HOW DOES CONFIDENCE IN PRACTICAL AND CLINICAL MANAGEMENT CHANGE FOLLOWING FOUR MONTHS WORKING IN THE EMERGENCY DEPARTMENT?

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Abstract

Objectives & Background

There is a lack of information available about how the skills of Foundation Doctors develop over their time spent working in the Emergency Department (ED). Knowing this could better focus future training. We wanted to examine to what extent working in the ED influences confidence of Year 2 Foundation Doctors in managing common conditions seen in the ED and in performing practical procedures.

Methods

Questionnaires were given to F2 doctors at the beginning and end of their four month EM jobs at sites within the Pennine Acute Hospitals NHS Trust. These measured confidence in performing eleven practical skills and managing eleven common scenarios seen in the ED. Subjects scored confidence from 0 to 10.

Results

11 full sets of data were obtained. There was a global improvement in confidence. The greatest mean improvement in skills was in suturing (mean improvement of 5 points) and the smallest in arterial stab (mean improvement 0.9 points). The lowest confidence rating before and after the study period was removing a foreign body from an eye (Mean improvement 1.5 to 5/10). Confidence in patient management improved most in paediatric emergencies; managing a wheezy child and a febrile child with a rash (mean improvements 3.2 and 3.0 points respectively). The smallest improvement was in managing chest pain though initial scores for this were high (mean 7 improving to 9/10). Confidence managing a febrile child with a rash was initially the lowest (mean 5 increasing to 8/10).

Conclusion

The ED provides good exposure for improving the skills of foundation doctors. The greatest improvement was in areas doctors had not experienced elsewhere (e.g. paediatrics, suturing, diagnosing fractures).

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