Enhancing frontline workforce volunteerism through exploration of motivations and impact during the COVID-19 pandemic

OBJECTIVES

During a pandemic, healthcare workers are requested to volunteer for potentially high-risk frontline duties outside of usual hospital and primary care clinic settings in order to better serve vulnerable communities. Examination of volunteer motivations and impact of such experiences can drive more effective pandemic response efforts with regards to volunteer recruitment and retention. This study aims to explore the motivational factors underlying healthcare worker volunteerism in COVID-19 pandemic response operations in the community, and to describe the impact of such operations on volunteers, in order to highlight important volunteer recruitment strategies and ensure volunteer sustainability.

METHODS

A qualitative phenomenological approach is taken in this study through the use of semi-structured individual interviews of healthcare staff, to provide in-depth exploration of personal experiences. Staff were purposefully sampled to ensure diversity of personal and professional backgrounds.

RESULTS

A total of 35 staff, consisting of 17 males and 18 females from medical, nursing, allied health, and administrative backgrounds, who participated in COVID-19 community-based operations in migrant worker dormitories and swab isolation facilities were interviewed. The main motivational factors were volunteer functions of values, understanding and enhancement. Participants were positively impacted on personal and professional levels, including self-growth, societal awareness, as well as skills development in leadership and team management.

CONCLUSIONS

Healthcare organizations should consider volunteer functions in matching individual motivations to volunteer opportunities. Additionally, personal narratives and role-modelling by senior staff can serve as useful adjunct strategies to volunteer recruitment, while providing pre-pandemic preparedness, reassurance of safety, support, and recognition.

Evolution of postgraduate medical education in paediatrics: the Singapore story

Postgraduate paediatric education in Singapore has seen a seismic shift in the past 50–60 years, from a primarily time-based, passive, teacher-centric and apprenticeship model with hierarchical learning culture to a competency-based and learner-centric one. The postgraduate medical education system in paediatrics in Singapore will continue to evolve and adapt with best practices in evidence-based medical education, with the aim to train and develop the next generation of paediatricians who will strive to continually improve child and population health in Singapore.

The Next Pandemic: Supporting COVID-19 Frontline Doctors Through Film Discussion

This paper describes an innovative just-in-time health humanities programme to educate and provide support to COVID-19 frontline doctors-in-training. The programme incorporates small-group screening of the Netflix documentary, The Next Pandemic from the Explained series, followed by a one-hour facilitated discussion to explore themes surrounding the current pandemic and its impact on frontline doctors in a tertiary paediatric hospital in Singapore. Themes derived from the film included preparedness, blame, and the impact on healthcare workers and public, which were further discussed to include concerns regarding current local readiness levels given global connectivity, the need for international cooperation, and the effects of blame such as racism and prejudice. The association with culture; the current impact on healthcare workers, physician-patient relationships, and the public including the role of social media, the government and associated public reactions were also explored. These rich discussions demonstrate the pivotal role health humanities has in times of uncertainty such as an emerging infectious disease outbreak by providing timely pandemic education and supporting reflective learning.

Trainees’ perception of education in communication and professionalism across two programs in two countries

Background:

Different health care systems impact on medical education.

Objective:

We aim to describe the differences and similarities in the perceptions of pediatric residents on education in professionalism and communication skills across two countries.

Methods:

We conducted a cross-sectional survey of pediatric residents in the United States and Singapore. A 108-item written questionnaire on perceptions regarding education in communication/professionalism was administered. A five-point Likert scale was used for each attribute in the survey. Quantitative analysis was performed using chi-square test.

Results:

Response rate was 65.9% (89/135). In the domain of professionalism, residents from both countries ranked shared decision making as the most important attribute (Singapore vs. USA: 26/50 (52.0%) vs. 19/39 (48.7%), p = 0.76). In contrast, there was a difference in ranking of the most important attribute in communication between the two countries, with dealing with difficult family and patient being most important for Singapore trainees (30/50(60.0%) vs. 8/39 (20.5%), p < 0.001). Direct observation and feedback and role modeling by seniors were the most common teaching methods in both centers. Main barriers in learning were high workload (55/89 (61.8%)) and time constraints (53/89 (59.6%)) in both countries. Promoters of teaching these competencies were similar, with role modeling by senior staff rated as most important.

Conclusions:

This investigation demonstrates more differences in the perception of how communication is taught compared to professionalism across two countries. Barriers and promoters to teaching were similar across these two countries, with role modeling being an important approach to teaching communication and professionalism across both countries.

A quality improvement project to reduce waiting time for pediatric outpatient referral clinics in Singapore

Background:

The long waiting time in our General Pediatric Clinic results in the delay in diagnosis and treatment leading to increase in morbidity and dissatisfaction rate among sick children who seek treatment at KK Women’s and Children’s Hospital, Singapore. The mean ± SD waiting time in our General Pediatric Clinic increased from 40 ± 4 days in 2008 and 45 ± 7 days in 2009 to 50 ± 5 days in 2010.

Objectives:

To reduce long waiting times in our General Pediatric Clinic by 20%.

Methods:

The Reducing Waiting Time Working Group was formed to tackle the waiting time problem in the General Pediatric Clinic. Extensive literature was searched and reviewed, brainstorming and discussions were carried out and strategies were developed. A series of implementations were carried out sequentially including clearing of the backlog of cases, development of general and fast track referral guidelines, triaging system and ‘5 Days SMS and 48 Hours Call’ system.

Results:

By clearing the backlog cases, waiting time was reduced from 57 days to 44 days. Through effective triaging system and ‘5 Days SMS and 48 Hours Call’ system, the mean ± SD waiting time was further reduced by 30% from 50 ± 5 days to 35 ± 7 days. By June 2012, the mean waiting time was 27 days.

Conclusions:

Waiting time is one of the important indicators of healthcare quality provided by any healthcare institution. Through these implementations, waiting time was successfully reduced by 30%. These methods may serve as viable options to improve waiting time in other healthcare settings.

Rapid rise in incidence of Irish paediatric inflammatory bowel disease

AIMS

To describe the change in incidence of paediatric inflammatory bowel disease (IBD) observed at the National Centre for Paediatric Gastroenterology, Hepatology and Nutrition, and to determine whether the presenting disease phenotype and disease outcomes have changed during the past decade.

METHODS

The annual incidence of IBD in Irish children aged <16 years was calculated for the years 2000-2010. Two subsets of patients, group A (diagnosed between 1 January 2000 and 31 December 2001), and group B (diagnosed between 1 January and 31 December 2008) were phenotyped according to the Paris Classification. Phenotype at diagnosis and 2-year follow-up were then compared.

RESULTS

406 new cases of IBD were identified. The incidence was 2.5/100 000/year in 2001, 7.3 in 2008 and 5.6 in 2010, representing a significant increase in the number of new cases of Crohn's disease (CD) and ulcerative colitis (UC). There were 238 cases of CD; 129 of UC; and 39 of IBD unclassified. Comparing groups A and B, no differences were found in disease location at diagnosis or, for CD, in its behaviour.

CONCLUSIONS

There has been a substantial and sustained increase in the incidence of childhood UC and CD in Ireland over a relatively short period of time. However, disease phenotype at diagnosis has not changed. At 2 years follow-up, CD appears to progress less frequently than in some neighbouring countries. These variations remain unexplained. Prospective longitudinal studies will help to elucidate further the epidemiology of childhood IBD.

Diagnostic outcome following routine genetics clinic referral for the assessment of global developmental delay

The aim of this study was to ascertain the diagnostic yield following a routine genetics clinic referral for the assessment of global developmental delay. Detailed retrospective review of 119 complete consecutive case notes of patients referred to one single clinical geneticist over a 14 month time period was undertaken (n = 119; 54 males, 65 females). The age at initial review ranged from 2 months to 37 years 3 months (mean 8 y 3 mo [SD 7 y 10 mo]). We made a diagnosis in 36/119 (30%); 21/36 were new diagnoses and 15/36 were confirmations of diagnoses. We removed a wrong diagnostic label in 8/119 (7%). In 3/8 we were able to achieve a diagnosis but in 5/8 no alternative diagnosis was reached. We had a better diagnostic rate where the patients were dysmorphic (odds ratio [OR] 1.825; 95% confidence interval [CI] 1.065 to 3.128, p = 0.044). In the majority, the diagnosis was made by clinical examination only. Molecular diagnosis was reached in seven cases. Five cases were confirmed by cytogenetic analysis. Brain magnetic resonance imaging (MRI) revealed a diagnosis in three cases. This study confirms the importance of a clinical genetics assessment in the investigation of global developmental delay.

Berry syndrome in association with familial limb malformation

We describe a newborn boy diagnosed with Berry syndrome consisting of a distal aortopulmonary septal defect, aortic origin of the right pulmonary artery, and interruption of the aorta. The child was noted to have reduplication of the right thumb. The child's mother had a claw malformation of her left hand but a normal cardiovascular status. Genetic analysis for TBX5 and SALL4 mutations were negative in both the patient and his mother. This case describes the first ever report of Berry syndrome in an infant with reduplication of the right thumb and familial limb malformation.

A novel constellation of cardiac findings for Kabuki syndrome: hypoplastic left heart syndrome and partial anomalous pulmonary venous drainage

This report describes the case of a child with Kabuki syndrome, hypoplastic left heart syndrome, and right-sided partial anomalous pulmonary venous drainage to the inferior vena cava. The child underwent successful Norwood and Glenn palliative procedures. At the age of 9 months, the genetic condition was recognized. This represents the first report describing this combination of findings for Kabuki syndrome.

Clinical and genetic spectrum of pyruvate dehydrogenase deficiency: Dihydrolipoamide acetyltransferase (E2) deficiency

Pyruvate dehydrogenase deficiency is a major cause of primary lactic acidosis and neurological dysfunction in infancy and early childhood. Most cases are caused by mutations in the X-linked gene for the E1alpha subunit of the complex. Mutations in DLAT, the gene encoding dihydrolipoamide acetyltransferase, the E2 core component of the complex, have not been described previously. We report two unrelated patients with pyruvate dehydrogenase deficiency caused by defects in the E2 subunit. Both patients are less severely affected than typical patients with E1alpha mutations and both have survived well into childhood. Episodic dystonia was the major neurological manifestation, with other more common features of pyruvate dehydrogenase deficiency, such as hypotonia and ataxia, being less prominent. The patients had neuroradiological evidence of discrete lesions restricted to the globus pallidus, and both are homozygous for different mutations in the DLAT gene. The clinical presentation and neuroradiological findings are not typical of pyruvate dehydrogenase deficiency and extend the clinical and mutational spectrum of this condition.