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AimsOne training region offers a free Induction Day, designed and led by paediatric trainees, to new ST1 trainees annually. It aims to prepare trainees to start training, whilst instilling them with confidence and enthusiasm.MethodsThe optional Induction Day occurs on the Friday before training commences. The programme includes topics which trainees are apprehensive about, including paediatric emergencies and neonatal medicine, and topics which are important to them, such as sleep and ePortfolio. Pocket cards are distributed detailing normal parameters, Newborn Life Support (NLS) and emergency calculations. Trainees can network, and free Headspace subscriptions are provided to support their wellbeing. The region provides NLS training at cost, targeting those starting on neonatal units. Attendees are invited to complete a feedback questionnaire.Results85 (81.7%) new ST1s attended the 2019 Induction Day. 62.4% provided feedback. Table 1 shows trainees’ fears before the Induction Day.Abstract G380 Table 1Trainees’ fears Number % Lacking knowledge/experience 15 28.3% Emergencies 14 26.4% Neonatal medicine 11 20.8% New environment 8 15.1% ePortfolio and exams 7 13.2% Being unsupported 5 9.4% Rota 4 7.5% 50 trainees (94.3%) felt more prepared to start training following the Induction Day. Table 2 shows the sessions trainees found the most useful.Abstract G380 Table 2Most useful aspects Number % ePortfolio 22 41.5% Prescribing 19 35.8% IT and apps 17 32.1% Assessment of the sick child 12 22.6% Structure and assessments 12 22.6% Sleep 6 11.3% Safeguarding 4 7.5% Surviving ST1 4 7.5% Neonatal medicine 3 5.7% Trainees requested additional time for ePortfolio and competencies, and further opportunities to identify trainees at the same Trust.Attendees said:’Excellent all round. Well organised, lovely atmosphere, informative and engaging.’’Fantastic day, really appreciated the focus on looking after ourselves, and also the huge amount of enthusiasm and positivity surrounding the training programme’’Really nice to see how excited and supportive everyone is!’ConclusionsThe Induction Day is an effective way to support trainees starting paediatric training, preparing them and increasing their understanding of the training pathway. They enter training with a supportive network of colleagues and an emphasis on self care.

BackgroundTime away from clinical practice can impact on a Healthcare professional’s clinical competence, technical skills and confidence. The Academy of Medical Royal Colleges (AoMRC)’s 2016 Maternity/Paternity Survey results found a lack of provision of resources to support trainee doctors returning to work. In addition, Health Education England (HEE) reported low confidence, reduced self-perception and lack of pastoral support as the upmost concern for returners.AimsEncourage focus on self-care, resilience and reduce stigma around mental wellbeing for paediatric trainees returning to clinical practice.MethodsWe successfully bid for HEE funds to pay for a psychologist-led session and provide a year’s free subscription to a Mindfulness Meditation app (Headspace®) for trainees attending a return to clinical practice course. Attendees were surveyed prior to and following attendance to the course for their feedback.Results51% (36/60) of trainees redeemed their subscription to Headspace®. 71% of attendees surveyed agreed that they intend to use their Headspace subscription regularly. 96% trainees agreed (42%) or strongly agreed (54%) that they benefitted from the session with the psychologist. In addition, 82% agreed (41%) or strongly agreed (41%) it has made them consider new techniques for managing stress and anxiety.ConclusionTrainees returning to clinical practice benefit from a group-based session from a psychologist prior to their return. These sessions can be successfully incorporated into a return to clinical practice programme. The introduction of self-care techniques and resources such as a subscription to Headspace® are well received. We plan to survey returning trainees 4 months following their return to training to assess long term impact of these interventions.

IntroductionWith increased emphasis on consultant led care and the frequency of ward rounds, documentation is paramount. We observed that during busy periods, the progress and plan from the evening consultant led ward round was not always transcribed to medical notes.MethodWe devised an efficient, clear and practical way of documenting the patient’s progress and plan made during these consultant led rounds – whether it be a ‘board round’ or bedside review. We designed and printed a proforma onto adhesive stickers which can be completed by the ward patient board list or bedside and then transferred to the medical notes. The proforma allows for notes on progress through the day and plan.Since implementation, we have carried out an audit to evaluate whether the stickers improved:Documentation of the evening ward roundsAdherence to the medical planCommunication of the medical plan through the multi-disciplinary team (MDT)We compared five days of notes of acute medical admissions (31 notes) with a sample of notes from previous admissions (31 notes).ResultsSince the introduction of stickers, 100% of patients audited had an evening ward round entry with a plan documented. This compared to only 16% prior to the introduction. Since our intervention, we noted that the plan documented was adhered to in 94% of patients compared to 80% previously. On surveying the nursing staff, we found 80% of nurses agreed the stickers improve communication of the medical plan and 100% agreed they made it easier for the night team to follow the plan made.ConclusionBedside reviews or board based ward rounds will always generate a plan, and it is essential this plan is accessible and recorded in the correct place. The stickers allow for an efficient and rapid way for the reviews and decisions made to be recorded in the medical notes; contributing to continuity of care. The evening round stickers also improved communication through the MDT hence improving adherence to the plan. We recommend any department looking to improve documentation, consider alternative and inventive methods which can contribute to efficiency and improve patient care.

AimsBreaks from clinical practice are increasing and attrition rates are high in Paediatrics. The 2012 Academy of Medical Royal Colleges’ ‘Return to Practice Guidance’ highlights that skills and knowledge decline with absences longer than three months and doctors, employers and designated bodies should share responsibility for patient safety by facilitating supportive processes.MethodsIn 2012 our School designed a ‘Returning to Training after Maternity Leave’ course, using low fidelity. This developed into a one-day course, ‘Paediatric Returning to Acute Clinical Practice’ (PRACP course), embedding high-fidelity simulation among related talks. Funding was secured for 60 places, three courses a year, corresponding with changeover dates. Utilising ‘Survey Monkey’, qualitative data was collected for a two-year period (2015, 2016), using pre course, immediate post course and four-month post course questionnaires.ResultsPre course data from 98 responders, indicated 98% were doctors, with 22% returning to level one, 34% level two, 40% level three and 4% post CCT. The mean time out was 18 months and median 12 months, corresponding with the high numbers post maternity leave (60%). Other reasons for breaks included research (12%), fellowships, out of programme experience/training, ill health and caring responsibilities. Course priorities for learners included practice of emergency skills (34%), overall confidence (23%), guideline/practice updates (21%), work life balance advice (7%) and peer support (5%).86 post course responders assessed usefulness (percentage strongly agreeing or agreeing) of various sessions: 100% simulation, 99% hot topics, 88% WPBA, 88% LTFT and 74% work life balance. Overall, 99% felt the course met their educational needs and 95% felt more prepared for acute practice.Four-month post course feedback from 2015 revealed that 90% felt the course aided their transition back to work and 90% felt skills were applicable to their new roles.ConclusionsTrainees were acutely aware of their loss of skills and confidence. This model of embedding simulation with targeted sessions, allowed learners to practice and update skills in a supportive environment. The evidence supports the course has a positive impact on transition back to the clinical practice and similar courses should be made available in other regions.

AimsTo evaluate the impact of a low fidelity paediatric training day on the confidence of Foundation doctors in treating common acute paediatric presentations.BackgroundMost Foundation trainees will not complete a paediatric placement, but they may work in allied areas attended by children including the emergency department and general practice. Children account for over 25% of ED and GP episodes, highlighting the importance of doctors being confident in treating younger patients.MethodA program of lectures and low fidelity simulation sessions was developed focusing on common paediatric emergency scenarios. 27 foundation doctors attended 2 separate courses. Questionnaires using 5-point Likert scales assessed the candidates’ self-reported knowledge and confidence on a range of topics before and after the educational experience.ResultsOf the attendees, 16 were FY2 and 11 FY1 trainees. 24 (89%) of these had only received paediatric training at medical school. The average score for both confidence and knowledge in all areas before teaching was ≤3.2/5. Delegates scored their ability to lead a simulation lowest (average for both confidence and knowledge 1.8), with management of acutely unwell neonates second (both averages 1.9). We saw a statistically significant improvement in total individual scores pre and post the course-average improvement of 1.1/5 (p≤0.0001, 95% CI=1.38–0.79). The trainee’s confidence and knowledge for leading a resuscitation, and their confidence in managing safeguarding showed the most improvement overall (p≤0.0001).ConclusionChildren account for a significant proportion of NHS workload. This project has demonstrated a lack of exposure to paediatrics and therefore confidence in managing cases, highlighting the need for ongoing postgraduate education. Safeguarding had the highest level of starting confidence, demonstrating the effectiveness of repeated, short lectures and revision used in trust inductions. This small pilot study assessing a low cost, low fidelity one day intervention demonstrated a statistically significant improvement in reported knowledge and confidence across all areas. This has encouraged the development of the course to reach a wider cohort, and continue to improve confidence in assessment and treatment of children accessing healthcare.

BackgroundBurnout is a work-related hazard for those working in Healthcare. A systematic meta-analysis demonstrated junior doctors experiencing burnout are twice as likely to be involved in patient safety incidents, to deliver suboptimal care and to receive low satisfaction ratings from patients. This year, for the first time, the GMC has asked trainee doctors and trainers a series of questions about burnout. Initial results identified that nearly a quarter of doctors in training are burnt out because of their work. Further research identified trainees in their early career are particularly at risk. Mindfulness-based interventions have a potential role in decreasing stress and burnout.AimsTo offer digital access to Mindfulness meditation to new ST1 doctors joining paediatrics at induction. We wanted to encourage early emphasis on self-care and reduce stigma around mental wellbeing.MethodWe purchased a 12 month subscription to a digital mindfulness online platform called Headspace®. We designed and shared a one page leaflet which included a code for free access to activate individual accounts. The leaflet was shared at the ST1 induction (prior to rotation commencing). We also delivered a 10 min session during the induction outlining benefits and usage of mindfulness to focus on self-care. Alongside this, we surveyed current ST2 trainees on their ST1 experience focusing on self-care, sleep and mindfulness.ResultsA total of 104 trainees attended ST1 induction. They were all offered access to Headspace® accounts. To date, 63/104 (61%) ST1s have activated their accounts in the one month since launch. The most accessed area of the platform is the sleep package (44%). In addition, the ST2’s reported 64% trainees had their sleep affected more than once a week during their ST1 rotation.ConclusionWe have demonstrated good uptake of a digital mindfulness online platform, Headspace®. Early data from the study (still ongoing) include the positive impact of a digital mindfulness medium on trainees’ self-belief and awareness of the importance of relaxation. We plan to survey the trainees at the end of ST1 to identify the impact through their first year of rotation and consider expanding the scheme further.

AimsThe management of severe sepsis and septic shock in children is complex and time critical and requires prompt recognition and secondly early administration of antibiotics and fluid resuscitation. The American College of Critical Care Medicine- Paediatric Advanced Life Support (ACCM-APLS 2007) Clinical Guideline for Haemodynamic Support of Neonates and Children with Septic Shock states that within 60 min one should be able to fluid resuscitate up to 60 ml/kg and if needed start inotropes to restore circulation. Therefore the research question we asked is ‘What is the recommended minimal gauge cannula for fluid resuscitation in each patient group to meet the first hour goals set by the American College of Critical Care Medicine (ACCM) for Paediatric Septic Shock?MethodThe study compared the total time taken to administer 60 ml/kg of fluid through different gauge cannula in the four patient groups using a pressurised delivery system. The four patient groups tested had a working weight of; 4 kg, 12 kg, 25 kg and 50 kg. The study was conducted in a non-clinical setting using a model simulating a child in septic shock. Under controlled conditions, one volunteer administered the 60 ml/kg volume in aliquots of 20 ml/kg to the simulated patient. The primary outcome was the total time taken to administer 60 ml/kg of 0.9% saline including time for preparation and re-assessment and secondary outcomes analysed were the flow rate (ml/min), average and fastest time to administer a 20 ml/kg bolus and the time taken to bolus with and without a cannula connector.ResultsTo achieve the ACCM-PALS first hour goal for rapid fluid resuscitation in Paediatric Septic Shock one should aim to use the following recommended minimum size and brand of cannula per patient group as per the table below:Abstract G303(P) Table 1Recommended minimum size and brand of cannula per patient groupPatient WeightRecommended size and brand of cannulaAverage time to administer 20 ml/kg bolus of 0.9% salineTime to administer 60 ml/kg (including time for preparation and standardised re-assessment)4 kgYellow 24G Jelco1 min and 18 s11 min and 10 s12 kgYellow 24G Jelco5 min and 2 s28 min and 56 s25 kgBlue 22G Venflon9 min and 36 s37 min and 41 s50 kgGreen 18G Venflon12 min and 42 s49 min and 4 sDiscussionThis study provides practical recommendations for time-critical fluid resuscitation in sepsis and should lead to further research in the clinical setting. It should also support future iterations of Paediatric Resuscitation Guidelines regarding the optimal Paediatric fluid resuscitation technique.

AimsThe 4th National Audit Project by the Royal College of Anaesthetists highlighted that difficult intubations account for 9% of all intubations in emergency departments (EDs).1 It subsequently recommends that all paediatric EDs should have a difficult airway trolley (DAT) dedicated to paediatric use. The 2012 emergency care standard by RCPCH4 also specified a list of recommended airway equipment in emergency situations. Previous surveys demonstrated a general low availability of a paediatric DAT in anaesthetics departments (16%)2 and PICU/HDUs (42%).3 This audit aims to survey the availability of paediatric DATs and difficult airway equipment in regional paediatric emergency units.MethodsA standard questionnaire for DAT and difficult airway equipment was devised according to the RCPCH guideline.4 In February 2014, data was collected from senior nursing staff in all 34 regional paediatric EDs via telephone, email or in person.Results30 out of 34 units were included. Only 40% had a paediatric DAT on the unit, although all units had some paediatric difficult intubation equipment. A significant number of departments did not have capnography recording (23%), cuffed endotracheal tubes of all sizes (33%), or a cricoidotomy set (33%). Variation in the choice of laryngeal blades reflected individual preferences by specialists. 90% of units kept a daily checking rota.ConclusionThis survey highlights the need for improved availability of paediatric DATs and intubation equipment. Particular effort should be made to secure the more advanced equipment, and ensure the availability of a full size range for basic equipment.ReferencesMajor Complications of Airway Management in the United Kingdom, the 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society, March 2011Khan et al. Paediatric Difficult Airway Trolley Survey. Association of Paediatric Anaesthetists Peninsula Meeting Torquay 2011Khan et al. Nationwide survey of Difficult Airway Trolleys in Paediatric Intensive Care, 24th Annual meeting of the European Society of Paediatric and Neonatal Intensive CareStandards for Children and Young People in Emergency Care Settings 2012, RCPCH