Optimizing resilience and wellbeing for healthcare professions trainees and healthcare professionals during public health crises - Practical tips for an 'integrative resilience' approach

Psychological distress among healthcare professionals in Mbarara, following the 2022 Ebola Virus Disease outbreak in Uganda: a mixed methods study

BACKGROUND

The 2022 Ebola Virus Disease (EVD) outbreak occurred at a time when Uganda was still battling the social and psychological challenges of the COVID-19 pandemic; placing health care professionals (HCPs) at a much higher risk of developing psychological distress. Psychological distress among HCPs can cause decreased workplace productivity and ineffective management of their patients. The current study aimed to investigate and understand psychological distress among HCPS in Mbarara city in Southwestern Uganda following the 2022 EVD outbreak.

METHOD

We enrolled 200 HCPs through convenient sampling from one private and one public health facility in Mbarara city in Southwestern Uganda, in a cross-sectional convergent parallel mixed method approach where qualitative and quantitative data were collected concurrently. Quantitative data, utilizing the Kessler Psychological Distress (K10) Scale, provided us with a quantitative measure of the prevalence of psychological distress among HCPs, and were analyzed using STATA version 16. Qualitative data, on the other hand, offered deeper insights into the nature, perceptions, and contextual factors influencing this distress, and were analyzed using emergent theme analysis.

RESULTS

The prevalence of psychological distress was 59.5% and it was higher among females (63.9%) compared to males (36.1%). HCPs vividly expressed distress and anxiety, with heightened suspicion that every patient might be an EVD carrier, creating a pervasive sense of unsafety in the workplace. However, the outbreak had an educational affect where concerns about the announcement of another EVD outbreak were diverse, with HCPs expressing anxiety, despair, and dissatisfaction with the country's management of potential outbreaks.

CONCLUSION

High levels of psychological distress were experienced by HCPs in Southwestern Uganda as a result of the 2022 EVD pandemic. HCPs express a wide range of feelings, such as dread, anxiety, despair, pessimism, and discontent with the way the outbreaks are handled throughout the nation. We recommend implementation of comprehensive psychosocial support programs tailored to the unique needs of HCPs, including counseling services, stress management workshops, and peer support networks.

Is knowledge liberating? The role of knowledge behaviors and competition on the workplace happiness of healthcare professionals

PURPOSE

The purpose of this paper is to highlight the joint impact of competitive culture and knowledge behaviors (sharing, hoarding and hiding) on workplace happiness among healthcare professionals. It addresses a literature gap that critiques the development of happiness programs in healthcare that overlook organizational, social and economic dynamics. The study is based on the Social Exchange Theory, the Conservation of Resources Theory and the principles of Positive Psychology.

DESIGN/METHODOLOGY/APPROACH

The study analyzes a linear relationship between variables using a structural equation model and a partial least squares approach. The data are sourced from a survey of 253 healthcare professionals from Portuguese healthcare organizations.

FINDINGS

The data obtained from the model illustrate a positive correlation between competitive culture and knowledge hoarding as well as knowledge hiding. Interestingly, a competitive culture also fosters workplace happiness among healthcare professionals. The complex relationship between knowledge behaviors becomes evident since both knowledge hoarding and sharing positively affected these professionals' workplace happiness. However, no direct impact was found between knowledge hiding and workplace happiness, suggesting that it negatively mediates other variables.

ORIGINALITY/VALUE

This research addresses a previously identified threefold gap. First, it delves into the pressing need to comprehend behaviors that enhance healthcare professionals' workplace satisfaction. Second, it advances studies by empirically examining the varied impacts of knowledge hiding, hoarding and sharing. Finally, it sheds light on the repercussions of knowledge behaviors within an under-explored context - healthcare organizations.

A Qualitative Exploration of Health Profession Students' Experiences of Resilience and Burnout Using the Coping Reservoir Model during the COVID-19 Pandemic

Phenomenon: The Coping Reservoir Model is a useful theoretical and analytical framework through which to examine student resilience and burnout. This model conceptualizes wellbeing as a reservoir which is filled or drained through students' adaptive and maladaptive coping mechanisms. This dynamic process has the capacity to foster resilience and reduce burnout or the inverse. This study aimed to explore health profession students' coping mechanisms and their experiences of resilience and burnout during the unprecedented COVID-19 pandemic. Approach: Employing the Coping Reservoir Model, qualitative focus groups involving health profession students enrolled at Qatar University were conducted, in October 2020, to solicit their lived experiences of stress and burnout during the pandemic. The Coping Reservoir Model was used to structure the topic guide for the focus group discussion and the Framework Analysis Approach was used in the data analysis. Findings: A total of 43 participants comprised eight focus groups. Health profession students encountered myriad personal, social, and academic challenges during the pandemic which adversely impacted their wellbeing and their capacity for coping. In particular, students reported high levels of stress, internal conflict, and heavy demands on their time and energy. The shift to online learning and uncertainty associated with adapting to online learning and new modes of assessment were exacerbating factors. Students sought to replenish their coping reservoir through engagement in a range of intellectual, social, and health-promoting activities and seeking psychosocial support in their efforts to mitigate these stressors. Insights: Students in this region have traditionally been left to their own devices to deal with stress and burnout during their academic training, wherein the institutions focus exclusively on the delivery of information. This study underscores student needs and potential avenues that health profession educators might implement to better support their students, for instance the development and inclusion of longitudinal wellbeing and mentorship curricula geared to build resilience and reduce burnout. The invaluable contributions of health professionals during the pandemic warrant emphasis, as does an examination of the stress associated with these roles to normalize and justify inclusion of wellbeing and resilience modules within the curriculum. Actively engaging health profession students in university-led volunteer activities during public health crises and campaigns would provide opportunities to replenish their coping reservoirs through social engagement, intellectual stimulation, and consolidating their future professional identities.

A scoping review and theory-informed conceptual model of professional identity formation in medical education

INTRODUCTION

Professional identity formation (PIF) is a central tenet of effective medical education. However, efforts to support, assess and study PIF are hindered by unclear definitions and conceptualisations of what it means to 'think, act, and feel like a physician'. Gaps in understanding PIF, and by extension, its support mechanisms, can predispose individuals towards disengaged or unprofessional conduct and institutions towards short-sighted or reactionary responses to systemic issues.

METHODS

A Systematic Evidence-Based Approach-guided systematic scoping review of PIF theories was conducted related to medical students, trainees and practising doctors, published between 1 January 2000 and 31 December 2021 in PubMed, Embase, ERIC and Scopus databases.

RESULTS

A total of 2441 abstracts were reviewed, 607 full-text articles evaluated and 204 articles included. The domains identified were understanding PIF through the lens of pivotal theories and characterising PIF by delineating the underlying factors that influence it and processes that define it.

CONCLUSIONS

Based on regnant theories and frameworks related to self-concepts of identity and personhood, the relationships between key PIF influences, processes and outcomes were examined. A theory-backed integrated conceptual model was proposed to delineate the interconnected relationships among these, aiming to untangle some of the complexities inherent to PIF, to shed light on existing practices and to identify shortcomings in our understanding so as to develop mechanisms in support of its multifaceted, interlinked components.

The Impact of Moral Distress on Staff and Novice Nurses

ABSTRACT

Moral distress is an interior affliction associated with exterior conflicts between one's values, obligations, and actions. This article builds understanding of moral distress among nurses and the importance of reducing its harmful impact, particularly to novice nurses. Moral distress is defined along with ethical issues and concepts related to moral distress, its current impact, coping with moral distress and building moral reserve, and the significance of acting according to one's conscience.

Psychological well-being, stressors, coping strategies and support of undergraduate healthcare students amid COVID-19

Background

Students function better academically when psychologically well. The COVID-19 pandemic proved a new challenge to the mental wellness of undergraduate healthcare students. Students were not only faced with academic changes but also had to complete clinical practice in healthcare facilities amid the COVID-19 pandemic.

Aim

This study investigated the psychological well-being, stressors, coping strategies and support of undergraduate healthcare students amid COVID-19.

Setting

A South African university's faculty of health sciences.

Methods

A survey design through a cross-sectional descriptive approach was used to collect data from the population of 1529 undergraduate healthcare students. One hundred and ninety-six (n = 196) students responded to the online survey.

Results

Participants reported a variety of stressors influencing their psychological well-being. Participants chose mostly adaptive coping strategies to deal with stressors. They gave feedback on the support they received from the faculty and institution. Most of the participants indicated they prefer weekly online communication from the higher education institution.

Conclusion

The COVID-19 pandemic influenced the psychological well-being of undergraduate healthcare students. The psychological well-being of these students is a collective responsibility between students and higher education institutions to enable academic success and positive patient outcomes.

Contribution

This study found that undergraduate healthcare students had academic, psychological, financial and other stressors during the COVID-19 pandemic. Higher education institutions, especially those involved in training undergraduate healthcare professionals, in collaboration with students, need to provide students with targeted continued support and training to use healthy coping behaviours to manage various stressors.

Looking beyond the COVID-19 pandemic: the recalibration of student-teacher relationships in teaching and learning process

BACKGROUND

Given the various novel educational approaches and online interactions following the pandemic, it is timely to identify lessons learned for post-pandemic student and teacher relationships within the 'new normal' teaching learning processes. This study aims to explore the dynamics and to what extent the disruption influences student-teacher relationships in teaching and learning process following the COVID-19 pandemic.

MATERIALS AND METHODS

A qualitative descriptive approach was employed to explore individual reflections and perspectives from 28 medical teachers and 35 medical students from different institutions who participated in 10 focus groups. Data were analyzed thematically using steps for coding and theorization (SCAT) approach. The emerging themes were then further analyzed and regrouped into the relationship-centered leadership framework based on emotional intelligence.

RESULTS

The identified themes described three elements representing student-teacher relationships in the teaching learning processes. The self as the center of the diagram consists of the co-existing role of the self as teachers and as students, which to some extent, is related to their personal and professional development, motivation, and struggles to maintain work-life balance. The middle layer represents the dynamic of student-teacher relationship, which showed that despite the increased number of teaching opportunities, the trust among teachers and students was compromised. These changes in the self and the dynamic relationship occurred in a broader and more complex medical education system, pictured as the outer layer. Thorough curriculum improvements, contents, and new skills were emphasized.

CONCLUSIONS

Our findings emphasized the need to recalibrate student-teacher relationships, taking into account the intrapersonal, interpersonal, and the system factors. The pandemic has reemphasized the aim of teachers' roles, not only to nurture students' competencies, but also to nurture meaningful interpersonal reciprocal relationships through responding towards both teachers' and students' needs as well as supporting both personal and professional development.

Professional identity formation amongst peer-mentors in a research-based mentoring programme

BACKGROUND

Mentoring plays a pivotal yet poorly understood role in shaping a physician's professional identity formation (PIF) or how they see, feel and act as professionals. New theories posit that mentoring nurtures PIF by functioning as a community of practice through its structured approach and its support of a socialisation process made possible by its assessment-directed personalized support. To test this theory and reshape the design, employ and support of mentoring programs, we evaluate peer-mentor experiences within the Palliative Medicine Initiative's structured research mentoring program.

METHODS

Semi-structured interviews with peer mentors under the Palliative Medicine Initiative (PMI) at National Cancer Centre Singapore were conducted and triangulated against mentoring diaries to capture longitudinal data of their PMI experiences. The Systematic Evidence-Based Approach (SEBA) was adopted to enhance the trustworthiness of the data. SEBA employed concurrent content and thematic analysis of the data to ensure a comprehensive review. The Jigsaw Perspective merged complementary themes and categories identified to create themes/categories. The themes/categories were compared with prevailing studies on mentoring in the Funnelling Process to reaffirm their accuracy.

RESULTS

Twelve peer-mentors participated in the interviews and eight peer-mentors completed the mentoring diaries. The domains identified were community of practice and identity work.

CONCLUSIONS

The PMI's structured mentoring program functions as a community of practice supporting the socialisation process which shapes the peer-mentor's belief system. Guided by a structured mentoring approach, stage-based assessments, and longitudinal mentoring and peer support, peer-mentors enhance their detection and evaluation of threats to their regnant belief system and adapt their self-concepts of identity and personhood to suit their context. These insights will help structure and support mentoring programs as they nurture PIF beyond Palliative Medicine.

"Flying a plane and building it at the same time": Lessons learned from the dynamic implementation of mass vaccination clinics in the Region of Waterloo, Ontario, Canada

BACKGROUND

Vaccination plays a critical role during pandemics, and mass vaccination clinics are often an imperative public health measure. These clinics usually consist of multi-disciplinary teams, which can pose significant coordination challenges, yet also present an opportunity for collectively contributing towards mitigating the impact of infection within communities. This study explores the coordination dynamics of the Region of Waterloo's coronavirus disease of 2019 (COVID-19) mass vaccination clinics in Ontario, Canada, between July 2021 and April 2022.

METHODS

This qualitative study included 16 purposively selected participants working in mass vaccination clinics. Participants were individually interviewed for 40-60 min. An inductive and iterative thematic analysis was undertaken, including open coding, grouping, labelling, regrouping and making sense of the themes.

RESULTS

Three interrelated themes were created: (1) unpredictable work environment, which was comprised of changing clinic processes and the impact of clinic adjustments to the running of the clinics; (2) clinic cohesion challenges, which included staff role disparities, limited job preparation and clinic system silos; and (3) adaptable and supportive work environment, which was comprised of staff adaptability, dispositional flexibility and a supportive work environment. While the first two themes created a precarious situation in the clinics, the third countered it, leading to a largely successful clinic implementation.

CONCLUSIONS

The rapid evolution and high transmissibility of COVID-19 in communities required a public health response that felt like flying and building a plane simultaneously - a seemingly impossible yet necessary task. However, an adaptable and supportive work environment was critical for establishing an atmosphere that can overcome challenges from a constantly changing pandemic and the guidance of public health officials. Such lessons gained from understanding the dynamic experiences in mass vaccination clinics are essential for improving the development and operation of future immunization campaigns.

Measuring deliberate reflection in residents: validation and psychometric properties of a measurement tool

PURPOSE

Reflective capacity is "the ability to understand critical analysis of knowledge and experience to achieve deeper meaning." In medicine, there is little provision for post-graduate medical education to teach deliberate reflection. The feasibility, scoring characteristics, reliability, validation, and adaptability of a modified previously validated instrument was examined for its usefulness assessing reflective capacity in residents as a step toward developing interventions for improvement.

METHODS

Third-year residents and fellows from four anesthesia training programs were administered a slightly modified version of the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT) in a prospective, observational study at the end of the 2019 academic year. Six written vignettes of imperfect anesthesia situations were created. Subjects recorded their perspectives on two randomly assigned vignettes. Responses were scored using a 5-element rubric; average scores were analyzed for psychometric properties. An independent self-report assessment method, the Cognitive Behavior Survey: Residency Level (rCBS) was used to examine construct validity. Internal consistency (ICR, Cronbach's alpha) and interrater reliability (weighted kappa) were examined. Pearson correlations were used between the two measures of reflective capacity.

RESULTS

46/136 invited subjects completed 2/6 randomly assigned vignettes. Interrater agreement was high (k = 0.85). The overall average REFLECT score was 1.8 (1-4 scale) with good distribution across the range of scores. ICR for both the REFLECT score (mean 1.8, sd 0.5; α = 0.92) and the reflection scale of the rCBS (mean 4.5, sd 1.1; α = 0.94) were excellent. There was a significant correlation between REFLECT score and the rCBS reflection scale (r = .44, p < 0.01).

CONCLUSIONS

This study demonstrates feasibility, reliability, and sufficiently robust psychometric properties of a modified REFLECT rubric to assess graduate medical trainees' reflective capacity and established construct/convergent validity to an independent measure. The instrument has the potential to assess the effectiveness of interventions intended to improve reflective capacity.

Let's Talk About it: The Utility of Formalized Support for Medical Residents

Medical residents are significantly impacted by burnout and depression. Recent events have only further increased the pressure and demands on the healthcare sector, intensifying the burden facing residents and posing a threat to residents' well-being. As a result, significant efforts are being made to provide formalized support and well-being programs. Yet, emergent evidence indicates that residents do not sufficiently utilize this form of support. Considering the organizational investment and focus on formalized support programs, we conducted a mixed-method study to investigate residents' utilization of formalized well-being support, and potential reasons for non-use. Our study was conducted during a period of increased work burden and stress for medical residents, where formalized support was specifically offered and targeted to medical staff. Our findings confirm earlier results of low support utilization and point to the importance of informal support mechanisms, in particular peer support. We conclude by discussing the role of managers and educational programs in facilitating a positive cultural shift to promote and support residents in seeking support.

Facilitators of Organizational Resilience Within South Carolina AIDS Service Organizations: Lessons Learned from the COVID-19 Pandemic

HIV care services have been interrupted by the COVID-19 pandemic in many states in the U.S. including South Carolina (SC). However, many HIV care facilities demonstrated organizational resilience (i.e., the ability to maintain needed health services amid rapidly changing circumstances) by addressing challenges to maintaining care during the pandemic. This study, therefore, aims to identify key facilitators for organizational resilience among AIDS Services Organizations (ASOs) in SC. In-depth interviews were conducted among 11 leaders, from 8 ASOs, across SC during the summer of 2020. The interviews were recorded after receiving proper consent and then transcribed. Utilizing a codebook based upon the interview guide, a thematic analysis approach was utilized to analyze the data. All data management and analysis were conducted in NVivo 11.0. Our findings demonstrate several facilitators of organizational resilience, including (1) accurate and timely crisis information dissemination; (2) clear and preemptive protocols; (3) effective healthcare system policies, management, and leadership; (4) prioritization of staff psychological wellbeing; (5) stable access to personal protective equipment (PPE); (6) adequate and flexible funding; and (7) infrastructure that supports telehealth. Given the facilitators of organizational resilience among ASOs in SC during the COVID-19 pandemic, it is recommended that organizations implement and maintain coordinated and informed responses based upon preemptive protocols and emerging needs. ASO funders are encouraged to allow a flexibility in spending. The lessons learned from the participating leaders enable ASOs to develop and strengthen their organizational resilience and experience fewer disruptions in the future.

The framework of Systematic Assessment for Resilience (SAR): development and validation

BACKGROUND

Burnout and depression among health professions education (HPE) students continue to rise, leading to unwanted effects that ultimately jeopardise optimal medical care and patient health. Promoting the resilience of medical students is one solution to this issue. Several interventions have been implemented to foster resilience, but they focus on aspects other than the primary cause: the assessment system. The purpose of this study is to develop a framework to promote resilience in assessment planning and practice.

METHODS

We followed the guidelines suggested by Whetten for constructing a theoretical model for framework development. There were four phases in the model development. In the first phase, different literature review methods were used, and additional students' perspectives were collected through focus group discussions. Then, using the data, we constructed the theoretical model in the second phase. In the third phase, we validated the newly developed model and its related guidelines. Finally, we performed response process validation of the model with a group of medical teachers.

RESULTS

The developed systematic assessment resilience framework (SAR) promotes four constructs: self-control, management, engagement, and growth, through five phases of assessment: assessment experience, assessment direction, assessment preparation, examiner focus, and student reflection. Each phase contains a number of practical guidelines to promote resilience. We rigorously triangulated each approach with its theoretical foundations and evaluated it on the basis of its content and process. The model showed high levels of content and face validity.

CONCLUSIONS

The SAR model offers a novel guideline for fostering resilience through assessment planning and practice. It includes a number of attainable and practical guidelines for enhancing resilience. In addition, it opens a new horizon for HPE students' future use of this framework in the new normal condition (post COVID 19).

The link among academic stress, sleep disturbances, depressive symptoms, academic performance, and the moderating role of resourcefulness in health professions students during COVID-19 pandemic

Background

The rapid shift to virtual learning in response to the COVID-19 pandemic contributed to high academic stress among health profession students. High academic stress was associated with impaired psychosocial well-being and decreased academic performance.

Objectives

The purpose of this study was to assess the relationship between academic stress, anxiety, sleep disturbances, depressive symptoms, academic performance, and the moderating effect of resourcefulness among undergraduate health profession students.

Methods

This descriptive and cross-sectional study included undergraduate health profession students. The primary investigator distributed the study link to all students through the university's Central Messaging Centre, Twitter account, and WhatsApp. The study variables were measured using the Student Life Stress Inventory, the Generalized Anxiety Disorder-7 questionnaire, the Centre for Epidemiology Scale of Depression, the Pittsburgh Sleep Quality Index, and the Resourcefulness Skills Scale. Pearson R correlation and linear regression analysis were utilized for statistical analysis.

Results

Our sample included 94 undergraduate health profession students, 60 % of which were females with a mean age of 21, and the majority were nursing and medicine students. High academic stress, anxiety, sleep disturbances, depressive symptoms, and resourcefulness were reported among 50.6 %, 43 %, 79.6 %, 60.2 %, and 60 % of the participants, respectively. However, no effect of resourcefulness was found on any of the study variables. Instead, academic stress and sleep disturbances were the strongest predictors of depressive symptoms regardless of the level of resourcefulness.

Conclusion

Adequate academic support during virtual learning and tools to early detect subtle signs of high academic stress, anxiety, depression, and sleep disturbance should be routinely utilized by educational institutions. In addition, incorporating sleep hygiene and resourcefulness training in health professions education is highly indicated.

Correlations of resilience with coping strategies, and the underlying factors in the nurses working in COVID-19 hospitals

BACKGROUND

As the core of a health-care team, nurses play a key role in promoting community health, and their job involves witnessing human suffering and pain in health-care settings. The present study aimed to evaluate the correlations between resilience coping strategies, and the underlying factors in the nurses working in COVID-19 hospitals.

MATERIALS AND METHODS

This descriptive, cross-sectional study was conducted on 320 nurses working in COVID-19 wards for a minimum of 6 months in 2021. The participants were selected via multistage sampling. Data were collected using demographic, resilience, and coping strategy instruments. Data analysis was performed in SPSS version 20.

RESULTS

The mean resilience score was 76.94 ± 11.33. The mean scores of emotion-focused and problem-focused strategies were 59.65 ± 4.40 and 96.08 ± 5.38, respectively. The assessment of the correlation between resilience with the emotion-focused and problem-focused strategies showed a positive significant correlation (r = 0.25; P < 0.001 and r = 0.33; P < 0.001, respectively).

CONCLUSION

According to the results, the nurses working in COVID-19 wards mostly adopted problem-focused strategies in difficult work conditions depending on the required care provision. Both coping strategies significantly affected the subscales of resilience in the nurses. Therefore, it is recommended that special attention be paid to teaching strategies to cope with anxiety and resilience and develop problem-solving skills in nursing personnel during the emergence and outbreak of new diseases in order to reduce their anxiety.

Where there are challenges, there are opportunities: An undergraduate medical students’ teaching concept for mental health in times of COVID-19

COVID-19 had a tremendous effect on medical education. Most teaching sessions had to be shifted online, posing additional stress and potential isolation on medical students. However, it also offered the promotion of innovative digital teaching concepts. In this article, an approach to undergraduate mental health training is presented and evaluated. The curriculum was designed according to Kern’s six-step approach and consisted of asynchronous online material as well synchronous digital teaching and was accompanied by a plethora of newly developed teaching material (videos, fact sheets, etc.). Content covered the whole spectrum of diseases seen in a service of psychosomatic medicine and psychotherapy (i.e. anxiety, depression, trauma, somatoform and eating disorders, as well as motivational interviewing). Feedback from participants was collected, and exam results (written and practical) were compared to pre-COVID-19 times using t-tests for dependent and independent samples. Students were highly satisfied with the teaching (rating of 1.3 ± 0.6, n = 139 students). There was no significant difference from course evaluations before COVID-19 (1.5 ± 0.5, p > .05). The teaching also received an award in the students’ competition “best digital teaching concept in summer term 2020”. In the written exams, there was no significant difference between before COVID-19 (2.4 ± 0.45) and during COVID-19 times (1.6 ± 0.39; p > .05). In the practical objective structured clinical examination (OSCE), there was also no significant difference between students’ judgement of the difficulty of the station (1.9 ± 0.22 vs 1.9 ± 0.31; p > .05) or how well-prepared they felt for the exam (2.0 ± 0.24 vs 2.0 ± 0.31; p > .05). However, there was a significant difference in terms of grades, with the pre-COVID-19 grades being significantly better (2.7 ± 0.37 vs 2.0 ± 0.44; p < .05), which reflects the difficulty of transferring practical skills training to an online setting. Students particularly valued the possibility of self-directed learning combined with personal guidance by departmental experts, reflecting the importance of wellbeing-centred medical education. The pandemic triggered overnight challenges for teaching mental health that may also offer the opportunity to think about worldwide teaching standards with easily accessible material and courses online. This may offer the opportunity to enthral medical students to become mental health specialists themselves.

Understanding the Nature and Sources of Conflict Among Healthcare Professionals in Nigeria: A Qualitative Study

Introduction

Inter-professional conflict in the Nigerian health sector is a concept that is as old as modern medical practice and has resulted in disruption of health care delivery, with the overall impact bearing down on patients.

Purpose

This study aimed to provide an in-depth understanding and a clearer insight into the causes of conflict in the Nigerian health sector.

Methods

A qualitative strategy was employed using a semi-structured interview approach. Data were obtained from health practitioners from diverse backgrounds in various healthcare facilities.

Results

The phenomenon of conflict was reported as a long existent and trans-generational strain on inter-professional relationships occurring in all sectors of health practice, primarily between the physicians and other health care professionals. Inter-professional conflict was reported to emanate primarily from lapses in leadership, remuneration structure, role description, communication and emotional intelligence. This has affected the effectiveness of the Nigerian healthcare system and has contributed to hindrance in the provision of high-quality care in the country.

Conclusion

Evidence from this study can help in developing contextual policy in addressing inter-professional conflict in the health sector, and this will consequently improve health care delivery in the country.

Managing Hospital Employees' Burnout through Transformational Leadership: The Role of Resilience, Role Clarity, and Intrinsic Motivation

Medical errors have been identified as one of the greatest evils in the field of healthcare, causing millions of patient deaths around the globe each year, especially in developing and poor countries. Globally, the social, economic, and personal impact of medical errors leads to a multi-trillion USD loss. Undoubtedly, medical errors are serious public health concerns in modern times, which could be mitigated by taking corrective measures. Different factors contribute to an increase in medical errors, including employees' risk of burnout. Indeed, it was observed that hospital employees are more exposed to burnout situations compared to other fields. In this respect, managing hospital employees through transformational leadership (TL) may reduce the risk of burnout. However, surprisingly, studies on the relationship between TL and burnout are scarce in a healthcare system, indicating the existence of a critical knowledge gap. This study aims to fill this knowledge gap by investigating the role of TL in reducing the risk of burnout among hospital employees. At the same time, this study also tests the mediating effects of resilience and role clarity with the conditional indirect effect of intrinsic motivation in the above-proposed relationship. To test different hypotheses, a hypothetical model was developed for which we collected the data from different hospital employees (n = 398). Structural equation modeling (SEM) was considered for statistical validation of hypotheses confirming that TL significantly reduces burnout. The results further indicated that resilience and role clarity mediate this relationship significantly. Lastly, the conditional indirect effect of intrinsic motivation was also confirmed. Our results provide meaningful insights to the hospital administrators to combat burnout, a critical reason for medical errors in hospitals. Further, by incorporating the TL framework, a hospital may reduce the risk of burnout (and, hence, medical errors); on the one hand, such a leadership style also provides cost benefits (reduced medical errors improve cost efficiency). Other different theoretical and practical contributions are discussed in detail.

A systematic concept analysis of healthcare team resilience in times of pandemic disasters

BACKGROUND

The concept of resilience has been used as a descriptor for individuals and organizations with the dominant themes of bouncing back and moving forward.

AIMS

To examine the concept of resilience in providers and healthcare teams during pandemic disasters.

RESEARCH DESIGN

Walker and Avant's eight-step concept analysis method.

DATA SOURCE

CINAHL, EBSCO Host, PubMed, and SCOPUS were searched using the combined terms "resilience" or "resiliency" or "resilient" and "healthcare professionals," or "healthcare worker" or "healthcare team" or "physician" or "nurse" or "doctor" and "pandemic" or "disaster."

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist was used to review the literature and apply findings using the eight-step Walker and Avant method for concept analysis.

RESULTS

Three clusters emerged as attributes of individual resilience that may be applied to healthcare teams in times of pandemic disasters: (1) resilience is a dynamic contextual process, (2) resilience stabilizes the team to maintain a routine level of function, and (3) resilience is a catalyst for the actualization of innate or acquired skills and ability within the healthcare team.

CONCLUSION

This analysis suggests that resilience enhances the healthcare team's ability to maintain function during acute changes created by pandemic disasters. Resilience in healthcare teams during pandemics requires future research to explore the phenomenon.

Resilience among health care workers while working during a pandemic: A systematic review and meta synthesis of qualitative studies

Background

Aim

Method

Results

Conclusion

Synchronised Video-assisted Clinical Skill Lab Sessions (SVCSLSs). Can SVCSLSs fill some gaps in virtual medical education? A mixed-method study

Despite the recent advancement of virtual education during the last pandemic, mastering clinical competencies remains challenging. The current study endorsed Synchronised Video-assisted Clinical Skill lab Sessions (SVCSLS) as a novel instructional design aiming to improve medical students' clinical competencies during virtual learning. The current study is a mixed-method study that was carried out among 210 medical students at a medical college in Saudi Arabia. It was revealed that students viewed SVCSLSs as an effective and safe tool during times of crisis. Students' performance did not show significant variations in all program phases compared with face-to-face learning. SVCSLSs has many advantages, including enjoyment, continuous access to learning material, Self-Directed Learning, fostering recall and memorisation, and enhancing higher cognitive skills. Students suggested that the sessions' content be updated, that workplace-related videos be added, and that constructive feedback is provided. Students recommended updating the contents of the sessions, enriching them with workplace-based videos, and providing constructive feedback. Though SVCSLSs have been proven to be an effective tool, we recommend using them during a crisis rather than replacing the face-to-face mode of learning in normal circumstances.

Wrestling With the Invincibility Myth: Exploring Physicians' Resistance to Wellness and Resilience-Building Interventions

PURPOSE

Physicians are expected to provide compassionate, error-free care while navigating systemic challenges and organizational demands. Many are burning out. While organizations are scrambling to address the burnout crisis, physicians often resist interventions aimed at enhancing their wellness and building their resilience. The purpose of this research was to empirically study this phenomenon.

METHOD

Constructivist grounded theory was used to inform the iterative data collection and analysis process. In spring 2018, 22 faculty physicians working in Canada participated in semistructured interviews to discuss their experiences of wellness and burnout, their perceptions of wellness initiatives, and how their experiences and perceptions influence their uptake of the rapidly proliferating strategies aimed at nurturing their resilience. Themes were identified using constant comparative analysis.

RESULTS

Participants suggested that the values of compassion espoused by health care organizations do not extend to physicians, and they described feeling dehumanized by professional values steeped in an invincibility myth in which physicians are expected to be "superhuman" and "sacrifice everything" for medicine. Participants described that professional values and organizational norms impeded work-life balance, hindered personal and professional fulfillment, and discouraged disclosure of struggles. In turn, participants seemed to resist wellness and resilience-building interventions focused on fixing individuals rather than broader systemic, organizational, and professional issues. Participants perceived that efforts aimed at building individual resilience are futile without changes in professional values and sustained organizational support.

CONCLUSIONS

Findings suggest that professional and organizational norms and expectations trigger feelings of dehumanization for some physicians. These feelings likely exacerbate burnout and may partly explain physicians' resistance to resilience-building strategies. Mitigating burnout and developing and sustaining a resilient physician workforce will require both individual resistance to problematic professional values and an institutional commitment to creating a culture of compassion for patients and physicians alike.

Memes and Poetry: A Descriptive Analysis on Creative Arts Therapy to Reduce Health Care Worker Burnout

BACKGROUND

Health care workers (HCWs) face high levels of burnout, which can lead to workforce turnover and poor patient outcomes. Health care leaders should identify strategies to improve staff resilience.

PURPOSE

The purpose of this study was to describe HCWs' perspective on using creative arts therapy to reduce burnout and improve resiliency.

METHODS

During Infection Prevention week, staff were encouraged to submit and vote on educational memes and haikus. Staff were asked their perspectives on how this activity could be used to reduce burnout and improve resiliency using a 4-point Likert scale.

RESULTS

Twenty-two staff members submitted 26 memes and 27 haikus. Staff felt this activity could be an effective strategy to help reduce burnout and improve resiliency.

CONCLUSIONS

Further research is warranted to better understand the correlation between this form of art therapy and burnout and resiliency; however, health care leaders may consider using this as a tool for staff well-being.

An iterative approach to promoting departmental wellbeing during COVID-19

RATIONALE, AIMS, AND OBJECTIVES

Addressing wellbeing among learners, faculty, and staff during the COVID-19 pandemic is a challenge for many clinical departments. Continued and systemic supports are needed to combat the pandemic's impact on mental health and wellbeing. This article describes an iterative approach to conducting a needs assessment and implementing a COVID-19-related wellness initiative in a psychiatry department.

METHODS

Development of the initiative followed the Plan-Do-Study-Act (PDSA) quality improvement cycle and was informed by Shanafelt and colleagues' framework for supporting healthcare workers during the COVID-19 pandemic. Key features included the establishment of a Wellness Working Group, the curation of relevant resources on the Department's website, and the deployment of regular, monthly surveys that informed the creation of further supports, such as a weekly online drop-in support group.

RESULTS

Survey response rates ranged from 22% to 32% (n = 90-127) throughout our initiative. Across multiple surveys, approximately 80% of respondents reported feeling supported or very supported by the Department, and 90% were satisfied or very satisfied with the quantity and quality of information provided. Our support group and resources page were accessed by nearly one-quarter and one-third of respondents, respectively, with satisfaction rates of 81% or higher. Consistent with the Department's mandate, ensuring equity was a key focus of the Working Group throughout its operations.

CONCLUSIONS

There is potential for this model to be scaled to create a faculty-wide, institution-wide, or regional approach to addressing wellbeing. Other departments may also wish to adopt similar approaches to supporting their members during this challenging time.

Proximity to COVID-19 patients and role-specific mental health outcomes of healthcare professionals

BACKGROUND

Healthcare professionals (HCPs) experience extreme hardships and challenges during the time of COVID-19, due to their professional roles. At the same time, HCPs may experience a feeling of importance as contributing members of the community, which could enhance their well-being alongside COVID-19-work-related stressors.

AIMS

This cross-sectional study examined the relationship between HCPs' proximity to COVID-19 patients and role-specific fears of COVID-19 and sense of emotional, social and psychological well-being.

METHODS

Participants (N = 1,378) included: HCPs who treated COVID-19 patients (frontliners, n = 188), HCPs that did not work directly with COVID-19 patients (secondliners, n = 524), and a group of non-HCPs who served as the comparison group (n = 666). Participants completed the Depression and Anxiety Stress Scale-21; Fear of COVID-19 Scale; Fear of COVID-19 Familial Infection Scale; and the Mental Health Continuum Short-Form.

RESULTS

Results indicate that the comparison group reported higher levels of fear of COVID-19 compared to secondliners, while frontliners reported the highest levels of fear of infecting their families. Frontliners and secondliners HCPs reported significantly higher levels of social and psychological well-being compared to the non-HCP group.

CONCLUSIONS

This study indicates that there are role-specific mental health outcomes related to HCP's proximity to COVID-19 patients.

OUP accepted manuscript

Quarantine is an essential practice during pandemics but it could have negative effects. There are currently no studies on the experiences of health care workers (HCWs) in quarantine during the coronavirus disease pandemic. The aim of this study was to assess the psychosocial effects of quarantine on tertiary hospital HCWs who were exposed to coronavirus. A cross-sectional study on the psychological wellbeing, needs and resources of HCWs during quarantine was conducted using an online survey in a large tertiary hospital. In total, 148 quarantined HCWs participated in this study. Overall self-reported psychological wellbeing scores were high (5.22 ± 1.11). Physicians had higher psychological wellbeing compared to nurses (5.58 ± 1.05 and 4.83 ± 1.21, respectively). Being a nurse, separation from family during quarantine, experiencing public shaming and longer quarantine period were associated with lower psychological wellbeing and higher needs. Working from home and confidence in safety at work was associated with fewer needs during quarantine. Nurses might be a risk group for the negative influences of quarantine. The ability to remain connected to work by working from home could have a protective effect on HCWs’ psychological wellbeing. More efforts should be implemented in order to support HCWs in quarantine and after their return to work.

During the COVID-19 crisis, health care workers (HCWs) were at the frontline of this pandemic and therefore were exposed to its risks and negative impact. One of the challenges during this time was the frequent quarantines of HCWs as a result of their exposure to patients. Although quarantine is important to stop the infection, it may effect mental and physical health. This study examined HCWs’ experience during quarantine, their well-being and ways of coping. We sent HCWs who are working in a tertiary hospital an online questionnaire and 148 replied. We found that the average well-being of HCWs in quarantine was high, with physicians having the highest reported well-being and nurses having the lowest. HCWs who reported low sense of well-being also reported on having more difficulties coping with the quarantine and reported more public shaming due to being in quarantine. We also found that HCWs who were working from home during quarantine and those who reported they felt safe in their place of work reported less difficulties coping with the quarantine. Our study suggests that nurses are more vulnerable to the negative impact of quarantine. It also suggests that being connected to work during quarantine can improve well-being. It is important to address stigma toward quarantined individuals and to provide more resources to support HCWs in quarantine and after their return to work.

The COVID-19 Pandemic: a Year Lost, or a Year Found?

This commentary is based on the Leadership Plenary at the IAMSE 2021 Virtual Conference and describes the response of the International Association of Medical Science Educators (IAMSE) to the COVID-19 pandemic.

Visitor Restrictions, Palliative Care, and Epistemic Agency: A Qualitative Study of Nurses' Relational Practice During the Coronavirus Pandemic

Efforts to curb spread of COVID-19 has led to restrictive visitor policies in healthcare, which disrupt social connection between patients and their families at end of life. We interviewed 17 Canadian nurses providing palliative care, to solicit their descriptions of, and responses to, ethical issues experienced as a result of COVID-19 related circumstances. Our analysis was inductive and scaffolded on notions of nurses' moral agency, palliative care values, and our clinical practice in end-of-life care. Our findings reveal that while participants appreciated the need for pandemic measures, they found blanket policies separating patients and families to be antithetical to their philosophy of palliative care. In navigating this tension, nurses drew on the foundational values of their practice, engaging in ethical reasoning and action to integrate safety and humanity into their work. These findings underscore the epistemic agency of nurses and highlight the limits of a purely biomedical logic for guiding the nursing ethics of the pandemic response.

Shifting Focus from Burnout and Wellness toward Individual and Organizational Resilience

Burnout is reported to be epidemic among physicians and medical trainees, and wellness has been the predominant target for intervention in academic medicine over the past several years. However, both burnout and wellness suffer from a lack of standardized definition, often making interventions difficult to generalize and extrapolate to different sites. Although well-meaning, current frameworks surrounding wellness and burnout have limitations in fully addressing the challenges of improving physician mental health. Wellness as a framework does not inherently acknowledge the adversity inevitably experienced in the practice of medicine and in the lives of medical trainees. During a crisis such as the current pandemic, wellness curricula often do not offer adequate frameworks to address the personal, organizational, or societal crises that may ensue. This leaves academic institutions and their leadership ill-equipped to appropriately address the factors that contribute to burnout. More recently, resilience has been explored as another framework to positively influence physician wellness and burnout. Resilience acknowledges the inevitable adversity individuals encounter in their life and work, allowing for a more open discussion on the tensions and flexibility between facets of life. However, emphasizing personal resiliency without addressing organizational resiliency may leave physicians feeling alienated or marginalized from critical support and resources that organizations can and should provide. Despite intense focus on wellness and burnout, there have not been significant positive changes in physicians' mental health. Many interventions have aimed at the individual level with mindfulness or other reflective exercises; unfortunately these have demonstrated only marginal benefit. Systems level approaches have demonstrated more benefit but the ability of organizations to carry out any specific intervention is likely to be limited by their own unique constraints and may limit the spread of innovation. We believe the current use of these conceptual lenses (wellness and burnout) has been clouded by lack of uniformity of definitions, an array of measurement tools with no agreed-upon standard, a lack of understanding of the complex interaction between the constructs involved, and an over-emphasis on personal rather than organizational interventions and solutions. If the frameworks of burnout and wellness are limited, and personal resilience by itself is inadequate, what framework would be helpful? We believe that focusing on organizational resilience and the connecting dimensions between organizations and their physicians could be an additional framework helpful in addressing physician mental health. An organization connects with its members along multiple dimensions, including communication, recognition of gifts, shared vision, and sense of belonging. By finding ways to positively affect these dimensions, organizations can create change in the culture and mental health of physicians and trainees. Educational institutions specifically would be well-served to consider organizational resilience and its relationship to individuals.

Health-Care Professionals Amid the COVID-19 Pandemic: How Emotional Intelligence May Enhance Work Performance Traversing the Mediating Role of Work Engagement

Upon the eruption of COVID-19, frontline health-care workers confronted substantial workload and stress along with braving additional difficulties when performing at work. The main aim of this research was to assess the mediating role of work engagement in the direct impact of emotional intelligence on health-care professionals' work performance. A cross-sectional study was conducted in several Spanish hospitals during the second half of 2020. A total of 1549 health-care workers (62.1% women; mean age 36.51 years) filled the Wong and Law Emotional Intelligence Scale, the Utrecht Work Engagement Scale and the Individual Work Performance Questionnaire. Our findings demonstrated that work engagement plays a mediating effect between emotional intelligence and work performance, even when accounting for sociodemographic variables. Indeed, among the three constructs of engagement, vigor dimension (a1b1 = 0.09; CI: 0.06; 0.12; p < 0.01) emerges over dedication (a2b2 = 0.083; CI = 0.05, 0.1; p < 0.01) and absorption (a3b3 = 0.047; CI = 0.02, 0.07; p < 0.01) as the most decisive one. Herewith, it is apparent that professionals with a higher self-perception of emotional intelligence report stronger levels of engagement, thereby leading to greater performance overall. The present work evinces the necessity for proactively developing the emotional competencies of the health-care workforce, especially in high-emotional demand contexts.

A longitudinal investigation of mental health, perceived learning environment and burdens in a cohort of first-year German medical students' before and during the COVID-19 'new normal'

BACKGROUND

Medical students' propensity to develop mental morbidity has been described for decades but remains unresolved. To assess student mental health person-centred and longitudinally, we have been investigating a cohort of German students since October 2019. After their first semester under 'normal' conditions, rapid changes became necessary due to the COVID-19 situation. In line with the initial aim, we investigated students' change of mental health, perceived learning environment and burdens in the 'new normal'.

METHODS

Students in a newly founded German medical study programme (n = 63) answered a questionnaire each semester (October 2019 = entering medical school; December 2019 = 'old normal'; June 2020 = 'new normal'; December 2020 = 'new normal') on their well-being (FAHW-12), burnout (Maslach Inventory), depression (PHQ-9), perception of the learning environment (DREEM), burdens and protective attitudes in the 'new normal' (items designed for the study).

RESULTS

Friedman tests reveal overall significant differences (all p < .001) in depression and burnout (emotional exhaustion, depersonalisation, personal accomplishment); changes in well-being were identified as just non-significant (p = .05). The effects were explained by a significant increase in burnout and depression identified post-hoc from October 2019 to December 2019. No increase in severity was identified in the 'new normal' semesters. The learning environment was perceived positively even with a significant improvement for June 2020 (repeated measures ANOVA p < .001). Study-related burdens (e.g. procrastination of online-learning material) took on greater relevance than burdens related to physicians' occupation (e.g. potential for students' recruitment to the healthcare system during their studies).

CONCLUSIONS

The 'new' when entering medical school had a greater impact on our students' mental health than the 'new normal'. The readiness for change in the context of a newly designed study programme may have been beneficial with regard to students' positively perceived learning environment during the virtual semesters. Monitoring medical students' mental health longitudinally should be a concern regardless of a pandemic.

COVID-19 has changed the way we think about training future pediatric hematologists/oncologists

COVID-19 has upended medical practice and education, but has also catalyzed enhancements in the field. Early on, a local group of researchers united to investigate the impact of the pandemic on pediatric hematology oncology (PHO). From this group, a regional educational series was established, "virtual-Symposium of Pediatric Hematology/Oncology of New York" (v-SYMPHONY). The implementation of these endeavors while PHO fellowship applications are declining has highlighted our perceptions that education, mentoring, and career expectations are not keeping up with the needs of current trainees. We describe our regional experience joining together to further education and research, and reflect on the current landscape of PHO training and workforce.

Building learning organizational culture during COVID-19 outbreak: a national study

Background

Hospitals and healthcare institutions should be observant of the ever-changing environment and be adaptive to learning practices. By adopting the steps and other components of organizational learning, healthcare institutions can convert themselves into learning organizations and ultimately strengthen the overall healthcare system of the country. The present study aimed to examine the influence of several organizational learning dimensions on organization culture in healthcare settings during the COVID-19 outbreak.

Methods

During COVID-19 crisis in 2020, an online cross-sectional study was performed. Data were collected via official emails sent to 1500 healthcare professionals working in front line at four sets of hospitals in Saudi Arabia. Basic descriptive analysis was constructed to identify the variation between the four healthcare organizations. A multiple regression was employed to explore how hospitals can adopt learning process during pandemics, incorporating several Dimensions of Learning Organizations Questionnaire (DLOQ) developed by Marsick and Watkins (2003) and Leufvén and others (2015).

Results

Organizational learning including system connections (M = 3.745), embedded systems (M = 3.732), and team work and collaborations (M = 3.724) tended to have major significant relationships with building effective learning organization culture. Staff empowerment, dialogues and inquiry, internal learning culture, and continuous learning had the lowest effect on building health organization culture (M = 3.680, M = 3.3.679, M = 3.673, M = 3.663, respectively). A multiple linear regression was run to predict learning organization based on the several variables. These variables statistically significantly predicted learning organization, F (6, 1124) = 168.730, p < .0005, R² = 0.471, (p < .05).

Discussion

The findings concluded that although intrinsic factors like staff empowerment, dialogues and inquiry, and internal learning culture, revealed central roles, still the most crucial factors toward the development of learning organization culture were extrinsic ones including connections, embed system and collaborations.

Conclusions

Until knowledge-sharing is embedded in health organizational systems; organizations may not maintain a high level of learning during crisis.

Surreal Becomes Real: Ethical Dilemmas Related to the COVID-19 Pandemic and Professional Identity Formation of Health Professionals

Fundamental quandaries of clinical and biomedical ethics for health care professionals, committees, and systems have been raised into stark relief by the COVID-19 pandemic. The nature and extent of critical issues raised by this ongoing crisis, including challenging ethical dilemmas for the health care profession, is likely to have an indelible impact on the professional identity formation (PIF) of learners and practitioners across the trajectory of the professional lifecycle. The lifelong process of PIF for health care practitioners, from learner through independent practice, is supported in medical education by intentional reflection, relationships within community of practice include guidance from mentoring, as well as resilience, both emotional and moral. We consider how grappling with ethical dilemmas related to the COVID-19 pandemic can challenge, inform, and even potentially transform the PIF process, thereby supporting development of a morally resilient, humanistic professional identity in health care trainees and health care professionals.

An Observation of Healthcare Professions Students' Perceptions During the COVID-19 Pandemic

This study conveys preclinical healthcare professions students' sentiments at 14 universities during the 2020 COVID-19 pandemic. Essays about students' thoughts and experiences were thematically sorted and revealed a variety of sentiments spanning from positive (e.g., pride, respect) to the more negative (e.g., anxiety, guilt, disappointment, anger). Themes revealed respect for the healthcare profession, but also the realization of its limitations, sacrifices, and risks. Healthcare profession educators need to be aware that the COVID-19 pandemic has affected students emotionally and may have long-term effects on the global healthcare profession. This study can serve as a historic documentation of how this generation of students felt and adds to the literature on how the pandemic affected the healthcare profession.

COVID-19 era healthcare ethics education: Cultivating educational and moral resilience

The COVID-19 pandemic crisis has had profound effects on global health, healthcare, and public health policy. It has also impacted education. Within undergraduate healthcare education of doctors, nurses, and allied professions, rapid shifts to distance learning and pedagogic content creation within new realities, demands of healthcare practice settings, shortened curricula, and/or earlier graduation have also challenged ethics teaching in terms of curriculum allotments or content specification. We propose expanding the notion of resilience to the field of ethics education under the conditions of remote learning. Educational resilience starts in the virtual classroom of ethics teaching, initially constituted as an "unpurposed space" of exchange about the pandemic's challenging impact on students and educators. This continuously transforms into "purposed space" of reflection, discovering ethics as a repertory of orientative knowledge for addressing the pandemic's challenges on personal, professional, societal, and global levels and for discovering (and then addressing) that the health of individuals and populations also has moral determinants. As such, an educational resilience framework with inherent adaptability rises to the challenge of supporting the moral agency of students acting both as professionals and as global citizens. Educational resilience is key in supporting and sustaining professional identify formation and facilitating the development of students' moral resilience and leadership amid moral complexity and potential moral transgression-not only but especially in times of pandemic.

Critical care nursing during the COVID-19 pandemic: a story of resilience

In this article, an intensive care unit (ICU) nurse provides some reflections on caring for patients with COVID-19 and relates her lived experience to the concept of resilience. Similarities and differences to pre-pandemic understandings of resilience are drawn out and factors that mediate acute stress, resilience and psychological recovery during a pandemic are considered. Resources to support ICU nurses and other healthcare staff to manage stress and promote wellbeing are signposted, and important research directions that warrant attention are recommended. The story is one of learning and hope and, importantly, it captures key lessons that can equip healthcare staff with positive coping strategies in a time of unprecedented pressure.

Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review

BACKGROUND

Evidence from disease epidemics shows that healthcare workers are at risk of developing short- and long-term mental health problems. The World Health Organization (WHO) has warned about the potential negative impact of the COVID-19 crisis on the mental well-being of health and social care professionals. Symptoms of mental health problems commonly include depression, anxiety, stress, and additional cognitive and social problems; these can impact on function in the workplace. The mental health and resilience (ability to cope with the negative effects of stress) of frontline health and social care professionals ('frontline workers' in this review) could be supported during disease epidemics by workplace interventions, interventions to support basic daily needs, psychological support interventions, pharmacological interventions, or a combination of any or all of these.

OBJECTIVES

Objective 1: to assess the effects of interventions aimed at supporting the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic. Objective 2: to identify barriers and facilitators that may impact on the implementation of interventions aimed at supporting the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic.

SEARCH METHODS

On 28 May 2020 we searched the Cochrane Database of Systematic Reviews, CENTRAL, MEDLINE, Embase, Web of Science, PsycINFO, CINAHL, Global Index Medicus databases and WHO Institutional Repository for Information Sharing. We also searched ongoing trials registers and Google Scholar. We ran all searches from the year 2002 onwards, with no language restrictions.

SELECTION CRITERIA

We included studies in which participants were health and social care professionals working at the front line during infectious disease outbreaks, categorised as epidemics or pandemics by WHO, from 2002 onwards. For objective 1 we included quantitative evidence from randomised trials, non-randomised trials, controlled before-after studies and interrupted time series studies, which investigated the effect of any intervention to support mental health or resilience, compared to no intervention, standard care, placebo or attention control intervention, or other active interventions. For objective 2 we included qualitative evidence from studies that described barriers and facilitators to the implementation of interventions. Outcomes critical to this review were general mental health and resilience. Additional outcomes included psychological symptoms of anxiety, depression or stress; burnout; other mental health disorders; workplace staffing; and adverse events arising from interventions.

DATA COLLECTION AND ANALYSIS

Pairs of review authors independently applied selection criteria to abstracts and full papers, with disagreements resolved through discussion. One review author systematically extracted data, cross-checked by a second review author. For objective 1, we assessed risk of bias of studies of effectiveness using the Cochrane 'Risk of bias' tool. For objective 2, we assessed methodological limitations using either the CASP (Critical Appraisal Skills Programme) qualitative study tool, for qualitative studies, or WEIRD (Ways of Evaluating Important and Relevant Data) tool, for descriptive studies. We planned meta-analyses of pairwise comparisons for outcomes if direct evidence were available. Two review authors extracted evidence relating to barriers and facilitators to implementation, organised these around the domains of the Consolidated Framework of Implementation Research, and used the GRADE-CERQual approach to assess confidence in each finding. We planned to produce an overarching synthesis, bringing quantitative and qualitative findings together.

MAIN RESULTS

We included 16 studies that reported implementation of an intervention aimed at supporting the resilience or mental health of frontline workers during disease outbreaks (severe acute respiratory syndrome (SARS): 2; Ebola: 9; Middle East respiratory syndrome (MERS): 1; COVID-19: 4). Interventions studied included workplace interventions, such as training, structure and communication (6 studies); psychological support interventions, such as counselling and psychology services (8 studies); and multifaceted interventions (2 studies). Objective 1: a mixed-methods study that incorporated a cluster-randomised trial, investigating the effect of a work-based intervention, provided very low-certainty evidence about the effect of training frontline healthcare workers to deliver psychological first aid on a measure of burnout. Objective 2: we included all 16 studies in our qualitative evidence synthesis; we classified seven as qualitative and nine as descriptive studies. We identified 17 key findings from multiple barriers and facilitators reported in studies. We did not have high confidence in any of the findings; we had moderate confidence in six findings and low to very low confidence in 11 findings. We are moderately confident that the following two factors were barriers to intervention implementation: frontline workers, or the organisations in which they worked, not being fully aware of what they needed to support their mental well-being; and a lack of equipment, staff time or skills needed for an intervention. We are moderately confident that the following three factors were facilitators of intervention implementation: interventions that could be adapted for local needs; having effective communication, both formally and socially; and having positive, safe and supportive learning environments for frontline workers. We are moderately confident that the knowledge or beliefs, or both, that people have about an intervention can act as either barriers or facilitators to implementation of the intervention.

AUTHORS' CONCLUSIONS

There is a lack of both quantitative and qualitative evidence from studies carried out during or after disease epidemics and pandemics that can inform the selection of interventions that are beneficial to the resilience and mental health of frontline workers. Alternative sources of evidence (e.g. from other healthcare crises, and general evidence about interventions that support mental well-being) could therefore be used to inform decision making. When selecting interventions aimed at supporting frontline workers' mental health, organisational, social, personal, and psychological factors may all be important. Research to determine the effectiveness of interventions is a high priority. The COVID-19 pandemic provides unique opportunities for robust evaluation of interventions. Future studies must be developed with appropriately rigorous planning, including development, peer review and transparent reporting of research protocols, following guidance and standards for best practice, and with appropriate length of follow-up. Factors that may act as barriers and facilitators to implementation of interventions should be considered during the planning of future research and when selecting interventions to deliver within local settings.

The Impact of the COVID-19 Pandemic on Vascular Surgery Trainees in the United States

BACKGROUND

The impact of the coronavirus disease 19 (COVID-19) pandemic on health care workers has been substantial. However, the impact on vascular surgery (VS) trainees has not yet been determined. The goals of our study were to gauge the impact of COVID-19 on VS trainees' personal and professional life and to assess stressors, coping, and support structures involved in these trainees' response to the COVID-19 pandemic.

METHODS

This was an anonymous online survey administered in April 12-24, 2020 during the surge phase of the global COVID-19 pandemic. It is a subset analysis of the cross-sectional Society for Vascular Surgery Wellness Committee Pandemic Practice, Anxiety, Coping, and Support Survey. The cohort surveyed was VS trainees, integrated residents and fellows, in the United States of America. Assessment of the personal impact of the pandemic on VS trainees and the coping strategies used by them was based on the validated Generalized Anxiety Disorder 7-item (GAD-7) scale and the validated 28-time Brief Coping Orientation to Problems Experienced inventory.

RESULTS

A total of 145 VS trainees responded to the survey, with a 23% response rate (145/638). Significant changes were made to the clinical responsibilities of VS trainees, with 111 (91%) reporting cancellation of elective procedures, 101 (82%) with call schedule changes, 34 (24%) with duties other than related to VS, and 29 (24%) participation in outpatient care delivery. Over one-third (52/144) reported they had performed a procedure on a patient with confirmed COVID-19; 37 (25.7%) reported they were unaware of the COVID-19 status at the time. The majority continued to work after exposure (29/34, 78%). Major stressors included concerns about professional development, infection risk to family/friends, and impact of care delay on patients. The median score for GAD-7 was 4 (interquartile range 1-8), which corresponds to no or low self-reported anxiety levels. VS trainees employed mostly active coping and rarely avoidant coping mechanisms, and the majority were aware and used social media and online support systems. No significant difference was observed between integrated residents and fellows, or by gender.

CONCLUSIONS

The pandemic has had significant impact on VS trainees. Trainees reported significant changes to clinical responsibilities, exposure to COVID-19, and pandemic-related stressors but demonstrated healthy coping mechanisms with low self-reported anxiety levels. The VS community should maintain awareness of the impact of the pandemic on the professional and personal development of surgeons in training. We recommend adaptive evolution in training to accommodate the changing learning environment for trainees.

Evaluation of Key Performance Indicators (KPIs) for Sustainable Postgraduate Medical Training: An Opportunity for Implementing an Innovative Approach to Advance the Quality of Training Programs at the Saudi Commission for Health Specialties (SCFHS)

The Kingdom of Saudi Arabia is undergoing a major transformation in response to a revolutionary vision of 2030, given that healthcare reform is one of the top priorities. With the objective of improving healthcare and allied professional performance in the Kingdom to meet the international standards, the Saudi Commission for Health Specialties (SCFHS) has recently developed a strategic plan that focuses on expanding training programs’ capacity to align with the increasing demand for the country’s healthcare workforce, providing comprehensive quality assurance and control to ensure training programs uphold high quality standards, and providing advanced training programs benchmarked against international standards. In this research paper, we describe our attempt for developing a general framework for key performance indicators (KPIs) and the related metrics, with the aim of contributing to developing new strategies for better medical training compatible with the future. We present the results of a survey conducted in the Kingdom of Saudi Arabia (KSA), for the enhancement of quality of postgraduate medical training. The recent developments in the field of learning analytics present an opportunity for utilizing big data and artificial intelligence in the design and implementation of socio-technical systems with significant potential social impact. We summarize the key aspects of the Training Quality Assurance Initiative and suggest a new approach for designing a new data and services ecosystem for personalized health professionals training in the KSA. The study also contributes to the theoretical knowledge on the integration of sustainability and medical training and education by proposing a framework that can enhance future initiatives from various health organizations.