Summary Background Well‐being encompasses a constellation of multiple interdependent factors influenced by our personal and professional lives. It has a reciprocal relationship with burnout, a phenomenon detrimental to physicians, students and patients alike. Despite this, well‐being is not a topic routinely integrated into undergraduate medical and nursing curricula. Local demand and increased global attention provided an impetus to create and deliver an ‘Introduction to well‐being’ workshop. Our aim was to start the well‐being conversation early in the professional journeys of students, and to provide strategies to gain and maintain well‐being throughout their careers. Methods We developed a practical, interprofessional well‐being workshop for first‐year medical and nursing students. Over six afternoons, 251 students in groups of 12–15 rotated through our three session, interactive workshop focusing on the interrelated subjects of self care, empathy and communication. On completion of the workshop, written evaluation and take‐home messages were collected and thematically analysed. Results The interprofessional aspect of the workshop and the practical tools imparted were positively evaluated. Take‐home messages highlighted the need to integrate well‐being into the curricula, particularly the self‐care aspect. Students concluded that ‘simple acts of care’ to self and to others were essential for the maintenance and improvement of well‐being. Conclusion Interprofessional early year well‐being workshops, designed to promote open discussion around the significance of self care, empathy and communication, and to provide practical advice for well‐being, were felt to be beneficial by first‐year nursing and medical students. Recognising the importance of simple acts of care is likely to advantage not only individuals but also the culture that they shape.
BackgroundOur affective (emotional) state has far reaching and well recognised implications relating to well-being, team-work and patient safety. The aim of this novel study was to gain an in depth understanding of factors that influence the transitory emotions of Emergency Department (ED) care providers whilst at work.Method and resultsUsing a pragmatist theoretical lens, a qualitative methodology was selected to explore staff members’ experiences of factors generating positive and negative emotions. Focus groups were facilitated with ED staff from a major acute teaching hospital in Scotland. Purposive sampling was used to recruit participants, with each group containing members of the same or similar grade and occupation. Consultant, higher specialty trainee, junior doctor and nursing focus groups were undertaken. Following transcription, data were coded and thematically analysed to arrive at key concepts.Abstract 015 Table 1Themes and representative quotesAbstract 015 Figure 1Where care provider emotion can impactConclusionsSix main themes were identified: ‘ ED team rapport’ referring to the personalities and attitudes of those working that day; ‘achievement’ with successful task completion, skill use, being thanked and constructive educational opportunities generating positive emotions and lack of this feeling generating the converse; ‘interpersonal interactions’ where the negative impact of incivility from staff or patients was highlighted; ‘equipment/infrastructure’ showcasing how frustration manifests when either fails; ‘the open and the close’ representing the impact of how the tone set in handover influences affect and finally, the self-explanatory ‘a bad day outside work can influence that inside.’This study illustrates the importance of recognising personal ‘wins’ whether that be a well-managed patient or successfully recognised teaching opportunity. It adds impetus to the campaign against incivility - reaffirming the negative effect rudeness has on affect. On a personal level, it highlights that we can take responsibility to ‘choose our own weather’ as a team member or leader in being a colleague that others enjoy working with. This may improve outcomes for all.
BackgroundIrregular patient volumes, high patient transit and limitless presentations means that Emergency Department (ED) handovers differ from other specialities. Therefore, a degree of handover unfamiliarity results for junior doctors.There is a high prevalence of stress and burnout in both junior doctors and doctors working in Emergency Medicine. Despite this, no literature was identified exploring if handover can be a source of stress. The aim of this study was to explore junior doctors’ perceptions of ED handover and to investigate if it is considered a stressful experience.Non-probabilistic sampling methods were used to recruit doctors working at or below the grade of Speciality Trainee year 2 (ST2) or equivalent in the ED of a major acute teaching hospital. Qualitative, semi-structured interviews were undertaken between March and April 2019 exploring participants’ experiences of ED handover. Interviews were recorded and transcribed verbatim. Using NVivo 12 software, data were analysed thematically using an inductive-deductive approach.10 interviews were undertaken and four themes were identified from the data: ‘stress decreases as familiarity increases’ which included familiarising with handover structure, content and purpose; ‘time pressure is an ongoing stressor’ representing the perceived need to efficiently handover during busy periods and at shift end; ‘handover as a solace’ relating to opportunities to both learn and socialise and ‘it’s nice to be nice’ reflecting the importance of civility.Junior doctors find aspects of ED handover stressful. These include: wanting to make a good impression; unfamiliarity; time pressures and the negative effects of hierarchy. However, handover can also help to ameliorate stress by facilitating opportunities for socialisation, education and morale boosting. Important recommendations for future practice regarding departmental handover can be made, most notably, the need to create a civil and pleasant working environment where doctors can flourish.Abstract 038 Figure 1Four themes explainedAbstract 038 Figure 2Recommendations for future handovers
Aims/Objectives/BackgroundFew empirical studies explore the contribution of non-clinical factors to perceptions of patient difficulty in EM. Fewer have investigated what students placed in EDs learn about ‘difficult’ patients or what, if anything, clinicians teach about the topic. We looked to address this. Considering these questions is imperative: patients perceived as frustrating report lower satisfaction with their clinical encounter, experience worse health outcomes and seem to be at risk of medical error secondary to faulty clinical reasoning.Methods/DesignWith ethical approval, we undertook three interrelated, qualitative studies to conduct a case study of the undergraduate EM module delivered at Edinburgh University. In the first two, focus groups were used as the method of data collection; five clinician (n=25) and four medical student (n=21) groups were facilitated. In the third, semi-structured interviews with clinicians (n=12) were conducted. All groups/interviews were audio-recorded and transcribed. The data were analysed inductively using reflexive thematic analysis.Results/ConclusionsFrequent attendance, demands, pre-existing relationships and unrealistic expectations contributed to perceived patient difficulty. These were modified by personal and circumstantial factors. Although rarely told, students were aware who these ‘difficult’ patients were through observing behaviours. Critically, clinicians and students alike believed frustration adversely impacted aspects of clinical reasoning. Students struggled when witnessing what they considered ‘bad’ behaviour as it contradicted their previously held ideals of how physicians should act.It seems we teach students to try to internalise emotion yet that it is acceptable to let it negatively impact patient care. To combat this, students sought greater emotional transparency from physicians as well as advice on self-management strategies. Clinicians recognised the benefits of being candid but were afraid of being so. Contributing to this is the culture in medicine being one that mistrusts emotion. Further, both groups desired a formal curriculum addressing emotion in clinical reasoning thus suggesting one is needed.
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