ABSTRACT
BackgroundThe COVID-19 pandemic has caused unprecedented pressures on hospital which has prompted early treatment escalation discussions. BMA guidance states that effective communication regarding DNACPRs should occur in a timely manner.1 Consideration should also be given to patients’ preferences and ample opportunity for discussions.2 However, from anecdotal evidence in an acute hospital, these conversations have not happened within general surgery. Previously, the main barriers to these discussions were having unresolved feelings around death and inadequate training.3 Many barriers to these discussions lie with doctors, we aimed to assess whether discussions were occurring, whether they were clear and accessible and to understand any barriers to discussions.MethodsCross-sectional quantitative data collection of patients admitted to an acute general surgical ward was undertaken between Nov’ 20 to March 21’. Treatment escalation and DNACPR decisions were identified from patient notes. This included time elapsed from admission, what was discussed, and by whom. A qualitative survey was sent to senior surgeons to explore ideas and any barriers to these discussions.ResultsThe study included 43 patients. 12/43 (28%) had treatment escalation discussions, with 8/12 (67%) being about DNACPR. Half of these decisions were made by ITU Outreach 4/8 (50%), none by senior surgeons. The average time elapsed from admission to a decision was 18.9 days. 35 senior surgeons were surveyed with a response rate of 14%. 4/5 (80%) thought treatment escalation options should only be discussed in patients who might deteriorate, with time pressures and fear of frightening patients as the main barriers cited.ConclusionMost patients did not have a treatment escalation plan. To address one of the main barriers identified, we have created a sticker with clear prompts for treatment escalation decisions to be placed in the clerking booklet. Further work is required to understand other barriers involved.ReferencesBritish Medical Assosciation, Resuscitation Council (UK), Royal College of Nursing. Decisions relating to cardiopulmonary resuscitation: a joint statement from the british medical association, the resuscitation council (UK) and the royal college of nursing. J Med Ethics 2001;27(5):310–6.Pitcher D, Fritz Z, Wang M, Spiller JA. Emergency care and resuscitation plans. Vol. 356, BMJ (Online). BMJ Publishing Group;2017.Chittenden EH, Clark ST, Pantilat SZ. Discussing resuscitation preferences with patients: challenges and rewards. J Hosp Med 2006 Jul 1;1(4):231–40.
ABSTRACT
BACKGROUND: The COVID-19 pandemic and the consequent social distancing measures caused unprecedented disruption for medical and healthcare education. This study examined medical teachers' experience with emergency remote teaching during the pandemic and their acceptance of online teaching after the pandemic. METHODS: In this sequential mixed methods study, online surveys were disseminated to teachers (n = 139) at two Asia-Pacific medical schools to evaluate their experience with emergency remote teaching during the pandemic. Subsequently, in-depth interviews were conducted with teachers from both institutions (n = 13). Each interviewee was classified into an adopter category based on Rogers' Diffusion of Innovations Theory. Interview transcripts were analyzed thematically, and the descriptive themes were mapped to broader themes partly based on the Technology Acceptance Model and these included: (i) perceived usefulness of online teaching, (ii) perceived ease of delivering online teaching, (iii) experience with institutional support and (iv) acceptance of online teaching after the pandemic. RESULTS: Our participants described accounts of successes with their emergency remote teaching and difficulties they experienced. In general, most participants found it difficult to deliver clinical skills teaching remotely and manage large groups of students in synchronous online classes. With regards to institutional support, teachers with lower technological literacy required just-in-time technical support, while teachers who were innovative in their online teaching practices found that IT support alone could not fully address their needs. It was also found that teachers' acceptance of online teaching after the pandemic was influenced by their belief about the usefulness of online teaching. CONCLUSIONS: This study demonstrated that our participants managed to adapt to emergency remote teaching during this pandemic, and it also identified a myriad of drivers and blockers to online teaching adoption for medical teachers. It highlights the need for institutes to better support their teaching staff with diverse needs in their online teaching.