Exploring newly qualified doctors' workplace stressors:an interview study from Australia

Purpose Postgraduate year 1 (PGY1) doctors suffer from high levels of psychological distress, yet the contributory factors are poorly understood. This study used an existing model of workplace stress to explore the elements most pertinent to PGY1 doctors. In turn, the data were used to amend and refine the conceptual model to better reflect the unique experiences of PGY1 doctors. Method Focus groups were undertaken with PGY1 doctors working at four different health services in Victoria, Australia. Transcripts were coded using Michie's model of workplace stress as the initial coding template. Remaining text was coded inductively and the supplementary codes were used to modify and amplify Michie's framework. Results There were 37 participants in total. Key themes included stressors intrinsic to the job, such as work overload and long hours, as well as those related to the context of work such as lack of role clarity and relationships with colleagues. The main modification to Michie's framework was the addition of the theme of uncertainty. This concept related to most of the pre-existing themes in complex ways, culminating in an overall sense of anxiety. Conclusions Michie's model of workplace stress can be effectively used to explore the stressors experienced by PGY1 doctors. Pervasive uncertainty may help to explain the high levels of psychological morbidity in this group. While some uncertainty will always remain, the medical education community must seek ways to improve role clarity and promote mutual respect.</p

The hydrology of glacier-bed overdeepenings : sediment transport mechanics, drainage system morphology, and geomorphological implications

Evacuation of basal sediment by subglacial drainage is an important mediator of rates of glacial erosion and glacier flow. Glacial erosion patterns can produce closed basins (i.e., overdeepenings) in glacier beds, thereby introducing adverse bed gradients that are hypothesised to reduce drainage system efficiency and thus favour basal sediment accumulation. To establish how the presence of a terminal overdeepening might mediate seasonal drainage system evolution and glacial sediment export, we measured suspended sediment transport from Findelengletscher, Switzerland during late August and early September 2016. Analyses of these data demonstrate poor hydraulic efficiency of drainage pathways in the terminus region but high sediment availability. Specifically, the rate of increase of sediment concentration with discharge was found to be significantly lower than that anticipated if channelised flow paths were present. Sediment availability to these flow paths was also higher than would be anticipated for discrete bedrock-floored subglacial channels. Our findings indicate that subglacial drainage in the terminal region of Findelengletscher is dominated by distributed flow where entrainment capacity increases only marginally with discharge, but flow has extensive access to an abundant sediment store. This high availability maintains sediment connectivity between the glacial and proglacial realm and means daily sediment yield is unusually high relative to yields exhibited by similar Alpine glaciers. We present a conceptual model illustrating the potential influence of ice-bed morphology on subglacial drainage evolution and sediment evacuation mechanics, patterns and yields, and recommend that bed morphology should be an explicit consideration when monitoring and evaluating glaciated basin sediment export rates

Space Shuttle Solid Rocket Booster Lightweight Recovery System

The cancellation of the Advanced Solid Rocket Booster Project and the earth-to-orbit payload requirements for the Space Station dictated that the National Aeronautics and Space Administration (NASA) look at performance enhancements from all Space Transportation System (STS) elements (Orbiter Project, Space Shuttle Main Engine Project, External Tank Project, Solid Rocket Motor Project, & Solid Rocket Booster Project). The manifest for launching of Space Station components indicated that an additional 12-13000 pound lift capability was required on 10 missions and 15-20,000 pound additional lift capability is required on two missions. Trade studies conducted by all STS elements indicate that by deleting the parachute Recovery System (and associated hardware) from the Solid Rocket Boosters (SRBS) and going to a lightweight External Tank (ET) the 20,000 pound additional lift capability can be realized for the two missions. The deletion of the parachute Recovery System means the loss of four SRBs and this option is two expensive (loss of reusable hardware) to be used on the other 10 Space Station missions. Accordingly, each STS element looked at potential methods of weight savings, increased performance, etc. As the SRB and ET projects are non-propulsive (i.e. does not have launch thrust elements) their only contribution to overall payload enhancement can be achieved by the saving of weight while maintaining adequate safety factors and margins. The enhancement factor for the SRB project is 1:10. That is for each 10 pounds saved on the two SRBS; approximately 1 additional pound of payload in the orbiter bay can be placed into orbit. The SRB project decided early that the SRB recovery system was a prime candidate for weight reduction as it was designed in the early 1970s and weight optimization had never been a primary criteria

Medical graduates’ preparedness to practice: A comparison of undergraduate medical school training

Background: There is evidence that newly qualified doctors do not feel prepared to start work. This study examined views of first year Foundation doctors (F1s) regarding how prepared they felt by their undergraduate medical education for skills required during the first Foundation training year in relation to their type of training. Method: One-hundred and eighty two F1s completed a questionnaire during their first rotation of Foundation training. Analysis was conducted by type of medical school training: Problem-Based Learning (PBL), Traditional or Reformed. Results: F1s from medical schools with a PBL curriculum felt better prepared for tasks associated with communication and team working, and paperwork than graduates from the other medical school types; but the majority of F1s from all three groups felt well prepared for most areas of practice. Less than half of graduates in all three groups felt well prepared to deal with a patient with neurological/visual problems; write referral letters; understand drug interactions; manage pain; and cope with uncertainty. F1s also indicated that lack of induction or support on starting work was affecting their ability to work in some areas. Conclusions: Whilst F1s from medical schools with a PBL curriculum did feel better prepared in multiple areas compared to graduates from the other medical school types, specific areas of unpreparedness related to undergraduate and postgraduate medical training were identified across all F1s. These areas need attention to ensure F1s are optimally prepared for starting work

The role of the smartphone in the transition from medical student to foundation trainee: a qualitative interview and focus group study

Background The transition from medical student to junior doctor is one of the most challenging in medicine, affecting both doctor and patient health. Opportunities to support this transition have arisen from advances in mobile technology and increased smartphone ownership. Methods This qualitative study consisted of six in-depth interviews and two focus groups with Foundation Year 1 Trainees (intern doctors) and final year medical students within the same NHS Trust. A convenience sample of 14 participants was recruited using chain sampling. Interviews and focus groups were recorded, transcribed verbatim, analysed in accordance with thematic analysis and presented below in keeping with the standards for reporting qualitative research. Results Participants represented both high and low intensity users. They used their smartphones to support their prescribing practices, especially antimicrobials through the MicroGuide™ app. Instant messaging, via WhatsApp, contributed to the existing bleep system, allowing coordination of both work and learning opportunities across place and time. Clinical photographs were recognised as being against regulations but there had still been occasions of use despite this. Concerns about public and colleague perceptions were important to both students and doctors, with participants describing various tactics employed to successfully integrate phone use into their practices. Conclusion This study suggests that both final year medical students and foundation trainees use smartphones in everyday practice. Medical schools and healthcare institutions should seek to integrate such use into core curricula/training to enable safe and effective use and further ease the transition to foundation training. We recommend juniors are reminded of the potential risks to patient confidentiality associated with smartphone use

The do's, don't and don't knows of supporting transition to more independent practice

Introduction: Transitions are traditionally viewed as challenging for clinicians. Throughout medical career pathways, clinicians need to successfully navigate successive transitions as they become progressively more independent practitioners. In these guidelines, we aim to synthesize the evidence from the literature to provide guidance for supporting clinicians in their development of independence, and highlight areas for further research. Methods: Drawing upon D3 method guidance, four key themes universal to medical career transitions and progressive independence were identified by all authors through discussion and consensus from our own experience and expertise: workplace learning, independence and responsibility, mentoring and coaching, and patient perspectives. A scoping review of the literature was conducted using Medline database searches in addition to the authors’ personal archives and reference snowballing searches. Results: 387 articles were identified and screened. 210 were excluded as not relevant to medical transitions (50 at title screen; 160 at abstract screen). 177 full-text articles were assessed for eligibility; a further 107 were rejected (97 did not include career transitions in their study design; 10 were review articles; the primary references of these were screened for inclusion). 70 articles were included of which 60 provided extractable data for the final qualitative synthesis. Across the four key themes, seven do’s, two don’ts and seven don’t knows were identified, and the strength of evidence was graded for each of these recommendations. Conclusion: The two strongest messages arising from current literature are first, transitions should not be viewed as one moment in time: career trajectories are a continuum with valuable opportunities for personal and professional development throughout. Second, learning needs to be embedded in practice and learners provided with authentic and meaningful learning opportunities. In this paper, we propose evidence-based guidelines aimed at facilitating such transitions through the fostering of progressive independence

Systematic and Controllable Negative, Zero, and Positive Thermal Expansion in Cubic Zr1–xSnxMo2O8

We describe the synthesis and characterization of a family of materials, Zr1–xSnxMo2O8 (0 < x < 1), whose isotropic thermal expansion coefficient can be systematically varied from negative to zero to positive values. These materials allow tunable expansion in a single phase as opposed to using a composite system. Linear thermal expansion coefficients, αl, ranging from −7.9(2) × 10–6 to +5.9(2) × 10–6 K–1 (12–500 K) can be achieved across the series; contraction and expansion limits are of the same order of magnitude as the expansion of typical ceramics. We also report the various structures and thermal expansion of “cubic” SnMo2O8, and we use time- and temperature-dependent diffraction studies to describe a series of phase transitions between different ordered and disordered states of this material

A Net Energy Analysis of the Global Agriculture, Aquaculture, Fishing and Forestry System

The global agriculture, aquaculture, fishing and forestry (AAFF) energy system is subject to three unsustainable trends: (1) the approaching biophysical limits of AAFF; (2) the role of AAFF as a driver of environmental degradation; and (3) the long-term declining energy efficiency of AAFF due to growing dependence on fossil fuels. In response, we conduct a net energy analysis for the period 1971–2017 and review existing studies to investigate the global AAFF energy system and its vulnerability to the three unsustainable trends from an energetic perspective. We estimate the global AAFF system represents 27.9% of societies energy supply in 2017, with food energy representing 20.8% of societies total energy supply. We find that the net energy-return-on-investment (net EROI) of global AAFF increased from 2.87:1 in 1971 to 4.05:1 in 2017. We suggest that rising net EROI values are being fuelled in part by ‘depleting natures accumulated energy stocks’. We also find that the net energy balance of AAFF increased by 130% in this period, with at the same time a decrease in both the proportion of rural residents and also the proportion of the total population working in AAFF—which decreased from 19.8 to 10.3%. However, this comes at the cost of growing fossil fuel dependency which increased from 43.6 to 62.2%. Given the increasing probability of near-term fossil fuel scarcity, the growing impacts of climate change and environmental degradation, and the approaching biophysical limits of global AAFF, ‘Odum’s hoax’ is likely soon to be revealed