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1.
BJPsych Bull ; 48(2): 139-144, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37408445

RESUMO

AIMS AND METHOD: This study assesses newly qualified doctors' confidence in practising clinical skills related to the assessment and management of mental health conditions and how this correlates with other areas of medicine. We conducted a national survey of 1311 Foundation Year 1 doctors in the UK. Survey items assessed confidence recognising mentally unwell patients, conducting a mental state examination, assessing cognition and mental capacity, formulating a psychiatric diagnosis and prescribing psychotropic medications. RESULTS: A substantial proportion of surveyed doctors lacked confidence in their clinical skills related to mental health and prescribing psychotropic medications. Network analysis revealed that items corresponding to mental health were highly correlated, suggesting a potential generalised lack of confidence in mental healthcare. CLINICAL IMPLICATIONS: We identify areas of lack of confidence in some newly qualified doctors' ability to assess and manage mental health conditions. Future research might explore how greater exposure to psychiatry, integrated teaching and clinical simulation might better support medical students for future clinical work.

2.
Med Teach ; 44(6): 622-628, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-34936534

RESUMO

BACKGROUND: Induction programmes aim to ease the transition from medical student to doctor. The interim foundation year 1 (FiY1) placement, introduced in the first COVID-19 wave, provided experience in advance of the Foundation Year 1 (FY1) start in August; providing more time and enhanced responsibilities than traditional induction programmes. This study examines the effects of the FiY1 placement on anxiety levels and preparedness for FY1. METHODS: This was a descriptive cross-sectional study using data from four cohorts of FY1s who completed the online National FY1 induction survey from 2017 to 2020 (n = 4766). Questions evaluated self-reported preparedness and anxiety levels. Differences in preparedness and anxiety levels of FiY1 and non-FiY1 participants in 2020, and the 2017-2019 participants (non-FiY1 controls), were evaluated. RESULTS: FiY1s in 2020 reported higher self-reported preparedness (79%) than non-FiY1s (54%) in 2020 (p = <0.001) and the control 2017-2019 cohort (63.8%) (p < 0.001). Fewer FiY1s experienced pathological anxiety (29.3% versus 40.8% for non-FiY1s; p = 0.001). CONCLUSION: Time spent in an FiY1 role is associated with an increase in self-perceptions of preparedness and a reduction in anxiety. These data indicate that time spent in an FiY1 role may have utility in further improving the transition period from medical school to FY1.


Assuntos
COVID-19 , Médicos , Estudantes de Medicina , COVID-19/epidemiologia , Competência Clínica , Estudos Transversais , Humanos , Inquéritos e Questionários , Reino Unido
3.
BMC Med Educ ; 20(1): 282, 2020 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-32854721

RESUMO

BACKGROUND: The number of UK foundation doctors choosing to go straight into speciality training has fallen drastically over the last 10 years: We sought to explore and understand the reasons for this change. METHODS: We undertook semi-structured interviews with 16 foundation year two doctors, who had not applied to speciality training, from two regional foundation schools. Transcripts were thematically analysed. RESULTS: The reasons that foundation doctors are choosing not to go straight into speciality training centre around the themes of feeling undervalued, career uncertainty and a new cultural norm. They report major feelings of uncertainty regarding career choice at such an early stage of their profession and this challenge was magnified by a perceived lack of flexibility of training and the growing normality of taking time out from training. Trainees feel a lack of support in planning and undertaking an "FY3" year and being helped back into the workforce. Trainees overwhelmingly reported that they feel undervalued by their employers. Importantly, however, not going into training directly was not always a reflection of dissatisfaction with training. Many trainees spoke very positively about their planned activities and often saw a break in training as an excellent way to recharge, develop skills and prepare for the rest of their careers in medicine. CONCLUSIONS: Taking a year or more out of training after foundation years has become the new cultural norm for UK junior doctors and reasons for this include feeling undervalued, career uncertainty and the perception that this is now "normal". Exploring these factors with participants has generated a number of recommendations related to improving the workplace environment, allowing more flexibility in training and supporting those who chose to take an FY3.


Assuntos
Atitude do Pessoal de Saúde , Médicos , Escolha da Profissão , Humanos , Pesquisa Qualitativa , Reino Unido
4.
Med Teach ; 42(1): 52-57, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31437062

RESUMO

Background: Stressed and anxious doctors are more likely to make errors, take time off work and to leave medicine. This study aims to quantify the prevalence of anxiety among newly-qualified Foundation Year 1 doctors (FY1s), identify high risk groups and determine workplace factors associated with anxiety.Methods: We investigated self-reported anxiety among eight cohorts of FY1s between 2010 and 2017. Participants completed an online survey after their first week of work (n = 11,839), with a follow-up survey later in the year (n = 3502). Surveys included questions about the workplace and a validated screening tool for pathological anxiety.Results: Overall, a large proportion of doctors screened positive for pathological anxiety at the start of their FY1 year (27.3%) and after 4 months of work (21.0%). Year-on-year, we found a growing burden of anxiety at the start of FY1 (22.8% in 2010 vs. 29.6% in 2017, p < 0.01) and at follow-up. Anxiety was significantly higher among females (p < 0.01), those aged 21-25 (p < 0.05) and those who did not feel part of a team (p < 0.01).Conclusion: We found a growing burden of anxiety among FY1s associated with a perceived lack of support. We hope our findings will inform interventions to support newly-qualified doctors as they transition into the workplace.


Assuntos
Ansiedade/epidemiologia , Médicos/psicologia , Médicos/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Fatores de Risco , Inquéritos e Questionários , Local de Trabalho/psicologia , Adulto Jovem
5.
Educ Prim Care ; 27(2): 106-13, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27005838

RESUMO

BACKGROUND: General practice is a popular placement in the second year of Foundation training. Evaluations suggest this is a positive experience for most trainee doctors and benefits their perceptions of primary care, but the impact on primary care supervisors has not been considered. At a time when placements may need to increase, understanding the experience of the GP supervisors responsible for these placements is important. AIM: To explore the views, experiences and needs of GPs who supervise F2 doctors in their practices including their perceptions of the benefits to individuals and practices. DESIGN AND SETTING: A qualitative approach with GPs from across Severn Postgraduate Medical Education who supervise F2 doctors. METHOD: Semi-structured interviews with 15 GPs between December 2012 and April 2013. RESULTS: GP supervisors are enthusiastic about helping F2 doctors to appreciate the uniqueness of primary care. Workload and responsibility around supervision is considerable making a supportive team important. Working with young, enthusiastic doctors boosts morale in the team. The presence of freshly trained minds prompts GPs to consider their own learning needs. Being a supervisor can increase job satisfaction; the teaching role gives respite from the demanding nature of GP work. CONCLUSION: Supervisors are positive about working with F2s, who lift morale in the team and challenge GPs in their own practice and learning. This boosts job and personal satisfaction. Nonetheless, consideration should be given to managing teaching workload and team support for supervision.


Assuntos
Medicina Geral/educação , Clínicos Gerais/psicologia , Internato e Residência/métodos , Atitude do Pessoal de Saúde , Educação de Pós-Graduação em Medicina/métodos , Feminino , Humanos , Masculino , Satisfação Pessoal , Ensino , Reino Unido
6.
Perspect Med Educ ; 4(2): 90-92, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25870119

RESUMO

The risks to patients at August handover time are well known, yet there is no national consensus on the best way to deliver induction programmes for Foundation Year One (F1). The aim of this study was to design, deliver and assess a targeted structured induction programme for new F1 doctors. The induction training programme was designed using educational models of topic analysis informed by results of a survey of F1s and medical students, and the F1 curriculum. Data regarding serious untoward incidents and self-reported preparedness were collected between 2008 and 2010, and rates were compared between those receiving optional (2008) and compulsory (2009 and 2010) training. By delivering targeted education and spending time with the outgoing F1 doctors, 97 % of our new doctors felt adequately prepared for practice. The incidence of self-reported mistakes made by F1s in the first 4 months of their practice fell by 45 % and serious untoward incidents also decreased. Targeted structured induction training addresses final-year medical students' concerns about their preparedness for practice as junior doctors, and improves patient safety. This study supports the General Medical Council recommendation that targeted structured induction training should be mandatory for all new doctors.

7.
Artigo em Inglês | MEDLINE | ID: mdl-27433336

RESUMO

There is a 4-12% increase in mortality in the month following the start of Foundation Year 1 doctors (FY1s) in the UK. In 2012 the National Health Service announced a compulsory shadowing period for FY1s, aiming to increase familiarity with the environment in which the FY1 would be commencing work. There is no national curriculum of the content for this shadowing period and evidence suggests variable content of induction programmes across the UK. Our project aimed to provide a near-peer induction, based on needs previously identified by a national survey and outgoing FY1s' experiences. The day consisted of expert-led lectures, interactive practical sessions delivered by outgoing FY1s, and simulated tasks within the clinical environment where they were about to commence work. The day was evaluated by questionnaires distributed to participants before and after the induction to measure whether there was a change in the perceived confidence of the FY1s in different aspects of their role. There was a 61% improvement in familiarity of equipment and knowing how to request investigations. Confidence levels increased by 45% and 28% in prescribing insulin and intravenous fluids, respectively. There was a 9% improvement in feeling adequately prepared to recognise the critically ill patient. Confidence was high in prescribing intravenous fluids (72% pre-induction and 100% post-induction) and simple analgesics (94% pre-induction and 96% post-induction). The induction day improved self-perceived confidence in all measured areas. The largest increase was in the area given most focus during the day - knowledge of the environment. Combining factual content with orientation of the environment increases confidence for new FY1s. Teaching by outgoing FY1s provides insight into what the job entails. We recommend this style of induction to maximise preparedness within a limited time frame.

8.
BMJ Qual Saf ; 22(8): 613-7, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23661281

RESUMO

The structure of postgraduate medical training rightly puts enormous emphasis on gathering clinical experience and constantly updating knowledge of relevant medical research to use in practice. At most, this can be contrasted with the slight emphasis on clinical leadership and acquiring the skills to effect change and improve the quality of care. Doctors play central roles in orchestrating the clinical management of patients across multiple settings within the healthcare system. They also routinely encounter the many problems within the systems that they work, affecting their own practices as well as those of other healthcare professionals. They thus represent a tremendous resource for identifying solutions to these problems and playing leadership roles in implementing them. However, physician training programs focus almost entirely on the knowledge and skills to manage clinical problems, with almost no training in skills related to healthcare management or effective quality improvement. In this article, we describe one attempt to improve this situation. In four hospitals in the Severn Deanery in the Southwest of England, first-year doctors carry out a structured and supported quality improvement project of their choice throughout their first year of training. To date, 30 such projects have been or are being run. This has significant benefits for both the trusts they are working for as well as for their own professional development. We describe the successes, difficulties and future of this programme.


Assuntos
Relações Hospital-Médico , Corpo Clínico Hospitalar , Melhoria de Qualidade/organização & administração , Gestão da Qualidade Total/organização & administração , Competência Clínica , Educação de Pós-Graduação em Medicina/métodos , Educação de Pós-Graduação em Medicina/organização & administração , Inglaterra , Humanos , Estudos de Casos Organizacionais , Papel do Médico , Desenvolvimento de Programas
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