The GMC national training survey: Does it have an impact?

The General Medical Council (GMC) national trainee survey (NTS) monitors junior doctor training experience annually, which is then used by organisations such as Health Education England to inform quality management. Its validity as an assessment of the learning environment to drive improvement is frequently questioned; currently there are no published evidence-based studies to demonstrate its impact. To explore the effects of the GMC survey, we carried out a retrospective cohort study using publicly available GMC NTS survey data. We compared 2018 and 2019 scores in paediatrics in London across all 18 survey indicators, to identify any relationship between these 2 consecutive years of data. Our findings demonstrate that results of the GMC NTS in 1 year are associated with a change in the NTS the following year, with both an improvement in below average departments and deterioration in above average units. These findings suggest that annual GMC NTS results may have an impact on the quality of learning environments as measured in subsequent surveys – therefore they act as both a measure and a potential modifier of outcome

Follow-up survey of patients with occupational asthma.

BACKGROUND: Occupational asthma (OA) is often associated with a poor prognosis and the impact of a diagnosis on an individual's career and income can be significant. AIMS: We sought to understand the consequences of a diagnosis of OA to patients attending our clinic. METHODS: Using a postal questionnaire, we surveyed all patients attending our specialist occupational lung disease clinic 1 year after having received a diagnosis of OA due to a sensitizer (n = 125). We enquired about their current health and employment status and impact of their diagnosis on various aspects of their life. Additional information was collected by review of clinical records. RESULTS: We received responses from 71 (57%) patients; 77% were referred by an occupational health (OH) provider. The median duration of symptoms prior to referral was 18 months (interquartile range (IQR) 8-48). At 1 year, 79% respondents were no longer exposed to the causal agent. Whilst the unexposed patients reported an improvement in symptoms compared with those still exposed (82% versus 53%; P = 0.023), they had poorer outcomes in terms of career, income and how they felt treated by their employer; particularly those not currently employed. Almost all (>90%) of those still employed had been referred by an OH provider compared with 56% of those currently unemployed (P = 0.002)x. CONCLUSIONS: The negative impact of OA on people's careers, livelihood and quality of life should not be underestimated. However, with early detection and specialist care, the prognosis is often good and particularly so for those with access to occupational health

Assessment and outcomes of firefighter applicants with possible asthma.

BACKGROUND: Firefighter applicants (FFAs) with a history of asthma may be refused entry to the fire service because of potentially putting themselves and others at risk. AIMS: We undertook a service evaluation to identify respiratory and employment outcomes of FFAs with a history of asthma who had undergone additional respiratory assessment at our specialist occupational lung disease clinic during 2005-19. METHODS: We reviewed FFA medical records and categorized them as having either no current asthma or definite/probable asthma at the time of clinic assessment. 'No current asthma' was defined as negative non-specific bronchial hyper-responsiveness (BHR) to histamine/methacholine, and no symptoms or treatment within the 2 years before clinic. 'Definite/probable current asthma' was defined as either positive BHR, or negative BHR with symptoms and/or treatment within the previous 2 years. Around 1 year later, we contacted FFAs to enquire about their application outcome and current respiratory symptoms. RESULTS: Data were available on 116 applicants; of whom, 45% (n = 52) had definite/probable current asthma and were significantly more likely to be older, atopic to common aeroallergens, report atopic disease and have a lower forced expiratory volume in one second/forced vital capacity ratio compared with applicants with no current asthma. Only two individuals' applications were rejected due to asthma. At follow-up, just 2 (2%) of the 90 operational firefighters reported any recent trouble with asthma. CONCLUSIONS: A history of asthma alone is not sufficient to determine current asthma in FFAs. Even with a diagnosis of current asthma, FFAs are mostly successful in their application to join the fire service

S108 Outcomes of firefighter applicants with a history of asthma

Introduction Firefighters work in a ‘safety critical role’ and undergo comprehensive pre-employment screening. Applicants with a history of asthma (often made in childhood) are regularly referred to our specialist occupational lung disease service for additional assessment including measurement of non-specific bronchial hyper-responsiveness (NSBHR). No studies have reported the impact of a pre-existing asthma diagnosis on future employment as a firefighter; most have studied current firefighters1 or others in safety critical roles.2 We sought to identify factors associated with a positive NSBHR test amongst UK firefighter applicants, and to link these to symptoms and employment status around one year later. Methods We reviewed case notes for all firefighter applicants referred between 2005–2019; we defined NSBHR as a fall in FEV1 of at least 20% (provocation concentration (PC)20) following inhalation of <8 mg/ml histamine. Around one year after their initial appointment we contacted them for follow up, including enquiring about their application outcome and current respiratory symptoms. Results Clinical data were available on 120 applicants of whom 19 (16%) had a positive NSBHR test (see table 1). Follow-up data were available on 116 applicants. Those with a positive NSBHR test (n=17; 14.7%) were less likely to be accepted into the fire service than those with a negative test (76.5% vs 95.0% respectively, p=0.026). However, of the 4 with a positive NSBHR and not accepted by the fire service, only 2 were due to asthma. Of the 90 serving firefighters at follow-up, only 2 (2.2%) reported any recent trouble with asthma

COPD and breathlessness in older workers predict economic inactivity; A prospective cohort study

RATIONALE: There is an aspiration to retain increasing numbers of older workers in employment and strategies to achieve this need to make provision for the increasing prevalence of chronic diseases with age. There is a consistent body of cross-sectional evidence that suggests that patients with chronic obstructive pulmonary disease are more likely to have adverse employment outcomes. OBJECTIVES: We report the findings of the first longitudinal study of this issue. METHODS: We recruited full-time employed men and women in their 50's and followed them for a period of 18 months; we examined, after adjustment for potential confounders, the associations between breathlessness and airway obstruction at baseline and loss of employment in the intervening period. MEASUREMENTS AND MAIN RESULTS: Among participants responding to the follow up questionnaire (1656/1773 (93%)), the majority (78.5%) continued in full-time employment, but 10.6% were in part-time employment and 10.9% were no longer in paid employment. The adjusted risk of loss of employment was significantly increased for those with moderate or severe chronic obstructive pulmonary disease (RR 2.89, 95% ci 1.80-4.65) or breathlessness (3.07, 2.16-4.37) at baseline. There was no evident modification by sex or by manual/non-manual work. CONCLUSIONS: Airway obstruction and breathlessness are independently associated with premature loss from the workforce in older workers; these observations provide strong support to the available cross-sectional evidence and suggest that interventions to help those with chronic obstructive pulmonary disease who wish to remain in work need to be tested