Significant uncertainty surrounds the sustainability of healthcare services in which junior doctors work. It is essential that student and foundation doctors (SFDs) are actively engaged if workforce morale is rebuilt. This narrative review explores the evidence driving the individual work-streams of the Royal College of Physicians' newly formed Student and Foundation Doctor Network. Undergraduate and postgraduate training reform has coincided with concerning feedback from newly qualified doctors. System-level efforts to address this include a focus on extra-contractual matters, where small, sustainable changes could address training and work issues. Fewer foundation year-2 doctors are entering specialty training immediately after the foundation programme. Providing dedicated careers guidance and highlighting opportunities within traditional placements and other career paths can support doctors who undertake non-traditional career routes, including those who take time out of programme. Disseminating these resources through an effective peerto-peer framework and a well-established mentoring scheme could be the most appropriate way to spread good practice.
Two previously fit and healthy males with acute onset dyspnoea and respiratory failure required invasive ventilation for respiratory failure. Insertion and correct positioning of nasogastric tubes (NGT) proved to be difficult repeatedly in both cases over the course of a number of days. Repeated imaging found NGT tips sited in varied, atypical positions including extension into the hemithoraces. Delineation of repeated malpositioned NGTs identified oesophageal perforations in the case of both patients, one with fistulation into the right pleura and the other into the left pleura. Both patients developed an empyema ipsilateral to the side of fistulation. Both patients died, with subsequent postmortems concluding one patient to have experienced a spontaneous out-of-hospital oesophageal perforation, and the second patient's perforation developing as a consequence of a distal oesophageal squamous cell carcinoma. These two cases highlight the importance of questioning the possibility of underlying oesophageal pathology promptly if repeated NGT insertions are unsuccessful or imaging reveals unusual transit paths of NGTs.
The drug class most frequently associated with allergic reactions are the penicillins. Yet penicillins have a vital role in being important treatment options for many common and uncommon infections. Junior doctors undertake the majority of hospital-based prescribing. Evidence suggests foundation doctors make the most prescribing-based errors. A questionnaire was designed to ascertain whether junior doctors displayed an adequate level of knowledge regarding individual and antibiotic class identification, use of trade names, beta lactam cross sensitivity and symptoms of type I and IV hypersensitivity reactions. Three quarters of respondents stated they had received allergy/non-allergic drug reaction teaching as an undergraduate but only just over a half had as a postgraduate. The Junior doctor responded group demonstrated adequate knowledge of correct identification of individual penicillins and non-penicillins and symptoms of a type I hypersensitivity reaction. There was inadequate knowledge of cephalosporin and carbapenem prescribing in the context of penicillin-associated anaphylaxis and of type IV hypersensitivity reaction symptoms. More core and higher specialty trainees correctly chose to prescribe in generic name form than foundation doctors. This survey suggests that there may be key elements of knowledge required to safely prescribe antibiotics in the context of penicillin that, overall, as a group, junior doctors may lack adequate knowledge of, with this inadequacy being most pronounced in foundation doctors. This suggests that junior doctors, and foundation trainees in particular, may need more education and training early in their careers to help support safe prescribing in the context of penicillin allergies.
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