Improving Burns and Plastic Surgery Induction Programmes: A Departmental Quality Improvement Project

Background: Changes to the undergraduate medical curriculum now offer a greater focus on community based teaching, communication skills and medical humanities. Unfortunately, this has been at the expense of surgical teaching. The senior house officer is usually the first port of call when a patient is being referred to a plastic surgery department. Therefore, a reasonable level of knowledge is required with regard to emergency presentations, examination skills, and clinical skills to appropriately manage the injury. The primary aims of this quality improvement project are to firstly improve the newly starting doctor's confidence in undertaking an on-calls in either trauma or burns following the induction programme and to also improve their level of satisfaction. Methods: The Quality Improvement Project (QIP) team consisted of a Foundation Year 2 doctor, a core surgical trainee, and a registrar. Three Plan, Do, Study, Act (PDSA) cycles were completed to improve the quality of the induction programme. In the first PDSA cycle, junior doctors were provided with a handbook that covered necessary topics regarding burns and plastic surgery. In the second cycle, a structured presentation which included case-based discussions, was incorporated into the trauma aspect of the induction. Finally, in the third cycle, a structured presentation which included case-based discussions, was incorporated into the burns aspect of the induction. Data was collected in the form of a questionnaire one month following the departmental induction for each cycle. The questionnaire assessed the doctor's confidence levels and degree of satisfaction with the induction programme. Students were also given the opportunity to complete written descriptive feedback at the end of the questionnaire. Furthermore, pre-and post-induction questionnaires on the day of induction for the December and April cohort of doctors were also obtained. Results: A total of 16 doctors completed the questionnaires. Overall satisfaction, confidence in undertaking trauma on-calls, and confidence in undertaking burns on-calls improved from 3.84/5, 1.83/5, and 2.67/5 in the first cycle to 4.6/5, 3.6/5, and 3.6/5 in the third cycle, respectively. Satisfaction with the clinical emergencies and case discussions aspect of the induction programme improved from 2.17/5 in the first cycle, to 4.6/5 in the third cycle. With regards to the pre-and post-induction questionnaire on the day of induction, the December cohort's correct answer percentage improved from 58.3% to 94.4%, and the April cohort improved from 47.2% to 93.3%. Conclusion: Whilst it is unlikely to completely prepare new junior doctors for the transition into clinical practice in a unique speciality such as burns and plastic surgery, our study highlights the value of a thorough, multi-stage induction in ensuring junior doctors feel confident to deliver high quality and safe patient care.