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Winderbaum J, Coventry LL. The benefits, barriers and facilitators of mentoring programs for first-year doctors: A systematic review. MEDICAL EDUCATION 2024; 58:687-696. [PMID: 38221676 DOI: 10.1111/medu.15299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION The transition from medical student to first-year doctor is notoriously difficult, yielding a high rate of transition failure, burn-out and mental health deterioration. Doctors in this cohort experience unique challenges during this time, which manifest through performance gaps, issues of professional identity, new occupational pressures, and cultural expectations. Mentoring programs are commonly utilised in the medical profession to foster personal and professional development and improve psychosocial well-being and career satisfaction. However, there exist no systematic reviews examining the use of mentorship specifically for the first-year doctor cohort, given the unique transition challenges faced by this vulnerable group. PURPOSE Due to their transition difficulties, evaluate the research on mentorship specifically for first-year doctors, and identify the emerging themes that can inform the benefits to this group, the barriers that impede program implementation and the facilitators that contribute to successful mentorship programs for this cohort. MATERIALS AND METHODS The PEO (population, exposure outcome) framework was adopted to develop the research inquiry, after which, a systematic review was conducted, adhering to PRISMA guidelines. The search strategy was conducted with assistance from an experienced university librarian. Screening and selection were completed independently against inclusion/exclusion criteria, by two reviewers. The methodological quality of included studies was assessed using Joanna Briggs critical appraisal instruments. Data sources used included Web of Science Medline, Ebsco Cinahl Plus, Scopus, Web of Science Core Collection and Ovid Journals. Search parameters were restricted to English language and peer-reviewed; date range was unobstructed up to 26 August 2022. RESULTS A total of 4137 articles were retrieved, with 13 considered to have met full inclusion criteria. An integrative review synthesis identified three major themes; benefits of mentoring for first-year doctors, intrinsic and extrinsic barriers to mentoring programs and facilitating factors that improve successful program implementation. CONCLUSION First-year doctors report untenable and highly strenuous working conditions, that result in poor mental health and high attrition rates. Formalised, near-peer, tier mosaic mentoring programs provide significant psychosocial and career benefits to this cohort specifically, bridge the training gap from medical student to first-year doctor and ameliorate patterns of intergenerational bullying, hierarchy and emotional inhibition. However, mentorship is inextricably interrelated to societal-cultural considerations of identity. Mentorship alone cannot overcome endemic cultural challenges within medicine without broader systemic change; however, programs are a valuable option towards positive support for first-year doctors.
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Affiliation(s)
- Joelle Winderbaum
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
| | - Linda L Coventry
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
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Simons M, Fisher G, Spanos S, Zurynski Y, Davidson A, Stoodley M, Rapport F, Ellis LA. Integrating training in evidence-based medicine and shared decision-making: a qualitative study of junior doctors and consultants. BMC MEDICAL EDUCATION 2024; 24:418. [PMID: 38637798 PMCID: PMC11027546 DOI: 10.1186/s12909-024-05409-y] [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: 09/04/2023] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND In the past, evidence-based medicine (EBM) and shared decision-making (SDM) have been taught separately in health sciences and medical education. However, recognition is increasing of the importance of EBM training that includes SDM, whereby practitioners incorporate all steps of EBM, including person-centered decision-making using SDM. However, there are few empirical investigations into the benefits of training that integrates EBM and SDM (EBM-SDM) for junior doctors, and their influencing factors. This study aimed to explore how integrated EBM-SDM training can influence junior doctors' attitudes to and practice of EBM and SDM; to identify the barriers and facilitators associated with junior doctors' EBM-SDM learning and practice; and to examine how supervising consultants' attitudes and authority impact on junior doctors' opportunities for EBM-SDM learning and practice. METHODS We developed and ran a series of EBM-SDM courses for junior doctors within a private healthcare setting with protected time for educational activities. Using an emergent qualitative design, we first conducted pre- and post-course semi-structured interviews with 12 junior doctors and thematically analysed the influence of an EBM-SDM course on their attitudes and practice of both EBM and SDM, and the barriers and facilitators to the integrated learning and practice of EBM and SDM. Based on the responses of junior doctors, we then conducted interviews with ten of their supervising consultants and used a second thematic analysis to understand the influence of consultants on junior doctors' EBM-SDM learning and practice. RESULTS Junior doctors appreciated EBM-SDM training that involved patient participation. After the training course, they intended to improve their skills in person-centered decision-making including SDM. However, junior doctors identified medical hierarchy, time factors, and lack of prior training as barriers to the learning and practice of EBM-SDM, whilst the private healthcare setting with protected learning time and supportive consultants were considered facilitators. Consultants had mixed attitudes towards EBM and SDM and varied perceptions of the role of junior doctors in either practice, both of which influenced the practice of junior doctors. CONCLUSIONS These findings suggested that future medical education and research should include training that integrates EBM and SDM that acknowledges the complex environment in which this training must be put into practice, and considers strategies to overcome barriers to the implementation of EBM-SDM learning in practice.
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Affiliation(s)
- Mary Simons
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia.
- Australian Institute of Health Innovation, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia.
| | - Georgia Fisher
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia
| | - Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia
| | - Andrew Davidson
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
| | - Marcus Stoodley
- Department of Clinical Medicine, Macquarie University, Sydney, NSW, 2109, Australia
| | - Frances Rapport
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia
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Doleman G, De Leo A, Bloxsome D. The impact of pandemics on healthcare providers' workloads: A scoping review. J Adv Nurs 2023; 79:4434-4454. [PMID: 37203285 DOI: 10.1111/jan.15690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/29/2023] [Accepted: 04/23/2023] [Indexed: 05/20/2023]
Abstract
AIMS To review and synthesize available evidence exploring the impact of pandemics on direct healthcare providers' workloads in the acute care setting. DESIGN Scoping review. DATA SOURCES A review of English research articles published up to August 2022 that examined the impact of pandemics on healthcare providers' workloads was undertaken. Studies were identified by searching four electronic databases: Medline (EBSCO), CINAHL (EBSCO), Web of Science and PsychInfo (EBSCO). Fifty-five studies met the inclusion criteria. REVIEW METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses Scoping Review checklist. RESULTS Healthcare workers experience an increase in workload pressures during a pandemic. This included patients requiring more care, undertaking non-normal work activities, increase in work content including changes to documentation, increase in demand and skills required, an increase in overtime and hours of work per week and higher patient-to-nurse ratios. The review also highlighted changes to the work environment and worsened work environments, including staffing shortages. CONCLUSION Focused efforts from health organizations to prioritize supportive conditions, policies focused on improved work environments, staffing adequacy and fair and reasonable workloads will enhance retention of the current workforce and future planning for pandemics. IMPACT Understanding workload challenges faced by frontline health professionals during the pandemic can improve planning, including policies and procedures, and resource allocation for future pandemic or emergency situations. In addition, extended periods of high workloads can impact staff retention. As many countries return to life after COVID-19, it is important that healthcare organizations examine staff pressures and identify ways to support staff moving forward. This will be vital for the future sustainability of the workforce. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Gemma Doleman
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gardiner Osbourne Park Healthcare Group, Perth, Western Australia, Australia
| | - Annemarie De Leo
- School of Medical Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Dianne Bloxsome
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
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Hopcraft MS, McGrath R, Stormon N, Parker G. Mental health, psychological distress and burnout in Australian dental practitioners. Aust Dent J 2023; 68:160-170. [PMID: 37199455 DOI: 10.1111/adj.12961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Dental practitioners are known to experience a high level of stress, but little is known about the mental health of Australian dental practitioners. The aim of this study was to investigate the prevalence of mental health conditions among Australian dental practitioners. METHODS A cross sectional survey of 1483 Australian dental practitioners was carried out from October to December 2021. Participants reported aspects of mental health including depression, anxiety disorder, burnout (Sydney Burnout Measure) and psychological distress (Kessler Psychological Distress Scale and General Health Questionnaire 12). RESULTS Self-reported psychological distress was high, with 32.0% rated as having moderate or severe psychological distress and 59.4% a high likelihood of minor (or more severe) psychological distress. One in four participants (24.8%) were classified as likely to be experiencing burnout, with 25.9% reporting ever having a diagnosis of depression, 11.4% a current diagnosis of depression, 23.1% ever having a diagnosis of anxiety disorder and 12.9% a current diagnosis of anxiety disorder. CONCLUSION Australian dental practitioners reported a high burden of psychological distress, burnout and mental health issues, suggesting a need for education and programmes to support their mental health and wellbeing. © 2023 Australian Dental Association.
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Affiliation(s)
- M S Hopcraft
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
- eviDent Foundation, Melbourne, Victoria, Australia
| | - R McGrath
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | - N Stormon
- School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
- Queensland Health Metro North Hospital and Health Service, Community and Oral Health, Brisbane, Queensland, Australia
| | - G Parker
- Discipline of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
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Fresán A, Guízar-Sánchez D, Yoldi-Negrete M, Robles-García R, Tovilla-Zárate CA, Saracco-Álvarez R. Gender Differences in Professional Adversities and Mental Health Among Surgical and Nonsurgical Medical Trainees: An Internet-Based Survey. JOURNAL OF SURGICAL EDUCATION 2023; 80:666-675. [PMID: 36801202 DOI: 10.1016/j.jsurg.2023.01.013] [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: 11/30/2022] [Revised: 01/05/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Physicians in training face a variety of stressors throughout their professional development and according to their gender. Among them, surgical trainees appear to be especially at risk for mental health problems. OBJECTIVE The aim of the present study was to compare demographic features, professional activities and adversities, depression, anxiety, and distress among men and women trainees of surgical and nonsurgical medical specialties. DESIGN AND PARTICIPANTS A cross-sectional, retrospective, comparative study was conducted on a total of 12,424 trainees (68.7% nonsurgical and 31.3% surgical) from Mexico through an online survey. Demographic features, variables related to professional activities and adversities, depression, anxiety, and distress were evaluated through self-administered measures. Comparative analyses using the Cochran-Mantel-Haenszel test for categorical variables and multivariate analysis of variance including medical residency program and gender as fixed factors to test their interaction effect for continuous variables were used. RESULTS An important interaction between medical specialty and gender was found. Women trainees from surgical specialties report more frequent psychological and physical aggressions. Women from both specialties had higher distress, significant anxiety, and depression than men. Men from surgical specialties worked more hours per day. CONCLUSIONS Gender differences are evident in trainees for medical specialties, with a larger impact in surgical fields. Mistreatment of students is a pervasive behavior that affects society as a whole, and actions to improve learning and working environments in all medical specialties, but mostly in surgical fields, are urgently needed.
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Affiliation(s)
- Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico.
| | - Diana Guízar-Sánchez
- Departamento de Fisiología de la Facultad de Medicina, Universidad Nacional Autónoma de México, UNAM, Copilco Universidad, Mexico City, Mexico
| | - María Yoldi-Negrete
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Rebeca Robles-García
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Carlos-Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Ranchería Sur, Cuarta sección, Comalcalco, Tabasco, Mexico
| | - Ricardo Saracco-Álvarez
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
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Moroni M, Díaz Crescitelli ME, Capuccini J, Pedroni C, Bianco M, Montanari L, Ghirotto L. 'Now I can train myself to be with death': a phenomenological study with young doctors in care homes supported by a palliative care unit during the second wave of the pandemic in Italy. BMJ Open 2023; 13:e065458. [PMID: 37041055 PMCID: PMC10105916 DOI: 10.1136/bmjopen-2022-065458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE During the second wave of the COVID-19 pandemic, one of the organisational strategies established by the Italian National Health System was the special units for continuity of care (SUCCs). In the province of Ravenna, those units enrolled novice doctors to care for elderly patients with COVID-19 in care homes (CHs). The local palliative care (PC) unit decided to offer consultations and support to them. This study aimed to comprehend the experience of young doctors who asked for consultations when facing, during their first early years of practice, complex situations. DESIGN We conducted a qualitative study employing a phenomenological approach and in-depth interviews. PARTICIPANTS We involved 10 young doctors who worked in Italian SUCC during the pandemic and used a PC consultation support service. RESULTS What describes our participants' experience is related to four main themes: (1) reducing distances, (2) perceiving medical futility and improvising, (3) being supported to learn how to be with death and (4) narrowed timing to humanise care. The pandemic was, for our participants, a moment of reflection and critique on the skills acquired during the university course. It was a strong experience of human and professional growth that helped them reshape and deepen their role and skills, incorporating the approach of PC into their professional identity. CONCLUSIONS Integration between specialists and young doctors with an early entry into the workforce during the pandemic in CHs set out a 'shift' to a proactive and creative approach through a new awareness of professional and personal roles in doctor-patient relations. The continuity of care models should be rethought by integrating CHs and PC. Adequate PC training for young doctors (at pregraduate and postgraduate levels) can change doctors' vision and daily practice in assisting patients at the end of life.
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Affiliation(s)
- Matteo Moroni
- S.S.D. Cure Palliative, AUSL della Romagna, Ravenna, Italy
| | | | | | | | - Mattia Bianco
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Luca Ghirotto
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Middleton K. Why working expectations need to change to protect doctors and the quality of patient care: A perspective from down-under. J Pediatr Rehabil Med 2023; 16:463-464. [PMID: 37718878 PMCID: PMC10578285 DOI: 10.3233/prm-230040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- Kate Middleton
- Monash Children’s Hospital and The Royal Children’s Hospital, Melbourne, Australia
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