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In this case study, we aimed to investigate residents’ agency through their participation in the development of their residential area in the city of Espoo, Finland. With the aid of seven themes, we identified by thematic analysis five types of residents in terms of agency: free floaters, home troops and helpers, representative information brokers, informed reviewers, and change agents. Relational agency, rooted from the cultural-historical activity theory, necessitated recognizing the available resources, understanding the motives of others, and collaborating in joint activities. The results of 30 interviews showed that residents are willing to participate, and they need space and structure to exploit their relational agency in order to build common interests in their neighbourhood. The findings are discussed with reference to the potential of residents’ agency while participating in neighbourhood governance and volunteering. Our study contributes to the understanding of residents’ relational agency in community development and in volunteering.
The characterization of ionizing radiation as a human carcinogen affecting most organs was a major achievement in epidemiological studies. Although high-dose or high-dose rate radiation effects are well established, the health impacts of low-dose or low-dose rate exposure (<100 mSv) remain controversial, which brings significant social attention and scientific inquiry. This paper outlined the current status and future plans of radiation epidemiology in Korea, focusing on research developments based on legal grounds, including the Korean Radiation Workers Study (KRWS) and epidemiological studies of aircrews and residents near nuclear facilities. The KRWS encompasses a large cohort of approximately 200 000 current and retired radiation workers, integrating individual dose data collected since 1984 with national health datasets to assess cancer and non-cancer risks. Initial findings showed a decrease in overall cancer incidence among workers compared to the general population, though thyroid cancer rates were higher, possibly due to increased screening. In 2023, new studies on aircrews and residents near nuclear facilities began, including systematic reviews and meta-analyses of existing studies, as well as ecological analyses of regional cancer risks. Despite challenges in low-dose research, these large-scale Korean studies using comprehensive national health data are expected to provide scientific evidence on the effects of low-dose radiation and address public concerns about radiation exposure.
The necessary staffing for an observation unit including physicians, advanced practice practitioners (APPs), residents, and support staff with the need for appropriate consultants and the design/set up needed for optimal functioning of the unit is discussed.
Persistence in physician-scientist careers has been suboptimal, particularly among women. There is a gender gap in self-confidence in medicine. We measured the impact of our physician-scientist training programs on trainee’s confidence in professional, personal, and scientific competencies, using a survey measuring self-rated confidence in 36 competencies across two timepoints.
Methods:
Results were analyzed for the full survey and for thematic subscales identified through exploratory factor analysis (EFA). A mixed effects linear model and a difference in differences (DID) design were used to assess the differential impact of the programing by gender and career level.
Results:
Analysis included 100 MD-PhD or MD-only medical student or resident/fellow trainees enrolled between 2020 and 2023. Five subscales were identified through EFA; career sustainability, science productivity, grant management, goal setting, and goal alignment (Cronbach’s alpha 0.85–0.94). Overall, mean scores increased significantly for all five subscales. Women significantly increased their confidence levels in all five areas, whereas men increased only in science productivity and grant management. Mixed effects models showed significant increases over time for women compared to men in career sustainability and goal alignment. Residents and fellows had greater increases than medical students across all subscales.
Conclusion:
Physician-scientist trainees fellows increased their confidence in personal, professional, and scientific skills during training. Training had a greater impact on women than men in building confidence in sustaining careers and aligning their goals with professional and institutional priorities. The magnitude of increased confidence among residents and fellows exceeded that in medical students.
The restrictive measures taken by nursing homes during the COVID-19 outbreak in 2020 (e.g., quarantine) may have been important stressors for which residents needed resilience to safeguard their well-being. Based on 30 semi-structured interviews with nursing home residents and close relatives, this study explored the lived experiences with respect to the restrictive measures. The data were collected in psychogeriatric, somatic, and mixed wards in The Netherlands and Flanders, Belgium. The restrictive measures were important stressors for residents, indicated by feelings of loneliness, sadness, and powerlessness. To deal with these measures, residents used various resources, which were determined by factors in the individual (e.g., health), interactional (e.g., possibilities for social interactions) and contextual (e.g. nursing home policy) domains. Because the lived experiences with respect to the restrictive measures seemed to relate to the resilience of nursing home residents, it is crucial to reinforce resources in the individual, interactional, and contextual domains.
Psychiatry residency training is a stressful transitional period for young doctors who are faced with challenging patients, increased clinical responsibility coupled with lack of clinical experience, and on-call obligations, leaving them at high risk of burnout.
Objectives
To assess the frequency of burnout among psychiatric trainees, and to identify factors associated with severe burnout.
Methods
A cross-sectional study was conducted through an online survey among psychiatry residents working in Tunisian hospitals. Participants completed an anonymous self-administered questionnaire and the Maslach Burnout Inventory (MBI) to assess burnout.
Results
Forty residents completed the survey. The average age was 28.08 ± 2.433. The majority of the participants (87.5%) were females, 27.5% were married and 17.5% had kids. One fifth of the residents were smokers, 22.5 % used alcohol and 5% used cannabis. History of psychiatric disorder was reported by 35% of the participants (depression 15%, anxiety 17.5%, bipolar disorder 2.5%). Half of participants were first year residents and 75% had psychiatry as their first-choice specialty. The majority (72.5%) declared working in poor conditions. Overall, 37.5% of the participants met the criteria for severe burnout. Female gender and poor conditions of the workplace were significantly associated with burnout symptoms (p=0.007 and p=0.014 respectively).
Conclusions
Attention to burnout during residency is important, given the potential to implement preventive and management strategies on time for physicians’ to promote wellness and avoid severe consequences.
Preventing burnout and promoting resilience are important to the well-being of health care professionals and the quality of patient care. Indeed, it’s a promising way to mitigate the negative effects of stressors and allow professional growth.
Objectives
study the association between job satisfaction and resilience in medical interns and residents.
Methods
As part of a descriptive and analytical cross-sectional study, interns and medical residents completed an online self-questionnaire using ’Google Forms’. It collected socio-demographic data and assessed the level of job satisfaction using a 5-point Likert-type scale for each item. The Brief Resilience Scale (BRS) was used to assess the level of resilience.
Results
The total number of participants was 56, of which 64.3% were medical residents.75% of the participants worked in a medical department and most had a number of shifts per month ≥4. The average years of practice was 2.27±1.23 years. Participants expressed dissatisfaction at work with salary (69.6%), task allocation and organization (66.1%), availability of resources (66.1%), comfort (57.1%), safety (53.6%) and supervision (50%). Referring to the BRS scale, higher resilience scores were objectified in male participants (p=0.002). The level of resilience decreased with the number of years of practice (p=0.039). Good satisfaction by management and recognition at work could enhance the level of resilience (p=0.029 and p=0.043 respectively).
Conclusions
The results of our study suggest that dissatisfaction with work-related aspects may influence the level of resilience. These results deserve special attention to improve job satisfaction and preserve resilience.
Emigration is the act of leaving one’s country of nationality or habitual residence to settle in another nation. In Tunisia, this phenomenon is increasing in particular for doctors.
Objectives
Evaluating the intentionality of emigration among interns and medical residents in Tunisia while studying the factors related to it.
Methods
We conducted a cross-sectional, descriptive and analytical study of interns and medical residents who participated in our study through the social network ’Facebook’ by an anonymous self-questionnaire. The level of satisfaction with the different aspects of life were assessed by a 5-point Likert scale, from “not at all satisfied” to “very satisfied”.
Results
The total number of participants was 56 of which 64.3% were medical residents. More than 50% of the participants expressed dissatisfaction with the distribution of tasks and organization of work (66.1%), safety at work (53.6%), comfort (57.2%), time allocated to personal life (53.6%) and salary (69.6%). The political, health and educational situation in the country was considered unsatisfactory by the majority of participants (90% to 95%). Among our participants, 44.6% regretted having chosen the profession of medicine and 53.6% had plans to immigrate to work abroad. The intentionality of immigration was significantly higher among men (p=0.02), those with siblings abroad (p=0.047) and those without dependent relatives (p=0.040).
Conclusions
Young physicians are strongly looking for emigration. This decision could emanate from professional, personal and political factors. Further studies seem to be necessary to explain this emigration phenomenon.
To assess the level of neonatal intensive care unit (NICU) disaster preparedness among pediatric residents.
Methods:
A mixed-methods study including qualitative interviews and quantitative surveys was used. Interviews guided survey development. Surveys were distributed to residents who rotated through Children’s National NICU. Questions assessed residents’ background in disaster preparedness, disaster protocol knowledge, NICU preparedness, roles during surge and evacuation, and views on training and education.
Results:
Survey response was 62.5% (n = 80) with 51.3% of invited residents completing it. Pediatric residents (PGY-2 and PGY-3) (n = 41) had low levels of individual disaster preparedness, particularly evacuations (86%). None were aware of specific NICU disaster protocols. Patient acuity, role ambiguity, knowledge, and training deficits were major contributors to unpreparedness. Residents viewed their role as system facilitators (eg, performing duties assigned, recruiting other residents, and clerical work like documentation). Resident training requests included disaster preparedness training every NICU rotation (48%) using multidisciplinary simulations (66%), role definition (56%), and written protocols (50%). Despite their unpreparedness, residents (84%) were willing to respond.
Conclusion:
Pediatric residents lacked knowledge of NICU disaster response but were willing to respond to disasters. Training should include multi-disciplinary simulations that can be refined iteratively to clarify roles, and residents should be involved in planning and execution.
Important changes have been done in economic status of residents in 2018. The impact of these measures in changing opinion was checked.
Objectives
The prioritization exercises of main factors related with psychiatric residents’ decision to emigrate could be a starting point of elaboration of a strategy of reforms.
Methods
The study was cross sectional evaluation at national level on a randomized selected sample of Romanian psychiatric residents’ opinion on factors which influence decision of migration in EU countries in two time points: 2015 and 2020.
Results
38% of residents intend to work abroad comparing with 78% before the economic changes (25.84% versus 71.66% for a limited period of time and 15.73% versus 28.33% intend to emigrate) and 2% versus 5% intend to leave the speciality. The most important factors for decision to emigrate changed from “Better working conditions” (15.73 versus 37.31% residents) to “Better training” 20.25% residents and the factor “respect and appreciation by colleagues” remained important for 19.10% versus 17.91%. “Lack of working place for partner” was considered by 26.96% of responders as an important disadvantage of working abroad. “Being far from family members” which was considered 5 years ago by 64.18% of responders as an important disadvantage of working abroad, nowadays concerns only 6.74%, probably because it seems easier to go abroad together with the family members.
Conclusions
The factors (better training in psychiatry and psychotherapy, better supervision, more involvement in research) which influence the residents’ decision to emigrate represent the starting points on futures reforms in educational and medical system in psychiatry.
Residents of care homes across the globe are affected by the spread of SARS-CoV-2 as they have been identified as a high-risk group and because they experienced strict social isolation regulations during the first wave of the pandemic. Social isolation of older people with poor physical and mental health is strongly associated with mental health problems and decreased life expectancy. Other research has shown that older people managed to adapt to the changes brought about by the pandemic and have linked this to the concept of resilience. The aim of this research project was to investigate how this applied to residents in care home settings during the first phases of the contact ban in Germany from sociology, developmental psychology and environmental gerontology perspectives, and to gain in-depth understanding of residents’ experiences. This paper draws on structured interview data collected from residents in two care homes during early June 2020 in Frankfurt am Main, Germany. The findings show that their experiences were shaped by three factors: care home settings and the approach of staff to handling the contact ban; biographical sense of resilience; and a hierarchy of life issues. The findings highlight the importance of locally specific response mechanisms in care homes, agency and belonging of residents despite health-related limitations and the importance of a critical (gendered) lens on understanding their experiences.
The overall aim of this grounded theory study was to explore the context of a nursing home as ‘home’ from the perspective of residents and staff. Sixteen focus group interviews were used to collect qualitative data from nursing home residents (N = 48) and staff (N = 44). Five distinct categories captured the views and experiences of participating residents and staff. These were: (a) Starting off on the right foot, ‘First impressions can be the lasting ones; (b) Making new and maintaining existing connections, ‘There is great unity between staff and residents’; (c) The nursing home as home, ‘It's a bit like home from home for me’; (d) Intuitive knowing, ‘I don't even have to speak, she just knows’; and (e) Feeling at home in a regulated environment, ‘It takes the home away from nursing home’. Together these five categories formed the basis of the core category ‘Knowing me, knowing you’, which captures the experiences of participants who repeatedly highlighted the importance of relationships and feelings of mutuality and respect between and among staff and residents as central to feeling at home in a nursing home. The reciprocity and mutuality associated with the core category, ‘Knowing me, knowing you’, was at times challenged by staff shortages, time constraints, and conflicting priorities associated with the co-existence of a regulated and homely environment.
Arguments about the ownership of natural resources have focused on the claims of cosmopolitans, who urge an equality of global claims to resources, and resource sovereigntists, who argue that national peoples are the proper owners of their resources. This focus is mistaken: Whatever one believes about the in-principle claims of the global community, there remains the practical question of how the national surplus is to be distributed. And in addressing this question, we must look at a distinction heretofore ignored in resource discussions—that between resident workers and citizens. I argue that the extracted value of natural resources should benefit all residents of the states in which they are found, not merely all citizens. By contrast, control of natural resources should be vested in a democratic citizenry, who are nonetheless normatively constrained by the distributive principle described above. I illustrate the argument with data showing the gap, especially in the Gulf States, between principles that allocate benefits to all citizens vs. to all resident workers. My argument is grounded in a broader theory of collective agency as it applies to questions of distributive justice, and it is aimed not only to criticize practices in the Gulf but to support the more inclusive resource policies found in democracies.
Cricothyrotomy is an intervention performed to salvage “can't intubate, can't ventilate” situations. Studies have shown poor accuracy with landmarking the cricothyroid membrane, particularly in female patients by surgeons and anesthesiologists. This study examines the perceived versus actual success rate of landmarking the cricothyroid membrane by resident and staff emergency physicians using obese and non-obese models.
Methods
Five male and female volunteers were models. Each model was placed supine, and a point-of-care ultrasound expert landmarked the borders of each cricothyroid membrane; 20 residents and 15 staff emergency physicians were given one attempt to landmark five models. Overall accuracy and accuracy stratified by sex and obesity status were calculated.
Results
Overall landmarking accuracy amongst all participants was 58% (SD 18%). A difference in accuracy was found for obese males (88%) versus obese females (40%) (difference = 48%, 95% CI = 30–65%, p < 0.0001), and non-obese males (77%) versus non-obese females (46%) (difference = 31%, 95% CI = 12–51%, p = 0.004). There was no association between perceived difficulty and success (correlation = 0.07, 95% CI = −0.081–0.214, p = 0.37). Confidence levels overall were higher amongst staff physicians (3.0) than residents (2.7) (difference = 0.3, 95% CI = 0.1–0.6, p = 0.02), but there was no correlation between confidence in an attempt and its success (p = 0.33).
Conclusion
We found that physicians demonstrate significantly lower accuracy when landmarking cricothyroid membranes of females. Emergency physicians were unable to predict their own accuracy while landmarking, which can potentially lead to increased failed attempts and a longer time to secure the airway. Improved training techniques may reduce failed attempts and improve the time to secure the airway.
Autonomy is important in every stage of life. However, little is known about how autonomy is enhanced for older adults living in residential care facilities (RCFs). This leads to the research question: which facilitators and barriers to autonomy of older adults with physical impairments due to ageing and chronic health conditions living in RCFs are known? The results will be organised according to the framework of person-centred practice, because this is related to autonomy enhancement. To answer the research question, a systematic literature search and review was performed in the electronic databases CINAHL, PsycINFO, PubMed, Social Services Abstracts and Sociological Abstracts. Inclusion and exclusion criteria were derived from the research question. Selected articles were analysed and assessed on quality using the Mixed Methods Appraisal Tool. Facilitators and barriers for autonomy were found and arranged in four themes: characteristics of residents, prerequisites of professional care-givers, care processes between resident and care-giver, and environment of care. The established facilitators and barriers are relational and dynamic. For a better understanding of the facilitators and barriers to autonomy for older adults with physical impairments living in RCFs, a description is based on the 35 included articles. Autonomy is a capacity to influence the environment and make decisions irrespective of having executional autonomy, to live the kind of life someone desires to live in the face of diminishing social, physical and/or cognitive resources and dependency, and it develops in relationships. The results provide an actual overview and lead to a better understanding of barriers and facilitators for the autonomy of older adults with physical impairments in RCFs. For both residents and care-givers, results offer possibilities to sustain and reinforce autonomy. Scientifically, the study creates new knowledge on factors that influence autonomy, which can be used to enhance autonomy.
Introduction: In recent years, there has been growing interest in the field of physician wellness and burnout. Past research has shown that the prevalence of burnout is non-uniform between specialties and is most prevalent amongst emergency medicine physicians. Additionally, burnout can be observed amongst individuals early in their medical careers, including medical students and residents. To date, there is no national perspective of burnout amongst Canadian Royal College of Emergency Medicine (EM) residents. Our study looks to provide a national survey of burnout in this population as well as characterize mentorship programs at training sites. Methods: An anonymous electronic survey was e-mailed to Canadian EM residents via local program directors. Characteristics of mentor-mentee relationships and quality of residents’ mentorship experiences were assessed on a 6-point Likert scale. The Maslach Burnout Inventory – Human Services Survey (MBI-HSS) for medical personnel was used to assess burnout on three dimensions (emotional exhaustion, depersonalization and personal accomplishment). Burnout was dichotomized as present or absent if the MBI criteria are met (emotional exhaustion score > 26 or depersonalization score > 9 or personal accomplishment <34). Results: To date, 52 responses have been collected. Respondents are primarily male (63%) and in their PGY year 1-3 (71%). Responses were collected from 6/14 (43%) of eligible programs. 84% of residents currently had an emergency medicine mentor. Of these, 8% were dissatisfied with their residency's mentorship program and 55% were satisfied/very satisfied. 72% of residents met the threshold for burnout in at least one dimension of the MBI (3 dimensions = 17%; 2 dimensions = 17%; 1 dimension = 38%) and 13% cited considering suicide during their training. Conclusion: Results thus far suggest significant burnout amongst Royal College of Emergency Medicine residents. Alarmingly, 13% of responders cited having contemplated suicide during their training. These results point to an important opportunity to better support EM residents during their training to improve wellness and reduce burnout. Our findings suggest a high prevalence of residents with established mentors and future analyses will examine the correlation between mentorship characteristics and resident burnout levels.
To quantify the effect of family medicine resident physicians on emergency department (ED) wait times and patients leaving without being seen or treated.
Methods
In a medium-volume community ED over twelve months, we used retrospective chart review to compare wait times between patients seen during shifts where staff were working alone versus with a resident. We measured the time from initial triage time to physician initial assessment (T1) and disposition time (LOS), and number of patients leaving without being seen or treated.
Results
In our analysis, 21,141 patients (91% of total visits) were included; 48% were in the staff-with-resident group, and 52% were in the staff-only group. Mean T1 in the resident group was significantly shorter than the staff-only group (1 hour 23 minutes versus 1 hour 38 minutes, difference 15 minutes, 95% CI 13 to 17 minutes, p<0.001). Mean total LOS in the resident group was also reduced (2 hours 38 minutes versus 2 hours 50 minutes, difference 12 minutes, 95% CI 8 to 17 minutes, p<0.001). Fewer patients left without being seen in the resident group than the staff only group (2.8% versus 4.9%, p<0.001). There were no differences in patients leaving without being treated (0.5% versus 0.5%).
Conclusions
This is the first study to demonstrate that residents are associated with a reduction in ED wait times and patients leaving without being seen in a low-acuity, community hospital, compared to previous studies demonstrating no difference or increased wait times.