The Impact of Multisource Feedback on Continuing Medical Education, Clinical Performance and Patient Experience: Innovation in a Child and Adolescent Mental Health Service.

This paper reiterates the importance of the role of multisource feedback (MSF) in continuing medical education/continuing professional development (CME/CPD) and its impact on doctors' performance and patient experience globally. It summarises a unique initiative of robust utilisation of internationally recognised multisource feedback tools in an outpatient child and adolescent mental health service (CAMHS) in Qatar. The process involved the effective adoption and administering of the General Medical Council's (GMC) self-assessment questionnaire (SQ), patient questionnaire (PQ), and colleague questionnaire (CQ) followed by the successful incorporation of these tools in CME/CPD. The original version of the PQ questionnaire and the instructions to the patient document were translated into Arabic through the blind back-translation technique. This initiative of introducing gold-standard MSF tools and processes into clinical practice, among other quality-improvement projects, has contributed to the improvement of service standards and doctors' clinical practice. Patient satisfaction was measured through the annual patient experience analysis using the Experience of Service Questionnaire (ESQ) whereas changes in doctors' performance were evaluated by comparing annual appraisal scores before and after implementation of this initiative. We have demonstrated that when MSF is obtained impartially and transparently using recognised and valid tools, it can improve patient experience and enhance doctors' performance.

Coping strategies, optimism, and resilience factors associated with mental health outcomes among medical residents exposed to coronavirus disease 2019 in Qatar.

OBJECTIVE: The aim of this study is to examine the association between coping strategies, resilience, optimism and different mental health outcomes like stress, anxiety, and depression among the medical residents' during the COVID-19 pandemic, with consideration of different factors like seniority, frontliner, gender, and coping style. METHODS: An electronic survey was sent to all medical residents in Qatar. Depression, anxiety, and stress were assessed by the DASS-21. Professional quality of life was measured by the ProQOL scale. The coping mechanisms were assessed with the Brief-COPE, and resilience was measured by the Brief Resilience Scale. RESULTS: The most commonly used coping strategies were acceptance, religion, and active coping. The avoidant coping style scores were higher among junior residents (p = .032) and non-COVID-19 frontliners (p = .039). Optimism LOT-R score was higher in senior than in junior residents (p < .001). Lower avoidant coping scores, higher optimism, and higher resilience were associated with lower stress, anxiety, and depressive symptoms. CONCLUSION: It seems that avoidant coping styles can exacerbate depressive, anxiety, and stress symptoms in medical residents amidst the COVID-19 pandemic. Strategies promoting optimism, resilience, and approach coping styles can decrease the mental health burden of the pandemic on medical residents.

Factors associated with mental health outcomes among medical residents exposed to COVID-19.

BACKGROUND: The COVID-19 outbreak has caused challenges for healthcare systems worldwide. Recent data indicates that the psychological impact has differed with respect to occupation. In many countries, medical residents have been on the front line of this pandemic. However, data on the psychological impact of infectious disease outbreaks, and COVID-19 in particular, on medical residents are relatively lacking. AIMS: The aim of our study was to assess the psychological impact of the COVID-19 pandemic on medical residents working on the front and second line. METHOD: An electronic survey was sent to all medical residents in Qatar. Depression, anxiety and stress were assessed by the Depression, Anxiety and Stress Scale - 21 Items. Professional quality of life was measured by the Professional Quality of Life measure. RESULTS: Of the 640 medical residents contacted, 127 (20%) responded. A considerable proportion of residents reported symptoms of depression (42.5%), anxiety (41.7%) and stress (30.7%). Multivariate analysis of variance showed significant effects of seniority in residency, with junior residents having poorer outcomes. In addition, there was a statistically significant interaction effect with moderate effect sizes between gender and working on the front line, as well as gender, working on the front line and seniority, on mental health outcomes. CONCLUSIONS: The COVID-19 pandemic may have a negative impact on junior residents' mental health. Preventive measures to reduce stress levels and easy access to professional mental health services are crucial.

p27 Kip1 expression is reduced in pancreatic carcinoma but has limited prognostic value.

p27(Kip1) is a cyclin-dependent kinase inhibitor whose loss in malignant tumors is associated with disease progression and an unfavorable clinical outcome. There is limited information about its expression in pancreatic carcinomas. In a previous Japanese study, p27(Kip1) loss was a powerful negative prognostic factor. In the present study, we assessed the expression of p27(Kip1) in resected pancreatic ductal adenocarcinomas from 46 European patients and in associated lymph node metastases from 13 patients, using a standard avidin-biotin peroxidase complex immunohistochemical method. We also analyzed the relationships among p27(Kip1) expression, pathologic features, and clinical outcome. The extent of p27(Kip1) expression (ie, the percentage of cells expressing p27(Kip1)) was lower in carcinomas than in nonneoplastic ductal epithelia. Carcinomas with <5% p27(Kip1) expression were more likely to be poorly or moderately differentiated than well differentiated (P =.022). p27(Kip1) expression did not correlate with patient gender, tumor maximum dimension, T classification, lymph node metastasis, or International Union Against Cancer stage. No significant difference was seen between the extent of p27(Kip1) expression in lymph node metastases and their corresponding primary tumors. Univariate survival analysis showed that an increased risk of death was associated with 2 established prognostic factors: tumor size >5 cm (P =.011) and incomplete surgical excision (P =.016). Trends toward worse survival for patients whose primary tumors had <4% p27(Kip1) expression (P =.060) and for patients whose lymph node metastases had <5% p27(Kip1) expression (P =.054) were seen, but multivariate analysis suggested that p27(Kip1) expression was not independently prognostic. The findings raise the possibility that abnormalities of p27(Kip1) play a role in the pathogenesis of pancreatic ductal adenocarcinoma. However, the extent of p27(Kip1) expression in lymph node metastases and primary tumors is similar. Also, reduced p27(Kip1) expression has limited prognostic value, at least in European patients.