Endocrine Abstracts

Background: Paediatric diabetes is predominantly an outpatient based specialty, limiting the training opportunities available to paediatric trainees. At our centre, out of hours diabetes advice calls are managed by paediatric specialty trainees working on the middle grade rota, with 24 hour support from an oncall paediatric diabetes consultant. Feedback locally from families has highlighted the quality of out of hours advice as an area of concern. We aimed to assess the knowledge and confidence of paediatric trainees in managing out of hours advice calls to help inform training and service provision.

Methodology: The study took two parts. Firstly all paediatric trainees at level ST4+ were asked to complete an anonymous questionnaire, with six scenarios covering common advice calls. Model answers were agreed by the diabetes team. Answers were marked by two independent diabetologists. The scoring system gave separate marks for knowledge and for safety. The second part involved a questionnaire for trainees who responded to advice calls during a three month study period, aiming to assess confidence in dealing with such calls. Timing of advice calls was recorded by the hospital switchboard.

Results: Eighteen of twenty-eight (64%) trainees completed the scenarios. Knowledge was variable, with technology based scenarios generally scoring poorly (average knowledge score for lost pump handset scenario 22% versus 63% for sick day rule scenario). Trainees however tended to act safely (average safety score 87%). There was no correlation between knowledge and safety. Sixteen out of hours advice calls were made during the 3 month study period. Questionnaires were completed for 75% of the calls. All trainees felt confident in managing the call and 92% felt they had adequate training to manage the call.

Conclusions: This project demonstrates a discrepancy between registrar confidence and family satisfaction with out of hours telephone advice. The knowledge base of paediatric trainees in dealing with common diabetes advice scenarios is very variable. We discuss the approach we are taking to the challenges of providing diabetes training to paediatric trainees and how this should be balanced with patient safety and satisfaction.