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Tungsupreechameth A, Tanpowpong P, Puranitee P. Mistreatment in paediatric residency programs in Thailand: a national survey. Med Educ Online 2023; 28:2220176. [PMID: 37270793 DOI: 10.1080/10872981.2023.2220176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/03/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND AIMS Mistreatment in the learning environment is associated with adverse outcomes for residents. Most studies with that regard have been performed in western countries which may have different socio-cultural background and educational and training systems than the non-Western Asian countries. This study aimed (1) to determine the national prevalence of mistreatment in Thai paediatric residents and a correlation with the risk for burnout and other factors and (2) to launch a mistreatment awareness program (MAP) in our training program. METHODS The study was divided into two phases. Phase 1, an online survey of mistreatment-related questions, was sent to current paediatric residents across the country. Burnout and depression were also self-evaluated by formal screening questions. The results were categorized by the Negative Acts Questionnaire-Revised into five domains of mistreatment: workplace learning-related bullying (WLRB), person-related bullying (PRB), physically intimidating bullying, sexual harassment, and ethnic harassment. Frequent mistreated exposure was defined as if mistreatment occurred >1/week. Phase 2, MAP was conducted by distributing the results of the first phase with some examples of mistreatment events and mistreatment-related videos. After 3 months, at our centre, the survey was resent to evaluate mistreatment. RESULTS The response rate was 27% (n = 140). We found that 91% experienced ≥1 mistreated situation in the prior 6 months. Most mistreatment domains were WLRB and PRB, and residents were commonly instigated by clinical faculty and nurses. Most (84%) mistreated residents did not report the events. An association between frequent mistreated exposure and burnout was also found (P < 0.001). For Phase 2, the mistreated situations especially the WLRB and PRB domains dropped after the launch of MAP. CONCLUSIONS Thai paediatric residents frequently perceive mistreatment in their learning environment. Specific aspects of mistreatment, such as WLRB and PRB, should be carefully explored and managed through particular groups of instigators.
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Affiliation(s)
| | - Pornthep Tanpowpong
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongtong Puranitee
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Chuented P, Puranitee P, Pakakasama S, Meepanya S. Factors affecting residents' internal motivation, grit, and well-being. BMC Med Educ 2023; 23:779. [PMID: 37858074 PMCID: PMC10588185 DOI: 10.1186/s12909-023-04679-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 09/13/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Residents completing competency-based medical education for postgraduate training face many challenging situations that may compromise their well-being or result in exhaustion or burnout. Factors described in self-determination theory and grit are important for residents' achievement of learning outcomes and well-being. This study explored the relationships among internal motivation, grit, well-being, and related factors among non-Western Asian residents. METHODS We conducted an explanatory sequential mixed-methods survey-based study to explore correlations among satisfaction with basic psychological needs, grit, and well-being from September to November 2021 among residents at Ramathibodi Hospital, Mahidol University, Thailand. Data were collected with the Basic Psychological Needs Scale, Short Grit Scale, and World Health Organization-Five Well-Being Index. Next, participants with the highest and lowest scores for each scale were purposively invited to participate in semi-structured interviews. Interview data underwent thematic analysis and data collection continued until saturation was reached. RESULTS In total, 245 residents (51% major ward, 65% female) completed the survey. There were strong associations between internal motivation, grit, and well-being (r = 0.46-0.90). Female residents had higher autonomy and relatedness scores than males (p = 0.04 and p = 0.01, respectively), and residents with less family responsibility had higher relatedness scores than other residents (p = 0.01). Residents who got more sleep had higher autonomy, relatedness, and well-being scores than those that slept less (p < 0.05). Residents who exercised > 5 times/week had higher well-being scores than other residents (p < 0.01). Thirty residents completed interviews. The thematic analysis revealed internal motivation, grit, and well-being were promoted by a supportive learning environment, a well-designed curriculum, actions and personalities of faculty members, and good personal factors. CONCLUSION Internal motivation is significantly correlated with residents' grit, well-being, gender, family burdens, exercise, and sleep hours. Priority should be given to promoting internal motivation, grit, and well-being among residents by enhancing a positive learning environment, creating well-designed curricula, fostering good characteristics and actions among faculty members, and supporting residents' personal lives.
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Affiliation(s)
- Pimwipa Chuented
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongtong Puranitee
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Samart Pakakasama
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suganda Meepanya
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Naothavorn W, Puranitee P, Kaewpila W, Sumrithe S, Heeneman S, van Mook WNKA, Busari JO. An exploratory university-based cross-sectional study of the prevalence and reporting of mistreatment and student-related factors among Thai medical students. BMC Med Educ 2023; 23:473. [PMID: 37365553 DOI: 10.1186/s12909-023-04462-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Mistreatment is a behavior that reflects disrespect for the dignity of others. Mistreatment can be intentional or unintentional, and can interfere with the process of learning and perceived well-being. This study explored the prevalence and characteristics of mistreatment, mistreatment reporting, student-related factors, and consequences among medical students in Thai context. METHODS We first developed a Thai version of the Clinical Workplace Learning Negative Acts Questionnaire-Revised (NAQ-R) using a forward-back translation process with quality analysis. The design was a cross-sectional survey study, using the Thai Clinical Workplace Learning NAQ-R, Thai Maslach Burnout Inventory-Student Survey, Thai Patient Health Questionnaire (to assess depression risk), demographic information, mistreatment characteristics, mistreatment reports, related factors, and consequences. Descriptive and correlational analyses using multivariate analysis of variance were conducted. RESULTS In total, 681 medical students (52.4% female, 54.6% in the clinical years) completed the surveys (79.1% response rate). The reliability of the Thai Clinical Workplace Learning NAQ-R was high (Cronbach's alpha 0.922), with a high degree of agreement (83.9%). Most participants (n = 510, 74.5%) reported that they had experienced mistreatment. The most common type of mistreatment was workplace learning-related bullying (67.7%), and the most common source was attending staff or teachers (31.6%). People who mistreated preclinical medical students were most often senior students or peers (25.9%). People who mistreated clinical students were most commonly attending staff (57.5%). Only 56 students (8.2%) reported these instances of mistreatment to others. Students' academic year was significantly related to workplace learning-related bullying (r = 0.261, p < 0.001). Depression and burnout risk were significantly associated with person-related bullying (depression: r = 0.20, p < 0.001, burnout: r = 0.20, p = 0.012). Students who experienced person-related bullying were more often the subject of filed unprofessional behavior reports, concerning conflict or arguments with colleagues, being absent from class or work without reasonable cause, and mistreatment of others. CONCLUSIONS Mistreatment of medical students was evident in medical school and was related to the risk for depression and burnout, as well as the risk of unprofessional behavior. TRIAL REGISTRATION TCTR20230107006(07/01/2023).
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Affiliation(s)
- Waravudh Naothavorn
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Pongtong Puranitee
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Winitra Kaewpila
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Sutida Sumrithe
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Sylvia Heeneman
- Department of Pathology, School of Health Professions Education, Faculty of Health, Medicine & Life Sciences (FHML), Maastricht University (UM), Maastricht, The Netherlands
| | - Walther N K A van Mook
- Department of Intensive Care, and Academy for Postgraduate Medical Training, Maastricht University Medical Centre+, and School of Health Professions Education, Faculty of Health, Medicine & Life Sciences (FHML), Maastricht University (UM), Maastricht, The Netherlands
| | - Jamiu O Busari
- Department of Educational Development & Research, Faculty of Health, Medicine & Life Sciences (FHML), Maastricht University (UM), Maastricht, The Netherlands and Department of Pediatrics and HOH Academy, Horacio Oduber Hospital, Oranjestad, Aruba
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Chucherd O, Vallibhakara SAO, Paiwattananupant K, Puranitee P, Wattanayingcharoenchai R, Vallibhakara O. The effect of online video-assisted teaching program on medical students learning procedure of fractional curettage. BMC Med Educ 2023; 23:82. [PMID: 36732732 PMCID: PMC9893180 DOI: 10.1186/s12909-023-04052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Since 2020, with the entire world in crisis over the coronavirus pandemic (COVID-19), medical students have adapted to hybrid and distance learning. This study aims to compare the learning outcomes of students learning the procedure of fractional curettage in an online video-assisted teaching program to those of students learning the procedure in a traditional class. METHODS A quasi-experimental study was conducted among fourth-year medical students who rotated to Obstetrics and Gynecology courses between April 2021 and October 2021. Participants in the first two rotations were enrolled in traditional classes, and the online video-assisted teaching program was introduced in the subsequent two rotations. Both study groups took OSCEs (objective structured clinical examinations), a pre-test and post-test with MCQs (multiple choice questions), and a confidence and satisfaction level questionnaire. RESULTS A total of 106 fourth-year medical students, 54 in the traditional group and 52 in the online video-assisted teaching program, were recruited. The online video-assisted group showed a statistically better mean OSCE score (85.67 ± 11.29 vs. 73.87 ± 13.01, p < 0.001) and mean post-test MCQ score than the traditional group (4.21 ± 0.87 vs. 3.80 ± 0.98, p = 0.0232). Moreover, the mean difference between the two groups' pre and post-test MCQ scores was significantly different (0.96 ± 1.37 vs. 1.79 ± 1.50 in traditional and online video-assisted teaching program groups, respectively, P = 0.0038). The participants in the experimental group reported significantly greater confidence (P < 0.001) in performing the fractional curettage procedure. However, the mean satisfaction score was significantly higher in the control group (p = 0.0053). CONCLUSION The online video-assisted teaching program on the fractional curettage procedure, a necessary and skill-demanding procedure, is an effective and advantageous education tool that improves skills, knowledge, and confidence in fourth-year medical students. We recommend that the video-assisted teaching program is another effectively procedural teaching method for medical students.
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Affiliation(s)
- Oracha Chucherd
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Sakda Arj-Ong Vallibhakara
- Faculty of Medicine, BangkokThonburi University, Bangkok, 10170, Thailand
- Child Safety Promotion and Injury Prevention Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Krissada Paiwattananupant
- Department of Obstetrics and Gynaecology, Gynecologic Oncology Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Pongtong Puranitee
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Rujira Wattanayingcharoenchai
- Department of Obstetrics and Gynaecology, Female Pelvic Medicine and Reconstructive Surgery Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Orawin Vallibhakara
- Department of Obstetrics and Gynaecology, Reproductive Endocrinology and Infertility Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
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Puranitee P, Kaewpila W, Heeneman S, van Mook WNKA, Busari JO. Promoting a sense of belonging, engagement, and collegiality to reduce burnout: a mixed methods study among undergraduate medical students in a non-Western, Asian context. BMC Med Educ 2022; 22:327. [PMID: 35484548 PMCID: PMC9047274 DOI: 10.1186/s12909-022-03380-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/15/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Burnout is a psychological condition induced by work-related chronic interpersonal stressors. Interventions creating a sense of belonging and collegiality have been proposed as approaches for alleviating burnout. The current study aimed to: (1) explore the relationships between burnout, sense of belonging (relatedness with others), and work engagement; and (2) identify the key elements perceived by undergraduate medical students as positively contributing to collegiality, engagement, and a sense of belonging, in an undergraduate medical training setting. METHODS An exploratory sequential mixed-methods design using questionnaires and semi-structured individual interviews collected quantitative and qualitative data among undergraduate medical students at Mahidol University, Thailand. The Maslach Burnout Inventory-Student Survey questionnaire was used to measure burnout. The Basic Psychological Need Satisfaction at Work Scale (BPNSS-21) and the Utrecht Work Engagement Scale-Student Version (UWESS-9) measured students' basic psychological needs satisfaction at work and work engagement, respectively. Descriptive statistical analysis and confirmatory factor analysis were performed on BPNSS-21 and UWESS-9 data. Spearman's correlation coefficient was used to identify the correlation between burnout and other factors. Twenty undergraduate medical students participated in the qualitative study. Qualitative analysis was conducted iteratively using constant comparison and the standard principles of primary, secondary, and tertiary coding for thematic analysis. RESULTS Thai versions of the BPNSS-21 and UWESS-9 showed an acceptable fit for the Thai cultural context. Burnout had significant weak inverse associations with engagement (r = - 0.39, p < 0.005) and basic psychological needs satisfaction (r = - 0.37, p < 0.005). Sense of belonging had a significant weak inverse relationship with burnout (r = - 0.25, p < 0.005). The main themes emerging from qualitative analysis were relevant tasks and learning activities, safety in the learning environment, peer interaction, program design factors, dynamics of collegiality while progressing through medical school, and personal stance and social skills. CONCLUSIONS Sense of belonging, engagement, and collegiality were related to burnout. The key features for promoting collegiality, the sense of belonging, and engagement were relevant tasks and learning activities, safety in the learning environment, peer interaction, program design factors, dynamics of collegiality while progressing through medical school, and personal stance and social skills.
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Affiliation(s)
- Pongtong Puranitee
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajthevi, Bangkok, 10400 Thailand
| | - Winitra Kaewpila
- Faculty of Medicine, The ChakriNaruebodindra Medical Institute, Mahidol University, 111 Tambon Bang Pla, Amphoe Bang Phli, 10540 Chang Wat Samutprakan, Thailand
| | - Sylvia Heeneman
- Department of Pathology, School of Health Professions Education, Faculty of Health, Medicine & Life Sciences (FHML), Maastricht University (UM), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Walther N. K. A. van Mook
- Department of Intensive care medicine, and Academy for Postgraduate Medical Training, Maastricht University Medical Center+, 6202 AZ, Maastricht, The Netherlands
- School of Health Professions Education, Faculty of Health, Medicine & Life Sciences (FHML), Maastricht University (UM), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Jamiu O. Busari
- Department of Educational Development & Research, Faculty of Health, Medicine & Life Sciences (FHML), Maastricht University (UM), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Pediatrics and HOH Academy, Horacio Oduber Hospital, Dr. Horacio E. Oduber Boulevard #1, Oranjestad, Aruba
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Puranitee P, Fuangfu S, Dumrongwongsiri O. Determination of Hemoglobin Level Among 9-Month-Old Infants Visiting Well Child Clinic. Glob Pediatr Health 2021; 8:2333794X211036629. [PMID: 34377746 PMCID: PMC8326615 DOI: 10.1177/2333794x211036629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
Screening for anemia is recommended among infants aged 9 to 12 months. This study was conducted to determine the prevalence of anemia among 9-month-old infants at Well Child Clinic, and associated factors with anemia. Well Child record of all visits during January to December 2018 were reviewed. Hemoglobin (Hb) was determined by complete blood count (CBC) or point-of-care Hb (POC-Hb). Anemia was found in 99 from 145 infants (68.3%). The prevalence of anemia was 33.3% and 72.8% when tested by CBC and POC-Hb, respectively. Breastfed Infants had significantly lower mean Hb than formula-fed infants. The odd ratio [95% confident interval] of having anemia among infants who were fed with infant formula were 0.37 [0.14-0.94]; P = .038 when compared to breastfed infants. There was a high proportion of anemia among 9-month-old infants in Rama-WCC and breastfeeding was associated with anemia in infants. The use of POC-Hb may overestimate the prevalence of anemia.
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Affiliation(s)
- Pongtong Puranitee
- Department of Pediatrics, Faculty of Medicine Ramamthibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sajee Fuangfu
- Department of Pediatrics, Faculty of Medicine Ramamthibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Oraporn Dumrongwongsiri
- Department of Pediatrics, Faculty of Medicine Ramamthibodi Hospital, Mahidol University, Bangkok, Thailand
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Puranitee P, Saetang S, Sumrithe S, Busari JO, van Mook WN, Heeneman S. Exploring burnout and depression of Thai medical students: the psychometric properties of the Maslach Burnout Inventory. Int J Med Educ 2019; 10:223-229. [PMID: 31786565 PMCID: PMC7252444 DOI: 10.5116/ijme.5dc6.8228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/09/2019] [Indexed: 05/16/2023]
Abstract
OBJECTIVES To examine the psychometric properties of the Maslach Burnout Inventory-Student Survey (MBI-SS) Thai version and to determine the frequency of burnout and correlation between burnout and associated factors. METHODS A cross-sectional study was conducted among undergraduate medical students using convenience sampling (n=545, 76.1% response rate, female 52.1%). Data were collected by a self-report survey. The MBI-SS was translated in Thai and tested for internal consistency using Cronbach's coefficient alpha. A confirmatory factor analysis was performed using as fit indices of the chi-square and degree of freedom ratio (χ2/df), Comparative Fit Index (CFI), the Goodness of Fit Index (GFI), the Non-normed Fit Index (NNFI), Akaike information criterion (AIC) and the Root Mean Square Error of Approximation (RMSEA). Spearman and Kendall's tau-b were used to identify correlations between burnout, depression and other factors. RESULTS Interrater reliability was acceptable with Kappa of 0.83. Confirmatory factor analysis demonstrated good fit indices (χ2/df=197.62/83, CFI=0.97, GFI=0.95, NNFI=0.96, AIC=271.62 and RMSEA=0.06). Burnout had a weak, positive association with the PHQ-9 (r=0.294, df=2, p< 0.001). The screening depression score had a significant, modest positive association with emotional exhaustion (r=0.469, df=4, p<0.001) and cynicism (r=0.411, df=4, p< 0.001), and a weak inverse association with professional efficacy (r=-0.273, df=4, p< 0.001). CONCLUSIONS The Thai version of the MBI-SS had adequate psychometric properties among Thai medical students and can be used to assess burnout among undergraduate medical students in Thailand. Burnout was associated with risk for depression. Further studies on other associated factors contributing to depression are suggested.
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Affiliation(s)
- Pongtong Puranitee
- Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Siam Saetang
- Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Sutida Sumrithe
- Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Jamiu O. Busari
- Department of Educational Development & Research, Faculty of Health, Medicine & Life Sciences (FHML), Maastricht University (UM), The Netherlands
| | - Walther N.K.A. van Mook
- School of Health Profession Education, Maastricht University (UM), Department of Intensive Care Medicine, The Netherlands
| | - Sylvia Heeneman
- Department of Pathology, Faculty of Health, Medicine & Life Sciences (FHML), School of Health Profession Education, Maastricht University (UM), The Netherlands
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Puranitee P, Stevens FFCJ, Pakakasama S, Plitponkarnpim A, Vallibhakara SAO, Busari JO, Heeneman S, van Mook WNKA. Correction to: Exploring burnout and the association with the educational climate in pediatric residents in Thailand. BMC Med Educ 2019; 19:296. [PMID: 31370842 PMCID: PMC6676602 DOI: 10.1186/s12909-019-1723-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Following publication of the original article.
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Affiliation(s)
- Pongtong Puranitee
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajthevi, Bangkok, 10400, Thailand.
| | - Fred F C J Stevens
- Department of Educational Development & Research, Faculty of Health, Medicine & Life Sciences (FHML), Maastricht University (UM), Maastricht, The Netherlands
| | - Samart Pakakasama
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajthevi, Bangkok, 10400, Thailand
| | - Adisak Plitponkarnpim
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajthevi, Bangkok, 10400, Thailand
- Child Safety Promotion and Injury Prevention and Research Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajthevi, Bangkok, 10400, Thailand
| | - Sakda Arj-Ong Vallibhakara
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajthevi, Bangkok, 10400, Thailand
- Child Safety Promotion and Injury Prevention and Research Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajthevi, Bangkok, 10400, Thailand
| | - Jamiu O Busari
- Department of Educational Development & Research, Faculty of Health, Medicine & Life Sciences (FHML), Maastricht University (UM), Maastricht, The Netherlands
| | - Sylvia Heeneman
- Department of Pathology, Faculty of Health, Medicine & Life Sciences (FHML), School of Health Profession Education, Maastricht University (UM), Maastricht, The Netherlands
| | - Walther N K A van Mook
- Department of Educational Development & Research, Faculty of Health, Medicine & Life Sciences (FHML), Maastricht University (UM), Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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Puranitee P, Stevens FFCJ, Pakakasama S, Plitponkarnpim A, Arj-OngVallibhakara S, Busari JO, Heeneman S, van Mook WNKA. Exploring burnout and the association with the educational climate in pediatric residents in Thailand. BMC Med Educ 2019; 19:245. [PMID: 31277615 PMCID: PMC6612205 DOI: 10.1186/s12909-019-1687-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 06/26/2019] [Indexed: 05/25/2023]
Abstract
BACKGROUND This study, undertaken in Bangkok, Thailand, explored the extent to which paediatric residents in a non-Western setting experienced burnout and the potential association with factors in the medical educational climate and work-related quality of life. METHODS An exploratory sequential mixed methods design was employed in a cross-sectional study. The initial, quantitative phase used the validated Maslach Burnout Inventory, the Postgraduate Hospital Educational Environmental Measure (PHEEM) and Work-Related Quality of Life scale (WRQoL). Regression analysis was used to identify the correlation between burnout and educational climate. Thereafter, residents in all years with high levels of burnout on subscales were interviewed individually. RESULTS Forty-one paediatric residents completed the three questionnaires. None had high levels related to burnout in all three domains (emotional exhaustion, high level of depersonalization and perceived low personal accomplishment), seven (17%) showed high levels in two out of three domains. Emotional exhaustion and educational climate (perceptions of role autonomy, perceptions of teaching, perceptions of social support) were correlated with work-related quality of life. In the interviews, the main themes related to burnout were inappropriate tasks, teachers and teaching styles, the perception of knowledge insecurity relating to task performance, time dimensions, life crisis during training, role expectations and work allocation clarity, and facilities such as accommodation. CONCLUSIONS The study, in a non-Western setting, demonstrated a positive relation between educational climate and work-related quality of life. To help reduce the risk of burnout, the following factors were identified: minimize unnecessary or duplicated workload, schedule time arrangements to avoid extension of regular duty hours, and clearly define role expectations. The impact of inappropriate tasks, teachers and teaching styles (including unsafe environment) on the incidence of burnout was also highlighted. Additional studies focusing on teaching styles, safe learning climate and mistreatment in a non-Western context are needed.
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Affiliation(s)
- Pongtong Puranitee
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajthevi, Bangkok 10400 Thailand
| | - Fred F. C. J. Stevens
- Department of Educational Development & Research, Faculty of Health, Medicine & Life Sciences (FHML), Maastricht University (UM), Maastricht, The Netherlands
| | - Samart Pakakasama
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajthevi, Bangkok 10400 Thailand
| | - Adisak Plitponkarnpim
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajthevi, Bangkok 10400 Thailand
- Child Safety Promotion and Injury Prevention and Research Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajthevi, Bangkok 10400 Thailand
| | - Sakda Arj-OngVallibhakara
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajthevi, Bangkok 10400 Thailand
- Child Safety Promotion and Injury Prevention and Research Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajthevi, Bangkok 10400 Thailand
| | - Jamiu O. Busari
- Department of Educational Development & Research, Faculty of Health, Medicine & Life Sciences (FHML), Maastricht University (UM), Maastricht, The Netherlands
| | - Sylvia Heeneman
- Department of Pathology, Faculty of Health, Medicine & Life Sciences (FHML), School of Health Profession Education, Maastricht University (UM), Maastricht, The Netherlands
| | - Walther N. K. A. van Mook
- Department of Educational Development & Research, Faculty of Health, Medicine & Life Sciences (FHML), Maastricht University (UM), Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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Siwarom S, Puranitee P, Plitponkarnpim A, Manuyakorn W, Sinitkul R, Arj-Ong Vallipakorn S. Association of indoor air quality and preschool children's respiratory symptoms. Asian Pac J Allergy Immunol 2019; 35:119-126. [PMID: 27996287 DOI: 10.12932/ap0838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND This study aimed to assess the association between exposure to indoor air pollution in DCCs (Child Day Care Centers) and the respiratory symptoms of children under 6 years old. METHODS Air quality data were collected three times regarding to seasonal variation. Pollutants measured in 11 DCCs included PM₁₀, CO, NO₂, SO₂, O₃, benzene, bacteria, fungi, and dust mite. The frequencyof respiratory symptoms including coughing, rhinitis, and dyspnea were recorded via teacher and parent-report questionnaires. Fractional exhaled nitric oxide (FENO) levels were measured to assess airway inflammation. RESULTS 436 children participated in the study. 83% completed data collection in all 3 seasons. The frequency of rhinitis correlated with PM₁₀ (IRR=70.3, 95%CI=12.4-399.7, p<0.001), CO (IRR=3.2, 95%CI=2.4-4.2, p<0.001), benzene (IRR=2.3, 95%CI=1.8-3.2, p<0.001) and D.Pteronyssinus level (IRR=2.1, 95%CI=1.7-2.7, p<0.001). The frequency of coughingcorrelated with levels of PM10 (IRR=15.2, 95%CI=3.0-78.2, p<0.001), CO (IRR=2.8, 95%CI=2.1-3.7, p<0.001), benzene (IRR=1.4, 95%CI=1.1-1.9, p=0.02). The frequency of dyspnea correlated with D.Pteronyssinus level (IRR=3.9, 95%CI=1.7-9.1, p=0.001). FENO levels associated with high benzene levels (OR=5.9, 95%CI=1.5-22.9, p=0.01). The majority of DCCs had at least one PM₁₀ measurement above the standard level, and these high levels were noted in all 3 seasons. Three DCCs had PM₁₀ levels above the standard level in all seasons. 64% of the DCCs had indoor bacterial counts above the standard level in all seasons. CONCLUSIONS PM₁₀ and bacterial count is a significant problem in Bangkok metropolitan DCCs. The respiratory symptoms of children positively associated with PM₁₀, CO, benzene and dust mite levels.
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Affiliation(s)
- Sirinapa Siwarom
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongtong Puranitee
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Adisak Plitponkarnpim
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wiparat Manuyakorn
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ratchaneewan Sinitkul
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Puranitee P, Kamchaisatian W, Manuyakorn W, Vilaiyuk S, Laecha O, Pattanaprateep O, Benjaponpitak S. Direct medical cost of Thai pediatric asthma management: a pilot study. Asian Pac J Allergy Immunol 2016; 33:296-300. [PMID: 26708393 DOI: 10.12932/ap0494.33.4.2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/20/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND The prevalence of asthma in Bangkok increased steadily over the last couple of decades and warrants an assessment of the costs associated with its treatment, particularly in the case of children. OBJECTIVE To estimate the direct medical costs of asthma care in children at the Allergy unit of the Department of Pediatrics, Ramathibodi hospital. METHODS In this retrospective study, we included asthmatic children aged less than 20 year-old having visited the allergy unit at least 4 times in 12 months between January and December, 2011. Cost data, retrieved from the allergy unit electronic database included billing invoices of inpatient care, outpatient and emergency room visits. From this dataset we estimated drug costs, physician and nursing services, diagnostic tests and procedures, supplies and room charges, and assessed an overall asthma-related direct medical cost. RESULTS Ninety-seven asthmatic children (aged 11.5 ± 3.7 years) were included in the study. Annual median direct medical cost was 8,537.9 Baht or 278 USD per patient. Annual direct medical cost was the highest in patients younger than 5 years old (p < 0.001). Moreover, expenses of patients who had at least one exacerbation increased significantly compared to patients without exacerbation (p = 0.02). Furthermore, direct medical cost was the highest when patients had exacerbation requiring hospitalization (p = 0.03). CONCLUSIONS Cases of patients having asthma exacerbation or being diagnosed with asthma before 5 years of age were associated with higher treatment expenses. Policies developed to achieve asthma control and prevention should identify young children and patients presenting risk factors for asthma exacerbation as high risk groups deserving particular attention.
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Affiliation(s)
- Pongtong Puranitee
- Division of Pediatric Allergy/Immunology/ Rheumatology, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Puranitee P, Vilaiyuk S, Kamchaisatian W, Manuyakorn W, Teawsomboonkit W, Sasisakunporn C, Benjaponpitak S. Reported Ant Re-sting Reaction in Thai Children with Ant Anaphylaxis Receiving Immunotherapy. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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