‘Trial by fire’: An online survey exploring confidence of junior doctors in managing toxicology presentations to the emergency department

Abstract

Introduction:The often unknown nature of acute drug intoxication, especially with illicit drugs and emerging novel psychoactive substances, can present a significant challenge for emergency clinicians. Less experienced clinicians are particularly vulnerable to the diagnostic dilemmas of complex toxicology emergencies. We sought to better understand the confidence of junior doctors in assessing and managing toxicological emergencies across two emergency departments in Perth, Australia. Methods: An online survey was conducted between August 2020 and February 2021. Self-rated confidence was measured on a five-point Likert Scale across 10 statements. Two open-ended questions were included to capture perceived barriers and facilitators impacting clinical confidence. Quantitative data were analysed using descriptive methods and Fisher's exact test. Free-text responses were analysed using content analysis.Results: A total of 104 surveys were completed (19.2% interns, 40.4% resident medical officers and 40.4% registrars). Self-rated confidence varied across statements and by staff type. The lowest confidence rating was for managing a patient who had overdosed from an unknown substance (31.7%) and the highest rating for referring a patient to psychiatry following deliberate self-poisoning (86.6%). Confidence increased with greater clinical experience for all statements. Qualitative analysis revealed perceptions of clinical preparedness, complexity of patients and a safe and supportive culture as key factors impacting confidence.Discussion and Conclusions: Overcoming perceived deficits in knowledge and clinical experience were key to building confidence. Our findings highlight the need for improved access to toxicology-specific curricula and training, and strategies to ensure adequate supervision from senior clinicians.

The value of toxicological analysis in acute poisoning patients with uncertain exposure histories: a retrospective and descriptive study from an institute of poisoning

“…[6,18,19] The identification and treatment of poisoned people can be extremely difficult in the absence of clinical experience. [6,[20][21][22] Regional poison centers have been set up in a number of nations to address this problem and provide poisoned patients with expert care. [23][24][25][26][27][28][29][30] Poison centers have just recently been established in China.…”

Feasibility and evaluation of high‐fidelity simulation education for acute clinical toxicology

“…As stated in the key learning outcomes for clinical pharmacology and therapeutics (CPT) education in Europe, 3 it is important that medical graduates have acquired the knowledge and skills to accurately assess, timely diagnose and appropriately manage toxicological emergencies. However, medical students and junior doctors lack confidence in managing toxicological emergencies, which may be due to a lack of education in clinical toxicology during the undergraduate medical curriculum 4,5 . Indeed, the complex nature of toxic exposures, the diversity of toxic agents and the acute and dynamic presentations make clinical toxicology a challenging subject to team to medical students through traditional didactic methods alone.…”

Illicit drugs in the emergency department: Can we determine on clinical grounds if patients are intoxicated? Results from the Western Australian Illicit Substance Evaluation (WISE) study

“…However, objective evidence of the accuracy of this assessment is lacking, which might also be affected by clinician bias or patient profiling. Clinician confidence in managing toxicological presentations, including patients with illicit drug intoxication, has been shown to vary with seniority [4].…”