Physicians' Practice of Dispensing Medicines: A Qualitative Study

Objectives: The physical act of giving medication to patients to administer away from a health care setting, dispensing, is normally performed by pharmacists. Dispensing of medication by physicians is a neglected patient safety issue, and having observed considerable variation in practice, the lead author sought to explore this issue further. A literature review yielded zero articles pertaining to this, so an exploratory study was commenced. The qualitative arm, relating to junior physicians' experience of, and training in, dispensing, is reported here. Methods: Focus groups were conducted to explore the beliefs, ideas, and experiences of physicians-in-training pertaining to dispensing of medication. These were recorded and transcribed. The transcriptions were thematically analyzed using the grounded theory. Results: The emergency department was the most common site of dispensing. No formal training in dispensing had been received. Informal training was variable in content and utility. The physicians felt that dispensing was part of their role. Conclusions: Despite being expected to dispense, and the patient safety issues involved in giving drugs to patients to use at home, physicians do not feel that they have been trained to undertake this task. These findings from 1 hospital raise questions about thewider quality and safety of this practic

Devising a consensus definition and framework for non-technical skills in healthcare to support educational design: A modified Delphi study

Background Non-technical skills are a subset of human factors that focus on the individual and promote safety through teamwork and awareness. There is no widely adopted competency or outcome based framework for non-technical skills training in healthcare outside the surgical environment. The authors set out to devise such a framework and reach a consensus on a definition using a modified Delphi approach. Methods An exhaustive list of published and team suggested items was presented to the expert panel for ranking and to propose a definition. In the second round, a focused list was presented, as well as the proposed definition elements. The finalised framework was sent to the panel for review. Summary of results 16 experts participated (58% response rate). A total of 36 items of 105 ranked highly enough to present in round two. The final framework consists of 16 competencies for all and 8 specific competencies for team leaders. The consensus definition describes non-technical skills as ‘a set of social (communication and team work) and cognitive (analytical and personal behaviour) skills that support high quality, safe, effective and efficient inter-professional care within the complex healthcare system’. Conclusions The authors have produced a new competency framework, through the works of an international expert panel, which is not discipline specific. This consensus competency framework can be used by curriculum developers, educational innovators and clinical teachers to support developments in the field

An ethnographic study of the retention of doctors in emergency medicine: materialities, retention work, and strategies

Demand on emergency departments has increased more than staff numbers, contributing to a problem with medical staffing that is politicised and emotive. Research on staff retention is decontextualised and has produced an ever-increasing list of factors of uncertain importance leading to a superficial understanding of retention in healthcare. This study aimed to gain a deep understanding of retention in emergency medicine, elucidate how retention is made possible, and make policy and practice recommendations. I conducted 11 weeks of ethnographic observation in a single emergency department, focusing on contextualised day-to-day practices of emergency physicians of all grades. I interviewed 21 emergency physicians from two emergency departments, ten emergency physicians who had left the profession, and ten individuals holding leadership roles with stakeholder organisations. An ethnomethodological lens allowed me to draw out the day-to-day practices from the data. Reflexive thematic analysis provided structure to the analysis and facilitated incorporating grey literature. The results showed how emergency physicians performed routine work to facilitate their retention. They did this using objects and space, which I called “materialities of retention”, and actions that l labelled “retention work”. Examples of retention work include humour, education, and building communities of practice. Portfolio careers and less than full time working were also employed as retention strategies. Emergency physicians utilised mentors, mostly informally, to navigate their careers and to take steps to facilitate their retention. This thesis has developed novel understandings of the importance of day-to-day objects and practices for retention. Policymakers, managers, and practitioners can enable emergency physicians to make their careers sustainable by facilitating retention work and strategies

Trainee and supervisor experience of the Academic Foundation Programme

BACKGROUND: The Academic Foundation Programme (AFP) is often the initial step along the Integrated Academic Training pathway in the UK. It is relatively new and research as to its effectiveness is limited. Our objective was to evaluate the AFP in terms of its impact on academic career aspirations and to explore trainees' expectations and experience of the programme and investigate the enablers and barriers to success. METHOD: Seven supervisors of Academic Foundation trainees were interviewed over a 5-month period in 2014. AFP trainees' views were sought by way of an online questionnaire that covered six areas: demographics, expectations, academic time, experience, research and achievements. RESULTS: Thirty-four trainees completed online questionnaires. The majority of trainees (94%) did not proceed directly along the Integrated Academic Training pathway to complete Academic Clinical Fellowships, but those who applied to do so were often successful (nine applicants, six successful). Free-text comments revealed an expectation of a more course-like structure to the programme, this is in contrast to the authentic experience of clinical academia, along with its associated challenges, that some of the supervisors reported. The importance of planning and preparation for success was a recurring theme from the supervisor interviews. CONCLUSIONS: The programme is achieving some success in encouraging academic careers. There are several areas that can be improved. Improving the availability of information and guidance for supervisors and facilitating Academic Foundation Doctors to network are both feasible changes that could lead to improvement

Retention of doctors in emergency medicine:a scoping review protocol

Objective: The primary question of the review is: What is known about retention of doctors in emergency medicine? Introduction: There is a staffing crisis in emergency medicine and retention problems across healthcare. The evidence is disparate and includes healthcare research, management studies and policy documents from government and other agencies. Therefore there is a need to map the evidence on retention of emergency medicine doctors. This review is part of a wider study of the retention of doctors in emergency medicine situated in the UK. Inclusion criteria: We will identify papers relating to emergency medicine doctors at all levels, using the different terms used internationally for these practitioners. We will exclude papers relating to other healthcare professions. We aim to include papers relating to retention; to identify these our search will include terms such as turnover and exodus. The setting is focused on the emergency department; studies focusing on working in other settings, for example, a minor injuries unit, will be excluded. Studies from any country will be included, however we are limited to those published in English. Methods: We will search medical literature databases including MEDLINE, Embase, HMIC, PsycINFO, the Cochrane Database of Systematic Reviews, and the British Medical Journal collection. We will supplement this by searching business and management journals including; Business Source Complete, ProQuest Business Database and Emerald Business and Management Journals. A structured iterative search of the gray literature will be conducted. Retrieved papers will be screened for inclusion by two reviewers. Data will be extracted and presented in tabular form and a narrative summary that align with the review's objective

Retention of doctors in emergency medicine:a scoping review of the academic literature

Abstract Introduction Workforce issues prevail across healthcare; in emergency medicine (EM), previous work improved retention, but the staffing problem changed rather than improved. More experienced doctors provide higher quality and more cost-effective care, and turnover of these physicians is expensive. Research focusing on staff retention is an urgent priority. Methods This study is a scoping review of the academic literature relating to the retention of doctors in EM and describes current evidence about sustainable careers (focusing on factors influencing retention), as well as interventions to improve retention. The established and rigorous JBI scoping review methodology was followed. The data sources searched were MEDLINE, Embase, Cochrane, HMIC and PsycINFO, with papers published up to April 2020 included. Broad eligibility criteria were used to identify papers about retention or related terms, including turnover, sustainability, exodus, intention to quit and attrition, whose population included emergency physicians within the setting of the ED. Papers which solely measured the rate of one of these concepts were excluded. Results Eighteen papers met the inclusion criteria. Multiple factors were identified as linked with retention, including perceptions about teamwork, excessive workloads, working conditions, errors, teaching and education, portfolio careers, physical and emotional strain, stress, burnout, debt, income, work–life balance and antisocial working patterns. Definitions of key terms were used inconsistently. No factors clearly dominated; studies of correlation between factors were common. There were minimal research reporting interventions. Conclusion Many factors have been linked to retention of doctors in EM, but the research lacks an appreciation of the complexity inherent in career decision-making. A broad approach, addressing multiple factors rather than focusing on single factors, may prove more informative

Identification of ASYNAPTIC4, a Component of the Meiotic Chromosome Axis

International audienceDuring the leptotene stage of prophase I of meiosis, chromatids become organized into a linear looped array via a protein axis that forms along the loop bases. Establishment of the axis is essential for the subsequent synapsis of the homologous chromosome pairs and the progression of recombination to form genetic crossovers. Here, we describe ASYNAPTIC4 (ASY4), a meiotic axis protein in Arabidopsis (Arabidopsis thaliana). ASY4 is a small coiled-coil protein that exhibits limited sequence similarity with the carboxyl-terminal region of the axis protein ASY3. We used enhanced yellow fluorescent protein-tagged ASY4 to show that ASY4 localizes to the chromosome axis throughout prophase I. Bimolecular fluorescence complementation revealed that ASY4 interacts with ASY1 and ASY3, and yeast two-hybrid analysis confirmed a direct interaction between ASY4 and ASY3. Mutants lacking full-length ASY4 exhibited defective axis formation and were unable to complete synapsis. Although the initiation of recombination appeared to be unaffected in the asy4 mutant, the number of crossovers was reduced significantly, and crossovers tended to group in the distal parts of the chromosomes. We conclude that ASY4 is required for normal axis and crossover formation. Furthermore, our data suggest that ASY3/ASY4 are the functional homologs of the mammalian SYCP2/SYCP3 axial components

Systematic review of interventions to encourage careers in academic medicine

Aims: Academic medicine is a career route that historically struggles to recruit and retain suitable doctors. The aim of this paper is to review the evidence for interventions to encourage careers in academic medicine by way of a descriptive systematic review. Methods: Key databases were searched in February 2017. Studies that evaluated interventions to encourage careers in academic medicine and that used a pre–post analysis or included a comparison group were included. Interventions reporting only learner satisfaction were excluded. The review was specific to medical students and graduates. Results: Twenty-four studies were identified for inclusion within the review. The included studies identified interventions across five domains: postgraduate funding, postgraduate training, mentoring, undergraduate interventions, and institutional change. The papers varied in terms of strength of conclusion and method of analysis with broad, structured, well-funded programs having the most palpable results. Conclusions: The five domains identified offer a framework that can be used by institutions who wish to develop similar programs. It also offers a body of research on which an evidence base can be built