Inappropriate behaviours experienced by doctors while undertaking specialty training

Purpose To explore inappropriate behaviours experienced during specialty training in Australia and their implications for doctors\u27 training experiences and outcomes. This is a subset of data from a larger study exploring experiences of doctors in Australian specialty training - a qualitative study of enablers, stressors and supports. Methods In this qualitative study, registrars in specialist training programmes in Australia were invited and interviewed between August 2015 and August 2016. Semistructured open-ended questions were used to explore topics of relevance to their workplace, training, support service use and personal lives. Interviews were transcribed verbatim, de-identified and content and thematic analysis undertaken. Recruitment was ceased when data saturation was reached and no new themes emerged. Key themes related to inappropriate behaviours experienced during specialty training are reported in this study. Results 17 participants were recruited (including one Indigenous and one international medical graduate). A total of six specialty training programmes across multiple states at various locations across Australia were represented in this cohort. Almost all participants reported confronting (personally experienced or witnessed) inappropriate behaviours during their training, perpetrated most commonly by senior doctors. Key themes of inappropriate behaviour that emerged were belittling and humiliation, sexually inappropriate behaviour, inappropriate behaviour as part of the \u27culture\u27 of medicine, reluctance to raise concerns due to fear of recrimination, and impacts of inappropriate behaviour. Conclusion Varying inappropriate behaviours were experienced by doctors in specialty training, having implications for their psychological well-being. A multidimensional and multisystem approach is required in the management of this serious issue

A rapid umbrella review of the literature surrounding the provision of patient-centred end-of-life care

Background: Patients have reported a broad range of unmet needs in their receipt of clinical care at the end of life. Therefore, enhancing the quality of end-of-life care through patient-centred healthcare interactions is warranted. Aim: The aim of this rapid umbrella review was to synthesise previous literature reviews that have examined: (1) patient preferences for patient-centred end-of-life care; (2) barriers and enablers to patient-centred end-of-life care; (3) interventions designed to enhance patient-centred end-of-life care; and (4) patient-centred models of end-of-life care. Design: A rapid umbrella review was conducted and informed by the Joanna Briggs Institute’s methodological guidance for conducting umbrella reviews. Data sources: Three academic databases were searched for relevant literature in May 2022: MEDLINE, PsycINFO and CINAHL Plus. Inclusion criteria encompassed literature reviews that examined the topic of patient-centred care for any adult patients in end-of-life care. Results: A total of 92 literature reviews were identified. Findings suggest that there is often a discrepancy between patient preferences and the provision of care. These discrepancies have been associated with a range of barriers at the patient, staff and system levels. Common interventions included education and training for staff which were often met with improved patient outcomes. Patient-centred models of care were underrepresented across the literature. Conclusions: This review highlighted a need for healthcare systems to support staff in providing a patient-centred end of life experience through the development of a co-designed patient-centred model of care, supplemented by professional development and a systematic approach to identifying and documenting patient preferences