Tuesday 26 April 2011

Using drama to explain medical errors and medical mistakes!

 I recently attended a conference about organisational culture and job burnout in hospitals (April 2011-Thessaloniki, Greece). I delivered a paper at the conference. However, I was very impressed by the presentation from a group of final year medical students (from Aristotle Medical School, Thessaloniki, Greece). The students used drama as a way to highlight the impact that medical mistakes have on both healthcare professionals and patients. It`s difficult to convey their approach without showing a video, but basically, they dramatised personal interviews from physicians as a series of short plays. In addition, they used clever technology to overlay the Hippocratic oath throughout the performance. Thus, we the audience, were prompted to reflect via the use of different modalities. Very innovative, very interesting and difficult to forget! Drama and medicine in Greece, very fitting!

Preventing job burnout in medical students

Treating burnout in physicians can be difficult and the evidence to date is mixed and patchy. However, a recent paper in Medical Education [Med Educ. 2010 Oct;44(10):1016-26. doi: 10.1111/j.1365-2923.2010.03754.x] provides some interesting insights on how we can try to prevent burnout in medical students. The researchers followed medical students prospectively and categorised students in three major groups; (1) no burnout (the resilient group), (2) initial burnout, but no burnout on follow-up (recovering group), (3) burnout continuously (chronic burnout group). Roughly, a third of students were classified in the resilient group. The researchers found that modifiable individual factors and learning climate characteristics including employment status, stress level and perceptions of the prioritising of student education by faculty members related to medical students’ vulnerability to burnout. The authors do not name it as such, but in my opinion, the factors identified by the authors all relate to organisational/educational climate. On the plus side, the fact that the identified factors are modifiable provides hope, and more importantly, the opportunity for us to test their hypotheses.

Tuesday 19 April 2011

The reason why doctors don`t fly planes!

 
The following study is from 2000 [BMJ 2000;320:745–9], but it`s worth reading if you missed it!
In a study comparing attitudes to work, fatigue and error among healthcare professionals and pilots; researchers found that 70% consultant surgeons claimed to perform effectively when fatigued, compared with 24% among pilots. Additionally, healthcare professionals (compared to pilots) were less likely to disagree with the statement that junior team members should not question the decisions made by senior team members.  The research also showed that error was difficult to discuss in medicine. Ultimately, healthcare professionals seem to be denial about the impact that stress and fatigue can have on their performance.

Friday 15 April 2011

Rain and selecting medical students

In a very interesting and novel piece of research, Redelmeier and Baxter [CMAJ 2009. DOI:10.1503/cmaj.091546] found that bad weather significantly influenced scores at admission interviews at a Canadian medical school. Potential medical students received lower scores from interviewers on bad weather days. The difference in scores was equivalent to about a 10% lower total mark on the Medical College Admission Test.
Interesting study, that shows how mood can influence our ratings of others!

Tuesday 12 April 2011

Irish Doctors, performance and Lifelong learning

From May 1st 2011, Irish doctors seeking to renew their professional registration will be required to complete an annual declaration that they have enrolled in and are complying with the requirements of a specific competence scheme. The new rules will require doctors to “systematically acquire, understand and demonstrate the substantial body of knowledge that is at the forefront of the field of learning in their speciality, as part of a continuum of lifelong learning”.
 [http://www.irishtimes.com/newspaper/health/2011/0412/1224294468256.html]

Obviously, encouraging doctors to continuously update knowledge is desirable, but one wonders whether such efforts can significantly influence behaviour and attitudes? Skills are important, but will such rules contribute positively to real behaviour change among doctors?

Friday 8 April 2011

What happens if you have to bring a family member to the doctor?

 A recent meta-analysis on this subject [Social Science & Medicine; 2011;doi:10.1016/j.socscimed.2011.01.015] found that accompanied patients were significantly older and more likely to be female, less educated, and in worse physical and mental health than unaccompanied patients. The heterogeneity of studies reviewed made broad conclusions difficult, but one result stands out in terms of physician behaviour. Physicians were found to provide more biomedical information to patients when a companion was present, and results suggest that they were also less apt to engage in social conversation. The studies reviewed did not systematically address patient outcomes, but there was no evidence to suggest that accompanied patient outcomes were inferior. However, outcomes were consistently favourable among accompanied patients when family companions were more verbally active suggesting that wasn’t not simply the presence of family companions, but the roles they assume that have a bearing for patient outcomes.

Friday 1 April 2011

Psychology works, but it takes time!

Psychological interventions can help healthcare professionals working in hospitals, but it takes time and the participation of the healthcare professionals themselves!  A 2010 study [Occup Environ Med doi: 10.1136/oem.2010.055202] found that a participatory intervention team, meaning the intervention involved people working in the target hospital, helped to reduce adverse psychosocial work factors and improve mental health. The interesting aspect of the intervention was that it involved 8 meetings (for 3 hours) over a four month period, and the actual follow-up was 3 years after the intervention. So, helping hospital workers takes an investment of time and the results may not be seen for quite some time!

Are doctors learning?

One would think that work-based assessment would be a useful tool for doctors. Ideally, we would hope that doctors assess their performance and use this as a tool to improve. We can imagine that continuously updating their education and performance would be especially desirable for doctors. However,  a  recent review [BMJ 2010;341:c5064doi:10.1136/bmj.c5064] on the impact of work based assessment on doctors’ education and performance found little evidence that such assessments act as an educational initiative. There was limited evidence for multi-source feedback. Put simply, there was little evidence that assessing work performance was leading to actual behaviour change among doctors.