Presentation Description
Thomas Gale1
Nicola Brennan1, Natasha Keates1, Nicola Langdon1, James Read2 and Karen Mattick3
1 Peninsula Medical School
2 Cardiff University
3 University of Exeter
Nicola Brennan1, Natasha Keates1, Nicola Langdon1, James Read2 and Karen Mattick3
1 Peninsula Medical School
2 Cardiff University
3 University of Exeter
Background
Clinical decision making is a core part of high-quality patient care and a fundamental activity for new doctors. But what makes clinical decisions ‘complex’ and how well prepared are graduates for making them? Monrouxe et al identified clinical decision making as a core skill underpinning preparedness for practice of Foundation doctors (1) but further exploration by other investigators has been limited. This study explores 1). Stakeholder perspectives on what makes clinical decisions complex for newly graduated doctors and 2). Ways that medical graduates are prepared for making complex clinical decisions.
Clinical decision making is a core part of high-quality patient care and a fundamental activity for new doctors. But what makes clinical decisions ‘complex’ and how well prepared are graduates for making them? Monrouxe et al identified clinical decision making as a core skill underpinning preparedness for practice of Foundation doctors (1) but further exploration by other investigators has been limited. This study explores 1). Stakeholder perspectives on what makes clinical decisions complex for newly graduated doctors and 2). Ways that medical graduates are prepared for making complex clinical decisions.
Summary of work
We conducted a national mixed methods study, funded by the General Medical Council, involving simulation scenarios, self-assessment using debriefing templates and semi-structured interviews with multiple stakeholders across the UK. Interviews lasting 45-60 minutes were conducted with 67 stakeholders including doctors in the first two years of practice, educational and clinical supervisors, postgraduate Deans, programme leads, medical educators and other healthcare professionals. Interviews were audio recorded, transcribed, coded in NVivo and analysed thematically.
Results
Types of complex clinical decisions that new graduates made included those relating to; acute or time-pressured situations, end of life and do not resuscitate. Graduates felt prepared for understanding their own knowledge and professional limits and knowing when to escalate. There was mixed preparedness reported for dealing with uncertainty and prioritising tasks. Doctors were less well prepared for leadership in acute scenarios and complex clinical decision-making in acute settings or ‘out of hours’ situations.
Discussion and conclusions
Current medical education provision is producing doctors that are prepared for many aspects of future anticipated practice. More focus could be applied to: Complex clinical decision making in acute settings, Difficult / complex communication and Leadership / followership.
Opportunities to improve training include more use of Interprofessional education, simulation training and clinical experience ‘out of hours’.
References (maximum three)
1. Monrouxe L, Bullock A, Cole J, et al. How prepared are UK medical graduates for practice, 2014. https://www.gmc-uk.org/-/media/gmc-site-images/about/how- prepared-are-uk-medicalgraduates-for- practice.pdf?la=en&hash=1D87E30FB8A260AB20D662629D0F654FB64695FA.