How post-call resident doctors perform, feel and are perceived in out-patient clinics

A Profile of Novice and Senior Nurses' Communication Patterns during the Transition to Practice Period: An Application of the Roter Interaction Analysis System

Novice nurses' successful transition to practice is impacted by their interactions with senior nurses. Ensuring that novice nurses are adequately supported during their transition to practice has wide-ranging and significant implications. The aim of this study is to explore the communication patterns between novice and senior nurses by applying an interaction analysis technique. Trimonthly onboarding evaluations between novice and senior nurses were recorded. The Roter Interaction Analysis System was adapted and deployed to identify communication patterns. In total, twenty-two interactions were analyzed. Senior nurses spoke more (64.5%). Task-focused exchange was predominant amongst senior (79.7%) and novice (59.5%) nurses. Senior nurses' talk was concentrated in clusters of information-giving (45%) and advice or instructions (17.2%), while emotional expression (1.4%) and social talk (0.4%) were rare. Novice nurses' talk was concentrated in clusters-information giving (57%) and positive talk (39.5%). The communication patterns between senior and novice nurses during the onboarding period indicate aspects of novice nurse transition that could be addressed, such as encouraging novice nurses to use these interactions to communicate more, or emphasizing the importance of social talk. These insights can be used to inform mentorship and preceptorship training to ensure that senior nurses are able to adequately support novice nurses through all parts of the transition to practice period.

Sleep deprivation and its effects on communication during individual and collaborative tasks

Sleep loss has been shown to cause impairments in a number of aspects central for successful communication, ranging from poorer linguistic comprehension to alterations in speech prosody. However, the effect of sleep loss on actual communication is unknown. This study investigated how a night of sleep deprivation affected performance during multiple tasks designed to test verbal communication. Healthy participants (N = 183) spent 8–9 hours per night in bed for three nights and were then randomised to either one night of total sleep deprivation or a fourth night with 8–9 hours in bed. The following day, participants completed two tasks together with another participant: a model-building task and a word-description task. Differences in performance of these tasks were assessed alongside speaking duration, speaking volume, and speaking volume consistency. Additionally, participants individually completed a verbal fluency assessment. Performance on the model-building task was worse if the model-builder was sleep deprived, whereas sleep deprivation in the instruction-giver predicted an improvement. Word-description, verbal fluency, speech duration, speaking volume, and speaking volume consistency were not affected. The results suggest that sleep deprivation leads to changes in communicative performance during instructive tasks, while simpler word-description tasks appear resilient.

Impact of night shifts on emergency medicine resident resuscitation performance

AIM

Emergency medicine (EM) trainees often work nightshifts. We sought to measure how this circadian disruption affects EM resident performance during simulated resuscitations.

METHODS

This retrospective cohort study enrolled EM residents at a single Canadian academic centre over a six-year period. Residents completed twice-annual simulation-based resuscitation-focused objective structured clinical examinations (OSCEs) with assessment in four domains (primary assessment, diagnostic actions, therapeutic actions and communication), and a global assessment score (GAS). Primary and secondary exposures of interest were the presence of a nightshift (late-evening shifts ending between midnight and 03h00 or overnight shifts ending after 06h00) the day before or within three days before an OSCE. A random effects linear regression model was used to quantify the association between nightshifts and OSCE scores.

RESULTS

From 57 residents, 136 OSCE scores were collected. Working a nightshift the day before an OSCE did not affect male trainee scores but was associated with a significant absolute decrease in mean total scores (-6% [95% CI -12% to 0%]), GAS (-7% [-13% to 0%]), and communication (-9% [-16% to -2%]) scores among women. Working any nightshift within three days before an OSCE lowered absolute mean total scores by 4% [-7% to 0%] and communication scores by 5% [-5% to 0%] irrespective of gender.

CONCLUSION

Our results suggest that shift work may impact EM resident resuscitation performance, particularly in the communication domain. This impact may be more significant in women than men, suggesting a need for further investigation.

Effect of 24 hours of sleep deprivation on auditory and linguistic perception: a comparison among young controls, sleep-deprived participants, dyslexic readers, and aging adults

PURPOSE

To test the effects of 24 hr of sleep deprivation on auditory and linguistic perception and to assess the magnitude of this effect by comparing such performance with that of aging adults on speech perception and with that of dyslexic readers on phonological awareness.

METHOD

Fifty-five sleep-deprived young adults were compared with 29 aging adults (older than 60 years) and with 18 young controls on auditory temporal order judgment (TOJ) and on speech perception tasks (Experiment 1). The sleep deprived were also compared with 51 dyslexic readers and with the young controls on TOJ and phonological awareness tasks (One-Minute Test for Pseudowords, Phoneme Deletion, Pig Latin, and Spoonerism; Experiment 2).

RESULTS

Sleep deprivation resulted in longer TOJ thresholds, poorer speech perception, and poorer nonword reading compared with controls. The TOJ thresholds of the sleep deprived were comparable to those of the aging adults, but their pattern of speech performance differed. They also performed better on TOJ and phonological awareness than dyslexic readers.

CONCLUSIONS

A variety of linguistic skills are affected by sleep deprivation. The comparison of sleep-deprived individuals with other groups with known difficulties in these linguistic skills might suggest that different groups exhibit common difficulties.

Shifting perceptions: a pre-post study to assess the impact of a senior resident rotation bundle

BACKGROUND

Extended duty hours for residents are associated with negative consequences. Strategies to accommodate duty hour restrictions may also have unintended impacts. To eliminate extended duty hours and potentially lessen these impacts, we developed a senior resident rotation bundle that integrates a night float system, educational sessions on sleep hygiene, an electronic handover tool, and a simulation-based medical education curriculum. The aim of this study was to assess internal medicine residents' perceptions of the impact of the bundle on three domains: the senior residents' wellness, ability to deliver quality health care, and medical education experience.

METHODS

This prospective study compared eligible residents' experiences (N = 67) before and after a six-month trial of the bundle at a training program in western Canada. Data was collected using an on-line survey. Pre- and post-intervention scores for the final sample (N = 50) were presented as means and compared using the t-test for paired samples.

RESULTS

Participants felt that most aspects of the three domains were unaffected by the introduction of the bundle. Four improved and two worsened perception shifts emerged post-intervention: less exposure to personal harm, reduced potential for medical error, more successful teaching, fewer disruptions to other rotations, increased conflicting role demands and less staff physician supervision.

CONCLUSIONS

The rotation bundle integrates components that potentially ease some of the perceived negative consequences of night float rotations and duty hour restrictions. Future areas of study should include objective measures of the three domains to validate our study participants' perceptions.

How tired is too tired? A case report

We report a case involving a 32-year-old male presenting with acute delirium after completing the daily duties of his job. Though previously well, social history was positive for surgical residency. Symptom resolution was achieved with conservative treatment. We feel that this patient's clinical course represents an emerging disease entity known as "fatigue," which may have important implications for surgical training and practice.