London Deanery Conference 2013

1. London Deanery Conference 2013 Clare van Hamel Severn Foundation School Director

2. Overview • Background • Methods • Results • Summary

3. Background • Some F1s feel inadequately prepared1-5 • High anxiety levels6,7 • Induction programmes can help8-11 • Compulsory for 2012 F1s • National survey to assess impact

4. Aims Measure anxiety levels Assess whether length of induction affected anxiety levels Assess prescribing confidence Assess whether F1s felt prepared for their first job

5. Why bother? • Time and effort for induction programmes • In the 2011 cohort 26.7% of F1s anxious7 • AMEE 2012 findings from other studies similar12 • Look for consistency • Department of Health interest

6. 2012 Methods • Opportunistic sampling was employed to survey F1 Doctors who were commencing their posts August 2012. • 23/26 Foundation Schools participated • 1829 respondents giving an • Overall response rate of 31%.

7. Methods

8. Results: Anxiety by Medical School

9. Results: Anxiety by Foundation School

10. Results: Anxiety • No evidence of a difference between schools using Chi Squared analysis • Medical Schools 0.5689 • Foundation Schools 0.1012 • Similar results to 2011 • 2011 26.7% screened positive (234 of 875) • 2012 27.8% screened positive (500 of 1799) • No significant difference using Fisher’s Exact Test 0.5797

11. Results: Anxiety • For every additional day of induction, the anxiety score is expected to decrease by 0.0485: • There is a significant relationship between the length of induction and anxiety score; P=0.0479 Anxiety score= 4.66-0.0485*Length of Induction (days)

12. Results: Anxiety • For every additional 10% shadowing during their final year at medical school, the anxiety score is expected to decrease by 0.168 • There is a strong relationship between anxiety score and time spent shadowing; P<0.0001

13. Results: Prescribing Confidence - overall

14. Results: Prescribing Confidence

15. Results: Preparedness

16. Results: Preparedness

17. General Preparedness to Practice- ‘I knew what was expected of me’ • p-value is highly significant (p<0.0001), there is very strong significant evidence that the general preparation mean scores vary between medical schools. • There is very strong evidence that there is a difference in the general preparation means between foundation schools (p<0.001).

18. Medical school preparedness- Adequately prepared in equipment, practical procedures and recognising the critically ill • P<.0001 between medical schools and • P<.0001 between foundation schools

19. Team questions- Clinical supervisor identified, team introductions, knowing who to call in and out of hours • There is no evidence to suggest that there is a difference in the team responses between the medical schools. • There is some evidence of a difference in the team responses between foundation schools.

20. Familiarity with E-portfolio • There is strong evidence that there is a difference in F1s agreement with the E-Portfolio statement depending on which medical school they graduated from p<0.001 • There is strong statistically significant evidence that the level of F1 agreement with the E-Portfolio statement differs depending on which foundation school they are appointed to, p<0.001.

21. Trainee survey –follow up (686 respondents)

22. Confidence in prescribing weeks 1-4 weeks 8-12

23. Critical Incidents

24. Critical Incidents 2012 (679 respondents) • 376 near miss reports – majority 214 prescribing errors • 91 critical incidents no significant harm • 17 critical incidents significant harm e.g. extended length of stay • 12 incidents leading to permanent harm of these 11 were due to failure to recognise the critically ill, 1 due to fluid prescription error • Similar results to previous years – need for clarity with regard to recognising the critically ill

25. Strengths and Limitations • Scale: 1829 participants (31%) • Validated questionnaire • Voluntary participation • Not all schools participated

26. Summary • Significant proportion screened positive for anxiety • For every day of induction anxiety was reduced • For every 10% extra shadowing during final year anxiety was reduced • Prescribing confidence varied by medical and foundation school • How prepared F1s were varied by medical and foundation school

27. References • Goldacre MJ, Lambert T, Evans J, Turner G. Pre-registration house officers’ views on whether their experience at medical school prepared them well for their jobs: national questionnaire survey. BMJ 2003; 326:1011-2. • GoldacreMJ, Taylor K, Lambert TW. Views of junior doctors about whether their medical school prepared them well for work: questionnaire surveys. BMC Medical Education 2010; 10:78. • Wall D, Bolshaw A, Carolan J. From undergraduate medical education to pre-registration house officer year: How prepared are students? Medical Teacher 2006; 28(5):435-439. • Jones A, McArdle P, O’Neill PA. How well prepared are graduates for the role of pre-registration house officer? A comparison of the perceptions of new graduates and educational supervisors. Med Ed 2001; 35(6):578-584. • Brennan N, Corrigan O, Allard J, Archer J, Barnes R, Bleakley A, Collett T, Regan de Bere S. The transition from medical student to junior doctor: today’s experiences of tomorrow’s doctors. Med Ed 2010; 44:449-458. • Newbury-Birch D, Kamali F. Psychological stress, anxiety, depression, job satisfaction, and personality characteristics in preregistration house officers. Postgrad Med J 2001; 77:109-111. • Van Hamel C, Jenner LE. Levels of anxiety and preparedness for work in the F1 2011 cohort: results of a national survey. Clinical Tutor 2012; 17(3):12-16. • AylinP, AzeemMajeed F. The killing season- fact or fiction? BMJ 1994; 309:1690. • BlencoweN, Moore A, Aspinall R. Improving the quality of patient care during the transition between passing medical school finals and the first night shift. Poster accessible via http://internationalforum.bmj.com/2010. • Jen MH, Bottle A, Majeed A, Bell D, Aylin P. Early in-hospital mortality following trainee doctors’ first day at work. PLoS ONE 4(9): e7103.doi:10.1371/journal/pone.0007103 • Evans DE, Wood DF, Roberts CM. The effect of an extended hospital induction on perceived confidence and assessed clinical skills of newly qualified pre-registration house officers. Med Ed 2004; 38:998-1001. • Kumar M, Furguson K. Survey of causes of stress and anxiety in junior doctors. Presented at the International Association for Medical Education conference. Lyon, France, 2012. • SnaithRP, Bridge GW, Hamilton M. The Leeds scales for the self-assessment of anxiety and depression. The British Journal of Psychiatry 1976; 128:156–65.