Review: Medical directors - Is there a need for reform?

Medical leadership remains integral to the health system amidst a growing burden of ill health and disease, rising patient expectations and medical and technological advancements. The study objectives were to (a) provide a perspective through a rapid review of medical director roles and responsibilities in public and private hospital settings across several Organisation for Economic Co-operation and Development (OECD) and Non-Organisation for Economic Co-operation and Development countries, and (b) provide recommendations on how health system performance could be strengthened. A rapid review of Medical Director job descriptions in public and private hospitals was carried out. Medical Directors are influential leaders in organisational decision-making and quality improvement; however, their role has shifted from clinical oversight to several managerial and leadership roles. We report some variation in their role and responsibilities, in the 'intensity of job requirements' and 'complexity of managing resources' dimensions. The changing expectations of medical directors and the variation in their roles and responsibiliteis may contribute to inefficiencies and misalignment within health systems. There may be a need to pursue reform to assure alignment with health system objectives, albeit reform may require different approaches to meet the needs of different health systems. Further research is needed to explore how reform of medical directors' roles and responsibilities can be quantified to demonstrate improvement within health systems.

The Chief Residency in U.S. and Canadian Graduate Medical Education: A Scoping Review

PHENOMENON

Despite the nearly universal presence of chief residents within U.S. and Canadian residency programs and their critical importance in graduate medical education, to our knowledge, a comprehensive synthesis of publications about chief residency does not exist. An understanding of the current state of the literature can be helpful to program leadership to make evidence-based improvements to the chief residency and for medical education researchers to recognize and fill gaps in the literature.

APPROACH

We performed a scoping review of the literature about chief residency. We searched OVID Medline, PsycINFO, ERIC, and Web of Science databases through January 2023 for publications about chief residency. We included publications addressing chief residency in ACGME specialties in the U.S. and Canada and only those using the term "chief resident" to refer to additional responsibilities beyond the typical residency training. We excluded publications using chief residents as a convenience sample. We performed a topic analysis to identify common topics among studies.

FINDINGS

We identified 2,064 publications. We performed title and abstract screening on 1,306 and full text review on 208, resulting in 146 included studies. Roughly half of the publications represented the specialties of Internal Medicine (n = 37, 25.3%) and Psychiatry (n = 30, 20.5%). Topic analysis revealed six major topics: (1) selection of chief residents (2) qualities of chief residents (3) training of chief residents (4) roles of chief residents (5) benefits/challenges of chief residency (6) outcomes after chief residency.

INSIGHTS

After reviewing our topic analysis, we identified three key areas warranting increased attention with opportunity for future study: (1) addressing equity and bias in chief resident selection (2) establishment of structured expectations, mentorship, and training of chief residents and (3) increased attention to chief resident experience and career development, including potential downsides of the role.

Issues in enhancing continuing professional development for midwives in clinical practice in Mongolia

Midwives are professionals who fulfill maternal and child health needs. In Mongolia, midwives were unable to transfer their knowledge and skills to the next generation midwives last few decades. The details of their experiences and the comprehensive aspects of continuing professional development (CPD) are still unclear. This study aimed to assess the current status of midwives in clinical practice through an online symposium. Relevant information was collected from presentations, question-and-answer sessions, and questionnaires. It was found that CPD has unclear training plans, no specialized training, and with them having little experience with CPD. Newly graduated midwives do not have an educational program. As of the current status, midwifery services are not provided at the clinical site in the scope of midwifery job descriptions. This study also discusses the situation of low status and salary in midwifery. Strengthening the system of midwifery CPD like development of the educational program is needed.

Scoping of advanced clinical practitioner role implementation using national job advertisements: Document analysis

AIM

The aim of this study is to profile the contemporary advanced clinical practitioner (ACP) role through standardized document sets.

DESIGN

Documentary analysis of job descriptions (JDs), person specification and advertisements.

DATA SOURCES

England based jobs advertised on NHS jobs website from 22 January to 21 April 2021.

RESULTS

A toatal of 143 trainee and qualified ACP roles were identified. A wide range of sectors and specialities were represented from across all English regions. The most common roles were urgent care, emergency medicine and primary care. Most qualified roles were agenda for change band 8A, although this did vary across specialities. Many roles were restricted to a small number of professions, notably nursing, physiotherapy and paramedic. Inconsistent role titles were noted. A lack of understanding of regulation across different professions was noted.

CONCLUSION

The ACP role has become an accepted across healthcare providers in England. Implementation remains varied across specialities and organizations. Eligibility criteria may relate to professional bias.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

ACP roles are expanding but this may be at the detriment to advanced nursing posts. Inconsistency in role eligibility suggests some professional bias exists.

IMPACT

This was scoping of ACP roles across England using job advertisements. ACP roles are common across sectors and specialities but eligibility varies. The research will have impact on those looking to recruit to ACP roles as well as those refining JDs.

REPORTING METHOD

No EQUATOR guideline exists for document analysis.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution. The research relates to organizational human resource information only.

The work of managing a chronic illness: A job description

RATIONALE

Self-management of a chronic illness is a struggle for many patients. There is substantial evidence that patients are not as successful as they and their providers would like. Considering patient self-management through an innovative and diverse lens could help patients, providers and the health care system to consider novel changes to improve success.

AIMS AND OBJECTIVES

To provide a complete view of patient work by utilizing the human resources management practice of job analysis to develop an initial job description for patients suffering from chronic illness.

METHODS

Study design was descriptive qualitative with analysis aiming to identify those reoccurring ideas from the data. Thirty patients, with at least one chronic illness, in three focus groups were assembled for this study. Verbatim recordings and notes were used to categorize the data provided. Five coders analyzed the data independently, and jointly met to discuss the themes identified. Demographic data was collected via surveys.

RESULTS

Patients with chronic illness engage in five primary 'job' duties including self-care (actions taken to effectively manage physical and psychological symptoms), managing relationships (effective management of relationships with employers, family, friends and providers to ensure the best outcomes), managing resources (understanding and managing finances, health and prescription medication insurance), coordination (managing and scheduling visits to providers) and research/education (gathering information and conducting research relative to all aspects of managing one's illness). Relevant knowledge, skills, abilities (KSAs) and other resources were identified that are necessary for patients to effectively perform the five job duties.

CONCLUSIONS

Creating a job description for the 'job' of patient is a crucial step in understanding the work chronically ill patients undertake. Knowing the duties, their associated tasks and KSAs, and resources required to perform those tasks enables patients and their providers and advocates to better identify ways to assist, relieve and encourage these patients in order to maximize patient success.

Physical work exposure matrix for use in the UK Biobank

BACKGROUND

UK Biobank (UKB) is a large prospective cohort capturing numerous health outcomes, but limited occupational information (job title, self-reported manual work and occupational walking/standing).

AIMS

To create and evaluate validity of a linkage between UKB and a job exposure matrix for physical work exposures based on the US Occupational Information Network (O*NET) database.

METHODS

Job titles and UK Standard Occupational Classification (SOC) codes were collected during UKB baseline assessment visits. Using existing crosswalks, UK SOC codes were mapped to US SOC codes allowing linkage to O*NET variables capturing numerous dimensions of physical work. Job titles with the highest O*NET scores were assessed to evaluate face validity. Spearman's correlation coefficients were calculated to compare O*NET scores to self-reported UKB measures.

RESULTS

Among 324 114 participants reporting job titles, 323 936 were linked to O*NET. Expected relationships between scores and self-reported measures were observed. For static strength (0-7 scale), the median O*NET score was 1.0 (e.g. audiologists), with a highest score of 4.88 for stone masons and a positive correlation with self-reported heavy manual work (Spearman's coefficient = 0.50). For time spent standing (1-5 scale), the median O*NET score was 2.72 with a highest score of 5 for cooks and a positive correlation with self-reported occupational walking/standing (Spearman's coefficient = 0.56).

CONCLUSIONS

While most jobs were not physically demanding, a wide range of physical work values were assigned to a diverse set of jobs. This novel linkage of a job exposure matrix to UKB provides a potentially valuable tool for understanding relationships between occupational exposures and disease.

Diagnosing occupational COVID-19 in Croatian healthcare workers

Coronavirus disease 2019 (COVID-19) can be diagnosed as occupational disease by an occupational health physician (OHP), if supported by relevant work-related and medical documentation. The aim of this study was to analyse such documentation submitted by Croatian healthcare workers (HCWs) and discuss its relevance in view of European and Croatian guidelines. The study included 100 Croatian HCWs who were SARS-CoV-2-positive and requested that their infection be diagnosed as occupational disease by their OHPs from 1 May 2020 to 10 March 2021. As participants they were asked to fill out our online Occupational COVID-19 in Healthcare Workers Questionnaire. For the purpose of this study we analysed answers about the type of close contact at the workplace, COVID-19 symptoms, and enclosed work-related (job description, employer statement about exposure to SARS-CoV-2) and medical documentation (positive SARS-CoV-2 polymerase chain reaction test and patient history confirming the diagnosis of COVID-19). Most participants were working in hospitals (N=95), mostly nurses (N=75), who became infected by a patient (N=68) or colleague (N=31), and had at least one COVID-19 symptom (N=87). Eighty participants did not enclose obligatory documents, 41 of whom failed to submit job description and 31 both job description and employer statement. These findings confirm that the major risk of occupational COVID-19 in HCWs is close contact with patients and colleagues, and points out the need for better cooperation between OHPs, occupational safety experts, employers, and diseased workers.

Needs assessment of the public health curriculum based on the first-level health services package in Isfahan University of Medical Sciences

INTRODUCTION

After graduation, public health students should be able to work as health care givers providing first-level health care services. Therefore, the educational objectives of public health bachelor's programs should ensure that they acquire the capabilities necessary for this purpose. This study identified the educational objectives that are essential for these students and compared them with the current curriculum in Isfahan, Iran.

METHODS

This needs assessment study was conducted in two phases. In the first phase, the essential educational objectives were identified using a qualitative approach, which involved eight focus group discussions held by a group consisting of experts of the public health headquarters and public health network administration offices of Isfahan province and the public health graduates working in the province's comprehensive health service centers, who were chosen using the purposive sampling method (n = 59). In the second phase, a comparative study was performed by turning the list of essential educational objectives into a checklist and using it to compare these objectives with the objectives in the current course plan in the examined curriculum. In the end, a list of educational objectives not included in the current curriculum of the public health bachelor's program was created.

RESULTS

The focus group discussions produced 433 educational objectives in the cognitive domain, 79 objectives in the affective domain, and 179 objectives in the psychomotor domain, which were arranged in eight competency categories. Comparison of the essential educational objectives with the current curriculum showed that the current curriculum does not cover any of the essential objectives regarding care for the age groups of 18-29 and 30-59 and the first aid and only partially covers essential objectives in other competency categories.

CONCLUSION

This study found that considering the requirements of first-level health services and the tasks expected from public health graduates to be providing these services, the current curriculum does not cover all essential learning objectives and should be revised to meet additional essential educational objectives.

The professional activities of nurse managers in Chinese hospitals: A cross-sectional survey in hunan province

OBJECTIVE

To explore nurse managers' perceptions of the frequency and importance of professional activities performed in their daily work in public hospitals in Hunan, China.

BACKGROUND

Nurse managers are responsible for the management of almost all nursing activities in Chinese hospitals. Understanding how nurse managers operationalize their role and their perceptions of the importance of each activity is essential for clarification of their role and the competencies required to perform it.

METHODS

A cross-sectional questionnaire survey.

RESULTS

A total of 1,371 nurse managers in Hunan Province completed the survey. Nursing quality/safety management and patient management were performed most frequently and perceived as most important. Nurse managers performed nursing information management frequently while perceiving it as less important. They seldom performed nursing research management and placed low value on it.

CONCLUSIONS

Patient-centred care remains central to nursing management. Nursing managers can create a leadership culture in their hospital settings that includes the effective management of information and facilitation of research knowledge to benefit nurse managers, staff and patients.

IMPLICATIONS FOR NURSING MANAGEMENT

The results provide evidence for standardization of roles and job descriptions of nurse managers and for developing their knowledge and skills to ensure quality patient care.

Construction glass and glazing job description: a qualitative case study

Construction workers regularly experience heavy workloads and various physical stressors that can result in work-related musculoskeletal disorders (WRMSDs). According to the Bureau of Labor Statistics, construction glass and glazing (CGG) workers had a higher rate of injuries and illnesses than the national average for all occupations. In 2010, CGG contractors presented the highest rate of back injuries reported by the Center for Construction Research and Training. This study aimed to develop a detailed job description that includes the CGG definition, tasks, activities and work conditions. A qualitative case study was conducted, and data were collected through CGG workers' interviews and observations. This information is not currently available in government publications, published research or job training materials for CGG workers and contractors. The results of this study can help facilitate the ergonomics analysis in future studies to eliminate or reduce the risk of WRMSDs in CGG work.

A Profile of Point of Care Coordinators: Roles, Responsibilities and Attitudes

BACKGROUND

Point of care (POC) testing is rapidly evolving. POC testing is often managed by POC coordinators (POCC), but this role is relatively new and has not been characterized.

OBJECTIVES

To characterize the background, responsibilities, and job satisfaction of POCCs.

METHODS

Structured interviews were conducted with 15 POCCs. On the basis of these interviews, a 38-item questionnaire was developed and administered as a web-based survey.

RESULTS

The respondents (N = 98) were mostly female (87%) and had a bachelor's degree (79%). About half the respondents were older than 55 years and were in supervisory positions. Overall, respondents indicated high job satisfaction, but women were significantly less satisfied than men. POCCs were infrequently involved in decisions regarding the implementation of new tests. The number of tests managed by each POCC varied widely (median, 6.0; range, 1-30).

CONCLUSIONS

The POCC role is in flux. There is consensus regarding some aspects of the job, but there are significant differences in the way that hospitals organize the POCC function.

Is Burnout Infectious? Understanding Drivers of Burnout and Job Satisfaction Among Academic Infectious Diseases Physicians

Burnout is pervasive in academic medicine. We administered the Maslach Burnout Inventory and an Infectious Diseases (ID) job description survey to our ID faculty. Respondents’ burnout (>50%) and job satisfaction (>90%) were each high. Although burnout may be balanced by job satisfaction, the relationship between the 2 deserves further study.

Community intellectual disability nurses' public health roles in the United Kingdom: An exploratory documentary analysis

The aim of this study was to explore how public health policy in the United Kingdom was reflected in community intellectual disability nurses' (CIDNs)' job descriptions and person's specifications. The role of CIDNs has evolved due to policy changes. As these roles evolve, job descriptions and person specifications are important in highlighting employer's expectations staff, priorities, and professional values of their employees. This study involved an exploratory documentary analysis of n = 203 CIDNs' job descriptions and person specifications in the context of role theory. The CIDNs' public health roles identified in this study are health education, health protection, health prevention, health surveillance, and health promotion. Key policies themes were intellectual disability health access, public health strategies, policy evaluation/redesign, and public health policy. There is a lack of public health role clarity and inconsistency in role expectations across organizational boundaries in the United Kingdom.

The content of nurse unit managers' work: a descriptive study using daily activity diaries

BACKGROUND

NUMs' job description in Icelandic hospitals has been revised and now also includes managerial and financial responsibilities.

AIM

To describe the actual work activities of nurse unit managers (NUMs) in surgical and internal medicine services as self-documented and reflected in their job description.

DESIGN

Prospective exploratory study.

METHOD

The study's setting was the largest hospital in Iceland. Data were collected over 7 days from NUMs working on surgical and medical units with an activity diary listing five domains and 41 activities: 'management and planning' (seven activities), 'staff responsibility (seven activities), 'direct clinical work' (five activities), 'service' (12 activities) and 'other' (nine activities).

RESULTS

The managers' spent most of their time within the 'other' domain (32% of their time), then the next significant amount of time on 'management and planning' and 'clinical nursing' (19%), and the least amount of time on 'service' (14%). All reported working on two or more activities simultaneously. NUMs made erroneous estimations approximately half of the time about the domain they spent most of their time in and their satisfaction with their work each day varied greatly.

CONCLUSION

The work of NUMs is highly diverse, including undefined miscellaneous tasks and clinical work beyond their job description.

Time allocation and temporal focus in nursing management: an integrative review

AIM

To describe the time allocation and temporal focus in nursing management.

BACKGROUND

There is limited information about the time allocation and temporal focus of nursing management activities. The role of nurse administrators is changing, resulting in challenges related to time management.

METHODS

Published literature in 2005-2014 related to the time allocation or temporal focus of nurse administrators' management activities was retrieved from five databases, and an integrative review was conducted. Data extraction, quality assessment and quantitative content analysis were performed for eight reviewed articles.

RESULTS

Daily reactive management activities and administrative routines were dominant in the nurse administrators' work, and strategic, proactive activities were scarce. Their daily work was fragmented by a variety of activities and numerous interruptions.

CONCLUSION

Little information exists about time allocation or temporal focus in nurse administrators' management activities. Further research on this topic is needed. The evidence was fairly modest, although the studies' results were generally similar.

IMPLICATIONS FOR NURSING MANAGEMENT

These results can be used to clarify the job descriptions of nurse administrators and to plan and focus their education and training. Organisations need to use evidence to standardise the job descriptions of different levels of nurse managers and directors.

Sailing the "Seven C's" of Leadership

Nurses are increasingly being called upon to lead changes within health care. How do nurses and, in particular, school nurses become leaders? School nurses lead daily in their work but often do not recognize themselves as leaders. The "Five C's of Leadership"-character, commitment, connectedness, compassion, and confidence-identified by Kowalski and Yoder-Wise are foundational to the development of leadership and are particularly relevant to school nurses and their role. Two additional attributes found in the literature-courage and capacity-also undergird school nursing practice. In this article, we describe how school nurses already embody these leadership qualities. Each leadership attribute is reviewed in light of the literature, followed by specific examples to demonstrate how school nurses provide leadership. Through these illustrations, school nurses can recognize and embrace their present leadership abilities. In addition, by using the "Seven C's" of leadership, school nurses can enhance their inherent leadership abilities.

Developing a Job Description for a Vice Chair of Education in Radiology: The ADVICER Template

RATIONALE AND OBJECTIVES

The newly formed Alliance of Directors and Vice Chairs of Education in Radiology (ADVICER), a group within the Alliance for Clinician Educators in Radiology, identified an acute need for a generic job description template for Vice Chairs of Education in Radiology, a role that is being developed in many academic Departments of Radiology. Eighty-three percent of current members who responded to a survey had no detailed job description, and over half had no job description at all. Having a comprehensive and detailed job description is vital to developing this key position.

MATERIALS AND METHODS

Using the results of a survey sent to ADVICER members and seven Education Vice Chair job descriptions provided by members, the authors developed a detailed job description encompassing all potential elements of this position.

RESULTS

Only 17% of survey respondents had a detailed job description. The role of an Education Vice Chair varies significantly between institutions in its scope and level of responsibilities. The resultant generic job description that was devised is intended to provide a template that would be modified by the candidate or the Department Chair. It is unlikely that any one individual would perform all the described activities.

CONCLUSIONS

ADVICER has developed a comprehensive, flexible job description for Vice Chair of Education in Radiology that can be adapted by institutions as appropriate. It can be downloaded from http://aur.org/ADVICER/.

Job Profiles of Biomedical Informatics Graduates. Results of a Graduate Survey

BACKGROUND

Biomedical informatics programs exist in many countries. Some analyses of the skills needed and of recommendations for curricular content for such programs have been published. However, not much is known of the job profiles and job careers of their graduates.

OBJECTIVES

To analyse the job profiles and job careers of 175 graduates of the biomedical informatics bachelor and master program of the Tyrolean university UMIT.

METHODS

Survey of all biomedical informatics students who graduated from UMIT between 2001 and 2013.

RESULTS

Information is available for 170 graduates. Eight percent of graduates are male. Of all bachelor graduates, 86% started a master program. Of all master graduates, 36% started a PhD. The job profiles are quite diverse: at the time of the survey, 35% of all master graduates worked in the health IT industry, 24% at research institutions, 9% in hospitals, 9% as medical doctors, 17% as informaticians outside the health care sector, and 6% in other areas. Overall, 68% of the graduates are working as biomedical informaticians. The results of the survey indicate a good job situation for the graduates.

CONCLUSIONS

The job opportunities for biomedical informaticians who graduated with a bachelor or master degree from UMIT seem to be quite good. The majority of graduates are working as biomedical informaticians. A larger number of comparable surveys of graduates from other biomedical informatics programs would help to enhance our knowledge about careers in biomedical informatics.

Nursing Care in Alcohol and Drug User Treatment Facilities

Registered and advanced practice nurses are employed in substance user treatment facilities across the US and in most industrialized countries. Patterns of employment and job descriptions for nurses, however, are highly inconsistent and seriously flawed. Many regulatory system, legislative and government agency factors and to some degree, the nursing profession itself, sustain the flaws and limit the delivery of comprehensive care. Competencies linked to addictions nursing best practices are often underutilized because of narrow job descriptions. This results in limited health and nursing service delivery to vulnerable populations receiving treatment in these government funded programs. This article highlights the increasing demand for the delivery of integrated care to psychiatric and substance using populations. The author considers factors which stake holders can influence to change flawed employment patterns and limited access to comprehensive care for substance users.

Development of a standardized job description for healthcare managers of metabolic syndrome management programs in Korean community health centers

PURPOSE

This study aimed to develop a job description for healthcare managers of metabolic syndrome management programs using task analysis.

METHODS

Exploratory research was performed by using the Developing a Curriculum method, the Intervention Wheel model, and focus group discussions. Subsequently, we conducted a survey of 215 healthcare workers from 25 community health centers to verify that the job description we created was accurate.

RESULTS

We defined the role of healthcare managers. Next, we elucidated the tasks of healthcare managers and performed needs analysis to examine the frequency, importance, and difficulty of each of their duties. Finally, we verified that our job description was accurate. Based on the 8 duties, 30 tasks, and 44 task elements assigned to healthcare managers, we found that the healthcare managers functioned both as team coordinators responsible for providing multidisciplinary health services and nurse specialists providing health promotion services. In terms of importance and difficulty of tasks performed by the healthcare managers, which were measured using a determinant coefficient, the highest-ranked task was planning social marketing (15.4), while the lowest-ranked task was managing human resources (9.9).

CONCLUSION

A job description for healthcare managers may provide basic data essential for the development of a job training program for healthcare managers working in community health promotion programs.

Leading by design

Leaders have the responsibility to develop leadership in their departmental members. Leadership capacity is needed so that health information professionals will be able to successfully respond to the constant changes in the healthcare environment. This article demonstrates how leadership can be modeled and developed through the redesign of jobs in departments of health information services.

Job analysis of standardized patient trainer

PURPOSE

Although standardized patients (SPs) have been used widely in medical education, there has been little research on SP trainers. The purpose of this study was to examine the roles SP trainers by establishing their job description and assessing the importance, frequency, and difficulty of each task element.

METHODS

SP trainers' responsibilities were defined and their job descriptions were developed based on a focus group interview (FGI) of 6 panels. The validity of the duties, tasks, and task elements that were elicited from the FGI was examined by the 6 panels and a medical school professor. The data were collected using a questionnaire survey from 24 SP trainers in April 2011. The questionnaire pertained to the importance, frequency, and difficulty of the duties, tasks, and task elements that were identified in SP trainers' job descriptions.

RESULTS

The job description of SP trainers consisted of 10 duties, 25 tasks, and 76 task elements. The average level of importance of the 10 duties was 4.29; "SP training" was identified as the most important duty (4.79+/-0.41). Of the 76 task elements, "providing training regarding the scoring criteria and standardizing the scoring system" had the highest levels of importance and frequency (4.83+/-0.48, 4.08+/-1.06). "Standardizing the acting abilities of SPs" was the most difficult task element (4.50+/-0.66).

CONCLUSION

By analyzing the job description of SP trainers, this study is expected to help define the roles of SP trainers and facilitate their deployment.

Office support staff

The pace at which we live and practice in this new century leaves little time to manage many of the menial tasks of day-to-day survival. This is especially true in the field of medicine. With today's insurance policies and procedures, Health Information Privacy Protection Act (HIPPA) regulations, and the low return of payment for time invested, it is crucial to have a supportive group of people around you to help make your valuable time as meaningful as possible. This article will describe an arrangement of ancillary office staff for a colorectal practice. There will be detailed information on job descriptions, expectations, and level of training required for each. Upon completion of this article, one should be able to identify the personnel needed to establish and manage an efficient office from the front desk to the billing department and ultimately the practice manager.