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It is well understood that human behavior can be influenced, often by the most subtle of factors. Otherwise known as "nudging", these attempts to affect human decision making in a predictable manner are possible due to individual cognitive boundaries, biases, routines, and habits. This quality improvement study analyzes the impact of a norms nudge on compliance of attending anesthesiologists providing breaks to the providers they are working with under the care team model. The nudge displays the top performing attendings as well as the top performing hospital to all attendings. Each individual can also view where they fall in relation to the department average as well as their deidentified partners. Implementation of the norms nudge was associated with a significant increase in the percentage of breaks given in the accepted time frame. Morning break compliance increased from 75.0 to 78.1% (p = 0.0002), lunch breaks increased from 83.0% to 86.3 (p < 0.0001), and afternoon breaks increased from 61.8 to 65.3% (p < 0.0001). The present study suggests that norm nudges may be able modify intraoperative practices with regards to breaks without significant cost, education, or other investment., Competing Interests: Declarations. Ethics Approval and Consent to Participate: The Endeavor Health Institutional Review Board waived requirement for approval as the project does not involve human subjects and is a quality improvement study. Financial Disclosures: None. Competing Interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The whole person care (WPC) model has become a core objective of medical education. In this model, transformative learning is employed to broaden health-care providers' (HCPs) perspectives. To explore how artistic creation influences HCPs' perceptions of the value of WPC, this study examined the content of artworks created by HCPs in teaching hospitals., Methods: In this study, using Mezirow's phases of perspective transformation as a theoretical framework, a retrospective qualitative analysis was conducted to investigate the content of HCPs' art projects presented at annual WPC-experience-sharing workshops held from 2019 to 2021 at a teaching hospital in Taiwan. A content analysis applying template analysis principles was employed. The data were categorized according to an iteratively refined template until a consensus was reached by the researchers regarding the identified themes and subthemes., Results: From 2019 to 2021, 226 art projects were presented in the annual week-long exhibition. Postgraduate-year physicians and other hospital staff created 140 and 86 artworks, respectively. The participants included 127 men and 99 women aged between 22 and 55 years. The researchers identified 4 themes and 12 subthemes of transformational learning concerning the meaning of life and the value of WPC across Mezirow's phases. The four themes were (1) deep reflection on the meaning of life and death, (2) connection, (3) deepening and valuing health-care professional identity, and (4) reaffirming the motivation to serve., Conclusions: Our results align with Mezirow's phases of TL, with art creation highlighting key phases such as self-examination and critical reflection. Physicians showed greater engagement in these phases than other professionals. The most commonly represented phase focused on connection, while themes related to life and death were less frequent among non-medical participants. Overall, our findings demonstrate how artistic expression facilitated TL among healthcare professionals, allowing them to reflect on their identities, relationships, and professional responsibilities. These cognitive exercises foster active learning, WPC, and promote an awareness of the meaning and value of life in teaching hospitals., Competing Interests: Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the principles of the Declaration of Helsinki and all applicable national ethical guidelines. Since the data used in this research were publicly displayed works, participants had previously consented to their public display and publication on the hospital’s website. The Research Ethics Committee of Kaohsiung Veterans General Hospital granted an exemption for this study, waiving the requirement for participant consent forms (KSVGH25-EM1-01). Consent for publication: All authors participating in the study give their consent for its publication. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objectives: The present study aimed to assess self-reported experience, knowledge, practices and attitudes of ED medical staff regarding teledermatology., Methods: Online questionnaire of ED medical staff at Prince of Wales Hospital (Sydney, Australia)., Results: Seventy-nine staff completed the questionnaire. Photographic technique and compliance with medicolegal policies were variable: 1% obtained written consent and 45.6% documented verbal consent for photography. 54.4% of respondents had concerns about the quality of their photographs., Conclusions: Skin photography image quality, knowledge and adherence to medicolegal policy were poor among ED medical staff. Education could reduce risk and improve outcomes., (© 2024 The Author(s). Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)

Background: Emergency departments (EDs) are high pressure work environments with several psychosocial job demands, e.g., violence, and job resources, e.g., colleague support. So far, the perceptions of working conditions have been compared between doctors and nurses, but there is limited knowledge regarding their respective supervisors. In addition, the violence prevention climate has not been assessed in German EDs before. Thus, the current study focuses on differences in the perceptions of working conditions and the violence prevention climate between the groups of doctor-supervisors, doctor-employees, nurse-supervisors, and nurse-employees within the ED. Further analyses regarding the association between social relations and pressure for unsafe practices are performed, including the moderating role of belonging to one of the aforementioned groups., Methods: A cross-sectional online survey was carried out among N = 370 participants, who were doctors or nurses from German EDs. The Questionnaire for Psychosocial Risk Assessment (QPRA) and the Violence Prevention Climate Scale (VPCS) were applied. Kruskal-Wallis tests were performed for group comparisons, followed by a hierarchical multiple linear regression model and moderation analyses., Results: Statistically significant differences between the groups were found for eight out of 13 variables. The highest number of significant pairwise comparisons was found between the groups of doctor-supervisors and nurse-employees. High job demands regarding work intensity and work interruptions became apparent across all groups. Nurse-employees reported the highest social and emotional demands as well as the highest pressure for unsafe practices regarding violence prevention, significantly differing from the other groups on these variables. The variables of supervisor support and social stressors were found to be significantly predictive of pressure for unsafe practices. Furthermore, there was no moderating effect of belonging to one of the above-mentioned groups in the relationships between variables of social relations and pressure for unsafe practices., Conclusions: Differences found in the current study can help tailor preventive measures according to the needs of distinct professions and positions in order to improve working conditions and the violence prevention climate in EDs. Furthermore, supervisor support should be strengthened while social stressors should be resolved in order to decrease pressure for unsafe practices regarding violence prevention., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee of the University Medical Center Hamburg - Eppendorf (UKE), Germany (LPEK-0388, 20 October 2021). Informed consent was obtained from every participant Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Phenomenon: Effective communication between team members is essential during the resuscitation of critically-ill patients. Failure of junior doctors to speak up and challenge erroneous clinical decisions made by their senior doctors is a serious communication failure which can result in catastrophic outcomes and jeopardize patient safety. Crisis resource management (CRM) and conflict resolution tools have been increasingly employed in the healthcare setting to reduce communication failure among healthcare providers and improve patient safety during crisis situations. The aims of our study were to: 1) evaluate the factors affecting junior doctors' ability to speak up on medical errors, 2) examine the effectiveness of CRM and conflict resolution tools, and 3) formulate a communication framework directed at training junior doctors in appropriate intellectual questioning of authority. Approach: From January to April 2019, we recruited twenty-five second-year postgraduate junior doctors working in an Emergency Department in Singapore. We provided training in CRM and conflict resolution communication for participants in the intervention arm. Participants underwent a high-fidelity simulated resuscitation scenario which was standardized to include faculty misdirection in the form of erroneous instructions given by a role-played senior doctor. We observed if participants appropriately challenged the erroneous instructions. We subsequently interviewed participants on their response during the simulation to elicit their barriers and motivations toward challenging authority. Video recordings were analyzed by an independent panel of investigators. Findings: Participants employed various non-verbal and verbal approaches when challenging erroneous decisions. We uncovered multiple personal, interpersonal, and situation-based factors influencing the junior doctor's willingness to challenge erroneous decisions made by seniors. From their responses, we conceptualized a theoretical model designed as a "weighing scale" to demonstrate how junior doctor's eventual response is the outcome of a delicate interplay of multiple barriers and motivations. Our intervention did not significantly increase the participants' likelihood of challenging authority (69% in control arm vs 75% in intervention arm, p  = 1.00). Insights: Our study provides insights into the mindset of junior doctors when faced with the dilemma of challenging authority on medical errors. Established CRM training may not be effective in addressing the challenges junior doctors face when communicating against the hierarchal gradient. We propose strategies to further develop and optimize CRM training to enhance its value for junior doctors. Drawing from our findings, we formulated a "SAFE" communication tool (State the safety concern, suggest Alternative course of action, Support with Facts, Engage via Enquiry) directed at helping junior doctors in appropriate intellectual questioning of authority.

Objective: To describe staff-perceived barriers to progressive patient mobilization., Design: Cross-sectional staff survey., Setting: Ten internal medicine wards in 4 hospitals in a large health service., Participants: Nursing, medical, and allied health staff (n=208)., Interventions: Not applicable., Main Outcome Measures: Patient Mobilization Attitudes and Beliefs Survey. An overall barriers score and subscale scores for knowledge, attitudes, and behaviors were calculated and compared between hospitals, discipline, and years of clinical experience., Results: The survey was completed by 208 participants (123 nurses, 27 medical, 58 allied health), of whom 104 (50%) had <5 years of experience. The greatest perceived barriers included nursing workload, medical orders not being in place, and patient and family resistance to mobilization. Overall barrier scores differed between hospitals, discipline (mean nursing score ± SD 50±7; mean medical score ± SD, 51±7; mean allied health score ± SD, 43±7), and years of clinical experience (<5y mean score ± SD, 50±7; 5-9y mean score ± SD, 47±7; ≥10y mean score ± SD, 46±8); significant differences by hospital and discipline persisted in multivariate analysis. The behavior subscale had the highest barriers score and knowledge the lowest across all subgroups., Conclusions: Staff-perceived nursing workload, lack of medical orders, and patient and family resistance to be the greatest barriers to patient mobilization. Barrier scores differed between disciplines, experience levels, and across hospitals within a single health service. Lower scores on the knowledge subscale highlight the need for multicomponent strategies beyond education that address culture and systems; education may particularly benefit medical staff., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Background: Influenza vaccination coverage in Germany is generally low. Even in hospitals, the demand for influenza vaccination is lacking although it has the potential to prevent the spread of the influenza virus and diseases. To take effective actions, a deeper understanding of vaccination behavior of healthcare workers is crucial., Methods: OKaPII is an annual German-wide online survey of clinical staff on influenza vaccination. Differences in vaccination behavior were tested for occupation, sex, and age, and differences in knowledge were tested between physicians and nurses. We used logistic regressions to analyze associations between psychological determinants and vaccination behavior among physicians and nursing staff., Results: From 115 clinics, 15,312 employees participated in the survey (17 April to 15 May 2023). In the 2022/23 season, 58.7% of the participants were vaccinated against influenza. The vaccination coverage was 80.7% for physicians and 51.1% for nursing staff . The vaccination behavior of physicians and nursing staff was significantly associated with collective responsibility and confidence in vaccination safety. Of the knowledge items, 87.2% were answered correctly by physicians and 62% by nursing staff., Discussion: We identified significant differences in vaccine uptake between occupational groups in German hospitals. Low vaccination coverage has existed for years, especially among nursing staff. Tailored interventions should promote the idea of protecting vulnerable people and confidence in the safety of vaccination. Increased education, especially on vaccination safety issues, can have a positive impact on the decision to vaccinate. Possibilities to get vaccinated despite time constraints in the workplace should be provided., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: E. Wulkotte und N.K. Schmid-Küpke geben an, dass kein Interessenkonflikt besteht. Vor Beginn der Onlinebefragung wurden die Klinikmitarbeitenden über Studienzweck und Datenschutz aufgeklärt und haben in die Teilnahme eingewilligt., (© 2024. The Author(s).)

The pandemic Covid-19 not only caused great public health problems but also caused enormous distress, especially for medical staff. The cross-sectional study aimed to investigate the prevalence rate of insomnia and to confirm the social factors among medical support staff in hospitals during the Covid-19 pandemic from 1st July 2020 to December 31st 2020. This study was conducted at Dhaka Medical College and Hospital (DMCH), Kurmitola General Hospital (KGH), Kuwait Bangladesh Friendship Government Hospital and Mugda Medical College and Hospital located at Dhaka and Tungipara UHC from Tungipara, Gopalganj, Bangladesh. Medical support staff in the Dhaka division was recruited. The face-to-face interview was conducted, obtained demographic data and asked self-design questions related to the Covid-19 pandemic and insomnia. Chi-square analysis was done to examine the associations between socio-demographic factors and insomnia symptoms. There were a total of 289 participants in our study. Participants 53(19.4%) had insomnia symptoms according to the Insomnia Severity Index (ISI) (total score ≥8). The chi-square test revealed that insomnia symptoms were associated with uncertainty in effective disease control (p=0.000, OR = 3.377, 95% CI = 1.842 - 6.189), worry about getting infected (p=0.001, OR = 2.748, 95% CI = 1.457 - 5.181). This study found that nearly one-fifth of the medical support staff suffered insomnia symptoms during the Covid-19 pandemic. The related factors included uncertainty in effective disease control and worry about getting infected.

Purpose: Junior doctors function as trainees from an educational perspective and as employees from a human resource management perspective. Employing the ability-motivation-opportunity (AMO) theory as a conceptual framework, this study longitudinally investigated the factors affecting the workplace well-being and career progression of junior doctors over a 3-year period following their graduation from medical schools., Materials and Methods: This 3-year prospective cohort study enrolled junior doctors who graduated from 2 medical schools in June 2019 in Taiwan. This study collected data by implementing web-based, self-administered structured questionnaires at 3-month intervals between September 2019 and July 2022. The collected data encompassed ability indicators (i.e. academic performance and perceived preparedness for clinical practice), motivation indicators (i.e. educational and clinical supervision), opportunity indicators (i.e. clinical unit cultures), and workplace well-being indicators (i.e. burnout, compassion satisfaction, and job performance). A total of 107 junior doctors participated, providing 926 total responses. The data were analysed using univariate analyses and structural equation modelling with path analysis., Results: Over the 3-year period following graduation, the junior doctors' confidence in their preparedness for clinical practice and the educational and clinical supervision had varying degrees of influence on the junior doctors' workplace well-being. The influence of clinical unit cultures, which can provide opportunities for junior doctors, became evident starting from the second year postgraduation; notably, unit cultures that emphasised flexibility and discretion played positive and critical roles in enhancing the junior doctors' workplace well-being lasted to the third year., Conclusions: Our findings provide insights into the distinct critical factors that affect the socialisation of junior doctors within workplace environments over 3 consecutive years. These findings can provide guidance for medical educators and healthcare managers, helping them understand and support the progressive integration of junior doctors into their work environments.

Purpose: Although school-based planned education has steadily been introduced, master-apprentice learning is still an indispensable part of medical education. All medical clinical teachers begin their careers as medical students, often without knowing exactly how they will learn to teach. Kilminster and Jolly identified three primary functions of clinical supervisors including clinical teaching, support and guidance, and work supervision. Therefore, we designed a study using questionnaires to assess the three factors of clinical educators for past supervised experiences, including 'being instructed,' 'being supported,' and 'being supervised,' based on Kilminster and Jolly's illustration in 2000, to see the relationship between the three factors mentioned above., Materials and Methods: The study started with a literature review to construct the essential items regarding past supervised experiences of physicians as clinical teachers. We invited 10 experts from fields including medical education and experienced clinical teachers to assess the content validity. One hundred physicians in teaching hospitals were sampled for the preliminary test. Another 364 physicians in teaching hospitals were sampled for the formal study of confirmatory factor analysis and pathway analysis., Results: The" Past Supervised Experiences with Educational Roles Scale" showed satisfying reliability with all Cronbach's α values exceeding .80, and three factors from supervised experiences were identified, including 'being supported,' 'being instructed,' and 'being supervised.' In our model, the 'being supported' experience could positively affect 'being supervised' with significance, directly and indirectly, by being instructed., Conclusions: Our study developed a validated instrument that allows investigation of the formation of better-supervised experiences from current physicians. Our findings inspired us to focus more on supportive coaching in teaching and supervising medical trainees. Our study indicated that faculty development for skills of supporting students is crucial to effective clinical teaching and supervision.

Background: Workplace bullying and harassment (WBH) in healthcare settings has been widely described in the literature, although a lack of consensus on the definition of behaviours constituting WBH makes findings difficult to interpret. The consequences for those experiencing WBH can be severe, including burnout, stress, and suicidal ideation, yet formal reporting rates are low, in part due to a lack of understanding of WBH and the support services designed to address it. Those who experience WBH are more likely to reproduce the behaviour, creating a self-perpetuating cycle. There is an urgent need to develop educational tools to help trainees identify behaviours that can constitute WBH, and the support services available to address this issue., Methods: The study setting was four acute hospital sites in Ireland; participants were interns (junior doctors in their first postgraduate year). A card-based discussion game, PlayDecide: Teamwork was developed with a multidisciplinary team (MDT), piloted, and implemented. Feedback was obtained from participants on the acceptability and educational value of the game via an anonymous online survey. The intervention is presented using the TIDieR framework. Data were analysed and presented using descriptive statistics., Results: Intern trainers and facilitators expressed satisfaction with the game. Intern attendance at the PlayDecide sessions was estimated at 63.64% (n = 70), with a 57.14% response rate to the survey (n = 40). The majority of interns found the game acceptable, the cards realistic and relevant, and agreed that it was a safe space to discuss workplace issues. Most interns agreed that the learning objectives had been met, although fewer agreed that they had learned about support services., Conclusion: PlayDecide: Teamwork is to the best of our knowledge the first intervention of its kind aimed at addressing WBH, and the first aimed at interns. We have shown it to be effective and acceptable to interns and intern trainers in the acute hospital setting. We hypothesised that strong group identification facilitated the discussion, and further, that the cards created cognitive distance, allowing for free discussion of the issues depicted without needing to divulge personal experiences. Further evaluation at behavioural and organisational levels is needed., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval or exemption was sought and obtained locally at all four sites: Trinity College Dublin Original Research Ethics Approval number 20180902, Amendment number 20210701. University College Dublin Research Ethics Exemption number EXE-E-21-01-Burke-TCD. Royal College of Surgeons of Ireland Research Ethics Approval number 212566551. University College Cork Clinical Research Ethics Committee Approval number ECM 4 (t) 20/06/23 and ECM 3 (h) 01/08/2023. Informed consent: to participate was obtained from participants in line with ethics approvals outlined above. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: The increasing complexity and scale of medical education in the UK demands increasing numbers of medical educators. A small proportion of educators are qualified doctors, but did not reach completion of clinical training (CCT) to become consultants or general practitioners before pursuing a career exclusively in education. This study aimed to (1) explore the experiences of medical educators who left clinical practice as junior doctors and (2) identify the barriers to professional identity formation in this group., Design: In this constructivist qualitative study, semi-structured interviews were conducted with medical educators. Audio data was recorded, transcribed and iteratively interpreted through the lens of reflexive thematic analysis., Setting and Participants: Nine UK-based educators were recruited using purposive and snowball sampling. Participants self-identified as medical educators who have experience of the transition from working as junior clinicians to holding positions exclusively in medical education. Participants had not completed clinical training before transitioning into medical education., Results: Three broad themes were identified: (1) push factors away from clinical medicine; (2) pull factors towards medical education; (3) navigating professional identity formation as an educator. Educators reported that medical education offered positives such as improved work-life balance, professional development opportunities and a sense of being more 'upstream' in the world of education. Significant barriers to successful transition were reported, including: a lack of guidance; low respect for medical education by the wider medical profession; and disparity between the educational opportunities afforded to consultant colleagues compared with educators who left medicine before CCT., Conclusions: Educators who leave clinical medicine before CCT perceive themselves as being disadvantaged in their education careers. This study highlights that more could be done to tackle stigmatising perceptions of a medical education career and present medical education as a viable option to junior doctors., 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 Group.)

The transition between medical students and junior doctors is known to be a notoriously challenging period of time, contributed by heavy clinical responsibilities, steep learning curves, poor working conditions and various psychological stressors. In addition, there is often a significant lack of support at the organisational or health systems level for fledgling junior physicians in their transition to work life. In this article, I hope to offer several important guiding principles from the perspectives of a medical resident-in-training that I hope will be useful for graduating medical students to ease their transition into the foundational year of practice, such that they can optimise their training and work experience within what is in their control and maintain a sense of purpose even in difficult times., Competing Interests: Declaration of conflicting interestsThe author declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Background: Common mental health problems (CMHP) are prevalent among junior doctors and medical students, and the COVID-19 pandemic has brought challenging situations with education disruptions, early graduations, and front-line work. CMHPs can have detrimental consequences on clinical safety and healthcare colleagues; thus, it is vital to assess the overall prevalence and available interventions to provide institutional-level support., Aims: This overview summarises the prevalence of CMHPs from existing published systematic reviews and informs public health prevention and early intervention practice., Methods: Four electronic databases were searched from 2012 to identify systematic reviews on the prevalence of CMHPs and/or interventions to tackle them., Results: Thirty-six reviews were included: 25 assessing prevalence and 11 assessing interventions. Across systematic reviews, the prevalence of anxiety ranged from 7.04 to 88.30%, burnout from 7.0 to 86.0%, depression from 11.0 to 66.5%, stress from 29.6 to 49.9%, suicidal ideation from 3.0 to 53.9% and one obsessive-compulsive disorder review reported a prevalence of 3.8%. Mindfulness-based interventions were included in all reviews, with mixed findings for each CMHP., Conclusions: The prevalence of CMHPs is high among junior doctors and medical students, with anxiety remaining relatively stable and depression slightly increasing during the COVID-19 pandemic. Future research on mindfulness-based interventions is required for a resilient and healthy future workforce., Prisma/prospero: the researchers have followed PRISMA guidance. This overview was not registered with PROSPERO as it was conducted as part of an MSc research project.

Background: International studies have revealed that numerous challenges (e.g. job demands) and opportunities (e.g. job resources as protective factors) affect the well-being of healthcare workers., Aims: Building on the job demands-resources theory, we explored how job-related demands and the role of inclusive leadership as a job resource influenced the well-being of junior doctors during the coronavirus disease 2019 (COVID-19) pandemic., Methods: A cross-sectional web survey was conducted in July 2022 for 82 junior doctors who had experienced the 3-year COVID-19 pandemic. The survey captured their perceived physical, psychological and COVID-19-related job demands and the inclusive leadership behaviours exhibited by their clinical unit supervisors as job resources. Data were also collected on junior doctors' experiences of burnout, compassion satisfaction and occupational commitment as variables of job outcomes. Hierarchical linear regression analysis was applied to explore the relationships between the variables., Results: Physical and COVID-19-related job demands were associated with increased burnout among junior doctors. Inclusive leadership as a job resource was associated with junior doctors' reduced burnout and increased compassion satisfaction and buffered the negative effects of psychological demands on their compassion satisfaction. Only COVID-19-related job demands were associated with junior doctors' occupational commitment., Conclusions: Our study highlights the critical effects of COVID-19-related job demands on junior doctors' burnout and occupational commitment. Inclusive leadership behaviours exhibited by clinical unit supervisors are a valuable job resource, which can be incorporated as one of the competencies training for medical staff., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society of Occupational Medicine.)

Background: Basic life support (BLS) is the recognition of sudden cardiac arrest and activation of emergency response system, followed by cardiopulmonary resuscitation (CPR), and rapid defibrillation., Aim: Our study aimed to determine the level of awareness of the Lebanese University medical students and trainees on BLS, by assessing the association between knowledge, attitude, and practice on BLS, and between the demographic variables and KAP scores., Methods: This was a cross-sectional study including 330 medical students enrolled at Lebanese University, from year four of general medicine till year five of residency. An online survey was used to collect data about demographic characteristics, knowledge (K), attitudes (A), and practice (P) about BLS. Data was analyzed using SPSS version 25., Results: Participants were 52.7% females, 47.3% males, and their mean age was 24 ± 2 years. Of the 330 participants, 38.8% received formal training regarding BLS. Medical students had low knowledge (90%), moderate to good attitudes (71.5%), and low practice (93%) regarding BLS. Multiple linear regression showed that knowledge was positively associated with age (p = 0.001), knowledge and information regarding BLS (p = 0.016), and any formal training/workshop regarding BLS (p = 0.021). Attitude was positively associated with academic year (p = 0.002) and knowledge (p = 0.003). Practice was positively associated with age (p < 0.001) and knowledge (p < 0.001)., Conclusion: Most Lebanese University medical students showed low knowledge, moderate to good attitudes, and low practice regarding BLS. We recommend that CPR/BLS should be a core competency across all health care professional programs., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Introduction: The role of global health and sustainable development in medical education is often debated. However, research regarding medical doctors' views on the application of their global health knowledge in the clinical setting remains scarce. This study aimed to explore junior doctors' perceptions of global health and sustainable development, the education they have received on these issues and the relevance of this knowledge in their current and future work., Methods: This was a qualitative study based on individual interviews conducted between May and June 2022. 16 junior doctors, in mandatory clinical training after completing medical school, were purposively sampled from five Swedish hospitals. Transcripts were analysed using qualitative content analysis., Results: Three themes were identified. The first theme (1) 'medical doctors have a role in the transition to a sustainable society', shows that sustainable development is increasingly perceived as relevant for junior doctors' clinical work. The second theme (2) 'global health and sustainable development teaching is inconsistent and somewhat outdated', highlights that there is an assumption that global health and sustainable development can be self-taught. A discrepancy between what is being taught in medical school and the clinical reality is also recognised. This causes challenges in applying global health interest and knowledge in the clinical setting, which is described in the third theme (3) 'application of global health and sustainable development is difficult'. This theme also highlights opportunities for continued engagement, with the perceived benefit of becoming a more versatile doctor., Conclusion: This study emphasises the need for conceptual clarity regarding global health in medical education and raises the need for clarification regarding the level of responsibility for integrating sustainable practices in Swedish healthcare settings., 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.)

Background: Evidence suggests that PTSD symptoms following public health emergencies are influenced by many factors. The aim of this study was to investigate the relationship between perceived social support and Post-traumatic stress disorder symptoms and to explore the chain-mediated role of resilience and positive coping style, among medical staff in Hubei Province, China, during a public health emergency., Methods: Convenience sampling was used to select medical staff from two general hospitals in Hubei Province in July 2022 for this study. A total of 2,751 medical staff were included in the study. Multidimensional Scale of Perceived Social Support, 10- itemConnor- Davidson resilience scale, Simplified Coping Style Questionnaire and The Post-traumatic stress disorder Checklist for DSM-5 were used to assess the levels of perceived social support, resilience, coping style and Post-traumatic stress disorder symptoms of medical staff two years after the public health emergency. Statistical descriptions were conducted using SPSS, and a structural equation model was established using AMOS to analyze the chain-mediated roles of resilience and positive coping style between perceived social support and Post-traumatic stress disorder symptoms., Results: Structural equation modeling results showed a standardized total effect of perceived social support on Post-traumatic stress disorder symptoms of -0.416 (95%CI [-0.456, -0.374], P < 0.001). Resilience mediated the effect of perceived social support and Post-traumatic stress disorder, with an indirect effect of -0.016 ( 95%CI [0.031, 0.001], P = 0.038). Positive coping mediated the effect of perceived social support and Post-traumatic stress disorder, with an indirect effect of -0.024 (95%CI [-0.035, -0.014], P < 0.001). Resilience and positive coping style chain-mediated between perceived social support and Post-traumatic stress disorder symptoms, mediating 17.1% of the total effect., Conclusion: Perceived social support has significant direct and indirect effects on Post-traumatic stress disorder symptoms and resilience. In addition, positive coping style act as chain mediators between perceived social support and Post-traumatic stress disorder symptoms. We suggest that strengthening perceived social support for medical staff can enhance their resilience, encouraging them to adopt positive coping, which in turn reduces the level of post-traumatic stress symptoms among medical staff following public health emergencies., (© 2024. The Author(s).)

Background: The transition period of becoming a new paediatric registrar has limited study. Consequently, the learning needs of such trainees are unclear including educational interventions that may improve the process. This qualitative study examined the negative and positive experiences of transitioning paediatric trainees to identify learning needs and subsequently derive educational interventions that are perceived to ease transition., Methods: This was a qualitative study of semi-structured interviews with Wales deanery paediatric speciality trainees 3 and 4 (ST3 and ST4) undergoing transition to registrar. Participants were asked to recall one positive and one negative experience during transition using the critical incident technique (CIT). Transcribed responses were coded and thematically analysed and categorised into higher and lower order themes., Results: Six paediatric trainees were interviewed for the study. A total of eighteen codes relating to learning needs were identified and dichotomised into two higher order themes; clinical skills, and leadership and management skills, with further exploration into lower order themes. Clinical skills included child protection procedures, difficult communication with relatives, emergencies, childhood death, difficult procedures, tertiary level neonatal care, managing family anxiety and expectations, dealing with uncertainty and running clinics. Leadership and management skills involved clinical decision making by new registrars, leading ward rounds, managing workload, leading a team and supervising junior colleagues. For educational interventions, sixty-seven initial codes were recorded and combined to form thirty-two lower order themes under six higher order themes. This outlined six educational interventions perceived to ease the transition to the registrar grade including; acting up whilst a senior house officer, seniors providing feedback, seniors providing support, staff providing support, trainee familiarisation with the new registrar placement and trainees maximising SHO learning opportunities., Conclusions: This study provided a grounding upon which further research can be based, by identifying learning needs within the themes of clinical skills and leadership and management skills, as well as providing further descriptions of perceived beneficial educational interventions that ease transition to paediatric registrar. Furthermore, this study proposes evidence-based recommendations involving five key stakeholders to improve the experience of transition for future trainees. These stakeholders include; trainees, seniors, educators, nursing staff and rota coordinators., (© 2024. Crown.)

Purpose: Effective interprofessional health care team (IHT) members collaborate to reduce medical errors, use resources effectively, and improve patient outcomes, making interprofessional collaboration imperative. Because physicians are often designated as the positional leaders of IHTs, understanding their perspectives on collaboration within IHTs could help to mitigate the disconnects between what is suggested in theory and what is happening in practice. This study aimed to explore leader-follower dynamics within medical teams that are commonly working in clinical care contexts., Method: Using a constructivist approach, the authors conducted 12 individual, semistructured interviews from November 2022 to September 2023 with attending physicians who have led IHTs in perioperative (i.e., preoperative clinic, operating room, postoperative and recovery unit) or emergency department settings. The transcripts were analyzed from December 2022 to December 2023 using inductive thematic analysis., Results: Three themes explained the physician perceptions of IHT leadership-followership dynamics: (1) physicians are comfortable sharing leadership intra professionally, (2) the clinical culture and environment constrain interprofessional followership and shared leadership, and (3) hierarchical models hold true even while active followers are appreciated, when appropriate., Conclusions: The data in this study suggest that, in perioperative and emergency department settings, shared leadership largely may not occur inter professionally but occurs intra professionally. Participants suggested that the clinical culture and environment (i.e., legal concerns, hierarchical assumption, patient care ownership responsibilities) constrained interprofessional followership and shared leadership. On the basis of the study's findings and how they align with previous research, future research into interprofessional collaboration and followership roles should focus on what factors enable and constrain active followership and shared leadership. Such collaboration can only be achieved when active followership and shared leadership are allowed and promoted. These findings and others suggest that not all contexts are enabling such types of interprofessional collaboration due to legal concerns, hierarchical traditions, and patient ownership considerations., (Copyright © 2024 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Background: Menezes et al. describe their experience with the diagnosis and management of disruptive medical staff behavior in a private hospital between 2020 and 2022. Surgical medical specialties were found to demonstrate the highest prevalence of such behavior, and continual education of physicians regarding appropriate workplace behavior was found to be the most important management strategy to prevent unsafe work environments and strengthen an appropriate culture of safety., Background: ■ Disruptive medical staff behavior potentially affects patient care., Background: ■ Surgical specialties have the highest incidence of disruptive medical staff behavior., Background: ■ Proper diagnosis and management is key to the mitigating disruptive medical staff behavior., Objective: To describe the 3-year long experience of addressing disruptive events by medical staff in a private hospital., Methods: The cross-sectional study that was conducted between 2020 and 2022, involved collection, analysis, and management of suspected cases of disruptive behavior by medical staff., Results: Relevant information was collected from reports issued by health care leaders (69%), anonymous reports accessed from the health institution's intranet tool "SINAPSE" (19%), the compliance center (5%), customer attendance service (3.7%), the hospital board (2.3%), and the medical practice department (1%). Surgical specialties were responsible for 70.3% of the disruptive incidents, and the average time to outcome was 24.5 days, with most solutions involving guided education of physicians (92.7%)., Conclusion: Management of disruptive behavior by medical staff is essential for the prevention of unsafe work environments and strengthening a culture of safety.

Background: To mitigate the growing burden of non-communicable diseases, doctors training to become paediatricians should be equipped with concepts and knowledge regarding Developmental Origins of Health and Disease (DOHaD)., Methods: We assessed the knowledge, attitudes, and practices (KAP) of medical officers, resident physicians, as well as junior and senior residents practising in the paediatric department of a tertiary women's and children's hospital. This was done through a cross-sectional online survey, with questions developed after focused group discussions with domain experts, and responses based on a 5-point Likert scale., Results: A total of 95 physicians met the inclusion criteria, grouped into Medical Officers (MOs) and Registrars (REGs), and we received a 100% response rate. Results showed that few physicians (n = 22, 23.2%) knew the term DOHaD, and majority rated their colleagues to be inadequately informed (n = 84, 88.4%). Among the physicians, one third (n = 32, 33.7%) were not confident in their ability to counsel patients about initiating healthy feeding practices to prevent future metabolic diseases in their children. However, there was a readiness to be better equipped with DOHaD principles and knowledge, and 95.8% (n = 91) strongly acknowledged the physician's responsibility to optimise early life determinants of cardiometabolic health., Conclusion: In conclusion, the findings suggest a poor translation of DOHaD concepts, indicating that bridging the gap between DOHaD research knowledge and clinical application represents an unmet need. These principles should be inculcated early in the professional training of all healthcare providers., (© 2024. The Author(s).)

Objective: Managing uncertainty is a core competency of pediatric residents. However, discussing uncertainty with attending physicians can be challenging. Research is needed to understand residents' goals when communicating about uncertainty with attending physicians and how residents' perceptions of communication change during residency. Therefore, we assessed changes in residents' perceptions of their own ability to communicate uncertainty and their perceptions of attending physicians' willingness to discuss uncertainty effectively. We also identify residents' goals and challenges communicating uncertainty., Methods: We conducted a 3-year (2018-2021) survey with 2 cohorts of residents at a US children's hospital. Of the 106 eligible residents, 100 enrolled and completed Phase I (94% response rate), 61 of the enrolled residents completed Phase II (61% response rate), and 53 completed Phase III (53% response rate). We employed hierarchical linear modeling to account for clustering of the data (Phases within residents) and to assess changes in communication efficacy and target efficacy over time. We coded open-ended responses to identify residents' communication goals and challenges., Results: Communication efficacy and target efficacy significantly increased over time. Open-ended responses indicated that residents managed multiple task, identity, and relational goals. Residents described persistent challenges related to wanting to appear competent and working with attending physicians who were unwilling to discuss uncertainty., Conclusions: Although residents may grow more confident communicating uncertainty, such conversations are complex and can present challenges throughout residency. Our results support the value of training on communication about uncertainty, not only for residents, but also attending physicians., Competing Interests: CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no conflicts of interest relevant to this article to disclose., (Copyright © 2024 by the American Academy of Pediatrics.)

Objective: Gossip-evaluative talk about an absent third party-exists in surgical residency programs. Attending surgeons may engage in gossip to provide residents with feedback on performance, which may contribute to bias. Nevertheless, the perspectives of attending surgeons on gossip has not been studied., Design: In this qualitative study, semi-structured interviews about gossip in surgical training were conducted with attending surgeons. We performed a reflexive thematic analysis of transcripts with a grounded theory approach to describe attendings' perceptions of their role in gossip within surgical residency., Setting: Interviews were conducted from September 23, 2023, to November 27, 2023 via Zoom™., Participants: Eighteen surgery attendings associated with 7 surgical training programs were interviewed., Results: Six themes were developed: 1) Attendings typically view gossip with a negative lens; thus, well-intended conversations about resident performance that meet the academic definition of gossip are not perceived as gossip; 2) Gossip can damage attendings' reputations as surgeons and educators; 3) Mitigating the negative impacts of gossip by maintaining accurate and objective standards of honest communication is hard; 4) Attendings express concerns about hearing other attendings' impressions of residents prior to formulating their own opinion; 5) The surgical hierarchy restricts the volume and content of gossip that reaches attendings, which may limit their knowledge of program culture; and 6) It is very difficult to mitigate gossip at the program level. Ultimately, attendings utilize gossip (e.g. triangulating their experience) with the goal of providing residents feedback., Conclusions: Defining important conversations about resident performance as gossip should not discourage these critically important conversations but rather underscore the importance of combating harmful gossip through 3 behaviors: 1) committing to objective communication; 2) limiting or reframing information about resident performance that is shared with attendings who have yet to formulate their own opinions; and 3) regulating gossip in particular high-stakes microenvironments (e.g. the operating room)., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: High-quality communication and relationships are associated with quality of care. Workflow differences across hospital units can impede communication and relationships among health care professionals. Relational coordination (RC) is a process of communication supported by shared goals, shared knowledge, and mutual respect and is associated with quality of care and better performance outcomes in civilian hospitals. However, RC has not been explored in military hospitals. The objective of our study was to determine whether RC differs between hospital units and professional roles. Specifically, we examined RC differences by unit type for nurses, resident physicians, and physicians working in an Army Medical Center., Methods: We conducted an exploratory analysis of a secondary question from a cross-sectional study using a convenience sample of active-duty and civilian licensed practical nurses (LPNs), registered nurses (RNs), physician residents, and physicians (n = 289). We received institutional review board approval from the study site. Data were collected from January 2020 to March 2020, and participants completed a 47-item survey regarding their experiences of RC in various hospital units. We used t tests and one-way analyses of variance to explore bivariate relationships between RC and other study variables, as well as multiple regression to explore whether RC varied by unit type. We controlled for education and experience by including them in the model because these variables may influence perceptions of nurse-physician RC and their interactions with each other., Results: Seventy percent of participants were civilian (n = 203), 75% RNs (n = 217), and 78% female (n = 216). The mean age of respondents was 40 years (SD = 11.7), and the mean experience level was 11.9 years (SD = 9.5). RC was not associated with unit type. Total RC and between-role RC were associated with professional role. Physicians reported higher RC (β = .45, P = .01), and LPNs reported lower RC (β = -.06, P = .01). Education and experience were associated with RC. Participants with less experience reported higher RC (β = -.01, P = .00), and participants with graduate degrees reported lower RC (β = -.62, P = .00)., Conclusions: We recommend hospital leaders consider interventions to build interprofessional relationships, including interdisciplinary meetings, huddles, and structured communication tools. Improving RC among health care professionals is a cost-effective and unique way to enhance communication and collaboration among health care professionals across hospital units., Competing Interests: The authors have no conflict of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Professional identity transitions, such as the transition to medical registrar, are challenging. How minoritised identities influence transitions during medical training requires further study. This study aimed to explore the factors influencing the transition to the medical registrar in Scotland to guide support during training., Methods: Interviews exploring this transition with internal medicine trainees were audio recorded, transcribed verbatim and double-coded using template analysis. We applied an initial coding template informed by multiple and multidimensional transition theory of individual, interpersonal, systemic and macro-level factors. Using a critical theory lens, a further template analysis specifically sought to understand how trainees' social identities interacted with the various levels., Findings: Nineteen IM trainees were interviewed between January 2021 and February 2022. Influential factors reflected a parallel process of competence (doing) and identity (being) development. The interaction of social identities, such as gender (being a woman) and country of origin (being an international medical graduate), occurred across levels. This can be conceptualised as a Rubik's cube with the interplay between doing and being from an individual to a macro level with trainees' social identities interacting at all levels., Conclusion: The transition to the medical registrar is multifaceted; with a challenging balance between support and independence in providing opportunities to perform (doing) whilst identity develops (being). Identity transitions involve multiple Rubik's-cube-like rotations between the facets of 'doing' and 'being,' until these align. Taking heed of influential factors and the interaction of minoritised social identities could guide a trainee-centred and smoother transition., (© 2023 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Objective: To estimate the prevalence of workplace violence and its impact on doctors in hospitals., Methods: The cross-sectional study was conducted from August 2021 to January 2022 in Baghdad and Karbala governorates of Iraq, and comprised resident doctors at a number of hospitals. Data was collected using a selfadministered questionnaire that focussed on the frequency of exposure to violence, type, source, most common time, and other details about violence as well as its impact on doctors and their careers. Data was analysed using SPSS 23., Results: Of the 1,079 subjects working at 18 participating hospitals and having a mean age 30.0±5.72 years, 567(52.5%) were females and 512(47.5%) were males, while 570(52.8%) were aged <30 years and 509(47.2%) were aged >30 years. Overall, violence exposure was reported by 811(75.2%) subjects; 427(52.6%) females and 384(47.4%) males. Gender was not significantly associated with exposure to violence (p>0.05). Due to missing data, further analysis was limited to 792(97.6%) subjects who faced exposure to workplace violence. In 671(85%) cases, the assaults were nonphysical. However, 110(14%) doctors reported physical attacks and severe consequences. There were 673(85%) doctors with exposure to violence who expressed their intention to change their job, workplace, or leave the country because of violence., Conclusions: The problem of violence against Iraqi doctors was found to be highly prevalent with a seriously negative impact on the medical professionals.

Background: Mental health problems among junior doctors in Malaysia pose a significant concern, as they not only adversely affect their overall well-being but also impact the quality of health services they provide. Therefore, it is important to implement interventions aimed at preserving their mental health. This study aimed to evaluate the effectiveness of the Sanubari Optimal Health Program (OHP) intervention in enhancing the mental well-being of junior doctors in Malaysia., Methods: The study utilised a quasi-experimental design involving 204 junior doctors who participated in the intervention. The Sanubari OHP Intervention Package was employed alongside self-administered questionnaires for mental health and well-being assessment. To evaluate the effects over time, repeated measures ANOVA was employed to analyse within-group and between-group changes in various endpoints, as measured at different assessment time points., Results: The study revealed that self-efficacy and adaptive coping behaviours scores increased over time among the intervention group and decreased among the control group. Yet, depression and anxiety scores decreased significantly over time among the intervention group but not in the control group. No significant differences were observed in well-being and maladaptive coping strategies among the groups., Conclusions: This study showed promising results regarding the effectiveness of Sanubari OHP in improving mental well-being among junior doctors., (© 2024. The Author(s).)

Background: Shift (Black Dog Institute) is the first mobile health smartphone app created to support the mental health of junior physicians. Junior physicians experience demanding work conditions, leading to high levels of psychological distress and burnout. However, they are often concerned about the potential career impacts of seeking mental health support. The confidentiality and ease of access of digital interventions may be particularly suited to address these concerns. The Shift app provides therapeutic and psychoeducational content and strategies contextualized for the specific needs of physicians in training. App content includes information on mental health, help seeking, mindfulness, and common workplace-related concerns of junior physicians., Objective: This study aims to test, at scale, the effectiveness of Shift among junior physicians working in Australia using a randomized controlled trial design. The primary aim is to examine whether junior physicians using Shift experience a reduction in depressive symptoms compared with a waitlist control group. The secondary aim is to examine whether the app intervention group experiences improvements in anxiety, work and social functioning, help seeking, quality of life, and burnout compared with the control group., Methods: A total of 778 junior physicians were recruited over the internet through government and nongovernment medical organizations across Australia, as well as through paid social media advertisements. They were randomly allocated to one of 2 groups: (1) the intervention group, who were asked to use the Shift app for a period of 30 days, or (2) the waitlist control group, who were placed on a waitlist and were asked to use the app after 3 months. Participants completed psychometric measures for self-assessing mental health and wellbeing outcomes, with assessments occurring at baseline, 1 month after completing the baseline period, and 3 months after completing the baseline period. Participants in the waitlist control group were asked to complete an additional web-based questionnaire 1 month after receiving access to the app or 4 months after completing the baseline survey. Participants took part in the study on the internet; the study was completely automated., Results: The study was funded from November 2022 to December 2024 by the New South Wales Ministry of Health. Data collection for the study occurred between January and August 2024, with 780 participants enrolling in the study during this time. Data analysis is underway; the effectiveness of the intervention will be estimated on an intention-to-treat basis using a mixed-model, repeated measures analysis. Results are expected to be submitted for publication in 2025., Conclusions: To the best of our knowledge, this is the first randomized controlled trial to examine the effectiveness of a mobile health smartphone app specifically designed to support the mental health of junior physicians., Trial Registration: Australia and New Zealand Clinical Trials Registry ACTRN12623000664640; https://tinyurl.com/7xt24dhk., International Registered Report Identifier (irrid): DERR1-10.2196/58288., (©Lauren Lai, Samineh Sanatkar, Andrew Mackinnon, Mark Deady, Katherine Petrie, Rosie Lipscomb, Isabelle Counson, Rohan Francis-Taylor, Kimberlie Dean, Samuel Harvey. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 19.09.2024.)

Background: The majority of junior doctors in the UK do not proceed directly into specialty training after completing mandatory foundation training but instead take a year out of training. A common post undertaken during a year out of training is a clinical teaching fellow (CTF) role which is used to provide undergraduate medical student teaching. There is only a small amount of literature available regarding CTF posts, and very little of this explores experiences or reasons for taking up such as post. An understanding of the reasons why doctors are choosing to work as CTFs and what their experiences are in post will contribute to how the role is further developed and utilised within the NHS. This study aimed to explore the experiences of CTFs employed in the West Midlands at NHS hospital Trusts., Methods: CTFs working in Trusts in the West Midlands region registered as students on the Education for Healthcare Professionals Post Graduate Certificate course at the University of Birmingham in August 2019 and 2020 who were enrolled in a longitudinal study were invited to take part in an individual interview asking about their experiences as CTFs., Results: Nine CTFs participated in an interview. Five main themes were identified which related to their experiences in post and plans for future careers. Participants reported choosing to undertake a CTF role due to wanting a break from clinical work and having previously enjoyed delivering teaching. Positive experiences in post included lifestyle related benefits and self-development opportunities. Challenges identified with the role included the impact of COVID-19 and volume of students., Conclusion: This is the first study to use interview methodology to explore experiences of CTFs, and has provided a valuable insight into the experiences of those in post in the West Midlands region. Understanding why doctors chose this job and what their experiences are could help to further develop and refine the role. To guarantee demands for teaching staff are met those employing CTFs should be aware of reasons why doctors apply for the post and ensure the post remains a desirable option., (© 2024. The Author(s).)

Objectives: This study addressed two research questions: What factors do doctors in training describe as influencing their choices to apply (or not apply) for specialty training during their Foundation Year 2? Which of these factors are specific to the context of the COVID-19 pandemic, and the unique experiences of the cohort of doctors who qualified early during the pandemic?, Design: Sequential explanatory mixed methods study: Quantitative survey. Qualitative semistructured interviews. Quantitative data were analysed with logistic regression. Qualitative data were analysed using reflexive thematic analysis., Setting: UK-wide., Participants: Junior doctors who graduated medical school in 2020., Survey: 320 participants (22% of those contacted). 68% (n=219) were female, 60% (n=192) under 25 and 35% (n=112) 25-30. 72% (n=230) were white, 18% (n=58) Asian and 3% (n=10) black. Interviews: 20 participants, 10 had applied for specialty training, 10 had not., Results: A minority of respondents had applied for specialty training to start in 2022 (114, 36%). While burnout varied, with 15% indicating high burnout, this was not associated with the decision to apply. This decision was predicted by having taken time off due to work-related stress. Those who had not taken time off were 2.4 times more likely to have applied for specialty training (OR=2.43, 95% CI 1.20 to 5.34). Interviews found reasons for not applying included wanting to 'step off the treadmill' of training; perceptions of training pathways as inflexible, impacting well-being; and disillusionment with the community and vocation of healthcare, based, in part, on their experiences working through COVID-19., Conclusions: Participants infrequently cited factors specific to the pandemic had impacted their decision-making but spoke more broadly about challenges associated with increasing pressure on the health service and an eroded sense of vocation and community., 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.)

Background: Communication and collaboration among health care professionals during bedside rounds improve patient outcomes and nurses' and physicians' satisfaction., Objectives: To determine barriers to nurse-physician communication during bedside rounds and identify opportunities to improve nurse-physician collaboration at an academic medical center., Methods: A survey with Likert-scale and open-ended questions regarding professional attitudes toward nurse-physician communication was administered to 220 nurses and physicians in medical-surgical units to assess perceptions of participation in bedside rounds. After the survey was given, observational data from 1007 bedside rounds were collected via a standardized data collection tool., Results: Nurses and physicians perceived different barriers to including nurses in bedside rounds. Nurses most often cited being unaware that bedside rounds were occurring (38 of 46 nurses [83%]); physicians most often cited nurse unavailability (43 of 52 physicians [83%]). Of 1007 observed rounds, 602 (60%) involved in-person contact of nurses and physicians; 418 (69%) of the 602 included a conversation between the nurse and physician about the nurse's concerns. Of 355 rounds with no in-person or telephone contact between nurses and physicians, the medicine team did not contact the nurse in 284 (80%). Conversations about nurses' concerns occurred more often after physician-initiated contacts (73% of 369 contacts) and nurse-initiated contacts (74% of 93 contacts) than after chance encounters (57% of 140 contacts)., Conclusion: Initiating discussions of care between nurses and physicians and discussing nurses' concerns during bedside rounds have multiple benefits., (©2024 American Association of Critical-Care Nurses.)

Aim: Junior doctors joining EDs are required to rapidly acquire new knowledge and skills, but there is little research describing how this process can be facilitated. We aimed to understand what would make ED formal induction and early socialisation more effective., Methods: Qualitative study; informal interviews of junior doctors, consultants and nursing staff and direct observation of clinical interactions, induction and training in a single ED in an English Emergency Department between August and October 2019. We used constant comparison to identify and develop themes., Findings: New junior doctors identified that early socialisation should facilitate patient safety and a safe learning space, with much of this process dependent on consultant interactions rather than formal induction. Clear themes around helpful and unhelpful consultant support and supervision were identified. Consultants who acknowledged their own fallibility and maintained approachability produced a safe learning environment, while consultants who lacked interest in their juniors, publicly humiliated them or disregarded the junior doctors' suggestions were seen as unhelpful and unconstructive., Conclusion: Effective socialisation, consistent with previous literature, was identified as critical. Junior doctors see consultant behaviours and interactions as key to creating a safe learning space., 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.)

Background: During the COVID-19 pandemic, health authorities recommended less interpersonal physical contact. Our hypothesis was that hospital doctors greet new patients with a handshake less frequently after the pandemic than before., Material and Method: In January 2024, we undertook a pragmatic cross-sectional survey of a sample of doctors from three different clinics at a large Norwegian hospital. The doctors were asked to report their handshaking habits before and after the pandemic., Results: A total of 152 hospital doctors took part in the study. Before the pandemic, 143 of these doctors (94 %) greeted outpatients with a handshake, while 115 (76 %) greeted hospitalised patients with a handshake. After the pandemic, these figures had fallen to 35 (23 %) and 33 (22 %) respectively. A total of 139 doctors (86 %) reported that they had changed their greeting habits. Of these, 95 (73 %) had changed their greeting habits for reasons of infection control., Interpretation: After the pandemic, hospital doctors are less inclined to greet patients with a handshake than before the pandemic.

Introduction: We present a case study dealing with the emotional coping of a physician's exposure to continuous traumatic stress starting with the events of Oct. 7, 2023 and during the following months., Background: The medical staff at Soroka Medical Center in southern Israel have faced unprecedented challenges over the past months due to ongoing conflict along the Gaza border. Since October 7, 2023, over 2,550 wounded patients have been treated at Soroka for injuries of varying severity, with more than 250 requiring life-saving surgeries. As the region's largest trauma center, Soroka's staff have endured continuous exposure to traumatic stress, suffering, distress and grief - both within the hospital and in their personal lives., Conclusions: While the long-term impacts remain to be seen, preliminary findings suggest that organizational efforts during routine may help mitigate potential negative effects of exposure to traumatic stress in the course of emergency. Further research is needed to understand how cumulative exposure interacts with process of recovery and growth., Discussion: The current report presents the different layers of traumatic exposure, the associated risk and resilience factors and a perception that was instilled in the hospital in the years preceding the current war which promoted a culture of proactive peer discourse about emotional hardship and normalization of referral for professional help when needed. We also present coping behaviors that were common among many staff members and organizational responses, considering the uniqueness of the current challenges, their scope and duration.

Operations management of a hospital unit is a shared activity involving nursing and medical professionals, characterized by suddenly changing situations, constant interruptions, and ad hoc decision-making. Previous studies have explored the informational needs affecting decision-making, but only limited information has been collected regarding factors affecting information management related to the daily operations of hospital units. The aim of this study was to describe the experiences of nursing and medical professionals of information management in the daily operations of hospital units. This qualitative study consists of interviews following the critical incidence technique. Twenty-six nurses and eight physicians working in operational leadership roles in hospital units were interviewed, and the data were subjected to thematic analysis. The data analysis showed that strengths of current systems were organizational operational procedures, general instruments supporting information management, and a digital operations dashboard, whereas opportunities for improvement included the information architecture, quality of information, and technology use. The study findings highlight that despite several decades of efforts to provide solutions to support information management in hospital daily operations, further measures need to be taken in developing and implementing information systems with user-centered strategies and systematic approaches to better support healthcare professionals., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Background: Psychological stress and anxiety have seriously affected the ability of new clinicians to adapt and coordinate their clinical work. Traditional pre-job training is often not very good at assisting new recruits to regulate their emotional problems., Methods: This study is a randomized controlled study. A total of 435 newly recruited clinicians participated in the study. 428 clinicians were randomized into a control group (n = 214) and an intervention group (n = 214). The control group conducted regular pre-job training. Doctors of the intervention group attend a themed course every two weeks on the basis of regular induction training. Their physiological status was evaluated by Perceived Stress Scale (PPS-10), Generalized Anxiety Scale (GAD-7) and Psychological Resilience Scale (CD-RISC-10) 3 months later. Participants in the intervention group received a training satisfaction questionnaire., Results: After entering the clinic for 3 months, the PSS-10 and GAD-7 scores of the intervention group were significantly lower than that of the control group. Consistently, the CD-RISC-10 score of new clinicians who received proof-of-concept pre-job training was significantly higher than that of new doctors in the control group., Conclusion: New doctors received the proof-of-concept group experienced alleviation in stress and anxiety., (© 2024. The Author(s) under exclusive licence to Belgian Neurological Society.)

Background: Physician burnout is rising, especially among academic physicians facing pressures to increase their clinical workload, lead administrative tasks and committees, and be active in research. There is a concern this could have downstream effects on learners' experiences and academic physician's ability to teach learners on the team., Methods: A 29-question RedCap survey was electronically distributed to 54 attending physicians within an academic learning health system who oversaw the General Medicine inpatient teaching services during the 2022-2023 academic year. The aims were to assess this cohort of attending physicians' experiences, attitudes, and perceptions on their ability to effectively teach learners on the team, feeling valued, contributors to work-life balance and symptoms of burnout, Fisher's Exact Tests were used for data analysis., Results: Response rate was 56%. Attendings splitting time 50% inpatient / 50% outpatient felt that team size and type of admissions model affected their ability to effectively teach learners (p = 0.022 and p = 0.049). Attendings with protected administrative time felt that non-patient care obligations affected their ability to effectively teach the learners (p = 0.019). Male attendings and attendings with ≤ 5 years of General Medicine inpatient teaching experience felt less valued by residency leadership (p = 0.019 and p = 0.026). 80% of attendings experienced emotional exhaustion, and those with > 10 weeks on a General Medicine inpatient teaching service were more likely to experience emotional exhaustion (p = 0.041). Attendings with > 10 weeks on a General Medicine inpatient teaching service and those who were a primary caregiver were more likely to experience depersonalization (p = 0.012 and p = 0.031). 57% of attendings had reduced personal achievement., Conclusions: Institutions should seek an individual and organizational approach to professional fulfillment. Special attention to these certain groups is warranted to understand how they can be better supported. Further research, such as with focus groups, is needed to address these challenges., (© 2024. The Author(s).)

Erosion of standard of healthcare in the United Kingdom underlies the industrial action taken recently by staff in the publicly provided National Health Service. Underfunding and understaffing, largely as a consequence of neoliberal government "austerity" policies implemented following the 2007-08 banking crisis, together with lack of long-term planning and a drive towards outsourcing, have led to a deterioration in the quality of services. Reduction in bed numbers and neglect of community and social support have compounded problems by making it more difficult both to admit and to discharge patients in a timely fashion. Access to services has been compromised with negative consequences for the sick. Reduction of doctors' real wages together with stress at work, moral injury caused by feelings of not being able to do the best for patients, burnout from the Covid-19 pandemic and uncertainty about the future have led to the longest ever strike action by junior doctors in England.

BACKGROUND Clinical training for allied health trainees (AHTs) and postgraduate-year (PGY) doctors needed to go online during the outbreak of coronavirus disease 2019 (COVID-19), which may have caused academic stress and consequent outcomes among this cohort. MATERIAL AND METHODS To evaluate academic-related stress, clinical confidence, psychological distress, and insomnia, an online survey-based study was conducted among Taiwanese AHTs and PGY doctors between July and December, 2022, during the COVID-19 pandemic. The survey included the 21-item Depression, Anxiety, and Stress Scale (DASS-21), the Insomnia Severity Index (ISI), and self-designed questions. It was distributed using convenience sampling and snowball sampling and was completed by 522 participants. RESULTS Structural equational modelling showed that academic stress was negatively associated with clinical confidence (standardized coefficient [ß]=-0.382, p<0.001). Clinical confidence was negatively associated with psychological distress (ß=-0.397, p<0.001), which was associated with insomnia (ß=0.648, p<0.001). Additionally, clinical confidence and psychological distress were the significant mediators. Results indicated that higher academic stress was associated with higher level of insomnia via the mediation of clinical confidence and psychological distress. CONCLUSIONS Academic stress related to changes in clinical training may have led to insomnia among AHTs and PGY doctors during the pandemic. Factors to reduce academic stress should be investigated to promote good mental health while providing sufficient clinical training, especially during events that can cause increased stress (eg, epidemics, pandemics).

Background: Adopting high-value, cost-conscious care (HVCCC) principles into medical education is growing in importance due to soaring global healthcare costs and the recognition that efficient care can enhance patient outcomes and control costs. Understanding the current opportunities and challenges doctors face concerning HVCCC in healthcare systems is crucial to tailor education to doctors' needs. Hence, this study aimed to explore medical students, junior doctors, and senior doctors' experiences with HVCCC, and to seek senior doctors' viewpoints on how education can foster HVCCC in clinical environments., Methods: Using a mixed-methods design, our study involved a cross-sectional survey using the Maastricht HVCCC-Attitude Questionnaire (MHAQ), with a subset of consultants engaging in semi-structured interviews. Descriptive analysis provided insights into both categorical and non-categorical variables, with differences examined across roles (students, interns, junior doctors, senior doctors) via Kruskal-Wallis tests, supplemented by two-group analyses using Mann-Whitney U testing. We correlated experience with MHAQ scores using Spearman's rho, tested MHAQ's internal consistency with Cronbach's alpha, and employed thematic analysis for the qualitative data., Results: We received 416 responses to the survey, and 12 senior doctors participated in the semi-structured interviews. Overall, all groups demonstrated moderately positive attitudes towards HVCCC, with more experienced doctors exhibiting more favourable views, especially about integrating costs into daily practice. In the interviews, participants agreed on the importance of instilling HVCCC values during undergraduate teaching and supplementing it with a formal curriculum in postgraduate training. This, coupled with practical knowledge gained on-the-job, was seen as a beneficial strategy for training doctors., Conclusions: This sample of medical students and hospital-based doctors display generally positive attitudes towards HVCCC, high-value care provision, and the integration of healthcare costs, suggesting receptiveness to future HVCCC training among students and doctors. Experience is a key factor in HVCCC, so early exposure to these concepts can potentially enhance practice within existing healthcare budgets., (© 2024. The Author(s).)

Background: Advanced Trauma Life Support was originated mainly to train doctors who don't manage trauma on a regular basis, including junior doctors as it prepares them more efficiently and effectively for treating and managing trauma patients. This study was conducted to study knowledge, attitude and practice of advanced trauma life support protocol among house-officers in Khartoum state hospitals, Sudan 2023., Methods: This is a cross-sectional descriptive health facility based study conducted in Bahri Teaching Hospital, Omdurman Teaching Hospital and Ibrahim Malik teaching hospital, Khartoum state, Sudan. Data of 151 House-officers of all nationality working in Khartoum state hospitals was collected using a simple random technique, filling questionnaire that was designed especially for this study. Comparison between different variables by Chi-square test and statistical significance difference at P value < 0.05 was done., Result: A total of 151 house officers were included in the study. 49% aged between 20 and 25 years, females were the majority 56.3%. About 41.1% have took ATLS course before. 55.21% of the study participants didn't take the course because it was not available, while 35.42% because it was expensive and 29.17% referred it to their busy lifestyle. 91% of the study population think that ATLS course should be compulsory and 85% think that the ATLS protocol should be recommended to both junior and senior doctors. 77% of the study participants stated that their seniors teaching skills affect how they apply ATLS., Conclusion: Overall junior doctors at Khartoum state hospitals demonstrated a positive attitude towards ATLS, but they showed poor knowledge regarding the topic. It's advised that an earlier training program is introduced by incorporating ATLS course to be part of all final year medical school's curriculum., (© 2024. The Author(s).)

Objectives: There is concern that junior doctors are not prepared for their post-graduate attachments in ENT. The aims of this study were to capture the learning priorities of those in the ENT first on-call role and facilitate further educational opportunities to address these needs., Method: Semi-structured interviews were undertaken to explore the learning needs of junior doctors with seven junior and two senior ENT clinicians., Results: The thematic analysis generated three themes: the role of the ENT Junior; the perceived, expressed and prescribed learning needs; and attitudes towards future learning. These themes explored the misalignment between undergraduate training and post-graduate expectations, the lack of competence in ENT practical skills and the need for focused ENT training prior to commencing on-call shifts., Conclusion: All interviewees identified the need for greater experience in practical interventional skills prior to their ENT attachments and expressed interest towards a standardised, bootcamp-style induction with simulated emergency experience.

Physical and mental health problems had been identified as the negative outcomes of workplace violence (WPV) against medical staff. Considering the proven associations between physical and mental health and suicidal ideation, it is reasonable to assume that WPV may associate with suicidal ideation. However, few studies were conducted to explore the relationship between WPV and their suicidal ideation against medical staff. Based on a cross-sectional design, 3, 426 medical staff working in general hospitals were interviewed in Shandong Province, China. Socio-demographic characteristics, work-related factors, psychological variables, WPV, and suicidal ideation were evaluated. Propensity score matching (PSM) was performed to explore the association between WPV and suicidal ideation. The prevalence of suicidal ideation among medical staff was 9.1% (312/3426), and 52.2% (1788/3426) of medical staff reported the WPV experience. Before PSM, we found that the association between WPV and suicidal ideation was statistically significant (aOR = 1.606, p  < 0.01). After PSM, there was a statistically significant correlation between WPV and suicidal ideation (aOR = 1.525, p  < 0.01). This study supported the correlations between WPV against medical staff and their suicidal ideation. The results of PSM further implied that WPV might cause suicidal ideation among medical staff. Psychological health, especially for suicidal ideation, should be paid attention for medical staff with WPV experiences.

Direct contact with COVID-19 patients affect the mental health of frontline healthcare professionals. The main goal of this study was to investigate the levels of burnout and psychological symptoms (posttraumatic symptoms-PTSS, depression, anxiety, and stress-DASS) as well as life satisfaction among nurses and physicians working at University Hospital Dubrava, Zagreb (impacted by the earthquakes) and University Hospital of Split. The second goal was to examine the contribution of gender and personality traits to the levels of psychological symptoms among all participants. A set of questionnaires measuring psychological symptoms and personal characteristics was sent via the Google form platform to healthcare professionals and in total 227 completed the form (138 nurses and 89 physicians). The sample consisted of 180 (79.3% females) and 47 (20.7% males). Among the respondents, 75 nurses and 64 physicians were employees of University Hospital Dubrava of 63 nurses and 25 physicians were employees in the University Hospital of Split. The results showed that physicians in general scored higher on the burnout scale (p<0.001) while nurses reported higher anxiety (p=0.011). Nurses working in Zagreb had higher levels of burnout (p<0.001), more depressive (p=0.009) and anxiety (p=0.027) symptoms as well as experienced more stress (p=0.007), and less life satisfaction (p=0.007) than nurses working in Split. Differences in psychological symptoms and resilience in physicians working in Split and Zagreb were not established. Regression analyses showed that the female gender predicted more PTSS, (B=-4.77, p=0.045) while the physician profession predicted higher burnout symptoms (B=2.67, p=0.002). Considering personality traits, higher emotional stability and resilience predicted lower PTSS and DASS symptoms. Traits extraversion (B=0.17, p=0.003), conscientiousness (B=0.26, p<0.001) and resilience (B=1.21, p=0.024) predicted more life satisfaction. Traits of agreeableness (B=-0.21, p= 0.001) and emotional stability (B=-0.45, p<0.001) predicted a decrease in the intensity of the burnout. This study recognized the importance of personality traits as protective factors contributing to psychological well-being in frontline hospital healthcare workers during the COVID-19 pandemic. On the contrary, exposure to multiple traumas and belonging to a profession of physician emerges as risk factors contributing to more psychological symptoms.

Introduction: Work environment related feelings of dissatisfaction, exhaustion, decreased interest and isolation is common. Burnout among health professionals has been on rise at every stage of professional growth affecting wellness of service providers, patient care and health care organizational efficiency. Assessment of burnout among health care workers from government setup in the current context in this post COVID era in our socio-geographical context has become essential. The aim of this study was to find the prevalence of burnout among nurses and doctors working at a tertiary care government hospital in Nepal., Methods: This descriptive cross sectional study was conducted among nurses and doctors working at a tertiary level government hospital from 10th May 2022 to 9th Nov 2022 after approval from Institutional Review Committee of the same institute. Nurses and doctors available on duty, from all ages were included. Trainees and students, those unable to participate due to their illness, on leave, known cases of mental illness were excluded. The point estimate was calculated at 95% Confidence., Results: Among 180 participants, the prevalence of moderate burnout was 94 (52.22%) (44.92-59.51, 95% Confidence Interval). Among nurses 72 (50%), while in doctors 22 (61.11%) had moderate burnout. Out of those with moderate levels of burnout, the majority of 66 (52.80%) were in the age group 26-50 years., Conclusions: The prevalence of burnout among nurses and doctors is high, similar to other studies done in similar settings.