ABSTRACT
BACKGROUND: During the COVID-19 pandemic, the Hillingdon Hospitals NHS Foundation Trust produced trust guidelines for the initial blood investigation of COVID-19 inpatients. However, insufficient education meant inconsistent adherence to this guidance. OBJECTIVE: To examine whether the implementation of a COVID-19 blood request panel improves adherence to local trust guidelines. METHOD: Between March and April 2020, initial blood investigations performed for positive COVID-19 cases were compared to guidelines. Results were presented locally and a COVID-19 panel was added to the electronic system that provided prompts for appropriate investigations. A re-audit between May and June 2020 was conducted to assess adherence post-intervention. RESULTS: 383 patients were identified in the initial audit cohort and a sample of 20 patients were re-audited. Adherence to Full Blood Count, Urea and Electrolytes, C-reactive Protein and Liver Function Tests increased to 100% from 99.7% (p = 0.8), 99.2% (p = 0.69), 98.7% (p = 0.61), and 96.6% (p = 0.4) respectively. Coagulation screen adherence increased to 90% from 72.8% (p = 0.09). Appropriate requesting of D dimers increased to 50% from 19.9% (p = 0.001). Inappropriate troponin requesting decreased to 26.3% from 38.9% (p = 0.23). CONCLUSION: A user-friendly COVID-19 panel of investigations resulted in improved adherence to guidelines. Clear communication and education are essential to help alleviate uncertainty during a pandemic.
Subject(s)
Blood Group Antigens , COVID-19 , Humans , COVID-19/epidemiology , Pandemics , Blood Cell CountABSTRACT
AimsThe aim was to evaluate the impact of the COVID-19 pandemic on final year medical students during a key period of transition into doctors. Cancellations of placements such as student assistantships severely disrupted this transition. Furthermore, a tailored teaching programme was implemented locally to aid the new doctors.MethodsA nationwide survey to graduating doctors and a focus group at The Hillingdon Hospital NHS Foundation Trust (THH) were conducted to identify concerns. We explored the students’ impression of the disruptive effects fof COVID-19, and the subsequent consequences this had on their preparedness and confidence. Subsequent analysis of the identified areas formed the basis of a teaching programme with 6 main domains: practical skills, attending arrest calls, prescribing independently, making referrals, prioritising jobs and on-call shifts.Results440 students across 32 UK medical schools responded to the survey. The impact of COVID-19 on OSCEs, written examinations, and student assistantships had significantly affected the students’ perception of preparedness in starting as doctors (respectively p=0.025;0.008;0.0005). In contrast, when measuring confidence, only changes to student assistantships had a significant effect (p=0.0005). Locally, 90% (n=9) did not have a student assistantship whilst only 50% (n=5) had shadowed on call shifts throughout the entirety of medical school.A pre- and post-teaching intervention questionnaire was performed. This showed an average increase of 26.4% in how participants scored their confidence and competencies post-intervention.ConclusionsThe transition after undergraduate training is a steep learning curve. It is clear that student assistantships designed specifically to aid the transition should be protected and enhanced. Finally, in addition to the mandatory training all trainees receive, the taught material during induction should be tailored more towards new doctors’ needs.
ABSTRACT
BackgroundThe COVID-19 pandemic highlighted the importance of evidence based guidelines and many studies have been published to identify appropriate investigations that may be used as predictors of mortality and ITU admission. The Hillingdon Hospitals NHS Foundation Trust (THH) produced trust guidelines for the initial blood investigation of COVID-19 inpatients. However, lack of awareness and education on these guidelines meant adherence could be improved.AimsTo improve adherence to the local trust guidelines, targeting clinicians involved in the initial assessment of patients presenting with COVID-19 symptoms where appropriate.MethodsBetween 16th April 2020 and 14th April 2020, investigations performed for positive COVID-19 cases were compared to guidelines. Results were presented locally and a COVID-19 panel was added to the electronic order-request system that allowed prompts for appropriate investigations. A re-audit between 15th May 2020 and 14th June 2020 was conducted to assess adherence post-intervention.Results383 patients were identified in the initial audit cohort, and 20 patients were identified in the re-audit cohort. Adherence to Full Blood Count, Urea and Electrolytes, C-Reactive Protein and Liver Function Tests increased to 100% (from 99.7%, 99.2%, 98.7%, and 96.6% respectively). Coagulation screen adherence increased from 72.8% to 90%. D-dimers were appropriately requested more often, increasing from 19.9% to 50%. Inappropriate troponin requisition decreased from 38.9% to 26.3%.ConclusionsReduced COVID-19 admissions meant that the re-audit cohort was not as large as the initial audit cohort. However, a user-friendly COVID-19 panel of investigations resulted in better-targeted management of patients, and improved adherence to guidelines. This showed the importance of disseminating information effectively. Education is essential during times of uncertainty, especially during a pandemic.
ABSTRACT
BACKGROUND: The coronavirus disease (COVID-19) global pandemic has resulted in unprecedented public health measures. This has impacted the UK education sector with many universities halting campus-based teaching and examinations. The aim of this study is to identify the impact of COVID-19 on final year medical students' examinations and placements in the United Kingdom (UK) and how it might impact their confidence and preparedness going into their first year of foundation training. METHODS: A 10-item online survey was distributed to final year medical students across 33 UK medical schools. The survey was designed by combining dichotomous, multiple choice and likert response scale questions. Participants were asked about the effect that the COVID-19 global pandemic had on final year medical written exams, electives, assistantships and objective structured clinical examinations (OSCEs). The survey also explored the student's confidence and preparedness going into their first year of training under these new unprecedented circumstances. RESULTS: Four hundred forty students from 32 UK medical schools responded. 38.4% (n = 169) of respondents had their final OSCEs cancelled while 43.0% (n = 189) had already completed their final OSCEs before restrictions. 43.0% (n = 189) of assistantship placements were postponed while 77.3% (n = 340) had electives cancelled. The impact of COVID-19 on OSCEs, written examinations and student assistantships significantly affected students' preparedness (respectively p = 0.025, 0.008, 0.0005). In contrast, when measuring confidence, only changes to student assistantships had a significant effect (p = 0.0005). The majority of students feel that measures taken during this pandemic to amend their curricula was necessary. Respondents also agree that assisting in hospitals during the outbreak would be a valuable learning opportunity. CONCLUSIONS: The impact on medical student education has been significant, particularly affecting the transition from student to doctor. This study showed the disruptions to student assistantships had the biggest effect on students' confidence and preparedness. For those willing to assist in hospitals to join the front-line workforce, it is crucial to maintain their wellbeing with safeguards such as proper inductions, support and supervision.