Hands-on teaching, shadowing, and supported learning through acute clinics to help improve the confidence of and meet training needs for junior doctors working in ear, nose, and throat surgery

Abstract

BackgroundEar, nose, and throat (ENT) surgery is a niche and unique specialty that has been recognized as being poorly taught throughout medical school and postgraduate training. Junior doctors who rotate into this specialty often find it hard and struggle to manage patients. Aims: The aim of this study was to devise a junior doctor-focused induction program with specific emphasis on shadowing and partnered working to improve confidence and competence.MethodsFeedback from previous trainees was used to identify valuable training opportunities within the 4-month rotation. Trainers identified clinical areas where supported learning could be delivered. Trainees were allocated to rotate between theater, ward, on-call shifts, and acute clinics. The degree of time spent in each area was analyzed in order to balance service provision vs learning needs. Furthermore, novel strategies were introduced in each session to maximize learning experiences. Junior doctors were aware of the opportunities that would be available to them at the start of the rotation. In order to assess whether the aims were met, a questionnaire survey was used to assess exposure to core ENT practical skills and junior doctors’ confidence levels in carrying them out unsupervised.ResultsJunior doctors spent 40% of their time assessing new acute admissions. Twenty percent of time was spent in ENT clinic, but novel practical methods of induction were introduced such as 1 week of directly supervised shadowing, followed by a transition period with regular debrief. A three-stage model was used to offer training in practical procedures in the clinical setting. Over half of the trainees felt confident in undertaking 50% of the core ENT procedures unsupervised.ConclusionOur study reveals that giving junior doctors a relevant, focused and appropriate induction helps orientate them, give them the opportunity to ask questions, and also find their grounding in order to begin working. Having dedicated time to shadow and be with a colleague to assess and treat patients initially, with ongoing telephone and in person support, ensured that their confidence and competence improved very quickly. It also improved workplace satisfaction and motivated doctors to undertake self-directed learning and improve and enhance their skills beyond the minimum.

Improving Burns and Plastic Surgery Induction Programmes: A Departmental Quality Improvement Project

“…Previous studies looking into the benefits of shadowing for Foundation Year 1 doctors have demonstrated this to be a highly valuable resource [ 10 , 11 ]. Furthermore, in a study performed by Aryasomayajula et al, junior doctors who received appropriate teaching in theory and practical skills, along with shadowing experience, went to later on be able to run their own acute ENT clinics [ 12 ]. We adopted a similar approach where new doctors were paired with a senior house officer who already had some experience within the role.…”

Ear, Nose and Throat (ENT) disease diagnostic error in low-resource health care: Observations from a hospital-based cross-sectional study

“…Even if some literature emphasizes the superiority of adequate undergraduate ENT medical training over the duration spent as a general practitioner in the acquisition of competence to treat ENT conditions [ 32 ], the majority of clinicians often do require additional training to improve their competence following their undergraduate medical education [ 31 ]. Therefore, improving ENT medical education and clinical exposure at undergraduate, graduate and in-service training in Zambia would give clinicians better knowledge and skill to handle ENT conditions [ 32 , 33 ]. A study assessing the knowledge, attitudes, and current practices of health workers with regard to the basic management of ENT diseases in Zambia is ongoing.…”

Factors contributing to clinician training and development in the clinical area of laryngectomy and tracheoesophageal voice

“…Aryasomayajula et al . (2018) reported how a protective training framework with dedicated support and feedback channels alongside work‐shadowing improved the attainment of competencies for junior ENTs. Caty et al .…”