ABSTRACT
Background The Paediatric Gastroenterology, Hepatology and Nutrition (PGHAN) GRID is the U.K. pathway for training. Training is overseen by College Specialist Advisory Committees (CSACs) and monitored in previous years through surveys, which have been used as a springboard to implement improvement and change. The Coronavirus pandemic has been well documented with impact on staffing, training, and mental wellbeing of healthcare professionals. We aimed to look holistically at the PGHAN training during a 6-month period of the pandemic. Aim . To understand the state of PGHAN training and trainees during the Coronavirus pandemic. . To provide clarity on the challenges and compare with data from previous surveys. . To highlight positive practices that can be continued or reinforced. Subject and Methods Trainees working between March 2021 and September 2021, after the 2nd U.K. lockdown, were surveyed anonymously using an electronic form. The survey included a combination of question types, including Likert scales, yes/no and sections for free text. Initial distribution of the survey was August 2021 and reminders were sent following the post before the survey was closed in November 2021. Results Surveys were completed by all 23 PGHAN GRID trainees, comparing favourably to 100% and 75% response rates in previous surveys in 2016 and 2018 respectively. 43% of trainees were less than full time (LTFT), with 26% at ST8 level. 43% of trainees were personally affected by Covid. 70% reported feeling safe at work. Online teaching was useful to 87% of trainees, though only 17% could attend >50% of sessions. 74% requested more online sessions. Of the 19 trainees that attended the virtual Trainees' Day, 63% found it useful. 59% of trainees were not signed off for OGD, with 23% citing a lack of Joint Advisory Group (JAG) approved course attendance as a reason. Table 1 summarises some captured effects of the pandemic and table 2 also shows some differences between previous years. Summary and Conclusion The survey received an excellent response rate. Notably, most trainees felt safe at work though a minority felt that their mental health was negatively affected with Covid-19. Most trainees felt supported by their team members during the pandemic. Endoscopy lists were felt to be reduced, though list numbers after the second lockdown were comparable to pre-pandemic year 2018. This suggests that services returned to near normal, though numbers still require improvement. The list numbers during the height of the pandemic were not captured. Availability and access to JAG accredited Paediatric endoscopy courses needs to be prioritised. Rota coordinators should be aware that almost half the PGHAN trainees are LTFT, a more recent phenomenon that requires dynamic solutions. Online teaching sessions were very well received, and we should embrace online strategies for education, training, and support. The attendance to online teaching has been an issue suggesting more support is required and the Trainees' Day attendance should be encouraged. Trainee access to the HPN clinic should be improved, and barriers to this should be explored. The overall percentage time worked in sub-speciality has improved from 2018, which should be carried forward for subsequent years.
ABSTRACT
BACKGROUND & AIMS: The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments, and provide practical guidance for nutritional care. The aim of this study was to modify the R-MAPP into a version suitable for children, Pediatric Remote Malnutrition Application (Pedi-R-MAPP), and provide a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation. METHODS: A ten-step process was completed: 1) permission to modify adult R-MAPP, 2) literature search to inform the Pedi-R-MAPP content, 3) Pedi-R-MAPP draft, 4) international survey of HCP practice using TECS, 5) nutrition experts invited to participate in a modified Delphi process, 6) first stakeholder meeting to agree purpose/draft of the tool, 7) round-one online survey, 8) statements with consensus removed from survey, 9) round-two online survey for statements with no consensus and 10) second stakeholder meeting with finalisation of the Pedi-R-MAPP nutrition awareness tool. RESULTS: The international survey completed by 463 HCPs, 55% paediatricians, 38% dietitians, 7% nurses/others. When HCPs were asked to look back over the last 12 months, dietitians (n = 110) reported that 5.7 ± 10.6 out of every 10 appointments were completed in person; compared to paediatricians (n = 182) who reported 7.5 ± 7.0 out of every 10 appointments to be in person (p < 0.0001), with the remainder completed as TECS consultations. Overall, 74 articles were identified and used to develop the Pedi-R-MAPP which included colour-coded advice using a traffic light system; green, amber, red and purple. Eighteen participants agreed to participate in the Delphi consensus and completed both rounds of the modified Delphi survey. Agreement was reached at the first meeting on the purpose and draft sections of the proposed tool. In round-one of the online survey, 86% (n = 89/104) of statements reached consensus, whereas in round-two 12.5% (n = 13/104) of statements reached no consensus. At the second expert meeting, contested statements were discussed until agreement was reached and the Pedi-R-MAPP could be finalised. CONCLUSION: The Pedi-R-MAPP nutrition awareness tool was developed using a modified Delphi consensus. This tool aims to support the technological transformation fast-tracked by the COVID-19 pandemic by providing a structured approach to completing a remote nutrition focused assessment, as well as identifying the frequency of follow up along with those children who may require in-person assessment.