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Cough measurement, mechanisms and treatment
P239 Junior Doctors Performance and Interpretation of Spirometry
  1. U Kamdar,
  2. K Tariq,
  3. J Morjaria,
  4. G Anderson
  1. Castle Hill Hospital, Cottingham, United Kingdom

Abstract

Background Spirometry is a fundamental respiratory function assessment tool. A significant proportion of junior doctors have great apprehension in performing and interpreting spirometry. The NICE (CG12) COPD guidelines state that all healthcare professionals managing patients with COPD should have access to spirometry and be competent in interpretation of results; and that it can be performed by any healthcare worker who has undergone appropriate training and keeps his/her skills up-to-date.

Aims We conducted an audit on junior doctors during their respiratory placement to establish whether hands-on skills training and teaching on spirometry in real-life may improve their understanding of the technique and reliability of interpreting spirometry.

Methods Doctors at different stages of training (foundation year (FY), core medical (CMT), GP vocational (GPVTS) and speciality trainees (ST)) participated in the audit. We used a pre-designed questionnaire containing a balanced mixture of questions testing procedural skill (maximum score 15) and interpretation (maximum score of 33) of different spirometry results. Confidence was assessed using a separate questionnaire of four domains. Baseline data was collected within the first month of joining the respiratory rotation, followed by training on technique and interpretation of results assisted by an accredited pulmonary physiologist (total time of 45 minutes). The same doctors were reassessed on the questionnaires in 12–16 weeks.

Results 25 doctors completed the audit assessment (10 FY1, 5 FY2, 4 CT1, 2 CT2, 2 GPVTS and 2 ST3). Significant improvements from baseline were noted in the median (IQR) scores of performance of spirometry technique (6 (4, 8) to 9 (8, 11); p<0.001) and interpretation (11.5 (5, 15) to 18 (17, 24.5); p<0.001). Moreover, there were marked improvements in total (performance and interpretation) and confidence scores from baseline.

Conclusion This audit demonstrates that spirometry is easily taught and its interpretation is a useful skill to acquire irrespective of a future career in respiratory medicine. We suggest that training for Foundation Year doctors is effective and feasible, and should be included in training programmes as spirometry is more reliable in the diagnosis and management of common respiratory conditions than PEFR testing mandated in the GMC core procedures.

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