Training

Acute Medicine Trainee Survey 2024

The training of Acute Physicians is crucial for future delivery of high-quality urgent care. The 2024 Acute Medicine Trainee Survey gathered 124 responses, assessing training satisfaction, challenges, and progress since the 2022 curriculum update. Most trainees (66.2%) reported satisfaction, with access to training in Point-of-Care Ultrasound (POCUS) improving (74.7% vs. 63% in 2023). Disparities in...

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Research in Acute Medicine. The results of a national survey of Society for Acute Medicine members

Background: Medical research improves patient outcomes, patient satisfaction, staff morale and retention. It is unclear what research opportunities and training staff in acute medicine had.Methods: The Society for Acute Medicine supported a survey to assess current research activity, training and perceived opportunities and barriers.Results: 292 responses were received from diverse professional backgrounds. Few respondents had...

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Becoming the medical registrar: a qualitative study of a professional transition as a transformative learning event

Background: The medical registrar is a daunting role to take on for the first time. While studies have explored how preparedness can be improved through simulation, less has been written about how doctors learn to be registrars through clinical practice.
Method: Doctors working as medical registrars were invited to participate in semi-structured interviews. The qualitative data collected underwent thematic analysis.
Results: The clinical environment was considered fertile ground for transformative experiential learning, but opportunities for debriefing and guided reflection were rare. Participants felt they needed additional support from supervisors after difficult experiences and mistakes, but this support was not always forthcoming.
Conclusion: Acute physicians involved in supervising new medical registrars must facilitate meaningful independent practice to encourage the next generation of medical generalists.

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Evaluation of a basic point-of-care ultrasound course for residents in internal medicine

Point-of-care ultrasound (POCUS) integrates imaging into the physical examination at the bedside. This offers the advantage of instant clinical information and has shown to speed up the diagnostic process, and to improve diagnostic accuracy and correct treatment.

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Developing priorities for quality improvement in acute medicine using a modified Delphi method
A consensus process hosted by the Society for Acute Medicine Quality Improvement Committee (SAM-QI)

Introduction: The SAM Quality Improvement Committee (SAM-QI), set up in 2016, has worked over the last year to determine the priority Acute Medicine QI topics. They have also discussed and put forward proposals to improve QI training for Acute Medicine professionals.
Methods: A modified Delphi process was completed over four rounds to determine priority QI topics. Online meetings were also used to develop proposals for QI training.
Results: Same Day Emergency Care (SDEC) was chosen as the priority topic for QI work within Acute Medicine.
Conclusion: The SAM-QI group settled on SDEC being the priority topic for Acute Medicine QI development. Throughout the Delphi process SAM-QI has also developed proposals for QI training that will help Acute Medicine professionals deliver coordinated meaningful improvements in care.

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Developing priorities for quality improvement in acute medicine using a modified Delphi method
A consensus process hosted by the Society for Acute Medicine Quality Improvement Committee (SAM-QI)
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Gaps in point of care ultrasound provision and the cost of ultrasound equipment provision: results of a nationwide audit of acute medical units

Introduction: Advances in ultrasound technology have allowed an investigation previously restricted to the radiology department to be used more liberally in clinical decision making. Point-of-Care-Ultrasound (PoCUS) has superior diagnostic performance to traditional clinical examination across a range of pathologies in the hands of a suitably experienced practitioner. The utilisation of PoCUS has the potential to greatly influence the delivery of acute care, but little is known about the current level of resource provision within the acute medical setting.

Methods: To establish the availability of ultrasound equipment and appropriately trained clinicians within Acute Medical Units (AMUs) in the United Kingdom (UK) we asked specific questions with an annual day of care survey, undertaken by the Society for Acute Medicine. We compared data across two years to assess interval changes.

Results: 58.1% (75/129) of AMUs had access to dedicated ultrasound equipment in SAMBA’19. This represents a small increase from SAMBA’18. Ultrasound expertise is concentrated across a small number of AMUs. Growth in the number of ultrasound trained clinicians is greatest units with established expertise.

Conclusion: The equipment to provide PoCUS is not present on all AMUs and appropriately trained clinicians are not distributed evenly across units. This is likely to affect individual AMUs ability to deliver bedside ultrasound to appropriate patients who may benefit. Bridging the gap to ensure all AMUs have the option to use PoCUS will require planning and investment.

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The appropriateness of current UK training in acute internal medicine

Doctors training in Acute Internal Medicine (AIM) need to provide evidence that they can effectively manage 20 ‘top’ and 40 ‘other important’ acute medical presentations. However, the presentations considered important in the AIM curriculum do not have an empirical evidence base. This study compared real-life presentations against those in the AIM curriculum. Data on all presentations to the acute medical service at The Royal Free Hospital, London, were collected retrospectively for five non-consecutive weeks and prospectively for one week. Five frequently encountered presentations viz: cough, nausea and vomiting, dizziness, hyperglycaemia and lethargy were not amongst those listed as ‘top’ or ‘other important’ in the AIM curriculum. Hence, demonstration of competency in these presentations is currently not an explicit requirement.

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Acute Internal Medicine Trainee Survey 2017

Introduction: Survey to ascertain views of Acute Internal Medicine trainees regarding their training programme.

Methods: Online survey circulated to higher specialty trainees (HSTs) via the Society of Acute Medicine (SAM), Training programme Directors (TPDs) and social media platforms.

Results: A total of 57 trainees participated in the survey; 43.86% trainees are either ‘happy’ or ‘very happy’ with their training, 10.53% are ‘quite unhappy’ with their training. Trainees enjoy the variety of workload and the variety of specialist exposure.

Discussion: The number of trainees who responded to this years survey was significantly lower than the previous two years. Perhaps this is because trainees feel that there is a lack of change/improvement over time and hence do not feel the need to participate in such a survey.

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Acute Internal Medicine Trainee Survey 2016

Objectives: To ascertain the views of current Acute Internal Medicine (AIM) trainees on the strengths and weakness of the specialty, their training programmes, practical procedures and the provision of training days.

Methods: Online electronic survey circulated to all Higher Specialty Trainees (HST) in AIM. Participation was voluntary and all answers confidential. A total of 108 trainees responded.

Results: There were respondents from across the United Kingdom. The majority of respondents are happy or quite happy with their training (61%), with 11% unhappy or very unhappy. The variety of workload (68%), specialty exposure (69%) and practical procedures (67%) were strengths while lack of respect from other specialties (55%) and rota gaps (59%) remain significant problems. 53% of respondents feel they are expected to cover more rota gaps than their GIM colleagues, and 54% trainees feel they do not get a session a week allocated to them for specialist skill training/admin. Only 33% of trainees expect to get dedicated leadership and/or management training during their programme, and a large proportion of trainees (78%) feel that some form of ultrasound training should be a core part of the curriculum. Despite the difficulties, 85% of respondents would recommend AIM as a specialty.

Conclusions: This survey highlights some of the positives and negatives of training in AIM, and highlights areas where potential improvements to programmes could be made. Comparison of the data with 2015 shows small improvements in a number of areas, but still some significant concerns remain. The findings were fed back to the Training Committee in March.

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A UK wide survey on attitudes to point of care ultrasound training amongst clinicians working on the Acute Medical Unit

Abstract

The use of point of care ultrasound (POCU) is increasing across a number of specialties, becoming mandatory within some specialist training programmes (for example respiratory and emergency medicine). Despite this, there are few data looking at the prevalence of use or the training clinicians have undertaken; this survey sought to address this. It shows that the majority of POCU undertaken on the Acute Medical Unit (AMU) is without formal accreditation, with significant barriers to training highlighted including a lack of supervision, time and equipment. For those who undertook POCU, it was shown to regularly speed up clinical decision making, while 76.3% respondents believed a lack of access to POCU out of hours may affect patient safety. The data provide support to the concept of developing AMU specific POCU accreditation, to ensure robust and safe use of this modality on the AMU.

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