Portfolio random thoughts Flashcards
Teaching experience
-students rotated through 4 week blocks
-Designed teaching programme consisting of:
–> history and examination sessions
–> case based discussion session
–> surgical skills session
–> Radiology teaching
-36 sessions total throughout the year
-Feedback: was largely positive, got some feedback that more data interpretation would be useful to match OSCE format-reflected on and learned from this
-Designed and delivered international series of 4 online lectures, with consultants/registrars from general surgery, orthopaedics and ITU
-PG dip in medical education
What have you done since the application?
-The hospital where I am working felt I was competent to step up to being a trust grade registrar
-Have done ?? how many extra inguinal hernias and appendixes, and scrotal explorations
-Become confident managing a busy UGI ward round
-Become confident managing the take
-Am planning to expand hot gallbladder audit to include cholecystitis and cholangitis patients
How has audit improved my clinical practice
Audit is essential in providing good clinical care to patients
And promotes the development of good care
Because of this I have carried out 4 audits, two of which were closed loop audits
The audit that taught me the most about how audit can improve patient care was the hot chole audit
The audit made me realise there was an appalling delay in patients awaiting hot chole after pancreatitis
Hot chole audit
Guideline: AUGIS lap chole pathway states that patients with mild pancreatitis should have a lap chole within 2 weeks. Those with severe pancreatitis should have a lap chole once recovered
Introduction of lap chole pathway included introduction of electronic preassessment and MRSA and historic G+S prior to discharge
Prior to hot chole pathway: 18% of patients had lap chole within 6 weeks
After hot chole pathway: 69% had lap chole within 6 weeks
Publication
-Co-author of 7 systematic reviews which are published in pubmed indexed journals.
-The systematic review I am most proud of is a review examining the role of fine needle aspiration cytology in the diagnosis of gallbladder cancer. This is because I was involved in all parts of constructing the paper including the literature review, data extraction and analysis, and also the write up of the paper.
-The systematic review I have most recently been involved in was a review of mesh rectopexy verses resection rectopexy for rectal prolapse. In this paper, I carried out the original draft preparation.
-Additionally first author in 1 case report and a co-author in 1 cohort study
Rectal prolapse paper
-Systematic review and meta-analysis comparing the two most common intra-abdominal procedures for rectal prolapse: mesh rectopexy and resection rectopexy.
-Compared complication rate, recurrence rate, improvement in symptoms
-Found no statistically significant difference between the two procedures
-Procedure is therefore down to surgeon preference/experience
Teaching
-Opening line
-4+5th year medical school: osce style sessions
-Foundation training: organised weekly F1+SHO lead teaching
F3
–> Honorary lecturer at cardiff uni
–> Surgical oncology block
–> Talk about feedback
–> Trauma series
–> PG dip in medical education (peyton’s 4 step model)
Pre F3 teaching experience
-Osce style sessions for junior medical studenst as 4th/5th year medical student
-f1/2: informal teaching on the wards, organised weekly foundation trainee lead teaching
F3 teaching experience
-students rotated through 4 week blocks
-Designed teaching programme consisting of:
–> history and examination sessions
–> case based discussion session
–> surgical skills session
–> Radiology teaching
-36 sessions total throughout the year
-Feedback: was largely positive, got some feedback that more data interpretation would be useful to match OSCE format-reflected on and learned from this
Trauma series
-Interest in trauma since elective
-Recognised lack of gen surg trauma teaching
-Designed online lecture series delivered by etc
-Internationally attended
PG dip in medical education
-Gave theoretical grounding for teaching
-Learned peyton’s 4 step approach for teaching practical skills
-This helped during hand tying session
Opening line teaching
Since medical school I have been passionate about teaching, having experienced how much the quality of teaching I receive impacts on my enthusiasm and knowledge acquisition
Leadership and management
-Opening line
-WJDC
-BMA leadership course
-Departmental rota
-Llandough mess
Leadership opening line
-Passoniate about improving training experience of other doctors
-Learned this through exeprience
-Sought out opportunities to develop this further
I have always felt passionate about improving the training experience of other doctors, having experienced both excellent and less good training in jobs where I have worked, and noticed how this has impacted on my job satisfaction and the improvement in my clinical practice. I have therefore actively sort out opportunities to improve training for those around me.
WJDC
–> Succeeded in being elected to the welsh junior doctor BMA committee, –> advocated for needs of junior doctors in training in wales
–> Covered contractual, training and workplace issues
—–> agreed mandate for negotiating team to negotiate contract with welsh government
Departmental rota
–> Offered to take control of rota to maximise training opportunities for SHOs
–>Individualised training opportunities
–> ANP managerial issue
Llandough mess
–>made improvements e.g. more food available in the mess and more socials
BMA foundation in leadership cousres
Gave theoretical underpinning to leadership
Publications
-Opening line
-7 systematic reviews
-Gallbladder paper
-Rectal prolapse paper
-Plan to carry out own systematic review ? idea
Publications opening line
I am highly passionate about evidence based medicine, particularly following teaching from a research oriented registrar on my HPB placement. I was unsure when to request MRCP for patients with presenting with symptoms suggestive of biliary disease, and following a case based discussion he sent me a paper advising MRCP in all patients with isolated rise in enzymes or hyperbilirubinaemia with or without dilatation of CBD On USS, which gave me an insight into how evidence can influence practice.
7 systematic reviews
-Co-author on 7 systematic reviews, a cohort study and a case report
-All published in pubmed indexed journals
-Have gained skills in literature search, following the PRISMA checklist, data extraction, statistical analysis using revman software and draft preparation
Gallbladder cancer paper
-No consensus guidelines on use of fine needle aspiration cytology on gallbladder polyps
-Systematic review and meta-analysis found good diagnostic accuracy for FNAC with no complications
-Therefore recommend using FNAC on all suspicious gallbladder lesions
-Potentially: more extended resection required if unexpeted T1b tumour encountered on pathology
-Risk of peritoneal seeding if gallbladder perforated during surgical manipulation
Audit
–> Opening line
–> Gallbladder audit
–> One stop haematuria clinic audit
–> valganciclovir audit
–> Expanding gallbladder audit to include cholecystitis/
