Job description and perception of clinical research personnel working in a network of French intensive care units

BACKGROUND

There is a lack of information about the organisation and management of clinical research personnel in Europe and of their professional activity in intensive care. We therefore conducted a cross-sectional survey among personnel currently working in a French intensive care research network that involves 41 centres nationwide. The aim of the survey was to describe the personnel's personal and institutional organisation and management, their job perception in terms of satisfaction and stress, and suggestions for improvement.

METHODS

Over 3 months in 2023, the research personnel received an electronic questionnaire on their personal and professional profile, past and present training, workplace and functions currently performed, personal knowledge about job skills required, job satisfaction and stress by as measured on a rating scale, and suggested ways of improvement.

RESULTS

Ninety seven people replied to the questionnaire (a response rate of 71.3%), of whom 78 (57.3%) were sufficiently involved in intensive care to provide complete answers. This core sample had profiles in line with French recruitment policies and comprised mainly Bachelor/Master graduates, with nurses accounting for only 21.8%. The female to male ratio was 77:23%. Many responders declared to have a shared activity of technician (for investigation) and assistant (for quality control). More than 70% of the responders considered that most of the tasks required of each worker were major. Figures were much lower for project managers, who were few to take part in the survey. On a scale of 10, the median of job satisfaction was 7 for personal work organisation, 6 for training and for institutional organisation, and only 5 for personal career management. The median of job stress was 5 and was inversely correlated with satisfaction with career management. Respect of autonomy, work-sharing activity between investigation and quality control, a better career progression, financial reward for demanding tasks, and participation in unit staff meetings were the main suggestions to improve employee satisfaction.

CONCLUSION

This nationwide survey provides a new insight into the activity of French clinical research personnel and points to ways to improve the quality and efficiency of this workforce.

Soft Skills: The Work of Communication and Persuasion Among Nurse Navigators in Hospital at Home Programs

OBJECTIVE

To assess the role of soft skills in the work of Hospital at Home (HaH) nurse navigators.

BACKGROUND

In HaH programs that employ them, nurse navigators are often responsible for identifying, assessing, referring, and educating potential HaH patients. The experiences of these navigators have gone understudied.

METHODS

Researchers conducted semistructured interviews and observations with nurse navigators (n = 7) who collectively cover 14 North Carolina-based HaH sites. Navigators were asked to keep diaries of responses to directed questions.

RESULTS

In their capacity as navigators, interviewees said they served several roles: intermediaries between hospital and HaH staff, interpreters of clinical knowledge for patients, and champions of, and educators for, the home-based program. The navigators noted that the interpersonal soft skills of building rapport, clear communication, and gentle persuasion were of the utmost importance in this work.

CONCLUSIONS

The job descriptions of nurse navigators in HaH programs should fully reflect the breadth of their responsibilities, including time performing soft skilled labor. Also, training for these roles should include techniques to develop and refine these skills.

Line Managers' Perspectives and Responses when Employees Burn Out

PURPOSE

Little is known about whether burnout can be stopped at an emerging stage. To develop this knowledge, we focus on line managers' perspectives and responses when an employee who seems to be heading for burnout is still at work.

METHODS

We interviewed 17 line managers working in the educational and health care sectors, who had been confronted with the sickness absence of at least one employee due to burnout in the past. Interviews were transcribed, coded, and analyzed thematically.

RESULTS

During the period that the employee seemed to be developing burnout while still at work, line managers experienced three different, successive phases: picking up signals, role-taking, and re-evaluation. Line managers' personal frame of reference (e.g., having experience with burnout) seemed to influence whether and how they picked up signals of burnout. Line managers not picking up signals, did not take any action. When picking up the signals, the managers however generally took an active role: they started a conversation, changed work tasks, and - at a later stage - adapted the employee's job description, sometimes without consulting the employee. The managers felt powerless yet learned from the experience when subsequently re-evaluating the period during which employees developed symptoms of burnout. These re-evaluations resulted in an adapted personal frame of reference.

CONCLUSION

This study shows that improving line managers' frame of reference, e.g., by organizing meetings and/or training, may help them to detect early signals of burnout and take action. This is a first step to prevent the further development of early burnout symptoms.

Unveiling the landscape: Investigating education, skills, job description, and challenges in sonography professions and framework development

INTRODUCTION

This paper discusses the current medical sonographer status in the United Arab Emirates (UAE). The paper explores the current education, skills, job description, and challenges towards developing sonography professions and a sonographer framework.

METHODS

The study employed a quantitative descriptive research approach using a cross-sectional study design to collect and analyse data from sonographers in the UAE. Data was collected through a structured survey that included sections addressing demographic information, education, skills, current practices, and challenges.

RESULTS

The data showed a relatively even distribution across different age groups, with a higher proportion falling in the 31-40 age range. Females constitute a slightly higher percentage (55.9 %) than males (44.1 %). The study found that sonographers have the necessary skills and knowledge to interpret the scan results and provide a formal report. A significant percentage of participants taught ultrasound to others and participated in research activities. The survey responses indicate difficulty in reporting sonograms.

CONCLUSIONS

The study found that sonographers possess the necessary expertise and skills to pass on their knowledge to trainees and colleagues. The participants expressing a desire to increase their knowledge and skills indicate that sonographers recognised that continuous professional development is crucial for staying updated with advancements in the field. The participant's "Advanced Practitioners" title recommendation suggests a desire for professional recognition, career progression, and specialisations in sonography. Effective interdisciplinary collaboration is important for providing quality patient care.

IMPLICATION FOR PRACTICE

The paper emphasises the importance of recognising sonography as a vital healthcare profession. It aims to raise awareness about the crucial role of sonographers in patient care. The study also stresses the need for a well-defined career progression framework to guide professional growth and acknowledgement.

The effects of job characteristics on physicians' orientation toward lifelong learning

With the rapidly growing body of medical knowledge, physicians must engage in lifelong learning. Physicians' orientation toward lifelong learning is of crucial importance. This study aimed to explore the effects of job characteristics on physicians' lifelong learning. A multicenter study collecting data from physicians from three medical centers in Taiwan was performed. A total of 321 physicians were surveyed with the Chinese version of the Job Content Questionnaire (C-JCQ) and the revised Jefferson Scale of Physician Lifelong Learning (JeffSPLL) to assess their job characteristics (i.e., job demands, job control, social support) and orientation toward lifelong learning. Exploratory factor analysis was employed to validate both questionnaires. Hierarchical regression was utilized to explore the relationship of job characteristics and predictors with physicians' lifelong learning. The results revealed that job demands (β = 0.10), job control (β = 0.19), social support from supervisors (β = 0.16), the interaction of job demands × job control (β =  - 0.11) and the interaction of job demands × social support from colleagues (β = 0.13) were significantly (p < .05, p < .001) related to lifelong learning. Moreover, physicians in the active group (high demand, high control) possessed a stronger orientation toward lifelong learning (mean = 3.57) than those in the low-strain group (mean = 3.42), high-strain group (mean = 3.39) and passive group (mean = 3.20). In conclusion, examining physicians' job demands, job control and social support helps us to understand their orientation toward lifelong learning and may provide insight to improve educational strategies.

Recruiting New Talent for Public Health Jobs With Evidence-Based Job Descriptions and Attractive Job Postings

CONTEXT

With $7.4 billion from the American Rescue Plan funding new hires in the public health workforce, health departments could benefit from well-written, accurate job descriptions and job postings/advertisements to attract candidates.

PROGRAM

We wrote accurate job descriptions for 24 jobs common in governmental public health settings.

IMPLEMENTATION

We searched the gray literature for existing templates of job descriptions, job task analyses, lists of competencies, or bodies of knowledge; synthesized several currently posted job descriptions per occupation; utilized the 2014 National Board of Public Health Examiners' job task analysis data; and gathered feedback from current public health professionals in each field. We then engaged a marketing specialist to change the job descriptions into advertisements.

DISCUSSION

Several occupations examined did not have available job task analyses, while others had multiple. This project appears to be the first time that a list of existing job task analyses have been compiled together. Health departments have a special opportunity to replenish their workforce. Having evidence-based and vetted job descriptions that can be tailored for specific health departments' usage will accelerate their recruitment efforts and attract more qualified candidates.

Evaluation of the updated SOCcer v2 algorithm for coding free-text job descriptions in three epidemiologic studies

OBJECTIVES

Computer-assisted coding of job descriptions to standardized occupational classification codes facilitates evaluating occupational risk factors in epidemiologic studies by reducing the number of jobs needing expert coding. We evaluated the performance of the 2nd version of SOCcer, a computerized algorithm designed to code free-text job descriptions to US SOC-2010 system based on free-text job titles and work tasks, to evaluate its accuracy.

METHODS

SOCcer v2 was updated by expanding the training data to include jobs from several epidemiologic studies and revising the algorithm to account for nonlinearity and incorporate interactions. We evaluated the agreement between codes assigned by experts and the highest scoring code (a measure of confidence in the algorithm-predicted assignment) from SOCcer v1 and v2 in 14,714 jobs from three epidemiology studies. We also linked exposure estimates for 258 agents in the job-exposure matrix CANJEM to the expert and SOCcer v2-assigned codes and compared those estimates using kappa and intraclass correlation coefficients. Analyses were stratified by SOCcer score, score distance between the top two scoring codes from SOCcer, and features from CANJEM.

RESULTS

SOCcer's v2 agreement at the 6-digit level was 50%, compared to 44% in v1, and was similar for the three studies (38%-45%). Overall agreement for v2 at the 2-, 3-, and 5-digit was 73%, 63%, and 56%, respectively. For v2, median ICCs for the probability and intensity metrics were 0.67 (IQR 0.59-0.74) and 0.56 (IQR 0.50-0.60), respectively. The agreement between the expert and SOCcer assigned codes linearly increased with SOCcer score. The agreement also improved when the top two scoring codes had larger differences in score.

CONCLUSIONS

Overall agreement with SOCcer v2 applied to job descriptions from North American epidemiologic studies was similar to the agreement usually observed between two experts. SOCcer's score predicted agreement with experts and can be used to prioritize jobs for expert review.

Reliability of O*NET physical exposures between Italian and US databases

BACKGROUND

Comparison between cross-national job-exposure matrices (JEMs) may provide indications of their reliability, particularly if created using the same items. This study evaluated concordance between two JEMs created from United States (US) and Italian O*NET data, using job codes linked through international job codes.

METHODS

Twenty-one physical exposures were obtained from the US and Italian O*NET databases. Italian O*NET items were direct translations of US O*NET items. Six hundred and eighty-four US and 586 Italian job codes were linked via crosswalks to 281 ISCO-08 job codes. A sensitivity study also assessed concordance on 258 jobs matched one-to-one across the two national job classifications. Concordance of US and Italian O*NET exposures was estimated by intraclass correlation coefficients (ICC) in multilevel models adjusted and not adjusted for country.

RESULTS

ICCs showed moderate to poor agreement for all physical exposures in jobs linked through ISCO-08 codes. There was good to moderate agreement for 14 out of 21 exposures in models with one-to-one matched jobs between countries; greater agreement was found in all models adjusted for country. Exposure to whole-body vibration, time standing, and working outdoor exposed to weather showed the highest agreement.

CONCLUSIONS

These results showed moderate to good agreement for most physical exposures across the two JEMs when US and Italian jobs were matched one-to-one and the analysis was adjusted for country. Job code assignments through crosswalks and differences in exposure levels between countries might greatly influence the observed cross-country agreement. Future multinational epidemiological studies should consider the quality of the cross-national job matching, and potential cross-national differences in exposure levels.

Use of Job Classifications, Career Ladders, and the Applied Epidemiology Competencies to Support Recruitment, Retention, and Practice of State Health Department Epidemiologists

CONTEXT

State health departments report that recruitment and retention of qualified epidemiologists is a significant challenge to ensuring epidemiology capacity to support essential public health services.

OBJECTIVE

To collect information on the use of epidemiology job classifications, career ladders, and professional competencies in state health departments to inform workforce development activities that improve epidemiology capacity.

DESIGN

Electronic survey of the designated state epidemiologist.

SETTING

Fifty state health departments and the District of Columbia.

PARTICIPANTS

State epidemiologists working in state health departments.

MAIN OUTCOME MEASURES

Use and perceived benefit of epidemiology job classifications, career ladders, and professional competencies.

RESULTS

All 50 states and the District of Columbia responded to the survey. Most state health departments reported having epidemiology-specific job classifications (n = 44, 90%) and career ladders (n = 36, 71%) in place. State epidemiologists strongly agreed or agreed that having an epidemiology-specific classification positively contributed to recruitment (n = 37, 84%) and retention (n = 29, 66%) of epidemiologists in their agency. State epidemiologists strongly agreed or agreed that having an epidemiology-specific career ladder positively contributed to recruitment (n = 24, 69%) and retention (n = 23, 66%) of epidemiologists in their agency. Only 10 (29%) state epidemiologists reported using the applied epidemiology competencies to develop or revise their jurisdiction's epidemiology career ladder.

CONCLUSIONS

State health departments should implement well-maintained epidemiology-specific job classifications and career ladders that are based on current epidemiology competencies. Career ladders should be supported with opportunities for competency-based training to support career progression.

''It sounded a lot simpler on the job description'': A qualitative study exploring the role of social prescribing link workers and their training and support needs (2020)

Social prescribing is an increasingly popular approach to promoting health and well-being, by addressing the wider determinants of health such as physical inactivity, social isolation and financial insecurity. Social prescribing link workers (SPs) connect people to local, non-clinical services. As part of the NHS Long Term Plan, NHS England aims to recruit 1,000 SPs across England by 2021. Understanding the role of SPs, including challenging aspects of the role and the types of training and support needed by SPs is crucial to optimising the effectiveness of social prescribing. Semi-structured qualitative interviews were conducted with nine SPs from five NHS and voluntary sector organisations in London to explore the role of SPs and identify SP training and support needs. Interviews were analysed thematically and three key themes emerged for which SPs needed particular support: defining and promoting their role; supporting clients with complex needs and coping with the emotional demands of their role. SP perceptions of training and future training needs is presented as a fourth theme. Most SPs felt that the initial training received for their role did not prepare them for the most demanding aspects of their roles. The findings of this study support the assertion that the social prescribing link worker role is complex and challenging. SPs are required to have in-depth knowledge of local services, which is built over time and makes retention in the role of high importance. Steps have been taken to develop online resources to support SPs, however, there may be a need for more comprehensive training, especially in mental health. SPs benefit from access to peer or one-to-one support to help them manage the emotional demands of the role and could benefit from the formation of local networks, especially for SPs working in isolation.

Data-Based Self-awareness as the Foundation for Effective Leadership

The AONL Nurse Executive Fellowship supports nurses who are new to an executive role in developing critical executive competencies. Participants engage in an in-depth specialized assessment process to help them understand themselves and the impact on their leadership. Learnings from the 1st 2 cohorts of fellowship participants provide insight into challenges faced by new executives and how self-awareness can improve performance to address those challenges.

Prediction of 10-year atherosclerotic cardiovascular disease risk among community residents in Shanghai, China - a comparative analysis of risk algorithms

BACKGROUND AND AIMS

The accuracy of various 10-year atherosclerotic cardiovascular disease (ASCVD) risk models has been debatable. We compared two risk algorithms and explored clustering patterns across different risk stratifications among community residents in Shanghai.

METHODS AND RESULTS

A total of 28,201 residents (aged 40-74 years old) who were free of ASCVD were selected from the Shanghai Survey in China. The 10-year ASCVD risk was estimated by applying the 2013 Pooled Cohort Equations (PCEs) and Prediction for ASCVD Risk in China (China-PAR). The agreement was assessed between PCEs and China-PAR using Cohen's kappa statistics. The mean absolute 10-year ASCVD risk calculated by PCEs and China-PAR was about 10.0% and 6.0%, respectively. PCEs estimated that 44.9% of participants [with a 95% confidence interval (CI):44.0%-45.8%] were at high risk, while China-PAR estimated only 16.7% (95%CI:15.8%-18.0%) were at high risk. In both models, the percentage of high ASCVD risk was higher for participants who were older, men, less educated, current smokers, drinkers and manual workers. Among high-risk individuals, almost all participants (PCEs:90.5%; China-PAR:98.6%) had at least one risk factor; hypertension being the most prevalent. The concordance between PCEs and China-PAR was moderate (kappa:0.428, 95%CI: 0.420-0.434) with a better agreement for women (kappa:0.503,95%CI: 0.493-0.513) than for men (kappa:0.211,95%CI: 0.201-0.221).

CONCLUSION

The proportion of participants with a 10-year ASCVD high risk predicted by China-PAR was lower than the results of the PCEs. The risk stratifications of the two algorithms were inconsistent in terms of demographic and life-behaviour characteristics.

Developing Committed Resident Leaders: A Survey of the Administrative Chief Resident Experience in Surgical Fields

OBJECTIVE

Administrative chief residents (ACRs) are integral to residency programs, however little research has been done on the experiences, training, and support of ACRs in surgical fields. The objective of this study was to define the challenges and experiences of surgical ACRs and identify support needed to make them successful.

DESIGN

A Qualtrics survey was electronically distributed to participants. Response styles included multiple choice questions, yes/no, Likert scales, and short answers. Question topics included demographics, ACR duties, support, and experiences.

SETTING

Obstetrics & Gynecology and General Surgery residency programs in the United States.

PARTICIPANTS

Current and past administrative chief residents (2019-2020; 2018-2019) and program directors from Obstetrics & Gynecology and General Surgery residency programs.

RESULTS

Seventy-nine surveys were completed by 48 (61%) ACRs and 31 (39%) program directors. The majority (52%) were from academic programs with a median of 6 residents and 2 ACRs per year. On a 10-point Likert scale, mean perceived support from faculty, program director, administration, and other residents was 7.0, 8.8, 6.7, and 7.7 respectively; however, mean stress level was also perceived to be high. Regarding preparation for the role, 56% of administrative chief residents do not receive a job description, 41% do not have a formal handoff process, 42% do not have formal leadership training, and only 61% agreed or strongly agreed that the administrative chief role was clear prior to starting. Common challenges reported by ACR's are limited preparation and training, conflict resolution, and workload management. Many ACRs felt they would benefit from formal leadership training and protected time.

CONCLUSIONS

These results summarize the experiences of ACRs in surgical residencies. Best practices and formal training in identified challenge areas should be added to residency curriculum and used to develop toolkits to support ACRs nationwide.

The Impact of the Fourth Industrial Revolution on Managers' Sense of Coherence

The Fourth Industrial Revolution (4IR) disrupts the world of work, new technologies change the nature of individuals' work and their tasks, and therefore it is necessary to determine how managers cope with these changes, specifically relating to their salutogenesis. There is a lack of research conducted on the salutogenesis of managers in times of the 4IR. The purpose of this study is to investigate the level of managers' sense of coherence (SOC) in terms of the adjustments and developments of the 4IR, and their in-depth understanding of their SOC. This study employs a hermeneutical research design with a qualitative approach by using a semi-structured interview. The method used to analyze the data was content analysis. From the data analysis, the findings indicate that a majority of the managers tend to have an understanding of the 4IR and what implications of the 4IR will have on the world of work and their job description, the necessary resources to cope with the 4IR, and find the 4IR meaningful, therefore, managers have a strong SOC level during the 4IR. The recommendations for future studies suggest that research could be conducted how managers and lower-level managers' SOC differ, which will provide insight into what different methods are required for the different level of managers.

Update on Pharmacist Workforce Data and Thoughts on How to Manage the Oversupply

The annual number of Doctor of Pharmacy (PharmD) graduates is projected to exceed the number of annual pharmacist job openings over the next 10 years. Loss of retail sector jobs will be partially offset by projected gains in several other sectors; however, oversupply will persist until the number of graduates is more reflective of job market capacity. Large-scale practice transformation will not happen overnight; consequently, schools and colleges of pharmacy must immediately change their perspective from producing graduates to fill pharmacist roles, to producing graduates who are prepared with expertise and professional skills to excel in many types of well-paying positions. Students need career advice including to convince potential employers how a PharmD education has prepared them with transferable high-level skills that are applicable beyond traditional pharmacist roles. Better communicating the value of pharmacy skills to students and employers may also have a positive impact on admission numbers as prospective applicants become more aware of the breadth of pharmacy career opportunities.

Prevalence of Musculoskeletal Symptoms in Interventional Radiologists

PURPOSE

To investigate the prevalence of musculoskeletal symptoms, defined as aches, pains, discomfort, or numbness, by using a validated assessment tool among interventional radiologists.

MATERIALS AND METHODS

A Web-based survey using the Nordic Musculoskeletal Questionnaire was disseminated to interventional radiologist members by email in November 2015. Musculoskeletal symptoms were evaluated in 9 body areas. Information regarding participant demographics, practice details, use of radio-protective equipment, and exercise routines was also gathered. Univariate and multivariate analyses were performed to determine risk factors associated with more severe symptoms.

RESULTS

Of 4,096 SIR members at the time of the survey, 640 completed the questionnaire in its entirety (16% response rate). Respondents consisted of 69 females (11%) and 571 males (89%), with a mean age of 47.5 ± 10.2 years old, a mean body mass index of 25.5 ± 3.9 kg/m², and a mean practice length of 17.1 ± 9.8 years. Prevalence of musculoskeletal symptoms was 88% in the 12 months preceding the survey. For those reporting musculoskeletal issues, 58% attributed the symptoms to work-related activities. Lower back (61%), neck (56%), and shoulder complaints (46%) were the most common. Symptoms prevented 21.2% of respondents from being able to work over the same time period. Multivariate analysis identified female gender, above-normal body mass index, and a practice length of 10 years or more as factors associated with a higher risk of moderate-to-severe symptoms.

CONCLUSIONS

Musculoskeletal symptoms are prevalent among interventional radiologists, the majority of which are attributed to work-related causes.

Qualitative and quantitative approach to assess of the potential for automating administrative tasks in general practice

OBJECTIVE

To identify the extent to which administrative tasks carried out by primary care staff in general practice could be automated.

DESIGN

A mixed-method design including ethnographic case studies, focus groups, interviews and an online survey of automation experts.

SETTING

Three urban and three rural general practice health centres in England selected for differences in list size and organisational characteristics.

PARTICIPANTS

Observation and interviews with 65 primary care staff in the following job roles: administrator, manager, general practitioner, healthcare assistant, nurse practitioner, pharmacy technician, phlebotomist, practice nurse, pharmacist, prescription clerk, receptionist, scanning clerk, secretary and medical summariser; together with a survey of 156 experts in automation technologies.

METHODS

330 hours of ethnographic observation and documentation of administrative tasks carried out by staff in each of the above job roles, followed by coding and classification; semistructured interviews with 10 general practitioners and 6 staff focus groups. The online survey of machine learning, artificial intelligence and robotics experts was analysed using an ordinal Gaussian process prediction model to estimate the automatability of the observed tasks.

RESULTS

The model predicted that roughly 44% of administrative tasks carried out by staff in general practice are 'mostly' or 'completely' automatable using currently available technology. Discussions with practice staff underlined the need for a cautious approach to implementation.

CONCLUSIONS

There is considerable potential to extend the use of automation in primary care, but this will require careful implementation and ongoing evaluation.

Effects of introduction of an inflammatory bowel disease nurse position on healthcare use

OBJECTIVE

Inflammatory bowel diseases (IBDs) are chronic relapsing remitting diseases which potentially result in hospitalisation, requiring long-term outpatient follow-up, ideally by a dedicated, multidisciplinary team. In this team, the IBD nurse is the key point of access for education, advice and support.The aim of this study was to assess the impact of introduction of an IBD nurse position on healthcare use and costs in a tertiary IBD centre.

METHODS

An IBD nurse was instituted in September 2017 in our multidisciplinary IBD team. We compared differences in healthcare use 1 year before and 1 year after the introduction of an IBD nurse position for all the patients with a confirmed diagnosis of IBD attending the Robert Debre Hospital via two information sources: Programme de Médicalisation des Systèmes d'Information and Centre des Maladies Rares.

RESULTS

252 patients (78.5% of patients with IBD followed up in our centre) were included in the patient education programme. After the introduction of an IBD nurse position, fewer patients were hospitalised for a flare, with less hospital stays: 56 before vs 28 after (p=0.002). An estimated saving of €35 070 was achieved through the decrease of hospitalisations for flare.More patients were also hospitalised for diagnosis: 32 hospitalisations before vs 54 hospitalisations after (p=0.001). All other hospitalisation categories were comparable, and the same reasons for hospitalisation were found before and after.

CONCLUSION

This study demonstrates that the IBD nurse position reduces hospital admissions. Instead of the traditional model, the IBD nurse provides accessible advice and allows patients to be outpatients.

Facilitating Advancement of Clinical-Track Pharmacy Faculty Members

Clinical faculty members in most pharmacy practice departments are expected to engage in practice, teaching, research and scholarship, and service. Although new clinical faculty members are typically well equipped to engage in the clinical practice aspect of their position, they generally lack experience in the other academic pillars and, depending on the institution, may not have dedicated time to engage in each area of effort, particularly research and scholarship. Consequently, achieving balance and realizing success in the tripartite mission of academia can be challenging. A multimodal approach can be used to facilitate advancement among clinical faculty members through faculty development and mentoring, attention to workload, clear expectations, and provision of feedback on performance and progression toward goals. This approach, which has been well received, has been associated with higher rates of promotion among clinical faculty members at one institution. Schools and colleges of pharmacy that value research and scholarship and are struggling to facilitate advancement among clinical faculty members may consider adopting some or all aspects of this program.

Public Health Workforce Self-Identified Training Needs by Jurisdiction and Job Type

CONTEXT

Ensuring adequate and appropriate training of the workforce is a crucial priority for governmental public health. This is particularly important, given the diverse backgrounds of the public health workforce; the vast majority (approximately 83%) do not have formal training in public health, and those that do have formal training in public health have limited training in management and other essential organizational skills.

OBJECTIVE

The purpose of this article is to identify training needs among public health workers in specific job types and settings.

DESIGN AND PARTICIPANTS

This cross section study used 2014 data from the Public Health Workforce Interests and Needs Survey. Qualitative analyses were used to code open-ended responses to questions about training needs. Needs are stratified across job types and jurisdiction.

RESULTS

Eight main themes or skill areas were identified with the largest proportion indicating a need for management/leadership skills (28.2%). The second most frequent need was communication skills (21.3%). Across the 9 job types examined, general management skills were either the first or second training need for 7 job types. Among individuals who already have leadership/management positions, budgeting was the most common training need.

CONCLUSIONS

Findings from this study can inform targeted strategies to address training needs for specific types of employees. Such strategies can influence the efficiency and effectiveness of public health efforts and employee satisfaction. As new public health frameworks-like Public Health 3.0 and the Chief Health Strategist-are advanced nationally, it is necessary to ensure that the workforce has the skills and abilities to implement these frameworks.

How Should Commerce and Calling Be Balanced?

Physicians and all health professionals need to find an appropriate balance between the interests of individual patients and their organization's bottom line. Corporatization in health care has complicated such efforts. More and more health professionals function as employees of health care organizations, some of which value leaders' and shareholders' interests over those of patients. When faced with such conflicts, physicians bear a responsibility to put patients first and to advocate for their profession.

The specialist dermatology nurse: providing expert care to patients

Sandra Lawton, Nurse Consultant, Dermatology, Rotherham NHS Foundation Trust, describes the wide variety of work undertaken by nurses specialising in dermatology.

"They say we have a choice, but we don't": A gendered reflection on work-family strategies and planning systems of atypical schedules within male-dominated occupations in Canada and Switzerland

For parents working in the transportation industry, atypical schedules are often a daily puzzle. Schedule planning systems allowing workers to choose shifts may affect job strenuousness and work-family balance (WFB) for both female and male workers. How could ergonomic interventions related to the implementation of those systems better consider gender dynamics regarding WFB strategies, and minimize inequities among workers? This article presents a joint analysis of two independent case studies related to ergonomic interventions in transport companies in Canada and Switzerland. Direct observation and semi-structured interviews shed light on the characteristics of schedule planning systems and their interaction with men's and women's WFB strategies. Issues related to each step of the planning process (shift construction, schedule choice, day-to-day schedule management) are discussed to inform interventions aimed at facilitating WFB, and ultimately gender equity, in atypical schedule contexts.

How Can Job Crafting Be Reproduced? Examining the Trickle-Down Effect of Job Crafting from Leaders to Employees

This study seeks to examine how and when job crafting trickles down from leaders to followers in a team context. Drawing on social learning theory, we hypothesize that team leaders' job resources mediate the relationship between team leaders' job crafting and team members' job crafting. Empowering leadership is proposed to strengthen the mediation effect, such that under a stronger (higher) empowering leadership style the relationship between team leaders' job resources and team members' job crafting is further strengthened, thereby positively influencing the overall mediated relationship. We tested our multilevel moderated mediation model with leader-subordinate paired data from 64 work teams in seven Chinese enterprises over two time periods. The results support our hypothesized mediated relationship; however, contrary to our prediction, we find that empowering leadership negatively moderates the relationship between team leaders' job resources and team members' job crafting, and weakens the mediation effect of team leaders' job resources. Theoretical and practical implications are discussed.

Wrist pain: a systematic review of prevalence and risk factors- what is the role of occupation and activity?

OBJECTIVE

To evaluate the prevalence and risk factors of wrist pain.

METHODS

Systematic review.

DATA SOURCES

The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from database inception to 9th March 2018. Specific criteria were used to define inclusion and exclusion. Data was extracted independently by a pair of reviewers.

RESULTS

In total 32 cross sectional studies were identified for inclusion (1 with a longitudinal component). The median prevalence of wrist pain in the general population and non-manual workers within the short term (within last week) was 6 and 4.2% within the medium term (> 1 week and within a year). The median prevalence of wrist pain in physically demanding occupations and sports people was 10% within the short term and 24% within the medium term. Non-modifiable factors associated with wrist pain included increased age (1 study in adults and 3 studies in children/adolescents) and female sex (2 studies). Modifiable risk factors included high job physical strain (2 studies), high job psychological strain (1 study), abnormal physeal morphology in children/adolescents (2 studies), high frequency impact tool use (1 study) and effort reward imbalance (1 study).

CONCLUSIONS

Wrist pain is highly prevalent in groups who partake in physically demanding activities from day to day such as manual labourers and sportspeople. It is less prevalent in the general population and non-manual workers, although there is a relative lack of research in the general population.

TRIAL REGISTRATION

The review protocol was registered with PROSPERO under the registration number CRD42018090834.

LEVEL OF EVIDENCE

1 (Prognostic study).

Does Visual Aesthetics of the Workplace Matter? Analyzing the Assessment of Visual Aesthetics as Antecedent of Affective Commitment and Job Crafting

In this work, two objectives were addressed. First, the visual aesthetics assessment of the workplace was explored for the first time as a potential antecedent of the proactive behaviors of job crafting. Second, the potential mediating role of the affective organizational commitment in this relationship was analyzed. To address these purposes, a field study was conducted with a sample of 428 workers. Following a set of hypotheses, the results of the measurement model, χ2 (df) = 494.288 (215); CFI = .920; TLI = .906; RMSEA = .066, showed that the visual aesthetics assessment of the workplace was significantly correlated with three of the four dimensions of job crafting (r = .19 with ISO-JR, r = .15 with IC-JD and; r = .17 with IST-JR; p < .001) and with affective organizational commitment (r = .27, p < .001). In addition, through a structural equation model, χ2(df) = 494.895 (219); CFI = .921; TLI = .909; RMSEA = .065, positive and significant indirect effects were found from the visual aesthetic assessment of the workplace to the same three dimensions of job crafting, all through the affective organizational commitment: .17 with ISO-JR, .25 with IC-JD and, .23 with IST-JR; 95% CI [.097, .276], [.161, .361] and [.161, .361], respectively. The results obtained provide useful evidence for researchers and managers about the value of providing an aesthetically satisfactory workplace, which would enhance the affective commitment of employees and, consequently, positively affect the proactive behaviors of job crafting.

Job satisfaction, work commitment and intention to leave among pharmacists: a cross-sectional study

OBJECTIVES

We assessed job satisfaction, work commitment and intention to leave among pharmacists working in different healthcare settings in Saudi Arabia.

DESIGN

This was a cross-sectional study utilising a previously validated questionnaire.

SETTING

We surveyed the workforce at different healthcare settings in Riyadh, Saudi Arabia.

PARTICIPANTS

The participants were pharmacists licensed by the Saudi Commission for Health Specialties.

OUTCOME MEASURES

We examined job satisfaction, work commitment and intention to leave.

RESULTS

In total, 325 out of 515 pharmacists completed the questionnaire, yielding a response rate of 63%. Over half of them were women (57.8%), 78.2% were Saudi Arabian nationals and 61.8% were married. The majority (88.1%) worked between 36 and 44 hours per week; 96.6% were full-time employees, and 63.4% were government employees working in public hospitals or primary healthcare centres. Although most of the pharmacists were satisfied (satisfied and slightly satisfied) with their current job (39.1% and 24.6%, respectively), about two-thirds (61.9%) had the intention to leave. Multiple logistic regression analysis showed that the most important predictors of pharmacists' intentions to leave were related to job satisfaction and work commitment (OR=0.923; 95% CI 0.899 to 0.947; p<0.001 and OR=1.044; 95% CI 1.014 to 1.08; p=0.004, respectively), whereas respondents' demographic characteristics had no effect.

CONCLUSIONS

Although the pharmacists surveyed were satisfied and committed to their current job, they had the intention to leave. Further research is recommended to clarify why pharmacists in Saudi Arabia have the intention to leave their pharmacy practice job.

Psychosocial working conditions, trajectories of disability, and the mediating role of cognitive decline and chronic diseases: A population-based cohort study

BACKGROUND

Unfavorable psychosocial working conditions have been associated with cognitive decline and chronic diseases, both of which may subsequently accelerate functional dependence. This study aimed to investigate the association between job demand-control-support combinations and trajectories of disability in later life and to further explore the role of cognitive decline and the co-occurrence of chronic diseases in mediating this association.

METHODS AND FINDINGS

In this cohort study, 2,937 community dwellers aged 60+ years (mean age 73 ± 10.6; 62.9% female) residing in the Kungsholmen District of Stockholm, Sweden, participated in the baseline survey (2001-2004) and were followed up to 12 years. Lifelong occupational history was obtained through a standardized interview; job demands, job control, and social support at work in the longest-held occupation were graded with a psychosocial job-exposure matrix. Job control, demands, and social support were dichotomized using the median values from the matrix, respectively, to further generate demand-control-support combinations. Disability was measured by summing the number of impaired basic and instrumental activities of daily living. Global cognitive function was assessed by Mini-Mental State Examination. Chronic conditions were ascertained by clinical examinations, medical history, and patient clinical records; the total number of chronic diseases was summed. Data were analyzed using linear mixed-effects models and mediation analysis. Age, sex, education, alcohol consumption, smoking, leisure activity engagement, early-life socioeconomic status, occupational characteristic and physical demands, and baseline cognitive function and number of chronic diseases were adjusted for in the analyses. Compared with active jobs (high control/high demands; n = 1,807), high strain (low control/high demands; n = 328), low strain (high control/low demands; n = 495), and passive jobs (low control/low demands; n = 307) were all associated with a faster rate of disability progression (β = 0.07, 95% CI 0.02-0.13, p = 0.01; β = 0.10, 95% CI 0.06-0.15, p < 0.001; β = 0.11, 95% CI 0.05-0.18, p < 0.001). The association between high strain and disability progression was only shown in people with low social support at work (β = 0.13, 95% CI 0.07-0.19, p < 0.001), but not in those with high social support (β = 0.004, 95% CI -0.09 to 0.10, p = 0.93). Moreover, we estimated that the association between demand-control status and disability trajectories was mediated 38.5% by cognitive decline and 18.4% by accumulation of chronic diseases during the follow-up period. The limitations of this study include unmeasured confounding, self-reported work experience, and the reliance on a psychosocial job-exposure matrix that does not consider variabilities in individuals' perception on working conditions or job characteristics within occupations.

CONCLUSIONS

Our findings suggest that negative psychosocial working conditions during working life may accelerate disability progression in later life. Notably, social support at work may buffer the detrimental effect of high strain on disability progression. Cognitive decline and chronic-disease accumulation, and especially the former, partially mediate the association of psychosocial working conditions with trajectories of disability. Further studies are required to explore more mechanisms that underlie the association between psychosocial working conditions and disability trajectories.

How important is embeddedness in predicting Australian speech-language pathologists' intentions to leave their jobs and the profession?

PURPOSE

This study explored the predictors of the outcomes of turnover and occupation attrition intentions for speech-language pathologists. The researchers examined the mediating effects of job satisfaction and strain on the relationship between stress and the latter outcomes. Additionally, the researchers examined the importance of embeddedness in predicting turnover intentions after accounting for stress, strain and job satisfaction.

METHOD

An online questionnaire was used to explore turnover and attrition intentions in 293 Australian speech-language pathologists.

RESULT

Job satisfaction contributed to a significant indirect effect on the stress and turnover intention relationship, however strain did not. There was a significant direct effect between stress and turnover intention after accounting for covariates. Embeddedness and the perceived availability of alternative jobs were also found to be significant predictors of turnover intentions. The mediating model used to predict turnover intentions also predicted occupation attrition intentions. The effect of stress on occupation attrition intentions was indirect in nature, the direct effect negated by mediating variables. Qualitative data provided complementary evidence to the quantitative model.

CONCLUSION

The findings indicate that the proposed parsimonious model adequately captures predictors of speech-language pathologists' turnover and occupation attrition intentions. Workplaces and the profession may wish to consider these retention factors.

Diabetes and work: The need of a close collaboration between diabetologist and occupational physician

AIM

The Italian Society of Occupational Medicine (SIML), the Italian Diabetes Society (SID) and the Association of Diabetologists (AMD) joined a working group that produced a consensus paper aimed to assess the available evidence regarding the interplay between specific working conditions, including shift- and night-time work, working activities at high risk of accidents and work at heights, working tasks requiring high-energy expenditure, working activities at extreme temperatures and diabetes.

DATA SYNTHESIS

Diabetes is a group of metabolic disorders caused by defects in insulin secretion and/or action affecting millions of people worldwide, many of whom are or wish to be active members of the workforce. Although diabetes, generally, does not prevent a person from properly performing his/her working tasks, disease complications can significantly compromise a person's ability to work. Therefore, it appears evident the need to understand the relationship between occupational risk factors and diabetes. The working group included in the document some practical recommendations useful to ensure diabetic workers the possibility to safely and effectively undertake their jobs and to adequately manage and treat their disease, also in the workplace. In this perspective concerted action of all the workplace preventive figures, occupational physicians and diabetologists should be strongly encouraged.

CONCLUSIONS

Further studies are necessary to define workplace-based interventions, which should be minimally invasive towards the work organization, allowing diabetic workers to fully realize their work skills while improving their wellbeing at work.

Identifying cut-off scores for job demands and job control in nursing professionals: a cross-sectional survey in Germany

OBJECTIVES

Nurses are generally found to be vulnerable to burnout, but nurses working in cancer care are even more so, since this profession is characterised by continuous confrontation with suffering and death. This study was designed to identify cut-off scores for job strain, that is, low job control and high job demands, for a sample of nurses working in breast cancer care. The main goal was to find cut-off scores, which predict the risk of nurses of developing a mental disorder from high job strain.

DESIGN

The design was a cross-sectional survey study.

SETTING

The study is based on an employee survey in breast cancer centres in Germany.

PARTICIPANTS

688 nurses received a questionnaire; 329 nurses from 33 hospitals participated in the survey (return rate: 50.2%).

PRIMARY AND SECONDARY OUTCOME MEASURES

Dependent variable: psychological well-being, measured by the WHO-5 Well-being Index; independent variables: job control and job demands, measured by the Job Content Questionnaire (JCQ).

RESULTS

Multivariable analysis indicates that low job control and high job demands are prognostic factors for low well-being. In a receiver operating curve (ROC) analysis, the cut-off scores, which demonstrated a maximum Youden index, were 34.5 for job control and 31.4 for job demands. The combination of both scales from a logistic regression analysis resulted in an area under the curve of 0.778. Sensitivity and specificity are 70.3% and 74.2%, respectively. The total of correct classification was 63.3%.

CONCLUSION

The determined cut-off scores indicate that there is a risk of becoming psychologically ill from a high workload when an individual reaches a score of ≤34.5 for job control and ≥31.4 for job demands. The described method of establishing risk-based cut-off scores is promising for nursing practice and for the field of occupational health. Transferability and generalisability of the cut-off scores should be further analysed.

Employers' Perspectives on Accommodating and Retaining Employees with Newly Acquired Disabilities: An Exploratory Study

Introduction Timely and appropriate accommodations can help employees who experience disabilities stay at work instead of exiting the labor force. Employers can play a critical role in connecting such workers with the accommodations they need. This qualitative study seeks to inform policy makers who want to improve workforce retention outcomes by uncovering factors that affect whether employers provide accommodations to, and ultimately retain, employees with disabilities. Methods We conducted semistructured interviews with a convenience sample of human resources professionals in 14 Arkansas-based employers, yielding detailed information on 50 cases in which an employee developed or disclosed a disability. We analyzed the interviews using a grounded theory approach and compared cases to identify key themes emerging across subgroups of cases. Results Two organization-level factors and four employee-level factors influenced employers' efforts to accommodate and retain employees with disabilities: employer resources; employers' communication with the employee and other stakeholders; employee tenure; employee work performance; active/sedentary nature of employee role; and the severity and type of employees' health conditions. Conclusions Consistent with prior literature, employers with greater access to resources and better ability to communicate generally made greater effort to accommodate and retain employees with disabilities. However, employers in the study did not deploy these resources and processes consistently when making decisions about whether and how to provide accommodations to workers with disabilities; employee-level characteristics affected their actions. Policy makers should consider intervention approaches that reach workers who may be overlooked by employers with scarce resources.

Incidence of filled antidepressant prescriptions among people with newly diagnosed diabetes and its interaction with occupational status within the working population of Denmark 1996-2010

AIMS

People with diabetes have heightened levels of depressive symptoms, but less is known about the development of these symptoms in relation to diabetes duration. In this study, we examined the use of prescribed antidepressants in the first five years after diagnosis of diabetes among the working-age population in Denmark.

METHODS

All Danish adults aged 18-54 years, diagnosed with diabetes in the study period were included. Diabetes status and purchase of prescription antidepressants were obtained from validated population registers. Data analysis focused on filled antidepressant prescriptions at ≤1 and ≤5years from diagnosis with diabetes.

RESULTS

35,677 people diagnosed with diabetes were included in the study. At ≤1 year post-diagnosis, 2.6% had filled antidepressant prescriptions. At ≤5years, this figure rose to 10.4%. Overall, both female gender and lower socioeconomic status were associated with higher incidence of filled antidepressant prescriptions. Diabetes duration modified the degree of differences between men and women and socioeconomic strata.

CONCLUSION

Diagnosis with diabetes immediately impacts mental wellbeing, with higher rates of filled antidepressant prescriptions in the first year after diagnosis. People of working age diagnosed with diabetes face specific challenges and addressing such challenges would enhance patient experiences. Focus on mental health in the clinical encounter with people newly diagnosed with diabetes is warranted and important.

[Promising Future in General Internal Medicine for the Next Generation of Physicians]

Promising Future in General Internal Medicine for the Next Generation of Physicians Abstract. We are facing a lack of specialists in general internal medicine in general practitioners' practices as well as in hospitals, while at the same time the population ages and usually displays several chronic diseases (multimorbidity). Thanks to more university places, an improved job description for general internal medicine and new further education offers (curricula), interest in general internal medicine increased again, as surveys of students indicate. The young generation of family doctors and generalists in hospitals wishes flexible working conditions in order to reconcile work, family and spare time in the best possible way. Working atmosphere and colleagues have a high priority. These wishes must now be incorporated into attractive further training with flexible curricula and mentoring offers so that young talents can successfully be promoted.

Science in the clinic: a qualitative study of the positioning of MD-PhDs in the everyday clinical setting

BACKGROUND

MD-PhDs have been hailed as significant to the advancement of medicine and health care. Yet when it comes to which positions MD-PhDs should be holding in the clinic and the academic world, there seems to be no real consensus. This article examines the ways in which a PhD-degree may contribute to medical doctors' professional practice in the clinic and discusses the positioning of MD-PhDs in the clinic.

METHODS

The study is explorative and qualitative, based on interviews with MD-PhDs, their physician colleagues without a PhD-degree, and their leaders. Positioning theory was applied as the analytical framework for data analysis.

RESULTS

We found two opposing positions cutting across the groups of informants with one side critiquing the MD-PhDs for not doing enough research and for using the PhD-degree to climb the career ladder, while the other side emphasized the ways in which MD-PhDs increase the clinical focus on evidence-based medicine and integrate it with clinical decision making, thereby enhancing patient care.

CONCLUSIONS

A debate is needed to establish more clearly how we wish to position MD-PhDs in the clinic, which in turn will give us a better idea of how many to educate and how to make better use of their competencies.

CDC's "Flexible" Epidemiologist: A Strategy for Enhancing Health Department Infectious Disease Epidemiology Capacity

CONTEXT

CDC's Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Cooperative Agreement aims to help health departments strengthen core epidemiology capacity needed to respond to a variety of emerging infectious diseases. In fiscal year 2014, $6 million was awarded to 41 health departments for flexible epidemiologists (FEs). FEs were intended to help meet health departments' unique needs and support unanticipated events that could require the diversion of resources to specific emerging or reemerging diseases.

OBJECTIVE

Explore multiple perspectives to characterize how FEs are utilized and to understand the perceived value of this strategy from the health department perspective.

DESIGN, SETTING, AND PARTICIPANTS

We conducted 14 in-depth interviews using a semistructured questionnaire with a heterogeneous sample of 8 state health departments; 2 different instruments were administered to ELC principal investigators (PIs) or supervisors, and FEs. The team produced a codebook consisting of both structural and data-driven codes to prepare for a thematic analysis of the data.

RESULTS

Three major patterns emerged to describe how FEs are being used in health departments; most commonly, FEs were used to support priorities and gaps across a range of infectious diseases, with an emphasis on enteric diseases. Almost all of the health departments utilized FEs to assist in investigating and responding to outbreaks, maintaining and upgrading surveillance systems, and coordinating and collaborating with partners. Both PIs and supervisors highly valued the flexibility it offered to their programs because FEs were cross-trained and could be used to help with situations where additional staff members were needed.

CONCLUSION

ELC enhances epidemiology capacity in health departments by providing flexible personnel that help sustain areas with losses in capacity, addressing programmatic gaps, and supporting unanticipated events. Our findings support the notion that flexible personnel could be an effective model for strengthening epidemiology capacity among health departments.

IMPLICATIONS FOR POLICY & PRACTICE

Our findings have practical implications for addressing the overall decline in the public health workforce, as well as the current context and environment of public health funding at both state and federal levels.

Job titles need to reflect modern times and go gender neutral

The chance to update nursing and midwifery titles can not only help streamline the confusing array of roles, but ensure that trusts employ bona fide registrants, suggests Sam Foster, Chief Nurse, Oxford University Hospitals.

A primer on entrustable professional activities

Entrustable professional activities (EPAs) have become a popular topic within competency-based medical education programs in many countries and hundreds of publications within only a few years. This paper was written to introduce the ins and outs of EPAs. After a brief historical overview, the rational of EPAs, as a bridge between a competency framework and daily clinical practice, is explained. Next, entrustment decision-making as a form of assessment is elaborated and framework of levels of supervision is presented. For readers interested to apply the concept in practice a stepwise approach to curriculum development is proposed. The paper concludes with an overview of the state of the art of working with EPAs in across disciplines, professions and countries.

Community intellectual disability nurses' public health roles in the United Kingdom: An exploratory documentary analysis

The aim of this study was to explore how public health policy in the United Kingdom was reflected in community intellectual disability nurses' (CIDNs)' job descriptions and person's specifications. The role of CIDNs has evolved due to policy changes. As these roles evolve, job descriptions and person specifications are important in highlighting employer's expectations staff, priorities, and professional values of their employees. This study involved an exploratory documentary analysis of n = 203 CIDNs' job descriptions and person specifications in the context of role theory. The CIDNs' public health roles identified in this study are health education, health protection, health prevention, health surveillance, and health promotion. Key policies themes were intellectual disability health access, public health strategies, policy evaluation/redesign, and public health policy. There is a lack of public health role clarity and inconsistency in role expectations across organizational boundaries in the United Kingdom.