School of Medical Specialties, North Western Deanery, Manchester, UK; National Comparative Audit, NHSBT, Oxford, UK; School of Medicine, University of Manchester, Foundation School, North Western Deanery, Manchester, UK; NHSBT, Manchester & Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
Transfusion. 2014 Jan;54(1):128-36. doi: 10.1111/trf.12274. Epub 2013 Jun 13.
There is scope to further improve the safety of transfusion practice within the United Kingdom. This study aims to identify the current role of junior doctors in the transfusion process and to assess their competency to appropriately prescribe blood and blood products to patients.
Transfusion competency in junior doctors training in a single region was addressed through anonymized questionnaires assessing factual knowledge, personal reflection, and documented evidence of competency. Factual knowledge comprised 33 true-false questions (competency score) covering indications for transfusion, special requirements, risks of transfusion, and guidelines for testing in transfusion. Background data on current practice and education in transfusion medicine were addressed using multiple-choice and single-response questions.
A total of 787 newly qualified doctors, comprising 79% of first-year (F1) and 62% of second-year (F2) Foundation doctors, completed the assessment over a 3-week period. There was no improvement in competency score between F1 and F2 doctors (p = 0.1). Competency scores correlated most strongly with undergraduate education in transfusion medicine and attendance at hospital induction (p < 0.01). Junior doctors had a high confidence level with regard to prescribing blood, although only 78% were aware they had been competency assessed against national standards.
Junior doctors are involved in sampling, prescribing, consenting, and documenting transfusion practice frequently enough to maintain competency. They are rarely involved in the collection, bedside checking, or administration of blood despite current curriculum requirements. There is scope to significantly improve both the training and the assessment of transfusion competency in doctors.
英国在输血实践安全方面还有进一步提高的空间。本研究旨在确定初级医生在输血过程中的当前作用，并评估他们适当为患者开具血液和血液制品的能力。
通过对初级医生进行匿名问卷调查，评估他们的事实知识、个人反思和记录的能力证明，以了解其在一个地区培训中的输血能力。事实知识包括 33 个是非题（能力得分），涵盖输血指征、特殊要求、输血风险和输血检测指南。使用多项选择题和单项选择题来了解当前输血医学实践和教育的背景数据。
在 3 周的时间内，共有 787 名新合格医生完成了评估，其中包括 79%的第一年（F1）和 62%的第二年（F2）基础医生。F1 和 F2 医生的能力得分之间没有改善（p=0.1）。能力得分与输血医学本科教育和医院入职培训相关性最强（p<0.01）。初级医生对开具血液的信心水平很高，尽管只有 78%的人知道他们已经按照国家标准进行了能力评估。
初级医生经常参与样本采集、处方、同意和记录输血实践，足以保持其能力。尽管目前的课程要求如此，但他们很少参与血液的采集、床边检查或管理。在医生的输血能力培训和评估方面还有很大的改进空间。
