IntroductionThere is a reduction in Foundation trainee applications to speciality training and this is attributed to an administrative job role, with subsequent fears of burnout. This pilot study presents the findings of a real-time self-reporting tool to map a group of Foundation doctors’ elective activities. Self-reporting is efficient, low cost to run and allows for repeated measures and scalability. It aimed to example how a time-map could be used by departments to address any work imbalances and improve both well-being and future workforce planning.MethodFoundation doctors’, at a busy District General Hospital, were asked to contemporaneously report their work activities over an ‘elective’ day. Outcomes measures included the mean duration per task and the time of day these were performed.ResultsNine Foundation doctors’ returned 26 timesheet days. Foundation doctors’ time was split between direct patient tasks (18.2%, 106.8 min per day), indirect patient tasks (72.9%, 428.6 min per day) and personal or non-patient activities. Indirect tasks were the most frequent reason for Foundation doctors leaving late. No clinical experience was recorded at all and only an average of 4% (23.4 min per day) of a Foundation doctors’ time was spent in theatre.ConclusionsThis particular cohort performed a high proportion of indirect tasks. These have been associated with burnout. Time-mapping is a low-cost, acceptable and seemingly scalable way to elucidate a clearer understanding of the type of activities Foundation doctors may perform. This methodology could be used to modernise the traditional Foundation doctor job description.
Aim To assess if patients are receiving their regular pre-operative medications in according with local and national guidance and to assess if patients are being appropriately fasted pre-operatively. Method A prospective study performed across a 2-week period, assessing if every patient booked on the emergency theatre list was receiving the correct medications pre-operatively and if they were fasted for the appropriate length of time. This involved assessment of the patient's notes and drug chart, as well as clarification of any unknowns with the patient. Results 65 patients met the inclusion criteria for the study; of which 28 (43%) had their regular medication prescribed. Of those, 61% did not receive their medications according to national and local guidance (medications were inappropriately held in the majority of cases). The omission of administering medication during the “nil by mouth” phase included the lack of critical medication in 3 cases: a potentially life-threatening error. Regarding fasting of the patient, it was found that the average time without drink was 14 hours 25 minutes, with the average time without food being even greater at 24 hours 12 minutes. Conclusions Patients are not receiving medications in the pre-operative fasting stage appropriately, this was mainly due to the incorrect assumption that “nil by mouth” is equivalent to no oral medications. In addition to this, the study found that patients are being kept without food or drink for far too long prior to surgery and hence reducing the quality of their pre-operative status both clinically and biochemically.
Aims 1) To determine whether ‘nil by mouth’ (NBM) emergency surgery patients are fasted for longer than the recommended 6 hours for food and 2 hours for clear fluids. 2) To establish whether oral medications are being correctly administered/omitted in these patients. Methods Fasting and medication administration data were collected prospectively on patients who received emergency surgery over a 2- week period. Drug administration decisions were categorised as ‘correct’ or ‘incorrect’ by comparison with local guidelines. Results A total of 65 patients were identified with the average preoperative fasting times being 24 hours for food and 14 hours for clear fluids. However, the range of fasting times exceeded 110 hours. Notably, only 16 (25%) patients had a drink while they were NBM and 29 (45%) patients were incorrectly administered medications, including several instances of omission of critical drugs. Conclusions Further work is needed to establish the cause of prolonged fasting periods. However, likely factors include; operation scheduling difficulties, lack of understanding of NBM guidelines, inadequate communication with patients, and patient choice. This is resulting in poor preoperative optimisation of patients (e.g. dehydration of patients), as well as a significant risk to patient safety with critical medications being omitted. In order to rectify the severe lack of adherence to the guidelines, we are introducing further NBM training for medical professionals in our trust, in addition to updating the current trust guideline to reflect a wider range of medications and keep up to date with current national guidance.
Background Applications to surgical training are declining. Whilst early introduction to surgical specialities may develop interest, medical schools do not place enough emphasis on the growing trend towards performing laparoscopic procedures. We hypothesised that exposing medical students to laparoscopy would stimulate an interest in pursuing a surgical career. Methods Clinical medical students were randomised into two groups: Laparoscopic skills with box trainer and open surgical skills. Each session lasted one hour and was organised and conducted by the same tutors. Prior to participation in the teaching session, each student completed a pre and post event questionnaires regarding their speciality interest. Results A total of 45 students participated. 18 (33%) expressed an interest in a surgical career prior to the event. After the session, 15/23 (65%) of students who participated in the laparoscopic skills session expressed an interest in a career in surgery. The open surgical skills group had a positive response from 9/22 (41%) with respect to a career in surgery. Conclusions Participation in our surgical skills course increased interest in pursuing a surgical career amongst clinical medical students. Of note, our laparoscopic skills session increased interest more in comparison to an open surgical skills session. Our study highlights the importance of introducing laparoscopy simulation to the medical school curriculum in order to maintain interest towards the surgical specialities.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.