Masters Degrees (Obstetrics and Gynaecology)

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Browsing Masters Degrees (Obstetrics and Gynaecology) by Subject "Accidents and injuries -- South Africa"

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    Reported competencies of junior medical doctors in managing seriously ill and injured children in South African hospitals
    (Stellenbosch : Stellenbosch University, 2020-03) Erasmus, Louisa Marina; Smit, Liezl; Redfern, Andrew; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    Background The correct management of seriously ill and injured children is a critical skill for doctors with dire consequences for the patient if interventions are not appropriate and timely. While children comprise a significant part of the burden of disease, little is known about the competencies of junior doctors in managing seriously ill and injured children in South African public hospitals. This study aimed to document the resuscitation experience, reported confidence and theoretical knowledge of South African junior doctors in managing seriously ill and injured children admitted to paediatric departments, as well as the formal and informal paediatric resuscitation training opportunities utilised by them. Methodology A quantitative cross-sectional descriptive study was done. Junior doctors (interns, medical officers and registrars) working in the Department of Paediatrics of all eight of South Africa’s Medical Schools and its direct affiliated teaching hospitals, were invited to participate in an anonymous, self-administered electronic questionnaire to assess their reported levels of confidence, experience and training in the management of seriously ill and injured children. Theoretical knowledge was assessed with a set of multiple-choice questions. These doctors were purposively sampled as a likely best-case scenario of junior doctor competencies in managing seriously ill children in South African public healthcare facilities. Descriptive statistics were used to analyse data. Either Pearson chi-squared or Fisher’s exact were used to test for associations between doctor’s training experience and categorical outcome variables. Ethics approval was obtained from the Stellenbosch University Human Research Ethics Committee (S17/09/176). Results Seven South African Medical Schools participated in the study. 118 Junior doctors completed the survey; a response rate of 24%. Sixty three (53%) registrars, 35 (30%) medical officers and 20 (17%) interns participated. Most (89%) had received their undergraduate medical training at South African universities. Participants were more likely to have attended an accredited advanced paediatric than neonatal training course; 75% a paediatric and 53% a neonatal training course. Ten percent of all respondents reported no formal training in the management of seriously ill and injured children; three paediatric registrars and seven interns. Structured in-house training and assessment events on the management of seriously ill and injured children during employment are not provided on a regular basis with 42% of all respondents reportedly never having received any such formal training nor having had exposure to simulations (mock codes). Where training was provided, it was reported as infrequent (53%). Debriefing and feedback opportunities were not standard practice. Only 8% of respondents reported consistent debriefing opportunities after resuscitations, with 29% of medical officers and 46% of registrars reportedly having never had any debriefing opportunities. Forty five percent of interns and 37% registrars had reportedly never received feedback after resuscitation events. No statistically significant difference was noted between the groups. Only 27% of respondents reported a dedicated resuscitation team in the event of a paediatric arrest at their institution. Resuscitation events were not uncommon, with 71% of respondents actively partaking in more than 10 resuscitations during the preceding 2-year period. Bag mask ventilation and intubation were the most common procedures reported by all participants, with defibrillation, intraosseous placement and pneumothorax needle decompression the least performed. As expected, the number of procedures performed increased as junior medical doctors progressed in rank (p-value <0.05). Although half of the interns (10/20; 50%) have reportedly been expected to take the lead in resuscitation, 25% have performed less than 5 bag mask ventilations, 65% have never intubated, 75% have never commenced inotropes and none had placed an intraosseous line. Most (17/20; 85%) interns experienced anxiety upon realizing the need for resuscitation of a paediatric patient and only 15% (3/20) reportedly feels confident when leading a resuscitation. Sixty percent (12/20) of interns reported their knowledge of the resuscitation of paediatric patients as lacking; with only 15% (3/20) passing the knowledge test. In the final year of training (year 4), not all registrars have had opportunities to practice some of the critical procedures/skills in the preceding 2 years. Commencement of inotropes ( 6%), placement of umbilical vein catheterization (6%), pneumothorax needle compression (33%), interosseous line placement (6%) and defibrillation (56%) have not been performed. Forty one percent (26/63) of paediatric registrars reportedly experienced anxiety upon realizing the need for resuscitation of a paediatric patient. Although participants overall regarded themselves to possess appropriate knowledge in respect to the management of seriously ill and injured children and neonates, only 56% (66/118) passed the MCQ test, of which 15% (3/20) were interns, 49% (17/35) medical officers and 74% (46/63) registrars. No positive correlation between reported confidence in managing ill children and pass rate of the MCQ questions were shown (p-value 0.18). Neither was a positive correlation found between respondents’ reported knowledge and assessed knowledge (p-value 0.18). Anxiety was less in those participants who have received formal assessment and training at commencement of their current employment (p- value < 0.05). Confidence increased with number of active participations in resuscitation events (p-value < 0.05). Conclusion Shortcomings in training, assessment, feedback and knowledge in respect to the management of seriously ill and injured paediatric patients were identified with reference to junior medical doctors; this may adversely affect the quality of health care in paediatric emergencies. It is recommended that directors of clinical programmes place more emphasis on the management of seriously ill and injured paediatric patients in their undergraduate and post-graduate training curricula. Structured feedback and debriefing opportunities should be introduced to improve junior medical practitioners’ competencies as well as patient outcomes. Structured feedback and debriefing opportunities should be introduced to allow reflection on experience, identification of learning opportunities and changed behaviour. Future larger studies are recommended to compare findings and include real-life assessments to make more valid deductions.