Gathering, strategizing, motivating and celebrating: the team huddle in a teaching general practice.

OBJECTIVES: To understand how implementing a daily team huddle affected the function of a complex interprofessional team including learners. DESIGN: A qualitative descriptive study using semi-structured interviews in focus groups. SETTING: An academic general practice teaching practice. PARTICIPANTS: All members of one interprofessional team, including nurses, general practitioners, junior doctors, and support staff. METHOD: Focus group interviews using semi-structured guidance were transcribed and the results analysed using qualitative content analysis. MAIN FINDINGS: Four interrelated themes were identified: communication and knowledge sharing; efficiency of care; relationship and team building; and shared responsibility for team function. The implementation of the daily team huddle was seen by participants to enhance the collaboration within the team and to contribute to work life enjoyment. Participants perceived that problems were anticipated and solved quickly. Clinical updates and information about patients benefited the team including learners. Junior doctors quickly understood the scope of practice of other team members, but some felt reluctant to offer clinical opinions. CONCLUSION: The implementation of a daily team huddle was viewed as worthwhile by this large interprofessional general practice team. The delivery of patient care was more efficient, knowledge was readily distributed, and problem solving was shared across the team, including junior doctors.

Building physician resilience.

OBJECTIVE: To explore the dimensions of family physician resilience. DESIGN: Qualitative study using in-depth interviews with family physician peers. SETTING: Hamilton, Ont. PARTICIPANTS: Purposive sample of 17 family physicians. METHOD: An iterative process of face-to-face, in-depth interviews that were audiotaped and transcribed. The research team independently reviewed each interview for emergent themes with consensus reached through discussion and comparison. Themes were grouped into conceptual categories. MAIN FINDINGS: Four main aspects of physician resilience were identified: 1) attitudes and perspectives, which include valuing the physician role, maintaining interest, developing self-awareness, and accepting personal limitations; 2) balance and prioritization, which include setting limits, taking effective approaches to continuing professional development, and honouring the self;3) practice management style, which includes sound business management, having good staff, and using effective practice arrangements; and 4) supportive relations, which include positive personal relationships, effective professional relationships, and good communication. CONCLUSION: Resilience is a dynamic, evolving process of positive attitudes and effective strategies.

Postpartum evolution of cervical squamous intraepithelial lesions with respect to the route of delivery.

OBJECTIVE.: To analyze the effect of the mode of delivery on the evolution of cervical squamous intraepithelial lesions. MATERIALS AND METHODS.: A chart review was performed of all pregnant women referred to the Northwestern Memorial Hospital Colposcopy Clinic between January 1990 and December 1998. Postpartum changes in the Pap smear and in a combined cytologic, histologic, and colposcopic impression of cervical status were evaluated. Data were analyzed using the chi, Fisher exact test, or Student t test. RESULTS.: Antepartum cytology was atypical squamous cells of undetermined significance in 23 women (7.1%), low-grade squamous intraepithelial lesions in 226 women (69.3%), and high-grade squamous intraepithelial lesions in 77 women (23.6%). Vaginal delivery occurred in 300 women (92.0%); 6 women (1.8%) had an elective cesarean section, and 20 women (6.1%) underwent a cesarean section after laboring. Of 306 women who had postpartum Pap smears, 37.9% had no change, 58.8% had improvement, and 3.3% had worsening of their cervical cytology. The rates of improvement of postpartum Pap smears were 164/285 (57.5%) following a vaginal delivery and 16/21 (76.2%) after a cesarean section (p = .81). Similarly, using a combined histologic, colposcopic, and cytologic evaluation of the cervix, the route of delivery did not affect postpartum cervical status (p = .68). CONCLUSION.: The route of delivery did not appear to influence the evolution of cervical squamous intraepithelial lesions during pregnancy and the puerperium.