1
|
McGurgan P, Calvert K, Celenza A, Nathan EA, Jorm C. The Schweitzer effect: The fundamental relationship between experience and medical students' opinions on professional behaviours. MEDICAL TEACHER 2024; 46:782-791. [PMID: 38048408 DOI: 10.1080/0142159x.2023.2284660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE We examined whether medical students' opinions on the acceptability of a behaviour were influenced by previously encountering a similar professionally challenging situation, assessed the magnitude of effect of 'experience' compared to other demographic factors which influence medical students' opinions, and evaluated whether opinions regarding some situations/behaviours were more susceptible to 'experience' bias? METHODS Confidential, on-line survey for medical students distributed to Australian and New Zealand (AUS/NZ) medical schools. Students submitted de-identified demographic information, provided opinions on the acceptability of a wide range of student behaviours in professionally challenging situations, and whether they had encountered similar situations. RESULTS 3171 students participated from all 21 Aus/NZ medical schools (16% of registered students). Medical students reported encountering many of the professionally challenging situations, with varying opinions on what was acceptable behaviour. The most significant factor influencing acceptability towards a behaviour was whether the student reported encountering a similar situation. The professional dilemmas most significantly influenced by previous experience typically related to behaviours that students could witness in clinical environments, and often involved breaches of trust. CONCLUSIONS Our results demonstrate the relationship between experience and medical students' opinions on professional behaviour- the 'Schweitzer effect'. When students encounter poor examples of professional behaviour, especially concerning trust breaches, it significantly influences their perception of the behaviour. These results highlight the importance of placing students in healthcare settings with positive professional role modelling/work cultures.
Collapse
Affiliation(s)
- Paul McGurgan
- Division of Obstetrics and Gynaecology, UWA Medical School, Perth, Australia
| | - Katrina Calvert
- Dept. of Post-Graduate Medical Education (PGME), K.E.M.H., Perth, Australia
| | - Antonio Celenza
- Division of Emergency Medicine, UWA Medical School, Perth, Australia
| | - Elizabeth A Nathan
- Division of Obstetrics and Gynaecology, UWA Medical School, Perth, Australia
| | - Christine Jorm
- School of Public Health, University of Sydney, Australia
| |
Collapse
|
2
|
Butler JM, Taft T, Taber P, Rutter E, Fix M, Baker A, Weir C, Nevers M, Classen D, Cosby K, Jones M, Chapman A, Jones BE. Pneumonia diagnosis performance in the emergency department: a mixed-methods study about clinicians' experiences and exploration of individual differences and response to diagnostic performance feedback. J Am Med Inform Assoc 2024:ocae112. [PMID: 38796835 DOI: 10.1093/jamia/ocae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/25/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES We sought to (1) characterize the process of diagnosing pneumonia in an emergency department (ED) and (2) examine clinician reactions to a clinician-facing diagnostic discordance feedback tool. MATERIALS AND METHODS We designed a diagnostic feedback tool, using electronic health record data from ED clinicians' patients to establish concordance or discordance between ED diagnosis, radiology reports, and hospital discharge diagnosis for pneumonia. We conducted semistructured interviews with 11 ED clinicians about pneumonia diagnosis and reactions to the feedback tool. We administered surveys measuring individual differences in mindset beliefs, comfort with feedback, and feedback tool usability. We qualitatively analyzed interview transcripts and descriptively analyzed survey data. RESULTS Thematic results revealed: (1) the diagnostic process for pneumonia in the ED is characterized by diagnostic uncertainty and may be secondary to goals to treat and dispose the patient; (2) clinician diagnostic self-evaluation is a fragmented, inconsistent process of case review and follow-up that a feedback tool could fill; (3) the feedback tool was described favorably, with task and normative feedback harnessing clinician values of high-quality patient care and personal excellence; and (4) strong reactions to diagnostic feedback varied from implicit trust to profound skepticism about the validity of the concordance metric. Survey results suggested a relationship between clinicians' individual differences in learning and failure beliefs, feedback experience, and usability ratings. DISCUSSION AND CONCLUSION Clinicians value feedback on pneumonia diagnoses. Our results highlight the importance of feedback about diagnostic performance and suggest directions for considering individual differences in feedback tool design and implementation.
Collapse
Affiliation(s)
- Jorie M Butler
- Department of Biomedical Informatics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
- Department of Internal Medicine, Division of Geriatrics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84132, United States
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT 84148, United States
- Geriatrics Research, Education, and Clinical Center (GRECC), VA Salt Lake City Health Care System, Salt Lake City, UT 84148, United States
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - Peter Taber
- Department of Biomedical Informatics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT 84148, United States
| | - Elizabeth Rutter
- Department of Emergency Medicine, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - Megan Fix
- Department of Emergency Medicine, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - Alden Baker
- Department of Family and Preventive Medicine, Division of Physician Assistant Studies, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - McKenna Nevers
- Department of Internal Medicine, Division of Epidemiology, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - David Classen
- Department of Internal Medicine, Division of Epidemiology, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - Karen Cosby
- Department of Emergency Medicine, Cook County Hospital, Rush Medical College, Chicago, IL 60612, United States
| | - Makoto Jones
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT 84148, United States
- Department of Internal Medicine, Division of Epidemiology, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - Alec Chapman
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| | - Barbara E Jones
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT 84148, United States
- Department of Internal Medicine, Division of Pulmonology, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT 84108, United States
| |
Collapse
|
3
|
Choucair F, Atilan O, Almohammadi A, Younis N, Al Hourani A, Curchoe CL, Raad G. Low E-visibility of embryologists on fertility clinic websites: a web-based cross-sectional study. J Assist Reprod Genet 2023; 40:2619-2626. [PMID: 37715874 PMCID: PMC10643726 DOI: 10.1007/s10815-023-02938-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023] Open
Abstract
PURPOSE This study assessed the visibility of embryologists on fertility clinic websites among Society for Assisted Reproductive Technology (SART) and the Human Fertilisation and Embryology Authority (HFEA) member clinics. METHODS During a 1-month interval (March 2022), all Society for Assisted Reproductive Technology (SART) and the Human Fertilisation and Embryology Authority (HFEA) member fertility clinic websites were evaluated. The professional representation of the primary care team was examined including specialties, the presence of headshots, and biographies. RESULTS A total of 446 fertility clinic websites were scanned in the search. The embryology team has the least common professional identification by their names (53.58%) compared to gynecology clinicians (96.21%, p < 0.001) and nurses (55.58%, p < 0.001). This trend also applies to other types of professional identifiers, such as headshots and biographies. Professional headshots of embryologists (50.34%) were less prominent than those of gynecology clinicians (93.51%, p < 0.001). A similar trend was observed in the biographies of the embryology team (47.20%) compared to gynecology clinicians (95.08%, p < 0.001). CONCLUSION The present study revealed that embryologists have low professional visibility on fertility clinic websites. Fertility clinics may prioritize enhancing the online visibility of their embryology laboratory team. This approach could potentially enhance the recognition of their team, foster transparency, and provide accessible information about the skills and expertise of healthcare professionals involved in the treatment process.
Collapse
Affiliation(s)
- Fadi Choucair
- Middle East Fertility Society Embryology Special Interest Group, Beirut, Lebanon
- Reproductive Medicine Unit, Sidra Medicine, Doha, Qatar
| | - Okan Atilan
- Middle East Fertility Society Embryology Special Interest Group, Beirut, Lebanon
- Reproductive Medicine Unit, Sidra Medicine, Doha, Qatar
| | - Abdulla Almohammadi
- Middle East Fertility Society Embryology Special Interest Group, Beirut, Lebanon
- Reproductive Medicine Unit, Sidra Medicine, Doha, Qatar
| | - Nagham Younis
- Middle East Fertility Society Embryology Special Interest Group, Beirut, Lebanon
- Ovation Fertility, Grand Rapids, MI, USA
| | - Alia Al Hourani
- Middle East Fertility Society Embryology Special Interest Group, Beirut, Lebanon
- Department of IVF and Fertility, International Hospital, Al Salmiya, Kuwait
| | - Carol Lynn Curchoe
- Middle East Fertility Society Embryology Special Interest Group, Beirut, Lebanon.
- ART Compass, Newport Beach, CA, USA.
| | - Georges Raad
- Middle East Fertility Society Embryology Special Interest Group, Beirut, Lebanon
- IVF Department, Al Hadi Laboratory and Medical Center, Beirut, Lebanon
| |
Collapse
|
4
|
Atreya S, Datta SS, Salins N. Using Social Constructivist Learning Theory to Unpack General Practitioners' Learning Preferences of End-of-Life Care: A Systematically Constructed Narrative Review. Indian J Palliat Care 2023; 29:368-374. [PMID: 38058487 PMCID: PMC10696355 DOI: 10.25259/ijpc_50_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/23/2023] [Indexed: 12/08/2023] Open
Abstract
General practitioners play a vital role in providing community-based palliative care to patients reaching end of life. In order for GPs to upgrade their skills at end-of-life care delivery, it is imperative that training programs be aligned to their learning needs and preferences. A narrative review was conducted using the electronic databases PubMed, CINAHL, PsycINFO, EMBASE, Scopus, Web of Science, and Cochrane from 01/01/1990 to 31/05/2021. 23 articles (of 10037 searched) were included for the review. Following themes were generated: Value attributed to end-of-life care learning, experience and reflection as a departure point for learning, learning as embedded in the clinical context; autonomy to decide upon their learning needs and learning preferences, learning as a transformative process; and learning as embedded in social interaction and interpretation. Training programs that are aligned to the preferences of GPs will encourage a larger clientele of GPs to access them.
Collapse
Affiliation(s)
- Shrikant Atreya
- Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Soumitra Shankar Datta
- Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
5
|
McGurgan P. Hiding in plain sight: Inconvenient facts for patient safety in non-24/7 theatre on-site staffed obstetric units. Aust N Z J Obstet Gynaecol 2023; 63:606-611. [PMID: 37555707 DOI: 10.1111/ajo.13701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/01/2023] [Indexed: 08/10/2023]
Abstract
The views expressed here are based on my professional experience as a consultant obstetrician, and previous role as clinical head of service for a small (<1800 births/year) obstetric unit in Perth metro. The obstetric unit in which I work has no 24/7 on-site staffed theatre capacity, no high dependency unit, and at night is staffed by a resident medical officer and junior obstetric registrar, with a consultant on-call within 30 min travel time. Based on my review of the literature on obstetric services nationally and various state guidelines (see Sources section), other Australian metro-located obstetric services appear to have similar challenges, but in this paper I focus on the health service models and patient safety systems that I am most familiar with (Perth metro) and ask why obstetric services in this, and by inference, other areas of the country which have similar high population density, would continue to have these staffing/service profiles.
Collapse
Affiliation(s)
- Paul McGurgan
- Divison of Obstetrics and Gynaecology, UWA Medical School, Perth, Western Australia, Australia
| |
Collapse
|
6
|
Pavlova A, Paine SJ, Sinclair S, O'Callaghan A, Consedine NS. Working in value-discrepant environments inhibits clinicians' ability to provide compassion and reduces well-being: A cross-sectional study. J Intern Med 2023; 293:704-723. [PMID: 36843313 DOI: 10.1111/joim.13615] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
BACKGROUND The practice of compassion in healthcare leads to better patient and clinician outcomes. However, compassion in healthcare is increasingly lacking, and the rates of professional burnout are high. Most research to date has focused on individual-level predictors of compassion and burnout. Little is known regarding how organizational factors might impact clinicians' ability to express compassion and well-being. The main study objective was to describe the association between personal and organizational value discrepancies and compassion ability, burnout, job satisfaction, absenteeism and consideration of early retirement among healthcare professionals. METHODS More than 1000 practising healthcare professionals (doctors, nurses and allied health professionals) were recruited in Aotearoa/New Zealand. The study was conducted via an online cross-sectional survey and was preregistered on AsPredicted (75407). The main outcome measures were compassionate ability and competence, burnout, job satisfaction and measures of absenteeism and consideration of early retirement. RESULTS Perceived discrepancies between personal and organizational values predicted lower compassion ability (B = -0.006, 95% CI [-0.01, -0.00], p < 0.001 and f 2 = 0.05) but not competence (p = 0.24), lower job satisfaction (B = -0.20, 95% CI [-0.23, -0.17], p < 0.001 and f 2 = 0.14), higher burnout (B = 0.02, 95% CI [0.01, 0.03], p < 0.001 and f 2 = 0.06), absenteeism (B = 0.004, 95% CI [0.00, 0.01], p = 0.01 and f 2 = 0.01) and greater consideration of early retirement (B = 0.02, 95% CI [0.00, 0.03], p = 0.04 and f 2 = 0.004). CONCLUSIONS Working in value-discrepant environments predicts a range of poorer outcomes among healthcare professionals, including hindering the ability to be compassionate. Scalable organizational and systems-level interventions that address operational processes and practices that lead to the experience of value discrepancies are recommended to improve clinician performance and well-being outcomes.
Collapse
Affiliation(s)
- Alina Pavlova
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Sarah-Jane Paine
- Te Kupenga Hauora Maori, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, Canada.,Compassion Research Lab, Calgary, Canada.,Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, Calgary, Canada
| | - Anne O'Callaghan
- Hospital Palliative Care Service, Auckland City Hospital, Auckland, New Zealand
| | - Nathan S Consedine
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| |
Collapse
|
7
|
Mutua MM, Nyoni CN. Undergraduate e-learning programmes in health professions: An integrative review of evaluation standards in low- and middle-income countries. PLoS One 2023; 18:e0281586. [PMID: 36780488 PMCID: PMC9925085 DOI: 10.1371/journal.pone.0281586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Before the Coronavirus COVID-19, universities offered blended learning as a mode of study. However, with the closure of all educational institutions, after the pandemic, most of these institutions were required to transition to e-learning to support continuous student learning. This transition was challenging to most institutions, as there were no standards to ensure the quality of e-learning. During this literature review, the researcher aimed to explore relevant literature and provide insight into the standards for undergraduate e-learning programmes in the health professions. DESIGN An integrative review of literature. DATA SOURCES Online databases MEDLINE, CINAHL with full text, Academic search ultimate, APA PsycInfo, ERIC, Health Source: Nursing/academic edition, CAB abstracts, Africa-wide information, Sociology source ultimate, and Communication and Mass media complete were searched. MATERIALS AND METHODS Studies pertaining to low- and middle-income countries (LMICs) on standards in evaluating undergraduate e-learning programmes in health professions, published between January 2010 to June 2022, were considered. A two-step process was followed involving three reviewers and guided by an inclusion criteria focused on the evaluation of undergraduate e-learning programmes in the health professions. The initial hit produced 610 articles altogether, and eight articles that met the inclusion criteria were included in the study. Data was then extracted and analysed, and key themes were identified. RESULTS Eight Key themes related to LMIC standards emerged from the eight selected articles: curriculum planning, proficiency of educators, learner proficiency and attitude, infrastructure for learning, support and evaluation. CONCLUSION In this review, we synthesised standards that have been used for evaluating undergraduate e-learning programmes in health professions in LMICs. A gap in standards related to clinical teaching and learning in undergraduate e-learning programmes in the health professions was evident from all the included articles. The identification of the eight unique LMIC standards in this review could contribute to guiding towards contextually appropriate quality e-learning programmes in the health professions.
Collapse
Affiliation(s)
- Moses M. Mutua
- Faculty of Health Sciences, School of Nursing, University of the Free State, Bloemfontein, South Africa
- * E-mail:
| | - Champion N. Nyoni
- Faculty of Health Sciences, School of Nursing, University of the Free State, Bloemfontein, South Africa
| |
Collapse
|
8
|
van Baal K, Stiel S, Schulte P. Public Perceptions of Climate Change and Health-A Cross-Sectional Survey Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1464. [PMID: 36674220 PMCID: PMC9859516 DOI: 10.3390/ijerph20021464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
Climate change is inseparably linked to human health. Although there is growing awareness of the threats to human health caused by climate change, it remains unclear how the German population perceives the relevance of climate change and its health consequences. Between May and September 2022, German residents were invited to participate in a cross-sectional online survey that explored three content areas: (1) the relevance of climate change, (2) health risks in connection with climate change and (3) collective and individual options for action against climate change. A total of 697 full data sets were collected for analysis (72% female, 51% ≥55 years old). The majority of participants agreed that human-induced climate change exists (85%), and that it has an impact on human health (83%). They also perceived the global population to be more strongly impacted by climate change than themselves (89% versus 68%). Most participants (76%) claimed to personally contribute to climate protection and 23% felt that their city or council contributed to climate protection. Although the majority of participants saw climate change as a threat to human health, they perceived other population groups to be most strongly affected. Cognitive dissonance might explain this lack of individual concern and one approach to addressing such distorted perceptions might be the dissemination of appropriate risk communication with health professionals involved in the communication.
Collapse
Affiliation(s)
- Katharina van Baal
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Peter Schulte
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Länger Besser Leben. Institute, University of Applied Sciences Weserbergland, Am Stockhof 2, 31785 Hameln, Germany
| |
Collapse
|
9
|
Broers DLM, Dubois L, de Lange J, Welie JVM, Brands WG, Lagas MBD, Bruers JJM, de Jongh A. How dentists and oral and maxillofacial surgeons deal with tooth extraction without a valid clinical indication. PLoS One 2023; 18:e0280288. [PMID: 36649347 PMCID: PMC9844881 DOI: 10.1371/journal.pone.0280288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES This study pertains to a secondary data analysis aimed at determining differences between oral and maxillofacial surgeons (OMFSs) and dentists handling dental extractions without an evident clinical indication. STUDY DESIGN A survey of 18 questions was conducted among 256 OMFSs in the Netherlands and a random sample of 800 dentists Respondents could answer the questions in writing or online. The data was collected in the period from November 2019 to January 2020, during which two reminders were sent. Analysis of the data took place via descriptive statistics and Chi Square test. RESULTS The response rate was 28.1% (n = 72) for OMFSs and 30.3% (n = 242) for dentists. In the past three years, 81.9% (n = 59) of the OMFSs and 68.0% (n = 164) of the dentists received a request for extraction without a clinical indication. The most common reasons were financial and severe dental fear (OMFSs: 64.9 and 50.9% vs dentists: 77.4 and 36.5%). Dentists were significantly more likely (75.6%, n = 114) than OMFS (60.7%, n = 34) to comply with their last extraction request without a clinical indication. Almost none of them regretted the extraction afterwards. As for the request itself, it was found that 17.5% (n = 10) of the OMFSs and 12.5% (n = 20) of the dentists did not check for patients' mental competency (p = 0.352). CONCLUSIONS Given that most of the interviewed dental professionals complied with non-dental extraction requests when such extractions are ethically and legally precarious, recommendations for handling such requests are greatly needed.
Collapse
Affiliation(s)
- Dyonne Liesbeth Maria Broers
- Academic Centre for Dentistry Amsterdam, Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
- * E-mail:
| | - Leander Dubois
- Academic Centre for Dentistry Amsterdam, Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, St Antonius Hospital, Nieuwegein/Utrecht/Woerden, The Netherlands
| | - Jan de Lange
- Academic Centre for Dentistry Amsterdam, Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - Jos Victor Marie Welie
- University College Maastricht, Maastricht University, Maastricht, The Netherlands
- St. André International Center for Ethics and Integrity, Saint-André-d’Olérargues, France
| | - Wolter Gerrit Brands
- St. André International Center for Ethics and Integrity, Saint-André-d’Olérargues, France
- Royal Dutch Dental Association (KNMT), Utrecht, The Netherlands
| | - Maria Barbara Diana Lagas
- Academic Centre for Dentistry Amsterdam, Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Jan Joseph Mathieu Bruers
- Academic Centre for Dentistry Amsterdam, Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
- Royal Dutch Dental Association (KNMT), Utrecht, The Netherlands
| | - Ad de Jongh
- Academic Centre for Dentistry Amsterdam, Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
- Research department PSYTREC, Bilthoven, The Netherlands
- School of Health Sciences, Salford University, Manchester, United Kingdom
- Institute of Health and Society, University of Worcester, Worcester, United Kingdom
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland
| |
Collapse
|
10
|
McGurgan PM, Calvert KL, Nathan EA, Narula K, Celenza A, Jorm C. Why Is Patient Safety a Challenge? Insights From the Professionalism Opinions of Medical Students' Research. J Patient Saf 2022; 18:e1124-e1134. [PMID: 35617637 DOI: 10.1097/pts.0000000000001032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Despite increased emphasis on education and training for patient safety in medical schools, there is little known about factors influencing decision making regarding patient safety behaviors. This study examined the nature and magnitude of factors that may influence opinions around patient safety-related behaviors as a means of providing insights into how Australian doctors and medical students view these issues relative to members of the public. METHODS A national, multicenter, prospective, cross-sectional survey was conducted using responses to hypothetical patient safety scenarios involving the following: fabricating results, personal protective equipment, presenteeism, and reporting concerns.Australian enrolled medical students, medical doctors, and members of the public were surveyed.Participant responses were compared for the different contextual variables within the scenarios and the participants' demographic characteristics. RESULTS In total, 2602 medical student, 809 doctors, and 503 members of the Australian public participated. The 3 demographic groups had significantly differing opinions on many of the patient safety dilemmas. Doctors were more tolerant of medical students not reporting concerning behaviors and attending placements despite recent illness. Medical students' opinions frequently demonstrated a "transition effect," bridging between the doctors and publics' attitudes, consistent with professional identity formation. CONCLUSIONS Opinions on the acceptability of medical students' patient safety-related behaviors were influenced by the demographics of the cohort and the contextual complexity of the scenario. Although the survey used hypothetical scenarios, doctors and medical students' opinions seem to be influenced by cognitive dissonances, biases, and heuristics, which may negatively affect patient safety.
Collapse
Affiliation(s)
- Paul M McGurgan
- From the Division of Obstetrics and Gynaecology, University of Western Australia
| | | | | | | | - Antonio Celenza
- Division of Emergency Medicine, University of Western Australia, Perth
| | - Christine Jorm
- Health and Medical Research Office, Australian Government Department of Health, Canberra, Australia
| |
Collapse
|
11
|
Competence and Involuntary Commitment of Patients with Anorexia Nervosa: A Qualitative study on the Perceptions and Performance of Psychiatrists and Clinical Psychologists. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2022; 51:261-271. [PMID: 36379875 DOI: 10.1016/j.rcpeng.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Anorexia nervosa poses an important bioethical dilemma, since patients often refuse treatment despite the danger that this poses to their health, and it is not clear that their decision is autonomous. The aim of this study was to investigate the perceptions/performance of psychiatrists and clinical psychologists regarding the capacity and involuntary hospitalisation of patients with anorexia nervosa. METHODS Seven psychiatrists, four clinical psychologists, and one third-year resident psychologist were interviewed. A qualitative research approach based on grounded theory was used. RESULTS The data analysis showed that these professionals articulate patient care around one main category - hospitalisation as a last resort and the search for voluntariness, which implies a change in the usual healthcare dynamics. Around this central category, some important concepts emerge: role stress, informal coercion, weight, family and chronicity. CONCLUSIONS It is concluded that the difficulty of reconciling professional demands can undermine the quality of care and job satisfaction itself, which highlights the need for reflection and research into the foundations of the responsibilities assumed.
Collapse
|
12
|
Gagliardi JP, Smith CM, Simmons KL, Tweedy DS. Racial Justice Beyond the Curriculum: Aligning Systems of Care With Anti-Racist Instruction in Graduate Medical Education. J Grad Med Educ 2022; 14:403-406. [PMID: 35991095 PMCID: PMC9380630 DOI: 10.4300/jgme-d-22-00056.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Jane P. Gagliardi
- Jane P. Gagliardi, MD, MHSc, is Associate Professor of Psychiatry and Behavioral Sciences, and Associate Professor of Medicine, Duke University School of Medicine
| | - Colin M. Smith
- Colin M. Smith, MD, is PGY-6 Chief Resident, Internal Medicine-Psychiatry, Duke University Medical Center
| | - Kirsten L. Simmons
- Kirsten L. Simmons, MD, MHSc, is a PGY-1, Department of Ophthalmology, W.K. Kellogg Eye Center, University of Michigan
| | - Damon S. Tweedy
- Damon S. Tweedy, MD, is Associate Professor of Psychiatry and Behavioral Sciences, Duke University School of Medicine, and Staff Psychiatrist, Durham VA Health Care System
| |
Collapse
|
13
|
Young JQ, Friedman KA, Thakker K, Hennus MP, Hennessy M, Patterson A, Yacht A, ten Cate O. Supervision and Care Quality as Perceived by Redeployed Attendings, Fellows, and Residents During a COVID-19 Surge: Lessons for the Future. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S28-S34. [PMID: 34789660 PMCID: PMC8855770 DOI: 10.1097/acm.0000000000004529] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To better prepare for potential future large-scale redeployments, this study examines quality of supervision and care as perceived by redeployed residents, fellows, and attendings during a COVID-19 surge. METHOD During April and May 2020, attendings, fellows, and residents redeployed at 2 teaching hospitals were invited to participate in a survey, which included questions on respondents' prior experience; redeployed role; amount of supervision needed and received; and perceptions of quality of supervision, patient care, and interprofessional collaboration. Frequencies, means, and P values were calculated to compare perceptions by experience and trainee status. Narrative responses to 2 open-ended questions were independently coded; themes were constructed. RESULTS Overall, 152 of 297 (51.2%) individuals responded, including 64 of 142 attendings (45.1%), 40 of 79 fellows (50.6%), and 48 of 76 residents (63.2%). Fellows and attendings, regardless of prior experience, perceived supervision as adequate. In contrast, experienced residents reported receiving more supervision than needed, while inexperienced residents reported receiving less supervision than needed and rated overall supervision as poor. Attendings, fellows, and experienced residents rated the overall quality of care as acceptable to good, whereas inexperienced residents perceived overall quality of care as worse to much worse, particularly when compared with baseline. CONCLUSIONS Narrative themes indicated that the quality of supervision and care was buffered by strong camaraderie, a culture of informal consultation, team composition (mixing experienced with inexperienced), and clinical decision aids. The markedly negative view of inexperienced residents suggests a higher risk for disillusionment, perhaps even moral injury, during future redeployments. Implications for planning are explored.
Collapse
Affiliation(s)
- John Q. Young
- J.Q. Young is professor, Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; ORCID: https://orcid.org/0000-0003-2219-5657
| | - Karen A. Friedman
- K.A. Friedman is professor, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; ORCID: https://orcid.org/0000-0003-1980-1839
| | - Krima Thakker
- K. Thakker is research associate, Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York
| | - Marije P. Hennus
- M.P. Hennus is professor, University Medical Center Utrecht, Utrecht, The Netherlands; ORCID: https://orcid.org/0000-0003-1508-0456
| | - Martina Hennessy
- M. Hennessy is associate professor, Trinity College Dublin School of Medicine, Dublin, Ireland; ORCID: https://orcid.org/0000-0002-2153-5288
| | - Aileen Patterson
- A. Patterson is assistant professor, Trinity College Dublin School of Medicine, Dublin, Ireland; ORCID: https://orcid.org/0000-0003-4315-0917
| | - Andrew Yacht
- A. Yacht is professor, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Olle ten Cate
- O. ten Cate is a professor, University Medical Center Utrecht, Utrecht, The Netherlands; ORCID: https://orcid.org/0000-0002-6379-8780
| |
Collapse
|
14
|
Barriers and Enablers to Delegating Malnutrition Care Activities to Dietitian Assistants. Nutrients 2022; 14:nu14051037. [PMID: 35268008 PMCID: PMC8912543 DOI: 10.3390/nu14051037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 01/27/2023] Open
Abstract
Delegation of malnutrition care to dietitian assistants can positively influence patient, healthcare, and workforce outcomes. However, nutrition care for hospital inpatients with or at risk of malnutrition remains primarily individually delivered by dietitians—an approach that is not considered sustainable. This study aimed to identify barriers and enablers to delegating malnutrition care activities to dietitian assistants. This qualitative descriptive study was nested within a broader quality assurance activity to scale and spread systematised and interdisciplinary malnutrition models of care. Twenty-three individual semi-structured interviews were completed with nutrition and dietetic team members across seven hospitals. Inductive thematic analysis was undertaken, and barriers and enablers to delegation of malnutrition care to dietitian assistants were grouped into four themes: working with the human factors; balancing value and risk of delegation; creating competence, capability, and capacity; and recognizing contextual factors. This study highlights novel insights into barriers and enablers to delegating malnutrition care to dietitian assistants. Successful delegation to dietitian assistants requires the unique perspectives of humans as individuals and in their collective healthcare roles, moving from words to actions that value delegation; engaging in processes to improve competency, capability, and capacity of all; and being responsive to climate and contextual factors.
Collapse
|
15
|
Jacobsen J, Jackson V, Asfaw S, Greenwald JL, Slavin P. One Hospital's Response to the Institute of Medicine Report, "Dying in America". J Pain Symptom Manage 2022; 63:e182-e187. [PMID: 34756956 DOI: 10.1016/j.jpainsymman.2021.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/05/2021] [Accepted: 10/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In response to the Institute of Medicine (IOM) report, Dying in America, we undertook an institution wide effort to improve the experience of patients and families facing serious illness by engaging leadership and developing a program to promote the practice of generalist palliative care. MEASURES The impact of the program was measured with process measures related to its' three parts. INTERVENTION We developed a three-part generalist palliative care program that focuses on 1) instructional design, 2) advance care planning, and 3) engagement. OUTCOMES Over four years, the program trained 51 interprofessional clinicians in a two-week intensive palliative care course and 1,541 interprofessional clinicians in a 90-150 min skills-based training. Clinicians documented 15,791 serious illness conversations. Zoom community engagement sessions were attended by 411 live viewers, and subsequently, 1918 YouTube views. Additionally, we report on the impact of the COIVD-19 crisis on our efforts. Early in the pandemic, over two months, 464 interprofessional clinicians documented 5,168 conversations with patients. CONCLUSION/LESSONS LEARNED A broad based strategy resulted wide institutional engagement with serious illness care.
Collapse
Affiliation(s)
- Juliet Jacobsen
- Harvard Medical School (J.J., V.J., J.L.G.), Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Vicki Jackson
- Harvard Medical School (J.J., V.J., J.L.G.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shae Asfaw
- Massachusetts General Hospital (S.A.), Boston, Massachusetts, USA
| | - Jeffrey L Greenwald
- Harvard Medical School (J.J., V.J., J.L.G.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peter Slavin
- Department of Health Care Policy (P.S.), Harvard Medical School; President, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
16
|
Experience of General Practice Residents Caring for Dependent Elderly during the First COVID-19 Lockdown-A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312281. [PMID: 34886006 PMCID: PMC8657085 DOI: 10.3390/ijerph182312281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/02/2022]
Abstract
Background: Understanding the experiences of general practice (GP) residents caring for dependent elderly people during the first lockdown as part of the countries COVID-19 pandemic strategy. The aim was to explore themes that could explain the gap between the missions and values at the heart of GP practice during this period of strict isolation. Method: Qualitative study using an iterative approach. Semi-structured interviews were conducted with 13 GP residents using a pre-established interview guide. Audio recordings were transcribed verbatim. Data were analyzed according to a coding grid, developed using Nvivo software (NVivo Qualitative Data Analysis Software; QSR International Pty Ltd. Version Release 1.5.1 (940) 2021), to identify emerging themes. Results: Three themes emerged from this qualitative research: cognitive dissonance, psychosocial risks, and fear. General practice residents have lived in the paradox between care and deprivation of liberty of dependent elderly people. Conclusion: The results suggest that the GP residents experienced a form of work-related suffering in this situation of deprivation of liberty of dependent elderly people. The present research serves as a pilot study to explore how GP residents experienced their care of locked-up dependent elderly people.
Collapse
|
17
|
Demyan L, Wu G, Moumin D, Blumenthaler AN, Deutsch GB, Nealon W, Herman JM, Weiss MJ, Burns EA, DePeralta DK. Advance care planning in patients undergoing surgery to resect pancreatic adenocarcinoma: Underlying tension between balancing hope and realism. Surgery 2021; 171:459-466. [PMID: 34563351 DOI: 10.1016/j.surg.2021.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/01/2021] [Accepted: 08/16/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The timing and the dose of Advanced Care Planning in patients with pancreatic ductal adenocarcinoma undergoing curative-intent resection are generally dictated by the surgeon performing the operation. METHODS A qualitative investigation using 1:1 interviews with 40 open-ended questions was conducted with a convenience sample of 10 high-volume pancreatic surgeons from across the country. The grounded theory approach was used for data analysis. RESULTS A total of 10 interviews were conducted with expert pancreatic surgeons-6 males and 4 females. During preoperative counseling, all surgeons attempt to motivate patients by emphasizing hope, optimism, and the fact that surgery offers the only opportunity for cure. All surgeons discuss the possibility of recurrence as well as postoperative complications; however, a majority perceived that patients do not fully appreciate the likelihood of recurrence or postoperative complications. All surgeons acknowledged the importance of end-of-life conversations when death is imminent. Seventy percent of surgeons had mixed opinions regarding benefits of preoperative Advanced Care Planning in the preoperative setting, while 20% felt it was definitely beneficial, particularly that delivery of care aligned with patient goals. All surgeons emphasized that Advanced Care Planning should be led by a physician who both knows the patient well and understands the nuances of pancreatic ductal adenocarcinoma management. Most common barriers to in-depth Advanced Care Planning discussion reported by surgeons include taking away hope, lack of time, and concern for sending "mixed messages." CONCLUSION We identified that surgeons experience a fundamental tension between promoting realistic long-term goals and expectations versus focusing on hope and enabling an overly optimistic perception of prognosis.
Collapse
Affiliation(s)
- Lyudmyla Demyan
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY.
| | - Grace Wu
- Zucker School of Medicine at Hofstra, New Hyde Park, NY
| | - Dina Moumin
- Zucker School of Medicine at Hofstra, New Hyde Park, NY
| | | | - Gary B Deutsch
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY; Zucker School of Medicine at Hofstra, New Hyde Park, NY
| | - William Nealon
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY; Zucker School of Medicine at Hofstra, New Hyde Park, NY
| | - Joseph M Herman
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY; Zucker School of Medicine at Hofstra, New Hyde Park, NY
| | - Matthew J Weiss
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY; Zucker School of Medicine at Hofstra, New Hyde Park, NY
| | - Edith A Burns
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY; Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Danielle K DePeralta
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY; Zucker School of Medicine at Hofstra, New Hyde Park, NY
| |
Collapse
|
18
|
Abstract
Rationale: Medical interventions that prolong life without achieving an effect that the patient can appreciate as a benefit are often considered futile or inappropriate by healthcare providers. In recent years, a multicenter guideline has been released with recommendations on how to resolve conflicts between families and clinicians in these situations and to increase public engagement. Although laypeople are acknowledged as important stakeholders, their perceptions and understanding of the terms "potentially inappropriate" or "futile" treatment have received little formal evaluation.Objectives: To evaluate the community perspective about the meaning of futile treatment.Methods: Six focus groups (two groups each of ages <65, 65-75, and >75 yr) were convened to explore what constitutes futile treatment and who should decide in situations of conflict between doctors and families. Focus group discussions were analyzed using grounded theory.Results: There were 39 participants aged 18 or older with at least one previous hospitalization (personal or by immediate relative). When asked to describe futile or inappropriate treatment, community members found the concept difficult to understand and the terminology inadequate, though when presented with a case describing inappropriate treatment, most participants recognized it as the provision of inappropriate treatment. Several themes emerged regarding participant difficulty with the concept, including inadequate physician-patient communication, lack of public emphasis on end-of-life issues, skepticism that medical treatment can be completely inappropriate, and doubts and fears that medical futility could undermine patient and/or family autonomy. Participants also firmly believed that in situations of conflict families should be the ultimate decision-makers.Conclusions: Public engagement in policy development and discourse around medical futility will first require intense education to familiarize the lay public about use of inappropriate treatment at the end of life.
Collapse
|
19
|
Fernández-Hernández JL, Herranz-Hernández P, Segovia-Torres L. Refusal of Treatment for Anorexia Nervosa: Mental Health Professionals' Opinion on Willingness and Role Stress. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 52:S0034-7450(21)00046-9. [PMID: 33888305 DOI: 10.1016/j.rcp.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/27/2020] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The hospitalisation of patients with anorexia nervosa poses an important bioethical quandary and can generate stress for the healthcare professionals. Our goal was to know and analyse the opinion of mental health professionals on some conditions for applying the involuntary hospitalisation of patients with anorexia nervosa. METHODS Cross-sectional descriptive observational study on a sample of 270 mental health professionals, using an ad hoc questionnaire with scores ranging from 0 to 10. RESULTS The professionals state that, in some cases, the patient accepts admission reluctantly: 7.74 (95% CI, 7.55-7.93). In the event of physical risk, it is difficult for them to combine respect for the patient's autonomy and the duty of care: 6.06 (95% CI, 5.70-6.41) and the relationship with the patient is largely oriented to convince them: 7.18 (95% CI, 6.91-7.46). They do not decide on the suitability of the participation of non-medical staff in the decision: 5.13 (95% CI, 4.75-5.52), or if the indication should correspond to someone other than the doctor in charge of their care: 4.79 (95% CI, 4.39-5.19). They reject the possibility of conscientious objection: 4.05 (95% CI, 3.68-4.41). CONCLUSIONS Mental health professionals are subject to ambiguous work demands, which affects their care dynamics.
Collapse
|
20
|
Swain MS, Gliedt JA, de Luca K, Newell D, Holmes M. Chiropractic students' cognitive dissonance to statements about professional identity, role, setting and future: international perspectives from a secondary analysis of pooled data. Chiropr Man Therap 2021; 29:5. [PMID: 33526067 PMCID: PMC7851948 DOI: 10.1186/s12998-021-00365-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 01/14/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chiropractic students demonstrate philosophically opposing views about the chiropractic profession. The primary aim was to describe chiropractic students' responses to statements about chiropractic identity, role, setting, and future direction. A secondary aim was to describe the frequency of internally conflicting responses. METHODS Three datasets from Europe, North America, and Australia/New Zealand were pooled in a secondary data analysis. Chiropractic students from 25 chiropractic training institutions completed interrelating surveys (combined response rate 21.9%) between 2013 and 2018. The survey instrument investigated student viewpoints about chiropractic professional identity, role, practice setting and future direction of chiropractic practice. Student attitudes about chiropractic were described using weighted proportions to adjust for unequal population sampling across the three geographical regions. The frequency of concordant and discordant student responses was described by combining identity items with items that explored responses about practice role, setting and future direction. The relationship between student characteristics (age, sex, education, association membership and geographical region) and ideologically conflicting responses were assessed using the Chi-squared test and Cramér's V. RESULTS Data from 2396 student chiropractors (50.8% female; from Europe 36.2%, North America 49.6% and Australia/New Zealand 14.5%) were analysed. For identity, nearly half of the chiropractic students (weighted 45.1%) agreed that it is important for chiropractors to hold strongly to the traditional chiropractic theory that adjusting the spine corrects "dis-ease" and agreed (weighted 55.5%) that contemporary and evolving scientific evidence is more important than traditional chiropractic principles. The frequency of discordant (ideologically conflicting) student responses ranged from 32.5% for statements about identity versus role, to 51.4% for statements about identity versus future. There was no association between student age, sex and internally conflicting responses. Chiropractic students' professional association membership status, pre-chiropractic education and geographical region were associated with ideologically conflicting responses. CONCLUSIONS Chiropractic students in this analysis show traditional and progressive attitudes towards the chiropractic profession. Individual student responses frequently contradict in terms of professional ideology, but most (approximately half) students demonstrate concordant progressive and mainstream attitudes. Ideological conflict may raise concerns about some students' ability to learn and make clinical judgements, and potential for disharmony in the chiropractic fraternity.
Collapse
Affiliation(s)
- Michael S Swain
- Department of Chiropractic, Macquarie University, Balaclava Rd, Sydney, NSW, 2109, Australia. .,Chiropractic Academy of Research Leadership (CARL), Odense, Denmark.
| | - Jordan A Gliedt
- Logan University College of Chiropractic, Chesterfield, USA.,Medical College of Wisconsin, Milwaukee, USA
| | - Katie de Luca
- Department of Chiropractic, Macquarie University, Balaclava Rd, Sydney, NSW, 2109, Australia.,Chiropractic Academy of Research Leadership (CARL), Odense, Denmark
| | | | - Michelle Holmes
- Chiropractic Academy of Research Leadership (CARL), Odense, Denmark.,AECC University College, Bournemouth, UK
| |
Collapse
|
21
|
Fernández-Hernández JL, Herranz-Hernández P, Segovia-Torres L. Competence and Involuntary Commitment of Patients with Anorexia Nervosa: A Qualitative study on the Perceptions and Performance of Psychiatrists and Clinical Psychologists. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 51:S0034-7450(20)30126-8. [PMID: 33735003 DOI: 10.1016/j.rcp.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/03/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Anorexia nervosa poses an important bioethical quandary, since patients often refuse treatment despite the danger that this poses to their health, and it is not clear that their decision is autonomous. The aim of this study was to investigate the perceptions/performance of psychiatrists and clinical psychologists regarding the capacity and involuntary hospitalisation of patients with anorexia nervosa. METHODS Seven psychiatrists, four clinical psychologists, and one third-year resident psychologist were interviewed. A qualitative research approach based on grounded theory was used. RESULTS The data analysis showed that these professionals articulate patient care around one main category - hospitalisation as a last resort and the search for voluntariness, which implies a change in the usual healthcare dynamics. Around this central category, some important concepts emerge: role stress, informal coercion, weight, family and chronicity. CONCLUSIONS The difficulty of reconciling professional demands can undermine the quality of care and job satisfaction itself, which highlights the need for reflection and research into the foundations of the responsibilities assumed.
Collapse
|
22
|
Braun LT, Schmidmaier R. Dealing with cognitive dissonance: an approach. MEDICAL EDUCATION 2019; 53:1167-1168. [PMID: 31532838 DOI: 10.1111/medu.13955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Leah T Braun
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Universität München, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Ralf Schmidmaier
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Universität München, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| |
Collapse
|