Respiratory Medicine in Dundee
SSCs, Audits, Research and 4th Year Projects
The Chest department is always happy to have students attached to the unit, whether just tagging along to clinics and ward rounds, getting involved in small group teaching, or SSC blocks. We always have research projects on the go, there’s always a junior doctor needing help with an audit project, there’s usually enough going on to go around!
A simple way to get involved is simply to ask us! We respond to e-mails, comments on DC 3.0, or even come down in person. We have a reasonable capacity to take on students from each year to do SSCs, so get to us early.
Current ongoing projects that need input from students (List to be completed in due course):
Radiation Doses
Last year we polled the medical staff to determine their understanding of radiation doses associated with commonly requested radiological interventions. We presented the findings at the Scottish Thoracic Society Spring Meeting 2009, and locally at the Medical Grand Round. We have ideas of how to improve the situation, and now we need to instigate the changes and re-poll the medical floor. It’s (very nearly) an audit project, and it’s (sort of) research too. Scoring points in all directions.
Pneumonia
We form part of a Scottish national program to collect prospective data on all patients with community acquired pneumonia. The data collected by us is our intellectual property, so we can interrogate that data as we see fit. Any individual who puts in 50 cases to the database will automatically get their name on every paper published based on that data. I currently have one student preparing to do a 4th year project based on this endeavour, but anyone else who is interested can be involved.
COPD Exacerbations
We form part of a Scottish national program to collect prospective data on all patients with COPD exacerbatuions. The data collected by us is our intellectual property, so we can interrogate that data as we see fit. Any individual who puts in 50 cases to the database will automatically get their name on every paper published based on that data. I currently have one student preparing to do a 4th year project based on this endeavour, but anyone else who is interested can be involved.
Pleural Drainage
We are currently auditing our chest drain practice on ward 3. We have a chest drain insertion bundle, and a sticker for the notes and the audit book. This would make a lovely little project for a couple of students to do, if anyone is interested.
Also, the latest sub-analysis of the MIST2 trial showed that flushing of chest drains is vitally important in the management of complicated parapneumonic effusion and empyema. We have a local protocol for chest drain flushing, but I suspect it is not being particularly well adhered to. This would make a neat audit project for a couple of students, if anyone is interested.
Inhaler Technique
We have a machine to test inspiratory flow rates, timing of plunger press, and co-ordination of the technique. We’d like to test the current staff to determine their competence, and the competence of patients. After an intervention, we can re-do the study, completing the cycle. This will definitely generate a poster at the Scottish and British Thoracic Society meetings, and possibly a paper in there too.
Acute Oxygen Administration
We have a group of 5th years who have been looking at oxygen administration on ward 3, but we will need to audit the oxygen pathway on other wards, so we’ll need more students to help out.
Long Term Oxygen Administration
We are trying to rationalise the long term oxygen delivery for patients in the community. We know there is inappropriate oxygen prescription in primary care, and as a consequence of secondary care discharges. We need students to look into the oxygen prescribing of individual practices and put into place solutions to suit each individual. This would be ideal for a 4th year project, and could generate a couple of posters, and probably a paper.
High Flow Nasal Oxygen
We are trialling high flow nasal oxygen in the high dependency areas of the hospital, and soon will be rolling it out to the wards. We need students to look at the protocol for utilising high flow nasal oxygen, and help fine tune its usage.
Sleep Apnoea and CPAP
We have over 1500 patients on CPAP machines for obstructive sleep apnoea. There are a wealth of data out there to analyse – perfect for a 4th year project.
Lung Cancer
There are at least 5 audit projects that need to be completed urgently. These could be done as 4th year projects, or as individual data gathering projects to be done in an SSC. We also have a long term project on SCLC that requires a student, or two, every year to follow up patients with SCLC.
Chronic Cough
The numbers of patients with chronic cough is increasing, certainly if our referral rate is anything to go by. I would like to look retrospectively at the cough referrals to see how many we have had, if the numbers are increasing, and what was done before referral. This should lead us to generate a pre-referral guideline for GPs, with roll out to the practices, and then a re-analysis 6 months later. We could even get the students involved with giving presentations to the GPs at the time of the roll out. - We have two students interested in this now.
I have many more elegant projects in my mind, but no space in this margin to demonstrate them….
(If you get the last reference, I’ll buy you a pint)
I did a 3rd year SPSSC in respiratory medicine this year (2010) for 4 weeks. I was initially going to be involved in an audit but for various reasons that never really got going. Instead I spent my time on the wards for rounds, talking to and examining patients, seeing investigations and at clinics. Essentially just getting a feel for this area of medicine… and hopefully learning a bit too! If you are thinking about doing a self proposed SSC just bear in mind that you are essentially your own boss – it’s up to you to see, do and learn. But definitely go for it if this is something you are keen for and there is plenty of scope to follow your own interests. Be flexible as things don’t always go to plan and if in doubt ask, the staff on the ward are all very friendly and happy to help.
Hi.
I’m just about to start my 3rd year, and was looking for a bit of extra work in the shape of an audit to get involved in when I get back. There are several pieces of work above which I’d be interested in, but the the inhaler technique one seems like it might be particularly good for patient contact and giving the opportunity to present findings. Is this piece of work still needing done?
Thanks
Ross
There’s loads of thing to do, in asthma and other things. Come down to East Block to talk to me about it. Tuesday afternoon is the only time I’m free this week coming.
I’m afraid I’m timetabled for something until 5pm tomorrow. If this is too late, are there any times next week which might be good to come down?
I’m in Barcelona all next week. You can catch me at 5, as I’m sure I’ll still be around.
Thanks. I’ll be down as soon after 5 as I can manage.
Is the the last reference referring to Fermat’s last theorem?
Anyone interested in performing an audit related to lung cancer can also feel free to contact Dr H Lord in Oncology – very happy to discuss a whole host of ideas.
See Cancer Dundee blog (http://cancerdundee.wordpress.com/) or contact Dr H Lord directly on hannah.lord@nhs.net
Loads of projects to tackle…..
Hello,
These projects look really interesting and I was just wondering if I could get some more information about some of them?
If so, who would you recommend I talk to?
Cheers,
Caitlin.
What do you want to know? What are you interested in doing?
I’m only in 2nd year, so I don’t know a lot, and wouldn’t want to hold things up due to my lack of knowledge. I feel that I am managing to keep up with my workload, only just. So I was wondering if there was anything not too strenuous, or should I wait a couple of years?
I don’t mean that to sound rude, but I would like to get involved, as long as it didn’t affect my main course work. Can you suggest anything? The ones that I was thinking about were the SCLC; the High Flow Nasal Oxygen or the Pneumonia one. Again, I won’t feel offended if you suggest leaving it a couple of years. I would just like to know a bit more about the workload just now, before (and if) I commit.
Cheers,
Caitlin.
Hi Catilin,
We have loads of things we can set you up with. Slow burn audit projects, short term PDSA, more strenuous things. It’s up to you. If you want to get involved, come and see me one afternoon, and we can talk about what’s available.
DC
@ Caitlin, I’m a third year and one of the PRN lot…
I completed an SPSSC in Resp Medicine last January. I had lots of patient contact, sat in lots of clinics ( got to take a few of the cases and present to the consultant too – good practice for 4th year GP amongst other things!) saw some chest drain insertions and became a regular at MDTs and in the bronchoscopy suite. All in all, a well spent month – I really did learn much more than I ever could from textbooks.
I got involved in an audit on oxygen prescribing – it didn’t take very long and wasn’t complicated at all. Once you know how to format the report you’re sorted!
Even if you dont feel like getting involved in a project, or doing an SPSSC…head along to east block sometime – I remember COPD / Asthma / Sarcoidosis / Lung cancer etc…as a result of individual patient stories rather than lecture slides…and I’m much more comfortable with CXRs as a result of one-one teaching!
Hope this ramble helps!
That was very helpful Laura, thank you!
I totally agree with you that going to the wards etc is a better way of learning than lectures (well, for me anyway). I don’t want to get involved with something I might have to give up in a few months, or something that might have a negative affect on my studies. I’ll have a think about it, and not rush into anything. It does sound very interesting though.
However, I was talking to someone who said it would probably be best to focus on one project (maybe in 4th year) instead of do little bits and pieces from different blocks throughout the course. So I don’t really know what to do.
Thanks again though, it was really helpful to hear a student’s point of view!
Good luck with 3rd year!
Cheers,
Caitlin
Hello,
I’m looking into doing a 4th year project in Ophthalmology. I’ve been in touch with the department already so its not a massive problem but according to a friend of mine there was recently a post about audits or projects in Ophthalmology on here but I can’t seem to find them…
Does this ring any bells? Know where these elusive posts might be?
Thanks!
Not on the Chest site, no.