Aims Trainees identify general paediatric outpatients as both a valuable learning experience and a challenge. Currently, the actual workload in the general paediatric outpatient department is based on experience and anecdotal evidence rather than concrete data as there is usually no coding of the patients seen. In order to meet the educational needs of the trainees, we undertook a detailed review of outpatient activity.
Methods A sample size calculator was used from www.clincalauditsupport.com to calculate the statistically valid sample size required in order to gain a representative sample of activity. The total annual general paediatric outpatients activity was 9355 patient reviews. This indicated a sample size of 370 clinic letters. We took a 4 week period, and reviewed every general paediatric out patient letter generated during this period. The clinical condition assessed in each clinic letter was coded using ICD10 codes by 2 independent reviewers, blinded to the code given by the other reviewer. To ensure consistency and accuracy, any disagreement was reviewed by a 3rd reviewer to give a final diagnosis. All data was anonymised and entered into an Excel spreadsheet.
Results A total of 495 letters were reviewed. The data was reviewed and a list of the most frequently seen diagnoses was assimilated. There were 24 conditions included in this list and these are shown in Figure 1. These conditions accounted for 69.2% of the patients reviewed.
Conclusions Whilst no list of conditions can comprehensively cover learning needs for trainees undertaking outpatient clinics, there are a small number of conditions that account for the majority of patients seen. Ensuring that trainees are familiar with this relatively short list of conditions will enhance confidence and improve performance in outpatients. We recommend that our doctors have teaching focused on these areas before entering tier two training.
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