Автор неизвестен - Mededworld and amee 2013 conference connect - страница 12

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ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015

Michelle Lam (University of Toronto, Department of Family & Community Medicine, Toronto, Canada) Sobia Khan (St. Michael's Hospital, Toronto, Canada) Maria Mylopoulos (University of Toronto, Department of Pediatrics, Toronto)

Background: Residents face numerous work-related challenges that lead to increased stress. Social networks can support residents, but little is known about the impact of residency on personal relationships. This study explores residents' experiences and perceptions of their relationships with friends, family, and significant others. Summary of work: Using a grounded theory approach, semi-structured interviews were conducted with a purposive sample of 13 residents at the University of Toronto. Emergent themes were identified through a process of constant comparative analysis. Summary of results: Residents described residency structure (e.g. demanding call schedule) as the prime influence on their life's normalcy. This "new" norm was a mechanism through which relationship quality (e.g. personality changes) and social obligations (e.g. attending events/milestones) were mostly negatively impacted. However, the limited personal time available meant that residents increasingly valued their social interactions (i.e. "seizing the moment"). Residents explained that relationships were strengthened when others could empathize with their situation, and were weakened in the absence of empathy. Resultantly, residents' social circles were dominated by those who were also in the medical profession or in professions that had similarly demanding schedules. Conclusions: Residency disrupts work-life balance in a manner that mostly negatively affects residents' ability to establish and maintain personal relationships. Social obligations often fail to be met, and residents generally believe that relationship quality suffers. Take-home messages: It is important to consider the implications of residency on personal relationships as an overall strategy to improve health and wellness, which includes helping residents manage these potential consequences.

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Sleep quality among first-year internal medicine residents

Kanokwan Boonyapisit (Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Internal Medicine, 2 Prannok Road, Bangkok Noi, Bangkok 10700, Thailand)

Nitipatana Chierakul (Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Internal Medicine, Bangkok, Thailand)

Background: Regulation of maximum hours of work per week and duty period for in-training physicians has not been established in Thailand. We aim to describe the sleep hygiene, perception of reduced sleep hours, and daytime function of internal medicine residents during the first year of training.

Summary of work: Self-administered questionnaires were distributed to first-year internal medicine residents at the time of orientation before training for baseline data, then at 6 and 12 months after training. Summary of results: Among 56 participants, the mean age was 26 ± 1 years, and 30 participants were female. Average sleep hours was significantly decreased from 7.0 hr at M0 to 6.0 hr at M6 and 6.1 hr at M12 (p < 0.001). The Epworth Sleepiness Scale (ESS) was significantly increased after being the trainee (5.7/24 at M0, 8.6 at M6, and 8.0 at M12 (p < 0.001). Perception of reduced sleep hours did not changed significantly after training (42.9/65 at M0, 43.5 at M6, and 43.0 at M12 (p > 0.46). Daytime function in term of fatigue, irritability, depressed mood, impaired memory, poor concentration, and decreased learning ability were significantly increased at M6 and remained stable at M12, except for the further increment of irritability and impaired memory (p < 0.05).

Conclusions: Internal medicine residency training greatly influences the sleep quality of physicians. Sleep loss may be one factor of the stressful environment, which leads to their self-reported impairment of daytime function. Take-home messages: Preparedness for sleep loss and its consequences should be cautioned in those considering internal medicine training.

2AA/9

Time spent in educational activities increases residents' quality of life

GA Deshpande (St. Luke's International Hospital/St. Luke's Life Science Center, Center for Clinical Epidemiology, 10-1 Akashi-cho, Chuo-ku, Tokyo 104­0044, Japan)

Y Ishida (St. Luke's International Hospital/St. Luke's Life Science Center, Center for Clinical Epidemiology, Tokyo, Japan)

K Soejima (St. Luke's International Hospital/St. Luke's Life Science Center, Center for Clinical Epidemiology, Tokyo, Japan)

O Takahashi (St. Luke's International Hospital/St. Luke's Life Science Center, Center for Clinical Epidemiology, Tokyo, Japan)

JL Jacobs (National Medical University of Singapore, Office of Medical Education, Singapore, Singapore) T Fukui (St. Luke's International Hospital/St. Luke's Life Science Center, Center for Clinical Epidemiology, Tokyo, Japan)

Background: Residency reforms to date have largely focused on work hour restrictions, not only to improve patient safety, but also to improve quality of life (QOL) of trainees. Many of these data have focused on the medical work culture of the United States; little is known about factors influencing resident QOL of non-US trainees.

Summary of work: We conducted a time-motion analysis of 64 residents at three large residency programs in Japan, recording data on work allocation, sleep, patient census, stress, and QOL metrics via SF-8

ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015

data. QOL data was compared against these practice characteristics.

Summary of results: SF-8 data did not differ by institution. No relationship was found between SF-8 parameters and hours of sleep, sleepiness, or patient census. Self-reported stress was associated with lower QOL scores each for lower general health (p=0.004), physical health, and increased pain and role limitations to due emotional health (p<0.04 for all). On adjusted analysis, a stepwise association was seen between increased time spent in educational activities and increased general health and vitality (p<0.05 for both). Conclusions: For young trainee physicians in Japan, QOL does not appear to correlate with sleep or patient census. Rather, time spent in educational activities, perhaps as a better modifier of stress, may prove to be a more optimal way to promote resident QOL. Take-home messages: These results suggest that, despite the many burdens of hospital duties, residency programs should continue to bolster active clinical teaching roles for faculty educators in teaching programs.

2AA/10

The Prevalence and Impact of Sleep Disturbances in Brazilian Residents and Their Relations with Quality of Life and Burnout

Heloisa Malfatti (UNICAMP, Emergency, Rodovia Professor Zeferino Vaz KM 121, Condominio Okinawa , rua 12 numero 79, Paulinia 13141000, Brazil) Marcelo Schweller (UNICAMP, Emergency, Campinas, Brazil)

Renata Azevedo (UNICAMP, Psychiatry, Campinas, Brazil)

Luiz Roberto Lopes (UNICAMP, Surgery, Campinas, Brazil)

Marco Antonio Carvalho Filho (UNICAMP, Emergency, Campinas, Brazil)

Background: Residency is a period of hard work, challenges and intense emotional experiences. Adequate residency workload and its impact in medical practice are under debate. In Brazil, residency programs are limited to 60-hours work per week, yet the residents are allowed to work extra shifts in other institutions. Despite the concern about the excessive workload on residents' sleep, quality of life, and burnout, there are few studies performed on this subject in our country. Summary of work: Pittsburgh Sleep Quality Index(PSQI), WHOqol-BREF, and Maslach Burnout Inventory(MBI) questionnaires were applied to 112 residents of Unicamp's University Hospital in 2012. A descriptive statistical analysis was performed and the correlations between the index evaluated in the questionnaires were studied.

Summary of results: We observed that 61% of the residents had sleep disorders, 52% had pathological daytime sleepiness, and 13% took sleeping medication. There was a negative and significant correlation among sleep disturbances and WHOqol-bref quality of life for physical (r= -0.61, p<0,001), psychological (r=-0.61, p<0,001), social (r=-0.46, p<0,001) and environmental

(r=-0.39, p<0,001) dimensions. There was a positive and significant correlation between sleep disturbance and the emotional exhaustion dimension of MBI (r= 0.355 and p<0.001).

Conclusions: Sleep disturbances among medical residents were highly prevalent and associated with burnout and a lower quality of life. Take-home messages: Further studies are required to evaluate sleep disturbances during residency in Brazil and to deal with the excessive workload at this stage of medical training.

2AA/11

ACGME standards promote sleep and mitigate sleep deprivation-related fatigue

Archana Roy (Mayo Clinic Florida, Hospital Internal Medicine, 4500 San Pablo Road, Jacksonville 32224,

United States)

Julie Griffis (Mayo Clinic Florida, Education, Jacksonville,

United States)

Cheryll Albold (Mayo Clinic Florida, Education, Jacksonville, United States)

Background: Sleepiness and fatigue negatively impact physician performance, well-being and patient safety. In July 2011, the ACGME issued new standards for residents. We evaluated the effect of these standards on residents' sleep and fatigue. Summary of work: We surveyed residents in mid January and June 2012 about the number of hours of sleep required to feel rested and hours they slept on weeknights and weekend. Responses were: less than 4, 4-6, 6-7.5, 7.5- 9, or > 9 hours. Fatigue questionnaire included: how often they feared fatigue negatively impacted their work performance; never, occasionally (1 to 2 times per week) or frequently (> 3 times per week). All surveys were sent and collected electronically and responses analyzed anonymously. Summary of results: We have 115 residents and received total 78 responses (68%). Seventy of 78 (90%) felt they needed 6-9 hours of sleep to feel rested. Forty-six of 78 (59%) reported getting 6-9 hours of sleep during weeknights and 70 (90%) reported 6-9 hrs on weekends. None reported < 4 hours of sleep on weeknight or weekend. Fifty residents responded to fatigue questionnaire: Six (12%) reported Never, 36 (72%) occasionally, and 8(16%) frequently. Conclusions: Our study shows that new standards allow time for adequate sleep and rest during residency. 59% residents reported 6-9 hours of sleep during weeknights and 90% reported that amount on weekend mitigating the risk of sleep deprivation and its associated adverse effects. The cause of fatigue in majority of residents is unclear and requires further study. Take-home messages: ACGME new standards have positive impact on residents' well-being.

ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015

2AA/12

Demographic-targeted mentorship may be effective for Internal Medicine residents

Rahim Kachra (University of Calgary, Department of Medicine, 401-2011 University Drive NW, Calgary

T2N4T4, Canada)

Alison Walzak (University of Calgary, Department of Medicine, Calgary, Canada)

Aleem Bharwani (University of Calgary, Department of Medicine, Calgary, Canada)

Background: Mentorship is a key component in the development of a medical career. Benefits to the mentee have been reported in career and research productivity, job satisfaction, career preparation, and psychosocial wellbeing. However, only 50-60% of young physicians have mentors. Males, proactive individuals, those who prioritise professional commitments, and trainees who have a chosen career path are more likely to have mentors. However, it is unclear if the provision or receipt of mentorship in Internal Medicine (IM) can be better informed by demographically targeted interventions.

Summary of work: This study aims to identify baseline characteristics of IM residents entering into a formal mentorship program in order to tailor effective mentorship. Academic achievements, professional achievements, and personal development and wellness were measured quantitatively through electronic surveys. 90 resident physicians were surveyed with a 61% response rate.

Summary of results: 73% of respondents were below age thirty. When compared to older resident physicians, those below thirty were less likely to: have a plan to prepare for the certifying exam (3.03 vs. 3.93; p=0.021), feel they have access to networks to accomplish their administration goals (3.05 vs. 3.60; p=0.04), be certain that they can accomplish their goals (3.80 vs. 4.40; p=0.005), and feel like they are on a definite career path which leads somewhere (3.55 vs. 4.13; p=0.038). Conclusions: Our data identify a perceived need for specific mentorship based on residents' age. When analysed by level-of-training the result was not statistically significant, suggesting that age is independently an important factor. Take-home messages: The literature has not previously identified younger age of a medical resident, specifically, as a need area for mentorship. Further study is warranted to determine whether it may be more effective to target mentorship towards specific age groups.

2AA/13

Benchmarking mentoring of specialising doctors

Mervi Vaisanen-Tommiska (Helsinki University and Helsinki University Central Hospital, Obstetrics & Gynecology, PL 610, Helsinki 00029 HUS, Finland) Background: Mentoring specialising doctors is still often just signatures in papers. Mentoring sessions seldom take place and then outside working hours. Mentoring is

considered to be needed only when problems in competence arise.

Summary of work: Benchmarking: mentoring in Ob & Gyn Helsinki Finland and anaesthesia Turku Finland and psychiatry Vantaa Finland. By taking care of mentoring facilities you can lead change, bring tools for mentoring sessions and make a change in attitudes toward mentoring.

Summary of results: The definition of mentoring depends on specialty. Critical guidelines: (1) Guide to insightful responsibility (how to learn to make decisions). (2) Ask, do not assume. Presume nothing! In ane/psych the number of mentored is ten compared to two in Ob & Gyn. The hours in working schedule / 6months was 180-300 in ane/spych compared to one hour in Ob & Gyn. The number of mentors was two in ane/psych compared to Ob & Gyn where all the staff do mentoring. Neither in ane/psych nor in Ob & Gyn you can choose your mentor.

Conclusions: Mentoring needs still definition (What it is / is not) and appreciation (part of work load which is done during normal working hours). Contents of mentoring depends on specialty, but discussion on mentoring should be inter-specialties. Take-home messages: A good system of mentoring has a positive effect on emotional working environment and is an advantage when recruiting new staff.

2AA/14

Enhanced supervision and support for training doctors at weekends: The role of the senior nurse

Elizabeth Bonham (East Kent Hospitals University NHS Foundation Trust, Medical Education Directorate, William Harvey Hospital, Kennington Road,

Willesborough, Ashford, Kent TN24 0LZ, United

Kingdom)

Emma Bull (East Kent Hospitals University NHS

Foundation Trust, Medical Education Directorate,

Ashford, Kent, United Kingdom)

Prathibha Bandipalyam (East Kent Hospitals University

NHS Foundation Trust, Medical Education Directorate,

Ashford, Kent, United Kingdom)

Susan Kennedy (East Kent Hospitals University NHS

Foundation Trust, Medical Education Directorate,

Ashford, Kent, United Kingdom)

Background: East Kent Hospitals University NHS Foundation Trust (EKHUFT) has been piloting a new medical rota under the sponsorship of Health Education England's Better Training Better Care Project. As part of the pilot, we have addressed the need for greater support and supervision for inexperienced F1 doctors working at weekends.

Summary of work: Our objective was to include a Senior Nurse, a Medical Registrar and a Healthcare Assistant in an enhanced, multi-professional weekend team, working exclusively on the medical wards, in order to improve supervision and learning opportunities for F1 doctors as well as improve patient care. Summary of results: Data show that: (1) F1 doctors feel very supported by the Senior Nurses; they appreciate

ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015

their advice, their help in completing procedures, their willingness to give feedback. (2) F1 doctors feel that working as part of a multi-professional team means that their workload is easier, lighter, less stressful and more effective in providing timely review and management of patients. (3) Senior nurses feel the role is extremely valuable in terms of enhancing and supporting training doctor competencies and confidence. (4) There are early data trends in reducing length of stay, numbers of safe weekend discharges, patient mortality, numbers of SLEs undertaken by FP doctors. Conclusions: The creation of a multi-professional weekend team has supported the training of doctors, provided a safer training environment and better patient care.

Take-home messages: The role of the Senior Nurse in the weekend team has proved crucial in building foundation doctor confidence, in the review of patients at the weekend and in identifying and facilitating safe discharge of patients.

2AA/15

Supervisors' experiences in supporting trainees' self-regulated learning

G Sagasser (Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, UMC St Radboud, ELG117, PO Box 9101, Nijmegen 6500

HB, Netherlands)

A Kramer (Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, Nijmegen, Netherlands)

C van Weel (Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, Nijmegen, Netherlands)

C van der Vleuten (Maastricht University, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands)

Background: The importance of self-regulation is increasing in medical education, certainly in postgraduate training. In a prior study we found that GP-trainees use a short and a long loop of self-regulation. We were interested in what GP-supervisors see from GP-trainees self-regulation, how they support this, and in facilitators and barriers hereby. Summary of work: We performed a phenomenological qualitative study by interviewing 20 GP-supervisors from The Netherlands. Transcripts were analyzed using iterative ongoing discussion by the research team. Summary of results: Supervisors have explicit ideas about their role in supporting trainees' self-regulated learning. They show a variety of supporting activities like identifying learning goals, arranging learning activities and assessments. Also, supervisors draw trainees' attention to learning opportunities within the practice. Supervisors recognize both loops of self-regulation and have several ways in monitoring the quality of trainees' learning. They seem to create a holistic view on trainees professional abilities using more than the assessment tools from the training institute. Supervisors adapt their

activities to trainees' self-regulation. Also they take patient safety into account. Supervisors warrant for making appointments for discussing trainees' expectations on supervision, learning and progress. However, we also noticed differences between supervisors. Supervisors' training is facilitative for their role.

Conclusions: Supervisors have a variety of activities in supporting trainees' self-regulated learning and in monitoring trainees' professional activities. They adjust their activities to trainees' need. The workplace is recognized as an important and powerful context for self-regulated learning.

Take-home messages: Within the context of workplace based learning there are numerous possibilities to support, enrich and safeguard self-regulated learning.

2AA/16

Clinical supervision of psychiatric trainees in Hospital district of Helsinki and Uusimaa - a focus group study

Tanja Svirskis (University of Helsinki, Department of

Psychiatry, PO BOX 590,, HUS 00029, Finland)

Maija Huttunen (University of Helsinki, Department of

Behavioural Sciences, Helsinki, Finland)

Eeva Pyorala (University of Helsinki, Research and

Development Unit for Medical Education, Helsinki,

Finland)

Grigori Joffe (Helsinki University Central Hospital , Psychiatry, Helsinki, Finland)

Andrew Brittlebank (Newcastle University, Department of Psychiatry, Newcastle, United Kingdom)

Background: Clinical supervision with high quality feedback is a powerful tool to change behaviours of doctors in specialist training. However, only one third of the specialists in Finland reported to have received good quality supervision during their specialization (Aine et al. 2011). The goal of this project is to set up a faculty development program for clinical supervisors in psychiatry in the Hospital District of Helsinki and Uusimaa in order to promote competency based clinical supervision while supervising trainees (comprises five hospital areas with population of 1.5 million inhabitants).

Summary of work: A qualitative study was carried out among 1) psychiatrists (supervisors) and 2) trainees in psychiatry to study attitudes, skills, needs and satisfaction related to clinical supervision and how clinical supervision is currently being delivered. The data gathered in focus group interviews (2-5 participants per group) was analyzed using content analysis. Summary of results: Expected goals and content of supervision were unclear for both supervisors and trainees. Supervisors had no training for delivering clinical supervision, and supervision was usually understood to be the same as clinical consultation. Trainees reported to get very little feedback of their performance.

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