Aryasomayajula Saraswati, Raithatha Amit, Haywood Matthew, Jobanputra Ravi, Roplekar Rujuta, Acharya Vikas
Department of ENT Surgery, Luton and Dunstable University Hospital, Luton, UK,
Department of ENT Surgery, Lister Hospital, Stevenage, UK.
Adv Med Educ Pract. 2018 Nov 14;9:827-835. doi: 10.2147/AMEP.S161187. eCollection 2018.
Ear, nose, and throat (ENT) surgery is a niche and unique specialty that has been recognized as being poorly taught throughout medical school and postgraduate training. Junior doctors who rotate into this specialty often find it hard and struggle to manage patients. The aim of this study was to devise a junior doctor-focused induction program with specific emphasis on shadowing and partnered working to improve confidence and competence.
Feedback from previous trainees was used to identify valuable training opportunities within the 4-month rotation. Trainers identified clinical areas where supported learning could be delivered. Trainees were allocated to rotate between theater, ward, on-call shifts, and acute clinics. The degree of time spent in each area was analyzed in order to balance service provision vs learning needs. Furthermore, novel strategies were introduced in each session to maximize learning experiences. Junior doctors were aware of the opportunities that would be available to them at the start of the rotation. In order to assess whether the aims were met, a questionnaire survey was used to assess exposure to core ENT practical skills and junior doctors' confidence levels in carrying them out unsupervised.
Junior doctors spent 40% of their time assessing new acute admissions. Twenty percent of time was spent in ENT clinic, but novel practical methods of induction were introduced such as 1 week of directly supervised shadowing, followed by a transition period with regular debrief. A three-stage model was used to offer training in practical procedures in the clinical setting. Over half of the trainees felt confident in undertaking 50% of the core ENT procedures unsupervised.
Our study reveals that giving junior doctors a relevant, focused and appropriate induction helps orientate them, give them the opportunity to ask questions, and also find their grounding in order to begin working. Having dedicated time to shadow and be with a colleague to assess and treat patients initially, with ongoing telephone and in person support, ensured that their confidence and competence improved very quickly. It also improved workplace satisfaction and motivated doctors to undertake self-directed learning and improve and enhance their skills beyond the minimum.
耳鼻喉（ENT）外科是一个细分且独特的专业领域，在整个医学院校教育和研究生培训阶段，该专业的教学质量一直被认为较差。轮转至该专业的低年资医生常常觉得工作困难，在管理患者方面力不从心。本研究的目的是设计一个以低年资医生为重点的入职培训项目，特别强调跟班学习和合作工作，以提高他们的信心和能力。
通过收集以往学员的反馈意见，确定在为期4个月的轮转期间有价值的培训机会。培训师确定了可以提供支持性学习的临床领域。学员被分配到手术室、病房、值班班次和急症诊所进行轮转。分析了在每个领域所花费的时间比例，以平衡服务提供与学习需求。此外，在每个环节都引入了新的策略，以最大化学习体验。低年资医生在轮转开始时就清楚了解他们将获得的机会。为了评估目标是否达成，通过问卷调查来评估低年资医生对耳鼻喉核心实践技能的接触情况以及他们在无人监督下执行这些技能的信心水平。
低年资医生将40%的时间用于评估新的急症入院患者。20%的时间用于耳鼻喉科门诊，但引入了新的实践入职培训方法，例如为期1周的直接监督下的跟班学习，随后是定期汇报的过渡期。采用三阶段模型在临床环境中提供实践操作培训。超过一半的学员对在无人监督的情况下完成50%的耳鼻喉核心操作有信心。
我们的研究表明，为低年资医生提供相关、重点突出且合适的入职培训有助于引导他们，让他们有机会提问，并找到工作的立足点。最初安排专门的时间进行跟班学习，并与同事一起评估和治疗患者，同时提供持续的电话支持和面对面支持，确保他们的信心和能力迅速提高。这也提高了工作场所的满意度，并激励医生进行自主学习，不仅达到最低要求，还能提升和增强自己的技能。
