Responsibility For Patient Care Research Articles

Physicians' and advanced practice providers' perceptions of the impact of embedded clinical pharmacists on the work environment in ambulatory care clinics.

Clinical pharmacists are recognized as valuable team members in primary care clinics due to the variety of patient care services they provide. This study examined nonpharmacist healthcare providers' perceptions of how embedded clinical pharmacists impact the work environment in ambulatory care clinics. This was an exploratory mixed methods study consisting of semistructured interviews and a subsequent survey. Participants included attending and resident physicians, and advanced practice providers (APPs) practicing in clinics with an embedded clinical pharmacist. Coded interview transcripts were analyzed to identify themes that were used to develop a survey. Interview participants were not asked to complete the survey. Survey responses were analyzed utilizing descriptive statistics. Subgroup analysis assessed for differences in responses based on provider type, gender, clinical practice area, years of practice, and pharmacy services utilization. Fourteen physicians and APPs participated in the semistructured interviews, and 43 other providers completed the survey. In the interviews, participants stated the clinical pharmacist contributed positively in terms of work environment, workload, work-related stress, and burnout. The major themes identified were sharing patient care responsibilities, saving provider time, and being a knowledgeable resource. Survey responses were consistent with interview statements; however, the positive impact differed between nonusers and moderate to high utilizers of clinical pharmacy services. The main barrier to collaborating with clinical pharmacists was their limited availability. Embedded clinical pharmacists positively impact the work environment in ambulatory care clinics by reducing provider workload, work-related stress, and burnout. Participants also noted clinical pharmacists are a trusted resource for patient care and drug information questions.

Assigning Online Educational Modules Before Orientation Increases Interns' Level of Readiness for Internship.

Purpose: Transitioning to residency is a stressful time in the life of a new physician as they bear significantly increased patient care responsibilities. Program directors and hospital administrators responsible for patient safety also share concerns regarding resident preparedness. 1 For the past 5 years, NYU Grossman School of Medicine has been providing incoming interns with e-learning modules before commencing their residency as a means of addressing issues related to patient assessment, management, and patient safety. We postulated that during the period between Match day and July 1, soon-to-be-residents would have the time and be eager to focus on patient care issues. 2 We studied whether these trainees would view the modules and, if so, find them helpful in their preparation for residency. Method: NYU Grossman School of Medicine faculty created a series of 12 online educational modules (WISE-OnCall) to address acute presentations of common clinical problems such as dyspnea, chest pain, abdominal pain, fever/sepsis, and oliguria. Each module was designed specifically for senior medical students and early interns with an emphasis on distinguishing life-threatening diagnoses from more benign causes. The importance of recognizing potentially critical situations from among the many possible diagnoses, initiating management, and escalating concerns to seniors is addressed in each of the modules. In 2017, we began assigning a subset of these modules to incoming interns in selected residency programs. Each subsequent year additional NYU residency programs participated and assigned modules to their incoming interns. In 2021, all incoming interns were assigned all 12 modules to complete. During orientation, incoming NYUGSOM interns participate in First Night on Call, a 4-hour simulation session that emphasizes patient safety and escalating problems to a superior during common clinical scenarios. 3 Trainees complete a survey at the end of this session. In 2017, 2018, and 2019, we also surveyed the trainees again 6 months into their intern year. Results: Over 4 years (n = 753), 86.6% of interns reported that they either agreed or strongly agreed that the WISE-OnCall modules increased their readiness for internship. Additionally, 86.9% of interns reported that they either agreed or strongly agreed that the WISE-OnCall modules provided them with a framework to organize clinical information during First Night On Call (Patient Safety Orientation). In 2017–2019, we also surveyed the interns 6 months later. Of 214 respondents, 62.6% of interns reported that they would recommend WISE-OnCall modules to future incoming interns. Discussion: Incoming interns are primed for learning about acute clinical issues they are likely to encounter early in their training. Providing interns with a series of online educational modules before their orientation is a highly feasible and acceptable approach to help prepare them. Since these online educational modules are focused on the recognition and management of acute inpatient problems, they help our trainees develop a framework for organizing clinical information and to feel more confident in their preparation for early internship. Follow-up surveys 6 months later reinforce the usefulness of the modules. These WISE OnCALL e-learning modules allow incoming interns an opportunity to familiarize themselves with clinical problems they will encounter before being integrated into a fast-paced and complex health care system. Significance: E-learning via online educational modules is an excellent format for supporting trainees’ readiness for internship. Interns are primed for learning shortly before starting residency and enthusiastically embrace resources developed to help their clinical skills.

Call of Duty - What are Physicians' Obligations During Crises?

BackgroundSociety allows physicians the privilege and responsibility of caring for patients. Those responsibilities demand that their knowledge and technical expertise meet standards defined and policed by their colleagues, through medical societies or governmental entities. However, the fiduciary duty that patients’ interests are held above those of the physicians’ is an ethical precept that is tested when society is under threat. DiscussionDisasters that stress society are a constant and can present themselves in a myriad of ways to include medical, meteorological, or political. Minimizing the potential damage to the quality and quantity of life of the population is dependent upon public safety personnel and health care professionals who may put their health and safety in harm's way to care for patients. These acts may be taken for granted or assumed to be part of the professional obligations of physicians and other health care workers who work at the bedside. The obligations of physicians to their patients and society may differ from those not in the medical field, and the level of risk deemed acceptable by the physician and by society should be clearly delineated. ConclusionDespite the conflict between normative and descriptive ethics, in times of disaster, physicians must respond to the call of duty. This duty is contingent on the responsibility being shared with governmental agencies and health care facilities, to mitigate the risks borne by those who answer the call.

Neonatal nurse practitioner job satisfaction, workforce environment, and mental well-being.

Increased demand for nurse practitioners emphasizes the importance of consistent and ongoing collection of data to provide a better understanding of the NNP workforce and to promote retention and recruitment of NNPs. To understand how work environment and work hours influence job or career satisfaction. The National Association of Neonatal Nurse Practitioners in collaboration with the National Certification Corporation emailed an online survey to all 6,558 certified neonatal nurse practitioners (NNPs) in 2020 with 845 (12.8%) responding. Subjects included those with responsibilities in direct patient care, transport NPs, faculty/directors, and advanced practice registered nurse coordinators/managers/administrators. Satisfaction with career choice as an NNP was reported as very satisfied by 58% (n = 493) and mostly satisfied by 37% (n = 310). Satisfaction with current job as an NNP was reported as very satisfied for 30% (n = 252), with 51% being mostly satisfied (n = 435). Age influenced satisfaction scores, with NNPs aged 61 years or older having a higher mean score than NNPs aged 31-40 years ( p = .041). The majority of NNPs did not use all of their available paid time off (72%; n = 609) and respondents worked an additional 248 extra hours per year. NNPs experience bullying (58%) and/or lateral violence (32%). Seventeen percent have called in sick for mental health reasons (n = 147). Neonatal nurse practitioners' satisfaction is multifactorial. Those who reported taking time off for self-prescribed mental health indicated less job satisfaction, more work hours, poor work/life balance, and a less-than-optimum work environment. Overall, NNPs are satisfied with their career choice but are less satisfied with their job choice. Understanding factors that influence mental well-being and job satisfaction will improve recruitment and retention of nurse practitioners.

Blood Culture Optimization: Practical Tips

Sepsis is a serious medical condition that continues to be a leading cause of hospital admission and mortality worldwide. Blood cultures play a crucial role in identifying the source of sepsis and thus directing appropriate treatment for improved patient outcomes. Blood culture data are not only utilized for patient treatment but also have utility for infection control and epidemiological purposes. An important challenge facing blood culture results and interpretation is contamination, which can have negative effects on patient care and health care costs, including in the clinical microbiology laboratory. This article reviews the process of blood culture collection, from the decision to collect blood cultures to processing, testing, and reporting. Strategies for blood culture optimization are discussed, along with data to support practices that can lead to improved patient care, diagnostic stewardship, and fiscal responsibility.

Creation of a Handoff Tool Between the Preprocedural Area and OR Team

<h3>Introduction</h3> Ineffective communication is one of the root causes of sentinel events reported to The Joint Commission. Handoff checklists are tools that assure continuity of care and promote patient safety, while allowing for questions to be asked and answered. These handoff checklists ensure proper communication and acceptance of responsibility for patient care between nurses or nursing teams. <h3>Identification of the problem</h3> The team identified a gap in communication between the preprocedural RN and the OR team. Previously, key information either verbally or through the use the EMR was the only form of communication. Ineffective handoff communication is a primary factor leading to errors. <h3>QI question/Purpose of the study</h3> The purpose of the project addresses the inconsistency in handoff between procedural RN and OR teams. The creation of a standardized communication tool reduces the risk throughout the patient's surgical process. <h3>Methods</h3> Theteam created and implemented a standardized checklist, to address the inconsistency in handoff. The new communication tool aligns with the elements corresponding with The Joint Commission Patient Safety Goals. Every patient entering the OR is subject to this process change. <h3>Outcomes/Results</h3> After implementation of the handoff checklist, items necessary for surgery and verification process are available prior to entering the OR. Use of evidence-based guidelines, included in our handoff checklist decreases preventable omissions and errors. Implementation of this handoff tool allows for greater interdepartmental communication. <h3>Discussion</h3> When our handoff tool is used consistently, communication is improved and safer outcomes are evident. The handoff tool is used throughout the entire surgical event, creating a closed loop narrative. <h3>Conclusion</h3> This communication tool has improved the process and reduced errors related to the handoff activity. Thereby, verifying the required elements and promoting patient safety. <h3>Implications for peri-anesthesia nurses and future research</h3> As a multi-building health system, it is important to work towards standardizing practices and policies ensuring consistency in patient care. Since the inception of the checklist, additional items were added to encompass the entire OR process, including handoff to PACU phase 1 and phase 2. ASPAN and AORN best practice recommended guidelines have been implemented in the version of the updated communication tool with focus on patient safety.

Evaluating the Association of a Core EPA-Oriented Patient Handover Curriculum on MedicalStudents' Self-reported Frequency of Observation and Skill Acquisition.

"Giving or receiving a patient handover to transition patient care responsibility" is one of the thirteen Core Entrustable Professional Activities (Core EPAs) for Entering Residency. However, implementing a patient handover curriculum in undergraduate medical education (UME) remains challenging. Educational leaders in the multi-institutional Core EPA8 pilot workgroup developed a longitudinal patient handover UME curriculum that was implemented at two pilot institutions. We utilized multi-school graduation questionnaire data to assess the association of our patient handover curriculum on self-reported frequency of observation/feedback and skill acquisition by comparing data from the shared curriculum schools to data from other Core EPA pilot schools (three schools with school-specific curriculum; five without a dedicated handover curriculum). Questionnaire data from 1,278 graduating medical students of the class of 2020 from all ten Core EPA pilot schools were analyzed. Graduates from the two medical schools that implemented the shared patient handover curriculum reported significantly greater frequency of handover observation/feedback compared to graduates at the other schools (school-specific curriculum (p < .05) and those without a handover curriculum (p < .05)). Graduates from the two shared approach schools also more strongly agreed that they possessed the skill to perform handovers compared to graduates from the other eight pilot schools that did not implement this curriculum. The findings of this study suggest that the implementation of a multi-institutional Core EPA-based curricular model for teaching and assessing patient handovers was successful and could be implemented at other UME institutions.

Competency-Based Medical Training in Anesthesiology: Has It Delivered on the Promise of Better Education?

Competency-Based Medical Training in Anesthesiology: Has It Delivered on the Promise of Better Education?

Creating an academic-practice partnership in a primary care pediatric clinic

There is increasing demand for primary care nationally, and advanced practice registered nurses are uniquely suited to meet this demand. Academic nursing programs are responding to this challenge by expanding graduate nurse practitioner (NP) programs, but they are limited by availability of student clinical placement sites and dedicated preceptors. We addressed these limitations by developing an academic-practice partnership between a College of Nursing pediatric nurse practitioner (PNP) program and a primary care clinic within an academic pediatric hospital. A novel PNP faculty role was developed with teaching, patient care, and clinical precepting responsibilities. This partnership increased access to pediatric primary care services within the local underserved community, increased the number of teaching faculty members and clinical preceptors, and expanded clinical education opportunities for PNP students.

Concordance of Narrative Comments with Supervision Ratings Provided During Entrustable Professional Activity Assessments.

Use of EPA-based entrustment-supervision ratings to determine a learner's readiness to assume patient care responsibilities is expanding. In this study, we investigate the correlation between narrative comments and supervision ratings assigned during ad hoc assessments of medical students' performance of EPA tasks. Data from assessments completed for students enrolled in the clerkship phase over 2 academic years were used to extract a stratified random sample of 100 narrative comments for review by an expert panel. A review panel, comprised of faculty with specific expertise related to their roles within the EPA program, provided a "gold standard" supervision rating using the comments provided by the original assessor. Interrater reliability (IRR) between members of review panel and correlation coefficients (CC) between expert ratings and supervision ratings from original assessors. IRR among members of the expert panel ranged from .536 for comments associated with focused history taking to .833 for complete physical exam. CC (Kendall's correlation coefficient W) between panel members' assignment of supervision ratings and the ratings provided by the original assessors for history taking, physical examination, and oral presentation comments were .668, .697, and .735 respectively. The supervision ratings of the expert panel had the highest degree of correlation with ratings provided during assessments done by master assessors, faculty trained to assess students across clinical contexts. Correlation between supervision ratings provided with the narrative comments at the time of observation and supervision ratings assigned by the expert panel differed by clinical discipline, perhaps reflecting the value placed on, and perhaps the comfort level with, assessment of the task in a given specialty. To realize the full educational and catalytic effect of EPA assessments, assessors must apply established performance expectations and provide high-quality narrative comments aligned with the criteria.

Effect of transition from inpatient oncology service to oncology consult service on fellow burn out and training.

11023 Background: The hematology-oncology inpatient service at the University of Louisville underwent a major change in July 2021 from a medical oncology service run by hematology/oncology fellows and attendings to a hospitalist-run service with hematology/oncology fellows and attendings sharing patient care responsibility as a consulting service. We planned this study because, to date, no published work has studied the effect of transitioning from an inpatient to consult service on fellow burnout, education, and training. Methods: A survey was distributed in July 2021, and a follow-up survey was sent in January 2022. The survey had 38 questions regarding the impact of the workload on time for study, research, personal and professional life, which were scored from 1 to 5. Two tail paired t-test was used to compare the difference in means. The survey also contained questions from the Mayo Clinic Resident Well-Being Index (RSWBI). This index has been validated to identify distress among fellows and allows for the comparison of local results with national data from RSWBI. In RSWBI, scores range from 0-7, with 0 being the lowest risk and 7 being the highest risk of burnout. A cut-off of a score ≥ 5 identifies individuals with a high degree of distress, is associated with an increased risk of error, suicidal ideation, and burnout, and has been validated in more than 1700 residents/fellows. Results: We distributed the survey to 2nd and 3rd-year fellows. 5/6 fellows completed the survey. 3 of them were male and 2 females. Change in inpatient service structure did not impact time for study, research, patient encounter, or ability to handle the volume of work. Improvement in adequate time preparing for clinic was statistically significant (P=0.03), and other improvements were also noted in concentration, time for family, and better personal and professional relationships (Table). RSWBI median score before the transition was 3.6, which improved to 2.0 after the transition to consulting service, which was similar to the national average where the median score was 2.0 among 8237 residents/fellows. 2 fellows (40%) were at high risk of distress before the transition. 1 fellow (20%) was at high risk of distress after the transition, which was comparable to the national average where 19.4% resident/fellows scored ≥5. Conclusions: These results show increased levels of distress in fellows that improved to the national average following transition from a primary inpatient medical oncology service to a consult service.[Table: see text]

Impact of COVID-19 Measures on Discharge Planning and Continuity of Integrated Care in the Community for Older Patients in Singapore.

Introduction:The COVID-19 pandemic affects the process of care transition for patients with underlying chronic conditions. This study aims to explore the impact of the pandemic measures on discharge planning and continuum of care for vulnerable older patients from multi-stakeholder perspectives.Methods:We conducted focus group discussions and individual interviews with healthcare workers, community partners, government officials and family caregivers in Singapore. All interviews were audio-recorded, transcribed verbatim and thematically analysed.Results:A total of 53 individuals participated in the study. Discharge planning and care continuity in the community were affected primarily by the limited step-down care options and remote assessment of discharge needs. Participants felt a need to revisit the decision of ‘essential’ community services through engagement of all stakeholders to enhance care community.To improve better care transition, participants suggested the need for clearer communication of guidelines, improved intersectoral collaboration, shared responsibility of patient care through community engagement and employment of novel models of care.Conclusion:The pandemic measures generated challenges of safe discharge of patients and care continuity in the community. Findings shed light on the need to proactively assess care pathways and catalyse novel models to improve care transition beyond the pandemic.

Medical Student Identity Construction Within Longitudinal Integrated Clerkships: An International, Longitudinal Qualitative Study.

Longitudinal integrated clerkships (LICs) have been implemented worldwide to increase authentic student participation in patient care over time. Studies have shown benefits of the model include the ability of LICs to attract future practitioners to underserved areas, student engagement in advocacy, and development of an "ethic of caring." Less is known, however, about how LICs impart their benefits, although LICs may strengthen professional identity. As such, this study aimed to explore medical student professional identity construction through time within LICs internationally. This was a longitudinal qualitative study from 2019 to 2020, involving 33 students across 4 medical schools in the United Kingdom, Ireland, and the United States. The authors explored participating students' identity construction during LICs. Data collection involved 3 stages: individual, semistructured interviews at entry (n = 33) and exit of the LIC (n = 29), and audio diaries throughout. Data were analyzed inductively using a reflexive thematic approach. Three themes were identified. Longitudinal relationships with patients and preceptors encouraged patient care ownership and responsibility; LIC students identified as patient advocates; and longitudinal relationships shaped students' social consciences. Themes were underpinned by continuity of relationships between students and patients, and students and tutors. Though continuity is lauded as the cornerstone of LICs, these findings suggest that this is too broad a way of understanding the benefits of LICs. Instead, continuity should be seen as facilitating the development of important relationships within diverse communities of practice, which leads medical students to construct professional identities as responsible, compassionate advocates for underserved populations. This was the case across the institutions, nations, and LIC types in this study. By highlighting the ways in which LICs influence identity, these findings offer important insight relating to the future development and delivery of LICs.

Resident physicians' advice seeking and error making: A social networks approach.

Resident physicians are especially at risk of being involved in medical errors because they bear tremendous responsibility for patient care yet are still in the process of learning and mastering their profession. To increase knowledge and gain information, they create a professional-instrumental network, that is, the deliberate initiation of advice ties with senior physicians. We aim to explore whether and how residents' networking with senior physicians is associated with their error rates. Specifically, we aim to identify whether the centralities of residents (advice seekers) and senior physicians (advice givers) in the social network are associated with residents' error rates. We surveyed 142 resident physicians working in 22 wards in two general hospitals about whom and how frequently they consult using a sociometric technique. Information about errors made in a 3-month period was collected independently. Residents made less errors when they sought advice from few senior physicians but consulted more frequently with focal senior physicians (those whom many other advice seekers frequently consult). However, when residents sought advice from many senior physicians, their frequency of consultation with focal senior physicians was not associated with their number of errors. These effects were more pronounced for residents at the beginning of their residency period. Results of this study provide evidence of a specific association between resident physicians' consultation patterns and their error rates. Results inform ward managers about ways to leverage opportunities and remove constraints for residents to ask for advice and for focal physicians to provide it.

Guiding Fellows to Independent Practice: Current Trends in Pediatric Emergency Medicine Fellow Supervision.

Recent studies highlight the importance of physician readiness to practice beyond graduate training. The Accreditation Council for Graduate Medical Education mandates that pediatric emergency medicine (PEM) fellows be prepared for independent practice by allowing "progressive responsibility for patient care." Prior unpublished surveys of program directors (PDs) indicate variability in approaches to provide opportunities for more independent practice during fellowship training. The aims of the study were to describe practices within PEM fellowship programs allowing fellows to work without direct supervision and to identify any barriers to independent practice in training. An anonymous electronic survey of PEM fellowship PDs was performed. Survey items were developed using an iterative modified Delphi process and pilot tested. Close-ended survey responses and demographic variables were summarized with descriptive statistics. Responses to open-ended survey items were reviewed and categorized by theme. Seventy two of 84 PDs (88%) responded to the survey; however, not all surveys were completed. Of the 68 responses to whether fellows could work without direct supervision (as defined by the Accreditation Council for Graduate Medical Education) during some part of their training, 31 (45.6%) reported that fellows did have this opportunity. In most programs, clinical independence was conditional on specific measures including the number of clinical hours completed, milestone achievement, and approval by the clinical competency committee. Reported barriers to fellow practice without direct oversight included both regulatory and economic constraints. Current training practices that provide PEM fellows with conditional clinical independence are variable. Future work should aim to determine best practices of entrustment, identify ideal transition points, and mitigate barriers to graduated responsibility.

Interprofessionelle Sozialisation und Zusammenarbeit auf einer interprofessionellen Ausbildungsstation – eine rekonstruktive Analyse

Interprofessional education has gained relevance in German-speaking countries, and interprofessional training wards (IPTW) can contribute to the acquisition of interprofessional competencies and thereby improve interprofessional collaborative practice and patient care. Professional socialization and identity development have proven to be critical for future clinical practice in addition to competency development. According to Khalili (2013) socialization through interprofessional education can result in a dual identity, i. e., a sense of belonging to one's own profession as well as to the interprofessional health care team.The aim of this study was to analyse to which extent interprofessional socialization takes place on the Interprofessional Training Ward in Heidelberg (HIPSTA) and how medical students in their practical year and nursing trainees in their third year of training experience their placement there.For this purpose, five semi-structured group discussions were conducted with undergraduates at the end of their placement on HIPSTA and analysed using the documentary method. Typification resulted in two types that differ with regard to interprofessional socialization. The type interprofessional responsiblepersons is characterized by the joint assumption of responsibility for patient care, open communication with each other and joint structuring of collaboration, which contributed to a removal of barriers and interprofessional role learning; the type interprofessional learners is characterized by their focus on learning processes and their anticipation of barriers between the professional groups, which would be relevant for future collaboration. All groups experienced a sense of belonging to their peer-student/learner group, regardless of their different professional background. Their professional identity underwent further development. These results show that placement on an IPTW does not warrant interprofessional socialization processes and the development of a dual identity. However, it can be a first step in the right direction.

337 Are Surgical Trainees Reviewing Their Post-Operative Patients in Cardiothoracic Surgery?

Abstract Aim Operating surgeons should review their post-operative patients regularly. They are responsible for decision-making on further management and planning discharge. Trainee surgeons who have operated should be reviewing their patients and encouraged to make independent decisions to develop their clinical judgement and responsibility for patient care. There are no specific guidelines on the number of recommended reviews in the post-operative patient Method 40 patients taken from cardiothoracic operating lists. Patients selected where the documented 1st operator was not a consultant. This was done using operative notes recorded on Infoflex. Operation date, type of operation, total days as inpatient, discharge date and number of days reviewed by the 1st operator were recorded. The results were presented to both consultants and registrars locally and an open discussion was held to make improvements. The audit was repeated 6 months later. Results Average inpatient stay post-operatively was comparable: 6.4 vs 6.9 days. There was a significant increase: 2.7 vs 0.6 days of average reviews by the lead operator. 9% to 39% increase. In phase 1, only 42% of patients were reviewed at all by the lead operator. In phase 2, this increased to 100%. Conclusions Open discussion and joint planning between consultants and registrars has led to an improvement in surgical trainee engagement in post-operative management. There is still scope for further improvement on documentation and communication with the on-call consultant. On multiple occasions the patients were reviewed but this was not documented or communicated with the consultant.

Standard Competencies in Ambulatory Care: An Urgent Need.

The ambulatory setting presents unique challenges for leadership and staff transitioning from other care areas, such as the inpatient environment. Nurses and support staff newly entering the world of ambulatory care may experience challenges acclimating to their new roles as they shift from an environment that provides focused care to achieve a safe discharge to one that focuses on holistic prevention and treatment over long periods. Inpatient hospital care relies on many protocols, orders, and guidelines and a multidisciplinary team of physicians, pharmacists, dieticians, and rehabilitation support to progress the patient through their illness or injury during their hospital admission. Nurses in ambulatory care have increased responsibility and autonomy in patient care. New challenges are encountered, for example, transportation to appointments, socioeconomic challenges, immediate resource needs, and patient support for future success in their own environment. In these situations, the ambulatory nurse is an immediate caregiver and a case manager, providing direct patient care for a short period, but following up over a longer period, in some cases, years. [J Contin Educ Nurs. 2022;53(2):59-62.].

Experiences of Black and Latinx health care workers in support roles during the COVID-19 pandemic: A qualitative study.

Black and Latinx individuals, and in particular women, comprise an essential health care workforce often serving in support roles such as nursing assistants and dietary service staff. Compared to physicians and nurses, they are underpaid and potentially undervalued, yet play a critical role in health systems. This study examined the impact of the coronavirus disease 2019 (COVID-19) pandemic from the perspective of Black and Latinx health care workers in support roles (referred to here as HCWs). From December 2020 to February 2021, we conducted 2 group interviews (n = 9, 1 group in English and 1 group in Spanish language) and 8 individual interviews (1 in Spanish and 7 in English) with HCWs. Participants were members of a high-risk workforce as well as of communities that suffered disproportionately during the pandemic. Overall, they described disruptive changes in responsibilities and roles at work. These disruptions were intensified by the constant fear of contracting COVID-19 themselves and infecting their family members. HCWs with direct patient care responsibilities reported reduced opportunities for personal connection with patients. Perspectives on vaccines reportedly changed over time, and were influenced by peers' vaccination and information from trusted sources. The pandemic has exposed the stress endured by an essential workforce that plays a critical role in healthcare. As such, healthcare systems need to dedicate resources to improve the work conditions for this marginalized workforce including offering resources that support resilience. Overall working conditions and, wages must be largely improved to ensure their wellbeing and retain them in their roles to manage the next public health emergency. The role of HCWs serving as ambassadors to provide accurate information on COVID-19 and vaccination among their coworkers and communities also warrants further study.

Insights into Diagnostic Radiography students’ perception of clinical stressors

IntroductionClinical placements are integral components of Diagnostic Radiography (DR) university training programs, providing students with necessary and unique learning experiences. Educators' understanding of the student experience on placement is growing, and it is important for educators to be attentive to students' reactions to their learning environments and to situations identified to reduce wellbeing. This study aimed to explore DR students’ perceptions of challenges experienced during clinical placements and their use of coping strategies. MethodsFinal year DR Students at the University of Sydney, were invited to participate in an online focus group. Three focus groups were conducted with a total of 13 participants. Participants were asked to narrate situations experienced while on clinical placement that reduced their emotional wellbeing, and coping strategies considered to support emotional wellbeing. An inductive thematic analysis of focus group transcripts was undertaken to identify the main discussion themes. ResultsThree themes were identified regarding situations considered to reduce emotional wellbeing: adapting to the ‘reality’ of the clinical environment, forming effective relationships, and balancing student role expectations and responsibilities of patient care. Three themes were identified about coping strategies for emotionally challenging situations: support from clinical and academic staff, peer support and personal strategies, and growing knowledge and confidence over time. ConclusionStudents’ emotional wellbeing during experiential learning experiences is an underappreciated factor in their transformations into competent diagnostic radiographers. Academic training programs are therefore encouraged to be sensitive to the wellbeing of their trainees, and to take deliberate steps to equip students with the skills to navigate emotions and to normalise emotional responses that may be experienced in the clinical setting. Implications for practiceStudents' experience of challenges in the clinical environment is largely influenced by students' abilities to deal with negative experiences, hence students’ concerns require implementation of focused interventions prior to first clinical placement.