Residents and Consultants Have Equal Outcomes When Performing Transrectal Fusion Biopsies: A Randomized Clinical Trial

The aim of our study was to compare the performance of residents vs. consultants in transrectal fusion prostate biopsies (FUS-PBs), as well as patient-reported comfort. Between January 2021 and October 2022, a consecutive series of patients undergoing FUS-PBs were randomized into two groups: (A) FUS-PBs performed by a consultant; (B) FUS-PBs performed by trained residents (>50 procedures). All patients underwent FUS-PBs with 12 systematic cores and 3/6 target cores. The detection rate and number of positive cores in the target lesion were compared between groups, and the patient's discomfort after the procedure was evaluated using the VAS scale. Overall, 140 patients with a median age of 72 years were enrolled. Overall, 69/140 (49.3%) presented prostate cancer and 53/69 (76.8%) presented a clinically significant cancer (Grade Group ≥ 2). Consultants presented a detection rate of 37/70 (52.9%) and residents a detection rate of 32/70 (45.7%) (p > 0.2); the mean number of positive cores in the index lesion was similar in both groups (1.5 vs. 1.1; p > 0.10). In terms of the patients' experiences, the procedure was well tolerated, with a median VAS score of 2 in both groups, with no statistically significant differences. Residents showed satisfactory outcomes in terms of detection rate, procedural time, and patient comfort when performing prostate biopsies. Residents, after adequate training, can safely perform prostate biopsies.

Smartphone and Mobile App Use Among Physicians in Clinical Practice: Scoping Review

BACKGROUND

Health care professionals are increasingly using smartphones in clinical care. Smartphone use can affect patient quality of care and clinical outcomes.

OBJECTIVE

This scoping review aimed to describe how physicians use smartphones and mobile apps in clinical settings.

METHODS

We conducted a scoping review using the Joanna Briggs Institute methodology and reported the results according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. We used the following databases in our literature search: MEDLINE, Embase, Cochrane Library, Web of Science, Google Scholar, and gray literature for studies published since 2010. An additional search was also performed by scanning the reference lists of included studies. A narrative synthesis approach was used.

RESULTS

A total of 10 studies, published between 2016 and 2021, were included in this review. Of these studies, 8 used surveys and 2 used surveys with focus group study designs to explore smartphone use, its adoption, experience of using it, and views on the use of smartphones among physicians. There were studies with only general practitioners (n=3), studies with only specialists (n=3), and studies with both general practitioners and specialists (n=4). Physicians use smartphones and mobile apps for communication (n=9), clinical decision-making (n=7), drug compendium (n=7), medical education and training (n=7), maintaining health records (n=4), managing time (n=4), and monitoring patients (n=2) in clinical practice. The Medscape medical app was frequently used for information gathering. WhatsApp, a nonmedical app, was commonly used for physician-patient communication. The commonly reported barriers were lack of regulatory oversight, privacy concerns, and limited Wi-Fi or internet access. The commonly reported facilitator was convenience and having access to evidence-based medicine, clinical decision-making support, and a wide array of apps.

CONCLUSIONS

Smartphones and mobile apps were used for communication, medical education and training, clinical decision-making, and drug compendia in most studies. Although the benefits of smartphones and mobile apps for physicians at work were promising, there were concerns about patient privacy and confidentiality. Legislation is urgently needed to protect the liability of health care professionals using smartphones.

Nurse Child Care Health Consultants, Professional Development, and Accreditation Improve Medication Safety in Child Care Programs

Medication administration is a critical safety issue in hospitals and the community. Children are especially at risk because of their dependence on adults to safely administer medications. The purpose of this study was to examine non-compliance with state child care medication administration regulations and factors associated with improved compliance. The data included routine, unannounced inspections of child care programs by state licensing specialists collected in two time periods over 10 years. Factors potentially associated with regulatory compliance were included in this secondary analysis. Most child care center medication administration regulations showed decreased non-compliance between the two time periods. However, regulations pertaining to prescriber orders and parent permission revealed a significant increase in non-compliance (58.4%). Factors positively associated with medication administration regulatory compliance included: compliance with annual professional development (p < 0.0001 in both periods), achievement of accreditation (p  =  0.0115 in Time 1), and among centers with children under 3 years of age, compliance with a weekly mandatory visit by a nurse consultant (p  =  0.0004 in Time 2). Though family child care homes had a lower frequency of medication administration non-compliance, only 19% were administering medications in Time 1. High quality, safe, and affordable child-care is essential for all children including those with special health care needs. This study highlights the importance of medication safety practices in child care programs, national child care health and safety standards, federal and state policies regarding medication administration regulations, and the critical role of nurse child care health consultants in promoting safe medication administration in child care programs.

"The other side of the table…': Early career gynaecological oncologists' transition from trainee to trainer

BACKGROUND

The transition to consultant practice represents an important transition from the role of trainee to trainer. We used the theoretical framework of Threshold Concepts to better understand this transition by analysing data from a broader qualitative study examining the experience of early career Certified Gynaecological Oncologists (CGOs) in Australia and New Zealand.

MATERIALS AND METHODS

Semi-structured interviews were conducted with CGOs of <5 years consultant experience. Transcripts were analysed using reflexive thematic analysis, sensitised by the theoretical framework of Threshold Concepts.

RESULTS

Seven early career CGOs were interviewed. Analysis resulted in the construction of five main themes related to the trainer role, each demonstrating characteristics of Threshold Concepts: 'Part of becoming and being a consultant'; 'Managing complex work environments and training responsibilities'; 'Optimising near peer relationships'; 'Recency informing evolution of training'; and "'Being responsible and letting go…' - the next transition."

DISCUSSION

The themes offer insights into the areas of the transition to trainer that are troublesome, the impact of negotiating these challenges on professional identity formation, and the strategies used by CGOs to negotiate them. Using the lens of Threshold Concepts, these experiences can be normalised, and supported through efforts to facilitate the development of skills in reflection, feedback, coaching and mentorship.

Weekend Mortality in an Italian Hospital: Immediate versus Delayed Bedside Critical Care Treatment

Background: a number of studies highlighted increased mortality associated with hospital admissions during weekends and holidays, the so–call “weekend effect”. In this retrospective study of mortality in an acute care public hospital in Italy between 2009 and 2015, we compared inpatient mortality before and after a major organizational change in 2012. The new model (Model 2) implied that the intensivist was available on call from outside the hospital during nighttime, weekends, and holidays. The previous model (Model 1) ensured the presence of the intensivist coordinating a Medical Emergency Team (MET) inside the hospital 24 h a day, 7 days a week. Methods: life status at discharge after 9298 and 8223 hospital admissions that occurred during two consecutive periods of 1185 days each (organizational Model 1 and 2), respectively, were classified into “discharged alive”, “deceased during nighttime–weekends–holidays” and “deceased during daytime-weekdays”. We estimated Relative Risk Ratios (RRR) for the associations between the organizational model and life status at discharge using multinomial logistic regression models adjusted for demographic and case-mix indicators, and timing of admission (nighttime–weekends–holidays vs. daytime-weekdays). Results: there were 802 and 840 deaths under Models 1 and 2, respectively. Total mortality was higher for hospital admissions under Model 2 compared to Model 1. Model 2 was associated with a significantly higher risk of death during nighttime–weekends–holidays (IRR: 1.38, 95% CI 1.20–1.59) compared to daytime–weekdays (RRR: 1.12, 95% CI 0.97–1.31) (p = 0.04). Respiratory diagnoses, in particular, acute and chronic respiratory failure (ICD 9 codes 510–519) were the leading causes of the mortality excess under Model 2. Conclusions: our data suggest that the immediate availability of an intensivist coordinating a MET 24 h, 7 days a week can result in a better prognosis of in-hospital emergencies compared to delayed consultation.

Strategies and criteria targeting the reform and development for the teaching resource of nursing undergraduate: A multi-center cross-sectional study

ABSTRACT

Teaching resource of nursing students play an important role in improving clinical performance, while there is a little know and dearth of the access and development criteria or guidance of teaching resources for nursing undergraduates.To develop the admission and development criteria of education resources for nursing undergraduates, and to explore and determine its composition and connotation.A cross-sectional survey has been used.A total of 22 Chinese nursing schools and affiliated teaching bases (hospitals and community health centers).A total of 20 nursing experts were consulted to develop the questionnaire of admission and development criteria of teaching resource for nursing undergraduates in China, and then 285 valid experts from 22 Chinese nursing schools and affiliated teaching bases (hospitals and community health centers) conducted the questionnaire survey to evaluate experts' consensus rate and view on the composition and connotation of the developed criteria.There were 6 domains and 43 items included in the admission and development criteria of teaching resource for nursing undergraduates, which domains included educational budget and allocation of resources, infrastructure, clinical teaching bases, books and information services, educational experts, and educational exchanges. The experts' consensus rate was more than 90.2%.The standard is helpful to guide the future admission and development of teaching resource for nursing undergraduates, and favor the education quality improvement of nursing undergraduates.

Breastfeeding in the first six months of life for babies seen by Lactation Consulting

OBJECTIVE

to identify breastfeeding patterns, survival of exclusive breastfeeding and factors associated with its interruption, in the first six months of life of babies seen by Lactation Consulting.

METHOD

a prospective cohort, with 231 mother-babies in a Baby-Friendly Hospital. An initial questionnaire was applied after 24 hours of birth, after consulting, as well as a follow-up questionnaire, applied by telephone at 15, 30, 60, 120 and 180 days, with sociodemographic and obstetric variables, maternal habits, father's schooling, birth data and baby feeding. Survival Analysis was carried out.

RESULTS

at 180 days of age, exclusive breastfeeding was 12.7% and the probability was 19.6% in the analysis of the survival curve. The factors associated with its interruption were smoking during pregnancy (HR 1.66; CI 1.05 - 2.61), age ≥ 35 years old (HR 1.73; CI 1.03 - 2.90), difficulty in breastfeeding after hospital discharge (HR 2.09; CI 1.29 - 3.41), search for professional assistance (HR 2.45; CI 1.69 - 3.54) and use of a pacifier (HR 1.76; IC 1.21 - 2.58).

CONCLUSION

lactation consultancy contributed to the improvement of the exclusive breastfeeding rates, although there are opportunities for advances.

Assessment of knowledge, attitude, and practice of child abuse amongst health care professionals working in tertiary care hospitals of Karachi, Pakistan

Introduction:

UNICEF report (2004) states that a significant percentage of total child population under the age of 5 years suffered malnutrition. Child sexual abuse remains undiscussed across Pakistan. Health care professionals (HCPs) are usually the first notifiers of child abuse and are ethically obliged to manage and report it.

Objective:

This study was conducted to assess HCPs' response in dealing with patients of child abuse. With a better understanding, we can have a better outcome for the victims.

Methods:

A total of 101 participants filled out a structured questionnaire by HCPs working in three tertiary hospitals of Karachi i.e., Aga Khan University, National Institute of Child Health (NICH), and Civil Hospital. Data were entered into SPSS 19.0.

Results:

HCPs believed that young male relatives were thought to be most likely the offender, and that every child regardless of class is prone to get abused triggered by financial stressors and the absence of parents. Proper physical exams helped identify cases. A proper system of reporting was required in hospitals, but HCPs were reluctant to report the cases to authorities. There was a significant difference noted between public and private hospitals.

Conclusion:

Our findings indicate that HCPs have limited knowledge in defining various types of abuse and most were unaware of any reporting facility in hospitals. Senior HCPs as consultants have a better understanding of child abuse than nurses or interns. Mandatory reporting should be implicated so that prompt action could be taken. There could be a more successful outcome of managing a child abuse victim with proper training.

The UK physician workforce: one-third at increased risk of death from COVID-19

INTRODUCTION

21% of NHS staff are from Black, Asian and minority ethnic (BAME) backgrounds yet account for a disproportionately high number of medical-staff deaths from COVID-19. Using data from the published OpenSAFELY Collaborative, we analysed consultant physicians to determine those at increased risk of COVID-19 related death.

METHODS

Data from 13,500 consultant physicians collected by the Royal College of Physicians were analysed to determine those at an increased risk of death from COVID-19, assuming no comorbidities.

RESULTS

The data reveal a picture in which a third of consultant physicians have a hazard ratio (HR) >1 for dying from COVID-19; one in five have HR >2; one in 11, HR >3; and one in 40, HR >4. Of concern are the risks to male physicians aged ≥60 with HR >3.8. Sub-specialties including cardiology, endocrine and diabetes, gastroenterology, haematology, neurology and rheumatology have a greater risk profile due to high proportion of men, physicians of older age, and proportion of BAME individuals.

CONCLUSION

A third of consultant physicians have an increased risk of a COVID-19-related death, and one in five have a higher relative risk (HR >2). The risk is mainly driven by age, gender, and ethnicity, the risk is highest in male consultant physicians over 60, especially from BAME backgrounds.

Comparison of knowledge and awareness between consultant physicians and resident doctors about non-alcoholic fatty liver disease

Aim of the study

Non-alcoholic fatty liver disease (NAFLD) is a multisystem disease and is commonly associated with diabetes mellitus, dyslipidaemia, hypertension and obesity. These illnesses are usually treated by physicians, and hence they need to stay updated on NAFLD. The aim of the study was to assess and compare the knowledge and awareness about NAFLD among consultant physicians and resident doctors.

Material and methods

A questionnaire concerning epidemiology, risk factors, complications, diagnostic methods, management options, progression and screening of NAFLD was given to the consultant physicians and resident doctors and their responses were sought. The comparison of responses was carried out between residents and consultants using Pearson's χ² test.

Results

A total of 240 doctors participated in the study with 60 resident doctors and 180 consultant physicians. 45% of the total participants did not consider NAFLD as a major health hazard. Consultants had better knowledge than residents about the prevalence of NAFLD, and the risks due to various factors. Also they had better knowledge about non-invasive diagnostic modalities. Resident doctors advocated use of antioxidants more than consultants. There was no statistically significant difference of perception between residents and physicians about association of NAFLD with diabetes and obesity, diet advice, dietary modification and exercise, usage of medications, avoidance of hepatotoxic drugs and alcohol.

Conclusions

This study revealed that physicians participating in our survey appreciate the prevalence of NAFLD but are unaware of the seriousness and the optimal management. This has implications for targeting 'at-risk' populations and appropriate referral of patients to gastroenterology/hepatology clinics.

Residents or Consultants: Who Writes Orders for Patients Taken Care of by the Internal Medicine Residency Service?

Background and aims The Accreditation Council for Graduate Medical Education (ACGME) mandates that Internal Medicine residents shall place all the orders for their patients. The purpose of this rule is to assure comprehensive knowledge of patient information and direct involvement in decision-making. However, there is a general perception that a large proportion of orders for patients taken care of by the residents are being written by consultants or other providers. The objective of the study was to determine the proportion of routine orders placed by Internal Medicine residents in comparison to consultants/subspecialty providers for patients under the care of the Internal Medicine Residency Service (IMRS).   Material and methods All the orders on patients admitted to the IMRS at AdventHealth Orlando from July 9, 2017, to July 15, 2017, were documented. Of these, Emergency Department (ED) orders, "STAT/ASAP/NOW orders," "discharge by consultant" orders, and "consent for procedure" orders were excluded. The main outcome measure was the proportion of orders placed by Internal Medicine residents as compared to consultants and all other providers. Results A total of 6471 orders placed on 90 patients admitted to the IMRS and with at least one consultant were included in the study. Of them, 96.8% of all orders were placed by Internal Medicine residents. Only 3.1% of all orders were placed by consultants and other providers. Of them, the majority of the orders were specialty-specific orders and were appropriate. Only 1.1% of all orders were "routine" orders placed inappropriately by consultants and other providers. A total of 121 consultations were made, and there were no new consultations initiated by consultants and other providers during the study period. Conclusion The vast majority of orders for patients taken care of by the IMRS were placed by the Internal Medicine residents themselves. Only a very small proportion of the orders were placed by consultants and other providers in this limited timeframe study. The findings are consistent with the ACGME mandate that residents write all orders for patients under their care except in special circumstances.

Chinese facial physiognomy and modern day aesthetic practice

BACKGROUND

Physiognomy is still practiced in China and is a factor influencing the cosmetic procedures offered by aesthetic practitioners, and treatments requested by patients.

OBJECTIVE

The aim of this study was to assess the prevalence of belief in physiognomy in China and its effect on cosmetic treatments requested and offered by aesthetic practitioners.

METHODS AND MATERIALS

This study consisted of a survey given to the general public (online) and Chinese aesthetic practitioners (face to face).

RESULTS

A total of 1816 responses (1070 general public, 746 aesthetic practitioners) were collected. About 63% of the general population and 86.3% of the aesthetic practitioners stated they believed in facial physiognomy. A majority of the general population surveyed believed that facial appearance can determine various aspects of their life. However, the majority believed changing their facial features would not affect factors believed to be determined by physiognomy. A total of 73.9% of the aesthetic practitioners thought their belief in physiognomy affected the treatments they suggest and most believed belief in physiognomy influences treatments requested.

CONCLUSION

The belief in facial physiognomy has a direct impact and needs to be taken into consideration during patient consultation.

The Role of Nursing Consultant in Iran: A Qualitative Study

Background:

Nursing consultation is one of the important roles of nurses and is very effective in improving care results. But this role is unknown in Iran and there are no respective organizational positions. The purpose of this study is to examine the factors affecting the position of this role.

Materials and Methods:

This study, as a qualitative research was conducted from April to December 2017 using content analysis approach. We performed semi-structured in-depth interviews with 23 participants who were selected using purposeful sampling and were asked to describe the factors affecting the organizational position of nurse consultant.

Results:

The mean (standard deviation) age of the participants was 44.5 years (10.68). 279 meaning units, 39 codes, 6 subcategories and two categories were obtained in this essay. The two main categories include necessity for nursing consultation role with two subcategories (nursing consultation role as one of the main roles in nursing, and the need for nursing consultation in healthcare system in Iran), and the obstacles of nursing consultation role with four subcategories (healthcare system problems, problems associated with physicians, problems associated with nurses and problems associated with patients' culture).

Conclusions:

Considering the importance of nursing consultation role in improving the health of the patients, the policymakers should take into account the consultant role of nurses and they should understand the importance of and the need for this role. As such, we hope that managers and policymakers create a role position by removing the obstacles and considering the necessity of this role.

A national survey of out-of-hours working and fatigue in consultants in anaesthesia and paediatric intensive care in the UK and Ireland

The tragic death of an anaesthetic trainee driving home after a series of night shifts prompted a national survey of fatigue in trainee anaesthetists. This indicated that fatigue was widespread, with significant impact on trainees' health and well-being. Consultants deliver an increasing proportion of patient care resulting in long periods of continuous daytime duty and overnight on-call work, so we wished to investigate their experience of out-of-hours working and the causes and impact of work-related fatigue. We conducted a national survey of consultant anaesthetists and paediatric intensivists in the UK and Ireland between 25 June and 6 August 2018. The response rate was 46% (94% of hospitals were represented): 84% of respondents (95%CI 83.1-84.9%) contribute to a night on-call rota with 32% (30.9-33.1%) working 1:8 or more frequently. Sleep disturbance on-call is common: 47% (45.6-48.4%) typically receive two to three phone calls overnight, and 48% (46.6-49.4%) take 30 min or more to fall back to sleep. Only 15% (14.0-16.0%) reported always achieving 11 h of rest between their on-call and their next clinical duty, as stipulated by the European Working Time Directive. Moreover, 24% (22.8-25.2%) stated that there is no departmental arrangement for covering scheduled clinical duties following a night on-call if they have been in the hospital overnight. Overall, 91% (90.3-91.7%) reported work-related fatigue with over half reporting a moderate or significantly negative impact on health, well-being and home life. We discuss potential explanations for these results and ways to mitigate the effects of fatigue among consultants.

Patterns and determinants of stress among consultant physicians working in Saudi Arabia

BACKGROUND

Physicians experience several work-related stressors that have been mounting up in recent decades. This study aimed to examine perceived stress and its risk factors and consequences among consultant physicians in Saudi Arabia.

METHODS

A cross-sectional study was conducted from November 2014 to March 2015 among physicians who were assigned rank of consultant. The stress level was assessed using perceived stress scale (PSS).

RESULTS

A total of 582 consultants participated. The average age was 46.9±7.9 years, 71% were males, 56% were Saudi, 15% were smokers, and 68% slept ≤6 hours per night. The median PSS score was 17 (interquartile range of 14-21), which represented 44% of maximum possible PSS score. The upper tertile of PSS score (represents a high stress level) was significantly associated with being younger, female, and Saudi. The majority (85%) considered job environment to be stressful and ~50% attributed that to a high workload and a noncooperative administration. In the year preceding this study, half of consultants frequently contemplated or even worked toward changing their medical institutes or even moving to work outside Saudi Arabia because of perception of a stressful working environment. Over the previous year, encountering life stressors, considering job environment as stressful and experiencing passive suicidal ideation, were significantly associated with higher levels of stress. In multivariate analysis, the following factors were independently associated with stress: female gender (odds ratio [OR]=2.41, 95% CI 1.58-3.70) and perceived stressful working environment (OR=3.66, 95% CI 1.87-7.17).

CONCLUSION

Consultant physicians in Saudi Arabia experience moderate to high levels of perceived stress that are relatively comparable to physicians worldwide. A significant association was found between stress levels and both female gender and perception of a stressful working environment. Further studies are required to assess physician-based interventions and organization-directed approaches to management of stress among physicians.

'Just an extra pair of hands'? A qualitative study of obstetric service users' and professionals' views towards 24/7 consultant presence on a single UK tertiary maternity unit

OBJECTIVES

To explore the views of maternity service users and professionals towards obstetric consultant presence 24 hours a day, 7 days a week.

DESIGN

Semistructured interviews conducted face to face with maternity service users and professionals in March and April 2016. All responses were analysed together (ie, both service users' and professionals' responses) using an inductive thematic analysis.

SETTING

A large tertiary maternity unit in the North West of England that has implemented 24/7 obstetric consultant presence.

PARTICIPANTS

Antenatal and postnatal inpatient service users (n=10), midwives, obstetrics and gynaecology specialty trainees and consultant obstetricians (n=10).

RESULTS

Five themes were developed: (1) 'Just an extra pair of hands?' (the consultant's role), (2) the context, (3) the team, (4) training and (5) change for the consultant. Respondents acknowledged that obstetrics is an acute specialty, and consultants resolve intrapartum complications. However, variability in consultant experience and behaviour altered perception of its impact. Service users were generally positive towards 24/7 consultant presence but were not aware that it was not standard practice across the UK. Professionals were more pragmatic and discussed how the implementation of 24/7 working had affected their work, development of trainees and potential impacts on future consultants.

CONCLUSIONS

The findings raised several issues that should be considered by practitioners and policymakers when making decisions about the implementation of 24/7 consultant presence in other maternity units, including attributes of the consultants, the needs of maternity units, the team hierarchy, trainee development, consultants' other duties and consultant absences.

Two-epoch cross-sectional case record review protocol comparing quality of care of hospital emergency admissions at weekends versus weekdays

INTRODUCTION

The mortality associated with weekend admission to hospital (the 'weekend effect') has for many years been attributed to deficiencies in quality of hospital care, often assumed to be due to suboptimal senior medical staffing at weekends. This protocol describes a case note review to determine whether there are differences in care quality for emergency admissions (EAs) to hospital at weekends compared with weekdays, and whether the difference has reduced over time as health policies have changed to promote 7-day services.

METHODS AND ANALYSIS

Cross-sectional two-epoch case record review of 20 acute hospital Trusts in England. Anonymised case records of 4000 EAs to hospital, 2000 at weekends and 2000 on weekdays, covering two epochs (financial years 2012-2013 and 2016-2017). Admissions will be randomly selected across the whole of each epoch from Trust electronic patient records. Following training, structured implicit case reviews will be conducted by consultants or senior registrars (senior residents) in acute medical specialities (60 case records per reviewer), and limited to the first 7 days following hospital admission. The co-primary outcomes are the weekend:weekday admission ratio of errors per case record, and a global assessment of care quality on a Likert scale. Error rates will be analysed using mixed effects logistic regression models, and care quality using ordinal regression methods. Secondary outcomes include error typology, error-related adverse events and any correlation between error rates and staffing. The data will also be used to inform a parallel health economics analysis.

ETHICS AND DISSEMINATION

The project has received ethics approval from the South West Wales Research Ethics Committee (REC): reference 13/WA/0372. Informed consent is not required for accessing anonymised patient case records from which patient identifiers had been removed. The findings will be disseminated through peer-reviewed publications in high-quality journals and through local High-intensity Specialist-Led Acute Care (HiSLAC) leads at the 121 hospitals that make up the HiSLAC Collaborative.

Consultant job planning for a 7-day service

At a time of competing demands on the National HealthService (NHS), systematic consultant job planning is necessary to ensure that limited resources are being used productively, especially with the prospect of expanded 7-day services. Based on a presentation to the Royal College of Physicians Annual Conference in March 2016, a broad overview of job planning is presented, together with more specific examples relating to acute medicine and gastroenterology/general medicine.

Specialist services in the community: a qualitative study of consultants holding novel types of employment contracts in England

The aim of this study was to understand, from consultants' experiences, the potential benefits and limitations of specialists being employed by a community organisation. We carried out a qualitative study using semi-structured interviews with consultants holding novel contracts across three specialties: geriatric, respiratory and palliative medicine. Consultants in our study reported that community-based roles offered a number of potential benefits. They felt better able to take a population perspective, to treat patients in a holistic sense and to form good working relationships with community-based colleagues. A number of challenges were also evident, including a lack of clarity about their role, professional isolation and, for those in geriatric and respiratory medicine, a lack of training and career development opportunities. Our study suggests that community-based consultant posts are often taken up by highly motivated individuals who report the benefits in terms of being able to provide more appropriate care for patients but that the long-term development of these posts may be constrained by a number of factors. Their idiosyncratic nature, the lack of clarity around the role, challenges to professional identity and lack of training opportunities or professional development suggest that current approaches to their development may not be sustainable.

"Teaching is like nightshifts …": a focus group study on the teaching motivations of clinicians

BACKGROUND

To ensure the highest quality of education, medical schools have to be aware of factors that influence the motivation of teachers to perform their educational tasks. Although several studies have investigated motivations for teaching among community-based practitioners, there is little data available for hospital-based physicians.

PURPOSES

This study aimed to identify factors influencing hospital-based physicians' motivations to teach.

METHODS

We conducted 3 focus group discussions with 15 clinical teachers from the Medical Faculty at Hamburg University. Using a qualitative inductive approach, we extracted motivation-related factors from the transcripts of the audio-recorded discussions.

RESULTS

Three main multifaceted categories influencing the motivation of teachers were identified: the teachers themselves, the students, and the medical faculty as an organization. Participants showed individual sets of values and beliefs about their roles as teachers as well as personal notions of what comprises a "good" medical education. Their personal motives to teach comprised a range of factors from intrinsic, such as the joy of teaching itself, to more extrinsic motives, such as the perception of teaching as an occupational duty. Teachers were also influenced by the perceived values and beliefs of their students, as well as their perceived discipline and motivation. The curriculum organization and aspects of leadership, human resource development, and the evaluation system proved to be relevant factors as well, whereas extrinsic incentives had no reported impact.

CONCLUSIONS

Individual values, beliefs, and personal motives constitute the mental framework upon which teachers perceive and assess motivational aspects for their teaching. The interaction between these personal dispositions and faculty-specific organizational structures can significantly impair or enhance the motivation of teachers and should therefore be accounted for in program and faculty development.

How can we recognize continuous quality improvement?

Objective

Continuous quality improvement (CQI) methods are foundational approaches to improving healthcare delivery. Publications using the term CQI, however, are methodologically heterogeneous, and labels other than CQI are used to signify relevant approaches. Standards for identifying the use of CQI based on its key methodological features could enable more effective learning across quality improvement (QI) efforts. The objective was to identify essential methodological features for recognizing CQI.

Design

Previous work with a 12-member international expert panel identified reliably abstracted CQI methodological features. We tested which features met rigorous a priori standards as essential features of CQI using a three-phase online modified-Delphi process.

Setting

Primarily United States and Canada.

Participants

119 QI experts randomly assigned into four on-line panels.

Intervention(s)

Participants rated CQI features and discussed their answers using online, anonymous and asynchronous discussion boards. We analyzed ratings quantitatively and discussion threads qualitatively.

Main outcome measure(s)

Panel consensus on definitional CQI features.

Results

Seventy-nine (66%) panelists completed the process. Thirty-three completers self-identified as QI researchers, 18 as QI practitioners and 28 as both equally. The features ‘systematic data guided activities,’ ‘designing with local conditions in mind’ and ‘iterative development and testing’ met a priori standards as essential CQI features. Qualitative analyses showed cross-cutting themes focused on differences between QI and CQI.

Conclusions

We found consensus among a broad group of CQI researchers and practitioners on three features as essential for identifying QI work more specifically as ‘CQI.’ All three features are needed as a minimum standard for recognizing CQI methods.

Electrical innovations, authority and consulting expertise in late Victorian Britain

In this article I examine the practices of electrical engineering experts, with special reference to their role in the implementation of innovations in late Victorian electrical networks. I focus on the consulting work of two leading figures in the scientific and engineering world of the period, Alexander Kennedy and William Preece. Both were Fellows of the Royal Society and both developed large-scale consulting activities in the emerging electrical industry of light and power. At the core of the study I place the issues of trust and authority, and the bearing of these on the engineering expertise of consultants in late Victorian Britain. I argue that the ascription of expertise to these engineers and the trust placed in their advice were products of power relations on the local scale. The study seeks to unravel both the technical and the social reasons for authoritative patterns of consulting expertise.

The new consultant survey 2005

BACKGROUND

Consultants in emergency medicine have to deal with a wide range of problems, many of which they will not have encountered during their training. One way to assess the adequacy of specialist training is to ask recently appointed consultants whether or not they feel adequately prepared for their role.

METHODS

A questionnaire was sent out to 60 newly appointed consultants in emergency medicine in January and February 2005 and the results analysed.

RESULTS

Many respondents feel that there should be greater emphasis on acquiring clinical skills, partly by greater consultant supervision and partly by providing more experience of anaesthetics and intensive care. New consultants also feel inadequately prepared for their management responsibilities, and this is a source of great stress.

CONCLUSIONS

Specialist training in emergency medicine needs to pay more attention to the acquisition of clinical skills and to preparation for management responsibility.