An on-call escape room: Escaping the monotony of a didactic induction for doctors.

AIMS: To establish an on-call escape room as a novel educational tool for Foundation Year 1 (FY1) doctors' induction at Epsom and St Helier University Hospitals Trust. The escape room simulates common on-call scenarios for newly qualified doctors, with a view to facilitating communication and teamwork with unfamiliar peers and establishing a safe environment to develop practical skills. Ultimately aiming to reduce anxiety and improve confidence amongst our FY1 cohort. METHODS: A pilot escape room, as a simulated on-call shift with nine clinical scenarios, was designed for groups of 4-5 doctors. Following feedback, a 70-minute escape room with 17 clinical scenarios was established. Sequential completion of tasks would 'unlock' the door to handover with a senior colleague, thereby finishing the 'shift'. Questionnaires utilised a 10-point Likert scale to assess confidence and anxiety levels with regards to on-call shifts. Statistical analysis was performed using the Student's t-test. RESULTS: Pilot: Nineteen participants trialled the pilot escape room. Perceived levels of confidence increased from a mean of 5.0 to 7.1 (p < 0.05).Final: Forty-one participants underwent the final version of the escape room with perceived levels of on-call confidence increasing from a mean of 4.2 to 6.5 (p < 0.05), prescribing confidence from 5.3 to 6.6 (p < 0.05), using apps from 6.3 to 7.5 (p < 0.05), consulting trust guidelines from 5.0 to 7.0 (p < 0.05) and handing over from 5.8 to 6.8 (p < 0.05). Anxiety levels also decreased from 7.2 to 6.3 (p < 0.05) with an overall mean score of 9/10 for 'enjoyability' of the session. CONCLUSION: Incorporating an on-call escape room scenario into induction has demonstrably increased confidence levels and reduced anxiety levels amongst new FY1 doctors. This novel teaching method maximises participant engagement with the view to an enhanced learning experience.

Safety and efficacy of T-DM1 in patients with advanced HER2-positive breast cancer The Royal Marsden experience.

BACKGROUND: Ado-trastuzumab emtansine (T-DM1) is standard of care for patients with advanced HER2+ breast cancer who relapse within 6 months of adjuvant trastuzumab or progress on first-line anti-HER2 therapy. We evaluated its safety and efficacy in our real-world population. METHODS: We identified patients on T-DM1 from 01/01/2014 to 12/03/2018 from our electronic records. Patients', tumour characteristics, safety and efficacy outcomes were recorded. Chi-squared/Fishers exact test and Kaplan-Meier methods were utilised. RESULTS: 128 patients receiving T-DM1 were included in the analysis with a median age of 55 years (26-85). 89.8% of patients had ECOG PS 0-1 and 21.1% had presented with de novo metastatic disease. 57.8% had ER-positive disease and 38.3% central nervous system involvement. 88.3% of patients had received trastuzumab for advanced disease (with pertuzumab in 28.9%) and 11.7% had only received trastuzumab in the adjuvant setting. Grade ≥3 adverse events occurred in 35.9% of patients. These were liver toxicity (19.5%), anaemia (6.2%) and thrombocytopenia (4.7%). Peripheral neuropathy of any grade was reported in 21.9% of cases, bleeding in 9.4% and ejection fraction decline in 5 patients. Median progression-free survival was 8.7 months and overall survival 20.4 months. Prior pertuzumab did not influence survival outcomes. CONCLUSIONS: The safety of T-DM1 in our population is similar to available literature, although we observed higher rates of peripheral neuropathy and deranged liver function. These findings are relevant for the potential role of TDM-1 in the curative setting.