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Finlayson AJR, Kim A, Mallory AB, Vandekar S, Martin PR. Changing characteristics of physicians referred for fitness-for-duty evaluation. Gen Hosp Psychiatry 2022; 77:128-129. [PMID: 35636150 DOI: 10.1016/j.genhosppsych.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/14/2022] [Accepted: 05/20/2022] [Indexed: 11/15/2022]
Affiliation(s)
- A J Reid Finlayson
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Comprehensive Assessment Program, for Professionals, Nashville, TN.
| | - Ahra Kim
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - April B Mallory
- Vanderbilt Comprehensive Assessment Program, for Professionals, Nashville, TN
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Peter R Martin
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN
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2
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Attoe C, Matei R, Thompson L, Teoh K, Cross S, Cox T. Returning to clinical work and doctors' personal, social and organisational needs: a systematic review. BMJ Open 2022; 12:e053798. [PMID: 35641015 PMCID: PMC9157349 DOI: 10.1136/bmjopen-2021-053798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE This systematic review aims to synthesise existing evidence on doctors' personal, social and organisational needs when returning to clinical work after an absence. DESIGN Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES AMED, BNI, CINAHL, EMBASE, EMCARE, HMIC, Medline, PsycINFO and PubMed were searched up to 4 June 2020. Non-database searches included references and citations of identified articles and pages 1-10 of Google and Google Scholar. ELIGIBILITY CRITERIA Included studies presented quantitative or qualitative data collected from doctors returning to work, with findings relating to personal, social or organisational needs. DATA EXTRACTION AND SYNTHESIS Data were extracted using a piloted template. Risk of bias assessment used the Medical Education Research Study Quality Instrument or Critical Appraisal Skills Programme Qualitative Checklist. Data were not suitable for meta-analyses and underwent narrative synthesis due to varied study designs and mixed methods. RESULTS Twenty-four included studies (14 quantitative, 10 qualitative) presented data from 92 692 doctors in the UK (n=13), US (n=4), Norway (n=3), Japan (n=2), Spain (n=1), Canada (n=1). All studies identified personal needs, categorised as work-life balance, emotional regulation, self-perception and identity, and engagement with return process. Seventeen studies highlighted social needs relating to professional culture, personal and professional relationships, and illness stigma. Organisational needs found in 22 studies were flexibility and job control, work design, Occupational Health services and organisational culture. Emerging resources and recommendations were highlighted. Variable quality and high risk of biases in data collection and analysis suggest cautious interpretation. CONCLUSIONS This review posits a foundational framework of returning doctors' needs, requiring further developed through methodologically robust studies that assess the impact of length and reason for absence, before developing and evaluating tailored interventions. Organisations, training programmes and professional bodies should refine support for returning doctors based on evidence.
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Affiliation(s)
- Chris Attoe
- Maudsley Learning, South London and Maudsley NHS Foundation Trust, London, UK
- Centre for Sustainable Working Life, Birkbeck University of London, London, UK
- Psychiatry Psychology and Neuroscience, King's College London Institute, London, UK
| | - Raluca Matei
- Centre for Sustainable Working Life, Birkbeck University of London, London, UK
| | - Laura Thompson
- Centre for Sustainable Working Life, Birkbeck University of London, London, UK
| | - Kevin Teoh
- Department of Organizational Psychology, Birkbeck University of London, London, UK
| | - Sean Cross
- Maudsley Learning, South London and Maudsley NHS Foundation Trust, London, UK
- Psychiatry Psychology and Neuroscience, King's College London Institute, London, UK
| | - Tom Cox
- Centre for Sustainable Working Life, Birkbeck University of London, London, UK
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3
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Harolds JA. Quality and Safety in Healthcare, Part LXXIV: Combating Disruptive Behavior in Healthcare Workers. Clin Nucl Med 2022; 47:e1-e3. [PMID: 32520491 DOI: 10.1097/rlu.0000000000003058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Disruptive behavior has major adverse consequences for patient care, morale of the staff, and institutional reputation. Disruptive actions must be confronted as soon as is feasible. Usually, such behavior will not recur following 1 more firm conversations by officials of the healthcare institution, but if necessary disciplinary measures and/or remediation may be necessary. Rarely, because of egregious or repeated offenses, it may be obligatory to suspend the privileges of the individual permanently or until there is further evaluation, such as by a subcommittee of the medical executive committee or perhaps by a fitness-for-duty assessment by an outside organization.
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Affiliation(s)
- Jay A Harolds
- From Advanced Radiology Services and the Division of Radiology and Biomedical Imaging, College of Human Services, Michigan State University, Grand Rapids, MI
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4
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Austin EE, Do V, Nullwala R, Fajardo Pulido D, Hibbert PD, Braithwaite J, Arnolda G, Wiles LK, Theodorou T, Tran Y, Lystad RP, Hatem S, Long JC, Rapport F, Pantle A, Clay-Williams R. Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims or impaired performance. BMJ Open 2021; 11:e050377. [PMID: 34429317 PMCID: PMC8386219 DOI: 10.1136/bmjopen-2021-050377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify the risk factors associated with complaints, malpractice claims and impaired performance in medical practitioners. DESIGN Systematic review. DATA SOURCES Ovid-Medline, Ovid Embase, Scopus and Cochrane Central Register of Controlled Trials were searched from 2011 until March 2020. Reference lists and Google were also handsearched. RESULTS Sixty-seven peer-reviewed papers and three grey literature publications from 2011 to March 2020 were reviewed by pairs of independent reviewers. Twenty-three key factors identified, which were categorised as demographic or workplace related. Gender, age, years spent in practice and greater number of patient lists were associated with higher risk of malpractice claim or complaint. Risk factors associated with physician impaired performance included substance abuse and burn-out. CONCLUSIONS It is likely that risk factors are interdependent with no single factor as a strong predictor of a doctor's risk to the public. Risk factors for malpractice claim or complaint are likely to be country specific due to differences in governance structures, processes and funding. Risk factors for impaired performance are likely to be specialty specific due to differences in work culture and access to substances. New ways of supporting doctors might be developed, using risk factor data to reduce adverse events and patient harm. PROSPERO REGISTRATION NUMBER PROSPERO registration number: CRD42020182045.
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Affiliation(s)
- Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Vu Do
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ruqaiya Nullwala
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise K Wiles
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Tahlia Theodorou
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Annette Pantle
- Medical Council of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Mgboji GE, Woreta FA, Fliotsos MJ, Zafar S, Ssekasanvu J, Srikumaran D, Zhao J, Buccino DL, Regan L. Prevalence of incivility between ophthalmology and emergency medicine residents during interdepartmental consultations. AEM EDUCATION AND TRAINING 2021; 5:e10653. [PMID: 34522830 PMCID: PMC8427183 DOI: 10.1002/aet2.10653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Since incivility is linked to adverse effects in patient care and health care worker well-being, evaluation of the prevalence of incivility during the formative years of residency training is warranted. The aim of this study was to determine the perceived presence and degree of incivility between emergency medicine (EM) and ophthalmology residents during emergency department (ED) consultations. METHODS We conducted a single-site, survey-based study, targeted to ophthalmology and EM residents. The survey we distributed included questions adapted from validated and widely used surveys measuring incivility in the workplace (Workplace Incivility Scale) and incivility within the ED. RESULTS Ophthalmology (13/15, 86.7%) and EM (42/48, 87.5%) residents participated, with an overall response rate of 55 of 63 (87.3%). Most residents (47/55, 85.5%) reported some degree of incivility during consultations, with a greater proportion of females reporting incivility (100%) than males (77.4%, p = 0.033). A total of 52.7% of respondents reported occurrence of incivility on a quarterly basis; 21.8% reported monthly, 10.9% weekly, and none daily. Incivilities were reported most commonly during nonurgent consults (85.5%). The two most common incivilities reported by trainees were when the other party paid little attention to their statements or opinions (80% of residents) or doubted their professional judgment (74.5% of residents). More female trainees reported jokes being told at their expense compared to males (15.8% vs. 0%, p = 0.049). Residents most often attributed incivility to stress (78.2%), loss of empathy/burnout (63.6%), or attempts to shift responsibility to another party (60.0%). Among EM residents surveyed, incivility was identified as occurring most often during consultations with surgical specialties. CONCLUSIONS Incivility during interdepartmental consultations between EM and ophthalmology is commonly reported by physicians-in-training. It occurs more often during consultations deemed as nonurgent and is more commonly reported by females. Given its associations with adverse outcomes, interventions to decrease incivility early in training may be warranted.
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Affiliation(s)
| | - Fasika A. Woreta
- Wilmer Eye InstituteJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | | | - Sidra Zafar
- Wilmer Eye InstituteJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Joseph Ssekasanvu
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Divya Srikumaran
- Wilmer Eye InstituteJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Jiawei Zhao
- Wilmer Eye InstituteJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Daniel L. Buccino
- Department of PsychiatryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Linda Regan
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Alsaleem SA, Almoalwi NM, Siddiqui AF, Alsaleem MA, Alsamghan AS, Awadalla NJ, Mahfouz AA. Current Practices and Existing Gaps of Continuing Medical Education among Resident Physicians in Abha City, Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8483. [PMID: 33207729 PMCID: PMC7696225 DOI: 10.3390/ijerph17228483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 05/28/2023]
Abstract
BACKGROUND Continuing medical education (CME) is an everlasting process throughout the physician's working life. It helps to deliver better services for the patients. OBJECTIVES To explore CME among resident physicians in Abha City; their current practices, their opinions, and barriers faced. METHODS A cross-sectional study was conducted among resident physicians at the Ministry of Health hospitals in Abha City using a validated self-administered questionnaire. It included personal characteristics, current CME practices, satisfaction with CME, and barriers to attendance. RESULTS The present study included 300 residents from 15 training specialties. Their reported CME activities during the previous year were lectures and seminars (79.7%) followed by conferences (43.7%), case presentations (39.7%), workshops (34.0%), group discussion (29/7%), and journal clubs (27.3%). Astonishingly enough, very few (8%) attended online electronic CME activities. There were significant differences in CME satisfaction scores by different training specialties. Regarding residents' perceptions of the effectiveness of different CME activities (conferences/symposia, workshops/courses, and interdepartmental activities) the results showed that workshops and courses were significantly the most effective method compared to the other two methods in retention of knowledge, improving attitudes, improving clinical skills, improving managerial skills, and in improving practice behaviors. Barriers reported were being busy, lack of interest, high cost, and lack of suitable providers. CONCLUSION Based on the findings of this study, it is recommended that online learning be promoted as a CME format for trainees. There should be support of residents and clinicians through the provision of protected time for their CME activities outside their daily clinical commitments.
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Affiliation(s)
- Safar Abadi Alsaleem
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (S.A.A.); (A.F.S.); (M.A.A.); (A.S.A.); (N.J.A.)
| | | | - Aesha Farheen Siddiqui
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (S.A.A.); (A.F.S.); (M.A.A.); (A.S.A.); (N.J.A.)
| | - Mohammed Abadi Alsaleem
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (S.A.A.); (A.F.S.); (M.A.A.); (A.S.A.); (N.J.A.)
| | - Awad S. Alsamghan
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (S.A.A.); (A.F.S.); (M.A.A.); (A.S.A.); (N.J.A.)
| | - Nabil J. Awadalla
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (S.A.A.); (A.F.S.); (M.A.A.); (A.S.A.); (N.J.A.)
- Department of Community Medicine, College of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed A. Mahfouz
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (S.A.A.); (A.F.S.); (M.A.A.); (A.S.A.); (N.J.A.)
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria 21511, Egypt
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Hastie MJ, Jalbout T, Ott Q, Hopf HW, Cevasco M, Hastie J. Disruptive Behavior in Medicine: Sources, Impact, and Management. Anesth Analg 2020; 131:1943-1949. [PMID: 33009135 DOI: 10.1213/ane.0000000000005218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Maya Jalbout Hastie
- From the Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | | | - Qi Ott
- Department of Anesthesiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Harriet W Hopf
- Departments of Anesthesiology and Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | - Marisa Cevasco
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan Hastie
- From the Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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Keller S, Yule S, Zagarese V, Henrickson Parker S. Predictors and triggers of incivility within healthcare teams: a systematic review of the literature. BMJ Open 2020; 10:e035471. [PMID: 32513884 PMCID: PMC7282335 DOI: 10.1136/bmjopen-2019-035471] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To explore predictors and triggers of incivility in medical teams, defined as behaviours that violate norms of respect but whose intent to harm is ambiguous. DESIGN Systematic literature review of quantitative and qualitative empirical studies. DATA SOURCES Database searches according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline in Medline, CINHAL, PsychInfo, Web of Science and Embase up to January 2020. ELIGIBILITY CRITERIA Original empirical quantitative and qualitative studies focusing on predictors and triggers of incivilities in hospital healthcare teams, excluding psychiatric care. DATA EXTRACTION AND SYNTHESIS Of the 1397 publications screened, 53 were included (44 quantitative and 9 qualitative studies); publication date ranged from 2002 to January 2020. RESULTS Based on the Medical Education Research Study Quality Instrument (MERSQI) scores, the quality of the quantitative studies were relatively low overall (mean MERSQI score of 9.93), but quality of studies increased with publication year (r=0.52; p<0.001). Initiators of incivility were consistently described as having a difficult personality, yet few studies investigated their other characteristics and motivations. Results were mostly inconsistent regarding individual characteristics of targets of incivilities (eg, age, gender, ethnicity), but less experienced healthcare professionals were more exposed to incivility. In most studies, participants reported experiencing incivilities mainly within their own professional discipline (eg, nurse to nurse) rather than across disciplines (eg, physician to nurse). Evidence of specific medical specialties particularly affected by incivility was poor, with surgery as one of the most cited uncivil specialties. Finally, situational and cultural predictors of higher incivility levels included high workload, communication or coordination issues, patient safety concerns, lack of support and poor leadership. CONCLUSIONS Although a wide range of predictors and triggers of incivilities are reported in the literature, identifying characteristics of initiators and the targets of incivilities yielded inconsistent results. The use of diverse and high-quality methods is needed to explore the dynamic nature of situational and cultural triggers of incivility.
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Affiliation(s)
- Sandra Keller
- Center for Surgery and Public Health (CSPH), Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Steven Yule
- Center for Surgery and Public Health (CSPH), Brigham and Women's Hospital, Boston, Massachusetts, USA
- STRATUS Center for Medical Simulation, Boston, Massachusetts, USA
- Department of surgery, Harvard Medical School, Boston, Massachusetts, USA
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom
| | - Vivian Zagarese
- Department of Psychology, Virginia Tech, Blacksburg, Virginia, USA
| | - Sarah Henrickson Parker
- Department of Psychology, Virginia Tech, Blacksburg, Virginia, USA
- Fralin Biomedical Research Institute (FBRI) at Virginia Tech Carilion, Roanoke, Virginia, USA
- Center for Simulation, Research and Patient Safety, Carilion Clinic, Roanoke, Virginia, USA
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Swiggart WH, Bills JL, Penberthy JK, Dewey CM, Worley LL. A Professional Development Course Improves Unprofessional Physician Behavior. Jt Comm J Qual Patient Saf 2020; 46:64-71. [DOI: 10.1016/j.jcjq.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
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Keshmiri F, Farahmand S, Bahramnezhad F, Hossein-Nejad Nedaei H. Exploring the challenges of professional identity formation in clinical education environment: A qualitative study. JOURNAL OF ADVANCES IN MEDICAL EDUCATION & PROFESSIONALISM 2020; 8:42-49. [PMID: 32039272 PMCID: PMC6946943 DOI: 10.30476/jamp.2019.74806.0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 12/09/2019] [Indexed: 06/08/2023]
Abstract
INTRODUCTION This study aimed to explore the challenges of professional identity formation at clinical education environments from the faculty members' viewpoints. METHODS This is a qualitative study. The population consisted of clinical faculty members of Tehran University of Medical Sciences. In this study, 39 faculty members participated in an in-depth semi-structured interview. To analyze the data, conventional content analysis approach was used. Open coding was extracted from the participants' statements that represented their experiences. Then, based on their similarities, the codes were classified. Subcategories were emerged and after arranging, they were classified into categories based on their relationships. RESULTS Instability of professional commitment, patient-centeredness as the missing loop care and treatment, and inappropriate conductive context were explored as the challenges of professional identity in clinical educational environment. CONCLUSION According to the results of the study, the formation of professional identity among the providers is not an easy task because many factors affect the formation of professional identity. Therefore, a comprehensive shift towards forming the professional identity at individual and organizational level should be planned.
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Affiliation(s)
- Fatemeh Keshmiri
- Educational Development Center, Medical Education Department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Shervin Farahmand
- Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Bahramnezhad
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Riley B. Incorporating a Standardized Online Professionalism Curriculum in Osteopathic Medical School. J Osteopath Med 2019; 119:112-115. [DOI: 10.7556/jaoa.2019.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Online social media platforms increase patients’ access to physicians, thus potentially blurring the boundaries between physicians’ professional and private lives. Although many medical organizations have established guidelines on how physicians should proceed on social media and social networking sites (SNSs), there has not been a mandated standardized curriculum on the use of social media, SNSs, and online professionalism for physicians or medical students. With the increase in physician involvement on social media and SNSs, professionalism issues can emerge. Online professionalism complaints have been increasing. Therefore, osteopathic medical students need to be taught the dangers and benefits of engaging with online media. This article seeks to address the need for mandating a standardized online professionalism curriculum for osteopathic medical students and show how a simulation-based medical education curriculum can help accomplish this goal.
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DuBois JM, Anderson EE, Chibnall JT, Mozersky J, Walsh HA. Serious Ethical Violations in Medicine: A Statistical and Ethical Analysis of 280 Cases in the United States From 2008-2016. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:16-34. [PMID: 30676904 PMCID: PMC6460481 DOI: 10.1080/15265161.2018.1544305] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances (97%) of intentional wrongdoing (99%), by males (95%) in nonacademic medical settings (95%), with oversight problems (89%) and a selfish motive such as financial gain or sex (90%). More than half of cases involved a wrongdoer with a suspected personality disorder or substance use disorder (51%). Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions.
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Affiliation(s)
- James M. DuBois
- Division of General Medical Sciences, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8005, St Louis MO 63110, USA,
| | - Emily E. Anderson
- Neiswanger Institute for Bioethics & Health Policy, Loyola University Chicago Stritch School of Medicine, 2160 S. First Avenue, Maywood, IL 60153,
| | - John T. Chibnall
- Department of Neurology & Psychiatry, Saint Louis University School of Medicine, 1438 S. Grand Blvd., St. Louis, MO 63104,
| | - Jessica Mozersky
- Division of General Medical Sciences, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8005, St Louis MO 63110, USA,
| | - Heidi A. Walsh
- Division of General Medical Sciences, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8005, St Louis MO 63110, USA,
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Reich J, Kelly M. Empirical findings of fitness-for-duty evaluations. MEDEDPUBLISH 2018; 7:258. [PMID: 38089235 PMCID: PMC10711949 DOI: 10.15694/mep.2018.0000258.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Background:The ability of physicians to practice appropriately is often evaluated by a fitness for duty exam. This report reviews the empirical literature on fitness for duty evaluations. Methods: A literature review was performed on PubMed using the terms physician, impairment, burnout, fitness to practice and fitness for duty. Results: At least one percent of physicians are referred each year for possibly serious difficulties. Surgery and its subspecialties and psychiatry may be at higher risk. Variables associated with fitness for duty evaluations include educational, personality, culture and emotional illness. Conclusions: Risk factors appear to vary between modifiable (training, culture and treatable emotional illness), less modifiable (personality) and likely unmodifiable (specialty). Fitness for duty should be part of the training of all psychiatrists.
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de Leon J, Wise TN, Balon R, Fava GA. Dealing with Difficult Medical Colleagues. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:5-11. [PMID: 29306944 DOI: 10.1159/000481200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 09/03/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
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Ferranti J. Fitness for Duty Assessments: Teaching Forensic Psychiatry Fellows Best Practices in Workplace Safety Consultation. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:798-802. [PMID: 29181657 DOI: 10.1007/s40596-017-0816-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 09/11/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Jessica Ferranti
- Division of Psychiatry and the Law, Department of Psychiatry and Behavioral Sciences, UC Davis Health System, Sacramento, CA, USA.
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Williams BW, Flanders P, Grace ES, Korinek E, Welindt D, Williams MV. Assessment of fitness for duty of underperforming physicians: The importance of using appropriate norms. PLoS One 2017; 12:e0186902. [PMID: 29053736 PMCID: PMC5650180 DOI: 10.1371/journal.pone.0186902] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 10/10/2017] [Indexed: 11/25/2022] Open
Abstract
Objective To determine whether population-specific normative data should be employed when screening neurocognitive functioning as part of physician fitness for duty evaluations. If so, to provide such norms based on the evidence currently available. Methods A comparison of published data from four sources was analyzed. Data from the two physician samples were then entered into a meta-analysis to obtain full information estimates and generate provisional norms for physicians. Results Two-way analysis of variance (Study x Index) revealed a significant main effect and an interaction. Results indicate differences in mean levels of performance and standard deviation for physicians. Conclusions Reliance on general population normative data results in under-identification of potential neuropsychological difficulties. Population specific normative data are needed to effectively evaluate practicing physicians.
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Affiliation(s)
- Betsy White Williams
- Department of Psychiatry School of Medicine, University of Kansas, Clinical Program, Kansas City, Kansas, United States of America
- Professional Renewal Center® (PRC®), Lawrence, Kansas, United States of America
- * E-mail:
| | - Philip Flanders
- Professional Renewal Center® (PRC®), Lawrence, Kansas, United States of America
| | - Elizabeth S. Grace
- Center for Personalized Education for Physicians (CPEP), Denver, Colorado, United States of America
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Elizabeth Korinek
- Center for Personalized Education for Physicians (CPEP), Denver, Colorado, United States of America
| | - Dillon Welindt
- Wales Behavioral Assessment (WBA), Lawrence, Kansas, United States of America
| | - Michael V. Williams
- Wales Behavioral Assessment (WBA), Lawrence, Kansas, United States of America
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Brown KP, Iannelli RJ, Marganoff DP. Use of the Personality Assessment Inventory in Fitness-for-Duty Evaluations of Physicians. J Pers Assess 2016; 99:465-471. [PMID: 27997225 DOI: 10.1080/00223891.2016.1255950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study provides normative data regarding the use of the Personality Assessment Inventory (PAI) in physician fitness-for-duty evaluations. Information was derived from a sample of 371 physicians who took the PAI as part of a comprehensive fitness-for-duty evaluation. A multidisciplinary evaluation team, not blinded to psychological testing results, recommended whether or not each physician was fit to practice, allowing for the differentiation of results by this finding. The majority of PAI protocols were valid and interpretively useful. Descriptive statistics are presented for validity, clinical, treatment, interpersonal, and subscale scores. Mean differences for those found fit versus unfit to practice are also presented. Significant elevations for clinical scales are rare in physicians referred for fitness-for-duty evaluations. Although mean differences were small between the fit and unfit groups, there were significant mean differences found. Guidance is offered for interpreting the PAI in this population.
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Affiliation(s)
- Kimberly P Brown
- a Department of Psychiatry and Behavioral Sciences , Vanderbilt University
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19
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Finlayson AJR, Iannelli RJ, Brown KP, Neufeld RE, DuPont RL, Campbell MD. Re: physician suicide and physician health programs. Gen Hosp Psychiatry 2016; 40:84-5. [PMID: 26874652 DOI: 10.1016/j.genhosppsych.2016.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 01/07/2016] [Accepted: 01/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- A J Reid Finlayson
- The Vanderbilt Comprehensive Assessment Program, Nashville, TN 37212, USA.
| | - Richard J Iannelli
- The Vanderbilt Comprehensive Assessment Program, Nashville, TN 37212, USA
| | - Kimberly P Brown
- The Vanderbilt Comprehensive Assessment Program, Nashville, TN 37212, USA
| | - Ronald E Neufeld
- The Vanderbilt Comprehensive Assessment Program, Nashville, TN 37212, USA
| | - Robert L DuPont
- The Institute For Behavior and Health, Inc, Rockville, MD 20852, USA
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MacDonald K, Sciolla AF, Folsom D, Bazzo D, Searles C, Moutier C, Thomas ML, Borton K, Norcross B. Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs. Gen Hosp Psychiatry 2015; 37:489-96. [PMID: 26554082 DOI: 10.1016/j.genhosppsych.2015.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The assessment and remediation of boundary-challenged healthcare professionals is enhanced through examination of individual risk factors. We assessed three such factors--attachment style, childhood trauma and maladaptive beliefs--in 100 attendees (mostly physicians) of a CME professional boundaries course. We propose a theoretical model which draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations. METHODS We administered the Experiences in Close Relationship Questionnaire (ECR-R), Childhood Trauma Questionnaire (CTQ), and Young Schema Questionnaire (YSQ) to 100 healthcare professionals (mostly physicians) attending a CME course on professional boundaries. Experts rated participant autobiographies to determine attachment style and early adversities. Correlations and relationships among self- and expert ratings and between different risk factors were examined. RESULTS Five percent of participants reported CTQ total scores in the moderate to severe range; eleven percent reported moderate to severe emotional neglect or emotional abuse. Average attachment anxiety and attachment avoidance were low, and more than half of participants were rated “secure” by experts. Childhood maltreatment was correlated with attachment anxiety and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs. CONCLUSION Our findings support a potential link between childhood adversity and boundary difficulties, partly mediated by insecure attachment and early maladaptive beliefs. Furthermore, these results suggest that boundary education programs and professional wellness programs may be enhanced with a focus on sequelae of childhood maltreatment, attachment and common maladaptive thinking patterns.
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Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs. Gen Hosp Psychiatry 2015; 37:81-8. [PMID: 25440724 DOI: 10.1016/j.genhosppsych.2014.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 08/20/2014] [Accepted: 09/01/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The assessment and remediation of boundary-challenged health care professionals is enhanced through examination of individual risk factors. We assessed three such factors - attachment style, childhood trauma and maladaptive beliefs - in 100 attendees (mostly physicians) of a continuing medical education (CME) professional boundaries course. We propose a theoretical model that draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations. METHODS We administered the Experiences in Close Relationships Questionnaire Revised (ECR-R), Childhood Trauma Questionnaire (CTQ) and Young Schema Questionnaire (YSQ) to 100 health care professionals attending a CME course on professional boundaries. Experts rated participant autobiographies to determine attachment style and early adversities. Correlations and relationships between self-ratings and expert ratings and among different risk factors were examined. RESULTS One fifth of participants reported moderate to severe childhood abuse; sixty percent reported moderate to severe emotional neglect. Despite this, average attachment anxiety and attachment avoidance were low, and more than half of participants were rated "secure" by experts. Childhood maltreatment was correlated with attachment anxiety and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs. CONCLUSIONS Our findings support a potential link between childhood adversity and boundary difficulties, partly mediated by insecure attachment and early maladaptive beliefs. Furthermore, these results suggest that boundary education programs and professional wellness programs may be enhanced with a focus on sequelae of childhood maltreatment, attachment and common maladaptive thinking patterns.
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Suicidal behavior among physicians referred for fitness-for-duty evaluation. Gen Hosp Psychiatry 2014; 36:732-6. [PMID: 25085717 PMCID: PMC4254198 DOI: 10.1016/j.genhosppsych.2014.06.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/19/2014] [Accepted: 06/23/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We compared fitness-for-duty assessment findings of physicians who subsequently engaged in suicidal behavior and those who did not. METHOD Assessments of 141 physicians evaluated at the Vanderbilt Comprehensive Assessment Program were retrospectively compared between those who later either attempted (n = 2) or completed (n = 5) suicide versus the remainder of the sample. RESULTS Subsequent suicidal behaviors were associated with being found unfit to practice (86% vs. 31%, P < .05), being in solo practice (71% vs. 33%) and chronically using benzodiazepines (57% vs. 11%, Fisher's Exact Test, P < .05). CONCLUSION Being found unfit for practice may trigger a cascade of adverse social and financial consequences. Those engaged in solo practice may be particularly vulnerable due to isolation and lack of oversight by supportive colleagues. Finally, chronic benzodiazepine use may impair resilience due to associated brain dysfunction. Although these characteristics must be investigated prospectively, our observations suggest that they may be important signals of increased risk for suicidal behavior in physicians. The intense stress associated with medical practice and the relatively high rates of suicidal behavior among physicians make it important to be able to identify physicians who are at risk, so that appropriate preventive actions can be taken.
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