Prevalence, risk factors and psychological consequences of workplace violence among health workers in the Greater Accra region, Ghana: a cross-sectional study.

BACKGROUND: Globally, close to one-third of all workplace violence (WV) occurs in the health sector. Exposure to WV among healthcare professionals in Ghana has been widely speculated, but there is limited evidence on the problem. This study therefore investigated WV, its risk factors, and the psychological consequences experienced by health workers in Ghana. METHODS: An analytic cross-sectional study was conducted in the Greater Accra region from January 30 to May 31, 2023, involving selected health facilities. The participants for the study were selected using a simple random sampling technique based on probability proportional-to-size. The data analyses were performed using STATA 15 software. Logistic regression analyses were employed to identify the factors associated with WV, considering a significance level of p-value < 0.05. RESULTS: The study was conducted among 607 healthcare providers and support personnel across 10 public and private hospitals. The lifetime career, and one-year exposure to any form of WV was 414 (68.2%) [95% CI: (64.3-71.9%)] and 363 (59.8%) [95% CI: (55.8-63.7%)], respectively. Compared to other forms of WV, the majority of healthcare workers, 324 (53.4%) experienced verbal abuse within the past year, and a greater proportion, 85 (26.2%) became 'super alert' or vigilant and watchful following incidents of verbal abuse. Factors significantly linked to experiencing any form of WV in the previous 12 months were identified as follows: older age [AOR = 1.11 (1.06, 1.17)], working experience [AOR = 0.91 (0.86, 0.96)], having on-call responsibilities [AOR = 1.75 (1.17, 2.61)], and feeling adequately secure within health facility [AOR = 0.45 (0.26, 0.76)]. CONCLUSION: There was high occurrence of WV, and verbal abuse was the most experienced form of WV. Age, work experience, on-call duties, and security within workplace were associated with exposure to WV. Facility-based interventions are urgently needed to curb the incidence of WV, especially verbal abuse.

Cost minimisation analyses of birth care in low-risk women in Norway: a comparison between planned home birth and birth in a standard obstetric unit.

BACKGROUND: Evidence exists that planned home births for low-risk women in settings in which they have access to hospital transfer if needed are safe. The costs of planned home births, compared to low-risk births in obstetric units, are not clear. The aim of this study was to compare costs associated with hospital births versus home births under different home birth organizations. METHODS: We performed a cost minimisation analysis (CMA) based on decision-analytic modelling while assuming that health outcomes were not affected by place of birth. Estimations of resource use were mainly based on three existing Norwegian datasets: (1) women with planned home births (n = 354), (2) women with planned home births (n = 482) of which 63 were transferred to a hospital, and (3) women with planned births in a hospital (n = 1550). RESULTS: Planned home birth costs 45.9% (credibility interval [CrI] 39.1-54.2) of a low-risk birth at a hospital. For planned home birth, the birth was the costliest activity (32.1%). The costs for planned home birth were estimated to be €1872 (CrI 1694-2071) and included hospitalisations for some. Costs for only those with actual home birth was €1353 (CrI 1244-1469). Costs of a birth, including possible birth-related complications, in low-risk women in a hospital was €4077 (CrI 3575-4615). When including the costs of being on call for one woman at a time, a planned home birth costs €5,531 (CrI 5,171-5,906), which is 135.7% (CrI 117.7-156.8) of low-risk births at a hospital. When organizing midwives in the on call teams for multiple women at a time, a planned home birth costs € 2,842 (CrI 2,647-3,053), which is 69.7% (CrI 60.3-80.9) of a low-risk birth in a hospital. CONCLUSIONS: Home birth can be cost-effective if the midwives who facilitate home births are organised into larger groups, or they work for hospitals that also facilitate home births. A model in which midwives work separately or in pairs to assist with a home birth and are on call for one birth at a time may not be cost-effective.

Preparing clinicians for practice: effectiveness and design of on-call simulation.

BACKGROUND: Final year medical students and postgraduate doctors regularly contend with feelings of under-preparedness when transitioning into new areas of clinical practice. This lack of confidence is most evident in the context of on-call work which frequently requires sound clinical prioritisation, rigorous decision making and the management of acutely unwell patients, often with reduced senior support and staffing. This has prompted the emergence of on-call simulation which seeks to enhance participant confidence in performing on-call tasks and facilitate the development of key clinical and non-technical skills. This narrative review examined the use of on-call simulation in medical student and newly qualified doctor cohorts, its effectiveness in achieving its stated outcomes and to identify novel areas for the development of existing models. METHOD: A search strategy was developed in conjunction with a specialist medical librarian. OVID Medline and Embase searches identified articles related to the use and design of on-call simulation in medical education with no restrictions placed upon date or language of publication. Key findings from articles were summarised to develop comprehensive themes for discussion. RESULTS: Twenty Three unique publications were reviewed which unanimously reported that on-call simulation had a positive effect on self-reported participant confidence in performing on-call roles. Furthermore the value on-call simulation when used as an induction activity was also evident. However, there was limited evidence around improved patient and performance outcomes following simulation. It also remains resource intensive as an educational tool and there is a distinct absence of interprofessional education in current models. CONCLUSIONS: We concluded that on-call simulation must adopt an interprofessional educational approach, incorporating other clinical roles. Further studies are needed to characterise the impact on patient outcomes. It remains highly useful as a confidence-boosting induction activity, particularly in specialities where clinical exposure is limited. Virtual and tabletop simulation formats, could potentially address the resource burden of manikin-based models, particularly with ever growing demands on medical educators and the expansion of training posts.

Analysis of a nurse-provided on-call peritoneal dialysis support in an outpatient reference care centre.

BACKGROUND: To analyse the nature of medical or technical emergency issues of ambulatory peritoneal dialysis (PD) patients calling a nurse-provided emergency PD support service of a reference centre that is provided all year in the after-hours. METHODS: We retrospectively analysed patients' chief complaint, urgency, resolution of and association to current PD treatment and modality directed to an on-call nurse-provided PD support service from 2015-2021 based on routinely collected health data. Calls were systematically categorized being technical/procedural-, medical-, material-related or type of correspondence. Call urgency was categorized to have "immediate consequence", inquiry was eligible for "processing next working day" or whether there was "no need for further action". Call outcomes were classified according to whether patients were able to initiate, resume or finalize their treatments or whether additional interventions were required. Unexpected adverse events such as patients' acute hospitalization or need for nurses' home visits were evaluated and quantified. RESULTS: In total 753 calls were documented. Most calls were made around 7:30 a.m. (5:00-9:00; median, 25-75th CI) and 6:30 p.m. (5:00-8:15). 645 calls were assigned to continuous ambulatory- (CAPD) or automated PD (APD). Of those, 430 calls (66.7%) had an "immediate consequence". Of those 77% (N = 331) were technical/procedural-, 12.8% (N = 55) medical- and 6.3% (N = 27) material related issues. 4% (N = 17) were categorized as other correspondence. Issues disrupting the course of PD were identified in 413 cases. In 77.5% (N = 320) patients were able to initiate, resume or finalize their treatment after phone consultation. Last-bag exchange was used in 6.1% enabling continued therapy in 83.6%. In 35 cases a nurse visit at patients' home or patients' visit to the practice at the earliest possible date were required, while hospitalization was required in seven medical category cases (5.4% and 1.09% of total assessed calls, respectively). CONCLUSION: The on-call PD-nurse provides patient support for acute and imminent issues enabling them to successfully initiate, resume or finalize their prescribed treatment. Nurses triage of acute conditions facilitated rapid diagnostics and therapy. Maintaining quality PD homecare, the provision of trained personnel is indispensable. The information gathered in this study may therefore be used as a foundation to tailor educational programs for nephrology nurses and doctors to further develop their competencies in PD.

Influence of organizational factors on the offer and success rate of a trial of labor after cesarean section in Belgium: an ecological study.

BACKGROUND: Trial of Labor After Cesarean is an important strategy for reducing the overall rate of cesarean delivery. Offering the option of vaginal delivery to a woman with a history of cesarean section requires the ability to manage a potential uterine rupture quickly and effectively. This requires infrastructure and organization of the maternity unit so that the decision-to-delivery interval is as short as possible when uterine rupture is suspected. We hypothesize that the organizational characteristics of maternity units in Belgium have an impact on their proposal and success rates of trial of labour after cesarean section. METHODS: We collected data on the organizational characteristics of Belgian maternity units using an online questionnaire. Data on the frequency of cesarean section, trial of labor and vaginal birth after cesarean section were obtained from regional perinatal registries. We analyzed the determinants of the proposal and success of trial of labor after cesarean section and report the associations as mean proportions. RESULTS: Of the 101 maternity units contacted, 97 responded to the questionnaire and data from 95 was included in the analysis. Continuous on-site presence of a gynecologist and an anesthetist was associated with a higher proportion of trial of labor after cesarean section, compared to units where staff was on-call from home (51% versus 46%, p = 0.04). There is a non-significant trend towards more trial of labor after cesarean section in units with an operating room in or near the delivery unit and a shorter transfer time, in larger units (> 1500 deliveries/year) and in units with a neonatal intensive care unit. The proposal of trial of labor after cesarean section and its success was negatively correlated to the number of cesarean section in the maternity unit (Spearman' rho = 0.50 and 0.42, p value < 0.001). CONCLUSIONS: Organizational differences in maternity units appear to affect the proposal of trial of labor after cesarean section. Addressing these organizational factors may not be sufficient to change practice, given that general tendency to perform a cesarean section in the maternity unit is the main contributor to the percentage of trial of labor after cesarean.

Introducing a triage and Nurse on Call model in primary health care - a focus group study of health care staff's experiences.

BACKGROUND: With the increased demand for health care services and with simultaneous staff shortages, new work models are needed in primary health care. In November 2015, a Swedish primary health care centre introduced a work model consisting of a structured patient sorting system with triage and Nurse on Call. The aim of this study was to describe the staff's experiences of introducing the triage and Nurse on Call model at the primary health care centre. METHODS: Five focus group discussions with staff (n = 39) were conducted 4 years after the introduction of the work model. Groups were divided by profession: medical secretaries, nursing assistants, physicians, primary health care nurses, and registered nurses. The transcribed text from the discussions was analysed using qualitative inductive content analysis. RESULTS: The analysis generated one overarching theme: The introduction of triage and Nurse on Call addresses changed preconditions in primary health care, but the work culture, organization, and acquisition of new knowledge are lagging behind. The overarching theme had five categories: (1) Changed preconditions in primary health care motivate new work models; (2) The triage and Nurse on Call model improves teamwork and may increase the quality of care; (3) Unclear purpose and vague leadership make introducing the work model difficult; (4) Difficulties to adopt the work model as it challenges professional autonomy; and (5) The triage and Nurse on Call model requires more knowledge and competence from nurses in primary health care. CONCLUSIONS: This study contributes with knowledge about implications of a new work model in primary health care from the perspective of health care staff. The work model using triage and Nurse on Call in primary health care was perceived by participants to increase availability and optimize the use of resources. However, before introduction of new work models, it is important to identify barriers to and facilitators for successful improvements in the local health care context. Additional education for the health care staff is important if the transition is to be successful. Complementary skills and teamwork, supported by a facilitator seems important to ensure a well-prepared workforce.

Rise and shine: The use of polychromatic short-wavelength-enriched light to mitigate sleep inertia at night following awakening from slow-wave sleep.

Sleep inertia is the brief period of performance impairment and reduced alertness experienced after waking, especially from slow-wave sleep. We assessed the efficacy of polychromatic short-wavelength-enriched light to improve vigilant attention, alertness and mood immediately after waking from slow-wave sleep at night. Twelve participants (six female, 23.3 ± 4.2 years) maintained an actigraphy-confirmed sleep schedule of 8.5 hr for 5 nights, and 5 hr for 1 night prior to an overnight laboratory visit. In the laboratory, participants were awakened from slow-wave sleep, and immediately exposed to either dim, red ambient light (control) or polychromatic short-wavelength-enriched light (light) for 1 hr in a randomized crossover design. They completed a 5-min Psychomotor Vigilance Task, the Karolinska Sleepiness Scale, and Visual Analogue Scales of mood at 2, 17, 32 and 47 min after waking. Following this testing period, lights were turned off and participants returned to sleep. They were awakened from their subsequent slow-wave sleep period and received the opposite condition. Compared with the control condition, participants exposed to light had fewer Psychomotor Vigilance Task lapses (χ2 [1] = 5.285, p = 0.022), reported feeling more alert (Karolinska Sleepiness Scale: F1,77  = 4.955, p = 0.029; Visual Analogue Scalealert : F1,77  = 8.226, p = 0.005), and reported improved mood (Visual Analogue Scalecheerful : F1,77  = 8.615, p = 0.004). There was no significant difference in sleep-onset latency between conditions following the testing period (t10  = 1.024, p = 0.330). Our results suggest that exposure to polychromatic short-wavelength-enriched light immediately after waking from slow-wave sleep at night may help improve vigilant attention, subjective alertness, and mood. Future studies should explore the potential mechanisms of this countermeasure and its efficacy in real-world environments.

Hours of work and on-call weeks preferences of Canadian midwives: relationships with intention to stay in the profession.

BACKGROUND: Midwives have long workdays and work many weeks on call. There is a concern that these extended work schedules can negatively affect their intention to stay in the profession. PURPOSE: This study provides evidence on Canadian midwives' preferences for and experiences with policies and guidelines which limit the hours of work and weeks per year preferred to be on call, and examines the relationship between preferences and midwives' intention to stay in the profession. METHODS: Data come from our 2018 pan-Canadian survey of midwives. Descriptive statistics of 720 midwives' preferences and experiences are provided. In the correlations followed by the OLS regressions, 596 midwives' data are used to test the associations between preferences and intention to stay in the profession. STATA (version 15) is used. A thematic analysis of 274 midwives' responses to the open-ended survey question is conducted to give voice to midwives on what can be done for retention. RESULTS: Three quarters of the 720 respondents prefer policies and guidelines to limit hours of work in a 24-hour period, though less than half have policies and guidelines on hours of work. More than half prefer to have fewer on-call weeks or never to be on call, less than a third prefer same number of on-call weeks, and only 2% prefer more weeks to be on call. Midwives are currently working on average 33 weeks per year on call. OLS regression analysis shows that 'met preference' for hours of work and on-call weeks are positively associated with intention to stay. In responding to the open-ended survey question, midwives recommend limiting the consecutive hours of work and on-call weeks to manageable hours and weeks to retain them in the profession. CONCLUSION: Midwives whose preferences are met are the ones intending to stay in the profession. There is, however, a large number of midwives with 'unmet needs' preferring to have policies and guidelines to limit the hours but do not have that currently, and would like to work fewer weeks on call than currently. These are the midwives who are not intending to stay in the profession.

Hospital physicians´ working hour characteristics and sleep quality: a cross-sectional analysis of realized working hour and survey data.

BACKGROUND: Hospital physicians' work includes on-call duties to provide 24/7 health care. Previous studies using self-reported survey data have associated long working hours and on-call work with sleep difficulties. To reduce recall bias, we complemented survey data with payroll-based objective data to study whether hospital physicians' realized working hours are associated with sleep. METHODS: The study was nested within the Finnish Public Sector study. We used survey data on 728 hospital physicians (mean age 43.4 years, 62% females) from 2015 linked to realized daily working hour data from 3 months preceding the survey. The associations of working hour characteristics with sleep quantity and quality were studied with multinomial logistic regression analysis adjusted for demographics, overall stressfulness of life situation, control over scheduling of shifts, and hospital district. RESULTS: One fourth (26%) of the participants reported short (≤6.5 h) average sleep duration. Frequent night work (> 6 shifts/91 days) was associated with short sleep (OR 1.87 95%CI 1.23-2.83) compared to no night work. Approximately one third (32%) of the physicians reported insufficient sleep. Physicians with long weekly working hours (> 48 hours) had higher odds for insufficient sleep (OR 1.78 95%CI 1.15-2.76) than physicians with short weekly working hours (< 40 hours). Insufficient sleep was also associated with frequent on-call duties (> 12 shifts/3 months OR 2.00 95%CI 1.08-3.72), frequent night work (OR 1.60 95%CI 1.09-2.37), and frequent short shift intervals (≤11 hours; > 12 times/3 months OR 1.65 95%CI 1.01-2.69) compared to not having these working hour characteristics. Nearly half of the physicians (48%) reported at least one sleep difficulty at least two times a week and frequent night work increased odds for difficulties in initiating sleep (OR 2.43 95%CI 1.04-5.69). Otherwise sleep difficulties were not associated with the studied working hour characteristics. CONCLUSION: We used realized working hour data to strengthen the evidence on on-call work and sleep quality and our results advice to limit the frequency of night work, on-call shifts, short shift intervals and long weekly working hours to promote hospital physicians' sufficient sleep.

Paediatric on-call consultants' learning within and beyond the objectives of a coherent CPD program.

BACKGROUND: Evaluations, using questionnaires, of a two-year long CPD program for on-call consultant paediatricians, showed that the overall objective of the program was largely met. We stipulate that the coherency of the CPD program contributed to the learning. To gains a deeper understanding of the participants learning within and beyond the overall objectives of the program, we decided to conduct an interview study enrolling participants from the first two CPD courses. METHODS: Nine experienced paediatric consultants were interviewed 1-4 years after completing a coherent two-year long CPD program, focusing on what and how they learned. The interviews were audio-recorded and transcribed as text, analysed, and categorised using qualitative content analysis. RESULTS: What the participants learned: improved medical competences, greater confidence in the role of an on-call consultant, better understanding of the role of an on-call consultant and importance of professional networks. Several categories were outside the overall objective, at personal level: an understanding of one's own and other's competences, taking responsibility for one's own CPD and managing things one does not know. At professional level: more secure as an individual and with colleagues. How it was learned: relevant objectives, preparatory material and case discussions were important. Participants learned by preparing, repeating, reflecting, and participating actively, and by applying what they learned in clinical practice. The participants learned from one other over a period of two years, when they also got to know one another and created networks. A safe learning environment imposed demands and enabled participants to define their competence and learn accordingly. CONCLUSIONS: This study describes what and how on-call consultant paediatricians learned during a coherent two-year long CPD program. The learning took place within and beyond the framework of the overall objectives. The study suggests that evaluation methods based on objectives may be blind to important areas of learning and need to be combined with qualitative methods that examine a broad impact of learning. Taken together, the analysis of what and how the participants learned shows that they were better equipped to work as consultant on call and deal with the things they did not know.

Is Call Karma Real? Resident After-Hours On-Call Imaging at the University of Saskatchewan: An Assessment of Call Volumes Including Inter-Resident Variability.

PURPOSE: Quantify resident caseload during call and determine if there are consistent differences in call volumes for individuals or resident subgroups. METHODS: Accession codes for after-hours computed tomography (CT) cases dictated by residents between July 1, 2012 and January 9, 2017 were reviewed. Case volumes by patient visits and body regions scanned were determined and categorized according to time period, year, and individual resident. Mean shift Relative Value Units (RVUs) were calculated by year. Descriptive statistics, linear mixed modeling, and linear regression determined mean values, differences between residents, associations between independent variables and outcomes, and changes over time. Consistent differences between residents were assessed as a measure of good or bad luck / karma on call. RESULTS: During this time there were 23,032 patients and 30,766 anatomic regions scanned during 1,652 call shifts among 32 residents. Over the whole period, there were on average 10.6 patients and 14.3 body regions scanned on weekday shifts and 22.3 patients and 29.4 body regions scanned during weekend shifts. Annually, the mean number of patients, body regions, and RVUs scanned per shift increased by an average of 0.2 (1%), 0.4 (2%), and 1.2 (5%) (all p < 0.05) respectively in regression models. There was variability in call experiences, but only 1 resident had a disproportionate number of higher volume calls and fewer lower volume shifts than expected. CONCLUSIONS: Annual increases in scan volumes were modest. Although residents' experiences varied, little of this was attributable to consistent personal differences, including luck or call karma.

Urology Residents' Perspectives on the In-House On-Call Systems: A Study in an Accredited Academic Center.

INTRODUCTION: Medical education and training are crucial in maintaining patients' safety and improving patient care quality. Multiple studies have evaluated the effects of restrictive policies on the resident's quality of life and education. Due to the compiling data and the fact that these trials evaluated programs with a substantial number of residents, it remains uncertain whether these conclusions can be extended to urology programs with a small number of residents. Multiple on-call systems have been adopted in residency programs across the world. This study evaluated the residents' quality of life, clinical experience, and education upon transitioning from 24-hour to 12-hour in-house on-call systems. METHODS AND MATERIALS: In this observational and questionnaire-based study, the effect of the transition from 24-hour to 12-hour in-house on-call systems was compared in terms of the resident's quality of life and education, surgical case volume, and working hours' rules compliance. Quality of life and education: We adopted a validated survey based on a 5-point Likert scale to assess the residents' perception of the transition to a 12-hour on-call system on their quality of life and education. Surgical case volume: We extracted the number of cases the residents operated on from the operating theater database at our institution. Working hours: compliance and violations: The weekly working hours, compliance, and violations per ACGME-I rules were collected from the MedHub platform. RESULTS: Quality of life and education: Residents rated the 12-hour on-call system superior in terms of quality of life, education, and surgical case volume. Surgical case volume: There was a 45% increment in the surgical case volume (p = 0.04) with the 12-hour on-call system. Working hours: compliance and violations There was no significant difference in the mean weekly working hours (p = 0.1). However, the total number of duty hours violations decreased in the 12-hour on-call system. CONCLUSION: The 12-hour system is a better alternative to the 24-hour system in terms of the resident's quality of life, education, surgical case volume, and compliance with duty hour rules.

"Doing it Right" Overnight: a Multi-perspective Qualitative Study Exploring Senior Medical Resident Overnight Call.

BACKGROUND: Competency-based medical education (CBME) requires the development of workplace-based assessment tools that are grounded in authentic clinical work. Developing such tools, however, requires a deep understanding of the underlying facets of the competencies being assessed. Gaining this understanding remains challenging in contexts where performance is not readily visible to supervisors such as the senior medical resident (SMR) on-call role in internal medicine. OBJECTIVE: This study draws on the perspectives of healthcare professionals with whom the SMR interacts with overnight to generate insights into the different components of on-call SMR practice and the range of ways SMRs effectively and less effectively enact these. APPROACH: We used a constructivist grounded theory (CGT) approach to examine variation in how on-call SMRs carry out their role overnight. PARTICIPANTS: Six medical students, five junior residents, five internal medicine attending physicians, five emergency physicians, and three emergency nurses conducted observations of their on-call interactions with SMRs. Participants were then interviewed and asked to elaborate on their observations as well as provide comparative reflections on the practices of past SMRs they worked with. KEY RESULTS: Strong collaboration and organizational skills were identified as critical components to effectively being the on-call SMR. Perceived weaker SMRs, while potentially also having issues with clinical skills, stood out more when they could not effectively manage the realities of collaboration in a busy workplace. CONCLUSION: What consistently differentiated a perceived effective SMR from a less effective SMR was someone who was equipped to manage the realities of interprofessional collaboration in a busy workplace. Our study invites medical educators to consider what residents, particularly those in more complex roles, need to receive feedback on to support their development as physicians. It is our intention that the findings be used to inform the ways programs approach teaching, assessment, and the provision of feedback.

The effect of a short burst of exercise during the night on subsequent sleep.

When on-call workers wake during the night to perform work duties, they may experience reduced alertness and impaired performance as a result of sleep inertia. After performing their duties, on-call workers may have the opportunity to return to sleep. Thus, it is important that sleep inertia countermeasures do not affect subsequent sleep. Exercise may be a suitable countermeasure; however, the impact on subsequent sleep is untested. Healthy participants (n = 15) completed three conditions in a counterbalanced order: sedentary, low-intensity exercise or high-intensity exercise, performed for 2 min upon awakening. Sleep was recorded 2 hr later using polysomnography, the Karolinska Sleepiness Scale was administered to measure subjective sleepiness, and core body temperature was measured continuously. Results indicate there was no effect of condition on most sleep variables; however, three variables had small differences, with longer total sleep time (p = .006), higher sleep efficiency (p = .006) and shorter N3 latency (p < .001) in the low-intensity exercise condition. There was no difference in subjective sleepiness (p = .124) or core body temperature (p = .216) 90 min after the exercise intervention. These results indicate that using a short burst of exercise to counteract sleep inertia when woken during the night may be a suitable countermeasure for on-call workers who not only need to be alert upon waking but also need quality sleep when returning to bed. Future research could include participants of other ages and health statuses to investigate whether the results are generalizable.

Sleepy Surgeons: A Multi-Method Assessment of Sleep Deprivation and Performance in Surgery.

BACKGROUND: Minimum rest is mandated in high stake industries such as aviation. The current system of healthcare provision permits on-call surgeons to work in sleep deprived states when performing procedures. Fatigue has been demonstrated to negatively affect performance. This study aimed to explore measurements of sleep deprivation and their impact on simulated performance. METHODS: This was a single site study conducted between September 2019 and February 2020. Surgical trainee and consultants were conveniently sampled from a single site. All testing was done between 7 AM and 9 AM. Participants completed electroencephalogram testing using a modified Multiple Sleep Latency Test testing for objective sleep measurement, the Pittsburgh Sleep Quality Index, Chalder Fatigue Scale and Epworth Sleepiness Scale for subjective sleep measurement. The Psychomotor Vigilance Task and the SIMENDO simulated tasks were used for standardized performance assessment. RESULTS: Surgeons entered sleep in 6 min, on average pre-call. This significantly decreased to an average of 164 s post-call (P = 0.016). Pittsburgh Sleep Quality Index scoring was 5, indicating poor baseline sleep quality. There was higher self-reported fatigue and sleepiness in post-call states. Performance decrements were noted in cognitive performance reaction time and aspects of technical instrument proficiency. CONCLUSIONS: Surgeons are objectively sleep deprived pre-call according to internationally recognized guidelines. This sleep deprivation increases significantly in post-call states. Tasks with higher cognitive demands showed greater levels of diminished performance compared to those with lower cognitive demands. Current models of provision of surgical on-call are not conducive to optimizing sleep in surgeons. Prioritization of workload in post-call states, focusing on preserving individuals cognitive resources and utilizing lower cognitively demanding aspects of work is likely to have positive impacts on performance outcomes.

Exploring why medical students still feel underprepared for clinical practice: a qualitative analysis of an authentic on-call simulation.

BACKGROUND: Current research shows that many UK medical graduates continue to feel underprepared to work as a junior doctor. Most research in this field has focused on new graduates and employed the use of retrospective self-rating questionnaires. There remains a lack of detailed understanding of the challenges encountered in preparing for clinical practice, specifically those faced by medical students, where relevant educational interventions could have a significant impact. Through use of a novel on-call simulation, we set out to determine factors affecting perceived preparation for practice in final year medical students and identify ways in which we may better support them throughout their undergraduate training. METHODS: 30 final year medical students from Imperial College London participated in a 90-minute simulation on hospital wards, developed to recreate a realistic on-call experience of a newly qualified doctor. Students partook in pairs, each observed by a qualified doctor taking field notes on their decisions and actions. A 60-minute semi-structured debrief between observer and student pair was audio-recorded for analysis. Field notes and students' clinical documentation were used to explore any challenges encountered. Debrief transcripts were thematically analysed through a general inductive approach. Cognitive Load Theory (CLT) was used as a lens through which to finalise the evolving themes. RESULTS: Six key themes emerged from the on-call simulation debriefs: information overload, the reality gap, making use of existing knowledge, negative feelings and emotions, unfamiliar surroundings, and learning 'on the job'. CONCLUSIONS: The combination of high fidelity on-call simulation, close observation and personalised debrief offers a novel insight into the difficulties faced by undergraduates in their preparation for work as a junior doctor. In using CLT to conceptualise the data, we can begin to understand how cognitive load may be optimised within this context and, in doing so, we highlight ways in which undergraduate curricula may be adapted to better support students in their preparation for clinical practice. Recommendations are centred around enhancing the expertise of the learner through 'whole task' training approaches and integrated learning, as well as navigating negative emotions and supporting lifelong 'learning while working'.

Preparing junior radiology residents for overnight call via peer-led, hands-on simulation.

PURPOSE: The aim of this study was to assess the perceived value and impact of a hands-on mock call simulation program on resident confidence with interpretation of emergency department overnight call cases. METHODS: A five-session course was implemented in June of 2018 for rising PGY-3/R2 residents to mimic the experience of overnight call with indirect supervision. Sessions were led by senior residents in the program and consisted of timed, independent interpretation of 15-20 high-yield cases per day which highlighted "do-not miss" critical findings and simulated workflow interruptions including phone calls, consultations, and questions from technologists. IRB-approved, and anonymous pre- and post-course surveys were administered to participants which assessed residents' degree of confidence in interpretation of on-call cases and comparison of the mock call experience with existing preparatory strategies. Survey responses were analyzed using McNemar's test and Mann-Whitney U test. RESULTS: Our survey response rate was 91% (29/32). After completing the mock call simulation, there was a significant increase in the mean Likert score of resident confidence levels and feelings of preparedness from 4.59 to 7.38 (p < 0.01). The majority of respondents (72.4% [21/29]) felt that the mock call simulation was "extremely useful." One hundred percent of respondents indicated that the mock call simulation should be implemented for the following year. CONCLUSION: Implementation of a hands-on mock call simulation significantly improves the confidence levels of radiology residents before assuming on-call responsibilities and may serve as an adjunct to existing preparatory strategies.

Impact of shift work on sleep and fatigue in Maritime pilots.

This study examined how objective measures of sleep change across shift-cycles, and the impact of this on sleep quality and fatigue. Forty maritime pilots were recruited from Australian ports. Sleep wake-behaviour (timing and length), and self-reported sleep quality and fatigue, were assessed to determine any impact of roster status and 'on-call' status. On-roster pilots experienced reduced night time sleep duration compared to those off-roster (57 ± 8.8 min), while working on-call also diminished night time sleep duration (126 ± 11.3 min) and quality, compared to workers not on-call. Fatigue scores indicated that participants were not fully recovered prior to commencing rostered night shift, while sleep quality was significantly worse following sleep that occurred after a night shift, compared to after a day shift. These findings potentially support workplace negotiations to change future shift cycles, and to adopt monitoring systems that may mitigate the risk of fatigue-related accidents and chronic health outcomes. Practitioner summary: Long and irregular work hours of maritime pilotage can compromise worker performance and safety. This observational study found that on-roster pilots experience reduced sleep duration compared to those off-roster, while working on-call further diminishes sleep duration and quality. Future workload/fatigue monitoring systems may mitigate fatigue-related accidents and adverse chronic health outcomes. Abbreviations: ANOVA: analysis of variance; ANCOVA: analysis of covariance; BMI: body mass index; CVD: cardiovascular disease; h: hours; mins: minutes; SE: standard error of the mean; SD: standard deviation; SO: sleep opportunities; TST: total sleep time; WASO: wake after sleep onset.

On-call duties in hospital pharmacies: National survey and elaboration of a training program for pharmacy residents.

OBJECTIVES: During their residency, pharmacy residents are required to attend a hospital on-call program in order to insure the continuum of care for inpatients. This activity is subject to risks, and requires a prior training. Our aim was to develop and to optimize such a training program. METHODS: To this end, we first established a baseline study of the existing training methods in our hospital and those in the different hospitals of France in which pharmacy residents realize in-house on-call duties, associated with an identification of both pharmacists and students' needs in our institution. These preliminary studies were used to create a transversal, structured and harmonized training program. RESULTS: The results of our national survey highlighted great disparities of training between the establishments and point out the lack of structure, organization and harmonization of the training, which residents expected to be improved. Our training program contains 3 parts: initial theoretical training, initial practical training and continuous training. Beyond the harmonization of the theoretical training's materials between the different sectors of the pharmacy, new tools were introduced like an in-house on-call duty notebook complementary to trainings adapted to note taking, simulation's workshops and interactive quizzes. The training was gradually implemented in our hospital pharmacy, in collaboration with the pharmacists of the different activity sectors. CONCLUSIONS: The next steps of our work will be to assess pharmacists and pharmacy residents' satisfaction about our program and its efficacy.

Out-of-hours calls in clinical microbiology: the when, the why and from whom.

Microbiology services provided to hospitals must be delivered 24 h a day. In addition to during routine so-called 'office hours', clinical microbiologists have to provide an on-call service 7 days a week. However, there are few data on what that involves and how the service is delivered. I reviewed the source, reason for, grade of staff from whom the call came and the need for any follow-up, over an 11-year period using a pro-forma, that had been used to review data before this time period. Details were available for 90% of calls received, and data from 809 calls were analysed. The sources of calls were most commonly from medicine specialties [163/809 (20.1%)], neurosurgery (which is a national referral centre) [148/809 (18.3%)] and the intensive care unit [143/809 (17.7%)]. The number of calls received between 23.00 hours and 07.00 hours was 107 (13.2%). Just over half of calls, i.e. 440/809 (54.6%), were related to treatment; 247/809 (30.5%) were for advice on diagnosis; and 79/809 (9.8%) were related to infection prevention and control (IPC) issues. Registrars (a senior training grade) accounted for 492/809 (60.8%) of calls, and 64/809 (7.9%) came from nurses mainly related to IPC matters. Overall, 25.4% (206/809) of calls required follow-up the next day but this increased from 4.5% in 2013 to 67.6% in 2018. The nature of calls received by a clinical microbiologist out-of-hours is varied and may be increasing due to the complexity of case mix and changes in medical staffing. Professional and other organisations would do well to review such workload when deciding on staffing levels and service planning, given increasing public and patient expectations, and the trend towards the centralisation/consolidation of laboratory diagnostic services.