How trainee therapists experience resilience: an interpretative phenomenological analysis

While the importance of nurturing resilience in therapists (professionals in psychological therapies, e.g. counsellors, psychotherapists and counselling psychologists), and, in particular, trainees, is broadly recognised, there remains limited research directly exploring this area. The intention of the present study, therefore, is to explore how prequalification trainee therapists who have started seeing clients make sense of their experiences of resilience and to investigate what fosters and sustains their resilience. Four trainee therapists were recruited and one‐to‐one audio‐recorded interviews conducted. Interpretative phenomenological analysis was used to analyse the interview transcripts. Three overarching themes emerged from an analysis across the four cases: ‘Reframing resilience’, ‘Locating resilience’ and ‘Finding the right path’. Understanding how resilience is developed is integral to fuller understanding of trainee development. Trainees need to develop competence and confidence en route to becoming therapists. Perhaps somewhat paradoxically then, findings in the present study suggest that building resilience is about becoming more vulnerable. Trainees' feelings of empowerment, self‐efficacy and control may be fostered through a new less judging relationship to the experience of vulnerability. Indeed, a sense of confidence may emanate from the capacity for managed vulnerability

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Positive outcomes from poor starts: Predictors of dropping back in

A vast body of research finds an association between missteps taken during the teen years (such as motherhood or dropping out of high school) and poor economic and educational outcomes. However, youth who take major missteps as teens often have subsequent success in school or the labor market. This paper attempts to draw lessons from youth who appear headed for a poor start in life, yet manage to have a positive economic or educational outcome by their early 20 s. Using National Educational Longitudinal Survey (NELS), we provide one of the first longitudinal analyses of well-being for teen mothers and high school dropouts that includes a nationally-representative population of Hispanic and Asian youth. In general, the predictors of positive outcomes are similar for those with high probabilities of poor starts as for the general population. A few high-school-age behaviors and community measures have additional associations with positive outcomes for likely poor starters. However, these correlates do not appear for all groups of likely poor starters, and they are not always in the expected direction.AM