7% (9/132) reported some but not all the time. 1% (1/132) reported every time Reasons cited for not reporting include:. 'Too time consuming' (25%, 34/136). 'Nothing will change'(10%, 14/136). 'Working over hours is normal/expected' (10%, 14/136). 'Don't know how to report' (10%, 14/136). 'Worried about perceptions' (8%, 10/136

Mycobacterium abscessus is a non-tuberculous mycobacterium which is found widely in soil and water. It is mostly known to cause infection in immunocompromised patients or those with an underlying lung disease, but infection is increasingly seen in otherwise healthy patients. It is commonly multi-drug resistant and presents a challenge for eradication.This case highlights the presentation of a previously well 2 month old with pulmonary Mycobacterium Abscessus infection. Initial treatment involved a prolonged course of antibiotics. At 9 months of age, whilst still on treatment, the patient presented with a swelling in the right axilla, which was shown to be osteomyelitis of the 6th rib, with cold abscess formation. He was managed with surgical debridement and antibiotics. The patient was also given interferon following the immunological testing. This identified a heterozygous IL-12 gene variant and reduced production of interferon-gamma to all stimuli.

Mycobacterium abscessus is a non-tuberculous mycobacterium which is found widely in soil and water. It is mostly known to cause infection in immunocompromised patients or those with an underlying lung disease, but infection is increasingly seen in otherwise healthy patients. It is commonly multi-drug resistant and presents a challenge for eradication.This case highlights the presentation of a previously well 2 month old with pulmonary Mycobacterium Abscessus infection. Initial treatment involved a prolonged course of antibiotics. At 9 months of age, whilst still on treatment, the patient presented with a swelling in the right axilla, which was shown to be osteomyelitis of the 6th rib, with cold abscess formation. He was managed with surgical debridement and antibiotics. The patient was also given interferon following the immunological testing. This identified a heterozygous IL-12 gene variant and reduced production of interferon-gamma to all stimuli.

Challenging conversations occur frequently within neonatology The aim of the study was to design a communication skill simulation course for neonatal trainees.We collected feedback from 10 neonatal trainees and 15 consultants regionally. 53% of consultants and no trainees had received formal communication skills training. Lack of confidence was the highest discussing end of life, post-mortem consent, breaking bad news and conflict resolution. Further feedback from 21 parents and 45 staff locally highlighted lack of privacy, sensitivity, clarity, consistency and empathy as areas to develop. We first trialled a virtual simulation workshop on antenatal counselling during the COVID-19 pandemic. A pre-recorded scenario was played and debriefed live. Two candidates then took part in a scenario, in break-out rooms, followed by a smaller group debrief. A face-to-face course was then developed. The day, designed for eight candidates, began with an introduction session focussed on psychological safety followed by ‘trauma-informed communication’ by a clinical psychologist. The candidates were then split into two groups for scenarios. Each had the opportunity to lead a scenario. Faculty utilized role play with a standardized faculty ‘parent’ and block simulation with an actor. The Diamond Model was used for debrief. A workshop on ‘post-mortem consent’ and a talk from a parent about their neonatal journey were also included.Ten trainees attended the virtual workshop. Nine strongly agreed that the pre-recorded and 10 that the live sessions were useful. All strongly agreed/agreed that the virtual learning environment worked well, was safe and comfortable, the debriefs were structured and educational, and that attendees’ confidence in antenatal counselling had improved. Seven candidates attended the face-to-face course. All strongly agreed/agreed that the sessions were relevant to their practice and skills learnt were transferrable. Self-rated confidence improved in all communication themes. All candidates strongly agreed that the learning environment was safe and supportive. Candidates found both methods of simulation valuable, four preferred block simulation. All would recommend the course to their colleagues. We addressed a training gap by developing this course. Despite using different styles of teaching and adapting to virtual training during the COVID-19 pandemic, feedback was consistently positive suggesting that flexibility enhances learning. A similar course could be developed in other regions to continue to strengthen communication skills training.

Practical procedures are integral to neonatal care. All first-year paediatric specialist trainees (ST1s) are expected to develop essential skills from their first neonatal placement. However, many trainees join the speciality with minimal prior exposure. With recent changes in junior doctors’ contracts, reduced working hours and evolving clinical practices, trainees may not get enough clinical exposure to acquire required skills. Simulation is recognized as essential to bridge this training gap The aim of the study was to adapt neonatal skills training to virtual delivery.In September 2020, we trialled a half-day virtual training course for new trainees on core topics. The first part included ‘Human Factors’ followed by ‘Stabilization of the premature infant’ using a pre-recorded simulation followed by a live debrief. The second part covered ‘intubation and difficult airway’ followed by ‘vascular access’. We used interactive lectures and pre-recorded demonstrations. A full-day course was then organized for new trainees in March 2021. We included additional sessions on ‘Newborn Infant Physical Examination’ (NIPE), ‘chest drain insertion’ and ‘journal club’, including sign posting to the Critical Appraisal Skills Programme (CASP). Interaction was encouraged to facilitate peer bonding. A Paediatric Trainee Committee representative also joined to outline the support available for trainees. We followed a similar structure to the first course but added live simulation demonstrations of equipment and techniques.Seventeen trainees attended the full-day course. A number of candidates rating the sessions as extremely useful were 16 for ‘Stabilization of the premature infant’ and ‘intubation and difficult airway’, 14 for ‘Human Factors’ and ‘NIPE’, 12 for ‘vascular access’ and ‘chest drain insertion’ and 11 for Journal club. Trainees commented positively on the videos, equipment demonstration, level of interactivity and overall usefulness of the course. Nine trainees commented on desire for additional face-to-face training.After balancing the safety and learning needs of trainees, we adapted an established face-to-face skills day for virtual delivery during the COVID-19 pandemic. Whilst we recognize that virtual training is not a substitute for doing, we were able to maintain essential education during highly pressured times. Feedback demonstrates that our virtual teaching programme was well received and useful. It also emphasizes the value of actual practice and the urgency to restore hands-on training as soon as possible.