Can compassionate leadership of senior hospital leaders help retain trainee doctors?

BackgroundHigh burnout and low retention rates among trainee doctors threaten the future viability of the UK medical workforce. This study empirically examined factors that can sustain trainee doctors.MethodA total of 323 trainee doctors from 25 National Health Service (NHS) Trusts in England and Wales completed an online survey on their training and employment experiences. A mixed method approach was employed.ResultsStructural equation modelling revealed that perceived compassionate leadership of hospital senior leaders (CLSL) (i.e., doctors in senior clinical and management positions, and senior managers) is directly and negatively associated with trainee doctors’ burnout and intention to quit. We propose the associations may be indirectly strengthened through two mediating pathways: increased psychological contract fulfilment (PCF) of training/organisational support and reduced worry about the state of the NHS; however, only the former is supported. The model can explain a substantial 37% of the variance in reported burnout and 28% of intention to quit among trainee doctors. Being a Foundation Year (FY) trainee was significantly associated with poor PCF and burnout. Rich qualitative data further elaborated on their experiences in terms of senior leaders’ awareness of their training/working experiences, listening to and acting on.ConclusionsActive and demonstrable CLSL plays a vital role in trainee doctors’ retention. It has both direct (through support) and indirect effects through improving trainee doctors’ PCF to reduce burnout and intention to quit. This seems particularly valuable among FY doctors. Implications for the development and management of the medical workforce are discussed

Extracorporeal shockwave therapy improves functional outcomes of adhesive capsulitis of the shoulder in patients with diabetes

Adhesive capsulitis of the shoulder (ACS) is the most prevalent musculoskeletal disorder of the upper extremity (1,2) among people with diabetes. ACS is characterized by intense shoulder pain with progressive limitation of joint mobility and functional disability, negative impact on the quality of life, and increased health care costs (3)

Additional file 1: Supplemental Information. of A null mutation in ANGPTL8 does not associate with either plasma glucose or type 2 diabetes in humans

Figure S1. In-silico predictions of the impact of premature termination codon p.Q121X suggests that the variant would trigger nonsensemediated decay. Table S1. ANGPTL8 p.Q121X and type 2 diabetes status by study. (PDF 145 kb

Clinical Characteristics of Go-DARTS Study Participants Stratified by PNPLA3 I148M Genotype.

<p>Abbreviations: Go-DARTS, Genetics of Diabetes Audit and Research Tayside Scotland; PNPLA3, patatin-like phospholipase domain-containing 3; II, individuals with two 148I alleles; MM, individuals with two 148M alleles; IM, heterozygotes; n, number; HOMA-IR, homeostasis model assessment for insulin resistance HDL, high-density lipoprotein; ALT, alanine transferase; HbA1c, glycated hemoglobin; ns, P value≥0.05.</p><p>Plus-minus values are means ± SD.</p>*<p>P values were calculated using linear regression model including age, body-mass index and gender for all variables. HOMA-IR, triglycerides and ALT were log-transformed before entering the model. See methods for more details on the statistical analyses.</p

Multivariate regression analysis of Risk of Type 2 Diabetes Mellitus in the Go-DARTS study.

*<p>P-values were calculated under an additive model using a binary logistic regression model including gender as a categorical variable (Males  =  referent) and age and BMI as continuous variables.</p><p>P value for interaction between severe obesity and I148M for type 2 diabetes risk  = 0.002.</p><p>Abbreviations: Go-DARTS, Genetics of Diabetes Audit and Research Tayside Scotland; OR, odds ratio; F, female; BMI, body mass index; PNPLA3, patatin-like phospholipase domain-containing 3.</p

Baseline Clinical Characteristics of SOS Study Participants Stratified by <i>PNPLA3</i> I148M Genotype.

<p>Abbreviations: SOS, Swedish obese subjects; PNPLA3, patatin-like phospholipase domain-containing 3; II, individuals with two 148I alleles; MM, individuals with two 148M alleles; IM, heterozygotes; n, number; HOMA-IR, homeostasis model assessment for insulin resistance; HDL, high-density lipoprotein; AST, aspartate transferase; ALT, alanine transferase.</p><p>Plus-minus values are means ± SD.</p>*<p>P values were calculated using linear regression model including age, gender and body-mass index for all variables. HOMA-IR, triglycerides, ALT and AST were log-transformed before entering the model. Male gender, lipid-lowering medications and type 2 diabetes distribution were compared by χ2 test. See methods for more details on the statistical analyses.</p>†<p>Fasting insulin and HOMA-IR are shown only in non-diabetic individuals.</p

Serum triglycerides and homeostasis model assessment for insulin resistance (HOMA-IR) at 2- and 10-year follow-up.

<p>Serum triglycerides (panel A and B) levels and HOMA-IR (panel C and D) at 2- and 10- year follow up (FU) in the control (A, C) and the surgery (B, D) group across the <i>PNPLA3</i> genotypes. Values are means and standard deviations. * HOMA-IR values are shown only in non-diabetic individuals.</p