S. Williams et al., EMERGENCY DEPARTMENT SENIOR HOUSE OFFICERS CONSULTATION DIFFICULTIES - IMPLICATIONS FOR TRAINING, Annals of emergency medicine, 31(3), 1998, pp. 358-363
Study objective: We investigated the types of patient presentations th
at cause senior house officers (SHOs) most difficulty during their ten
ure in emergency departments and report the extent to which such diffi
culties are related to SHOs' communication problems, stress, or percei
ved lack of skills or knowledge.Methods: We conducted a questionnaire
survey of 171 newly appointed SHOs employed in 27 EDs in the South Tha
mes region of England. Subjects were asked to describe the presentatio
n that gave them greatest difficulty during three subsequent shifts at
the end of the first and fourth months of their ED appointment.Result
s: A total of 132 (77%) and 110 (64%) respondents returned questionnai
res at the end of the first and fourth months, respectively; 61% (105)
responded to both questionnaires. The respondents described 537 of a
possible total of 726 cases (74%). Communication problems caused diffi
culty in 406 (76%) cases, SHOs' experience of stress in 352 (66%) case
s, and a perceived lack of knowledge or skills in 281 (52%) cases. Com
munication problems and the experience of stress occurred in 141 (26%)
cases. Patients presenting with mental or behavioral disorders and sy
mptoms most frequently gave rise to communication problems, perceived
lack of skills, and the experience of stress. The difficulties describ
ed at the two time periods were very similar indicating that experienc
e alone had little effect on these problems. Conclusion: ED SHOs may b
enefit from communication skills training, the opportunity to review d
ifficult case presentations, and the alleviation of organizational str
ess factors.