Establishing paediatric trainee clinics during the COVID-19 pandemic

BackgroundPaediatric trainees delivering outpatient clinics provides a valuable learning opportunity and forms part of the Royal College of Paediatrics and Child Health (RCPCH) postgraduate paediatric training curriculum. Due to the current COVID-19 pandemic at Birmingham Children’s Hospital it was identified that 2 months into the current post 83% ST4–8 trainees had attended 0 or only 1 clinic. Consequently, outpatient clinics were redesigned to incorporate telephone and video consults as well as continuing some face-to-face consultations.ObjectivesThe aims developed during this quality improvement project included:In a 6–month post, trainees should aim to attend a minimum of 5 clinics.To devise trainee clinics such that it provides a useful learning opportunity with adequate time built in for consultant supervision and to enable supervised learning events (SLEs) to be undertaken.To develop trainee confidence in doing telephone or video clinics.MethodsAn initial 2-week pilot was commenced with involvement of 5 supervising consultants which was subsequently extended. The standard operating procedure (SOP) for how to run a registrar clinic was distributed to trainees along with a clinic rota and supervising consultant. The SOP included:Step by step instructions regarding what to prepare before clinic.How to conduct telephone and video calls using the AccuRx NHS digital accredited system as well as face to face consultations.How to dictate letters and order investigations.We organised regular monthly virtual meetings with consultants, management and the rota co-ordinator to facilitate clinic set up and address any issues. Questionnaires were sent to trainees and patients. Feedback from consultants took the form of a semi-structured interview. Details are available on the RCPCH website https://qicentral.rcpch.ac.uk/projects/systems-of-care/establishing-paediatric-trainee-clinics-during-the-covid-19-pandemic/.Results19 phone clinics and 12 face to face clinics were undertaken by trainees during the 4-month period generating a possible 106 appointments. The number of trainee clinics occurring monthly increased from an average of 2 to 8. All the trainees that completed the rotation had achieved 5 or more clinic attendances even being less than full time (LTFT). 2 trainees did not complete the rotation due to change of job or redeployment back to community. There were improvements in learning with consultant supervision as 14 requests for SLEs were submitted. A trainee survey conducted after clinics revealed confidence in doing a telephone or video consult increased to 8/10 on a rating scale from 5/10. When trainees were asked about advantages or disadvantages some of the comments included ‘different way of working and gaining experience in an outpatient setting’, ‘ease of patient/family to attend but missing out on interaction that face to face clinics may provide’, ‘found completing SLEs easier during clinic’. A patient satisfaction survey revealed 100% felt the doctor listened and concerns were adequately addressed. Consultant feedback via semi structured interview included ‘found watching the trainee do a video consult interesting/enjoyable’, ‘some trainees still feel nervous doing video consults’, ‘supervising trainee clinics remotely easier and not too much added work’.ConclusionsThere was positive feedback received from trainees, consultants and patients. Trainee led induction using the AccuRx NHS digital accredited system has improved uptake. Clearer appointment letters explaining video consultation will also encourage patient participation. During each rotation managing trainee clinics will be given as a task to a trainee. This will help to ensure sustainability so trainees will continue to deliver clinics remotely with one-to-one consultant engagement, supervision and learning. Birmingham Children’s Hospital is looking at redesigning the whole outpatient service to incorporate telemedicine.

Challenges and opportunities for conducting a vaccine trial during the COVID-19 pandemic in the United Kingdom.

The COVID-19 pandemic has resulted in unprecedented challenges for healthcare systems worldwide. It has also stimulated research in a wide range of areas including rapid diagnostics, novel therapeutics, use of technology to track patients and vaccine development. Here, we describe our experience of rapidly setting up and delivering a novel COVID-19 vaccine trial, using clinical and research staff and facilities in three National Health Service Trusts in Cambridgeshire, United Kingdom. We encountered and overcame a number of challenges including differences in organisational structures, research facilities available, staff experience and skills, information technology and communications infrastructure, and research training and assessment procedures. We overcame these by setting up a project team that included key members from all three organisations that met at least daily by teleconference. This group together worked to identify the best practices and procedures and to harmonise and cascade these to the wider trial team. This enabled us to set up the trial within 25 days and to recruit and vaccinate the participants within a further 23 days. The lessons learned from our experiences could be used to inform the conduct of clinical trials during a future infectious disease pandemic or public health emergency.