Busy Workload Research Articles

Expectations and experiences associated with rural GP placements

Evidence indicates a need to recruit more GPs to a career in rural general practice (GP). Research has indicated that placement experiences have the potential to impact on medical career decision-making. Research also suggests that rural placements can raise both professional and psychosocial concerns, but there is no existing evidence about whether pre-placement expectations translate into actual placement experiences. This study aimed to explore both the pre-placement expectations and the post-placement experiences of GP registrars undertaking a rural placement. A qualitative research design was used where 11 pre-rural placement and 19 post-rural placement GP registrars associated with the Adelaide to Outback GP Training Program (AOGP) were interviewed until no new information emerged. An even distribution of gender and training pathway was achieved. Transcripts were subjected to thematic analysis, which explored the pre-placement expectations and the post-placement experiences of GP registrars undertaking a rural placement. Rater consensus was achieved for the themes extracted. RESULTSs: Analysis resulted in positive and negative pre-placement expectation and post-placement experience themes. One-third of pre-placement expectations were positive. The overall trend was for negative expectation themes to be viewed positively by registrars interviewed post-placement. Five positive post-placement experience themes, relating to support received, were not identified at pre-placement. This demonstrates that there are positive rural placement experiences that are not understood by registrars before their placement ('being known to all', 'support from AOGP', 'support from Division', 'support from family and friends' and 'self-initiated support'). The only negative expectations that were also discussed by registrars post-placement as negative experiences were 'separation from family', 'busy workload' and 'driving'. The negative expectations that were also viewed as negative experiences were 'separation from family', 'busy workload' and 'driving', which are difficult to change but should be discussed and planned for pre-placement. Based on these results it is important for GP supervisors, regional training providers, Divisions and rural workforce agencies to work together to ensure that registrars are provided with information and support pre-placement to alleviate their unwarranted negative expectations, while confirming warranted positive expectations. Warranted negative expectations should also be discussed beforehand to plan strategies for managing them during the placement. If the findings are used in this way, an improvement in overall rural placement experience could be expected.

Michael Bentley: JM Dental Care

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Q&A - How can I reduce my stress at

Q: I work in a busy practice and my workload is becoming overwhelming. I am constantly stressed and work long hours to catch up with paperwork. How can I combat this?

Training outside of the box.

Developments in surgical training in Australasia allow for individualization of training to suit individual requirements. One uncommon career track is medical aid or missionary surgery in the developing world. It is difficult to receive appropriate training for this type of surgical practice in Australasia. The present paper describes a novel approach to preparing for this kind of work by spending a 6 month rotation in a mission hospital in rural East Africa. The surgical trainee spent 5 months working at Kijabe Hospital in Kenya. This is a large mission hospital with a busy general surgical workload and adequate staffing for training. The trainee performed 214 major cases, in a broad range of general surgery, under appropriate supervision. He also took part in regular educational sessions, surgical audit, and helped to develop one of East Africa's pioneering laparoscopic surgical -programmes. The present paper demonstrates that it is possible for Australasian trainees to gain useful experience in the rural African environment, in hospitals where appropriate surgical supervision is available.

Imbedding quality improvement into all aspects of nursing practice.

Influencing nurses to accept and implement best practice and continuous quality improvement into everyday nursing activities and to change practice is a significant challenge for any nursing service. Quality improvement is often considered by clinicians to be yet another task to be added to their already busy workloads. This paper describes the attempts of one large metropolitan tertiary teaching hospital to imbed quality improvement and best practice across the spectrum of its nursing service and to foster a culture of quality within clinical practice and documentation. It outlines the methods used by one hospital to enshrine best practice into all nursing activities and to minimize variations in practice throughout the hospital through the use of its nursing clinical information system.

A hierarchical and multiscale approach to analyze E-business workloads

Understanding the characteristics of electronic business (E-business) workloads is a crucial step to improve the quality of service offered to customers in E-business environments. This paper proposes a hierarchical and multiple time scale approach to characterize E-business workloads. The three levels of the hierarchy are user, application, and protocol, and are associated with customer sessions, functions requested, and HTTP requests, respectively. Within each layer, an analysis across several time scales is conducted. The approach is illustrated by presenting a detailed characterization of two actual E-business sites: an online bookstore and an electronic auction site. Our analysis of the workloads showed that the session length, measured in number of requests to execute E-business functions, is heavy-tailed, especially for sites subject to requests generated by robots. An overwhelming majority of the sessions consist of only a handful requests, which seems to suggest that most customers are human (as opposed to robots). A significant fraction of the functions requested by customers were found to be product selection functions as opposed to product ordering. An analysis of the popularity of search terms revealed that it follows a Zipf distribution. However, Zipf’s law as applied to E-business is time scale dependent due to the shift in popularity of search terms. We also found that requests to execute frequent E-business functions exhibit a pattern similar to the HTTP request arrival process. Finally, we demonstrated that there is a strong correlation in the arrival process at the HTTP request level. These correlations are particularly stronger at intermediate time scales of a few minutes.

Physicians attitudes toward DNR of terminally ill cancer patients in Taiwan.

The purpose of this study was to survey physicians attitudes toward DNR of terminally ill cancer patients in Taiwan. A total of 7626 structured questionnaires were sent by mail to physicians who were members of the Taiwan Society of Internal Medicine and the Surgical Association of Taiwan, and 1328 valid responses were received. The response rate was 17.6%. The instrument, a structured questionnaire, was composed of one scenario and six questions. A majority (77.6%) of the physicians under investigation would tell a terminally ill cancer patient or his family about the possibility of DNR and ask them to consider signing a consent form. Over one half of the physicians (58.4%) did not know whether the Medical Law in Taiwan permits natural death, and 96.1% of the subjects felt they would need legal protection for agreeing patient s autonomy to decide DNR. Unfortunately, 41.2% of the respondent admitted that they did not have a formal Informed Consent Form that could be used for DNR. Even of those who had such a form, only 27.4% had clear guidelines given by their institutions. Among 623 physicians whose institutions had an formal Informed Consent Form for DNR, 63.7% agreed that it was reasonably used. Surprisingly, 67.9% of the physicians had used Slow Codes. The findings of this study served as a solid base. The investigator and other colleagues used it to convince legislators to pass a Natural Death Act in Taiwan. Since some legislators disliked the term death and the main promotes were people engaged in hospice palliative care, the new law entitled Hospice Palliative Act was passed on May 23, 2000. The DNR order finally gained its legal base for medical practice. The limitation of this study was the low response rate. However, since the subjects, physicians, had a busy work load, this was still an acceptable response rate.

The Effect of the Busy Season Workload on Public Accountants' Job Burnout

Anecdotal evidence suggests that the escalated workload of the public accounting “busy season” is a major contributor to employee “burnout.” Academic research on the psychological impact of the busy season workload, however, is virtually absent from the accounting literature. We partially address this void by employing a longitudinal design and structural equation modeling to examine the causal impact of the busy season workload on public accountants' job burnout—a dysfunctional stress syndrome. Prior to the start of the busy season and again at its end, we measured hours worked, role stressors, and job burnout for a sample of public accountants from a national firm. The results of our analyses indicate that public accountants' pre-busy season burnout was not directly affected by hours worked, even though subjects reported an average workload of 49 hours per week. This result implies that public accountants may develop a relatively high workload threshold before it directly impacts their job burnout. During the busy season, our subjects' weekly workload increased to approximately 63 hours. The additional workload burden introduced by the busy season caused job burnout for our sample of public accountants to rise to levels rarely reported in the research literature.

Vaginal and speculum examination in medical curricula.

Medical students' perception of their own psychomotor skills and attitudes to different methods of teaching the gynaecological examination were studied. Students rated their physical skills poorly, only 7% feeling confident they could detect an abnormality and only 14% considering their ability to perform a Pap smear was good or very good. They rated their doctor/patient skills better, 55% considering they are good at conducting an examination with sensitivity and 67% at explaining to their patient what they were doing and why. Students' first preference for instruction was to examine patients in the Outpatient Clinic under the supervision of a doctor, a method experienced by most students on one occasion. The next preferred method was for students to work with 2 trained gynaecological assistants, acting as patient and instructor, with discussion of feelings and feedback (see Subjects and Methods). The option of student volunteers was a least favoured method but was cited as first preference by 5% of students. Over 25% of the female students considered volunteering for vaginal examination a 'possibility' if they were examined by a student of the same sex. Over 25% of males would 'possibly' volunteer for rectal examination only if the same sex was present. The comments by the students offer help in the future planning of teaching vaginal examination.

FACTORS INFLUENCING CAREER CHOICE AND SATISFACTION IN PEDIATRICS

The “dissatisfied pediatrician syndrome” has been manifested in an extremely high career burn-out rate among pediatricians. This study's purpose was to cite factors which lead to career satisfaction and dissatisfaction or burn-out in pediatricians. METHODOLOGY: Pediatricians (87) surveyed in Washington, D.C. and at the fall 1983 AAP meeting career assessment exhibit (125) completed a questionnaire, the FIRO-B Scale, and Rezler Learning Preference Inventory. 63% were in practice, 32% in academics, and 5% in research or other. 73% were males; 27% were females. RESULTS: Many pediatricians, unrelated to career choice or satisfaction, reported feeling stressed and tense. Dissatisfying factors were: long hours, busy workloads, inadequate remuneration, stress, and malpractice threats. Academicians found the difficulty of balancing patient care, administration, research, and teaching responsibilities and the lack of support and time for research and teaching to be dissatisfying. Practitioners reported endless telephone calls, practice management, insecurity, routine work, limited time for research and teaching and lack of contact with peers to be dissatisfying. The time spent in patient care, teaching, administration, and research were found to significantly correlate with career satisfaction. Career profiles for pediatricians in practice and academics were predictable based on study results.

John R. Hodgson, A.B., M.D. President, Radiological Society of North America.

At its recent Scientific Assembly and Annual Meeting, the Radiological Society of North America elected as its President a diagnostic radiologist whose interests encompass most of the problems and goals of the organization and whose characteristics epitomize the qualities needed in seeking solutions to these problems and in giving direction to advancing the aims of the Society. John R. Hodgson, A.B., M.D., was born on Nov. 14, 1914, in Muskegon, Mich. He was educated in the University of Michigan and in the University of Michigan Medical School in Ann Arbor, from which he was graduated in 1940. After an internship at Providence Hospital, Detroit, he held a residency in pathology and medicine which he was forced to interrupt because of a bout with tuberculosis. This also forced his resignation from the Army Medical Reserve Corps. After recovery, his interests fortunately shifted to radiology, and he became a Fellow in Radiology in the Mayo Graduate School of Medicine of the University of Minnesota at Rochester, Minn., on July 1, 1943. He completed his residency training there and received the degree of Master of Science in Radiology in December 1946. He remained in Rochester as a consultant in the Section of Diagnostic Roentgenology at the Mayo Clinic, and since Nov. 1, 1967, he has been head of that section, succeeding Dr. C. Allen Good. In this role he not only engages in the very busy departmental workload but also directs and coordinates the ever-expanding complexities of a large, increasing staff whose interests and activities integrate closely with those of other sections within the Mayo Clinic. Furthermore, his duties demand the careful supervision of a large residency training program and participation in courses of continuing education for physicians in practice. Because of his sustained interest and work in the formal educational aspects of radiology, he was given the appointment of Professor of Clinical Radiology in the Mayo Graduate School of Medicine in 1967. His long-maintained efforts and interest in pediatric and gastroenterologic roentgenology have produced an impressive bibliography. In the attainment of professional skills and administrative ability, John Hodgson has maintained a broad perspective of the whole field of radiology. He has been in the front ranks of the battle to maintain diagnostic radiology as an intact discipline without fragmentation, but at the same time he has encouraged the development of subspecialty proficiency within radiology rather than outside it, and he has stressed the truly consultative role the radiologist can and should play. In this era of personal commitment and involvement in matters of professional and public concern, Jack Hodgson has been a dedicated and active participant in both the scientific and organizational aspects of local and state medical organizations. He has been President of the Minnesota Radiological Society.