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House Officers (house + officer)

Distribution by Scientific Domains

Medical Sciences	100%

Kinds of House Officers

senior house officer

Selected Abstracts

Senior house officers' experience of a six month post in a hospice

MEDICAL EDUCATION, Issue 1 2002
M Lloyd Williams
Background Hospices provide care for patients with a terminal prognosis , a very small number of hospices employ Senior House Officers. Method A survey was carried out to determine the experiences of SHOs working in hospices and their perceptions of the learning opportunities available. Perceived stress was measured by a Visual Analogue scale and psychological distress by the GHQ 12. Results Of the 38 posts identified 23 SHOs (60%) responded and the majority had qualified during the last five years. Formal teaching was limited, but experiential teaching was very positively described. Many SHOs described their posts as stressful and cited staff conflict and caring for young patients as particularly stressful. Median stress scores as measured on the VAS was 55 mm (range 0,98 mm). Five respondents 22% scored for identifiable psychological distress on the GHQ 12. Conclusion Conclusions include the need to acknowledge the important learning opportunities provided within hospices but also the need for consultant staff to be aware of the sources of stress for SHOs and their need for support. [source]

Toward a more efficient and effective neurologic examination for the 21st century,

EUROPEAN JOURNAL OF NEUROLOGY, Issue 12 2005
T. H. Glick
Practice pressures and quality improvement require greater efficiency and effectiveness in the neurologic examination. I hypothesized that certain ,marginal' elements of the examination rarely add value and that ,core' elements, exemplified by the plantar response (Babinski), are too often poorly performed or interpreted. I analyzed 100 published, neurologic clinicopathologic conferences (CPCs) and 180 ambulatory neurologic consultations regarding 13 hypothetically ,marginal' examination components (including ,frontal' reflexes, olfaction, jaw strength, corneal reflex, etc.); also, 120 exams on medical inpatients with neurologic problems, recording definitive errors. I surveyed the recalled practices of 24 non-neurologists and reviewed the literature for relevant data or guidance. In the CPCs the ,marginal' elements of the examination were rarely provided, requested, or used diagnostically, nor did they contribute in the 180 ambulatory consultations. In the chart review errors and omissions dominated testing of plantar responses, with missed Babinski signs in 14% of all cases and 77% of patients with Babinski signs. House officers harbored unrealistic expectations for performance of ,marginal' examination elements. Most textbooks omit detailed guidance (and none cite evidence) on achieving greater efficiency. Exams should be streamlined, while improving ,core' skills. Neurologists should apply evidence to update the exam taught to students and non-neurologists. [source]

Using job analysis to identify core and specific competencies: implications for selection and recruitment

MEDICAL EDUCATION, Issue 12 2008
Fiona Patterson
Objective, Modern postgraduate medical training requires both accurate and reliable selection procedures. An essential first step is to conduct detailed job analysis studies. This paper reports data on a series of job analyses to develop a competency model for three secondary care specialties (anaesthesia, obstetrics and gynaecology, and paediatrics). Methods, Three independent job analysis studies were conducted. The content validity of the resulting competency domains was tested using a questionnaire-based study with specialty trainees (specialist registrars [SpRs]) and consultants drawn from the three specialties. Job analysis was carried out in the Yorkshire and the Humber region in the UK. The validation study was administered with additional participants from the West Midlands and Trent regions in the UK. This was an exploratory study. The outcome is a set of competency domains with data on their importance at senior house officer, SpR and consultant grade in each specialty. Results, The study produced a model comprising 14 general competency domains that were common to all the three specialties. However, there were significant between-specialty differences in both definitions of domains and the ratings of importance attached to them. Conclusions, The results indicate that a wide range of attributes beyond clinical knowledge and academic achievement need to be considered in order to ensure doctors train and work within a specialty for which they have a particular aptitude. This has significant implications for developing selection criteria for specialty training. Future research should explore the content validity of these competency domains in other secondary care specialties. [source]

How reliable is contact endoscopy of the nasopharynx in patients with nasopharyngeal cancer?

THE LARYNGOSCOPE, Issue 3 2009
Martin Wai Pak FRCS Ed (ORL)
Abstract Objectives/Hypothesis: To evaluate diagnostic reliability of contact rhinoscopy in patients with nasopharyngeal carcinoma. Study Design: A cross-sectional randomized single-blinded study was carried out to evaluate the reliability of the findings of contact rhinoscopy in patients with nasopharyngeal carcinoma assessed by different observers. Methods: Random images of contact endoscopy of 157 subjects including normal patients and patients with nasopharyngeal carcinoma, both prior to external beam radiation therapy (RT), the non-RT group, and after external beam radiation therapy, the post-RT group, were available for analysis. Three independent observers of varying clinical experience and histopathologic knowledge viewed the images and made a diagnosis for each image. The diagnosis of each image was correlated with the histology of the biopsy from the corresponding patient. Results: In the non-RT group, Kappa values for inter- and intraobserver reliability to differentiate normal epithelium from primary nasopharyngeal carcinoma were 0.894, 1.000, 0.794 and 0.694, 1.000, 0.776 for the house officer, radiologist, and pathologist, respectively. There were no significant differences in interobserver and intraobserver reliabilities between the assessors. In the post-RT group, Kappa values for the inter- and intraobserver reliability to diagnose recurrent carcinoma or atypia, squamous metaplasia, and radiation change for the three observers were 0.820, 0.718, 0.775 and 0.731, 0.622, 0.734, respectively. There were no significant differences in interobserver and intraobserver reliabilities between the assessors. Conclusions: The clinical diagnosis of nasopharyngeal carcinoma by contact endoscopy is highly reliable and is not dependent on the clinical experience or knowledge of histopathology of the observers. Laryngoscope, 119:523,527, 2009 [source]

A 3-year study of medication incidents in an acute general hospital

JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 2 2008
L. Song MPhil
Summary Background and objective:, Inappropriate medication use may harm patients. We analysed medication incident reports (MIRs) as part of the feedback loop for quality assurance. Methods:, From all MIRs in a university-affiliated acute general hospital in Hong Kong in the period January 2004,December 2006, we analysed the time, nature, source and severity of medication errors. Results:, There were 1278 MIRs with 36 (range 15,107) MIRs per month on average. The number of MIRs fell from 649 in 2004, to 353 in 2005, and to 276 in 2006. The most common type was wrong strength/dosage (36·5%), followed by wrong drug (16·7%), wrong frequency (7·7%), wrong formulation (7·0%), wrong patient (6·9%) and wrong instruction (3·1%). 60·9%, 53·7% and 84·0% of MIRs arose from handwritten prescription (HP) rather than the computerized medication order entry in 2004, 2005 and 2006 respectively. In 43·1% of MIRs, preregistration house officers were involved. Most errors (80·2%) were detected before any drug was wrongly administered. The medications were administered in 212 cases (19·7%), which resulted in an untoward effect in nine cases (0·8%). Conclusions:, The most common errors were wrong dosage and wrong drug. Many incidents involved preregistration house officers and HPs. Our computerized systems appeared to reduce medication incidents. [source]

Multiple mini-interviews: opinions of candidates and interviewers

MEDICAL EDUCATION, Issue 2 2008
Sarah Humphrey
Objectives, To assess candidates' and interviewers' perceptions of the use of a multiple mini-interview (MMI) for selection of senior house officers (SHOs) to a UK regional paediatric training programme. Methods, Both candidates and interviewers completed anonymous questionnaires (comprising 16 and 25 questions, respectively). Demographic data were recorded for both groups. Data were analysed by frequencies; using Mann,Whitney and Kruskall,Wallis tests for comparisons; and Cronbach's alpha for internal consistency within the data. Results, Both candidates and interviewers were positive about the fairness of the MMI (mean scores of 4.0 and 4.4, respectively). The majority of candidates (83%) had not been to this type of interview before. Gender, age and previous experience of MMIs did not account for differences in candidate responses (P > 0.05). A total of 86% of candidates were international medical graduates who preferred the format more than UK graduates did (P = 0.01). Interviewers were mainly experienced consultants who agreed that the multi-station format was better than the traditional interview (mean score 4.8) and represented a reliable process (mean score 4.4). Interviewers were concerned about the range of competencies covered and the subsequent performance of candidates in post (mean scores 3.6 and 3.2, respectively). Conclusions, Both candidates and interviewers agreed that the MMI format was reliable, fair and asked appropriate, easy-to-understand questions. In high-stakes interviews such as for specialty training in Modernising Medical Careers programmes, it is vital that all concerned have confidence in the selection process. [source]

Becoming a new doctor: a learning or survival exercise?

MEDICAL EDUCATION, Issue 7 2007
Jeremy Brown
Objective, This study set out to establish why some new doctors view their training as a valuable period in their professional development, whereas others see it as a year to be endured and survived. Methods, This multi-method case study focused on the interaction of key participants within 1 deanery, sampling the 237 pre-registration house officers (PRHOs) and 166 educational supervisors populating the associated 12 National Health Service trusts at the time (2001). The design of the case study was predicated on gathering the views of both teachers and learners in a way that allowed each stage of the data collection process to inform and influence the next phase. Results, Lack of formal guidance and support were common characteristics associated with the first few days in post. The first day in post as a doctor is, for most, an experience that is hard to prepare for, even after a useful induction period. Those PRHOs who felt they were not guided or advised on how to undertake their new professional responsibilities tended to feel undervalued and under-recognised as individuals. Conclusions, Without the support of senior colleagues who can help the new doctor reflect on quite difficult and uncertain situations, new doctors will almost certainly perceive the first year of the new Foundation Programme as a survival exercise. If new doctors are working in an environment where their learning is properly facilitated, they are more likely to recognise their progress in their professional development and be more proactive in addressing concerns about professional expectations. [source]

Doctors' views about their first postgraduate year in UK medical practice: house officers in 2003

MEDICAL EDUCATION, Issue 11 2006
Trevor W Lambert
Aim, To report house officers' views in 2003 of their first postgraduate year, and to compare their responses with those of house officers 2 and 3 years previously. Methods, Postal questionnaires to all house officers in 2003 who graduated from UK medical schools in 2002. Results, The response rate was 65.3% (2778/4257). The house officers of 2003 enjoyed the year more than those of 2000,1. A total of 78% of respondents in 2003 scored 7,10 in reply to the question ,How much have you enjoyed the house officer year overall?', scored from 0 (no enjoyment) to 10 (enjoyed it greatly), compared with 70% of 2000,1 house officers. They were more satisfied with leisure time available to them (51% scoring 6,10 in 2003; 35% in 2000,1). There were significant improvements in almost every aspect of doctors' experience. Hospital medical posts were rated more highly than surgical posts, and general practice posts higher still. Overall, 38% of respondents regarded their training as having been of a high standard, and 37% felt that they received constructive feedback on their performance. Differences between men and women in their views about their jobs were small. Discussion, The house officers of 2003 reported more positively on their experiences than did those of 2000,1. Although a substantial percentage were negative about specific aspects of clinical support and training, particularly in surgical posts, almost all the responses covering training and clinical support moved in a favourable direction over time. [source]

Effect of the undergraduate curriculum on the preparedness of pre-registration house officers

MEDICAL EDUCATION, Issue 12 2003
Jill Morrison
No abstract is available for this article. [source]

Does a new undergraduate curriculum based on Tomorrow's Doctors prepare house officers better for their first post?

MEDICAL EDUCATION, Issue 12 2003
A qualitative study of the views of pre-registration house officers using critical incidents
Introduction, In 1994 Manchester University introduced an integrated undergraduate medical course using problem-based learning (PBL) throughout. The study reported here explored whether there were any differences between the new course graduates (NCGs) and the traditional course graduates (TCGs) in the types of scenarios they recalled as ,critical incidents', or challenging cases, while working as pre-registration house officers (PRHOs). The focus is on differences rather than causal links. Method, We used semistructured interviews to generate our data. Twenty-four traditional course graduates and 23 new course graduates were interviewed approximately 3 months after starting their first PRHO placement. Results, We identified 4 types of critical incidents relating to: clinical practice; limitations of competence; emotional involvement; and communication. Traditional course graduates reported difficulties in making patient management decisions, whereas the NCGs were better at dealing with uncertainty, knowing their limits and asserting their rights for support. Communication difficulties and coping with emotional involvement were common across both groups of graduates and hence remain problems in relation to being prepared for the role of a PRHO. Conclusions, Graduates of the new, integrated curriculum seemed to be much better at dealing with uncertainty, knowing their personal limits and asserting their rights for support when they felt these limits had been reached. Communication difficulties and emotional involvement remain major factors in the transition from student to PRHO. [source]

Sci45: the development of a specialty choice inventory

MEDICAL EDUCATION, Issue 7 2002
Rodney Gale
Objective, To devise a valid career selection instrument to help doctors in training choose from a range of specialties that match their attributes and aspirations and to help selection interviewers focus on the key issues pertaining to the suitability of candidates for particular training opportunities. Design, A psychometric instrument of 130 4-response choice items was developed to match individual personal and professional preferences to possible career specialty choices. The development process involved semi-structured interviews with consultants in 35 specialties, a national postal survey of consultants in 45 specialties, factor analysis of the results, design of the pilot instruments, testing on 450 senior house officers (doctors in basic specialist training within 2,5 years of leaving medical school), and further item analysis to derive the final instrument. A scoring system and software were developed to indicate the best and worst fit specialties for the respondent. Participants, The participants were hospital consultants, general practitioners and senior house officers (SHOs) in basic specialist training. Outcome measure, The successful construction of a valid and accessible career choice instrument (Specialty Choice Inventory/Sci45). Conclusions This project has yielded a psychometrically valid computer- or paper-based instrument that can be used by doctors at any stage of training to assist in career choice. It can be used as part of the selection process, for careers guidance, for analysis of career problems, for research or to validate a particular range of career options. [source]

Making and sharing decisions about management with patients: the views and experiences of pre-registration house officers in general practice and hospital

MEDICAL EDUCATION, Issue 1 2002
J E Thistlethwaite
Objectives To explore the views and experiences of pre-registration house officers (PRHOs) in general practice and hospital settings regarding the concept of patient partnership and their experience of involving patients in management decisions. Design The 12 PRHOs who had graduated from British universities and who were working within the Yorkshire Deanery were interviewed towards the end of their four-month general practice attachments. The interviews were semi-structured and analysed qualitatively. Results Three major themes emerged. The PRHOs perceived differences in approach between consultations carried out in hospital and primary care settings, with general practitioners being more likely to share information and decisions with patients. As medical students, the PRHOs had little opportunity to practise sharing information and management decisions with patients, and variable experience of this after graduation. On the whole they were favourable to the concept of patient partnership. Conclusions Medical students and PRHOs lack training and opportunities to decide on management and discuss this with patients and yet, particularly in general practice settings, they have to practise these skills. The PRHOs had begun to develop strategies to decide how much information to give to patients and to what extent to involve patients in management decisions. This is an area that needs further consideration when planning both undergraduate and postgraduate medical education. [source]

Surgical skills training: simulation and multimedia combined

MEDICAL EDUCATION, Issue 9 2001
Roger Kneebone
Context Basic surgical skills are needed throughout the medical profession, but current training is haphazard and unpredictable. There is increasing pressure to provide transparency about training and performance standards. There is a clear need for inexperienced learners to build a framework of basic skills before carrying out surgical procedures on patients. Effective learning of a skill requires sustained deliberate practice within a cognitive framework, and simulation offers an opportunity for safe preparation. Objectives This paper presents a new approach to basic surgical skills training, where tuition using a specially designed computer program is combined with structured practice using simulated tissue models. This approach to teaching has evolved from practical experience with surgical skills training in workshops. Methods Pilot studies with 72 first-year medical students highlighted the need for separate programs for teaching and for self-directed learning. The authors developed a training approach in the light of this experience. Subsequent in-depth observational and interview studies examined (a) individual teaching sessions between surgical teachers and learners (five consultant surgeons and five senior house officers) and (b) group teaching sessions with general practitioners (14 participants in three group interviews). Further work has resulted in a self-directed learning program. Conclusions Qualitative analysis of observational and interview data provides strong preliminary support for the effectiveness of this approach. The response of teachers and learners was extremely positive. The combination of information (presented by computer) and practice of psychomotor skill (using simulated tissue models) could be extended to other surgical and practical skills. [source]

A study of pre-registration house officers' clinical skills

MEDICAL EDUCATION, Issue 12 2000
R A Fox
Background Little is known about the ability of pre-registration house officers (PRHOs) to perform basic clinical skills just prior to entering the medical register. Objectives To find out whether PRHOs have deficiencies in basic clinical skills and to determine if the PRHOs themselves or their consultants are aware of them. Method All 40 PRHOs at the Chelsea and Westminster and Whittington Hospitals were invited to undertake a 17 station OSCE of basic clinical skills. Each station was marked by one examiner completing an overall global score after completing an itemised checklist. An adequate station performance was the acquisition of a pass/borderline pass grade. Prior to the OSCE, a questionnaire was given to each PRHO asking them to rate their own abilities (on a 5-point scale) in the skills tested. A similar questionnaire was sent to the educational supervisors of each PRHO asking them to rate their house officer's ability in each of the same skills. Results Twenty-two PRHOs participated. Each PRHO failed to perform adequately a mean of 2·4 OSCE stations (SD 1·8, range 1,8). There were no significant correlations between OSCE performance and either self- or educational supervisor ratings. The supervisor felt unable to give an opinion on PRHO abilities in 18% of the skills assessed. Discussion This study suggests that PRHOs may have deficiencies in basic clinical skills at the time they enter the medical register. Neither the PRHOs themselves nor their consultants identified these deficiencies. A large regional study with sufficient power is required to explore the generalizability of these concerns in more detail. [source]

Defining the content for the objective structured clinical examination component of the Professional and Linguistic Assessments Board examination: development of a blueprint

MEDICAL EDUCATION, Issue 7 2000
Philip Tombleson
Introduction We describe the steps taken to develop an appropriate list of ,clinical problems' used to define the content of the objective structured clinical examination (OSCE) component of the Professional and Linguistic Assessments Board (PLAB) examination. Method A blueprint and list of 255 clinical problems was compiled by reviewing PLAB questions, published curricula of the UK Royal Colleges and other sources such as the General Medical Council's own guidelines. This list was sent to a random sample of 251 successful PLAB candidates who were asked to rate the clinical problems using a scale of ,seen frequently/seldom/never' and to 120 members of the accident and emergency (A&E) specialists' association who were asked to identify ,important' tasks. The list was further validated using activity data obtained for consecutive A&E attendances (934) and admissions (6130) at three hospitals. Results After two mailings, 131/251 (52%) former PLAB candidates and 89/120 (74%) A&E specialists replied. All of the 255 clinical problems were seen by some former candidates and were felt to be important by some A&E specialists. Of the 255 problems, 40 were neither rated as important nor as seen frequently/seldom by over 50% of respondents. The 255 clinical problems covered a mean 94% consecutive A&E attendances and 97·6% reasons for hospital admission. The correlation between clinical problems that were frequently encountered and those felt to be important was rho=0·38 (P < 0·01). Conclusion The clinical problems appear to be appropriate for defining the content of the PLAB OSCE. We suggest that our problem list is useful in that all the problems are seen by some senior house officers, are felt to be important by some A&E specialists and cover greater than or equal to 94% of the conditions for which patients both attend and are admitted from casualty. The correlation between clinical task importance and the frequency that they were seen was only moderate, partly reflecting the relative seriousness of some uncommon medical conditions, which should not be missed on clinical assessment. The content of the OSCE component of the PLAB examination is being reviewed in the light of the findings of this study. The limitations of the study are discussed. [source]

ORIGINAL ARTICLE: Accuracy of surface landmark identification for cannula cricothyroidotomy

ANAESTHESIA, Issue 9 2010
D. S. J. Elliott
Summary Cannula cricothyroidotomy is recommended for emergency transtracheal ventilation by all current airway guidelines. Success with this technique depends on the accurate and rapid identification of percutaneous anatomical landmarks. Six healthy subjects underwent neck ultrasound to delineate the borders of the cricothyroid membrane. The midline and bisecting transverse planes through the membrane were marked with an invisible ink pen which could be revealed with an ultraviolet light. Eighteen anaesthetists were then invited to mark an entry point for cricothyroid membrane puncture. Only 32 (30%) attempts by anaesthetists accurately marked the skin area over the cricothyroid membrane. Of these only 11 (10%) marked over the centre point of the membrane. Entry point accuracy was not significantly affected by subjects' weight, height, body mass index, neck circumference or cricothyroid dimensions. Consultant and registrar anaesthetists were significantly more accurate than senior house officers at correctly identifying the cricothyroid membrane. Accuracy of percutaneously identifying the cricothyroid membrane was poor. Ultrasound may assist in identifying anatomical landmarks for cricothyroidotomy. [source]

Effects of the European Working Time Directive on anaesthetic training in the United Kingdom

ANAESTHESIA, Issue 8 2004
D. J. Sim
Summary Decreases in the hours worked by trainee anaesthetists are being brought about by both the New Deal for Trainees and the European Working Time Directive. Anticipated improvements in health and safety achieved by a decrease in hours will be at the expense of training time if the amount of night-time work remains constant. This audit examined the effects of a change from a partial to a full shift system on a cohort of trainee anaesthetists working in a large district general hospital in the South-west of England. Logbook and list analyses were performed for two 10-week periods: one before and one after the decrease in hours. An 18% decrease in the number of cases done and an 11% decrease in the number of weekly training lists were found for specialist registrars. A 22% decrease in the number of cases done and a 14% decrease in the number of weekly training lists were found for senior house officers. Furthermore, a decrease of one service list per specialist registrar per week was seen, which will have implications for consultant manpower requirements. [source]

Supervision of trainee anaesthetists: a survey of opinions and practices

ANAESTHESIA, Issue 1 2002
J. Kerr
This questionnaire survey investigated the different degrees of supervision of trainee anaesthetic senior house officers (SHOs) in hospitals across the United Kingdom, and compared it with past practices as well as with The Royal College of Anaesthetists' recommendations at that time. It is apparent that the duration of intensive supervision of new anaesthetic trainees has increased over the last 25 years. This study assesses these changes in order to evaluate whether or not these reforms have achieved their intended outcomes. [source]