Early structured core training of junior trainees in ophthalmology

Confidence of Emergency Department doctors in managing ophthalmic emergencies: a systematic review

BACKGROUND

Eye emergencies constitute a significant portion of attendances to general Emergency Departments (EDs) in the UK, therefore it is important to assess the confidence of doctors who work in this setting in managing these potentially sight- and life-threatening presentations. This systematic review aims to assess the confidence of UK doctors working in general EDs in managing ophthalmic emergencies.

METHODS

MEDLINE (Ovid), EMBASE (Ovid), ProQuest Central and Web of Science databases and grey literature were searched from inception to 1 October 2022 for publications that (1) featured doctors working in UK general EDs, (2) assessed doctors' confidence in managing ophthalmic emergencies, (3) contained original data, (4) were full-text, and (5) written in English. Methodological quality was assessed using the AXIS tool.

RESULTS

462 articles were screened, and 7 papers included for data extraction, which collectively assessed the confidence of 956 doctors working in EDs in managing ophthalmic emergencies. There was a widespread lack of confidence amongst foundation doctors, which has worsened over time. Most doctors lacked confidence in performing funduscopy and using the slit-lamp, and considered formal ophthalmology training received in EDs to be inadequate.

CONCLUSIONS

Evidence suggests a lack of confidence amongst foundation doctors in managing ophthalmic emergencies. High-quality evidence investigating the confidence amongst more experienced Emergency Medicine (EM) physicians was lacking. It is important to assess why foundation doctors feel so ill-prepared to manage eye emergencies and develop further ophthalmic training for doctors working in EDs. Further investigation exploring the confidence of EM trainees and consultants is required.

[Training concept for personnel in a university outpatient clinic: development and evaluation of a structured introductory training concept]

BACKGROUND

The training of new employees is crucial for effective interaction and commitment to the company.

OBJECTIVE

Development and evaluation of a structured induction into the process flows of a university outpatient clinic.

MATERIAL AND METHODS

We developed and tested a two-stage model for getting to know staff, premises, nursing and medical process flows, and learning examination techniques: Participants went through all stages of an outpatient clinic visit as fictitious patients and subsequently evaluated learning success by self-assessment of general (process-related) and specific (examination-related) competencies in writing and in a feedback interview.

RESULTS

In this study, 11 residents, 8 operating room nursing staff, and 6 students underwent the training program. The self-assessed level of competence before and after the run-through as well as the extent of the increase in competence varied depending on the stage and professional group. Residents and students experienced a specific increase in general competences (both 98%; nursing personnel 64%). Specific competence gains for residents were particularly evident in becoming familiar with important process-related interfaces between the occupational groups, in software and examination techniques, and in improved orientation in the outpatient clinic (competence gain at 83% of stages). Operating room nursing staff benefited most from improved communication with staff.

CONCLUSION

An increase in general competence can be achieved by a structured training with little time expenditure for different professional groups and facilitates, especially the start for new residents. For maximum specific competence gain, an outpatient clinic run tailored to the employee's field of activity seems desirable.

Neonatal pain: a comparison of the beliefs and practices of junior doctors and current best evidence

AIM

To obtain information on the practices and beliefs of junior doctors regarding neonatal pain and to compare this with best evidence.

METHODS

A survey was distributed to junior doctors in five tertiary neonatal intensive care units in Sydney. Questions investigated the doctors' knowledge and treatment of pain in neonates, specifically regarding the perception and effects of pain, pain assessment tools, and the safety and efficacy of treatments for both procedural and long-term pain.

RESULTS

The survey was completed by 33 junior doctors (77% response rate). Respondents generally had adequate knowledge about the effects of pain in neonates; however, a low proportion of respondents acknowledged the difference in long-term effects between neonates and older children. Less experienced doctors were especially unaware of this. Pain assessment tools were not perceived to be reliable, valid or routinely used, especially by less experienced doctors. Respondents were appropriately unsupportive of the use of topical anaesthetic agents. Participants acknowledged the efficacy breastfeeding and oral sucrose during short-term procedures but skin-to-skin contact and massage were less recognised as useful. Mixed opinions were noted on the benefits and risks of use of opioid analgesics, morphine infusions and midazolam but most agreed that sedation does not necessarily provide adequate pain relief. Disturbingly, doctors who were aware of the Royal Australasian College of Physicians Guidelines were more likely to agree with the routine use of midazolam in neonates.

CONCLUSIONS

Increased educational programmes should be developed to improve the knowledge of junior doctors regarding neonatal pain.