Deaprtment of Anaesthetics, Aberdeen Royal Infirmary, UK NHS Grampian, Aberdeen, United Kingdom
Department of Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom.
Postgrad Med J. 2020 Jun;96(1136):339-342. doi: 10.1136/postgradmedj-2019-137438. Epub 2020 Mar 9.
The role of a foundation year 1 (FY1) doctor has evolved over the years. Many doctors report significant anxiety and stress during this period. In this Quality Improvement Project, we looked at the difficulties FY1s face in their working day and if these issues could be resolved by implementing some structural changes.
The project was conducted in three cycles, each lasting 5 days (Monday to Friday), over three consecutive weeks. Week 1 consisted of shadowing of Surgical FY1s on wards observing daily routine (arrival, lunch and departure time), communication and handovers. Following this a number of interventions were made to the structure of their daily practice to improve productivity and performance. These improvements were measured in week 2 (as the new model was scaffolded into place) and week 3 (strictly observed).
There was no significant difference in number of tasks between week 1, 2 and 3. In week 1, there was no set times for lunch, all of the FY1s lunches were interrupted, there was no structure for handovers and 100% of FY1s stayed at work beyond there contracted hours. In week 2 and 3 there was significant improvement in the number of uninterrupted lunches, amount of time spent beyond contracted hours, number and quality of handovers. The qualitative results collected also suggested positive impact on the working lives of those involved.
The implementation of structural changes improved the quality of FY1s working day and increased the efficiency of service delivered on the surgical ward.
住院医师规范化培训 1 年（FY1）医生的角色多年来发生了演变。许多医生在这段时间报告说感到严重焦虑和压力。在这个质量改进项目中，我们观察了 FY1 在工作日中面临的困难，以及通过实施一些结构性变革是否可以解决这些问题。
该项目分三个周期进行，每个周期持续 5 天（星期一至星期五），共持续三周。第 1 周，在外科病房对 FY1 进行跟班观察，了解日常工作流程（到达、午餐和离开时间）、沟通和交接班。在此之后，对他们日常工作的结构进行了一些干预，以提高生产力和绩效。在第 2 周（新模型逐步到位）和第 3 周（严格观察）对这些改进进行了测量。
在第 1、2 和 3 周之间，任务数量没有显著差异。在第 1 周，午餐时间没有固定，所有 FY1 的午餐都被打断，交接班没有结构，100%的 FY1 工作时间超过合同规定。在第 2 周和第 3 周，未被打断的午餐次数、超过合同规定的工作时间、交接班的次数和质量都有显著改善。收集的定性结果也表明，这些变化对参与人员的工作生活产生了积极影响。
结构性变革的实施改善了 FY1 工作日的质量，并提高了外科病房服务的效率。
