An evaluation of the West of Scotland in-programme Chief Resident role.

Background: Postgraduate leadership education is an evolving field. Locally we have an established 'Chief Residency' programme where centres have two to four senior trainees completing leadership duties alongside clinical workload, supported by local directors of medical education. This is twinned with a 4-day central training programme and peer-support network. Methods: To assess perspectives of the CR role, we adopted a qualitative case-study design using an electronic questionnaire delivered to previous chief residents between 2020 and 2023. Results were analysed using thematic analysis. Results: Trainees valued involvement within quality improvement and trainee support, demonstrating successful multi-departmental projects. Leadership education was viewed ubiquitously positively but participants felt further work is needed to address role legitimacy locally. A proposed solution was junior doctor leadership teams to address workload and emotional challenges. Conclusion: This model provides further evidence of the value in investing in trainee leadership positions, demonstrating organisational impact. Future work will research hospital peer leadership teams.

New approach to undergraduate quality improvement.

BACKGROUND: While quality improvement (QI) is an essential component to modern day clinical practice, some foundation doctors fail to engage. This is compounded by a lack of formalised undergraduate QI teaching. We trial an undergraduate active learning workshop and evaluate it using a concurrent triangulation mixed methods design. APPROACH: We constructed a 2-hour interactive QI workshop utilising near-peer educators for third year undergraduate medical students. Our workshop demonstrated an exemplary project and a template featuring evidenced-based QI tools to grasp key concepts. Informal support was provided for student QI projects, undertaken in small peer groups. Utility was assessed using linked pre-and-post event questionnaires with Likert scales, free text thematic analysis and project completion rates. EVALUATION: We recruited 74 students to attend our workshops delivered over 3 months. We achieved high event satisfaction and significant improvements on baseline confidence. Free text comments suggested students perceive QI as an important part of the undergraduate curriculum, described barriers to engagement and the value they place on project autonomy. The workshop eased student feelings of anxiety and intimidation regarding change ideas. Nine projects were completed with one winning a poster prize at a regional conference. IMPLICATIONS: We demonstrate a popular resource light model that can be scaled up to a variety of centres. Targeting QI teaching at the undergraduate level may be instrumental in developing QI culture in health care systems and address barriers to postgraduate involvement. Our study furthers the understanding of undergraduate students' perspectives of QI and demand for further sessions.

Extended Tourniquet Times and the Impact on Wound Healing in Foot Surgery.

OBJECTIVE: The aim of this study was to compare the effect of tourniquet time less than or in excess of 120 minutes on foot surgery wound healing. NULL HYPOTHESIS: A tourniquet time of over 120 minutes will not affect wound healing in foot surgery. DESIGN, SETTING, PARTICIPANTS AND METHOD: A retrospective comparative cohort analysis was performed on 96 patients undergoing complex hindfoot surgery in a large central teaching hospital. Fifty-five patients receiving tourniquet pressure for >120 minutes and 41 receiving <120 minutes of tourniquet pressure were identified from electronic case records. The primary outcome was surgical wound healing. Secondary outcomes were discharge date and complication rate. RESULTS: There was no significant difference in reported time for wounds to heal in the <120-minute or >120-minute cohort. There were no other significant differences in secondary clinical outcomes and no significant variations in patient demographics. CONCLUSION: This study suggests that tourniquet times from 2 to 3 hours in foot and ankle surgery with pressures up to 300 mmHg are not associated with a significant effect on wound healing.

A novel endoscopic treatment for anastomotic leakage post anterior resection: Padlock over the scope clip.

BACKGROUND: Anastomotic dehisense is a serious complication of anterior resections. We have had success in our centre utilising Endosponge therapy to salvage anastomotic leaks but this requires multiple endoscopic sessions and can take around 6 weeks to heal in some cases. This can delay further management such as chemotherapy. AIM: We describe the novel use of Padlock over the scope clips to manage patients with anastomotic dehisense post anterior resection. METHOD: Padlock over the scope clips were used to manage three patients who presented with anastomotic breakdown post laparoscopic anterior resection between February 2016 and July 2017. RESULTS: These patients were initially managed conservatively with IV antibiotics and fluids. One case was first managed with Endosponge treatment before a Padlock clip was utilised to bridge a narrow defect. The other cases were managed initially with CT-guided percutaneous drains before clip deployment. Patients were followed up with regular clinic and sigmoidoscopies. All three cases demonstrated anastomotic salvage and satisfactory healing. This allowed the patients to be fit for their chemotherapy in less than 4 weeks from presentation. There were no complications from utilising the Padlock clips in these cases. CONCLUSION: Utilising over the scope endoclips previously has been thought to be limited by the size of defect. Our experience details novel combination techniques that allow for quick resolution and the expeditious commencement of further management such as chemotherapy. These clips also proved to be cost-effective in our centre, utilising less inpatient and outpatient resources than alternative management plans.