Senior Hospital Doctors Research Articles

Changes in weekly working hours, proportion of doctors with hours above the limitations of European Working Time Directive (EWTD) and time spent on direct patient care for doctors in Norway from 2016 to 2019: a study based on repeated surveys

ObjectivesTo compare the total weekly working hours, proportions with work hours above the limitations of European working time directive (EWTD) and time spent on direct patient care in 2016 and...

Leadership identity construction in a hybrid medical context: ‘Claimed’ but not ‘granted’

In the United Kingdom National Health Service (NHS), the growing number of hybrid clinical leaders has given rise to professional practice and identity struggles. Co-construction theories of leadership point to a need for leaders to engage in significant ‘identity work’ to construct themselves as leaders and to make legitimate claims for a leadership identity to potential followers. Our research aimed to contribute to the leader-follower literature by examining how medical leaders deal with professional identity struggles and changes to traditional work identities. We draw on data from a study of senior hospital doctors (consultant-level doctors from a variety of medical specialties in Health Boards in NHS Scotland). Our findings suggest that most senior hospital doctors in our study struggle to grant leadership identities to their medical leaders who claim such leadership identities, although they seek to see more doctors engaging in leadership. This article contributes to extant research on the influence of medical leadership roles on leader-follower identity construction.

Understanding online dual practice of public hospital doctors in China: a mixed-methods study

Telemedicine and telehealth hold promise for reducing access barriers, improving quality and containing medical costs. As Internet companies enter the healthcare market, a rising number of online healthcare platforms have emerged worldwide. In some countries like China, public hospital doctors are providing direct-to-consumer telemedicine services on these commercial platforms as independent providers. Such online service provision creates a new form of dual practice, which we refer to as 'online dual practice' in this study. Using a mixed-methods design, this study aims to investigate the prevalence of online dual practice, doctors' time allocation and motivations for engaging in it and its potential impacts on the health system in China. We use the web-crawled data from four leading online health platforms to examine the prevalence of online dual practice in China. Then we conduct in-depth interviews with 38 active doctors on these platforms to investigate their time allocation, motivations and perception regarding online service provision. We find that the nationwide prevalence of online dual practice in China reaches at least 16.5% in 2020 and that it is more common among senior public hospital doctors. Public hospital doctors mainly use small pockets of time during working hours and after-hours to render services on the platforms The five most commonly cited motivations for their engagement in online dual practice are efficiency improvement, personal control, career development, financial rewards and serving the patients. Interviewed doctors believe that their online service provision is conducive to increasing healthcare access and improving efficiency, but some also express their concerns about the quality of care. Further analysis shows that the impact of online dual practice on health system performance remains an open question and regulatory policies on it should be health-system specific.

Factors affecting consultant attitudes to undertaking undergraduate medical student teaching in the UK: a systematic review

ObjectiveThis systematic review aimed to explore consultant attitudes towards teaching undergraduate medical students in the UK.DesignSystematic review.MethodologyStandard systematic review methodology was followed. MEDLINE, EMBASE and OpenGrey were searched from inception...

Artificial intelligence-assisted cytology for detection of cervical intraepithelial neoplasia or invasive cancer: A multicenter, clinical-based, observational study

ObjectiveArtificial intelligence (AI) could automatedly detect abnormalities in digital cytological images, however, the effect in cervical cancer screening is inconclusive. We aim to evaluate the performance of AI-assisted cytology for the detection of histologically cervical intraepithelial lesions (CIN) or cancer. MethodsWe trained a supervised deep learning algorithm based on 188,542 digital cytological images. Between Mar 13, 2017, and Oct 20, 2018, 2145 referral women from organized screening were enrolled in a multicenter, clinical-based, observational study. Cervical specimen was sampled to generate two liquid-based slides: one random slide was allocated to AI-assisted reading, and the other to manual reading conducted by skilled cytologists from senior hospital and cytology doctors from primary hospitals. HPV testing and colposcopy-directed biopsy was performed, and histological result was regarded as reference. We calculated the relative sensitivity and relative specificity of AI-assisted reading compared to manual reading for CIN2+. This trial was registered, number ChiCTR2000034131. ResultsIn the referral population, AI-assisted reading detected 92.6% of CIN 2 and 96.1% of CIN 3+, significantly higher than or similar to manual reading. AI-assisted reading had equivalent sensitivity (relative sensitivity 1.01, 95%CI, 0.97–1.05) and higher specificity (relative specificity 1.26, 1.20–1.32) compared to skilled cytologists; whereas higher sensitivity (1.12, 1.05–1.20) and specificity (1.36, 1.25–1.48) compared to cytology doctors. In HPV-positive women, AI-assisted reading improved specificity for CIN1 or less at no expense of reduction of sensitivity compared to manual reading. ConclusionsAI-assisted cytology may contribute to the primary cytology screening or triage. Further studies are needed in general population.

A cross-sectional audit of the risk of burnout among senior medical staff in a UK district general hospital

The objective was to assess burnout in senior hospital doctors (consultants and staff grade, associate specialist and specialty (SAS) doctors) within a UK-based NHS district general hospital (DGH). A web-based survey was created using the validated abbreviated Maslach Burnout Inventory (aMBI) with consultants and SAS doctors in a DGH. We measured scores on aMBI subscales: depersonalisation, emotional exhaustion, personal accomplishment and efficacy. One-hundred and seventy-eight senior clinicians (60% of consultant and SAS doctors) completed the survey with 85% of these being substantive consultants. Forty-nine per cent of senior clinicians were found to be at high risk of burnout using metrics from the aMBI. Burnout is prevalent among senior clinicians at this DGH.

Does regulation increase the rate at which doctors leave practice? Analysis of routine hospital data in the English NHS following the introduction of medical revalidation

BackgroundIn 2012, the UK introduced medical revalidation, whereby to retain their licence all doctors are required to show periodically that they are up to date and fit to practise medicine. Early reports suggested that some doctors found the process overly onerous and chose to leave practice. This study investigates the effect of medical revalidation on the rate at which consultants (senior hospital doctors) leave NHS practice, and assesses any differences between the performance of consultants who left or remained in practice before and after the introduction of revalidation.MethodsWe used a retrospective cohort of administrative data from the Hospital Episode Statistics database on all consultants who were working in English NHS hospitals between April 2008 and March 2009 (n = 19,334), followed to March 2015. Proportional hazard models were used to identify the effect of medical revalidation on the time to exit from the NHS workforce, as implied by ceasing NHS clinical activity. The main exposure variable was consultants’ time-varying revalidation status, which differentiates between periods when consultants were (a) not subject to revalidation—before the policy was introduced, (b) awaiting a revalidation recommendation and (c) had received a positive recommendation to be revalidated. Difference-in-differences analysis was used to compare the performance of those who left practice with those who remained in practice before and after the introduction of revalidation, as proxied by case-mix-adjusted 30-day mortality rates.ResultsAfter 2012, consultants who had not yet revalidated were at an increased hazard of ceasing NHS clinical practice (HR 2.33, 95% CI 2.12 to 2.57) compared with pre-policy levels. This higher risk remained after a positive recommendation (HR 1.85, 95% CI 1.65 to 2.06) but was statistically significantly reduced (p < 0.001). We found no statistically significant differences in mortality rates between those consultants who ceased practice and those who remained, after adjustment for multiple testing.ConclusionRevalidation appears to have led to greater numbers of doctors ceasing clinical practice, over and above other contemporaneous influences. Those ceasing clinical practice do not appear to have provided lower quality care, as approximated by mortality rates, when compared with those remaining in practice.

What should be in hospital doctors' continuing professional development?

To ask those most affected by continuing professional development for senior doctors - patients, other professional groups and doctors themselves - what it needs to encompass. The nominal group technique. Six groups of between seven and nine members (n = 49). Separate groups were held for nurses and therapists (n = 9), patient representatives (n = 8), medical directors (n = 8), consultants (n = 8) and medical trainees (n = 7). An additional group consisted of 'Darzi Fellows' (n = 9), trainee doctors who were undertaking a leadership fellowship. Groups were held at the Royal Society of Medicine in London. Priorities for the content of continuing professional development for senior hospital doctors, ranked in order of importance. Themes derived from analysis of group discussions. We present the ranked priorities of different groups for what should be included in continuing professional development for senior hospital doctors. Analysis of group discussions identified the following three themes: developing and supporting the system of care; changes in the way medicine is practised; and personal wellbeing and caring for colleagues. The implication of our findings for providers of continuing professional development is to consider the balance of content. Doctors and other healthcare professionals need to keep up with scientific advances and technical developments. But in addition, they need to be adept at working with the system changes required for translation of research into practice, the development of new ways of working, and for the organisational changes that underpin continual quality and safety improvement.

Perceived bullying among Norwegian doctors in 1993, 2004 and 2014–2015: a study based on cross-sectional and repeated surveys

ObjectivesTo examine 12-month prevalence of perceived bullying at work for doctors in different job categories and medical disciplines in 1993, 2004 and 2014–2015, and personality traits, work-related and health-related factors...

Eroding ‘Respectability’: Deprofessionalization Through Organizational Spaces

This article addresses the question – can a deterioration in organizational spaces erode a profession’s status? It draws on the organizational spaces literature to analyse the relationship between design of the physical work setting and senior doctors’ experiences of deprofessionalization. Analysis of qualitative data from a study of senior hospital doctors identifies two main themes that link the experience of spaces with perceptions of the erosion of professional status and reduced knowledge sharing. These two themes are: emplacement, which is the application of coercive power both in and through spatial arrangements; and isolation, which refers to physical alienation in the workplace leading to disconnection and a perceived loss of power. Observing the changes in the physical environment over time and mapping them against these processes of deprofessionalization offers interesting new insights into the sociology of professions.

Adequacy of postgraduate medical training: views of different generations of UK-trained doctors

BackgroundOver the last decade, many changes have taken place in the UK, which have affected the training that doctors receive.AimTo assess doctors’ views on quality and adequacy of postgraduate training.MethodsQuestionnaires...

The Iron Cage and the Gaze: Interpreting Medical Control in the English Health System

This paper seeks to determine the value of theoretical ideal-types of medical control. Whilst ideal types (such as the iron cage and gaze) need revision in their application to medical settings, they remain useful in describing and explaining patterns of control and autonomy in the medical profession. The apparent transition from the cage to the gaze has often been over-stated since both types are found in many contemporary health reforms. Indeed, forms of neo-bureaucracy have emerged alongside surveillance of the gaze. These types are contextualised and elaborated in terms of two empirical examples: the management of medical performance and financial incentives for senior hospital doctors in England. Findings point towards the reformulation of medical control, an on-going re-stratification of the medical profession, and the internalisation of managerial discourses. The cumulative effect involves the medical profession’s ability to re-cast and enhance its position (vis-à-vis managerial interests).&#x0D; Keywords: medical profession, medical control, iron cage, gaze

Weekly working hours for Norwegian hospital doctors since 1994 with special attention to postgraduate training, work–home balance and the European Working Time Directive: a panel study

ObjectivesTo examine the weekly working hours of Norwegian hospital doctors from 1994 to 2012 with special emphasis on the quality of postgraduate training and work–home balance, and in relation to...

The Effectiveness of the Summary of Product Characteristics (SmPC) and Recommendations for Improvement.

One of the roles of the Summary of Product Characteristics (SmPC) is to provide information for health professionals. The objective of this work was to understand the effectiveness of the SmPC document in communicating essential information to prescribers. The process of user testing, widely used to test information for patients, was applied. First, 30 general practitioners were involved in the testing of the SmPC for Lariam, an antimalarial drug. As user testing is an iterative process, 15 points of information in the original SmPC were tested in 3 rounds of 10 participants. The document was revised between rounds according to the results; good practice in information writing and design was used. Next, the SmPC for CellCept, an immunosuppressant, was tested in 20 senior hospital doctors. Again, the document was revised between rounds, according to the results, with revisions also taking account of findings from the Lariam testing related to the general structure of SmPCs. Of the 15 points of information tested, for the original Lariam SmPC, 6 points of information met the target of 90% to find, and 90% of those to understand, whereas for the final version of the CellCept SmPC, 11 points of information met this target. Qualitative comments showed that in their current format, SmPCs are of low perceived value to prescribers and are not central to the clinicians' prescribing behavior. Current content and presentation of SmPCs, while meeting regulatory approval standards, contribute little to the safe and effective use of medication in practice. Key recommendations include revising and simplifying the heading structure and making the headings more visible, adding a "Key Information" summary at the start, using simpler language, and adding bullet points for listings.

Gendered forms of othering in UK hospital medicine

PurposeAttempts to modernise the National Health Service (NHS) in the UK involve promoting flexible approaches to work and training, restructuring postgraduate training and increasing control and scrutiny of doctors' work. However, the medical community has responded with expressed anxiety about the implications of these changes for medical professionalism and the quality of patient care. This paper aims to address these issues.Design/methodology/approachDrawing on literature on nostalgia, gender, identity and organisations, the paper explores the narratives of 20 senior NHS hospital doctors to identify ways in which doctors use nostalgia to react to organisational and professional challenges and resist modernisation and feminisation of medicine.FindingsThis paper illustrates how senior hospital doctors' nostalgic discourses of temporal commitment may be used to constitute a highly esteemed professional identity, creating a sense of personal and occupational uniqueness for senior hospital doctors, intertwined with gendered forms of othering and exclusionary practices.Practical implicationsNostalgia at first sight appears to be an innocuous social construct. However, this study illustrates the significance of nostalgia as a subversive practice of resistance with implications for women's career and identity experiences. Change initiatives that seek to tackle resistance need also to address discourses of nostalgia in the medical profession.Originality/valueThe main contribution of this study is that we illustrate how supposedly neutral discourses of nostalgia may sometimes be mobilised as devices of resistance. This study questions simplistic focus on numerical representation, such as feminisation, as indicative of modernisation and highlights the significance of exploring discourses and head counts for understanding resistance to modernisation.

Mentoring and the meaning of soul

I have just received my copy of JRSM and as usual anticipated your editorial1 which is usually stimulating and thought‐provoking. This one was no exception, but I was particularly struck by your statement that ‘The medical profession has developed a siege mentality, attacked by government, betrayed by its trade union …’.1 By this latter remark I must presume you are referring to the BMA. I agree with you. But as President of the Hospital Consultants and Specialists Association I would not want your readers to tarnish all Health Unions with your same brush. There is no ‘one’ trade union representing doctors. While the BMA may wish to speak for itself in response to your editorial, there is an alternative. The HCSA is a non‐political Trade Union, and affiliated to the TUC (which the BMA is not) and represents senior hospital doctors in their daily working lives and wider professional interests. It would be wrong to imply that Unions generally stand accused of betraying the profession. If you look at recent history you will find that we did not support the dreadful contract that most senior staff now work to, and which has done so much damage to the profession and its relationship with its patients. We advanced then, and continue to believe in, the concept of a professional contract that is work, not time, sensitive and which recognizes individual contributions doctors make. We stood alongside our junior colleagues when they marched in protest at the MMC debacle; we supported and subsidized Remedy UK when others failed to do so. We listen to the members we serve. Yes, the profession is justified in feeling betrayed. But the profession needs to think carefully not just how this came about but what to do about it.

Familiarity breeds discontent: Senior hospital doctors’ attitudes towards complementary/alternative medicine

Studies have shown that many general medical practitioners refer their patients to complementary/alternative medicine (CAM) practitioners and believe in the therapeutic benefit of these modalities. However, there is less information concerning the beliefs and practices of senior hospital doctors. In view of the increasing institutionalization of CAM and moves to incorporate CAM into secondary and tertiary healthcare settings, the objective of this study is to understand the attitudes and practices of senior hospital doctors, a sector whose members are often responsible for formulating and implementing institutional policy. A questionnaire was administered to 294 directors of hospital departments and their deputies on their attitudes and practices concerning CAM. Response rate was 70%. Almost all general hospitals in Israel participated in the study. The findings show, in general, that while senior hospital physicians in Israel hold positive attitudes towards CAM, they are not well disposed towards co-operation with CAM practitioners. Incorporating a CAM clinic into the hospital site does not seem to enhance clinical co-operation between conventional physicians and CAM practitioners. In hospitals that had functioning CAM clinics, doctors were consistently and significantly more opposed to co-operation with CAM than in hospitals without CAM clinics.

Breaking bad news: consultants' experience, previous education and views on educational format and timing

Breaking bad news is a difficult task for health professionals. Senior hospital doctors acknowledge the importance of breaking bad news well, but previous surveys have found them to be sceptical of formal training and disinclined to seek courses in this area. We sought to ascertain if this view was still held. A postal questionnaire was sent to 285 consultants across 3 acute hospital trusts in the Midlands, UK. Questions included items on the frequency and types of breaking bad news situations encountered, and the timing and modality of previous training. Open comment on what forms of education would be useful, and when, was requested. Eleven consultants were no longer in post. Of the remainder, 173/274 (63%) replied; 153 (56%) returned questionnaires of which 150 (55%) were useable. Respondents represented 32/33 (97%) of the surveyed specialties. The majority reported breaking bad news frequently (> 1-2 times weekly); however, almost half (49%) had received no formal training in this specific area, although 53% described having received experiential training in either clinical, training or management contexts. Of 118 respondents who commented, only 5 believed no form of training was useful, whereas 47 specifically recommended some form of role play. Regarding timing, 72 thought it desirable at postgraduate level or at all stages of training, with 44 explicitly stating at consultant level. Consultants in clinical specialties break bad news frequently. Although many have not received formal training, the majority believe it is useful and are increasingly willing to undertake experiential approaches. This augurs well for future training programmes.

Validation of the PHEEM instrument in a Danish hospital setting

The Postgraduate Hospital Educational Environment Measure (PHEEM) has been translated into Danish and then validated with good internal consistency by 342 Danish junior and senior hospital doctors. Four of the 40 items are culturally dependent in the Danish hospital setting. Factor analysis demonstrated that seven items are interconnected. This information can be used to shorten the instrument by perhaps another three items.

The suspensions scandal

The process by which senior hospital doctors are disciplined within the National Health Service is analysed. The mechanisms used are discussed and a number of faults are identified. Many of these faults give an unfair advantage to management and are contrary to the rules of 'Natural Justice'. These faults lead to an excessive number of doctors being wrongfully suspended for an unnecessarily long period. The process is oppressive to doctors as well as being contrary to the Human Rights Act. A number of risk factors are identified; race, sex, speciality and obstetricians appear to be particularly vulnerable. The process causes significant morbidity as well as having a 2% mortality. The process is also remarkably inefficient with management, despite all the inbuilt advantages, unable to prove that the suspended doctor is at fault in the majority of cases. It is also very wasteful of the NHS's financial resources.