BackgroundThe term ‘moral injury’ may be useful in conceptualising the negative psychological effects of delivering emergency and prehospital medicine as it provides a non-pathological framework for understanding these effects. This is in contrast to concepts such as burnout and post-traumatic stress disorder which suggest practitioners have reached a crisis point. We conducted an exploratory, pilot study to determine whether the concept of moral injury resonated with medical students working in emergency medicine and what might mitigate that injury for them.MethodsStructured interviews and focus groups were carried out with medical students involved in the delivery of prehospital and emergency medicine. The study was carried out at Barts and the London School of Medicine and Dentistry in May and June 2017. The data were analysed using theoretically driven thematic analysis.ResultsConcepts of moral injury such as witnessing events which contravene one’s moral code, especially those involving children, or acts of violence, resonated with the experiences of medical students in this study. Participants stated that having more medical knowledge and a clear sense of a job to do on scene helped reduce their distress at the time. While social support was a protective factor, not all students found the process of debrief easy to access or undergo, those with more established relationships with colleagues fared better in this regard.ConclusionsThe term moral injury is useful in exploring the experience of medical students in emergency medicine. More effort should be made to ensure that students effectively access debrief and other support opportunities. It is hoped that future work will be undertaken with different professional groups and explore the potential psychological and neuropsychological impact of witnessing trauma.

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Vocational training appears to satisfy its aim to enhance clinical and administrative confidence.

Background and objectivesInternational and national health policies advocate greater integration of emergency and community care. The Physician Response Unit (PRU) responds to 999 calls ‘taking the Emergency Department to the patient’. Operational since 2001, the service was reconfigured in September 2017. This article presents service activity data and implications for the local health economy from the first year since remodelling.MethodsA retrospective descriptive analysis of a prospectively maintained database was undertaken. Data collected included dispatch information, diagnostics and treatments undertaken, diagnosis and disposition. Treating clinical teams recorded judgments whether patients managed in the community would have been (1) conveyed to an emergency department (ED)and (2) admitted to hospital, in the absence of the PRU. Hospital Episode Statistics data and NHS referencing costs were used to estimate the monetary value of PRU activity.Results1924 patients were attended, averaging 5.3 per day. 1289 (67.0%) patients were managed in the community. Based on the opinion of the treating team, 945 (73.3%) would otherwise have been conveyed to hospital, and 126 (9.7%) would subsequently have been admitted. The service was estimated to deliver a reduction of 868 inpatient bed days and generate a net economic benefit of £530 107.ConclusionsThe PRU model provides community emergency medical care and early patient contact with a senior clinical decision-maker. It engages with community providers in order to manage 67.0% of patients in the community. We believe the PRU offers an effective model of community emergency medicine and helps to integrate local emergency and community providers.

Trainers and VDPs have different perceptions concerning the protocol of interviews for VT.

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Objectives The purpose of this paper is to review the literature on the use of a portfolio and discuss the evidence for the impact of a portfolio on professional practice, in particular pharmacy practice. Method A literature review was performed using databases from health care and education, namely AMED, BEI, CINAHL, Embase, ERIC, IPA, MedLine, PHARM-LINE, PsycInfo, TIMELIT and ZETOCs, as well as a manual search of relevant journals and documents between 1991 and 2007. The search terms included portfolio, progress files and assessment, and these were linked with pharmacy. Articles were included in the review if they had a focus on the portfolio as a contribution to professional practice. Key findings Portfolios have been used in the education field for over decade. A total of 26 out of 1901 papers were identified which examined portfolios in a post-registration setting. The majority of these publications were from medicine (12), with education (six), pharmacy (five) and nursing (three) making up a small proportion. Portfolios were seen as (a) a tool for use in feedback, (b) a useful trigger for reflection and (c) a link between academic learning and practice. A similar set of findings were seen in the educational context. In addition, a portfolio (a) requires motivation to record and (b) can change behaviour towards colleagues. Conclusions There is still confusion about the meaning of a professional portfolio in health care professions. It is suggested that portfolios should be classified according to a modified system from the teaching profession. The evidence that portfolios can contribute to practice is limited. This review suggests the need for more studies into the impact of portfolios on professional practice, in particular in a pharmacy context.

The Big-Five personality questionnaire is a useful tool to investigate pharmacists' use of a portfolio. Results of the PPEBQ suggested that hospital pharmacists who had a portfolio were concerned with having control over its production. However, the PPEBQ requires further development to improve its reliability. These findings have implications for the educational support of CPD.