A narrative synthesis of learners' experiences of barriers and facilitators related to effective interprofessional simulation.

Interprofessional simulation has been linked to improved self-efficacy, communication, knowledge and teamwork skills in healthcare teams. However, there are few studies that synthesize learners' perceptions of interprofessional simulation-based approaches and barriers or facilitators they encounter in such learning approaches. The aim of this review was to explore these issues through synthesis of the published literature on healthcare staff engaging in interprofessional simulation to inform enhancement of instructional design processes. Searches of four major databases resulted in the retrieval of 2,727 studies. Following screening and full-text review, a total of 13 studies were included in the final review and deductive content analysis was used to collate the findings, which were then synthesized using a narrative approach. Three categories of barriers and facilitators were identified: characteristics of the simulation learning process, outcomes of interprofessional simulation, and interprofessional dynamics. Related to the latter, the findings indicate the instructional design of interprofessional simulation-based approaches may benefit from a greater focus on the context of healthcare teams that prioritizes teamwork. Furthermore, greater emphasis on designing realistic clinical situations promotes effectiveness of simulation. It is important to recognize the perspectives of healthcare team members engaging in these learning approaches and how they may affect clinical performance and influence patient outcomes.

A mixed-methods examination of the nature and frequency of medical error among junior doctors.

PURPOSE OF THE STUDY: To examine junior doctors' experience and perceptions of medical errors in which they had been involved. STUDY DESIGN: A mixed-methods design, consisting of an error survey and critical incident technique (CIT) interviews, was used. The survey asked doctors in the first year of postgraduate training in Ireland whether they had made a medical error that had 'played on (their) mind', and if so, to identify factors that had contributed to the error. The participants in the CIT interviews were asked to describe a medical error in which they had been involved. RESULTS: A total of 201 out of 332 (60.5%) respondents to the survey reported making an error that 'played on their mind'. 'Individual factors' were the most commonly identified group of factors (188/201; 93.5%), with 'high workload' (145/201; 72.1%) the most commonly identified contributory factor. Of the 28 CIT interviews which met the criteria for analysis, 'situational factors' (team, staff, task characteristics, and service user factors) were the most commonly identified group of contributory factors (24/28; 85.7%). A total of eight of the interviews were judged by subject matter experts (n=8) to be of medium risk to patients, and 20 to be of high-risk to patients. A significantly larger proportion of high-risk scenarios were attributed to 'local working conditions' than the medium-risk scenarios. CONCLUSIONS: There is a need to prepare junior doctors to manage, and cope with, medical error and to ensure that healthcare professionals are adequately supported throughout their careers.

A Mixed-Methods Exploration of the Educational Climate and Safety Climate During the First Year of Clinical Practice in Ireland.

PURPOSE: Educational climate (EC) and safety climate (SC) are key determinants of residents' professional development. The goal of this study was to gather longitudinal EC data and data on perceptions of SC in residency, and provide data on practices related to perceptions of EC and SC, by identifying factors associated with and changes in perceptions of EC and SC across the first year of practice, and elucidating good and poor practice relating to key elements of EC and SC. METHOD: A mixed-methods design was adopted. First, 131 first-year residents in Ireland were surveyed at the end of each of their first 3 rotations (August 2016-March 2017). The survey measured EC and SC using established measures. Next, 69 semistructured interviews were conducted with a representative sample of residents (March-May 2017). An interview schedule was developed to aid in-depth probing of EC and SC perceptions. A deductive content analysis approach was adopted. RESULTS: Perceptions of EC worsened over time. The EC and SC of surgical rotations were significantly poorer than those of medical rotations. Residents were more likely to describe team practices, rather than organizational practices, that contributed positively to their perceptions of EC and SC. CONCLUSIONS: Further research is necessary to facilitate improvement of EC and SC for residents, particularly within surgical training. Future research exploring the contribution of organizational practices to EC and SC, the impact of targeted improvement activities, and best practices for involving residents in quality and safety initiatives is recommended.

Disturbing and distressing: a mixed methods study on the psychological impact of end of life care on junior doctors.

BACKGROUND: The Irish Medical Council has identified gaps in knowledge and communications skills of new-entrant doctors in legal, ethical and practical aspects of end of life care. AIMS: To determine the frequency with which junior doctors deal with end of life care and patient death and to evaluate the impact this has on their psychological wellbeing. DESIGN: A questionnaire was distributed to junior doctors to determine the frequency with which the participants had managed a patient at end of life. An abbreviated Posttraumatic Stress Disorder Checklist-Civilian version was used to evaluate psychological distress. Critical incident technique interviews explored the challenges of caring for patients at end of life. SETTING/PARTICIPANTS: A total of 110 junior doctors in two teaching hospitals in Ireland completed the questionnaire: 39 (35.5%) interns and 71 (64.5%) senior house officers. In addition, 31 interviews were carried out with interns, senior house officers and registrars. RESULTS: The majority (81.8%) had pronounced a death with 39.4% of senior house officers doing so more than 10 times. Three quarters (75.5%) had discussed end of life with a patient's family. Of the 110 respondents that completed the posttraumatic stress disorder checklist, 11.8% screened positively for posttraumatic stress disorder. Challenges identified at interview included lack of knowledge and preparedness, difficulty communicating with family members, a lack of support and a feeling of failure. CONCLUSIONS: Junior doctors are regularly carrying out tasks related to end of life care, resulting in high levels of psychological distress. Further training and a change in culture are required.

Stress, coping, and psychological resilience among physicians.

BACKGROUND: Recent research has demonstrated that burnout is widespread among physicians, and impacts their wellbeing, and that of patients. Such data have prompted efforts to teach resilience among physicians, but efforts are hampered by a lack of understanding of how physicians experience resilience and stress. This study aimed to contribute to knowledge regarding how physicians define resilience, the challenges posed by workplace stressors, and strategies which enable physicians to cope with these stressors. METHODS: A qualitative approach was adopted, with 68 semi-structured interviews conducted with Irish physicians. Data were analysed using deductive content-analysis. RESULTS: Five themes emerged from the interviews. The first theme, 'The Nature of Resilience' captured participants' understanding of resilience. Many of the participants considered resilience to be "coping", rather than "thriving" in instances of adversity. The second theme was 'Challenges of the Profession', as participants described workplace stressors which threatened their wellbeing, including long shifts, lack of resources, and heavy workloads. The third theme, 'Job-related Gratification', captured aspects of the workplace that support resilience, such as gratification from medical efficacy. 'Resilience Strategies (Protective Practices)' summarised coping behaviours that participants considered to be beneficial to their wellbeing, including spending time with family and friends, and the final theme, 'Resilience Strategies (Attitudes)', captured attitudes which protected against stress and burnout. CONCLUSIONS: This study emphasised the need for further research the mechanisms of physician coping in the workplace and how we can capitalise on insights into physicians' experiences of coping with system-level stressors to develop interventions to improve resilience.

A systematic review of interventions to foster physician resilience.

This review aimed to synthesise the literature describing interventions to improve resilience among physicians, to evaluate the quality of this research and to outline the type and efficacy of interventions implemented. Searches were conducted in April 2017 using five electronic databases. Reference lists of included studies and existing review papers were screened. English language, peer-reviewed studies evaluating interventions to improve physician resilience were included. Data were extracted on setting, design, participant and intervention characteristics and outcomes. Methodological quality was assessed using the Downs and Black checklist. Twenty-two studies were included. Methodological quality was low to moderate. The most frequently employed interventional strategies were psychosocial skills training and mindfulness training. Effect sizes were heterogeneous. Methodologically rigorous research is required to establish best practice in improving resilience among physicians and to better consider how healthcare settings should be considered within interventions.

Barriers and facilitators related to the implementation of a physiological track and trigger system: A systematic review of the qualitative evidence.

PURPOSE: To identify the barriers to, and facilitators of, the implementation of physiological track and trigger systems (PTTSs), perceived by healthcare workers, through a systematic review of the extant qualitative literature. DATA SOURCES: Searches were performed in PUBMED, CINAHL, PsycInfo, Embase and Web of Science. The reference lists of included studies were also screened. STUDY SELECTION: The electronic searches yielded 2727 papers. After removing duplicates, and further screening, a total of 10 papers were determined to meet the inclusion criteria and were reviewed. DATA EXTRACTION: A deductive content analysis approach was taken to organizing and analysing the data. A framework consisting of two overarching dimensions ('User-related changes required to implement PTTSs effectively' and 'Factors that affect user-related changes'), 5 themes (staff perceptions of PTTSs and patient safety, workflow adjustment, PTTS, implementation process and local context) and 14 sub themes was used to classify the barriers and facilitators to the implementation of PTTSs. RESULTS OF DATA SYNTHESIS: Successful implementation of a PTTS must address the social context in which it is to be implemented by ensuring that the users believe that the system is effective and benefits patient care. The users must feel invested in the PTTS and its use must be supported by training to ensure that all healthcare workers, senior and junior, understand their role in using the system. CONCLUSION: PTTSs can improve patient safety and quality of care. However, there is a need for a robust implementation strategy or the benefits of PTTSs will not be realized.

5-Carboxamido-1,3,2-dioxaphosphorinanes, potent inhibitors of MTP.

5-Carboxamido-1,3,2-dioxaphosphorinanes have been identified as potent inhibitors of microsomal triglyceride-transfer protein. The 1,3,2-dioxaphosphorine functionality acted as a neutral and stable replacement for piperidine and piperidine N-oxide.

Microsomal triglyceride transfer protein inhibitors: discovery and synthesis of alkyl phosphonates as potent MTP inhibitors and cholesterol lowering agents.

A series of newly synthesized phosphonate esters were evaluated for their effects on microsomal triglyceride transfer protein activity (MTP). The most potent compounds were evaluated for their ability to inhibit lipoprotein secretion in HepG2 cells and to affect VLDL secretion in rats. These inhibitors were also found to lower serum cholesterol levels in a hamster model upon oral dosing.