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1.
Br J Hosp Med (Lond) ; 82(3): 1-10, 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33792379

RESUMO

Ever-developing changes to the working hours of junior doctors by the European Working Time Directive, the junior doctor contract of 2019 and most recently the COVID-19 pandemic have impacted the professional identity of doctors. There has been little investigation into its influence on the multifaceted aspects of postgraduate medical training, which feeds into how trainees consider themselves professionally and the concept of professional identity or 'being a doctor'. A review of the medical, socio-political and educational literature reveals that the impact on the professional identity development of trainees is influenced by several perspectives from the trainee, trainer and the public. Gross reduction in working hours has no doubt decreased the raw volume of clinical experiences. However, to counteract this, smarter learning processes have evolved, including narrative reflection, supervised learning events, and a greater awareness of coaching and training among trainers.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Educação de Pós-Graduação em Medicina , Corpo Clínico Hospitalar/educação , Admissão e Escalonamento de Pessoal , Identificação Social , Continuidade da Assistência ao Paciente , Europa (Continente) , Humanos , Internato e Residência , Medicina Estatal , Reino Unido
2.
Br J Hosp Med (Lond) ; 82(2): 1-9, 2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33646028

RESUMO

Research carried out in 2016 by the authors investigated the challenges that doctors in training experience around leadership and followership in the NHS. The study explored contemporary healthcare leadership culture and the role of followership from the perspective of early career doctors. It found that the leadership and followership challenges for these doctors in training were associated with issues of social and professional identity, communication, the medical hierarchy, and relationships with senior colleagues (support and trust). These challenges were exacerbated by the busy and turbulent clinical environment in which they worked. To cope with various clinical situations and forms of leadership, doctors in training engage in a range of different followership behaviours and strategies. The study raised implications for medical education and training and suggested that followership should be included as part of formal training in communication and team working skills. The importance of both leadership and followership in the delivery of safe and effective patient care has been brought sharply into focus by the COVID-19 pandemic. This article revisits these challenges in light of the pandemic and its impact on the experiences of doctors in training.


Assuntos
Educação Médica , Liderança , Corpo Clínico Hospitalar , Ensino/tendências , /epidemiologia , Mobilidade Ocupacional , Comportamento Cooperativo , Educação Médica/métodos , Educação Médica/tendências , Humanos , Corpo Clínico Hospitalar/educação , Corpo Clínico Hospitalar/psicologia , Corpo Clínico Hospitalar/normas , Equipe de Assistência ao Paciente/organização & administração , Habilidades Sociais
6.
J Ultrasound ; 23(4): 449-456, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32638333

RESUMO

COVID-19 pandemic is representing a serious challenge to worldwide public health. Lung Ultrasonography (LUS) has been signaled as a potential useful tool in this pandemic contest either to intercept viral pneumonia or to foster alternative paths. LUS could be useful in determining early lung involvement suggestive or not of COVID-19 pneumonia and potentially plays a role in managing decisions for hospitalization in isolation or admission in general ward. In order to face pandemic, in a period in which a large number of emergency room accesses with suspicious symptoms are expected, physicians need a standardized ultrasonographic approach, fast educational processes in order to be able to recognize both suggestive and not suggestive echographic signs and shared algorithms for LUS role in early management of patients.


Assuntos
Protocolos Clínicos , Infecções por Coronavirus/diagnóstico por imagem , Serviço Hospitalar de Emergência/organização & administração , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Algoritmos , Betacoronavirus , Tomada de Decisão Clínica , Infecções por Coronavirus/terapia , Diagnóstico Precoce , Hospitalização , Humanos , Capacitação em Serviço , Corpo Clínico Hospitalar/educação , Pandemias , Isolamento de Pacientes , Pneumonia Viral/terapia , Ultrassonografia
8.
Med Clin North Am ; 104(4): 739-750, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32505264

RESUMO

Although not suitable for every patient encounter, rounding at the beside provides an opportunity to teach and augment the attitudes essential for optimal medical care. It also provides an opportunity to establish and grow the team's culture as well as the culture for each patient encounter. Finally, it provides the attending physician with an opportunity to assess learners' position on the supervision-to-autonomy spectrum, thereby ensuring appropriate supervision while enabling the autonomy necessary for optimal learner growth.


Assuntos
Corpo Clínico Hospitalar/educação , Cultura Organizacional , Visitas com Preceptor , Competência Clínica , Educação Médica Continuada , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Assistência Centrada no Paciente
10.
Int J Surg ; 79: 31-35, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32426020

RESUMO

IMPORTANCE: Although Singapore was one of the first countries outside of China to be affected by COVID-19, for the first 2.5 months since its first reported case on January 23, 2020, it remained one of the few nations with successful containment of spread of the pandemic with little mortality and zero intra-hospital transmissions, without instituting a major lockdown of the country. In times of an infectious epidemic where medical subspecialties lead the frontline, a surgeon's role becomes rather vague. However, the only obstacle that stands in between the surgeon and fighting in the frontline of an infectious disease outbreak, is the traditional perception of what a surgeon can do. By presenting the strategies employed by our institution and its surgical unit, which remains the epicenter of the COVID-19 fight in Singapore, together with our medical counterparts, we hope to be able to improve our practices to respond and prevent the pandemic from escalating further as a collective community of surgeons across the globe. OBSERVATIONS: Contingencies should be in place for prioritization of existing patients, triaging and treatment of suspected patients, infection control, manpower management and novel strategies for inter-disciplinary communications and education in a hospital's surgical unit during a pandemic. Working in a high risk environment with manpower and resource limitations for prolonged periods of time has effect on morale and affects surgeon burn-out. Transparent communication, avenues to address psychological needs of surgeons and leadership by example are key strategies in ensuring a sustainable fight against the pandemic. CONCLUSIONS AND RELEVANCE: With the varies strategies implemented, every surgical discipline and every surgeon should be unified and place their desire to operate aside. There should not be any differentiation between surgeon and physician, but instead, everyone has to work together as one united health care front battling the common enemy - COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Controle de Infecções , Pandemias/prevenção & controle , Papel do Médico , Pneumonia Viral/epidemiologia , Cirurgiões , Centro Cirúrgico Hospitalar/organização & administração , Betacoronavirus , Estudos de Coortes , Comunicação , Infecções por Coronavirus/prevenção & controle , Humanos , Relações Interprofissionais , Corpo Clínico Hospitalar/educação , Corpo Clínico Hospitalar/organização & administração , Pneumonia Viral/prevenção & controle , Singapura/epidemiologia , Triagem
11.
Int J Surg ; 79: 233-248, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32413502

RESUMO

The Coronavirus (COVID-19) Pandemic represents a once in a century challenge to human healthcare with over 4.5 million cases and over 300,000 deaths thus far. Surgical practice has been significantly impacted with all specialties writing guidelines for how to manage during this crisis. All specialties have had to triage the urgency of their daily surgical procedures and consider non-surgical management options where possible. The Pandemic has had ramifications for ways of working, surgical techniques, open vs minimally invasive, theatre workflow, patient and staff safety, training and education. With guidelines specific to each specialty being implemented and followed, surgeons should be able to continue to provide safe and effective care to their patients during the COVID-19 pandemic. In this comprehensive and up to date review we assess changes to working practices through the lens of each surgical specialty.


Assuntos
Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Centro Cirúrgico Hospitalar/organização & administração , Triagem , Betacoronavirus , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Serviços Médicos de Emergência/organização & administração , Humanos , Corpo Clínico Hospitalar/educação , Corpo Clínico Hospitalar/provisão & distribução , Procedimentos Cirúrgicos Minimamente Invasivos , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Fluxo de Trabalho
12.
Aust J Gen Pract ; 49(5): 280-287, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32416655

RESUMO

BACKGROUND AND OBJECTIVES: Currently when undergoing Australian general practice training, a registrar must determine when clinical supervision is needed. The aim of this study was to identify situations in early Australian general practice training requiring closer supervision and consider how this can be achieved. METHOD: The study used a qualitative approach involving 75 registrars, supervisors and medical educators from seven focus groups in Victoria and Tasmania. RESULTS: Eighty circumstances in which a registrar should call their general practice supervisor were identified. Participants indicated the 'call for help' list should be modified early in the term after considering the registrar's prior experience, and through the term as supervision and teaching identifies readiness for independent practice. DISCUSSION: The size of the list developed by the focus groups reflects the breadth of general practice. It is a 'call for help' list rather than a safety checklist as it is not exclusively concerned with high-risk scenarios and includes broad triggers to call for help. The 'call for help' list is an aid to patient safety and the supervisor-registrar alliance.


Assuntos
Medicina Geral/educação , Corpo Clínico Hospitalar/educação , Adulto , Feminino , Grupos Focais/métodos , Medicina Geral/tendências , Humanos , Masculino , Corpo Clínico Hospitalar/tendências , Pesquisa Qualitativa , Tasmânia , Vitória
13.
J Laryngol Otol ; 134(4): 284-292, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32178742

RESUMO

OBJECTIVE: Recent studies have indicated a lack of ENT training at the undergraduate and post-graduate levels. This study aimed to review the impact of recent educational innovations in improving ENT training for medical students and junior doctors in the UK. METHODS: Three independent investigators conducted a literature search of published articles on ENT education. Included studies were analysed using qualitative synthesis methods. RESULTS: An initial search yielded 2008 articles; 44 underwent full-text evaluation and 5 were included for final analysis. Most included studies demonstrated benefits for students when compared to existing teaching standards in terms of objective assessment (knowledge and skills gained) or subjective assessment (confidence and preference) following implemented educational innovations. CONCLUSION: This study identified educational innovations developed in the past 15 years to enhance the teaching of core ENT competencies. More research is needed to establish their impact on the state of ENT medical education in the UK.


Assuntos
Educação de Graduação em Medicina/métodos , Corpo Clínico Hospitalar/educação , Otolaringologia/educação , Estudantes de Medicina/psicologia , Competência Clínica/normas , Currículo , Educação Médica , Estudos de Avaliação como Assunto , Conhecimentos, Atitudes e Prática em Saúde , Ensaios Clínicos Controlados não Aleatórios como Assunto , Publicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Autoimagem , Estudantes de Medicina/estatística & dados numéricos , Reino Unido/epidemiologia
15.
BMC Med Educ ; 20(1): 12, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931784

RESUMO

BACKGROUND: New doctors are expected to assess and manage acutely deteriorating patients from their first days in the hospital. However, current evidence suggests that medical graduates are not prepared for this. We aimed to explore junior doctors' first experiences with unwell patients and how they developed preparedness over time. METHODS: We conducted seven semi-structured interviews with doctors in their first postgraduate year. The interview transcripts underwent inductive thematic analysis using consensual qualitative research approaches. Themes identified were categorised into early experiences of unpreparedness, first experiences of genuine preparedness, and making sense of how they became prepared. Reflection on how participants progressed between the two was facilitated through a sorting and ranking exercise. RESULTS: Most participants initially felt unprepared when responding to acutely unwell patients. They described feeling overwhelmed, apprehensive and challenged. Two main challenges involved knowing when to escalate, and feeling expected to perform beyond their level of competency. A lack of acute care exposure at medical school was a common thread. All participants felt prepared to respond to unwell patients three to six months after starting work. Hands-on experience, reflection, simulation and multidisciplinary team-working were consistently ranked as the most useful learning experiences. CONCLUSION: Starting work as a doctor is a challenging time and preparedness to manage an acutely deteriorating patient is a common area of concern. As preparedness in acute care ranks poorly compared to other outcomes, we see this as an important area for improvement. Our findings suggest that undergraduates may lack sufficient opportunities for scaffolded decision making in acute care, and that increasing the intensity of clinical shadowing may improve preparedness and should inform future educational interventions.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Cuidados Críticos , Educação Médica , Corpo Clínico Hospitalar/educação , Corpo Clínico Hospitalar/psicologia , Adulto , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Autoavaliação , Reino Unido , Adulto Jovem
16.
PLoS One ; 15(1): e0227865, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978199

RESUMO

INTRODUCTION: Junior residents routinely prescribe medications for hospitalised patients with only arms-length supervision, which compromises patient safety. A cardinal example is insulin prescribing, which is commonplace, routinely delegated to very junior doctors, difficult, potentially very dangerous, and getting no better. Our aim was to operationalise the concept of 'readiness to prescribe' by validating an instrument to quality-improve residents' workplace prescribing education. METHODS: Guided by theories of behaviour change, implementation, and error, and by empirical evidence, we developed and refined a mixed-methods 24-item evaluation instrument, and analysed numerical responses from Foundation Trainees (junior residents) in Northern Ireland, UK using principal axis factoring, and conducted a framework analysis of participants' free-text responses. RESULTS: 255 trainees participated, 54% women and 46% men, 80% of whom were in the second foundation year. The analysis converged on a 4-factor solution explaining 57% of the variance. Participants rated their capability to prescribe higher (79%) than their capability to learn to prescribe (69%; p<0.001) and rated the support to their prescribing education lower still (43%; p<0.001). The findings were similar in men and women, first and second year trainees, and in different hospitals. Free text responses described an unreflective type of learning from experience in which participants tended to 'get by' when faced with complex problems. DISCUSSION: Operationalising readiness to prescribe as a duality, comprising residents' capability and the fitness of their educational environments, demonstrated room for improvement in both. We offer the instrument to help clinical educators improve the two in tandem.


Assuntos
Prescrições de Medicamentos/normas , Corpo Clínico Hospitalar/normas , Segurança do Paciente , Médicos/normas , Educação Médica , Feminino , Humanos , Insulina/uso terapêutico , Aprendizagem , Masculino , Registros Médicos , Corpo Clínico Hospitalar/educação , Pacientes , Farmacêuticos/normas , Inquéritos e Questionários
17.
Eur J Clin Pharmacol ; 76(2): 249-255, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31758216

RESUMO

BACKGROUND: As prescribing skills are a prerequisite for rational use of medicines, and education and training are important in acquiring these skills, we aimed to explore what aspects junior physicians find important when being taught the art of prescribing. METHODS: Written feedback from 34 interns after participating in an educational session as part of a randomized controlled study at a university hospital formed the qualitative data in this study. Manifest content analysis was performed, guided by the research question "Educating junior physicians in the art of prescribing: what aspects do they find important?" Meaning units were extracted and categorized, and emergent themes were identified. RESULTS: Five themes emerged. The first, clinical relevance, was exemplified by the categories valuable for health care; perceived relevance for one's own work; and translating theory into practice while the second, applicable content, included categories such as clinical advice; practical tips on using the electronic medical record system; and tools that facilitate. The third and fourth themes, reality-based teaching and creative discussions, were exemplified by the categories patient cases and feedback; and discussion-based teaching; wide-ranging discussions and a permissive and open atmosphere, respectively. In the last theme, effective structure, we identified the categories clear structure; small group teaching; allocated time for discussion; well-organized administration; and home assignment for practice. CONCLUSION: Creative discussions, effectively structured in small group sessions, with clinically relevant, reality-based content built on case studies and feedback, are aspects which junior physicians find important when educated in the art of prescribing.


Assuntos
Competência Clínica , Internato e Residência/métodos , Corpo Clínico Hospitalar/estatística & dados numéricos , Padrões de Prática Médica/normas , Adulto , Feminino , Hospitais Universitários , Humanos , Masculino , Corpo Clínico Hospitalar/educação , Pessoa de Meia-Idade
18.
Injury ; 51(1): 103-108, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31732120

RESUMO

BACKGROUND: Training in trauma forms a fundamental component of general surgical training in Australia. It faces a number of challenges, including the limitations of working hours and increasing use of non-operative management techniques. Adjustment of rosters to encompass a "swing shift" (12pm-midnight) is one proposed solution to maximise exposure of junior surgical doctors to trauma. This proposal prompted a review of the timing of major trauma presentations and interventions at a Level 1 trauma centre. METHODS: A retrospective observational study was performed of all major trauma presentations to Westmead Hospital, Australia over ten-years (2008-2017). Trauma operative procedures and major resuscitations were reviewed across three potential shifts: day shift (0730-1930), night shift (1930-0730) and "swing shift" (1200-midnight). Operative interventions included: laparotomy, thoracotomy/sternotomy, re-look laparotomy, rib fixation and tracheostomy. Descriptive statistics were obtained for between-shift comparisons. RESULTS: Over the ten-years there were 3745 full trauma team activations (FTTAs). The "swing shift" had the highest number of FTTAs, patients with injury severity scores >15, patients requiring resuscitation and emergency operations (laparotomies, sternotomies/thoracotomies). CONCLUSIONS: More major trauma calls, laparotomies and thoracotomies occurred during a theoretical "swing shift" rather than the standard day and night shifts. Changing trauma rostering for junior doctors to reflect this peak in clinical and operative demand could change exposure to trauma training.


Assuntos
Competência Clínica , Corpo Clínico Hospitalar/educação , Centros de Traumatologia/organização & administração , Traumatologia/educação , Adulto , Austrália , Feminino , Humanos , Masculino , Estudos Retrospectivos
19.
BMJ Support Palliat Care ; 10(1): 114-117, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30425051

RESUMO

OBJECTIVES: Junior doctors learn from the formal and informal curriculum. In a palliative care rotation, the informal curriculum may be useful in teaching attitudes like empathy and compassion. Our study aims to explore how the informal curriculum augments the formal curriculum of a palliative care rotation in shaping the professional development of a doctor. METHODS: We conducted a qualitative study with seven focus group discussions involving 21 junior doctors (medical officers and residents) who spent at least 2 months in a palliative care setting in a tertiary hospital or an inpatient hospice. Data were analysed using qualitative thematic analysis to identify the themes related to the junior doctors' perceptions of how the informal curriculum impacted their humanistic and professional development, thereby augmenting the formal curriculum in a palliative care setting. RESULTS: Three main themes illustrated how the informal curriculum influenced the doctors: (1) reconceptualisation of control: shifting perspectives as they grappled with their envisioned control versus reality while caring for dying patients; (2) emergence of professionalism: adapting perspectives as they learnt how to bridge theory and reality while developing professionalism and (3) personal growth: forming new perspectives, as doctors reflected on life, death and their calling through a renewed lens. CONCLUSION: This study explored how the informal curriculum influenced doctors' perceptions about professionalism and personal growth, embodying the values of the profession. Observations and interpersonal interactions with healthcare professionals, patients and their caregivers encouraged the doctors to reflect upon their own calling into medicine.


Assuntos
Atitude do Pessoal de Saúde , Corpo Clínico Hospitalar/psicologia , Cuidados Paliativos/psicologia , Medicina Paliativa/educação , Adulto , Currículo , Empatia , Feminino , Grupos Focais , Humanos , Masculino , Corpo Clínico Hospitalar/educação , Pesquisa Qualitativa
20.
Ann R Coll Surg Engl ; 102(4): 277-283, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31874048

RESUMO

INTRODUCTION: Safe staffing levels are increasingly being threatened by gaps in rotas. When a gap occurs in junior grade on-call rotas the orthopaedic registrar needs to step down and undertake the role of both junior and middle-grade doctor. This increased responsibility could compromise the safety and wellbeing of patients and doctors. This study quantifies the prevalence and effects for trainees of stepdown while on call. MATERIALS AND METHODS: An anonymous online and paper survey of trainees was conducted. The primary outcomes were the prevalence of stepdown in trainees' experience, the effects of stepdown on trainees and patients, and the overall impact on training and morale. RESULTS: The response rate was 93% (n = 51). Of the total, 55% of trainees had experienced stepdown, which occurred a minimum of 84 times, statistically more frequently for expected absences rather than unexpected absences (p = 0.002). Of the trainees who stepped down, 64% felt pressure to do so from seniors and 79% from hospital management. Some 50% of trainees felt that step down was managed in an unsafe manner; 40% of trainees stated that stepdown impacted on their own personal safety and 50% of trainees lost a training opportunity. Overall, 57% of trainees considered that stepdown and rota gaps affected their morale negatively. In 85% of cases there were no issues that resulted in patient harm. CONCLUSION: The survey results suggest that stepdown is common and it does impact negatively upon registrar training, safety and morale. Patient safety overall seems to be well protected.


Assuntos
Educação Médica Continuada/estatística & dados numéricos , Corpo Clínico Hospitalar/educação , Ortopedia/educação , Admissão e Escalonamento de Pessoal/organização & administração , Atitude do Pessoal de Saúde , Inglaterra , Humanos , Corpo Clínico Hospitalar/organização & administração , Corpo Clínico Hospitalar/psicologia , Corpo Clínico Hospitalar/estatística & dados numéricos , Ortopedia/estatística & dados numéricos , Segurança do Paciente , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos
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