Engagement Of Doctors Research Articles

Smoking Cessation Practices in Australian Oncology Settings: A Cross-Sectional Study of Who, How, and When.

Patients who smoke tobacco during and after a cancer diagnosis have poorer health outcomes. Oncology healthcare providers (HCPs) are crucial to providing smoking cessation support. The study examined the characteristics associated with differences in HCPs' smoking cessation practices. As part of the Care to Quit trial, a cross-sectional survey exploring smoking cessation practices was completed by HCPs across nine cancer centers in New South Wales and Victoria, Australia. One hundred and seventy-seven HCPs completed the survey. Over half of the HCP respondents reported asking patients their smoking status, but fewer than half advised patients about the benefits of quitting, referred patients to behavioral support such as Quitline, or offered pharmacotherapy medication. All components of the "3A's" model (Ask, Advise, Act) were more likely to be completed by doctors compared to registered nurses (OR: 7.86, 95% CI: 3.64, 16.95, p<0.001), by those with more years of practice (OR: 0.26, 95% CI: 0.07-0.93, p = 0.039), and those who had received smoking cessation training (OR: 3.91, 95% CI: 1.80, 8.48, p = 0.001). Multivariate analyses also identified differences in the amount of cancer-specific advice provided between occupation type (p<0.001) and years of practice (p = 0.021). The need for smoking cessation care training in oncology continues to be apparent. Training in prescribing pharmacotherapies (for doctors) or supporting the use of pharmacotherapies (for nurses) is a particular "gap." Differences between the roles and engagement of doctors and nurses in relation to smoking cessation care should be carefully considered when developing site-specific models of cessation care and providing training.

Staff engagement, co‐workers' complementarity and employee retention: evidence from English NHS hospitals

AbstractRetention of skilled workers is essential for labour‐intensive organizations like hospitals, where an excessive turnover of doctors and nurses can reduce the quality and quantity of services provided to patients. Exploiting a unique and rich panel dataset based on employee‐level payroll and staff survey records from the universe of English NHS hospitals, we investigate empirically the role played by two non‐pecuniary job factors, staff engagement and the retention of complementary co‐workers, in affecting employee retention within the public hospital sector. We estimate dynamic panel data models to deal with reverse causality bias, and validate these estimates through unconditional quantile regressions with hospital‐level fixed effects. Our findings show that a one standard deviation increase in nurse engagement is associated with a 16% standard deviation increase in their retention; and also that a 10% increase in nurse retention is associated with a 1.6% increase in doctor retention, with this co‐workers' complementarity spillover effect driven by the retention of more experienced nurses. Nurse and doctor engagement is positively associated with managers who have effective communication, involve staff in the decision‐making process, and act on staff feedback; in particular, older nurse engagement is responsive to managers caring for staff health and wellbeing.

Netiquette and social media engagement of doctors: A renaissance in health-care delivery

Netiquette and social media engagement of doctors: A renaissance in health-care delivery

Netiquette and social media engagement of doctors: A renaissance in health-care delivery

Background: Netiquette is the term used for online etiquette or Internet etiquette. It refers to a set of guidelines, acceptable for communication. With the advent of the pandemic and online taking the major stage for discharging the majority of professional duties, proper netiquette practices among professionals are the basic necessity. Aims and Objectives: The aims and objectives of the study are to assess the knowledge regarding netiquette and its practices among health-care professionals (HCPs) and to determine the factors associated with social media engagement among doctors. Materials and Methods: A cross-sectional observational study was conducted for 2 months, consisting of a total of 64 participants. A pre-tested, semi-structured questionnaire was used to collect data on netiquette and its practices, the professional involvement of health-care personnel in delivering health care, and their encounter with online trolls and harassment. Results: On analysis, it was found that 74.3% had knowledge about netiquette and its practices, however, very few had knowledge about cyberspace usage. Around 68.3% of the participants were unaware of the American Medical Association social media policy for HCPs, guiding the Internet usage for discharging their professional duties. Only 29.7% observed proper netiquette practices to avoid being cyber-bullied. Very few of the study participants faced online troll and harassment and they chose to reply to troll by facts rather than staying quiet. An in-depth study can be done by creating an awareness program as an intervention. Conclusion: Netiquette and its practices are the key to online consultations and practices among HCPs. There is a need to create awareness among them by conducting workshops on the same.

Medical practice in gamified online communities: Longitudinal effects of gamification on doctor engagement

Medical practice in gamified online communities: Longitudinal effects of gamification on doctor engagement

Informal Payments and Doctor Engagement in an Online Health Community: An Empirical Investigation Using Generalized Synthetic Control

Recognizing the importance of doctor engagement in online health communities (OHCs), managers and platform owners seek to foster doctor-patient interactions and encourage doctors’ knowledge sharing by introducing informal payments. This study investigates how informal payments in the form of monetary gifts affect doctor engagement, using the launch of a gifting feature by a leading OHC as a natural experiment that exogenously provides doctors with extra monetary incentives. We find that informal payments can have a crowding-out effect on doctors’ intrinsic motivation to engage in medical consultations. We also find that monetary and nonmonetary gifts play distinct roles in motivating doctor responses, with nonmonetary gifts having a more significant carryover effect on follow-up interactions and better promoting the doctor-patient relationship. Our findings additionally suggest that social status moderates the impact of digital gifting on doctor engagement. These findings provide useful implications for online health communities that have implemented or are planning to implement digital gifting to stimulate user engagement.

Informal Payments and Doctor Engagement in an Online Health Community: An Empirical Investigation Using Generalized Synthetic Control

Recognizing the importance of doctor engagement in online health communities (OHCs), managers and platform owners seek to foster doctor-patient interactions and encourage doctors’ knowledge sharing by introducing informal payments. This study investigates how informal payments in the form of monetary gifts affect doctor engagement, using the launch of a gifting feature by a leading OHC as a natural experiment that exogenously provides doctors with extra monetary incentives. We find that informal payments can have a crowding-out effect on doctors’ intrinsic motivation to engage in medical consultations. We also find that monetary and nonmonetary gifts play distinct roles in motivating doctor responses, with nonmonetary gifts having a more significant carryover effect on follow-up interactions and better promoting the doctor-patient relationship. Our findings additionally suggest that social status moderates the impact of digital gifting on doctor engagement. These findings provide useful implications for online health communities that have implemented or are planning to implement digital gifting to stimulate user engagement.

HOME BLOOD PRESSURE MONITORING IN SLOVAKIA IN 2022. WHO MANAGES THE PATIENTS WITH ARTERIAL HYPERTENSION THE BEST?

Objective: Home blood pressure monitoring (HBPM) is a reliable, convenient method for the diagnosis and management of arterial hypertension (AH). Moreover, HBPM can help improve the control of blood pressure in patients (pts). Design and method: To evaluate HBPM and office blood pressure (BP) measurements. To compare the efficacy of the AH treatment according to doctors‘ and patients‘ age and gender. Results: 4375 pts with AH were enrolled (2089 women, 51,8%), mean age 61,1 ± 19,1 years. The mean office BP was higher in male pts 136,7 ± 10,9/ 81,9 ± 7,2 mmHg, vs in female pts 135±7,2/ 80,2 ± 6,2 mmHg. Mean HBPM was also higher in male pts 134,1± 7,2/ 81,1± 6,3 mmHg. In our program participated 129 female doctors (72%), mean age of 49,6 ± 10,1 years, and the mean age of male doctors was 44,9 ± 7,2 years. The reduction in BP for 7 days of HBPM was documented. A greater reduction of HBPM was achieved when the female doctor treated female patients 132,01/78 mmHg p = 0,0081, contrary to a smaller reduction of BP when the female doctor treated male pts 134,18/81,32 mmHg p = 0,026. The highest office BP was measured in male pts treated by male doctors 136,59/81,59 mmHg, beyond the lowest office BP was measured when the female doctor treated female pts 132,01/78,74 mmHg p = 0,0081. Male doctors treated more frequently with a higher number of AH drugs. The proportion of use of fixed-dose AH drugs combination was highest when the male doctor treated male pts (70,7%), and the lowest use of fixed-dose combination was when the female doctor treated female patients 52,1%. Conclusions: In our project with HBPM and office BP measurement in 2022 in Slovakia we found that the most precise BP control both in the office and in HBPM was reached when female patients were treated by female doctors. On the other hand, male doctors have preferred to use fixed-dose AH combinations. These data show that better involvement and engagement of doctors, and patients could lead to better implementation of guidelines and better BP control.

The junior doctor shadow board

Before 2020, North Manchester General Hospital had a history of poor feedback from junior doctors, regarding both their overall experience and access to non-clinical development opportunities. The circumstances of the COVID-19 pandemic resulted in the medical leadership team giving junior doctors the opportunity to lead the reorganisation of services and redeployment. The aim of this was to increase engagement, representation and development opportunities. This led to the formation of the Junior Doctor Leaders Group, using similar principles as the ‘shadow boards’ seen in the corporate sector. This article reviews the impact of the group. Analysis was conducted using internal key performance indicators, identifying improvement initiatives generated by the Junior Doctor Leaders Group and surveying group members. Initial results suggest that junior doctors felt their voices had gained recognition in the organisation, with 95% of group members stating that it increased junior doctor representation and 90% agreeing that the group made them feel more confident representing and advocating for their colleagues. Increased transparency and trust between junior and senior staff facilitated escalation of concerns to higher management, and the design and implementation of solutions. Members of the Junior Doctor Leaders Group also reported improvements to their work and educational experiences. In the first year after the group was established, members led or co-led a total of 14 organisation-wide improvement projects. Results from the General Medical Council training survey showed improvement across almost all indicators. Therefore, the authors believe that the Junior Doctor Leaders Group offers a novel approach to improving junior doctor engagement and experience, and can be beneficial to both the cohort of junior doctors and the wider organisation.

Exploring the experiences and views of doctors working with Artificial Intelligence in English healthcare; a qualitative study.

The National Health Service (NHS) aspires to be a world leader of Artificial Intelligence (AI) in healthcare, however, there are several barriers facing translation and implementation. A key enabler of AI within the NHS is the education and engagement of doctors, however evidence suggests that there is an overall lack of awareness of and engagement with AI. This qualitative study explores the experiences and views of doctor developers working with AI within the NHS exploring; their role within medical AI discourse, their views on the implementation of AI more widely and how they consider the engagement of doctors with AI technologies may increase in the future. This study involved eleven semi-structured, one-to-one interviews conducted with doctors working with AI in English healthcare. Data was subjected to thematic analysis. The findings demonstrate that there is an unstructured pathway for doctors to enter the field of AI. The doctors described the various challenges they had experienced during their career, with many arising from the differing demands of operating in a commercial and technological environment. The perceived awareness and engagement among frontline doctors was low, with two prominent barriers being the hype surrounding AI and a lack of protected time. The engagement of doctors is vital for both the development and adoption of AI. AI offers big potential within the medical field but is still in its infancy. For the NHS to leverage the benefits of AI, it must educate and empower current and future doctors. This can be achieved through; informative education within the medical undergraduate curriculum, protecting time for current doctors to develop understanding and providing flexible opportunities for NHS doctors to explore this field.

Canadian Naturopathic Doctor Engagement, Preparedness, and Perceptions of Evidence-Based Practice: A National Cross-Sectional Study.

Background: Despite the reported benefits of evidence-based practice (EBP), there are concerns that some practitioners, including naturopathic doctors (NDs), may be cautious about its use. The objective of this study was to explore Canadian ND perceptions, preparedness, and engagement in EBP, and the barriers and enablers to EBP uptake. Methods: The study was a national cross-sectional survey. NDs practicing in Canada were invited to complete the validated 84-item Evidence-Based Practice Attitudes and Utilization Survey between February and May 2020. Results: A total of 252 Canadian NDs were recruited. Participant attitudes toward EBP were predominantly positive, with three-quarters of participants indicating that >50% of their practice was informed by clinical research evidence. One-half of participants self-reported a medium-high to high level of skill across most EBP-related activities. Notable barriers to EBP uptake were lack of clinical evidence in naturopathy, and lack of time. Access to the internet and online databases were identified as useful enablers to improving EBP engagement. Conclusions: By shedding light on Canadian ND engagement with, preparedness for, and perceptions of EBP, the findings will help guide the development of strategies to support EBP uptake in NDs with the expectation of improving quality of care.

691 ‘ARE YOU CONCERNED ABOUT ME TODAY’ - AN MDT APPROACH TO IMPROVING DELIRIUM RECOGNITION

IntroductionDelirium is a common neuropsychiatric syndrome that increases the likelihood of adverse outcomes for patients admitted to hospital. Delirium is preventable and treatable. Recognition of the syndrome is challenging. Our aim was to increase this recognition through robust inpatient screening, utilising a multi-disciplinary team (MDT) approach.MethodStakeholder analysis for a quality improvement project revealed that junior doctors were members of the team most likely to perform a 4AT. Plan, do, study, act (PDSA) cycles were carried out: 1. Junior doctor engagement 2. Verbal prompts in huddle 3. Healthcare assistant (HCA) questionnaires.ResultsBaseline data showed that on average 0.6% patients had new 4AT over one week on elderly care wards. Intervention 1 involved 4AT handouts given to junior doctors. Number of 4ATs was 3% of patients per week. Intervention 2 used prompts in the morning MDT huddle, asking about concerns for patients. This increased the number of patients having 4AT per week to 6.5%. HCAs did not attend huddles and were targeted in the third intervention. A questionnaire with delirium information and the subsequent question ‘are you concerned about this patient’ was placed in patient bedside folders. This gave opportunity for HCAs to escalate patients to huddle so 4ATs could be carried out. The questionnaire was completed for 62% of patients, but only 1.4% patients were flagged up and subsequently had 4AT. This time was complicated however by the wards becoming Covid-19 wards.ConclusionDelirium is common however there is missed opportunity for earlier identification. Utilising HCAs with bedside questionnaires was time efficient and ensured robust escalation to prompt further investigation. When incorporated into huddle this could lead to more delirium diagnoses if carried out over a longer period, outside of the Covid-19 pandemic and on a ward solely populated with elderly care patients.

Planning and Setting Up of a Communication Program for Hospitalized COVID-19 Patients: Challenges and Potential Solutions in Resource Constrained Setting

Background The recent onset of COVID-19 pandemic has necessitated many patients to be hospitalized in the COVID-19 treating centers. Owing to the need for isolation of these patients and minimizing the risk of transmission to healthy people, COVID-19-positive patients are completely restricted from meeting their friends and families. This gives rise to anxiety amongst the patients' relatives as they are not able to monitor the progress of the patients and have to depend entirely on the healthcare staff for any updates regarding the patient. In contrast, the treating doctors are undergoing severe stress due to the unknown nature of the virus and the risks involved in treating patients. They are thoroughly exhausted after the long hours donning the personal protection equipment (PPE). Objective To structure and form an interface for communication between the treating physician and the families, as a “communication team,” to decrease the workload on the treating physicians and minimize their contact time in a COVID-19 setting. Results The addition of a communication team improved the physicians' efficiency of patient management and family satisfaction. Several challenges were faced during the setting up of this interface effectively. However, most of these were dealt with along the way. The communication team was instrumental in allaying the anxiety of the family with respect to their patients' clinical condition. This also ensured engagement of doctors from non-clinical and laboratory-based departments in the COVID-19 treatment process. Conclusion Adding up a communication team for communicating clinical updates to the family in a resource-limited scenario greatly improved communication and thus family satisfaction of the COVID-19-positive patients.

Implementation Science: An Essential Tool for Advancing DrPH Practice

This commentary describes how implementation science (IS) complements and adds value to public health decision making, applied research, and practice. The commentary then presents opportunities for integrating IS into public health, with a specific focus on engagement of Doctors of Public Health (DrPHs) in IS research and a call for advanced training in IS for DrPHs. IS can advance public health by improving the translation of research into practice and policy and by addressing health inequities. IS has an increasing focus on incorporating health equity into its frameworks, enhancing community and stakeholder engagement in IS, studying the implementation of multilevel interventions, as well as policy implementation science. IS examines and influences how we move evidence into practice; therefore, it is essential to have practitioners engaged in the field. There is an obvious role for IS to augment foundational DrPH training. Specifically for DrPHs, expertise in IS would elevate leadership and applied research competencies, facilitating evidence-based decision making in policy and practice. In order to achieve this goal, greater awareness of opportunities to build IS capacity and engage in IS research is needed.

The Importance of Leadership Development in Medical Curricula: A UK Perspective (Stars are Aligning).

“Medical leadership and management” describes the engagement of doctors in the leadership and management of both individual patient care and of the departments, organizations and systems within which they work. Around the world, doctors are generally accepted as the leaders of clinical teams, holding ultimate accountability for individual patient care. However, the role of doctors as organizational and system leaders within healthcare, despite evidence of benefit, shows considerable variation. In this article, we briefly explore the history of leadership development for doctors, and then, taking a UK perspective on recent developments in undergraduate education and postgraduate training, consider the opportunities and challenges for medical schools, educators and doctors in implementing these. The future of medical leadership and management development is promising although there is still a lack of evidence on the longer-term outcomes and impact on patients of current interventions. It is clear, however, that faculty need to be skilled in holding effective developmental conversations and structuring formative experiences for those they educate, and that leadership development must be integrated longitudinally throughout a doctor’s career, with undergraduate development being a critical stage for helping medical students recognize and understand their wider responsibility to the system, as well as the patient in front of them.

Reviving clinical governance? A qualitative study of the impact of professional regulatory reform on clinical governance in healthcare organisations in England

Until recently, processes of professional regulation and organisational clinical governance in the UK have been largely separate. However, the introduction of medical revalidation in 2012 means that all doctors have to demonstrate periodically to the regulator that they are up to date and fit to practise, and as part of this process doctors must engage with clinical governance activities in the organisations in which they work. To explore how the recent implementation of medical revalidation has affected the arrangements for clinical governance in healthcare organisations in England. Thematic analysis of interviews with 62 senior clinicians and non-clinicians in management or senior administrative roles, from a range of healthcare organisations in England. Revalidation has engendered changes to clinical governance systems, resulting in: increased doctor engagement with clinical governance activities; new or improved systems for access to clinical governance data for doctors and leaders within healthcare organisations; and more leverage - through the Responsible Officer role - to enforce engagement with clinical governance. Organisational context has been an important mediator of the impact of revalidation on clinical governance. Revalidation has increased alignment between systems for organisational and professional oversight and accountability, resulting in increased scrutiny of clinical practice. However, it is still a matter of conjecture whether this will in turn lead to improvements in medical performance.

The prevalence of burnout among registrars in the School of Clinical Medicine at the University of the Witwatersrand, Johannesburg, South Africa.

Burnout is a response to prolonged stress and consists of three elements: emotional exhaustion (EE), depersonalisation (DP), and feelings of personal accomplishment (PA). The existence of burnout in doctors is often not acknowledged but has major consequences for personal and professional life. Only limited research has been done on the prevalence of burnout among registrars in South Africa (SA). To describe the prevalence of burnout in a cohort of SA registrars, and assess relationships between burnout and sociodemographic factors. A cross-sectional descriptive internet survey was conducted. Respondents were registrars in departments of the School of Clinical Medicine at the University of the Witwatersrand, Johannesburg, SA. The Maslach Burnout Inventory (MBI) was used to measure burnout. Relationships were assessed by the independent-samples t-test and analysis of variance. A total of 585 emails were delivered to registrars, of whom 201 started the survey (response rate 34%); 170 questionnaires were analysed. The mean age of the respondents was 33 years, and the male/female ratio was 1:1.8. The mean (standard deviation) score for EE was 3.5 (1.2), for DP 2.7 (1.1) and for PA 4.1 (1.1). The overall level of burnout was 84%. None of the respondents scored low over all categories. No significant association between sociodemographics (age, sex, discipline, year in the programme and experience) and MBI dimensions was found. The prevalence of burnout in this study was higher than that reported in the national and international literature. Levels of DP were extremely high and are worrying, as DP affects professionalism and engagement of doctors. In keeping with the literature, no associations were found between sociodemographic factors and burnout, suggesting that the cause of burnout should be sought in the work environment. Efforts to improve autonomy in the workplace, development opportunities and promoting peer collaboration are needed to prevent burnout.

Taking back control: a better deal for junior doctor engagement in rota design using e-Delphi and Assignment Problem Algorithm.

The British Medical Association and NHS Employers published a guide to good rostering practice, which emphasised the need for a collaborative approach, in which the views of junior doctors should be taken into account when designing a rota.1 The guidance, however, did not provide tools for promoting junior doctor engagement in this process. Lack of structured consultation strategy and low level of satisfaction contribute to the prevailing narrative that junior doctor's input is undervalued, resulting in ’a crisis in junior doctor engagement’.2 This case study presents the utility of e-Delphi exercise for consultation and Assignment Problem Algorithm to improve satisfaction by matching work patterns to doctors’ preferences. Following review of workload and medical staffing, Medway Maritime Hospital undertook a redesign of its medical registrar (MR) rota in October 2018. With support from the Medical Staffing Department, a new rota was drafted by …

Taking back control: a better deal for junior doctor engagement in rota design using e-Delphi and Assignment Problem Algorithm

The British Medical Association and NHS Employers published a guide to good rostering practice, which emphasised the need for a collaborative approach, in which the views of junior doctors should be taken into account when designing a rota.1 The guidance, however, did not provide tools for promoting junior doctor engagement in this process. Lack of structured consultation strategy and low level of satisfaction contribute to the prevailing narrative that junior doctor's input is undervalued, resulting in ’a crisis in junior doctor engagement’.2 This case study presents the utility of e-Delphi exercise for consultation and Assignment Problem Algorithm to improve satisfaction by matching work patterns to doctors’ preferences. Following review of workload and medical staffing, Medway Maritime Hospital undertook a redesign of its medical registrar (MR) rota in October 2018. With support from the Medical Staffing Department, a new rota was drafted by …

Developing a trustworthy quality improvement framework

To develop a dynamic and facilitated quality improvement (QI) project framework within Solent NHS Trust for doctors-in-training to improve junior doctor engagement with quality and service improvement projects. The NHS is currently showing a gradual shift towards further quality and service improvement projects and we highlighted the trust's need for improved support for doctors-in-training. The requirement for a quality improvement project (QIP) …