Future hospital journal最新文献

Background: High profile cases continue to demonstrate failures to raise concerns with detrimental effects on patient safety. This research sought to establish what educational support junior doctors needed to effectively raise clinical and professional concerns.

Study design: A qualitative study with 16 participants taking part in three focus groups. The transcripts were thematically analysed.

Results: All the data could be coded into four themes: past experiences of teaching; suggested teaching; reporting mechanisms and educational challenges. Most participants were dissatisfied with the teaching they had received on raising concerns. Current systems were thought to be good for raising patient safety issues but not for concerns about professional behaviour of healthcare staff.

Conclusions: There is a need for improved education to tackle the way this is taught in postgraduate curricula. Frequent rotations and a lack of meaningful relationships left junior doctors feeling less invested in improving organisational culture. Junior doctors are apprehensive about raising concerns because of personal risk to their career trajectory.

While we will all have personal experience of losing, the increasing use of awards has raised concerns that the beneficial effects both of winning and of losing may be diluted. I will explore background concepts of both winning and losing, considering the potential advantages of awards when delivered via a competitive and just structure. Great advantages can come from losing, which are often more significant than those obtained merely through winning. I illustrate this point with my own background and that of the distance learning clinical neurology course that I help run at Queen Square. Finally, I use the example of our course as a way that some challenges currently facing medicine in the matter of neurology numbers can be tackled.

Physician associates (PAs) are a relatively new medical professional group working as part of the multidisciplinary team to deliver patient care. This article aims to look at how PAs can work effectively in teams, highlighting the benefits and current working practices of PAs across the NHS and address the concerns and challenges raised.

Medical training in the UK provides limited exposure to formal training in leadership and management, and yet the role of a consultant or general practitioner requires such skills which deal with commissioning arrangements, service transformation, quality improvement, Care Quality Commission visits, complaints and supervision of junior colleagues. A number of clinical fellowships in leadership now exist to bridge this gap, and provide training in leadership and management, together with experiential learning in a complex organisation. Well-established leadership schemes suited to junior doctors include the National Medical Director's Clinical Fellow Scheme, the Royal College of Physicians' chief registrar scheme, the Darzi Fellowship scheme and local schemes run by Health Education England. Here we describe and compare our experience of these schemes, and outline what junior doctors should consider when applying for a clinical fellowship.

[This corrects the article on p. 90 in vol. 6.].

The Shape of Training review and the General Medical Council (GMC) requirements in demonstrating generic professional capabilities were major drivers for the Joint Royal Colleges of Physicians Training Board (JRCPTB) to develop the new internal medicine curriculum. In particular, the GMC required progression to a more outcomes-based curriculum. The present curricula for physician training are based on demonstrating a large number of individual competencies that are assessed by a variety of different methods. It was felt that current system was overwhelming and had become a 'tick box' exercise. The new curriculum is based on a much smaller number of outcomes, called capabilities in practice, which reflect the key professional work activities of a fully trained physician. The aim is to re-emphasise the role of professional judgement in 'trusting' the work a trainee does and thus make assessment more realistic and meaningful for both trainees and trainers. The proof of concept study explored the feasibility of using this outcomes-based model of assessment in a UK NHS setting. The learning from the study has enabled us to make significant changes to the internal medicine curriculum. The GMC has recently approved the curriculum and the JRCPTB is implementing the programme from August 2019.

[This corrects the article on p. 85 in vol. 6.].

At a time of competing demands on the National HealthService (NHS), systematic consultant job planning is necessary to ensure that limited resources are being used productively, especially with the prospect of expanded 7-day services. Based on a presentation to the Royal College of Physicians Annual Conference in March 2016, a broad overview of job planning is presented, together with more specific examples relating to acute medicine and gastroenterology/general medicine.

Delivering safe, high-quality patient care is dependent on high-quality clinical leadership. The General Medical Council has outlined the capabilities expected to be achieved through the medical curricula leading to full registration and Certificate of Completion of Training but our training programmes are not yet consistent on how the capabilities are best acquired. Trainees can begin by understanding their own strengths and reflecting on how they interact in the team; trainers can use existing opportunities to enable greater and more specific learning on how to lead across all the opportunities available during routine clinical activity. Some trainees may wish to expand on their leadership portfolio through national and local fellowships; however, all doctors need to understand how to lead in different situations to ensure the safest possible patient care.