Dara Byrne

Interns and their smartphones: use for clinical practice

Purpose of the study Smartphone use among healthcare professionals has become widespread and will continue to grow in the coming years. Study design In October 2012, a survey was distributed to 230 interns at two of the national intern training networks in the Republic of Ireland, asking how they used smartphones to carry out their clinical work. Results It was found that out of 108 interns (47.0% response rate, 108/230), 94.4% (102/108) owned a smartphone. Of those respondents who owned a smartphone, on at least a daily basis for the purposes of work, 83.3% (85/102) made or received phone calls, 87.2% (89/102) sent or received texts, and 41.2% (42/102) sent or received emails on their smartphone. A total of 52.9% (54/102) had used their smartphone to take a work related picture. The most commonly used app was the British National Formulary. It was used daily by 30.4% (31/102) of respondents with a smartphone. The most commonly used website was Wikipedia. It was accessed at least weekly by 38.2% (39/102) of respondents with a smartphone. Conclusions Smartphones are used by the majority of interns on a daily basis in order to perform their job. As such, there is a need for guidance on how patient information can be safely secured and transmitted using smartphones, their appropriate use, and any restrictions on the use of these devices in certain clinical settings. For interns in particular, advice is needed on the credibility of medical apps and websites.

A longitudinal and multicentre study of burnout and error in Irish junior doctors

Background Junior doctors have been found to suffer from high levels of burnout. Aims To measure burnout in a population of junior doctors in Ireland and identify if: levels of burnout are similar to US medical residents; there is a change in the pattern of burnout during the first year of postgraduate clinical practice; and burnout is associated with self-reported error. Methods The Maslach Burnout Inventory—Human Services Survey was distributed to Irish junior doctors from five training networks in the last quarter of 2015 when they were approximately 4 months into their first year of clinical practice (time 1), and again 6 months later (time 2). The survey assessed burnout and whether they had made a medical error that had ‘played on (their) mind’. Results A total of 172 respondents out of 601 (28.6%) completed the questionnaire on both occasions. Irish junior doctors at time 2 were more burned out than a sample of US medical residents (72.6% and 60.3% burned out, respectively; p=0.001). There was a significant increase in emotional exhaustion from time 1 to time 2 (p=0.007). The association between burnout and error was significant at time 2 only (p=0.03). At time 2, of those respondents who were burned out, 81/122 (66.4%) reported making an error. A total of 22/46 (47.8%) of the junior doctors who were not burned out at time 2 reported an error. Conclusion Current levels of burnout are unsustainable and place the health of both junior doctors and their patients at risk.

An Evaluation of the Use of Deliberate Practice and Simulation to Train Interns in Requesting Blood Products

Introduction Technical or practical skills deficits upon graduation from medical school are prevalent and contribute to increasing medical error. The current study sought to evaluate the efficacy of a simulation- and deliberate practice-based learning program for requesting blood products, delivered to newly graduated interns. Methods The requesting of blood products by a group of 27 “trained” interns was prospectively compared with that of a group of 30 “untrained” interns throughout the first 13 weeks of internship at an Irish teaching hospital. Results Our analysis showed that the training intervention reduced the risk of a rejected sample by 65% as compared with interns who did not receive the training. Moreover, the risk of a rejected sample for trained interns was 45% lower than for much more experienced doctors. The untrained interns required more than 2 months of clinical experience to reach an error rate that was not significantly different from that of the trained interns. Conclusions These findings indicate that skills acquired through deliberate practice generalized to the clinical setting led to a significant reduction in blood product prescribing errors.

A mixed-methods investigation of health professionals’ perceptions of a physiological track and trigger system

Background Physiological track and trigger systems (PTTSs) regulate the monitoring of patients’ vital signs and facilitate the detection and treatment of deteriorating patients. These systems are widely used, although compliance with protocol is often poor. Objective This study aimed to examine the perceptions of a national PTTS among nurses and doctors and to identify the variables that impact on intention to comply with protocol. Methods A mixed-methods research design was employed. During the initial qualitative phase, 30 hospital-based nurses and doctors participated in a series of semistructured interviews. During the subsequent quantitative phase, 215 nurses and doctors (24.1% response rate) responded to a questionnaire designed to assess attitudes towards the PTTS and factors that influence adherence to protocol. Results Interview data revealed largely positive attitudes towards the PTTS but highlighted a number of barriers to its implementation and indicated that it is sometimes a source of tension between doctors and nurses. Quantitative data confirmed the validity of these findings, although nurses appeared to have more positive attitudes towards, and to perceive fewer barriers to, the usage of PTTS than were reported by the participating doctors. Conclusions These findings reveal that non-compliance with PTTS protocol is unlikely to be attributable to negative perceptions of PTTSs. Instead, there are a number of barriers to the implementation of the system. These findings suggest that interprofessional training in PTTSs is essential while increased support for PTTS implementation among senior doctors would also yield improved adherence to protocol.

Impact of working 48 h per week on opportunities for training and patient contact: the experience of Irish interns

OBJECTIVE The European Working Time Regulations (EWTR) have been criticized for its purported negative impact on the training of junior doctors. The aim of this study was to examine the amount of time interns spent engaging in various work activities. DESIGN An online time-use diary was used to collect data from interns. SETTING Two teaching hospitals in the Republic of Ireland. PARTICIPANTS A total of 45 interns logged at least one 24-h period. The logs were obtained from 67 shifts from a surgical rotation and 83 shifts from a medical rotation. MAIN OUTCOME MEASURES The amount of time interns spent engaging in direct patient care, indirect patient care, educational activities and personal activities. RESULTS On day shift, medical interns spent a significantly smaller proportion of the shift on direct care (159/613 min, 25.9% versus 214/636 min, 33.6%) and a greater proportion on education (195/613 min, 31.8% versus 139/636 min, 21.9%) than surgical interns. On extended days, medical interns spent a significantly larger proportion of the shift on education than surgical interns (243/814 min, 29.9% versus 126/804, 15.7% min). On night shift, medical interns spent a significantly greater proportion of the shift on direct care (590/720 min, 81.9% versus 346/727 min, 47.6%) and education (33/720 min, 4.6% versus 6/727 min, 0.8%) than surgical interns. CONCLUSIONS The interns in the study reported spending more time on direct patient care and educational activities, and less time on indirect patient care activities than interns in other countries.

Excuse me: teaching junior doctors to speak up.

A consistent finding in healthcare is that juniors are unwilling to ‘speak up’ to seniors. Training designed to encourage junior doctors to speak up was designed, delivered, and evaluated. The training was constructed around filmed stories of senior doctors describing situations in which their communication and assertiveness skills were challenged. A total of 110 interns attended the training. The feedback from participants was positive. There was a significant increase in knowledge as a result of the training, and some evidence to support a shift in attitudes in the desirable direction relating to the need to speak-up to seniors. No effect of the training was found on behavior. The results are encouraging in terms of reactions and learning, but further training is required to impact the behavior of junior doctors.

An assessment of stress in Irish interns

High levels of stress have been identified as an issue for doctors. Research shows that stressed doctors do not produce quality patient care and are more likely to make errors when treating patients. A particularly stressful part of medical training is the intern year, the first postgraduate year. Data on the levels of stress were collected using the General Health Questionnaire (GHQ)-12 from interns at the beginning and end of their intern year (described as inexperienced and experienced interns, respectively). In addition, the experienced interns were asked to rate nine sources of stress using a four-point scale from ‘not a source of stress’ to a ‘major source of stress’. The sources were based upon the three categories of stress: situational, personal, and professional. Responses were obtained from 56 interns commencing internship, and 34 interns at the end of internship. A total of 33.3% of the interns met the threshold for experiencing pathological levels of stress. A significant interaction was found between experience and gender (F(1,86) 1⁄4 5.26, p50.05). Experienced female interns reporting significantly lower levels of stress (5.6% reported pathological levels of stress) than inexperienced female interns (36.3% reported pathological levels of stress), experienced male interns (50.0% reported pathological levels of stress) and inexperienced male interns (39.1% reported pathological levels of stress). Experienced female interns also reported situational (t (35)1⁄42.13; p50.05) and personal (t (26.7)1⁄4 2.90, p50.05) stressors to be significantly lower sources of stress than experienced male interns. The levels of stress reported by the inexperienced interns were typical of that of other studies that have utilised the GHQ to measure stress in healthcare workers. However, the responses of the experienced interns were atypical of those reported in the literature. Consistent with the gender difference found in the GHQ scores, experienced male interns rated situational and personal stressors to be significantly higher source of stress than experienced female interns. Also, experienced male interns reported significantly more problems with managing work-life balance than experienced female interns. These findings indicate a need for a multi-centre prospective study of levels of stress in Irish interns and screening to identify stressors which may impact the ability to deliver optimal patient care.

State of the Art and Future Trends in the Usability of Patient Monitors

According to the recent literature, approximately 250,000 deaths occur annually in U.S. hospitals resulting from medical error, making it the 3rd leading cause of death. One of the most commonly used devices in hospitals is the Patient Monitor (PM), a device which constantly monitors the vital signs of the patient. This paper reports on a review of the scientific literature on the usability of PMs in critical care. A detailed analysis of the data reveals that: (i) PMs are undergoing a slow, but continuous process of evolution with new advances focusing on enhancing the interaction between the caregivers and the PM, (ii) the usability of PMs is beginning to receive particular attention as usability is now considered to be strongly associated with patient safety. The data from this study will be used to carry out further investigations into the usability of PMs and to inform the design of future PMs.

Investigation of the Human Factors, Usability and User Experience of Patient Monitors used in a Hospital Setting

According to the recent literature, approximately 250,000 deaths occur annually in U.S. hospitals resulting from medical error, making it the 3rd leading cause of death. One of the most commonly used devices in hospitals is the Patient Monitor (PM), a device which constantly monitors the vital signs of the patient. In this study, nurses and physicians who regularly interact with patient monitors were surveyed on their perceptions of the usability of the PMs they use on a regular basis. Results indicate that clinicians appeared to be mostly satisfied with the general usability of the monitors, particularly in terms of the information being presented and how it is presented. However, participants pointed out problems with the menu navigation during moments of high stress and the high frequency of false alarms. Also, participants expressed the desire to see additional information displayed on screen.

Stress, coping, and psychological resilience among physicians

BackgroundRecent research has demonstrated that burnout is widespread among physicians, and impacts their wellbeing, and that of patients. Such data have prompted efforts to teach resilience among physicians, but efforts are hampered by a lack of understanding of how physicians experience resilience and stress. This study aimed to contribute to knowledge regarding how physicians define resilience, the challenges posed by workplace stressors, and strategies which enable physicians to cope with these stressors.MethodsA qualitative approach was adopted, with 68 semi-structured interviews conducted with Irish physicians. Data were analysed using deductive content-analysis.ResultsFive themes emerged from the interviews. The first theme, ‘The Nature of Resilience’ captured participants’ understanding of resilience. Many of the participants considered resilience to be “coping”, rather than “thriving” in instances of adversity. The second theme was ‘Challenges of the Profession’, as participants described workplace stressors which threatened their wellbeing, including long shifts, lack of resources, and heavy workloads. The third theme, ‘Job-related Gratification’, captured aspects of the workplace that support resilience, such as gratification from medical efficacy. ‘Resilience Strategies (Protective Practices)’ summarised coping behaviours that participants considered to be beneficial to their wellbeing, including spending time with family and friends, and the final theme, ‘Resilience Strategies (Attitudes)’, captured attitudes which protected against stress and burnout.ConclusionsThis study emphasised the need for further research the mechanisms of physician coping in the workplace and how we can capitalise on insights into physicians’ experiences of coping with system-level stressors to develop interventions to improve resilience.