Access to personal protective equipment in healthcare workers during the COVID-19 pandemic in the United Kingdom: results from a nationwide cohort study (UK-REACH).

BACKGROUND: Healthcare workers (HCWs) are at high risk of SARS-CoV-2 infection. Effective use of personal protective equipment (PPE) reduces this risk. We sought to determine the prevalence and predictors of self-reported access to appropriate PPE (aPPE) for HCWs in the UK during the COVID-19 pandemic. METHODS: We conducted cross sectional analyses using data from a nationwide questionnaire-based cohort study administered between December 2020-February 2021. The outcome was a binary measure of self-reported aPPE (access all of the time vs access most of the time or less frequently) at two timepoints: the first national lockdown in the UK in March 2020 (primary analysis) and at the time of questionnaire response (secondary analysis). RESULTS: Ten thousand five hundred eight HCWs were included in the primary analysis, and 12,252 in the secondary analysis. 35.2% of HCWs reported aPPE at all times in the primary analysis; 83.9% reported aPPE at all times in the secondary analysis. In the primary analysis, after adjustment (for age, sex, ethnicity, migration status, occupation, aerosol generating procedure exposure, work sector and region, working hours, night shift frequency and trust in employing organisation), older HCWs and those working in Intensive Care Units were more likely to report aPPE at all times. Asian HCWs (aOR:0.77, 95%CI 0.67-0.89 [vs White]), those in allied health professional and dental roles (vs those in medical roles), and those who saw a higher number of COVID-19 patients compared to those who saw none (≥ 21 patients/week 0.74, 0.61-0.90) were less likely to report aPPE at all times. Those who trusted their employing organisation to deal with concerns about unsafe clinical practice, compared to those who did not, were twice as likely to report aPPE at all times. Significant predictors were largely unchanged in the secondary analysis. CONCLUSIONS: Only a third of HCWs in the UK reported aPPE at all times during the first lockdown and that aPPE had improved later in the pandemic. We also identified key determinants of aPPE during the first UK lockdown, which have mostly persisted since lockdown was eased. These findings have important implications for the safe delivery of healthcare during the pandemic.

The Extended Supervised Learning Event (ESLE): Assessing Nontechnical Skills in Emergency Medicine Trainees in the Workplace.

STUDY OBJECTIVE: The contribution of emergency medicine clinicians' nontechnical skills in providing safe, high-quality care in the emergency department (ED) is well known. In 2015, the UK Royal College of Emergency Medicine introduced explicit validated descriptors of nontechnical skills needed to function effectively in the ED. A new nontechnical skills assessment tool that provided a score for 12 domains of nontechnical skills and detailed narrative feedback, the Extended Supervised Learning Event (ESLE), was introduced and was mandated as part of the Royal College of Emergency Medicine assessment schedule. We aim to evaluate the psychometric reliability of the ESLE in its first year of use. METHODS: ESLEs were mandated for all UK emergency medicine trainees in the final 4 years of a 6-year national training program from August 2015. The completed assessments were uploaded to the Royal College of Emergency Medicine e-portfolio. All assessments recorded in the Royal College of Emergency Medicine e-portfolio database between August 2015 and August 2016 were anonymized and analyzed for psychometric reliability, using generalizability theory. Decision analysis was used to model the effect of altering the number of episodes and assessors on reliability. RESULTS: A total of 1,390 ESLEs were analyzed. The majority (62%) of the variation in nontechnical skills scores was attributable to the trainee's ability. The circumstances of the event (eg, case complexity, workload) accounted for 21% and the stringency or leniency of assessors the remaining 16%. Decision analysis suggests that 3 ESLEs by 2 or more assessors, as currently recommended in the Royal College of Emergency Medicine curriculum, provide an assessment with a reliability coefficient of 0.8. CONCLUSION: Board-certified-equivalent emergency medicine supervisors are able to provide reliable assessments of emergency medicine trainees' nontechnical skills in the workplace by using the ESLE.

Academic poster design at a national conference: a need for standardised guidance?

BACKGROUND: Academic posters are a common means of disseminating information at conferences. Presentation at conferences is frequently given weight in postgraduate training programme recruitment. Some conferences provide guidance for visual presentation of posters. For the Association of the Study of Medical Education (ASME) Annual Scientific Meeting (ASM) 2015, poster abstract guidance was provided; however, the guidance on poster design was limited to size and orientation. The aim of this study was to investigate academic poster quality at a national medical education conference to identify where standards could be promoted and improved. Presentation at conferences is frequently given weight in postgraduate training programme recruitment METHODS: Six auditors assessed all posters displayed at the ASME ASM (15-17 July 2015) using guidelines based upon a modified checklist for academic posters. Ten criteria were agreed as assessment standards for poster design quality. RESULTS: One-hundred-and-eighty posters were assessed: 29 per cent had appropriate copyright for the materials displayed (n = 52); 41 per cent included suitable contact details (n = 73); 48 per cent (n = 87) had a text to graphic ratio of 50 : 50; 72 per cent (n = 130) met ASME guidance for layout and orientation; 76 per cent (n = 137) had appropriate referencing; 78 per cent showed evidence of proofreading for grammar and spelling (n = 140); 79 per cent (n = 142) were readable at a distance of 2 metres; and 87 per cent used appropriate academic logos (n = 156). DISCUSSION: There was variability in design quality as assessed by these criteria. We recommend that detailed guidance should be produced and disseminated by the organising conference. This may improve poster quality and aid in the communication of presented material. We aim to re-audit following the production and dissemination of poster presentation guidance.