Boisenkjeldgaard2042
This is particularly relevant in the current COVID-19 pandemic with patients facing challenges in accessing outpatient appointments. With many hospitals kickstarting virtual outpatient clinics to ensure continuity of care during a time of social isolation; we await to see the ingenuities that arise from the current pandemic.The birth of the COVID-19 pandemic has transformed working lives of British Asian general practitioners (GPs), such as one of the authors. The effects of the national lockdown and the subsequent loneliness have impacted every aspect of our lives and increased mental health problems. The added social isolation of local lockdowns, such as in Leicester, will undoubtedly exacerbate some health problems due to a lack of patient willingness to attend healthcare services and the postponement of some appointments. The lack of culturally competent support is likely to add to the isolation in non-English-speaking people. learn more Thus, we should pre-empt these issues in a culturally effective manner. To prepare for subsequent waves, GPs are risk-stratifying patients for COVID-19 and have commenced ReSPECT care-plan conversations with higher-risk patients. But with the increased risk from COVID-19 to Black, Asian and minority ethnic patients, should this and other groups of patients also have a ReSPECT care plan? Is now the time to consider community-hospice settings for our palliative COVID-19 patients? This pandemic has uncovered a training need for healthcare professionals to feel more comfortable in discussing end of life as an integral consultation component. We should focus our efforts in alleviating suffering by achieving 'shared understanding' and 'negotiating management' of our ReSPECT conversations.
Physician training is seeing increasing numbers of doctors adopting the role of medical registrar. Non-clinical as well as clinical responsibilities are a source of great anxiety prior to trainees assuming this role.
A standardised, blended, 1-day course to address the needs of doctors transitioning to become a medical registrar was designed and delivered across four hospitals. A mixed methods evaluation approach was employed to assess the effect of the course.
Thirty-four trainees approaching the transition to becoming a medical registrar participated. Quantitative and qualitative analysis of participants' written feedback showed a significant pre- to post-course increase in candidates' self-reported confidence in undertaking the medical registrar role along with learning in non-technical skills.
This course was shown to be effective in helping to improve the confidence of trainees approaching the medical registrar role. The carefully designed standardised format may facilitate wider expansion of such training.
This course was shown to be effective in helping to improve the confidence of trainees approaching the medical registrar role. The carefully designed standardised format may facilitate wider expansion of such training.The COVID-19 pandemic has led to a dramatic increase in patients presenting with type 1 respiratory failure. In order to protect our limited critical care capacity, we rapidly developed a new ward-based inpatient continuous positive airway pressure (CPAP) service with direct input from the respiratory, infectious diseases and critical care teams. link2 Close collaboration between these specialties and new innovative solutions were required to facilitate this. CPAP equipment (normally reserved for domiciliary care) was adapted to reduce the pressure on our strained oxygen infrastructure. Side rooms on the infectious diseases ward were swiftly converted into new negative pressure areas using temporary installed ventilatory equipment, reducing the viral aerosol risk for staff. Novel patient monitoring solutions were used to protect staff while also ensuring patient safety. link3 Staff training and specialist oversight was organised within days. The resulting service was successful, with over half (17/26 (65%)) of patients avoiding invasive ventilation.Postgraduate medical education faces ongoing disruption due to the COVID-19 pandemic, with specific challenges in providing training in laboratory medicine. We report an online approach that has enabled us to continue to deliver haematology morphology training in a teaching hospital setting. The method described is associated with high levels of participant satisfaction and could easily be adapted for use in other clinical pathology specialties.
Staff shortages and rising locum costs prompted Barking, Havering and Redbridge University Hospitals NHS Trust to design an innovative training pathway for doctors in surgery. The 'Academy of Surgery' is a 2-year structured educational programme with rotations through surgical and emergency care specialties and includes a funded MSc.
We recruited 27 doctors over a 2-year period. The first cohort started in October 2018, the second in October 2019. These doctors are heavily supervised in a 2-year programme that aims to prepare them for higher specialty training. They undergo regular assessment and annual review of competencies and progression. They receive regular formal classroom teaching and there are regular sessions to discuss welfare.
Surgical rotas are now fully staffed and not reliant on locum doctors. This has led to significant cost savings. Locum spending in 2017 was £3,856,000 vs £1,284,000 in 2020 - a net saving of £1,187,000 over 2 years.
This innovative training programme has contributed to full staffing of a number of surgical rotas within our Trust and delivered a large financial saving for the NHS. We hope to expand this work into neighbouring trusts.
This innovative training programme has contributed to full staffing of a number of surgical rotas within our Trust and delivered a large financial saving for the NHS. We hope to expand this work into neighbouring trusts.We present a model of employment of healthcare professional students successfully used during the COVID-19 pandemic to support and increase the local workforce. Following recruitment, students from multiple year groups, with varying experience, were deployed to many areas within the trust. The model used allowed overseeing staff to re-deploy students as required in response to changing demand. We received positive feedback from staff and students throughout and present the analysis of a student survey performed towards the end of their roles. We hope the model provides vital insight and an example for other trusts should future need arise during the COVID-19 pandemic and beyond.Work experience is considered as a vital part of an application to medical school and other healthcare-related educational programmes. Gaining clinical work experience via various previously available opportunities from healthcare centres has currently become more challenging and less accessible due to the COVID-19 pandemic-related limitations and resource shortages. In order to provide experience in the healthcare field, we conducted a case study by inviting two secondary school students to participate in Simulation via Instant Messaging -Birmingham Advance (SIMBA) as moderators. Despite no previous clinical knowledge, they found it accessible and to be an excellent alternative to the more traditional types of work experience, which had become unavailable to them. We, therefore, propose SIMBA can act as an alternative and/or an adjunct to work experience for healthcare-related courses.This project involved the implementation of a simulation session followed by interviews to assess and improve foundation interim year 1 (FiY1) preparedness. The session focused on the interpretation of investigations, clinical examinations, the implementation of management plans and appropriate escalation. Preparedness was measured quantitatively using Likert-type scales and qualitatively using interviews. Following the simulation, there was a significant increase in median preparedness for giving treatment (3 vs 4; p=0.04), paperwork (2 vs 4; p=0.03) and independent, responsible working (3 vs 4.5; p=0.03), before and after, respectively. Following the FiY1 period, participants demonstrated significant improvement in median preparedness for giving treatment (3 vs 4.5; p=0.01), paperwork (2 vs 5; p=0.01), independent, responsible working (3 vs 4.5; p=0.02), and communication and teamworking (4 vs 5; p=0.01), before and after, respectively. This simulation and the FiY1 period increased preparedness. This study suggests that future medical apprenticeships should provide the same opportunities and responsibilities as the FiY1 programme.We designed, implemented and evaluated a near-peer simulation training programme teaching diagnostic and therapeutic abdominal paracentesis to core medical trainees (CMTs). We taught diagnostic and therapeutic abdominal paracentesis to 77 north-west London CMTs over 8 training days over 4 years, 2015 to 2019. The programme was optimised by use of plan, do, study, act (PDSA) cycles and the content was evaluated by anonymous pre- and post-course questionnaires. There was a need for this training; 89% of participants reported inadequate training opportunities pre-course and only 28% felt 'confident' or 'very confident' to insert an ascitic drain. Simulation training appears effective when teaching these skills. Having been low in confidence before the course, all participants reported increased confidence after completing the course. Simulation training has been highlighted as a key aspect of the new internal medicine training programme, which replaces CMT. We would recommend using PDSA cycles to implement effective simulation programmes.
The COVID-19 pandemic necessitated changes to the traditional medical ward round to protect staff and patients. This study investigated the value and acceptability of using the Microsoft HoloLens 2 mixed reality headset in a COVID-19 renal medicine ward.
The HoloLens 2 was used during the height of the COVID-19 pandemic and it was compared with the days prior to its introduction. Staff exposure to COVID-19 and PPE usage were measured, and staff and patients were surveyed on the HoloLens 2 experience.
The average ward round was significantly shorter with the use of the HoloLens 2 (94 minutes vs 137 minutes; p=0.006). With the HoloLens 2, only the consultant was in direct contact with COVID-19 patients compared with up to seven staff members on a normal ward round. Personal protective equipment usage was reduced by over 50%. Both staff and patients were positive about its use but raised some important concerns.
The HoloLens 2 mixed reality technology is an innovative solution to the challenges posed by COVID-19 to the traditional medical ward round.
The HoloLens 2 mixed reality technology is an innovative solution to the challenges posed by COVID-19 to the traditional medical ward round.
DECAF is a scoring tool that can predict severity in patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Previous research has shown AECOPD patients with DECAF scores of 0-1 are candidates for early discharge.
Plan, do, study, act (PDSA) methodology was used. Patients with AECOPD and a DECAF score of 0-1 were included. Notes were retrospectively reviewed for patients for DECAF score, length of stay, 30-day re-admission and 30-day mortality (PDSA cycle 1). A framework to facilitate early discharge for patients was subsequently established. Awareness was increased through teaching sessions, posters and targeted emails. To evaluate our improvements, the same parameters were collected prospectively (PDSA cycle 2).
DECAF score was assessed for no patients in PDSA cycle 1 (n=20) but was assessed for all patients in PDSA cycle 2 (n=14). Hospital stay was significantly decreased in PDSA cycle 2 (mean 0.29±0.45 days) compared with PDSA cycle 1 (mean 3.71±2.69 days; difference p<0.
