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Mendall J, Tolley A, Parisi V, Hornby S, Brown R, Nowak V. Confidence of Emergency Department doctors in managing ophthalmic emergencies: a systematic review. Eye (Lond) 2024; 38:2751-2760. [PMID: 38729998 PMCID: PMC11427453 DOI: 10.1038/s41433-024-03115-z] [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: 11/06/2023] [Revised: 04/10/2024] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Eye emergencies constitute a significant portion of attendances to general Emergency Departments (EDs) in the UK, therefore it is important to assess the confidence of doctors who work in this setting in managing these potentially sight- and life-threatening presentations. This systematic review aims to assess the confidence of UK doctors working in general EDs in managing ophthalmic emergencies. METHODS MEDLINE (Ovid), EMBASE (Ovid), ProQuest Central and Web of Science databases and grey literature were searched from inception to 1 October 2022 for publications that (1) featured doctors working in UK general EDs, (2) assessed doctors' confidence in managing ophthalmic emergencies, (3) contained original data, (4) were full-text, and (5) written in English. Methodological quality was assessed using the AXIS tool. RESULTS 462 articles were screened, and 7 papers included for data extraction, which collectively assessed the confidence of 956 doctors working in EDs in managing ophthalmic emergencies. There was a widespread lack of confidence amongst foundation doctors, which has worsened over time. Most doctors lacked confidence in performing funduscopy and using the slit-lamp, and considered formal ophthalmology training received in EDs to be inadequate. CONCLUSIONS Evidence suggests a lack of confidence amongst foundation doctors in managing ophthalmic emergencies. High-quality evidence investigating the confidence amongst more experienced Emergency Medicine (EM) physicians was lacking. It is important to assess why foundation doctors feel so ill-prepared to manage eye emergencies and develop further ophthalmic training for doctors working in EDs. Further investigation exploring the confidence of EM trainees and consultants is required.
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Affiliation(s)
| | - Abraham Tolley
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Stella Hornby
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruth Brown
- Imperial College Healthcare NHS Trust, London, UK
| | - Victoria Nowak
- The National Hospital for Neurology and Neurosurgery, London, UK
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Lin YK, Lin BYJ. Coronavirus pandemic derived demands and inclusive leadership on junior doctors' well-being. Occup Med (Lond) 2024:kqae081. [PMID: 39304520 DOI: 10.1093/occmed/kqae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND International studies have revealed that numerous challenges (e.g. job demands) and opportunities (e.g. job resources as protective factors) affect the well-being of healthcare workers. AIMS Building on the job demands-resources theory, we explored how job-related demands and the role of inclusive leadership as a job resource influenced the well-being of junior doctors during the coronavirus disease 2019 (COVID-19) pandemic. METHODS A cross-sectional web survey was conducted in July 2022 for 82 junior doctors who had experienced the 3-year COVID-19 pandemic. The survey captured their perceived physical, psychological and COVID-19-related job demands and the inclusive leadership behaviours exhibited by their clinical unit supervisors as job resources. Data were also collected on junior doctors' experiences of burnout, compassion satisfaction and occupational commitment as variables of job outcomes. Hierarchical linear regression analysis was applied to explore the relationships between the variables. RESULTS Physical and COVID-19-related job demands were associated with increased burnout among junior doctors. Inclusive leadership as a job resource was associated with junior doctors' reduced burnout and increased compassion satisfaction and buffered the negative effects of psychological demands on their compassion satisfaction. Only COVID-19-related job demands were associated with junior doctors' occupational commitment. CONCLUSIONS Our study highlights the critical effects of COVID-19-related job demands on junior doctors' burnout and occupational commitment. Inclusive leadership behaviours exhibited by clinical unit supervisors are a valuable job resource, which can be incorporated as one of the competencies training for medical staff.
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Affiliation(s)
- Y K Lin
- Department of Surgery, Jen-Ai Hospital, Taichung, Taiwan
| | - B Y-J Lin
- Department of Medical Humanities and Social Sciences, School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Swancott L, Armstrong N, Roland D, Walters HL, Kirk K. Emergency department workforces' experiences and perceptions of well-being from an international perspective: a scoping review. BMJ Open 2024; 14:e087485. [PMID: 38986554 PMCID: PMC11288155 DOI: 10.1136/bmjopen-2024-087485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/03/2024] [Indexed: 07/12/2024] Open
Abstract
OBJECTIVES To identify and present the available evidence regarding workforce well-being in the emergency department. DESIGN Scoping review. SETTING The emergency department (ED). DATA SOURCES CINAHL, MEDLINE, APA PsycINFO and Web of Science were searched with no publication time parameters. The reference lists of articles selected for full-text review were also screened for additional papers. ELIGIBILITY CRITERIA FOR STUDY SELECTION All peer-reviewed, empirical papers were included if: (1) participants included staff-based full-time in the ED, (2) ED workforce well-being was a key component of the research, (3) English language was available and (4) the main focus was not burnout or other mental illness-related variables. RESULTS The search identified 6109 papers and 34 papers were included in the review. Most papers used a quantitative or mixed methods survey design, with very limited evidence using in-depth qualitative methods to explore ED workforce well-being. Interventions accounted for 41% of reviewed studies. Findings highlighted pressing issues with ED workforce well-being, contributed to by a range of interpersonal, organisational and individual challenges (eg, high workloads, lack of support). However, the limited evidence base, tenuous conceptualisations and links to well-being in existing literature mean that the findings were neither consistent nor conclusive. CONCLUSIONS This scoping review highlights the need for more high-quality research to be conducted, particularly using qualitative methods and the development of a working definition of ED workforce well-being.
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Affiliation(s)
- Lucy Swancott
- Population Health Sciences, University of Leicester, Leicester, UK
| | | | - Damian Roland
- Population Health Sciences, University of Leicester, Leicester, UK
- Emergency Department, Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester, UK
| | - Helen L Walters
- Population Health Sciences, University of Leicester, Leicester, UK
| | - Kate Kirk
- Population Health Sciences, University of Leicester, Leicester, UK
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Hawsawi AA, Nixon N, Stewart E, Nixon E. Exploring access to support services for medical students: recommendations for enhancing wellbeing support. BMC MEDICAL EDUCATION 2024; 24:671. [PMID: 38886747 PMCID: PMC11184748 DOI: 10.1186/s12909-024-05492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 04/29/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Medical students have reported facing unique challenges in their academic journey that can have a significant impact on their mental health and wellbeing; therefore, their access to support services and wellbeing resources has been deemed crucial for dealing effectively with the various challenges they tend to face. While previous research has highlighted certain barriers affecting medical students' help-seeking and access to wellbeing support more generally, there is a pressing need for more in-depth research into the factors that may hinder or facilitate medical students' acceptability and uptake of the wellbeing resources available to them within institutional contexts. The current study aims to explore students' perceptions and utilization of wellbeing interventions and welfare resources within a medical school setting, as well as the factors influencing their help-seeking attitudes or behaviours. Additionally, it seeks to instigate medical students' deeper reflections on potential enhancements that could be applied to wellbeing resources so that they are better suited to address their needs. METHODS This study employed a qualitative design, involving semi-structured interviews and a series of focus groups with medical students at the University of Nottingham (UK). Post-interview, focus groups were deemed necessary to gain deeper insights into emerging findings from the interviews regarding students' views on wellbeing support services. Qualitative data from the interviews was subjected to thematic analysis while a hybrid thematic analytic approach was applied for the focus group data in order to allow for both pre-defined themes from the interviews and newly emerging patterns to be identified and analysed in a combined manner. RESULTS Twenty-five participants took part in the semi-structured interviews and twenty-two participants were recruited in a total of seven focus groups. Thematic analysis findings identified several key barriers to medical students' accessing wellbeing resources, including difficulties in finding relevant information, lengthy processes and difficulties receiving prompt help in urgent situations, learning environment issues, confidentiality concerns, and stigma around mental health. Student suggestions for the enhancement of wellbeing provision were centered around proposed improvements in the format that the relevant information was presented and in the structure underlying the delivery of support services. CONCLUSION The study findings shed light on multi-faceted factors contributing to medical students' challenges in accessing support services; and provided a deeper understanding of medical students' wellbeing needs through a consolidation of their recommendations for the implementation of practical steps to address these needs. These steps can potentially inform key medical education stakeholders so that they can actively and proactively foster more supportive environments that may help improve medical students' help-seeking, as well as their acceptability and uptake of wellbeing services.
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Affiliation(s)
- Aisha Ali Hawsawi
- Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, UK.
- Dar Al-Hekma University, Jeddah, Saudi Arabia.
| | - Neil Nixon
- Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, UK
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Emily Stewart
- Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, UK
| | - Elena Nixon
- Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, UK
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Coret A, Perrella A, Regehr G, Farrell L. Practicing Confidence: An Autoethnographic Exploration of the First Years as Physicians. TEACHING AND LEARNING IN MEDICINE 2024; 36:143-153. [PMID: 37071765 DOI: 10.1080/10401334.2023.2200766] [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: 12/17/2022] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
Phenomenon: Every year is heralded with a cohort of newly-minted medical school graduates. Through intense residency training and supervision, these learners gradually develop self-assurance in their newfound skills and ways of practice. What remains unknown, however, is how this confidence develops and on what it is founded. This study sought to provide an insider view of this evolution from the frontline experiences of resident doctors. Approach: Using an analytic collaborative autoethnographic approach, two resident physicians (Internal Medicine; Pediatrics) documented 73 real-time stories on their emerging sense of confidence over their first two years of residency. A thematic analysis of narrative reflections was conducted iteratively in partnership with a staff physician and a medical education researcher, allowing for rich, multi-perspective input. Reflections were analyzed and coded thematically and the various perspectives on data interpretation were negotiated by consensus discussion. Findings: In the personal stories and experiences shared, we take you through our own journey and development of confidence, which we have come to appreciate as a layered and often non-linear process. Key moments include fears in the face of the unknown; the shame of failures (real or perceived); the bits of courage gained by everyday and mundane successes; and the emergence of our personal sense of growth and physicianship. Insights: Through this work, we - as two Canadian resident physicians - have ventured to describe a longitudinal trajectory of confidence from the ground up. Although we enter residency with the label of 'physician,' our clinical acumen remains in its infancy. We graduate from residency still as physicians, but decidedly different in terms of our knowledge, attitudes, and skills. We sought to capitalize on the vulnerability and authenticity inherent in autoethnography to enrich our collective understanding of confidence acquisition in the resident physician and its implications for the practice of medicine.
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Affiliation(s)
- Alon Coret
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Perrella
- Department of Internal Medicine, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Glenn Regehr
- Center for Health Education Scholarship and Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Farrell
- Department of Community Internal Medicine, Faculty of Medicine, University of British Columbia, Victoria, British Columbia, Canada
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Lin YK, Lin CD, Lin BYJ. Junior doctors' workplace well-being and the determinants based on ability-motivation-opportunity (AMO) theory: Educational and managerial implications from a three-year longitudinal observation after graduation. MEDICAL TEACHER 2024:1-16. [PMID: 38460181 DOI: 10.1080/0142159x.2024.2322719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/20/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE Junior doctors function as trainees from an educational perspective and as employees from a human resource management perspective. Employing the ability-motivation-opportunity (AMO) theory as a conceptual framework, this study longitudinally investigated the factors affecting the workplace well-being and career progression of junior doctors over a 3-year period following their graduation from medical schools. MATERIALS AND METHODS This 3-year prospective cohort study enrolled junior doctors who graduated from 2 medical schools in June 2019 in Taiwan. This study collected data by implementing web-based, self-administered structured questionnaires at 3-month intervals between September 2019 and July 2022. The collected data encompassed ability indicators (i.e. academic performance and perceived preparedness for clinical practice), motivation indicators (i.e. educational and clinical supervision), opportunity indicators (i.e. clinical unit cultures), and workplace well-being indicators (i.e. burnout, compassion satisfaction, and job performance). A total of 107 junior doctors participated, providing 926 total responses. The data were analysed using univariate analyses and structural equation modelling with path analysis. RESULTS Over the 3-year period following graduation, the junior doctors' confidence in their preparedness for clinical practice and the educational and clinical supervision had varying degrees of influence on the junior doctors' workplace well-being. The influence of clinical unit cultures, which can provide opportunities for junior doctors, became evident starting from the second year postgraduation; notably, unit cultures that emphasised flexibility and discretion played positive and critical roles in enhancing the junior doctors' workplace well-being lasted to the third year. CONCLUSIONS Our findings provide insights into the distinct critical factors that affect the socialisation of junior doctors within workplace environments over 3 consecutive years. These findings can provide guidance for medical educators and healthcare managers, helping them understand and support the progressive integration of junior doctors into their work environments.
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Affiliation(s)
- Yung Kai Lin
- Department of Surgery, Jen-Ai Hospital, Taichung, Taiwan, ROC
| | - Chia-Der Lin
- Department of Otorhinolaryngology Head & Neck Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
- School of Medicine, China Medical University, Taichung, Taiwan, ROC
| | - Blossom Yen-Ju Lin
- Department of Medical Humanities and Social Sciences, School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
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Alghamdi BA, Alhassan AI. The Influence of Saudi Board of Emergency Medicine Residency Educators on Residents' Academic and Clinical Performance in Riyadh, Saudi Arabia. Cureus 2024; 16:e54316. [PMID: 38496141 PMCID: PMC10944657 DOI: 10.7759/cureus.54316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION The Saudi Board of Emergency Medicine (SBEM) is required to assign educators including program directors to supervise their residents. These educators may impact the residents' academic and clinical performances. After thorough review, we noticed that the current literature lacks information about the direct influence of emergency medicine educators on their residents' academic and clinical performances. The main purpose of this study is to assess the residents' confidence level, and to measure the program directors' satisfaction of the residents' performances during their SBEM training years in Riyadh hospitals. METHODS This concurrent mixed-methods study was conducted in nine training hospitals in Riyadh, Saudi Arabia, during the 2021-2022 academic year. For the quantitative aspect, a cross-sectional survey was used, based on a questionnaire administered to postgraduate year (PGY)-2 to PGY-4 SBEM residents (n=120) using a nonprobability convenient sampling technique. The survey aimed to assess residents' confidence in their academic and clinical performance, influenced by their educators. A Likert scale with a total of 25 items, covering the seven roles of the CANMEDs framework, was employed. This assessment utilized a published tool called the In-Training Evaluation Report. For the qualitative aspect, program directors' perspectives were gathered through one-on-one unstructured interviews (n=9), guided by theoretical saturation. A purposive sampling technique was employed to select program directors. The interview tool collected demographic data, including gender, years of experience, and training hospital, and included 17 open-ended questions to explore program directors' opinions. RESULTS The result of mixed methods showed that both quantitative and qualitative data sets were divergent with all independent variables (resident's age, gender, and training level) with the exception of the training hospital which was convergent. Thus, the residents' confidence toward their academic and clinical performances induced by their institutional educators was high. However, the program directors indicated changes that related to residents' training level. CONCLUSION The residents' confidence toward their academic and clinical performance induced by their institutional educators was high. The educators had a great deal of influence over the academic and clinical performance of the residents. However, the program directors thought there were some issues with the performance of the residents. Most of the program directors also believed that several influential factors that may have affected the residents' overall performance include stress and receipt of constructive feedback.
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Affiliation(s)
- Bader A Alghamdi
- Department of Emergency Medicine, Prince Sultan Military Medical City, Riyadh, SAU
| | - Abdulaziz I Alhassan
- Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Department of Research, King Abdullah International Medical Research Center, Riyadh, SAU
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Stassen P, Westerman D. Novice Doctors in the Emergency Department: A Scoping Review. Cureus 2022; 14:e26245. [PMID: 35898382 PMCID: PMC9308466 DOI: 10.7759/cureus.26245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/18/2022] Open
Abstract
In many emergency departments (EDs), young, inexperienced doctors treat patients who are critically ill. At the start of their career, these novice doctors are not sufficiently qualified to take care of these potentially critically ill patients in the highly demanding environment of an ED. This not only poses a threat to the well-being of the doctor, who feels inadequately prepared and experiences a lot of stress, but also to that of the patients, who may not receive optimal care. Lastly, young doctors may influence the efficiency of the organization, with longer throughput times, more orders of ancillary investigations, and more admissions. Training novice doctors with regard to simple or complex skills using simulation techniques is part of the solution. However, the transfer of newly learned skills to clinical practice remains unexplored, and not everything can be trained before the actual skill is required. Therefore, it is important to train young doctors in their learning abilities, for instance, teach them how to be adaptive and how to use their skills in new situations. Lastly, the way care is organized is essential. Good supervision, leaving room for the learning processes of young doctors, developing a team with more experienced professionals (paramedics, nurses, and doctors), and well-organized processes, aiming to reduce the complexity of the work, are ways to improve the quality of care, independent of the experience level of the novice doctor.
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Pooja V, Khan A, Patil J, Chaudhari B, Chaudhury S, Saldanha D. Burnout and resilience in doctors in clinical and preclinical departments in a tertiary care teaching and dedicated COVID-19 hospital. Ind Psychiatry J 2021; 30:S69-S74. [PMID: 34908668 PMCID: PMC8611565 DOI: 10.4103/0972-6748.328792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/17/2021] [Accepted: 06/21/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The worldwide COVID-19 pandemic has significantly altered our life. Doctors more so than the general public because of their involvement in managing the COVID-infected individuals, some of them 24/7 end in burnout. Burnout in doctors can lead to reduced care of patients, increased medical errors, and poor health. Burnout among frontline health-care workers has become a major problem in this ongoing epidemic. On the other hand, doctors in preclinical department have a lack of interaction with patients, with not much nonclinical professional work to boot, find the profession less gratifying which perhaps increase their stress level. AIM The aim was to study the prevalence of burnout and measure resilience in doctors in clinical and in preclinical departments. MATERIALS AND METHODS This observational, cross-sectional, comparative study was carried out in a tertiary care teaching hospital and COVID care center. By purposive sampling 60 preclinical and 60 clinical doctors in a tertiary health care center were included in the study. After obtaining the Institutional Ethics Committee approval and informed consent, the doctors were administered a self made socio-demographic questionnaire, the Copenhagen Burnout Inventory, and the Connor-Davidson Resilience Scale. Doctors were given a self-made questionnaire, the Copenhagen Burnout Inventory, and the Connor-Davidson Resilience Scale. RESULTS The prevalence of burnout was seen more in clinical doctors (55.47) and the resilience was observed more in preclinical doctors (88.9). DISCUSSION Resident doctors are a major force to combat COVID-19 as frontline health workers; hence, one can visualize burnout amongst them. On an individual basis, the work-related burnout was severely high in the clinical group owing to the workload which has been corresponding to a number of western studies. Nonclinical department doctors from pathology, community medicine, and microbiology did show burnout but showed a greater score in resilience. Psychological resilience has been identified as a component in preventing burnout. CONCLUSION Therapy sessions can be used in clinical doctors facing burnout to build up their resilience.
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Affiliation(s)
- V Pooja
- Department of Psychiatry, Dr. D.Y. Patil Medical College, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Aslam Khan
- Department of Psychiatry, Dr. D.Y. Patil Medical College, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Jaideep Patil
- Department of Psychiatry, Dr. D.Y. Patil Medical College, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Bhushan Chaudhari
- Department of Psychiatry, Dr. D.Y. Patil Medical College, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D.Y. Patil Medical College, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Daniel Saldanha
- Department of Psychiatry, Dr. D.Y. Patil Medical College, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
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Ashraf Z, Crone L, Higgins MF. Factors affecting confidence and competence of doctors in performing operative vaginal births: A qualitative study. Eur J Obstet Gynecol Reprod Biol 2021; 258:348-352. [PMID: 33550214 DOI: 10.1016/j.ejogrb.2021.01.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Operative vaginal birth (OVB) is an important skill for obstetricians. It is the most common emergency intervention in obstetrics and requires a high degree of skill. While there is a lot of data available on technical and non-technical factors affecting the outcome of OVBs little work has been done to investigate the factors that make obstetricians feel confident and competent when performing such a procedure. The objective of this study was therefore to identify the common factors that affect confidence and competence of obstetricians in operative vaginal births (OVB). Our hypothesis was that a qualitative research method would provide a rich approach where themes would be developed that the participants themselves identify as important. STUDY DESIGN Qualitative research within two University Hospitals and one District Hospital in Ireland. Participants interviewed ranged from first year trainees to consultant obstetricians. Interviews using open ended questions. Interviews were recorded on audio and later transcribed. Thematic analysis was performed until saturation. RESULTS 35 obstetricians were interviewed. The median number of years of experience was 5 years (range 3-20 years). The median number of OVB was 200 (range 20-1000+). Vacuum was the preferred choice amongst junior trainees. Preference shifted to forceps with increasing clinical experience. Seven clear themes emerged. Three themes were common to all participants: firstly, that all clinicians reported respect for the primiparous OVB in anticipation of possible complications, secondly the wish for senior midwifery support and finally the importance of clinical experience and exposure. Four themes were common to trainees only. Female clinicians in training reported significant self-doubt in their ability to perform an OVB and had concerns about causing harm. Clinicians in training wished to be trained by consultants during their first year on the labour ward. Experience was important. The final theme was a wish for more training in forceps OVB by clinicians in training. CONCLUSION This qualitative study identified factors that can be used to design education and training in OVB in order to support trainees and ultimately improve care for the woman and baby.
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Affiliation(s)
- Z Ashraf
- Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland
| | - L Crone
- UCD School of Medicine, University College Dublin, Ireland
| | - M F Higgins
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin, Holles Street, Dublin 2, Dublin, Ireland.
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Ikeda-Sonoda S, Ichihara N, Okochi J, Takahashi A, Miyata H. Association of care workers' job satisfaction and global happiness with change of functional performance of severely disabled elderly residents in nursing homes: a cohort and questionnaire study in Japan. BMJ Open 2020; 10:e033937. [PMID: 33020074 PMCID: PMC7537441 DOI: 10.1136/bmjopen-2019-033937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES There is growing concern regarding quality of work life (QWL) among care staff in nursing homes. However, little is known about the impact of QWL on nursing home residents' functional performance. Recent literature suggests that job satisfaction and happiness of healthcare workers reflect their perceived QWL and impact the quality of their care. This study examined the association between job satisfaction and global happiness with change in functional performance of severely disabled elderly residents in nursing homes. DESIGN A retrospective cohort study of nursing home residents combined with a questionnaire survey of their care staff. SETTING Eighteen nursing homes in Japan. PARTICIPANTS Data were collected from 1000 residents with a required care level of 3-5 and from 412 care staff in nursing homes between October 2017 and March 2018. OUTCOMES AND EXPLANATORY VARIABLES Functional performance was structurally assessed with ICF (International Classification of Functioning, Disability and Health) staging, composed of 52 items concerning activities of daily life, cognitive function and social participation, at baseline and 6 months later. Deterioration and improvement of functional performance were dichotomously defined as such change in any of the items. QWL of care staff was evaluated with a questionnaire including questions about job satisfaction and global happiness. RESULTS Functional performance deteriorated and improved in 23.0% and 12.7% of residents, respectively. Global happiness of care staff was associated with lower probability of residents' deterioration (adjusted OR, 0.61; CI 0.44 to 0.84). There was no significant correlation between job satisfaction or happiness of care staff and improvement of residents' functional performance. CONCLUSION These results suggest that QWL of care staff is associated with changes in functional performance of elderly people with severe disabilities in nursing homes.
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Affiliation(s)
- Shino Ikeda-Sonoda
- Department of Health Policy and Management, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Nao Ichihara
- Department of Healthcare Quality Assessment, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Jiro Okochi
- Geriatric Health Services Facility of Tatsumanosato, Wakakoukai Health Care Corporation, Daito City, Osaka, Japan
| | - Arata Takahashi
- Department of Health Policy and Management, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Health Policy and Management, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Tokyo, Japan
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Gill SD, Stella J, Blazeska M, Bartley B. Distant supervision of trainee emergency physicians undertaking a remote placement: A preliminary evaluation. Emerg Med Australas 2020; 32:446-456. [PMID: 32043301 DOI: 10.1111/1742-6723.13440] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 11/03/2019] [Accepted: 11/06/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Clinical supervision is an essential part of post-graduate medical training. The current study investigated emergency medicine trainees' experiences and preferences regarding distant supervision via information and communication technology (ICT). METHODS Four emergency medicine trainees completed a 6-month placement, one at a time, at a rural urgent care centre. Trainees were remotely supervised by emergency physicians located at another ED using ICT. Trainees recorded the frequency and content of their distant supervision experiences. Trainees also completed semi-structured interviews before and after the placement to describe their experiences and preferences regarding distant supervision. Quantitative data were analysed descriptively using counts and proportions. Qualitative data were analysed using the principles of thematic analysis. RESULTS Trainees provided care to 1458 patients and communicated with a supervisor for 126 (8.6%) patients. Phone or audio-visual ICT was used for 111 (88.1%) and 12 (9.5%) patients, respectively. Trainees described the placement as a unique learning experience that demanded independent practice, enhanced their communication and leadership skills and increased their confidence. The trainees also described disadvantages to the placement such as reduced quality and quantity of communication with supervisors, ICT failure and the supervisor's inability to provide hands-on assistance. Trainees provided their perspectives on the essential requirements of a successful remote placement that involved distant supervision. CONCLUSIONS According to trainees, distant supervision had positive and negative effects on their supervision experiences, professional development and on patient management. Trainees used ICT infrequently. The trainee's perspectives on the ideal components of a remote placement programme are presented.
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Affiliation(s)
- Stephen D Gill
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia.,Barwon Centre for Orthopaedic Research and Education (B-CORE), School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Julian Stella
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Marija Blazeska
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Bruce Bartley
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
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McKinley N, McCain RS, Convie L, Clarke M, Dempster M, Campbell WJ, Kirk SJ. Resilience, burnout and coping mechanisms in UK doctors: a cross-sectional study. BMJ Open 2020; 10:e031765. [PMID: 31988223 PMCID: PMC7045750 DOI: 10.1136/bmjopen-2019-031765] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS This cross-sectional study aimed to assess resilience, professional quality of life and coping mechanisms in UK doctors. It also aimed to assess the impact of demographic variables, such as sex, grade and specialty on these factors. METHODS During October and November 2018, medical doctors in the UK were eligible to complete an online survey made up of validated psychological instruments. Royal Colleges and other medical organisations invited their membership to participate via newsletters, email invitations, websites and social media. RESULTS 1651 doctors participated from a wide range of specialties and grades across the UK. The mean resilience score was 65.01 (SD 12.3), lower than population norms. Of those who responded, 31.5% had high burnout (BO), 26.2% had high secondary traumatic stress and 30.7% had low compassion satisfaction (CS). Doctors who responded from emergency medicine were more burned out than any other specialty group (F=2.62, p=0.001, df 14). Those who responded from general practice scored lowest for CS (F=6.43, p<0.001, df 14). 120 (8%) doctors met the criteria for all three of high BO, high STS and low CS. The most frequently reported coping mechanism was the maladaptive strategy of self-distraction. CONCLUSIONS One-third of UK doctors who responded are burned out and suffering from STS. Those who responded from emergency medicine and general practice appear to be suffering the most. Over 100 doctors fell into the at-risk category of high BO, high STS and low CS. Future analysis of the free text responses from doctors may help to identify factors that are playing a role in the high levels of BO and STS being reported by medical staff.
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Affiliation(s)
- Nicola McKinley
- General Surgery, Ulster Hospital, Dundonald, UK
- Queen's University Belfast Centre for Public Health, Belfast, UK
| | | | - Liam Convie
- General Surgery, Ulster Hospital, Dundonald, UK
- Queen's University Belfast Centre for Public Health, Belfast, UK
| | - Mike Clarke
- Northern Ireland Methodology Hub, Queen's University Belfast, Belfast, UK
| | - Martin Dempster
- Queen's University Belfast School of Psychology, Belfast, UK
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Hariharan TS, Griffin B. A review of the factors related to burnout at the early-career stage of medicine. MEDICAL TEACHER 2019; 41:1380-1391. [PMID: 31345077 DOI: 10.1080/0142159x.2019.1641189] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Background: Globally, burnout is an increasingly prevalent problem amongst young medical professionals. This review aims to understand the factors related to burnout in the early-career stage of medicine. Drawing on the widely used Job Demands-Resources Model, the antecedents of burnout were distinguished from its outcomes.Methods: The review adopted the PRISMA guidelines. Using specific search terms, peer-reviewed articles were obtained from a range of databases and assessed against selection criteria. To meet inclusion requirements, the study had to be published between 2000 and 2018, include a validated measure of burnout, and undertake empirical assessment of factors related to burnout in medical students and/or junior medical officers/residents. Additional studies were obtained and reviewed from the reference lists of selected articles.Results: Out of the 3796 studies that were initially found, 585 were assessed against the eligibility criteria leaving 113 studies for review. These studies highlighted the negative consequences of burnout in the early medical career. Also identified were work-specific and person-specific demands that likely lead to burnout and, work and person resources that appear to reduce burnout.Conclusion: This review provides a framework to explain the growing problem of burnout amongst early-career medical professionals. However, further research is necessary to overcome the current reliance on cross-sectional designs and small sample sizes.
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Affiliation(s)
| | - Barbara Griffin
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
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15
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Ishikawa M, Nomura M, Miyoshi M, Nishi N, Yokoyama T, Miura H. A self-reported measurement scale on a potential component of competency in the healthcare staff engaged in the prevention and control of non-communicable disease in Fiji. BMC Health Serv Res 2019; 19:838. [PMID: 31727066 PMCID: PMC6857309 DOI: 10.1186/s12913-019-4695-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 10/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background According to the World Health Organization, an estimated 80% or more deaths in Pacific island countries, including Fiji, were related to non-communicable diseases (NCDs). Although competency-based approaches have been effective for developing healthcare workers’ capabilities, there are only a few reports on competency scales of healthcare workers for NCD prevention. We aimed to develop a self-reported measurement scale on a potential component of competency in the healthcare staff engaged in the prevention and control of NCDs in Fiji. Methods There were 378 Ministry of Health and Medical Services staff members working on NCD prevention and control in Fiji included in this study, which was a cross-sectional survey of social factors, working situation factors, and competency. Exploratory factor analysis was conducted to assess potential competency components, whereas Cronbach’s α coefficient and analysis of variance were used to assess the validity and reliability of the scale items, respectively. Multivariate regression analyses were conducted to analyze the respondents’ factor scores relative to social status and work situations. Results The factor analysis revealed 16 items that identified competency in four work types: 1) work management, 2) monitoring and evaluation, 3) community partnership, and 4) community diagnosis. The monitoring and evaluation roles were related to ethnic background, community partnership was related to religion, and community diagnosis was related to academic qualifications. Conclusions Based on the results, we developed a competency scale for the four work types. This scale can help healthcare workers engage in better management of residents with NCDs in Fiji.
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Affiliation(s)
- M Ishikawa
- Department of Health Promotion, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan.
| | - M Nomura
- Department of International Health and Collaboration, National Institute of Public Health, 3-6 Wako, Saitama, 351-0197, Japan
| | - M Miyoshi
- Department of Nutrition, Faculty of Health Sciences, Aomori University of Health and Welfare, 58-1, Mase, Hamadate, Aomori, 030-8505, Japan
| | - N Nishi
- International Center for Nutrition and Information, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan
| | - T Yokoyama
- Department of Health Promotion, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan
| | - H Miura
- Department of International Health and Collaboration, National Institute of Public Health, 3-6 Wako, Saitama, 351-0197, Japan
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16
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Tomo A, De Simone S. Professional status and well-being in healthcare organizations. Health Serv Manage Res 2019; 33:43-51. [PMID: 31672058 DOI: 10.1177/0951484819885053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper aims to explore what aspects of work-life affect healthcare professionals’ well-being and if these aspects may explain a possible categorization considering different professional status. We administered a slightly altered version of the Copenhagen Psychosocial Questionnaire to assess the well-being of patient care workers in a government-funded healthcare organization in Southern Italy. Then, we run an analysis of variance test to explore the aspects affecting the well-being of patient care workers, and to understand if these aspects vary per different professional status (physicians, nurses, and health technicians). Results show important differences among the various professional categories of patient care workers, thus providing the basis for reflections and interventions to improve employee well-being, relevant from a theoretical, practical, and above all policy-making perspectives.
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Affiliation(s)
- Andrea Tomo
- Department of Economics, Management, Institutions, University of Naples "Federico II", Naples, Italy
| | - Stefania De Simone
- Institute for Research on Innovation and Services for Development, Italian National Research Council, Naples, Italy
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17
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Naidu K, Torline JR, Henry M, Thornton HB. Depressive symptoms and associated factors in medical interns at a tertiary hospital. S Afr J Psychiatr 2019; 25:1322. [PMID: 31308973 PMCID: PMC6620542 DOI: 10.4102/sajpsychiatry.v25i0.1322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 05/10/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND It is known that medical doctors suffer from increased rates of depression with medical interns being most at risk. Despite this, little is known about the prevalence of depression in interns in South Africa. OBJECTIVES This study aimed to assess the prevalence of depressive symptoms in interns employed at Groote Schuur Hospital, a tertiary hospital in the Western Cape. METHOD The study was a cross-sectional study. All 91 interns were invited to participate in the study and consenting interns were required to complete a demographic and related questionnaire and the Beck Depression Inventory 2 (BDI-2). RESULTS Fifty-four (59.3%) of all invited interns participated in the study. Twenty-two interns (40.7%) reported a BDI-2 score of 14 or greater, indicating at least mild self-reported symptoms of depression. Features associated with a BDI-2 score of 14 or greater, included female gender, a previous diagnosis of depression, seeing a psychotherapist and previously being on antidepressant medication during internship. Other features also significantly associated with higher BDI-2 scores included suicidal ideation, thoughts of emigration, wanting to leave medicine and using substances to cope. The most significant associated feature of high BDI-2 scores was a subjective feeling of being 'burnt out'. CONCLUSION Interns had a higher prevalence of depressive symptoms when compared to the general population. The feeling of being 'burnt out' was the most significant factor associated with the severity of depressive symptoms. It is imperative that the mental health of both medical students and newly qualified doctors be prioritised, supported and monitored.
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Affiliation(s)
- Kaveshin Naidu
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Michelle Henry
- Centre for Higher Education Development, University of Cape Town, Cape Town, South Africa
| | - Helena B. Thornton
- Centre for Higher Education Development, University of Cape Town, Cape Town, South Africa
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Asante JO, Li MJ, Liao J, Huang YX, Hao YT. The relationship between psychosocial risk factors, burnout and quality of life among primary healthcare workers in rural Guangdong province: a cross-sectional study. BMC Health Serv Res 2019; 19:447. [PMID: 31269949 PMCID: PMC6610857 DOI: 10.1186/s12913-019-4278-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/19/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Healthcare workers are often exposed to stressful working conditions at work which affect their quality of life. The study investigated the relationship between psychosocial risk factors, stress, burnout, and quality of life among primary healthcare workers in general medical practice in Qingyuan and Chaozhou cities in Guangdong province. METHOD The cross-sectional study was conducted in 108 primary health facilities including 36 community health centers (CHCs) across two developing cities in Guangdong province. A total of 873 healthcare workers completed the questionnaires. Quality of life was evaluated using The World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) and psychological risk factors were evaluated by the Copenhagen Psychosocial Questionnaire (COPSOQ). General quality of life and the quality of life domains were transformed into a score range from minimum 0 to 100 maximum. Higher scores indicated better quality of life and vice versa. Significant associations were verified using multiple regression analysis. RESULTS Poor quality of life was observed in 74.6% of healthcare workers surveyed. General poor quality of life was significantly higher among workers who reported higher burnout (Beta = - 0.331, p < 0.001). In addition, workers with high levels of burnout, unmarried workers and female workers had a higher possibility of physical health. A greater risk of poor psychological health was observed among workers with high burnout, poor sense of community and those with lower educational levels. Workers who lacked social support, those with fewer possibilities for development had increased probability of poor quality of life in the social domain. Poor quality of life in the environmental domain was observed among workers who were dissatisfied with their jobs and workers with low salaries. CONCLUSIONS Primary healthcare workers in developing cities in China have a highly demanding and strained working environment and poor quality of life. Reducing job stress and improving work conditions may ultimately improve the well-being of primary healthcare workers.
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Affiliation(s)
- Joseph Obiri Asante
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74# Zhongshan 2nd Road Building 20, Guangzhou, Guangdong People’s Republic of China
| | - Meng Jie Li
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74# Zhongshan 2nd Road Building 20, Guangzhou, Guangdong People’s Republic of China
| | - Jing Liao
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74# Zhongshan 2nd Road Building 20, Guangzhou, Guangdong People’s Republic of China
| | - Yi Xiang Huang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74# Zhongshan 2nd Road Building 20, Guangzhou, Guangdong People’s Republic of China
| | - Yuan Tao Hao
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74# Zhongshan 2nd Road Building 20, Guangzhou, Guangdong People’s Republic of China
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McKinley N, Karayiannis PN, Convie L, Clarke M, Kirk SJ, Campbell WJ. Resilience in medical doctors: a systematic review. Postgrad Med J 2019; 95:140-147. [PMID: 30926716 DOI: 10.1136/postgradmedj-2018-136135] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Resilience can be difficult to conceptualise and little is known about resilience in medical doctors. AIMS This systematic review discusses the existing literature on influences on resilience levels of medical doctors. METHODS The bibliographic databases PubMed, MEDLINE, EMBASE and PsycINFO were searched from 2008 to November 2018 using keyword search terms resilience* AND ("medical physician*" OR doctor* OR surgeon* OR medical trainee* or clinician*). RESULTS Twenty-four studies were deemed eligible for inclusion. A narrative synthesis was performed. The following influences on resilience in doctors were identified: demographics, personality factors, organisational or environmental factors, social support, leisure activities, overcoming previous adversity and interventions to improve resilience. CONCLUSIONS Resilience is not limited to a doctor's own personal resource. Published studies also highlight the influence of other modifiable factors.
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Affiliation(s)
| | | | - Liam Convie
- General Surgery, Ulster Hospital, Dundonald, UK
| | - Mike Clarke
- Queen's University Belfast Centre for Public Health, Belfast, UK
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20
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Lawton R, Robinson O, Harrison R, Mason S, Conner M, Wilson B. Are more experienced clinicians better able to tolerate uncertainty and manage risks? A vignette study of doctors in three NHS emergency departments in England. BMJ Qual Saf 2019; 28:382-388. [PMID: 30728187 PMCID: PMC6560462 DOI: 10.1136/bmjqs-2018-008390] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 12/03/2022]
Abstract
Background Risk aversion among junior doctors that manifests as greater intervention (ordering of tests, diagnostic procedures and so on) has been proposed as one of the possible causes for increased pressure in emergency departments (EDs). Here we tested the prediction that doctors with more experience would be more tolerant of uncertainty and therefore less risk-averse in decision making. Methods In this cross-sectional, vignette-based study, doctors working in three EDs were asked to complete a questionnaire measuring experience (length of service in EDs), reactions to uncertainty (Gerrity et al, 1995) and risk aversion (responses about the appropriateness of patient management decisions). Results Data from 90 doctors were analysed. Doctors had worked in the ED for between 5 weeks and 21 years. We found a large association between experience and risk aversion so that more experienced clinicians made less risk-averse decisions (r=0.47, p<0.001). We also found a large association between experience and reactions to uncertainty (r=−0.50, p<0.001), with more experienced doctors being much more at ease with uncertainty. Mediation analyses indicated that tolerance of uncertainty partially mediated the relationship between experience and lower risk aversion, explaining about a quarter of the effect. Conclusion While we might be tempted to conclude from this research that experience and the ability to tolerate uncertainty lead to positive outcomes for patients (less risk-averse management strategies and higher levels of safety netting), what we are unable to conclude from this design is that these less risk-averse strategies improve patient safety.
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Affiliation(s)
- Rebecca Lawton
- Institute of Psychological Sciences, University of Leeds, Leeds, UK .,Quality and Safety Research, Bradford Institute for Health Research, Bradford, UK
| | | | | | - Suzanne Mason
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| | - Brad Wilson
- Accident and Emergency, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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McCain RS, McKinley N, Dempster M, Campbell WJ, Kirk SJ. A study of the relationship between resilience, burnout and coping strategies in doctors. Postgrad Med J 2017; 94:postgradmedj-2016-134683. [PMID: 28794171 DOI: 10.1136/postgradmedj-2016-134683] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/19/2017] [Accepted: 07/16/2017] [Indexed: 11/04/2022]
Abstract
PURPOSE OF THE STUDY The aim of this study was to measure resilience, coping and professional quality of life in doctors. STUDY DESIGN A cross-sectional study using an online questionnaire in a single National Health Service trust, including both primary and secondary care doctors. RESULTS 283 doctors were included. Mean resilience was 68.9, higher than population norms. 100 (37%) doctors had high burnout, 194 (72%) doctors had high secondary traumatic stress and 64 (24%) had low compassion satisfaction. Burnout was positively associated with low resilience, low compassion satisfaction, high secondary traumatic stress and more frequent use of maladaptive coping mechanisms, including self-blame, behavioural disengagement and substance use. Non-clinical issues in the workplace were the main factor perceived to cause low resilience in doctors. CONCLUSIONS Despite high levels of resilience, doctors had high levels of burnout and secondary traumatic stress. Doctors suffering from burnout were more likely to use maladaptive coping mechanisms. As doctors already have high resilience, improving personal resilience further may not offer much benefit to professional quality of life. A national study of professional Quality of Life, Coping And REsilience, which we are proposing to undertake, will for the first time assess the UK and Ireland medical workforce in this regard and guide future targeted interventions to improve professional quality of life.
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Affiliation(s)
- R Scott McCain
- Department of General Surgery, Ulster Hospital, Belfast, UK
| | | | - Martin Dempster
- School of Psychology, Queen's University Belfast, Belfast, UK
| | | | - Stephen J Kirk
- Department of General Surgery, Ulster Hospital, Belfast, UK
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Competence Theory and Research: A Synthesis. TECHNICAL AND VOCATIONAL EDUCATION AND TRAINING: ISSUES, CONCERNS AND PROSPECTS 2017. [DOI: 10.1007/978-3-319-41713-4_50] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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O'Keeffe C, Carter A, Mason S. The value of emergency medicine placements for postgraduate doctors: views of Foundation Year 2 doctors and training leads in the emergency department (ED): Table 1. Postgrad Med J 2016; 93:15-19. [DOI: 10.1136/postgradmedj-2016-133973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/20/2016] [Accepted: 05/24/2016] [Indexed: 11/03/2022]
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