Objectives: To assess whether initial patient consult by senior clinicians reduces numbers of patients waiting to be seen as an indirect measure of waiting time throughout the emergency department (ED). Methods: An emergency medicine consultant and a senior ED nurse (G or F grade), known as the IMPACT team, staffed the triage area for four periods of four hours per week, Monday to Friday between 9 am to 5 pm for three months between December 2001 and February 2002 when staffing levels permitted. Patients normally triaged by a nurse in this area instead had an early consultation with the IMPACT team. Data were collected prospectively on all patients seen by the IMPACT team. The number of patients waiting to be seen (for triage, in majors and in minors) was assessed every two hours during the IMPACT sessions and at corresponding times when no IMPACT team was operational. Results: There was an overall reduction in the number of patients waiting to be seen in the department from 18.3 to 5.5 (p,0.0001) at formal two hourly assessments. The largest difference was seen in minors. Of the patients seen at triage by the IMPACT team, 48.9% were discharged home immediately after assessment and treatment. With the IMPACT team present, no patient waited more than four hours for initial clinical consult. Conclusions: By using a senior clinical team for initial patient consultation, the numbers of patients waiting fell dramatically throughout the ED. Many patients can be effectively treated and discharged after initial consult by the IMPACT team.

Summary Background:  The trainee‐held learning portfolio is integral to the foundation programme in the UK. In the Northern Deanery, portfolio assessment is standardised through the Annual Review of Competence Progression (ARCP) process. In this study we aimed to establish how current trainees evaluate portfolio‐based learning and ARCP, and how these attitudes may have changed since the foundation programme was first introduced. Methods:  Deanery‐wide trainee attitudes were surveyed by an electronic questionnaire in 2009 and compared with perceptions recorded during the pilot phase (2004–2005). Results:  Many trainees continue to view the e‐portfolio negatively. Indeed, significantly fewer trainees in 2009 thought that the e‐portfolio was a ‘good idea’ or a ‘worthwhile investment of time’ than in 2005. Trainees remain unconvinced about the educational value of the e‐portfolio: fewer trainees in 2009 regarded it as a tool that might help focus on training or recognise individual strengths and weaknesses. Issues around unnecessary bureaucracy persist. Current trainees tend to understand how to use the e‐portfolio, but many did not know how much, or what evidence to collect. Few supervisors were reported to provide useful guidance on the portfolio. ARCP encouraged portfolio completion but did not give meaningful feedback to drive future learning. Discussion:  Continued support is needed for both trainees and supervisors in portfolio‐building skills and in using the e‐portfolio as an educational tool. Trainee‐tailored feedback is needed to ensure that portfolio‐based assessment promotes lifelong, self‐directed and reflective learners.

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