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Background: Attending physicians exhibit varied patterns in enacting educational roles, but no standardized framework or measurement tools currently exist to evaluate these roles and associated behaviors. This study aimed to create an analytical framework and develop an instrument to measure the educational role enactment of attending physicians through a questionnaire survey and detailed descriptions of educational behaviors., Methods: A 15-item questionnaire was designed based on a literature review to examine the enactment of three educational roles within the role set of attending physicians. Experts assessed its content validity, while feasibility and readability were tested in a pilot study involving 100 attending physicians from seven teaching hospitals and medical centers in Kaohsiung City. In the formal study, purposive sampling from the same institutions yielded 364 valid responses, achieving a response rate of 91%. Data analysis included item analysis, factor analysis, and evaluation of internal consistency reliability., Results: All questionnaire items related to the enactment of attending physicians' educational roles as clinical teachers met the retention criteria, including composite reliability (CR) and homogeneity. Factor analysis revealed a three-factor structure with acceptable reliability, representing three educational roles within the role set: "Clinical Teaching," "Supportive Counseling," and "Job Supervision.", Conclusion: The Teaching Hospitals Attending Physician Educational Role Enactment Scale is a reliable and comprehensive tool for assessing the educational roles enacted by attending physicians in the teaching hospital. It encompasses a range of educational roles and aligns with diverse teaching behaviors, offering a self-evaluation tool supported by an analytical framework for clinical teaching practices., Competing Interests: Declarations. Ethics approval and consent to participate: This study, with protocol number KMUHIRB-E (I) -20170052, was reviewed and approved by the Institutional Review Board of Kaohsiung Medical University Hospital and has been concluded. Informed consent was obtained from all participants at the beginning of the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: The optimal level of resident autonomy in emergency colorectal surgery is unclear. This study assessed perioperative outcomes in patients undergoing emergency colectomy with end stoma based on the presence of an attending surgeon., Participants: A retrospective analysis was conducted at a tertiary teaching hospital, including 360 patients who underwent emergency colectomy with end stoma between 2013 and 2023. The primary outcome was perioperative complications, including mortality., Results: Of the 360 patients, 36 (10 ​%) had surgery without an attending surgeon present. Baseline characteristics such as age (p ​= ​0.34), Charlson Comorbidity Index (p ​= ​0.313), and sex (p ​= ​0.598) were similar across groups. Perioperative outcomes showed no significant differences in major complications (Clavien-Dindo ≥3, p ​= ​0.176), 90-day complication rate (p ​= ​0.698), or 90-day mortality (p ​= ​0.389). Malignancy-related cases also did not differ in lymph node yield (p ​= ​0.685) or overall survival (log-rank p ​= ​0.574)., Conclusion: In this study, Hartmann resections performed by resident teams were not associated with worse perioperative or oncologic outcomes, suggesting that resident autonomy can be safely increased without compromising patient safety., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

In interventions for structural heart disease (SHD), an echocardiologist and an anesthesiologist are also present close to the side of the bed at the patient's head. The purpose of this study was to investigate the effectiveness of X-ray protective devices in reducing exposure to scatter radiation for medical staff at the side of the head end of the angiography system bed during interventions for structural heart disease. The ambient radiation dosage was measured, with and without X-ray protective equipment, to determine the rate of reduction of scatter radiation. The dosage tended to be higher at the working angle compared to the PA direction. When protective equipment was not used, the dosage tended to be higher at the side of the head end of the bed than at the operator's position. The dose was reduced by more than 90% compared to that without protective equipment by installing a protective device at the side of the head end of the bed. It is important to understand the spatial dose distribution at the working angle, and the installation of protective equipment at the side of the head end of the bed during SHD interventions can reduce the exposure of attending staff.

Aim: Three rounds of industrial action (IA) were carried out by junior doctors in the United Kingdom between March and June 2023. We investigated the impact of radiology registrars undertaking IA on the efficiency of a large teaching hospital's radiology department., Materials and Methods: This service evaluation was registered with the local Quality Surveillance Information System and involved analysing data pertaining to the computed tomography, magnetic resonance imaging, ultrasound, and x-ray studies performed before, during, and after periods of IA., Results: Across the three strike periods, there was a temporary 5-10% reduction in imaging studies, predominantly driven by decreases in x-ray and MRI studies. Urgent CT and MRI studies were reported faster during strikes, particularly for out-of-hours scans., Conclusion: Overall, patient safety in CT and MRI reporting remained uncompromised during strikes, and in some areas, the efficiency of the department improved. However, this does not take into account the significant displacement of consultants from non-clinical activities, who volunteered to cover during these IA periods, as well as the impact on other factors such as research output and medical training., Competing Interests: Conflict of interest The authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Oxygen is an essential drug that is commonly used in clinical practice, and its misadministration can result in severe consequences. This research sought to evaluate the knowledge and perceptions of physicians and nurses regarding acute oxygen therapy and delivery barriers., Methodology: This was a cross-sectional hospital-based survey. The study was conducted at Managil Teaching Hospital, Sudan. The study included 159 physicians and 25 nurses who were working at the hospital during the study period. The previously validated acute oxygen therapy questionnaire (AOTQ) was used to assess knowledge and barriers regarding acute oxygen therapy (AOT). The collected data were then analysed via R software., Results: A total of 184 medical professionals were included in the survey. The mean age of the study participants was 26 years, and 66.2% of all participants were male. A total of 74% of the physicians were junior physicians. Among the physicians, 15 (9.4%) had good knowledge (score > 80%), 75 (47.2%) had moderate knowledge (score > 60% & less than 80%), and 69 (43.4%) had poor knowledge about acute oxygen therapy (score < 60%). Among the nurses, 2 (8%) had good knowledge, 10 (40%) had moderate knowledge, and 13 (52%) had poor knowledge. Most of them were from medical departments, with 33% from physicians and 40% from nurses. Approximately 64% of the physicians and 68% of the nurses stated that oxygen is not a medication rather than a supportive therapy, and only 13% of the physicians and 28% of the nurses knew that oxygen should be given only after the doctor's prescription. The availability of oxygen was reported as a barrier by 85% of the physicians and 72% of the nurses., Conclusion: A considerable percentage of physicians and nurses exhibited a limited understanding of acute oxygen therapy, demonstrated infrequent adherence to AOT guidelines due to a lack of awareness, and reported germane barriers to delivery that necessitate administrative and educational interventions., Competing Interests: Declarations. Ethical approval and consent to participate: The study ethical clearance was obtained from the ethical committee at Managil Teaching Hospital under the institutional review board (IRB) number: GSMTH092023, and from health affairs at the Managil locality. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: To compare the manual dexterity and composure under pressure of people in different hospital staff roles using a buzz wire game., Design: Prospective, observational, comparative study (Tremor study)., Setting: Leeds Teaching Hospitals NHS Trust, Leeds, UK, during a three week period in 2024., Participants: 254 hospital staff members comprising of 60 physicians, 64 surgeons, 69 nurses, and 61 non-clinical staff., Main Outcome Measures: Successful completion of the buzz wire game within five minutes and occurrence of swearing and audible noises of frustration., Results: Of the 254 hospital staff that participated, surgeons had significantly higher success rates in completing the buzz wire game within five minutes (84%, n=54) compared with physicians (57%, n=34), nurses (54%, n=37), and non-clinical staff (51%, n=31) (P<0.001). Time-to-event analysis showed that surgeons were quicker to successfully complete the game, independent of age and gender. Surgeons exhibited the highest rate of swearing during the game (50%, n=32), followed by nurses (30%, n=21), physicians (25%, n=60), and non-clinical staff (23%, n=14) (P=0.004). Non-clinical staff showed the highest use of frustration noises (75%), followed by nurses (68%), surgeons (58%), and physicians (52%) (P=0.03)., Conclusions: Surgeons showed greater dexterity, but higher levels of swearing compared with other hospital staff roles, while nurses and non-clinical staff showed the highest rates of audible noises of frustration. The study highlights the diverse skill sets across hospital staff roles. Implementation of a surgical swear jar initiative should be considered for future fundraising events., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: With hospital electronic prescribing and medicines administration (HEPMA) systems now in widespread use across hospital inpatient clinical services, work is underway to measure the benefits of HEPMA on healthcare systems and patient care. HEPMA functionality enables users to prescribe medicines by 'bundle' or 'protocol'. Although it is assumed that this is a significant system benefit, there are few qualitative studies supporting this conclusion., Aim: To explore the impact of an electronic anticipatory care medicines protocol on junior doctor perceptions of their confidence and competence to prescribe opioids and midazolam for patients at the end of life., Method: Between May and August 2022, one-to-one semi-structured interviews were conducted at a 570-bed District General Hospital with junior doctors who had experience of prescribing on both HEPMA and paper-based systems. Audio recordings of the interviews were transcribed verbatim and underwent thematic analysis., Results: Ten junior doctors participated (median age 23 years). Analysis generated five main themes that described perceptions and attitudes towards confidence and competence. These were prescribing safety benefits; information technology infrastructure, interoperability and system design concerns; clinical knowledge and training needs; cultural and social factors and risks of automation in prescribing., Conclusion: This study suggests that junior doctors experienced an overall increase in their confidence and perceived competence to prescribe anticipatory medicines post-implementation of a HEPMA protocol. Further studies are required to detail the impact of HEPMA/CPOE protocols on clinical practice., Competing Interests: Conflicts of interest The authors declared that they have no conflict of interest., (© 2024. The Author(s).)

Introduction: Air embolism is a potentially serious complication of central venous catheter (CVC) use. While CVC insertion is usually performed by a trained specialist, extraction is frequently the responsibility of junior staff members. This complication can be easily prevented by following several simple measures described in common guidelines., Aim: We conducted a single-center survey to assess knowledge and practices concerning the prevention of air embolism associated with CVC removal among healthcare workers from nonintensive care units., Methods: The correct answers to the questionnaire were determined according to best-practice recommendations for CVC removal. Based on a comparison of the total sum of correct answers between the categories of groups, factors that predicted the level of knowledge were identified using an independent sample t test., Results: Of the 156 respondents, one-third were unfamiliar with air embolism as a complication of CVC extraction. Almost 80% were unaware of the existence of a CVC removal protocol. Almost half of respondents did not follow guidelines regarding patient position when removing a CVC, 72% did not ask the patient to perform the Valsalva maneuver during the procedure, and 54% did not ask the patient to remain supine after the procedure. Adherence to the protocol was correlated with professional experience, with a lower level among those with experience of less than 1 year and, particularly, among interns., Conclusions: Our survey revealed inappropriately low awareness of CVC removal-associated air embolism risk and low familiarity with CVC removal best-practice recommendations among nonintensive care unit healthcare workers. Staff members with experience of less than 1 year, including interns, were found to have a lower level of knowledge. These findings emphasize the importance of development and distribution an internal hospital protocol and the integration of educational intervention into a preliminary internship program., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Patients in rural Australia have limited access to intravitreal treatments due to a maldistribution of the ophthalmology workforce. To improve access, a novel outreach service model was implemented whereby junior medical staff administered intravitreal injections under a supervising ophthalmology consultant. This model involves outreach visits in hospitals, mobile clinics and a remote hub with intravitreal injections administered by junior doctors overseen by an ophthalmologist. The article explores the safety of this approach with respect to the rate of post-injection endophthalmitis., Methods: A retrospective audit was conducted by the Lions Outback Vision outreach ophthalmology service from 2017 to mid-2023. The number of injections, locations, diagnoses, intravitreal agents used, designation of administering doctor and cases of endophthalmitis were reviewed., Results: A 12 632 intravitreal injections were administered across 32 locations throughout rural Western Australia in the 6.5-year period. Three cases of endophthalmitis occurred representing a rate of 0.0237%., Conclusion: The rate of endophthalmitis in the outreach service is comparable to other centres. The outreach model with supervising ophthalmology consultant support in person or via telehealth and administration of injections by junior medical staff has improved access for underserved or marginalised populations., (© 2024 The Author(s). Clinical & Experimental Ophthalmology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Ophthalmologists.)

This reflective article examines the profound challenges faced by junior doctors in Nigeria, focusing on the pervasive lack of support from senior colleagues and the systemic failures within the healthcare system. Drawing from personal experiences, the narrative highlights how newly qualified doctors are often "left in the lurch", thrust into demanding roles with insufficient guidance, training, and resources. The consequences of this abandonment are explored, not only in terms of the personal and professional toll on junior doctors but also in the broader context of patient care and the overall efficacy of the healthcare system. The article concludes with a call for urgent reforms to address these critical issues, advocating for a more supportive and sustainable environment for the next generation of medical professionals in Nigeria., Competing Interests: The authors declare no competing interests., (Copyright: Muhammed Raji Modibbo et al.)

Objectives: To develop and validate a novel measure, action entropy, for assessing the cognitive effort associated with electronic health record (EHR)-based work activities., Materials and Methods: EHR-based audit logs of attending physicians and advanced practice providers (APPs) from four surgical intensive care units in 2019 were included. Neural language models (LMs) were trained and validated separately for attendings' and APPs' action sequences. Action entropy was calculated as the cross-entropy associated with the predicted probability of the next action, based on prior actions. To validate the measure, a matched pairs study was conducted to assess the difference in action entropy during known high cognitive effort scenarios, namely, attention switching between patients and to or from the EHR inbox., Results: Sixty-five clinicians performing 5 904 429 EHR-based audit log actions on 8956 unique patients were included. All attention switching scenarios were associated with a higher action entropy compared to non-switching scenarios (P < .001), except for the from-inbox switching scenario among APPs. The highest difference among attendings was for the from-inbox attention switching: Action entropy was 1.288 (95% CI, 1.256-1.320) standard deviations (SDs) higher for switching compared to non-switching scenarios. For APPs, the highest difference was for the to-inbox switching, where action entropy was 2.354 (95% CI, 2.311-2.397) SDs higher for switching compared to non-switching scenarios., Discussion: We developed a LM-based metric, action entropy, for assessing cognitive burden associated with EHR-based actions. The metric showed discriminant validity and statistical significance when evaluated against known situations of high cognitive effort (ie, attention switching). With additional validation, this metric can potentially be used as a screening tool for assessing behavioral action phenotypes that are associated with higher cognitive burden., Conclusion: An LM-based action entropy metric-relying on sequences of EHR actions-offers opportunities for assessing cognitive effort in EHR-based workflows., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Electronic medical records (EMRs) have been widely implemented in Australian hospitals. Their usability and design to support clinicians to effectively deliver and document care is essential, as is their impact on clinical workflow, safety and quality, communication, and collaboration across health systems. Perceptions of, and data about, usability of EMRs implemented in Australian hospitals are key to successful adoption., Objective: To explore perspectives of medical and nursing clinicians on EMR usability utilising free-text data collected in a survey., Method: Qualitative analysis of one free-text optional question included in a web-based survey. Respondents included medical and nursing/midwifery professionals in Australian hospitals (85 doctors and 27 nurses), who commented on the usability of the main EMR used., Results: Themes identified related to the status of EMR implementation, system design, human factors, safety and risk, system response time, and stability, alerts, and supporting the collaboration between healthcare sectors. Positive factors included ability to view information from any location; ease of medication documentation; and capacity to access diagnostic test results. Usability concerns included lack of intuitiveness; complexity; difficulties communicating with primary and other care sectors; and time taken to perform clinical tasks., Conclusion: If the benefits of EMRs are to be realised, there are good reasons to address the usability challenges identified by clinicians. Easy solutions that could improve the usability experience of hospital-based clinicians include resolving sign-on issues, use of templates, and more intelligent alerts and warnings to avoid errors., Implications: These essential improvements to the usability of the EMR, which are the foundation of the digital health system, will enable hospital clinicians to deliver safer and more effective health care., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Hypospadias repair is regarded as a technically demanding, complex procedure, with variable outcomes. Therefore, it tends to be performed by consultants, with limited trainee involvement. We aimed to study the clinical outcomes of supervised registrars performing proximal and distal hypospadias repairs, compared to their consultant mentors., Methods: We undertook a retrospective review of all primary hypospadias repairs performed between April 2013-April 2022 at our tertiary paediatric urology centre. Redo repairs and patients lost to follow-up were excluded. Pre-operative anatomy, theatre time, grade of primary surgeon (registrar (trainees and non-training middle grades) or consultant), operative technique, follow-up duration, complications, and reoperation rates were recorded. The procedures were assessed in two groups according to the primary operator: registrar or consultant. The Zwisch scale is used to describe level of consultant support. Registrars as primary operators received "passive help" or "supervision" (Zwisch levels 3/4). Consultants as primary operators provided registrars with "show-and-tell" or "active help" (Zwisch levels 1/2)., Results: 270 procedures performed on 228 patients met the inclusion criteria. 109 were performed by registrars and 161 by consultants. In both groups, median age was two years (p = 0.23). Median theatre time was similar (registrars 2.8 h vs. consultants 2.7 h, p = 0.88), as was median follow-up (registrars 25months, vs. consultants 21months, p = 0.99). Operations performed by registrars were 76% distal and 24% proximal; and by consultants were 62% distal and 38% proximal. The overall urethroplasty complication rate was similar, at 24% for registrars and 23% for consultants (p = 0.89). The summary table shows the distribution of different complications. Re-operation rate was 16% in both groups (p = 0.99). Complications were further assessed according to operation type (TIP vs. two-stage repair)., Discussion: Contrary to popular belief amongst hypospadiologists, we found complication rates were similar for registrar and consultant surgeons. We question that involvement of registrars increases complications. The literature demonstrates safety of trainee performance of limited steps of the procedure. However our institution permits registrars to perform up to the whole hypospadias repair under direct supervision, with no predefined limit to their involvement., Conclusion: Paediatric surgical registrars can be safely supervised to have substantial involvement in proximal and distal hypospadias repair, without compromising the duration or outcomes of surgery. We hope that allowing more registrar involvement can lead to faster acquisition of surgical skills, whilst remaining under the safety of senior supervision. Increasing opportunities for those with an aptitude for hypospadias repair can equip them with skills and confidence for entering fellowship training., Competing Interests: Conflict of interest None., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Background: In the past, evidence-based medicine (EBM) and shared decision-making (SDM) have been taught separately in health sciences and medical education. However, recognition is increasing of the importance of EBM training that includes SDM, whereby practitioners incorporate all steps of EBM, including person-centered decision-making using SDM. However, there are few empirical investigations into the benefits of training that integrates EBM and SDM (EBM-SDM) for junior doctors, and their influencing factors. This study aimed to explore how integrated EBM-SDM training can influence junior doctors' attitudes to and practice of EBM and SDM; to identify the barriers and facilitators associated with junior doctors' EBM-SDM learning and practice; and to examine how supervising consultants' attitudes and authority impact on junior doctors' opportunities for EBM-SDM learning and practice., Methods: We developed and ran a series of EBM-SDM courses for junior doctors within a private healthcare setting with protected time for educational activities. Using an emergent qualitative design, we first conducted pre- and post-course semi-structured interviews with 12 junior doctors and thematically analysed the influence of an EBM-SDM course on their attitudes and practice of both EBM and SDM, and the barriers and facilitators to the integrated learning and practice of EBM and SDM. Based on the responses of junior doctors, we then conducted interviews with ten of their supervising consultants and used a second thematic analysis to understand the influence of consultants on junior doctors' EBM-SDM learning and practice., Results: Junior doctors appreciated EBM-SDM training that involved patient participation. After the training course, they intended to improve their skills in person-centered decision-making including SDM. However, junior doctors identified medical hierarchy, time factors, and lack of prior training as barriers to the learning and practice of EBM-SDM, whilst the private healthcare setting with protected learning time and supportive consultants were considered facilitators. Consultants had mixed attitudes towards EBM and SDM and varied perceptions of the role of junior doctors in either practice, both of which influenced the practice of junior doctors., Conclusions: These findings suggested that future medical education and research should include training that integrates EBM and SDM that acknowledges the complex environment in which this training must be put into practice, and considers strategies to overcome barriers to the implementation of EBM-SDM learning in practice., (© 2024. The Author(s).)

Clinical handovers from out-of-hours activity are essential for relaying information about events such as new admissions, outstanding or complete investigations, physical health reviews, ward jobs and risk. This information enables the day team to effectively prioritise and follow-up any necessary tasks.Junior doctors at a hospital site in the London Borough of Newham were aware that the existing handover system, constituted of a word document circulated via email, was lacking robustness and that the handover was not sent out reliably on a daily basis.Quality improvement (QI) methods including process mapping, PDSA ('Plan, Do, Study, Act') cycles, driver diagrams and run charts were used to understand the issue, create a more robust process and measure the improvements made, all supported by regular QI project meetings. The change ideas included moving from an informal Microsoft (MS) Word document, which was emailed out, to an Excel spreadsheet stored centrally on MS Teams. Column headers were added for admissions, ward jobs, seclusion reviews, matters relating to mental health law and Accident and Emergency (A&E) assessments, as well as defined columns for outstanding jobs and standard tasks that need to be completed for all admissions. Responsibility for circulating the handover list was given to the incoming day duty doctor if the night doctor was too busy, with admin support to chase the circulation of the handover. Results were studied for the following 18 months.The percentage of handovers being appropriately sent out increased from a median of 80% to 100% during the project period, and the availability of handover data where the data were visible to doctors on MS Teams but had not been sent out also increased from a median of 80% to 100%. The system was deemed safe, effective and easy to use, and has already been replicated at neighbouring hospitals., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: The author has no potential conflicts of interest to disclose.

This quality improvement project (QIP) aimed to assess the impact of automating patient list generation on the acute medical unit (AMU) at Sandwell and West Birmingham Hospitals NHS Trust. The AMU patient list categorises patients requiring 'clerking', 'post-take' (PTWR) and 'post-post-take' (PPTWR) for the morning ward round. During weekdays, this list need only include the patients in AMU. For weekends, this list must include 'outliers', that is, patients transferred to different wards (which may lack resident medical teams over the weekends) but still requiring PTWR/PPTWR. The list is created by the junior doctor on their night shift, a daily necessity due to the high AMU patient turnover.A pilot study, followed by three complete 'plan-do-study-act' (PDSA) cycles, was conducted over 2021/2022. Cycle 1 (pre-intervention) and cycle 2 (post-intervention) assessed the impact of the generator on weekdays. This was adapted for the weekend over cycles 2 and 3. The process measure assessed was the time taken for list generation. The outcome measure was the total number of patients clerked per night. The balancing measure was doctors' attitudes.The intervention reduced the time taken for list generation by an average of 44.3 min (66.3%) during weekdays and 37.8 min (42%) during weekends. Run charts demonstrated significance for the reduction in weekday list generation time. Both weekdays (63.5% decrease, p<0.00001) and weekends (50.5% decrease, p=0.0007) had significant reductions in total negative attitudes. Both weekdays and weekends had 'time-consuming' as the most frequently selected attitude pre-intervention, whereas 'easy to make' was most frequently selected post-intervention. Some junior doctors reported the generator enabled clerking of extra patients, supported by non-significant increases in the averages for this outcome.This QIP demonstrates how the automation of labour-intensive administrative tasks results in notable time-saving outcomes. Thereby improving doctor attitudes and well-being, and facilitating the delivery of quality patient care., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The goal of better medical student preparation for clinical practice drives curricular initiatives worldwide. Learning theory underpins Entrustable Professional Activities (EPAs) as a means of safe transition to independent practice. Regulators mandate senior assistantships to improve practice readiness. It is important to know whether meaningful EPAs occur in assistantships, and with what impact. Final year students at one UK medical school kept learning logs and audio-diaries for six one-week periods during a year-long assistantship. Further data were also obtained through interviewing participants when students and after three months as junior doctors. This was combined with data from new doctors from 17 other UK schools. Realist methods explored what worked for whom and why. 32 medical students and 70 junior doctors participated. All assistantship students reported engaging with EPAs but gaps in the types of EPAs undertaken exist, with level of entrustment and frequency of access depending on the context. Engagement is enhanced by integration into the team and shared understanding of what constitutes legitimate activities. Improving the shared understanding between student and supervisor of what constitutes important assistantship activity may result in an increase in the amount and/or quality of EPAs achieved., (© 2023. The Author(s).)

Purpose: In daily practice, junior doctors can contribute to quality improvement by providing innovative suggestions for change, referred to as voice behavior. Junior doctors are more likely to engage in voice behavior when they receive sufficient support from supervisors and peers. Such support has also been associated with less burnout and more work engagement. However, whether less burned-out and more work-engaged junior doctors demonstrate more voice behaviors in the face of sufficient supervisor and peer support is unclear. Therefore, we studied whether and how associations of supervisor and peer support with junior doctors' voice behaviors are mediated by burnout and work engagement., Materials & Methods: Participants were 301 junior doctors that completed a web-based survey including validated questionnaires on supervisor and peer support, burnout, work engagement, and voice behavior., Results: Supervisor and peer support were associated with lower levels of burnout and higher levels of work engagement. Work engagement, but not burnout, mediated the associations of supervisor and peer support with voice behaviors., Conclusions: Junior doctors who received more supervisor or peer support were more work-engaged and reported more voice behaviors. Thus, supervisor and peer support should be cultivated to facilitate junior doctors' roles as work-engaged professionals in quality improvement.

Context: The reform of the third cycle of medical studies in France has introduced of the "Junior Doctor" status during the concluding year of residency. We wish to evaluate its implementation for the first promotion of medical oncology residents during 2021-2022 in correlation with the published guidelines., Method: AERIO conducted a cross-sectional study among French medical oncology residents. The survey was released via social networks and emails., Results: Twenty-eight of 47 residents responded. The typical week involved one to two half-days of consultation, one dedicated to clinical research, one multidisciplinary team meetings, with the rest of time being occupied by day care (mostly) and hospitalization. Teaching and quality management activities were infrequent (monthly or less). The Junior Doctors rated their overall satisfaction at 8/10. A large majority (92.5 %) felt equipped to handle most of the situations they encountered. Almost all residents (92.9 %) had negotiated with their placement supervisor prior to the selection procedure. In one third of the cases (35.7 %), the principle of mismatch between the number of residents and the number of training sites was not respected. Only 42.9 % received training in scientific writing and 82.2 % of the residents agreed on the relevance of the post-internship training modules developed in other specialties., Conclusions: Junior doctors in medical oncology express overall satisfaction with this reform, which aligns with the recommendations. Nevertheless, certain concerns, such as selection procedure and inadequacy, along with areas requiring improvement, such as post-internship training and scientific writing, are clearly established., (Copyright © 2023 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Background and Importance: Healthcare worker strikes are a global phenomenon. Mortality and morbidity seem to be unaffected by doctor strikes, but there is little evidence on the impact on emergency department (ED) flow and patient characteristics. In March and April 2023, two consecutive UK junior doctor strikes occurred., Objectives: This study investigated the impact of junior doctor strikes on ED patient flow. Additionally, variation in patient presentations was compared between non-strike and strike days., Design, Setting and Participants: This cross-sectional study was conducted at King's College Hospital ED, a university hospital in London. All ED attendances during the 72- and 96-hour strike actions were compared with the corresponding non-strike days of the previous week., Outcome Measures and Analysis: National key performance indicators (KPIs) were analysed and compared between non-strike and strike days. Patients' demographics, acuity and diagnoses were compared. Outcome measures included number of 4-hour breaches, number of patients admitted or discharged and ED mortality. Staff seniority was categorised into levels for analysis., Main Results: There was increased ED patient flow during strike days with a significantly shorter total time in department in March [240 min (IQR 155-469) vs. 286 min (IQR 198.5-523.5), P  < 0.001] and in April [222.5 min (IQR 147-351) vs. 251.5 min (IQR 174-443), P  < 0.001]. Time to first clinician, treatment, and decision to admit were all shorter during both strike actions. Number of attendances, acuity, diagnoses, admission, discharge, and mortality rates were similar during strike and non-strike days. Staffing numbers were lower or equivalent on strike days but level of seniority was higher ( P  < 0.001)., Conclusion: The improved KPIs and increased patient flow during strike days, while multifactorial, seem largely attributed to the higher number of senior staff. Patient presentations and outcomes were unaffected by junior doctor strike action., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Competing interests: None declared.

Background: Poor communication contributes to adverse events (AEs). In our hospital, following an experience of a fatal incident in 2014, we developed an educational programme aimed at improving communication for better teamwork that led to a reduction in AEs., Methods: We developed and implemented an intervention bundle comprising external investigation committee reviews, the establishment of a working group (WG), standards and emergency response guidelines, as well as educational programmes and tools. To determine the effectiveness of the educational programmes, we measured communication abilities among doctors and nurses by administering psychological scales focused on their confidence in speaking up. Furthermore, we applied the trigger tool methodology in a retrospective study to determine if our interventions had reduced AEs., Results: The nurses' scores for 'perceived barriers to speaking up' and 'negative attitude toward voicing opinions in the healthcare team' decreased significantly after the training from 3.20 to 3.00 and from 2.47 to 2.29 points, respectively. The junior doctors' scores for the same items also decreased significantly after the training from 3.34 to 2.51 and from 2.42 to 2.11 points, respectively. The number of AEs was 32.1 (median) before the WG, 39.9 (median) before the general training, 22.2 (median) after the general training and 18.4 (median) after implementing the leadership educational programmes. During the intervention period the hospital's incident reports per employee kept increasing., Conclusion: Our new educational programmes improved junior doctors and nurses' perceptions of speaking up. We speculated that our intervention may have improved staff communication, which in turn may have led to a reduction in AEs and a sustained increase in incident reports per employee., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)