Monitoring real-time junior doctor sentiment from comments on a public social media platform: a retrospective observational study.

OBJECTIVES: To investigate whether sentiment analysis and topic modelling can be used to monitor the sentiment and opinions of junior doctors. DESIGN: Retrospective observational study based on comments on a social media website. SETTING: Every publicly available comment in r/JuniorDoctorsUK on Reddit from 1 January 2018 to 31 December 2021. PARTICIPANTS: 7707 Reddit users who commented in the r/JuniorDoctorsUK subreddit. MAIN OUTCOME MEASURE: Sentiment (scored -1 to +1) of comments compared with results of surveys conducted by the General Medical Council. RESULTS: Average comment sentiment was positive but varied significantly during the study period. Fourteen topics of discussion were identified, each associated with a different pattern of sentiment. The topic with the highest proportion of negative comments was the role of a doctor (38%), and the topic with the most positive sentiment was hospital reviews (72%). CONCLUSION: Some topics discussed in social media are comparable to those queried in traditional questionnaires, whereas other topics are distinctive and offer insight into what themes junior doctors care about. Events during the coronavirus pandemic may explain the sentiment trends in the junior doctor community. Natural language processing shows significant potential in generating insights into junior doctors' opinions and sentiment.

Physical and psychological health of medical students involved in the coronavirus disease 2019 response in Switzerland.

Students involved in the COVID-19 response reported a similar proportion of COVID-19 symptoms or confirmed diagnoses, but lower levels of anxiety, depression and burnout compared with their non-involved peers.

The educational and psychological impact of the COVID-19 pandemic on medical students: A descriptive survey at the American University of Beirut.

ABSTRACT: The SARS- CoV-2 virus has been a public health crisis since its emergence in 2019. It has affected nearly all aspects of life. Education has been particularly hit, and a lot of effort has been put to implement more and more virtual platforms through online classes, meetings and conferences. Medical education has also been affected, especially because of the need for hands-on education, specifically in the clinical setting of the last 2 years. This had a huge psychological impact on the medical students currently enrolled in medical schools around the globe.In this descriptive study, we sent all medical students at the American University of Beirut Faculty of Medicine (AUBFM) an online anonymous survey by email. The survey started with general questions (age, gender and medical school year), followed by 3 sections that contain questions pertaining to the attitudes of medical students towards clinical rotations and online classes. Data was then analyzed using SPSSv24 and was then reported as percentages.Students were almost equally divided among the medical school classes (Med 1, 2, 3, and 4). The majority of clinical students (Med 3 and Med 4) reported that they feel nervous during their rotations in the hospital. Moreover, they reported that they have increased their use of disinfectants and personal protective equipment since the emergence of the pandemic. Moreover, the majority of medical students reported that they feel more stressed after shifting to online classes. Medical students also reported that they would be willing to go back to on-campus classes.This study aimed at describing the response of medical students at AUBFM to the COVID-19 pandemic in terms of stress. Limited data exists in the literature concerning the psychological impact of the COVID-19 pandemic on medical students in the middle East. Medical students reported that they feel more stressed and nervous during their clinical rotations and after the shift to online education, affecting their academic and social life. Further studies using a larger sample size are needed.

Qualitative study to explore UK medical students' and junior doctors' experiences of occupational stress and mental health during the COVID-19 pandemic.

OBJECTIVES: This qualitative study aimed to explore the occupational experiences of medical students and junior doctors working during the COVID-19 pandemic. In particular, the research sought to identify factors which mediated work stress, barriers to disclosing mental health problems and levels of support medical students and junior doctors received during the pandemic. DESIGN: This study was a form of thematic analysis and adopted an inductive, 'bottom-up' approach, in which coded categories were derived from rich, descriptive data. SETTING: Semistructured interviews were conducted online with UK-based medical students and junior doctors. Interviews were recorded, and analysis was done by coding salient quotes into themes. PARTICIPANTS: The final sample consisted of seven junior doctors and eight medical students, during the summer of 2021. RESULTS: High levels of occupational stress were identified, which were exacerbated by COVID-19. A number of organisational difficulties associated with the pandemic compounded participants' experiences of work stress. Participants recognised progress towards promoting and managing mental health within the profession but may still be reluctant to access support services. Barriers to disclosure included fear of stigmatisation, concerns about adding to colleagues' workloads, lack of clarity about career implications and mistrust of occupational health services. CONCLUSIONS: While attitudes towards mental health have improved, medical students and junior doctors may avoid seeking help. Given the immense pressures faced by health services, it is imperative that extra measures are implemented to minimise work-stress, encourage help-seeking behaviours and promote supportive work cultures.

Recommendations for improving the working conditions and cultures of distressed junior doctors, based on a qualitative study and stakeholder perspectives.

BACKGROUND: Doctors, including junior doctors, are vulnerable to greater levels of distress and mental health difficulties than the public. This is exacerbated by their working conditions and cultures. While this vulnerability has been known for many years, little action has been taken to protect and support junior doctors working in the NHS. As such, we present a series of recommendations from the perspective of junior doctors and other relevant stakeholders, designed to improve junior doctors' working conditions and, thus, their mental health. METHODS: We interviewed 36 junior doctors, asking them for recommendations for improving their working conditions and culture. Additionally, we held an online stakeholder meeting with a variety of healthcare professionals (including junior doctors), undergraduate medical school leads, postgraduate speciality school leads and NHS policymakers where we asked what could be done to improve junior doctors' working conditions. We combined interview data with notes from the stakeholder discussions to produce this set of recommendations. RESULTS: Junior doctor participants and stakeholders made organisational and interpersonal recommendations. Organisational recommendations include the need for more environmental, staff and educational resources as well as changes to rotas. Interpersonal recommendations include changes to communication and recommendations for better support and teamwork. CONCLUSION: We suggest that NHS policymakers, employers and managers consider and hopefully implement the recommendations set out by the study participants and stakeholders as reported in this paper and that the gold standards of practice which are reported here (such as examples of positive learning environments and supportive supervision) are showcased so that others can learn from them.

Successful implementation of round-the-clock care in a virtual ward during the COVID-19 pandemic.

The COVID-19 pandemic led to unprecedented demand on NHS infrastructure. Virtual wards (VW) were created in response, using technology to monitor patients remotely. Their implementation required new systems of staffing, escalation, risk management and information governance. The Norfolk and Norwich University Hospitals Foundation Trust offered an example of a highly successful VW. It cared for 852 patients in its first year of operation, providing 24/7 nursing cover, supported by pharmacists and junior doctors, daily consultant-led ward rounds and virtual visits. The remote care platform collected continuous vital sign observations and generated custom alarms. The care team triaged, then escalated to nurse-specialists or consultants as required. Patients reported increased confidence and relief at earlier discharge. Staff highlighted the benefits of working from home, even if isolating or shielding. Challenges included developing awareness of the new service, overcoming concerns around increased workload and transitioning from emergency to long-term funding. The ward subsequently expanded from COVID-19 to nine other use cases.

Preliminary Investigation of Shift, a Novel Smartphone App to Support Junior Doctors' Mental Health and Well-being: Examination of Symptom Progression, Usability, and Acceptability After 1 Month of Use.

BACKGROUND: Shift is a novel smartphone app for providing a digital-first mental health resource to junior doctors. It contains psychoeducational material, cognitive behavioral modules, guided mediations, information on common work stressors, and a section on help-seeking options for psychological problems through workplace and private avenues. OBJECTIVE: This study aimed to conduct a preliminary investigation of the use and potential effectiveness of Shift on depressive and anxiety symptoms (primary outcomes) and work and social functioning, COVID-19 safety concerns, and help seeking (secondary outcomes). This study also sought feedback on whether Shift was seen as an acceptable tool. METHODS: Junior doctors in New South Wales, Australia, were approached through promotional activities from the Ministry of Health, specialist medical colleges, and social media advertisements between June and August 2020. Consenting participants provided web-based baseline data, used the Shift app for 30 days, and were asked to complete a poststudy web-based questionnaire. Outcomes were analyzed under the intention-to-treat principle. RESULTS: A total of 222 female (n=156, 70.3%; mean age 29.2, SD 4.61 years) junior doctors provided full baseline data. Of these, 89.2% (198/222) downloaded the app, logged into the app approximately 6 times (mean 5.68, SD 7.51), completed 4 in-app activities (mean 3.77, SD 4.36), and spent a total of 1 hour on in-app activities (mean 52:23, SD 6:00:18) over 30 days. Postintervention and app use data were provided by 24.3% (54/222) of participants. Depressive and anxiety symptoms significantly decreased between the pre- and postassessment points as expected; however, physicians' COVID-19 safety concerns significantly increased. Work and social functioning, COVID-19 concerns for family and friends, and help seeking did not change significantly. There was no significant relationship between symptom changes and app use (number of log-ins, days between first and last log-in, and total activity time). Most poststudy completers (31/54, 57%) rated Shift highly or very highly. CONCLUSIONS: Despite high levels of nonresponse to the poststudy assessment and increases in COVID-19 safety concerns, junior doctors who used the app reported some improvements in depression and anxiety, which warrant further exploration in a robust manner.

The void: COVID-19 restrictions and junior doctor education opportunities.

BACKGROUND: In the setting of the COVID-19 pandemic, the modes of hospital service delivery, education, training, and the context surrounding them has undergone enormous change and disruptions. OBJECTIVE: This study aimed to understand the 'lived-experience' of junior doctors in relation to their education, training, and professional development during the pandemic. METHODS: A qualitative study based on thematic and cohort narrative analysis. 20 junior doctors who trained at an Australian tertiary paediatric hospital during the time of COVID-19 restrictions were interviewed. Based on a phenomenological approach, the interviews examined junior doctors' experiences in relation to medical education, adaptive education styles and the value attributed by participants to different forms of education provided to them. RESULTS: Four overarching themes were identified regarding trainee perceptions of the impact of COVID-19 restrictions on learning opportunities, both positive and negative. These were: 'The void' - learning expectations junior doctors felt were missed, education affordances, peers and networks, and professional identity. CONCLUSION: The pace with which educators have adapted to new teaching modes should be harnessed to incite equally novel curriculum evolution, smart investment in clinical moments, reconnect learning communities and create robust virtual learning environments.

How junior doctors perceive personalised yoga and group exercise in the management of occupational and traumatic stressors.

OBJECTIVES: Junior doctors are exposed to occupational and traumatic stressors, some of which are inherent to medicine. This can result in burnout, mental ill-health and suicide. Within a crossover pilot study comparing personalised, trauma-informed yoga to group-format exercise, qualitative interviews were conducted to understand the experience of junior doctors and whether such interventions were perceived to help manage these stressors. METHODS: Twenty-one doctors, 76% female, were order-randomised to consecutive 8-week yoga and exercise programmes. Fifty-two interviews were recorded before and after each programme. RESULTS: Many participants reported being time poor, sleep-affected, frequently stressed and occasionally in physical pain/distress. Major stressor themes were workplace incivility, death/human suffering and shift work with minimal support. Both interventions were acceptable for different reasons. Personalised yoga offered a therapeutic alliance, time to check-in and reduced anxiety/rumination. Group exercise provided energy and social connection. One participant found yoga beneficial following an acute workplace trauma: 'It was really eye opening how much I felt my body just needed to detox … I wouldn't have gone to a group fitness the next day … I just wanted to relax and breathe …We still had a big debrief which was great … (but) I almost felt like … I dealt with it physically and emotionally before going into it (P20).' CONCLUSION: Junior doctors found both interventions useful for stress management adjunctive to other organisational programmes though for different and complementary reasons, possibly related to delivery mode. Personalised, trauma-informed yoga provided a confidential therapeutic alliance whereas group exercise offered social connection.

During COVID-19, which is more effective in work accident prevention behavior of healthcare professionals: Safety awareness or fatalism perception?

BACKGROUND: As the pandemic process, COVID-19 has a serious occupational safety risk for healthcare professionals. Therefore, determining their health and safety perceptions and attitudes in the pandemic process is very important. This study aims to determine which is more effective in work accident prevention behavior: safety awareness and competencies of healthcare professionals or perception of fatalism. METHOD: For this purpose, a questionnaire was applied to 326 healthcare professionals. The questionnaire consists of four parts: (1) demographic information of the employees, (2) scale of preventing occupational accidents, (3) fatalism perception scale in occupational health and safety, and (4) security awareness and competency scale. Descriptive statistical methods, multiple regression and correlation analysis were used in the analysis of the data. RESULTS: It was determined that the participants' safety awareness and competencies were at the high level and their fatalism perceptions were at the low level. The average of the responses given by the participants to the scale of preventing work accidents was above the middle level. According to the study, the safety awareness and competencies of health workers were found to be about three times more effective on the behavior of preventing work accidents than the perception of fatalism. CONCLUSION: In conclusion, it is important to recommend managers to take the step to increase the safety awareness and competencies of those working in their institutions.

A Dispatch Screening Tool to Identify Patients at High Risk for COVID-19 in the Prehospital Setting.

INTRODUCTION: Emergency medical services (EMS) dispatchers have made efforts to determine whether patients are high risk for coronavirus disease 2019 (COVID-19) so that appropriate personal protective equipment (PPE) can be donned. A screening tool is valuable as the healthcare community balances protection of medical personnel and conservation of PPE. There is little existing literature on the efficacy of prehospital COVID-19 screening tools. The objective of this study was to determine the positive and negative predictive value of an emergency infectious disease surveillance tool for detecting COVID-19 patients and the impact of positive screening on PPE usage. METHODS: This study was a retrospective chart review of prehospital care reports and hospital electronic health records. We abstracted records for all 911 calls to an urban EMS from March 1-July 31, 2020 that had a documented positive screen for COVID-19 and/or had a positive COVID-19 test. The dispatch screen solicited information regarding travel, sick contacts, and high-risk symptoms. We reviewed charts to determine dispatch-screening results, the outcome of patients' COVID-19 testing, and documentation of crew fidelity to PPE guidelines. RESULTS: The sample size was 263. The rate of positive COVID-19 tests for all-comers in the state of Massachusetts was 2.0%. The dispatch screen had a sensitivity of 74.9% (confidence interval [CI], 69.21-80.03) and a specificity of 67.7% (CI, 66.91-68.50). The positive predictive value was 4.5% (CI, 4.17-4.80), and the negative predictive value was 99.3% (CI, 99.09-99.40). The most common symptom that triggered a positive screen was shortness of breath (51.5% of calls). The most common high-risk population identified was skilled nursing facility patients (19.5%), but most positive tests did not belong to a high-risk population (58.1%). The EMS personnel were documented as wearing full PPE for the patient in 55.7% of encounters, not wearing PPE in 8.0% of encounters, and not documented in 27.9% of encounters. CONCLUSION: This dispatch-screening questionnaire has a high negative predictive value but moderate sensitivity and therefore should be used with some caution to guide EMS crews in their PPE usage. Clinical judgment is still essential and may supersede screening status.

Improving the care of patients with COVID-19 with a medical student-run telemedicine clinic.

INTRODUCTION: In March 2020, the Dallas Fort Worth Metroplex experienced a surge in acute COVID-19 infections. At that time, no consistent protocols existed for follow-up of discharged patients with COVID-19 from the William P Clements Jr University Hospital at the University of Texas Southwestern Medical Center. Simultaneously, medical students were suspended from in-person clinical activities to limit viral spread. In response to these events, a telemedicine elective was created to provide timely and high-quality telehealth follow-up for recently discharged patients with COVID-19. METHODS: The pilot team, consisting of several second-year through fourth-year medical students, developed a call script that included warning signs and symptoms, Centers for Disease Control and Prevention (CDC) guidelines for isolation and primary care physician referral information. Patients with COVID-19 discharged from the emergency department (ED) and inpatient services were identified and assigned to student callers. All patients were discussed with an attending physician, who was available if an acute issue arose. The elective also included education on the SBAR (situation, background, assessment, and recommendation) handover technique, telehealth education, updated COVID-19 literature and CDC guidelines. RESULTS: Improvement was noted in students' ability to identify patients who required escalation of care, as seen by over 60% of patients who were advised to return to ED required hospital admission. Statistically significant improvement was observed in the students' degree of feeling informed about the current state of COVID-19 and their degree of comfort with interviewing patients over the phone. DISCUSSION: This elective provided quality virtual healthcare to patients with COVID-19 while allowing medical students to progress in their medical education and participate in patient care.

The workplace and psychosocial experiences of Australian junior doctors during the COVID-19 pandemic.

BACKGROUND: Junior doctors experience high levels of psychological distress and emotional exhaustion. The current Coronavirus disease 2019 (COVID-19) pandemic has resulted in significant changes to healthcare globally, with quantitative studies demonstrating increased fatigue, depression and burnout in junior doctors. However, there has been limited qualitative research to examine junior doctors' experiences, challenges and beliefs regarding management of future crises. AIMS: To investigate the workplace and psychosocial experiences of Australian junior doctors working during the second wave of the COVID-19 pandemic. METHODS: Australian healthcare workers were invited to participate in a nationwide, voluntary, anonymous, single time point, online survey between 27 August and 23 October 2020. A qualitative descriptive study of responses to four free-text questions from 621 junior doctors was undertaken, with responses analysed using inductive content analysis. RESULTS: Participants were predominantly female (73.2%), aged 31-40 years (48.0%) and most frequently reported working in medical specialties (48.4%), emergency medicine (21.7%) or intensive care medicine (11.4%). Most (51.9%) participants had 0-5 years of clinical experience since medical graduation. Junior doctors described experiences related to four key themes: a hierarchical, difficult workplace culture; challenging working conditions; disrupted training and career trajectories; and broader psychosocial impacts. The COVID-19 pandemic exacerbated longstanding, workplace issues and stressors for junior doctors and highlighted the threat that crises pose to medical workforce retention. There is an urgent need for authentic, positive workplace cultural interventions to engage, validate and empower junior doctors. CONCLUSIONS: Challenging workplace cultures and conditions, which have worsened during the COVID-19 pandemic, are associated with poor psychological well-being in junior doctors. There exists a need for long-term, widespread improvements in workplace culture and working conditions to ensure junior doctors' well-being, facilitate workforce retention and enhance the safety and quality of patient care in Australia.

Differential Impacts of the COVID-19 Pandemic on Mental Health Symptoms and Working Conditions for Senior and Junior Doctors in Australian Hospitals.

OBJECTIVE: This study investigated severity, prevalence, and predictors of workplace disruption and mental health symptoms in Australian junior and senior hospital medical staff during the COVID-19 pandemic. METHODS: A cross-sectional survey collected data on demographics, workplace disruption, personal relationships, and mental health. RESULTS: One thousand twenty-one (62.1%) senior and 745 (37.9%) junior medical staff, located primarily in Victoria, completed the survey. Work disruptions were common but varied by seniority, withjunior staff more frequently exposed to COVID- 19 (P < 0.001). Symptoms of anxiety, depression, post-traumatic stress disorder and burnout were common but significantly higher in junior doctors (P  = 0.011 to < 0.001). Common predictors for experiencing mental health symptoms were identified, including prior mental health diagnoses and worsening personal relationships. CONCLUSIONS: COVID-19 has had significant but varied impacts on junior and senior doctors, with junior doctors particularly susceptible to harm to mental health. Interventions to safeguard hospital medical staff and prevent attrition of this important workforce are urgently needed.

Assessment of anxiety level and sleep quality of medical staff treating patients with COVID-19.

OBJECTIVE: Worldwide transmission of the novel coronavirus (COVID-19) and related morbidity and mortality has presented a global challenge for several reasons. One such underrecognized and unaddressed aspect is the emotional health problems that medical staff have developed during this pandemic. The purpose of this one-month study was to examine anxiety levels and sleep quality of 100 medical staff members who worked in medical clinics treating COVID-19 patients in Saudi hospitals and to investigate the association of both anxiety levels and sleep quality with age, sex, and distinctive demographics. MATERIALS AND METHODS: We investigated anxiety levels and sleep quality of 100 medical staff members (age range 20-60 years) who worked in medical clinics treating COVID-19 patients in Saudi hospitals and the association of both anxiety levels and sleep quality with age, sex, and distinctive demographics. Anxiety levels and sleep quality were measured using the Self-Rating Anxiety Scale and the Pittsburgh Sleep Quality Index (SAS and PSQI, respectively). RESULTS: A significant increment in anxiety and poor sleep quality was found in medical staff caring for COVID-19 patients. Anxiety levels in females were higher than males; however, poor sleep quality was somewhat higher in males vs. females but did not vary between age groups. Age was significantly negatively correlated with anxiety symptoms; individuals < 40 years old vs. ≥ 40 had more significant anxiety levels. We observed that medical staff with top-level salaries demonstrated a significant correlation (p = 0.028) between poor sleep quality and ill effects vs. those who had lower pay rates. A correlation between income and anxiety was not found. CONCLUSIONS: The higher the probability and intensity of exposure to coronavirus patients, the more noteworthy the danger that medical staff will experience the ill effects of mental issues.