Evaluating a Structured Workflow Guide to Improve Junior Doctor Preparedness for Vascular Surgery Late Shifts: A...

Background Junior doctors covering vascular surgery late shifts, defined locally as shifts covering 12:00 to 22:00, often manage specialty-specific workflows with limited formal induction, including elective admissions, post-operative reviews, medication reconciliation, investigations, and escalation of complications. The objective of this study was to evaluate whether a structured workflow guide improved junior doctors' preparedness and confidence in managing vascular surgery late shifts. Methods We conducted a prospective paired pre-post interventional study in a tertiary vascular surgery department. A structured workflow guide was developed and introduced at Foundation Year 1 (FY1) departmental induction. The guide covered shift workflow, electronic admission processes, pre-operative and post-operative review responsibilities, peri-operative medication guidance, investigation requirements, escalation advice, and use of an outpatient accommodation facility. Eight FY1 doctors completed a pre-intervention questionnaire before using the guide and a post-intervention questionnaire after one week. Survey items used a five-point Likert scale across ten preparedness and confidence domains. Supplementary survey items assessed self-reported clerking time and average escalations to senior colleagues per shift per person. Results Eight respondents completed both surveys. Median scores improved across all ten domains. The composite preparedness/confidence score increased from 19.5 (interquartile range (IQR) 17.5-21.5] pre-intervention to 46.0 (IQR 43.75-47.5) post-intervention, representing a statistically significant improvement (Wilcoxon signed-rank test, W = 0, p = 0.0078). Supplementary workflow survey items suggested reduced average clerking time from 1.8 to 1.2 hours and reduced average escalations to senior colleagues per shift per person from 5.25 to 3.5. Post-intervention usability scores were high, including median scores of 5.0 (IQR 5.0-5.0) for improved understanding of post-operative review priorities and recommendations to future FY1 doctors. Conclusions A structured workflow guide was associated with improved self-reported preparedness and confidence among FY1 doctors covering vascular surgery late shifts. Supplementary survey findings also suggested reduced clerking time and reduced reliance on senior escalation.