Purpose This review aimed to synthesise some of the extant work on the use of entrustable professional activities (EPAs) for postgraduate physicians, to assess the quality of the work and provide direction for future research and practice. Method Systematic searches were conducted within five electronic databases (Medline, Scopus, Web of Science, PsycINFO and CINAHL) in September 2018. Reference lists, Google Scholar and Google were also searched. Methodological quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Results In total, 49 studies were included, classified as Development of EPAs (n = 37; 76% of total included), Implementation and/or assessment of EPAs (n = 10; 20%), or both (n = 2; 4%). EPAs were described for numerous specialties, including internal medicine (n = 14; 36%), paediatrics (n = 8; 21%) and psychiatry (n = 4; 10%). Of the development studies, 92% utilised more than one method to generate EPAs. The two most commonly used methods were developing initial EPAs in a working group, (n = 27; 69%) and revising through deliberation (n = 21; 54%). Development papers were of variable quality (mean QATSDD score = 20, range 6–41). Implementation and assessment studies utilised methods that included observing trainee performance (n = 6; 50%) and enrolling trainees in competency‐based curricula, which included EPAs (n = 4; 33%). The methodological quality of these implementation studies varied (mean QATSDD score = 19.5, range = 6–32). Conclusions This review highlighted a need for: (i) consideration of best practice guidelines for EPA development; (ii) focus on the methodological quality of research on EPA development and of EPAs, and (iii) further work investigating the implementation of EPAs in the curriculum.

This review aimed to synthesise the literature describing interventions to improve resilience among physicians, to evaluate the quality of this research and to outline the type and efficacy of interventions implemented. Searches were conducted in April 2017 using five electronic databases. Reference lists of included studies and existing review papers were screened. English language, peer-reviewed studies evaluating interventions to improve physician resilience were included. Data were extracted on setting, design, participant and intervention characteristics and outcomes. Methodological quality was assessed using the Downs and Black checklist. Twenty-two studies were included. Methodological quality was low to moderate. The most frequently employed interventional strategies were psychosocial skills training and mindfulness training. Effect sizes were heterogeneous. Methodologically rigorous research is required to establish best practice in improving resilience among physicians and to better consider how healthcare settings should be considered within interventions.

Objectives: To synthesize the literature describing compliance with WHO hand hygiene (HH) guidelines in Intensive Care Units (ICUs), to evaluate the quality of extant research, and to examine differences in compliance rates across geographical regions, ICU types, and healthcare worker groups, observation methods, and Moments (indications) of HH. Data sources: Electronic searches were conducted in August 2018 using Medline, CINAHL, PsycInfo, Embase, and Web of Science. Reference lists of included studies and related review articles were also screened. Study selection: English-language, peer-reviewed studies measuring HH compliance by healthcare workers in an ICU setting using direct observation guided by the WHO's 'Five Moments of Hand Hygiene', published since 2009, were included. Data extraction: Information was extracted on study location, research design, type of ICU, healthcare workers, measurement procedures, and compliance rates. Data synthesis: Sixty-one studies were included. Most were conducted in high-income countries (60.7%) and in adult ICUs (85.2%). Mean HH compliance was 59.6%. Compliance rates appeared to differ by geographic region (high-income countries 64.5%, low-income countries 9.1%), type of ICU (neonatal 67.0%, pediatric 41.2%, adult 58.2%), and type of healthcare worker (nursing staff 43.4%, physicians 32.6%, other staff 53.8%). Conclusions: Mean HH compliance appears notably lower than international targets. The data collated may offer useful benchmarks for those evaluating, and seeking to improve, hand hygiene compliance in ICUs internationally.

Context Gender bias has been observed in the authorship and editorship of academic literature in varied medical specialties. This is important as peer‐reviewed publications, and participation on editorial boards, are closely related to academic productivity and advancement. The aim of this paper was to examine whether gender‐based disparities in authorship and editorship exist in leading medical education journals. Methods A retrospective bibliometric review was conducted of articles published at eight different time‐points across a 49‐year time period (specifically: 1970, 1980, 1990, 2000, 2005, 2010, 2015 and 2019) in four leading medical education journals (Academic Medicine, BMC Medical Education, Medical Education and Medical Teacher). First and last (as a proxy for senior) author gender was determined for each article, along with the gender of the 2019 editorial board members of each journal. Chi‐square tests for trend were conducted to examine variations in author gender distributions over time, and binomial tests of proportions were conducted to examine gender distributions in authorship and editorship in 2019. Logistic regression analyses were carried out to determine factors that predicted the odds of authorship by women. Results A total of 5749 articles were included. A significant trend of increased women as first and last authors was observed across all journals. The percentage of women first authors increased from 6.6% in 1970 to 53.7% in 2019 (P < .001), and women last authors increased from 9.5% in 1970 to 46% in 2019 (P < .001). Overall, the distributions of women first authors, last authors and editorial board members in 2019 indicated greater gender parity than many other fields of medicine. Conclusions Positive progress towards gender parity has been made in medical education scholarship. However, future research and efforts are needed to ensure the continued participation, and highlighting, of women in medical education scholarship and to address other factors which may hinder academic advancement for women in this field.

Objective: To synthesize the literature describing interventions to improve hand hygiene (HH) in Intensive Care Units (ICUs), to evaluate the quality of the extant research, and to outline the type, and efficacy, of interventions described.Data sources: Systematic searches were conducted in November 2016 using five electronic databases: Medline, CINAHL, PsycInfo, Embase, and Web of Science. Additionally, the reference lists of included studies and existing review papers were screened.Study selection: English language, peer-reviewed studies that evaluated an intervention to improve HH in an adult ICU setting, and reported HH compliance rates collected via observation, were included.Data extraction: Data were extracted on the setting, participant characteristics, experimental design, HH measurement, intervention characteristics and outcomes. Interventional components were categorized using the Behavior Change Wheel. Methodological quality was examined using the Downs and Black Checklist.Data synthesis: Thirty-eight studies were included. The methodological quality of studies was poor, with studies scoring a mean of 8.6 out of 24 (SD=2.7). Over 90% of studies implemented a bundled intervention. The most frequently employed interventional strategies were Education (78.9%), Enablement (71.1%), Training (68.4%), Environmental Restructuring (65.8%), and Persuasion (65.8%). Intervention outcomes were variable with a mean relative percentage change of 94.7% (SD=195.7; range: 4.3-1155.4%) from pre-to post-intervention.Conclusions: This review demonstrates that best practice for improving HH in ICUs remains unestablished. Future research employing rigorous experimental designs, careful statistical analysis, and clearly described interventions is important.

Background: There is limited research, and guidance, on how to address safety in general practice proactively.Objectives: This review aimed to synthesize the literature describing the use of patient record review (PRR) to measure and improve patient safety in primary care. The PRR methodologies utilized and the resulting outcomes were examined.Methods: Searches were conducted using Medline, Embase, CINAHL and PsycINFO in February 2017. Reference lists of included studies and existing review papers were also screened. English language, peer-reviewed studies that utilized PRR to identify patient safety incidents (PSIs) occurring in general practice were included. Two researchers independently extracted data from articles and applied the Quality Assessment Tool for Studies with Diverse Designs.Results: A total of 3265 studies were screened, with 15 included. Trigger tools were the most frequent method used for the PRRs (n = 6). The mean number of safety incidents per 100 records was 12.6. Within studies, a mean of 30.6% of incidents were associated with severe harm (range 8.6–50%), and a mean of 55.6% of incidents was considered preventable (range 32.7–93.5%). The most commonly identified types of PSIs related to medication and prescribing, diagnosis, communication and treatment. Three studies reported on improvement actions taken after the PRRs.Conclusion: This review suggests that PRR may be a promising means of proactively identifying patient safety incidents and informing improvements.

This article provides an overview and synthesis of the 100 most cited healthcare simulation publications to provide insight into the articles that have shaped current knowledge and practice. Searches of the Scopus and Web of Science databases were conducted in July 2017. Most articles were concerned with medical education and training (86%) and were most often published in surgical journals (33%). Manikins (20%), standardized patients (16%), inanimate part-task trainers (16%), fully simulated environments (17%), and virtual reality part-task trainers (14%) were the most commonly featured types of simulators. Healthcare simulation research has matured and grown during the preceding decades. There has been a move away from research questions focused on "does simulation work?" to an assessment of the conditions under which simulation is most effective. It is hoped that providing an overview of highly cited works will help identify topics for further research.

Psychometric Evaluation of a Measure of Factors Influencing Hand Hygiene Behaviour to Inform Intervention Background. Although the hand hygiene (HH) procedure is simple, the related behaviour is complex and is not readily understood, explained, or changed. There is a need for practical tools to provide data that can guide healthcare managers and practitioners not only on the 'what' (the standards that must be met), but also the 'how' (guidance on how to achieve the standards). Aim. To develop a valid questionnaire to evaluate attitudes to the factors that influence engagement in HH behaviour that can be readily completed, administered, and analysed by healthcare professionals to identify appropriate intervention strategies. Construct validity was assessed using confirmatory factor analysis, predictive validity through comparison with selfreported HH behaviour, and convergent validity through direct unit-level observation of HH behaviour. Methods. The Capability, Opportunity, Motivation-Behaviour (COM-B) model was used to design a 25-item questionnaire that was distributed to Intensive Care Unit (ICU) personnel in Ireland. Direct observation of HH behaviour was carried out at two ICUs. Findings. A total of 292 responses to the survey (response rate 41.0%) were included in the analysis. Confirmatory factor analysis resulted in a 17-item questionnaire. Multiple regression revealed that a model including Capability, Opportunity, and Motivation, was a significant predictor of self-reported Behavioural intention (F(3,209) =22.58, p<0.001). However, the Opportunity factor was not found to make a significant contribution to the regression model. Conclusion. The COMB HH questionnaire is reliable and valid and provides data to support the development, and evaluation, of HH interventions that meet the needs of specific healthcare units.