Early Career Doctors Research Articles

Gender Differences in Perception of Neurosurgery as a Career Choice in Pakistan: A Nationwide Cross-Sectional Survey

A low neurosurgeon-to-patient ratio persists to be a problem in many developing nations including Pakistan. Concurrent gender disparities further exacerbate the challenges posed by the already limited workforce. An understanding of the perceptions of neurosurgery among female early career doctors is crucial in the evolution of the field in terms of both, workforce strength and inclusivity. A cross-sectional study was conducted across public and private medical schools of Pakistan. A close-ended self-administered questionnaire was employed to assess subject-reported challenges and perceptions regarding neurosurgery. Statistical analysis was performed using SPSS version 28, and p< 0.05 was considered significant. The influence of these perceptions on the choice of neurosurgery as a career was determined by binary logistic regression analysis. Of the 387 responses received from over 45 institutions across the country, 55.6% were females and 44.4% were male respondents. Compared to men, women were more likely to opt out of neurosurgery due to fear of problems with parenting (p<0.001), absence of daycare facilities (p<0.001), lack of female role models (p=0.001), fear of gender discrimination (p<0.001), and the mental (p=0.04) and physical distress (p=0.008) associated with neurosurgery. Binary logistic regression revealed that these concerns were responsible for an increased likelihood of opting out of neurosurgery among female medical students and intern doctors. Significant differences exist in how male and female medical students perceive neurosurgery as a career choice. Interventions including availability of day care facilities for children, creation of inclusive workplace environment, and promotion of mentorship programs catering to women can help bridge this gap and contribute to evolution of the field of neurosurgery in the developing world.

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.

Optimising patient care: comprehensive evaluation of inpatient hypokalaemia.

Hypokalaemia is a common electrolyte disorder affecting hospitalised patients. It is associated with adverse outcomes including increased mortality. Inpatients with hypokalaemia need a different approach to workup and management as the aetiologies and progression of the hypokalaemia are distinct to outpatients. Potassium homeostasis is predominantly maintained by renal potassium handling. The clinical manifestations of hypokalaemia depend on the severity of hypokalaemia, however, most of the findings are non-specific. The approach to management is guided by the severity of the hypokalaemia and the underlying aetiology. Oral potassium replacement can be used in many cases of mild hypokalaemia. Intravenous replacement of potassium is necessary for many inpatients. Close monitoring is essential to ensure adequacy and to prevent adverse outcomes. An interdisciplinary approach with critical care input is needed in severe cases, and in patients where routine intravenous replacement may not be feasible (e.g., patients with heart failure). In addition to replacement, the cornerstone of management is a comprehensive review of the patient to identify the underlying cause of the hypokalaemia and the factors sustaining it. In patients in whom the cause is not apparent, or the potassium does not improve as anticipated, a referral to nephrology or endocrinology should be considered. This paper reviews the assessment of hypokalaemia in a hospital setting. It is aimed at early career doctors on the wards to help carry out a thorough evaluation. It also provides a useful framework for management.

Letter to editor: Perception of Neurosurgery as a Career Choice Among Early Career Doctors in Pakistan: A Nationwide Cross-Sectional Survey

Letter to editor: Perception of Neurosurgery as a Career Choice Among Early Career Doctors in Pakistan: A Nationwide Cross-Sectional Survey

Girls in scrubs: An ethnographic exploration of the clinical learning environment.

Gender bias is an enduring issue in the medical profession despite women being more represented within medical schools and the health care workforce in numerous countries across the world. There have been frequent calls for further exploration of gender-based discriminations within medical education, owing to its lasting impact on student's professional development and career trajectories. This paper presents an ethnographic exploration of the experiences of female medical students and doctors in the clinical learning environment (CLE), aiming to disrupt the cycle of gender inequity in the clinical workplace. Our research field involved two teaching wards in a Scottish urban hospital, where 120 h of non-participant observations were conducted over 10months. Combining purposive and convenience sampling, we conducted 36 individual interviews with key informants, which included medical students, foundation doctors, postgraduate trainees, consultant supervisors, and other health care professionals such as nurses and pharmacists. Data was thematically analysed using Bourdieu's theory of social power reproduction. The research team brought diverse professional backgrounds and perspectives to the exploration of data on gendered encounters. Combining the observational and interview data, five themes were generated, which suggested gender-related differentials in social and cultural capital that the participants acquired in the CLE. Experiences of discriminatory behaviour and stereotypical thought processes impacted the female students' engagement and drive towards learning, implying an adverse influence on habitus. In contrast, the valuable influence of gendered role-models in building confidence and self-efficacy signified a positive transformation of habitus. The research participants displayed considerable internalisation of the gendered processes in the CLE that appeared to be linked to the transient nature of clinical placements. This research reveals that despite constituting the majority demographic of medical school, female students struggle to gain social and cultural capital. Gendered hierarchies that structure clinical workplaces disadvantage female students and doctors, and the differential experiences transform their habitus. Based on our theoretically informed investigation, we advocate for role-models given their positive impact on students' and doctors' habitus. Additionally, medical educators may consider extended clinical placements that provide opportunities for female students and early-career doctors to secure social and cultural capital through integrating better in health care teams and building meaningful interprofessional relationships.

Perception of Neurosurgery as a Career Choice Among Early Career Doctors in Pakistan: A Nationwide Cross-Sectional Survey

BackgroundA low neurosurgeon-to-patient ratio persists to be a problem in many developing nations including Pakistan. We aim to investigate the perceptions of medical students regarding neurosurgery as a first step to recognizing this problem, and potentially suggesting ways to solve this. MethodsA questionnaire comprising three sections was designed; 1) Demographics, 2) Possible challenges and perceptions regarding neurosurgery as a profession, and 3) General perceptions about neurosurgery. SPSS version 28.0 was utilized to conduct the statistical analysis with a level of significance 0.05. ResultsOf the 387 responses received, 44.4% of male and 50.6% of female participants revealed intent to ‘consider opting for neurosurgery as a profession’. Regression analysis revealed inadequate dexterity (p=0.001) and inability to carry out private practice (p=0.002) were responsible for increased likelihood of opting out of neurosurgery by medical students. ConclusionsThis study identifies the perceptions that may influence the decision to pursue neurosurgical training among doctors early in their careers. Certain interventions including availability of daycare facilities for children and introduction of curricula to promote neurosurgical knowledge in clinical years are expected to increase the trend towards neurosurgery among medical students of Pakistan.

Developing a transgender and non-binary inclusive obstetrics and gynaecology undergraduate medical curriculum in Aotearoa/New Zealand: Where are we at, and where do we need to be?

Internationally, undergraduate medical education is not currently enabling early career doctors to meet the needs of trans and gender diverse (TGD) people as healthcare consumers. This review outlines inclusion of TGD education in undergraduate medical education more broadly to contextualise curriculum development needs in obstetrics, gynaecology and reproductive medicine in Aotearoa/New Zealand. Limited, and lack of integrated content, teaching capability and current absence of TGD health knowledge as graduate outcomes, compounded by pedagogy (biomedical/binary framing) and more appropriate learning resources are indicators for curricula, and workforce, development.

Burnout: A predictor of oral health impact profile among Nigerian early career doctors.

There have been reported association of oral health disorders with burnout, stress, and mental health. Arguably, with these reported associations, and the current prevalence of burnout amongst Nigerian doctors, exploring the role of burnout on oral health amongst Nigerian doctors is timely. This study aims to determine the relationship between burnout and oral health-related quality of life amongst Early Career Doctors (ECDs) in Nigeria, while also identifying the role other possible predictors plays in this relationship. This was a cross-sectional study conducted amongst Nigerian ECDs as part of Challenges of Residency Training in Nigeria (CHARTING) II project. A total of 632 ECDs were recruited across thirty-one tertiary hospitals in the 6 geopolitical zones of the country using a multistage cluster sampling technique. A self-administered paper-based semi-structured questionnaire was given to each participant that consented. The tools used to assess burnout and Oral health-related quality of life (OHRQoL) were Copenhagen Burnout Inventory (CBI) and Oral Health Impact Profile (OHIP-14) respectively. Independent samples T-test, ANOVA and Multiple linear regression were used to draw inferences from the data collected. Overall mean OHIP-14 score of all participants was 11.12 (±9.23). The scores for the 3 dimensions of burnout were below 50% with CBI-Personal Burnout having the highest score of 49.96 (±19.15). Significant positive correlations (p < 0.001) were found between OHIP-14 and all the dimensions of burnout, as the burnout scores were increasing, there was a corresponding increase in the OHIP scores thus poorer OHRQoL. The regression model shows that the predictors of OHIP were CBI-PB (p = 0.003), use of fluoride paste (p = 0.039), use of tobacco (p = 0.005) and being a denture user (p = 0.047). This study shows a positive correlation between burnout and OHIP of ECDs. We found that as burnout was increasing, OHIP increased thus implying poorer oral health related quality of life amongst ECDs. The use of fluoride toothpaste, tobacco and denture are other factors we found that could affect the OHIP of ECDs.

Weighing the necessities and concerns of deprescribing among older ambulatory patients and primary care trainees: a qualitative study

BackgroundDeprescribing can be a challenging and complex process, particularly for early career doctors such as primary care trainees. To date, there is limited data from patients’ and doctors’ perspectives regarding the deprescribing of medications in older persons, particularly from developing countries. This study aimed to explore the necessities and concerns of deprescribing in older persons among older ambulatory patients and primary care trainees.MethodsA qualitative study was conducted among patients and primary care trainees (known henceforth as doctors). Patients aged ≥ 60 years, having ≥ 1 chronic disease and prescribed ≥ 5 medications and could communicate in either English or Malay were recruited. Doctors and patients were purposively sampled based on their stage of training as family medicine specialists and ethnicity, respectively. All interviews were audio-recorded and transcribed verbatim. A thematic approach was used to analyse data.ResultsTwenty-four in-depth interviews (IDIs) with patients and four focus group discussions (FGDs) with 23 doctors were conducted. Four themes emerged: understanding the concept of deprescribing, the necessity to perform deprescribing, concerns regarding deprescribing and factors influencing deprescribing. Patients were receptive to the idea of deprescribing when the term was explained to them, whilst doctors had a good understanding of deprescribing. Both patients and doctors would deprescribe when the necessity outweighed their concerns. Factors that influenced deprescribing were doctor-patient rapport, health literacy among patients, external influences from carers and social media, and system challenges.ConclusionDeprescribing was deemed necessary by both patients and doctors when there was a reason to do so. However, both doctors and patients were afraid to deprescribe as they ‘didn’t want to rock the boat’. Early-career doctors were reluctant to deprescribe as they felt compelled to continue medications that were initiated by another specialist. Doctors requested more training on how to deprescribe medications.

Virtual medical research mentoring.

Medical research is important for professional advancement, and mentoring is a key means by which students and early-career doctors can engage in research. Contrasting international research collaborations, research mentoring programmes are often geographically limited. As the COVID-19 pandemic has led to increased use of online technology for classes and conferences, a virtual, international approach to medical research mentoring may be valuable. We hereby describe our experience at the Cardiovascular Analytics Group, a virtual international medical research mentoring group established in 2015. We make use of virtual platforms in multi-level mentoring with peer mentoring and emphasise active participation, early leadership, an open culture, accessible research support and a distributed research workflow. With 63 active members from 14 different countries, the Group has been successful in training medical students and early-career medical graduates in academic medicine. Our members have led over 100 peer-reviewed publications of original research and reviews since 2015, winning 13 research prizes during this time. Our accessible-distributed model of virtual international medical research collaboration and multi-level mentoring is viable and efficient and caters to the needs of contemporary healthcare. Others should consider building similar models to improve medical research mentoring globally.

Health, well-being, and burnout amongst Early Career Doctors in Nigeria.

Early Career Doctors (ECDs) in Nigeria are faced with many individual and systemic problems, which consequently adversely affect their health, well-being, patient care and safety. This study, the second phase of the Challenges of Residency Training and Early Career Doctors in Nigeria (CHARTING II) Study, sought to examine the risk factors and contributors to the health, well-being and burnout amongst Nigerian ECDs. This was a study of health, well-being and burnout amongst Nigerian ECDs. Outcome variables included burnout, depression, and anxiety, which were respectively assessed using the Copenhagen Burnout Inventory (CBI) and Oldenburg Burnout Inventory (OLBI), Patient Health Questionnaire (PHQ-9) depression scale, and Generalized Anxiety Disorder (GAD-7) scale. The quantitative data obtained was analysed using the IBM SPSS, version 24. Associations between categorical outcome and independent variables were assessed using chi square, with level of significance set at < 0.05. The mean body mass index (BMI), durations of smoking and alcohol consumption of the ECDs were 25.64 ± 4.43 kg/m2 (overweight range), 5.33 ± 5.65 years and 8.44 ± 6.43 years respectively. Less than a third (157, 26.9%) of the ECDs exercised regularly. The most common disease conditions affecting the ECDs were musculoskeletal (65/470, 13.8%) and cardiovascular diseases (39/548, 7.1%). Almost a third (192, 30.6%) of the ECDs reported experiencing anxiety. Male and lower cadre ECDs were more likely than female and higher cadre ECDs to report anxiety, burnout and depression. There is an urgent need to prioritize the health and well-being of Nigerian ECDs, so as to optimize patient care and improve Nigeria's healthcare indices.

Changes in alcohol-related perceptions and behaviour among Vietnamese early career doctors after graduation.

Vietnamese medical students believe becoming "strong" drinkers is important for their future career working as doctor. However, it is unclear if this is a temporary behaviour associated with life as a student, or a phenomenon associated with the transition to working as a medical practitioner. This study explored changes in alcohol-related perceptions and behaviour among Vietnamese early career doctors working after graduation. In-depth interviews were conducted with 15 Vietnamese early career doctors in Hanoi city. Thematic analysis was used to analyse the qualitative data. Vietnamese early career doctors perceived binge drinking as common among doctors, especially male doctors, surgeons, and preventive medicine doctors. This perception was different from when they were medical students because, at that time, they believed doctors would not drink alcohol at hazardous levels. Additionally, Vietnamese early career doctors' drinking behaviour changed in the frequency and quantity of alcohol consumption after graduation due to peer pressure, job stress, working collaborations, and working environment. Vietnamese early career doctors changed their alcohol-related perceptions and behaviour after graduation. Gender, mental health (stress), factors related to the working environment, and the role of professional relationships should be considered in strategies to reduce risky alcohol consumption among Vietnamese early career doctors.

The future integrated care workforce.

The future integrated care workforce.

Systematic Review of Work-life Balance among Early Career Doctors

Background: Early Career Doctors (ECDs) are medical doctors who are in their internship, postgraduate specialist training and medical/dental officers below the rank of principal medical/dental officers. The long hours of work, staff-shortage and various expectations at this formative stage expose ECDs to potential negative outcomes including poor work-life balance.&#x0D; Methods: This systematic review included all available original articles on the work-life balance among ECDs world-wide between 2006 and 2020. PubMED, Google Scholar and African Journals Online (AJOL) databases were searched, and the review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.&#x0D; Results: The literature search yielded 145 articles, and after screening 33 articles were included in this review. Twenty (87.9%) of the studies were cross sectional studies, 5 (15.2%) were prospective cohort studies and 1 (3%) was an interventional study, sample size ranged from 21 to 4,581 ECDs with a mean age range 24-35±7yrs. Positive work-life balance was reported among ECDs in 4.7% Karachi, 21% Ireland, 23% USA, 27% Australia; major determining factors include work-load and burn-out, female gender, specialty and location of practice, flexibility of work schedule; and the impacts are burn-out and reduced career satisfaction.&#x0D; Interpretation: Work-life balance among ECDs is poor worldwide, and is worse amongst the more junior cadre and female gender. It is recommended that reduction in work hours, improved wages, social and organizational support could improve the quality of work-life balance among ECDs.

Understanding the non-professional needs of early career doctors: An interview-based study.

Speciality colleges and health services are often well attuned to professional factors, but non-professional needs are less acknowledged and are the focus of this study. This likely relates to limited research about the non-professional needs of early career doctors. This study aimed to describe the non-professional needs of doctors in their early postgraduate career, including how they intersect with career and training experiences. Semi-structured interviews were conducted with 32 male and female medical graduates working across all Australian states and territories, spanning a variety of speciality areas and early career stages. Participants were asked about their career journey to date including non-professional factors related to their experiences. This study identified important non-professional needs, that strongly interplayed with career and training experiences, including: children's education; partner's career needs; family stability; major life stages; proximity to the extended family; and spending time with immediate family. Results suggested clear gender differences, with female doctor's needs orientated to partner work and carer responsibilities, while male doctor's needs were oriented to spending time with family and meeting the family's needs. Non-professional needs should be considered as legitimate needs within health service employment and speciality training arrangements enabling early career doctors to realise their full potential.

Correlation between Stress and Meaning in Life in Early Career Doctors in Pakistan

Doctors experience significant stress in their everyday occupational activities. Objective: To assess the correlation between stress and meaning in life in early career doctors in Pakistan. Methods: The study design was cross-sectional. It was conducted from March to May 2021 using non-probability convenience sampling with early career doctors in Pakistan as the subjects. The data was collected using a form distributed online that included demographic variables, Purpose in Life (PIL) test and Perceived Stress Scale (PSS). SPSS 26.0 was used for data entry and analysis. Results: The average score on PIL test was 67.64 ± 15.20 and PSS was 20.20 ± 5.88. Women doctors reported higher perceived stress (18.82 ± 6.11) than men (20.75 ± 5.07). A statistically significant negative correlation between the PIL and PSS was found, r (215) = -.610, p &lt;0.01. r = -0.610 represents a large effect size. Conclusions: Higher meaning in life is associated with lower perceived stress in doctors. Interventions that focus on meaning in life may help improve the well-being of doctors

Correlation between Burnout and Meaning in Life in Doctors in Pakistan: A Cross Sectional Study

According to ICD-11, burnout is a syndrome caused by poorly managed chronic workplace stress that is characterized by feelings of depleted energy or exhaustion, increased mental distance from the job one has, or feeling negative or cynical about it, as well as a sense of ineffectiveness and lack of accomplishment. Objective: To assess the correlation between Burnout, its dimensions and Meaning in Life in early career doctors in Pakistan. Methods: Online questionnaire containing a demographic survey, Purpose in Life test and Maslach Burnout Inventory, Human Services Survey was circulated among early career doctors. Responses were analyzed using SPSS 26.0. Results: 135 doctors (34.6%) reported burnout while 253 (64.9%) did not. Doctors who reported burnout had significantly less meaning in life (M = 59.39, SD = 12.57) than those who did not (M = 74.83, SD = 13.68); t (386) = 10.883, p &lt;0.01. A significant negative correlation was found between meaning in life and emotional exhaustion, r (386) = -.565, p = 0.001 and between meaning in life and depersonalization, r (386) = -.452, p = 0.001. Meaning in life and personal accomplishment were significantly positively correlated, r (386) = .581, p = 0.001. Conclusion: Doctors who have greater meaning in life experience less burnout. Meaning centered interventions can help combat the problem.

Becoming a neurosurgeon in the United Kingdom: A road map for medical students and early career doctors

Neurosurgery is one of the most sought-after specialties worldwide. It is one of the most competitive specialties in the United Kingdom. The entire process takes 8 years and the recruitment process aims to select the best of candidates. Not much has been said about the entire selection process from the online application to the interview process, especially with the unprecedented changes brought about by the coronavirus pandemic. There needed to be a roadmap of the entire process, from start to finish, to enable the medical students and early career doctors to make an informed decision, as well as prepare beforehand to meet the criteria that have been set out. A balanced perspective is needed as well, to highlight the drawbacks of pursuing this arduous training specialty in the United Kingdom. This article builds on existing information and throws more light on the application, interview, and the challenges faced by doctors in training. It also shows the challenges the international medical graduate might face during the application process in terms of the shortlisting matrix as well as during training. This article offers advice to all doctors willing to specialize in neurosurgery and highlights what they can do to improve their chances. It sheds more light on the interview process so that shortlisted doctors can know where to focus on during the interviews. Most importantly, by describing the challenges that may be encountered as doctors in training under the NHS, it aims to give a balanced view. This will enable the would-be candidate to make a well-informed choice.

Perceptions of oncology as a career choice among the early career doctors in Pakistan

BackgroundLack of oncologists is a growing global concern. With the rise in cancer burden across the world, the supply–demand mismatch of the oncology workforce is projected to increase. Furthermore, oncology is a low-ranked field of choice among medical students, and without understanding the perceptions and concerns of early-career doctors regarding oncology, any investments made in cancer care will be futile. This study aims to determine the opinions of young doctors and the factors most affecting their preferences in order to devise focused strategies to attract more doctors into oncology.MethodsA cross-sectional study was conducted on 300 early-career doctors across various public and private hospitals in Pakistan, from March to November 2019. A close-ended, self-administered questionnaire was used to assess their opinions in terms of the workplace environment, scope, and the emotional and financial aspects of oncology. Data was analyzed using SPSS version 23 and the influence (positive or negative) of the perceptions on the choice of oncology as a career was determined by binary logistic regression analysis.ResultsAlmost three-quarters of the participants did not want a career in oncology. The top positive perceptions about oncology in descending order were: progressive field, gender-neutral, stable working hours, financially healthy, and work-family balance. Top negative perceptions were: lack of oncologic facilities in hospitals, radiation exposure, need for private practice, poor patient prognosis, high patient load, and depressing environment. Participants who attended private medical school (p < 0.10), planned to live abroad (p < 0.10), had an oncologist (p < 0.05), cancer survivor or death due to cancer in the family (p < 0.05), were more likely to adopt oncology as a career. Those who believed that poor patient prognosis can have an impact on career choice were less likely to prefer oncology (p < 0.05).ConclusionDespite the rising cancer burden, early career doctors are reluctant to join oncology. Curricular, infrastructural and policy changes are needed at the level of medical school, oncology training and practice to recruit more young doctors and minimize the existing paucity of the oncologic workforce.

Profile and determinants of intention to migrate by early career doctors in Nigeria: A report from CHARTING study.

Recently, there has been an upsurge in the migration of medical personnel, especially early career doctors (ECDs) from low- and middle-income countries, Nigeria inclusive, to high-income countries with wide-ranging consequences on the social and economic systems of the donor countries. This study assessed the profile and determinants of intention to emigrate by ECDs in Nigeria. A cross-sectional study conducted among Nigerian ECDs from nine tertiary hospitals. Socio-demographic characteristics, intention & reasons to emigrate and willingness to return were collected using a self-administered semi-structured questionnaire. Data were analysed using Statistical Package for Social Sciences (SPSS) version 23. A total number of 763 ECDs participated in the study. The majority (88.2%) were less than 40years of age and the male to female ratio was 2:1. Majority of the participants (69.4%) received monthly income ≤833 US Dollar. About two-thirds of ECDs had plans to emigrate and most to developed countries. Common reasons for intention to migrate were better quality of postgraduate training, improved quality of life and better remuneration. High proportion of Nigerian ECDs has intention to emigrate out with potential adverse effect on the fragile health system in the country.