ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) forms were introduced in Royal Derby Hospital a year ago. ReSPECT prompts clinicians to record more than just ‘CPR’ decisions, and should include personalised recommendations for patients’ care in a future emergency. Anecdotally we felt junior doctors were uneasy with ReSPECT, and that forms were often ‘partially completed’, reducing their value to clinicians and patients alike. An audit of ReSPECT forms confirmed poor completion in some areas of documentation.
We organised a pilot teaching afternoon for Core Medical Trainees (CMTs), incorporating a Powerpoint presentation on ReSPECT, handouts of ‘mock forms’, and role play. In groups of six, alongside a facilitator, CMTs worked through vignettes of clinical scenarios requiring a ReSPECT form to be completed. Ground rules ensured confidentiality and opportunity for ‘time out’.
CMTs engaged enthusiastically with scenarios – in each, one trainee acted as a patient/relative, and another as the doctor. Facilitators led reflection and learning pre- and post- each scenario. Ten trainees completed pre- and post- course questionnaires. Despite 80% reporting formal ReSPECT training previously, 30% and 20% rated themselves ‘not confident’ to have ReSPECT discussions with patients/relatives respectively, pre-course. None of the CMTs had completed online ReSPECT learning, and 60% reported informal ‘on the job’ learning.
Post-course none reported lack of confidence. The pre-/post- course numbers who reported confident rose from 10% to 40%, and from 10% to 50%, in discussions with patients/relatives respectively. Free text comments about the session were positive. A re-audit of ReSPECT forms is planned in the summer-it will be interesting to review whether forms completed by CMT doctors have changed.
We hope to embed similar ReSPECT teaching into junior doctor teaching in the trust at August change over, to allow all juniors practical ‘simulated’ experience in ReSPECT in addition to formal learning online and through presentations.
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