Can I handle the scalpel?:Different views on critical subtask assessment between residents and expert surgeons

Background: Success of surgical procedures largely depends on good judgment and decision making and these skills are mostly taught implicitly in the OR. Cognitive task analysis (CTA) has been used successful to elicit tacit expert knowledge to determine the decision points in a medical procedure and then use this in medical skill instructions. For instructions to be effective, it is also important that they are timed properly, that is, during low mental workload in the resident. Aim(s): As a start for further research, we therefore asked residents to indicate their mental workload during the steps of an orthopaedic procedure. Because in the OR, residents are commonly guided by supervisors, we also investigated which steps supervisors find mentally demanding. Methods: A task analysis of a total hip replacement procedure was constructed. Subsequently we asked both 17 orthopedic surgeons (supervisors) and 21 residents to rate (5-point scale) how much mental effort they invest in each subtask. They were asked to explain ratings above average (>3). Results: Although there were subtasks where supervisors and residents disagreed on the level of attention required, overall, supervisors and residents agreed for most subtasks. High attention was related to subtasks that require decision making skills. However, the reasons were different. In residents, high ratings were associated with subtasks that they found difficult, or where they were anxious about doing it accurately. Supervisors’ ratings were more correlated with the evaluation of crucial, i.e., point-of-no-return steps where quality of execution has important consequences for later steps, end result or complications. Discussion/Conclusion: Supervisors pay more attention to steps that will become important later in the procedure, whereas residents are more anxious about their own performance in crucial steps. It may be useful for supervisors and residents to be aware of this difference in interpretation of “important steps”

Implementing the pharmacy technician role in existing pharmacy settings:Stakeholders views of barriers and facilitators

Background: The field of pharmacy will benefit from pharmacy technicians, a higher educated mid-level support workforce. They support pharmacists in providing pharmaceutical patient care through delegated roles and responsibilities. Empirical research on pharmacy technicians within pharmacy practice community and hospital pharmacy practices tends to focus on the practical outcomes of this workforce addition. It mostly addresses the ‘WHAT’ of service delivered by pharmacy technicians. Literature on the ‘HOW’ of their role development in practice is scarce. Furthermore, it seems difficult for most pharmacy technicians to effectively fulfil this professional role. Objective: This qualitative study explored factors influencing role development of pharmacy technicians in community and hospital pharmacies. Methods: On site, individual and small-group interviews were conducted with pharmacy technicians (n = 10), and two colleagues: pharmacists (n = 7) and pharmacy assistants (n = 6). Interviews were based on a semi-structured interview guide. Participants were asked to describe specific incidents and organisational, relational and pharmaceutical care perspectives, illustrative of the process of developing and implementing the pharmacy technician role. Template analysis was used to develop a list of codes representing themes identified in the data. Results: Five interrelated themes influenced development and implementation of the pharmacy technician role. Two of them were at a more contextual level: (a) experiencing a lack of vision on added value of the new role within the field of pharmacy and (b) learning climate. The other three were related to personal interactions between staff members: (c) role expectations and organisational fit, (d) personal traits of pharmacy technicians and (e) support of pharmacy technicians through task delegation and role enhancement. Conclusions: The data showed that development and implementation of pharmacy technician roles is a complicated process. A detailed plan for addressing and remediating the five identified themes is important to promote role development of pharmacy technicians

Learning the ropes:strategies program directors use to facilitate organizational socialization of newcomer residents, a qualitative study

Background: Many residents experience their transitions, such as from medical student to resident, as demanding and stressful. The challenges they face are twofold: coping with changes in tasks or responsibilities and performing (new) social roles. This process of 'learning the ropes' is known as Organizational Socialization (OS). Although there is substantial literature on transitions from the perspective of residents, the voices of program directors (PDs) who facilitate and guide residents through the organizational socialization process have not yet been explored. PDs' perspectives are important, since PDs are formally responsible for Postgraduate Medical Education (PGME) and contribute, directly or indirectly, to residents' socialization process. Using the lens of OS, we explored what strategies PDs use to facilitate organizational socialization of newcomer residents. Methods: We conducted semi-structured interviews with 17 PDs of different specialties. We used a theory-informing inductive data analysis study design, comprising an inductive thematic analysis, a deductive interpretation of the results through the lens of OS and, subsequently, an inductive analysis to identify overarching insights. Results: We identified six strategies PDs used to facilitate organizational socialization of newcomer residents and uncovered two overarching insights. First, PDs varied in the extent to which they planned their guidance. Some PDs planned socialization as an explicit learning objective and assigned residents' tasks and responsibilities accordingly, making it an intended program outcome. However, socialization was also facilitated by social interactions in the workplace, making it an unintended program outcome. Second, PDs varied in the extent to which they adapted their strategies to the newcomer residents. Some PDs used individualized strategies tailored to individual residents' needs and skills, particularly in cases of poor performance, by broaching and discussing the issue or adjusting tasks and responsibilities. However, PDs also used workplace strategies requiring residents to adjust to the workplace without much intervention, which was often viewed as an implicit expectation. Conclusions: PDs' used both intentional and unintentional strategies to facilitate socialization in residents, which may imply that socialization can occur irrespective of the PD's strategy. PDs' strategies varied from an individual-centered to a workplace-centered approach to socialization. Further research is needed to gain a deeper understanding of residents' perceptions of PD's efforts to facilitate their socialization process during transitions

Physican2040 is now already needed:Medical training should orient better on society

De transitie naar ‘de drie V’s’ – zorg voorkomen, verplaatsen en vervangen – vraagt van artsen dat zij inspelen op de maatschappelijke context van hun werk. Maar, zeggen de auteurs, dan moeten we medisch studenten wel anders opleiden