Search results

Handover is essential to ensure high quality care. It is also a dynamic educational opportunity for trainee doctors. In the UK, the General Medical Council's annual training survey has repeatedly highlighted handover as a major concern in the training of doctors in psychiatry. The purpose of this paper is to evaluate the handover experiences for Core Trainees (years one to three) in psychiatry in the North Western Deanery (England).

An online questionnaire focusing on current practice, safety and the educational aspects of handover was sent to all Core Trainees (years one to three) in psychiatry from the North Western Deanery in April 2013. The questionnaire had quantitative and qualitative elements and was analysed descriptively, with free text collated into themes by the authors.

The survey was completed by 77.7 per cent of trainees, and indicated a wide variety in the structure of the handover process. There were no specific safety incidents but concerns regarding the handover of medical problems and handover from peripheral hospital sites. Trainees felt that handover was an important opportunity to learn, but in practice it had limited educational value. It is important to consider the robustness of handover in the context of the types of problems handed over, multiple sites and a lack of senior involvement. There also needs consideration as to how a high quality handover can be of educational value.

This is the first report that evaluates clinical handover between Psychiatry trainee doctors in the UK which evaluates both a clinical and educational perspective.

Doctors are more likely to suffer from mental illness in comparison to the wider population. This is particularly true for junior doctors, who are at increased risk in comparison to their senior colleagues. This study aims to identify whether junior doctors in North London are comfortable discussing mental health problems with their peers and supervisors and to compare how comfortable they are discussing mental and physical health problems.

An anonymous online questionnaire was designed with demographic data, multiple-choice questions and free-text boxes. This was distributed via email to core psychiatry trainees and foundation doctors in North London. Drug- and alcohol-related disorders were excluded from our definition of mental illness in this survey, as these are reportable to the General Medical Council.

A total of 51 junior doctors responded to the survey. The respondents were significantly more likely to discuss mental health problems with their peers in comparison to their supervisors. They were also less likely to discuss mental health problems in comparison to physical health problems with their peers, supervisors or general practitioner. Qualitative analysis of the free-text comments elucidated several themes including the stigmatisation of mental health.

To the best of the authors’ knowledge, there has been no prior research in the UK comparing the attitudes of junior doctors towards physical and mental ill-health. The questionnaire highlights the continued stigma towards mental health within the medical profession. The difference in attitudes towards physical and mental ill-health has important implications for the training and well-being of junior doctors.

The purpose of this study is to explore how trainee hospital doctors led work-based projects undertaken on an accredited development programme in England.

This is a case study of a leadership programme for hospital-based specialty trainees. The programme included participants leading work-based projects which were submitted for academic accreditation. Accounts of 35 work-based projects were thematically analysed to explore how participants led their projects.

Leadership was often informal and based on a series of individual face-to-face conversations. The establishment of project teams and the use of existing communication processes were often avoided. The reasons for this approach included lack of opportunities to arrange meetings, fear of conflict in meetings and the personal preferences of the participants. The authors discuss these findings with reference to theory and evidence about conversations and informal leadership, highlighting the relevance of complexity theory.

The data are limited and drawn from the best accounts written for a specific educational context. There is therefore limited transferability to the leadership work of hospital-based specialty trainees in general. Future research into medical leadership might explore the micro practices of leadership and change, particularly in informal settings.

Leadership development programmes for trainee hospital doctors might concentrate on developing skills of conversation, particularly where there are or may be perceived power imbalances. Exploring conversations within the theory of complex responsive processes should be considered for inclusion in programmes.

This paper adds some detail to the general understanding of learning leadership in practice.

The purpose of this paper is to determine the prevalence of feedback following adverse clinical incident reporting among trainee doctors in obstetrics and gynaecology within the Northwestern Deanery of England.

An anonymous questionnaire was circulated among the Specialist Registrar trainees within the specialty attending a regional teaching session. The questionnaire was analysed.

There were 50 responses, of those 45 (90 per cent) had been involved in an adverse clinical incident; 44 had submitted an incident form related to the incident. Three had submitted incident forms without being involved in an adverse incident. Most (80 per cent) had submitted an incident form as well as a related statement. Feedback was available to 23 (51 per cent) of those involved in adverse incidents. More of the senior trainees received feedback than the junior ones. A lecture on clinical incident reporting was available to only 35(70 per cent) of the respondents on the hospital induction day at their latest clinical placement.

This study is limited to adverse clinical incident reporting among the trainees in a single specialty within one deanery in UK; hence the small numbers.

This study demonstrates the presence of awareness regarding adverse incident reporting among the trainees in a high‐risk specialty. It also shows the suboptimal rate of feedback following adverse incident reporting, which does not encourage a learning environment. It is suggested that a lecture should be dedicated to incident reporting at the junior doctors' induction day programme in every hospital.

This paper highlights the lack of adequate feedback following adverse clinical incident reporting.

This study aims to explore current attitudes among doctors working in psychiatry, with regard to their perceived role and their confidence in managing their patients’ physical health problems.

A 20-item electronic questionnaire was distributed to doctors working in psychiatry within two large UK mental health trusts in 2018. Quantitative analysis was conducted, alongside qualitative analysis of free-text comments made by participants.

Many participants perceived their physical examination skills to have deteriorated since working in psychiatry (78 per cent). Participants were questioned on which professional group should hold responsibility for managing the physical health of patients under psychiatric services. A minority felt it should be psychiatrist-led (5 per cent), followed by general practitioner (GP)-led (42 per cent) and then shared responsibility (47 per cent). The majority felt there should be more focused training on physical health in the Core (72 per cent) and Advanced (63 per cent) psychiatry training. Key themes from a framework analysis of qualitative data included potential barriers to shared care, psychiatrists’ concerns regarding their experience and confidence in managing physical health, reasons in favour of shared responsibility, ideas for training and suggestions for improving the current situation.

Psychiatric patients may engage less well with health services, yet psychiatric medication often impacts significantly on physical health. In this context, there is often a blurring of role boundaries between a psychiatrist and a GP, and there is considerable variation between individual teams. There is a consistent call for more physical health training opportunities for psychiatrists and for mental health services to more proactively promote the physical health of their patients.

This study aims to test the relationship between perceived coworker social undermining and knowledge hiding behavior among Pakistani doctors working in hospitals. This study further investigates the mediating role of employee cynicism (EC) and the moderating role of family social support between the association of family social support and knowledge hiding.

Time lagged approach was used to collect the data from 391 trainee doctors working in large hospitals in Pakistan.

The findings suggest that coworker social undermining is significantly related to EC and knowledge hiding behaviors. EC mediates the relationship between EC and knowledge hiding. Furthermore, family social support was found to play a buffer role such that the indirect effect of social undermining on knowledge hiding through cynicism was weak for those who received high family social support and vice versa.

Knowledge hiding is deleterious to effective organizational functioning. This study adds to knowledge about the relationship between coworker social undermining and knowledge hiding behavior. This research extends the existing research streams of social undermining and knowledge hiding research to one of the underrepresented South Asian context, Pakistan.

Doctors are seen as key to embedding health improvement and patient safety initiatives and there has been much international debate over how best to engage doctors in healthcare leadership and management. This paper explores the current focus on leadership development programmes for doctors through taking a comparative approach to initiatives in New Zealand and the UK. It also considers the challenges to embedding leadership development programmes at all levels of training, education and continuing professional development and highlights some of the implications arising from the two approaches.

The purpose of this paper is to discuss the potentialities of innovative accounting tools in supporting “transparency” and “resource allocation” in public hospitals, by describing the implementation of a pilot project of time-driven activity-based costing (TDABC).

An interventionist research (IR) approach has been adopted: two medical doctors, three financial controllers and three researchers were involved. Collection of data used to implement the accounting model is based on hospital databases and interviews.

The information produced may allow a higher coherence between resources and activities. TDABC may enhance transparency and support decisions toward a better organization of work and an informed allocation of resources.

Further studies are required to analyze decisions following the implementation of the TDABC model.

The accounting literature lacks case studies describing the application of TDABC in hospital settings, despite its good informative potentialities and the limited investment required to introduce TDABC. Moreover, the use of the IR approach and the involvement of medical doctors may help to get coherence between accounting data and clinical work and may support the further diffusion and development of this costing model in hospitals.

The purpose of this paper is to explore the attitudes and beliefs of doctors towards medication error reporting following 15 years of a national patient safety agenda.

This is a qualitative descriptive study utilising semi-structured interviews. A group of ten doctors of different disciplines shared their attitudes and beliefs about medication error reporting. Using thematic content analysis, findings were reflected upon those collected by the same author of a similar study 13 years before (2002).

Five key themes were identified: lack of incident feedback, non-user-friendly incident reporting systems, supportive cultures, electronic prescribing and time pressures. Despite more positive responses to the benefits of medication error reporting in 2015 compared to 2002, doctors at both times expressed a reluctance to use the hospital’s incident reporting system, labelling it time consuming and non-user-friendly. A more supportive environment, however, where error had been made was thought to exist compared to 2002. The role of the pharmacist was highlighted as critical in reducing medication error with the introduction of electronic prescribing being pivotal in 2015.

To the authors’ knowledge, this is the first study to compare doctors’ attitudes on medication errors following a period of time of increased patient safety awareness. The results suggest that error reporting today is largely more positive and organisations are more supportive than in 2002. Despite a change from paper to electronic methods, there is a continuing need to improve the efficacy of incident reporting systems and ensure an open, supportive environment for clinicians.

Patients with severe mental illness (SMI) treated with antipsychotic medication are at increased risk of metabolic side‐effects like weight gain, diabetes mellitus and dyslipidaemia. This study aims to examine the feasibility of maintaining a physical health monitoring sheet in patients' records and its impact on physical health of patients with SMI, over a period of one year.

A physical health monitoring sheet was introduced in all the patients' records on a 15‐bedded male medium secure forensic psychiatric rehabilitation unit, as a prompt to regularly monitor physical health parameters. An audit cycle was completed over a one year period. The data between baseline and re‐audit were compared.

At baseline, 80 per cent of the patients were identified as smokers, 80 per cent had increased body mass index (BMI) and 87 per cent had raised cardiovascular risk over the next ten years. Appropriate interventions were offered to address the risks. At re‐audit, the physical health monitoring sheets were up to date in 100 per cent of patients' records. The serum lipids and cardiovascular risk over the next ten years reduced over time. No significant change was noted on the parameters including BMI, central obesity, high blood pressure and smoking status.

This was a pilot study and was limited by the small sample size, male gender only and the specific nature of the ward.

There is a need for improved access to physical health care in long‐stay psychiatric settings. A more robust lifestyle modification programme is required to positively influence the physical health parameters in this cohort of patients.

Introduction of a physical health monitoring sheet in patients' records led to regular screening of cardiovascular risks and subsequent increased prescribing of hypolipidaemic agents in individuals with severe mental illness.