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General surgical foundation doctor: optimisation of daily practice
  1. Emmanuel Feldano1,
  2. Michael Clark2,
  3. Benjamin Ramasubbu2
  1. 1Deaprtment of Anaesthetics, Aberdeen Royal Infirmary, UK NHS Grampian, Aberdeen, United Kingdom
  2. 2Department of Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
  1. Correspondence to Dr Emmanuel Feldano, Departement of Anaesthetics, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, Scotland, UK; emmanuel.feldano{at}


Introduction The role of a foundation year 1 (FY1) doctor has evolved over the years. Many doctors report significant anxiety and stress during this period. In this Quality Improvement Project, we looked at the difficulties FY1s face in their working day and if these issues could be resolved by implementing some structural changes.

Methods The project was conducted in three cycles, each lasting 5 days (Monday to Friday), over three consecutive weeks. Week 1 consisted of shadowing of Surgical FY1s on wards observing daily routine (arrival, lunch and departure time), communication and handovers. Following this a number of interventions were made to the structure of their daily practice to improve productivity and performance. These improvements were measured in week 2 (as the new model was scaffolded into place) and week 3 (strictly observed).

Results There was no significant difference in number of tasks between week 1, 2 and 3. In week 1, there was no set times for lunch, all of the FY1s lunches were interrupted, there was no structure for handovers and 100% of FY1s stayed at work beyond there contracted hours. In week 2 and 3 there was significant improvement in the number of uninterrupted lunches, amount of time spent beyond contracted hours, number and quality of handovers. The qualitative results collected also suggested positive impact on the working lives of those involved.

Conclusion The implementation of structural changes improved the quality of FY1s working day and increased the efficiency of service delivered on the surgical ward.

  • audit
  • education & training (see medical education & training)
  • organisational development
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  • Contributors EF was involved in the organisation of the study, collected the data, constructed the abstract and was involved in the writing of this paper. MC collected the qualitative results and was involved in the writing of this paper. BR organised the study, analysed the data and was involved in the writing of this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval for this quality improvement project was obtained from the hospital quality improvement lead.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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