Fatigue and training of obstetrics and gynaecology trainees in Australia and New Zealand

A qualitative analysis of adding kindness into the ISBAR handover tool

BACKGROUND

The COVID pandemic has highlighted the stresses experienced by our medical workforce, with worldwide publications attesting to high rates of depression, anxiety and burnout, particularly in junior doctors. Many studies focus on reporting on the prevalence of mental health issues, but not many report on interventional strategies. One of the most stressful interactions in the day of a junior doctor is the medical handover. The incorporation of kindness into clinical handover has coined the term 'KISBAR' to underline the importance of delivering handover in a kind manner.

AIM

The aim is to analyse the efficacy of a novel intervention by introducing an emotional support representative to participate in the morning labour ward handover.

METHODS

We undertook an ethnographic constructivist qualitative research project in a tertiary hospital in Perth, Western Australia, using focus groups to explore the views of junior medical staff on the KISBAR handover tool in the specific context of labour ward handover. Fifty per cent of the total junior doctors from the hospital participated in this study.

RESULTS

Four dominant themes arose from analysis of the focus group discussions: (i) inherent stress experienced by junior doctors during the labour ward handover process, (ii) support strategies for junior doctors during labour ward handover; (iii) role modelling and the hidden curriculum aspects of communication from senior doctors at labour ward handover; and (iv) benefit of having an emotional support person present for labour ward handover.

CONCLUSION

Our study confirmed the benefit of having an emotional support person present at labour ward handover: improved perception of safety and an environment that junior doctors found to be supportive. This is a novel and reproducible interventional strategy which is applicable to various obstetric units around Australia.

Health and well-being of rotation workers in the mining, offshore oil and gas, and construction industry: a systematic review

Introduction

Rotation work, characterised by travelling long distances to work in isolated areas where workers typically rotate consecutive days working and living on-site with periods at home, is increasingly used in the resources and construction sectors globally. Such employment practices may have an impact on workers’ health and well-being. This systematic review explores the impact rotation work has on mental and physical outcomes in rotation workers in the resources and construction sectors.

Method

The PubMed, Medline, EMBASE, CINAHL, PsycINFO, and Scopus databases were systematically searched on 1 May 2020 to identify quantitative, qualitative and mixed-method studies addressing the health of rotation workers published in peer-reviewed journals. Findings from the studies were summarised narratively.

Results

Of 6268 studies retrieved, 90 studies were included in the review. Studies suggested higher prevalence of psychological distress in onshore rotation workers and higher overweight/obesity rates among rotation workers as compared with the general population. We found more sleep problems and higher levels of smoking during work periods compared with off-site days; and higher alcohol intake during off-site days compared with on-site days. Workers generally perceived their physical health status as good. High-perceived job demands (such as workload, repetitive work) were associated with mental distress and exhaustion, sleep problems and perceived poor physical health status, while high-perceived job resources (such as job clarity/control, support) were associated with low mental distress and exhaustion, less smoking and alcohol intake, and better sleep.

Conclusion

Rotation work is associated with several poorer health behaviours and outcomes, such as sleep problems, smoking, alcohol consumption and overweight/obesity. Interventions needed to improve rotation workers’ health should include maximising available job resources and reducing job demands. Further longitudinal studies are needed to explore the long-term health effects of rotation work and the short-term contextual effects of the different aspects of rotation work.

Doctors' Mental Health in the Midst of COVID-19 Pandemic: The Roles of Work Demands and Recovery Experiences

The COVID-19 pandemic potentially increases doctors’ work demands and limits their recovery opportunity; this consequently puts them at a high risk of adverse mental health impacts. This study aims to estimate the level of doctors’ fatigue, recovery, depression, anxiety, and stress, and exploring their association with work demands and recovery experiences. This was a cross-sectional study among all medical doctors working at all government health facilities in Selangor, Malaysia. Data were collected in May 2020 immediately following the COVID-19 contagion peak in Malaysia by using self-reported questionnaires through an online medium. The total participants were 1050 doctors. The majority of participants were non-resident non-specialist medical officers (55.7%) and work in the hospital setting (76.3%). The highest magnitude of work demands was mental demand (M = 7.54, SD = 1.998) while the lowest magnitude of recovery experiences was detachment (M = 9.22, SD = 5.043). Participants reported a higher acute fatigue level (M = 63.33, SD = 19.025) than chronic fatigue (M = 49.37, SD = 24.473) and intershift recovery (M = 49.97, SD = 19.480). The majority of them had no depression (69.0%), no anxiety (70.3%), and no stress (76.5%). Higher work demands and lower recovery experiences were generally associated with adverse mental health. For instance, emotional demands were positively associated with acute fatigue (adj. b = 2.73), chronic fatigue (adj. b = 3.64), depression (adj. b = 0.57), anxiety (adj. b = 0.47), and stress (adj. b = 0.64), while relaxation experiences were negatively associated with acute fatigue (adj. b = −0.53), chronic fatigue (adj. b = −0.53), depression (adj. b = −0.14), anxiety (adj. b = −0.11), and stress (adj. b = −0.15). However, higher detachment experience was associated with multiple mental health parameters in the opposite of the expected direction such as higher level of chronic fatigue (adj. b = 0.74), depression (adj. b = 0.15), anxiety (adj. b = 0.11), and stress (adj. b = 0.11), and lower level of intershift recovery (adj. b = −0.21). In conclusion, work demands generally worsen, while recovery experiences protect mental health during the COVID-19 pandemic with the caveat of the role of detachment experiences.

Fatigue and recovery among Malaysian doctors: the role of work-related activities during non-work time

OBJECTIVES

This paper aims to estimate the level of acute fatigue, chronic fatigue and intershift recovery among doctors working at public hospitals in Malaysia and determine their inter-relationship and their association with work-related activities during non-work time.

DESIGN

Cross-sectional.

SETTING

Seven core clinical disciplines from seven tertiary public hospitals in Malaysia.

PARTICIPANTS

Study was conducted among 330 randomly-sampled doctors. Response rate was 80.61% (n=266).

RESULTS

The mean score of acute fatigue, chronic fatigue and intershift recovery were 68.51 (SD=16.549), 54.60 (SD=21.259) and 37.29 (SD=19.540), respectively. All these scores were out of 100 points each. Acute and chronic fatigue were correlated (r=0.663), and both were negatively correlated with intershift recovery (r=-0.704 and r=-0.670, respectively). Among the work-related activities done during non-work time, work-related ruminations dominated both the more frequent activities and the association with poorer fatigue and recovery outcomes. Rumination on being scolded/violated was found to be positively associated with both acute fatigue (adjusted regression coefficient (Adj.b)=2.190, 95% CI=1.139 to 3.240) and chronic fatigue (Adj.b=5.089, 95% CI=3.876 to 6.303), and negatively associated with recovery (Adj.b=-3.316, 95% CI=-4.516 to -2.117). Doing work task at workplace or attending extra work-related activities such as locum and attending training were found to have negative associations with fatigue and positive associations with recovery. Nevertheless, doing work-related activities at home was positively associated with acute fatigue. In terms of communication, it was found that face-to-face conversation with partner did associate with higher recovery but virtual conversation with partner associated with higher acute fatigue and lower recovery.

CONCLUSIONS

Work-related ruminations during non-work time were common and associated with poor fatigue and recovery outcomes while overt work activities done at workplace during non-work time were associated with better fatigue and recovery levels. There is a need for future studies with design that allow causal inference to address these relationships.

Resilience and workplace stress in Australian and New Zealand obstetrics and gynaecology trainees: A cross-sectional survey

BACKGROUND

Obstetrics and gynaecology training is a demanding vocation; there is a paucity of data on trainee resilience and well-being in this field.

AIM

To investigate resilience, support and perceived levels of stress and burnout in Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trainees.

MATERIALS AND METHODS

A cross-sectional survey of RANZCOG trainees in Australia and New Zealand (n = 638) was distributed electronically in May 2018.

RESULTS

Two-hundred and thirty-one (36%) valid responses were received. The mean resilience score was moderate (mean = 77; SD = 11). Resilience was significantly associated with general health (F = 7.5, P = 0.007), depression in the last two weeks (F = 4.4, P = 0.013) and seriously considering leaving the program at some point (F = 15.4, P < 0.001). Most participants (204; 88%) stated improvements could be made to the level of trainee support; with over half identifying the support they received from RANZCOG to be low or very low (132; 57%). One-third of participants (76; 33%) rated the support from their direct supervisor as low to very low. Over half of all participants identified high to very high responses to: burnout (127; 55%); personal stress (134; 58%); workplace stress (143; 62%) and depression (103; 45%).

CONCLUSION

RANZCOG trainees exhibit moderate resilience levels, yet they report high levels of perceived stress, depression and burnout and low-level support from direct supervisors. This may highlight the need for enhanced support and working conditions to allow trainees to remain resilient and thrive in their careers.