ABSTRACT
Food allergy is common, it can lead to significant morbidity andnegatively impacts on quality of life; therefore, it is vitally important we get the diagnosis right. However, making the diagnosis can be complex. Clinical history is the most important diagnostic tool and subsequent investigation may help confirm the diagnosis. The investigations available to most paediatric departments are skin prick testing and specific IgE so we will focus on these. Within this article we explore the evidence related to targeted testing and how to interpret these within the clinical context.
Subject(s)
Food Hypersensitivity , Immunoglobulin E , Adolescent , Child , Food Hypersensitivity/diagnosis , Humans , Predictive Value of Tests , Quality of Life , Skin TestsABSTRACT
BackgroundThe promotion from ‘SHO’ to ‘Registrar’ can be daunting. As a group of senior trainees, we were keen to support our more junior colleagues through this transition by providing a bespoke ‘Stepping up to Reg’ teaching programme, utilising our own recent experiences targeted with stakeholder feedback.ObjectivesTo identify perceived areas for development ahead of transitioning to a middle-grade rota from SHO, consultant and recently appointed registrar perspectives. To create and facilitate a teaching programme to meet these perceived learning needs.MethodsSupported by the Northern Ireland Medical and Dental Training Agency (NIMDTA) School of Paediatrics we assembled a faculty of senior trainees to create and deliver the teaching programme. A pre-course online questionnaire, completed by both SHOs and consultants, identified areas of perceived learning needs and was used to design the content of the programme. The SHO questionnaire included a 5-point Likert scale, to assess their perceived preparedness for certain aspects of the job;managing a resuscitation, phoning the consultant on-call, managing out-patients, safeguarding, prioritising workload and managing colleagues.The same questionnaire was completed 6 months later to assess the experience of their first registrar post and ask ‘in hindsight’ how prepared they actually were to transition for those certain aspects of the job. We then compared these responses to the same questions posed prior to the transition using the Man Whitney U-test.Faced with COVID-19 restrictions we adapted to virtual delivery creating an interactive half day online programme, with the use of breakout rooms, case presentations and question/answer sessions.ResultsThe SHO (n=15) and consultant (n=12) pre-course questionnaires identified some similar themes for development, including the management of paediatric and neonatal emergencies and team management/prioritisation. However, SHOs initially emphasised further specific clinical scenarios as areas of concern whilst consultants suggested a greater focus should be on managerial and career development aspects.On the follow up questionnaire (n=7), trainees identified ‘managing junior colleagues’ as the most challenging aspect of their first registrar post with less emphasis on the management of clinical scenarios.In hindsight, new registrars felt that they were actually better prepared than they had initially thought ‘in general’ (p<0.05) and specifically for ‘managing resuscitations’ and ‘safeguarding scenarios’ (p<0.05). Interestingly, they expressed being less well prepared for ‘managing colleagues’ than they had initially anticipated but this did not reach statistical significance.ConclusionsSHO anxiety during the transition to middle-grade relates to the responsibility of managing emergency situations, but following a 6-month period of ‘on the job’ experience they identified managerial aspects of the role as the biggest challenge, more in line with what consultants had already identified as an important area for development.Trainees responded positively to this near peer teaching programme with plans in place for this to be an annual event. Future iterations of the course need to be revised to continue to incorporate feedback from all stakeholders.