A new tool to evaluate postgraduate training posts: the Job Evaluation Survey Tool (JEST).

BACKGROUND: Three reports in 2013 about healthcare and patient safety in the UK, namely Berwick, Francis and Keogh have highlighted the need for junior doctors' views about their training experience to be heard. In the UK, the General Medical Council (GMC) quality assures medical training programmes and requires postgraduate deaneries to undertake quality management and monitoring of all training posts in their area. The aim of this study was to develop a simple trainee questionnaire for evaluation of postgraduate training posts based on the GMC, UK standards and to look at the reliability and validity including comparison with a well-established and internationally validated tool, the Postgraduate Hospital Educational Environment Measure (PHEEM). METHODS: The Job Evaluation Survey Tool (JEST), a fifteen item job evaluation questionnaire was drawn up in 2006, piloted with Foundation doctors (2007), field tested with specialist paediatric registrars (2008) and used over a three year period (2008-11) by Foundation Doctors. Statistical analyses including descriptives, reliability, correlation and factor analysis were undertaken and JEST compared with PHEEM. RESULTS: The JEST had a reliability of 0.91 in the pilot study of 76 Foundation doctors, 0.88 in field testing of 173 Paediatric specialist registrars and 0.91 in three years of general use in foundation training with 3367 doctors completing JEST. Correlation of JEST with PHEEM was 0.80 (p < 0.001). Factor analysis showed two factors, a teaching factor and a social and lifestyle one. CONCLUSION: The JEST has proved to be a simple, valid and reliable evaluation tool in the monitoring and evaluation of postgraduate hospital training posts.

Self-assessment by trainees using self-TAB as part of the team assessment of behaviour multisource feedback tool.

BACKGROUND: Team assessment of behaviour (TAB) is the MSF assessment tool for doctors in training in the UK Foundation Curriculum. To encourage self-assessment by Foundation doctors of their own performance, they were asked to complete a Self-TAB. AIM: To compare doctors' self-scores with raters' scores on TAB. METHODS: Self-TAB scores for 834 Foundation doctors were compared with rater scores in terms of descriptive statistics, concerns, correlations and a multivariate linear regression model using SPSS. RESULTS: Foundation doctors self-scored far fewer concerns than did raters (12 doctors as having some concern, compared with 73 doctors with some concern and 23 doctors with major concern rated by others). The correlations between Self-TAB and TAB was positive, but not high, although significant. A total of 42% of Foundation doctors correctly identified concerns confirmed by other raters. CONCLUSION: Foundation doctors have a limited ability to self assess. Nevertheless, this needs to be developed through constructive feedback and appraisal.

Using assessment to drive learning by linkage to foundation year 2 appointment.

The premise of this study is that engagement with assessment, and doing well in it, will drive education itself. Engagement and success with assessment during foundation year 1 training was therefore used to allocate foundation year 2 posts to 440 trainees. A web-based system was used, with all contacts being on-line only.

Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients.

BACKGROUND: The prevalence and risk factors for recurrent instability and functional impairment following a primary glenohumeral dislocation remain poorly defined in younger patients. We performed a prospective cohort study to evaluate these outcomes. We also aimed to produce guidelines for the design of future clinical trials, assessing the efficacy of interventions designed to improve the outcome after a primary dislocation. METHODS: We performed a prospective cohort study of 252 patients ranging from fifteen to thirty-five years old who sustained an anterior glenohumeral dislocation and were treated with sling immobilization, followed by a physical therapy program. Patients received regular clinical follow-up to assess whether recurrent instability had developed. Functional assessments were made and were compared for two subgroups: those who had not had instability develop and those who had received operative stabilization to treat recurrent instability. RESULTS: On survival analysis, instability developed in 55.7% of the shoulders within the first two years after the primary dislocation and increased to 66.8% by the fifth year. The younger male patients were most at risk of instability, and 86.7% of all of the patients known to have recurrent instability had this complication develop within the first two years. A small but measurable degree of functional impairment was present at two years after the initial dislocation in most patients. Sample-size calculations revealed that a relatively small number of patients with a primary dislocation would be required in future clinical trials examining the effects of interventions designed to reduce the prevalence of recurrent instability and improve the functional outcome. CONCLUSIONS: Recurrent instability and deficits of shoulder function are common after primary nonoperative treatment of an anterior shoulder dislocation. There is substantial variation in the risk of instability, with younger males having the highest risk and females having a much lower risk. Future clinical trials to evaluate primary interventions should evaluate the prevalence of recurrent instability and functional deficits, with use of an assessment tool specifically for shoulder instability, during the first two years after the initial dislocation.