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Bugaj TJ, Schwarz TA, Friederich HC, Nikendei C. The curious physician: exploring the role of curiosity in professionalism, patient care, and well-being. Ann Med 2024; 56:2392887. [PMID: 39155851 PMCID: PMC11334747 DOI: 10.1080/07853890.2024.2392887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 06/15/2024] [Accepted: 07/14/2024] [Indexed: 08/20/2024] Open
Abstract
INTRODUCTION Curiosity is a fundamental human trait that drives learning and exploration. However, research on curiosity has received little attention in the medical field, despite its potential to enhance knowledge acquisition, work performance, and psychosocial well-being. This study aimed to address part of this gap by investigating physicians' perspectives on their personal experiences with curiosity and its role in their professional practice and medical training. MATERIALS AND METHODS This qualitative study was conducted with 12 physicians from the University of Heidelberg Medical Hospital. Participants were contacted randomly via email and invited to participate in the study. Data were collected through semi-structured interviews between September 2019 and February 2020. The authors employed Mayring's approach, which denotes a qualitative content analysis method characterized by its systematic and rule-guided approach to analyzing textual data, aiming to extract meaningful insights and patterns or themes. The identified themes were linked to overall categories to draw conclusions from the data. RESULTS The interviewees highlighted three main areas regarding curiosity's importance [1]: as a driving force for (lifelong) education [2], in building empathetic physician-patient relationships, and [3] as a core quality of a good researcher. They primarily linked curiosity with positive emotions, while the non-expression of curiosity was associated with dissatisfaction, boredom, and exhaustion. Factors such as heavy workloads, time constraints, stress, and lack of autonomy inhibit their curiosity, while varied activities, professional exchange with colleagues, and exposure to new challenges foster it. Physicians' perspectives on the link between burnout and curiosity were not consistent. Interestingly, some viewed curiosity as protective against burnout, while others saw excessive curiosity as a potential source of frustration and burnout. CONCLUSION This study represents the first attempt to explore physicians' perspectives on curiosity in medicine. The findings highlight the potential importance of curiosity in shaping medical professionalism and improving patient care. However, its pursuit is hampered by the challenging working conditions faced by doctors, suggesting a need for enhanced support and cultivation.
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Affiliation(s)
- Till Johannes Bugaj
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Germany
| | - Tim Alexander Schwarz
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Germany
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Prentice S, Mullner H, Benson J, Kay M. Family medicine and general practitioner supervisor wellbeing: a literature review. BJGP Open 2024:BJGPO.2023.0230. [PMID: 38479758 DOI: 10.3399/bjgpo.2023.0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Research examining general practice supervisor wellbeing has often been conducted within the context of trainee wellbeing and educational outcomes. AIM To consolidate the current literature regarding the wellbeing of GP supervisors through a 'supervisor-wellbeing' lens. DESIGN & SETTING Literature review of original research studies on Embase, Ovid MEDLINE, and Ovid PsycINFO from inception to December 2022. METHOD The Embase, Ovid MEDLINE, and Ovid PsycINFO databases were systematically searched from inception to December 2022. Original research studies were eligible if they explored any aspect of wellbeing or burnout (that is, construct conceptualisations, risk and protective factors, implications, or interventions) among GPs involved in educating GP trainees. Reporting quality of included studies was assessed using the QualSyst tool. Results from included studies were narratively synthesised. RESULTS Data from 26 independent samples were reviewed. Burnout was generally conceptualised using the Leiter and Maslach model. Wellbeing was poorly defined in the literature, largely being conceptualised in personal psychological terms and, to a lesser extent, professional satisfaction. Risk and protective factors were identified and grouped as individual (for example, satisfaction with capacity to teach) and external (for example, autonomy, collegial relationships, resource availability) factors. GP supervisors' wellbeing appeared to affect their job performance and retention. This review identified only two studies evaluating interventions to support GP supervisors' wellbeing. CONCLUSION The present review highlights a lack of conceptual clarity and research examining interventions for GP supervisor wellbeing. It provides guidance for future research designed to maximise the wellbeing of GP supervisors and support the wellbeing of trainees.
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Affiliation(s)
- Shaun Prentice
- School of Psychology, The University of Adelaide, Adelaide, South Australia
- General Practice Training Research Department, Royal Australian College of General Practitioners, Adelaide, South Australia
| | - Helen Mullner
- General Practice Training, Royal Australian College of General Practitioners, Adelaide, South Australia
| | - Jill Benson
- General Practice Training, Royal Australian College of General Practitioners, Adelaide, South Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Margaret Kay
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland
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Bayot M, Boone A, Godderis L, Lenoir AL. Multidimensional factors of burnout in general practice: a cross sectional survey. BJGP Open 2024; 8:BJGPO.2023.0171. [PMID: 38253400 PMCID: PMC11300977 DOI: 10.3399/bjgpo.2023.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND GPs are particularly vulnerable to job burnout. Tailored prevention and intervention strategies are needed. AIM To investigate organisational, interpersonal, and individual factors contributing to exhaustion and disengagement at work among GPs. DESIGN & SETTING We conducted a cross-sectional study in a sample of Belgian GPs. METHOD A total of 358 doctors (73% females, 301 with complete data) completed an online anonymous questionnaire assessing job burnout, psychosocial characteristics of the work environment, perceived social support in the private domain, emotional competence, and self-compassion. RESULTS GPs reported moderate levels of exhaustion and disengagement. Regression models showed that included factors jointly explained 69% of the variance in exhaustion and 63% in disengagement. Exhaustion was significantly predicted by female sex (β effect size = -0.1), high perceived emotional demands (β = 0.19), as well as low self-compassion (β = -0.14) and low emotional competence (β = 0.09). Disengagement was significantly predicted by low seniority (β = -0.12) and limited opportunities for development (β = -0.16). Both exhaustion and disengagement were predicted by low perceived quality of work (β = -0.19 and -0.14, respectively), meaning of work (β = -0.17 and -0.31, respectively), and role clarity (β = 0.09 and 0.12, respectively), as well as high perceived work-life conflict (β = 0.46 and 0.21, respectively). Moreover, GPs working in a multidisciplinary group reported lower levels of exhaustion and disengagement than those working in a monodisciplinary group or a solo practice, and this difference was associated with factors such as work-life conflict. CONCLUSION Organisational, interpersonal, and intrapersonal factors interact to predict a substantial part of burnout in general practice. The most significant risk factors were perceived work-life conflict and poor meaning of work. Policymakers should work to support more sustainable practices based on the specific needs and constraints reported by GPs.
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Affiliation(s)
- Marie Bayot
- Department of Clinical Sciences, Université de Liège, Liège, Belgium
| | - Anke Boone
- Centre for Environment and Health, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Lode Godderis
- Centre for Environment and Health, Katholieke Universiteit Leuven, Leuven, Belgium
- Idewe, External Service for Prevention and Protection at Work, Heverlee, Belgium
| | - Anne-Laure Lenoir
- Department of Clinical Sciences, Université de Liège, Liège, Belgium
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Schwarz TA, Nikendei C, Cranz A, Friederich HC, Bugaj TJ. An untapped potential: Curiosity in medical school. MEDICAL TEACHER 2024; 46:939-947. [PMID: 38048416 DOI: 10.1080/0142159x.2023.2288546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/23/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND There seems to be a common perception among medical educators that curiosity is untapped or even subjugated in medical education. This review aims to summarize research on curiosity across the fields of psychology, neuroscience, and education and report its potential to advance medical education. METHODS For this narrative review multiple online libraries were searched using variations of the terms curiosity and school/education/learning. Additional studies were reviewed using the reference lists of included studies, and all studies were assessed for quality and relevance. RESULTS This review of previous research on curiosity shows that curiosity can significantly impact characteristics relevant to medical education, particularly mental health and learning. In addition, the authors outline how curiosity is linked to other epistemic emotions such as anxiety, novelty, surprise, and uncertainty. Finally, an epistemic-emotion-framework (EEF) is proposed to help educators encourage curiosity in medical students. CONCLUSION By drawing from other research fields, medical educators can learn valuable lessons about the importance of curiosity and how to influence it. This review provides an overview of current research and a framework for how the potential of curiosity can be harnessed to play an important role in students' medical education.
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Affiliation(s)
- Tim Alexander Schwarz
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Heidelberg, Germany
| | - Anna Cranz
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Heidelberg, Germany
| | - Till Johannes Bugaj
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Heidelberg, Germany
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Ji J, Han Y, Li R, Jin H, Yin C, Niu L, Ying X, Gao Y, Ma Q. The role of effort-reward imbalance and depressive symptoms in the relationship between long working hours and presenteeism among Chinese village doctors: a moderated mediation model. BMC Psychiatry 2023; 23:497. [PMID: 37434160 DOI: 10.1186/s12888-023-04986-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Long working hours and effort-reward imbalance (ERI) among medical workers may contribute to poor mental health and reduced productivity. However, the potential mechanisms among them are not well understood. This study aimed to explore the role of depressive symptoms and ERI in the relationship between long working hours and presenteeism among village doctors. METHODS We conducted a cross-sectional study in Jiangsu Province, eastern China. 705 village doctors were assessed for working hours, ERI (the Effort-Reward Imbalance Questionnaire, ERI questionnaire), presenteeism (6-item Stanford Presenteeism Scale, SPS-6 Scale), and depressive symptoms (12-item General Health Questionnaire, GHQ-12). A moderated mediation model was used to test the role of depressive symptoms (M), and ERI (W) in the relationship between long working hours (X) and presenteeism (Y). RESULTS 45.11% of the village doctors worked more than 55 h per week, and 55.89% were exposed to ERI. The prevalence of depressive symptoms among Chinese village doctors was 40.85%. Long working hours (≥ 55 h per week) were significantly associated with presenteeism behaviors (β = 2.17, P < 0.001). Mediation analysis demonstrated that depressive symptoms (GHQ score > 3) could partly mediate the relationship between long working hours and presenteeism (indirect effect β = 0.64, P < 0.001). Moderated mediation further indicated that the interaction of long working hours and ERI was significantly and positively associated with depressive symptoms, which in turn predicted elevated presenteeism behaviors. CONCLUSIONS Depressive symptoms had a mediating role in the association of long working hours with presenteeism behaviors among Chinese village doctors and ERI augment their negative effects.
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Affiliation(s)
- Jingya Ji
- Department of Health Management, School of Public Health, Nantong University, 9 Seyuan Road, Jiangsu, 226019, China
- Department of Health Management, Affiliated Hospital of Nantong University, Nantong, China
| | - Yarong Han
- Nantong Center for Disease Control and Prevention, Nantong, China
| | - Ruyu Li
- Department of Health Management, School of Public Health, Nantong University, 9 Seyuan Road, Jiangsu, 226019, China
| | - Hui Jin
- Department of Health Management, School of Public Health, Nantong University, 9 Seyuan Road, Jiangsu, 226019, China
| | - Chengjie Yin
- Department of Health Management, School of Public Health, Nantong University, 9 Seyuan Road, Jiangsu, 226019, China
| | - Luyao Niu
- Department of Health Management, School of Public Health, Nantong University, 9 Seyuan Road, Jiangsu, 226019, China
| | - Xinyu Ying
- Department of Health Management, School of Public Health, Nantong University, 9 Seyuan Road, Jiangsu, 226019, China
| | - Yuexia Gao
- Department of Health Management, School of Public Health, Nantong University, 9 Seyuan Road, Jiangsu, 226019, China.
- Institute for Health and Development, Nantong University, Nantong, China.
| | - Qiang Ma
- Department of Health Management, School of Public Health, Nantong University, 9 Seyuan Road, Jiangsu, 226019, China.
- Department of Health Management, Affiliated Hospital of Nantong University, Nantong, China.
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Schwill S, Bugaj TJ, Rentschler A, Nikendei C, Szecsenyi J, Krug K. Effects of an educational compact intervention in self-care - a mixed methods study with postgraduate trainees in primary care. BMC PRIMARY CARE 2023; 24:124. [PMID: 37328816 PMCID: PMC10273587 DOI: 10.1186/s12875-023-02074-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Multiple studies indicate that residents in family medicine (FM) are exposed to considerable stress and are particularly affected by burnout syndrome. Aim of the study was to specify the effects of a so-called "compact intervention" (i.e., a short intervention) in self-care on FM residents. METHODS The authors performed a concurrent and independent mixed-methods study with FM residents on the KWBW VerbundweiterbildungPLUS© program. FM residents could voluntarily take part in a two-day seminar including 270 min on self-care, which can be regarded as a compact intervention. Study participants completed a questionnaire before (T1) and ten to twelve weeks after the course (T2), with subsequent recruitment to interview. The main outcomes of the quantitative part were to evaluate (I) self-rated change of cognition and (II) change in behavior. The qualitative outcomes were all possible effects of the compact intervention on participants´ competencies as well as all sorts of induced behavioral changes. RESULTS From a total of n = 307 residents, n = 287 FM residents (intervention group: n = 212; control group: n = 75) participated in the study. At T2, 111 post-intervention questionnaires were completed. 56% rated the intervention to be helpful for their well-being (n = 63/111). At T2, there was a significant increase in those willing to act in comparison to T1 (p = .01): 36% (n = 40/111) had changed their behavior and half of the study participants had passed on competencies to others (n = 56/111). From the intervention group, n = 17 participants additionally gave an interview. FM residents favored a trustful learning atmosphere, an interactive teaching concept and practical exercises. They described an encouraging stimulus to act and specified behavioral changes. CONCLUSIONS A compact intervention in self-care could increase well-being, foster competencies and induce behavioral changes, if implemented into a training program with sufficient group cohesiveness. Further studies are required to specify long-term-results.
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Affiliation(s)
- Simon Schwill
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Till Johannes Bugaj
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Annalena Rentschler
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
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Prentice S, Elliott T, Dorstyn D, Benson J. Burnout, wellbeing and how they relate: A qualitative study in general practice trainees. MEDICAL EDUCATION 2023; 57:243-255. [PMID: 35997632 PMCID: PMC10086955 DOI: 10.1111/medu.14931] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Although research has explored burnout risk factors among medical trainees, there has been little exploration of the personal experiences and perceptions of this phenomenon. Similarly, there has been little theoretical consideration of trainee wellbeing and how this relates to burnout. Our study aimed to conceptualise both constructs. METHOD We situated this study within a post-positivist epistemology using grounded theory to guide the research process. Participants were recruited from one Australian General Practice training organisation. Fourteen trainees completed interviews, while a further five focus groups explored the views of 33 supervisors, educators and training coordinators. Data collection and analysis occurred concurrently, drawing upon constant comparison and triangulation. Template analysis, using an iterative process of coding, was employed to generate conceptual models of the phenomena of interest. RESULTS Participants described burnout as an insidious syndrome lying on a spectrum, with descriptions coalescing under seven themes: altered emotion, compromised performance, disengagement, dissatisfaction, exhaustion, overexertion and feeling overwhelmed. Wellbeing was perceived to comprise personal and professional domains that interacted and were fuelled by an underlying 'reservoir'. Both constructs were linked by the degree of a trainee's value fulfilment, with burnout occurring when a trainee's wellbeing reservoir was depleted. CONCLUSIONS Participants in this study characterised burnout and wellbeing as multifaceted, connected constructs. Given the complexity of these constructs, preventive interventions should target both person and workplace-focused factors, with value fulfilment proposed as the basic change mechanism. A novel model that synthesises and advances previous research is offered based on these findings.
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Affiliation(s)
- Shaun Prentice
- School of Psychology, Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
- GPEx Ltd.AdelaideSouth AustraliaAustralia
| | | | - Diana Dorstyn
- School of Psychology, Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Jill Benson
- GPEx Ltd.AdelaideSouth AustraliaAustralia
- Health in Human Diversity Unit, School of Medicine, Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
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Riasat R. Humanities and GP training: the perception of GP trainers towards using medical humanities to teach GP trainees primary care. EDUCATION FOR PRIMARY CARE 2023; 34:26-30. [PMID: 36473174 DOI: 10.1080/14739879.2022.2141665] [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: 12/12/2022]
Abstract
PURPOSE The benefits of medical humanities in medical education have been extensively cited. The aim of this research was to explore the perspectives of UK GP trainers towards using medical humanities to teach GP trainees in primary care. METHOD Phenomenological, qualitative research designed was used. Semi-structured interviews were conducted with eight GP trainers from across the UK, between April and May 2020. Poems were used as discussion prompts for those participants who lacked experience using medical humanities to teach GP trainees. RESULTS Emerging themes were that all participating GP trainers recognised the benefit of medical humanities to GP training, yet only 50% of them were actually using medical humanities in their teaching. An overburdened GP curriculum, a lack of funding and a lack of clinically relevant art and literature resources were identified as barriers for the inclusion of medical humanities into GP training. Furthermore, GP trainers identified the need for peer networks and medical humanities conferences to encourage the use of medical humanities in GP training. CONCLUSION This study provides the perspective of UK GP trainers towards using medical humanities in teaching GP trainees in primary care. GP trainers identified sustainable funding to develop a resource bank of art and literature, peer network events and medical humanities conferences as key interventions to facilitate medical humanities teaching in GP training. Recommendations for future research include robust studies focusing on the effectiveness of various techniques used to integrate medical humanities into GP training, such as poetry.
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Affiliation(s)
- Rahhiel Riasat
- Warwick Medical School, The University of Warwick, Coventry, UK
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Greenhalgh T, Shaw SE, Alvarez Nishio A, Booth A, Byng R, Clarke A, Dakin F, Davies R, Faulkner S, Hemmings N, Husain L, Kalin A, Ladds E, Moore L, Rosen R, Rybczynska-Bunt S, Wherton J, Wieringa S. Protocol: Remote care as the 'new normal'? Multi-site case study in UK general practice. NIHR OPEN RESEARCH 2022; 2:46. [PMID: 37881300 PMCID: PMC10593351 DOI: 10.3310/nihropenres.13289.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 10/27/2023]
Abstract
Background Following a pandemic-driven shift to remote service provision, UK general practices offer telephone, video or online consultation options alongside face-to-face. This study explores practices' varied experiences over time as they seek to establish remote forms of accessing and delivering care. Methods This protocol is for a mixed-methods multi-site case study with co-design and national stakeholder engagement. 11 general practices were selected for diversity in geographical location, size, demographics, ethos, and digital maturity. Each practice has a researcher-in-residence whose role is to become familiar with its context and activity, follow it longitudinally for two years using interviews, public-domain documents and ethnography, and support improvement efforts. Research team members meet regularly to compare and contrast across cases. Practice staff are invited to join online learning events. Patient representatives work locally within their practice patient involvement groups as well as joining an online patient learning set or linking via a non-digital buddy system. NHS Research Ethics Approval has been granted. Governance includes a diverse independent advisory group with lay chair. We also have policy in-reach (national stakeholders sit on our advisory group) and outreach (research team members sit on national policy working groups). Results anticipated We expect to produce rich narratives of contingent change over time, addressing cross-cutting themes including access, triage and capacity; digital and wider inequities; quality and safety of care (e.g. continuity, long-term condition management, timely diagnosis, complex needs); workforce and staff wellbeing (including non-clinical staff, students and trainees); technologies and digital infrastructure; patient perspectives; and sustainability (e.g. carbon footprint). Conclusion By using case study methods focusing on depth and detail, we hope to explain why digital solutions that work well in one practice do not work at all in another. We plan to inform policy and service development through inter-sectoral network-building, stakeholder workshops and topic-focused policy briefings.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Amy Booth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Aileen Clarke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Francesca Dakin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Stuart Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Asli Kalin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | | | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
- Centre for Sustainable Health Education, University of Oslo, Oslo, Norway
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Lamb E, Burford B, Alberti H. The impact of role modelling on the future general practitioner workforce: a systematic review. EDUCATION FOR PRIMARY CARE 2022; 33:265-279. [PMID: 35904161 PMCID: PMC9519122 DOI: 10.1080/14739879.2022.2079097] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Role modelling has been identified as an important phenomenon in medical education. Key reports have highlighted the ability of role modelling to support medical students towards careers in family medicine although the literature of specific relevance to role modelling in speciality has not been systematically explored. This systematic review aimed to fill this evidence gap by assimilating the worldwide literature on the impact of role modelling on the future general practitioner (GP) workforce. A systematic search was conducted in Medline, Embase, Scopus, Web of Science, Cochrane, ERIC and CINAHL, and all authors were involved in the article screening process. A review protocol determined those articles selected for inclusion, which were then quality assessed, coded and thematically analysed. Forty-six articles were included which generated four broad themes: the identity of role models in general practice, role modelling and becoming a doctor, the impact of role modelling on attitudes towards the speciality, and the subsequent influence on behaviours/career choice. Our systematic review confirmed that role modelling in both primary and secondary care has a crucial impact on the future GP workforce, with the potential to shape perceptions, to attract and deter individuals from the career, and to support their development as professionals. Role modelling must be consciously employed and supported as an educational strategy to facilitate the training of future GPs.
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Affiliation(s)
- Elizabeth Lamb
- School of Medical Education, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Bryan Burford
- School of Medical Education, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Hugh Alberti
- School of Medical Education, The Medical School, Newcastle University, Newcastle upon Tyne, UK
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Prentice S, Benson J, Dorstyn D, Elliott T. Promoting Wellbeing among Family Medicine Trainees: A Hermeneutic Review of Intervention Mechanisms of Change and their Delivery Methods. TEACHING AND LEARNING IN MEDICINE 2022:1-12. [PMID: 35465799 DOI: 10.1080/10401334.2022.2048833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
PHENOMENON Efforts to promote wellbeing and reduce burnout amongst postgraduate medical trainees have been hampered by little consideration of interventions' underlying mechanisms, as well as how interventions are delivered. The critical role of trainee specialty has also been overlooked, despite the unique personal and work-based stressors faced among subgroups - such as those completing Family Medicine/General Practice. A consolidation of intervention research can help to guide the design, implementation and evaluation of future targeted programs and potentially enhance their effectiveness. The present hermeneutic literature review addresses this gap. APPROACH The Embase, Ovid Medline, and Ovid PsycINFO databases were searched for articles exploring wellbeing and related concepts of burnout and stress amongst Family Medicine/General Practice trainees. Thirty-one studies were identified through seven iterative rounds, with articles that offered novel insights and/or addressed knowledge gaps identified in each round and analyzed, followed by refinement of the overarching coding structure. Thematic analysis was conducted by two researchers. FINDINGS Proposed and enacted wellbeing interventions typically involved a combination of individualistic (e.g., self-awareness), organizational (e.g., increasing policy flexibility), and cultural (e.g., leadership) strategies. Change mechanisms were interpersonal (e.g., comradery) and, to a greater extent, intrapersonal (e.g., normalizing and accepting feelings of insecurity). Key delivery methods included the need to ingrain trainee wellness into daily work life and the importance of contextualizing interventions to increase their relevance, acceptance, and effectiveness. INSIGHTS The present review identifies and consolidates key mechanisms of change intrinsic to wellbeing-promotion interventions, alongside delivery methods. These findings provide guidance for practice and research to identify these attributes of interventions in the design and evaluation stages. This, in turn, will enhance the clarity of what is being evaluated, facilitating more informed comparisons between evaluations.
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Affiliation(s)
- Shaun Prentice
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Jill Benson
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- GPEx Ltd, Adelaide, South Australia, Australia
| | - Diana Dorstyn
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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Olm M, Roos M, Hapfelmeier A, Schneider D, Gensichen J, Berberat PO, Schneider A. [The importance of the learning environment and reduction of burnout in clinical training: an analysis of the Competence Centre for Residency Training in Family Medicine Bavaria (CCRTB)]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 168:88-95. [PMID: 35144910 DOI: 10.1016/j.zefq.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/29/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The Competence Centre for Residency Training in Family Medicine Bavaria (CCRTB) was established to improve the quality of postgraduate medical training by offering additional seminars and mentoring programmes as well as regular 'train-the-trainer' courses for educating physicians. In addition, residents have the opportunity to participate in a regional training network. OBJECTIVE The aim was to assess the burden of burnout and the importance of the learning environment in the clinical training phase. METHODS We conducted a cross-sectional study. Burnout was assessed using the Maslach Burnout Inventory (MBI), which comprises the scales "Emotional Exhaustion", "Depersonalisation" and "Personal Accomplishment". The quality of the learning environment was recorded using the German version of the Dutch Residency Educational Climate Test (D-RECT German). In addition, multivariable linear regressions were performed to estimate the impact of learning environment, year of training and participation in a regional network on the level of burnout. RESULTS 129 clinical residents enrolled in the CCRTB were invited to participate in the study, 78 (61%) of whom submitted a response. 76 (59%) of these residents were included in the analyses. The present study discloses an increased burden of burnout among residents in the clinical training phase, with approx. 40% reaching a critical burnout score. A higher quality of the learning environment was associated with significantly milder burnout symptoms on the majority of the D-RECT scales. CONCLUSION Family medicine residents in the clinical training phase show a high burden of burnout. Therefore, increasing the quality of the learning environment appears to be an effective key element in achieving a reduction of burnout in clinical training. This might contribute to an increase in professional satisfaction, which finally may also prevent migration from the medical profession.
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Affiliation(s)
- Michaela Olm
- Institut für Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - Marco Roos
- Kompetenzzentrum Weiterbildung Allgemeinmedizin Bayern (KWAB), Erlangen, Deutschland; Allgemeinmedizinisches Institut, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Alexander Hapfelmeier
- Institut für Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum rechts der Isar der Technischen Universität München, München, Deutschland; Institut für KI und Informatik in der Medizin, Universitätsklinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - Dagmar Schneider
- Kompetenzzentrum Weiterbildung Allgemeinmedizin Bayern (KWAB), Erlangen, Deutschland; Koordinierungsstelle Allgemeinmedizin, München, Deutschland
| | - Jochen Gensichen
- Kompetenzzentrum Weiterbildung Allgemeinmedizin Bayern (KWAB), Erlangen, Deutschland; Institut für Allgemeinmedizin, LMU Klinikum, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Pascal O Berberat
- Medizindidaktisches Zentrum für Ausbildungsforschung und Lehre, Fakultät für Medizin, Technische Universität München, München, Deutschland
| | - Antonius Schneider
- Institut für Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum rechts der Isar der Technischen Universität München, München, Deutschland; Kompetenzzentrum Weiterbildung Allgemeinmedizin Bayern (KWAB), Erlangen, Deutschland.
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Terzi O, Arslan HN, Midik O, Dundar C. The Psychological Effects of the COVID-19 on Students Who Choose the Medical Profession With Different Motivational Factors: A Cross-Sectional Study. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221109671. [PMID: 35787194 PMCID: PMC9260571 DOI: 10.1177/00469580221109671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has generated mental and psychological health problems
worldwide. The aim of this study was to determine whether the psychological
effects of COVID-19 were different in medical students who chose the medical
profession with different motivational factors. In the study, there were 389
medical school students. The survey asks about sociodemographic features and the
students’ reasons for choosing the medical profession. The study also included a
self-assessed Hospital Anxiety-Depression Scale and Beck Hopelessness Scale.
While 41% of students chose the medical profession for economic reasons, the
ratio of whom have an extrinsic and intrinsic source of motivation was 37% and
22%, respectively. It was found that there was a statistically significant
difference in the distribution of motivational factors by gender. Almost 50% of
males were affected by economic motivation factors. The difference in
motivational factors between genders was found to be statistically significant.
Anxiety in females, depression in students with low-income families, and
hopelessness in students older than 22 years and interns were higher than in the
others (P < .05). Median scores for anxiety, depression, and
hopelessness were higher for students with extrinsic motivational sources.
However, only the difference in scores of anxiety and hopelessness was found
statistically significant (P < .05). We found that the
psychological effects of the COVID-19 pandemic varied according to both
sociodemographic characteristics of the medical students and reasons for
choosing medical profession. According to our results, the idealistic students
interested in the medical profession, who want to support others and prioritize
economic benefits, had fewer psychological issues than those who chose the
medical profession due to family pressure or external factors.
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Affiliation(s)
- Ozlem Terzi
- Department of Public Health, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Hatice Nilden Arslan
- Department of Public Health, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ozlem Midik
- Department of Medical Education, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Cihad Dundar
- Department of Public Health, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Olm M, Roos M, Hapfelmeier A, Schneider D, Gensichen J, Berberat PO, Schneider A. Increased professionalization and lower burnout scores were associated with structured residency training program: results of a cross sectional survey. MEDICAL EDUCATION ONLINE 2021; 26:1959284. [PMID: 34323662 PMCID: PMC8330728 DOI: 10.1080/10872981.2021.1959284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 06/13/2023]
Abstract
The competence centre for Residency Training in Family Medicine Bavaria (CCRTB) was established to improve the quality of postgraduate medical education by offering training and mentoring programmes for residents, and by providing train-the-trainer and mentoring courses for supervisors. Beyond that, regional Residency Training Networks (RTN) on avoluntary basis were developed to facilitate structured and efficient clinical rotation programs. Primary aim was to investigate the burden of burnout and the development of professionalism among CCRTB-residencies within a cross-sectional study. Secondary aim was to evaluate differences between CCRTB-residents with and without participation in aregional RTN. Burnout was determined with the Maslach Burnout Inventory (MBI), comprising the scales emotional exhaustion, depersonalization, and personal accomplishment. Ambulatory professionalization was evaluated using the German Professional Scale (Pro-D), comprising the scales professionalism towards the patient, towards other professionals, towards society, and towards oneself. Statistical significance of group differences was calculated by nonparametric tests. Multivariable linear regression modelling was performed to estimate the independent impact of professionalization and RTN participation on burnout scores. 347 CRRTB residents in ambulatory postgraduate training were invited, 212 (61.1%) participated, and 197 (92.9%) were included in our analyses. Lower emotional exhaustion and depersonalization, and increased personal accomplishment was associated with increased professionalisation, which was significant for nearly all Pro-D scales (p ≤ 0.05). RTN residents showed higher professionalism towards the patient (p = 0.031), other professionals (p = 0.012), and towards the society (p = 0.007) than residents of unstructured programs, and higher levels of personal accomplishment (p < 0.05). Early and efficient professionalization might be akey to reduce burnout and to establish asatisfying career in family medicine. Train-the-trainer and mentoring concepts should be implemented regularly for the training of residents. Thus, increased engagement in medical didactics should be aprerequisite for accreditation as atraining practice for residents.
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Affiliation(s)
- Michaela Olm
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Germany
| | - Marco Roos
- Kompetenzzentrum Weiterbildung Allgemeinmedizin Bayern (KWAB), Erlangen, Germany
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Alexander Hapfelmeier
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Germany
- TUM School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Technical University Munich, Munich, Germany
| | - Dagmar Schneider
- Kompetenzzentrum Weiterbildung Allgemeinmedizin Bayern (KWAB), Erlangen, Germany
- Koordinierungsstelle Allgemeinmedizin, Munich, Germany
| | - Jochen Gensichen
- Kompetenzzentrum Weiterbildung Allgemeinmedizin Bayern (KWAB), Erlangen, Germany
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians University of Munich, Munich, Germany
| | - Pascal O. Berberat
- TUM Medical Education Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Antonius Schneider
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Germany
- Kompetenzzentrum Weiterbildung Allgemeinmedizin Bayern (KWAB), Erlangen, Germany
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Valentini J, Klocke C, Güthlin C, Joos S. Integration of complementary and integrative medicine competencies in general practice postgraduate education - development of a novel competency catalogue in Germany. BMC Complement Med Ther 2021; 21:250. [PMID: 34615506 PMCID: PMC8496071 DOI: 10.1186/s12906-021-03419-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Complementary and integrative medical procedures (CIM) play an important role in general practice (GP). Consequently, in some countries (e.g. USA, Australia) specific curricula for the integration of CIM competencies in GP postgraduate education exist. Although Germany is one of the countries where CIM is strongly integrated in general practice, no such catalogue exists up to date. The aim of this study was to define a set of CIM competencies that are seen as relevant and feasible for postgraduate education in the German general practice setting. Methods We used a multi-step, peer-based approach combining four different steps. Firstly, a survey among GP trainees (n = 138) was performed in order to assess needs and attitudes towards CIM. Then, existing competency-based CIM curricula were identified in international literature, translated into German and compared with the needs assessment from the survey. In a next step, we performed a survey among the CIM working group of the German Society for General Medicine and Family Medicine (DEGAM). As a last step, in a peer-based survey, GP trainers, GP trainees, and members of professional CIM associations (n = 131) evaluated a list of CIM competencies according to relevance and feasibility for general practice. Results Within this multistage process, a final catalogue of 16 competencies was defined, covering the following areas: Medical knowledge, patient care and communication, practice-based learning, professionalism, and competencies based on the German healthcare system. Conclusion The final catalogue of CIM competencies is intended to serve for GP training complementing the German competency-based curriculum for general practice. These competencies cover basic skills and are not intended to replace existing additional qualifications awarded by the medical associations in specific CIM methods, such as acupuncture or manual medicine. Therefore, a list of relevant competencies on CIM is available in order to serve as add-on for postgraduate education in general practice in Germany. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-021-03419-7.
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Affiliation(s)
- Jan Valentini
- Institute for General Practice and Interprofessional Care, University Hospital and Faculty of Medicine Tuebingen, Tuebingen, Germany.
| | - Carina Klocke
- Institute for General Practice and Interprofessional Care, University Hospital and Faculty of Medicine Tuebingen, Tuebingen, Germany
| | - Corina Güthlin
- Institute for General Practice, Goethe University, Frankfurt, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, University Hospital and Faculty of Medicine Tuebingen, Tuebingen, Germany
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[Determinants of participation in seminars as part of a post-graduate training programme: a qualitative study with general practice residents]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2021; 163:57-65. [PMID: 33992582 DOI: 10.1016/j.zefq.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/14/2021] [Accepted: 04/01/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Germany is facing a shortage of primary care physicians (general practitioners, GPs). To improve post-graduate training in general practice, competency centres were established across Germany. The core of their work is a seminar programme. It was observed that some GP trainees constantly participate, while others are seldomly seen. The aim of this study was to explore what helps and what hinders constant participation. METHODS GP trainees of the Verbundweiterbildungplus Baden-Württemberg (2008 - 2017), predecessor of the KWBW Verbundweiterbildungplus© program (2017 - present), were included in the study. First, participation in the years 2014 and 2015 was analysed. We recruited the very active as well as the no-show participants for semi-structured telephone interviews. Content analysis was performed by three independent scientists. RESULTS Participation of n=353 trainees was analysed. N=30 trainees participated in the study (including n=13 no show). The average interview length was 25minutes (13-36minutes). Trainees felt motivated by practice-oriented, varying and learner-oriented subjects. They highlighted the professional and personal interaction and its networking effects. Participants favoured lecturing during working days, topics structuring daily training and supporting every day practice. The seminar moderators' treasure trove of experience and their teaching competencies were regarded as essential. The fact that employers do not regularly grant time away from work to attend the training programme was cited as a major inhibiting factor. Other reasons given for non-attendance included long travel distances, repeat topics or an imbalance between gain of knowledge and social interactions, and finally, a high individual level of work strain, given the dual burden on those trying to combine work and family life and taking on the main responsibility for children. CONCLUSIONS The main enablers (motivators) of participation were practice- and learner-oriented topics and beneficial social interactions. During the seminars, participants experience group membership and the enthusiastic (learning) atmosphere boosts trainees to proceed with their training and follow their career paths in general practice. Continuous participation requires protected time. Competence centres for postgraduate medical education should take these findings into consideration for quality management and programme planning, and, if possible, should initiate and evaluate appropriate countermeasures.
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Schwill S, Krug K, Valentini J, Rentschler A, Nikendei C, Szecsenyi J, Bugaj TJ. How to strengthen basic competencies in self-care - a pre-post interventional study with postgraduate trainees in family medicine in Germany. Postgrad Med 2021; 133:572-580. [PMID: 33843446 DOI: 10.1080/00325481.2021.1916298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Self-care includes taking care of our psychosocial health. Many experts agree that self-care should be included in training for Family Medicine (FM) residents, though it is unclear to what extent and by what means. Objective: The aim of this study was to evaluate competencies of FM residents in self-care and changes in knowledge, skills and attitudes after an educational compact intervention.Methods: The authors performed a pre-post comparison on residents who were registered in the FM residency program KWBW VerbundweiterbildungPLUS© (n = 401). FM residents were offered participation in a self-care training (270 minutes featuring a broad spectrum of input and practical experience). The intervention group (IG) completed a questionnaire directly before the seminar (T1) and 10 weeks afterwards (T2). Non-attendees (=control group; CG) were asked to fill out a basic questionnaire once. Basic questionnaires for IG and CG covered previous experiences and skills while the follow-up questionnaire at T2 also focused on change of competencies and attitudes. All questionnaires contained free-text questions to capture qualitative impressions.Results: 287 FM residents (IG: n = 212; CG: n = 75) participated in the study. Generally, 86.4% of FM residents had worried that their profession might endanger their personal health (T1: n = 180, CG: n = 68). At T2, 59.5% of IG (n = 66/111) declared that they would not worry about their personal health anymore (T1:T2, p < .01). IG learned to facilitate time for recreation (T1:T2, p = .04) and to use relaxation techniques (T1:T2, p = .01). Gain in competence was described in awareness of stress, self-reward, activation of personal resources, and time management. A total of 85.6% of IG reflected their attitudes towards psychosocial health of physicians in general (n = 95/111) and 22.5% of IG changed the views on their own health (n = 25/111) in terms of improved risk-awareness, increased intention for self-care and change of behavior.Conclusion: A compact intervention in self-care strengthens competencies, increases awareness, and helps FM residents identify their psychosocial health risks. Further research is necessary to specify the effectiveness of similar compact interventions in self-care and their long-term results.
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Affiliation(s)
- S Schwill
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - K Krug
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - J Valentini
- Institute of General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | - A Rentschler
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - C Nikendei
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Heidelberg, Germany
| | - J Szecsenyi
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - T J Bugaj
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Heidelberg, Germany
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Stengel S, Förster C, Fuchs M, Bischoff M, Ledig T, Streitlein-Böhme I, Gulich M, Haumann H, Valentini J, Kohlhaas A, Graf von Luckner A, Reith D, Fehr F, Magez J, Eismann-Schweimler J, Szecsenyi J, Joos S, Schwill S. Developing a seminar curriculum for the Competence Center for General Practice in Baden-Wuerttemberg - a progress report. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc36. [PMID: 33763521 PMCID: PMC7958914 DOI: 10.3205/zma001432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/04/2020] [Accepted: 11/20/2020] [Indexed: 05/31/2023]
Abstract
Aim: The seminar program of the KWBW Verbundweiterbildungplus® is offered by the Competence Center for Postgraduate Medical Education in Baden-Württemberg (KWBW) for physicians specializing in general practice (GP trainees). Attendance is a voluntary one comprised of 48 curricular units of 45 minutes each per GP trainee. This seminar program is meant to be attended in parallel to the postgraduate medical education in clinic or practice. The intention behind this project was to develop objectives, topics and a feasible structure for a seminar curriculum while taking time and financial constraints into account. Method: The Kern cycle was applied in an open, modified nominal group consensus technique in the form of an iterative process. Participating were 17 experts from the departments of general practice at the universities in Freiburg, Heidelberg, Tuebingen and Ulm, plus a pediatrician. Results: The main objective was defined as empowering GP trainees to independently provide high-quality primary care, including in rural areas. A basic curriculum was defined based on relevant frameworks, such as the 2018 Model Regulation for Postgraduate Medical Training (Musterweiterbildungsordnung/MWBO) and the Competency-based Curriculum General Practice (KCA). Overall, the seminar curriculum has 62 basic modules with 2 curricular units each (e.g. Basic Principles of General Practice, Chest Pain, Billing) and another 58 two-unit modules on variable topics (e.g. digitalization, travel medicine) adding up to 240 (124+116) curricular units. A blueprint with a rotation schedule for all of the teaching sites in Baden-Württemberg allows regular attendance by n=400 GP trainees over a period of five years, with individual variability in terms of program length. Conclusion: The model entails a five-year, flexible program to accompany the postgraduate medical education in general practice which can also be implemented in multicenter programs and those with high enrollments. The model's focus is on acquisition of core competencies for general practice. Despite the current shift to eLearning seminars due to SARS-CoV, the program's implementation is being continued, constantly evaluated, and used to further develop the KWBW Verbundweiterbildungplus® program.
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Affiliation(s)
- Sandra Stengel
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
| | - Christian Förster
- University Hospital Tübingen, Institute of General Practice and Interprofessional Care, Tübingen, Germany
| | - Monika Fuchs
- University Hospital Ulm, Institute of General Practice, Ulm, Germany
| | - Martina Bischoff
- University of Freiburg, Division of General Practice, Medical Center, University Freiburg, Germany
| | - Thomas Ledig
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
| | - Irmgard Streitlein-Böhme
- University of Freiburg, Division of General Practice, Medical Center, University Freiburg, Germany
- Ruhr-University Bochum, Medical Faculty, Department of General Practice, Bochum, Germany
| | - Markus Gulich
- University Hospital Ulm, Institute of General Practice, Ulm, Germany
| | - Hannah Haumann
- University Hospital Tübingen, Institute of General Practice and Interprofessional Care, Tübingen, Germany
| | - Jan Valentini
- University Hospital Tübingen, Institute of General Practice and Interprofessional Care, Tübingen, Germany
| | - Anja Kohlhaas
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
| | - Andreas Graf von Luckner
- University of Freiburg, Division of General Practice, Medical Center, University Freiburg, Germany
| | - Dorothee Reith
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
| | - Folkert Fehr
- Group Practice Dr. Folkert Fehr & Dr. Jan Buschmann, Sinsheim, Germany
| | - Julia Magez
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
| | | | - Joachim Szecsenyi
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
| | - Stefanie Joos
- University Hospital Tübingen, Institute of General Practice and Interprofessional Care, Tübingen, Germany
| | - Simon Schwill
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
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Brodie N, Perdomo JE, Silberholz EA. The dual pandemics of COVID-19 and racism: impact on early childhood development and implications for physicians. Curr Opin Pediatr 2021; 33:159-169. [PMID: 33394742 DOI: 10.1097/mop.0000000000000985] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The novel coronavirus (COVID-19) pandemic has highlighted healthcare and racial inequities. This article discusses recent literature documenting the impact of racism on early childhood development, disparities in access to developmental services and ways healthcare providers and health systems can promote physician well being during these difficult times. RECENT FINDINGS Exposure to racism begins prenatally, and early childhood experiences with racism are intimately tied to adverse physical and mental health outcomes. Early intervention is key to treating children with developmental delay, but disparities exist in accessing eligibility screening and in the provision of services. Paediatric providers are at risk of developing secondary traumatic stress and burnout, which may affect the care that they provide. SUMMARY New research has led to the development of resources that help paediatric providers address racism, access developmental resources in a novel manner and protect the paediatric workforce from trauma and burnout.
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Affiliation(s)
| | - Joanna E Perdomo
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth A Silberholz
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Finn GM, Brown MEL, Laughey W. Holding a mirror up to nature: the role of medical humanities in postgraduate primary care training. EDUCATION FOR PRIMARY CARE 2020; 32:73-77. [PMID: 32926808 DOI: 10.1080/14739879.2020.1816860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The humanities are academic disciplines that study aspects of human society, experience and culture. Typically, the humanities, including philosophy, literature, art, music, history and language have been used to interpret and record our understanding of the world. In recent decades, the humanities have seen somewhat of a renaissance within medicine, particularly within undergraduate medical education. This leading article explores the value of utilising medical humanities, such as art, poetry and theatre, within postgraduate primary care training. Using examples of approaches already interwoven into the fabric of undergraduate medical education, such as simulated patient consultations and anatomical body painting, the tangible benefits of applying humanities disciplines within general practice training are discussed. The humanities have much to offer from the value of utilising an artistic lens to examine the body, the creation of socially cohesive working environments and supporting the development of empathy within trainees. This article recommends the provision of both increased informal and formal engagement with the medical humanities within postgraduate primary care training, providing practical tips for GP educators looking to integrate the humanities within pre-existing tutorials.
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Affiliation(s)
- Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK.,Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - William Laughey
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
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Bugaj TJ, Krug K, Rentschler A, Nikendei C, Szecsenyi J, Schwill S. Mental health of postgraduate trainees in primary care: a cross-sectional study. BMC FAMILY PRACTICE 2020; 21:123. [PMID: 32593291 PMCID: PMC7321542 DOI: 10.1186/s12875-020-01199-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 06/17/2020] [Indexed: 01/21/2023]
Abstract
Background General Practitioners (GPs) are increasingly affected by stress-related complaints and burnout. Although many studies have addressed this issue, little is known about the stress burden and burnout rates of postgraduate trainees specialising in General Practice (GP). This cross-sectional study was performed to explore the prevalence and risk of depression, stress and burnout in a large cohort of GP trainees. Methods All GP trainees enrolled in the postgraduate training programme KWBW Verbundweiterbildungplus© in southwest Germany were invited to participate. A paper-based survey for the purpose of psychosocial screening was used: Prevalence of depression, perceived stress and burnout were measured with the depression module of the Patient Health Questionnaire (PHQ-9), Perceived Stress Questionnaire (PSQ-20) and Maslach Burnout Inventory (MBI). Additionally, linear regression models were used to analyse the association between sociodemographic characteristics and mental health scales. Results N = 211 GP trainees participated in this study (response rate 95%). 75.3% (n = 159) of the participants were female and median age was 34 (IQR 32; 39). GP trainees had a mean PHQ-9 sum score of 5.4 (SD 3.4). Almost 11% (n = 23) reported symptoms of a moderate or moderately severe depression. PSQ-20 revealed moderate level of distress, whereas 20.8% (n = 42) showed a high level of perceived stress with a sum-score higher than .59. GP trainees showed moderate rates of burnout and only 2.5% (n = 5) scored high in all three dimensions of the MBI score. GP trainees showed increased levels of depression, perceived stress and burnout when compared with age-matched general population. Being a woman led to a higher PHQ-9 sum score (p < .05). Higher age was associated with less depersonalisation in the MBI (p < .05). Conclusions The results of our study suggest that GP trainees considerably suffer from stress. Some GP trainees were even affected by depression or burnout. To detect and support colleagues at risk, trainees should be supported by early preventive measures such as anti-stress or resilience trainings and mentoring during their training. Prospective longitudinal studies are needed to understand the character and the course of the stress burden among GP trainees.
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Affiliation(s)
- Till J Bugaj
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Annalena Rentschler
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Simon Schwill
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany.
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