Emergency Medicine at St Vincentʼs Hospital, Australia
Objective: To ascertain whether Junior Medical Officer clinical note taking in the Emergency Department meets the standards required of New South Wales Health
Methods: One week worth of clinical entries were compared against a checklist adapted from New South Wales health documentation policy before and after an intervention.
Results: Substantial numbers of entries written by Junior Doctors were missing key information, specifically adequate timing of entries (36%), differential diagnoses (35%), Results of investigations (32%) and Addendums (18%). There was at least 50% improvement in these shortcomings post intervention.
Conclusion: There were consistent shortcomings in documentation standards amongst ED Junior Medical Officers prior to intervention. Results of this closed loop audit have shown this could easily be improved with simple interventions highlighting the importance of documentation standards in either a medical school or induction setting.
Bruce Alexander Hay MBChB(Edinb.) BSc (Sports Med) is a Senior Resident in Emergency Medicine at St Vincentʼs Hospital, Sydney, Australia.
He undertook his undergraduate studies at Edinburgh Medical School, Scotland attaining a Bachelor of Science degree in Sports Science Medicine in 2014 followed by his Bachelor of Medicine and Bachelor of Surgery in 2017.
He subsequently completed his foundation training in Glasgow, Scotland with affiliation to the Glasgow Royal Infirmary and University Hospital Monklands.
He has an interest in Trauma and Orthopaedics and is in the process of completing an application for UK surgical training cohort in August 2021.
University of Exeter Medical School, UK
Introduction: There is evidence to suggest inadequate preparation for acute care within the undergraduate medical curriculum. Whilst previous attempts have been made to address this concern, a lack of formal evaluation of intervention effectiveness limits their utility. This review aimed to identify educational interventions seeking to prepare medical students for acute care and evaluate their effectiveness.
Methods: MEDLINE, CENTRAL, Embase, Scopus and Web of Science were systematically searched. Primary research studies published between 2000-2020 and reporting changes in outcomes related to medical student preparation for acute care were included. A modified version of a standardized approach was used to determine intervention effectiveness. Study quality was appraised using the Medical Education Research Study Quality Instrument (MERSQI). Studies with a MERSQI score of ≥14 were classed as high-quality.
Results: Overall, 72 studies were included in this review. The majority were single group pre and post-test studies (n=39, 54.2%) and none measured changes in student behavior nor patient/healthcare outcomes. Courses, clerkships and simulation were found to be the most effective of the interventions identified. Clerkships were the most successful at improving acute care skills. Mean MERSQI score was 12.4 (range=7.8-15.5, SD=1.7) and 18 studies (25%) were classed as high-quality.
Conclusion: This review favors the use of clerkships, as well as courses and simulation. However, considerable heterogeneity and numerous study limitations prevent firm conclusions from being drawn. Future high-quality studies, especially those measuring behavioral changes and patient/healthcare outcomes, are subsequently needed. Reviews with a more focused area of research and those assessing long-term outcomes would additionally prove beneficial.
Haider Merchant is currently a final year medical student at the University of Exeter. He had developed an interest in medical education, which led me to completing an intercalated Masters in Clinical Education last academic year. He had particularly become interested in improving undergraduate preparedness for practice. Hence, He completed this research as part of the dissertation component of the Masters degree. He hope to undertake further academic training in medical education and subsequently undertake an Academic Clinical Fellowship as part of my further specialty training. He also hope to complete either a PhD or MD in medical education.
Prince of Wales Hospital, Australia
Objective: To evaluate documentation in patients presenting with burn wounds and the appropriateness of referral to a specialist burns centre.
Methods: Documentation from patients presenting with burns to an Emergency Department in Sydney was audited from May and June 2020. Criteria provided by the State Agency for Clinical Innovation are used to ascertain whether a patient requires referral to a specialist burn unit. These include: the burn location, total body surface area (TBSA), and depth. The data was analysed to decide whether referral to a specialist burns centre was required and if a referral was made.
Results: Data from 47 patients was collected, 36 of whom met inclusion criteria. 11 (21%) of patients had their TBSA documented, and 29 (81%) of patients had the depth of their burn documented. 31 (86%) of patients met referral criteria, 12 (33%) of patients were referred by clinicians.
Conclusion: The majority of patients did not have their TBSA documented in the medical notes, although a description of the burn was often given. Often patients met referral criteria due to the location of their burns, with most being on their hands. They were usually small superficial burns and were managed without referral or discussion with the specialist burns centre. Despite meeting referral criteria, these patients may have been appropriately managed by ED doctors and nurse practitioners, with follow-up from patientʼs community doctors. Clinical guidelines should be used in conjunction with clinical judgement to decide whether referral to a tertiary centre is required.
Rajeev Ram Graduated with Bachelor of Medicine, Bachelor of Surgery Degree from the Peninsula College of Medicine and Dentistry, UK in 2017. Intercalated in Exercise & Sport Sciences at the University of Exeter, UK in 2015. Undertook 2 years of Foundation Training at University Hospitals Coventry & Warwickshire, and South Warwickshire Foundations Trusts in the UK. Currently works as a Senior Resident Medical Officer in Emergency Medicine at Prince of Wales Hospital, Sydney Australia.