EMERGENCY DEPARTMENT SENIOR HOUSE OFFICERS CONSULTATION DIFFICULTIES - IMPLICATIONS FOR TRAINING

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.