Educational needs of junior doctors caring for hospitalised older adults

Physicians' explanatory models of commonly encountered clinical problems reflect not only formal medical training, but also personal and professional experience. In situations where formal training is absent, the clinical context of informal learning is likely to have an important influence on junior doctors' evolving knowledge and practice. The purpose of this study was to explore junior doctors' explanatory models of somatisation in the absence of formal training, and in particular the influence of working with a large proportion of immigrants (asylum seekers and refugees) on their understanding and practice. Semi-structured interviews were conducted with all 14 junior doctors working at the Geneva University Hospitals general medicine outpatient clinic. Interviews explored junior doctors' definitions, understanding and management of somatisation. Interviews were tape-recorded, transcribed verbatim and analyzed for key themes. In the absence of formal training, somatisation evoked considerable uncertainty and frustration in terms of diagnosis and management. Junior doctors' understanding of somatisation was heavily influenced by their contact with immigrant patients. They primarily attributed somatisation to psychosocial stresses related to migration and tended to label certain socio-cultural groups as more prone to somatisation than others. It is important to recognize that contextual factors have an important influence on physicians' evolving explanatory models for commonly encountered problems, especially in the absence of formal training. Results from this study suggest that formal training in management of somatisation should be offered in order to broaden junior doctors' understanding of somatisation and avoid cultural stereotyping.

Physicians' explanatory models of commonly encountered clinical problems reflect not only formal medical training, but also personal and professional experience. In situations where formal training is absent, the clinical context of informal learning is likely to have an important influence on junior doctors' evolving knowledge and practice. The purpose of this study was to explore junior doctors' explanatory models of somatisation in the absence of formal training, and in particular the influence of working with a large proportion of immigrants (asylum seekers and refugees) on their understanding and practice. Semi-structured interviews were conducted with all 14 junior doctors working at the Geneva University Hospitals general medicine outpatient clinic. Interviews explored junior doctors' definitions, understanding and management of somatisation. Interviews were tape-recorded, transcribed verbatim and analyzed for key themes. In the absence of formal training, somatisation evoked considerable uncertainty and frustration in terms of diagnosis and management. Junior doctors' understanding of somatisation was heavily influenced by their contact with immigrant patients. They primarily attributed somatisation to psychosocial stresses related to migration and tended to label certain socio-cultural groups as more prone to somatisation than others. It is important to recognize that contextual factors have an important influence on physicians' evolving explanatory models for commonly encountered problems, especially in the absence of formal training. Results from this study suggest that formal training in management of somatisation should be offered in order to broaden junior doctors' understanding of somatisation and avoid cultural stereotyping.

Cardiothoracic surgery training in Australia and New Zealand

'People-centered care' is one of the World Health Organization's six defining features of quality care and recognizes the importance of tailoring healthcare to individual needs. This is particularly important for older patients who are more vulnerable to complications during their hospitalization. The initial medical assessment in hospital is a vital part of any admission, however, the older patient's experience of this is not well understood. The aim of this study was to investigate the perspectives of older patients, exploring their experience and expectations during these critical encounters. This was a qualitative study. Semi-structured interviews were conducted at a major teaching hospital in Sydney, Australia with adult inpatients who were > 75 years old, admitted from the Emergency Department, and had multimorbidity, polypharmacy or frailty. Interviews were transcribed and data were thematically analyzed. The 20 study participants had a median (range) age of 85 (75-95) years and 13 (65%) were frail. Six themes were identified: (1) addressing the presenting complaint, (2) implicit trust, (3) being understood as an individual, (4) kindness and respect, (5) well-informed and sometimes shared decision-making and (6) willingness for challenging conversations. Our findings highlight that older patients expect holistic and individualized care, extending beyond clinical expertise to encompass key professional and interpersonal characteristics such as effective communication, respect and kindness. The next steps are developing ways to upskill doctors in these aspects and involve older people in the development of training and standards to support the delivery of medical care that aligns with their experiences, expectations and preferences. The study design and interview guide were shaped by feedback from a patient and public involvement (PPI) workshop, which informed the interview process. Study findings were also shared with a PPI panel, whose insights were incorporated into this manuscript. As part of a larger research program, these findings will contribute to the co-design of educational interventions aimed at improving health professionals' assessment and management of older hospital patients.

Infectious diseases and antimicrobial prescribing: Online spaced education for junior doctors

Junior doctors’ prescribing work after-hours and the impact of computerized decision support

BACKGROUND The European Cooperation in Science and Technology (COST) Action 21122, PROmoting GeRiAtric Medicine in countries where it is still eMergING (PROGRAMMING) developed an online open survey to assess the educational interests and needs of health care professionals and final-year medical students across participating countries. This survey aims to establish a current baseline for developing educational content on geriatric medicine for nongeriatricians and a framework for its delivery. OBJECTIVE This paper describes the aim, development, structure, content, and dissemination of this survey. METHODS The mixed methods electronic survey, initially developed in English through a cocreation process with key stakeholders, was subsequently translated into 24 languages. It received ethics approval from multiple participating countries. Within- and cross-country analyses of the survey data will be conducted using descriptive and inferential statistics for quantitative data and content analyses for qualitative data. National and international teams will conduct analyses in parallel exploring responses within a specific country or region, professional category (or among medical students), or setting of work. Basic descriptive statistics and chi-square tests will evaluate differences in knowledge, relevance, and interest in geriatric topics across countries, professions, and settings of work. The effectiveness of formal education in geriatric medicine and clinical rotations in geriatric settings versus the lack thereof in promoting higher self-perceived knowledge on geriatric medicine topics will be explored using binary logistic regression. We will provide basic descriptive statistics (frequencies) of reported barriers to receiving further training in geriatric medicine and the effectiveness of various teaching methods as rated by the respondents and explore differences across countries, professions, and settings using chi-square tests. We will conduct qualitative content analyses of free-text responses to the questions exploring professionals’ and medical students’ thoughts on caring for older people and medical students’ thoughts on becoming geriatricians. RESULTS The survey included the following sections: Informed Consent, Demographics, Topics and Skills, Medical Students vs. Professionals, Current Profession (for professionals), Previous Education in Geriatric Medicine (for professionals), Education in Geriatric Medicine (for medical students), Interest in Care of Older People or Geriatric Medicine, Suggestions for Courses in Care for Older People or Geriatric Medicine, and Closure. The survey was disseminated between October 9, 2023, and June 5, 2024, and received 6099 responses; after cleaning, there were 5922 (97.1%) responses (n=5474, 92.43% from professionals and n=448, 7.57% from medical students). CONCLUSIONS This survey’s findings will inform educational projects across the PROGRAMMING countries. We will share these findings with national and international stakeholders, including professional societies, medical schools, and other relevant organizations. We will advocate for professional educational curricula to include geriatric topics rated as relevant by the survey respondents and promote clinical rotations in geriatric settings and teaching methods rated as effective by the survey respondents. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/64985

BackgroundThe European Cooperation in Science and Technology (COST) Action 21122, PROmoting GeRiAtric Medicine in countries where it is still eMergING (PROGRAMMING) developed an online open survey to assess the educational interests and needs of health care professionals and final-year medical students across participating countries. This survey aims to establish a current baseline for developing educational content on geriatric medicine for nongeriatricians and a framework for its delivery.ObjectiveThis paper describes the aim, development, structure, content, and dissemination of this survey.MethodsThe mixed methods electronic survey, initially developed in English through a cocreation process with key stakeholders, was subsequently translated into 24 languages. It received ethics approval from multiple participating countries. Within- and cross-country analyses of the survey data will be conducted using descriptive and inferential statistics for quantitative data and content analyses for qualitative data. National and international teams will conduct analyses in parallel exploring responses within a specific country or region, professional category (or among medical students), or setting of work. Basic descriptive statistics and chi-square tests will evaluate differences in knowledge, relevance, and interest in geriatric topics across countries, professions, and settings of work. The effectiveness of formal education in geriatric medicine and clinical rotations in geriatric settings versus the lack thereof in promoting higher self-perceived knowledge on geriatric medicine topics will be explored using binary logistic regression. We will provide basic descriptive statistics (frequencies) of reported barriers to receiving further training in geriatric medicine and the effectiveness of various teaching methods as rated by the respondents and explore differences across countries, professions, and settings using chi-square tests. We will conduct qualitative content analyses of free-text responses to the questions exploring professionals’ and medical students’ thoughts on caring for older people and medical students’ thoughts on becoming geriatricians.ResultsThe survey included the following sections: Informed Consent, Demographics, Topics and Skills, Medical Students vs. Professionals, Current Profession (for professionals), Previous Education in Geriatric Medicine (for professionals), Education in Geriatric Medicine (for medical students), Interest in Care of Older People or Geriatric Medicine, Suggestions for Courses in Care for Older People or Geriatric Medicine, and Closure. The survey was disseminated between October 9, 2023, and June 5, 2024, and received 6099 responses; after cleaning, there were 5922 (97.1%) responses (n=5474, 92.43% from professionals and n=448, 7.57% from medical students).ConclusionsThis survey’s findings will inform educational projects across the PROGRAMMING countries. We will share these findings with national and international stakeholders, including professional societies, medical schools, and other relevant organizations. We will advocate for professional educational curricula to include geriatric topics rated as relevant by the survey respondents and promote clinical rotations in geriatric settings and teaching methods rated as effective by the survey respondents.International Registered Report Identifier (IRRID)DERR1-10.2196/64985

Junior doctors who experience high levels of burnout gain comfort and reassurance from debriefing sessions, say Australian researchers. Further investigation is now needed to see whether such interventions should be implemented more widely, the researchers argue. Few studies so far have investigated strategies to prevent or reduce burnout among juniors. Now a small pilot study has been carried out in an inner city teaching hospital in Sydney involving 31 postgraduate year one doctors.1 Burnout …

Introduction: Engaging junior doctors in research can contribute to improved health outcomes, but there is a lack of guidance on how best to support junior doctor research engagement through their workplace experiences. This study aims to identify factors influencing Australian junior doctors’ workplace engagement in research and inform recommendations for building research capacity. Methods: This qualitative interview study, using convenience sampling, explored junior doctors’ perceptions and experiences of research engagement. Seventeen junior doctors working at an Australian teaching hospital were interviewed. Data were analysed using the framework method, informed by workplace learning theory. Results: Junior doctors found it challenging to engage in research activities and attributed this to the lack of a practice-based curriculum to sequence their learning. They described an absence of workplace affordances for research engagement, including time, research-active clinician mentors and accessible projects. Whilst career progression was one motivator for research engagement, a key motivator was engaging in research contributing to patient care. Conclusions: The findings suggested that absence of practice-based curriculum, mentor guidance and engagement in meaningful research activities hampered research engagement. These findings may inform junior doctor research development programs in acute healthcare organisations.

IntroductionThere is a growing emphasis on developing effective leadership within healthcare, including better training and support for clinical leaders.1 The views and experiences of senior NHS leaders have recently been...

Recognition and management of sepsis by junior doctors

Concerns have been growing about the effects of the working environment on junior doctors and the learning opportunities available to them. In order to identify problems and opportunities for improvement, we explored junior doctors' opinions about the transition from student to practitioner. Seventeen recent graduates in four focus groups discussed the transition. Related comments were combined in the report of the discussions, which was approved by the participants. The transition was perceived as a major change, particularly the increased responsibility and workload and contacts with other health care workers and patients. Preparation during undergraduate training was adequate as regards knowledge, communication, history taking and physical examination skills but not for pharmacological knowledge and patient management skills. Problems were connected with practical procedures and feelings of uncertainty. There was little formal education. Proposals to ease the transition were earlier patient contacts, more involvement in patient management and growing responsibility during clerkships. Although the sample was small, the uniform opinion in all groups supports the validity of the findings. Junior doctors felt confident with regard to knowledge and skills, but experienced difficulties with patient management, practical matters and their role on the team. Contrary to the idea of an educational continuum, formal learning appeared to be very limited in the hospital environment. Preparation for medical practice may benefit from active involvement of clerks in patient management decisions and a gradual increase in responsibilities. An effective medical education continuum would require more attention for house officers' learning.

Background Studies show that newly qualified doctors feel unprepared for clinical practice in several key areas in the care of older people, despite older people occupying two thirds of inpatient beds [1,2]. Grounded in experiential learning theory, simulation has been hugely effective in undergraduate education in geriatric medicine [3]. We aimed to evaluate a novel simulation series exploring practically challenging aspects of geriatric medicine, such as ‘silver trauma’ and using de-escalation strategies in the management of delirium. Methods Using quality improvement methodology, we developed two inpatient simulation scenarios for fourth-year medical students on their geriatric medicine clerkships. The scenarios (managing delirium and post-falls assessment) are commonly encountered during on-call shifts, with learning outcomes aligned to Outcomes for Graduates. Our initial cycle involved eight students piloting the two scenarios and evaluation tool. Using their feedback, we will iteratively improve the methods and evaluation before repeating and obtaining pre- and post-simulation data on students’ ‘preparedness for F1’. Results Following the pilot, 100% of participants agreed that they felt more prepared for clinical work in geriatrics as an F1 doctor. 12.5% felt confident assessing a patient following a fall pre-session, which increased to 100% afterwards. Confidence in using de-escalation techniques in managing delirium improved from 50% (pre-) to 100% (post-session). Common themes in free-text feedback were that the simulation felt realistic and effectively tested prioritisation. Conclusion Our work highlights the merits of using simulation in geriatric medicine to help undergraduates prepare for the complexities and uncertainty involved in caring for the ageing population.

BackgroundNICE organ donation guidance makes it explicit in its first recommendation that ‘organ donation should be considered as a usual part of “end-of-life care” planning.’ The Liverpool Care Pathway (LCP)...