Martel Gareth, Magee Cathy
NHS.
BMJ Qual Improv Rep. 2014 May 16;3(1). doi: 10.1136/bmjquality.u202528.w1897. eCollection 2014.
Reduced working hours and fragmentation of the surgical firm has resulted in a gradual change in FY1 duties. Locally, FY1 doctors were no longer routinely seeing surgical emergency admissions, while FY1s informally reported reduced confidence in dealing with surgical emergencies. The goal of this project was to assess the current training of FY1 doctors within the unit, and to attempt to improve this by increasing exposure to surgical emergencies. Two months into their four month surgical rotation, FY1s completed an anonymous online survey that focused on their confidence in dealing with emergency surgical admissions. Working practice was then changed by the creation of a formal emergency foundation year one (FY1) rota, and the introduction of a baton bleep. The expectation was that all emergency admissions would be clerked by an FY1 doctor. The cohort were asked to repeat the survey after implementation of change. Across all areas assessed, the confidence and experience of the junior doctors was improved. Initially 70% of FY1s felt exposure to emergency surgical cases was inadequate, falling to 0% after the intervention. This was associated with a rise in the average number of acute cases clerked by each FY1 per week from 1.2 to 4.0. At baseline, only 30% of those surveyed felt that they were gaining the skills and experience necessary to prepare them for an FY2 job in general surgery, and after the intervention this increased to 100%. The increased pressures of service provision within reduced working hours does not necessitate the exclusion FY1 doctors from the assessment and management of surgical emergencies. We have demonstrated that preserving this exposure is a priority in the training of junior doctors, resulting in more experienced and confident medical staff.
工作时长的减少以及外科团队的碎片化导致了第一年住院医生（FY1）职责的逐渐变化。在本地，FY1医生不再常规接诊外科急诊入院患者，同时FY1医生非正式地报告称在处理外科急诊方面信心下降。该项目的目标是评估该科室目前对FY1医生的培训情况，并试图通过增加接触外科急诊的机会来改善这一状况。在为期四个月的外科轮转的两个月时，FY1医生完成了一项匿名在线调查，该调查聚焦于他们处理外科急诊入院患者的信心。随后通过制定正式的第一年急诊住院医生（FY1）排班表以及引入接力传呼改变了工作模式。预期所有急诊入院患者都将由FY1医生进行诊疗。在实施变革后，要求该群体重复进行调查。在所有评估领域，初级医生的信心和经验都得到了提升。最初，70%的FY1医生认为接触急诊外科病例的机会不足，干预后这一比例降至0%。这与每位FY1医生每周诊疗的急性病例平均数量从1.2例增加到4.0例相关。在基线时，只有30%的受访者认为他们正在获得为普通外科的第二年住院医生（FY2）工作做好准备所需的技能和经验，干预后这一比例增至100%。在工作时长减少的情况下服务提供压力的增加并不必然导致将FY1医生排除在外科急诊的评估和管理之外。我们已经证明，在初级医生培训中保留这种接触机会是一个优先事项，这会造就更有经验、更自信的医务人员。
