The British Student Doctor Journal is a high quality, open access, biannual, peer-reviewed, general medical journal, which publishes articles written primarily by medical students. In addition to publishing original research and systematic reviews, we also provide a platform to medical students to express original thought and reflections on clinical practice, student life and medical education.All of our content is fully open access, available without subscription and with no authorship charges. All articles published in The British Student Doctor Journal go through a rigorous peer-review process, led by our student editorial team. The governance of the journal is overseen by our faculty advisory board, and we are published by Cardiff University Press and funded by Cardiff University School of Medicine.For more information, please visit our homepage at www.bsdj.org.uk.
Introduction Our DGH secured funding for a winter-pressure (WP) registrar locum shift to cover CAU for 8-hours overnight from October 2018 to March 2019. Managing the WP-rota was taken up by a paediatric registrar (overseen by a consultant) as a management and leadership QI project. We aimed to evaluate trends in how locum shifts are booked and to see if a mobile messaging application (WhatsApp) administrated by a trainee could lead to improved uptake of locum bookings. Methods Utilising our network of current and previous trainees a WhatsApp ‘WP group’ was created to advertise and book WP–shifts (alongside medical staffing advertising via their e–mailing lists). Shifts were also open to level–1 trainees with full MRCPCH membership. We managed at standardised NHS–P rate. There were flexible start times: 10pm, 11pm or midnight. The paediatric registrar administrator was the direct clinical contact and liaised with medical staffing to organise bookings. Results 96% (N=174) of WP–shifts were booked. 91% (N=160) of WP–shifts were booked via direct communication with the registrar administrator through WhatsApp. 9% (N=14) of WP–shifts were booked as a result of medical staffing emailing advertisements alone. 57% (N=99) of WP–shifts were booked with more than 4 weeks’ notice. 19 doctors booked shifts. 100% of doctors booked more than one shift. Informal feedback from registrars was collected; both local trainees and locums felt the WP–rota made the department feel safer and had improved staff morale. Take Home Messages Anecdotally locums liked the flexibility and convenience of choosing their start time. Good communication with a personal touch is key. Using a mobile chat application is an efficient way to advertise shifts, answer queries and confirm bookings. The locums valued the ease of communication with a clinical contact who would liaise and book shifts with medical staffing on their behalf. Locum doctors and local trainees appreciated a clinical person who could relate to them overseeing the WP–rota. Co–ordinating the WP–rota takes commitment and personal time for the trainee lead – we suggest allocating 4 hours’ admin time each fortnight for this. Taking on this role improves a trainee’s leadership and management experience.
Background and Objective Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a dynamically evolving global pandemic. As such, it demands that doctors be adaptable in the face of uncertainty and ever-changing practice. The aim of this study was to evaluate the benefits of simulation under such arduous circumstances. Methodology A COVID-19 scenario was developed and delivered in the simulation suite at Watford General Hospital. The learners were foundation trainee doctors (years 1 and 2) and student nurses. The trainee was asked to review a patient who had returned from a cruise with coryzal symptoms. Debriefing was achieved using the TRUST acronym (terminate, reflect, understand, summarise and take-home message). The learners completed a pre- and post-simulation questionnaire, rating their performance from 1–5, across domains including human factor and technical skills. The template used for this has been validated and is used in all simulation sessions at the hospital. Results and discussion Analysis of the feedback determined that there was an improvement in both confidence and technical skills among the delegates (13.5 and 5.3% respectively.) The opportunity to debrief and reflect in a safe and controlled environment also allowed various observations to be made. For instance, it was necessary for the doctor to leave the patient area to don on the personal protective equipment. The learners were understandably hesitant to do this owing to the time taken to do this correctly and as it would invariably leave a potentially moribund patient unattended. This, after all, appears to contradict the medical ethos of rapid review and timely resuscitation, as exemplified by the golden hour of intervention in trauma and sepsis. Nonetheless, the learners were reminded of the importance of ensuring their own safety first, akin to the DRABC approach to the primary survey, where the ‘D’ directs the responder to inspect for danger first prior to eliciting a patient response. Conclusion and Recommendations An unprecedented global crisis may inevitably result in a shambolic human response. At a time of fear and despair, simulation serves as a catalyst to promote consistency in the delivery of care and to allow for the dissemination of new guidelines and practice. A pitfall identified in this study, which is especially relevant to a pandemic, is the inability to accommodate for large volumes of learners in one sitting and this is where virtual reality simulation may play a significant role in the future. References Lateef F. Simulation-based learning: Just like the real thing. Journal of Emergencies, Trauma and Shock 2010;3(4):348–352. doi:10.4103/0974-2700.70743 World Health Organisation. Coronavirus disease (COVID-19) Pandemic. 2020. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 [Accessed April 2020].
Background Managing and stabilising a critically ill child within a district general hospital prior to transfer to PICU can present communication challenges. Our study aims to identify ways in which teams can improve the delivery of family-centred care during this difficult time. Methods We reviewed the notes of 14 children who were transferred from the resuscitation area of a district general hospital to a tertiary PICU over a one-year period. We then conducted semi-structured telephone interviews with 14 parents focusing on the team’s communication with the family and how this could be improved. Results When reviewing patient notes, documentation of clinicians’ discussions with families was poor. Only 20% of notes had evidence of these discussions taking place. This was in stark contrast with the feedback from families themselves, with 100% of parents feeling they were adequately updated throughout. It is assumed that the most senior clinician should update parents whereas the parental voice refutes this, with 80% preferring to have an update from a junior member to allow the most senior person to focus on their child. 75% of parents recall needing to have explanations repeated. 88% of parents remember overhearing words that frightened them. Where available, 60% of parents were grateful to other allied healthcare professionals who offered one-to-one support (e.g. play specialists). Take-Home Messages Listening to parental voices allows teams to reflect on the true impact of their interaction with families Updates can come from any team member, not necessarily the most senior Documentation of communication is poorly done, not the communication itself Be prepared to re–explain things and re–check understanding Be sensitive to medical jargon and discussions that parents can overhear We recommend having dedicated teaching for play specialists and allied healthcare workers about the algorithms and the equipment used during emergencies, so they are able to explain to parents what is happening during stabilisation. Allied healthcare workers and play specialists should be involved in MDT in–situ simulation teaching Parents may forget the technicalities of what was said and the complexity of the situation – they remember how they felt and how they were made to feel
Background Our statistics showed that the average length of time from referral to death in March 2017 was 1–2 months. This represented too many patients missing out on support and planned end of life care. We hypothesised that by engaging with more people, earlier we might reduce the stigma around engagement with hospice services. Aims Our aim was to increase the number of people accessing the Living Well Services over a six-month period. Methods After considering which activities attracted more referrals and listening to our users we relaunched our original day services as 'Living Well Services'. The programme of activities offered was enhanced to offer more of our popular activities such as physiotherapy supervised exercise groups, Fatigue and breathlessness courses, Creative Cafes, singing and Tai Chi. We used community collaborations to deliver some of these activities. We also complemented our day service with a support group for patients with complex neurodegenerative conditions. We presented our new service to community colleagues, targeting disease specific groups such as pulmonary rehab courses where we delivered education on 'Living with Long Term Conditions', the Heart Failure CNS team at the acute trusts, as well as pre-established links with the local Navigator for Complex Neuro. We also opened all our Living Well services to self-referrals and improved our website to encourage engagement. Results Over the period October 2017 to March 2018 the total number of attendances at the Living Well services increased from 340 to 667 representing a 96% increase. This included seven self-referrals. The caseload increased from 131 to 186, a 42% increase. Our non -cancer referrals increased from 38% in October 2017 to 48% in March 2018. Conclusions We will review first referral to death times in a year to confirm that the significant increase in earlier engagement carries through.
