16:e66313. [PMID: 39238682 PMCID: PMC11376968 DOI: 10.7759/cureus.66313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 09/07/2024] Open
Abstract
Background The transition of junior doctors into working in the emergency department (ED) in the United Kingdom often poses challenges in adapting to new hospital systems and protocols. To address this issue at Queen Elizabeth Hospital, King's Lynn (QEHKL), a quality improvement project (QIP) was undertaken to develop an electronic ED handbook with the primary aim of enhancing the confidence and knowledge of newly appointed doctors during their ED rotation. This electronic handbook serves as a comprehensive repository for vital medical protocols, guidelines, and trust referral pathways, offering an easily accessible resource for junior doctors. Objectives The primary objective of this study was to determine whether there was an improvement in the confidence and knowledge of ED junior doctors following the introduction of the Electronic ED Handbook. The secondary objectives were to determine whether introducing the ED Handbook increased the overall satisfaction rating of the content of the ED Junior Doctor Induction program and assess the level of recommendation for the ED Handbook among the doctors for inclusion in future ED inductions. Method The QIP was designed using the Model for Improvement framework, Plan, Do, Study, Act (PSDA). The aims were designed to be Specific, Measurable, Achievable, Relevant, and Time-bound (SMART). Pre- and post-intervention surveys were conducted for comparison before and after the ED Handbook was introduced. Results Regarding the confidence of junior doctors to proceed into their new roles, the responses of "quite confident" or "very confident" increased from 77.8% (before) to 100% (after the ED Handbook introduction). One hundred percent of the responders found the ED Handbook to be either "very useful" or "extremely useful" in increasing their confidence and knowledge in the first month of their ED rotation. The satisfaction rating of "excellent" for the content of the ED Junior Doctor Induction program increased from 55.5% to 66.7%. One hundred percent of the responders recommended the inclusion of the ED Handbook for future inductions. Conclusion and recommendations Comparing the results from the pre- and post-intervention surveys shows a significant improvement in the confidence and knowledge of ED junior doctors following the introduction of the Electronic ED Handbook. The handbook was formally endorsed by the ED clinical governance team as an integral component of the ED induction process, aiding junior doctors in making a seamless transition into their new roles in emergency medicine. This study emphasizes the importance of utilizing digital resources to improve the confidence and knowledge of junior doctors and recommends the continued use of the handbook in future induction programs.
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Affiliation(s)
- Udara Wickramanayake
- Emergency Medicine, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, GBR
| | - Ahmed Arrayeh
- Emergency Medicine, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, GBR
| | | | - Bhaskar Sarvesh
- Emergency Medicine, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, GBR
| | - Charles Nwankpa
- Emergency Medicine, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, GBR
| | - Ravindu Hewagamage
- Information Technology, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, GBR
| | - Ayesha Malik
- Emergency Medicine, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, GBR
| | - Angelo Giubileo
- Emergency Medicine, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, GBR
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Rai A, Shukla S, Mehtani N, Acharya V, Tolley N. Does a junior doctor focused 'Bootcamp' improve the confidence and preparedness of newly appointed ENT registrars to perform their job roles? BMC MEDICAL EDUCATION 2024; 24:702. [PMID: 38937721 PMCID: PMC11212423 DOI: 10.1186/s12909-024-05691-w] [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: 07/19/2023] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND To assess changes in confidence and preparedness after conducting a 2-day induction bootcamp for novice Ear Nose and Throat (ENT) first year specialty trainee registrars (ST3s) in the United Kingdom (UK). The bootcamp covered common ENT presentations on the ward, and in the elective and emergency settings. METHODS A total of 32 trainees (ST3 or research fellow) voluntarily registered via an online application form to the Southern ST3 accelerated learning course bootcamp through ENT UK. ENT UK is a membership body that supports ENT trainees throughout their careers. They completed a two-day bootcamp that was hosted at St Mary's Hospital, London and 10 skills sessions were delivered by either a senior ENT registrar or an ENT consultant. A pre-session questionnaire was distributed to all participants and a post-session questionnaire was provided that assessed the changes in confidence and preparedness of the participants, if any. The responses were scored by a 10-point Likert scale. Only participants who fully completed the pre and post questionnaire were included, which was 29 in total. RESULTS Participants self-reported a significant increase in confidence (p < 0.001) and preparedness (p < 0.001) following the bootcamp course. The greatest improvements in comparison to all other stations were self-preparedness in the rigid bronchoscopy station and self-confidence in the sphenopalatine artery (SPA) ligation station. CONCLUSION The use of a two-day bootcamp improved confidence and preparedness of managing common ENT presentations in the ward, elective and emergency settings for ENT ST3s. It provides a useful adjunct in the acquisition of technical and non-technical skills alongside the traditional surgical apprenticeship. In the future, more work is required to assess the impact of bootcamps on patient outcomes and long-term benefits on trainees' skill retention and clinical proficiency.
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Affiliation(s)
- Amar Rai
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Shivani Shukla
- The School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Nikita Mehtani
- Department of ENT Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Vikas Acharya
- Department of ENT Surgery, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
| | - Neil Tolley
- Department of ENT Surgery, Imperial College Healthcare NHS Trust, London, UK
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Lee S, Kim S, Ahn S, Cho H, Moon S, Cho YD, Park JH. The mortality of patients with sepsis increases in the first month of a new academic year. Clin Exp Emerg Med 2024; 11:161-170. [PMID: 38286506 PMCID: PMC11237255 DOI: 10.15441/ceem.23.117] [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: 08/28/2023] [Accepted: 10/31/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE Many studies have examined the July effect. However, little is known about the July effect in sepsis. We hypothesized that the July effect would result in worse outcomes for patients with sepsis. METHODS Data from patients with sepsis, collected prospectively between January 2018 and December 2021, were analyzed. In Korea, the new academic year starts on March 1, so the "July effect" appears in March. The primary outcome was 30-day mortality. Secondary outcomes included adherence to the Surviving Sepsis Campaign bundle. Outcomes in March were compared to other months. A multivariate Cox proportional hazard regression was performed to adjust for confounders. RESULTS We included 843 patients. There were no significant differences in sepsis severity. The 30-day mortality in March was higher (49.0% vs. 28.5%, P<0.001). However, there was no difference in bundle adherence in March (42.2% vs. 48.0%, P=0.264). The multivariate Cox proportional hazard regression showed that the July effect was associated with 30-day mortality in patients with sepsis (adjusted hazard ratio, 1.925; 95% confidence interval, 1.405-2.638; P<0.001). CONCLUSION The July effect was associated with 30-day mortality in patients with sepsis. However, bundle adherence did not differ. These. RESULTS suggest that the increase in mortality during the turnover period might be related to unmeasured in-hospital management. Intensive supervision and education of residents caring for patients with sepsis is needed in the beginning of training.
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Affiliation(s)
- Sukyo Lee
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Sungjin Kim
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Sejoong Ahn
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Hanjin Cho
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Sungwoo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Young Duck Cho
- Department of Emergency Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jong-Hak Park
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
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Wang YY, Prendergast E, Butler M. Improving induction to support new junior paediatric staff through an electronic induction guide and buddy scheme. Arch Dis Child Educ Pract Ed 2024; 109:35-37. [PMID: 37907327 DOI: 10.1136/archdischild-2022-324949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/21/2023] [Indexed: 11/02/2023]
Affiliation(s)
- Yang Yang Wang
- General Paediatrics, Evelina London, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Emily Prendergast
- General Paediatrics, Evelina London, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark Butler
- General Paediatrics, Evelina London, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Conway R, Byrne D, O'Riordan D, Silke B. No evidence of a "July Effect" on mortality. Eur J Intern Med 2024; 119:149-150. [PMID: 37867005 DOI: 10.1016/j.ejim.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Richard Conway
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - Declan Byrne
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - Deirdre O'Riordan
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - Bernard Silke
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
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Grissa MH, Dhaoui R, Bel Haj Ali K, Sekma A, Toumia M, Sassi S, Sakly AK, Zorgati A, Bouraoui H, Ben Soltane H, Mezgar Z, Boukef R, Boubaker H, Bouida W, Beltaief K, Nouira S. Comparison of simulation and video-based training for acute asthma. BMC MEDICAL EDUCATION 2023; 23:873. [PMID: 37974223 PMCID: PMC10655321 DOI: 10.1186/s12909-023-04836-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Emergency medicine is particularly well suited to simulation training. However, evidence for the efficacy of simulation-based medical training remains limited especially to manage high-risk cases such as acute asthma. OBJECTIVE The objective of our study was to compare the performance of high-fidelity simulation (HFS) and interactive video-case challenge-based training (IVC) for final-year medical students in the management of acute asthma. METHODS This was a prospective randomized controlled study conducted at the emergency department (ED) of Monastir University hospital ( Tunisia). 69 final-year medical students were randomized to HFS (n = 34) and IVC (n = 35) training on acute asthma topic. The study was conducted over a 1-week period. Efficacy of each teaching method was compared through the use of multiple-choice questionnaires (MCQ) before (pre-test), after (post-test) training and a simulation scenario test conducted 1 week later. The scenario was based on acute asthma management graded on predefined critical actions using two scores: the checklist clinical score (range 0 to 30), and the team skills score (range 0 to 16). Student satisfaction was also evaluated with the Likert 5 points scale. Two years after the post-test, both groups underwent a third MCQ testing to assess sustainability of knowledge. RESULTS There were no differences in age between groups. There was no statistically significant difference between the HFS and IVC groups pre-test scores (p = 0.07). Both groups demonstrated improvement in MCQ post-test from baseline after training session; the HFS MCQ post-test score increased significantly more than the IVC score (p < 0.001). The HFS group performed better than the IVC group on the acute asthma simulation scenario (p < 0.001). Mean checklist clinical score and mean team skills score were significantly higher in HFS group compared to IVC group (respectively 22.9 ± 4.8 and 11.5 ± 2.5 in HFS group vs 19.1 ± 3 and 8.4 ± 3.1 in IVC group) (p < 0.001). After 2 years, MCQ post-test scores decreased in both groups but the decrease was lower in HFS group compared to the IVC group. CONCLUSION High-fidelity simulation-based training was superior to interactive video-case challenge for teaching final year medical students,and led to more long-term knowledge retention in the management of simulated acute asthma patients. TRIAL REGISTRATION The study was registered at www. CLINICALTRIALS gov NCT02776358 on 18/05/2016.
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Affiliation(s)
- Mohamed Habib Grissa
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
| | - Randa Dhaoui
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia
| | - Khaoula Bel Haj Ali
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia
| | - Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia
| | - Maroua Toumia
- Emergency Department, Haj Ali Soua Regional Hospital of Ksar Hellal, Ksar Hellal, 5070, Tunisia
| | - Sarra Sassi
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia
| | - Abdel Karim Sakly
- Orthopedic Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
| | - Asma Zorgati
- Emergency Department, Sahloul University Hospital, Sousse, 4000, Tunisia
| | - Hajer Bouraoui
- Pharmacology Department Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Houda Ben Soltane
- Emergency Department, Farhat Hached University Hospital, Sousse, 4000, Tunisia
| | - Zied Mezgar
- Emergency Department, Farhat Hached University Hospital, Sousse, 4000, Tunisia
| | - Riadh Boukef
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia
- Emergency Department, Sahloul University Hospital, Sousse, 4000, Tunisia
| | - Hamdi Boubaker
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia
| | - Wahid Bouida
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia
| | - Kaouthar Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia.
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.
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Lietz A, Kraller J, Hoffelner A, Ritschl V, Berger A, Wagner M. Dose-response of virtual reality training of paediatric emergencies in a randomised simulation-based setting. Acta Paediatr 2023; 112:1995-2005. [PMID: 37195147 DOI: 10.1111/apa.16847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/18/2023]
Abstract
AIM To determine the effect of different virtual reality training intervals on individual performance to facilitate the optimal implementation of medical virtual reality training. METHODS Emergency scenarios in virtual reality were performed by 36 medical students from the Medical University of Vienna. After baseline training, the participants were randomised into three groups of equal size and underwent virtual reality training at different time intervals (monthly, one training after 3 months, and no further training) before undergoing final assessment training after 6 months. RESULTS Group A, with monthly training exercises, improved their performance score significantly by 1.75 mean score points compared with Group B, who repeated baseline training after 3 months. Statistically significant difference was indicated when comparing Group A with Group C, which was not further trained and served as the control group. CONCLUSION One-month intervals are associated with statistically significant performance improvements compared with additional training after 3 months and to a control group without regular training. The results show that training intervals of 3 months or longer are insufficient to achieve high performance scores. Virtual reality training is a cost-effective alternative to conventional simulation-based training for regular practice.
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Affiliation(s)
- Andrea Lietz
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Julian Kraller
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Alexander Hoffelner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Michael Wagner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
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Chan JEZ, Hakendorf P, Thomas JS. Key aspects of teaching that affect perceived preparedness of medical students for transition to work: insights from the COVID-19 pandemic. Intern Med J 2023; 53:1321-1331. [PMID: 37255312 DOI: 10.1111/imj.16146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/15/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND The self-perceived preparedness of medical students to transition into practising junior doctors has implications for patient safety, graduate well-being and development of professional identity. AIMS To examine the impact of changes to final-year education and placements and determine key elements that contribute to self-perceived preparedness for transition to work. METHODS An online survey among final-year medical students at one Australian medical school in 2020 (the cohort most affected by the coronarvirus disease 2019 [COVID-19] pandemic), exploring overall self-perceived preparedness and specific competencies, including questions in previous Australian Medical Council/Medical Board of Australia annual national surveys. Quantitative and qualitative content analyses were performed. RESULTS Thirty-three percent of eligible participants completed the survey. There was a significant decline in overall self-perceived preparedness among participants (mean preparedness, 3.55 ± 0.88) compared with 2019 graduates from the same medical school (mean preparedness, 4.28 ± 0.64, P < 0.001) and the national average (mean preparedness, 3.81 ± 0.93, P = 0.04). There was a decline in self-perceived preparedness for all specific competencies, with complex competencies more greatly affected. Qualitative content analysis of free text responses identified limitations of an online compared with a face-to-face formal education program and specific aspects of placements, which contribute to perceived preparedness. CONCLUSION The current study highlights key aspects of clinical placements and formal teaching programs that contribute to perceptions of preparedness for transition to clinical practice. Relevant experiential learning in the clinical setting, opportunities for deliberate practice of necessary skills (in simulation and the clinical setting) and reflective opportunities from formal teaching programs contribute to perceived preparedness and are important elements to be included in the final phase of any medical program.
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Affiliation(s)
- Joel Ern Zher Chan
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Paul Hakendorf
- Clinical Epidemiology Services, Flinders Medical Centre, Bedford Park, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Josephine Suzanne Thomas
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
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Brar G, Harney S, McGarr O, McFarland J. Mentoring & support practices for final year medical students during a pandemic - 'The covid doctors'. BMC MEDICAL EDUCATION 2023; 23:534. [PMID: 37496028 PMCID: PMC10373250 DOI: 10.1186/s12909-023-04513-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 07/16/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Transition from final-year medical student to newly graduated doctor is challenging with evidence of associated increased patient mortality and medical errors. Previous work suggests tackling preparedness alone does not 'solve' this transition. The current focus on mentoring and support provision during this period and is an under-researched area. The COVID-19 pandemic represents a unique disruptive critical incident in which to examine mentoring and support practices, exposing strengths and weaknesses. The perspectives of this cohort and their implications remains an under-researched area. METHODS Individual semi-structured interviews were conducted with nine graduate-entry final-year medical students. An inductive latent phenomenological approach explored individual experiences of mentoring and support practices during final-year and transition to professional practice. RESULTS Three major themes emerged: 1) Mentoring & Support; 2) Clinical Exposure; 3) Graduation & Transition. A journey metaphor was used to aid the description of participants' lived experience of mentoring and support practices during their final year. Final year medical students (FYMs) felt under-supported and found practices inadequate. Reduced clinical exposure yielded unpreparedness and regression, potentially impacting future careers. Positive experiences were variable and unstructured. 'The COVID Doctors', subtheme provided rich insights into shared narratives and identities amongst participants. CONCLUSIONS This study provides qualitative evidence for perceived inadequate mentoring and support provision for final year medical students at transition during a critical incident (the COVID-19 pandemic). Several themes using the metaphor of a journey explore the lived experience of this unique cohort determining their perceptions on the delivery of their medical education and their identity as 'covid doctors'. There are several implications for this study in a post-pandemic era and for pandemic-preparedness, both rapidly growing areas of research in medical education. Recommendations include updating contingency plans, balancing clinical exposure with patient safety issues, and providing support to 'bottom-up' mentoring practices.
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Borja AJ, Ahmad HS, Tomlinson SB, Na J, McClintock SD, Welch WC, Marcotte PJ, Ozturk AK, Malhotra NR. "July Effect" in Spinal Fusions: A Coarsened Exact-Matched Analysis. Neurosurgery 2023; 92:623-631. [PMID: 36700756 DOI: 10.1227/neu.0000000000002256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/21/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Few neurosurgical studies examine the July Effect within elective spinal procedures, and none uses an exact-matched protocol to rigorously account for confounders. OBJECTIVE To evaluate the July Effect in single-level spinal fusions, after coarsened exact matching of the patient cohort on key patient characteristics (including race and comorbid status) known to independently affect neurosurgical outcomes. METHODS Two thousand three hundred thirty-eight adult patients who underwent single-level, posterior-only lumbar fusion at a single, multicenter university hospital system were retrospectively enrolled. Primary outcomes included readmissions, emergency department visits, reoperation, surgical complications, and mortality within 30 days of surgery. Logistic regression was used to analyze month as an ordinal variable. Subsequently, outcomes were compared between patients with surgery at the beginning vs end of the academic year (ie, July vs April-June), before and after coarsened exact matching on key characteristics. After exact matching, 99 exactly matched pairs of patients (total n = 198) were included for analysis. RESULTS Among all patients, operative month was not associated with adverse postoperative events within 30 days of the index operation. Furthermore, patients with surgeries in July had no significant difference in adverse outcomes. Similarly, between exact-matched cohorts, patients in July were observed to have noninferior adverse postoperative events. CONCLUSION There was no evidence suggestive of a July Effect after single-level, posterior approach spinal fusions in our cohort. These findings align with the previous literature to imply that teaching hospitals provide adequate patient care throughout the academic year, regardless of how long individual resident physician assistants have been in their particular role.
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Affiliation(s)
- Austin J Borja
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Samuel B Tomlinson
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jianbo Na
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- McKenna EpiLog Fellowship in Population Health, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott D McClintock
- The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania, USA
| | - William C Welch
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul J Marcotte
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali K Ozturk
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- McKenna EpiLog Fellowship in Population Health, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Gatti CA, Parker-Conway K, Okorie M. COVID-19 pandemic interim Foundation Year 1 post and confidence in core skills and competencies: a longitudinal survey. BMJ Open 2022; 12:e059487. [PMID: 36323477 PMCID: PMC9638744 DOI: 10.1136/bmjopen-2021-059487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES The interim Foundation Year 1 (FiY1) post was created in response to the COVID-19 pandemic to help bolster the workforce and manage increased clinical pressures. This study aimed to assess the impact of the FiY1 post on medical graduates' self-reported confidence in common tasks, core skills, competencies and procedures prior to starting FY1, as a measure of increasing preparedness for practice. SETTING A longitudinal survey was performed at a tertiary teaching hospital in the South East of England. FiY1 posts ran from June to July 2020. PARTICIPANTS Questionnaires were sent to 122 medical graduates from a single medical school (recipients included FiY1s and non-FiY1s) and to 69 FiY1s at a single Teaching Hospital NHS Trust, irrespective of medical school attended. Initial and follow-up questionnaires had 86 and 62 respondents, respectively. Of these, 39 graduates were matched; 26 were FiY1s and 13 non-FiY1s. The 39 matched results were analysed. PRIMARY OUTCOME MEASURES Confidence levels in common FY1 tasks, core procedures and competencies were gathered before and after the FiY1 post through online questionnaires. Change in confidence comparing FiY1s and non-FiY1s was measured and analysed using linear regression. RESULTS On a 5-point scale, the FiY1 post increased overall confidence in starting FY1 by 0.62 (95% CI 0.072 to 1.167, p=0.028). The FiY1 post increased confidence in performing venepuncture by 0.32 (95% CI 0.011 to 0.920, p=0.045), performing intravenous cannulation by 0.48 (95% CI 0.030 to 1.294, p=0.041) and recognising, assessing and initiating the management of the acutely ill patient by 0.32 (95% CI 0.030 to 1.301, p=0.041). CONCLUSIONS The COVID-19 pandemic FiY1 post improved confidence in core skills and competencies. These findings may help guide future educational interventions in conjunction with further larger scale studies, ultimately aiding to bridge the transition gap between being a medical student and a doctor.
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Affiliation(s)
- Cristina Angela Gatti
- Department of Medical Education, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- General Internal Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Kathryn Parker-Conway
- Department of Medical Education, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
| | - Michael Okorie
- Department of Medical Education, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Department of Medicine, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
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Gupta KK, Bhamra N, Jolly K. The Effectiveness of a Specific Foundation Year 1 Induction Programme in Improving Confidence for Newly Qualified Doctors in the UK. MEDICAL SCIENCE EDUCATOR 2022; 32:1073-1076. [PMID: 36276765 PMCID: PMC9583957 DOI: 10.1007/s40670-022-01616-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 06/16/2023]
Abstract
Background Despite the completion of 5 or 6 years of undergraduate study, the transition to a newly qualified foundation year 1 doctor (FY1) in the UK has been recognised as challenging. We created a specific FY1 Induction Programme and aimed to evaluate its effectiveness on perceived confidence and preparedness for newly qualified doctors by assessing their responses to surveys before and after the delivery of the course. Methods Pre- and post-course surveys were administered at the start and end of the course, respectively. All questions were subjective and used a 5-point Likert scale (1, not at all confident, to 5, definitely confident) to assess perceived confidence in a range of questions before and after the course. Results A total of 35 participants completed the pre-course survey and 41 completed the post-course survey. For all questions, there was a statistically significant increase in confidence ratings. All 41 participants completing the post-course questionnaire responded 'yes' to feeling more confident to be an FY1 after completing the programme compared to before (100%). Conclusions Our study, along with previously published work, has shown a repeatable positive effect with implementation of transition courses for newly qualified doctors. Future research in this area could focus on more large-scale standardised learning events incorporated by different trusts prior to commencement as an FY1, to see if the positive effects found in our study are translatable across other regions. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-022-01616-8.
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Affiliation(s)
- Keshav Kumar Gupta
- Department of Surgery, Royal Wolverhampton NHS Trust, Wolverhampton Road, Wolverhampton, WV10 0QP UK
| | - Navdeep Bhamra
- Department of Surgery, Royal Wolverhampton NHS Trust, Wolverhampton Road, Wolverhampton, WV10 0QP UK
| | - Karan Jolly
- Department of Surgery, Royal Wolverhampton NHS Trust, Wolverhampton Road, Wolverhampton, WV10 0QP UK
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Chen S, Smith H, Bartlam B, Low-Beer N, Chow A, Rosby LV, Shelat VG, Cleland J. Role of social comparison in preparedness for practice as a junior doctor in Singapore: a longitudinal qualitative study. BMJ Open 2022; 12:e061569. [PMID: 36691130 PMCID: PMC9454008 DOI: 10.1136/bmjopen-2022-061569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/20/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To date, most research on medical graduates' preparedness for practice has conceptualised preparedness as something possessed by the individual. However, new doctors work within social settings with other people and, given this, we argue that preparedness has a social and comparative dimension. The aim of this paper is to explore medical students'/graduates' self-assessments of their preparedness for practice using the lens of social comparison theory. SETTING We invited medical students from one of Singapore's three medical schools who were in their final-year Student Assistantship Programme to participate in semi-structured interviews, and follow-up interviews 6 months later when they were working as junior doctors. Data was collected from two cohorts, in 2018 and 2019. Initial analysis of interview transcripts was inductive and thematic. Social comparison theory was used for subsequent theory-driven analysis. PARTICIPANTS 31 participants took part, of whom 21 also engaged in follow-up interviews. RESULTS We identified three uses of social comparison: as coping strategy to manage uncertainties in transitions where there was no formal, objective testing of their performance; as a means to confirm their self-perceived preparedness (upwards or downwards, eg, being better or worse prepared than comparator others); and as the basis for decision-making (eg, changing career choices). CONCLUSIONS Senior medical students and newly-graduated doctors compare themselves with peers and near-peers in terms of prior learning and current performance to evaluate and understand their own performance at work. Future studies need to examine further how the feeling of preparedness or unpreparedness generated from social comparisons may affect subsequent clinical performance and professional development.
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Affiliation(s)
- Shiwei Chen
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Singapore
| | - Helen Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Singapore
| | | | - Naomi Low-Beer
- Brunel Medical School, Brunel University London, Uxbridge, UK
| | - Aloysius Chow
- Office of Medical Education, Lee Kong Chian School of Medicine, Singapore
| | | | | | - Jennifer Cleland
- Office of Medical Education, Lee Kong Chian School of Medicine, Singapore
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Tano BP, Laraman J. Virtual on-call: Does a simulated on-call session increase the preparedness of final-year medical students? Future Healthc J 2022; 9:46. [PMID: 36310989 PMCID: PMC9601071 DOI: 10.7861/fhj.9-2-s46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Metersky ML, Eldridge N, Wang Y, Eckenrode S, Galusha D, Jaser L, Mathew J, Angus S, Nardino R. Rates of Adverse Events in Hospitalized Patients After Summer-Time Resident Changeover in the United States: Is There a July Effect? J Patient Saf 2022; 18:253-259. [PMID: 34387249 PMCID: PMC8831642 DOI: 10.1097/pts.0000000000000887] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to determine whether patients in teaching hospitals are at higher risk of suffering from an adverse event during the summer trainee changeover period. METHODS We performed a retrospective analysis of data from the Medicare Patient Safety Monitoring System, a medical-record abstraction-based database in the United States. Hospital admissions from 2010 to 2017 for acute myocardial infarction, heart failure, pneumonia, or a major surgical procedure were studied. Admissions were divided into nonsurgical (acute myocardial infarction, heart failure, or pneumonia) and surgical. Adverse event rates in July/August were compared with the rest of the year. Hospitals were stratified into major teaching, minor teaching, or nonteaching. Results were adjusted for patient demographics, comorbidities, and hospital characteristics. Outcomes were the adjusted odds of having at least 1 adverse event in July/August versus the rest of the year. RESULTS We included 185,652 hospital admissions. The adjusted odds ratios (ORs) of suffering from at least one adverse event in a major teaching hospital in July/August was 0.83 (95% confidence interval [CI], 0.69-0.98) for nonsurgical patients and 1.09 (95% CI, 0.84-1.40) for surgical patients. In minor teaching hospitals, the adjusted ORs were 0.96 (95% CI, 0.88-1.04) for nonsurgical patients and 0.99 (95% CI, 0.87-1.12) for surgical patients. In nonteaching hospitals, the adjusted ORs were 0.98 (95% CI, 0.91-1.06) for nonsurgical patients and 1.10 (95% CI, 0.96-1.24) for surgical patients. CONCLUSIONS Patients admitted to teaching hospitals in July/August are not at increased risk of adverse events. These findings should reassure patients and medical educators that patients are not excessively endangered by admission to the hospital during these months.
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Affiliation(s)
| | - Noel Eldridge
- Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, MD
| | | | - Sheila Eckenrode
- From the Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven
| | - Deron Galusha
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven
| | | | - Jasie Mathew
- From the Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven
| | - Steven Angus
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT
| | - Robert Nardino
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT
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21
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Gupta A, Ionides A. Does the ‘Changeover Effect’ Apply to Cataract Surgery Complications? Semin Ophthalmol 2022; 37:682. [DOI: 10.1080/08820538.2022.2052115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ankur Gupta
- Cataract Service, Moorfields Eye Hospital, London, UK
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22
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Sanchez C. The psychology of being a beginner. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2022. [DOI: 10.1111/spc3.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Carmen Sanchez
- Gies College of Business University of Illinois at Urbana Champaign Urbana Illinois USA
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Chow A, Chen S, Rosby L, Low-Beer N, Shelat VG, Cleland J, Bartlam B, Smith HE. Student assistantship programme: an evaluation of impact on readiness to transit from medical student to junior doctor. BMC MEDICAL EDUCATION 2022; 22:99. [PMID: 35164723 PMCID: PMC8845282 DOI: 10.1186/s12909-022-03159-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 02/01/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Studies report that medical graduates are not prepared for practice as expected, and interventions have been developed to prepare them for practice. One such intervention is the assistantship, which provides hands-on opportunities to hone clinical skills and undertake responsibilities under supervision. The Lee Kong Chian School of Medicine (LKCMed) is Singapore's newest medical school, and students undergo a Student Assistantship Programme (SAP) to prepare for practice as junior doctors (PGY1). This study evaluated the SAP from the students' and clinical supervisors' perspectives. METHODS Students completed online questionnaires to assess readiness for practice before and after SAP, and a subsample were interviewed about their experiences of SAP and its impact on their preparedness for PGY1. In addition, after our graduates had begun work as PGY1 doctors, their clinical supervisors completed an online questionnaire and were interviewed about the perceived benefits of SAP and the attributes of our graduates as junior doctors. RESULTS Fifty (96%) students completed the pre-SAP questionnaire and 46 (92%) completed the post-SAP questionnaire. Levels of preparedness increased post-SAP (mean scores range pre-SAP: 2.38 to 4.32 vs post-SAP: 3.08 to 4.48); so did opportunities to undertake PGY1 duties (pre-SAP: 56% vs post-SAP: 96%), and hands-on experience in medical emergencies (pre-SAP: 76% vs post-SAP: 89%).Experience of acute care situations increased except "paracetamol overdose". Readiness to be first respondents in ten acute situations improved (statistically significant for asthma, chronic obstructive pulmonary disease exacerbation, gastrointestinal bleed, sepsis, and adverse drug reactions). Three themes emerged from twenty-five student interviews: learning about the work environment, opportunities to learn in a safe environment, and enhancing SAP for future students. Thirty-three supervisors completed the questionnaire, and 70% rated SAP positively in preparing students for PGY1. Eight supervisors interviewed shared positively about the content, timing, and duration of SAP; and suggested future SAPs help students to develop coping and reflective skills. CONCLUSIONS The SAP improved students' preparedness and experience across clinical areas, and students felt the SAP helped bridge undergraduate curriculum and work, provided opportunities to hone their skills and learn from junior doctors. Most clinical supervisors rated the SAP effective in preparing students for PGY1. This is the first formal evaluation of an assistantship in Singapore, and the findings are encouraging from the perspective of students and PGY1 supervisors.
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Affiliation(s)
- Aloysius Chow
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Nanyang, Singapore
| | - Shiwei Chen
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Nanyang, Singapore
| | - Lucy Rosby
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Nanyang, Singapore
| | - Naomi Low-Beer
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Nanyang, Singapore
| | | | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Nanyang, Singapore
| | - Bernadette Bartlam
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Nanyang, Singapore
- School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Helen Elizabeth Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Nanyang, Singapore.
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Wilkinson C, Finn G, Crampton P. Responsibility with a Safety Net: Exploring the Medical Student to Junior Doctor Transition During COVID-19. MEDICAL SCIENCE EDUCATOR 2022; 32:121-129. [PMID: 34873496 PMCID: PMC8635475 DOI: 10.1007/s40670-021-01476-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The Foundation Interim Year-one (FiY1) Programme was part of a UK strategy to increase the medical workforce in response to the COVID-19 pandemic. However, the strategy was introduced urgently without evidence. We sought to explore the transition experience of medical student to FiY1 to foundation doctor, with a view to inform future undergraduate education. METHODS In this hermeneutic phenomenology study, semi-structured individual interviews were completed with nine foundation doctors who had experience of an FiY1 placement. A template analysis approach was taken, and themes reported. RESULTS Participants reported that FiY1 tended to offer a positive experience of transition as a stepping stone to becoming a foundation doctor. Having a degree of clinical responsibility including the right to prescribe medication with supervision was highly valued, as was feeling a core member of the healthcare team. Participants perceived that FiY1 made them more prepared for the foundation transition, and more resilient to the challenges they faced during their first foundation job. DISCUSSION The FiY1 fostered many opportunities for junior doctors to bridge the transition to foundation doctor. Aspects of the FiY1 programme, such as early licencing and increased team membership, should be considered for final-year students in the future.
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Affiliation(s)
- Chris Wilkinson
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, William Leech Building, Newcastle upon Tyne, NE2 4HH UK
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - Gabrielle Finn
- Health Professions Education Unit, Hull York Medical School, York, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Paul Crampton
- Health Professions Education Unit, Hull York Medical School, York, UK
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Tan YX, Jalal AHB, Ngai V, Manobharath N, Soh TCF. What are the non-technical skills required by junior doctors in the NHS to manage medical emergencies? A scoping review. Postgrad Med J 2021; 97:813-818. [PMID: 33541930 DOI: 10.1136/postgradmedj-2020-139285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/25/2020] [Accepted: 12/28/2020] [Indexed: 11/04/2022]
Abstract
Many junior doctors have reported a lack of confidence in managing emergency conditions. However, there is insufficient literature summarising the current knowledge about the non-technical skills needed by junior doctors to tackle medical emergencies. This paper aims to identify the non-technical skills necessary for the management of medical emergencies by junior doctors. Three databases were systematically searched to identify relevant articles published between January 2000 and March 2020. In total, 8707 unique articles were identified and independently screened by at least two authors, using predetermined inclusion and exclusion criteria. A coding framework was applied to extract relevant data and for thematic analysis of the included studies. These methods have been performed following the PRISMA-ScR Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. There were a total of 13 articles included in the thematic analysis. The result of this review was the identification of several key non-technical skills: teamwork, communication, asking for help, challenging seniority, task prioritisation, decision-making, leadership and handling stress. In conclusion, lack of non-technical skills in junior doctors has a negative impact on patient care in a medical emergency. The training of junior doctors can be re-evaluated and designed to reflect the importance of these non-technical skills.
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Affiliation(s)
- Ying Xin Tan
- UCL Medical School, University College London, London, UK
| | | | - Victoria Ngai
- UCL Medical School, University College London, London, UK
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Baldock TE, Brown LR, McLean RC. The junior doctor changeover effect: does it exist in general surgery? Ann R Coll Surg Engl 2021; 104:57-66. [PMID: 34432533 DOI: 10.1308/rcsann.2021.0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Junior doctor changeover has been perceived as a period of increased risk to patients. However, there is a paucity of contemporary evidence of this 'changeover effect'. The aim of this study was to evaluate the presence of an adverse patient effect during periods of junior doctor changeover. METHODS Data were requested on all patients aged 18 years or older admitted acutely under General Surgery in the North of England between 2005 and 2016. This included patient characteristics, diagnoses, comorbidities, procedure codes, mortality and length of stay. Patients were included in the study if they were admitted during the 'changeover week'; defined as the first day of the changeover followed by the six subsequent days. For junior trainees (FY1-CT2), this is the first Wednesday of August, December and April each year. For higher surgical trainees (ST3-ST8), it is the first Wednesday in October. Another week, four weeks prior, was chosen as a historical comparator. RESULTS In total, 61,714 patients were included in this study. Patient characteristics did not vary between the cohorts. There was no difference in 30-day mortality between changeover and non-changeover groups (2.5% vs 2.6%, p = 0.280) or length of stay (5.3 vs 5.2, p = 0.613). Changeover week was not a predictor of increased mortality (OR 1.06, p = 0.302) following multivariable adjustment. Further analysis of the first junior and higher specialty trainee periods, August and October, respectively, showed no significant difference for measured outcomes. CONCLUSIONS This retrospective cohort study provides contemporary evidence that the 'changeover effect' does not exist in acute general surgical admissions in the UK.
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Affiliation(s)
| | - L R Brown
- South East Scotland Deanery, NHS Education for Scotland, UK
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Dave MS, Mobarak S, Spiers HVM, Tarazi M, Jamdar S. Improving knowledge and confidence in foundation doctors during specialty changeover. Int J Qual Health Care 2021; 32:490-494. [PMID: 32671391 DOI: 10.1093/intqhc/mzaa070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/07/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022] Open
Abstract
QUALITY PROBLEM Foundation year junior doctors rotate every 4 months into different specialties. They are often expected to manage patients with complex underlying conditions despite inadequate clinical induction. INITIAL ASSESSMENT No structured induction was offered to junior doctors rotating to hepato-pancreatico-biliary surgery, a complex and highly specialized discipline within general surgery. We hypothesized that junior doctors will be lacking in both knowledge and confidence when managing these patients. CHOICE OF SOLUTION Create a structured induction programme and evaluate its effectiveness in improving knowledge and confidence amongst doctors. IMPLEMENTATION Plan Do Study Act methodology was used along with driver diagrams to map change. A learning resource was developed in the form of a booklet, which included relevant clinical information, processes for escalation and referral as well as guidance for managing acutely unwell patients. A structured 1-hour teaching programme was delivered to junior doctors alongside this. Pre- and post-session questionnaires and statistical analysis were used to determine effect. EVALUATION Marked improvements in both knowledge and confidence were seen. The intervention showed a statistically significant improvement. LESSONS LEARNED Clinical induction resources can improve junior doctors' knowledge and confidence in managing their patients. Such induction is both valuable and necessary. Similar interventions can be used with allied health professionals and can involve the use of technology and virtual learning.
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Affiliation(s)
- Madhav Sanatkumar Dave
- Department of Hepatobiliary and General Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford M13 9WL, UK
| | - Shahd Mobarak
- Department of Hepatobiliary and General Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford M13 9WL, UK
| | - Harry V M Spiers
- Department of Hepatobiliary and General Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford M13 9WL, UK
| | - Munir Tarazi
- Department of Hepatobiliary and General Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford M13 9WL, UK
| | - Saurabh Jamdar
- Department of Hepatobiliary and General Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford M13 9WL, UK
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Wu AW, Vincent C, Shapiro DW, Koizumi S, Francis R, Strametz R, Tono T, Mair A, Kelley E, Walsh P, Pronovost PJ, Haut ER. Mitigating the July effect. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2021. [DOI: 10.1177/25160435211019142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Albert W Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | - Teresa Tono
- Organización para la Excelencia de la Salud, Bogotá, Columbia
| | - Alpana Mair
- Health and Social Care Directorate, Scottish Government, Edinburgh, UK
| | | | - Peter Walsh
- Action against Medical Accidents (AvMA), Croydon, UK
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Violeta B, Alex B, Paul A. Assessing the impact of a shadowing programme on in-hospital mortality following trainee doctors' changeover. BMC Health Serv Res 2021; 21:563. [PMID: 34098938 PMCID: PMC8186218 DOI: 10.1186/s12913-021-06578-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/24/2021] [Indexed: 12/04/2022] Open
Abstract
Background To assess the impact on seven-day in-hospital mortality following the introduction in 2012 of a shadowing programme for new UK medical graduates requiring them to observe the doctor they are replacing for at least 4 days before starting work. Methods Data on emergency admissions were derived from Hospital Episode Statistics between 2003 and 2019. A generalised estimating equation model was used to examine whether the introduction of the programme was associated with a change in mortality. Results There were 644,018 emergency admissions, of which 1.8% (7612) ended in death in hospital within a week following the admission. Throughout the study period, there was an annual increase in the number of emergency admissions during July and August, though in-hospital mortality rates declined. The generalised estimating equation analysis found no significant change in the odds of death within 7 days after admission for patients admitted on the first Wednesday in August compared with patients admitted on the last Wednesday in July (OR = 1.03, 95% CI 0.94–1.13, p = 0.53). Furthermore, there was no significant change observed for any clinical diagnosis category following the introduction of the shadowing programme. Conclusion There was a rising trend in the number of emergency admissions over the study period, though mortality was decreasing. We found no significant association between the introduction of shadowing programme and in-hospital mortality; however, lack of power means that we cannot rule out a small effect on mortality. There are other outcomes that might have changed but were not examined in this study. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06578-y.
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Affiliation(s)
| | - Bottle Alex
- School of Public Health, Imperial College London, London, AZ, SW7, UK
| | - Aylin Paul
- School of Public Health, Imperial College London, London, AZ, SW7, UK
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Carpenter C, Keegan T, Vince G, Brewster L. Does simulation training in final year make new graduates feel more prepared for the realities of professional practice? BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:510-516. [DOI: 10.1136/bmjstel-2020-000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 11/04/2022]
Abstract
IntroductionThe transition from medical student to doctor has long been a source of concern, with widespread reporting of new graduates’ lack of preparedness for medical practice. Simulation has been suggested as a way to improve preparedness, particularly due to the difficulties in allowing full autonomy for patient care for undergraduate medical students. Few studies look at simulation alone for this purpose, and no studies have compared different simulation formats to assess their impact on preparedness.MethodsThis mixed-method study looked at two different simulation courses in two UK universities. Data were collected in two phases: immediately after the simulation and 3–4 months into the same students’ postgraduate training. Questionnaires provided quantitative data measuring preparedness and interviews provided a more in-depth analysis of experiential learning across final year and how this contributed to preparedness.ResultsThere were no significant differences between the two courses for overall preparedness, stress or views on simulation, and no significant differences in opinions longitudinally. Although the study initially set out to look at simulation alone, emergent qualitative findings emphasised experiential learning as key in both clinical and simulated settings. This inter-relationship between simulation and the student assistantship prepared students for practice. Longitudinally, the emphasis on experiential learning in simulation was maintained and participants demonstrated using skills they had practised in simulation in their daily practice as doctors. Nevertheless, there was evidence that although students felt prepared, they were still scared about facing certain scenarios as foundation doctors.DiscussionThe results of this study suggest that simulation may positively affect students’ preparedness for practice as doctors. Simulation will never be a replacement for real clinical experience. However, when used prior to and alongside clinical experience, it may have positive effects on new doctors’ confidence and competence, and, therefore, positively impact patient care.
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Alwan W, Banerjee P. Evaluating the baseline experience, attitudes and educational needs of newly appointed Dermatology trainees: results of a 5-year study. Clin Exp Dermatol 2021; 46:1328-1330. [PMID: 33896025 DOI: 10.1111/ced.14705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Affiliation(s)
- W Alwan
- St John's Institute of Dermatology, Guy's Hospital, London, UK
| | - P Banerjee
- St John's Institute of Dermatology, Guy's Hospital, London, UK.,Department of Dermatology, University Hospital Lewisham, London, UK
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Simelane T, Ryan DJ, Stoyanov S, Bennett D, McEntee M, Maher MM, O'Tuathaigh CMP, O'Connor OJ. Bridging the divide between medical school and clinical practice: identification of six key learning outcomes for an undergraduate preparatory course in radiology. Insights Imaging 2021; 12:17. [PMID: 33576894 PMCID: PMC7881064 DOI: 10.1186/s13244-021-00971-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/19/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There exists a significant divide between what is learnt in medical school and subsequently what is required to practice medicine effectively. Despite multiple strategies to remedy this discordance, the problem persists. Here, we describe the identification of a comprehensive set of learning outcomes for a preparation for practice course in radiology. METHODS Assessment of interns' readiness to interact with the radiology department was conducted using a national survey of both interns and radiologists. In parallel, group concept mapping (GCM) which involves a combination of qualitative and quantitative techniques was used to identify the shared understanding of participants from a diverse range of medical specialties regarding what topics should be included in an intern preparatory course for interacting with the radiology department. RESULTS The survey demonstrated that most interns and radiologists felt that undergraduate medical training did not prepare interns to interact with the radiology department. GCM identified six learning outcomes that should be targeted when designing a preparatory module: requesting investigations; clinical decision support; radiology department IT and communication; adverse reactions and risks; interpretation of radiology results and urgent imaging. The thematic clusters from the group concept mapping corroborated the deficiencies identified in the national survey. CONCLUSION We have identified six key learning outcomes that should be included in a preparation for practice module in radiology. Future courses targeting these thematic clusters may facilitate a smoother transition from theory to practice for newly graduated doctors.
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Affiliation(s)
| | - David J Ryan
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
| | - Slavi Stoyanov
- Open University of the Netherlands, 177, Valkenburgerweg, 6401 DL, Heerlen, The Netherlands
| | - Deirdre Bennett
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Mark McEntee
- Department of Radiography, School of Medicine, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland
| | - Colm M P O'Tuathaigh
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland
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Patel R, Snydman LK. An Interactive Mock Paging Curriculum to Prepare New Internal Medicine Interns for Inpatient Wards. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11082. [PMID: 33473383 PMCID: PMC7809929 DOI: 10.15766/mep_2374-8265.11082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/12/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The July effect refers to an increase in adverse outcomes during periods of physician trainee turnover in teaching hospitals. We created an interactive resident-led curriculum to train new internal medicine interns for routine encounters on inpatient wards by role-playing through mock paging scenarios and focusing on practical information relevant to intern year. METHODS A formal assessment of the academic year 2018 intern boot camp curriculum revealed that interns preferred sessions that involved active learning strategies and covered common issues. In the first week of academic year 2019, interns participated in two 1-hour small-group sessions involving mock paging scenarios. Interns were divided into small groups with one facilitator who was a senior medicine resident. Within these groups, facilitators acted as the nurse and provided pages. Interns took turns answering these mock pages based on a sign-out of patients. The facilitator emphasized desired learner actions and teaching points using a provided guide. RESULTS Twenty interns participated in the curriculum. Interns rated the curriculum highly and felt that the sessions improved their knowledge, comfort, and skills in managing routine inpatient encounters. On a 2-week follow-up knowledge test to determine if they retained the information from the curriculum, interns scored an average of 85% (response rate: 60%, N = 12), indicating that they could apply the knowledge/skills learned to new scenarios. DISCUSSION This curriculum prepares medicine interns to manage common inpatient issues at the beginning of their residency. After completing the curriculum, interns reported increased confidence in handling these issues.
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Affiliation(s)
- Rima Patel
- Resident Physician, Department of Medicine, Tufts Medical Center
| | - Laura K. Snydman
- Associate Professor, Department of Medicine, Tufts Medical Center
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Halfwerk F, Groot Jebbink E, Groenier M. Development and Evaluation of a Proficiency-based and Simulation-based Surgical Skills Training for Technical Medicine Students. MEDEDPUBLISH 2020; 9:284. [PMID: 38058860 PMCID: PMC10697565 DOI: 10.15694/mep.2020.000284.1] [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] [Indexed: 12/08/2023] Open
Abstract
This article was migrated. The article was marked as recommended. Objective Surgical graduate training to achieve practice-ready students is needed, yet is often lacking. This study developed and evaluated a proficiency-based, simulation-based course for basic surgical skills at graduate level. Learning outcomes were measured at the level of knowledge and skills and evaluated with a post-course questionnaire after students' clinical rotations. Methods The surgical skills course was anchored to surgical patient flow and covered topics and skills related to pre-, intra-, and post-operative care, including case-based medical reasoning, patient safety, infection management, operating theatre etiquette, scrubbing and donning, instrument handling, local anaesthesia, excision of tissue, and suturing. Students were assessed on knowledge and procedural skills. Results 155 graduate Technical Medicine students from academic years 2015-2016 and 2016-2017 entered this 10-week, 3 ECTS credits graduate Surgical Skills course. Pass rates of the knowledge test were 78%, and 87% for the procedural skill assessment. Graduate students reached proficiency level in a simulation-based basic surgical skills course. Students stated to go with confidence to the operating room and felt competent in performing four basic surgical skills. Conclusion Based on this study, we recommend that proficiency-based training using simulation should be standard in surgical curricula before students are allowed to practice on patients.
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Ashokka B, Dong C, Law LSC, Liaw SY, Chen FG, Samarasekera DD. A BEME systematic review of teaching interventions to equip medical students and residents in early recognition and prompt escalation of acute clinical deteriorations: BEME Guide No. 62. MEDICAL TEACHER 2020; 42:724-737. [PMID: 32493155 DOI: 10.1080/0142159x.2020.1763286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background: Current educational interventions and teaching for acute deteriorations seem to address acute care learning in discreet segments. Technology enhanced and team training methodologies are in vogue though well studied in the nursing profession, teaching avenues for junior 'doctors in training' seem to be a lacuna.Aims: The BEME systematic review was designed to (1) appraise the existing published evidence on educational interventions that are intended for 'doctors in training' to teach early recognition and prompt escalation in acute clinical deteriorations (2) to synthesise evidence & to evaluate educational effectiveness.Methodology: The method applied was a descriptive, justification & clarification review. Databases searched included PubMed, PsycINFO, Science Direct and Scopus for original research and grey literature with no restrictions to year or language. Abstract review, full text decisions and data extraction were completed by two primary coders with final consensus by a third reviewer.Results: 5592 titles and abstracts were chosen after removal of 905 duplications. After exclusion of 5555 studies, 37 full text articles were chosen for coding. 22 studies met final criteria of educational effectiveness, relevance to acute care. Educational platforms varied from didactics to blended learning approaches, small group teaching sessions, simulations, live & cadaveric tissue training, virtual environments and insitu team-based training. Translational outcomes with reduction in long term (up to 3-6 years) morbidity & mortality with financial savings were reported by 18% (4/22) studies. Interprofessional training were reported in 41% (9/22) of studies. Recent evidence demonstrated effectiveness of virtual environment and mobile game-based learning.Conclusions: There were significant improvements in teaching initiatives with focus on observable behaviours and translational real patient outcomes. Serious game-based learning and virtual multi-user collaborative environments might enhance individual learners' cognitive deliberate practice. Acute care learning continuum with programmatic acute care portfolios could be a promise of the future.
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Affiliation(s)
| | | | | | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Fun Gee Chen
- Anaesthesia, National University of Singapore, Singapore
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Medical schools in India: pattern of establishment and impact on public health - a Geographic Information System (GIS) based exploratory study. BMC Public Health 2020; 20:755. [PMID: 32448195 PMCID: PMC7245906 DOI: 10.1186/s12889-020-08797-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/28/2020] [Indexed: 11/22/2022] Open
Abstract
Background Indian medical education system is on the brink of a massive reform. The government of India has recently passed the National Medical Commission Bill (NMC Bill). It seeks to eliminate the existing shortage and maldistribution of health professionals in India. It also encourages establishment of medical schools in underserved areas. Hence this study explores the geographic distribution of medical schools in India to identify such under and over served areas. Special emphasis has been given to the mapping of new medical schools opened in the last decade to identify the ongoing pattern of expansion of medical education sector in India. Methods All medical schools retrieved from the online database of Medical Council of India were plotted on the map of India using geographic information system. Their pattern of establishment was identified. Medical school density was calculated to analyse the effect of medical school distribution on health care indicators. Results Presence of medical schools had a positive influence on the public health profile. But medical schools were not evenly distributed in the country. The national average medical school density in India amounted to 4.08 per 10 million population. Medical school density of provinces revealed a wide range from 0 (Nagaland, Dadra and Nagar Haveli, Daman and Diu and Lakshadweep) to 72.12 (Puducherry). Medical schools were seen to be clustered in the vicinity of major cities as well as provincial capitals. Distance matrix revealed that the median distance of a new medical school from its nearest old medical school was just 22.81 Km with an IQR of 6.29 to 56.86 Km. Conclusions This study revealed the mal-distribution of medical schools in India. The problem is further compounded by selective opening of new medical schools within the catchment area of already established medical schools. Considering that medical schools showed a positive influence on public health, further research is needed to guide formulation of rules for medical school establishment in India.
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Burridge S, Shanmugalingam T, Nawrozzadeh F, Leedham-Green K, Sharif A. A qualitative analysis of junior doctors' journeys to preparedness in acute care. BMC MEDICAL EDUCATION 2020; 20:12. [PMID: 31931784 PMCID: PMC6958569 DOI: 10.1186/s12909-020-1929-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/06/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND New doctors are expected to assess and manage acutely deteriorating patients from their first days in the hospital. However, current evidence suggests that medical graduates are not prepared for this. We aimed to explore junior doctors' first experiences with unwell patients and how they developed preparedness over time. METHODS We conducted seven semi-structured interviews with doctors in their first postgraduate year. The interview transcripts underwent inductive thematic analysis using consensual qualitative research approaches. Themes identified were categorised into early experiences of unpreparedness, first experiences of genuine preparedness, and making sense of how they became prepared. Reflection on how participants progressed between the two was facilitated through a sorting and ranking exercise. RESULTS Most participants initially felt unprepared when responding to acutely unwell patients. They described feeling overwhelmed, apprehensive and challenged. Two main challenges involved knowing when to escalate, and feeling expected to perform beyond their level of competency. A lack of acute care exposure at medical school was a common thread. All participants felt prepared to respond to unwell patients three to six months after starting work. Hands-on experience, reflection, simulation and multidisciplinary team-working were consistently ranked as the most useful learning experiences. CONCLUSION Starting work as a doctor is a challenging time and preparedness to manage an acutely deteriorating patient is a common area of concern. As preparedness in acute care ranks poorly compared to other outcomes, we see this as an important area for improvement. Our findings suggest that undergraduates may lack sufficient opportunities for scaffolded decision making in acute care, and that increasing the intensity of clinical shadowing may improve preparedness and should inform future educational interventions.
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Affiliation(s)
- Samuel Burridge
- London North West University Healthcare NHS Trust, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK.
- Imperial College London, Medical Education Research Unit, Sir Alexander Fleming Building, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK.
| | - Thurkaa Shanmugalingam
- London North West University Healthcare NHS Trust, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK
- Imperial College London, Medical Education Research Unit, Sir Alexander Fleming Building, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK
| | - Fatima Nawrozzadeh
- London North West University Healthcare NHS Trust, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK
- Imperial College London, Medical Education Research Unit, Sir Alexander Fleming Building, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK
| | - Kathleen Leedham-Green
- Imperial College London, Medical Education Research Unit, Sir Alexander Fleming Building, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK
| | - Amar Sharif
- London North West University Healthcare NHS Trust, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, UK
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Evaluating the Impact of Resident Participation and the July Effect on Outcomes in Autologous Breast Reconstruction. Ann Plast Surg 2019; 81:156-162. [PMID: 29846217 DOI: 10.1097/sap.0000000000001518] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Although resident involvement in surgical procedures is critical for training, it may be associated with increased morbidity, particularly early in the academic year-a concept dubbed the "July effect." Assessments of such phenomena within the field of plastic surgery have been both limited and inconclusive. We sought to investigate the impact of resident participation and academic quarter on outcomes for autologous breast reconstruction. METHODS All autologous breast reconstruction cases after mastectomy were gathered from the 2005-2012 American College of Surgeons National Surgical Quality Improvement Program database. Multivariable logistic regression models were constructed to investigate the association between resident involvement and the first academic quarter (Q1 = July-September) with 30-day morbidity (odds ratios [ORs] with 95% confidence intervals). Medical and surgical complications, median operation time, and length of stay (LOS) were also compared. RESULTS Overall, 2527 cases were identified. Cases with residents (n = 1467) were not associated with increased 30-day morbidity (OR, 1.20; 0.95-1.52) when compared with those without (n = 1060), although complications including transfusion (OR, 2.08; 1.39-3.13) and return to the operating room (OR, 1.46; 1.11-1.93) were more frequently observed in resident cases. Operation time and LOS were greater in cases with resident involvement.In cases with residents, there was decreased morbidity in Q1 (n = 343) when compared with later quarters (n = 1124; OR, 0.67; 0.48-0.92). Specifically, transfusion (OR, 0.52; 0.29-0.95), return to operating room (OR, 0.64; 0.41-0.98), and surgical site infection (OR, 0.37; 0.18-0.75) occurred less often during Q1. No differences in median operation time or LOS were observed within this subgroup. CONCLUSIONS Our study reveals that resident involvement in autologous breast reconstruction is not associated with increased morbidity and offers no evidence for a July effect. Notably, our results suggest that resident cases performed earlier in the academic year, when surgical attendings may offer more surveillance and oversight, is associated with decreased morbidity.
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Buist N, Webster CS. Simulation Training to Improve the Ability of First-Year Doctors to Assess and Manage Deteriorating Patients: a Systematic Review and Meta-analysis. MEDICAL SCIENCE EDUCATOR 2019; 29:749-761. [PMID: 34457539 PMCID: PMC8368756 DOI: 10.1007/s40670-019-00755-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Many simulation courses now exist which aim to prepare first-year doctors for the task of assessing and managing potentially deteriorating patients. Despite the substantial resources required, the degree to which participants benefit from such courses, and which aspects of the simulation training are optimal for learning, remains unclear. A systematic literature search was undertaken across seven electronic databases. Inclusion criteria were that the intervention must be a simulation of a deteriorating patient scenario that would likely be experienced by first-year doctors, and that participants being first-year doctors or in their final year of medical school. Studies reporting quantitative benefits of simulation on participants' knowledge and simulator performance underwent meta-analyses. The search returned 1444 articles, of which 48 met inclusion criteria. All studies showed a benefit of simulation training, but outcomes were largely limited to self-rated or objective tests of knowledge, or simulator performance. The meta-analysis demonstrated that simulation improved participant performance by 16% as assessed by structured observation of a simulated scenario, and participant knowledge by 7% as assessed by written assessments. A mixed-methods analysis found conflicting evidence about which aspects of simulation were optimal for learning. The results of the review indicate that simulation is an important tool to improve first-year doctors' confidence, knowledge and simulator performance with regard to assessment and management of a potentially deteriorating patient. Future research should now seek to clarify the extent to which these improvements translate into clinical practice, and which aspects of simulation are best suited to achieve this.
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Affiliation(s)
- Nicholas Buist
- Department of Emergency Medicine, Whangarei Hospital, Northland District Health Board, Maunu Rd, Private Bag 9742, Whangarei, 0110 New Zealand
| | - Craig S. Webster
- Centre for Medical and Health Sciences Education and Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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McKenzie S, Mellis C. The impact on internship of a tailored intern preparation package. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2018; 9:639-648. [PMID: 30233271 PMCID: PMC6135221 DOI: 10.2147/amep.s164321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION On commencing internship, new medical graduates (new interns) are often required to perform core procedural skills under differing levels of supervision. This variability of knowledge and experience with procedural skills can place patient safety at risk. Consequently, in 2012, we developed a targeted, intensive, 3-day training course for our pre-intern (PrInt) students. The aim of this study was to evaluate the intern preparation package by exploring interns' self-reported knowledge, confidence, and experience in key procedural skills during the early months of internship. METHODS Between 2012 and 2016, 5 cohorts of PrInt students (n=223) participated in our course. In the following years 2013-2017, the same 5 cohorts, at 4-5 months into their internship, were surveyed anonymously and invited to attend focus groups. Descriptive statistics and thematic analysis were used to analyze data. RESULTS Of the 223 interns, 91 (41%) responded. Of the 91, 82 (93%) agreed that the intern preparation package provided during PrInt had been beneficial to their practice as an intern. Awareness of potential risks to patient safety was high, ranging from infection control at 89/89 (100%) to 87/90 (97%) for patient identification. Confidence in performing procedural skills varied from moderate in identifying nasogastric tube placement on X-ray (66/89; 85%), to equal least confidence in managing cardiac-related emergencies (53/90; 59%) and identifying the correct placement of peripherally inserted central catheter lines on X-ray (52/89; 58%). MAJOR QUALITATIVE FINDINGS The preparation package had refreshed interns' procedural skills ability and awareness of risks to patient safety. Integration into the clinical team was positive, but requests to perform procedural skills on day 1 was unexpected. CONCLUSION Interns reported that they had gained substantial benefit from their preparation package, and they performed practical procedures from day 1, further highlighting the need for an intensive preparation course immediately prior to entering internship.
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Affiliation(s)
| | - Craig Mellis
- Education Office, Sydney Medical School, The University of Sydney, Sydney, NSW, 2050, Australia
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Monrouxe LV, Bullock A, Gormley G, Kaufhold K, Kelly N, Roberts CE, Mattick K, Rees C. New graduate doctors' preparedness for practice: a multistakeholder, multicentre narrative study. BMJ Open 2018; 8:e023146. [PMID: 30158236 PMCID: PMC6119440 DOI: 10.1136/bmjopen-2018-023146] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE While previous studies have begun to explore newly graduated junior doctors' preparedness for practice, findings are largely based on simplistic survey data or perceptions of newly graduated junior doctors and their clinical supervisors alone. This study explores, in a deeper manner, multiple stakeholders' conceptualisations of what it means to be prepared for practice and their perceptions about newly graduated junior doctors' preparedness (or unpreparedness) using innovative qualitative methods. DESIGN A multistakeholder, multicentre qualitative study including narrative interviews and longitudinal audio diaries. SETTING Four UK settings: England, Northern Ireland, Scotland and Wales. PARTICIPANTS Eight stakeholder groups comprising n=185 participants engaged in 101 narrative interviews (27 group and 84 individual). Twenty-six junior doctors in their first year postgraduation also provided audio diaries over a 3-month period. RESULTS We identified 2186 narratives across all participants (506 classified as 'prepared', 663 as 'unprepared', 951 as 'general'). Seven themes were identified; this paper focuses on two themes pertinent to our research questions: (1) explicit conceptualisations of preparedness for practice; and (2) newly graduated junior doctors' preparedness for the General Medical Council's (GMC) outcomes for graduates. Stakeholders' conceptualisations of preparedness for practice included short-term (hitting the ground running) and long-term preparedness, alongside being prepared for practical and emotional aspects. Stakeholders' perceptions of medical graduates' preparedness for practice varied across different GMC outcomes for graduates (eg, Doctor as Scholar and Scientist, as Practitioner, as Professional) and across stakeholders (eg, newly graduated doctors sometimes perceived themselves as prepared but others did not). CONCLUSION Our narrative findings highlight the complexities and nuances surrounding new medical graduates' preparedness for practice. We encourage stakeholders to develop a shared understanding (and realistic expectations) of new medical graduates' preparedness. We invite medical school leaders to increase the proportion of time that medical students spend participating meaningfully in multiprofessional teams during workplace learning.
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Affiliation(s)
- Lynn V Monrouxe
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital, Gueishan, Taiwan
| | - Alison Bullock
- Cardiff University, Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), Cardiff, UK
| | - Gerard Gormley
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | | | - Narcie Kelly
- Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | | | - Karen Mattick
- Centre for Research in Professional Learning, University of Exeter, Exeter, UK
| | - Charlotte Rees
- Monash University, Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Melbourne, Victoria, Australia
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Otokiti A, Sideeg A, Ward P, Dongol M, Osman M, Rahaman O, Abid S. A quality improvement intervention to enhance performance and perceived confidence of new internal medicine residents. J Community Hosp Intern Med Perspect 2018; 8:182-186. [PMID: 30181822 PMCID: PMC6116264 DOI: 10.1080/20009666.2018.1487244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/31/2018] [Indexed: 12/02/2022] Open
Abstract
Background: Orientation for new medical residents is challenging due to the diversity of prior experiences and cultural backgrounds and is compounded by a lack of orientation curricula that adequately addresses the needs of the medical residents to allow them to perform their duties in an efficient manner from the start. The beginning of residency training is associated with reduced quality of healthcare widely referred to as the ‘July effect’. Objective: To assess the impact of a peer-led orientation for new interns on (a) self-reported confidence level, (b) improvement in performance of first-year residents in appropriate clinical documentation and efficient discharge procedures and protocols. Design/methods: In June 2016, a hybrid of interactive teaching and simulation exercises was used to teach documentation of critical information, such as discharge medication reconciliation and discharge summary. A handout of an intern guide/manual was also provided. The previous year’s data served as comparison/control data. Comparison data were obtained for both groups from hospital’s utilisation review department. Results: Twenty-one of 23 expected new interns (91%) participated in the intervention. There was a significant decrease in non-compliance for clinical documentation in the intervention group compared to the control group. The self-reported confidence level in the intervention group increased 34%. Conclusions: Such peer-to-peer orientation has the potential to effectively improve appropriate documentation and discharge process by new residents and may help to reduce the ‘July effect’.
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Affiliation(s)
- Ahmed Otokiti
- Department of Medicine, Harlem Hospital Center, Affiliate of Columbia University of Physicians and Surgeons, NY, USA
| | - Abdelhaleem Sideeg
- Department of Medicine, Harlem Hospital Center, Affiliate of Columbia University of Physicians and Surgeons, NY, USA
| | - Paulisa Ward
- Department of Medicine, Harlem Hospital Center, Affiliate of Columbia University of Physicians and Surgeons, NY, USA
| | - Merina Dongol
- Department of Medicine, Harlem Hospital Center, Affiliate of Columbia University of Physicians and Surgeons, NY, USA
| | - Mohamed Osman
- Department of Medicine, Harlem Hospital Center, Affiliate of Columbia University of Physicians and Surgeons, NY, USA
| | - Oloruntobi Rahaman
- Department of Medicine, Harlem Hospital Center, Affiliate of Columbia University of Physicians and Surgeons, NY, USA
| | - Syed Abid
- Department of Medicine, Harlem Hospital Center, Affiliate of Columbia University of Physicians and Surgeons, NY, USA
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Shenouda JEA, Davies BS, Haq I. The role of the smartphone in the transition from medical student to foundation trainee: a qualitative interview and focus group study. BMC MEDICAL EDUCATION 2018; 18:175. [PMID: 30064424 PMCID: PMC6196342 DOI: 10.1186/s12909-018-1279-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/13/2018] [Indexed: 05/15/2023]
Abstract
BACKGROUND The transition from medical student to junior doctor is one of the most challenging in medicine, affecting both doctor and patient health. Opportunities to support this transition have arisen from advances in mobile technology and increased smartphone ownership. METHODS This qualitative study consisted of six in-depth interviews and two focus groups with Foundation Year 1 Trainees (intern doctors) and final year medical students within the same NHS Trust. A convenience sample of 14 participants was recruited using chain sampling. Interviews and focus groups were recorded, transcribed verbatim, analysed in accordance with thematic analysis and presented below in keeping with the standards for reporting qualitative research. RESULTS Participants represented both high and low intensity users. They used their smartphones to support their prescribing practices, especially antimicrobials through the MicroGuide™ app. Instant messaging, via WhatsApp, contributed to the existing bleep system, allowing coordination of both work and learning opportunities across place and time. Clinical photographs were recognised as being against regulations but there had still been occasions of use despite this. Concerns about public and colleague perceptions were important to both students and doctors, with participants describing various tactics employed to successfully integrate phone use into their practices. CONCLUSION This study suggests that both final year medical students and foundation trainees use smartphones in everyday practice. Medical schools and healthcare institutions should seek to integrate such use into core curricula/training to enable safe and effective use and further ease the transition to foundation training. We recommend juniors are reminded of the potential risks to patient confidentiality associated with smartphone use.
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Affiliation(s)
- John E. A. Shenouda
- Division of Medical Education, Brighton and Sussex Medical School, Room 344A, Mayfield House, University of Brighton, Falmer, Brighton, BN1 9PH England
| | - Bethany S. Davies
- Department of Global Health and Infection, Brighton and Sussex Medical School Teaching Building, University of Sussex, Brighton, East Sussex BN1 9PX England
| | - Inam Haq
- Sydney Medical Program, Rm 208, A27 – Edward Ford Building, The University of Sydney, Sydney, NSW 2006 Australia
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Rashid MA, McKechnie D, Gill D. What advice is given to newly qualified doctors on Twitter? An analysis of #TipsForNewDocs tweets. MEDICAL EDUCATION 2018; 52:747-756. [PMID: 29766550 DOI: 10.1111/medu.13589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/12/2017] [Accepted: 02/19/2018] [Indexed: 05/24/2023]
Abstract
CONTEXT Twitter is a social media platform on which users post very brief messages that can be rapidly communicated across wide geographical areas and audiences. Many doctors use Twitter for personal as well as professional communications and networking. The #TipsForNewDocs hashtag is used on Twitter to give advice to newly qualified doctors as they commence their careers. This study explores the nature and focus of such advice. METHODS An analysis of Twitter activity containing the #TipsForNewDocs hashtag was performed using Symplur health care analytics software. Tweets sent during a peak 48-hour period in 2016 (immediately preceding the first day of work for newly qualified UK doctors) were studied. The geographical locations and professional backgrounds of participants were categorised and the content of tweets was subjected to thematic analysis. During 1 and 2 August 2016, 661 unique #TipsForNewDocs tweets were posted. A total of 621 (94.0%) were posted by people in the UK; 522 (79.0%) were posted by doctors, and the remainder by allied health care professionals and patients. RESULTS The majority of included tweets focused on aspects of professional development, improving personal or professional knowledge, particularly tacit knowledge, and developing 'know-how'. These aspects of professional knowledge have previously been described as fundamental to professional education and training. However, a significant subset of tweets focused on accelerating socialisation into the profession, an essential step in joining a professional community. The tweets relating to socialisation were often humorous and colloquial in nature. CONCLUSIONS Despite their brief and often jocular nature, #TipsForNewDocs tweets provided meaningful advice for newcomers to the profession, often focusing on tacit learning and professional socialisation. Hashtag-driven enquiries can be a valuable and time-efficient way of accessing and sharing tacitly held knowledge. Social media content analysis can provide valuable insights into key educational issues.
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Affiliation(s)
| | - Doug McKechnie
- UCL Medical School, University College London, London, UK
| | - Deborah Gill
- UCL Medical School, University College London, London, UK
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Bashjawish B, Patel S, Kılıç S, Hsueh WD, Liu JK, Baredes S, Eloy JA. Examining the "July effect" on patients undergoing pituitary surgery. Int Forum Allergy Rhinol 2018; 8:1157-1161. [PMID: 29905016 DOI: 10.1002/alr.22164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/17/2018] [Accepted: 05/22/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Our aim in this study was to assess the impact of the turnover of residents in July on patients undergoing pituitary surgery. METHODS This work was a retrospective cohort study of cases from the National Inpatient Sample (NIS). Patients who underwent pituitary surgery from 2005 to 2012 were selected in the NIS. Patients undergoing surgery in July and in non-July months were compared to determine differences in demographics, comorbidities, and complications. RESULTS Of the 12,939 patients, 1098 (8.5%) underwent pituitary surgery in July. Patients receiving surgery in July had similar demographics and Agency for Healthcare Research and Quality comorbidity values compared with patients receiving surgery in other months. There were no significant differences in mortality, cerebral edema, cerebrospinal fluid leakage, iatrogenic pituitary complications, iatrogenic cerebrovascular accidents, urinary tract infections, pulmonary edema, pulmonary complications, or acute cardiac complications. There were no differences in the rate of postoperative fistulas, hematomas, perforations, or infections. The use of meningeal suturing, pedicled or free-flap reconstruction, and skin reconstruction was more frequent in July. Finally, hospitalization costs in July were similar to costs in other months. CONCLUSION The turnover of new residents in July showed no change in complication rates for patients undergoing pituitary surgery. Patient care in July is similar to care during other months, demonstrating that hospitals are adequately supervising surgical residents during this transition.
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Affiliation(s)
- Bassel Bashjawish
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Shreya Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Suat Kılıç
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Wayne D Hsueh
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ
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Middleton S, Charnock A, Forster S, Blakey J. Factors affecting -individual task prioritisation in a workplace setting. Future Healthc J 2018; 5:138-142. [PMID: 31098549 PMCID: PMC6502562 DOI: 10.7861/futurehosp.5-2-138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Task prioritisation (TP), the ability to arrange assigned responsibilities in order of importance, has been identified by doctors as the most important non-technical skill when working out of hours. This review aimed to identify the factors influencing task prioritisation in a workplace setting. The following databases were searched for relevant studies: BNI, CINAHL, EMBASE, MEDLINE and PsycINFO as well as the reference lists of relevant articles, review papers and Google Scholar. Data were extracted from the studies using a standard proforma. Twenty relevant papers were identified from management, aviation and healthcare fields. Task prioritisation ability differed across individuals and was associated with personality and experience. Tasks were prioritised based on length, urgency, importance and reward. With practice people become more efficient at task prioritisation. Practical applications include education, personalised task management software and intrusive notifications. Additional research is needed to assess the effects of such interventions in a healthcare setting.
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Affiliation(s)
| | | | - Sarah Forster
- University of Nottingham School of Medicine, Nottingham, UK
| | - John Blakey
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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Desai R, Patel U, Goyal H. Does "July effect" exist in colonoscopies performed at teaching hospitals? Transl Gastroenterol Hepatol 2018; 3:28. [PMID: 29971259 DOI: 10.21037/tgh.2018.05.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/08/2018] [Indexed: 12/14/2022] Open
Abstract
Background To compare the outcomes of the colonoscopies between the early (July-September) and the later (April-June) academic year at the urban-teaching hospitals. Methods Our study cluster was derived from the National Inpatient Sample (NIS) database for the years 2010-2014. International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) procedure codes were used to identify the adult patients who underwent inpatient colonoscopy at urban-teaching hospitals. Post-colonoscopy outcomes and the complications were recognized using ICD-9 CM codes among any of the secondary diagnoses. Categorical and continuous variables were assessed using Pearson's Chi-square and Student's t-test respectively. Odds of complications during the early vs. later academic year was also evaluated by the two-way hierarchical logistic regression analysis. Results A total of 124,155 (weighted n=617,907) colonoscopy procedures were performed at the urban teaching hospitals in the US from 2010 to 2014. Out of these, 61,272 (weighted n=304,946) and 62,883 (weighted n=312,961) procedures were performed during early (July to September) and later (April to June) academic months, respectively. There was no significant difference in the all-cause mortality (1.4% vs. 1.4%, P=0.208), and the complications such as colonic perforations (3.1% vs. 3.2%, P=0.229) and postoperative infections (0.6% vs. 0.6%, P=0.733) between the two groups. Similarly, the splenic rupture (0.0% vs. 0.0%, P=0.180) was equally infrequent in both the groups. Bleeding/hematoma following colonoscopy (0.9% vs. 0.8%, P=0.004) was marginally higher during the later academic months. There were no statistically distinctions in terms of length of stay (LOS) (days) (7.3±9.1 vs. 7.3±9.1, P=0.918), total hospitalization charges ($60,549.41 vs. $59,918.56, P=0.311) and discharge of patients to other facilities between the early and the later academic months. Colonoscopy performed during the early academic months was not found to be a significant independent predictor for post-colonoscopy complications such as colon perforation (OR =0.99, 95% CI: 0.93-1.06, P=0.760), postoperative bleeding/hematoma (OR =0.92, 95% CI: 0.81-1.04, P=0.196) and postoperative infection (OR =0.99, 95% CI: 0.84-1.15, P=0.850). Conclusions There was no "July effect" on the outcomes of colonoscopies between the early vs. the later academic months.
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Affiliation(s)
- Rupak Desai
- Research Fellow, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Upenkumar Patel
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY, USA
| | - Hemant Goyal
- Department of Internal Medicine, Mercer University, Macon, GA, USA
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Goodwin JS, Salameh H, Zhou J, Singh S, Kuo YF, Nattinger AB. Association of Hospitalist Years of Experience With Mortality in the Hospitalized Medicare Population. JAMA Intern Med 2018; 178:196-203. [PMID: 29279886 PMCID: PMC5801052 DOI: 10.1001/jamainternmed.2017.7049] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Substantial numbers of hospitalists are fresh graduates of residency training programs. Current data about the effect of hospitalist years of experience on patient outcomes are lacking. OBJECTIVE To describe the association of hospitalist years of experience with 30-day mortality and hospital mortality of their patients. DESIGN, SETTING, AND PARTICIPANTS We used a 5% sample of national Medicare data of patient and hospital characteristics to build a multilevel logistic regression model to predict mortality as a function of years of experience of the hospitalists. We created 2 cohorts. The first was a cross-sectional cohort of 21 612 hospitalists working between July 1, 2013, and June 30, 2014, with a 5-year look-back period to assess their years of prior experience as a hospitalist, and the second was a longitudinal cohort of 3860 hospitalists in their first year of practice between July 1, 2008, and June 30, 2011, who continued practicing hospital medicine for at least 4 years. MAIN OUTCOMES AND MEASURES Thirty-day postadmission mortality adjusted for patient and hospital characteristics in a 3-level logistic regression model. Hospital mortality was a secondary outcome. RESULTS Among 21 612 hospitalists caring for Medicare inpatients from July 1, 2013, to June 30, 2014, 5445 (25%) had 1 year of experience or less, while 11 596 (54%) had 4 years of experience or more. We then identified 3860 physicians in their first year as hospitalists who continued to practice as hospitalists for 4 years. There was a significant association between hospitalist experience and mortality. Observed 30-day mortality was 10.50% for patients of first-year hospitalists vs 9.97% for patients of hospitalists in their second year. The mortality odds for patients of second-year hospitalists were 0.90 (95% CI, 0.84-0.96) compared with patients of first-year hospitalists. Observed hospital mortality was 3.33% for patients cared for by first-year hospitalists vs 2.96% for second-year hospitalists. (odds ratio, 0.84; 95% CI, 0.75-0.95). For both 30-day and hospital mortality, there was little change in odds of mortality between the second year and subsequent years of experience. CONCLUSIONS AND RELEVANCE Patients cared for by hospitalists in their first year of practice experience higher mortality. Early-career hospitalists may require additional support to ensure optimal outcomes for their patients.
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Affiliation(s)
- James S Goodwin
- Department of Medicine, University of Texas Medical Branch, Galveston.,Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | - Habeeb Salameh
- Department of Medicine, University of Texas Medical Branch, Galveston
| | - Jie Zhou
- Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | | | - Yong-Fang Kuo
- Sealy Center on Aging, University of Texas Medical Branch, Galveston.,Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
| | - Ann B Nattinger
- Department of Medicine, Medical College of Wisconsin, Milwaukee
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Zeitoun JD, Reboul-Marty J, Lefèvre JH. Impact of resident and fellow changeovers on patient outcomes: a nationwide cross-sectional study. Eur J Public Health 2017; 27:960-965. [PMID: 28549099 DOI: 10.1093/eurpub/ckx072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Findings regarding the association of cohort changeovers with patient outcomes are mixed. We sought to examine the association of resident and fellow changeovers with a comprehensive set of indicators. Methods We performed a cross-sectional comparative study including all French teaching and non-teaching hospitals. All-cause mortality and length of stay were assessed. Focused analysis for three medical conditions (myocardial infarction, intestinal hemorrhage, stroke) and three surgical procedures (colorectal, vascular and spine surgery) was performed regarding other quality and efficiency indicators (readmissions, intensive care unit admission, transfers). Results Overall, 34 330 716 patients were admitted in 2011 and 2012. Within the month following cohort changeovers, no increase in mortality was observed in teaching hospitals. Length of stay was longer in May and November in teaching hospitals (P < 0.0001) whereas it was shorter in the private sector. When focusing on six selected causes of hospitalization, we observed significant differences associated with resident changeovers, suggesting a decreased efficiency. In particular, readmissions rates and lengths of stay were found to be significantly higher (P < 0.0005) after intestinal hemorrhage and with a trend toward worse efficiency (P < 0.005) after colorectal surgery and stroke in teaching hospitals. Conclusion Our findings provide some reassurance regarding cohort changeover and mortality even if they suggest a loss of efficiency in some cases.
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Affiliation(s)
- Jean-David Zeitoun
- Department of Gastroenterology and Nutrition, Saint-Antoine Hospital, APHP, Paris, France.,Department of Proctology, Croix Saint-Simon Hospital, Paris, France
| | | | - Jérémie H Lefèvre
- Department of General and Digestive Surgery, Saint-Antoine Hospital, APHP, Paris, France.,University Paris VI, Paris, France
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Effect of weekend admission on mortality associated with severe acute kidney injury in England: A propensity score matched, population-based study. PLoS One 2017; 12:e0186048. [PMID: 29016687 PMCID: PMC5634642 DOI: 10.1371/journal.pone.0186048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 09/25/2017] [Indexed: 11/19/2022] Open
Abstract
Background Increased in-hospital mortality associated with weekend admission has been reported for many acute conditions, but no study has investigated “weekend effect” for acute kidney injury requiring dialysis (AKI-D). Methods In this large, propensity score matched cohort of AKI-D, we examined the impact of weekend admission and in-centre nephrology services in 53,170 AKI-D admissions between 1st April 2003 and 31st March 2015 using a hospital episode statistic dataset. Propensity score matching (PSM) was performed to match 4284 weekend admissions with AKI-D with 14,788 admissions on weekdays. Results Of the 53,170 admissions with AKI-D in the whole dataset, 12,357 (23%) were at weekends. The unadjusted mortality for weekend admissions was significantly higher compared to admissions on weekdays (40·6% versus 39·6%, p 0·046). However, in multivariable analysis of the PSM cohort, the odds of death for weekend admissions with AKI-D was 1·01 (95%CI 0·93,1·09). Mortality was higher for weekend admissions in West Midlands (odds ratio (OR) 1·32, 95% confidence interval (CI) 1·05, 1·66) and lower in East of England (OR 0·77, 95%CI 0·59, 1·00) but was not different to weekday admissions in all other regions. In 2003–04, weekend admissions had lower odds of death (OR 0·45, 95%CI 0·21, 0·96) and in 2010–11 higher odds of death (OR 1·28, 95%CI 1·00, 1·63) but in the other ten years observed, there was no significant difference in mortality between weekday and weekend admissions. Provision of in-centre nephrology services was associated with lower odds of death at 0·57 (95%CI 0·54, 0·62). Conclusions Weekend admissions in patients with AKI-D had no effect on mortality. Further research is warranted to elucidate the reasons for the lower mortality in hospitals with in-centre nephrology services.
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