1. A Structured Shadowing Programme Increases Levels of Confidence in New Junior Doctors T Nieto, H Collyer-Merritt, A Gray Aim: Assess the effectiveness of a structured shadowing programme at BSUH compared to informal shadowing arrangements of the previous year. Methods A week long structured shadowing programme was created. FY1s were split into groups of 6-8 and were timetabled into ward based activities and lectures. Ward based activities allowed time to be spent with their new firm and on call. A ward based role play scenario involved responding to simulated medical emergency calls familiarising the new starters with the hospital layout, bleep system, IT systems, requesting common investigations and who to contact for help in an emergency. Lecture sessions included e- discharge summaries, a talk from pharmacy, outreach team and on call commitments. These sessions were an open forum to address questions, concerns and common pitfalls before their first day on the wards. The 2010 survey results were presented to the trust faculty. Our proposal for a structured shadowing week was approved for the new FY1s of 2011. Such a programme was a new innovation at the Trust and attracted volunteer doctors of all grades and a range of specialities to help run the shadowing week. After two weeks of working, the same questionnaire was distributed to the FY1s as 2010. The aim was to assess the effectiveness of the structured shadowing programme compared to informal shadowing arrangements of the previous year using a Likert scale to assess confidence and preparedness when carrying out day to day tasks of a FY1 doctor. Background The first few weeks of a new job are stressful and daunting, especially for newly qualified doctors embarking on their first Foundation Year 1 post. It is imperative that FY1s are given optimum preparation before they start their first job since it has been shown that patient safety is compromised every August (1). A survey of newly qualified FY1s in 2010 showed that a period of shadowing increased confidence levels. Results 36 Responses, 35 given opportunity to shadow, 31 actually shadowed. We found that 2011’s FY1s felt significantly more prepared when they started compared to the 2010 cohort (p<0.01). Levels of confidence in time management were better (p<0.01) and they were more aware of who to contact for help (p<0.05). A higher percentage of new starters from 2011 felt they knew the hospital layout, had met their consultant (69.1% in 2010 vs 77.4% in 2011), and received a formal handover from the outgoing team (66.7% in 2010 vs 72.73% in 2011). Conclusion We have shown that a structured shadowing programme is a key tool in preparation for FY1. We would suggest that a national shadowing programme with key learning objectives should to be created. Individual hospital trusts should use these objectives as a framework to design a shadowing week tailored for their specific needs. We are confident that this would decrease morbidity and mortality rates in August, which are currently significantly higher than the rest of the year. Effects of Changes The direct effect of our change is better prepared, better orientated and more confident FY1s commencing their job in August, a notoriously difficult time for every UK hospital. “Dr Foster shows fresh thinking needed on the week junior doctors start” TimeMonday 25th JulyTuesday 26th JulyWednesday 27thThursday 28thFriday 29th 0900- 1300 0900-1000: Welcome in the Mess Introduction & aims of the week, hours, On-call duties, Bleeps, etc then find individual ward teams Group 10 Shadows on-call teams (Medical SHOs, F1s, Surgical SHO & F1) Ward work Group 3: Shadows on-call teams Ward Work Group 5: Shadows on-call teams 0830 Morning Report (Medicine in the Audrey Emerton Building); Ward work; Group 7: Shadows on-call teams Wards work; Group 9: Shadows on-call teams 1300- 1400 Getting the most out of Radiology - Hugh Harvey Radiology SpR; Death Certification Guide to on-calls: Surgery (Tom Nieto, Surgeon) Medicine (Pro- formas, Cardiology, PTWR, A&E, AMU, Referrals) Grand Round Audrey EmertonLecture from Professor Halligan on Quality & Safety; Service Improvement Projects, After Action Review Training & Ward Round Checklist E-Portfolio & Foundation competencies - James Hawken 1400- 1700 Groups 1 & 3-: PACS & Imaging, IT, Lab, TTO, Weekend handover/Patient lists Tutorial Groups 5-6: PACS & Imaging, IT, Lab, TTO, Weekend handover/Patient lists Tutorial Groups 4 & 7: PACS & Imaging, IT, Lab, TTO, Weekend handover/Patient lists Tutorial Groups 9-10: PACS & Imaging, IT Lab, TTO, Weekend handover/Patient lists Tutorial Groups 2 & 8: PACS & Imaging, IT Lab, TTO, Weekend handover/Patient listsTutorial Group 6: Shadows on-call teamsGroup 4: Shadows on-call teamsGroup 2: Shadows on-call teamsGroup 8: Shadows on-call teamsGroup 1: Shadows on-call teams Groups 4 & 8: Hospital Tour, Outreach & Recognition of the unwell Groups 6-7: Hospital Tour, Outreach, SBAR & Recognition of the unwell Groups 9-5: Hospital Tour, Outreach, SBAR & Recognition of the unwell Groups 1-2: Hospital Tour, Outreach, SBAR & Recognition of the unwell Groups 3 & 10: Hospital Tour, Outreach, SBAR & Recognition of the unwell Groups 1-2: Pharmacy, Fluid, Transfusion & VTE Prescribing Skills; Groups 8, 10: Pharmacy, Fluid, Transfusion & VTE Prescribing Skills; Groups 6-7: Pharmacy, Fluid, Transfusion & VTE Prescribing Skills; Groups 3-4: Pharmacy, Fluid, Transfusion & VTE Prescribing Skills; Groups 5, 9: Pharmacy, Fluid, Transfusion & VTE Prescribing Skills; Groups 9-10: ward on-call 'role- play' Group 1 - 2 Ward on-call role playGroups 3-8: 'ward on-call role-play'Groups 5-6: ward on-call role-playGroups 4 & 7: 'ward on-call role- play' (or Ward Work or Find Consultant Tutors or get passwords & photo ID) Evening Beach BBQFootballVolleyballDrinks reception: Mess, Brighton life etc Likert Scale Confidence Levels20102011 Confidence Level Before Shadowing2.072.16 Confidence Level After Shadowing3.053.67 Confident Navigating Around Hospital2.923.44 Who to Contact For Help2.973.63 Time Management2.793.59 Shadowing Timetable References 1. Jen MH, Bottle A, Majeed A, Bell D, Aylin P (2009) Early In-Hospital Mortality following Trainee Doctors’ First Day at Work. PLoS ONE 4(9): e7103. doi:10.1371/journal.pone.0007103