Bridging the Gap: First-Cycle Results of a Multi- Centre NHS Survey on Junior Doctors’ Confidence in Managing Acute Orthopaedic Emergencies

Introduction: Acute orthopaedic emergencies like Cauda Equina Syndrome (CES) and Compartment Syndrome demand immediate intervention, yet junior NHS doctors often report significant confidence deficits in handling them. This multi-centre study assesses baseline preparedness across six high-risk conditions to highlight gaps in junior doctor confidence. Objectives: Our study aims to evaluate baseline confidence levels among junior doctors in diagnosing and managing conditions, including Cauda Equina Syndrome, Compartment Syndrome, Necrotizing Fasciitis, and Fractures with Neurovascular Deficit, septic arthritis and Spinal Injuries; to identify specific gaps in junior confidence in handling these cases; and to recommend targeted interventions. Methods: This observational study spanned 10 NHS Trusts and included 204 junior doctors, ranging from FY1 to Registrar level. Pre-intervention surveys measured diagnostic confidence, management confidence, and documentation using a 1-5 Likert scale. Data were analysed descriptively. Results: For Cauda Equina Syndrome, junior doctors reported low confidence in management (2.67/5), with only 30% correctly identifying the diagnostic triad. Registrars showed moderate diagnostic confidence (4.3/5) but demonstrated gaps in MRI interpretation (40%). For Fractures with Neurovascular Deficit: Registrars reported high diagnostic confidence 4.3/5 (86%) while junior doctors showed diagnostic confidence of 2.1/5 (42%); Their management confidence with neurovascular compromise was rated at 4/5 (90%) while juniors reported only 1.1/5 (22%). But for Necrotizing Fasciitis, junior doctors had the lowest management confidence (2.3/5), and 62% were unable to list more than two diagnostic criteria ("Four D’s"). Regarding Compartment Syndrome , junior doctors delayed fasciotomy referrals in 68% of cases and had low diagnostic confidence (3.6/5). Registrars showed over-reliance on pressure monitoring (35%). For Spinal Injuries: Across all junior roles, documentation confidence was low (2.5/5), and only 49% felt confident applying the NEXUS criteria. In terms of Septic Arthritis, Junior doctors reported weak confidence in management (3.8/5), while 41% of registrars delayed aspiration pending senior review. Conclusion: Pre-intervention data reveal widespread confidence deficits among junior doctors, especially FY2/SHOs, in managing acute emergencies. Shortcomings in guideline adherence, diagnostic accuracy, and documentation emphasize the urgent need for structured interventions such as simulation training and decision support tools.