identifying the work activities performed by doctors in the … · 2018-04-17 · the work of...

Identifying the work activities performed

by doctors in the Foundation Programme

Research conducted for the General Medical Council

Gillian Vance

Bryan Burford

Sharmila Jandial

Jon Scott

School of Medical Education

Newcastle University

Appendices to final report

September 2015

List of Appendices

Appendix A – Details of literature search ........................................................................................ A1

Appendix B – Derivation of questionnaire items from GMC-specified outcomes ........................... A3

Appendix C – Full text of Foundation Programme doctor and nurse questionnaires ................... A13

Appendix D – Guides for interviews and focus groups .................................................................. A25

Appendix E – Details of response and completion rates of questionnaires .................................. A30

Appendix F – Detailed Foundation Programme doctor sample demographics compared with

National Trainee Survey responses ................................................................................................ A32

Appendix G – Frequency of specialties reported by Foundation Programme doctor and nurse

questionnaire respondents ............................................................................................................ A34

Appendix H – Full distribution table for nurse questionnaire scale items ..................................... A36

Appendix I – Significant differences between medical and surgical placement questionnaire

responses (F1 only) ........................................................................................................................ A39

Appendix J – Example of activity prioritisation matrix ................................................................... A41

Appendix K – Full list of activities in descending order of being part of F1 or F2 work ................. A43

The Work of Foundation Programme Doctors Newcastle University

Appendices A1

Appendix A – Details of literature search

A full systematic literature review was not one of our aims in this research, but in order to place the project and its findings in a historical perspective, a structured literature search was carried out to establish whether any relevant finding exist in the wider literature.

The scope of the literature search was limited to studies that aimed explicitly to identify what newly qualified doctors and junior trainees do. Inclusion criteria were therefore: i) a focus on doctors in their first two years of postgraduate training, and ii) presentation of empirical data on actual work carried out by doctors.

Formal search query

A search was conducted of the Medline and Embase medical literature databases, using the Ovid portal.

In constructing the query, two core concepts were identified: {junior doctors} and {work}.

The first of these was relatively straightforward to expand, with a focus on early stages of postgraduate training. The more general phrases “medical education” and “medical training” were also included to increase sensitivity after preliminary searches found very few hits.

{Junior doctor} => "junior doctor?" OR "newly qualified doctor?" OR "Foundation Programme" OR FY1? OR FY2? OR "Foundation Year" OR "SHO" OR "SHOs" or "House officer?" OR Intern OR interns OR PGY1? OR PGY2? OR "newly qualified doctor?" OR "medical education" OR "medical training"

The second term was harder to define with the appropriate degree of specificity. Preliminary searches with terms such as ‘work’ or ‘skills’ were over-sensitive, returning several thousand references with few satisfying inclusion criteria. For this reason the second term was framed in terms of appropriate methodologies.

{Work} => "work study" OR "time and motion" OR "time motion" OR "work analysis" OR "job analysis" OR "activity sampl*" OR ethnograph$

The 312 records identified in this search were imported into Endnote, which identified 3 duplicates. This left 309 for further review. Review of titles against the inclusion criteria led to the rejection of 246 and closer examination of 63 papers. More detailed review of abstracts led to the rejection of a further 53, leaving a final set of 10. Figure A1 illustrates the process of filtering.

Figure A1. Schematic of literature search

312 possible papers identified in search

63 potentially relevant papers remaining

10 papers included in the review

249 papers removed following review of titles against exclusion

criteria and removal of duplicates

53 papers excluded against criteria following detailed

review of abstracts


Appendices A2

Retained references were:

Arabadzhiyska PN, Baysari MT, Walter S, Day RO & Westbrook JI. Shedding light on junior doctors’ work practices after hours. Internal Medicine Journal, 2013;43:321-1326

Block L, Habicht R, Wu AW, Desai SV, Wang K, Silva KN & Niessen T. In the wake of the 2003 and 2011 duty hours regulations, how do internal medicine interns spend their time? J Gen Intern Med, 2013;28:1042–1047.

Dijkstra IS, Pols J, Remmelts P, Bakker B, Mooij JJ, Borleffs JCC & Brand PLP. What are we preparing them for? Development of an inventory of tasks for medical, surgical and supportive specialties. Medical Teacher, 2013; 35:e1068-e1077.

Dresselhaus TR, Luck J, Wright, BC, Spragg RG, Lee ML & Bozzette SA. Analyzing the time and value of house-staff inpatient work. J Gen Intern Med, 1998;13:534-540.

Fletcher KE, Visotcky AM, Slagle JM, Tarima S, Weinger MB & Schapira MM. The composition of intern work while on Call. J Gen Intern Med, 2012;27:1432–1437

Magnussen A.R., Hedges JR, Harper RJ & Greaves P. First-postgraduate-year Resident Clinical Time Use on Three Specialty Rotations. Academic Emergency Medicine, 1999;6: 939-946

Mitchell J, Hayhurst C & Robinson SM. Can a senior house officer’s time be used more effectively? Emerg Med J, 2004;21:545-547.

Tipping MD, Forth VA, Magill DB, Englert K, Williams MV. Systematic review of time studies evaluating physicians in the hospital setting. J Hosp Med, 2010;5:353-359.

Ward DR, Ghali WA, Graham A & Lemaire JB. A real-time locating system observes physician time-motion patterns during walk-rounds: a pilot study. BMC Medical Education, 2014;14: 37

Westbrook JI, Ampt A, Kearney L & and Rob MI. All in a day's work: an observational study to quantify how and with whom doctors on hospital wards spend their time. The Medical journal of Australia, 2008;188:506-509

The search was supplemented by ancestor searching (looking at reference lists in papers found in the search) and citation searching (looking at papers which referred to those found in search).


Appendices A3

Appendix B – Derivation of questionnaire items from GMC-

specified outcomes

Tomorrow’s Doctors 2009 (TD09) was at the time of this research the primary specification of outcomes for undergraduate medical education, with those in The Trainee Doctor (TTD, specifying the outcomes for full GMC registration) being largely the same. The 15 core procedures for Foundation Programme trainees also reflect these outcomes.

Construction of questionnaire items split outcomes which contained different elements, and excluded those which were embedded in practice and so could not be judged against a frequency scale.

Grouping Outcome statement in TD09 ‘Doctor as practitioner’

Corresponding statement in TTD

Final questionnaire item

Comment on wording or exclusion

Communication with patients

13 The graduate will be able to carry out a consultation with a patient:

(a) Take and record a patient's medical history, including family and social history, talking to relatives or other carers where appropriate.

(i) obtaining an appropriate and relevant history and identifying the main findings.

Take a medical history

Take a family and social history

Take a history from relatives or carers

Separated as distinct skills

(b) Elicit patients’ questions, their understanding of their condition and treatment options, and their views, concerns, values and preferences.

Elicit a patient’s questions and understanding about their condition and treatment options

Wording simplified

(c) Perform a full physical examination.

(ii) carrying out an appropriate physical and mental health examination.

Perform a full physical examination

(d) Perform a mental-state examination.

(ii) carrying out an appropriate physical and mental health examination.

Perform a mental state examination

(e) Assess a patient’s capacity to make a particular decision in accordance with legal requirements and the GMC’s guidance.

Assess patient’s

capacity to make a decision

Wording simplified


Appendices A4





(f) Determine the extent to which patients want to be involved in decision-making about their care and treatment.

(viii) helping patients to make decisions on their immediate and longer-term care (including self care) taking into account the way the patient wants to make decisions (through shared decision-making, or by the doctor explaining the options and the patient asking the doctor to decide, or by the doctor explaining the options and the patient deciding).

Identify a patient’s preferences for involvement in decision making about their care and treatment

Help a patient to make decisions about their care, including self-care, and treatment

Two items reflecting essence of TD09 and TDD statements on elicitation of preference and supporting decision-making

(g) Provide explanation, advice, reassurance and support.

Provide explanation, advice, reassurance and support to a patient

Diagnosis and management

14 Diagnose and manage clinical presentations.

(a) Interpret findings from the history, physical examination and mental-state examination, appreciating the importance of clinical, psychological, spiritual, religious, social and cultural factors.

Interpret findings

from history and/or examination

Simplified to reflect behavioural, rather than judgemental, content

(b) Make an initial assessment of a patient's problems and a differential diagnosis. Understand the processes by which doctors make and test a differential diagnosis.

(iii) using their knowledge and taking account of relevant factors including physical, psychological and social factors to identify a possible differential diagnosis (v) establishing a differential diagnosis where possible and considering what might change this.

Make an initial assessment of a patient’s problems

Formulate a differential diagnosis

Wording simplified

(c) Formulate a plan of investigation in partnership with the patient, obtaining informed consent as an essential part of this process.

(vii) asking for patients’ informed consent (under supervision) in accordance with GMC guidance.

Formulate a plan of investigation

Obtain informed consent from patient for investigations

Separated and simplified

(d) Interpret the results of investigations, including growth charts, x-rays and the results of the diagnostic procedures in Appendix 1.

(iv) asking for and interpreting the results of appropriate investigations to confirm clinical findings in a timely manner.

Interpret the results of investigations

Performance of appendix 1 investigations measured explicitly elsewhere. Interpretation of specific investigations felt to be less important.


Appendices A5





(e) Synthesise a full assessment of the patient's problems and define the likely diagnosis or diagnoses.

Establish a problem list and likely diagnosis or diagnoses

Language modified to reflect common usage.

(f) Make clinical judgements and decisions, based on the available evidence, in conjunction with colleagues and as appropriate for the graduate’s level of training and experience. This may include situations of uncertainty.

Make clinical judgements and decisions in conjunction with colleagues

Seek advice from other health professionals in a situation of clinical uncertainty

Separated and clarified to reflect difference between making a judgement, and seeking advice.

(g) Formulate a plan for treatment, management and discharge, according to established principles and best evidence, in partnership with the patient, their carers, and other health professionals as appropriate. Respond to patients’ concerns and preferences, obtain informed consent, and respect the rights of patients to reach decisions with their doctor about their treatment and care and to refuse or limit treatment.

(vi) demonstrating knowledge of treatment options and the limits of evidence supporting them.

Formulate a plan for treatment and management

Formulate a discharge plan

Seek advice from other health professionals to formulate a plan for treatment, management and discharge

Seek professional opinion from another specialty or professional

Separated to reflect different elements of planning and seeking advice.

(h) Support patients in caring for themselves.

Subsumed into question 9 above.

(i) Identify the signs that suggest children or other vulnerable people may be suffering from abuse or neglect and know what action to take to safeguard their welfare.

Look for signs of abuse or neglect in children or vulnerable adults

Simplified and wording modified to reflect behaviour, rather than outcome.

(j) Contribute to the care of patients and their families at the end of life, including management of symptoms, practical issues of law and certification, and effective communication and teamworking.

Manage symptoms of patients at the end of life

Support families when patients at the end of life

Complete a death certificate

Simplified into behaviours.

Communication with carers

15 Communicate effectively with patients and colleagues in a medical context.


Appendices A6





(a) Communicate clearly, sensitively and effectively with patients, their relatives or other carers, and colleagues from the medical and other professions, by listening, sharing and responding.

Participate in a

multi-disciplinary clinical discussion.

Simplified to reflect core of inter-professional discussion. Patient communication dealt with elsewhere. Adverbs omitted on the grounds they are a value judgement of one’s own behaviour.

(b) Communicate clearly, sensitively and effectively with individuals and groups regardless of their age, social, cultural or ethnic backgrounds or their disabilities, including when English is not the patient’s first language.

Communicate with patients of different age groups

Communicate with a patient who does not have English as their first language.

Simplified to focus on core skills. Again, adverbs omitted.

(c) Communicate by spoken, written and electronic methods (including medical records), and be aware of other methods of communication used by patients. The graduate should appreciate the significance of non-verbal communication in the medical consultation.

(xi) keeping (or arranging for the keeping of) accurate and clear clinical records that can be understood by colleagues.

Communicate with a patient by an electronic method

Communicate with a patients by a written method

Simplified to main elements not implicit in other items.

(d) Communicate appropriately in difficult circumstances, such as when breaking bad news, and when discussing sensitive issues, such as alcohol consumption, smoking or obesity.

Break bad news to a patient

Discuss sensitive issues with a patient, such as alcohol consumption, smoking or obesity

Split into core skills

(e) Communicate appropriately with difficult or violent patients.

Communicate with

a difficult or violent patient

(f) Communicate appropriately with people with mental illness.

Communicate with

a patient presenting with a mental illness

(g) Communicate appropriately with vulnerable patients.

Communicate with a vulnerable patient

Communicate with a patient who has a disability

Specific disability question added

Emergency care 16 Provide immediate care in

medical emergencies.

(a) Assess and recognise the severity of a clinical presentation and a need for immediate emergency care.

Assess the severity

of a medical emergency

Wording simplified


Appendices A7





(b) Diagnose and manage acute medical emergencies.

Diagnose a medical emergency

Manage a medical emergency


(c) Provide basic first aid. Provide basic first

aid

(d) Provide immediate life support.

Provide immediate

life support

(e) Provide cardio-pulmonary resuscitation or direct other team members to carry out resuscitation.

Carry out cardio-pulmonary resuscitation

Direct other team members to carry out cardio-pulmonary resuscitation


Prescribing 17 Prescribe drugs safely,

effectively and economically.

(a) Establish an accurate drug history, covering both prescribed and other medication.

Take a drug history, covering prescribed and other medication, including complementary and alternative therapies

‘Accurate’ omitted as it involves a performance judgement

(b) Plan appropriate drug therapy for common indications, including pain and distress.

Plan drug therapy for common indications, including pain and distress

‘Appropriate’ omitted as it involves a performance judgement

(c) Provide a safe and legal prescription.

(ix) using medicines safely and effectively (under supervision) including giving a clear explanation to patients.

Provide a safe and legal prescription

(d) Calculate appropriate drug doses and record the outcome accurately.

Calculate and

record drug doses Wording simplified

(e) Provide patients with appropriate information about their medicines.

(ix) using medicines safely and effectively (under supervision) including giving a clear explanation to patients.

Give patients information about their medicines

(f) Access reliable information about medicines.

Access reliable

information about medicines

(g) Detect and report adverse drug reactions.

Detect an adverse drug reactions

Report an adverse drug reactions



Appendices A8





(h) Demonstrate awareness that many patients use complementary and alternative therapies, and awareness of the existence and range of these therapies, why patients use them, and how this might affect other types of treatment that patients are receiving.

Incorporated into Q46 on drug history

Performing practical procedures

18 Carry out practical procedures safely and effectively.

(a) Be able to perform a range of diagnostic procedures, as listed in Appendix 1 and measure and record the findings.

1. Measuring body temperature

Measure body

temperature

2. Measuring pulse rate and blood pressure

Measure pulse rate

Measure blood pressure

Separated as distinct tasks

3. Transcutaneous monitoring of oxygen saturation

Measure

transcutaneous oxygen saturation

4. Venepuncture Venepuncture. * Perform

venepuncture

5. Managing blood samples correctly

Omitted as mandatory requirement

6. Taking blood cultures Blood culture from peripheral sites. *

Take peripheral blood cultures

7. Measuring blood glucose Measure blood

glucose

8. Managing an electrocardiograph (ECG) monitor

Perform and interpret an ECG. *

Set up an electrocardiograph (ECG) monitor

Wording simplified

9. Performing and interpreting a 12-lead electrocardiograph

Perform a 12-lead

ECG

10. Basic respiratory function tests

Basic respiratory function tests (including peak flow)

Peak flow included as specific example from TTD

11. Urine multi dipstick test Perform a urine

multi dipstick test

12. Advising patients on how to collect a mid-stream urine specimen

Advise a patient on how to collect a mid-stream urine specimen

13. Taking nose, throat and skin swabs

Take nose, throat

and skin swabs

14. Nutritional assessment Carry out a

nutritional assessment

15. Pregnancy testing Perform a

pregnancy test


Appendices A9





(b) Be able to perform a range of therapeutic procedures, as listed in Appendix 1.

16. Administering oxygen Administer oxygen

17. Establishing peripheral intravenous access and setting up an infusion; use of infusion devices

IV cannulation.* Prepare and administer IV medications and injections.* Intravenous infusion including the prescription of fluids.* Intravenous infusion of blood and blood products.*

Perform intravenous cannulation

Administer an IV medication

Prescribe IV fluids

Set up an infusion device for IV fluids

Prescribe a blood transfusion

Wording clarified. Blood transfusion expanded upon below.

18. Making up drugs for parenteral administration

Make up a drug for

IV administration

Term changed for consistency

19. Dosage and administration of insulin and use of sliding scales

Calculate dose, prescribe route and type of insulin

Use a sliding scale for insulin


20. Subcutaneous and intramuscular injections

Injection – subcutaneous (eg insulin or LMW heparin).** Injection – intramuscular.*

Give a subcutaneous injection

Give an intramuscular injection

21. Blood transfusion

Start a blood or blood product transfusion following relevant procedures

Monitor a blood or blood product transfusion for a reaction

Treat a reaction following blood transfusion

Clarified and separated into discrete elements of process, following full description of requirement in TD09.

22. Male and female urinary catheterisation

Urethral catheterisation (male).* Urethral catheterisation (female).*

Perform urethral catheterisation (male)

Perform urethral catheterisation (female)

23. Instructing patients in the use of devices for inhaled medication

Instruct a patient in the use of devices for inhaled medication

24. Use of local anaesthetics

Injection of local anaesthetic to skin.*

Use a local anaesthetic (topical or injected)

Expanded to include topical application. SC injection is covered elsewhere.

25. Skin suturing Suture skin

26. Wound care and basic wound dressing

Carry out wound

care and basic wound dressing


Appendices A10





27. Correct techniques for 'moving and handling', including patients

Use or direct ’moving and handling’ techniques for patients or objects in the context of clinical care

Wording clarified following TD09 detail, following query in pilot.

(c) Be able to demonstrate correct practice in general aspects of practical procedures, as listed in Appendix 1.

28. Giving information about the procedure, obtaining and recording consent, and ensuring appropriate aftercare

Take informed

consent for a procedure

Wording simplified

29. Hand washing (including surgical ‘scrubbing up’)

Generic skill omitted as embedded in practice and non-negotiable.

30. Use of personal protective equipment (gloves, gowns, masks)


31. Infection control in relation to procedures

(xiii) demonstrating knowledge and application of the principles and practice of infection control to reduce the risk of cross-infection.


32. Safe disposal of clinical waste, needles and other ‘sharps’


19. Use information effectively in a medical context.

(a) Keep accurate, legible and complete clinical records.

(xi) keeping (or arranging for the keeping of) accurate and clear clinical records that can be understood by colleagues.

Maintain handwritten medical notes

Wording revised to reflect specifics of ‘legible’. Performance judgment is implicit in ‘accurate’.

(b) Make effective use of computers and other information systems, including storing and retrieving information.

Use electronic systems to retrieve patient data including results

Use electronic systems to enter patient information (eg discharge plan)

Separated and clarified to reflect input and retrieval of patient information (which will include notes)


Appendices A11





(c) Keep to the requirements of confidentiality and data protection legislation and codes of practice in all dealings with information.


(d) Access information sources and use the information in relation to patient care, health promotion, giving advice and information to patients, and research and education.

Access information (for example online, in books or journals) to support patient care, research or education

Wording clarified.

(e) Apply the principles, method and knowledge of health informatics to medical practice.

Omitted as unclear and not a defined behaviour.

TTD activities that do not correspond to practitioner outcomes in Tomorrow’s Doctors 2009

(x) demonstrating an understanding of the safety procedure involved in prescribing controlled drugs.

Been involved in the prescription of controlled drugs

Wording simplified to reflect a behavioural element

Airway care including simple adjuncts (eg Guedal airway or laryngeal masks).*

Use an airway adjunct (eg Guedal airway or laryngeal masks)

Wording made more specific.

Arterial puncture in an adult.*

Perform arterial puncture in an adult

Perform and interpret peak flow.*

Incorporated in Q addressing respiratory tests

Additional items added at GMC request

Clerk a new patient (ie take history, perform observations, order investigations) in an emergency setting (eg A&E, assessment unit)

Clerk a new patient

in a clinic setting

Clerk a new patient

in an inpatient setting

Manage a patient

with acute mental disorder


Appendices A12





Manage a patient with impaired consciousness, including seizures

Manage a patient

with sepsis

* Foundation Programme core procedure.

.


Appendices A13

Appendix C – Full text of Foundation Programme doctor and

nurse questionnaires

Questionnaires were administered via SurveyMonkey.com, with responses via radio buttons, pop-up menus and free text boxes.

Formatting and page breaks are not reproduced below, but the text and question numbering are as used in the online questionnaires.

C1. Questionnaire for Foundation Programme doctors

The GMC has commissioned Newcastle University School of Medical Education to carry out research to look at what activities are routinely carried out by Foundation Programme doctors.

If you would like to know more about the project before completing this questionnaire, you can view an information sheet here (opens in a new window).

A letter of endorsement from the GMC can be viewed here (opens in a new window).

All data are completely confidential and will be used only by the research team at Newcastle University: www.ncl.ac.uk/sme/research/mbbs (opens in a new window)

Before continuing, please indicate whether you are in Foundation Year 1, or Foundation Year 2.

1. Before continuing, please indicate whether you are in Foundation Year 1, or Foundation Year 2.

Foundation Year 1 Foundation Year 2

2. Which Foundation School are you based in? [Pop up list] 3. Are you on the Academic Foundation Programme?

Yes No

4. Which clinical area you have been mainly working in over the last FOUR WEEKS?

If you have been working in more than one area, for example on daytime shifts and on-calls, please enter your primary daytime location - you can enter your on call specialty in Q5 below.

[Pop-up list with options as below]

General practice

Medicine: General (internal) medicine

Medicine: Acute internal medicine

Medicine: Anaesthetics

Medicine: Cardiology

Medicine: Clinical radiology

Medicine: Emergency medicine

Medicine: Endocrinology and diabetes

Medicine: Gastro-enterology

Medicine: Sexual health/Genito-urinary

medicine

Medicine: Geriatric medicine

Medicine: Infectious Diseases

Medicine: Intensive care medicine

Medicine: Neurology

Medicine: Rehabilitation medicine

Medicine: Renal medicine

Medicine: Respiratory medicine

Medicine: Rheumatology

Medicine: Other Medical specialty

Psychiatry

Paediatrics: Medicine

Paediatrics: Surgery

Surgery: General surgery

Surgery: Cardio-thoracic surgery

Surgery: Neurosurgery

Surgery: Ophthalmology

Surgery: Otolaryngology

Surgery: Plastic surgery

Surgery: Trauma and orthopaedic surgery

Surgery: Urology

Surgery: Vascular surgery

Surgery: Other surgical specialty

Obstetrics and gynaecology

Please provide any more details about your current specialty [Free text]


Appendices A14

5. If you have worked on-calls in a different specialty to that given in Q4 above, please indicate which here.

[Pop-up list as Q4]

6. What shift patterns have you worked over the last four weeks? (Please tick all that apply)

Short days

Long days

Weekend days

Nights

Other on-call

Other (please specify) Please give any more detail here

7. What type of organisation have you been mainly working in over the last four weeks?

Large teaching hospital (patients are often referred for specialist care from other hospitals)

District general hospital (patients are mostly referred from general practice or A&E)

General Practice

Psychiatry: community and hospital

Psychiatry: community only

Psychiatry: hospital only

Other (please specify)

Please specify other or give any more detail here

The following pages ask how often in the last four weeks (including out of hours and on calls) you have had to perform a number of tasks which are referred to in current GMC policy (Tomorrow's Doctors and The Trainee Doctor).

8. How often have you had to perform each task in the last four weeks?

Never: I have not had to do this at all in

this placement

Rarely: Only once or

twice in this placement

Sometimes:Once or twice a week

Often: Several times a week

Constantly:Many times per shift

6. Measure body temperature 7. Measure pulse rate 8. Measure blood pressure 9. Measure transcutaneous

oxygen saturation

10. Administer oxygen 11. Measure blood glucose 12. Perform a pregnancy test 13. Set up an electrocardiograph

(ECG) monitor

14. Perform a 12-lead ECG 15. Perform basic respiratory

function tests (including peak flow)

16. Perform a urine multi dipstick test

17. Advise a patient on how to collect a mid-stream urine specimen

18. Take nose, throat and skin swabs

19. Carry out a nutritional assessment

20. Perform venepuncture 21. Take peripheral blood cultures 22. Perform intravenous

cannulation

23. Perform arterial puncture in an adult

https://www.surveymonkey.net/%E2%80%9Dhttp:/www.gmc-uk.org/education/undergraduate/tomorrows_doctors.asp%E2%80%9D

https://www.surveymonkey.net/%E2%80%9Dhttp:/www.gmc-uk.org/education/postgraduate/standards_and_guidance.asp%E2%80%9D


Appendices A15


this placement






24. Make up a drug for IV administration

25. Administer an IV medication 26. Set up an infusion device for

IV fluids

27. Give a subcutaneous injection 28. Give an intramuscular

injection

29. Use a local anaesthetic (topical or injected)

30. Start a blood or blood product transfusion following relevant procedures

31. Monitor a blood or blood product transfusion for a reaction

32. Treat a reaction following blood transfusion

33. Perform urethral catheterisation (male)

34. Perform urethral catheterisation (female)

35. Suture skin 36. Carry out wound care and

basic wound dressing

37. Use an airway adjunct (eg Guedal airway or laryngeal masks)

38. Use or direct ’moving and handling’ techniques for patients or objects in the context of clinical care

39. Look for signs of abuse or neglect in children or vulnerable adults

40. Manage symptoms of patients at the end of life

41. Support families when patients are at the end of life

42. Complete a death certificate 43. Take a drug history, covering

prescribed and other medication, including complementary and alternative therapies

44. Plan drug therapy for common indications, including pain and distress

45. Provide a safe and legal prescription

46. Prescribe a blood transfusion 47. Calculate dose, prescribe

route and type of insulin

48. Use a sliding scale for insulin 49. Prescribe IV fluids 50. Calculate and record drug

doses

51. Access reliable information about medicines


Appendices A16


this placement






52. Detect an adverse drug reaction

53. Report an adverse drug reaction

54. Be involved in the prescription of controlled drugs

55. Give patients information about their medicines

56. Instruct a patient in the use of devices for inhaled medication

57. Assess the severity of a medical emergency

58. Diagnose a medical emergency

59. Manage a medical emergency 60. Manage a patient with

impaired consciousness, including seizures

61. Manage a patient with acute mental disorder

62. Manage a patient with sepsis 63. Provide basic first aid 64. Provide immediate life

support

65. Carry out cardio-pulmonary resuscitation

66. Direct other team members to carry out cardio-pulmonary resuscitation

67. Take a medical history 68. Take a family & social history 69. Take a history from relatives

or carers

70. Perform a full physical examination

71. Perform a mental state examination

72. Interpret findings from history and/or examination

73. Make an initial assessment of a patient’s problems

74. Formulate a differential diagnosis

75. Formulate a plan of investigation

76. Obtain informed consent from patient for investigations

77. Interpret the results of investigations

78. Establish a problem list and likely diagnosis or diagnoses

79. Make clinical judgements and decisions, in conjunction with colleagues

80. Participate in a multi-disciplinary clinical discussion


Appendices A17


this placement






81. Elicit a patient’s questions & understanding about their condition and treatment options

82. Identify a patient’s preferences for involvement in decision making about their care and treatment

83. Help a patient to make decisions about their care, including self-care, and treatment

84. Provide explanation, advice, reassurance and support to a patient

85. Communicate with patients of different age groups

86. Communicate with a patient who does not have English as their first language.

87. Communicate with a patient by an electronic method (eg email)

88. Communicate with a patient by a written method (eg letter)

89. Break bad news to a patient 90. Discuss sensitive issues with a

patient, such as alcohol consumption, smoking or obesity

91. Communicate with a difficult or violent patient

92. Communicate with a patient presenting with a mental illness

93. Communicate with a vulnerable patient

94. Communicate with a patient who has a disability

95. Assess a patient’s capacity to make a decision

96. Taken informed consent for a procedure

97. Maintain handwritten medical notes

98. Formulate a plan for treatment and management

99. Formulate a discharge plan 100. Seek advice from other health

professionals in a situation of clinical uncertainty

101. Seek advice from other health professionals to formulate a plan for treatment, management and discharge

102. Seek professional opinion from another specialty or professional


Appendices A18


this placement






103. Use electronic systems to retrieve patient data including results

104. Use electronic systems to enter patient information (eg discharge plan)

105. Access information (for example online, in books or journals) to support patient care, research or education

106. Clerk a new patient (ie take history, perform observations, order investigations) in an emergency setting (eg A&E, assessment unit)

107. Clerk a new patient in a clinic setting

108. Clerk a new patient in an inpatient setting

We want to get as complete a picture as possible of what a Foundation Programme Doctor does, so on this page please list any activities not mentioned in the previous pages that you have done regularly - at least once or twice a week - over the last four weeks. Please limit your responses to things you have had direct experience of in the last four weeks.

9. Practical procedures

[free text]

10. Communication with patients, relatives or carers

[free text]

11. Communication with other professionals

[free text]

12. Administration or paperwork

[free text]

13. Finally, is there any other regular part of your job that you would like to tell us about?

[free text]

The questions on this page will allow us to see how representative respondents to this questionnaire are of the national population of Foundation Programme doctors.

14. Where did you gain your primary medical qualification?

UK

European Economic Area

Elsewhere in the world

15. Are you...

Male Female Prefer not to say


Appendices A19

16. What age group do you fall into?

20-24 25-34 35-44 Over 44

17. What is your ethnic group?

White - English/Welsh/Scottish/Northern Irish/British

White - Irish

White - Gypsy or Irish Traveller

White - Any other White background (please specify below)

Mixed/Multiple ethnic groups - White and Black Caribbean

Mixed/Multiple ethnic groups - White and Black African

Mixed/Multiple ethnic groups - White and Asian

Mixed/Multiple ethnic groups - Any other Mixed/multiple ethnic background (please specify below)

Asian/Asian British - Indian

Asian/Asian British - Pakistani

Asian/Asian British - Bangladeshi

Asian/Asian British - Chinese

Asian/Asian British - Any other Asian background (please specify below)

Black/African/Caribbean/Black British - African

Black/African/Caribbean/Black British - Caribbean

Black/African/Caribbean/Black British - Any other Black/African/Caribbean background (please specify below)

Other ethnic group - Arab

Other ethnic group - Any other ethnic group (please specify below)

Prefer not to say

Please specify any 'other' background here

18. Are your day-to-day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months?

Yes, limited a lot

Yes, limited a little

No

Prefer not to say

Invitation to a research interview

Thank you for completing the questionnaire.

In the next stage of the research we will be looking to interview a sample of doctors in April and May. This can be by

telephone, Skype or FaceTime.

If you would like to take part, please enter your details below.

We will sample respondents from all expressions of interest

We will select a random sample of expressions of interest to invite for interview, and so giving details does not

guarantee we will contact you. We will review the Foundation School and specialty given in questionnaire responses

from the IP addresses of that sample to ensure that we have a range of locations and specialties represented. At no

point will the anonymity of your individual questionnaire responses be compromised.

After the interview, your contact information will be erased.

Name

Email address


Appendices A20

C2. Questionnaire for nurses

The General Medical Council (GMC) has commissioned Newcastle University School of Medical Education to carry out research looking at what activities are routinely carried out by junior doctors on the Foundation Programme. As part of this we want to know more about the overlap between the work of Foundation Programme doctors and nursing staff.

On the following pages are a number of specific activities and procedures. For each of them, please indicate the extent to which you feel they are tasks performed mainly by a suitably qualified member of the nursing team, or mainly by Foundation Programme doctors, in your place of work.

If you would like to know more about the project before completing this questionnaire, you can view an information sheet here (opens in a new window)

All data are completely confidential and will be used only by the research team at Newcastle University:

www.ncl.ac.uk/sme/research/mbbs (opens in a new window)

1. Before continuing, please indicate whether you work regularly with Foundation Programme doctors

Yes No

2. Which clinical area do you mainly work in?

General practice

Medicine: General (internal) medicine

Medicine: Acute internal medicine

Medicine: Anaesthetics

Medicine: Cardiology

Medicine: Clinical radiology

Medicine: Emergency medicine

Medicine: Endocrinology and diabetes

Medicine: Gastro-enterology

Medicine: Sexual health/Genito-urinary

medicine

Medicine: Geriatric medicine

Medicine: Infectious Diseases

Medicine: Intensive care medicine

Medicine: Neurology

Medicine: Rehabilitation medicine

Medicine: Renal medicine

Medicine: Respiratory medicine

Medicine: Rheumatology

Medicine: Other Medical specialty

Psychiatry (including CPNs)

Paediatrics: Medicine

Paediatrics: Surgery

Surgery: General surgery

Surgery: Cardio-thoracic surgery

Surgery: Neurosurgery

Surgery: Ophthalmology

Surgery: Otolaryngology

Surgery: Plastic surgery

Surgery: Trauma and orthopaedic surgery

Surgery: Urology

Surgery: Vascular surgery

Surgery: Other surgical specialty

Obstetrics and gynaecology (community or hospital-based midwifery)

Community nursing (for example health visitors, school nurses)

Outpatients

Other

Please specify other or give more details

3. What is your grade and job role? Band 2-3 Health Care Assistant Band 4 Assistant Practitioner

Band 5 Staff Nurse / Research Nurse

Band 6 Sister / Staff Nurse / Research Nurse / Specialist Nurse / Nurse practitioner / Health Visitor

Band 7 Sister / Specialist Nurse / Nurse practitioner / Health Visitor

Band 8a Nurse Specialist / Nurse Consultant / Matron

Band 8b Nurse Consultant

4. What type of organisation do you mainly work in?

Large teaching hospital (patients are often referred for specialist care from other hospitals)

District general hospital (patients are mostly referred from General Practice or A&E)

General Practice

Psychiatry: community placement


Appendices A21

Psychiatry: hospital

Psychiatry: Community and hospital

Other (please specify) [free text]

The following pages ask about a number of tasks which are referred to in current GMC policy (Tomorrow's Doctors and The Trainee Doctor).

Please indicate whether you think each is done mainly by Foundation Programme doctors, or by nurses. Think of the nursing team as encompassing all grades of nurse, and think of the skill-mix that is usually present in your area.

If a task is not relevant to your clinical area OR is mostly done by someone else - for example, a more senior trainee (registrar) or a phlebotomist - then please select NOT APPLICABLE.

Not applicable

This is exclusively done

by Foundation Programme

doctors (with very occasional

exceptions)

This is mostly done by

Foundation Programme

doctors

This is done fairly

equally

This is mostly done by a

member of the nursing

team

This is exclusively done by a member of

the nursing team (with very

occasional exceptions)

1. Measure body temperature

2. Measure pulse rate

3. Measure blood pressure

4. Measure transcutaneous oxygen saturation

5. Administer oxygen

6. Measure blood glucose

7. Perform a pregnancy test

8. Set up an electrocardiograph (ECG) monitor

9. Perform a 12-lead ECG

10. Perform basic respiratory function tests (including peak flow)

11. Perform a urine multi dipstick test

12. Advise a patient on how to collect a mid-stream urine specimen

13. Take nose, throat and skin swabs

14. Carry out a nutritional assessment

15. Perform venepuncture

16. Take peripheral blood cultures

17. Perform intravenous cannulation

18. Perform arterial puncture in an adult

19. Make up a drug for IV administration

20. Administer an IV medication

21. Set up an infusion device for IV fluids

22. Give a subcutaneous injection

23. Give an intramuscular injection

24. Use a local anaesthetic (topical or injected)

25. Start a blood or blood product transfusion following relevant procedures

26. Monitor a blood or blood product transfusion for a reaction

27. Treat a reaction following blood transfusion

28. Perform urethral catheterisation (male)

29. Perform urethral catheterisation (female)



https://www.surveymonkey.net/%E2%80%9Dhttp:/www.gmc-uk.org/education/postgraduate/standards_and_guidance.asp%E2%80%9D


Appendices A22

Not applicable




exceptions)



doctors

This is done fairly

equally



team




30. Suture skin

31. Carry out wound care and basic wound dressing

32. Use an airway adjunct (eg Guedal airway or laryngeal masks)

33. Use or direct ’moving and handling’ techniques for patients or objects in the context of clinical care

34. Look for signs of abuse or neglect in children or vulnerable adults

35. Manage symptoms of patients at the end of life

36. Support families when patients are at the end of life

37. Complete a death certificate

38. Take a drug history, covering prescribed and other medication, including complementary and alternative therapies

39. Plan drug therapy for common indications, including pain and distress

40. Provide a safe and legal prescription

41. Prescribe a blood transfusion

42. Calculate dose, prescribe route and type of insulin

43. Use a sliding scale for insulin

44. Prescribe IV fluids

45. Calculate and record drug doses

46. Access reliable information about medicines

47. Detect an adverse drug reaction

48. Report an adverse drug reaction

49. Be involved in the prescription of controlled drugs

50. Give patients information about their medicines

51. Instruct a patient in the use of devices for inhaled medication

52. Assess the severity of a medical emergency

53. Diagnose a medical emergency

54. Manage a medical emergency

55. Manage a patient with impaired consciousness, including seizures

56. Manage a patient with acute mental disorder

57. Manage a patient with sepsis

58. Provide basic first aid

59. Provide immediate life support

60. Carry out cardio-pulmonary resuscitation

61. Direct other team members to carry out cardio-pulmonary resuscitation

62. Take a medical history

63. Take a family & social history

64. Take a history from relatives or carers

65. Perform a full physical examination


Appendices A23

Not applicable




exceptions)



doctors

This is done fairly

equally



team




66. Perform a mental state examination

67. Interpret findings from history and/or examination

68. Make an initial assessment of a patient’s problems

69. Formulate a differential diagnosis

70. Formulate a plan of investigation

71. Obtain informed consent from patient for investigations

72. Interpret the results of investigations

73. Establish a problem list and likely diagnosis or diagnoses

74. Make clinical judgements and decisions, in conjunction with colleagues

75. Participate in a multi-disciplinary clinical discussion

76. Elicit a patient’s questions & understanding about their condition and treatment options

77. Identify a patient’s preferences for involvement in decision making about their care and treatment

78. Help a patient to make decisions about their care, including self-care, and treatment

79. Provide explanation, advice, reassurance and support to a patient

80. Communicate with patients of different age groups

81. Communicate with a patient who does not have English as their first language.

82. Communicate with a patient by an electronic method (eg email)

83. Communicate with a patient by a written method (eg letter)

84. Break bad news to a patient

85. Discuss sensitive issues with a patient, such as alcohol consumption, smoking or obesity

86. Communicate with a difficult or violent patient

87. Communicate with a patient presenting with a mental illness

88. Communicate with a vulnerable patient

89. Communicate with a patient who has a disability

90. Assess a patient’s capacity to make a decision

91. Taken informed consent for a procedure

92. Maintain handwritten medical notes

93. Formulate a plan for treatment and management

94. Formulate a discharge plan


Appendices A24

Not applicable




exceptions)



doctors

This is done fairly

equally



team




95. Seek advice from other health professionals in a situation of clinical uncertainty

96. Seek advice from other health professionals to formulate a plan for treatment, management and discharge

97. Seek professional opinion from another specialty or professional

98. Use electronic systems to retrieve patient data including results

99. Use electronic systems to enter patient information (eg discharge plan)

100. Access information (for example online, in books or journals) to support patient care, research or education

101. Clerk a new patient (ie take history, perform observations, order investigations) in an emergency setting (eg A&E, assessment unit)

102. Clerk a new patient in a clinic setting

103. Clerk a new patient in an inpatient setting

On this page we would like to get as complete a picture as possible of what a Foundation Programme Doctor does, and how their work relates to that of nurses.

5. Are there any other clinical activities that junior doctors regularly carry out in your place of work (please list them)?

[Free text]

6. Do you have any other comments about how much overlap there may be between the work of junior doctors and nursing staff.

The questions on this page will allow us to check that we have opinions from a range of nurses.

7. Are you...

Male Female Prefer not to say

8. What age group do you fall into?

20-24 25-34 35-44 Over 44

9. Where did you train as a nurse?

UK European Economic Area Elsewhere in the world


Appendices A25

Appendix D – Guides for interviews and focus groups

D1. Interview guide for Foundation Programme doctors

1. Introduction

Are you an F1 or F2?

What specialties are you in / have you worked in so far?

2. Perception/experience of role

What do you think the primary role of an F1 is?

[what are you there for?]

What skills are involved in that?

[What do you actually do]

Does it feel like a good use of your time?

3. Specifics of policy

You completed the questionnaire which included skills drawn from TD09. Overall how appropriate do you think they are?

We know from our questionnaire data that some of these are often ‘Never’ performed by F1s [top 5 list provided].

o What do you think about those?

o Why do you think that may be?

o Should they be in TD?

Some are also done very frequently [top 5 list provided].


There are also a number of things identified that don’t feature in TD09 [short list provided].

o What do you think of them?

o Do they seem appropriate to you?

What overlap or conflict is there between the work of F1s and nurses?

[This may already have emerged earlier on]

o How does this resolve itself?

4. Variability

[this may emerge in response to the previous questions]

How does the role, or job vary between specialties?

Have you worked in different settings so far (different hospitals, primary care)

o If yes, how do demands vary between locations

5. Progression

[For F2s only]

What changed with progression into F2?

o How is the increase in responsibility/authority manifested?


Appendices A26

D2. Topic guide for Focus Group Foundation Programme doctors

Introduction

Background to project

Post-it note exercise

Write down the things you’ve done a lot of in your job in the last week – as many as you want

Share findings from post-it note exercise

Discuss how these compare to the ‘regular’ list (stimulus materials)

What do you think about these?

Are these a good use of your time?

Should you be doing them? If no, who?

How have regular tasks varied by your specialty?

How have regular tasks been determined by the nursing staff?

What else might influence what you do routinely?

Discuss items on questionnaire ‘Rare’ list

What do you think about these? Do these match your experience?

Are there any ‘surprises’ on the list?

Should things you don’t do routinely be in the undergraduate curriculum?

Discuss items on questionnaire ‘other’ list

What do you think about these?

Can you add to this list?

Should these items appear in training guidance documents?

How would you describe your role as an F1? (What are you ‘for’?)

What do you think influences your role?

If F2s present

How does F2 differ from F1?

(explore differences in activities, responsibility, perceptions of progression)


Appendices A27

D3. Interview guide for clinical supervisors/clinical employers

Introduction

What is your role or involvement with Foundation Programme trainees?

Does your role involve decisions around the deployment of Foundation Posts?

o If yes, what drives those decisions?

[explore service vs training drivers]

Perception of role

What do think the primary role of an F1 is?

[What are they there to do? Clarify clinical setting here.]

What skills or activities does that role involve?

[What do they actually spend their time doing]

Specifics of policy – related to quadrants. Questionnaire data used as stimulus.

We have sent you a list of activities specified in TD09 – How relevant are these to the needs or service requirements of your ward area/specialty?

We know from our questionnaire data that some of these are often ‘Never’ performed by F1s [top 5 list provided].


o Why do you think that may be?

Some are also done very frequently [top 5 list provided].


There are also a number of things identified that don’t feature in TD09 [short list provided].

o What do you think of them?

o Do they seem appropriate to you?

[Underlying question here - are these activities a good use of F1 time]

What other activities do doctors need to take on to meet the needs of your service?

o Can some tasks be dropped in order to take on those activities?

What overlap or conflict is there between the work of F1s and nurses?

[This may already have emerged earlier on]

o How does this resolve itself?

Progression

Finally, thinking some more about the specific demands of your ward area/specialty, what changes with F2?

Are there differences in the types of task performed?

How is the increase in responsibility/authority manifested?


Appendices A28

D4. Topic Guide for Nursing Focus Group

Introduction

We know that there are some things that Foundation Programme doctors learn to do that overlap with your role, and we want to know more about how that works from your perspective.

What is your specialty/department and your nursing grade?

Role(s)

In your clinical area, what do you see as the role of an F1 and F2? (what are they for?)

How has your nursing role changed – is it still changing?

Division of labour [things to listen for: culture, leadership, tension] (nursing questionnaire

stimulus list)

Is there clear demarcation on your ward of ‘who does what’?

How does division of labour vary during the day and at night/OOH

Are there doctors’ jobs and nurses’ jobs – who decides; who tells the doctors (How do you think doctors get to know who does what?)

Is there every any conflict between doctors and nurses over this?

Are some things done better (or better done) by nurses?

Referral

When does responsibility shift from nurse to doctor?

At what point/in what circumstances do you ask an FP doctor to do something?

Do you ever bypass the FP doctor (eg high NEWS)?

Educational aspects

Do you feel you have a role in teaching FP doctors?

What happens around e-portfolio competency sign-off?

How familiar are you with medical education and doctors’ training needs

Do nurses learn explicitly about working with FP doctors?

How aware are new doctors of nursing roles?

Skill mix

How do nurse skills vary?

What policy limitations are there on your jobs - things you can’t do or have to do (eg male catheterisation, cannulation, naso-gastric tube insertion)?

Do Foundation Programme doctors come into judgements regarding the necessary skill mix of a ward?


Appendices A29

D5. Interview guide for non-clinical employers

Introduction

Tell us about your organisation (setting, size, geography)

Tell us about your role or involvement with Foundation Programme trainees?

Does your role involve decisions around the deployment of Foundation Programme doctor posts?

If yes, what drives those decisions? [explore service vs training drivers]

Role

How would you view the role(s) of the FP doctor within the organisation?

Is your view changing?

Is this role(s) achieved?

Does your view influence how you deploy F1 doctors?

Activities (+/- stimulus list)

Some activities are done ‘rarely’ by trainees. Are these expendable for F1s within your organisation?

How do you approach ‘division of labour’ (specifically, extended nursing roles) in your organisation?

Out of hours activities differ for trainees. What are your views? (explore consultant presence 24x7).

Future challenges and opportunities

Would full registration of new graduates impact on your organisation? If so, how?

Any other comments on training / service involving Foundation Programme doctors.


Appendices A30

Appendix E – Details of response and completion rates of

questionnaires

The SurveyMonkey link was initially distributed on 30 January 2015 via the Northern Foundation School to all UK Foundation School Managers and Directors. Subsequent cascade to trainees within the individual Foundation Schools took longer, but most had done so within the following week.

A first reminder was distributed on 11 February, and was also placed on the e-portfolio system used by most Foundation Schools. The Health Education North East (HENE) and GMC Twitter accounts also promoted the questionnaire. Additionally, Foundation School Directors were provided with updates on response rates roughly on a weekly basis, in anticipation that ‘competition’ would encourage trainees’ participation.

A second (final) reminder was sent on 19 February, advertising that the questionnaire would close at the end of February. A header was added to the first page of the questionnaire stating that the questionnaire would close at midnight on 28 February. The SurveyMonkey page was set to close automatically at 0015 on 1 March.

Figure F1 illustrates the number of daily responses, indicating the effect of the reminders, and suggesting that responses were approaching a natural end by the closing date.

Figure F1. Completion frequency per day. Red columns indicate days on which invitations were distributed.

When the survey closed on 28 February, 3,918 had begun the questionnaire – ie completed the first item asking whether they were F1 or F2. This constitutes an approximate global response rate of 27% (the denominator is estimated from the number of F1 applications in 2014). This is in line with the response rate of <30% anticipated in our proposal, and we expect it will be sufficient to allow publication in a peer-reviewed journal, particularly in light of the high response rates gained in some Foundation Schools.

Response rates from individual Foundation Schools varied between 9.2% and 79.1%, with a mean of 30% (see table F1). Of the 21 Schools, seven had a response rate below 15%, five between 15% and 30%, six between 30% and 50%, and three over 50% (all actually above 70%). 244 respondents (6% of all hits) did not give their Foundation School – this was left as an optional response in order to enable anonymity and avoid false responses.


Appendices A31

Table F1. Number of responses and response rates for different Foundation Schools (ordered by response rate).

Foundation School

F1 population F2 Population F1 responses F2 responses Overall response rate

3 150 155 113 (75%) 128 (83%) 241 (79%)

16 101 104 89 (88%) 52 (50%) 141 (69%)

17 296 305 208 (70%) 205 (67%) 413 (69%)

18 318 328 149 (47%) 146 (45%) 295 (46%)

9 389 401 143 (37%) 184 (46%) 327 (41%)

5 315 324 111 (35%) 100 (31%) 211 (33%)

21 568 585 160 (28%) 210 (36%) 370 (32%)

1 85 88 27 (32%) 25 (29%) 52 (30%)

12 194 200 60 (31%) 59 (30%) 119 (30%)

14 265 273 70 (26%) 88 (32%) 158 (29%)

11 217 224 42 (19%) 53 (24%) 95 (22%)

13 790 814 177 (22%) 166 (20%) 343 (21%)

10 239 246 58 (24%) 41 (17%) 99 (20%)

19 295 304 53 (18%) 37 (12%) 90 (15%)

8 511 526 61 (12%) 73 (14%) 134 (13%)

4 306 315 35 (11%) 48 (15%) 83 (13%)

2 275 283 28 (10%) 37 (13%) 65 (12%)

7 261 269 29 (11%) 29 (11%) 58 (11%)

6 324 334 30 (9%) 43 (13%) 73 (11%)

15 798 822 95 (12%) 72 (9%) 167 (10%)

20 417 430 38 (9%) 39 (9%) 77 (9%)

Not given 43 43

There was a moderate negative correlation (r=-0.39) between size of Foundation School and response rate, indicating higher response rates from smaller Schools. This may reflect more engagement between trainees and administration in those schools.

There was little attrition over the course of the questionnaire. Of those who completed the first page, 5.7% did not complete any of the items asking about specific activities, and so did not provide any data for the analysis. (Some of these may have later completed it from a different device, but this is speculation). However, of those who continued with the survey, only 4.9% did not complete the final page.

This leaves us with data from 3,697 respondents, 3,515 (95%) of whom completed all pages. This low rate of attrition, despite the length of the questionnaire, suggests that the format and time for completion were acceptable to respondents (as reported by the pilot group).


Appendices A32

Appendix F – Detailed Foundation Programme doctor sample

demographics compared with National Trainee Survey responses

Foundation School GMC National Trainee Survey Questionnaire sample

F1 F2 Total F1 F2 Total West Midlands Central (Birmingham) 201 (2.7%) 211 (2.8%) 412 (2.7%) 38 (2.1%) 39 (2.1%) 77 (2.2%)

East Anglian Foundation School 293 (4%) 319 (4.2%) 612 (4.1%) 28 (1.6%) 37 (2%) 65 (1.9%)

West Midlands South (Hereford & Worcestershire/Coventry and Warwick) 142 (1.9%) 163 (2.1%) 305 (2%) 27 (1.5%) 25 (1.4%) 52 (1.5%)

Leicestershire, Northamptonshire and Rutland Foundation School 167 (2.3%) 171 (2.2%) 338 (2.3%) 113 (6.4%) 128 (7%) 241 (7%)

Mersey Foundation School 331 (4.5%) 382 (5%) 713 (4.7%) 35 (2%) 48 (2.6%) 83 (2.4%)

North Central Thames Foundation School 342 (4.6%) 333 (4.4%) 675 (4.5%) 111 (6.3%) 100 (5.4%) 211 (6.1%)

North East Thames Foundation School 332 (4.5%) 332 (4.4%) 664 (4.4%) 30 (1.7%) 43 (2.3%) 73 (2.1%)

North West Thames Foundation School 284 (3.8%) 296 (3.9%) 580 (3.9%) 29 (1.6%) 29 (1.6%) 58 (1.7%)

North Western Foundation School 528 (7.1%) 538 (7.1%) 1066 (7.1%) 61 (3.4%) 73 (4%) 134 (3.9%)

Northern Foundation School 386 (5.2%) 394 (5.2%) 780 (5.2%) 143 (8.1%) 184 (10%) 327 (9.5%)

Northern Ireland Foundation School 247 (3.3%) 256 (3.4%) 503 (3.3%) 58 (3.3%) 41 (2.2%) 99 (2.9%)

Oxford Foundation School 239 (3.2%) 263 (3.5%) 502 (3.3%) 42 (2.4%) 53 (2.9%) 95 (2.8%)

Peninsula Foundation School 198 (2.7%) 200 (2.6%) 398 (2.6%) 60 (3.4%) 59 (3.2%) 119 (3.5%)

Scotland 814 (11%) 805 (10.6%) 1619 (10.8%) 177 (10%) 166 (9%) 177 (5.1%)

Severn Foundation School 273 (3.7%) 290 (3.8%) 563 (3.7%) 70 (3.9%) 88 (4.8%) 158 (4.6%)

South Thames Foundation School 849 (11.4%) 830 (10.9%) 1679 (11.2%) 95 (5.3%) 72 (3.9%) 167 (4.8%)

West Midlands North (Staffordshire) 244 (3.3%) 251 (3.3%) 495 (3.3%) 89 (5%) 52 (2.8%) 141 (4.1%)

Trent Foundation School 294 (4%) 308 (4%) 602 (4%) 208 (11.7%) 205 (11.2%) 413 (12%)

Wales Foundation School 326 (4.4%) 358 (4.7%) 684 (4.6%) 149 (8.4%) 146 (8%) 295 (8.6%)

Wessex Foundation School 306 (4.1%) 306 (4%) 612 (4.1%) 53 (3%) 37 (2%) 90 (2.6%)

Yorkshire and Humber 624 (8.4%) 623 (8.2%) 1247 (8.3%) 160 (9%) 210 (11.4%) 370 (10.7%)

Grand Total 7420 (100%) 7629 (100%) 15049 (100%) 1776 (100%) 1835 (100%) 3445 (100%)

Sex GMC National Trainee Survey Questionnaire sample F1 F2 Total F1 F2 Total

Male 3287 (44.3%) 3306 (43.3%) 6593 (43.8%) 645 (37.9%) 634 (36.4%) 1279 (37.1%)

Female 4133 (55.7%) 4323 (56.7%) 8456 (56.2%) 1056 (62.1%) 1108 (63.6%) 2164 (62.9%)

Grand Total 7420 (100%) 7629 (100%) 15049 (100%) 1701 (100%) 1742 (100%) 3443 (100%)

Age group GMC National Trainee Survey Questionnaire sample

F1 F2 Total F1 F2 Total

20-24 2982 (40.2%) 796 (10.4%) 3778 (25.1%) 784 (45.6%) 247 (14.1%) 1031 (29.7%)

25-34 4265 (57.5%) 6584 (86.3%) 10849 (72.1%) 882 (51.3%) 1433 (81.7%) 2315 (66.7%)

35-44 153 (2.1%) 214 (2.8%) 367 (2.4%) 46 (2.7%) 65 (3.7%) 111 (3.2%)

45+ 20 (0.3%) 35 (0.5%) 55 (0.4%) 6 (0.3%) 10 (0.6%) 16 (0.5%)

Grand Total 7420 (100%) 7629 (100%) 15049 (100%) 1718 (100%) 1755 (100%) 3473 (100%)

Place of Primary Medical Qualification GMC National Trainee Survey Questionnaire sample


EEA 91 (1.2% 184 (2.4%) 275 (1.8%) 39 (2.3%) 63 (3.6%) 102 (2.9%)

International 54 (0.7%) 175 (2.3%) 229 (1.5%) 49 (2.9%) 86 (4.9%) 135 (3.9%)

UK 7275 (98.1%) 7270 (95.3%) 14545 (96.7%) 1624 (94.9%) 1603 (91.5%) 3227 (93.2%)

Grand Total 7420 (100%) 7629 (100%) 15049 (100%) 1712 (100%) 1752 (100%) 3464 (100%)


Appendices A33

Ethnic group

GMC National Trainee Survey Questionnaire sample


Asian/Asian British - Any other Asian background (please write in) 300 (4%) 308 (4%) 608 (4%) 60 (3.6%) 62 (3.6%)

122 (3.6%)

Asian/Asian British - Bangladeshi 62 (0.8%) 59 (0.8%) 121 (0.8%) 11 (0.7%) 10 (0.6%) 21 (0.6%)

Asian/Asian British - Chinese 344 (4.6%) 326 (4.3%) 670 (4.5%) 90 (5.3%) 61 (3.5%) 151

(4.4%)

Asian/Asian British - Indian 573 (7.7%) 657 (8.6%) 1230 (8.2%) 115 (6.8%) 144

(8.3%) 259

(7.6%)

Asian/Asian British - Pakistani 310 (4.2%) 303 (4%) 613 (4.1%) 70 (4.1%) 63 (3.6%) 133

(3.9%)

Black/African/Caribbean/Black British - African 146 (2%) 187 (2.5%) 333 (2.2%) 32 (1.9%) 41 (2.4%) 73 (2.1%)

Black/African/Caribbean/Black British - Any other Black/African/Caribbean background (please write in) 12 (0.2%) (0%) 14 (0.1%) 4 (0.2%) 1 (0.1%) 5 (0.1%)

Black/African/Caribbean/Black British - Caribbean 26 (0.4%) 25 (0.3%) 51 (0.3%) 6 (0.4%) 9 (0.5%) 15 (0.4%)

Mixed/Multiple ethnic groups - Any other Mixed/Multiple ethnic background (please write in) 80 (1.1%) 81 (1.1%) 161 (1.1%) 14 (0.8%) 14 (0.8%) 28 (0.8%)

Mixed/Multiple ethnic groups - White and Asian 137 (1.9%) 134 (1.8%) 271 (1.8%) 29 (1.7%) 23 (1.3%) 52 (1.5%)

Mixed/Multiple ethnic groups - White and Black African 21 (0.3%) 17 (0.2%) 38 (0.3%) 5 (0.3%) 3 (0.2%) 8 (0.2%)

Mixed/Multiple ethnic groups - White and Black Caribbean 16 (0.2%) 19 (0.3%) 35 (0.2%) 4 (0.2%) 1 (0.1%) 5 (0.1%)

Other ethnic group - Any other ethnic group (please write in) 99 (1.3%) 75 (1%) 174 (1.2%) 17 (1%) 16 (0.9%) 33 (1%)

Other ethnic group - Arab 91 (1.2%) 103 (1.4%) 194 (1.3%) 13 (0.8%) 24 (1.4%) 37 (1.1%)

Prefer not to say 366 (4.9%) 367 (4.8%) 733 (4.9%) 60 (3.6%) 61 (3.5%)

121 (3.5%)

White - Any other White background (please write in) 341 (4.6%) 338 (4.4%) 679 (4.5%) 90 (5.3%) 96 (5.6%)

186 (5.4%)

White - English/Welsh/Scottish/Northern Irish/British

4261 (57.4%)

4369 (57.3%)

8630 (57.4%)

1021 (60.4%)

1057 (61.2%)

2078 (60.8%)

White - Gypsy or Irish Traveller (0%) (0%) 3 (0%) 2 (0.1%) 2 (0.1%) 4 (0.1%)

White - Irish 234 (3.2%) 257 (3.4%) 491 (3.3%) 47 (2.8%) 39 (2.3%) 86 (2.5%)

Grand Total

7420 (100%)

7629 (100%)

15049 (100%)

1690 (100%)

1727 (100%)

3417 (100%)

Limited by health or disability GMC National Trainee Survey Questionnaire sample


Yes, limited a lot 15 (0.2%) 5 (0.1%) 20 (0.1%) 4 (0.2%) 4 (0.2%) 8 (0.2%)

Yes, limited a little 189 (2.6%) 136 (1.8%) 325 (2.2%) 32 (1.9%) 37 (2.1%) 69 (2%)

Prefer not to say 204 (2.8%) 181 (2.4%) 385 (2.6%) 25 (1.5%) 25 (1.4%) 50 (1.4%)

No 7012 (94.5%) 7307 (95.8%) 14319 (95.2%) 1656 (96.4%) 1692 (96.2%) 3348 (96.3%)

Grand Total 71420 (100%) 7629 (100%) 15049 (100%) 1717 (100%) 1668 (100%) 3475 (100%)


Appendices A34

Appendix G – Frequency of specialties reported by Foundation

Programme doctor and nurse questionnaire respondents

G1. Frequency of reported specialties as main place of work, and on-call where different, in Foundation Programme doctor questionnaire

Specialty group and specialty

Number of academic trainees

(F1 or F2)

Main work frequency On-call frequency

F1 F2 F1 F2

All medicine 901 758 637 417

Medicine: General (internal) medicine 2 90 56 323 157

Medicine: Acute internal medicine 5 112 64 217 158

Medicine: Anaesthetics 4 28 15 0 1

Medicine: Cardiology 5 85 50 14 7

Medicine: Clinical radiology 1 1 4 1 0

Medicine: Emergency Medicine (eg in A&E or Emergency Assessment Unit)

3 75 215 25 47

Medicine: Endocrinology and diabetes 5 45 19 1 2

Medicine: Gastroenterology 3 71 28 9 3

Medicine: Sexual health/Genito-urinary medicine 5 1 19 0 0

Medicine: Geriatric medicine 2 150 79 18 9

Medicine: Infectious diseases 9 12 11 1 0

Medicine: Intensive care medicine 3 32 44 2 3

Medicine: Neurology 0 9 12 2 4

Medicine: Rehabilitation medicine 0 7 9 0 3

Medicine: Renal medicine 1 14 22 2 5

Medicine: Respiratory medicine 7 90 31 20 8

Medicine: Rheumatology 4 15 10 0 0

Medicine: Other Medical specialty 5 64 70 2 10

All surgery 695 428 312 138

Surgery: General surgery 13 371 79 241 77

Surgery: Cardio-thoracic surgery 0 9 12 1 2

Surgery: Neurosurgery 0 4 9 1 2

Surgery: Ophthalmology 0 4 17 0 1

Surgery: Otolaryngology 1 13 31 1 9

Surgery: Plastic surgery 0 4 7 1 4

Surgery: Trauma and orthopaedic surgery 4 89 131 17 16

Surgery: Urology 4 75 23 29 12

Surgery: Vascular surgery 4 58 10 10 2

Surgery: Other surgical specialty 2 37 18 10 8

General practice 9 0 378 0 1

Psychiatry 2 126 122 1 3

All Paediatrics 75 107 10 14

Paediatrics: Medicine 2 65 98 10 12

Paediatrics: Surgery 0 10 9 0 2

Obstetrics and gynaecology 5 31 91 1 5

Other 17 22 85 18 23


Appendices A35

G2. Frequency of reported specialties in nurse questionnaire

Specialty group and specialty Frequency

All medicine 81

Medicine: General (internal) medicine 11

Medicine: Acute internal medicine 8

Medicine: Anaesthetics 4

Medicine: Cardiology 7

Medicine: Clinical radiology 0

Medicine: Emergency Medicine (eg in A&E or Emergency Assessment Unit) 10

Medicine: Endocrinology and diabetes 3

Medicine: Gastroenterology 3

Medicine: Sexual health/Genito-urinary medicine 2

Medicine: Geriatric medicine 8

Medicine: Infectious diseases 0

Medicine: Intensive care medicine 9

Medicine: Neurology 3

Medicine: Rehabilitation medicine 1

Medicine: Renal medicine 1

Medicine: Respiratory medicine 2

Medicine: Rheumatology 2

Medicine: Other Medical specialty 7

All surgery 48

Surgery: General surgery 13

Surgery: Cardio-thoracic surgery 4

Surgery: Neurosurgery 2

Surgery: Ophthalmology 6

Surgery: Otolaryngology 1

Surgery: Plastic surgery 1

Surgery: Trauma and orthopaedic surgery 10

Surgery: Urology 4

Surgery: Vascular surgery 0

Surgery: Other surgical specialty 7

General practice 4

Psychiatry 17

All Paediatrics 17

Paediatrics: Medicine 12

Paediatrics: Surgery 5

Obstetrics and gynaecology 8

Community nursing 6

Outpatients 7

Other 33


Appendices A36

Appendix H – Full distribution table for nurse questionnaire scale

items

Not applicable

This is exclusively

done by junior doctors

This is mostly done by junior

doctors

This is done fairly equally


member of the nursing team

This is exclusively done by a


Measure body temperature 14 (6.3%) 0 (0%) 1 (0.5%) 6 (2.7%) 62 (28.1%) 138 (62.4%)

Measure pulse rate 10 (4.5%) 0 (0%) 0 (0%) 17 (7.7%) 96 (43.4%) 98 (44.3%)

Measure blood pressure 8 (3.6%) 0 (0%) 0 (0%) 9 (4.1%) 89 (40.3%) 115 (52%)

Measure transcutaneous oxygen saturation 19 (8.6%) 0 (0%) 0 (0%) 10 (4.5%) 88 (39.8%) 104 (47.1%)

Administer oxygen 21 (9.5%) 0 (0%) 0 (0%) 13 (5.9%) 110 (49.8%) 77 (34.8%)

Measure blood glucose 12 (5.4%) 0 (0%) 0 (0%) 2 (0.9%) 77 (34.8%) 130 (58.8%)

Perform a pregnancy test 61 (28%) 0 (0%) 2 (0.9%) 10 (4.6%) 59 (27.1%) 86 (39.4%)

Set up an electrocardiograph (ECG) monitor 31 (14%) 1 (0.5%) 13 (5.9%) 20 (9%) 85 (38.5%) 71 (32.1%)

Perform a 12-lead ECG 32 (14.5%) 4 (1.8%) 15 (6.8%) 24 (10.9%) 81 (36.8%) 64 (29.1%)

Perform basic respiratory function tests (including peak flow) 49 (22.4%) 2 (0.9%) 5 (2.3%) 23 (10.5%) 79 (36.1%) 61 (27.9%)

Perform a urine multi dipstick test 13 (5.9%) 0 (0%) 1 (0.5%) 7 (3.2%) 63 (28.8%) 135 (61.6%)

Advise a patient on how to collect a mid-stream urine specimen 21 (9.5%) 0 (0%) 1 (0.5%) 13 (5.9%) 63 (28.5%) 123 (55.7%)

Take nose, throat and skin swabs 14 (6.4%) 0 (0%) 4 (1.8%) 8 (3.6%) 50 (22.7%) 144 (65.5%)

Carry out a nutritional assessment 30 (13.6%) 0 (0%) 8 (3.6%) 20 (9%) 57 (25.8%) 106 (48%)

Perform venepuncture 21 (9.6%) 10 (4.6%) 41 (18.8%) 70 (32.1%) 64 (29.4%) 12 (5.5%)

Take peripheral blood cultures 44 (20.1%) 43 (19.6%) 74 (33.8%) 26 (11.9%) 27 (12.3%) 5 (2.3%)

Perform intravenous cannulation 33 (15.3%) 23 (10.7%) 71 (33%) 56 (26%) 28 (13%) 4 (1.9%)

Perform arterial puncture in an adult 70 (32.3%) 72 (33.2%) 63 (29%) 7 (3.2%) 2 (0.9%) 3 (1.4%)

Make up a drug for IV administration 36 (16.4%) 3 (1.4%) 0 (0%) 3 (1.4%) 57 (26%) 120 (54.8%)

Administer an IV medication 35 (16%) 5 (2.3%) 3 (1.4%) 3 (1.4%) 63 (28.8%) 110 (50.2%)

Set up an infusion device for IV fluids 38 (17.4%) 3 (1.4%) 2 (0.9%) 1 (0.5%) 50 (22.9%) 124 (56.9%)

Give a subcutaneous injection 12 (5.5%) 0 (0%) 0 (0%) 2 (0.9%) 73 (33.5%) 131 (60.1%)

Give an intramuscular injection 14 (6.4%) 0 (0%) 1 (0.5%) 3 (1.4%) 75 (34.2%) 126 (57.5%)

Use a local anaesthetic (topical or injected) 47 (21.6%) 34 (15.6%) 63 (28.9%) 41 (18.8%) 15 (6.9%) 18 (8.3%)

Start a blood or blood product transfusion following relevant procedures 54 (25.6%) 0 (0%) 1 (0.5%) 1 (0.5%) 45 (21.3%) 110 (52.1%)

Monitor a blood or blood product transfusion for a reaction 52 (24.6%) 0 (0%) 1 (0.5%) 1 (0.5%) 36 (17.1%) 121 (57.3%)

Treat a reaction following blood transfusion 57 (27.1%) 22 (10.5%) 60 (28.6%) 41 (19.5%) 18 (8.6%) 12 (5.7%)

Perform urethral catheterisation (male) 60 (28.6%) 8 (3.8%) 27 (12.9%) 37 (17.6%) 51 (24.3%) 27 (12.9%)

Perform urethral catheterisation (female) 54 (25.7%) 2 (1%) 8 (3.8%) 16 (7.6%) 72 (34.3%) 58 (27.6%)

Suture skin 71 (34.3%) 65 (31.4%) 50 (24.2%) 15 (7.2%) 4 (1.9%) 2 (1%)

Carry out wound care and basic wound dressing 19 (9.1%) 0 (0%) 0 (0%) 2 (1%) 53 (25.4%) 135 (64.6%)

Use an airway adjunct (eg Guedal airway or laryngeal masks) 71 (33.8%) 11 (5.2%) 31 (14.8%) 78 (37.1%) 12 (5.7%) 7 (3.3%)

Use or direct ’moving and handling’ techniques for patients or objects in the context of clinical care 14 (6.7%) 0 (0%) 0 (0%) 19 (9.1%) 74 (35.4%) 102 (48.8%)

Look for signs of abuse or neglect in children or vulnerable adults 18 (8.6%) 1 (0.5%) 8 (3.8%) 148 (70.5%) 26 (12.4%) 9 (4.3%)

Manage symptoms of patients at the end of life 60 (28.7%) 2 (1%) 4 (1.9%) 101 (48.3%) 36 (17.2%) 6 (2.9%)

Support families when patients are at the end of life 54 (26%) 1 (0.5%) 2 (1%) 78 (37.5%) 59 (28.4%) 14 (6.7%)

Complete a death certificate 63 (30.3%) 102 (49%) 40 (19.2%) 2 (1%) 0 (0%) 1 (0.5%)


Appendices A37

Not applicable

This is exclusively



doctors






Take a drug history, covering prescribed and other medication, including complementary and alternative therapies 7 (3.4%) 46 (22.5%) 90 (44.1%) 53 (26%) 5 (2.5%) 3 (1.5%)

Plan drug therapy for common indications, including pain and distress 18 (8.8%) 55 (27%) 92 (45.1%) 35 (17.2%) 2 (1%) 2 (1%)

Provide a safe and legal prescription 9 (4.4%) 83 (40.7%) 84 (41.2%) 26 (12.7%) 1 (0.5%) 1 (0.5%)

Prescribe a blood transfusion 53 (26%) 89 (43.6%) 60 (29.4%) 2 (1%) 0 (0%) 0 (0%)

Calculate dose, prescribe route and type of insulin 38 (18.5%) 80 (39%) 65 (31.7%) 16 (7.8%) 6 (2.9%) 0 (0%)

Use a sliding scale for insulin 66 (32.2%) 35 (17.1%) 36 (17.6%) 36 (17.6%) 22 (10.7%) 10 (4.9%)

Prescribe IV fluids 39 (19%) 74 (36.1%) 81 (39.5%) 7 (3.4%) 4 (2%) 0 (0%)

Calculate and record drug doses 19 (9.5%) 51 (25.4%) 69 (34.3%) 42 (20.9%) 15 (7.5%) 5 (2.5%)

Access reliable information about medicines 12 (5.9%) 14 (6.9%) 48 (23.8%) 121 (59.9%) 1 (0.5%) 6 (3%)

Detect an adverse drug reaction 9 (4.5%) 3 (1.5%) 14 (6.9%) 136 (67.3%) 33 (16.3%) 7 (3.5%)

Report an adverse drug reaction 9 (4.5%) 14 (6.9%) 32 (15.8%) 113 (55.9%) 29 (14.4%) 5 (2.5%)

Be involved in the prescription of controlled drugs 25 (12.4%) 72 (35.6%) 69 (34.2%) 32 (15.8%) 4 (2%) 0 (0%)

Give patients information about their medicines 7 (3.5%) 1 (0.5%) 13 (6.5%) 130 (65%) 36 (18%) 13 (6.5%)

Instruct a patient in the use of devices for inhaled medication 35 (17.2%) 0 (0%) 2 (1%) 60 (29.4%) 71 (34.8%) 36 (17.6%)

Assess the severity of a medical emergency 19 (9.7%) 14 (7.2%) 43 (22.1%) 114 (58.5%) 4 (2.1%) 1 (0.5%)

Diagnose a medical emergency 25 (12.8%) 18 (9.2%) 45 (23.1%) 100 (51.3%) 7 (3.6%) 0 (0%)

Manage a medical emergency 30 (15.6%) 16 (8.3%) 57 (29.7%) 87 (45.3%) 2 (1%) 0 (0%)

Manage a patient with impaired consciousness, including seizures 25 (13%) 14 (7.3%) 44 (22.8%) 101 (52.3%) 8 (4.1%) 1 (0.5%)

Manage a patient with acute mental disorder 53 (27.3%) 10 (5.2%) 24 (12.4%) 89 (45.9%) 14 (7.2%) 4 (2.1%)

Manage a patient with sepsis 39 (20%) 16 (8.2%) 46 (23.6%) 90 (46.2%) 4 (2.1%) 0 (0%)

Provide basic first aid 20 (10.3%) 2 (1%) 6 (3.1%) 103 (52.8%) 40 (20.5%) 24 (12.3%)

Provide immediate life support 23 (11.9%) 4 (2.1%) 11 (5.7%) 134 (69.1%) 19 (9.8%) 3 (1.5%)

Carry out cardio-pulmonary resuscitation 22 (11.2%) 4 (2%) 6 (3.1%) 149 (76%) 11 (5.6%) 4 (2%)

Direct other team members to carry out cardio-pulmonary resuscitation 36 (18.4%) 10 (5.1%) 46 (23.5%) 93 (47.4%) 9 (4.6%) 2 (1%)

Take a medical history 4 (2.1%) 45 (23.4%) 86 (44.8%) 45 (23.4%) 7 (3.6%) 5 (2.6%)

Take a family & social history 4 (2.1%) 16 (8.3%) 50 (26%) 86 (44.8%) 26 (13.5%) 10 (5.2%)

Take a history from relatives or carers 8 (4.2%) 15 (7.8%) 46 (24%) 96 (50%) 21 (10.9%) 6 (3.1%)

Perform a full physical examination 17 (8.9%) 53 (27.6%) 97 (50.5%) 21 (10.9%) 3 (1.6%) 1 (0.5%)

Perform a mental state examination 18 (9.5%) 44 (23.3%) 71 (37.6%) 45 (23.8%) 8 (4.2%) 3 (1.6%)

Interpret findings from history and/or examination 8 (4.2%) 46 (24%) 88 (45.8%) 42 (21.9%) 4 (2.1%) 4 (2.1%)

Make an initial assessment of a patient’s problems 4 (2.1%) 27 (14.1%) 74 (38.5%) 73 (38%) 10 (5.2%) 4 (2.1%)

Formulate a differential diagnosis 15 (7.9%) 51 (26.7%) 87 (45.5%) 31 (16.2%) 4 (2.1%) 3 (1.6%)

Formulate a plan of investigation 15 (7.9%) 52 (27.2%) 83 (43.5%) 36 (18.8%) 3 (1.6%) 2 (1%)

Obtain informed consent from patient for investigations 9 (4.8%) 41 (21.7%) 67 (35.4%) 63 (33.3%) 6 (3.2%) 3 (1.6%)

Interpret the results of investigations 16 (8.4%) 45 (23.7%) 82 (43.2%) 40 (21.1%) 4 (2.1%) 3 (1.6%)

Establish a problem list and likely diagnosis or diagnoses 17 (8.9%) 49 (25.7%) 85 (44.5%) 35 (18.3%) 3 (1.6%) 2 (1%)

Make clinical judgements and decisions, in conjunction with colleagues 11 (5.7%) 25 (13%) 69 (35.9%) 82 (42.7%) 3 (1.6%) 2 (1%)

Participate in a multi-disciplinary clinical discussion 7 (3.7%) 5 (2.6%) 29 (15.3%) 139 (73.2%) 8 (4.2%) 2 (1.1%)


Appendices A38

Not applicable

This is exclusively



doctors






Elicit a patient’s questions & understanding about their condition and treatment options 7 (3.9%) 4 (2.2%) 29 (16.1%) 123 (68.3%) 13 (7.2%) 4 (2.2%)

Identify a patient’s preferences for involvement in decision making about their care and treatment 8 (4.5%) 2 (1.1%) 16 (8.9%) 131 (73.2%) 19 (10.6%) 3 (1.7%)

Help a patient to make decisions about their care, including self-care, and treatment 11 (6.1%) 2 (1.1%) 9 (5%) 129 (71.3%) 25 (13.8%) 5 (2.8%)

Provide explanation, advice, reassurance and support to a patient 7 (3.8%) 1 (0.5%) 6 (3.3%) 121 (66.5%) 44 (24.2%) 3 (1.6%)

Communicate with patients of different age groups 7 (3.8%) 1 (0.5%) 3 (1.6%) 147 (80.8%) 21 (11.5%) 3 (1.6%)

Communicate with a patient who does not have English as their first language. 10 (5.5%) 0 (0%) 3 (1.7%) 142 (78.5%) 22 (12.2%) 4 (2.2%)

Communicate with a patient by an electronic method (eg email) 100 (55.2%) 0 (0%) 7 (3.9%) 64 (35.4%) 6 (3.3%) 4 (2.2%)

Communicate with a patient by a written method (eg letter) 51 (28.2%) 11 (6.1%) 37 (20.4%) 73 (40.3%) 6 (3.3%) 3 (1.7%)

Break bad news to a patient 38 (21.1%) 14 (7.8%) 48 (26.7%) 75 (41.7%) 3 (1.7%) 2 (1.1%)

Discuss sensitive issues with a patient, such as alcohol consumption, smoking or obesity 8 (4.4%) 6 (3.3%) 18 (9.9%) 132 (72.9%) 14 (7.7%) 3 (1.7%)

Communicate with a difficult or violent patient 8 (4.5%) 0 (0%) 6 (3.4%) 136 (76.4%) 22 (12.4%) 6 (3.4%)

Communicate with a patient presenting with a mental illness 19 (10.5%) 1 (0.6%) 12 (6.6%) 131 (72.4%) 14 (7.7%) 4 (2.2%)

Communicate with a vulnerable patient 5 (2.8%) 0 (0%) 5 (2.8%) 151 (83.4%) 17 (9.4%) 3 (1.7%)

Communicate with a patient who has a disability 5 (2.8%) 0 (0%) 5 (2.8%) 152 (84.4%) 15 (8.3%) 3 (1.7%)

Assess a patient’s capacity to make a decision 17 (9.7%) 16 (9.1%) 54 (30.7%) 83 (47.2%) 3 (1.7%) 3 (1.7%)

Taken informed consent for a procedure 23 (13.1%) 30 (17%) 63 (35.8%) 55 (31.3%) 3 (1.7%) 2 (1.1%)

Maintain handwritten medical notes 20 (11.4%) 26 (14.9%) 65 (37.1%) 57 (32.6%) 4 (2.3%) 3 (1.7%)

Formulate a plan for treatment and management 17 (9.7%) 26 (14.8%) 70 (39.8%) 55 (31.3%) 4 (2.3%) 4 (2.3%)

Formulate a discharge plan 28 (16.1%) 18 (10.3%) 38 (21.8%) 73 (42%) 13 (7.5%) 4 (2.3%)

Seek advice from other health professionals in a situation of clinical uncertainty 6 (3.4%) 11 (6.3%) 36 (20.5%) 114 (64.8%) 6 (3.4%) 3 (1.7%)

Seek advice from other health professionals to formulate a plan for treatment, management and discharge 8 (4.6%) 13 (7.5%) 34 (19.5%) 106 (60.9%) 10 (5.7%) 3 (1.7%)

Seek professional opinion from another specialty or professional 8 (4.6%) 18 (10.3%) 61 (34.9%) 84 (48%) 1 (0.6%) 3 (1.7%)

Use electronic systems to retrieve patient data including results 2 (1.1%) 3 (1.7%) 25 (14.2%) 139 (79%) 4 (2.3%) 3 (1.7%)

Use electronic systems to enter patient information (eg discharge plan) 14 (8%) 10 (5.7%) 31 (17.7%) 107 (61.1%) 8 (4.6%) 5 (2.9%)

Access information (for example online, in books or journals) to support patient care, research or education 9 (5.2%) 4 (2.3%) 32 (18.4%) 120 (69%) 6 (3.4%) 3 (1.7%)

Clerk a new patient (ie take history, perform observations, order investigations) in an emergency setting (eg A&E, assessment unit) 37 (21.1%) 44 (25.1%) 51 (29.1%) 32 (18.3%) 7 (4%) 4 (2.3%)

Clerk a new patient in a clinic setting 45 (25.6%) 38 (21.6%) 52 (29.5%) 34 (19.3%) 3 (1.7%) 4 (2.3%)

Clerk a new patient in an inpatient setting 37 (21.1%) 52 (29.7%) 57 (32.6%) 26 (14.9%) 3 (1.7%) 0 (0%)


Appendices A39

Appendix I – Significant differences between medical and surgical

placement questionnaire responses (F1 only)

Those which meet criteria of interest (different modal responses and Cramer’s V >= 0.20) are highlighted in bold.

Not part of job

Regular part of job

Measure.blood.pressure: X2=23.61, df=1, p=1e-06, Cramer=0.12

Medicine 432 (48%) 469 (52%)

Surgery 401 (60%) 262 (40%)

Measure.transcutaneous.oxygen.saturation: X2=60.24, df=1, p=0, Cramer=0.2

Medicine 238 (26%) 662 (74%)

Surgery 301 (45%) 361 (55%)

Administer.oxygen: X2=38.64, df=1, p=0, Cramer=0.16

Medicine 256 (29%) 641 (71%)

Surgery 290 (44%) 371 (56%)

Perform.basic.respiratory.function.tests..including.peak.flow: X2=38.36, df=1, p=0, Cramer=0.16

Medicine 765 (85%) 132 (15%)

Surgery 629 (95%) 32 (5%)

Perform.urethral.catheterisation..male.: X2=14.95, df=1, p=0.00011, Cramer=0.1

Medicine 555 (62%) 337 (38%)

Surgery 344 (52%) 314 (48%)

Suture.skin: X2=42.32, df=1, p=0, Cramer=0.17

Medicine 850 (96%) 40 (4%)

Surgery 567 (86%) 92 (14%)

Carry.out.wound.care.and.basic.wound.dressing: X2=21.37, df=1, p=4e-06, Cramer=0.12

Medicine 817 (92%) 69 (8%)

Surgery 556 (85%) 101 (15%)

Use.an.airway.adjunct..eg.Guedal.airway.or.laryngeal.masks.: X2=32.87, df=1, p=0, Cramer=0.15

Medicine 779 (87%) 113 (13%)

Surgery 632 (96%) 27 (4%)

Use.or.direct..moving.and.handling...techniques.for.patients.or.objects.in.the.context.of.clinical.care: X2=16.29, df=1, p=5.4e-05, Cramer=0.1

Medicine 531 (60%) 359 (40%)

Surgery 459 (70%) 199 (30%)

Look.for.signs.of.abuse.or.neglect.in.children.or.vulnerable.adults: X2=26.21, df=1, p=0, Cramer=0.13

Medicine 725 (81%) 167 (19%)

Surgery 597 (91%) 61 (9%)

Manage.symptoms.of.patients.at.the.end.of.life: X2=78.19, df=1, p=0, Cramer=0.23

Medicine 227 (26%) 662 (74%)

Surgery 311 (47%) 346 (53%)

Support.families.when.patients.are.at.the.end.of.life: X2=89.44, df=1, p=0, Cramer=0.24

Medicine 274 (31%) 617 (69%)

Surgery 361 (55%) 298 (45%)

Complete.a.death.certificate: X2=153.7, df=1, p=0, Cramer=0.32

Medicine 402 (45%) 490 (55%)

Surgery 504 (77%) 154 (23%)

Prescribe.a.blood.transfusion: X2=37.7, df=1, p=0, Cramer=0.16

Medicine 285 (32%) 595 (68%)

Surgery 118 (18%) 529 (82%)

Use.a.sliding.scale.for.insulin: X2=29.77, df=1, p=0, Cramer=0.14

Medicine 484 (55%) 397 (45%)


Appendices A40

Not part of job

Regular part of job

Surgery 265 (41%) 386 (59%)

Instruct.a.patient.in.the.use.of.devices.for.inhaled.medication: X2=40.71, df=1, p=0, Cramer=0.16

Medicine 592 (67%) 287 (33%)

Surgery 534 (82%) 117 (18%)

Manage.a.patient.with.impaired.consciousness..including.seizures: X2=58.89, df=1, p=0, Cramer=0.2

Medicine 441 (51%) 432 (49%)

Surgery 457 (70%) 194 (30%)

Manage.a.patient.with.acute.mental.disorder: X2=71.48, df=1, p=0, Cramer=0.22

Medicine 510 (59%) 361 (41%)

Surgery 515 (79%) 135 (21%)

Provide.immediate.life.support: X2=27.12, df=1, p=0, Cramer=0.13

Medicine 560 (64%) 312 (36%)

Surgery 499 (77%) 151 (23%)

Carry.out.cardio.pulmonary.resuscitation: X2=53.12, df=1, p=0, Cramer=0.19

Medicine 700 (80%) 172 (20%)

Surgery 608 (94%) 42 (6%)

Take.a.history.from.relatives.or.carers: X2=16.5, df=1, p=4.9e-05, Cramer=0.11

Medicine 93 (11%) 777 (89%)

Surgery 117 (18%) 529 (82%)

Perform.a.mental.state.examination: X2=86.68, df=1, p=0, Cramer=0.24

Medicine 351 (40%) 518 (60%)

Surgery 418 (65%) 228 (35%)

Participate.in.a.multi.disciplinary.clinical.discussion: X2=25.2, df=1, p=1e-06, Cramer=0.13

Medicine 84 (10%) 783 (90%)

Surgery 121 (19%) 524 (81%)

Break.bad.news.to.a.patient: X2=12.78, df=1, p=0.000349, Cramer=0.09

Medicine 495 (58%) 359 (42%)

Surgery 428 (67%) 209 (33%)

Communicate.with.a.difficult.or.violent.patient: X2=44.95, df=1, p=0, Cramer=0.18

Medicine 406 (47%) 450 (53%)

Surgery 413 (65%) 222 (35%)

Communicate.with.a.patient.presenting.with.a.mental.illness: X2=96.57, df=1, p=0, Cramer=0.26

Medicine 465 (54%) 391 (46%)

Surgery 504 (79%) 134 (21%)

Communicate.with.a.vulnerable.patient: X2=59.5, df=1, p=0, Cramer=0.2

Medicine 341 (40%) 514 (60%)

Surgery 384 (60%) 254 (40%)

Communicate.with.a.patient.who.has.a.disability: X2=30.32, df=1, p=0, Cramer=0.14

Medicine 333 (39%) 523 (61%)

Surgery 340 (53%) 297 (47%)

Assess.a.patient.s.capacity.to.make.a.decision: X2=34.82, df=1, p=0, Cramer=0.15

Medicine 277 (32%) 579 (68%)

Surgery 302 (48%) 333 (52%)

Clerk.a.new.patient.in.a.clinic.setting: X2=16.66, df=1, p=4.5e-05, Cramer=0.11

Medicine 661 (77%) 195 (23%)

Surgery 430 (68%) 206 (32%)


Appendices A41

Appendix J – Example of activity prioritisation matrix

The matrix below is an example of how individual activities may be prioritised for inclusion in undergraduate curricula, against six criteria emerging from our empirical findings. This example considers only those activities that were rarely performed by trainees, as these are the most open to question of curriculum priority, but the matrix could be applied to all and any activities.

The example here is illustrative, and any application to all activities would require definitions and application to be considered by stakeholders across clinical specialties.

The six criteria indicating prioritisation for inclusion are:

i) Empirical finding from questionnaire data that the activity is commonly performed by Foundation Programme trainees. Those activities that are regular are de facto part of the Foundation Programme doctor’s role, and so should be included in future policy.

ii) The presence or involvement of a doctor is essential, and the activity cannot be done by any other healthcare professional. This may be because it requires specific medical knowledge, is legally restricted (eg prescription of controlled drugs), or implicitly assumes a doctor is present (eg multi-disciplinary team discussion).

iii) The activity may be required in emergency contexts where even a short wait for support from a colleague who can perform the activity may be life-threatening. This need not mean the trainee is working alone, but could include being part of a team.

iv) The activity may be required in circumstances of limited workforce, such as out of hours working or times of high workload. At these times the trainee may be effectively working alone. These activities are less urgent, but an F1 may still be required to perform them unsupervised for clinical reasons.

v) The activity may be required with greater frequency in particular specialties because of specific clinical demands not present elsewhere.

Criteria i)-v) are qualities of the activity itself and can be used for ranking activities. A sixth criterion is a property of the policy text, and should be applied as a redundancy check.

vi) The requirements of an activity cannot be derived from other curriculum outcomes - those which are not contained or implicit in other, broader outcomes.

The example tabulated below refers to TD09 outcomes. A question for the interpretation and application of this final criterion is the level of granularity and specificity required in GMC policy documents, and its relation to clinical policies and protocols that may provide detailed specification.

In the matrix below, green shading against criteria i)-v) indicates that the activity meets each criterion. Red indicates that it does not meet the criterion, and hence may be expendable. The number of green criteria provides an index of prioritisation.

In this representation of the model, we have assumed equal weighting of criteria, but this may be open to review. For example, an activity being required in emergency care may be regarded as more important (greater priority) that it being required only in some specialties.


Appendices A42

Table J.1 Example prioritisation matrix applied to activities identified as ‘rare’ in questionnaire data.

Activity (Green if fulfils criterion)

i) Empirically common (% Regular part of F1 job > 75%)

ii) Doctor is essential

iii) Required in emergency

iv) Limited workforce

v) Required more in particular specialties

INDEX (no. of green criteria)

vi) Redundancy check: is activity contained or implicit in another outcome? (TD09 paragraph)

Use an airway adjunct eg Guedal airway or laryngeal masks

8 3 16b)

Measure blood glucose 15 3 14d) 16a), d)

Start a blood or blood product transfusion following relevant procedures

21 3 23d)

Carry out cardio pulmonary resuscitation

12 3 16d)

Monitor a blood or blood product transfusion for a reaction

15 3 17g) 23d)

Perform a pregnancy test 5 2 14d), e)

Perform urethral catheterisation female

9 2

Direct other team members to carry out cardio-pulmonary resuscitation

4 2 16d)

Suture skin 8 2

Perform basic respiratory function tests including peak flow

10 2 14d) 16a)

Use a local anaesthetic topical or injected

19 2 17b)

Measure body temperature 21 2 14d), e) 16a)

Treat a reaction following blood transfusion

3 2 17g)

Give an intramuscular injection 7 2 16b) 17b)

Carry out wound care and basic wound dressing

11 2 16c)

Set up an infusion device for IV fluids

12 2 17b)

Make up a drug for IV administration

16 2 17b)

Administer an IV medication 19 2 17b)

Give a subcutaneous injection 9 1 17b)

Take nose throat and skin swabs 5 1 23h)

Advise a patient on how to collect a mid-stream urine specimen

13 1 14c)

Perform a urine multi dipstick test 16 1 14b), c), d)

Look for signs of abuse or neglect in children or vulnerable adults

20 1 20f)

Communicate with a patient by a written method eg letter

24 0 15

Communicate with a patient by an electronic method eg email

7 0 15

Report an adverse drug reaction 9 0 23d)

Carry out a nutritional assessment 12 0 14e)


Appendices A43

Appendix K – Full list of activities in descending order of being

part of F1 or F2 work

Percentages indicate the proportion of F1, F2 and all respondents indicating each activity is a regular part of work.

Activity % Regular part of F1

work

% Regular part of F2

work

% Regular part of F1 or

F2 work

Use electronic systems to retrieve patient data including results 99% 98% 99%

Interpret the results of investigations 98% 97% 97%

Interpret findings from history and/or examination 97% 98% 97%

Make clinical judgements and decisions, in conjunction with colleagues 97% 97% 97%

Seek advice from other health professionals in a situation of clinical uncertainty 98% 96% 97%

Provide a safe and legal prescription 97% 97% 97%

Plan drug therapy for common indications, including pain and distress 97% 96% 96%

Provide explanation, advice, reassurance and support to a patient 96% 96% 96%

Formulate a plan for treatment and management 95% 96% 96%

Take a medical history 93% 97% 95%

Seek advice from other health professionals to formulate a plan for treatment, management and discharge

98% 93% 95%

Formulate a plan of investigation 94% 97% 95%

Make an initial assessment of a patient’s problems 93% 97% 95%

Establish a problem list and likely diagnosis or diagnoses 93% 96% 95%

Formulate a differential diagnosis 93% 97% 95%

Take a family & social history 92% 97% 95%

Perform a full physical examination 94% 95% 95%

Access reliable information about medicines 95% 94% 94%

Seek professional opinion from another specialty or professional 96% 92% 94%

Use electronic systems to enter patient information (eg discharge plan) 96% 92% 94%

Communicate with patients of different age groups 93% 94% 94%

Elicit a patient’s questions & understanding about their condition and treatment options

93% 94% 93%

Take a drug history, covering prescribed and other medication, including complementary and alternative therapies

89% 93% 91%

Identify a patient’s preferences for involvement in decision making about their care and treatment

86% 91% 89%

Perform venepuncture 96% 81% 88%

Take a history from relatives or carers 86% 91% 88%

Help a patient to make decisions about their care, including self-care, and treatment

84% 91% 88%

Participate in a multi-disciplinary clinical discussion 87% 86% 87%

Obtain informed consent from patient for investigations 83% 89% 86%

Be involved in the prescription of controlled drugs 88% 83% 86%

Access information (for example online, in books or journals) to support patient care, research or education

83% 88% 85%

Maintain handwritten medical notes 95% 75% 85%

Give patients information about their medicines 83% 86% 85%

Measure pulse rate 84% 84% 84%

Prescribe IV fluids 92% 70% 81%

Perform intravenous cannulation 91% 69% 80%

Calculate and record drug doses 81% 77% 79%

Formulate a discharge plan 86% 71% 78%

75% threshold – common activities above here

Manage a patient with sepsis 82% 67% 74%

Take peripheral blood cultures 83% 63% 73%

Clerk a new patient (ie take history, perform observations, order investigations) in an emergency setting (eg A&E, assessment unit)

73% 70% 72%

Assess the severity of a medical emergency 74% 69% 71%

Discuss sensitive issues with a patient, such as alcohol consumption, smoking or obesity

63% 79% 71%

Perform arterial puncture in an adult 82% 55% 68%

Measure transcutaneous oxygen saturation 62% 70% 66%

Assess a patient’s capacity to make a decision 62% 69% 66%


Appendices A44

Activity % Regular part of F1

work

% Regular part of F2

work

% Regular part of F1 or

F2 work

Clerk a new patient in an inpatient setting 71% 60% 65%

Diagnose a medical emergency 64% 63% 63%

Taken informed consent for a procedure 60% 65% 63%

Manage a medical emergency 62% 60% 61%

Communicate with a patient who does not have English as their first language. 55% 65% 60%

Communicate with a vulnerable patient 54% 63% 59%

Communicate with a patient who has a disability 55% 59% 57%

Prescribe a blood transfusion 67% 47% 57%

Perform a mental state examination 51% 62% 56%

Calculate dose, prescribe route and type of insulin 61% 47% 54%

Administer oxygen 59% 45% 52%

Measure blood pressure 45% 58% 52%

Communicate with a difficult or violent patient 46% 52% 49%

Manage symptoms of patients at the end of life 58% 40% 49%

Support families when patients are at the end of life 52% 39% 46%

Communicate with a patient presenting with a mental illness 38% 52% 46%

Break bad news to a patient 35% 49% 42%

Use a sliding scale for insulin 46% 34% 40%

Manage a patient with impaired consciousness, including seizures 38% 39% 38%

Manage a patient with acute mental disorder 35% 40% 38%

Detect an adverse drug reaction 34% 38% 36%

Clerk a new patient in a clinic setting 27% 42% 35%

Instruct a patient in the use of devices for inhaled medication 26% 42% 34%

Use or direct ’moving and handling’ techniques for patients or objects in the context of clinical care

34% 34% 34%

Provide basic first aid 31% 33% 32%

Measure body temperature 21% 42% 32%

Perform a 12-lead ECG 36% 27% 31%

Perform urethral catheterisation (male) 37% 23% 30%

Look for signs of abuse or neglect in children or vulnerable adults 20% 37% 29%

Perform a urine multi dipstick test 16% 40% 28%

Provide immediate life support 27% 27% 27%

Complete a death certificate 36% 18% 27%

Communicate with a patient by a written method (eg letter) 24% 29% 27%

Advise a patient on how to collect a mid-stream urine specimen 13% 37% 25%

Set up an electrocardiograph (ECG) monitor 28% 22% 25%

25% threshold – rare activities below here

Use a local anaesthetic (topical or injected) 19% 29% 24%

Perform basic respiratory function tests (including peak flow) 10% 27% 19%

Administer an IV medication 19% 17% 18%

Measure blood glucose 15% 18% 17%

Start a blood or blood product transfusion following relevant procedures 21% 12% 17%

Carry out wound care and basic wound dressing 11% 20% 15%

Make up a drug for IV administration 16% 12% 14%

Suture skin 8% 18% 13%

Perform a pregnancy test 6% 20% 13%

Carry out cardio-pulmonary resuscitation 12% 13% 13%

Carry out a nutritional assessment 12% 14% 13%

Monitor a blood or blood product transfusion for a reaction 15% 9% 12%

Set up an infusion device for IV fluids 12% 10% 11%

Take nose, throat and skin swabs 5% 17% 11%

Use an airway adjunct (eg Guedal airway or laryngeal masks) 8% 12% 10%

Report an adverse drug reaction 9% 11% 10%

Give a subcutaneous injection 9% 10% 9%

Give an intramuscular injection 7% 10% 9%

Perform urethral catheterisation (female) 9% 7% 8%

Communicate with a patient by an electronic method (eg email) 7% 9% 8%

Direct other team members to carry out cardio-pulmonary resuscitation 4% 7% 6%

Treat a reaction following blood transfusion 3% 2% 3%

identifying the work activities performed by doctors in the … · 2018-04-17 · the work of...

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