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      A survey-based cross-sectional study of doctors’ expectations and experiences of non-technical skills for Out of Hours work

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          Abstract

          Objectives

          The skill set required for junior doctors to work efficiently and safely Out of Hours (OoH) in hospitals has not been established. This is despite the OoH period representing 75% of the year and it being the time of highest mortality. We set out to explore the expectations of medical students and experiences of junior doctors of the non-technical skills needed to work OoH.

          Design

          Survey-based cross-sectional study informed by focus groups.

          Setting

          Online survey with participants from five large teaching hospitals across the UK.

          Participants

          300 Medical Students and Doctors

          Outcome measure

          Participants ranked the importance of non-technical skills, as identified by literature review and focus groups, needed for OoH care.

          Results

          The focus groups revealed a total of eight non-technical skills deemed to be important. In the survey ‘Task Prioritisation’ (mean rank 1.617) was consistently identified as the most important non-technical skill. Stage of training affected the ranking of skills, with significant differences for ‘Communication with Senior Doctors’, ‘Dealing with Clinical Isolation’, ‘Task Prioritisation’ and ‘Communication with Patients’. Importantly, there was a significant discrepancy between the medical student expectations and experiences of doctors undertaking work.

          Conclusions

          Our findings suggest that medical staff particularly value task prioritisation skills; however, these are not routinely taught in medical schools. The discrepancy between expectations of students and experience of doctors reinforces the idea that there is a gap in training. Doctors of different grades place different importance on specific non-technical skills with implications for postgraduate training. There is a pressing need for medical schools and deaneries to review non-technical training to include more than communication skills.

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          Most cited references12

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          Human error: models and management.

          J. Reason (2000)
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            Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents.

            Physician distress is common and has been associated with negative effects on patient care. However, factors associated with resident distress and well-being have not been well described at a national level. To measure well-being in a national sample of internal medicine residents and to evaluate relationships with demographics, educational debt, and medical knowledge. Study of internal medicine residents using data collected on 2008 and 2009 Internal Medicine In-Training Examination (IM-ITE) scores and the 2008 IM-ITE survey. Participants were 16,394 residents, representing 74.1% of all eligible US internal medicine residents in the 2008-2009 academic year. This total included 7743 US medical graduates and 8571 international medical graduates. Quality of life (QOL) and symptoms of burnout were assessed, as were year of training, sex, medical school location, educational debt, and IM-ITE score reported as percentage of correct responses. Quality of life was rated "as bad as it can be" or "somewhat bad" by 2402 of 16,187 responding residents (14.8%). Overall burnout and high levels of emotional exhaustion and depersonalization were reported by 8343 of 16,192 (51.5%), 7394 of 16,154 (45.8%), and 4541 of 15,737 (28.9%) responding residents, respectively. In multivariable models, burnout was less common among international medical graduates than among US medical graduates (45.1% vs 58.7%; odds ratio, 0.70 [99% CI, 0.63-0.77]; P $200,000 relative to no debt). Residents reporting QOL "as bad as it can be" and emotional exhaustion symptoms daily had mean IM-ITE scores 2.7 points (99% CI, 1.2-4.3; P < .001) and 4.2 points (99% CI, 2.5-5.9; P < .001) lower than those with QOL "as good as it can be" and no emotional exhaustion symptoms, respectively. Residents reporting debt greater than $200,000 had mean IM-ITE scores 5.0 points (99% CI, 4.4-5.6; P < .001) lower than those with no debt. These differences were similar in magnitude to the 4.1-point (99% CI, 3.9-4.3) and 2.6-point (99% CI, 2.4-2.8) mean differences associated with progressing from first to second and second to third years of training, respectively. In this national study of internal medicine residents, suboptimal QOL and symptoms of burnout were common. Symptoms of burnout were associated with higher debt and were less frequent among international medical graduates. Low QOL, emotional exhaustion, and educational debt were associated with lower IM-ITE scores.
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              Crisis resource management and teamwork training in anaesthesia.

              D.M. Gaba (2010)
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2015
                14 February 2015
                : 5
                : 2
                : e006102
                Affiliations
                [1 ]Human Factors Research Group/Horizon Digital Economy Research, University of Nottingham , Nottingham, Nottinghamshire, UK
                [2 ]Department of Respiratory Medicine, University of Nottingham , Nottingham, Nottinghamshire, UK
                [3 ]East Midlands Academic Health Science Network, Nottingham, Nottinghamshire, UK
                [4 ]Department of Clinical Sciences, Liverpool School of Tropical Medicine , Nottingham, Nottinghamshire, UK
                Author notes
                [Correspondence to ] Dr Michael Brown; Michael.brown@ 123456nottingham.ac.uk
                Article
                bmjopen-2014-006102
                10.1136/bmjopen-2014-006102
                4336458
                25687899
                d049a8b0-73a1-4bf4-bd78-9e44f60e2823
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

                History
                : 15 July 2014
                : 12 January 2015
                : 13 January 2015
                Categories
                Health Services Research
                Research
                1506
                1704
                1704
                1709
                1710

                Medicine
                Medicine

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