Experience Of Doctors Research Articles

Consequences of career progression barriers experienced by doctors in GP training: an interpretative phenomenological study

ABSTRACT Background Despite commitment across national medical education and training bodies to tackle differential attainment (DA), alongside a wealth of research into contributing factors and solutions, progression in narrowing the gap has lagged. This study explores the lived experiences of doctors facing DA, career progression barriers and their wider consequences. Methods Interpretative phenomenological analysis was chosen as the methodological framework. The six doctors interviewed were released from General Practice training before enrolling in a ‘targeted’ intervention scheme designed to support them with training completion. Results The cohort included four international medical graduates and two graduates from the United Kingdom. Three participants were neurodiverse. Three inter-related themes were identified. 1) ‘Career insecurity’ is defined as uncertainty about career prospects and attainment of career goals. At varying points along their journey navigating through progression barriers, participants frequently questioned their futures and the decision to persist in the arduous pursuit of training completion. 2) ‘Psychological injury’ featured prominently in the experiences of the ‘targeted trainees’. Feelings of worthlessness, helplessness, low energy and mood, and ‘traumatic’ experiences were described. 3) ‘Social injury’ illustrates consequences to doctors’ familial and social contexts (including relationships), as well as wider societal consequences (such as attrition). Conclusion Our research evidences the consequences of DA and career progression barriers. We highlight the urgent need for escalated efforts in addressing the challenges faced by different groups of doctors and narrowing the attainment gap. Recommendations for interventions are included in our study.

Doctoral memes as public pedagogy? Or, heaven knows I’m miserable now

ABSTRACT Social media afford the proliferation of doctoral memes across numerous, generally anonymous, accounts spread over multiple platforms – the timeline where the PhD candidate starts off gleaming with health and beaming in delight and ends up an overweight, dishevelled wreck. Or the exhausted cat who has managed to write one line of their thesis in an entire day. But should these memes be a cause for concern? After all, it’s just humour, albeit somewhat dark. My exploratory thematic analysis of a corpus of 292 doctoral memes and a theorisation of memes as public pedagogy, point to strong resonances between the memes and research on the doctoral experience. This enhances their credibility as a source of information. Based on the analysis, I suggest we might seriously examine doctoral meme-based learning, focusing on the potential of their gallows humour to support identity formation, community building, coping and wellbeing. Memes may be small but could potentially do useful work for both doctoral researchers and their supervisors.

Enacting writing differently through a collective liminal experience

ABSTRACT Writing differently presents numerous challenges, impossibilities, and anxieties. While literature underscores the significance of cultivating new writing forms, the actual experience of writing differently remains obscure. This paper seeks to better understand how alternative forms of writing can be enacted. More specifically, it aims to explore how writing differently affects the process of becoming an academiX, by analyzing our collective and individual experiences within Compo·X, a collective of PhD students. We perceive our doctoral experience as a liminal one, a transitional phase that reshapes our identities. We illustrate how our distinct writing practices facilitated the development of a shared identity and an environment for growth in academic world often known for its lack of inclusivity. At the end, we show how writing differently and collective writing helped us to swim against the tide and served as a platform for micro-revolutions within us and academia’s competitive and normative culture and organization.

Impact and evaluation report of the DTA3/COFUND programme

Background This report evaluates the outcomes and effectiveness of the DTA3/COFUND doctoral fellowship programme, which ran from 2019 to 2023. Funded by the Horizon 2020 Marie Skłodowska-Curie PhD Fellowship programme, DTA3 aimed to foster interdisciplinary, international, and industry-focused research across 15 UK universities. Methods The programme supported 71 international fellows from diverse countries, emphasising inter-sectoral skills and post-doctorate employability. A mixed-methods study design was employed, involving online surveys, focus groups, and interviews with fellows, supervisors, and university programme leads. Results Key areas of evaluation included research activities, employment outcomes, wellbeing, doctoral training experiences, and institutional impact. The data revealed that 72% of fellows had submitted their PhD theses, with 66% having completed their viva by the report's conclusion. The programme also recorded a high employment rate, with 55% of fellows in the final stages of their PhD already employed. The DTA3 programme featured an enhanced training component, including annual summer schools, spring refresh events, autumn schools, and residential writing retreats. These events focused on enhancing employability, academic skills, research impact, and intersectoral collaboration. Despite challenges such as visa complications, COVID-19 restrictions, and international supervisor movements, the programme maintained a strong completion rate. Conclusions The report highlights the programme's success in providing fellows with significant international mobility opportunities, with many securing employment in their home countries or abroad shortly after completing their PhD. The DTA3 legacy includes ongoing cohort tracking, an alum network, and a dedicated legacy fund to support further international collaboration and knowledge exchange. Overall, the DTA3/COFUND programme demonstrated substantial impact in training and developing skilled researchers, promoting international collaboration, and enhancing employability in diverse sectors, thereby contributing positively to the global research community.

8463 Navigating Medical Decisions: A Study Of Second Opinions From Both The Physician And Patient Standpoints

Abstract Disclosure: O. Derevyanko: None. Background: In contemporary healthcare, the concept of seeking second opinions has become increasingly prevalent, shaping the dynamics of patient-physician relationships. This study aims to delve into the multifaceted landscape of second opinions, examining the perspectives of both doctors and patients. As medical decision-making becomes more collaborative, understanding the factors influencing the second opinion process is crucial for enhancing patient outcomes and fostering effective communication within the healthcare system. Objectives: • To identify patterns and discrepancies between doctors' and patients' viewpoints on the importance and impact of second opinions.• To provide insights that can contribute to the development of strategies for improving the second opinion experience for both doctors and patients.• To assess how often patients seek for second opinion MethodsA comprehensive survey conducted among 756 doctors endocrinologists in social media Instagram , aiming to explore their attitudes and concerns regarding patients seeking second opinions in medical practice and 787 patients to find out how many of them seek for a second opinion. Results: Out of the surveyed doctors, 51.3% (n=388) expressed a positive and accepting attitude toward patients seeking second opinions. This majority acknowledged the importance of patient autonomy and the right to seek additional perspectives on their medical conditions.A significant portion, 34.5% (n=261) of doctors, voiced concerns related to potential drawbacks associated with second opinions. These concerns primarily revolved around the possibility of patients receiving conflicting advice or experiencing delays in crucial treatment decisions.A noteworthy 14.2% (n=107) of doctors indicated concerns related to the potential impact of second opinions on the trust between doctors and patients. This subset of professionals expressed apprehensions about how seeking additional perspectives might influence the doctor-patient relationship. 554 out of 787 patients reported about seeking for the second opinion most of the time. Conclusion: The insights gleaned from this survey shed light on the complex landscape of doctors' perspectives on second opinions. Recognizing the nuances within these attitudes is imperative for developing strategies that support collaborative decision-making and patient-centered care in the medical community. This research contributes valuable insights to the ongoing discourse surrounding patient autonomy and doctor-patient relationships. Presentation: 6/3/2024

Standardized treatment of oral cancer under the guidance of clinical practice guidelines of National Comprehensive Cancer Network.

Oral cancer represents a serious public health problem affecting oral and system health with a high global incidence. Treatment strategies for oral cancer vary in different disciplines and are likely to be limited to certain doctor's personal experience. While clinical practice guidelines are considered to enable doctors to determine the most appropriate and consistent treatment strategy according to the patient's situation. National Comprehensive Cancer Network (NCCN) clinical practice guidelines have become the most prevalent in global clinical oncology practice. This article mainly focuses on cases to discuss the normalized treatment strategy for oral cancer in different stages based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Head and Neck Cancers, Version 3, 2024.

Consensus-Based Guidelines for Communicating a Misdiagnosis of Multiple Sclerosis to Reduce Psychological Distress.

Multiple sclerosis (MS) misdiagnosis is common, and when discovered, frequently leads to substantial disruption to patients' lives and anxiety for clinicians. Our objective was to develop expert consensus-based guidelines about how to communicate a misdiagnosis of MS to a patient, to reduce the potential for both psychological distress and litigation. A modified Delphi method using a systematic literature review on doctor and patient experiences of the MS diagnosis communication was used to populate items for a first-round questionnaire. Our Delphi panel represented three perspectives (clinicians, people with MS, and published experts in health communication), and we recruited 18 panelists in total (6 per perspective). Consensus was defined a priori as 75% of panelists giving an item the same rating. A feedback round was undertaken with six external reviewers, naïve to the guideline development process, and the panelists. Items were reviewed by the study team and synthesized to create the finalized guidelines. Consensus was reached for 45 items rated as "very important" and presented in the feedback round. The study team synthesized the 45 items to 27 items. Ten items related specifically to the communication of the MS misdiagnosis and 17 items to generic guidelines highlighted as important in the MS misdiagnosis appointment. Seven recommendations form the guidelines presented here. Seven consensus-based recommendations offer guidance to practising neurologists in their communication with patients in a situation that has the potential to be highly distressing, for both clinician and patient.

Frailty Assessment and Management: A Qualitative Study of the Educational and Training Experiences of Postgraduate Doctors

Abstract Background Understanding and addressing frailty, a complex syndrome commonly found in older adults, demands a deep understanding and proficiency across various health domains. Existing research indicates a disparity between medical education and the hands-on management of frailty in practice. There is a scarcity of research on the educational requirements of postgraduate doctors in caring for frail patients. Methods Qualitative semi-structured interviews were conducted with post-internship doctors working in an AMU, using transcripts to analyse themes. The focus was on frailty conceptualisation, educational training, and clinical experience. Results Several themes were noted, particularly the lack of focus and variation on frailty teaching in undergraduate curriculums. This, coupled with limited hands-on experience, an emphasis on acute care over chronic management, inadequate multidisciplinary training, and a need for more structured education on frailty assessment tools, underscores the need for ongoing education and support. Many interviewees shared their experiences of being well-equipped to handle acute medical emergencies, demonstrating the effectiveness of their current medical education. However, they also pointed out that this preparation did not adequately equip them for the ongoing, multidimensional care that frail patients require. Several interviewees stressed the role of continued education and support for healthcare professionals managing frailty, suggesting ongoing professional development opportunities could effectively bridge the gap between initial medical education and the evolving demands of clinical practice. The potential of mentorship from experienced geriatricians adds invaluable guidance for early career doctors. Conclusion This qualitative study underscores a significant gap between medical education and the practical management of frailty. Addressing this gap requires a multifaceted approach that integrates frailty-focused content into undergraduate curricula, provides hands-on experience, fosters multidisciplinary collaboration, and offers ongoing professional development. By enhancing frailty education and training, healthcare systems can improve the quality of care for this vulnerable population, leading to better patient outcomes and more efficient use of resources.

A qualitative descriptive study examining the impact of child‐raising experience on Japanese family doctors

AbstractBackgroundThe Patient‐Centered Clinical Method (PCCM) plays an important role in family doctors' ability to communicate effectively with patients. Although the parenting experiences of healthcare providers can be utilized to communicate with patients, it is unclear how they contribute to family doctors' practice.MethodsA qualitative descriptive study focusing on the parenting experiences of Japanese family doctors and their perceptions of how these experiences interfaced with their clinical practice of the PCCM was conducted. Participants were selected using snowball sampling, and the data were collected via semi‐structured interviews while recording online, which were transcribed verbatim and analyzed using qualitative descriptive analysis, with data‐derived codes being systematically applied and reflexively interpreted. The categories were refined concurrently with the interviews. Once it was established that no additional categories were required, the recruitment and analysis process was concluded.ResultsThe eight participants were recruited, and the following themes were extracted; these were “Developing patience and new perspectives through raising children,” “Empathizing with the experiences of others,” “Building awareness of social factors and home context,” “Reflecting on one's own words and behavior,” “Forming partnerships with patients through shared parenting experiences,” and “Facilitating interpersonal growth.”ConclusionThe communication skills that have been refined through personal experiences of raising children are transferable between professional and family situations. This research shows that such skills are not mutually exclusive to professional or family settings and can be used effectively to improve clinical practice as part of the PCCM model of consulting.

Knowledge and perceptions about fragile X syndrome and fragile X-premutation-associated conditions among medical doctors in Nigeria.

Fragile X syndrome (FXS) is a significant cause of intellectual disability and autism, while Fragile X Premutation -Associated Conditions (FXPAC) are a significant cause of morbidity and mortality globally. This study assessed the level of knowledge and perceptions about FXS and FXPAC among doctors in Nigeria. It was a web-based, cross-sectional study conducted among a cohort of doctors in Nigeria. Socio-demographic profile, knowledge of FXS, perceptions about FXS, knowledge of FXPAC, experience of doctors, and suggested ways of improving knowledge and management of FXS were obtained. Data were analyzed using STATA 16.0. Chi-square and Fisher's exact tests of association were used to determine the association between variables, with the significance level set at p < 0.05. A total of 274 doctors participated in the study. A significant proportion of respondents had limited knowledge about the clinical features of FXS. Nine of ten (90.0%) participants with good knowledge of FXS had good perceptions of FXS management. This was statistically significant (p < 0.001). There was a high nonresponse rate to what FXPAC is (164/274, 59.9%) among the respondents because of insufficient knowledge. Suboptimal knowledge of FXS which influenced perception was noted among doctors. More strategies should be considered to improve doctors' knowledge and management of FXS and FXPAC in Nigeria.

“Do they think I’m good enough?”: General practitioners’ experiences when treating doctor-patients

BackgroundWhen doctors seek medical care, there is evidence that the treating doctor can struggle to provide optimal treatment. Guidelines state that doctor-patients should be treated like any other patient, but this is challenging for the treating doctor. This study set out to explore both the positive experiences general practitioners (GPs) have when caring for doctor-patients, and the challenges they confront. It sought to identify whether GPs believe they treat doctor-patients differently to other patients and if so, in what ways, for what reasons, and how this impacts their provision of care. The study also aimed to develop a model that makes sense of GPs’ experiences when caring for a patient who is also a medical doctor.MethodQualitative in-depth interviews with 26 GPs were carried out, with analysis of de-identified transcripts using pragmatic grounded theory. Evolving understandings were used to develop a model to make sense of GPs’ experiences caring for their doctor-patients.ResultsThe core aspects of GPs’ experiences of treating fellow doctors centred around concepts of respect and collegiality. These play a central role in mediating how a treating doctor experiences a consultation with a doctor-patient, influencing the quality of care provided. GPs shared that the use of medical language (and assumptions about the doctor-patient’s knowledge/behaviours), testing, the exploration of sensitive issues, and the degree of shared decision-making were areas where their treatment might vary when treating a doctor-patient. Treating doctors often experience anxiety about errors and the likely scrutiny from the medical, and wider community. The decision to treat the doctor-patient differently was driven by a desire to maintain a sense of collegiality, to not offend, to meet their doctor-patient’s expectations, and to appear competent.ConclusionThe professional socialisation of doctors, with its emphasis on collegiality and respect, plays a significant role in the dynamics of the therapeutic relationship when a doctor treats a doctor-patient. Current guidelines make little reference to these dynamics with the over-simplified ‘keep it normal’ recommendations. Treating doctors need evidence-informed training to navigate these challenges and ensure they can effectively deliver quality care to their doctor-patients.

Multi-Feature Extraction and Selection Method to Diagnose Burn Depth from Burn Images

Burn wound depth is a significant determinant of patient treatment. Typically, the evaluation of burn depth relies heavily on the clinical experience of doctors. Even experienced surgeons may not achieve high accuracy and speed in diagnosing burn depth. Thus, intelligent burn depth classification is useful and valuable. Here, an intelligent classification method for burn depth based on machine learning techniques is proposed. In particular, this method involves extracting color, texture, and depth features from images, and sequentially cascading these features. Then, an iterative selection method based on random forest feature importance measure is applied. The selected features are input into the random forest classifier to evaluate this proposed method using the standard burn dataset. This method classifies burn images, achieving an accuracy of 91.76% when classified into two categories and 80.74% when classified into three categories. The comprehensive experimental results indicate that this proposed method is capable of learning effective features from limited data samples and identifying burn depth effectively.

Retaining doctors in emergency medicine: an ethnographic study of emergency departments in England

ObjectivesTo gain a deep understanding of factors driving retention in emergency medicine. To understand in detail the day-to-day lived experience of emergency medicine doctors, to identify and explore factors influencing...

Working practices and integration of primary health care doctors in remote rural areas in Brazil: a qualitative study

Health care challenges in remote rural municipalities (RRMs) emphasize the importance of primary health care (PHC) and require an expanded scope of practice. Doctors are key actors in this context. The aim of this study was to explore the level of integration of doctors in RRMs and working practices. We conducted a qualitative study involving semi-structured interviews with 46 PHC doctors working in 27 RRMs in Brazil. Content analysis was performed, resulting in the identification of categories of analysis grouped under three core dimensions: doctor training and experience; comprehensive care and timely access; and the community-based approach. Doctors working in RRMs were mainly recent graduates with limited experience who had undertaken their degree outside Brazil, and care was focused on the individual. The findings also revealed weak sociocultural adaptation and a harsh working environment and issues related to social status that reinforced prejudice against rurality and poverty. Practice was limited in scope and care tended to be oriented towards acute problems, disease-centered and focused on the biomedical model of medicine. Barriers to the delivery of comprehensive care include both structural constraints, such as poor facilities and centralization of services in administrative centers, and the lack of professional competencies necessary for PHC in these areas. The findings point to the need to promote an expanded scope of practice in PHC delivery in RRMs, with major public investment in the promotion of training and strengthening career pathways in these areas.

A novel AI-based diagnostic model for pertussis pneumonia.

It is still very difficult to diagnose pertussis based on a doctor's experience. Our aim is to develop a model based on machine learning algorithms combined with biochemical blood tests to diagnose pertussis. A total of 295 patients with pertussis and 295 patients with non-pertussis lower respiratory infections between January 2022 and January 2023, matched for age and gender ratio, were included in our study. Patients underwent a reverse transcription polymerase chain reaction test for pertussis and other viruses. Univariate logistic regression analysis was used to screen for clinical and blood biochemical features associated with pertussis. The optimal features and 3 machine learning algorithms including K-nearest neighbor, support vector machine, and eXtreme Gradient Boosting (XGBoost) were used to develop diagnostic models. Using univariate logistic regression analysis, 18 out of the 27 features were considered optimal features associated with pertussis The XGBoost model was significantly superior to both the support vector machine model (Delong test, P = .01) and the K-nearest neighbor model (Delong test, P = .01), with the area under the receiver operating characteristic curve of 0.96 and an accuracy of 0.923. Our diagnostic model based on blood biochemical test results at admission and XGBoost algorithm can help doctors effectively diagnose pertussis.

From Dreaming to Forging Ahead ——Analysis of the Ideological and Political Elements of the Curriculum in the Growth Experience of the Four Masters in Jin and Yuan Dynasties

Chinese medicine is an important resource and excellent carrier for carrying out ideological and political education based on excellent traditional culture. From the experience of famous doctors of traditional Chinese medicine and the teaching of biographies, we can purify the purpose of practicing medicine, learn the way of refinement, understand the principle of fame, and practice the benevolence of doctors to effectively improve the quality of ideological and political education in the classroom from multiple angles and stages. Compared with the above four aspects, it points out that the growth experience of the four masters in the Jin and Yuan Dynasties is closely related to the spirit of "respecting and protecting life, saving the dying and healing the wounded, being willing to dedicate, and loving people without boundaries", analyzes the ideological and political elements of the curriculum with "cultural people, moral people, and medical talents" as the main body, and points out that the growth experience of the four masters in the Jin and Yuan Dynasties can enrich the basic knowledge of Chinese medicine and shape the soul of Chinese medicine literacy, Promote the profound skills of traditional Chinese medicine to carry out ideological and political education.

Experience as a physician attending to traffic accident victims in hospitals in Managua, Nicaragua

Introduction: Every 23 seconds a person dies from a traffic accident in the world, that is about 3756 deaths per day, with the consequent impact on relatives and health personnel. Doctors are part of the health team that is on the front line of care. Although this is part of their daily work, their feelings and emotions are deeply affected. There is a deficit of research of this type carried out by doctors.Methodology: Qualitative study, under the constructivist paradigm with a phenomenological approach. The objective was; explore the lived experience of doctors who treat victims of traffic accidents. The sample was intentional with five participating physicians . The phenomenological interview was used as an information collection technique and analyses were carried out according to Van Manen.Results: From the analysis, 15 codes were obtained inductively, which gave rise to 6 sub-themes: Impacts of Tragedies; Communication of bad news; Becoming of emotion; Coping; Narratives that endure and Resignation that in turn made up the 3 central themes: Body Lived in the impact, Time Lived in the here and after and Human Relations lived: between narratives and resignation.Conclusion: The study reveals that doctors are indirect victims of adverse events in the face of damage to the patient and their family in the face of a traffic accident. Constant monitoring of their psychological and emotional well-being, training communication strategies and improving patient-centered curricular programs are recommended. Extending the study to other specialties would enrich this understanding..

Enhancing the doctoral experience: factors influencing academic success and well-being of Ph.D. students in a cultural context

Enhancing the doctoral experience: factors influencing academic success and well-being of Ph.D. students in a cultural context

I See You: A Dual Testimonio of The Latina Doctoral Experience

This article is a dual testimonio of the doctoral experiences of two Latina doctoral candidates. It focuses on the context of the Hispanic community and the lack of Hispanic female representation in academia. It examines the influence of colonialism, sexism, racism, and socioeconomic disadvantages throughout their journey. These testimonios are a raw reflection of the struggle as a female, academic scholar, and human being within a boxed academic society.

Evaluating the interactions of Medical Doctors with chatbots based on large language models: Insights from a nationwide study in the Greek healthcare sector using ChatGPT

In this AI-focused era, researchers are delving into AI applications in healthcare, with ChatGPT being a primary focus. This Greek study involved 182 doctors from various regions, utilizing a custom web application connected to ChatGPT 4.0. Doctors from diverse departments and experience levels engaged with ChatGPT, which provided tailored responses. Over a month, data was collected using a form with a 1-to-5 rating scale. The results showed varying satisfaction levels across four criteria: clarity, response time, accuracy, and overall satisfaction. ChatGPT's response speed received high ratings (3.85/5.0), whereas clarity of information was moderately rated (3.43/5.0). A significant observation was the correlation between a doctor's experience and their satisfaction with ChatGPT. More experienced doctors (over 21 years) reported lower satisfaction (2.80–3.74/5.0) compared to their less experienced counterparts (3.43–4.20/5.0). At the medical field level, Internal Medicine showed higher satisfaction in evaluation criteria (ranging from 3.56 to 3.88), compared to other fields, while Psychiatry scored higher overall, with ratings from 3.63 to 5.00. The study also compared two departments: Urology and Internal Medicine, with the latter being more satisfied with the accuracy, and clarity of provided information, response time, and overall compared to Urology. These findings illuminate the specific needs of the health sector and highlight both the potential and areas for improvement in ChatGPT's provision of specialized medical information. Despite current limitations, ChatGPT, in its present version, offers a valuable resource to the medical community, signaling further advancements and potential integration into healthcare practices.