Bc Winder

The causal links between stress and burnout in a longitudinal study of UK doctors.

Burnout and stress are common, linked problems in health-care workers. We aimed to clarify their causal associations. We assessed stress and the three components of burnout (emotional exhaustion, depersonalisation, and low personal accomplishment) using structural equation modelling in a 3-year longitudinal study of a representative sample of 331 UK doctors. Emotional exhaustion and stress showed reciprocal causation: high levels of emotional exhaustion caused stress (beta=0 189), and high levels of stress caused emotional exhaustion (beta=0 175). High levels of personal accomplishment increased stress levels (beta=0 080), whereas depersonalisation lowered stress levels (beta=-0 105).

The shortened Study Process Questionnaire: An investigation of its structure and longitudinal stability using confirmatory factor analysis

BACKGROUND The Study Process Questionnaire (SPQ) is a widely used measure of learning approach and was proposed to have three orientations: surface, deep, and achieving, each with an underlying motive and strategy. AIMS This study aimed to examine the factor structure and longitudinal stability over five to seven years of a modified shortened 18-item version of the SPQ. SAMPLES A total of 1349 medical students completed the shortened SPQ at application and in their final year of medical school. Three additional cohorts of students completed the shortened SPQ during their third and fourth year of medical school (sample size: 194, 203, 174). METHOD Confirmatory factor analysis was used to examine the dimensionality and longitudinal stability of the shortened SPQ. RESULTS Like the full 42-item version, the shortened SPQ has six subscales and the data are best fit by three second order shared indicator factors (surface, deep and achieving) and a single higher order composite deep-achieving factor. The longitudinal analysis found 26.8%, 26.3%, and 18.7% of the non-attenuated variance of the surface, deep and achieving factor scores in the final year is predicted from the shortened SPQ completed at application to medical school. CONCLUSIONS The shortened 18-item SPQ has the same six subscales as the full SPQ as well as three second order shared indicator factors (surface, deep, achieving) and one higher order deep-achieving factor similar to that suggested by Biggs (1987). The longitudinal analysis supports this hypothesis and suggests that these learning approaches are partly stable during medical school undergraduate training and partly modifiable under the influence of the educational environment.

Intercalated degrees, learning styles, and career preferences: prospective longitudinal study of UK medical students

Abstract Objectives: To assess the effects of taking an intercalated degree (BSc) on the study habits and learning styles of medical students and on their interest in a career in medical research Design: Longitudinal questionnaire study of medical students at application to medical school and in their final year. Setting: All UK medical schools Participants: 6901 medical school applicants for admission in 1991 were studied in the autumn of 1990. 3333 entered medical school in 1991 or 1992 and 2695 who were due to qualify in 1996 or 1997 were studied 3 months before the end of their clinical course. Response rates were 92% for applicants and 56% for final year students. Main outcome measures: Study habits (surface, deep, and strategic learning style) and interest in different medical careers, including medical research. Identical questions were used at time of application and in final year. Results: Students who had taken an intercalated degree had higher deep and strategic learning scores than at application to medical school Those with highest degree classes had higher strategic and deep learning scores and lower surface learning scores. Students taking intercalated degrees showed greater interest in careers in medical research and laboratory medicine and less interest in general practice than their peers. The effects of the course on interest in medical research and learning styles were independent. The effect of the intercalated degree was greatest in schools where relatively few students took intercalated degrees. Conclusions: Intercalated degrees result in a greater interest in research careers and higher deep and strategic learning scores. However, the effects are much reduced in schools where most students intercalate a degree Introduction of intercalated degrees for all medical students without sufficient resources may not therefore achieve its expected effects. Key messages Although intercalated degrees are well established, little is known about their effect on medical students In this longitudinal study final year students who had taken intercalated degree were more interested in medical research, and had higher deep and strategic learning style scores than other students The effects of the intercalated degree were dose dependent, being greatest in those gaining a first class degree The effects of the intercalated degree were greatest in medical schools where a relatively small proportion of medical students took the degree Differences between medical schools are most easily explained by resource dilution

Stressful incidents, stress and coping strategies in the pre-registration house officer year.

Previous studies have drawn attention to the stresses experienced by doctors in their first year.

Clinical experience of UK medical students

Sir—I C McManus and colleagues (March 14, p 802) argue for a decline in medical training in the UK, based on a trend of decreasing exposure of medical students to medical conditions, surgical operations, and practical procedures. I will not comment on the surgical cases or the procedures, but wonder whether the downward trend they show with regard to “acute medicine” would apply if the medical conditions were more appropriate to what we actually see referred to a tertiary care hospital. I would argue the category of acute medical conditions should include ventricular failure, exacerbation of chronic obstructive airway disease, pneumothorax, status asthmaticus, drug overdose, central chest pain, altered mental state, syncopal attack, stroke, acute gastrointestinal bleed, unilateral swollen leg, acute oliguria, acute arthritis, and complications of drug addiction. The spectrum of medical disease is changing. Can one expect an average medical student to see meningitis, diabetic ketoacidosis, hypothermia, subarachnoid haemorrhage, and acute glaucoma these days? I think not. Possibly, the goal posts should be changed before we use the data provided by McManus and co-workers to argue for a decline in medical training in the UK.

The relationship between pre-registration house officers and their consultants

Previous studies have drawn attention to the importance of the trainee/trainer relationship in determining job satisfaction and motivation to learn.

Duties of a doctor: UK doctors and Good Medical Practice

Objective—To assess the responses of UK doctors to the General Medical Councils (GMC) Good Medical Practice and the Duties of a Doctor, and to the GMCs performance procedures for which they provide the professional underpinning. Design—Questionnaire study of a representative sample of UK doctors. Subjects—794 UK doctors, stratified by year of qualification, sex, place of qualification (UK v non-UK), and type of practice (hospital v general practice) of whom 591/759 (78%) replied to the questionnaire (35 undelivered). Main outcome measures—A specially written questionnaire asking about awareness of Good Medical Practice, agreement with Duties of a Doctor, amount heard about the performance procedures, changes in own practice, awareness of cases perhaps requiring performance procedures, and attitudes to the performance procedures. Background measures of stress (General Health Questionnaire, GHQ-12), burnout, responses to uncertainty, and social desirability. Results—Most doctors were aware of Good Medical Practice, had heard the performance procedures being discussed or had received information about them, and agreed with the stated duties of a doctor, although some items to do with doctor-patient communication and attitudes were more controversial. Nearly half of the doctors had made or were contemplating some change in their practice because of the performance procedures; a third of doctors had come across a case in the previous two years in their own professional practice that they thought might merit the performance procedures. Attitudes towards the performance procedures were variable. On the positive side, 60% or more of doctors saw them as reassuring the general public, making it necessary for doctors to report deficient performance in their colleagues, did not think they would impair morale, were not principally window dressing, and were not only appropriate for problems of technical competence. On the negative side, 60% or more of doctors thought the performance procedures were not well understood by most doctors, were a reason for more defensive practice, and could not be used for problems of attitude. Few differences were found among older and younger doctors, hospital doctors, or general practitioners, or UK and non-UK graduates, although some differences were present. Conclusions—Most doctors working in the UK are aware of Good Medical Practice and the performance procedures, and are in broad sympathy with Duties of a Doctor. Many attitudes expressed by doctors are not positive, however, and provide areas where the GMC in particular may wish to encourage further discussion and awareness. The present results provide a good baseline for assessing change as the performance procedures become active and cases come before the GMC over the next few years. (Quality in Health Care 2000;9:14–22)

Are UK doctors particularly stressed

Doctors are thought to have higher levels of stress than the general population. However, in a survey of a nationally representative sample of UK doctors, we found that stress levels were equivalent to those in the general population; previous findings may have been biased by inappropriate use of the general health questionnaire.

How consultants, hospitals, trusts and deaneries affect pre‐registration house officer posts: a multilevel model

To examine variation in reported quality and working conditions of pre‐registration house officer (PRHO) posts. To use multilevel modelling to determine how much of the variation was due to the effects of consultant firms, hospitals, trusts and deaneries, as well as variation at the level of the individual doctor.

UK doctors' attitudes to the General Medical Council's Performance Procedures, 1997-99.

The UK General Medical Council’s Performance Procedures were introduced in 1997. This study aimed to assess the changing knowledge and attitudes about the procedures in British doctors at the time of their introduction and in the following 2 years.