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Sahiti Q, Shearer C, Thomson C, Sutherland L, Bowes D. Addressing medical resident mistreatment: A resident-centred approach. MEDICAL TEACHER 2024; 46:769-775. [PMID: 37972586 DOI: 10.1080/0142159x.2023.2279903] [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: 11/19/2023]
Abstract
INTRODUCTION Mistreatment negatively impacts the wellbeing of medical learners and is related to worse patient outcomes and team functioning. Resident perspectives on improving mistreatment reporting structures and investigations have not been explored. We aimed to understand residents' views on safe reporting structures, investigations, and resolution processes. METHOD We conducted an exploratory sequential mixed method study beginning with a series of qualitative interviews to inform an anonymous online survey to all Dalhousie University residents (N = 645). RESULTS When interviewed, residents (N = 10) discussed personal experiences with mistreatment, barriers to reporting, and how these processes could better serve them. Themes from the interviews were imbedded in an anonymous online survey to explore their prevalence among a larger group. Residents (N = 120; 19%) completed the online survey and revealed that mistreatment was very common yet underreported. Barriers to reporting included confidentiality concerns, perceptions that reporting would not change anything, and fear of retaliation. Desired outcomes for perpetrators depended on the perpetrator's position and incident severity, and most prefer a remedial approach. CONCLUSION Resident mistreatment remains prevalent and current processes of dealing with reports may be inadequate. Residents have thoughtful insights for improving institutional policies and procedures and should be meaningfully engaged.
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Affiliation(s)
| | - Cindy Shearer
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Postgraduate Medical Education, Dalhousie University, Halifax, Canada
| | - Carolyn Thomson
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Postgraduate Medical Education, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Family Medicine, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Office of Resident Affairs, Dalhousie University, Halifax, Canada
| | - Lisa Sutherland
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Office of Resident Affairs, Dalhousie University, Halifax, Canada
| | - David Bowes
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Postgraduate Medical Education, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Radiation Oncology, Dalhousie University, Halifax, Canada
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Lv X, Mou T, Hua W, Liu Y, Li X, Ma Z. Overall Description and Predictors of Disruptive Behavior Toward Nurses in the Perioperative Arena. J Perianesth Nurs 2024; 39:425-432. [PMID: 38206219 DOI: 10.1016/j.jopan.2023.09.004] [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: 11/14/2022] [Revised: 09/01/2023] [Accepted: 09/14/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To investigate the prevalence, characteristics, causes, consequences, and predictors of and responses to disruptive behavior toward nurses in the perioperative arena. DESIGN A cross-sectional design using a network questionnaire platform. METHODS Nurses in the perioperative arena were recruited online in March 2020. Data on disruptive behavior toward nurses in the past 6 months and nurses' sociodemographic and environmental factors were collected. FINDINGS Nurses (N = 496) responded validly to the survey. In total, 82.1% of participants experienced disruptive behavior. Assignment of overwhelming workloads and verbal aggression were the most common behaviors, and surgeons were the major perpetrators. Perpetrators' intrapersonal issues were the most commonly perceived causes. A positive strategy was the most common strategy adopted by participants. Further, 80.8% of participants recounted their negative experiences, and more than half of respondents (59.9%) talked with their nursing colleagues. Nearly half of respondents (45.9%) did not report disruptive behavior. Negative emotions as an immediate effect were reported by 53.1% of the participants, and the most common long-term impact was decreased passion for work. Middle age, job position, practice environment, and system help were risk factors for experiencing disruptive behavior. CONCLUSIONS The prevalence of disruptive behavior toward nurses in the perioperative arena is high, and its ramifications should not be ignored. Health care institutions should urgently implement intervention strategies to reduce disruptive behavior toward nurses.
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Affiliation(s)
- Xiaofan Lv
- Department of Operating Rooms, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Tong Mou
- Department of Operating Rooms, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
| | - Wei Hua
- Department of Operating Rooms, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
| | - Yue Liu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
| | - Xueyun Li
- Department of Operating Rooms, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
| | - Zhengliang Ma
- Department of Anesthesiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
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Putney K, Gupta V, Williams E, Unni E. Viewpoints of Residency Program Directors Regarding Depressive Symptoms in Pharmacy Residents. J Pharm Pract 2024; 37:399-409. [PMID: 36251312 DOI: 10.1177/08971900221134647] [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] [Indexed: 11/16/2022]
Abstract
Objective: Several publications have highlighted residency-specific factors being associated with depressive symptoms in pharmacy residents, but no studies have investigated the viewpoint of residency program directors (RPDs) regarding this issue. This study's primary objectives were to identify potential contributing factors, determine current resources, and outline possible solutions to decrease depressive symptoms among pharmacy residents from the point of view of RPDs. Methods: RPDs were asked to participate in a 45-60-minute semi-structured interview conducted via phone by the primary investigator, recorded, and transcribed using NVivo. Interviews were manually analyzed by study investigators to identify emerging themes. The investigators discussed findings and discrepancies to agree upon thematic interpretations of the transcripts. Results: Ten interviews were conducted between May 2019 and February 2020. RPD experience ranged from 2-15 years. Pharmacy practice PGY1 programs comprised 60% of interviews, 20% for community practice, and 10% each for managed care and ambulatory care. All RPDs indicated increased workload as a contributing factor to depressive symptoms in residents. The inability to accept and utilize constructive feedback and difficulties transitioning from student to resident were identified as contributing factors by 50% of the RPDs. Nine RPDs reported having employee assistance programs, stating the resource was underutilized, and identified the need for additional education regarding identification and triage, not necessarily management, to help residents. Conclusion: This study highlights consistency among RPDs regarding potential contributors to depressive symptoms in pharmacy residents and emphasizes the need for additional RPD and preceptor training to identify and help residents more effectively with these issues.
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Affiliation(s)
- Kaylee Putney
- Roseman University of Health Sciences, Henderson, NV, USA
| | - Vasudha Gupta
- Roseman University of Health Sciences, Henderson, NV, USA
| | - Evan Williams
- Roseman University of Health Sciences, Henderson, NV, USA
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Sulistio MS, Chen CL, Eleazu I, Godfrey S, Abraham RA, Toft LEB. Personal Actions to Create a Culture of Inclusion: Navigating Difficult Conversations With Medical Colleagues. Ann Intern Med 2023; 176:1520-1525. [PMID: 37931258 DOI: 10.7326/m23-1374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
Microaggressions between members of a team occur often in medicine, even despite good intentions. Such situations call for difficult conversations that restore inclusivity, diversity, and a healthy work culture. These conversations are often hard because of the unique background, experiences, and biases of each person. In medicine, skillful navigation of these interactions is paramount as it influences patient care and the workplace culture. Although much has been published about difficult interactions between providers and patients, significantly less information is available to help navigate provider-to-provider interactions, despite their critical role in improving multidisciplinary patient care teams and organizational environments. This article is intended to serve as a guide for medical professionals who are interested in taking personal responsibility for promoting a safe and inclusive culture by engaging in and modeling difficult conversations with colleagues. The article outlines important considerations to assist with intentional preparation and modulation of responses for all parties involved: conversation initiators, observers of the incident, and conversation receivers. Although these interactions are challenging, together as medical professionals we can approach each other with humility and compassion to achieve our ultimate goal of promoting humanity, not only for our patients but for ourselves and one another.
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Affiliation(s)
- Melanie S Sulistio
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas (M.S.S., I.E., S.G.)
| | - Christine L Chen
- Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (C.L.C.)
| | - Ijeoma Eleazu
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas (M.S.S., I.E., S.G.)
| | - Sarah Godfrey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas (M.S.S., I.E., S.G.)
| | - Reeni A Abraham
- Division of General Internal Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas (R.A.A.)
| | - Lorrel E B Toft
- Department of Medicine, Cardiology, University of Nevada Reno School of Medicine, Reno, Nevada (L.E.B.T.)
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Real Delor RE, Ayala Saucedo A. [Mistreatment of Paraguayan medical residents in 2022: a multicenter study]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2023; 80:112-118. [PMID: 37402296 PMCID: PMC10443419 DOI: 10.31053/1853.0605.v80.n2.40440] [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: 03/02/2023] [Accepted: 05/07/2023] [Indexed: 07/06/2023] Open
Abstract
Introducción los residentes de postgrado tienden a sufrir maltratos durante sus prácticas hospitalarias y estos comportamientos abusivos no deben considerarse normales. El objetivo fue describir la frecuencia y las características del maltrato en residentes de medicina del Paraguay en 2022. Metodología se aplicó un diseño observacional de corte transversal. Se incluyó a los residentes de hospitales del Paraguay que aceptaban completar una encuesta online difundida por las redes sociales. Se utilizó un cuestionario de 23 preguntas que evalúa el maltrato psicológico, físico, académico y sexual. Adicionalmente se solicitó datos demográficos, académicos y aspectos relacionados a la denuncia del maltrato. Resultados el cuestionario fue llenado por 348 residentes. La edad media fue 28 ± 3 años y hubo predomino del sexo femenino (63,2%). Participaron residentes de 32 hospitales, la mayoría era de 1° año (50,3%) y de especialidades clínicas (60,6%). Acorde al cuestionario, 339 residentes (97,4%) refirieron algún grado de maltrato. Relacionando las especialidades con el maltrato, el mismo fue mayor en las quirúrgicas: RR 1,4 IC 95% 1,0-1,9 (p 0,01). Los principales responsables del maltrato fueron los residentes superiores (55,2%) y los jefes de salas (31,8%). La denuncia fue realizada por 8% de los afectados. El principal motivo para no denunciar fue el temor a que realizarla le traería problemas (67,8%). Conclusiones el maltrato fue referido por 97,4% de los residentes, siendo mayor en las especialidades quirúrgicas. Urge aplicar medidas preventivas para evitar este tipo de abusos durante la residencia.
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DiFiori MM, Gupta SS, Cannada LK, Pei KY, Stamm MA, Mulcahey MK. Bullying in Orthopaedic Surgery: A Survey of US Orthopaedic Trainees and Attending Surgeons. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202305000-00006. [PMID: 37141506 PMCID: PMC10155897 DOI: 10.5435/jaaosglobal-d-23-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/10/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Bullying is a notable problem in surgery, creating a hostile environment for surgeons and trainees, and may negatively affect patient care. However, specific details regarding bullying in orthopaedic surgery are lacking. The primary aim of this study was to determine the prevalence and nature of bullying within orthopaedic surgery in the United States. METHODS A deidentified survey was developed using the survey created by the Royal College of Australasian Surgeons and the validated Negative Acts Questionnaire-Revised survey tool. This survey was distributed to orthopaedic trainees and attending surgeons in April 2021. RESULTS Of the 105 survey respondents, 60 (60.6%) were trainees and 39 (39.4%) were attending surgeons. Although 21 respondents (24.7%) stated they had been bullied, 16 victims (28.1%) did not seek to address this behavior. Perpetrators of bullying were most commonly male (49/71, 67.2%) and the victims' superior (36/82, 43.9%). Five bullying victims (8.8%) reported the behavior, despite 46 respondents (92.0%) stating that their institution has a specific policy against bullying. CONCLUSION Bullying behavior occurs in orthopaedic surgery, with perpetrators being most commonly male and the victims' superiors. Despite the fact that an overwhelming majority of institutions have policies against bullying, the reporting of such behavior is lacking.
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Affiliation(s)
- Monica M DiFiori
- From the Department of Orthopaedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA, (Dr. DiFiori); Tulane University School of Medicine, New Orleans, LA (Ms. Gupta); Department of Orthopaedics, University of North Carolina and Novant Health Orthopaedic Fracture Clinic, Hughston Clinic, Jacksonville, FL (Dr. Cannada); Graduate Medical Education, Parkview Health, Fort Wayne, Indiana (Dr. Pei); Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA (Dr. Stamm and Dr. Mulcahey)
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Vermette D, Reardon JL, Israel HP, Zhen S, Windish DM, White MA. Development and Validation of a Novel Instrument to Measure the Community Well-Being of Residency Programs. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:614-622. [PMID: 36731081 DOI: 10.1097/acm.0000000000004987] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE To develop and validate the Residency Community Well-Being (RCWB) instrument, a novel instrument to measure the subjective community well-being of an individual residency program, and to explore differences in RCWB scores between demographic groups. METHOD An initial questionnaire to measure a residency program's community well-being was developed after literature review. Items were pilot tested, and the questionnaire was reviewed by experts in the fields of residency education, survey design, and sociology. The questionnaire was administered electronically between March and July 2021 to U.S. residents in 18 specialties recruited through convenience and snowball sampling using social media, a listserv, and personal emails to residency program leaders. Three previously validated instruments were administered as well to examine criterion validity: the Professional Fulfillment Index, the Brief Inventory of Thriving, and a single-item burnout measure. Data were analyzed with descriptive statistics, and exploratory factor analysis was performed using principal axis factoring with direct oblimin rotation to reduce the items and identify subscales. RESULTS Of the 366 participants who opened and started the survey, 219 completed it (completion rate: 59.8%). Most respondents were women (133, 60.7%), 26-30 years old (132, 60.3%), and White (149, 68.0%). Three subscales emerged with 18 items: program leadership, structures, and practices (PLSP); resident interpersonal relationships (RIR); and resident mistreatment (RM). The Cronbach's alphas were 0.96 for PLSP, 0.92 for RIR, 0.82 for RM, and 0.95 for the overall RCWB. RCWB score positively correlated with professional fulfillment ( r = .52, P < .001) and thriving ( r = .45, P < .001) and inversely correlated with burnout ( r = -.39, P < .001). CONCLUSIONS The RCWB instrument demonstrates strong internal consistency and content and criterion validity that shows that a residency program's subjective community well-being is primarily composed of program leadership quality, supportive interpersonal relationships, and the absence of mistreatment.
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Affiliation(s)
- David Vermette
- D. Vermette is a general internal medicine medical education fellow, Section of General Internal Medicine, Department of Internal Medicine, and a clinical fellow, Section of Pediatric Hospital Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut; ORCID: https://orcid.org/0000-0003-0150-2064
| | - Juliann L Reardon
- J.L. Reardon was a clinical fellow, Section of Pediatric Nephrology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, at the time of the study. She is currently pediatric nephrologist, Connecticut Children's Medical Center, Hartford, Connecticut, and assistant professor of pediatrics, Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Hayley P Israel
- H.P. Israel was a clinical fellow, Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, at the time of the study. She is currently assistant professor of medicine, Section of Pulmonary and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Shirley Zhen
- S. Zhen was a graduate student, Yale School of Public Health and Yale School of Nursing, New Haven, Connecticut, at the time of the study. She is currently behavioral health nurse practitioner, South Cove Community Health Center, Boston, Massachusetts
| | - Donna M Windish
- D.M. Windish is professor of medicine, Section of General Internal Medicine, and program director, General Internal Medicine Medical Education Fellowship, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marney A White
- M.A. White is professor of social and behavioral sciences, Yale School of Public Health, and professor of psychiatry, Yale School of Medicine, New Haven, Connecticut
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Barbier JM, Carrard V, Schwarz J, Berney S, Clair C, Berney A. Exposure of medical students to sexism and sexual harassment and their association with mental health: a cross-sectional study at a Swiss medical school. BMJ Open 2023; 13:e069001. [PMID: 37105707 PMCID: PMC10151891 DOI: 10.1136/bmjopen-2022-069001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES To assess the self-reported prevalence of sexism and sexual harassment at a Swiss medical school, and to investigate their association with mental health. Research hypotheses were an association between sexism/sexual harassment and poor mental health and a higher prevalence of sexism/sexual harassment in clinical rotations. DESIGN Cross-sectional study as a part of ETMED-L project, an ongoing cohort study of interpersonal competences and mental health of medical students. SETTING Single-centre Swiss study using an online survey submitted to medical students. PARTICIPANTS From 2096 registered students, 1059 were respondents (50.52%). We excluded 26 participants (25 due to wrong answers to attention questions, and 1 who did not answer the sexism exposure question). The final sample (N=1033) included 720 women, 300 men and 13 non-binary people. MEASURES Prevalence of self-reported exposure to sexism/sexual harassment. Multivariate regression analyses of association between being targeted by sexism or sexual harassment and mental health (depression, suicidal ideation, anxiety, stress, burnout, substance use and recent mental health consultation). Regression models adjusted for gender, academic year, native language, parental education level, partnership and an extracurricular paid job. RESULTS Being targeted by sexism or sexual harassment was reported by 16% of participants with a majority of women (96%). The prevalence increased with clinical work. After adjusting for covariates, we found association between being targeted by sexism/harassment and risk of depression (OR 2.29, 95% CI 1.54 to 3.41, p<0.001), suicidal ideation (B coefficient (B) 0.37, p<0.001) and anxiety (B 3.69, p<0.001), as well as cynicism (B 1.46, p=0.001) and emotional exhaustion (B 0.94, p=0.044) components of burnout, substance use (B 6.51, p<0.001) and a recent mental health consultation (OR 1.78, 95% CI 1.10 to 2.66, p=0.005). CONCLUSIONS Sexism and sexual harassment, although less common than usually reported, are behaviours of concern in this medical school and are significantly associated with mental health.
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Affiliation(s)
- Jeanne Marie Barbier
- Health and Gender Unit, Department of ambulatory care, University Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland, Lausanne, Switzerland
| | - Valerie Carrard
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Joelle Schwarz
- Health and Gender Unit, Department of ambulatory care, University Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland, Lausanne, Switzerland
| | - Sylvie Berney
- General Psychiatry Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Carole Clair
- Health and Gender Unit, Department of ambulatory care, University Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland, Lausanne, Switzerland
| | - Alexandre Berney
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Ayyala MS, Rios R, Wright SM. Gender differences in bullying among internal medicine residents. Postgrad Med J 2023; 99:11-16. [PMID: 36947422 DOI: 10.1093/postmj/qgac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 09/17/2022] [Accepted: 10/29/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE To describe gender differences in experienced types of bullying, and resulting personal consequences, among internal medicine (IM) residents. METHODS Participants in this cross-sectional study included 21 212 IM trainees who completed a voluntary survey with their 2016 in-training exam that assessed bullying during residency training. The 2875 (13.6% of) trainees who reported experiencing bullying on a screening question were asked for additional details about types of bullying experienced and resulting personal consequences. RESULTS Female and male trainees experienced bullying at similar rates (47% versus 53%, P = .08). Gender differences were seen in both the type of bullying experienced and the resulting personal consequences. Female trainees were more likely than their male counterparts to report bullying characterized as verbal (83% versus 77%, P < .001) and sexual (5% versus 2%, P < .001), whereas male trainees were more likely to experience physical (6% versus 4%, P = .03) and "other" bullying types (27% versus 22%, P < .001). Female trainees were more likely to report negative personal consequences than male trainees, and the most common resultant sequela reported was feeling burned out (63% versus 51%, P < .001). CONCLUSION Gender differences exist in both the types and consequences of bullying experienced among this national sample of IM residents. These results should be considered by programs and institutions that are hoping to optimize the culture of their workplace and enhance safety in the learning environment.
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Affiliation(s)
- Manasa S Ayyala
- Department of Medicine, Division of General Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Rebeca Rios
- Behavioral Scientist and Medical Educator, Washington, D.C. 20057, USA
| | - Scott M Wright
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
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Coakley N, O'Leary P, Bennett D. Endured and prevailed: a phenomenological study of doctors' first year of clinical practice. BMC MEDICAL EDUCATION 2023; 23:109. [PMID: 36782187 PMCID: PMC9923928 DOI: 10.1186/s12909-023-04059-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT The challenging nature of the transition from medical student to doctor is highlighted by the associated negative consequences to new doctors' mental health and wellbeing. Enhanced understanding of the lived experience of recent medical graduates as they move through the stages of transition over the first year of practice can inform interventions to ease the difficulties encountered. METHODS Using interpretative phenomenological analysis (IPA), a novel approach to this topic, we explored the lived experience of transition from student to doctor over the first year of practice after graduation. Twelve new graduates were purposively recruited. We conducted semi-structured interviews at the end of their first year of practice with respect to their experience over the first year. RESULTS The experience of transition was characterised by overlapping temporal stages. Participants' initial adjustment period was characterised by shock, coping and stabilisation. A phase of development followed, with growth in confidence and a focus on self-care. Adversity was experienced in the form of interprofessional tensions, overwork, isolation and mistreatment. Finally, a period of reflection and rationalisation marked the end of the first year. DISCUSSION Following initial anxiety regarding competence and performance, participants' experience of transition was predominantly influenced by cultural, relational and contextual aspects of clinical practice. Solutions to ease this challenging time include stage-specific transitional interventions, curricular change at both undergraduate and postgraduate levels and a re-evaluation of the clinical learning environment to mitigate the difficulties endured.
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Affiliation(s)
- Niamh Coakley
- Department of Medicine, University College Cork, National University of Ireland, Cork, Ireland.
| | - Paula O'Leary
- School of Medicine, University College Cork, National University of Ireland, Cork, Ireland
| | - Deirdre Bennett
- Medical Education Unit, University College Cork, National University of Ireland, Cork, Ireland
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Nasca BJ, Cheung EO, Eng JS, Zhang L, Smink DS, Greenberg JA, Bilimoria KY, Hu YY. National Comparison of Program Director Perceptions vs. Resident Reports of the Learning Environment and Well-Being. JOURNAL OF SURGICAL EDUCATION 2023; 80:72-80. [PMID: 36207254 DOI: 10.1016/j.jsurg.2022.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Our research objectives were to (1) assess the correlation between PD perceptions and their residents' reported experiences and (2) identify PD and program characteristics associated with alignment between PD perceptions and their residents' reports. DESIGN, SETTING, PARTICIPANTS A survey was administered to US general surgery residents following the 2019 American Board of Surgery In-Training Examination (ABSITE) to study wellness (burnout, thoughts of attrition, and suicidality) and mistreatment (gender discrimination, sexual harassment, racial/ethnic/religious discrimination, bullying). General surgery program directors (PDs) were surveyed about the degree to which they perceived mistreatment and wellness within their programs. Concordance between PDs' perceptions and their residents' reports was assessed using Spearman correlations. Multivariable logistic regression models examined factors associated with alignment between PDs and residents. RESULTS Of 6,126 residents training at SECOND Trial-enrolled programs, 5,240 (85.5%) responded to the ABSITE survey. All 212 PDs of programs enrolled in the SECOND Trial (100%) responded to the PD survey. Nationally, the proportion of PDs perceiving wellness issues was similar to the proportion of residents reporting them (e.g., 54.9% of PDs perceive that burnout is a problem vs. 40.1% of residents experience at least one burnout symptom weekly); however, the proportion of PDs perceiving mistreatment vastly underestimated the proportion of residents reporting it (e.g., 9.3% of all PDs perceive vs. 65.9% of all residents report bullying). Correlations between PDs' perceptions of problems within their program and their residents' reports were weak for racial/ethnic/religious discrimination (r = 0.176, p = 0.019), sexual harassment (r = 0.180, p = 0.019), burnout (r = 0.198, p = 0.007), and thoughts of attrition (r = 0.193, p = 0.007), and non-existent for gender discrimination, bullying, or suicidality. Multivariable regression models did not identify any program or PD characteristics that were consistently associated with improved resident-program director alignment. CONCLUSIONS Resident and PD perceptions were generally disparate regarding mistreatment, burnout, thoughts of attrition, and suicidality. Reconciling this discrepancy is critical to enacting meaningful change to improve the learning environment and resident well-being.
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Affiliation(s)
- Brian J Nasca
- Albany Medical College, Department of Surgery, Albany, New York; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elaine O Cheung
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Indiana University School of Medicine, Department of Surgery, Indianapolis, Indiana
| | - Lindsey Zhang
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jacob A Greenberg
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Indiana University School of Medicine, Department of Surgery, Indianapolis, Indiana
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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Álvarez Villalobos NA, De León Gutiérrez H, Ruiz Hernandez FG, Elizondo Omaña GG, Vaquera Alfaro HA, Carranza Guzmán FJ. Prevalence and associated factors of bullying in medical residents: A systematic review and meta-analysis. J Occup Health 2023; 65:e12418. [PMID: 37443455 PMCID: PMC10345236 DOI: 10.1002/1348-9585.12418] [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: 03/01/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE To assess the prevalence of bullying in medical residents and its associated factors. METHODS In this systematic review and meta-analysis, articles from MEDLINE, EMBASE, Scopus, PsycInfo, Cochrane databases, and Web of Science were searched. Published and unpublished cross-sectional studies were included. Cochrane's Q test and I2 statistics were used to assess the existence of heterogeneity. Subgroup analysis and sensitivity analysis were performed on evidence of heterogeneity. Egger's test and funnel plots were performed to investigate publication bias. RESULTS A total of 13 cross-sectional studies with a total of 44 566 study participants from different medical residencies were analyzed. The overall prevalence of bullying was 51% (95% CI 36-66). Furthermore, female residents and residents that belong to a minority group had higher odds of experiencing bullying compared to their peers. CONCLUSION A high prevalence of bullying in medical residents exists around the world. There is a need for education, dissemination, and more effective interventions among the residents and authorities about bullying to build and promote adequate behaviors and diminish bullying prevalence.
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Affiliation(s)
- Neri Alejandro Álvarez Villalobos
- Unidad de Medicina Familiar Número 7Instituto Mexicano del Seguro SocialSan Pedro Garza GarcíaNuevo LeónMexico
- Facultad de MedicinaUniversidad Autónoma de Nuevo LeónMonterreyNuevo LeónMexico
- Plataforma INVEST Medicina UANL‐KER Unit Mayo Clinic (KER Unit México)Universidad Autónoma de Nuevo LeónMonterreyNuevo LeónMexico
- Knowledge and Evaluation Research UnitMayo ClinicRochesterMinnesotaUSA
| | - Humberto De León Gutiérrez
- Facultad de MedicinaUniversidad Autónoma de Nuevo LeónMonterreyNuevo LeónMexico
- Plataforma INVEST Medicina UANL‐KER Unit Mayo Clinic (KER Unit México)Universidad Autónoma de Nuevo LeónMonterreyNuevo LeónMexico
| | - Fernando Gerardo Ruiz Hernandez
- Facultad de MedicinaUniversidad Autónoma de Nuevo LeónMonterreyNuevo LeónMexico
- Plataforma INVEST Medicina UANL‐KER Unit Mayo Clinic (KER Unit México)Universidad Autónoma de Nuevo LeónMonterreyNuevo LeónMexico
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Health care professionals' perceptions of unprofessional behaviour in the clinical workplace. PLoS One 2023; 18:e0280444. [PMID: 36656827 PMCID: PMC9851503 DOI: 10.1371/journal.pone.0280444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Unprofessional behaviour undermines organizational trust and negatively affects patient safety, the clinical learning environment, and clinician well-being. Improving professionalism in healthcare organizations requires insight into the frequency, types, sources, and targets of unprofessional behaviour in order to refine organizational programs and strategies to prevent and address unprofessional behaviours. OBJECTIVE To investigate the types and frequency of perceived unprofessional behaviours among health care professionals and to identify the sources and targets of these behaviours. METHODS Data was collected from 2017-2019 based on a convenience sample survey administered to all participants at the start of a mandatory professionalism course for health care professionals including attending physicians, residents and advanced practice providers (APPs) working at one academic hospital in the United States. RESULTS Out of the 388 participants in this study, 63% experienced unprofessional behaviour at least once a month, including failing to respond to calls/pages/requests (44.3%), exclusion from decision-making (43.0%) and blaming behaviour (39.9%). Other monthly experienced subtypes ranged from 31.7% for dismissive behaviour to 4.6% for sexual harassment. Residents were more than twice as likely (OR 2.25, p<0.001)) the targets of unprofessional behaviour compared to attending physicians. Female respondents experienced more discriminating behaviours (OR 2.52, p<0.01). Nurses were identified as the most common source of unprofessional behaviours (28.1%), followed by residents from other departments (21%). CONCLUSIONS Unprofessional behaviour was experienced frequently by all groups, mostly inflicted on these groups by those outside of the own discipline or department. Residents were most frequently identified to be the target and nurses the source of the behaviours. This study highlights that unprofessional behaviour is varied, both regarding types of behaviours as well as targets and sources of such behaviours. This data is instrumental in developing training and remediation initiatives attuned to specific professional roles and specific types of professionalism lapses.
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Swed S, Shoib S, Almoshantaf MB, Bohsas H, Hassan ASEM, Motawea KR, Hassan NAIF, Ahmad EMS, Sheet L, Khairy LT, Bakkour A, Muwaili AHH, Muwaili DHH, Abdelmajid FAA, Ahmad S, Hasan MM, Elkalagi NKH. A National Cross-Sectional Survey of Bullying in Syrian Graduate Medical Education. Front Public Health 2022; 10:916385. [PMID: 35875042 PMCID: PMC9301191 DOI: 10.3389/fpubh.2022.916385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Bullying is defined as unpleasant behavior that causes someone to feel disturbed or embarrassed, affecting their self-esteem. Based on this premise, we set out to investigate bullying among Syrian graduate medical education residents and fellows, estimate its prevalence among specific subgroups, and give recommendations to help validate the findings and enhance the graduate medical education training experience. A sample of 278 residents and fellows in Syrian graduate medical school were recruited for the study in a national cross-sectional survey, with 276 participants completing a Bullying survey in 2021 and two people refusing to participate. Participants in the survey were asked to provide basic demographic and programming information and three general Bullying and 20 specific bullying behavior items. Differences across groups were compared for demographic and programmatic stratifications. About 51% of participants had experienced one or more bullying behaviors, 69% said they had been bullied, and 87% said they had witnessed Bullying. Residents and supervisor-attendings were the most common sources of perceived Bullying (~67 and 62%, respectively), followed by patients (58%), nurses (46%), and pharmacists (46%) (33%). More specific bullying behaviors have been recorded by female Arabic Syrians who are shorter than 5'8, have a body mass index (BMI) of 25, and are 30 years old or younger who were -compared to males- more likely to report attempts to minimize and devalue work (55 vs. 34%, P ≤ 0.01) and criticism and work monitoring (56 vs. 33%, P ≤ 0.01). In addition, general medical graduates and PGY-2-PGY-6 respondents reported more specific bullying behaviors than private medical graduates and post-graduate participants in the first year (PGY 1), respectively. For example, a significant difference is noticed when reporting unreasonable pressure to perform work (83 vs. 6%, P ≤ 0.01). Except for physical violence, which does not differ statistically between groups, most bullying behaviors were reported by participants with statistically significant differences between study groups—many residents and fellows in Syria's graduate medical school system report being bullied. Anti-bullying rules and a multidisciplinary strategy including all players in the medical system are essential to eradicating these pervasive practices in healthcare.
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Affiliation(s)
- Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
- *Correspondence: Sarya Swed
| | - Sheikh Shoib
- Department of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Srinagar, India
| | | | | | | | | | | | | | - Lana Sheet
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Lina Taha Khairy
- Faculty of Medicine, The National Ribat University, Al-Ribat, Sudan
| | - Agyad Bakkour
- Faculty of Medicine, Albaath University, Homs, Syria
| | - Ali Hadi Hussein Muwaili
- Faculty of Medicine, Ivano-Frankivsk National Medical University, Ivano-Frankivsk Oblast, Ukraine
| | | | | | - Shoaib Ahmad
- District Head Quarters Teaching Hospital, Faisalabad, Pakistan
- Faculty of Medicine, Punjab Medical College, Faisalabad, Pakistan
| | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
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Stacy M, Gross G, Adams L. Applying Organizational Change Theory to Address the Long-Standing Problem of Harassment in Medical Education. TEACHING AND LEARNING IN MEDICINE 2022; 34:313-321. [PMID: 34493134 DOI: 10.1080/10401334.2021.1954523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
Issue: Harassment is a common experience for medical and healthcare trainees. Experiencing harassment can have significant consequences for trainees in multiple domains, including mental, physical, social, and occupational well-being. Harassment remains entrenched in medical education despite efforts to address it. Evidence: Many articles have documented the prevalence of harassment in medical education. Likewise, articles have provided recommendations for how individuals or hospitals can attempt to reduce harassment. However, despite calls for reform, harassment persists, largely due to the hierarchical, paternalistic, high-pressure, and evaluative nature of medical culture. Most literature has emphasized the need for policies and reporting structures, yet such top-down initiatives have not had a sufficient impact on the attitudes and beliefs that drive culture change. Instead, change requires intervention at every level of an organization. Little, if any, literature has proposed applying a change management model to change the culture of medical training and therefore decrease harassment. Implications: This paper applies principles of organizational change theory, and in particular, the ADKAR model, in conjunction with a summary of the existing harassment literature, to propose a framework for addressing harassment by facilitating organizational culture change. Intervention is needed at all levels of the medical education system (the healthcare system, the supervisor or training program, and the individual), and the ADKAR framework can guide what interventions are offered and when to capitalize on the current level of change readiness. Recommendations go beyond the typical focus on formalized policies and procedures, which are necessary, but not sufficient, components of culture change. Implementation of these practices, as well as ongoing evaluation and refinement through research, should foster cultural change in medical education to address harassment.
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Affiliation(s)
- Meaghan Stacy
- Psychology Department, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Georgina Gross
- Psychology Department, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- PTSD Program Evaluation, VA Northeast Program Evaluation Center, West Haven, Connecticut, USA
| | - Lynette Adams
- Psychology Department, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Hatfield M, Ciaburri R, Shaikh H, Wilkins KM, Bjorkman K, Goldenberg M, McCollum S, Shabanova V, Weiss P. Addressing Mistreatment of Providers by Patients and Family Members as a Patient Safety Event. Hosp Pediatr 2022; 12:181-190. [PMID: 35102377 DOI: 10.1542/hpeds.2021-006267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Mistreatment of health care providers (HCPs) is associated with burnout and lower-quality patient care, but mistreatment by patients and family members is underreported. We hypothesized that an organizational strategy that includes training, safety incident reporting, and a response protocol would increase HCP knowledge, self-efficacy, and reporting of mistreatment. METHODS In this single-center, serial, cross-sectional study, we sent an anonymous survey to HCPs before and after the intervention at a 213-bed tertiary care university children's hospital between 2018 and 2019. We used multivariable logistic regression to examine the effect of training on the outcomes of interest and whether this association was moderated by staff role. RESULTS We received 309 baseline surveys from 72 faculty, 191 nurses, and 46 residents, representing 39.1%, 27.1%, and 59.7%, respectively, of eligible HCPs. Verbal threats from patients or family members were reported by 214 (69.5%) HCPs. Offensive behavior was most commonly based on provider age (85, 28.5%), gender (85, 28.5%), ethnicity or race (55, 18.5%), and appearance (43, 14.6%) but varied by role. HCPs who received training had a higher odds of reporting knowledge, self-efficacy, and experiencing offensive behavior. Incident reporting of mistreatment increased threefold after the intervention. CONCLUSIONS We report an effective organizational approach to address mistreatment of HCPs by patients and family members. Our approach capitalizes on existing patient safety culture and systems that can be adopted by other institutions to address all forms of mistreatment, including those committed by other HCPs.
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Affiliation(s)
| | | | - Henna Shaikh
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | | | - Kurt Bjorkman
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | | | - Sarah McCollum
- Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | | | - Pnina Weiss
- Pediatrics, Yale School of Medicine, New Haven, Connecticut
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Gianakos AL, Freischlag JA, Mercurio AM, Haring RS, LaPorte DM, Mulcahey MK, Cannada LK, Kennedy JG. Bullying, Discrimination, Harassment, Sexual Harassment, and the Fear of Retaliation During Surgical Residency Training: A Systematic Review. World J Surg 2022; 46:1587-1599. [PMID: 35006329 DOI: 10.1007/s00268-021-06432-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The negative effects of bullying, discrimination, harassment, and sexual harassment (BDHS) on well-being and productivity of surgical residents in training have been well documented. Despite this, little has changed over the past decade and these behaviors continue. The purpose of this study was to determine the prevalence of each abusive behavior experienced by residents, identify the perpetrators, and examine the reporting tendency. METHODS A systematic review of articles published between 2010 and 2020 in the MEDLINE, EMBASE, and Cochrane databases was performed following PRISMA guidelines. The following search terms were used: bullying, harassment, sexual harassment, discrimination, abuse, residency, surgery, orthopedic surgery, general surgery, otolaryngology, obstetrics, gynecology, urology, plastic surgery, and training. RESULTS Twenty-five studies with 29,980 surgical residents were included. Sixty-three percent, 43, 29, and 27% of surgical residents experienced BDHS, respectively. Female residents reported experiencing all BDHS behaviors more often. Thirty-seven percent of resident respondents reported burnout, and 33% reported anxiety/depression. Attending surgeons, followed by senior co-residents, were the most common perpetrators. Seventy-one percent did not report the behavior to their institution. Fifty-one percent stated this was due to fear of retaliation. Of those who reported their experiences, 56% stated they had a negative experience reporting. CONCLUSION Our review demonstrates high prevalence rates of BDHS experienced by residents during surgical training, which have been associated with burnout, anxiety, and depression. The majority of residents did not report BDHS due to fear of retaliation. Residency programs need to devise methods to have a platform for residents to safely voice their complaints.
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Affiliation(s)
- Arianna L Gianakos
- Department of Orthopaedic Surgery, Harvard-Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA.
| | | | | | | | - Dawn M LaPorte
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Lisa K Cannada
- Department of Orthopaedic Surgery, Novant Health Orthopaedics, Charlotte, NC, USA
| | - John G Kennedy
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
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Zhou S, Chen J, Lin H, Ye Y, Xiao Y, Ouyang N, Pan S, Feng S, Xie M, Li B. Associations Among Workplace Bullying, Resilience, Insomnia Severity, and Subjective Wellbeing in Chinese Resident Doctors. Front Psychiatry 2022; 13:840945. [PMID: 35250677 PMCID: PMC8894656 DOI: 10.3389/fpsyt.2022.840945] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although workplace bullying is common among medical workers, its associations with insomnia severity and subjective wellbeing are still unclear. Our study aimed to investigate these associations among resident doctors who are more vulnerable to both workplace bullying and insomnia. METHODS We conducted a cross-sectional survey of 1,877 resident doctors from 12 hospitals across 7 administrative regions in China. Workplace bullying, resilience, insomnia severity, and subjective wellbeing were evaluated by the Negative Acts Questionnaire-Revised (NAQ-R), the Chinese version of the Connor-Davidson Resilience Scale-10-item (CD-RISC-10), the Insomnia Severity Index, and the Index of Wellbeing, respectively. Further, a logistic regression analysis was used to analyze factors associated with insomnia. In addition, structural equation modeling (SEM) was applied to examine the associations among workplace bullying, resilience, insomnia severity, and subjective wellbeing. RESULTS In the present study, the rates of workplace bullying and insomnia were 51.4 and 33.2%, respectively. Workplace bullying (OR = 1.056, p < 0.001) and poor resilience (OR = 0.957, p < 0.001) were the factors associated with insomnia after controlling the confounding variables. Further, SEM of the present study revealed a direct relationship between workplace bullying and subjective wellbeing (std-β = -0.223, p < 0.001). In addition, insomnia severity (std-β = -0.071, p < 0.001) and resilience (std-β = -0.092, p < 0.001) can individually or collectively (std-β = -0.008, p < 0.001) mediate the indirect associations between workplace bullying and subjective wellbeing. However, resilience was found to act as a moderator only in the direct association between workplace bullying and subjective wellbeing. CONCLUSIONS Workplace bullying and poor resilience were the factors associated with insomnia. Further, greater resilience acted as a buffer in the direct association between workplace bullying and subjective wellbeing, whereas both insomnia severity and resilience were critical mediators in the indirect associations between them.
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Affiliation(s)
- Shaojiong Zhou
- Department of Neurology, Shantou Central Hospital, Shantou, China
- Shantou University Medical College, Shantou, China
- *Correspondence: Shaojiong Zhou
| | - Jia Chen
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Han Lin
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Ying Ye
- Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Yu Xiao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Na Ouyang
- Shantou University Medical College, Shantou, China
| | - Shaomei Pan
- Shantou University Medical College, Shantou, China
| | - Siqi Feng
- Kunming Medical University, Kunming, China
| | - Meiling Xie
- Shantou University Medical College, Shantou, China
| | - Bingxian Li
- Department of Neurology, Shantou Central Hospital, Shantou, China
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Messiaen M, Duba A, Boulangeat C, Boucekine M, Bourbon A, Viprey M, Auquier P, Lançon C, Boyer L, Fond G. Repeated bullying at the workplace in medical students and young doctors: the MESSIAEN national study. Eur Arch Psychiatry Clin Neurosci 2021; 271:1123-1131. [PMID: 32462290 DOI: 10.1007/s00406-020-01144-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/15/2020] [Indexed: 11/26/2022]
Abstract
Despite clues indicating high Bullying at the Work Place (BWP) rates in French hospitals, there has been no quantitative study so far. To determine the prevalence of repeated BWP in a national sample of French young physicians; its risk factors, and the mental health consequences of BWP. The study is a cross-sectional observational epidemiological national study addressed to young physicians. The online internet anonymous questionnaire was elaborated according to previous studies exploring BWP. In addition, we explored the quality of initial training. BWP was defined according to the French legal definition. Mental health was assessed by Hamilton Anxiety and Depression scale, psychotropic drug consumption and psychotherapy follow-up. A Structured Equation Modeling (SEM) was carried out to confirm our theoretical model. 2003 participants of the 37 French medical faculties were included. At least one history of BWP was identified in 41.7% of the participants. The SEM model showed good fit (RMSEA = 0.025, CFI = 0.93, TLI = 0.92, WRMR = 1.285). In the SEM model, BWP was associated with age and number of monthly night shifts and weekly worked hours. Obstetric gynecology, psychiatry, surgery, and medical specialties and low-quality initial training were associated with higher risk of BWP. BWP was associated with increased anxiety and depressive symptoms, daily antidepressant and anxiolytic consumption, and psychotherapy follow-up. Decreasing worked hours and night shifts and improving the quality of the initial training may help preventing BWP among medical students and young physicians. Obstetric gynecology, surgical and medical specialties, and psychiatry should be targeted with a focus on developing prevention programs.
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Affiliation(s)
- M Messiaen
- Hôpitaux Universitaires de Marseille, Faculté de Médecine-Secteur Timone, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de Vie, HUM, Aix-Marseille Univ, 27 Boulevard Jean Moulin EA 3279, 13005, Marseille, France
| | - A Duba
- Hôpitaux Universitaires de Marseille, Faculté de Médecine-Secteur Timone, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de Vie, HUM, Aix-Marseille Univ, 27 Boulevard Jean Moulin EA 3279, 13005, Marseille, France
| | - C Boulangeat
- Hôpitaux Universitaires de Marseille, Faculté de Médecine-Secteur Timone, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de Vie, HUM, Aix-Marseille Univ, 27 Boulevard Jean Moulin EA 3279, 13005, Marseille, France
| | - M Boucekine
- Hôpitaux Universitaires de Marseille, Faculté de Médecine-Secteur Timone, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de Vie, HUM, Aix-Marseille Univ, 27 Boulevard Jean Moulin EA 3279, 13005, Marseille, France
| | - A Bourbon
- Hôpitaux Universitaires de Marseille, Faculté de Médecine-Secteur Timone, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de Vie, HUM, Aix-Marseille Univ, 27 Boulevard Jean Moulin EA 3279, 13005, Marseille, France
| | - M Viprey
- Hôpitaux Universitaires de Marseille, Faculté de Médecine-Secteur Timone, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de Vie, HUM, Aix-Marseille Univ, 27 Boulevard Jean Moulin EA 3279, 13005, Marseille, France
| | - P Auquier
- Hôpitaux Universitaires de Marseille, Faculté de Médecine-Secteur Timone, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de Vie, HUM, Aix-Marseille Univ, 27 Boulevard Jean Moulin EA 3279, 13005, Marseille, France
| | - C Lançon
- Hôpitaux Universitaires de Marseille, Faculté de Médecine-Secteur Timone, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de Vie, HUM, Aix-Marseille Univ, 27 Boulevard Jean Moulin EA 3279, 13005, Marseille, France
| | - L Boyer
- Hôpitaux Universitaires de Marseille, Faculté de Médecine-Secteur Timone, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de Vie, HUM, Aix-Marseille Univ, 27 Boulevard Jean Moulin EA 3279, 13005, Marseille, France
| | - G Fond
- Hôpitaux Universitaires de Marseille, Faculté de Médecine-Secteur Timone, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de Vie, HUM, Aix-Marseille Univ, 27 Boulevard Jean Moulin EA 3279, 13005, Marseille, France.
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Samsudin EZ, Isahak M, Rampal S, Rosnah I, Zakaria MI. Workplace Bullying Among Junior Doctors in Malaysia: A Multicentre Cross-Sectional Study. Malays J Med Sci 2021; 28:142-156. [PMID: 33958968 PMCID: PMC8075595 DOI: 10.21315/mjms2021.28.2.13] [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: 09/07/2020] [Accepted: 01/12/2021] [Indexed: 12/04/2022] Open
Abstract
Background Research suggests that junior doctors often experience workplace bullying, which may have adverse impacts on medical training and delivery of quality healthcare. However, evidence among local population has not been established. The present study aims to examine the prevalence of workplace bullying among Malaysian junior doctors and explore its associated sociodemographic and employment factors. Methods A multicentre cross-sectional study was conducted in 12 government hospitals accredited for housemanship training within the central zone of Malaysia. The study included a total of 1,074 house officers who had been working for at least 6 months in various housemanship rotations. The Negative Acts Questionnaire-Revised (NAQ-R) was used to examine workplace bullying. Results The 6-month prevalence of workplace bullying among study participants was 13%. Work-related bullying such as ‘being ordered to do work below your level of competence’, person-related bullying such as ‘being humiliated or ridiculed in connection with your work’, and physically intimidating bullying such as ‘being shouted at or being the target of spontaneous anger’ were commonly reported by study participants. Medical officers were reported to be the commonest perpetrators of negative actions at the workplace. Study participants who graduated from Eastern European medical schools (adjusted odds ratio [AOR] 2.27; 95% confidence interval [CI]: 1.27, 4.07) and worked in surgical-based rotation (AOR 1.83; 95% CI: 1.13, 2.97) had higher odds of bullying compared to those who graduated from local medical schools and worked in medical-based rotation, whereas study participants with good English proficiency (AOR 0.14; 95% CI: 0.02, 0.94) had lower odds of bullying compared to those with poor English proficiency. Conclusion The present study shows that workplace bullying is prevalent among Malaysian junior doctors. Considering the gravity of its consequences, impactful strategies should be developed and implemented promptly in order to tackle this serious occupational hazard.
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Affiliation(s)
- Ely Zarina Samsudin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Marzuki Isahak
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjay Rampal
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ismail Rosnah
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Mohd Idzwan Zakaria
- Dean's Office, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Hastie CR, Barclay L. Early career midwives' perception of their teamwork skills following a specifically designed, whole-of-degree educational strategy utilising groupwork assessments. Midwifery 2021; 99:102997. [PMID: 33930799 DOI: 10.1016/j.midw.2021.102997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether a specifically designed whole-ofdegree strategy utilising groupwork assessments was effective in facilitating the development of early career midwives' teamwork skills. DESIGN AND METHODS A qualitative study using in-depth, semi-structured interviews was undertaken with early career midwives who had graduated within the previous two years. This study is the final cycle of a larger participatory action research project. Qualitative data was analysed using thematic analysis. PARTICIPANTS Nineteen early career midwives from one Australian university participated. Their preregistration education was via a Bachelor of Midwifery. Their education included a whole-of-degree educational strategy to facilitate the development of teamwork skills. FINDINGS One overarching theme "Becoming an Effective Team Member' and three sub-themes: 'Learning and developing Teamwork Skills'; 'More secure and confident' and 'Self-Assurance in interprofessional interactions' were identified in the interview data. Despite their junior status, the midwives demonstrated the knowledge, skills, and attitudes of an effective team member. Their social and emotional skills appeared well developed and they felt confident interacting with other health care workers in a professional manner. KEY CONCLUSIONS Early career midwives who were taught and practiced teamwork skills throughout their degree, appear to have developed the social and emotional competencies required for effective teamwork. IMPLICATIONS FOR PRACTICE The capacity for effective teamwork of this small group of early career midwives has the potential to improve the quality and safety of their care for childbearing women. Learning teamwork skills in the educational setting appears to have generated skills focused on conflict resolution, emotional self-regulation and social and emotional competency in these new midwives. These are favourable skills in the emotionallycharged environment of maternity care, where inter-collegial bullying is present and where new midwives can experience poor psychological wellbeing. Health care employers want new graduate health professionals to be work ready and to have the skills necessary to be effective team members. The program undertaken by these new graduates may be of assistance in developing these capabilities in other health students. THE KNOWN Teamwork skills are an intrinsic part of the day-to-day activities of maternity services, influencing the workplace culture, retention of midwives and the quality and safety of care. Poor teamwork is associated with clinical errors, bullying and high turnover of staff. THE NEW Early career midwives who were taught teamwork skills and practice these skills using their groupwork assignments throughout their undergraduate degree appear to demonstrate the social and emotional competencies required for effective teamwork. THE IMPLICATIONS Implementing a whole-of-degree program to develop teamwork skills in undergraduate midwifery students may improve early career midwives' social and emotional competencies and interactions with other health professionals. Learning teamwork skills in the educational setting may generate skills in the new midwife that focus on conflict resolution, emotional self-regulation, and social and emotional competency. These are favourable skills in the emotionally charged environment of maternity care, where inter-collegial bullying is present and where new midwives can experience poor psychological wellbeing.
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Affiliation(s)
- Carolyn Ruth Hastie
- Griffith University, School of Nursing and Midwifery, Gold Coast Campus, 1 Parklands Drive, Southport Queensland 4215.
| | - Lesley Barclay
- The University of Sydney, School of Medicine, University Centre for Rural Health, PO Box 3074 Lismore NSW Australia 2480.
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22
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Bormuth S, Ackermann H, Schulze J. Inadequate treatment in internships: a comparison between medical and other students. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc45. [PMID: 33763530 PMCID: PMC7958909 DOI: 10.3205/zma001441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 10/22/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
Aims: Inadequate treatment is one of the factors interfering with a successful social and working life. Among students, it can impair their health and learning progress. In the field of medicine the problem of inadequate treatment seems widespread. This study examines wether inadequate treatment in internships differs between medicine and other academic disciplines. Method: Using a questionnaire, the frequency, forms and severity of inadequate treatment among students were compared between the disciplines of medicine, civil engineering and teaching. Results: 69,3% of medical students reported inadequate treatment during their internships, about twice as many as students of other disciplines. The ratios of verbal, non-verbal and organisational inadequate treatment were similar between the different academic disciplines. However, medical students executed tasks without receiving sufficient safety precautions or training significantly more often (sevenfold) than students of other disciplines. In total however, the experienced incidents of inadequate treatment were seen as similarly severe across the different academic fields. Conclusion: Inadequate treatment of students during internships is a larger problem in medicine than in civil engineering or teaching, particularly concerning the performance of unsafe tasks. With regard to the health of students and patients, inadequate treatment in the medical education should be tackled. Previous studies suggest that this goal can be achieved only through longtime extensive measures on the level of students, lecturers, faculty and teaching hospitals.
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Affiliation(s)
- Sonia Bormuth
- Goethe-University Frankfurt/Main, Institute of Occupational, Social and Environmental Medicine, Frankfurt/Main, Germany
| | - Hanns Ackermann
- Goethe-University Frankfurt/Main, Institute of Biostatistics and Mathematical Modelling, Frankfurt/Main, Germany
| | - Johannes Schulze
- Goethe-University Frankfurt/Main, Institute of Occupational, Social and Environmental Medicine, Frankfurt/Main, Germany
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May RW, Fincham FD, Sanchez-Gonzalez MA, Firulescu L. Forgiveness: protecting medical residents from the detrimental relationship between workplace bullying and wellness. Stress 2021; 24:19-28. [PMID: 32063074 DOI: 10.1080/10253890.2020.1729733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Bullying of medical residents is associated with numerous negative psychological and physiological outcomes. As bullying within this demographic grows, there is increased interest in identifying novel protective factors. Accordingly, this research investigated whether interpersonal forgiveness buffers the relationship between two forms of workplace bullying and indices of well-being. Medical residents (N = 134, 62% males) completed measures assessing person and work-related bullying victimization, dispositional forgiveness, and depressive symptoms and underwent a series of cardiovascular assessments during which cardiovascular reactivity was induced by a 3-min serial subtraction math task. It was hypothesized that the tendency to forgive would be negatively related to bullying victimization and that forgiveness would reduce the association of bullying with psychological distress (i.e. depressive symptoms), cognition errors (i.e. incorrect serial subtraction computations), and exaggerated cardiovascular reactivity and recovery. Findings show that forgiveness reduced the harmful relationship between the two forms of workplace bullying and depressive symptoms, serial subtraction errors, and cardiovascular reactivity and recovery for systolic blood pressure (SBP). Study results suggest that forgiveness may serve as an effective means for reducing the outcomes of bullying for medical residents. Implications for forgiveness interventions are discussed. Lay summary This research demonstrated that forgiveness reduced the harmful relationship between bullying victimization and negative outcomes (i.e. depressive symptoms, subtraction errors, and exaggerated cardiovascular reactivity and recovery for SBP) in medical residents. This study suggests that forgiveness may serve as a protective factor and provide an effective means for reducing the negative association between workplace bullying and negative outcomes.
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Affiliation(s)
- Ross W May
- Family Institute, The Florida State University, Tallahassee, FL, USA
| | - Frank D Fincham
- Family Institute, The Florida State University, Tallahassee, FL, USA
| | | | - Lidia Firulescu
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, FL, USA
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24
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Sharan P, Hans G. The culture of medicine and students' wellness. INDIAN JOURNAL OF SOCIAL PSYCHIATRY 2021. [DOI: 10.4103/ijsp.ijsp_186_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Sadati L, Yazdani S, Heidarpoor P. Surgical residents' challenges with the acquisition of surgical skills in operating rooms: A qualitative study. JOURNAL OF ADVANCES IN MEDICAL EDUCATION & PROFESSIONALISM 2021; 9:34-43. [PMID: 33521139 PMCID: PMC7846717 DOI: 10.30476/jamp.2020.87464.1308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/10/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Training in operating rooms is challenging. Specifically, surgical residents often experience a stressful environment in training arenas that, in turn, might affect their ability in the acquisition of the required qualifications. This study aims at the qualitative explanation of how the surgical residents acquire the surgical skills in operating rooms. METHODS This qualitative study was conducted in 2019-2020 using the conventional content analysis method. Participants were selected using purposive sampling. Data were collected through 25 semi-structured in-depth interviews. Then, the interview transcriptions were analyzed in MaxQDA2 software using the content analysis method. RESULTS The data were classified into two main categories, namely challenges/obstacles and strategies for dealing with the challenges. The data in the first category were further classified into four subcategories, including burnout, confusion in technique selection, unequal learning opportunities, ignorance, and responsibility misassignment. Similarly, four subcategories of establishing communication channels with chief residents and faculty members, learning by the non-surgeon pathway, covert progress in the learning path, and taking advantage of force from a position of power in the learning path were considered for the second category. CONCLUSION Based on the findings of the study, surgical residents face serious challenges and obstacles in their training course. To address these challenges, the curriculum of the surgical course needs to be improved with the emphasis on the balanced responsibility assignment and enhanced human communication.
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Affiliation(s)
- Leila Sadati
- Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Yazdani
- Department of Medical Education, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Peigham Heidarpoor
- Department of Community- Based Health Education, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran
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26
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Tay KT, Tan XH, Tan LHE, Vythilingam D, Chin AMC, Loh V, Toh YP, Krishna LKR. A systematic scoping review and thematic analysis of interprofessional mentoring in medicine from 2000 to 2019. J Interprof Care 2020; 35:927-939. [PMID: 33290115 DOI: 10.1080/13561820.2020.1818700] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Interprofessional mentoring in palliative care sees different members of the interprofessional team providing holistic, personalised andlongitudinal mentoring support, skills training and knowledge transfer as they mentor trainees at different points along their mentoring journeys. However, gaps in practice and their risk of potential mentoring malpractice even as interprofessional mentoring use continues to grow in palliative medicine underlines the need for careful scrutiny of its characteristics and constituents in order to enhance the design, evaluation and oversight of interprofessional mentoring programmes. Hence, a systematic scoping review on prevailing accounts of interprofessional mentoring in medicine is conducted to address this gap. Using Arksey and O'Malley's (2005) methodological framework for conducting scoping reviews and identical search strategies, 6 reviewers performed independent literature reviews of accounts of interprofessional mentoring published in 10 databases. Braun and Clarke's (2006) thematic analysis approach was adopted to evaluate across different mentoring settings. A total of 11111 abstracts were identified from 10 databases, 103 full-text articles reviewed and 14 full-text articles were thematically analysed to reveal 4 themes: characterizing, implementing, evaluating and obstacles to interprofessional mentoring. Interprofessional mentoring is founded upon a respectful and collaborative mentoring relationship that thrives despite inevitable differences in individual values, ethical perspectives at different career stages within diverse working environments. This warrants effective mentor-mentee trainings, alignment of expectations, roles and responsibilities, goals and timelines, and effective oversight of the programmes. Drawing upon the data provided, an interprofessional mentoring framework is forwarded to guide the design, evaluation and oversight of the programmes.
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Affiliation(s)
- Kuang Teck Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lorraine Hui En Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Divya Vythilingam
- School of Medicine, International Medical University Malaysia, Kuala Lumpur, Malaysia
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, National University of Singapore, Singapore
| | - Victor Loh
- Department of Family Medicine, National University Health System, Singapore
| | - Ying Pin Toh
- Department of Family Medicine, National University Health System, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore.,Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK.,Centre for Biomedical Ethics, National University of Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore
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27
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Al-Surimi K, Al Omar M, Alahmary K, Salam M. Prevalence of Workplace Bullying and Its Associated Factors at a Multi-Regional Saudi Arabian Hospital: A Cross-Sectional Study. Risk Manag Healthc Policy 2020; 13:1905-1914. [PMID: 33061722 PMCID: PMC7537811 DOI: 10.2147/rmhp.s265127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background Workplace bullying (WPB) refers to any form of repeated and unreasonable verbal, physical or sexual harassment that an employee endures by a person or a group. In healthcare settings, practitioners are occasionally victims of WPB incidents. The aim of this study was to survey victims of WPB and determine factors associated with being a victim of WPB at a multiregional health care facility in Saudi Arabia. Methods This cross-sectional study was conducted in 2018, by distributing a self-administered questionnaire via a private electronic mail to all fulltime healthcare practitioners within a multi-regional hospital in Saudi Arabia. Healthcare practitioners included physicians, nurses, allied healthcare professionals and pharmacists who reported being exposed to WPB in the past year. Study outcomes were the prevalence rate ratio of WPB and its associated factors, such as victim, perpetrator and incident characteristics. Results WPB has been reported by 684 participants. Perpetrators were mainly patients (36.1%), their families/relatives (29.5%), and hospital staff (27.2%) or managers/supervisors (7.2%). The type of WPB incident was mostly verbal abuse (98.1%) followed by physical harassment (11.8%) and sexual connotations (5.8%). WPB was 30% more prevalent among younger nurses and 24% less prevalent among higher educated nurses compared to their counter groups, P<0.001 each. Among technicians and administrative employees, WPB was 54% more prevalent among females, 36% more prevalent among the younger group, and 25% more prevalent among expatriate workers compared to their counter groups P<0.014, P<0.001 and P=0.017, respectively. WPB was 20% less prevalent among higher educated allied health professionals, P=0.002. Among physicians, WPB was 33% more prevalent among females, P=0.041 and was 47% more prevalent among higher educated physicians compared to their counter groups, P=0.018. Conclusion WPB might occur any time, anywhere and by any person within health care facilities. The prevalence of WPB varies within health occupational groups. Gender, age, educational level, and nationality were significantly associated factors with WPB.
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Affiliation(s)
- Khaled Al-Surimi
- Department of Health System Management, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Munirah Al Omar
- Department of Health System Management, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Khalid Alahmary
- Department of Health System Management, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mahmoud Salam
- Department of Health System Management, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
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28
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Dalton J, Ivory K, Macneill P, Nash L, River J, Dwyer P, Hooker C, Williams D, Scott KM. Verbatim Theater: Prompting Reflection and Discussion about Healthcare Culture as a Means of Promoting Culture Change. TEACHING AND LEARNING IN MEDICINE 2020; 32:531-540. [PMID: 32489123 DOI: 10.1080/10401334.2020.1768099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Problem: The mistreatment of medical and nursing students and junior health professionals has been reported internationally in research and the media. Mistreatment can be embedded and normalized in hierarchical healthcare workplaces, limiting the effectiveness of policies and reporting tools to generate change; as a result, some of those who experience mistreatment later perpetuate it. We used a novel, creative approach, verbatim theater, to highlight the complexity of healthcare workplaces, encourage critical reflection, and support long-term culture change. Intervention: Verbatim theater is a theater-for-change documentary genre in which a playscript is devised using only the words spoken by informants. In 2017, 30 healthcare students and health professionals were recruited and interviewed about their experience of work and training by the multidisciplinary Sydney Arts and Health Collective using semi-structured interviews. Interview transcripts became the primary material from which the script for the verbatim theater play 'Grace Under Pressure' was developed. The performing arts have previously been used to develop the communication skills of health professional students; this esthetic expression of the real-life effects of healthcare workplace culture on trainees and students was implemented to stimulate consciousness of, and dialogue about, workplace mistreatment in healthcare work and training. Context: The play premiered at a major Sydney theater in October 2017, attended by the lay public and student and practicing health professionals. In November 2017, three focus groups were held with a sample of audience members comprising healthcare professionals and students. These focus groups explored the impact of the play on reflection and discussion of healthcare culture and/or promoting culture change in the health workplace. We analyzed the focus group data using theoretical thematic analysis, informed by Turner's theory of the relation between 'social' and 'esthetic' drama to understand the impact of the play on its audience. Impact: Focus group members recognized aspects of their personal experience of professionalism, training, and workplace culture in the play, Grace Under Pressure. They reported that the play's use of real-life stories and authentic language facilitated their critical reflection. Participants constructed some learning as 'revelation,' in which the play enabled them to gain significant new insight into the culture of health care and opened up discussions with colleagues. As a result, participants suggested possible remedies for unhealthy aspects of the culture, including systemic issues of bullying and harassment. A small number of participants critiqued aspects of the play they believed did not adequately reflect their experience, with some believing that the play over-emphasized workplace mistreatment. Lessons Learned: Verbatim theater is a potent method for making personal experiences of healthcare workplace and training culture more visible to lay and health professional audiences. In line with Turner's theory, the play's use of real-life stories and authentic language enabled recognition of systemic challenges in healthcare workplaces by training and practicing health professionals in the audience. Verbatim theater provides a means to promote awareness and discussion of difficult social issues and potential means of addressing them.
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Affiliation(s)
- James Dalton
- Department of Theatre and Performance Studies, Faculty of Arts and Social Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Kimberley Ivory
- Sydney Health Ethics, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Macneill
- Sydney Health Ethics, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Nash
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Sydney Local Health District, Sydney, New South Wales, Australia
| | - Jo River
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Dwyer
- Department of Theatre and Performance Studies, Faculty of Arts and Social Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Claire Hooker
- Sydney Health Ethics, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - David Williams
- Department of Theatre and Performance Studies, Faculty of Arts and Social Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Karen M Scott
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Llewellyn A, Karageorge A, Nash L, Li W, Neuen D. Bullying and sexual harassment of junior doctors in New South Wales, Australia: rate and reporting outcomes. AUST HEALTH REV 2020; 43:328-334. [PMID: 29448972 DOI: 10.1071/ah17224] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/11/2017] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to describe rates of exposure to bullying and sexual harassment in junior doctors in first- or second-year prevocational medical training (PGY1 or PGY2 respectively) positions in New South Wales (NSW) and the Australian Capital Territory (ACT), and to explore the types of actions taken in response. Methods A cross-sectional survey of junior doctors in PGY1 or PGY2 positions was undertaken in 2015 and 2016 (n=374 and 440 respectively). Thematic analysis was undertaken on free-text responses to describe the reporting process and outcomes in more depth. Results The estimated response rate was 17-20%. Results from both surveys followed almost identical trends. Most respondents in 2015 and 2016 reported being bullied (n=203 (54.3%) and 253 (57.5%) respectively), 16-19% reported sexual harassment (n=58 and 82 respectively) and 29% of females reported sexual harassment. Qualitative analysis elucidated reasons for not taking action in response to bullying and harassment, including workplace normalisation of these behaviours, fear of reprisal and lack of knowledge or confidence in the reporting process. For respondents who did take action, most reported ineffective or personally harmful outcomes when reporting to senior colleagues, including being dismissed or blamed, and an intention not to trust the process in the future. Conclusions The findings suggest that interventions targeted at the level of junior doctors to improve the culture of bullying and harassment in medicine are unlikely to be helpful. Different approaches that address the problem in a more systemic way are needed, as is further research about the effectiveness of such interventions. What is known about the topic? Bullying and sexual harassment are common workplace experiences in the medical profession. What does this paper add? Over half the junior doctors in the present study experienced bullying and nearly one-fifth experienced sexual harassment. Junior doctors are reluctant to speak out, not only for fear of reprisal, but also because they do not believe it is worth doing so. What are the implications for practitioners? The data confirm a systemic problem of bullying in NSW. Primarily focusing on interventions with junior doctors (e.g. resilience training) is unlikely to solve the problem. Different and multipronged approaches (e.g. raising awareness in senior colleagues and training bystanders to intervene) should be tried and studied.
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Affiliation(s)
- Anthony Llewellyn
- University of Newcastle School of Medicine and Public Health, Mater Hospital, Waratah, NSW 2298, Australia
| | - Aspasia Karageorge
- Health Education and Training Institute of NSW, Locked Bag 5022, Gladesville, NSW 1675, Australia. Email
| | - Louise Nash
- Health Education and Training Institute of NSW, Locked Bag 5022, Gladesville, NSW 1675, Australia. Email
| | - Wenlong Li
- Health Education and Training Institute of NSW, Locked Bag 5022, Gladesville, NSW 1675, Australia. Email
| | - Dennis Neuen
- Wagga Wagga Rural Clinical School, University of Notre Dame Australia, PO Box 5050, Wagga Wagga, NSW 2650, Australia. Email
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30
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Mélo Silva Júnior ML, Sampaio Rocha‐Filho PA. Response to Impact of 24‐Hour On‐Call Shifts on Headache in Medical Residents: A Cohort Study. Headache 2020; 60:1803-1804. [DOI: 10.1111/head.13905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Mário Luciano Mélo Silva Júnior
- Post‐Graduation Program in Neuropsychiatry and Behavioral Sciences – Posneuro Federal University of Pernambuco Recife Brazil
- Neurology Unit Hospital da Restauração Recife Brazil
- Medical School Uninassau Recife Brazil
| | - Pedro Augusto Sampaio Rocha‐Filho
- Post‐Graduation Program in Neuropsychiatry and Behavioral Sciences – Posneuro Federal University of Pernambuco Recife Brazil
- Headache Clinic Hospital Universitario Oswaldo CruzUniversity of Pernambuco Recife Brazil
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31
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Lopez J, Huber M, McLaughlin T, Tomanec A, Xu KT, Messman A, Richman P. Emergency medicine program director perception and processes for consultant abuse of residents -results of a national survey. Am J Emerg Med 2020; 42:237-238. [PMID: 32563617 DOI: 10.1016/j.ajem.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jessica Lopez
- Department of Emergency Medicine, CHRISTUS Health/Texas A&M Health Science Center, Corpus Christi, TX, United States of America
| | - Mark Huber
- Department of Emergency Medicine, CHRISTUS Health/Texas A&M Health Science Center, Corpus Christi, TX, United States of America
| | - Thomas McLaughlin
- Department of Emergency Medicine, CHRISTUS Health/Texas A&M Health Science Center, Corpus Christi, TX, United States of America
| | - Alainya Tomanec
- Department of Emergency Medicine, CHRISTUS Health/Texas A&M Health Science Center, Corpus Christi, TX, United States of America
| | - K Tom Xu
- Texas Tech University, Lubbock,TX, United States of America
| | - Anne Messman
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, United States of America
| | - Peter Richman
- Department of Emergency Medicine, CHRISTUS Health/Texas A&M Health Science Center, Corpus Christi, TX, United States of America.
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32
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Samsudin EZ, Isahak M, Rampal S, Rosnah I, Zakaria MI. Individual antecedents of workplace victimisation: The role of negative affect, personality and self-esteem in junior doctors' exposure to bullying at work. Int J Health Plann Manage 2020; 35:1065-1082. [PMID: 32468617 DOI: 10.1002/hpm.2985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/03/2020] [Accepted: 04/30/2020] [Indexed: 01/17/2023] Open
Abstract
Previous studies have indicated that junior doctors commonly experience workplace bullying and that it may adversely impact medical training and delivery of quality healthcare. Yet, evidence on the precursors of bullying among them remains elusive. Drawing on the individual-disposition hypothesis, the present paper examined the relationships of negative affect, personality and self-esteem with workplace bullying among junior doctors. Multilevel analysis of a universal sample (n = 1074) of junior doctors working in the central zone of Malaysia using mixed effects logistic regression was performed. The results indicate that participants with moderate (AOR 4.40, 95% CI 2.20-8.77) and high degree (AOR 13.69, 95% CI 6.46-29.02) of negative affect as well as high degree of neuroticism (AOR 2.99, 95% CI 1.71-5.21) have higher odds of being bullied compared to their counterparts. The findings present evidence that individual traits are associated with junior doctors' exposure to bullying. While victim blaming should be avoided, this suggest that antibullying measures with an interpersonal focus should be considered when developing antibullying initiatives targeted at junior doctors. This includes primary intervention such as cognitive training, secondary interventions such as resource enhancement building and conflict management skills training, and tertiary interventions such as counselling.
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Affiliation(s)
- Ely Zarina Samsudin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia
| | - Marzuki Isahak
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjay Rampal
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ismail Rosnah
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Bangi, Malaysia
| | - Mohd Idzwan Zakaria
- Dean's Office Division, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Cheng MY, Neves SL, Rainwater J, Wang JZ, Davari P, Maverakis E, Rea M, Servis M, Nuovo J, Fazel N. Exploration of Mistreatment and Burnout Among Resident Physicians: a Cross-Specialty Observational Study. MEDICAL SCIENCE EDUCATOR 2020; 30:315-321. [PMID: 34457673 PMCID: PMC8368104 DOI: 10.1007/s40670-019-00905-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Resident physician mistreatment and burnout are widespread issues in medical training, but the association between the two remains unclear. This study examines the prevalence and types of mistreatment among resident physicians in core specialties and its association with burnout syndrome as well as feelings of depression/anxiety. METHODS A cross-sectional, survey-based observational study of medical residents was conducted at the University of California, Davis Medical Center in 2014. Current residents (PGY2 or higher) in the internal medicine, family medicine, obstetrics/gynecology, surgery, and pediatrics programs completed anonymous questionnaires addressing topics such as workplace mistreatment, feelings of depression/anxiety, and stress management. Burnout was measured using the Maslach Burnout Inventory. RESULTS Forty-four out of 105 residents (41.9%) witnessed mistreatment of their co-residents while 26 residents (24.8%) disclosed personal accounts of mistreatment. Seventy-one percent of residents met the criteria for burnout. Residents who had been personally mistreated were almost eight times more likely to report burnout (OR 7.6, 95% CI = 1.7-34.4) and almost four times more likely to report symptoms of anxiety and depression (OR 3.8, 95% CI = 1.6-9.1). Public belittlement or humiliation was the most common type of mistreatment. CONCLUSION Encountering mistreatment was associated with higher rates of burnout, as well as depression/anxiety. While it is uncertain if mistreatment in the workplace has a causative impact on burnout syndrome, the findings reveal the need to address work-related environmental factors that may contribute to both resident physician mistreatment and burnout.
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Affiliation(s)
- Michelle Y. Cheng
- Department of Dermatology, University of California, Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA 95816 USA
| | - Stacey L. Neves
- Schools of Health, University of California, Davis, Sacramento, CA USA
| | - Julie Rainwater
- Evaluation Unit for Schools of Health, University of California, Davis, Sacramento, CA USA
| | - Jenny Z. Wang
- Department of Dermatology, University of California, Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA 95816 USA
- Albert Einstein College of Medicine, Bronx, NY USA
| | - Parastoo Davari
- Department of Dermatology, University of California, Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA 95816 USA
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA 95816 USA
| | - Margaret Rea
- Student Wellness, University of California, Davis School of Medicine, Sacramento, CA USA
| | - Mark Servis
- Medical Education, University of California, Davis School of Medicine, Sacramento, CA USA
| | - Jim Nuovo
- Graduate Medical Education, University of California, Davis School of Medicine, Sacramento, CA USA
| | - Nasim Fazel
- Department of Dermatology, University of California, Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA 95816 USA
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Liang R, Anthony A, Leditschke IA. Five myths about unacceptable behaviour in surgical education. ANZ J Surg 2020; 90:965-969. [PMID: 32090442 DOI: 10.1111/ans.15756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 01/05/2023]
Abstract
Recent evidence of the occurrence of discrimination, bullying and sexual harassment in surgery and more generally within healthcare has led to widespread discussion about the effects of unacceptable behaviour in surgical education and practice. Despite accumulating evidence of the adverse effects of unacceptable behaviour in clinical practice, not only on health care professionals but on patient care and outcomes, many surgeons and other health care professionals continue to embrace false perceptions about appropriate professional behaviour, interactions and approaches to teaching within surgical departments and more generally within healthcare institutions. This article explores five misperceptions about unacceptable behaviour in surgical education and provides evidence that supports a change in practice.
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Affiliation(s)
- Rhea Liang
- Operating with Respect Education Committee, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.,Gold Coast Health Service, Gold Coast, Queensland, Australia
| | - Adrian Anthony
- Operating with Respect Education Committee, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.,Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - I Anne Leditschke
- Operating with Respect Education Committee, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.,Intensive Care Unit, Mater Health, Brisbane, Queensland, Australia.,Optimising Acute Care Research Stream, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
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Bogaert B, Dekeuwer C, Eggert N, Harpet C. "Repeated Hierarchies": Uneven Participation in Research of Ethical Spaces in Hospitals. J Empir Res Hum Res Ethics 2019; 14:493-495. [PMID: 31779557 DOI: 10.1177/1556264619831889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present a case study of uneven participation in a focus group discussion with health care professionals involved in local ethical committees. We conclude that the status of the different participants did not give adequate space for full participation of the members involved. Two commentators were invited to comment on the case study to enable further reflection on the methodology used for the target group. The first reviewer investigated whether research should address power relations and hierarchies of knowledge encountered in the study process. She also discussed whether researchers should be held ethically and politically responsible for the consequences of producing relations and hierarchies. The second reviewer looked at what focus groups say about professional practices in hospitals, what participants are willing (or unwilling) to invest, and what are the conditions for setting up ethical reflection.
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Al Omar M, Salam M, Al-Surimi K. Workplace bullying and its impact on the quality of healthcare and patient safety. HUMAN RESOURCES FOR HEALTH 2019; 17:89. [PMID: 31779630 PMCID: PMC6883683 DOI: 10.1186/s12960-019-0433-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 11/04/2019] [Indexed: 06/02/2023]
Abstract
BACKGROUND Workplace bullying (WPB) is a physical or emotional harm that may negatively affect healthcare services. The aim of this study was to determine to what extent healthcare practitioners in Saudi Arabia worry about WPB and whether it affects the quality of care and patient safety from their perception. METHODS A cross-sectional study was conducted in 2018. An online survey was distributed among all practitioners at a multi-regional healthcare facility. A previously validated tool was sourced from an integrative literature review by Houck and Colbert. Responses to 15 themes were rated on a 5-point Likert scale, converted to percentage mean scores (PMS) and compared across participants' characteristics using bivariate and regression analyses. RESULTS A total of 1074/1350 (79.5%) completed the questionnaire. The overall median [interquartile range] score of worrying about WPB was 81.7 [35.0]. Participants were mainly worried about the effect of WPB on their stress, work performance, and communication between staff members. A significant negative relationship developed between the quality of care and worrying about WPB, P < 0.001. More educated practitioners were 1.7 times more likely to be worried about WPB compared with their counter group, adj.P = 0.034. Junior practitioners were 1.6 times more likely to be worried about WPB, adj.P = 0.017. The group who has not been trained in handling WPB (1.7 times), and those who had been exposed to WPB (2.2 times) were both more likely to be worried about WPB compared with their counter groups, adj.P = 0.026 and adj.P < 0.001 respectively. CONCLUSIONS Most healthcare practitioners worry about WPB, especially its negative impact on the quality of care and patient safety. A greater proportion of practitioners with higher levels of education and their less experienced counterparts were more worried about WPB. Previous exposure to a WPB incident amplifies the practitioners' worry, but being trained on how to counteract bullying incidents makes them less likely to be worried.
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Affiliation(s)
- Munirah Al Omar
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mahmoud Salam
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Khaled Al-Surimi
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Primary Care and Public Health Department, School of Public Health, Imperial College London, London, UK
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Lim SYS, Koh EYH, Tan BJX, Toh YP, Mason S, Krishna LKR. Enhancing geriatric oncology training through a combination of novice mentoring and peer and near-peer mentoring: A thematic analysis ofmentoring in medicine between 2000 and 2017. J Geriatr Oncol 2019; 11:566-575. [PMID: 31699675 DOI: 10.1016/j.jgo.2019.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 06/10/2019] [Accepted: 09/16/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Training in Geriatric Oncology is in crisis, facing increasing demands in the face of a growing population of older adults, a lack of trainers, and the need to adapt training to different settings and trainee needs. A combination of novice mentoring and near-peer and peer mentoring (C-NP mentoring) has been proposed to provide trainees with personalized training and additional support. This study proposes to evaluate the possibility of establishing a C-NP mentoring program in geriatric oncology, through extrapolation of data from well-established practices in Internal Medicine programs. MATERIALS AND METHODS A systematic scoping review was carried out to provide scope of prevailing data and highlight the key processes behind effective C-NP mentoring programs. Six reviewers carried out independent literature searches on C-NP mentoring in medicine using Embase, ERIC, PubMed, and Scopus databases for articles published between 1st January 2000 and 31st December 2017. The Best Evidence Medical Education (BEME) collaboration guide and the STORIES (STructured apprOach to the Reporting In healthcare education of Evidence Synthesis) statement were used to develop a narrative from the thematic analysis of selected articles. Braun & Clarke (2006)'s approach to thematic analyses [1] and Sambunjak et al. (2010)'s approach of "negotiated consensual validation" were then used to identify the final list of themes. RESULTS 3913 citations were identified, 133 full-text articles were reviewed, and fifteen full-text articles were included. Thematic analysis was employed to circumnavigate mentoring's context-specific nature and identified ten semantic themes including the need, outcomes, obstacles, and improvements for C-NP mentoring, mentee and mentor participation and training, and matching and mentoring processes. CONCLUSION Data from this review allows the forwarding of the C-NP Mentoring Framework that will potentially enhance Geriatric Oncology training. The framework ensures a balance of consistency in recruitment, training, matching, pre-mentoring meetings, assessments processes, and flexibility to inculcate personalized aspects to the training and support. The C-NP Mentoring Framework will also enable effective oversight of the program and timely support of mentees in need.
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Affiliation(s)
| | | | | | - Ying Pin Toh
- Family Medicine Residency, National University Hospital, Singapore; Division of Palliative Medicine, National Cancer Centre Singapore, Singapore.
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, UK
| | - Lalit K R Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Palliative Medicine, National Cancer Centre Singapore, Singapore; Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, UK; Center for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Duke-NUS Medical School, Singapore
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Pradhan A, Buery-Joyner SD, Page-Ramsey S, Bliss S, Craig LB, Everett E, Forstein DA, Graziano S, Hopkins L, McKenzie M, Morgan H, Hampton BS. To the point: undergraduate medical education learner mistreatment issues on the learning environment in the United States. Am J Obstet Gynecol 2019; 221:377-382. [PMID: 31029660 DOI: 10.1016/j.ajog.2019.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/08/2019] [Accepted: 04/19/2019] [Indexed: 10/27/2022]
Abstract
This article, from the To the Point series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, is an overview of issues to consider regarding learner mistreatment and its effects on the undergraduate medical education learning environment in the United States. National data from the American Association of Medical Colleges Graduate Questionnaire and local data regarding learner mistreatment provide evidence that the learning environment at most medical schools needs to be improved. The American Association of Medical Colleges' definition of learner mistreatment focuses on active mistreatment, but data on passive mistreatment also contribute to a negative learning environment. The lack of tolerance for active mistreatment issues such as public humiliation and sexual and racial harassment need to be made transparent through institutional and departmental policies. Additionally, reporting mechanisms at both levels need to be created and acted upon. Passive mistreatment issues such as unclear expectations and neglect can also be addressed at institutional and departmental levels through training modules and appropriate communication loops to address these concerns. To fully confront and solve this challenging issue regarding learner mistreatment at the undergraduate medical education level, solutions to need to be implemented for faculty, residents, and students in the institutional, departmental, and clerkship settings.
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Samsudin EZ, Isahak M, Rampal S, Rosnah I, Zakaria MI. Organisational antecedents of workplace victimisation: The role of organisational climate, culture, leadership, support, and justice in predicting junior doctors' exposure to bullying at work. Int J Health Plann Manage 2019; 35:346-367. [PMID: 31659793 DOI: 10.1002/hpm.2926] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 01/08/2023] Open
Abstract
Workplace bullying is a pervasive phenomenon among junior doctors that may negatively impact their training and abilities to deliver quality healthcare, yet evidence on the factors of bullying among them remains lacking. This study examined the role of organisational climate, culture, leadership, support, and justice in junior doctors' exposure to workplace bullying on the basis of the work environment hypothesis, which suggests that workplace psychosocial factors are the main antecedents of bullying at work. Multilevel analysis of a universal sample (n = 1074) of junior doctors working in the central zone of Malaysia, using mixed effects logistic regression, was conducted. Analysis indicates that junior doctors working in departments with neutral and positive organisational climate, moderate and high degree of clan culture, moderate and high degree of adhocracy culture, moderate degree of hierarchy culture, moderate degree of production and achievement-oriented leadership style, moderate and high degree of organisational support, moderate degree of procedural justice, moderate and high degree of interactional justice, and high degree of distributive justice have lower odds of bullying compared with their counterparts. The results present evidence that all aspects of the organisation influence junior doctors' exposure to bullying and should be considered when developing antibullying initiatives targeted at them.
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Affiliation(s)
- Ely Zarina Samsudin
- Population Health and Preventive Medicine Unit, Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia
| | - Marzuki Isahak
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjay Rampal
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ismail Rosnah
- Department of Community Health, Faculty of Medicine, Bangi, Malaysia
| | - Mohd Idzwan Zakaria
- Dean's Office, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Rasmussen CM. A Small-Group Stratified-Learner Modification of Team-Based Learning (SGSL-TBL) for Resident Education. MEDICAL SCIENCE EDUCATOR 2019; 29:731-737. [PMID: 34457538 PMCID: PMC8368341 DOI: 10.1007/s40670-019-00762-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Providing learner-specific didactic instruction to a small group of residents can be a challenge in postdoctoral education programs. To date, no data has been published reporting Team-Based Learning (TBL) outcomes when modified for a small group of resident learners, nor on stratifying information presented to learners based on postgraduate year (PGY). Stratification of the advance assignment appears effective as each individual resident outperformed their peers on information assigned to their training level. The group performed significantly better on questions pertaining to their assigned reading than on questions from reading assigned to other residents (p = 0.02), due to the significant difference in PGY1 performance (p = 0.01). Overall performance is similar to traditional TBL, shown by a significantly better group Team Readiness Assurance Test (TRAT) score over Individual Readiness Assurance Test (IRAT) scores (p = 0.01). The Accreditation Council for Graduate Medical Education (ACGME) and Commission on Dental Accreditation (CODA) require evaluation of residents relative to their training level and to their peers. This Small-Group Stratified-Learner TBL (SGSL-TBL) may offer useful resident evaluation tools, providing quantitative data not previously available to small-group resident-training programs through application of TBL.
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Affiliation(s)
- Chad M. Rasmussen
- Department of Dental Specialties, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
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Weber J, Skodda S, Muth T, Angerer P, Loerbroks A. Stressors and resources related to academic studies and improvements suggested by medical students: a qualitative study. BMC MEDICAL EDUCATION 2019; 19:312. [PMID: 31429744 PMCID: PMC6701044 DOI: 10.1186/s12909-019-1747-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/06/2019] [Indexed: 05/16/2023]
Abstract
BACKGROUND Prior evidence suggests that medical students' mental health is poor and deteriorates during the course of academic studies. This qualitative study therefore aims to improve our understanding of medical students' perceptions of i) stressors related to their academic studies, ii) resources that may facilitate coping with those stressors and iii) suggestions to potentially reduce stress. METHODS Eight focus groups were conducted with medical students enrolled at a medical school in Germany until thematic saturation was reached. A topic guide was used to facilitate the discussion. Subsequently, focus group discussions were transcribed and content-analyzed using MaxQDA. RESULTS Organizational factors especially related to inadequate information flow as well as exams (e.g. repeat exams, scheduling, perceived unfair grading), poor theoretical and practical teaching quality, time and performance pressure, social interactions and individual characteristics (e.g. self-expectations, fear of failure) emerged as major contributors to stress. Resources perceived to facilitate coping with those stressors pertained to some other organizational aspects (e.g. flexibility, availability of contact persons), career prospects, practical training, social support, personal characteristics (e.g. knowledge base, past experience) and leisure time. Suggestions for improvement related primarily to organizational measures rather than individual-level measures. CONCLUSIONS Besides well-known stressors (e.g. exams and high performance pressure), some new aspects emerged from our study including stress related to organizational factors and repeat exams. Accordingly, students' wishes for organizational-level interventions, including better information systems and better interweaving of practical and theoretical education, could be first target areas for improvement.
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Affiliation(s)
- Jeannette Weber
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Stefanie Skodda
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Thomas Muth
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
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Robertson JJ, Long B. Medicine's Shame Problem. J Emerg Med 2019; 57:329-338. [PMID: 31431319 DOI: 10.1016/j.jemermed.2019.06.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/18/2019] [Accepted: 06/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Physician mental health is an increasingly discussed topic. Despite the progress made regarding the discussion of physician mental health, these issues remain concerning. In particular, the discussion as to why these issues are so problematic remains limited. Contributors can include bullying, the "hidden curriculum" of medicine, how the medical culture handles errors, and importantly, shame. OBJECTIVE This narrative review evaluates the literature on bullying and abuse in medicine, how abuse can exacerbate shame, how the handling of medical errors can exacerbate shame, how shame can negatively affect mental health, and how the medical community and leaders can mitigate these issues. DISCUSSION Physician mental health remains an important issue. Job-related stressors, bullying, medicine's hidden curriculum, medical error, traumatic patient encounters, and perfectionism can contribute to physician depression and burnout. Shame may underlie these factors. Shame is a universal emotion that leads to poor self-esteem, depression, eating disorders, abuse, and addiction. However, shame can be addressed and overcome, especially via acknowledgment, vulnerability, and empathy. The medical community can provide some of these techniques by encouraging environments of kindness and respect, giving constructive rather than destructive feedback, providing empathy and support after a medical error, and encouraging mutual learning environments where questions are asked with respect in order to enhance learning. This is opposed to hierarchies and "pimping," where questions are asked with intimidation and disrespect. CONCLUSIONS Shame is likely a contributor to physician mental health issues. For shame resilience to occur, it must not be kept secret and mutual support should be provided. By addressing the possible causes behind physician mental health concerns, including shame, more solutions can be proposed.
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Affiliation(s)
| | - Brit Long
- Brooke Army Medical Center, Fort Sam Houston, Texas
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Abstract
This study uses IM-ITE survey data to characterize the proportion of internal medicine residents in 2016 who self-reported having been bullied during their residency training.
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Affiliation(s)
- Manasa S. Ayyala
- Department of Medicine, Rutgers New Jersey Medical School, Newark
| | - Rebeca Rios
- Department of Family Medicine, Georgetown University School of Medicine, Washington, DC
| | - Scott M. Wright
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hoskison K, Beasley BW. A Conversation About the Role of Humiliation in Teaching: The Ugly, the Bad, and the Good. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1078-1080. [PMID: 30640268 DOI: 10.1097/acm.0000000000002594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this Invited Commentary, the authors identify the ugly, the bad, and the good in teaching in medical education, based on their experiences as medical students and then educators. They reflect on the mistreatment they endured during medical school and its impact on their education and their careers as educators. They also highlight those exemplars from their training who role modeled the type of physician and educator they want to be. The authors conclude by describing the elements of learner-centered education that they practice, which may be helpful for others to consider, and call on their fellow educators to end the practice of humiliating learners by moving away from a controlled-motivation model toward an autonomy-supportive approach to education.
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Affiliation(s)
- Karl Hoskison
- K. Hoskinson is associate professor and chief, Internal Medicine Hospitalist Service, Department of Internal Medicine, University of Oklahoma-Tulsa School of Community Medicine, Tulsa, Oklahoma. B.W. Beasley is professor and medical director, Department of Internal Medicine, University of Oklahoma-Tulsa School of Community Medicine, Tulsa, Oklahoma
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Kremer T, Mamede S, van den Broek WW, Schmidt HG, Nunes MDPT, Martins MA. Influence of negative emotions on residents' learning of scientific information: an experimental study. PERSPECTIVES ON MEDICAL EDUCATION 2019; 8:209-215. [PMID: 31338789 PMCID: PMC6684560 DOI: 10.1007/s40037-019-00525-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Medical training is consistently described as emotionally challenging. Students commonly encounter situations that are likely to trigger emotional reactions, but the influence of emotional reactions to these situations on learning is unclear. This experiment examined the effects of negative emotions on medical residents' learning of scientific information. METHODS Sixty first-year internal medicine residents (i.e. physicians in training to become specialists) at the São Paulo University Medical School were randomly assigned to watching a video clip either presenting an emotional (experimental group) or a neutral (control group) version of the same situation. Subsequently, all residents studied the same scientific text. Main outcome measurements were learning processes (inferred through study time and cognitive engagement) and outcomes (recall accuracy). Data were analyzed using chi-square and independent t‑tests. RESULTS The experimental group spent significantly less time (p < 0.001) studying the text and performed significantly worse on the free recall test (p < 0.001) than the control group. DISCUSSION Negative emotions decreased time invested in a learning task and the amount of knowledge gained from it, possibly because they automatically activated avoidance attitudes or captured part of the residents' cognitive resources, hindering processing of the learning material. Future studies should further explore the underlying mechanisms of this effect and how it can be diminished.
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Affiliation(s)
- Telma Kremer
- Institute of Medical Education Research Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - Silvia Mamede
- Institute of Medical Education Research Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Walter W van den Broek
- Institute of Medical Education Research Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Henk G Schmidt
- Institute of Medical Education Research Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Maria do P T Nunes
- Department of Internal Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Milton A Martins
- Department of Internal Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
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Castillo-Angeles M, Calvillo-Ortiz R, Acosta D, Watkins AA, Evenson A, Atkins KM, Kent TS. Mistreatment and the Learning Environment: A Mixed Methods Approach to Assess Knowledge and Raise Awareness Amongst Residents. JOURNAL OF SURGICAL EDUCATION 2019; 76:305-314. [PMID: 30318301 DOI: 10.1016/j.jsurg.2018.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/07/2018] [Accepted: 07/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Trainee mistreatment, either intentional or unintentional, negatively affects the learning environment. This study was undertaken to evaluate the impact of an educational intervention about mistreatment and the learning environment on general surgery residents. DESIGN Video-based modules were developed and added to the residency curriculum. Modules provided definitions and examples of active and passive mistreatment and components of positive and negative learning environments. A mixed-methods approach was used to assess the impact of this intervention. Residents completed a previously validated pre and post-test of related knowledge and attitudes (Abuse Sensitivity Questionnaire). Wilcoxon Signed Rank test was used to compare test results. During video-review sessions, discussion was prompted amongst residents using a semistructured interview guide. Immersion crystallization method was used to identify dominant themes. SETTING Beth Israel Deaconess Medical Center, an academic tertiary care facility located in Boston, Massachusetts. PARTICIPANTS All general surgery residents in our institution (n = 58) were invited to complete a survey at 3 time points. RESULTS Fifty-eight residents (55% male) responded to the survey (100% response rate). Mean age was 30.2 year (SD 3.9). Perception of nicknames related to personal identifiers (p = 0.0065) and name-calling (p = 0.02) changed significantly postintervention (Table 1). Regarding standards of behavior, 42 (72.4%) residents considered yelling not to be abusive unless it occurred frequently or constantly; 15 (25.8%) residents considered swearing (not directed at a person) as "not abuse"; 6 (10.3%) considered constructive criticism to be abusive if it was frequent or constant; and 24 (41%) residents feel powerless to intervene in these scenarios. Multiple themes emerged regarding resident-student interactions: (1) resident perception that description of behavior as mistreatment depends on medical student sensitivity; (2) neglect of medical students avoids trouble (e.g., being labeled as active mistreatment); (3) failure to integrate students into the surgical team may occur due to perceived lack of student interest; and (4) communication with the medical student is key. Residents reported that discussion along with video review was more effective than video review alone. CONCLUSIONS The video-based curriculum on mistreatment and the learning environment created awareness amongst residents about this important topic. Knowledge and attitudes about mistreatment changed in some areas postintervention. These findings suggest a need for development of complementary curricula to improve resident awareness and understanding of components of a positive learning environment and definition/examples of mistreatment.
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Affiliation(s)
| | | | - Danilo Acosta
- Department of Obstetrics & Gynecology, Maimonides Medical Center, Brooklyn, New York.
| | - Ammara A Watkins
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Amy Evenson
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Katharyn M Atkins
- Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Carl J. Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Chowdhury ML, Husainat MM, Suson KD. Workplace Bullying of Urology Residents: Implications for the Patient and Provider. Urology 2019; 127:30-35. [PMID: 30742867 DOI: 10.1016/j.urology.2018.11.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/03/2018] [Accepted: 11/20/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To elucidate whether urology residents in the United States feel bullied by nurses, how respected they feel at work, and whether this impacts personal and patient care. METHODS We distributed an Institutional Review Board-approved online, validated, revised Negative Acts Questionnaire to US urology residents in their first year or above. We evaluated bullying through scoring work (total range 5-25), person (total range 9-45), and physical intimidation (total range 3-15) related bullying domains. We also solicited how respected residents feel by different staff on a Likert scale and the perceived personal and professional impact of bullying. Bullying domains were assessed with descriptive statistics and mean total bullying scores (MTBS) and demographics compared. RESULTS We received 102 responses (82% MD, 18% DO). One resident reported never experiencing bullying. Overall average MTBS was 28.9 ± 0.9 (17-68). 98.0%, 82.4%, and 77.5% of residents reported at least 1 incident of work, person, and physical intimidation-related bullying, respectively. DO residents reported higher MTBS than MD residents (33.7 ± 2.2vs 27.8 ± 1.0, P = .015). Higher MTBS scores were seen in residents who feared retaliation and considered transferring programs, while lower scores were seen where the resident-nurse relationship was nurtured. CONCLUSION Ninety percent of residents perceived some degree of bullying and report a negative impact on personal performance and patient outcomes.
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Wolfman DJ, Parikh JR. Resident bullying in diagnostic radiology. Clin Imaging 2019; 55:47-52. [PMID: 30739034 DOI: 10.1016/j.clinimag.2019.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE Workplace bullying has been reported in multiple medical specialties outside of diagnostic radiology within the United States. The purpose of this study was to survey diagnostic radiology residents in the United States to determine if: (1) residents had experienced bullying, (2) residents had witnessed bullying of other residents, (3) residents were aware of zero-tolerance policy for workplace bullying at their institution, (4) residents were aware of no retaliation policies for reporting bullying at their institution. MATERIALS AND METHODS In December 2017, a weekly E-mail for 4 weeks was sent to diagnostic radiology residents in the United States (residents) who had attended the July 2017, September 2017 and October 2017 4-week American Institute for Radiologic Pathology (AIRP) resident course to participate in an online, anonymous, voluntary survey. RESULTS 28% of radiology resident respondents reported workplace bullying during their residency. One third of radiology residents have witnessed workplace bullying of another radiology resident at their facility. Approximately one half (48%) of respondents did not know if their institution had a zero-tolerance policy for workplace bullying, and approximately one half (55%) of respondents did not know if their institution had a no retaliation policy for reporting workplace bullying. CONCLUSION Our survey of diagnostic radiology residents across the United States confirms workplace bullying during residency, and the opportunity for implementation of zero-tolerance and zero retaliation policies for reporting workplace bullying in residency training institutions.
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Affiliation(s)
- Darcy J Wolfman
- Community Radiology Division, Department of Diagnostic Radiology, Johns Hopkins School of Medicine, Washington, DC, United States of America; American Institute for Radiologic Pathology, American College of Radiology, Silver Spring, MD, United States of America.
| | - Jay R Parikh
- Section of Breast Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
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Discrimination, Bullying and Harassment in Surgery: A Systematic Review and Meta-analysis. World J Surg 2019; 42:3867-3873. [PMID: 29971462 DOI: 10.1007/s00268-018-4716-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND In 2015, the public media in Australia reported a series of life stories of victims who had been subjected to inappropriate behaviors in their surgical careers, bringing the profession into disrepute. Currently, limited data are available in the medical literature on discrimination, bullying and harassment (DBH) in surgery. This significant information gap prompted a systematic review to compile relevant information about DBH in surgical practice and training, in particular, its prevalence and impact. METHODS A literature search was conducted using the MEDLINE, EMBASE and PubMed databases (May 1929-October 2017). Studies identified were appraised with standard selection criteria. Data points were extracted, and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS Eight studies, comprising 5934 participants, were examined. Discrimination occurred in a pooled estimate of 22.4% [95% Confidence Interval (CI) = 14.0-33.9%]. One of the papers reported the prevalence of bullying using two methods including Revised Negative Acts Questionnaire and a definition by Einarsen. Pooled estimate of incidence rate was thus 37.7% (95% CI = 34.0-41.5%) and 40.3% (95% CI = 34.7-46.2%), respectively. In terms of harassment, pooled prevalence was 31.2% (95% CI = 10.0-65.0%). CONCLUSIONS DBH is a significant issue in surgery. The true incidence of these issues may remain underestimated. Actions are being taken by professional bodies to create a positive culture in surgery. The effectiveness of these strategies is yet to be determined. More studies are warranted to investigate the magnitude of these issues given their psychological impact, and more importantly to monitor the effectiveness of current measures.
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Abhary S, Botti M, Dhulia A, Loh E, Catford J. Inappropriate behaviours experienced by doctors while undertaking specialty training. BMJ LEADER 2018. [DOI: 10.1136/leader-2018-000090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PurposeTo explore inappropriate behaviours experienced during specialty training in Australia and their implications for doctors’ training experiences and outcomes. This is a subset of data from a larger study exploring experiences of doctors in Australian specialty training—a qualitative study of enablers, stressors and supports.MethodsIn this qualitative study, registrars in specialist training programmes in Australia were invited and interviewed between August 2015 and August 2016. Semistructured open-ended questions were used to explore topics of relevance to their workplace, training, support service use and personal lives. Interviews were transcribed verbatim, de-identified and content and thematic analysis undertaken. Recruitment was ceased when data saturation was reached and no new themes emerged. Key themes related to inappropriate behaviours experienced during specialty training are reported in this study.Results17 participants were recruited (including one Indigenous and one international medical graduate). A total of six specialty training programmes across multiple states at various locations across Australia were represented in this cohort. Almost all participants reported confronting (personally experienced or witnessed) inappropriate behaviours during their training, perpetrated most commonly by senior doctors. Key themes of inappropriate behaviour that emerged were belittling and humiliation, sexually inappropriate behaviour, inappropriate behaviour as part of the ‘culture’ of medicine, reluctance to raise concerns due to fear of recrimination, and impacts of inappropriate behaviour.ConclusionVarying inappropriate behaviours were experienced by doctors in specialty training, having implications for their psychological well-being. A multidimensional and multisystem approach is required in the management of this serious issue.
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