Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims or impaired performance

Austin, Elizabeth; Do, Vu; Nullwala, Ruqaiya; Pulido, Diana Fajardo; Hibbert, Peter; Braithwaite, Jeffrey; Arnolda, Gaston; Wiles, Louise; Theodorou, Tahlia; Tran, Yvonne; Lystad, Reidar P.; Hatem, Sarah; Long, Janet C.; Rapport, Frances; Pantle, Annette C.; Clay‐Williams, Robyn

doi:10.1136/bmjopen-2021-050377

Cited by 20 publications

(18 citation statements)

References 72 publications

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“…Personal factors are more likely to require remediation when learners are older [ 102 , 117 , 118 ], had reported character failings [ 119 ], required remediation in the past [ 120 ], learners who required more time to complete medical school [ 121 ], had more re-examinations in the past [ 121 ] and previous lapses in professionalism in medical school [ 92 ].…”

Section: Resultsmentioning

confidence: 99%

“…Program related factors predisposing to professional lapses and the need for remediation [ 66 ] include high workload [ 84 , 112 , 118 ], chronic fatigue, sleep deprivation, stress and overwork [ 84 ], a “culture of recurrent assessment and unsupportive teaching environments” [ 74 ] and changing placements which requires learners to adapt to new environments and form new relationships [ 74 ]. Frameworks for Remediation …”

Section: Resultsmentioning

confidence: 99%

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Post graduate remediation programs in medicine: a scoping review

et al. 2022

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Background Recognizing that physicians may struggle to achieve knowledge, skills, attitudes and or conduct at one or more stages during their training has highlighted the importance of the ‘deliberate practice of improving performance through practising beyond one’s comfort level under guidance’. However, variations in physician, program, contextual and healthcare and educational systems complicate efforts to create a consistent approach to remediation. Balancing the inevitable disparities in approaches and settings with the need for continuity and effective oversight of the remediation process, as well as the context and population specific nature of remediation, this review will scrutinise the remediation of physicians in training to better guide the design, structuring and oversight of new remediation programs. Methods Krishna’s Systematic Evidence Based Approach is adopted to guide this Systematic Scoping Review (SSR in SEBA) to enhance the transparency and reproducibility of this review. A structured search for articles on remediation programs for licenced physicians who have completed their pre-registration postings and who are in training positions published between 1st January 1990 and 31st December 2021 in PubMed, Scopus, ERIC, Google Scholar, PsycINFO, ASSIA, HMIC, DARE and Web of Science databases was carried out. The included articles were concurrently thematically and content analysed using SEBA’s Split Approach. Similarities in the identified themes and categories were combined in the Jigsaw Perspective and compared with the tabulated summaries of included articles in the Funnelling Process to create the domains that will guide discussions. Results The research team retrieved 5512 abstracts, reviewed 304 full-text articles and included 101 articles. The domains identified were characteristics, indications, frameworks, domains, enablers and barriers and unique features of remediation in licenced physicians in training programs. Conclusion Building upon our findings and guided by Hauer et al. approach to remediation and Taylor and Hamdy’s Multi-theories Model, we proffer a theoretically grounded 7-stage evidence-based remediation framework to enhance understanding of remediation in licenced physicians in training programs. We believe this framework can guide program design and reframe remediation’s role as an integral part of training programs and a source of support and professional, academic, research, interprofessional and personal development.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Post graduate remediation programs in medicine: a scoping review

et al. 2022

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“…Previous studies have suggested that risk factors in healthcare settings are multifactorial and interdependent. 2 Therefore, adopting an organizational or system theory might advance the understanding of related topics. 40 The present study is not exempt from limitations.…”

Section: Discussionmentioning

confidence: 99%

Understanding Risk Factors for Complaints Against Pharmacists: A Content Analysis

Wang,

Ram,

Scahill

2024

J Patient Saf

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Objectives Pharmacists constitute a crucial component of the healthcare system, significantly influencing the provision of medication services and ensuring patient safety. This study aims to understand the characteristics and risk factors for complaints against pharmacists through Health and Disability Commissioner (HDC) published decisions. Methods This study adopts a retrospective, qualitative approach. An inductive content analysis technique was used to analyze 37 complaints against pharmacists published decisions from the New Zealand Health and Disability Commissioner website to investigate a range of underlying risk factors contributing to the occurrence of complaints against pharmacists. Results A set of 20 categories of risk factors emerged through the content analysis and were subsequently grouped into five overarching themes: pharmacist individual factors, organizational factors, system factors, medication-specific factors, and external environmental factors. Conclusions The findings of this study provide valuable insights that expand the understanding of risk management in pharmacist practice, serving as a valuable resource for regulatory bodies, policymakers, educators, and practitioners. It is recommended not only to focus solely on individual pharmacists but also to consider integrating their environment and individual behaviors to proactively address situations prone to errors and subsequent complaints.

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“…One conservative case-based model estimated a $4.6 billion each year in added health care cost from burnout related to physician turnover and reduced clinical hours 5 . Additional consequences of physician burnout include medical errors, staff turnover, and decreased patient satisfaction 6,7 …”

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confidence: 99%

“…5 Additional consequences of physician burnout include medical errors, staff turnover, and decreased patient satisfaction. 6,7 Many contributing factors to burnout have been identified, with 80% categorized as system-related, such as loss of autonomy, use of an electronic health record, and excessive workload, the latter related to increased time on patient-related tasks and administrative work outside of clinical hours. [8][9][10][11] Additional factors contributing to burnout include longer hours at work and more nights on call.…”

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confidence: 99%

Burnout Among US Gastroenterologists and Fellows in Training

Anderson

Bilal

Burke

et al. 2022

Journal of Clinical Gastroenterology

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Background: Consequences of physician burnout include medical errors, higher rate of staff turnover, and decreased patient satisfaction. We examined the prevalence of burnout and identified the contributing factors in gastroenterologists and fellows in training. Methods: We performed 3 separate surveys through the American College of Gastroenterology. (1) A national survey of practicing gastroenterologists in the United States that measured burnout and contributing factors, (2) a survey of gastroenterology fellows in training to determine self-identified burnout, as well as mitigating and exacerbating factors, and (3) a follow-up survey of fellows during the COVID-19 pandemic. Results: One thousand and twenty-one persons responded (9.2% response rate) to the first survey, including 756 individuals who completed the Maslach Burnout Inventory survey. Overall, the prevalence of high burnout was 49.3%. Factors associated with high burnout included female sex, younger age, shorter duration in practice, considering the electronic health record non–user-friendly, 2 or more hours of patient-related work at home per day, 8 or more hours of outpatient time per day, 6 or more inpatient consults per day, taking call with procedures 10 or more times per year, and having children at home. With regard to lifestyle factors, taking 20 days or more of vacation time was associated with a lower rate of burnout. The level of burnout for fellows was observed to be high (42.7% in survey 2 and 35.3% in survey 3). Conclusions: Burnout is high in gastroenterologists and fellows in training. Specific contributing factors were both systems based and personal and provide insight into changes that can be made to address burnout.

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Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims or impaired performance

Cited by 20 publications

References 72 publications

Post graduate remediation programs in medicine: a scoping review

Post graduate remediation programs in medicine: a scoping review

Understanding Risk Factors for Complaints Against Pharmacists: A Content Analysis

Burnout Among US Gastroenterologists and Fellows in Training

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