Burnout among hospital staff during the COVID-19 pandemic: Longitudinal results from the international Cope-Corona survey study.

OBJECTIVE: Long-term changes in burnout and its predictors in hospital staff during the COVID-19 pandemic were investigated in an international study. METHODS: Two online surveys were distributed to hospital staff in seven countries (Germany, Andorra, Ireland, Spain, Italy, Romania, Iran) between May and October 2020 (T1) and between February and April 2021 (T2), using the following variables: Burnout (emotional exhaustion and depersonalization), job function, age, gender, and contact with COVID-19 patients; individual resources (self-compassion, sense of coherence, social support) and work-related resources and demands (support at the workplace, risk perception, health and safety at the workplace, altruistic acceptance of risk). Data were analyzed using linear mixed models repeated measures, controlled for age. RESULTS: A total of 612 respondents were included (76% women). We found an increase in burnout from T1 to T2. Burnout was high among personnel with high contact with COVID-19 patients. Individual factors (self-compassion, sense of coherence) and work-related factors (support at the workplace, risk perception, health and safety at the workplace) showed associations with burnout. Low health and safety at the workplace at T1 was associated with an increase in emotional exhaustion at T2. Men showed an increase in depersonalization if they had much contact with COVID-19 patients. CONCLUSION: Burnout represents a potential problematic consequence of occupational contact with COVID-19 patients. Special attention should be paid to this group in organizational health management. Self-compassion, sense of coherence, support at the workplace, risk perception, and health and safety at the workplace may be important starting points for interventions. REGISTRATION: Müller, M. M. (2020, August 30). Cope-Corona: Identifying and strengthening personal resources of hospital staff to cope with the Corona pandemic. Open Science Foundation.

Gender Matters: Understanding Transitions in Surgical Education.

Introduction: Diverse transitions are elemental to medical career trajectories. The effective navigation of such transitions influences a sense of belonging and wellbeing, positive relationships, and good engagement and attainment within new contexts. Using Multiple and Multidimensional Transitions (MMT) theory as an analytical lens, this paper aims to answer the research question: "What gendered transitions do female surgeons experience, and how do these gendered transitions impact them?" Methods: We conducted a qualitative study drawing on narrative inquiry, with face-to-face and online semi-structured interviews with 29 female surgeons across nine surgical specialities in Ireland and Scotland. This paper is part of a larger study including male surgeons, other colleagues and patients of female surgeons. The female surgeons in this paper were purposively sampled using maximum variation sampling across several levels (consultants, trainees and middle-grade doctors), as well as six who had transitioned out of surgery. Framework analysis was employed to interrogate the interview data. Results: Five overarching types of transitions were identified across surgical education but only three of these transitions-work, culture and health-were primarily experienced by female surgeons (not male surgeons so were considered gendered), thereby impacting social, academic, and psychological domains. The remaining two types of transition-education and geography-were seemingly experienced equally by female and male surgeons, so are beyond the scope of this paper focused on female surgeons' gendered experiences. Conclusion: This novel qualitative study drawing on MMT theory illustrates how multiple gendered transitions interact and impact female surgeons across the surgical education continuum. Aligned with MMT theory, family members and others are also purportedly affected by female surgeons' transitions. Healthcare educators, leaders and policymakers need to better understand gendered transitions and their impacts to improve support for female surgical trainees on their educational journeys.

Experiencing racism within medical school curriculum: 2020 ICCH student symposium.

OBJECTIVE: To explore student experiences relating to racism, microaggressions and implicit bias within healthcare communication and medical education in the wake of the Black Lives Matter movement METHODS: Students and faculty from different racial/ethnic backgrounds, medical schools, countries, and levels of training shared their perspectives with a multi-disciplinary, international audience at the 2020 International Conference on Communication in Healthcare (ICCH). RESULTS: We highlight experiences shared at the symposium and demonstrate how the student voice can help shape the medical school curriculum. 3 main themes are discussed: 1) Institutional bias and racism, 2) Racial discrimination during medical training and 3) Recommendations for curricula change. CONCLUSION: Racism influences many aspects of student experiences and often appears in covert and institutional forms. These shared experiences reflect a common problem faced by ethnic minority medical students. PRACTICE IMPLICATIONS: Student experiences provide thoughtful recommendations for educators regarding incorporating anti-racism teaching into their curricula. It is essential that this teaching is collaborative, non-tokenistic and implemented early in the syllabus. It is beneficial for educators to build on the various existing approaches demonstrated by other institutions.

Postgraduate training in Cancer Genetics-a cross-specialty survey exploring experience of clinicians in Ireland.

BACKGROUND: As genomic profiling of constitutional and tumour-derived DNA becomes increasingly critical in cancer risk estimation, prognostication and treatment, there is a growing need for clinicians involved in cancer care to up-skill in Cancer Genetics. In the Republic of Ireland (ROI), this is particularly crucial, given a paucity of vocationally trained Clinical Geneticists per capita compared to other European countries. AIMS: We aimed to assess the self-reported confidence of postgraduate medical/surgical trainees in ROI in requesting, interpreting, and managing genomic data in patients with cancer, and to assess their selfreported experience, and demand for future training in this area. METHODS: A cross-sectional survey of postgraduate trainees in four specialties (Medical and Radiation Oncology, Surgery, and Obstetrics and Gynaecology (O&G)), training in ROI, was undertaken. A bespoke electronic questionnaire was designed to capture data regarding preceding experience, and confidence across several hypothetical clinical scenarios involving genomic testing. The survey was circulated to eligible participants by training programme administrators, after relevant institutional ethical approval. Data was collected anonymously. RESULTS: The study cohort included 62 respondents. A paucity of cancer genetics training at every level was demonstrated, with "hardly any" or "none at all" reported by 47(76%), 62(100%), and 50(81%) during undergraduate, core specialty, and higher specialist training, respectively. A relative lack of confidence in all clinical scenarios was apparent, particularly among Surgery/O&G trainees. Most respondents would value more training in Cancer Genetics. CONCLUSIONS: This study demonstrates an unmet need in dedicated Cancer Genetics training for postgraduate specialty trainees in ROI.

Doctor Retention in Ireland - Where Are the Failings That Prolong the Problem? Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle".

The issue of doctor retention has been a challenge in Ireland for many years. Poor working conditions including poor supervision, cost of training, bullying, worsening mentoring experiences and speciality specific issues are a substantial challenge faced by doctors in Ireland, thus leading to a higher degree of emigration. While some changes have been introduced to the system and have some positive effects, the root causes of doctor emigration have not been addressed. This commentary reviews the publication by Brugha et al published in the IJHPM in April 2020 on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle" and explains why the current system needs to change for the benefit of patient safety, doctor well-being and better patient care. Ireland's Health Service Executive intends to take steps towards developing a new model of medical workforce to address the issue of recruitment and retention challenges within the healthcare system.

The development of a framework of entrustable professional activities for the intern year in Ireland.

BACKGROUND: Entrustable Professional Activities (EPAs) are units of professional practice that capture essential competencies in which trainees must become proficient before undertaking them independently. EPAs provide supervisors with a solid justification for delegating an activity to trainees. This study aimed to develop and ensure face validity of a set of EPAs for junior doctors in the first year of clinical practice in the Republic of Ireland. METHODS: An iterative eight stage consensus building process was used to develop the set of EPAs. This process was based on international best practice recommendations for EPA development. A series of surveys and workshops with stakeholders was used to develop a framework of EPAs and associated competencies. An external stakeholder consultation survey was then conducted by the Irish Medical Council. The framework of EPAs was then benchmarked against the 13 core EPAs developed by the Association of American Medical Colleges (AAMC). RESULTS: A framework of seven EPAs, and associated competencies resulted from this study. These EPAs address all core activities that junior doctors should be readily entrusted with at the end of the intern year, which is the first year of clinical practice in the Republic of Ireland. Each EPA contains a series of defined competencies. The final EPAs were found to be comparable to the AAMC core EPAs for entering residency. CONCLUSIONS: A framework of EPAs for interns in Ireland that are appropriate for the intern year has been developed by key stakeholders. The implementation of the EPAs in practice is the next step, and is likely to result in an improved intern training process and increased patient safety.

Evaluation of medical student retention of clinical skills following simulation training.

BACKGROUND: Adequate clinical skills training is a challenge for present day medical education. Simulation Based Education (SBE) is playing an increasingly important role in healthcare education worldwide to teach invasive procedures. The impact of this teaching on students along with retention of what is taught is not fully understood. The purpose of this study was to evaluate the retention levels of practical skills taught and assessed by SBE and to explore the degree of re-training required to restore decayed performance. In exploring this aim, the study further investigates how skilled performance decays over time and which dimensions of clinical skills were more likely to decay. METHODS: Study participants were 51 final year medical students. They were provided with online pre-course videos and procedural guides asynchronously with repeatedly access. 7 of the skills taught over 2 years using task trainers were selected. Following demonstration from faculty, students practiced in small groups with faculty facilitated supervision and peer support prior to formal testing. Score sheets with itemised procedure checklists detailing the minimum passing standard (MPS) for each skill were designed. To test retention of skills, 18 months later, there was an unannounced test to demonstrate proficiency in the skills. Students were asked to complete a questionnaire indicating how many times and where they had practiced or performed the skills. RESULTS: 55% of the students were deficient in 3 or more skills and 4% were not competent in 5 or more skills. A significant number of students had never practiced some skills following the initial teaching session. A relationship was noted with the number of times students self-declared that they had practiced and their performance. Decay is evident in both psychomotor and cognitive domains of the skills. CONCLUSION: A curriculum with deliberate practice significantly increases the competence of students in defined clinical skills. Deliberate practice of clinical skills, under supervision of an engaged instructor, is a key component of the mastery model. Experiences and assessments in the clinical setting need to be augmented with focus on direct observation and focused feedback to reinforce the skills acquired in the simulated setting.

Tricks of the trade: time management tips for newly qualified doctors.

BACKGROUND: The transition from medical student to doctor is an important milestone. The discovery that their time is no longer their own and that the demands of their job are greater than the time they have available is extremely challenging. METHODS: At a recent surgical boot camp training programme, 60 first-year surgical trainees who had just completed their internship were invited to reflect on the lessons learnt regarding effective time management and to recommend tips for their newly qualified colleagues. They were asked to identify clinical duties that were considered urgent and important using the time management matrix and the common time traps encountered by newly qualified doctors. RESULTS: The surgical trainees identified several practical tips that ranged from writing a priority list to working on relationships within the team. These tips are generic and so applicable to all newly qualified medial doctors. POTENTIAL IMPLICATION: We hope that awareness of these tips from the outset as against learning them through experience will greatly assist newly qualified doctors.

A longitudinal and multicentre study of burnout and error in Irish junior doctors.

BACKGROUND: Junior doctors have been found to suffer from high levels of burnout. AIMS: To measure burnout in a population of junior doctors in Ireland and identify if: levels of burnout are similar to US medical residents; there is a change in the pattern of burnout during the first year of postgraduate clinical practice; and burnout is associated with self-reported error. METHODS: The Maslach Burnout Inventory-Human Services Survey was distributed to Irish junior doctors from five training networks in the last quarter of 2015 when they were approximately 4 months into their first year of clinical practice (time 1), and again 6 months later (time 2). The survey assessed burnout and whether they had made a medical error that had 'played on (their) mind'. RESULTS: A total of 172 respondents out of 601 (28.6%) completed the questionnaire on both occasions. Irish junior doctors at time 2 were more burned out than a sample of US medical residents (72.6% and 60.3% burned out, respectively; p=0.001). There was a significant increase in emotional exhaustion from time 1 to time 2 (p=0.007). The association between burnout and error was significant at time 2 only (p=0.03). At time 2, of those respondents who were burned out, 81/122 (66.4%) reported making an error. A total of 22/46 (47.8%) of the junior doctors who were not burned out at time 2 reported an error. CONCLUSION: Current levels of burnout are unsustainable and place the health of both junior doctors and their patients at risk.

A mixed-methods study of the causes and impact of poor teamwork between junior doctors and nurses.

OBJECTIVES: This study aimed to collect and analyse examples of poor teamwork between junior doctors and nurses; identify the teamwork failures contributing to poor team function; and ascertain if particular teamwork failures are associated with higher levels of risk to patients. DESIGN: Critical Incident Technique interviews were carried out with junior doctors and nurses. SETTING: Two teaching hospitals in the Republic of Ireland. PARTICIPANTS: Junior doctors (n = 28) and nurses (n = 8) provided descriptions of scenarios of poor teamwork. The interviews were coded against a theoretical framework of healthcare team function by three psychologists and were also rated for risk to patients by four doctors and three nurses. RESULTS: A total of 33 of the scenarios met the inclusion criteria for analysis. A total of 63.6% (21/33) of the scenarios were attributed to 'poor quality of collaboration', 42.4% (14/33) to 'poor leadership' and 48.5% (16/33) to a 'lack of coordination'. A total of 16 scenarios were classified as high risk and 17 scenarios were classified as medium risk. Significantly more of the high-risk scenarios were associated with a 'lack of a shared mental model' (62.5%, 10/16) and 'poor communication' (50.0%, 8/16) than the medium-risk scenarios (17.6%, 3/17 and 11.8%, 2/17, respectively). CONCLUSION: Poor teamwork between junior doctors and nurses is common and places patients at considerable risk. Addressing this problem requires a well-designed complex intervention to develop the team skills of doctors and nurses and foster a clinical environment in which teamwork is supported.

A mixed-methods investigation of health professionals' perceptions of a physiological track and trigger system.

BACKGROUND: Physiological track and trigger systems (PTTSs) regulate the monitoring of patients' vital signs and facilitate the detection and treatment of deteriorating patients. These systems are widely used, although compliance with protocol is often poor. OBJECTIVE: This study aimed to examine the perceptions of a national PTTS among nurses and doctors and to identify the variables that impact on intention to comply with protocol. METHODS: A mixed-methods research design was employed. During the initial qualitative phase, 30 hospital-based nurses and doctors participated in a series of semistructured interviews. During the subsequent quantitative phase, 215 nurses and doctors (24.1% response rate) responded to a questionnaire designed to assess attitudes towards the PTTS and factors that influence adherence to protocol. RESULTS: Interview data revealed largely positive attitudes towards the PTTS but highlighted a number of barriers to its implementation and indicated that it is sometimes a source of tension between doctors and nurses. Quantitative data confirmed the validity of these findings, although nurses appeared to have more positive attitudes towards, and to perceive fewer barriers to, the usage of PTTS than were reported by the participating doctors. CONCLUSIONS: These findings reveal that non-compliance with PTTS protocol is unlikely to be attributable to negative perceptions of PTTSs. Instead, there are a number of barriers to the implementation of the system. These findings suggest that interprofessional training in PTTSs is essential while increased support for PTTS implementation among senior doctors would also yield improved adherence to protocol.

Impact of working 48 h per week on opportunities for training and patient contact: the experience of Irish interns.

OBJECTIVE: The European Working Time Regulations (EWTR) have been criticized for its purported negative impact on the training of junior doctors. The aim of this study was to examine the amount of time interns spent engaging in various work activities. DESIGN: An online time-use diary was used to collect data from interns. SETTING: Two teaching hospitals in the Republic of Ireland. PARTICIPANTS: A total of 45 interns logged at least one 24-h period. The logs were obtained from 67 shifts from a surgical rotation and 83 shifts from a medical rotation. MAIN OUTCOME MEASURES: The amount of time interns spent engaging in direct patient care, indirect patient care, educational activities and personal activities. RESULTS: On day shift, medical interns spent a significantly smaller proportion of the shift on direct care (159/613 min, 25.9% versus 214/636 min, 33.6%) and a greater proportion on education (195/613 min, 31.8% versus 139/636 min, 21.9%) than surgical interns. On extended days, medical interns spent a significantly larger proportion of the shift on education than surgical interns (243/814 min, 29.9% versus 126/804, 15.7% min). On night shift, medical interns spent a significantly greater proportion of the shift on direct care (590/720 min, 81.9% versus 346/727 min, 47.6%) and education (33/720 min, 4.6% versus 6/727 min, 0.8%) than surgical interns. CONCLUSIONS: The interns in the study reported spending more time on direct patient care and educational activities, and less time on indirect patient care activities than interns in other countries.

Emotional intelligence assessment in a graduate entry medical school curriculum.

BACKGROUND: The management of emotions in the workplace is a skill related to the ability to demonstrate empathic behaviour towards patients; to manage emotional reactions in oneself and to lead others as part of a team. This ability has been defined as emotional intelligence (EI) and doctor's EI may be related to communication skills and to patient satisfaction levels. This study reports on the use of two assessments of EI as part of a course on Personal and Professional Development (PPD) in a graduate medical school curriculum. METHODS: Fifty one graduate entry medical students completed an eight session course on PPD between December 2005 and January 2006. Students completed two measures of EI: self-report (EQ-i) and ability (MSCEIT V2.0) over a two year study period. The data gathered were used to explore the relationship between self-report and ability EI and between EI and student demographics, academic performance and change over time. RESULTS: Analysis of the EI data demonstrated that self-report EI did not change over time and was not related to ability EI. Females scored higher than males on a number of self-report and ability EI scores. Self-reported self-awareness was found to deteriorate in males and females over time. High self-reported EI was found to be associated with poor performance on clinical competency assessments but with good performance on a number of bio-medical knowledge based assessments. CONCLUSIONS: This report concludes that assessments of EI can be incorporated into a medical school curriculum as part of a PPD programme and that the concept of EI may be associated with performance in medical school.

Tight junctions: a barrier to the initiation and progression of breast cancer?

Breast cancer is a complex and heterogeneous disease that arises from epithelial cells lining the breast ducts and lobules. Correct adhesion between adjacent epithelial cells is important in determining the normal structure and function of epithelial tissues, and there is accumulating evidence that dysregulated cell-cell adhesion is associated with many cancers. This review will focus on one cell-cell adhesion complex, the tight junction (TJ), and summarize recent evidence that TJs may participate in breast cancer development or progression. We will first outline the protein composition of TJs and discuss the functions of the TJ complex. Secondly we will examine how alterations in these functions might facilitate breast cancer initiation or progression; by focussing on the regulatory influence of TJs on cell polarity, cell fate and cell migration. Finally we will outline how pharmacological targeting of TJ proteins may be useful in limiting breast cancer progression. Overall we hope to illustrate that the relationship between TJ alterations and breast cancer is a complex one; but that this area offers promise in uncovering fundamental mechanisms linked to breast cancer progression.