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Richardson LC, Lehnbom EC, Baysari MT, Walter SR, Day RO, Westbrook JI. A time and motion study of junior doctor work patterns on the weekend: a potential contributor to the weekend effect? Intern Med J 2017; 46:819-25. [PMID: 27094756 DOI: 10.1111/imj.13120] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/02/2016] [Accepted: 04/06/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients admitted to hospital on weekends have a greater risk of mortality compared to patients admitted on weekdays. Junior medical officers (JMO) make up the majority of medical staff on weekends. No previous study has quantified JMO work patterns on weekends. AIM To describe and quantify JMO work patterns on weekends and compare them with patterns previously observed during the week. METHODS Observational time and motion study of JMO working weekends using the Work Observation Method by Activity Timing (WOMBAT; Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia) software. Descriptive statistics were used to determine the proportion of total observed time spent in tasks. RESULTS Weekend JMO predominately spent time in indirect care (32.0%), direct care (23.0%) and professional communication (22.1%). JMO spent 20.9% of time multitasking and were interrupted, on average, every 9 min. Weekend JMO spent significantly more time in direct care compared with weekdays (13.0%; P < 0.001) and nights (14.3%; P < 0.001). Weekend JMO spent significantly less time on breaks (8.5%), with less than 1 h in an 11-h shift, compared with JMO during weekdays (16.4%; P = 0.004) and nights (27.6%; P = <0.001). Weekend JMO were interrupted at a higher rate (6.6/h) than on weekdays (rate ratio (RR) 2.9, 95% confidence intervals (CI) 2.6, 3.3) or nights (RR 5.1, 95% CI 4.2, 6.1). Multitasking on weekends (20.9%) was comparable to weekdays (18.9%; P = 0.19) but significantly higher than nights (6.4%; P = <0.001). CONCLUSION On weekends, JMO had few breaks, were interrupted frequently and engaged in high levels of multitasking. This pattern of JMO work could be a potential contributing factor to the weekend effect in terms of JMO abilities to respond safely and adequately to care demands.
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Affiliation(s)
- L C Richardson
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.,Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - E C Lehnbom
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - M T Baysari
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.,Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - S R Walter
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - R O Day
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia.,UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - J I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Sholl S, Ajjawi R, Allbutt H, Butler J, Jindal-Snape D, Morrison J, Rees C. Balancing health care education and patient care in the UK workplace: a realist synthesis. MEDICAL EDUCATION 2017; 51:787-801. [PMID: 28429527 DOI: 10.1111/medu.13290] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/11/2016] [Accepted: 01/19/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT Patient care activity has recently increased without a proportionate rise in workforce numbers, impacting negatively on health care workplace learning. Health care professionals are prepared in part by spending time in clinical practice, and for medical staff this constitutes a contribution to service. Although stakeholders have identified the balance between health care professional education and patient care as a key priority for medical education research, there have been very few reviews to date on this important topic. METHODS We conducted a realist synthesis of the UK literature from 1998 to answer two research questions. (1) What are the key workplace interventions designed to help achieve a balance between health care professional education and patient care delivery? (2) In what ways do interventions enable or inhibit this balance within the health care workplace, for whom and in what contexts? We followed Pawson's five stages of realist review: clarifying scope, searching for evidence, assessment of quality, data extraction and data synthesis. RESULTS The most common interventions identified for balancing health care professional education and patient care delivery were ward round teaching, protected learning time and continuous professional development. The most common positive outcomes were simultaneous improvements in learning and patient care or improved learning or improved patient care. The most common contexts in which interventions were effective were primary care, postgraduate trainee, nurse and allied health professional contexts. By far the most common mechanisms through which interventions worked were organisational funding, workload management and support. CONCLUSION Our novel findings extend existing literature in this emerging area of health care education research. We provide recommendations for the development of educational policy and practice at the individual, interpersonal and organisational levels and call for more research using realist approaches to evaluate the increasing range of complex interventions to help balance health care professional education and patient care delivery.
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Affiliation(s)
- Sarah Sholl
- Business School, Edinburgh Napier University, Edinburgh, UK
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Burwood, Vic., Australia
| | - Helen Allbutt
- Planning and Corporate Governance, NHS Education for Scotland, Edinburgh, UK
| | - Jane Butler
- Health Education England - Kent, Surrey and Sussex, Crawley, UK
| | | | - Jill Morrison
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Charlotte Rees
- Faculty of Medicine, Nursing and Health Sciences, HealthPEER (Health Professions Education and Education Research), Monash University, Clayton, Vic., Australia
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3
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Price S, Lusznat R. Do trainees feel that they belong to a team? CLINICAL TEACHER 2017; 15:240-244. [PMID: 28517038 DOI: 10.1111/tct.12664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Postgraduate medical education has undergone significant reorganisation in recent years, with changes to the traditional apprenticeship model and an increasing reliance on shift working. The importance of teamwork in clinical care is well established; however, there is little literature on the extent to which trainees actually feel part of a team in the context of current working patterns. METHOD This is a qualitative study using semi-structured interviews of medical and surgical trainees. Data were analysed thematically using an inductive qualitative approach. RESULTS Fifteen trainees who had worked in a range of hospitals across the UK participated. Emerging themes fell into several categories: what constitutes the team; the effect of shift patterns on the team; the role of the team in education, support and well-being; and influences on team rapport. Whilst in general interviewees felt part of a team, this was not true for all posts. The nature of the team was also highly variable, and had evolved from the traditional 'Firm' structure to a more nebulous concept. Shift-working patterns could result in the fragmentation of the team, which had implications for patient care as well as for training. DISCUSSION The team played an important role in both education and well-being for trainees, and several factors were identified that could engender a more supportive team. With an ageing population and with increasing demands on limited resources, the requirement for shift work is likely to increase, and there is a fundamental need to maintain support for the next generation of doctors. There is little literature on the extent to which trainees actually feel part of a team.
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Affiliation(s)
- Sophie Price
- Health Education England Wessex, Otterbourne, Hampshire, UK
| | - Rosie Lusznat
- Health Education England Wessex, Otterbourne, Hampshire, UK
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4
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Brooks HL, Pontefract SK, Hodson J, Blackwell N, Hughes E, Marriott JF, Coleman JJ. An evaluation of UK foundation trainee doctors' learning behaviours in a technology-enhanced learning environment. BMC MEDICAL EDUCATION 2016; 16:133. [PMID: 27142695 PMCID: PMC4855751 DOI: 10.1186/s12909-016-0651-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/23/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Technology-Enhanced Learning (TEL) can be used to educate Foundation Programme trainee (F1 and F2) doctors. Despite the advantages of TEL, learning behaviours may be exhibited that are not desired by system developers or educators. The aim of this evaluation was to investigate how learner behaviours (e.g. time spent on task) were affected by temporal (e.g. time of year), module (e.g. word count), and individual (e.g. knowledge) factors for 16 mandatory TEL modules related to prescribing and therapeutics. METHODS Data were extracted from the SCRIPT e-Learning platform for first year Foundation trainee (F1) doctors in the Health Education England's West Midland region from 1(st) August 2013 to 5(th) August 2014. Generalised Estimating Equation models were used to examine the relationship between time taken to complete modules, date modules were completed, pre- and post-test scores, and module factors. RESULTS Over the time period examined, 688 F1 doctors interacted with the 16 compulsory modules 10,255 times. The geometric mean time taken to complete a module was 28.9 min (95% Confidence Interval: 28.4-29.5) and 1,075 (10.5%) modules were completed in less than 10 min. In February and June (prior to F1 progression reviews) peaks occurred in the number of modules completed and troughs in the time taken. Most modules were completed, and the greatest amount of time was spent on the learning on a Sunday. More time was taken by those doctors with greater pre-test scores and those with larger improvements in test scores. CONCLUSIONS Foundation trainees are exhibiting unintended learning behaviours in this TEL environment, which may be attributed to several factors. These findings can help guide future developments of this TEL programme and the integration of other TEL programmes into curricula by raising awareness of potential behavioural issues that may arise.
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Affiliation(s)
- Hannah L Brooks
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sarah K Pontefract
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - James Hodson
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TH, UK
| | | | - Elizabeth Hughes
- Health Education England's West Midlands team, St Chads Court, 213 Hagley Road, Edgbaston, Birmingham, B16 9RG, UK
| | - John F Marriott
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jamie J Coleman
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TH, UK.
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Tasker F, Newbery N, Burr B, Goddard AF. Survey of core medical trainees in the United Kingdom 2013 - inconsistencies in training experience and competing with service demands. Clin Med (Lond) 2014; 14:149-56. [PMID: 24715126 PMCID: PMC4953286 DOI: 10.7861/clinmedicine.14-2-149] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is currently considerable concern about the attractiveness of hospital medicine as a career and experiences in core medical training (CMT) are a key determinant of whether trainees continue in the medical specialties. Little is understood about the quality and impact of the current CMT programme and this survey was designed to assess this. Three key themes emerged. Firstly, the demands of providing service have led to considerable loss of training opportunities, particularly in outpatients and formal teaching sessions. Trainees spend a lot of this service time doing menial tasks and over 90% report that service takes up 80-100% of their time. Secondly, clinical and educational supervision is variable, with trainees sometimes getting little consultant feedback on their clinical performance. Finally, 44% of trainees report that CMT has not prepared them to be a medical registrar and many trainees are put off acute medical specialties by their experiences in CMT.
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Affiliation(s)
| | - Nina Newbery
- Medical Workforce Unit, Royal College of Physicians, London, UK
| | - Bill Burr
- Joint Royal College of Physicians Training Board, London, UK
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6
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Oates RK, Goulston KJ, Bingham CM, Dent OF. The cost of teaching an intern in New South Wales. Med J Aust 2014; 200:100-3. [DOI: 10.5694/mja13.10213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 10/02/2013] [Indexed: 11/17/2022]
Affiliation(s)
- R Kim Oates
- Sydney Medical School, University of Sydney, Sydney, NSW
| | | | - Craig M Bingham
- General Medical Education and Training Unit, Health Education and Training Institute, Gladesville Hospital, Sydney, NSW
| | - Owen F Dent
- School of Medicine, University of Western Sydney, Sydney, NSW
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7
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Mason S, O’Keeffe C, Carter A, O’Hara R, Stride C. An evaluation of foundation doctor training: a mixed-methods study of the impact on workforce well-being and patient care [the Evaluating the Impact of Doctors in Training (EDiT) study]. HEALTH SERVICES AND DELIVERY RESEARCH 2013. [DOI: 10.3310/hsdr01150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundA major reform of junior doctor training was undertaken in 2004–5, with the introduction of foundation training (FT) to address perceived problems with work structure, conditions and training opportunities for postgraduate doctors. The well-being and motivation of junior doctors within the context of this change to training (and other changes such as restrictions in working hours of junior doctors and increasing demand for health care) and the consequent impact upon the quality of care provided is not well understood.ObjectivesThis study aimed to evaluate the well-being of foundation year 2 (F2) doctors in training. Phase 1 describes the aims of delivering foundation training with a focus on the role of training in supporting the well-being of F2 doctors and assesses how FT is implemented on a regional basis, particularly in emergency medicine (EM). Phase 2 identifies how F2 doctor well-being and motivation are influenced over F2 and specifically in relation to EM placements and quality of care provided to patients.MethodsPhase 1 used semistructured interviews and focus groups with postgraduate deanery leads, training leads (TLs) and F2 doctors to explore the strategic aims and implementation of FT, focusing on the specialty of EM. Phase 2 was a 12-month online longitudinal study of F2 doctors measuring levels of and changes in well-being and motivation. In a range of specialties, one of which was EM, data from measures of well-being, motivation, intention to quit, confidence and competence and job-related characteristics (e.g. work demands, task feedback, role clarity) were collected at four time points. In addition, we examined F2 doctor well-being in relation to quality of care by reviewing clinical records (criterion-based and holistic reviews) during the emergency department (ED) placement relating to head injury and chronic obstructive pulmonary disease (COPD).ResultsPhase 1 of the study found that variation exists in how successfully FT is implemented locally; F2 lacks a clearly defined end point; there is a minimal focus on the well-being of F2 doctors (only on the few already shown to be ‘in difficulty’); the ED presented a challenging but worthwhile learning environment requiring a significant amount of support from senior ED staff; and disagreement existed about the performance and confidence levels of F2 doctors. A total of 30 EDs in nine postgraduate medical deaneries participated in phase 2 with 217 foundation doctors completing the longitudinal study. F2 doctors reported significantly increased confidence in managing common acute conditions and undertaking practical procedures over their second foundation year, with the biggest increase in confidence and competence associated with their ED placement. F2 doctors had levels of job satisfaction and anxiety/depression that were comparable to or better than those of other NHS workers, and adequate quality and safety of care are being provided for head injury and COPD.ConclusionsThere are ongoing challenges in delivering high-quality FT at the local level, especially in time-pressured specialties such as EM. There are also challenges in how FT detects and manages doctors who are struggling with their work. The survey was the first to document the well-being of foundation doctors over the course of their second year, and average scores compared well with those of other doctors and health-care workers. F2 doctors are benefiting from the training provided as we found improvements in perceived confidence and competence over the year, with the ED placement being of most value to F2 doctors in this respect. Although adequate quality of care was demonstrated, we found no significant relationships between well-being of foundation doctors and the quality of care they provided to patients, suggesting the need for further work in this area.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- S Mason
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - C O’Keeffe
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - A Carter
- Institute of Work Psychology, Sheffield University Management School, Sheffield, UK
| | - R O’Hara
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - C Stride
- Institute of Work Psychology, Sheffield University Management School, Sheffield, UK
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8
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Mason NC, Chaudhuri E, Newbery N, Goddard AF. Training in general medicine - are juniors getting enough experience? Clin Med (Lond) 2013; 13:434-9. [PMID: 24115695 PMCID: PMC4953789 DOI: 10.7861/clinmedicine.13-5-434] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is a widespread perception that trainees in medicine in the UK are 'not as good as they used to be' and reduction in hours of training is often cited as one cause. However, there are no data on the current experience of medical trainees in general medicine. The experience of foundation year doctors (FY1/2) and core medical trainees (CTs) in the management of 10 common medical conditions, eight common medical procedures and other aspects of medical training were collected by national survey in 2011. Trainees reported finding out-of-hours care the best setting for acute general medical experience and that the medical registrar was a key part of training. There was a significant lack of experience in both the management of medical conditions and the use of common procedures. These results highlight the challenges in general medical training and show that there is substantial room for improvement.
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Affiliation(s)
| | | | - Nina Newbery
- Medical Workforce Unit, Royal College of Physicians
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9
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McWilliams C, Manochin MM. Engaging junior doctors: evidence from "open spaces" in England. J Health Organ Manag 2013; 27:520-6. [PMID: 24003635 DOI: 10.1108/jhom-09-2012-0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This paper aims to report on a project undertaken in order to identify, develop and reflect on the leadership and managerial skills of clinicians. The main aim of the project was to design, plan, organise and deliver a learning session for Foundation Year 2 Doctors within the premises of one of the largest NHS Foundation Trusts in the UK. The key theme of the learning session was the introduction of the notion of competent medical leadership in the NHS. A leadership role has been traditionally seen as the task of managers and as such clinicians have seemed reluctant to engage. DESIGN/METHODOLOGY/APPROACH A two hour workshop was designed and delivered with the use of Open Space Technology. Foundation Year 2 doctors were invited to consider the importance of leadership in their everyday roles. An awareness of the Medical Leadership Competency Framework had been a key aspect of the learning session. FINDINGS The project's outcome can be identified as being the encouragement of Foundation Year 2 doctors in considering their roles as leaders in their everyday tasks. ORIGINALITY/VALUE Design, planning, organisation and delivery of a two hour Open Space learning session with the Foundation Year 2 doctors portrays the session's learning potentials and the potential for such sessions to provide a platform for difficult discussions in the NHS. This is particularly beneficial where a cultural shift is needed in order to see a way forward, notably when facing significant change.
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Affiliation(s)
- Claire McWilliams
- Faculty of Medical Education, HEFT NHS Foundation Trust, Birmingham, UK
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10
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Chaudhuri E, Mason NC, Newbery N, Goddard AF. Career choices of junior doctors: is the physician an endangered species? Clin Med (Lond) 2013; 13:330-5. [PMID: 23908498 PMCID: PMC4954295 DOI: 10.7861/clinmedicine.13-4-330] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There are increasing concerns regarding the recruitment and retention within general medicine. National surveys were conducted among foundation year 2 doctors (FY2), year 1 and year 2 core medical trainees (CT1 and CT2) and medical registrars (StR/ST3+) exploring their enjoyment of medicine, overall satisfaction, career aspirations, influencing factors and perceptions of the medical registrar. The results highlight that many doctors at the FY2, CT1 and CT2 levels are being deterred from general medicine by the perceived unmanageable workload and poor work-life balance of the medical registrar. Medical registrars themselves are less satisfied in general internal medicine than they are in their main specialties. Therefore, priority needs to be placed on clarifying the roles, and improving the morale, of medical registrars. If current trends persist, these will have a significant impact on patient safety, patient care and workforce planning.
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Affiliation(s)
- Ella Chaudhuri
- Medical Workforce Unit, Royal College of Physicians, London, UK.
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11
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Mehta F, Brown J, Shaw NJ. Do trainees value feedback in case-based discussion assessments? MEDICAL TEACHER 2013; 35:e1166-e1172. [PMID: 23137264 DOI: 10.3109/0142159x.2012.731100] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Feedback is important in learning, including in workplace-based assessments. AIM To explore trainee's perceptions of the educational value of case-based discussions (CBDs) specifically focusing on feedback. METHODS An online questionnaire and interviews obtaining detailed descriptions of paediatric trainees at UK specialist training levels 1 and 2 views and experiences were used. Qualitative data were analysed using a thematic framework analysis. RESULTS Trainees viewed CBDs as educationally valuable, aiding reflective learning, improving decision making skills and effecting a change in practice. Opinions varied regarding how useful they found the feedback. Feedback was perceived as more valuable from assessors who had a positive attitude towards CBDs, understood the process and had experience in leading them. Time constraints and assessments performed in less suitable environments had a negative impact on feedback. Trainees felt the choice of case played an important role, with challenging cases resulting in more beneficial feedback. CONCLUSIONS CBD assessments provide a new opportunity for good quality learning and feedback, providing there is a commitment to the educational aspects of the process by both trainer and trainee. Trainers being aware of the qualities of the discussions that result in successful feedback, could significantly improve their educational value.
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12
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Nurse practitioners can improve VTE prophylaxis prescribing in plastic surgery. J Plast Reconstr Aesthet Surg 2011; 65:688-90. [PMID: 22000210 DOI: 10.1016/j.bjps.2011.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 09/26/2011] [Accepted: 09/27/2011] [Indexed: 11/24/2022]
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13
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Hore CT, Lancashire W, Fassett RG. Clinical supervision by consultants in teaching hospitals. Med J Aust 2009; 191:220-2. [DOI: 10.5694/j.1326-5377.2009.tb02758.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 04/27/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Craig T Hore
- Port Macquarie Base Hospital, Port Macquarie, NSW
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14
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Bowhay AR. An investigation into how the European Working Time Directive has affected anaesthetic training. BMC MEDICAL EDUCATION 2008; 8:41. [PMID: 18700001 PMCID: PMC2518917 DOI: 10.1186/1472-6920-8-41] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 08/12/2008] [Indexed: 05/26/2023]
Abstract
BACKGROUND The European Working Time Directive (EWTD) became law in 1993 but only applied to doctors in training in the United Kingdom in 2004. The trainees have in consequence had a reduction in their working hours but also a change to a shift pattern of working. For craft specialities, such as anaesthesia, there are concerns that a reduction in working hours has also led to a reduction in the time available for learning and that ultimately this may affect patient care. However, there is scant research on the perceptions of trainees concerning the impact of the EWTD on their training and working lives. This study investigated what the anaesthetic Specialist Registrars (SpRs) on the Mersey Deanery SpR rotation perceived to be training and also what effect the EWTD has had on that training and their quality of life, both within and outside work. METHODS The project was a cross sectional survey, using a quantitative questionnaire with qualitative free text comments which were aggregated into overarching themes and sub themes. RESULTS 117 SpRs were sent questionnaires in April 2005; 73 completed questionnaires were returned (response rate 62.4%). Hierarchies of training opportunities emerged with training by consultants being most valued. 71.8% (95% CI 60.7-81.3) of trainees believed the EWTD has had a deleterious effect on their training and experience and 74.3% (95% CI 63.2-83.4) thought that they will be less prepared for a consultant post. 69.9% (95% CI 58.7-79.5) considered that their quality of life outside work had deteriorated, with only 15% (95% CI 8.3-24.6) finding improvement. 38.6% (95% CI 27.8-50.3) felt that they were not functioning as well as doctors, only 14.3% (95% CI 7.6-23.9) noting improvement. The trainees were still positive about anaesthesia and 73.2% (95% CI 62.2-82.5) would recommend this specialty to a student. CONCLUSION The majority of anaesthetic SpRs in the Mersey Deanery have not welcomed the changes brought by the EWTD to their training, experience and quality of life outside work.
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Affiliation(s)
- Andrew R Bowhay
- Jackson Rees Department of Paediatric Anaesthesia, Royal Liverpool Children's Hospital, Alder Hey, Eaton Road, Liverpool, L12 2 AP, UK.
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15
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Bloomfield L, Subramaniam R. Development of an instrument to measure the clinical learning environment in diagnostic radiology. J Med Imaging Radiat Oncol 2008; 52:262-8. [PMID: 18477121 DOI: 10.1111/j.1440-1673.2008.01928.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A clinical learning environment survey instrument was developed that provided insights into diagnostic radiology trainees' perceptions of the culture and context of the hospital-based training programme. The survey was completed by trainees allocated to 37 important training hospitals in Australia, New Zealand and Singapore in 2006. The main findings were that most obvious strengths of the diagnostic radiology programme are the wide variety of work-based learning opportunities and the social atmosphere. These were well regarded in all training sites. Work overload was seen as a significant problem in most hospitals and will probably remain a challenge. The areas that are most likely to repay efforts to bring about change are supervision and feedback. The study provides baseline data against which the influence of changes to the training programme may be evaluated.
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Affiliation(s)
- L Bloomfield
- School of Public and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
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16
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Westbrook JI, Ampt A, Kearney L, Rob MI. All in a day's work: an observational study to quantify how and with whom doctors on hospital wards spend their time. Med J Aust 2008; 188:506-9. [DOI: 10.5694/j.1326-5377.2008.tb01762.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2007] [Accepted: 12/16/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Johanna I Westbrook
- Health Informatics Research and Evaluation Unit, University of Sydney, Sydney, NSW
| | - Amanda Ampt
- Health Informatics Research and Evaluation Unit, University of Sydney, Sydney, NSW
| | - Leanne Kearney
- Health Informatics Research and Evaluation Unit, University of Sydney, Sydney, NSW
| | - Marilyn I Rob
- Health Informatics Research and Evaluation Unit, University of Sydney, Sydney, NSW
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Mantzoukas S, Watkinson S. Review of advanced nursing practice: the international literature and developing the generic features. J Clin Nurs 2007; 16:28-37. [PMID: 17181664 DOI: 10.1111/j.1365-2702.2006.01669.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The aim of this article is to review the nursing literature on the notion of advanced nursing practice (ANP) and consequently provide clarifications on the concept of advanced nurse practitioner by developing its' generic features. BACKGROUND This paper commences by critically reviewing the concept of advanced nursing practice as it is portrayed within the literature. From this review, a series of contradictions emerged in terms of definitions and roles. On further analysis of the literature the core aims and goals of the ANP are revealed. METHODS An informative and narrative systematic literature review was undertaken, using specific inclusion and exclusion criteria. The mass of retrieved material was carefully screened and methods of data saturation were used. Consequently, the material was read, re-read and indexed as to develop seven thematic units that formed the generic features of the ANP. FINDINGS The generic features that emerged are: (i) the use of knowledge in practice, (ii) critical thinking and analytical skills, (iii) clinical judgement and decision-making skills, (iv) professional leadership and clinical inquiry, (v) coaching and mentoring skills, (vi) research skills and (vii) changing practice. CONCLUSION Reviewing the literature on the concept of ANP, a great variety of definitions, conceptualizations and roles emerged. Nonetheless, on a closer reading, a common goal was identified, which was the attainment of practice and professional autonomy via ANP roles for enhanced practice provision. Eventually, from the reviewed literature, seven generic features of the ANP were developed, thus providing clarification to the role and the characteristics of the ANP. RELEVANCE TO CLINICAL PRACTICE Clarifying the confusion surrounding advanced nursing practice and gaining an in-depth understanding of its' generic features would facilitate practitioners, practice educators and clinical managers to develop those skills that would allow them or their staff or students to practise at an advanced level.
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Affiliation(s)
- Stefanos Mantzoukas
- Department of Adult Nursing, Institute of Health and Human Sciences, Thames Valley University, Ealing, London, UK.
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Carr S. The Foundation Programme assessment tools: an opportunity to enhance feedback to trainees? Postgrad Med J 2006; 82:576-9. [PMID: 16954453 PMCID: PMC2585733 DOI: 10.1136/pgmj.2005.042366] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The recent change in working patterns of doctors in training has meant that the traditional systems of education are under increasing pressure and that there is the need to maximise new opportunities for learning. One new opportunity may arise after the introduction of the mandatory assessment systems (Mini-CEX, DOPPS, Multi-source feedback, and Case based discussion) in the Foundation Programmes. In this review the new assessment procedures for the Foundation Programmes are outlined and the potential of these assessments (using Mini-CEX as main example) as an opportunity to give feedback to trainees discussed. The importance of feedback in professional development and some of the techniques available for giving feedback are described. The Foundation Programme assessments will occupy a significant amount of trainees' and trainers' time and it is important that opportunity for feedback and learning is maximised.
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Affiliation(s)
- S Carr
- University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
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Sanfey H, Savas J, Hollands C. The view of surgery department chairs on part time faculty in academic practice: results of a national survey. Am J Surg 2006; 192:366-71. [PMID: 16920432 DOI: 10.1016/j.amjsurg.2006.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Revised: 05/14/2006] [Accepted: 05/14/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reduced resident work hours sparked debate regarding lifestyle of clinical faculty. We hypothesized surgery department chairs would not be supportive of part-time clinical faculty (PTF) and would be reluctant to grant requests to reduce total institutional commitment (TIC) or total professional effort. METHOD A 16-question survey was mailed to 202 surgery chairs requesting department demographics, and perception of PTF. Chairs were given the option of identifying themselves. PTF referred to full-time equivalent clinicians who reduce their TIC for personal/family reasons and did not include clinicians with research or teaching commitments limiting clinical responsibilities. RESULTS A total of 112 of 186 (61.2%) delivered surveys were returned. Of these, 48.2% of respondents indicated clinicians had requested reduced TIC and 40.2% of departments had PTF. Only 1 chair was unable to grant a request to reduce TIC. A total of 42.8% of respondents indicated that PTF receive reduced salary-linked benefits but (58.9%) no change in either academic status or (52.7%) eligibility for promotion/tenure. The percentage of women faculty was 12.0% in departments with PTF and 10.5% in departments without PTF. A total of 42.8% of chairs agreed facilitating PTF would improve faculty retention versus 24.1% who disagreed (P<.0001). When compared with departments without PTF, chairs with PTF were more supportive that facilitating PTF would improve faculty retention (53.3% vs 32.7%, P<.001) and would be beneficial to their departments (57.8% vs 22.4%, P<.001). Sixty-two percent of respondents volunteered their names and contact information for follow-up. CONCLUSIONS Contrary to our hypothesis, surgery department chairs appear to be supportive of PTF and were interested in discussing this further.
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Affiliation(s)
- Hilary Sanfey
- Department of Surgery, Transplant Division, P.O. Box 800709, University of Virginia Health System, Charlottesville, VA 22908-0709, and Department of Pediatric Surgery, Children's Hospital of Buffalo, NY, USA.
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Derrick S, Badger B, Chandler J, Nokes T, Winch G. The training/service continuum: exploring the training/service balance of senior house officer activities. MEDICAL EDUCATION 2006; 40:355-62. [PMID: 16573672 DOI: 10.1111/j.1365-2929.2006.02406.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND The continued reduction in junior doctors' hours in the UK has made it necessary to re-examine traditional assumptions about the synonymous natures of training and service. This paper researches senior house officers' (SHOs) perceptions of 'service' and 'training', with reference to where they place activities along the training/service continuum, and the factors that lead them to classify these activities in the way they do. METHODS Questionnaires were sent to all identified SHOs at Plymouth Hospitals NHS Trust (40% response rate). Three focus groups were held with 5 SHOs, 3 consultants and 2 clinical tutors. Quantitative data derived from the questionnaires were analysed using spss. Qualitative data collected in the focus groups was coded with the aid of n6, which facilitated the thematic analysis of transcripts. RESULTS Analysis of the quantitative data allowed the construction of the training/service continuum diagram. Identified factors affecting the perceived training/service balance of SHO activities included: frequency, time, type and nature of work, number of patients, supervision, interaction, other commitments, purpose and focus of the activity, the individual trainee and trainer, and experience and competence. DISCUSSION It is no longer appropriate to assume that all junior doctor activities represent either training or service individually: activities are perceived differently along the training/service continuum depending on their execution and their relation to the SHOs' learning curves. Within the reduced hours framework, it is necessary to match this balance to experience, in order for both training and service requirements to be satisfied.
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Affiliation(s)
- Sonja Derrick
- Faculty of Social Science and Business, University of Plymouth, Plymouth, UK.
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Varley I, Keir J, Fagg P. Changes in caseload and the potential impact on surgical training: a retrospective review of one hospital's experience. BMC MEDICAL EDUCATION 2006; 6:6. [PMID: 16420692 PMCID: PMC1379640 DOI: 10.1186/1472-6920-6-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Accepted: 01/18/2006] [Indexed: 05/06/2023]
Abstract
BACKGROUND Recent reforms to the training grades have provoked debate about both quality and quantity of training. The bulk of previous research into this area has been qualitative, and little is known about the quantity of training opportunities. This study aimed to determine if the number of elective operations available to trainees was stable. METHODS The number of elective procedures carried out in each surgical specialty (General & Vascular Surgery, Urology, Orthopaedics, ENT) in a large district general hospital was analysed in 6 month periods and adjusted for the number of basic surgical trainees in each specialty. In order to allow comparison between specialties, results for each 6 month period were calculated as a percentage of those for the first period. RESULTS The number of elective operations available per trainee fell in 3 of the 4 specialties, with a rise in Orthopaedics. Overall, the number of operations available to each trainee was 56% of that less than a decade ago. CONCLUSION The number of operations available in a conventional hospital setting is decreasing. Introduction of the Modernizing Medical Careers reforms must take account of this if they are to succeed in improving the quality of surgical training.
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Affiliation(s)
- Iain Varley
- Doncaster & Bassetlaw Foundation Hospitals NHS Trust, Doncaster Royal Infirmary, Armthorpe Road, Doncaster, DN2 5LT
| | - James Keir
- Doncaster & Bassetlaw Foundation Hospitals NHS Trust, Doncaster Royal Infirmary, Armthorpe Road, Doncaster, DN2 5LT
| | - Phillip Fagg
- Doncaster & Bassetlaw Foundation Hospitals NHS Trust, Doncaster Royal Infirmary, Armthorpe Road, Doncaster, DN2 5LT
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Kendall ML, Hesketh EA, Macpherson SG. The learning environment for junior doctor training--what hinders, what helps. MEDICAL TEACHER 2005; 27:619-24. [PMID: 16332554 DOI: 10.1080/01421590500069710] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
As part of a larger study on learning outcomes for the first year of postgraduate medical training (already reported), semi-structured interviews with middle grade trainees were used to explore their perceptions of trainee development during this first training year. Data generated focused not only on learning outcomes, but also on important process issues. Dissatisfaction was expressed with formal and informal teaching and learning opportunities. Factors that enhance the learning environment were identified. These included being supported, a feeling of being a valued member of the team, being stretched but not over stretched, having a broad range of experiences, knowing the system, having a clear remit and being well organized. Factors inhibiting the learning environment included fractured working patterns, insufficient time with patients and seniors, as well as the converse of many of the enhancing factors. The process issues gathered in this paper will be of interest to those involved in the delivery of training for junior doctors.
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Kochhar A, French S. Higher surgical training in the UK. J R Soc Med 2005. [PMID: 16055913 DOI: 10.1258/jrsm.98.8.387-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kochhar A, French S. Higher Surgical Training in the UK. Med Chir Trans 2005; 98:387-8. [PMID: 16055913 PMCID: PMC1181856 DOI: 10.1177/014107680509800828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
The role of the nurse continues to change, with the point where nursing stops and medicine begins becoming increasingly blurred. Arguably, the main driver for this change could be the recent reduction in junior doctors' working hours. However, modern nursing is ripe for innovation and nurses are taking on more and more tasks and skills that were traditionally part of the doctor's remit. One example is physical assessment, which has very little evidence to support its use in any setting. Analysis of the utilization of physical assessment in the respiratory unit indicates that although it could facilitate earlier recognition of peri-arrest symptoms, its usage highlights training and legal issues. Furthermore, this article will explore whether the continual adoption of tasks, such as physical assessment, constitute mere role extension, with nurses becoming physicians' assistants rather than advanced autonomous practitioners.
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Bickel J, Brown AJ. Generation X: implications for faculty recruitment and development in academic health centers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2005; 80:205-10. [PMID: 15734801 DOI: 10.1097/00001888-200503000-00003] [Citation(s) in RCA: 183] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Differences and tensions between the Baby Boom generation (born 1945-1962) and Generation X (born 1963-1981) have profound implications for the future of academic medicine. By and large, department heads and senior faculty are Boomers; today's residents and junior faculty are Generation X'ers. Looking at these issues in terms of the generations involved offers insights into a number of faculty development challenges, including inadequate and inexpert mentoring, work-life conflicts, and low faculty morale. These insights suggest strategies for strengthening academic medicine's recruitment and retention of Generation X into faculty and leadership roles. These strategies include (1) improving career and academic advising by specific attention to mentoring "across differences"--for instance, broaching the subject of formative differences in background during the initial interaction; adopting a style that incorporates information-sharing with engagement in problem solving; offering frequent, frank feedback; and refraining from comparing today to the glories of yesterday; to support such improvements, medical schools should recognize and evaluate mentoring as a core academic responsibility; (2) retaining both valued women and men in academic careers by having departments add temporal flexibility and create and legitimize less-than-full-time appointments; and (3) providing trainees and junior faculty with ready access to educational sessions designed to turn their "intellectual capital" into "academic career capital."Given the trends discussed in this article, such supports and adaptations are indicated to assure that academic health centers maintain traditions of excellence.
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Affiliation(s)
- David A Lloyd
- Department of Child Health, University of Liverpool, Liverpool, L12 2AP, UK.
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