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Pseudohyperkalaemia is defined as a rise in serum potassium with concomitantly normal plasma potassium. The case of long undiagnosed pseudohyperkalaemia in an 84-year-old lady with thrombocytosis post splenectomy is presented. Presenting a historical perspective and the multifactorial aetiology of pseudohyperkalaemia the author underlines the importance of detecting apparent hyperkalaemia by testing the plasma potassium. Awareness of the possible causes of pseudohyperkalaemia increases the likelihood of it being detected earlier thereby decreasing the risk of harming the patient. Unnecessary treatment and investigation of pseudohyperkalaemia can cause harm to the patient in the form of undesired side effects, unnecessary investigations and concerns, and potentially dangerous iatrogenically induced cardiac arrhythmias.

Background: Burnout among postgraduate medical trainees is common. It is a syndrome characterised by emotional exhaustion, depersonalisation and reduced personal accomplishment. Burnout is seen as an organisational problem rather than the result of an individual’s ability to cope with the stress at work. The educational environment can play a pivotal role in the prevention of burnout among postgraduate medical trainees. This narrative literature review is aimed at assessing the effect of the educational environment on burnout in postgraduate doctors-in-training. Methods: A search of the databases Medline and PscyInfo for articles published between 2015 and 2020 was performed with the key words ‘burnout’ and ‘educational environment’ or ‘clinical learning environment’ or ‘postgraduate medical education’ or ‘learning environment’. Results: A total of 27 studies were identified and reviewed by the author. The prevalence of burnout reported varied widely between studies, ranging from 10% to 62%. Many of the factors that contribute to burnout form part of the educational environment, for example, hours worked, mistreatment, harassment and perceptions of injustice. Residency itself is a stressful period wherein trainees have to balance their responsibilities towards their patients with their responsibilities at home, all while furthering their studies and taking on new responsibilities. Interventions to prevent burnout and tackle existing burnout are multiple but very little solid evidence exists to attest to their efficacy. More research is needed to identify the most effective ways to deal with burnout in postgraduate medical trainees.

BackgroundPostgraduate medical trainees are at an increased risk of burnout. Burnout has been defined as “a psychological condition of emotional exhaustion, depersonalization and reduced personal accomplishment occurring in people persistently exposed to emotional and interpersonal stressors at work”. It can arise either from within the individual, from the medical profession itself or from healthcare organisations. Burnout is associated with mental health issues in trainees, impaired work performance and suboptimal patient outcomes.MethodsA cross-sectional observational study of three cohorts of the Malta Foundation Programme was conducted using the Copenhagen Burnout Inventory (CBI) to evaluate incidence of personal-, work-related and client related burnout. The cohorts were at 3-months, 1-year and 2-years of training respectively. The CBI was administered via Google Forms after ethical clearance. Descriptive statistics and non-parametric comparative statistics were used to analyse the results through SPSS v25.0.ResultsA global response rate of 26.5% was achieved. CBI and its sub scales showed good internal validity. High scores for burnout in all three scales were identified except for client-related burnout in First Year doctors. Burnout peaked midway through the 2-year period. High numbers reported “feeling “tired” and “physically exhausted”. Males reported more burnout than females.ConclusionThe high level of burnout so early in the career of Maltese postgraduate medical trainees is of concern. More studies are needed on the causality of this burnout and what factors are associated with burnout in this population.

Background: Learning from managing patients in a real-world context is by far superior to simulation learning. A substandard educational environment is associated with poor patient care and suboptimal learning outcomes. The measurement of the educational environment provides insight into what is needed to improve the level of training. Objective: To measure the educational environment as perceived by trainees within the Malta Foundation Programme. Methods: This study used the Postgraduate Hospital Educational Environment Measure (PHEEM) to measure the educational environment at the Malta Foundation Programme. Descriptive statistics were used to describe the demographics of the study population. Nonparametric comparative statistics were used to identify statistically significant differences between groups. Results: Ninety-eight trainees out of 370 (26.5%) completed the online questionnaire. These consisted of 39 FY1s (31.5% of 124), 33 FY2s (24.8% of 133), and 26 extended FYs (23.0% of 113). The 40-item PHEEM showed good reliability with a Cronbach’s α value of .912. These doctors perceived their educational environment as more positive than negative. Perceptions are worst among trainees at the end of their first year of training. Those who had just finished their training have reported better perceptions. The 3 worst scoring items are related to when the trainees are on call. Conclusion: Among trainees within the Malta Foundation Programme, perceptions of role autonomy and social support are areas where most work is needed. Teaching seems to be moving in the right direction, but there is always room for improvement.

Background Learning from managing patients in a real-world context is by far superior to simulation learning. A substandard educational environment is associated with poor patient care and suboptimal learning outcomes. The measurement of the educational environment provides an insight on what is needed to improve the level of training.Methods This study used the Postgraduate Hospital Educational Environment Measure (PHEEM) to measure the educational environment at the Malta Foundation Programme. Descriptive statistics were used to describe the demographics of the study population. Non-parametric comparative statistics were used to identify statistically significant differences between groups.Results 98 trainees out of 370 (26.5%) completed the online questionnaire. These consisted of 39 FY1s (31.5% of 124), 33 FY2s (24.8% of 133) and 26 Extended FYs (23.0% of 113). The 40-item PHEEM showed good reliability with a Cronbach’s α value of 0.912. These doctors have perceived their educational environment as more positive than negative. There seems to be a dip midway through training with an improvement towards the end of the two-year training period. The three worst scoring items seem to be related to when the trainees are on call.Conclusion Perceptions of role autonomy and of social support are areas where most work is needed. Teaching seems to be moving in the right direction but there is always room for improvement.

Introduction: The stigmatization of mental healthcare services and users is a barrier to the achievement of mental wellness present on a global level. 800000 suicides are estimated each year, 25 suicide attempts for every suicide (ratio of 25:1), and in 2017 estimated a prevalence > 10% of people suffering from mental disorder or substance abuse (global data). The stigmatization is a multifactorial phenomenon and process that involves different factors, which overall cause health, social and economic damage. Slowing down and reducing access to mental health and well-being pathways due to their influence in the community, also affect social relationships and self-determination. Purpose: to identify and describe the process, causes, and factors of stigmatization. Propose destigmatization activities led by the medical educator. Methodology: The manuscript develops a proposal focused on the destigmatization process of mental health/wellbeing services and users, through the guidance of the medical educator as a figure of connection between different professions (interdisciplinary and multidisciplinary), and between different stakeholders. Conclusion: each identifies factor described, can be involved in the destigmatization process to generate inclusion, through different social interventions led by the role of the medical educator, with the aim of supporting access to patient support processes and quality of life in communities, generating inclusion through destigmatization

Background: Postgraduate medical trainees are at an increased risk of burnout. Burnout has been defined as "a psychological condition of emotional exhaustion, depersonalization and reduced personal accomplishment occurring in people persistently exposed to emotional and interpersonal stressors at work". It can arise either from within the individual, from the medical profession itself or from healthcare organisations. Burnout is associated with mental health issues in trainees, impaired work performance and suboptimal patient outcomes. Objective: To evaluate the level of burnout among trainees of the Malta Foundation Programme. Methods: A cross-sectional observational study of three cohorts of the Malta Foundation Programme was conducted using the Copenhagen Burnout Inventory (CBI) to evaluate incidence of personal-, work-related and client related burnout. The cohorts were at 3 months, 1 year and 2 years of training respectively. The CBI was administered via Google Forms after ethical clearance. Descriptive statistics and non-parametric comparative statistics were used to analyse the results through SPSS v25.0. Results: A global response rate of 26.5% was achieved. CBI and its subscales showed good internal validity. High scores for burnout in all three scales were identified except for client-related burnout in First Year doctors. Burnout peaked midway through the 2-year period. High numbers reported "feeling "tired" and "physically exhausted". Males reported more burnout than females. Conclusion: The high level of burnout so early in the career of Maltese postgraduate medical trainees is of concern. More studies are needed on the causality of this burnout and what factors are associated with burnout in this population.