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Background: Basic life support (BLS) is the recognition of sudden cardiac arrest and activation of emergency response system, followed by cardiopulmonary resuscitation (CPR), and rapid defibrillation., Aim: Our study aimed to determine the level of awareness of the Lebanese University medical students and trainees on BLS, by assessing the association between knowledge, attitude, and practice on BLS, and between the demographic variables and KAP scores., Methods: This was a cross-sectional study including 330 medical students enrolled at Lebanese University, from year four of general medicine till year five of residency. An online survey was used to collect data about demographic characteristics, knowledge (K), attitudes (A), and practice (P) about BLS. Data was analyzed using SPSS version 25., Results: Participants were 52.7% females, 47.3% males, and their mean age was 24 ± 2 years. Of the 330 participants, 38.8% received formal training regarding BLS. Medical students had low knowledge (90%), moderate to good attitudes (71.5%), and low practice (93%) regarding BLS. Multiple linear regression showed that knowledge was positively associated with age (p = 0.001), knowledge and information regarding BLS (p = 0.016), and any formal training/workshop regarding BLS (p = 0.021). Attitude was positively associated with academic year (p = 0.002) and knowledge (p = 0.003). Practice was positively associated with age (p < 0.001) and knowledge (p < 0.001)., Conclusion: Most Lebanese University medical students showed low knowledge, moderate to good attitudes, and low practice regarding BLS. We recommend that CPR/BLS should be a core competency across all health care professional programs., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Introduction: The role of global health and sustainable development in medical education is often debated. However, research regarding medical doctors' views on the application of their global health knowledge in the clinical setting remains scarce. This study aimed to explore junior doctors' perceptions of global health and sustainable development, the education they have received on these issues and the relevance of this knowledge in their current and future work., Methods: This was a qualitative study based on individual interviews conducted between May and June 2022. 16 junior doctors, in mandatory clinical training after completing medical school, were purposively sampled from five Swedish hospitals. Transcripts were analysed using qualitative content analysis., Results: Three themes were identified. The first theme (1) 'medical doctors have a role in the transition to a sustainable society', shows that sustainable development is increasingly perceived as relevant for junior doctors' clinical work. The second theme (2) 'global health and sustainable development teaching is inconsistent and somewhat outdated', highlights that there is an assumption that global health and sustainable development can be self-taught. A discrepancy between what is being taught in medical school and the clinical reality is also recognised. This causes challenges in applying global health interest and knowledge in the clinical setting, which is described in the third theme (3) 'application of global health and sustainable development is difficult'. This theme also highlights opportunities for continued engagement, with the perceived benefit of becoming a more versatile doctor., Conclusion: This study emphasises the need for conceptual clarity regarding global health in medical education and raises the need for clarification regarding the level of responsibility for integrating sustainable practices in Swedish healthcare settings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The transition period of becoming a new paediatric registrar has limited study. Consequently, the learning needs of such trainees are unclear including educational interventions that may improve the process. This qualitative study examined the negative and positive experiences of transitioning paediatric trainees to identify learning needs and subsequently derive educational interventions that are perceived to ease transition., Methods: This was a qualitative study of semi-structured interviews with Wales deanery paediatric speciality trainees 3 and 4 (ST3 and ST4) undergoing transition to registrar. Participants were asked to recall one positive and one negative experience during transition using the critical incident technique (CIT). Transcribed responses were coded and thematically analysed and categorised into higher and lower order themes., Results: Six paediatric trainees were interviewed for the study. A total of eighteen codes relating to learning needs were identified and dichotomised into two higher order themes; clinical skills, and leadership and management skills, with further exploration into lower order themes. Clinical skills included child protection procedures, difficult communication with relatives, emergencies, childhood death, difficult procedures, tertiary level neonatal care, managing family anxiety and expectations, dealing with uncertainty and running clinics. Leadership and management skills involved clinical decision making by new registrars, leading ward rounds, managing workload, leading a team and supervising junior colleagues. For educational interventions, sixty-seven initial codes were recorded and combined to form thirty-two lower order themes under six higher order themes. This outlined six educational interventions perceived to ease the transition to the registrar grade including; acting up whilst a senior house officer, seniors providing feedback, seniors providing support, staff providing support, trainee familiarisation with the new registrar placement and trainees maximising SHO learning opportunities., Conclusions: This study provided a grounding upon which further research can be based, by identifying learning needs within the themes of clinical skills and leadership and management skills, as well as providing further descriptions of perceived beneficial educational interventions that ease transition to paediatric registrar. Furthermore, this study proposes evidence-based recommendations involving five key stakeholders to improve the experience of transition for future trainees. These stakeholders include; trainees, seniors, educators, nursing staff and rota coordinators., (© 2024. Crown.)

Background: Surgical bootcamps provide hands-on learning opportunities for junior doctors and trainees in low-pressure, non-clinical environments. Participants develop skills, knowledge, and confidence in preparation for their registrar years. A number of international urology-specific bootcamps have demonstrated improvements in these technical and non-technical domains. However, there was no such opportunity for Australian doctors. In the first urology bootcamp in Australia, we aimed to assess participants' knowledge, technical skills, and confidence in managing urological conditions pre- and post-bootcamp., Methods: Twenty-five early-career medical officers attended the bootcamp and completed a comprehensive written survey at the beginning and end of the bootcamp., Results: Results showed that self-perceptions of knowledge, confidence, and technical skill all improved at the conclusion of the bootcamp (P = 0.01). All participants reported the bootcamp to be 'useful' or 'very useful' in furthering their urological training., Conclusion: This study demonstrates the success of an inaugural Australian urology bootcamp in preparing junior doctors and unaccredited registrars for their registrar training years., (© 2024 Royal Australasian College of Surgeons.)

Background: To mitigate the growing burden of non-communicable diseases, doctors training to become paediatricians should be equipped with concepts and knowledge regarding Developmental Origins of Health and Disease (DOHaD)., Methods: We assessed the knowledge, attitudes, and practices (KAP) of medical officers, resident physicians, as well as junior and senior residents practising in the paediatric department of a tertiary women's and children's hospital. This was done through a cross-sectional online survey, with questions developed after focused group discussions with domain experts, and responses based on a 5-point Likert scale., Results: A total of 95 physicians met the inclusion criteria, grouped into Medical Officers (MOs) and Registrars (REGs), and we received a 100% response rate. Results showed that few physicians (n = 22, 23.2%) knew the term DOHaD, and majority rated their colleagues to be inadequately informed (n = 84, 88.4%). Among the physicians, one third (n = 32, 33.7%) were not confident in their ability to counsel patients about initiating healthy feeding practices to prevent future metabolic diseases in their children. However, there was a readiness to be better equipped with DOHaD principles and knowledge, and 95.8% (n = 91) strongly acknowledged the physician's responsibility to optimise early life determinants of cardiometabolic health., Conclusion: In conclusion, the findings suggest a poor translation of DOHaD concepts, indicating that bridging the gap between DOHaD research knowledge and clinical application represents an unmet need. These principles should be inculcated early in the professional training of all healthcare providers., (© 2024. The Author(s).)

Background: Shift (Black Dog Institute) is the first mobile health smartphone app created to support the mental health of junior physicians. Junior physicians experience demanding work conditions, leading to high levels of psychological distress and burnout. However, they are often concerned about the potential career impacts of seeking mental health support. The confidentiality and ease of access of digital interventions may be particularly suited to address these concerns. The Shift app provides therapeutic and psychoeducational content and strategies contextualized for the specific needs of physicians in training. App content includes information on mental health, help seeking, mindfulness, and common workplace-related concerns of junior physicians., Objective: This study aims to test, at scale, the effectiveness of Shift among junior physicians working in Australia using a randomized controlled trial design. The primary aim is to examine whether junior physicians using Shift experience a reduction in depressive symptoms compared with a waitlist control group. The secondary aim is to examine whether the app intervention group experiences improvements in anxiety, work and social functioning, help seeking, quality of life, and burnout compared with the control group., Methods: A total of 778 junior physicians were recruited over the internet through government and nongovernment medical organizations across Australia, as well as through paid social media advertisements. They were randomly allocated to one of 2 groups: (1) the intervention group, who were asked to use the Shift app for a period of 30 days, or (2) the waitlist control group, who were placed on a waitlist and were asked to use the app after 3 months. Participants completed psychometric measures for self-assessing mental health and wellbeing outcomes, with assessments occurring at baseline, 1 month after completing the baseline period, and 3 months after completing the baseline period. Participants in the waitlist control group were asked to complete an additional web-based questionnaire 1 month after receiving access to the app or 4 months after completing the baseline survey. Participants took part in the study on the internet; the study was completely automated., Results: The study was funded from November 2022 to December 2024 by the New South Wales Ministry of Health. Data collection for the study occurred between January and August 2024, with 780 participants enrolling in the study during this time. Data analysis is underway; the effectiveness of the intervention will be estimated on an intention-to-treat basis using a mixed-model, repeated measures analysis. Results are expected to be submitted for publication in 2025., Conclusions: To the best of our knowledge, this is the first randomized controlled trial to examine the effectiveness of a mobile health smartphone app specifically designed to support the mental health of junior physicians., Trial Registration: Australia and New Zealand Clinical Trials Registry ACTRN12623000664640; https://tinyurl.com/7xt24dhk., International Registered Report Identifier (irrid): DERR1-10.2196/58288., (©Lauren Lai, Samineh Sanatkar, Andrew Mackinnon, Mark Deady, Katherine Petrie, Rosie Lipscomb, Isabelle Counson, Rohan Francis-Taylor, Kimberlie Dean, Samuel Harvey. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 19.09.2024.)

Objective: Effective clinical leadership is crucial for the delivery of high-quality medical care. However, the extent to which current leadership development effectively enhances leadership competencies for junior doctors remains uncertain., Methods: This study aimed to investigate the utilisation of quality improvement projects (QIPs) to enhance leadership skills among junior doctors in a District General Hospital. Additionally, the feasibility of implementing a leadership programme in a smaller District General Hospital alongside didactic learning, reflection and stakeholder engagement was assessed. The Medical Leadership Competency Framework Self-Evaluation Tool was used to assess current leadership qualities and develop personal action plans., Results: While the majority of junior doctors completed QIPs, only a few engaged in reflective practice. Moreover, limited participation in formal leadership programmes was observed., Conclusion: The study suggests that effective interpersonal development combined with long-term leadership training can be a resource-intensive yet valuable approach to adequately prepare future leaders even within District General Hospitals. The findings highlight the need for a structured leadership curricula utilising longitudinal project-based learning., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The majority of junior doctors in the UK do not proceed directly into specialty training after completing mandatory foundation training but instead take a year out of training. A common post undertaken during a year out of training is a clinical teaching fellow (CTF) role which is used to provide undergraduate medical student teaching. There is only a small amount of literature available regarding CTF posts, and very little of this explores experiences or reasons for taking up such as post. An understanding of the reasons why doctors are choosing to work as CTFs and what their experiences are in post will contribute to how the role is further developed and utilised within the NHS. This study aimed to explore the experiences of CTFs employed in the West Midlands at NHS hospital Trusts., Methods: CTFs working in Trusts in the West Midlands region registered as students on the Education for Healthcare Professionals Post Graduate Certificate course at the University of Birmingham in August 2019 and 2020 who were enrolled in a longitudinal study were invited to take part in an individual interview asking about their experiences as CTFs., Results: Nine CTFs participated in an interview. Five main themes were identified which related to their experiences in post and plans for future careers. Participants reported choosing to undertake a CTF role due to wanting a break from clinical work and having previously enjoyed delivering teaching. Positive experiences in post included lifestyle related benefits and self-development opportunities. Challenges identified with the role included the impact of COVID-19 and volume of students., Conclusion: This is the first study to use interview methodology to explore experiences of CTFs, and has provided a valuable insight into the experiences of those in post in the West Midlands region. Understanding why doctors chose this job and what their experiences are could help to further develop and refine the role. To guarantee demands for teaching staff are met those employing CTFs should be aware of reasons why doctors apply for the post and ensure the post remains a desirable option., (© 2024. The Author(s).)

Purpose: To explore the ability of Dental Students (DS), Medical Students (MS), Trainee Interns (TI) and Pre-vocational Junior Doctors (JD) in identifying procedures performed by Oral and Maxillofacial Surgery (OMS), the scope of practice (SOP) of OMS and ability to differentiate OMS from similar specialities., Methods: The study included 282 complete responses to a survey consisting of: 9 demographic questions, 11 OMS awareness, professional ambition, teaching and exposure, confidence in identifying and referring questions and 70 procedural/scenario questions across four domains. Collected data was qualitatively and statistically analysed using SPSS V29., Results: OMS awareness was limited. 92.2% reported None to Small amount of OMS teaching and exposure during university, with 66.0% preferring to have had a Fair to Significant amount. DS experienced more than medical respondents (2.1 vs. 1.5, p < 0.001). Most respondents reported No to Low confidence in identifying the SOP and procedures performed by OMS (67.7%) and referring to OMS (62.4%) compared to similar specialities (32.4% and 33.2%, respectively). 52.9% of procedures performed by OMS were correctly identified as being performed by OMS. The ability to identify the OMS SOP (8.7%) and differentiate OMS from similar specialities (5.0%) was low, however better among DS than medical respondents (14.9% vs. 6.3%, p = 0.002 and 12.2% vs. 2.2%, p < 0.001)., Conclusion: The study has highlighted a deficit in the understanding of OMS with potential implications in the public and private healthcare sector. Identification of procedures, OMS SOP and ability to differentiate OMS from similar specialities is limited however slightly better among DS., (© 2024. The Author(s).)

Background: On-call simulation has been shown to improve the confidence of prospective junior doctors in undertaking on-call shifts. Despite this, it is not mandated in UK medical school curricula, leading to variations in provision. Barriers to widespread implementation may include doubts surrounding effectiveness, feasibility of delivering on-call simulation across multiple sites and unknown costs. To address these gaps in the literature, we designed and implemented a multi-site on-call simulation programme. We aimed to evaluate it both educationally, using student preparedness to complete on-call shifts as our outcome, and economically, by performing a cost-outcome description., Approach: An on-call simulation programme, 'Bleep 101', was developed and implemented at eight hospitals. Students were 'bleeped' around a circuit of written scenarios including clinical emergencies, prescribing and distractor tasks. Students could escalate to their facilitator on the phone for advice at any time. Sessions concluded with a 30-minute debrief focusing on prioritisation and communication skills., Evaluation: Between 2018 and 2023, 217 students took part and completed feedback forms. Post-session feedback using Likert scales demonstrated a significant increase in preparedness to complete an on-call shift (pre-4/10, post-7/10, p < 0.01) with outcomes consistent across sites. A cohort of 20 students completed paired pre- and post-session feedback to evaluate the impact of the session on specific skills. This demonstrated increased confidence in using a bleep, prioritisation, gathering information and handing over. The costs of implementation at one site were reported, demonstrating a cost of £1.99/student/year or £99.48/student/year excluding costs saved by volunteers and room hire., Implications: This study indicates that on-call simulation can be delivered at a low cost using existing medical education infrastructure within hospitals. Results suggested an improvement in medical students' preparedness for on-call practice. We therefore recommend on-call simulation be available to all medical students as part of medical school curricula., (© 2024 The Author(s). The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Objective: To determine whether a brief educational intervention for Junior Medical Officers (JMOs), using teaching methods aimed at achieving higher outcomes on Bloom's Taxonomy, significantly improved participant confidence and knowledge in decision making about restrictive care., Method: JMOs received a teaching session on restrictive medical and mental health care. Groups were randomly assigned to either sessions including a component of modern pedagogical interventions (Think-Pair-Share and SNAPPS), or sessions including a control period focusing on reviewing a condensed summary of relevant information. Pre- and post-intervention measures were recorded for subjective self-ratings of confidence and scores on standardized clinically relevant extended matching questions (EMQs)., Results: There was no difference in subjective confidence improvement between groups; however, the group receiving the modern pedagogical intervention demonstrated significantly greater objective performance on knowledge-based EMQs., Conclusions: A brief modern pedagogical intervention using interactive teaching methods shows promise for improving knowledge of restrictive care and the Mental Health and Guardianship Acts. In the control group, similarly increased confidence in knowledge did not equate to increased competence on a knowledge assessment. Refurbishing educational interventions presents opportunities for improving clinical outcomes and engaging junior doctors in psychiatry., Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Psychological stress and anxiety have seriously affected the ability of new clinicians to adapt and coordinate their clinical work. Traditional pre-job training is often not very good at assisting new recruits to regulate their emotional problems., Methods: This study is a randomized controlled study. A total of 435 newly recruited clinicians participated in the study. 428 clinicians were randomized into a control group (n = 214) and an intervention group (n = 214). The control group conducted regular pre-job training. Doctors of the intervention group attend a themed course every two weeks on the basis of regular induction training. Their physiological status was evaluated by Perceived Stress Scale (PPS-10), Generalized Anxiety Scale (GAD-7) and Psychological Resilience Scale (CD-RISC-10) 3 months later. Participants in the intervention group received a training satisfaction questionnaire., Results: After entering the clinic for 3 months, the PSS-10 and GAD-7 scores of the intervention group were significantly lower than that of the control group. Consistently, the CD-RISC-10 score of new clinicians who received proof-of-concept pre-job training was significantly higher than that of new doctors in the control group., Conclusion: New doctors received the proof-of-concept group experienced alleviation in stress and anxiety., (© 2024. The Author(s) under exclusive licence to Belgian Neurological Society.)

Background: Physician burnout is rising, especially among academic physicians facing pressures to increase their clinical workload, lead administrative tasks and committees, and be active in research. There is a concern this could have downstream effects on learners' experiences and academic physician's ability to teach learners on the team., Methods: A 29-question RedCap survey was electronically distributed to 54 attending physicians within an academic learning health system who oversaw the General Medicine inpatient teaching services during the 2022-2023 academic year. The aims were to assess this cohort of attending physicians' experiences, attitudes, and perceptions on their ability to effectively teach learners on the team, feeling valued, contributors to work-life balance and symptoms of burnout, Fisher's Exact Tests were used for data analysis., Results: Response rate was 56%. Attendings splitting time 50% inpatient / 50% outpatient felt that team size and type of admissions model affected their ability to effectively teach learners (p = 0.022 and p = 0.049). Attendings with protected administrative time felt that non-patient care obligations affected their ability to effectively teach the learners (p = 0.019). Male attendings and attendings with ≤ 5 years of General Medicine inpatient teaching experience felt less valued by residency leadership (p = 0.019 and p = 0.026). 80% of attendings experienced emotional exhaustion, and those with > 10 weeks on a General Medicine inpatient teaching service were more likely to experience emotional exhaustion (p = 0.041). Attendings with > 10 weeks on a General Medicine inpatient teaching service and those who were a primary caregiver were more likely to experience depersonalization (p = 0.012 and p = 0.031). 57% of attendings had reduced personal achievement., Conclusions: Institutions should seek an individual and organizational approach to professional fulfillment. Special attention to these certain groups is warranted to understand how they can be better supported. Further research, such as with focus groups, is needed to address these challenges., (© 2024. The Author(s).)

Background: The coronavirus disease (COVID-19) pandemic has accentuated the need for effective clinical skills training in infectious diseases. This study aimed to explore the influencing factors of infectious disease clinical skills training based on scenario simulation teaching for medical staff in China., Methods: This hospital-based, cross-sectional study was conducted at the Third People's Hospital of Shenzhen between March and December 2022. Scenario simulation teaching was applied, and factors such as gender, educational level, professional background, and previous experience were examined to determine their impact on qualification outcomes., Results: The study included participants primarily between the ages of 20-40 years, with a higher proportion of women holding university degrees. Nurses and physicians were more likely to qualify, indicating the significance of professional backgrounds. Women showed a higher likelihood of qualifying than men and higher educational attainment correlated with better qualification rates. Prior experience with protective clothing in isolation wards was a significant determinant of successful qualification. Multivariate analysis underscored the influence of sex, education, and previous experience on training effectiveness., Conclusion: Scenario simulation is an effective strategy for training clinical skills in treating infectious diseases. This study highlights the importance of considering sex, education, professional background, and prior experience when designing training programs to enhance the efficacy and relevance of infectious disease training., (© 2024. The Author(s).)

Background: To assess changes in confidence and preparedness after conducting a 2-day induction bootcamp for novice Ear Nose and Throat (ENT) first year specialty trainee registrars (ST3s) in the United Kingdom (UK). The bootcamp covered common ENT presentations on the ward, and in the elective and emergency settings., Methods: A total of 32 trainees (ST3 or research fellow) voluntarily registered via an online application form to the Southern ST3 accelerated learning course bootcamp through ENT UK. ENT UK is a membership body that supports ENT trainees throughout their careers. They completed a two-day bootcamp that was hosted at St Mary's Hospital, London and 10 skills sessions were delivered by either a senior ENT registrar or an ENT consultant. A pre-session questionnaire was distributed to all participants and a post-session questionnaire was provided that assessed the changes in confidence and preparedness of the participants, if any. The responses were scored by a 10-point Likert scale. Only participants who fully completed the pre and post questionnaire were included, which was 29 in total., Results: Participants self-reported a significant increase in confidence (p < 0.001) and preparedness (p < 0.001) following the bootcamp course. The greatest improvements in comparison to all other stations were self-preparedness in the rigid bronchoscopy station and self-confidence in the sphenopalatine artery (SPA) ligation station., Conclusion: The use of a two-day bootcamp improved confidence and preparedness of managing common ENT presentations in the ward, elective and emergency settings for ENT ST3s. It provides a useful adjunct in the acquisition of technical and non-technical skills alongside the traditional surgical apprenticeship. In the future, more work is required to assess the impact of bootcamps on patient outcomes and long-term benefits on trainees' skill retention and clinical proficiency., (© 2024. The Author(s).)

Background: Adopting high-value, cost-conscious care (HVCCC) principles into medical education is growing in importance due to soaring global healthcare costs and the recognition that efficient care can enhance patient outcomes and control costs. Understanding the current opportunities and challenges doctors face concerning HVCCC in healthcare systems is crucial to tailor education to doctors' needs. Hence, this study aimed to explore medical students, junior doctors, and senior doctors' experiences with HVCCC, and to seek senior doctors' viewpoints on how education can foster HVCCC in clinical environments., Methods: Using a mixed-methods design, our study involved a cross-sectional survey using the Maastricht HVCCC-Attitude Questionnaire (MHAQ), with a subset of consultants engaging in semi-structured interviews. Descriptive analysis provided insights into both categorical and non-categorical variables, with differences examined across roles (students, interns, junior doctors, senior doctors) via Kruskal-Wallis tests, supplemented by two-group analyses using Mann-Whitney U testing. We correlated experience with MHAQ scores using Spearman's rho, tested MHAQ's internal consistency with Cronbach's alpha, and employed thematic analysis for the qualitative data., Results: We received 416 responses to the survey, and 12 senior doctors participated in the semi-structured interviews. Overall, all groups demonstrated moderately positive attitudes towards HVCCC, with more experienced doctors exhibiting more favourable views, especially about integrating costs into daily practice. In the interviews, participants agreed on the importance of instilling HVCCC values during undergraduate teaching and supplementing it with a formal curriculum in postgraduate training. This, coupled with practical knowledge gained on-the-job, was seen as a beneficial strategy for training doctors., Conclusions: This sample of medical students and hospital-based doctors display generally positive attitudes towards HVCCC, high-value care provision, and the integration of healthcare costs, suggesting receptiveness to future HVCCC training among students and doctors. Experience is a key factor in HVCCC, so early exposure to these concepts can potentially enhance practice within existing healthcare budgets., (© 2024. The Author(s).)

Background: Advanced Trauma Life Support was originated mainly to train doctors who don't manage trauma on a regular basis, including junior doctors as it prepares them more efficiently and effectively for treating and managing trauma patients. This study was conducted to study knowledge, attitude and practice of advanced trauma life support protocol among house-officers in Khartoum state hospitals, Sudan 2023., Methods: This is a cross-sectional descriptive health facility based study conducted in Bahri Teaching Hospital, Omdurman Teaching Hospital and Ibrahim Malik teaching hospital, Khartoum state, Sudan. Data of 151 House-officers of all nationality working in Khartoum state hospitals was collected using a simple random technique, filling questionnaire that was designed especially for this study. Comparison between different variables by Chi-square test and statistical significance difference at P value < 0.05 was done., Result: A total of 151 house officers were included in the study. 49% aged between 20 and 25 years, females were the majority 56.3%. About 41.1% have took ATLS course before. 55.21% of the study participants didn't take the course because it was not available, while 35.42% because it was expensive and 29.17% referred it to their busy lifestyle. 91% of the study population think that ATLS course should be compulsory and 85% think that the ATLS protocol should be recommended to both junior and senior doctors. 77% of the study participants stated that their seniors teaching skills affect how they apply ATLS., Conclusion: Overall junior doctors at Khartoum state hospitals demonstrated a positive attitude towards ATLS, but they showed poor knowledge regarding the topic. It's advised that an earlier training program is introduced by incorporating ATLS course to be part of all final year medical school's curriculum., (© 2024. The Author(s).)

Objectives: There is concern that junior doctors are not prepared for their post-graduate attachments in ENT. The aims of this study were to capture the learning priorities of those in the ENT first on-call role and facilitate further educational opportunities to address these needs., Method: Semi-structured interviews were undertaken to explore the learning needs of junior doctors with seven junior and two senior ENT clinicians., Results: The thematic analysis generated three themes: the role of the ENT Junior; the perceived, expressed and prescribed learning needs; and attitudes towards future learning. These themes explored the misalignment between undergraduate training and post-graduate expectations, the lack of competence in ENT practical skills and the need for focused ENT training prior to commencing on-call shifts., Conclusion: All interviewees identified the need for greater experience in practical interventional skills prior to their ENT attachments and expressed interest towards a standardised, bootcamp-style induction with simulated emergency experience.

Objective: Otitis externa is a common condition managed by junior doctor-led ENT clinics in secondary/tertiary care, but no national guidelines exist for presentations in these settings. The aim of this study was to implement a treatment algorithm to support junior doctors and improve otitis externa management., Methods: Baseline data were retrospectively collected for 16 weeks. A standardised otitis externa treatment algorithm was then implemented, and 16 weeks of data prospectively gathered. A second improvement cycle was completed thereafter focusing on topical antibiotics and water precaution advice., Results: Overall, 202 cases of otitis externa managed between November 2021 to October 2022 were reviewed. Following the interventions, topical antibiotic prescribing improved ( p = 0.01) as well as the provision of water precaution advice ( p < 0.01). Junior doctors trended towards reviewing patients more frequently but required less senior support., Conclusion: Our treatment algorithm empowers junior doctors to become more independent in their management of otitis externa and improves overall otitis externa treatment.

Background: High-risk medications like benzodiazepines, sedative hypnotics, and antipsychotics are commonly prescribed for hospitalized older adults, despite guidelines recommending avoidance. Prior interventions have not fully addressed how physicians make such prescribing decisions, particularly when experiencing stress or cognitive overload. Simulation training may help improve prescribing decision-making but has not been evaluated for overprescribing., Methods: In this two-arm pragmatic trial, we randomized 40 first-year medical resident physicians (i.e., interns) on inpatient general medicine services at an academic medical center to either intervention (a 40-minute immersive simulation training) or control (online educational training) groups. The primary outcome was the number of new benzodiazepine, sedative hypnotic, or antipsychotic orders for treatment-naïve older adults during hospitalization. Secondary outcomes included the same outcome by all providers, being discharged on one of the medications, and orders for related or control medications. Outcomes were measured using electronic health record data over each intern's service period (~2 weeks). Outcomes were evaluated using generalized estimating equations, adjusting for clustering., Results: In total, 522 treatment-naïve older adult patients were included in analyses. Over follow-up, interns prescribed ≥1 high-risk medication for 13 (4.9%) intervention patients and 13 (5.0%) control patients. The intervention led to no difference in the number of new prescriptions (Rate Ratio [RR]: 0.85, 95%CI: 0.31-2.35) versus control and no difference in secondary outcomes. In secondary analyses, intervention interns wrote significantly fewer "as-needed" ("PRN") order types for the high-risk medications (RR: 0.29, 95%CI: 0.08-0.99), and instead tended to write more "one-time" orders than control interns, though this difference was not statistically significant (RR: 2.20, 95%CI: 0.60-7.99)., Conclusions: Although this simulation intervention did not impact total high-risk prescribing for hospitalized older adults, it did influence how the interns prescribed, resulting in fewer PRN orders, suggesting possibly greater ownership of care. Future interventions should consider this insight and implementation lessons raised., Trial Registration: Clinicaltrials.gov(NCT04668248)., (© 2024 The American Geriatrics Society.)

Indonesian physicians working in rural and remote areas must be equipped not only with generic competencies but also with the attributes and skills necessary to provide health care services without compromising quality. This study sought to reach a consensus on the attributes and competencies that are viewed as essential and important for working effectively as an early career doctor in rural and remote practice in Indonesia. A two-round Delphi study was conducted by reference to 27 consenting physicians working in rural and remote Indonesia. Forty-three items covering 9 attributes and 34 competencies were sent to these physicians to be rated on a Likert scale ranging from 1 to 5 in terms of their importance for effective rural and remote practice. Nine attributes and 29 competencies progressed to Round 2. All nine attributes and 29 competencies were identified as essential or important for junior physicians' ability to be effective in their practice. The essential attributes included professional quality related to prioritising the rural community. The essential competencies included medical skills, professional behaviour, interprofessional skills, health promotion and connection to the rural community. The consensus thus reached on these essential and important attributes and competencies can inform curriculum development for the undergraduate and postgraduate training of junior rural and remote physicians., (© 2023. The Author(s).)

Background: Onboarding of junior staff in the intensive care unit is vital to ensure high-quality critical care treatment. This process depends on beginner's training., Aim: We aimed to determine structure and duration of intensive care onboarding and the job satisfaction of junior professionals in German intensive care units., Materials and Methods: We conducted an anonymous, interprofessional online survey regarding quality of onboarding and job satisfaction among young professionals., Results: A total of 554 young professionals participated, about two thirds were physicians. A written concept was used in 59% of the nurse's and 27% of physicians' training. Median duration of training before taking full charge of patient treatment was 30 days among nurses and 7 days among physicians. About one third of nurses and 17% of physicians stated that they were sufficiently prepared after the training period, whereby 49% of physicians often felt overwhelmed. More than 42% can imagine working in critical care longer than the next 3 years., Conclusion: Fundamental methods for training of critical care professionals starting their intensive care career are underused in Germany and the duration of training blatantly differs from national guideline recommendations. Although there seem to be deficits concerning material and staff resources, participants are satisfied with learning progress and teamwork., (© 2023. The Author(s).)

Background: Modern medicine becomes more dependent on radiologic imaging techniques. Over the past decade, radiology has also gained more attention in the medical curricula. However, little is known with regard to students' perspectives on this subject. Therefore, this study aims to gain insight into the thoughts and ideas of medical students and junior doctors on radiology education in medical curricula., Methods: A qualitative, descriptive study was carried out at one medical university in the Netherlands. Participants were recruited on social media and were interviewed following a predefined topic list. The constant comparative method was applied in order to include new questions when unexpected topics arose during the interviews. All interviews were transcribed verbatim and coded. Codes were organized into categories and themes by discussion between researchers., Results: Fifteen participants (nine junior doctors and six students) agreed to join. From the coded interviews, four themes derived from fifteen categories arose: (1) The added value of radiology education in medical curricula, (2) Indispensable knowledge on radiology, (3) Organization of radiology education and (4) Promising educational innovations for the radiology curriculum., Conclusion: This study suggests that medical students and junior doctors value radiology education. It provides insights in educational topics and forms for educational improvement for radiology educators., (© 2024. The Author(s).)

Continuing medical education plays a pivotal role in fostering and upholding the standard of excellence in medicine. Both SPOC (small private online course) and BOPPPS (bridge-in, learning objective, pretest, participatory learning, posttest, and summary) methodologies are rooted in the same educational and learning theories, emphasizing active student engagement, interaction, and feedback. Using ultrasound-guided spinal anesthesia as an exemplar, we aimed to investigate the feasibility of blended teaching (combination of BOPPPS and SPOC) for anesthesiology clinicians and explore trainees' and trainers' perspectives towards the innovative method. Twenty-seven attending anesthesiologists were randomly divided into experimental group (n = 14, blended teaching method) and control group (n = 13, traditional teaching method). The questionnaire was administered before and a week post-training. Their operative skills (measured by operation time) were assessed. The students' cognitive evaluation of the blended teaching mode was conducted in the experimental group. The experimental group demonstrated notably higher theoretical scores compared to the control group [(46.42 ± 5.345) vs (41.92 ± 5.219), t = 2.213, P < .05]. The operation time in the experimental group was significantly shorter than that in the control group [(84.79 ± 28.450) seconds vs (114.23 ± 35.607) seconds, t = -2.383, P < .05]. Most participants preferred blended learning as it was more effective than traditional learning. Suggestions for enhancement included enhanced online interactivity with trainers and the inclusion of case analysis. Integration of blended teaching incorporating BOPPPS and SPOC methodologies holds promise for enhancing the efficiency of skill training among anesthesiologists. Blended learning may become a viable and well-received option among anesthesia clinicians in China., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: dermatology is a prevalent field of global health and dermatological conditions are amongst the most frequent complaints affecting communities, yet dermatology has become an overlooked aspect of the medical school curricula and many medical schools have failed to provide doctors with training to manage these conditions confidently and adequately. This study aimed to determine the baseline dermatological knowledge of medical doctors and determine the influence of fundamental dermatology education on hospital medical staff at a regional hospital in Johannesburg, South Africa., Methods: the knowledge and confidence of 33 medical doctors were tested using a pre-test and post-test quasi-experimental design. Participants completed an online questionnaire followed by an image-based test consisting of 20 questions to determine their level of confidence in diagnosing and managing common dermatological conditions. The participants then attended a sixty-minute educational session based on common dermatological conditions. Following this, their level of confidence and knowledge on the subject was re-assessed using the same online test. Pre and post-intervention confidence and test scores were compared., Results: the pre-intervention test mean score was 67.11%. The post-intervention mean score was 92.50%. The difference between means (post-intervention - pre-intervention) ± SEM was 25.39 ± 4.81. The intervention significantly improved overall test scores (p-value < 0.0001). Many participants felt that their undergraduate training was insufficient in preparing them for the management of common dermatological conditions., Conclusion: the baseline knowledge and confidence of medical doctors in managing common dermatological conditions was poor and such educational interventions have significant value in improving the ability of medical doctors in managing common dermatological conditions. More time should be dedicated to dermatology training at an undergraduate level., Competing Interests: The authors declare no competing interests., (Copyright: Tamara Romanini et al.)

Background: Systematic reviews provide the highest level of evidence about a topic. Ten-week workshops in conducting systematic reviews were held with hospital doctors in 2019 and 2020., Aim: This study analysed participants' feedback about the systematic review workshops to improve how we teach clinicians about conducting systematic reviews., Methods: Attendees completed a post-workshop survey (with multiple-choice and free-text items) to assess knowledge and skills gained. We compared the responses of senior and junior doctors. We used descriptive statistics for the quantitative data and compared groups using Χ 2 testing. Qualitative data were analysed using conceptual content analysis., Results: Of 81 attendees, 52% completed the survey. Of those, 69% had no prior experience with systematic reviews, 93% reported increased knowledge and ability to conduct research and 69% reported increased ability to conduct systematic reviews. More senior than junior clinicians reported gaining knowledge about writing and publishing (37% vs 11%, P = 0.047) and making greater use of skills gained to conduct research (56% vs 23%, P = 0.029). Five themes were identified: learning through course structure; learning through course organisation; teaching style; flexible learning; and suggestions for progression and improvement. Respondents suggested running the workshops during protected teaching time, more time for some sessions, conducting the workshop series more often and making clinicians aware of the workshop series at hospital orientation., Conclusion: The skills learnt from the systematic review workshop series impacted not only participants' research knowledge and skills, and plans to conduct future research, but also facilitated looking up medical literature in daily clinical work, supporting evidence-based clinical practice., (© 2023 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.)

Purpose: This study aimed to compare cognitive, non-cognitive, and overall learning outcomes for sepsis and trauma resuscitation skills in novices with virtual patient simulation (VPS) versus in-person simulation (IPS)., Methods: A randomized controlled trial was conducted on junior doctors in emergency departments from January to December 2022, comparing 70 minutes of VPS (n=19) versus IPS (n=21) in sepsis and trauma resuscitation. Using the nominal group technique, we created skills assessment checklists and determined Bloom's taxonomy domains for each checklist item. Two blinded raters observed participants leading 1 sepsis and 1 trauma resuscitation simulation. Satisfaction was measured using the Student Satisfaction with Learning Scale (SSLS). The SSLS and checklist scores were analyzed using the 2-tailed t-test., Results: For sepsis, there was no significant difference between VPS and IPS in overall scores (2.0; 95% confidence interval [CI], -1.4 to 5.4; Cohen's d=0.38), as well as in items that were cognitive (1.1; 95% CI, -1.5 to 3.7) and not only cognitive (0.9; 95% CI, -0.4 to 2.2). Likewise, for trauma, there was no significant difference in overall scores (-0.9; 95% CI, -4.1 to 2.3; Cohen's d=0.19), as well as in items that were cognitive (-0.3; 95% CI, -2.8 to 2.1) and not only cognitive (-0.6; 95% CI, -2.4 to 1.3). The median SSLS scores were lower with VPS than with IPS (-3.0; 95% CI, -1.0 to -5.0)., Conclusion: For novices, there were no major differences in overall and non-cognitive learning outcomes for sepsis and trauma resuscitation between VPS and IPS. Learners were more satisfied with IPS than with VPS (clinicaltrials.gov identifier: NCT05201950).

Purpose: The primary aim of this study was to investigate the effect of including the Dutch National Pharmacotherapy Assessment (DNPA) in the medical curriculum on the level and development of prescribing knowledge and skills of junior doctors. The secondary aim was to evaluate the relationship between the curriculum type and the prescribing competence of junior doctors., Methods: We re-analysed the data of a longitudinal study conducted in 2016 involving recently graduated junior doctors from 11 medical schools across the Netherlands and Belgium. Participants completed three assessments during the first year after graduation (around graduation (+ / - 4 weeks), and 6 months, and 1 year after graduation), each of which contained 35 multiple choice questions (MCQs) assessing knowledge and three clinical case scenarios assessing skills. Only one medical school used the DNPA in its medical curriculum; the other medical schools used conventional means to assess prescribing knowledge and skills. Five medical schools were classified as providing solely theoretical clinical pharmacology and therapeutics (CPT) education; the others provided both theoretical and practical CPT education (mixed curriculum)., Results: Of the 1584 invited junior doctors, 556 (35.1%) participated, 326 (58.6%) completed the MCQs and 325 (58.5%) the clinical case scenarios in all three assessments. Junior doctors whose medical curriculum included the DNPA had higher knowledge scores than other junior doctors (76.7% [SD 12.5] vs. 67.8% [SD 12.6], 81.8% [SD 11.1] vs. 76.1% [SD 11.1], 77.0% [12.1] vs. 70.6% [SD 14.0], p < 0.05 for all three assessments, respectively). There was no difference in skills scores at the moment of graduation (p = 0.110), but after 6 and 12 months junior doctors whose medical curriculum included the DNPA had higher skills scores (both p < 0.001). Junior doctors educated with a mixed curriculum had significantly higher scores for both knowledge and skills than did junior doctors educated with a theoretical curriculum (p < 0.05 in all assessments)., Conclusion: Our findings suggest that the inclusion of the knowledge focused DNPA in the medical curriculum improves the prescribing knowledge, but not the skills, of junior doctors at the moment of graduation. However, after 6 and 12 months, both the knowledge and skills were higher in the junior doctors whose medical curriculum included the DNPA. A curriculum that provides both theoretical and practical education seems to improve both prescribing knowledge and skills relative to a solely theoretical curriculum., (© 2023. The Author(s).)

Objective: This study aimed to assess the effectiveness of an ENT simulation course for equipping foundation doctors with core ENT skills in preparation for an ENT senior house officer post., Method: A total of 41 foundation doctors in the East of England participated in our two-part simulation course. Pre- and post-course surveys, consisting of Likert scales and a Dundee Ready Educational Environment Measure, were sent to assess confidence in core ENT skills and acceptability of course format., Results: Post-simulation, confidence improved in all core ENT skills taught ( p < 0.001), along with confidence and preparedness to work as an ENT senior house officer ( p < 0.001). Overall course median Dundee Ready Educational Environment Measure score was 48, and 100 per cent of participants would recommend this course to colleagues., Conclusion: Simulation improves foundation doctors' confidence in core ENT skills and increases preparedness for working as an ENT senior house officer. Guidance on core ENT skills requirements should be made available to improve uniformity amongst ENT simulation courses.

Background: Few studies have investigated how doctors in Norway deal with medical uncertainty. The purpose of the study was to explore how first year junior doctors perceive and manage uncertainty in clinical practice., Material and Methods: Ten first year junior doctors at two hospitals in Norway were recruited for interviews following response pattern analysis from a mapping questionnaire. The interviews were analysed using systematic text condensation., Results: The analysis revealed three main themes in the interviews: dealing with medical uncertainty, personal response to medical uncertainty, and working environment, feedback and preparation. Within all three thematic areas, the informants used the words 'certain/uncertain' and 'secure/insecure' interchangeably., Intepretation: The first year junior doctors struggled with the inherent uncertainty of medicine and felt a marked sense of insecurity, particularly at the start of their training period. How the doctors were welcomed in the workplace and the feedback they were given were important factors. Their undergraduate medical education had not sufficiently prepared the first year junior doctors for how to deal with medical uncertainty in clinical practice.

Background: Concerns have been raised surrounding the training of Foundation Doctors on the ethical, legal and professionalism (ELP) aspects of clinical practice, leading to some to claim a degree of educational neglect. Foundation Doctors are junior doctors in the United Kingdom within the first 2 years of their medical career since graduating from medical school., Approach: Lancaster University and Health Education England North West (HEE NW) introduced a series of training materials specially created to meet the ELP training needs of Foundation Doctors, which were piloted by Foundation Schools., Evaluation: The training was delivered to Foundation Doctors in first and second year of their training either online or in person. The facilitators were clinical senior doctors and did not have an academic qualification in ELP. Some large Foundation Schools used two training packs to provide an optional ELP day for their Foundation Doctors, while individual hospitals within a Foundation School used the training packs to provide training as part of their mandatory weekly training for Foundation Doctors. Feedback was gathered from Foundation Doctors and training facilitators when a training pack was piloted., Implications: Foundation Doctors were able to make links between the messages delivered in the training to their own clinical practice. Foundation Schools have incorporated the training packs into the 2-year Foundation Programme, which creates the possibility for ELP training to become standardised across Foundation Schools., (© 2023 The Authors. The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background: Palliative and end-of-life care is a core competency for doctors and is increasingly recognised as a key clinical skill for junior doctors. There is a growing international movement to embed palliative care education in medical student and junior doctor education. To date there has been no review of the literature concerning the views and experiences of junior doctors delivering this care., Aim: To review the published literature between 2000 and 2019 concerning junior doctors' experience of palliative and end-of-life care., Methods: Systematic literature review and narrative synthesis., Results: A search of six databases identified 7191 titles; 34 papers met the inclusion criteria, with a further 5 identified from reference searching. Data were extracted into a review-specific extraction sheet and a narrative synthesis undertaken. Three key themes were identified: (1) 'Significance of death and dying': all papers found that junior doctors care for many patients approaching the end of life, and this often causes emotional distress and can leave persisting memories for many years afterwards; (2) 'Thrown in at the deep end': junior doctors feel unprepared and unsupported in providing palliative and end-of-life care; and (3) 'Addressing the gaps': junior doctors often experience a medical culture of disengagement towards dying patients and varying attitudes of senior doctors. Subsequently they have to learn the skills needed through seeking their own opportunities., Conclusion: Medical education needs to change in order to better prepare and support junior doctors for their role in caring for dying patients. This education needs to focus on their knowledge, skills and attitudes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: An online survey was undertaken to analyse the perception of medical school graduates, in postgraduate years 1 and 2, of being ready to work (preparedness) and of managing the demands of practice as a junior doctor on a general surgical attachment., Methods: An email-based survey was designed to assess medical school graduates' sense of preparedness, and was sent electronically to all house officers at the beginning of their 3-month attachment in general surgery between December 2020 and December 2021. One email reminder was sent 2 weeks after the initial email with the embedded survey hyperlink., Results: The overall response rate was 50%. Of those, over 90% had accompanied surgical teams on acute calls and over extended hours as a medical student. However, only 50% had ever attended a trauma call or a resuscitation call with clinical teams. Half of the respondents indicated that they would have liked specific teaching on mental and physical self-care, preparation for night shifts and extended periods of duty as well as in prioritisation, delegation and management of workloads., Conclusion: This survey showed that new doctors lacked dedicated teaching in professional behaviours and felt it to be an important part of medical training and preparation for medical practice., Competing Interests: Nil., (© PMA.)

Introduction: The often unknown nature of acute drug intoxication, especially with illicit drugs and emerging novel psychoactive substances, can present a significant challenge for emergency clinicians. Less experienced clinicians are particularly vulnerable to the diagnostic dilemmas of complex toxicology emergencies. We sought to better understand the confidence of junior doctors in assessing and managing toxicological emergencies across two emergency departments in Perth, Australia., Methods: An online survey was conducted between August 2020 and February 2021. Self-rated confidence was measured on a five-point Likert Scale across 10 statements. Two open-ended questions were included to capture perceived barriers and facilitators impacting clinical confidence. Quantitative data were analysed using descriptive methods and Fisher's exact test. Free-text responses were analysed using content analysis., Results: A total of 104 surveys were completed (19.2% interns, 40.4% resident medical officers and 40.4% registrars). Self-rated confidence varied across statements and by staff type. The lowest confidence rating was for managing a patient who had overdosed from an unknown substance (31.7%) and the highest rating for referring a patient to psychiatry following deliberate self-poisoning (86.6%). Confidence increased with greater clinical experience for all statements. Qualitative analysis revealed perceptions of clinical preparedness, complexity of patients and a safe and supportive culture as key factors impacting confidence., Discussion and Conclusions: Overcoming perceived deficits in knowledge and clinical experience were key to building confidence. Our findings highlight the need for improved access to toxicology-specific curricula and training, and strategies to ensure adequate supervision from senior clinicians., (© 2022 Australasian Professional Society on Alcohol and other Drugs.)

Background: In the setting of the COVID-19 pandemic, the modes of hospital service delivery, education, training, and the context surrounding them has undergone enormous change and disruptions., Objective: This study aimed to understand the 'lived-experience' of junior doctors in relation to their education, training, and professional development during the pandemic., Methods: A qualitative study based on thematic and cohort narrative analysis. 20 junior doctors who trained at an Australian tertiary paediatric hospital during the time of COVID-19 restrictions were interviewed. Based on a phenomenological approach, the interviews examined junior doctors' experiences in relation to medical education, adaptive education styles and the value attributed by participants to different forms of education provided to them., Results: Four overarching themes were identified regarding trainee perceptions of the impact of COVID-19 restrictions on learning opportunities, both positive and negative. These were: 'The void' - learning expectations junior doctors felt were missed, education affordances, peers and networks, and professional identity., Conclusion: The pace with which educators have adapted to new teaching modes should be harnessed to incite equally novel curriculum evolution, smart investment in clinical moments, reconnect learning communities and create robust virtual learning environments.

Introduction: Increasing healthcare sector litigation, accountability and governance has resulted in the identification of human factors (HF) as a common source of error. Both NHS and military doctors must have awareness of HF to enhance safety and productivity. There is limited published evidence examining knowledge of HF in these two healthcare professional groups., Methods: Doctors of all grades and specialties across the NHS and 3 military groups including the Defence Deanery within the UK were invited to complete a 10-item web-based survey. Questions focused on training undertaken, HF knowledge and potential future training needs., Results: The survey link was emailed to 250 military and 1400 NHS doctors, 191 military and 776 NHS responded (response rate: 76% and 55%, respectively). Military doctors above foundation trainees are more familiar with HF, have had more training and recognise a requirement for additional training. Military foundation trainees had similar responses to their NHS colleagues. Doctors who had not undertaken any HF training are less likely to appreciate its value, with almost 60% of senior NHS doctors reporting no training. Foundation trainees have more training in HF than their senior peers when military seniors are excluded and more frequently identified a need for further training. Junior doctors identified stress, fatigue, communication and leadership more frequently, with seniors identifying work environment and music in theatre correctly more often., Conclusion: Non-training grade doctors are less likely to seek HF training. Military doctors are more familiar with HF and have undertaken more training. Given the role of HF in communication, human error, potential litigation, stress, conflict and gross negligence manslaughter convictions, further education is vital., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Training in medicine is highly demanding and coincides with critical life tasks including relationship development, childbearing and rearing. The rigid requirements of training programmes risk precluding successful achievement of these extracurricular roles, forcing choices between work and other life commitments. Flexible employment structures that facilitate the development of high-quality physicians are needed., Aim: To assess the outcomes of 2 novel flexible training positions in Rheumatology., Methods: The clinical department, trainees and senior administration designed flexible, part-time advanced training positions in rheumatology. We sought to deliver excellent training, supervision and support while ensuring safe, efficient clinical service delivery within existing systems and cultures. Barriers to implementation were actively identified. We rejected job share arrangements in favour of independent part-time positions anchored to departmental education, clinical and trainee needs. The outcomes of these positions have been determined through regular trainee meetings, clinic activity and costs., Results: Trainees achieved all training requirements, reported high levels of job satisfaction, strong professional development, improved work-life balance and reduction of stress. Outpatient events increased and waiting times have decreased. We estimate that increased rebatable outpatient services have rendered the positions cost neutral., Conclusion: Flexible training positions can enhance clinical departments while enabling high-quality training for junior doctors. Further work should consider longer term outcomes and application to different clinical and training settings., (© 2021 Royal Australasian College of Physicians.)

Aim: Junior doctors are frequently required to discuss resuscitation status with patients. They generally lack experience, confidence and skill in having these conversations. However, there is currently no formal postgraduate education requirement to improve or develop in this area. The aim of this educational intervention was to improve junior doctors' level of confidence and skill in having resuscitation status conversations with patients., Method: An educational intervention for 27 prevocational postgraduate second and third-year house officers at a tertiary hospital in Hamilton, New Zealand was conducted. A self-administered survey was completed preintervention and postintervention., Results: Four factors were assessed in the survey (level of confidence having conversations regarding resuscitation status, ability to prognosticate, content of conversations and perceived barriers to having conversations), with a statistically significant difference found with respect to level of confidence having conversations regarding resuscitation status (p=0.001)., Conclusion: This study demonstrated that a short education session improves confidence in discussing resuscitation status. It has also identified the need for further postgraduate training in complex communication skills., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Relief junior doctors provide cover for absent colleagues on leave. One of the main advantages of the relief system is the availability of covered leave for junior doctors. However, it also has several drawbacks, including the lack of time-accreditation by Training Colleges. This viewpoint identifies some of the problems with the current relief system in New Zealand and suggests potential solutions to improve the experiences for junior doctors, patients and employers., Competing Interests: Nil.

Objective: To examine associations between bedside rounding (BSR) and other rounding strategies (ORS) with resident evaluations of teaching attendings and self-reported attending characteristics., Methods: Faculty from three academic medical centers who attended resident teaching services for ≥4 weeks during the 2018-2019 academic year were invited to complete a survey about personal and rounding characteristics. The survey instrument was iteratively developed to assess rounding strategy as well as factors that could affect choosing one rounding strategy over another. Survey results and teaching evaluation scores were linked, then deidentified and analyzed in aggregate. Included evaluation items assessed resident perceptions of autonomy, time management, professionalism, and teaching effectiveness, as well as a composite score (the numeric average of each attending's scores for all of the items at his or her institution). BSR was defined as spending >50% of rounding time in patients' rooms with the team. Hallway rounding and conference room rounding were combined into the ORS category and defined as >50% of rounding time in these settings. All of the scores were normalized to a 10-point scale to allow aggregation across sites., Results: A total of 105 attendings were invited to participate, and 65 (62%) completed the survey. None of the resident evaluation scores significantly differed based on rounding strategy. Composite scores were similar for BSR and ORS (difference of <0.1 on a 10-point scale). Spearman correlation coefficients identified no statistically significant correlation between rounding strategy and evaluation scores. An exploratory analysis of variance model identified no single factor that was significantly associated with composite teaching scores ( P > 0.45 for all) or the domains of teaching efficacy, professionalism, or autonomy ( P > 0.13 for all). Having a formal educational role was significantly associated with better evaluation scores for time management, and the number of lectures delivered per year approached statistical significance for the same domain., Conclusions: Conducting BSR did not significantly affect resident evaluations of teaching attendings. Resident perception of teaching effectiveness based on rounding strategy should be neither a motivator nor a barrier to widespread institution of BSR.

Objectives: Adverse drug events (ADEs) during hospitalization are common. Insulin-related events, specifically, are frequent and preventable. At a tertiary children's hospital, we sought to reduce insulin-related ADEs by decreasing the median event rate of hyper- and hypoglycemia over a 12-month period., Methods: Using Lean 6 σ methodology, we instituted a house-wide process change from a single-order ordering process to a pro re nata (PRN) standing order process. The standardized process included parameters for administration and intervention, enabling physician and nursing providers to practice at top of licensure. Automated technology during dose calculation promoted patient safety during dual verification processes. Control charts tracked rates of insulin-related ADEs, defined as hyperglycemia (glucose level >250 mg/dL) or hypoglycemia (glucose level <65 mg/dL). Events were standardized according to use rates of insulin on each nursing unit. The rates of appropriately timed insulin doses (within 30 minutes of a blood sugar check) were assessed., Results: Baseline median house-wide frequencies of hyperglycemic and hypoglycemic episodes were 55 and 6.9 events (per 100 rapid-acting insulin days), respectively. The median time to insulin administration was 32 minutes. The implementation of the PRN process reduced the median frequencies of hyperglycemic and hypoglycemic episodes to 45 and 3.8 events, respectively. The median time to insulin administration decreased to 18 minutes., Conclusions: A PRN ordering process and education decreased insulin-associated ADEs and the time to insulin dosing compared with single-entry processes. Engaging bedside providers was instrumental in reducing insulin-related ADEs. Strategies that decrease the time from patient assessment to drug administration should be studied for other high-risk drugs., Competing Interests: FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose., (Copyright © 2022 by the American Academy of Pediatrics.)

Background: A resuscitation plan is a medically authorised order to use or withhold resuscitation interventions. Absence of appropriate resuscitation orders exposes patients to the risk of invasive medical interventions that may be of questionable benefit depending on individual circumstances., Aims: To describe among junior doctors: (i) self-reported confidence discussing and completing resuscitation plans; (ii) knowledge of resuscitation policy including whether resuscitation plans are legally enforceable and key triggers for completion; and (iii) the factors associated with higher knowledge of triggers for completing resuscitation plans., Methods: A cross-sectional survey was conducted at five hospitals. Junior doctors on clinical rotation were approached at scheduled training sessions, before or after ward rounds or at change of rotation orientation days and provided with a pen-and-paper survey., Results: A total of 118 junior doctors participated. Most felt confident discussing (79%; n = 92) and documenting (87%; n = 102) resuscitation plans with patients. However, only 45% (n = 52) of doctors correctly identified that resuscitation plans are legally enforceable medical orders. On average, doctors correctly identified 6.8 (standard deviation = 1.8) out of 10 triggers for completing a resuscitation plan. Doctors aged >30 years were four times more likely to have high knowledge of triggers for completing resuscitation plans (odds ratio 4.28 (95% confidence interval 1.54-11.89); P = 0.0053)., Conclusion: Most junior doctors feel confident discussing and documenting resuscitation plans. There is a need to improve knowledge about legal obligations to follow completed resuscitation plans, and about when resuscitation plans should be completed to ensure they are completed with patients who are most at risk., (© 2020 Royal Australasian College of Physicians.)

ObjectiveTo investigate junior doctors' views about careers in academic medicine. DesignPostal questionnaire survey. Setting National Health Service in England. Subjects Doctors in university posts at specialist registrar level, Medical Research Council and Wellcome Trust training fellows, and specialist registrars in National Health Service posts. Results Incentives to pursue an academic career which respondents rated as strong related to the challenge of research and the intellectual environment of research units. The strongest disincentives were perceived difficulties in obtaining research grants and uncertainty regarding pay parity with National Health Service colleagues. Medical Research Council and Wellcome fellows had much more protected research time than other academic doctors but were less satisfied with their clinical training. Academic doctors who were not fellows reported spending less than half their time on research and the great majority agreed that their research suffers when there is pressure on the service side. Conclusions The job content of academic posts should be kept under regular review to ensure that clinical service pressures do not inappropriately erode research time while also ensuring that postholders have adequate clinical training. Training programmes need flexibility to accommodate the needs of clinical academics in their progress through higher specialist training. [ABSTRACT FROM AUTHOR]

Epidemiological evidence has confirmed the potential causal relationship between specific dietary factors and non-communicable diseases. However, currently nutrition was shown to be insufficiently integrated into medical education, regardless of the country. Without an adequate nutrition education, it is reasonable to assume that future physicians, as well as other health care professionals, will be not able to provide the highest quality care to patients in preventing and treating non-communicable diseases. Furthermore, the insufficient availability of physicians with specializations in nutrition has posed the basis for the development of non-medical careers in the field of nutrition. The present document was drafting by the Italian College of Academic Nutritionists, MED-49 (ICAN-49), with the aim to provide an overview on the nutritional competency standards covered by several health care professionals (Physicians Clinical Nutrition Specialists, Clinical Dietitians, Professional Clinical Nutrition Specialists, etc) for the prevention of diseases and/or support of pharmacological therapies. The aim of the ICAN 49 is to suggest a major shift in practice opportunities and roles for many nutritionists, especially for the management of the metabolic diseases, and promote a paradigm change: a clinical and educational leadership role for Physician Clinical Nutrition Specialists in the hospital setting., Competing Interests: Declaration of competing interest The authors have no competing financial interests in relation to the work described., (Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)