Trainees' perceptions of course quality in postgraduate General Practice training in Ireland.

BACKGROUND: Postgraduate General Practice (GP) training is structured around a formal curriculum set out by the training body. It also includes a "hidden curriculum" of experiential workplace learning in a heterogenous learning environment [1]. There is no formal national annual survey of GP trainees and their views in Ireland. METHODS: The research aim was to evaluate what the trainee population think of their training environment, and to analyse the contributory factors. A mixed methods cross-sectional survey was distributed to all third- and fourth-year GP trainees (N = 404). The Manchester Clinical Placement Index was adapted for the study. RESULTS: The response rate was 30.94% (N = 125). Questions 1 to 7 provided a description of the characteristics of the study population. The remainder of the questions focused on aspects which relate to constituents of the learning environment. The responses were broadly and convincingly positive and supportive of the good work being done in GP training and by trainers in Ireland today across both qualitative and quantitative findings. One notable exception was in the area of feedback where single handed fourth year practices were found to be underperforming. CONCLUSIONS: The current research findings were broadly positive and supportive of the good work being done in GP training and by trainers in Ireland today. Further research will be needed to validate the study instrument and to further refine some aspects of its configuration. The implementation of such a survey on a regular basis may have merit as part of the quality assurance process in GP education alongside existing feedback structures [2].

Knowledge, skills, and confidence among healthcare staff in urinary catheterization.

INTRODUCTION: There is an increasing volume of urology referrals for urinary catheterization (UC). The aim of this study was to determine the confidence and knowledge among healthcare staff on UC. We also assessed their satisfaction with training and support received during catheter education and clinical practice. METHODS: This was a mixed-methods model using an anonymous, online survey circulated among all hospital staff. Weekly reminders were sent, quantitative data was obtained from closed-ended questions, and thematic analysis was performed for qualitative, open-ended questions. RESULTS: The response rate was 26% (n=90/350), from a heterogenous group of doctors and nurses from various specialties and grades in the hospital and community frequently dealing with UC. There was decreasing confidence levels in female UC (54%, n=47/87), three-way catheters (33%, n=29/89), and managing suprapubic catheters (25%, n=21/85). Female UC was reported as the most difficult of catheter insertions (35%, n=31/90). Although 83% (n=74/89) of respondents received catheter education, 53% (n=48/90) felt this was insufficient for clinical practice. Fifty-one percent (n=45/89) believed more support with UC in clinical practice was required and 64% (n=57/89) recommended changes in catheter education. The most common theme identified was the need for ongoing education and more practical supervision in clinical practice. CONCLUSIONS: Catheter training should focus on different types of catheters and management of difficult catheter scenarios. Standardizing safe catheter education during undergraduate training and including this as a part of regular annual or biannual mandatory training for healthcare staff involved in dealing with catheters in clinical practice would be the way forward.

Ankle Kinematics and Temporal Gait Characteristics over the Duration of a 6-Minute Walk Test in People with Multiple Sclerosis Who Experience Foot Drop.

Foot drop is a common gait impairment in people with MS (pwMS) but in some foot drop may only occur after a period of prolonged walking and may be a sign of motor fatigability. The purpose of the study was to explore whether, for pwMS, an adapted six-minute walk test (6minWT) would result in an increase in foot drop as measured using electrogoniometry. Sagittal ankle kinematics were recorded for fifteen participants (10 females and 5 males, aged 37-64) with MS (EDSS 4-6) throughout the 6minWT. Ankle kinematics and temporal stride parameters were compared between the first and last 10 gait cycles of the 6minWT. Peak dorsiflexion in swing was significantly reduced at the end of the 6minWT compared to the start, with six of the fifteen participants having a decrease of two degrees or more. Statistically significant changes in temporal stride parameters suggested a decrease in walking speed. Our results suggest that with the protocol used in this study it is feasible to identify patients who experience increased foot drop as a result of a prolonged exercise task.

The use of pedometers in stroke survivors: are they feasible and how well do they detect steps?

OBJECTIVES: To determine (1) the feasibility of pedometers for stroke patients and (2) the level of agreement between pedometers and actual step count. DESIGN: Observational agreement study. SETTING: Six stroke units. PARTICIPANTS: Independently mobile stroke patients (N=50) ready for hospital discharge. INTERVENTIONS: Patients were asked to apply 3 pedometers: 1 around the neck and 1 above each hip. Patients performed a short walk lasting 20 seconds, then a 6-minute walk test 6MWT. Video recordings determined the criterion standard step count. MAIN OUTCOME MEASURE: Agreement between the step count recorded by pedometers and the step count recorded by viewing the criterion standard video recordings of the 2 walks. RESULTS: Five patients (10%) needed assistance to put on the pedometers, and 5 (10%) could not read the step count. Thirty-nine (78%) would use pedometers again. Below a gait speed of about 0.5 m/s, pedometers did not generally detect steps. Agreement analyses showed that even above 0.5 m/s, pedometers undercounted steps for both the short walk and 6MWT; for example, the mean difference between the video recorder and pedometer around the neck was 5.93 steps during the short walk and 32.4 steps during the 6MWT. CONCLUSIONS: Pedometers are feasible but generally do not detect steps at gait speeds below about 0.5 m/s, and they undercount steps at gait speeds above 0.5 m/s.