ABSTRACT
Objective: This survey is the first part of a regional improvement project for Gynaecological surgical training in Ireland. Initial step to ascertain current opinions and confidence levels of trainees in gynaecological surgery and develop an understanding of their career goals. Design: Many surveys have been conducted on training within Obstetrics & Gynaecology. However, with the devastating impact on gynaecological surgical training from the COVID-19 Pandemic, a new vigour has emerged to assess this area, enhanced via the publication of the RCOG Gynaecological Surgery Recovery Plan. Ireland equally has felt the impact to surgical training and our project hopes to start to address this. This survey was designed with specific focus on gynaecological surgical training and to identify the key areas to focus the recovery process on. Designed using the SurveyMonkeyR platform and distributed via email. Methods: The survey was circulated to all O&G trainees in Ireland. The 34 questions focused on the number of procedures performed over last 12 months, confidence levels on performing these procedures alongside management of complications. Questions also assessed future career aspirations. The returned results were anonymised and analysis performed using a password protected ExcelR database. Results: We received 76 respondents, with 46% (n = 35) having worked in O&G for more than 5 years. A concerning 51% of trainees had contemplated leaving the specialty in the last 12 months. Only 20% (n = 16) of trainees had access to a Laparoscopic box trainer in their hospital and of these, only 38% (n = 29) received dedicated teaching on the trainer. The only laparoscopic procedure in which >50% of trainees felt comfortable performing was Veres entry at laparoscopy. Two thirds of respondents (n = 51) believed that the lack of gynaecological surgery training has impacted decisions on future career choices. 43% of SpR (ST4-8) trainees experienced difficulty in annual training progression due to a lack of surgical numbers. 95% felt a forum for surgical education and career guidance was needed. Conclusions: Trainees are significantly impacted by a lack of surgical exposure and training. This has understandably affected their confidence but also career planning, which may in turn affect national workforce structure and patient care. Our project design has moved forward using this survey information to develop a regional laparoscopic simulation hub in Dublin following the award of funding from the Mater Hospital Foundation and SPARK initiative. A pilot programme for trainees will be offered from January 2022.
ABSTRACT
BACKGROUND: Foot health problems are common in the general population, and particularly so in people with rheumatic and musculoskeletal disorders (RMD). Several clinical guidelines state that people with RMDs should have access to foot health services, although service capacity is often limited. The current COVID-19 pandemic has increased the need for alternative ways to provide patient care. The aim of this clinical audit was to review a newly implemented telephone follow-up appointment service conducted within the Rheumatology Podiatry Department in Leeds, UK. METHODS: Fifty-eight patients attending the Rheumatology Podiatry Department at Leeds Teaching Hospitals NHS Trust were contacted by telephone approximately 6-8 weeks following initial intervention. During the telephone consultation, all patients were asked pre-defined questions relating to their symptoms, intervention efficacy, the need for further appointments and their preference for the type of consultation. To assess the cost of the telephone consultation the number of attempts needed in order to make successful contact, the duration of the call and the number of telephone follow-up appointments completed in a working day were also recorded. RESULTS: Twenty-five patients (43%) were successfully contacted within the 6-8 weeks stipulated time frame and were included in the analysis. Of the 25 contacted, twelve (48%) patients were successfully contacted on the first attempt. Ten (40%) were successfully contacted on the second attempt. The remaining three patients (12%) required 3 or more attempts to make successful contact. Telephone consultations were estimated not to last longer than 10 min, including notes screening and documentation. Eleven patients (44%) reported an improvement in their symptoms, thirteen (52%) reported no change and one patient (4%) reported their symptoms to be worse. CONCLUSION: Telephone follow-up consultations may be a potentially cost-effective alternative to face-to-face appointments when implemented in a Rheumatology Podiatry Department, and provide an alternative way of providing care, especially when capacity for face-to-face contact is limited. The potential cost saving and efficiency benefits of this service are likely to be enhanced when telephone consultations are pre-arranged with patients.