Dataset Information

Assessment of junior doctors' admission notes: do they follow what they learn?

ABSTRACT:

Objectives

To assess the completeness of history-taking and physical-examination notes of junior doctors at King Abdulaziz University Hospital per the approach they learned in medical school.

Methods

In this retrospective study, we reviewed 860 admission notes written by 269 junior doctors (interns and residents) in an academic tertiary-care medical centre in Jeddah, Saudi Arabia, over a two-month period. Notes were evaluated for completeness using a checklist developed with reference to relevant medical textbooks. The checklist included 32 items related to history-taking and physical examination. Based on the review of the notes, checklist items were evaluated as complete, incomplete, not present, or not applicable according to set criteria. Data were analysed and summarised for information on the frequency and relative frequency of these types.

Results

The history items varied in completeness. At the high end, asking about chief complaint and duration, associated symptoms, aggravating and relieving factors, and conducting systemic review were marked 'complete' in 74.2%, 81.7%, 80.4%, and 79.7% of notes, respectively. At the low end, asking about previous episodes, allergies, medications, and family history were complete in 5.3%, 1.9%, 4.8%, and 2.9% of notes, respectively. All physical examination items were poorly documented, especially breast examination, which was 'not present' in 95.8% of the notes.

Conclusions

Junior doctors' history and physical-examination notes are often incomplete and do not follow the approach taught in medical school. The reasons for this must be studied via focus-group discussions with junior doctors.

SUBMITTER: Barnawi RA

PROVIDER: S-EPMC5357543 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

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Publications

Assessment of junior doctors' admission notes: do they follow what they learn?

Barnawi Rashid A RA Ghurab Abdulaziz M AM Balubaid Hassan K HK Alfaer Sultan S SS Hanbazazah Kamal A KA Bukhari Mohammed F MF Hamed Omayma A OA Bakhsh Talal M TM

International journal of medical education 20170311

<h4>Objectives</h4>To assess the completeness of history-taking and physical-examination notes of junior doctors at King Abdulaziz University Hospital per the approach they learned in medical school.<h4>Methods</h4>In this retrospective study, we reviewed 860 admission notes written by 269 junior doctors (interns and residents) in an academic tertiary-care medical centre in Jeddah, Saudi Arabia, over a two-month period. Notes were evaluated for completeness using a checklist developed with refer ...[more]

PMID: 28285275

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Project description:BackgroundSierra Leone is pursuing multiple initiatives to establish in-country postgraduate medical education (PGME), as part of national efforts to strengthen the health workforce. This paper explored the career preferences of junior doctors in Sierra Leone; and the potential benefits and challenges with regards to the development of PGME locally.MethodsJunior doctors (n = 15) who had graduated from the only medical school in Sierra Leone were purposively sampled based on maximum variation (e.g. men/women, years of graduation). In-depth interviews were conducted in October 2013, and digital diaries and two follow-up interviews were used to explore their evolving career aspirations until November 2016. Additionally, 16 semi-structured interviews with key informants were held to gather perspectives on the development of PGME locally. Results were thematically analysed.ResultsAll junior doctors interviewed intended to pursue PGME with the majority wanting primarily a clinical career. Half were interested in also gaining a public health qualification. Major factors influencing career preferences included: prior exposure, practical (anticipated job content), personal considerations (individual interests), financial provision, and contextual (aspirations to help address certain health needs). Majority of doctors considered West Africa but East and South Africa were also location options for clinical PGME. Several preferred to leave the African continent to pursue PGME. Factors influencing decision-making on location were: financial (scholarships), practical (availability of preferred specialty), reputation (positive and negative), and social (children). Key informants viewed the potential benefits of expanding PGME in Sierra Leone as: cost-effectiveness (compared to overseas specialist training), maintaining service delivery during training years, decreasing loss of doctors (some decide not to return after gaining their specialist degree abroad), and enhancing quality control and academic culture of the local medical school. Major perceived challenges were capacity constraints, especially the dearth of specialists required to achieve training programme accreditation.ConclusionsThis study has provided an insight into the career preferences of junior doctors in Sierra Leone. It is timely as there is increasing political and professional momentum to expand PGME locally. Findings may guide those involved in this PGME expansion in terms of how possibly to influence junior doctors in their career decision-making.

Project description:ContextThe transition from medical student to junior doctor is challenging. Junior doctors need to become part of the physician community of practice (CoP), while dealing with new responsibilities, tasks and expectations. At the same time, they need to learn how to navigate the frontiers and intersections with the other communities of practice that form the Landscape of Practice (LoP). This study aims to understand how junior doctors experience interprofessional collaboration (IPC) and what elements shape these experiences considering their transition to clinical practice.MethodsIn this multicentre qualitative study, 13 junior doctors individually drew two rich pictures of IPC experiences, one positive and one negative. A rich picture is a visual representation, a drawing of a particular situation intended to capture the complex and non-verbal elements of an experience. We used semi-structured interviews to deepen the understanding of junior doctors' depicted IPC experiences. We analysed both visual materials and interview transcripts iteratively, for which we adopted an inductive constructivist thematic analysis.ResultsWhile transitioning into a doctor, junior doctors become foremost members of the physician CoP and shape their professional identity based on perceived values in their physician community. Interprofessional learning occurs implicitly, without input from the interprofessional team. As a result, junior doctors struggle to bridge the gap between themselves and the interprofessional team, preventing IPC learning from developing into an integrative process. This professional isolation leaves junior doctors wandering the landscape of practice without understanding roles, attitudes and expectations of others.ConclusionsLearning IPC needs to become a collective endeavour and an explicit learning goal, based on multisource feedback to take advantage of the expertise already present in the LoP. Furthermore, junior doctors need a safe environment to embrace and reflect on the emotions aroused by interprofessional interactions, under the guidance of experienced facilitators.

Dataset Information

Assessment of junior doctors' admission notes: do they follow what they learn?

Objectives

Methods

Results

Conclusions

Publications

Assessment of junior doctors' admission notes: do they follow what they learn?

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