Destructive communication is a problem within the NHS; however previous research has focused on bullying. Rude, dismissive and aggressive (RDA) communication between doctors is a more widespread problem and underinvestigated. We conducted a mixed method study combining a survey and focus groups to describe the extent of RDA communication between doctors, its context and subsequent impact. In total, 606 doctors were surveyed across three teaching hospitals in England. Two structured focus groups were held with doctors at one teaching hospital. 31% of doctors described being subject to RDA communication multiple times per week or more often, with junior and registrar doctors affected twice as often as consultants. Rudeness was more commonly experienced from specific specialties: radiology, general surgery, neurosurgery and cardiology. 40% of respondents described that RDA moderately or severely affected their working day. The context for RDA communication was described in five themes: workload, lack of support, patient safety, hierarchy and culture. Impact of RDA communication was described as personal, including emotional distress and substance abuse, and professional, including demotivation. RDA communication between doctors is a widespread and damaging behaviour, occurring in contexts common in healthcare. Recognition of the impact on doctors and potentially patients is key to change.

Background: There is great variation in the Accident and Emergency workload and location of Urology services in UK hospitals. This study investigated the relationship of the initial management of acute renal colic with the department workload plus local facilities including location of X-ray and urology services in UK Accident and Emergency (A&E) departments.

the responsibilities of the role and that more effort should be devoted to training such skills. 5,10,11 We describe the development and evaluation of an educational course specifically designed for medical trainees in this regard. Methods A standardised 1 day course was developed by an interdisciplinary working group of interested educationalists and physician trainees and trainers from a variety of specialties who volunteered to take part in the project. The learning outcomes for the course (Box 1) were identified based on data from a pilot survey of 25 core medical trainees' experiences, apprehensions and views about becoming a medical registrar. The working group then met to formulate its structure. A blended, multi-modal approach

BackgroundReferrals are an important and frequent part of a junior doctor’s work. Difficulty with making successful referrals is also very common. Despite this, training in referral skills is not routinely carried out in medical schools.ResultsWe designed and delivered a 1-h interactive lecture to final year medical students to teach referral skills. The lecture was delivered on six occasions to up to 70 students at each session. 191 students attended and provided evaluation. 68 % of students had no previous training in referral skills and 99 % felt that referral skills should be included in the undergraduate curriculum. 90 % reported that the lecture had improved their understanding of referral techniques and 83 and 80 % felt that the lecture had improved their ability and confidence, respectively.ConclusionsReferral skills can be successfully taught in a large group lecture setting. We recommend that the teaching of referral skills is incorporated into all medical schools’ curricula.

International Medical Graduates represent a significant part of the UK medical workforce. Often highly qualified in their home countries, they arrive in the NHS without the experience of either system or culture. Their chance of success is determined by the orientation program and governance structures are in place to support them. In this report, we describe two structures we designed independently to support IMGs from recruitment through to their transition into working in the NHS. We describe the Epsom St Helier Academy and King’s College Orientation Programs in the pre-COVID and COVID19 era.  Our programs offer a blueprint for other healthcare organisations looking to improve the integration and experience of IMGs in the NHS.