Department of Upper Gastrointestinal Surgery, Broomfield Hospital, Chelmsford, Essex, UKUnited Kingdom
Department of Upper Gastrointestinal Surgery, Royal Derby Hospital, Derby, UKUnited Kingdom
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Aims: The primary purpose of audit is to improve quality of care, but it is also considered educationally valuable. Audits are often sought in job applications and also form annual review targets. The study aimed to examine audit activity across hospital trainees. Methods: 100 doctors, ranging from F1 to Specialty Training year 5 (ST5) level across 10 UK hospitals were invited to complete a printed or online questionnaire about audit involvement. Results: Seventy five (75%) participated, including 1 F1 (1.3%), 34 F2s (45%), 6 ST1s (8%), 14 ST2s (19%), and 20 ST3-5s and post-basic training fellows (26%). Their Specialities included: Medicine 33(44%), Surgery 29(38%), General Practice (GP) 6(8%), Anaesthesia 4(5.3%), Accident and Emergency (A&E) 2(2.6%) and Ophthalmology 1(1.3%). Seventy (93%) claimed audit involvement in the last year. Most (54, 72%) worked by themselves, with over a quarterled by others (28%). None received audit training. Most (86%) completed within 6 months. Audits focused chiefly on local practice (96%), with only 3 regional or national audits (4%). Only five were re-audits (6.7%), and just four were submitted for publication (5.3%). Most (60, 80%) were formally presented: 46 at local meetings (61%), 10 reaching regional (13%) and 4 international (5.3%) conferences. Conclusion: The positive response rate indicates that audit is a frequent trainee activity, but the results suggest that it is mainly a self-directed portfolio fulfilling exercise. Improved training and supervision may be needed to achieve the primary aim of audit, which is improved clinical practice, whilst the educational value is unproven.
Keywords: Audit; Portfolio; Doctors
This study was carried out in accordance with UK clinical governance guidelines. Doctors ranging from F1 to ST5 level from ten hospitals in UK participated by completing online questionnaires or hand written forms. Seventy-five percent (n=75, 75%) completed questionnaires were returned.
Among those 75 responses, 1(1.33%) was from F1, 34(45%) were from F2s, 6(8%) were from ST1, 14(18.66%) were from ST2, and 20(26%) were from ST3-5s and post-basic training fellows. (Figure 1)
33(44%) respondents were from medicine, 29(38%) from General surgery and allied Specialities, 6(8%) from GP rotation, 4(5.3%) from anaesthesia, 2(2.6%) from A&E and 1(1.33%) from ophthalmology. (Figure 2)
6,7
About 70 respondents (93.3%) had been involved in audit in last 12 months of their job across all the Specialities. Most (54, 72%) of the respondents did audit on their own initiative and only about one fourth of them were motivated by others (n=21, 28%). (Figure 3)
Departmental help Own initiative
Figure 3. Involvement of various specialities.
Eighty six percent (65) of the respondents completed their audit within six months. (Figure 4)
>6 months
<6 months
0 10 20 30 40 50 60 70 SPR/ST3
Figure 4. Completion of audit. ST2 F1 F2 F2 Only 6.66% (n=5) of the audit topics were related to the ST1
re-audit part of the audit loop. (Figure 5)
Only four respondents (5.33%) manage to submit it for
publication. (Figure 6)
6070
2030
Audit Reaudit
Figure 5. Topics were related to the re-audit.
Most of the audits (n=60, 80%) were presented at a local (n=46, 76.66%), regional (n=10, 16.66%) international (n=4, 6.66%) and none of the audits were presented on national forum. (Figure 7)
Most of the audits were focused on local practices within their own institution (n=71, 96%) and only 4% of the respondents were involved in regional and national audits. Very few respondents (1.3%) were using advanced statistical software like Statistics is a software package used for statistical analysis (SPSS) and Parameter-related Internal Standard Method (PRISM).
Audit has always been considered as a key component in improving medical education and training. It has been sug-
Modernising Medical Careers (MMC) or European Working Time Directives (EWTD) in conjunction has lead to shorter training period, wanting people short of time to do academic/clinical governance activities. However, undertaking such activities is always beneficial and leaves a person with reflective education.
It cannot be overemphasized the importance of audit activity in clinical career and the same can be achieved by simple audit exercises better methods and appropriate guidance.10
Medical trainees have always been questioning about the educational value of audit activity and it creates subconscious resentments towards fulfilling audit activity and the same impression is carried on as being a consultant and thereby undermining the clinical significance of audit activity.11
We are already aware of the fact that most of the trainee doctors are involved in audit activities but the need to have bet- Not submitted for ter education and training about audit practices has been emphapublication 12 sized time and time again. Vast majority of clinical audits con- Submitted for publication ducted by junior doctors don’t have significant clinical impact in terms of change of practice purely due to wont of quality of conducted audit and inadequate skilled clinical supervision.12
Nettleton J et al have reported experience of 146 junior doctor’s across 21 Specialities about clinical audit and have suggested that although enthusiasm was abundant, however falling short of core knowledge and methodology of audit and therefore failing to have robust framework for undertaking effective audit for a meaningful result which may reflect in change of clinical practice.13
Karran et al in 1993 have reviewed the perception of general surgical staff within the Wessex region of the status of quality assurance and surgical audit and they inferred that majority of registrars (86%) agreed the importance of collection local 14 Regional of relevant, accurate and complete clinical outcome. However, National 56% among them realized that that the primary objectives were international not met. The reply from the consultants was in agreement with meeting meaningful surgical audit and quality assurance, which should be ideally critically peer reviewed.14 Brazil et al have looked into audit as a learning tool in postgraduate emergency medicine training.9
Our study suggests that re-audits were rarely carried out, causing audit cycles to be incomplete. We have also identified that we need to encourage the trainees to use the latest available statistical software’s, so that they can appreciate the value of having scientifically robust approach and to be in a better position to critically appraise any recent advancements in our profession. Most of the junior doctors are motivated to do the audit on their own initiative but we need to better educate them in all aspects of auditing practices including presentation of audit results at national level and to encourage them to publish it. Better education will ensure that audits produce useful recommenda-
good auditing practices is particularly important amongst junior doctors so that they in turn can educate their juniors as their careers progress.
The authors are grateful to all the trainee doctors who have responded to the questionnaires.
The authors declare that they have no conflicts of interest.