Clinical Skills Day: A Novel Approach to Enhancing Procedural Skills Teaching for Foundation Year One Doctors.

Background Completion of the Foundation Year One (FY1) doctor training is a requirement for full General Medical Council registration in the United Kingdom. Training during this year is mapped to a curriculum with one of the key elements being safe procedural skills. The objective of this project was to improve the teaching of procedural skills through the means of a Clinical Skills Day (CSD) and to quantify any improvement. Materials and methods A one-group pretest-posttest design was conducted on 32 doctors who completed a confidence inventory before and after four core procedural stations: suturing, urethral catheterisation (both male and female), lumbar puncture, and bimanual and speculum examinations. The intervention of simulated procedural skills occurred under the supervision of senior clinicians, with FY1 doctors receiving teaching and practising the four skills. The primary outcome was the impact of a CSD on trainees' confidence in performing certain skills. Pre- and post-CSD trainees' confidence levels were collected via an online-focused questionnaire and descriptive statistics, paired t-test, and one-way analysis of variance (ANOVA) with post-hoc Bonferroni comparisons were undertaken for statistical analysis. Results The difference in the mean scores of confidence post-intervention was significant in all four procedural stations with or without supervision (p <0.0001). Conclusions The use of CSDs impacted positively on the FY1 doctors' confidence in performing certain skills. Wider implementation of this promising approach for Foundation Doctors is recommended.

The shifting demographics of birth-related brachial plexus injury: The impact of socio-economic status and ethnic groups.

INTRODUCTION: Many of the risk factors for birth-related brachial plexus injury (BRBPI), such as maternal gestational diabetes and macrosomia, are known to vary between demographic groups. Socio-economic differences are known to influence access to healthcare, including elective caesarean section rates and access to consultant obstetricians, which could impact the rates of BRBPI. This study aims to explore whether BRBPI is affected by demographic factors. METHOD: This retrospective study compares cohorts of BRBPI patients referred to the Royal National Orthopaedic Hospital in 2004, 2014 and 2017. N = 67 in 2004, N = 61 in 2014 and N = 71 in 2017. RESULTS: The risk of BRBPI for Black patients was 6 times higher than for White patients, and 2.7 times higher for Asian patients as compared to White patients (p < 0.001). There was an unequal distribution of BRBPI occurring in patients from lower socio-economic groups based on the index of multiple deprivation, with the highest level seen in those from the second lowest quintile. Neither of these risk factors have changed within the three years that they were examined. CONCLUSION: In this sample, the risk of BRBPI varies with ethnic groups; patients from non-White backgrounds are at a higher risk overall and are disproportionately represented in the BRBPI cohort as compared to White groups. Similarly, there seems to be a trend towards greater risk for those from lower socio-economic groups. These changes are consistent each year, suggesting that these inconsistencies are yet to be addressed. Further studies are warranted to explore why these demographic factors are significantly affecting health outcomes.