Continuing medical education and primary physicians' job stress, burnout and dissatisfaction

Job and life satisfaction among emergency physicians: A qualitative study

The prevalence of burnout among emergency physicians is among the highest of any specialty. Multiple studies have described factors that contribute to physician burnout, such as age, institutional support, and the electronic medical record (EMR). However, there have been few studies that investigate those physicians who are satisfied with their career and their personal lives. This qualitative study evaluated emergency physicians who were satisfied with both their career and personal lives to propose a model for physician well-being. Physicians were recruited using email solicitation and referral by their peers from June-September 2020. Inclusion criteria involved those physicians who were satisfied with their life and their job and did not meet the criteria for burnout. A qualitative, non-structured interview with open-ended questions was performed with each participant. Emergent themes were identified using standard practice for qualitative studies. Twenty-three physicians participated with a mean age of 45.4 years old (range 32-65), 17 (73.9%) were men, 13 (56.5%) were Caucasian, 6 (26.0%) were Asian/South Asian, 1 (4.3%) were Latino, and 3 (13.0%) were another ethnicity. Several important themes emerged. Physicians satisfied with their lives and their jobs tended to be personally resilient, socially connected, with significant outside interests. These physicians self-identified their personality type as having both introverted and extroverted features. Threats to thriving included ineffective leadership and the EMR. This project proposes a model for job and life satisfaction among emergency physicians. Encouraging these qualities, while fostering supportive leadership, and optimizing the EMR, may improve satisfaction among physicians experiencing burnout.

Association of off-the-job training with work performance and work-family conflict among physicians: a cross-sectional study in China

OBJECTIVES

To determine whether experiences of off-the-job training in domestic (DT) and overseas study (OS) settings are associated with work performance and work-family conflict in physicians.

DESIGN, SETTING AND PARTICIPANTS

We conducted a national cross-sectional survey in 77 public hospitals across seven provinces in China between July 2014 and April 2015. Participants were 3182 physicians.

EXPOSURE

Participants were categorised into four groups: none, DT only, OS only and DT and OS.

PRIMARY OUTCOME MEASURES

Work performance was assessed by work engagement, career attrition and patient-centred care. Work-family conflict was assessed by affecting care for family, feeling guilty towards family and receiving complaints from family.

RESULTS

A total of 25.89% participants had experienced DT only, 8.71% OS only and 8.47% DT and OS. After adjustment for potential confounders, participants who had experiences of DT and OS compared with those with no training were more likely to report positive work performance (pride in work: OR=2.11, 95% CI: 1.43 to 3.10; enjoyment of work: OR=1.67, 95% CI: 1.11 to 2.51; turnover intention: OR=0.54, 95% CI: 0.38 to 0.77; early retirement: OR=0.63, 95% CI: 0.45 to 0.89; and exhaustion: OR=0.66, 95% CI: 0.45 to 0.98) and less work-family conflicts (feeling guilty towards family: OR=0.51, 95% CI: 0.35 to 0.74; and complaints from family: OR=0.66, 95% CI: 0.47 to 0.91). We found no obvious association between DT/OS experience with patient-centred care.

CONCLUSIONS

Physicians with DT and OS experiences are more likely to have better work performance and less work-family conflict than those without such experience. Physicians face increasing pressure to pursue continuing education and experience associated distress. Therefore, hospitals and government policy-makers should promote DT and OS.

Building Veterinarians beyond Veterinary School: Challenges and Opportunities for Continuing Professional Development in Veterinary Medicine

Continuing professional development (CPD) is an important mechanism for veterinarians to acquire, maintain, and enhance their capability to perform competently in their chosen practice area over their career. Although most licensing bodies require veterinarians to complete a minimum number of CPD hours each registration cycle, there are known issues with verifying that these activities are having the desired effects of ensuring professional competence and improving outcomes for patients, owners, and veterinarians. In this review, we summarize the literature across different health care professions to highlight three key challenges for veterinary CPD programs. These are (a) defining what it means to be professionally competent across different career stages from graduation to retirement, (b) delivering CPD activities that are effective in promoting evidence-based medicine and behavioral change in practice, and (c) developing reliable and sustainable systems to formally assess the continued professional competence of veterinarians. A common theme across all challenges was the importance of interacting with colleagues as an opportunity to receive external feedback on their professional strengths and weaknesses and to develop stronger support networks for managing common stressors in clinical practice. There was also a recognized need to develop more transparent outlines of the available and acceptable options for managing different animal health concerns as a first step toward identifying new opportunities for the veterinary profession to elevate the level of care provided. Based on these findings, we propose a new framework for defining, delivering, and evaluating CPD that promotes stronger collaboration between veterinarians to improve professional and personal well-being.

The effect of role-related stressors on nurses' burnout syndrome: The mediating role of work-related stress

PURPOSE

This study sought to investigate the effects of role conflict, role ambiguity, and workload on burnout syndrome among clinical nurses working in university hospitals and the mediating role of work-related stress in these effects.

DESIGN AND METHODS

Cross-sectional questionnaire-based survey was conducted. Data from 386 nurses were evaluated. The research variables were analyzed using statistical methods such as factor analysis, correlation analysis, regression analysis, Sobel tests, and bootstrapping method.

FINDINGS

It was determined that role conflict, role ambiguity, workload, and work-related stress affect nurses' burnout significantly and work-related stress has a mediator role between burnout and the independent variables.

PRACTICE IMPLICATIONS

Nurses' burnout syndrome can be prevented if managerial practices to reduce the sources of role-related stressors and work-related stress are implemented by managers.

Associations between job demands, job resources and patient-related burnout among physicians: results from a multicentre observational study

OBJECTIVES

To investigate associations of job demands and resources with patient-related burnout among physicians.

DESIGN

Multicentre observational study.

SETTING

Fifty medical departments at 14 (academic and non-academic) hospitals in the Netherlands.

PARTICIPANTS

Four hundred sixty-five physicians (71.6% response rate), comprising 385 (82.8%) medical specialists and 80 (17.2%) residents.

MAIN OUTCOME MEASURES

Job demands (workload and bureaucratic demands), job resources (participation in decision making, development opportunities, leader's inspiration, relationships with colleagues and patients)-measured with the validated Questionnaire of Experience and Evaluation of Work and Physician Worklife Survey-and patient-related burnout, measured using the validated Copenhagen Burnout Inventory.

RESULTS

Patient-related burnout was positively associated with workload (b=0.36; 95% CI, 0.25 to 0.48; p<0.001) and negatively associated with development opportunities (b=-0.18; 95% CI, -0.27 to -0.08; p<0.001) and relationships with patients (b=-0.12; 95% CI, -0.22 to -0.03; p=0.01). Relationships with patients moderated the association between bureaucratic demands and patient-related burnout (b=-0.15; 95% CI, -0.27 to -0.04; p=0.01).

CONCLUSIONS

Physicians with high workloads and few development opportunities reported higher levels of patient-related burnout. Those with positive patient relationships were less likely to experience patient-related burnout, even in the presence of excessive bureaucracy. Therefore, positive physician-patient relationships may be supported to reduce the likelihood of physicians' patient-related burnout. However, the specific support needed to effectively reduce patient-related burnout may vary per healthcare context and thus requires intensified research across healthcare systems and settings.

Exploring whether teaching activity is a way to improve GPs' satisfaction and wellbeing: a cross-sectional study

BACKGROUND

GP dissatisfaction and stress at work have been a growing domain of interest for several decades. However, few studies have focused on positive predictors of GPs' satisfaction and wellbeing. The diversity of activities could be one area that could be explored to aid job satisfaction.

AIM

The aim of this study was to investigate the association between the meaning in GPs' work and medical teaching activity.

DESIGN & SETTING

This is a secondary analysis of the Swiss data of the QUALICOPC study, a multicentric European-wide study, investigating primary care quality, costs, and equity.

METHOD

A total of 199 GPs in Switzerland answered a 60-question postal questionnaire. Descriptive and multivariate logistic regression analyses were performed using Stata (version 15). A focus group with six GPs gave qualitative data to help interpret the results.

RESULTS

Thirty-one per cent of GPs reported a loss of meaning in their work. In multivariate analyses, loss of meaning was lower in GPs with teaching activity (odds ratio [OR] = 0.50; 95% confidence interval [CI] = 0.27 to 0.90). In addition, loss of meaning was associated with late hospital discharge letter reception time (OR = 2.28; 95% CI = 1.20 to 4.35 if ≥15 days) and an administrative overload (OR = 4.18; 95% CI = 2.04 to 5.58). For GPs in the focus group, medical teaching occurred mostly because of intrinsic motivations.

CONCLUSION

Loss of meaning in GPs' work was lessened with teaching activity. Therefore, encouraging a GP practice that is varied in its activities may encourage GP satisfaction. Ultimately, job satisfaction may impact patient quality of care and this study offers some insight on how to improve work satisfaction for the next generation of GPs.

Impact of participation in continuing medical education small group learning (CME-SGL) on the stress, morale, and professional isolation of rurally-based GPs: a qualitative study in Ireland

BACKGROUND

The pressures of general practice contribute to high levels of stress, low morale, and burnout in some GPs. In addition, rurally-based doctors may experience significant professional isolation. Participation in continuing medical education (CME) appears to reduce stress, and may improve the retention of rural GPs.

AIM

As part of a larger study devised to examine the effectiveness of regular participation in CME small group learning (SGL) on rurally-based Irish GPs, this study explored whether CME-SGL had any impact on GP stress, morale, and professional isolation.

DESIGN & SETTING

This was a qualitative study involving four CME-SGL groups based in rural Ireland.

METHOD

Semi-structured focus group interviews were conducted in established CME-SGL groups in four different rural geographical locations. Interviews were audiorecorded, transcribed verbatim, and analysed thematically.

RESULTS

All members of these CME-SGL groups (n = 43) consented to interview. These GPs reported that regular meetings with an established group of trusted colleagues who are 'in the same boat' provided a 'safe space' for discussion of, and reflection on, both clinical concerns and personal worries. This interaction in a supportive, non-threatening atmosphere helped to relieve stress, lift morale, and boost self-confidence. The social aspect of CME-SGL sustained these rural GPs, and served to alleviate their sense of professional isolation.

CONCLUSION

Delivery of CME through locally-based SGL provides as an important means of supporting GPs working in rural areas. The non-educational benefits of CME-SGL, as described by these Irish GPs, are of relevance for rural doctors in other countries.

Learning on the job, the use of selection, optimization, and compensation strategies, and their association with telomere length as an indicator of biological aging

PURPOSE

Due to the increased need for retention of older workforce caused by demographic changes in industrialized countries, support of healthy aging in occupational settings is of increasing relevance. This study examines the relationship between leucocyte telomere length (LTL), a potential biomarker for biological aging, and selection, optimization, and compensation (SOC) and learning opportunities as strategies involving efficient management and gain of resources at work.

METHODS

Within a cross-sectional study, blood samples were drawn from 141 geriatric care professionals to measure LTL by quantitative real-time polymerase-chain reaction. Furthermore, all participants were asked with standardized questionnaires to rate their learning opportunities at work and use of SOC strategies. Analyses were performed by multiple linear regressions.

RESULTS

SOC use, especially compensation, tended to be negatively, and learning opportunities tended to be positively associated with LTL. Furthermore, a significant interaction was found between optimization and learning opportunities, such that LTL and learning opportunities were only positively associated when optimization was high.

CONCLUSIONS

Resources at work were weakly associated with telomere length, which is not unexpected in view of the multiplicity of factors affecting LTL. The results further suggest that a mismatch between SOC and learning opportunities may negatively affect successful aging. They also suggest that more detailed research on biological aging and its relation to resources at work is needed.

The making of a doctor: the matrix and self

Foulkes’ concept of the matrix, the hypothetical web of communication, has long since left the consulting room and entered the wider sphere of communities, countries, and institutions. This article will discuss how the matrix encompasses a whole profession, that of medical doctors. Together with a deep-rooted sense of identity, which I refer to as the medical self, the medical matrix contributes to doctors’ professional wellbeing but also begins to explain the enormous recent increase in mental illness in the medical profession seen across the world.

The article focuses on doctors. However, the ideas are relevant to any group (for example, teachers, the clergy, psychotherapists) which has a strong personal and professional identity, with all its attendant privileges and problems.

Burnout and intentions to quit the practice among community pediatricians: associations with specific professional activities

BACKGROUND

Burnout is an occupational disease expressed by loss of mental and physical energy due to prolonged and unsuccessful coping with stressors at work. A prior survey among Israeli pediatricians published in 2006 found a correlation between burnout and job structure match, defined as the match between engagement with, and satisfaction from, specific professional activities. The aims of the present study were to characterize the current levels of burnout and its correlates among community pediatricians, to identify changes over time since the prior survey, and to identify professional activities that may reduce burnout.

METHODS

A questionnaire was distributed among pediatricians both at a medical conference and by a web-based survey.

RESULTS

Of the 518 pediatricians approached, 238 (46%) responded to the questionnaire. High burnout levels were identified in 33% (95% CI:27-39%) of the respondents. Higher burnout prevalence was found among pediatricians who were not board-certified, salaried, younger, and working long hours. The greater the discrepancy between the engagement of the pediatrician and the satisfaction felt in the measured professional activities, the greater was the burnout level (p < 0.01). The following activities were especially associated with burnout: administrative work (frequent engagement, disliked duty) and research and teaching (infrequent engagement, satisfying activities). A comparison of the engagement-satisfaction match between 2006 and 2017 showed that the discrepancy had increased significantly in research (p < 0.001), student tutoring (P < 0.001), continuing medical education and participation in professional conferences (P = 0.0074), management (p = 0.043) and community health promotion (P = 0.006). A significant correlation was found between burnout and thoughts of quitting pediatrics or medicine (p < 0.001).

CONCLUSIONS

Healthcare managers should encourage diversification of the pediatrician's job by enabling greater engagement in the identified "anti-burnout" professional activities, such as: participation in professional consultations, management, tutoring students and conducting research.

Burnout in Chest Physicians after Health Care Reforms: A Cross-Sectional Study in Turkey

OBJECTIVES

The health reform has recently been one of the most important items on the agenda worldwide. The aim of this study is to investigate burnout syndrome in chest physicians and exhibit its connection with reform processes.

MATERIALS AND METHODS

In this survey, the "Socio-demographic Data Form" and "Maslach Burnout Inventory" were used. Between September and November 2016, chest physicians were reached with permissions by expertise associations via e-mail groups. A sample size of 352 physicians was included in the study out of 2,349 chest physicians in Turkey.

RESULTS

Among 352 physicians, 238 (67.60%) were women, and the mean age was 38.93 (±9.97). Higher burnout scores were determined in young physicians (aged ≤35), residents, those with low income, and those with ≥55 weekly working hours. The performance-based salary system was regarded as a problem by 84.7%, and 83.5% stated that they had not enough leisure time for themselves and their families. More than a half (55.7%) indicated that they would not choose the same specialty if they ever had a chance to choose again.

CONCLUSION

We observed that most of chest physicians in Turkey experience burnout syndrome, which might be influenced by reforms in the health care system. The health system and working conditions should be dealt with immediately by health authorities and reformed in accordance with human dignity and rights to life.

Work Preferences and General Abilities Among US Pharmacy Technicians and Danish Pharmaconomists

INTRODUCTION

The importance of pharmacy support personnel is increasingly recognized. Studies have evaluated workplace issues and evolving roles; however, needed information from technicians themselves is scarce. The purpose of this study was to examine preferences for work activities and the general abilities of US pharmacy technicians and Danish pharmaconomists.

METHODS

Surveys were administered to random samples of US technicians in 8 states and the general population of Danish pharmaconomists. Respondents indicated their preference for involvement in a set of work activities in community or hospital pharmacy on numeric scales. They also self-assessed their level of ability on facets associated with professional practice, in general. Descriptive results were tabulated, and bivariate tests were conducted on total general abilities ratings.

RESULTS

The 494 technicians and 313 pharmaconomists provided similar ratings on many activities. In community pharmacy, US technician ratings for performance of activities were generally higher than those of pharmaconomists; however, pharmaconomists rated certain "higher order" communication activities quite highly, such as discussing lifestyle changes with the patient. In hospital practice, Danish pharmaconomists provided low preferences for medication handling but high preferences for communication activities. General ability ratings were given high self-evaluations, but lower on some components, such as keeping up with the profession. Employer commitment was a strong correlate for both.

CONCLUSIONS

Evaluation of preferred work activities and general abilities were likely reflected in different scopes of practice between the two and could be insightful for education and work redesign in both countries, particularly the United States, as leaders evaluate shifts in technician professionalization.

Applying sport psychology to improve clinical performance. Med Teach 2017;39:1205-1213. [PMID: 28784016 DOI: 10.1080/0142159x.2017.1359523]

Preparedness for practice has become an international theme within Medical Education: for healthcare systems to maintain their highest clinical standards, junior doctors must "hit the ground running" on beginning work. Despite demonstrating logical, structured assessment and management plans during their undergraduate examinations, many newly qualified doctors report difficulty in translating this theoretical knowledge into the real clinical environment. "Preparedness" must constitute more than the knowledge and skills acquired during medical school. Complexities of the clinical environment overwhelm some junior doctors, who acknowledge that they lack strategies to manage their anxieties, under-confidence and low self-efficacy. If uncontrolled, such negative emotions and behaviors may impede the delivery of time-critical treatment for acutely unwell patients and compound junior doctors' self-doubt, thus impacting future patient encounters. Medical Education often seeks inspiration from other industries for potential solutions to challenges. To address "preparedness for practice," this AMEE Guide highlights sport psychology: elite sportspeople train both physically and psychologically for their discipline. The latter promotes management of negative emotions, distractions and under-confidence, thus optimizing performance despite immense pressures of career-defining moments. Similar techniques might allow junior doctors to optimize patient care, especially within stressful situations. This AMEE Guide introduces the novel conceptual model, PERFORM, which targets the challenges faced by junior doctors on graduation. The model applies pre-performance routines from sport psychology with the self-regulatory processes of metacognition to the clinical context. This model could potentially equip junior doctors, and other healthcare professionals facing similar challenges, with strategies to optimize clinical care under the most difficult circumstances.

Prevalence of burnout among Irish general practitioners: a cross-sectional study

BACKGROUND

Burnout constitutes a significant problem among physicians which impacts negatively upon both the doctor and their patients. Previous research has indicated that burnout is prevalent among primary care physicians in other European countries and North America. However, there is a paucity of research assessing burnout among Irish general practitioners and examining predictive factors.

AIMS

To report the findings of a survey of burnout among Irish general practitioners, and assess variables related to burnout in this population.

METHODS

An online, anonymous questionnaire was distributed to general practitioners working in the Republic of Ireland.

RESULTS

In total, 683 general practitioners (27.3 % of practising Irish general practitioners) completed the survey. Of these, 52.7 % reported high levels of emotional exhaustion, 31.6 % scored high on depersonalisation and 16.3 % presented with low levels of personal accomplishment. In total, 6.6 % presented with all three symptoms, fulfilling the criteria for burnout. Emotional exhaustion was higher among this sample than that reported in European and UK studies of burnout in general practitioners. Personal accomplishment was, however, higher in this sample than in other studies. Multiple regression analyses revealed that younger age, non-principal status role, and male gender were related to increased risk of burnout symptoms.

CONCLUSIONS

The symptoms of burnout appear prevalent among Irish general practitioners. This is likely to have a detrimental impact both upon the individual general practitioners and the patients that they serve. Research investigating the factors contributing to burnout in this population, and evaluating interventions to improve general practitioner well-being, is, therefore, essential.

Burnout in medical residents: a study based on the job demands-resources model

Purpose. Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job. The purpose of our cross-sectional study was to estimate the burnout rates among medical residents in the largest Greek hospital in 2012 and identify factors associated with it, based on the job demands-resources model (JD-R). Method. Job demands were examined via a 17-item questionnaire assessing 4 characteristics (emotional demands, intellectual demands, workload, and home-work demands' interface) and job resources were measured via a 14-item questionnaire assessing 4 characteristics (autonomy, opportunities for professional development, support from colleagues, and supervisor's support). The Maslach Burnout Inventory (MBI) was used to measure burnout. Results. Of the 290 eligible residents, 90.7% responded. In total 14.4% of the residents were found to experience burnout. Multiple logistic regression analysis revealed that each increased point in the JD-R questionnaire score regarding home-work interface was associated with an increase in the odds of burnout by 25.5%. Conversely, each increased point for autonomy, opportunities in professional development, and each extra resident per specialist were associated with a decrease in the odds of burnout by 37.1%, 39.4%, and 59.0%, respectively. Conclusions. Burnout among medical residents is associated with home-work interface, autonomy, professional development, and resident to specialist ratio.

Chinese primary care physicians and work attitudes

China passed a landmark health care reform in 2009, aimed at improving health care for all citizens by strengthening the primary care system, largely through improvements to infrastructure. However, research has shown that the work attitudes of primary care physicians (PCPs) can greatly affect the stability of the overall workforce and the quality and delivery of health care. The purpose of this study is to investigate the relationship between reported work attitudes of PCPs and their personal, work, and educational characteristics. A multi-stage, complex sampling design was employed to select a sample of 434 PCPs practicing in urban and rural primary care settings, and a survey questionnaire was administered by researchers with sponsorship from the Ministry of Health. Four outcome measures describing work attitudes were used, as well as a number of personal-, work-, and practice-related factors. Findings showed that although most PCPs considered their work as important, a substantial number also reported large workloads, job pressure, and turnover intentions. Findings suggest that policymakers should focus on training and educational opportunities for PCPs and consider ways to ease workload pressures and improve salaries. These policy improvements must accompany reform efforts that are already underway before positive changes in reduced disparities and improved health outcomes can be realized in China.

Clinical supervision among family physicians: prevalence, needs, and attitudes

BACKGROUND

Clinical supervision (CS) is not an established support system among physicians. Family physicians (FPs) have used Balint groups as a form of clinical supervision. In all, not much is known about the prevalence of physicians' attendance to or needs for CS.

OBJECTIVE

We studied what proportion of FPs compared with other physicians have attended or report they would need CS and whether having patients who request certain tests or medicines is associated with FPs' attendance to or need for CS.

DESIGN

A postal survey for all working-aged Finnish physicians was performed in 2008. Special questions concerning CS (eg, Balint) and patients' requests were included.

RESULTS

Response rate for the survey was 74% (N = 13 708). Special questions were responded by 10 559 physicians of whom 1252 were FPs. FPs had attended CS more often than other physicians (42% vs 29%, P < .001). Of FPs, 25% reported a need for CS with no availability of it. FPs experienced with or needing for CS were more often than other FPs females, had participated in continuing medical education, and reported that patients with requests have increased in recent years.

CONCLUSION

Both experience of CS and a need for CS with no availability are common among Finnish FPs. Experiences of patients with requests may reflect a need for CS among FPs. Studies on the content, significance and effectiveness CS among FPs are needed.

The relationship between continuing education and perceived competence, professional support, and professional value among clinical psychologists

INTRODUCTION

Continuing education is one of the means by which professionals maintain and increase their level of competence. However, the relationship between continuing education and the professional's sense of personal competence and other practice-related variables remains unclear. This study examined practicing psychologists' continuing education activities and how these relate to feelings of perceived competence, professional value, and professional support.

METHODS

Psychologists (n = 418) licensed to practice in Quebec were surveyed by pencil-and-paper mail-in survey concerning their continuing education activities, as well as their perceptions of their competence in practice, and their feelings of being professionally valued and professionally supported.

RESULTS

Results indicated that feelings of competence in practice were related to professional reading, taking courses/workshops, years being licensed, and attending psychology conferences/conventions. Feelings of professional value were related to age and participating in psychology networking groups, and feelings of professional support were related to participating in case discussion groups, supervision groups, and psychology networking groups.

DISCUSSION

The results showcase the complexity of professional development. Although relationships were found between continuing education activities and the 3 factors of interest, these relationships were moderate. Findings are discussed in the context of their value to individual psychologists, as well as to psychology licensing and regulatory boards, such as promoting participation in those activities related to feelings of competence and support.

Exploring physician perceptions of the impact of emotions on behaviour during interactions with patients

BACKGROUND

There is relatively little research on affective influences on physician behaviour, especially on prescribing and referrals. Affects include transitory moods and lasting emotions.

OBJECTIVES

We explored physician perceptions of the impact of four mood states on perceived rates of five behaviours: talking with patients, prescribing medications and referrals for laboratory tests, diagnostic tests and specialists. We also examined whether burnout modified the impact of moods on behaviour.

METHODS

A total of 188 family physicians responded anonymously to a self-reporting questionnaire that assessed the perceived rate of behaviours when in a positive, negative, tired and nervous mood and burnout level.

RESULTS

Five analyses of variance with repeated measures on mood states and contrast analyses computed the effects of mood and burnout on the behaviours. The mood factor was found significant for each of the behaviours, in all P < 0.001. The respondents reported that on good mood compared with negative mood days, they talked more, prescribed less and referred less. The burnout factor was also significant: high compared with low burnout physicians had higher perceived rates of all referral behaviours. Significant mood × burnout interactions indicated that the effects of mood were stronger among high compared with low burnout physicians.

CONCLUSIONS

The physicians perceived that their moods had different effects on different behaviours: the negative mood decreased talking and increased prescribing and referral behaviours and vice versa for the positive mood. Burnout intensified the effects of moods. The incremental effects of negative moods and burnout may impair quality of health care and may be costly to health services.

Sources of distress during medical training and clinical practice: Suggestions for reducing their impact

BACKGROUND

Medical students and doctors experience several types of professional distress. Their causes ("stressors") are commonly classified as exogenous (adapting to medical school or clinical practice) and endogenous (due to personality traits). Attempts to reduce distress have consisted of providing students with support and counseling, and improving doctors' management of work time and workload.

AIM

To review the common professional stressors, suggest additional ones, and propose ways to reduce their impact.

METHOD

Narrative review of the literature.

RESULTS AND CONCLUSION

We suggest adding two professional stressors to those already described in the literature. First, the incongruity between students' expectations and the realities of medical training and practice. Second, the inconsistencies between some aspects of medical education (e.g., its biomedical orientation) and clinical practice (e.g., high proportion of patients with psychosocial problems). The impact of these stressors may be reduced by two modifications in undergraduate medical programs. First, by identifying training-practice discrepancies, with a view of correcting them. Second, by informing medical students, both upon admission and throughout the curriculum, about the types and frequency of professional distress, with a view of creating realistic expectations, teaching students how to deal with stressors, and encouraging them to seek counseling when needed.

Can outcome-based continuing medical education improve performance of immigrant physicians?

INTRODUCTION

Immigrant physicians are a valued resource for physician workforces in many countries. Few studies have explored the education and training needs of immigrant physicians and ways to facilitate their integration into the health care system in which they work. Using an educational program developed for immigrant civilian physicians working in military primary care clinics at the Israel Defence Force, we illustrate how an outcome-based CME program can address practicing physicians' needs for military-specific primary care education and improve patient care.

METHODS

Following an extensive needs assessment, a 3-year curriculum was developed. The curriculum was delivered by a multidisciplinary educational team. Pre/post multiple-choice examinations, objective structured clinical examinations (OSCE), and end-of-program evaluations were administered for curriculum evaluation. To evaluate change in learners' performance, data from the 2003 (before-program) and 2006 (after-program) work-based assessments were retrieved retrospectively. Change in the performance of program participants was compared with that of immigrant physicians who did not participate in the program.

RESULTS

Out of 28 learners, 23 (82%) completed the program. Learners did significantly better in the annual post-tests compared with the pretests (p <.01) and improved their OSCE scores (p <.001). Most program graduates (90%) rated overall satisfaction as very good or excellent. In comparison with nonparticipants, program graduates performed better on work-based assessments (Cohen's d =.63).

DISCUSSION

Our intensive, outcome-based, longitudinal CME program has yielded encouraging results. Other medical educators, facing the challenge of integrating immigrant physicians to fit their health care system, may consider adapting our approach.

Career satisfaction and professional accomplishments

CONTEXT

Research on doctor career satisfaction has often focused on factors such as income, specialty, gender, work hours, autonomy, patient load, lifestyle preferences, work environment, and insurance regulations. Other educational, personal and professional factors have not received sufficient empirical attention.

OBJECTIVE

This study was designed to test the following five hypotheses that doctors' career satisfaction is associated with: (i) Higher satisfaction with their undergraduate medical education; (ii) Greater academic and clinical competence; (iii) More involvement in teaching and research activities; (iv) Higher orientation toward lifelong learning; and (v) Increased professional accomplishments.

METHODS

A survey was mailed in 2006 to a national sample of 5349 doctors in the United States who graduated from Jefferson Medical College between 1975 and 2000; 3170 (59%) returned completed surveys. Based on responses to a career satisfaction question, doctors were classified into three groups: Highly satisfied (top third, n=1078); moderately satisfied (middle third, n=1031); and least satisfied (bottom third, n=1061). These groups were compared on a number of variables.

RESULTS

All five research hypotheses were confirmed. Additionally, no significant association was observed between career satisfaction, age, years in practice, gender, or ethnicity; however, career satisfaction was associated with doctors' specialties.

CONCLUSIONS

The findings suggest that factors such as satisfaction with medical education, medical school class rank, assessments of clinical competence, teaching, and research activities, orientation toward lifelong learning, and professional accomplishments should be considered for a more comprehensive understanding of doctors' career satisfaction.

Immediate impact of a diabetes training programme for primary care physicians--an endeavour for national capacity building for diabetes management in India

AIMS

India faces a huge burden from diabetes. National capacity for management of diabetes has to be strengthened by improving knowledge of physicians treating diabetes, especially in semi urban and rural areas. A training programme was formulated and conducted at national level, as a step towards this goal.

METHODS

Physicians from 6 states of India (n=3023, M:F 2311:712), aged 30-55 years, with service of >or=3 years, (government n=1720, private n=1303, semi urban and rural areas (n=1581:1442)) were trained in diabetes care in 5-day workshops between March 2004 to December 2006. Impact of training was assessed by pre- and post-training knowledge scores, feedback on usefulness of training modules, prioritizing activities to be introduced in their practice and methods to be used for raising public awareness on diabetes.

RESULTS

The training significantly improved knowledge on treatment, complications, pathophysiology and diagnosis of diabetes (p<0.001). The participants considered information on preventive aspects of diabetes and foot care as highly educative. Patient education and team-training were considered important in diabetes management. Interest was evinced in raising public awareness about the disease.

CONCLUSIONS

Well-planned short training programmes are useful in improving knowledge and in creating enthusiasm to improve diabetes care and awareness.

Effect of an EBM course in combination with case method learning sessions: an RCT on professional performance, job satisfaction, and self-efficacy of occupational physicians

OBJECTIVE

An intervention existing of an evidence-based medicine (EBM) course in combination with case method learning sessions (CMLSs) was designed to enhance the professional performance, self-efficacy and job satisfaction of occupational physicians.

METHODS

A cluster randomized controlled trial was set up and data were collected through questionnaires at baseline (T0), directly after the intervention (T1) and 7 months after baseline (T2). The data of the intervention group [T0 (n = 49), T1 (n = 31), T2 (n = 29)] and control group [T0 (n = 49), T1 (n = 28), T2 (n = 28)] were analysed in mixed model analyses. Mean scores of the perceived value of the CMLS were calculated in the intervention group.

RESULTS

The overall effect of the intervention over time comparing the intervention with the control group was statistically significant for professional performance (p < 0.001). Job satisfaction and self-efficacy changes were small and not statistically significant between the groups. The perceived value of the CMLS to gain new insights and to improve the quality of their performance increased with the number of sessions followed.

CONCLUSION

An EBM course in combination with case method learning sessions is perceived as valuable and offers evidence to enhance the professional performance of occupational physicians. However, it does not seem to influence their self-efficacy and job satisfaction.

Integrating Children's Mental Health in Primary Health Care

The Healthy Minds/Healthy Children Outreach Service is part of Alberta's strategy to increase the capacity of primary care providers to identify and treat children and youth with mental health issues. Program development, implementation, and interim results are presented. Particular challenges connecting with Aboriginal communities, developing resources, and providing clinical consultation and online professional development are discussed. Evaluation data suggest that this form of collaborative, educational, interprofessional service is a promising approach to narrowing the care gap for children with mental health issues.

Continuing medical education and burnout among Danish GPs

BACKGROUND

There has been minimal research into continuing medical education (CME) and its association with burnout among GPs.

AIM

The aim of this study was to investigate the association between participating in CME and experiencing burnout in a sample of Danish GPs.

DESIGN OF STUDY

Cross-sectional questionnaire study.

SETTING

All 458 active GPs in 2004, in the County of Aarhus, Denmark were invited to participate.

METHOD

Data on CME activities were obtained for all GPs and linked to burnout which was measured using the Maslach Burnout Inventory--Human Services Survey. The relationship between CME activity and burnout was calculated as prevalence ratios (PR) in a generalised linear model.

RESULTS

In total, 379 (83.5%) GPs returned the questionnaire. The prevalence of burnout was about 25%, and almost 3% suffered from 'high burnout'. A total of 344 (92.0%) GPs were members of a CME group or a supervision group. Not being a member of either a CME group or a supervision group was statistically significantly associated with doubled likelihood of burnout (PR = 2.2). Among GPs not making use of a practice facilitator, a seven-fold higher likelihood of high burnout was found.

CONCLUSION

GPs who were not members of a CME group and did not take part in outreach visits had a higher likelihood of suffering from burnout and high burnout than those who were members of a CME group or received outreach visits. Therefore, not being a member of a CME group could indicate that the GP is more likely to suffer from burnout. Although the present study does not unequivocally establish causality, it would be interesting to see whether staying active in CME may also prevent burnout among GPs.

Burnout, staff support, and coping in Pediatric Oncology

GOALS OF WORK

The goals of the study were the following: (1) to study the rate of burnout of the staff in Pediatric Oncology and compare it with that of a group of staff in other pediatric specialties, (2) to find out if job satisfaction, role clarity, staff support, and ways of coping are related to the burnout of these two groups, and (3) as a secondary aim, to identify other parameters, i.e., profession, experience, having children, etc., which might affect burnout, staff support, and ways of coping.

MATERIALS AND METHODS

The study group (n = 58) consisted of the staff of two Pediatric Oncology units and a Bone Marrow Transplantation unit, and the control group (n = 55) consisted of the staff of two Pediatric departments and one Pediatric Orthopedics department. The Maslach Burnout Inventory, the Staff Support Questionnaire, the Shortened Ways of Coping Questionnaire-Revised, and the Social Readjustment Scale were used.

MAIN RESULTS

No differences were found in burnout between Pediatric Oncology staff and that of other specialties, the existing staff support, and the ways of coping. Decreased role clarity and wishful thinking, as a way of coping, were positively correlated to emotional exhaustion, whereas a negative correlation of the lack of role clarity existed with personal accomplishment. Not having children and less experience increased burnout in both groups studied.

CONCLUSIONS

The hospital management and the heads of departments should be knowledgeable of ways to prevent burnout in their staff. Strategies targeting role clarity and wishful thinking are useful toward this goal.

Organizational role stress among medical school faculty members in Iran: dealing with role conflict

BACKGROUND

Little research has been conducted to investigate role stress experienced by faculty members in medical schools in developing countries. This becomes even more important when the process of reform in medical education has already taken place, such as the case of Iran. The objectives of this study were to investigate and assess the level and source of role-related stress as well as dimensions of conflict among the faculty members of Iranian medical schools. Variables like the length of academic work, academic rank, employment position, and the departments of affiliation were also taken into consideration in order to determine potentially related factors.

METHODS

A survey was conducted at three different ranks of public medical schools. The validated Organizational Role Stress Scale was used to investigate the level of role stress and dimensions of role conflict among medical faculty members. The response rate was 66.5%.

RESULTS

The findings show that role stress was experienced in high level among almost all faculty members. All three studied medical schools with different ranks are threatened with relatively the same levels of role stress. Specific differences were found among faculty members from different disciplines, and academic ranks. Also having permanent position and the length of services had significant correlation with the level of role stress. The major role- related stress and forms of conflict among faculty members were role overload, role expectation conflict, inter-role distance, resource inadequacy, role stagnation, and role isolation.

CONCLUSION

The most role-related stressors and forms of conflict among faculty members include too many tasks and everyday work load; conflicting demands from colleagues and superiors; incompatible demands from their different personal and organizational roles; inadequate resources for appropriate performance; insufficient competency to meet the demands of their role; inadequate autonomy to make decision on different tasks; and a feeling of underutilization. The findings of this study can assist administrators and policy makers to provide an attractive working climate in order to decrease side effects and consequences of role stress and to increase productivity of faculty members. Furthermore, understanding this situation can help to develop coping strategies in order to reduce role-related stress.

Doctors' learning habits: CME activities among Norwegian physicians over the last decade

BACKGROUND

Coping with the increasing body of medical knowledge is a main challenge to all doctors. The aim of this study was to investigate self reported reading and learning habits among Norwegian doctors and their subjective ability to keep professionally updated.

METHODS

A cross sectional survey among a randomised sample of Norwegian doctors was undertaken in 2004 (n = 1005, response rate 71%). A similar study with many identical questions was done in 1993 (n = 1041, response rate 71%) and a comparison of the results was made.

RESULTS

Attending courses/congresses and reading medical literature were reported to be the most important sources of professional information in 2004, just like in 1993. Less time was spent on courses/congresses in 2004 than in 1993, and more time was spent on medical reading. The internet was regarded as useful for their professional life for three out of five, mostly among the younger and least among GPs. Two out of three doctors felt that they could obtain sufficient information for keeping updated in 2004, the same proportion as in 1993. A correlation was found between subjective coping with the information and a high level of continuing medical education (CME)-activities. The information copers had a higher level of job satisfaction than non-copers.

CONCLUSION

Over the last decade Norwegian doctors spend less time on attending courses/congresses and more time on medical reading, while the level of self perceived coping with information has been unchanged. The changing pattern of professional updating may reflect a more general individualistic trend in society. The consistent finding of a correlation between reading and attending courses, subjective coping and job satisfaction gives good reasons for recommending a high level of CME-activities among doctors.

Training and motivational factors as predictors of job satisfaction and anticipated job retention among implementers of a school-based prevention program

Despite increasing dissemination of prevention programs, little is known about program implementers, including factors that promote satisfying job roles. Using Self-Determination Theory as a conceptual framework, we surveyed 128 implementers of the widely disseminated Primary Mental Health Project. Implementers reported 7.1 years average experience on the job (range 1-25 years), and 55% had two or more years of college. In a multivariate regression model, predictors of higher job satisfaction were: lower education level; positive perceptions of supervision and continuing education opportunities; and satisfaction at work of needs for autonomy and competence. For implementers with </=3 years experience, satisfaction of competence needs predicted job satisfaction; for implementers with >3 years experience, satisfaction of needs for autonomy and for relatedness predicted job satisfaction. Contrary to expectations, job satisfaction was unrelated to anticipated job retention.

La salud mental en los médicos de familia: efectos de la satisfacción y el estrés en el trabajo

OBJECTIVES

To asses "burnout" and psychiatric morbidity among family physicians and its relationship with stress and satisfaction at work.

METHODS

The 346 family doctors and 84 pediatricians in the Primary Health Care district of Majorca were invited to fill-out a questionnaire. Psychiatric morbidity was evaluated using the 28-item General Health Questionnaire. The three components of "burnout" (emotional exhaustion, depersonalization and low personal accomplishment) were assessed with the Maslach Burnout inventory. Satisfaction and stress at work were assessed with the Font Roja and Tabarca scales, respectively.

FINDINGS

266 family doctors and pediatricians answered the questionnaire (61.86%). Estimated prevalence of psychiatric morbidity was 25.7%. No significant differences were found between those with GHQ results and demographic and job variables. Fifty three per cent had high emotional exhaustion, 47.1% high depersonalization and low personal accomplishment were found in 33.3% of the doctors. Non significant differences were identified in the distribution of burnout dimensions and demographic and job characteristics. Satisfaction at work seems to protect doctors from mental distress and burnout. Job stress is related to higher emotional exhaustion and depersonalization but not with psychiatric morbidity.

CONCLUSIONS

Family practitioner's mental health is likely to be protected in those who are more satisfied at work and threatened in those doctors with high job stress. These facts have to be assumed not so much as an individual problem but rather as a general problem of all health organizations.

Is small-group education the key to retention of sessional GPs?

WHAT IS ALREADY KNOWN IN THIS AREA • Recruitment and retention et general practitioners (GPs) are topical issues in the modern NHS. • There is/a link between reduced stress/burnout in GPs and continuing medical education. • Sessional GPs are known to suffer from isolation and difficulty accessing educational support. • One previous study of retention of sessional GPs cites three key factors: a secure contract, mentoring support and a stimulating work environment with a culture of personal and professional development. WHAT THIS WORK ADDS • A primary care trust (PCT)-funded, peer-facilitated educational support group can be a key instrument in the recruitment and retention of sessional GPs, in particular by providing a network of supportive colleagues and help keeping up to date. • This is the first study examining this factor in the retention of sessional GPs. • Other modifiable factors influencing recruitment include type of post and contract. • Other modifiable factor influencing retention include financial factors. SUGGESTIONS FOR FUTURE RESEARCH • Calculation of retention rates of sessional GPs in PCTs (work in progress) will allow further studies assessing the-impact, including cost-benefit ratio, of interventions relating to specific factors influencing retention. • The association between educational support and retention should be studied for: other members of the primary care team, health professionals outside general practice and healthcare systems outside the NHS and the UK.

Electives in Complementary Medicine: Are We Preaching to the Choir?

CONTEXT

Many medical schools offer electives on complementary medicine, but little is known about the characteristics of students who sign up for such electives compared with those who do not.

OBJECTIVE

Compare enrollees to nonenrollees in an elective course on therapeutic touch and healing touch (TTHT).

DESIGN

Cross-sectional survey.

SETTING

Wake Forest University School of Medicine, second-year course on medicine as a profession.

SUBJECTS

Second-year medical students who returned surveys: 22 who signed up for an elective on TTHT and 58 who did not.

INSTRUMENT

Anonymous surveys included questions about demographics, attitudes, practices, and the Maslach Burnout Inventory (MBI).

RESULTS

Those who signed up for the elective were more likely to be women (73% for TTHT vs 33% for others, P < .01). Nearly all students thought that being centered and compassionate were very important. Students who signed up for TTHT were less likely to report feeling confident in being able to be centered when it was quiet (41% vs 64%, respectively, very confident, P < .04) and less confident in their ability to demonstrate nonverbal comforting behaviors (9% vs 43%, respectively, very confident, P = .02). Only 18% of elective vs 66% of others reported being centered during patient encounters (P < .001). The TTHT students and their classmates reported comparable levels of burnout.

CONCLUSIONS

Elective students were no more likely than classmates to believe that it is very important to be centered and to extend compassion toward patients; they reported being less confident and practicing these skills less often than their classmates. Burnout was not less common among those in the elective. Electives may not be "preaching to the choir." Future studies need to determine whether training enhances confidence and skills and whether it protects against developing burnout.

Child health care centres: an academic model for comprehensive child health care in the community

The challenge of the discipline of paediatrics in the 21st century is to promote health and development of children in a way that will enable them to maximize their biological and social potential. The community child health centre (CHC) in Israel is a model of community health care service built to provide comprehensive health care to children and adolescents, as well as an academic setting for under- and postgraduate paediatric training. Today there are 34 CHCs in Israel, serving a population of 220 000 children from birth to 18 years of age. The CHC combines the advantages of group practice with those of an academic medical centre and enables flexibility and mutual learning. Further expansion and development are required to realize the CHC's mission of a true comprehensive academic centre for paediatric community health.

Interaction among general practitioners age and patient load in the prediction of job strain, decision latitude and perception of job demands. A cross-sectional study

Background

It is widely recognized and accepted that job strain adversely impacts the workforce. Individual responses to stressful situations can vary greatly and it has been shown that certain people are more likely to experience high levels of stress in their job than others. Studies highlighted that there can be age differences in job strain perception.

Methods

Cross-sectional postal survey of 300 Lithuanian general practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale. Job demands were investigated with the Karasek scale. The analysis included descriptive statistics; logistic regression beta coefficients to find out predictors and interactions between characteristics and predictors.

Results

Response rate was 66% (N = 197). Logistic regression as significant predictors for job strain assigned – duration of work in primary care; for job demands- age and duration of working in primary care; for decision latitude- age and patient load.

The interactions with regard to job strain showed that GP's age and job strain are negatively associated to a low patient load. Lower decision latitude for older GP age is strongly related to higher patient load. Job demands and GP age are slightly positively related at low patient load.

Conclusions

Lithuanian GP's have high patient load and are at risk of stress, they have high job demands and low decision latitude. Older GP's perceive less strain, lower job demands and higher decision latitude in case of low patient load. Young GP's decision latitude has week association to patient load. Regarding to the changes in patient load younger GP's perceive it more sensitively as changes in job demands.

Professional Liability and Other Career Pressures: Impact on Obstetrician-Gynecologists’ Career Satisfaction

OBJECTIVE

To investigate the impact of career pressures on career satisfaction and satisfaction with job-specific activities among obstetrician-gynecologists.

METHODS

A questionnaire was sent to 1,500 member-Fellows of The American College of Obstetricians and Gynecologists in June 2001. The analyses were designed to examine the relationship between career pressures in 3 domains on clinicians' professional satisfaction.

RESULTS

Overall career satisfaction and satisfaction with job-specific activities were both inversely related to the perceived impact of career pressures. The major impact reported was that liability insurance costs would shorten the duration of the members' careers. Managed care had less impact than liability, with moderate concern surrounding the limitation of diagnostic and treatment options. Obstetrician-gynecologists were less satisfied with their careers and job-specific activities if they believed the cost or time of obtaining continuing medical education requirements to be a burden.

CONCLUSION

Career pressures produced by liability insurance costs have more negative impact on clinicians' satisfaction with their professional lives and job-specific activities than managed care and requirements for continuing medical education.

Job satisfaction among mental health professionals in Rome, Italy

Although various surveys on job satisfaction have been performed in mental health care settings, no studies have investigated in-depth the level of satisfaction with the various aspects of work in Italian mental health services. In the present study, all clinical mental health staff working in a large psychiatric catchment area in Rome were invited to anonymously complete a previously validated questionnaire designed to measure job satisfaction among mental health professionals. Of the total 236 health professionals, 196 (83%) agreed to participate. Most participants were not completely satisfied with many aspects of their job, and many were not even moderately satisfied. The level of satisfaction increased with age, and it was significantly lower among hospital-ward staff compared to the staff of outpatient clinics or residential facilities, even after adjusting for age, gender, profession, work setting, and time in current job, using a multiple logistic regression model. Our findings suggest that interventions aimed at increasing job satisfaction among Italian mental health professionals might be warranted, particularly among hospital-ward staff.

GPs working in solo practice: obstacles and motivations for working in a group? A qualitative study

OBJECTIVE

Our aim was to analyse the obstacles and eventual motivations of solo GPs for working in group practice.

METHODS

A qualitative study using 12 focus groups was carried out in primary care in French-speaking Belgium. The subjects comprised four samples of GPs: 20 GP trainers, 18 GP trainees, 25 women GPs and 25 other GPs. The focus groups were taped and transcribed. Two independent researchers carried out the analysis using the QSR NUD.IST software.

RESULTS

The participants (88 GPs) did not share a common definition of group practice-in particular multidisciplinary working-the need for a common pool of patients and shared premises. Their main sources of motivation for eventually setting up a group practice were better quality of life, continuity of care and sharing professional knowledge. The main obstacles were a required agreement between colleagues, the loss of a personal patient-GP relationship, budgetary constraints, and divergent views on group practice and GPs' profession (especially true for the association of GPs from different age groups).

CONCLUSION

The current study shows that GPs working solo have divergent views of group practice. However, they clearly perceive advantages to this type of association (e.g. better quality of life and continuity of care). This study also confirms the high level of stress and tiredness felt by GPs and especially senior practitioners.

A comparative study of stress and burnout among staff caregivers in nursing homes and acute geriatric wards

OBJECTIVE

To compare levels of stress and burnout among staff caregivers in nursing homes and acute geriatric wards of general hospitals.

METHODS

A cross-sectional survey was conducted in three nursing homes (total of 522 beds, 270 caregivers) and nine geriatric sections of general hospitals (total of 371 beds, 280 caregivers). Staff caregivers were asked to answer a four-part questionnaire made up of socio-demographic data, the General Health Questionnaire (GHQ-12), the Maslach Burnout Inventory (MBI) and the Stressful Events Questionnaire (SEQ).

RESULTS

355 carers (172 from nursing homes, 183 from acute geriatric wards) answered the questionnaire (response rate 66%). Bivariate analysis reveals that general hospital carers show higher GHQ scores, higher MBI-Depersonalisation (DP) and Emotional Exhaustion (EE) sub-scores and lower MBI-Personal Accomplishment sub-scores. Stressful Events (as revealed by the SEQ) are more frequently reported by general hospital carers, particularly events related to patients' behavioural disorders. Multivariate analysis shows that general hospital work-setting, professional role, female gender and patient/carer ratio are significant explanatory variables of a high MBI-EE sub-score, while general work setting and disability are the best explanatory variables of a high MBI-DP sub-score. Professional role and general hospital work-setting are independent factors in a low MBI-Personal Accomplishment (PA) sub-score.

CONCLUSION

These results appear to show that levels of stress and burnout among staff caregivers are moderate in acute geriatric wards, but significantly higher than in nursing homes. This suggests that increasing the rate of trained staff and improving staff support-for instance by the implementation of Consultation-Liaison (C-L) Psychiatry and/or continuing education programmes-could be needed mostly in acute geriatric wards.

Chiropractors' attitudes to, and perceptions of, the impact of continuing professional education on clinical practice

OBJECTIVES

As with other health care professions, there is a need for chiropractors to maintain their clinical competencies through continuing professional education (CPE) and development (CPD). This study set out to evaluate chiropractors' attitudes to, and opinions of, current CPE provision, and their perceived needs for the future. In particular, their perceptions of the impact of CPE on clinical practice were assessed.

DESIGN

A survey in which primary quantitative and secondary qualitative data were collected using a self-administered questionnaire. The questionnaire concentrated on four areas: (i) attitudes to CPE; (ii) impact of current CPE on practice; (iii) modes of delivery most likely to change practice; and (iv) future learning needs from continuing education programmes.

RESPONDENTS

A random sample of chiropractors registered with the British Chiropractic Association.

RESULTS

Overall, chiropractors were positive to CPE and cognisant of the need to keep up to date. However, in spite of several benefits, chiropractors did not perceive current CPE to be instrumental in changing practice. As might be expected, chiropractors perceived clinical updates and hands-on practical workshops to be most effective in changing clinical practice.

DISCUSSION

There is currently considerable debate surrounding the ability of CPE and CPD to actually make a difference to the way clinicians practice. This study describes a method of evaluating the impact of CPE/D in changing clinical practice from the viewpoint of the practitioners themselves.