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INTRODUCTION@#This is a retrospective analysis of outcomes by Singapore Medical Council (SMC) disciplinary tribunals in cases involving junior doctors. We aimed to classify the types of unprofessional behaviour and consider appropriate measures for remediation and prevention.@*METHODS@#SMC's annual reports from 1979 to 2017 and published grounds of decision from 2008 to 2017 were examined using two screening levels to identify cases involving junior doctors. Cases were sorted into five outcome categories: (a) professional misconduct; (b) fraud and dishonesty; (c) defect in character; (d) disrepute to the profession; and (e) acquitted.@*RESULTS@#A total of 317 cases were identified, of which 13 (4.1%) involved junior doctors: 4 (30.8%) cases involved professional misconduct, 4 (30.8%) cases involved fraud and dishonesty, 3 (23.1%) cases saw an acquittal, and one case each involved defect in character and disrepute to the profession. The four cases of professional misconduct highlight the need to differentiate medical errors due to systems factors from those due to individual culpability, by applying analytical tools such as root cause analysis and Unsafe Act Algorithms. Disciplining the individual alone does not help prevent the recurrence of similar medical errors. We found that fraud and dishonesty was an important category of unprofessional behaviour among junior doctors.@*CONCLUSION@#While the frequency of unprofessional behaviour among junior doctors, as determined by the SMC disciplinary tribunal, is low (4.1%), this study highlights that complaints against medical doctors often involve systems issues and individual factors. Unprofessional behaviours related to fraud and dishonesty need special attention in medical school.
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Background: Surgical informed consent is an essential part of a surgical procedure that is based on good communication between patients and physicians. Informed consent is an important part of medical practices worldwide that goes beyond just a signature; it equips patients with knowledge that helps them in making decisions. Aim: We aimed to evaluate the surgical team’s role and level of knowledge of informed consent for an upcoming procedure. Methods: Between May 2018 and June 2018, we conducted a cross-sectional study among 255 doctors at King Abdulaziz University Hospital, Jeddah, Saudi Arabia to evaluate their experiences of obtaining patient consent. Data for this research were collected using a 14-point questionnaire and entered into Microsoft Excel. Statistical analysis was performed with SPSS, version 21. Descriptive statistics and a chi-squared test were applied to analyze the data. Results: Of the 188 participants who returned the questionnaire, 95.2% had experience obtaining surgical consent. Approximately 35.5% of interns, 78.9% of junior residents, 87.5% of senior residents, and 54.5% of specialists mentioned that they always take consent from patients; 37.2% reported knowledge of “all” steps of surgical procedures. Seventy-seven participants claimed to know “all” the risks of surgical procedures. Interns were the least comfortable while taking consent. Conclusion: SIC is an essential ethical skill and an integral part of any surgical procedure. Senior doctors, who are the most eligible and qualified, usually facilitate the SIC process. Nevertheless, SIC is also facilitated by a non-negligible number of unqualified junior doctors.
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Background: House-officers and medical officers are at the forefront during medical emergencies in the ward and casualty which impose cognitive, communication, social and system challenges and yet, training in this area is commonly lacking. A workshop was conducted using simulation to provide training on some acute medical emergencies like cord prolapse, post- partum haemorrhage with collapse, poly-trauma and acute exacerbation of asthma. Objective: To determine the effectiveness of simulation in developing competency in managing selected clinical emergencies Methodology: There were 22 participants consisting of house-officers, junior medical officers and nursing clinical instructors. Only doctors were included in the study. Four medical emergencies were chosen viz.: Cord prolapse; post- partum haemorrhage with collapse; poly-trauma and acute exacerbation of asthma. The simulated sessions were conducted using high fidelity manikins and simulated patients. Simulated patients were trained and moulage was applied accordingly. The skills stations were on airway equipment and techniques of application, latest cardiac life support algorithm and hands on chest compression using manikins. Results: A 5 point Likert scale used to rate the sessions. The skills station had 65% (n=13) rating as excellent and 35% (n=7) good. The skills simulation was rated excellent by 75% (n=15) and good by 25% (n=5) of participants. Verbal feedback was that it was very refreshing, informative, and helpful in terms of improving their skills. Conclusion: The simulated skills training for the junior doctors was very well received and maybe beneficial for work preparedness and in the long run address patient safety
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Education, MedicalABSTRACT
Objective: To determine the prevalence of needle stick injuries (NSIs) among junior doctors of RIMS and to assess the measures undertaken by the respondents after the NSI. Methods: A cross sectional study was conducted in RIMS, Imphal, Manipur among internees, house officers and post graduate trainees from Sept to Oct 2011. Self-administered questionnaire was used to collect data. Descriptive statistics like mean, percentage and standard deviation were used. Analysis was done using Chi square test. And P-value of <0.05 was taken as significant. Results: Out of 382 eligible respondents, 289 participated in the study. Males were 70.2% (n=203). Prevalence of NSI among junior doctors within the last one year was 39.4% (N=114). Of the three designations, NSI was highest among the house officers. Most NSI took place while blood withdrawal (33.3%), suturing (27.3%), giving injections (16.6%) and recapping (14.9%). Majority of those doctors injured, 56.1% attributed NSI during rush hour. Around fifty-four percent of them were not wearing gloves during the NSI. Nearly forty-five percent of the doctors washed their injured part with water and soap and also applied antiseptic as immediate measures after NSI. Only 10 (8.8%) took Post Exposure Prophylaxis (PEP). Conclusion: Needle stick injuries among junior doctors are common and often not reported and majority of them did not take post exposure prophylaxis. These findings warranted the need for ongoing attention to strategies to reduce such injuries in a systematic way and to improve reporting system so that appropriate medical care can be delivered.