Doctors In Ireland Research Articles

An Exploratory Study of Capacity Assessment in Medical Practice in Ireland.

The current legal test for capacity under the common law is a functional test. It determines whether a person can make a particular decision at a particular time; it focuses on retained abilities rather than on presumed deficits - in order to promote patient autonomy in decision-making. International evidence suggests however that the test is not well understood and consequently not being correctly applied in practice by a range of medical professionals. Donnelly has argued that gaining a better understanding of how capacity assessments are actually employed is essential to improving the quality of assessments. To date, there is little data on how doctors in particular make their assessments in practice. Using a socio-legal methodology, this quantitative study aims to assess understanding of capacity among a group of general practitioners/family medicine doctors in Ireland, and to determine how they assess capacity in clinical practice. Our study found that notwithstanding a lack of confidence in their ability to assess decision-making capacity, that respondents in fact demonstrated a high level of understanding and of ability to correctly apply the functional test in practice.

Assessing current handover practices in surgery: A survey of non-consultant hospital doctors in Ireland

BackgroundHandovers of care are potentially hazardous moments in the patient journey and can lead to harm if conducted poorly. Through a national survey of surgical doctors in Ireland, this paper assesses contemporary surgical handover practices and evaluates barriers and facilitators of effective handover. MethodsAfter ethical approval and pre-testing with a representative sample, a cross-sectional, online survey was distributed to non-consultant hospital doctors (NCHDs) working in the Republic of Ireland. A mixed-methods approach was used, combining data using triangulation design. Main findingsA total of 201 responses were received (18.5%). Most participants were senior house officers or senior registrars (49.7% and 37.3%). Most people (85.1%) reported that information received during handover was missing or incorrect at least some of the time. One-third of respondents reported that a near-miss had occurred as a result of handover within the past three months, and handover-related errors resulted in minor (16.9%), moderate (4.9%), or major (1.5%) harm. Only 11.4% had received any formal training. Reported barriers to handover included negative attitudes, a lack of institutional support, and competing clinical activities. Facilitators included process standardisation, improved access to resources, and staff engagement. ConclusionsSurgical NCHDs working in Irish hospitals reported poor compliance with international best practice for handover and identified potential harms. Process standardisation, appropriate staff training, and the provision of necessary handover-related resources is required at a national level to address this significant patient safety concern.

Establishing a Platform for Public Health Advocacy in the midst of a Pandemic

Abstract Issue/problem Prior to the COVID-19 pandemic, Doctors working in Public Health Medicine in Ireland lacked a platform to present a collective voice to advocate on issues of public health concern. The aim of this abstract is to describe the establishment of a platform for advocacy through the formation of the Irish Society of Specialists in Public Health Medicine (ISSPHM). Description of the problem An independent society for Public Health Doctors in Ireland was lacking. Models used by other medical specialties in Ireland and international practice was reviewed. The ISSPHM was developed to build capacity and capability for advocacy amongst Public Health Doctors in Ireland by providing indemnity for members and a forum to interact with the media. Results A constitution, mission statement and website for the society were developed. The formal launch of the ISSPHM took place in December 2021. Outputs to date include co-hosting of webinar entitled ‘Public Health and the Law'; contributing to the Irish Public Health Reform Expert Advisory Group; a position paper on pandemic preparedness; a statement on migrant health (published on the ISSPHM website and widely quoted in the media); letters published in Irish media; interviews on national radio and the formation of a Climate Change Working Group. Lessons The ISSPHM successfully creates an environment where Public Health Doctors can advocate on major issues. The establishment of an independent society requires diverse expertise and resources. Future plans for the ISSPHM are to further collaborate and build on existing partnerships and expand eligibility for membership to include other colleagues working in Public Health e.g. nurses, surveillance scientists, data analysts. Key messages • An independent national society for Public Health Doctors is an extremely useful vehicle for advocacy. • The establishment and development of an independent society is a significant undertaking requiring diverse expertise.

Knowledge, attitudes and practices of Irish doctors regarding stop smoking care and electronic cigarettes.

Smoking continues to cause harm on a huge scale in Ireland. Doctors can help this harm through providing safe, effective and clinically sound stop smoking care, but theneeds of Irish doctors in this area are largely uncharted. We assessed the knowledge, attitudes and practices of Irish doctors regarding stop smoking care and electronic cigarettes. An Internet-based cross-sectional survey was administered to members of the Royal College of Physicians in Ireland and the Irish College of General Practitioners. Descriptive statistics for key parameters were derived and factors associated with more consistent practice of brief intervention, a key component of stop smoking care, were analysed using chi-square testing. There were 250 responses (58.7% female, 53.0% aged under 45years, 55.1% graduated in medicine before 2000 and 57.2% worked in general practice). Most (84.9%) reported often or always asking about patient's smoking behaviour, and most (86.1%) reported often or always advising patients to stop. However, providing or arranging effective stop smoking care was weak and less consistently practised, and while most (91.4%) saw it as a responsibility, few doctors (28.5%) agreed they were sufficiently trained in this area of clinical care. Confidence in the knowledge of e-cigarettes was poor. While there is a strong reservoir support and areas of good reported practice in stop smoking care among doctors in Ireland, the development of their knowledge and skills in arranging effective care should be supported if doctors are to fulfil their huge potential role in tackling the harm caused by smoking.

AB090. SOH23ABS_218. An audit on post operative extubation practices among non-consultant hospital doctors in Ireland

AB090. SOH23ABS_218. An audit on post operative extubation practices among non-consultant hospital doctors in Ireland

Workforce retention of junior doctors in Ireland: what can be learnt from the literature and international experience?

This article examines the issue of non-consultant hospital doctor (or junior doctor) retention in the Irish healthcare system. It explores factors relating to the mass emigration of junior doctors, and proposes local and organisational solutions to improve training and working conditions, enhance staff engagement and ensure a sustainable workforce.

Physician burnout and symptom of anxiety and depression: Burnout in Consultant Doctors in Ireland Study (BICDIS).

Burnout is a work related syndrome comprising three major dimensions: emotional exhaustion, depersonalisation and reduced professional efficacy. It is recognised that burnout may be associated with psychopathological sequelae, such as symptoms of anxiety and depression. This study aimed to examine the relationship between burnout and symptoms of depression and anxiety in senior doctors in Ireland. We examined personality traits as a mediating factor on burnout, in relation to work related stress among the participants. This study was a national cross sectional survey of consultants. Data included basic demographic data, work-related data, burnout as measured by the Maslach Burnout Inventory, personality traits, and symptoms of depression and anxiety from the Depressive Anxiety Stress Scale [DASS]. Results were obtained from 477 consultants, yielding a response rate 21.9%. Nearly half (42%) reported high burnout levels. Over one-quarter (25.8%) screened positive for depression and 13.8% for anxiety. After controlling for gender and age, depressive symptoms were associated with high levels of emotional exhaustion (p<0.001) and a higher clinical workload, and stress with cynicism and reduced professional efficacy (p<0.001). The this study reported a high level of work-related burnout, associated with symptoms of depression and anxiety in senior doctors. This is concerning, and strategies are required that consider the relationship between symptoms of depression/anxiety and burnout. Further research to evaluate strategies to ensure physician wellbeing and optimal delivery of patient care are required to address this serious problem.

The retention of training doctors in the Irish health system

BackgroundThere is limited quantitative evidence on the migration patterns of training doctors in Ireland. The aim of this study is to estimate the number of trainee doctors leaving the Irish health system and the numbers returning.MethodsThis study uses administrative data to track the migration patterns of Irish trained doctors at various career stages.ResultsEighty-four percent of interns who commenced intern training in 2015 subsequently commenced a basic specialist training (BST) or general practice (GP) training programme in subsequent years (2016–2021). Of those who completed BST training in 2017, 75% went on to higher specialist training (HST) in Ireland. In 2021, of the 2016 cohort of doctors awarded Certificates of Satisfactory Completion of Specialist Training (CSCST), 68% are employed in Ireland and 32% are abroad or unknown. Of the 2016 group that are abroad, the UK is the main country of practice. There are variations in the retention rate across disciplines; from the 2016 cohort, 52% of anaesthesiology CSCSTs were working in Ireland in 2021 compared to 88% of psychiatry CSCSTs.ConclusionPrevious research has highlighted Irish doctor’s intentions to migrate and intentions to return to Ireland. This study documents for the first time the extent to which Irish doctors are leaving and returning to the Irish health system from 2015 to 2021. The paper also gives a picture of variations across medical disciplines and the location of emigration of qualified specialists.

A catalyst for change: Developing a collaborative reflexive ethnographic approach to research with hospital doctors during the COVID-19 pandemic.

The understanding of what ethnography looks like, and its purpose, is continuously evolving. COVID-19 posed a significant challenge to ethnographers, particularly those working in health-related research. Researchers have developed alternative forms of ethnography to overcome some of these challenges; we developed the Mobile Instant Messaging Ethnography (MIME) adaptation to ethnography in 2021 to overcome restrictions to our own research with hospital doctors. However, for ethnographic innovations to make a substantial contribution to methodology, they should not simply be borne of necessity, but of a dedicated drive to expand paradigms of research, to empower participant groups and to produce change - in local systems, in participant-collaborators and in researchers and the research process itself. In this paper, we reflect on our experiences using MIME, involving collaborative remote observation and reflection with 28 hospital doctors in Ireland from June to December 2021. After reviewing literature on ethnography in COVID-19 and general epistemological developments in ethnography, we detail the MIME approach and illustrate how MIME presents an evolution of the ethnographic approach, not only practically but in terms of its reflexive shift, its connected and co-creative foundations, and its ability to drive change in research approaches, participant life-worlds and real-world improvement.

The impact of the COVID-19 pandemic on non-national doctors in Ireland.

International doctors make up nearly half of the physicians working in Ireland and are an integral part of the health service. The COVID-19 pandemic declared in March 2020 led to a global healthcare emergency. Resulting national lockdowns precluded travel at a time of need for family support. We aimed to measure the professional, psychosocial, and financial impact of the COVID-19 pandemic on non-EEA doctors working in Ireland. An 88-item online survey of demographics, well-being, and financial resilience was circulated nationally between November 2021 and January 2022. The results were analysed using RStudio and Microsoft Excel 365. One hundred thirty-eight responses were received. Sixty-two percent of responders reported wishing to stay in Ireland long-term and 44% had applied for citizenship. Despite 80% of responders working in their desired speciality, only 36% were on a specialist training scheme. Forty-seven percent felt their career was affected by the COVID-19 pandemic. Seventy-three percent of respondents reported missing significant events in their home country. Over 50% reported significant mental health issues personally or in their families; however, only a minority sought professional help. Financial issues were a source of anxiety for 15% of respondents. Financial resilience was poor, 20% of respondents cited a 1-month financial reserve, 10% had a personal pension, and 9% had made a will. The COVID-19 pandemic has had a multifactorial negative impact on non-national doctors working in Ireland. More must be done to offer multidimensional support to this cohort who are a crucial part of the underserviced Irish healthcare system.

Hospital doctors in Ireland working through COVID-19 pandemic: learning from individual experience

Abstract Background This study was part of a 5-year, HRB-funded research project about hospital doctor retention and emigration. Methods In 2021, we conducted a Mobile Instant Messaging Ethnography (MIME) with 28 hospital doctors in Ireland. This involved interviewing doctors via Zoom and engaging them in a 12-week work-related conversation via WhatsApp. Results Our findings illustrate that the pandemic intensified already difficult working conditions. Respondents described working in an under-staffed and under-resourced system, in which they were unable to protect their own wellbeing or achieve a work-life balance. Morale was low and few had hope of health system improvement. Conclusions The findings reveal a workforce under strain and raise concerns about health worker wellbeing and health worker attrition, post-pandemic. However, they also highlight the importance (and value) of listening to the voices of frontline health workers and using their insights to inform and enhance retention policies.

The Impact of COVID-19 on Burnout, Psychological Well-being, and Work Satisfaction in Psychiatry Trainees in Ireland

ObjectivePrior to the pandemic, trainee doctors were at higher risk of psychological ill health. There is limited evidence measuring the impact of COVID-19 on psychiatry trainees. This study evaluates levels of burnout, work satisfaction, and psychological well-being in psychiatry junior doctors in Ireland and identifies potential contributing factors.MethodsThe authors carried out a cross-sectional online survey measuring demographic and work-related variables. Questions including exposure to COVID-19 and stress-related factors were included. We evaluated burnout, work satisfaction, and psychological well-being using the Abbreviated-Maslach Burnout Inventory, Basic Needs Satisfaction at Work Scale, and WHO-5 Well-being Index.ResultsOne hundred and five doctors responded (21%). The biggest stressor reported was reduced face-to-face contact with family and friends (73%). Forty one percent reported weekly supervision changes. Sixty five percent met the criteria for burnout, compared with 36.2% in 2018. Significant factors associated with burnout included staff shortages, longer hours, and less experience. Changes in supervision and working in non-European Working Time Directive compliant rotas were associated with lower scores across all subdomains of the BNSW Scale. The WHO-5 Well-being Index identified 48% scored low in personal well-being, indicating these trainees met the threshold for depression. Changes in regular supervision (p=0.010) were a significant predictor of low personal well-being.ConclusionsHigh prevalence of burnout and low levels of well-being in this vulnerable cohort, particularly those who are inexperienced, have changes in supervision, and working longer hours is concerning. This study highlights the importance of regular supervision and support for this group.

172 ‘NCHD’S UNDERSTANDING OF THE ‘DYING WITH DIGNITY BILL”

Abstract Background The Dying with Dignity Bill is potential legislation that would permit terminally ill people to avail of medical assistance to die in certain circumstances. It would give a medical practitioner the legal right to provide assistance to a qualifying person to end their life, thus changing the medical landscape as we know it. This project aimed to assess current understanding in non-consultant hospital doctors (NCHDs) of the Dying with Dignity Bill. Methods An online survey was distributed to NCHD’s across a range of disciplines to ascertain current knowledge of the Dying with Dignity Bill. Descriptive analysis of data was conducted on Excel. Results The survey was completed by 80 NCHDs. Of respondents 67.5% (n = 54) of respondents had heard of the Bill and 32.5% (n = 26) of them knew what it was. The Bill had not been read by 88% (n = 71) of respondents. Fifty seven per cent (n = 46) did not understand what was entailed in the Bill. The majority agreed (61.3%; n = 49) that it would impact their work as a clinician. Some 70.1% (n = 56) agreed that legislation was needed in this area. The majority answered neutral (45%; n = 35) that their profession were consulted in the creation of the Bill. It is believed that the Bill will not require a vote however 48% (n = 37) believed it would. However, the majority (72.7%, n = 56) answered correctly that the Bill had not been enacted yet. This Bill does not define the length of a ‘terminal illness’ yet 36.8% (n = 28) believed it to be within six months. It also states that it is the practitioner’s role to decide when somebody is palliative and only 54.5% (n = 42) knew this. Conclusion The Dying with Dignity Bill is poorly understood by NCHDs, despite it potentially having an impact on the role of hospital doctors in Ireland. Discussion and involvement of NCHD’s in the potential formation of this Bill is crucial.

249 A SURVEY OF IRISH DOCTORS VIEWS ON FLEXIBLE TRAINING

Abstract Background We aimed to establish the views of non consultant hospital doctors working in Ireland on the options available for ‘Flexible Training’ or ‘Less-Than-Full-Time-Training’. Our population is ageing rapidly, and an expanding workforce will be required. Difficulties with doctor retention and recruitment are growing challenges in Ireland. Methods An anonymised survey of 9 questions was carried out using Survey Monkey®. Question format included multiple choice, yes/no or a free text box. This was disseminated via the Royal College of Physicians of Ireland to 1,557 trainees of the Institute of Medicine, the national postgraduate body for medical specialties. It was also circulated to members of the Irish Medical Organisation, the national medical organisation, and to approximately 200 doctors across two hospitals on social media. Results There were 674 (84.3%) respondents in training- 46.3% BST, 53.7% HST; and 125 (15.6%) non-training respondents. Doctors overwhelmingly felt trainees should have access to flexible training (n = 849, 99.41%), with 82.39% reporting they would apply (n = 702). Most (92.5%) felt that 16 WTE positions was inadequate (n = 789). Reasons chosen for not applying for flexible training included- 36.1% (n = 169) felt it could impact their career, 25.4% (n = 119) identified they did not meet the criteria, 14.32% (n = 67) reported no interest, while 24.1% (n = 113) gave ‘other’ reasons including lengthy training, salary impacts, and not having a requirement for flexible training. When asked about suggestions for improving flexible training, 19.7% chose ‘offer more places’, 6.7%-‘remove eligibility criteria’, 19.6% -‘offer job sharing options’, 9.5%- ‘allow more flexible training years’, 17.7% -‘regional based training’, 22.5% -‘all of the above’, 4.9%—‘other’. Conclusion Our survey suggests non consultant hospital doctors in Ireland strongly desire an expansion of current flexible training options. This is essential to ensure Ireland is an attractive place for doctors to work, to support their health and wellbeing, and to ensure an adequate workforce to care for an ageing population.

Doctors’ engagement with a formal system of continuing professional development in Ireland: a qualitative study in perceived benefits, barriers and potential improvements

ObjectivesTo examine experiences of participation in a mandatory system of continuing professional development (CPD) among doctors in Ireland, in order to identify areas for improvement.DesignA qualitative cross-sectional design was used.Participants1408...

‘…the way it was staffed during COVID is the way it should be staffed in real life…’: a qualitative study of the impact of COVID-19 on the working conditions of junior hospital doctors

ObjectivesCOVID-19 has prompted the reconfiguration of hospital services and medical workforces in countries across the world, bringing significant transformations to the work environments of hospital doctors. Before the pandemic, the...

"I feel I have no voice": hospital doctors' workplace silence in Ireland.

Workplace silence impedes productivity, job satisfaction and retention, key issues for the hospital workforce worldwide. It can have a negative effect on patient outcomes and safety and human resources in healthcare organisations. This study aims to examine factors that influence workplace silence among hospital doctors in Ireland. A national, cross-sectional, online survey of hospital doctors in Ireland was conducted in October-November 2019; 1,070 hospital doctors responded. This paper focuses on responses to the question "If you had concerns about your working conditions, would you raise them?". In total, 227 hospital doctor respondents (25%) stated that they would not raise concerns about their working conditions. Qualitative thematic analysis was carried out on free-text responses to explore why these doctors choose to opt for silence regarding their working conditions. Reputational risk, lack of energy and time, a perceived inability to effect change and cultural norms all discourage doctors from raising concerns about working conditions. Apathy arose as change to working conditions was perceived as highly unlikely. In turn, this had scope to lead to neglect and exit. Voice was seen as risky for some respondents, who feared that complaining could damage their career prospects and workplace relationships. This study highlights the systemic, cultural and practical issues that pressure hospital doctors in Ireland to opt for silence around working conditions. It adds to the literature on workplace silence and voice within the medical profession and provides a framework for comparative analysis of doctors' silence and voice in other settings.

Attitudes, Perceived Benefits, and Experiences of Engagement With Professional Competence Schemes for Doctors in Ireland: Findings From a National Survey.

Introduction:This study aimed to assess the attitudes, perceived benefits, and experiences of engaging with a formal system of continuing professional development (CPD) in the form of Professional Competence Schemes (PCSs) among doctors in Ireland.Methods:The study utilized an anonymous online survey measure with both open-ended and Likert-scale questions. The measure examined general attitudes, perceived impact, and experiences of engagement with PCS. This study examines the scale items only. All 4350 doctors enrolled on a PCS were invited through email to complete the survey. One thousand four hundred eight doctors participated, indicating a response rate of 32%.Results:Descriptive and inferential statistics (analysis of variance and Kruskal–Wallis) were performed on the scale items using IBM SPSS statistics, with group comparisons examining differences in responses according to gender and current primary role. A majority (80%) of respondents had positive overall attitudes to PCS. Most participants reported that CPD positively impacts their practice across a wide range of areas, particularly patient care. Most participants reported positive experiences engaging with PCS, although a minority reported difficulties, including lack of time to participate in and record CPD activities, difficulties obtaining evidence of participation, and feeling that their CPD activities are not easily captured by the PCS system. Significant differences in responses according to role were found for overall attitudes (confidence interval = 95%, P < .00) and overall experiences of PCS (confidence interval = 95%, P < .00) with nonconsultant hospital doctors emerging as a particularly vulnerable group with less positive attitudes and experiences.Discussion:Across the board overall attitudes, perceived impact and experiences of PCS were positive, and indicate that doctors feel that PCS is a valuable and beneficial activity. However, a minority of respondents reported experiencing difficulties with engagement, and these areas of difficulty represent targets for future improvement.

COVID-19 and doctor emigration: the case of Ireland

BackgroundSince the 2008 recession, Ireland has experienced large-scale doctor emigration. This paper seeks to ascertain whether (and how) the COVID-19 pandemic might disrupt or reinforce existing patterns of doctor emigration.MethodThis paper draws on qualitative interviews with 31 hospital doctors in Ireland, undertaken in June–July 2020. As the researchers were subject to a government mandated work-from-home order at that time, they utilised Twitter™ to contact potential respondents (snowball sampling); and conducted interviews via Zoom™ or telephone.FindingsTwo cohorts of doctors were identified; COVID Returners (N = 12) and COVID Would-be Emigrants (N = 19). COVID Returners are Irish-trained emigrant doctors who returned to Ireland in March 2020, just as global travel ground to a halt. They returned to be closer to home and in response to a pandemic-related recruitment call issued by the Irish government. COVID Would-be Emigrants are hospital doctors considering emigration. Some had experienced pandemic-related disruptions to their emigration plans as a result of travel restrictions and border closures. However, most of the drivers of emigration mentioned by respondents related to underlying problems in the Irish health system rather than to the pandemic, i.e. a culture of medical emigration, poor working conditions and the limited availability of posts in the Irish health system.Discussion/conclusionThis paper illustrates how the pandemic intensified and reinforced, rather than radically altered, the dynamics of doctor emigration from Ireland. Ireland must begin to prioritise doctor retention and return by developing a coherent policy response to the underlying drivers of doctor emigration.

Maintenance of professional competence in Ireland: a national survey of doctors’ attitudes and experiences

ObjectivesProgrammes to ensure doctors’ maintenance of professional competence (MPC) have been established in many countries. Since 2011, doctors in Ireland have been legally required to participate in MPC. A significant...