[THE PREFERENCES OF DIFFERENT INSTRUCTION METHODS FOR RISK AND SAFETY MANAGEMENT IN RELATION TO MEDICAL PROFESSION AND SENIORITY].

INTRODUCTION: Adult post-graduate teaching is always a challenging and sometimes a frustrating task. Since teaching risk management has to do with adult learning and changing personal and organizational culture and attitudes - the quest for an effective learning method is important and challenging. AIMS: In this study we examined the preferences of doctors from different medical professions in order to find out if there are any differences among doctors from different professions, since we assume that preferring a certain learning strategy has an impact on the effectivity of learning. METHODS: Participants in the study were randomly divided into three groups of learners - one group participated in a lecture, another group participated in a workshop instruction activity and the third group had an e-learning session. All participants completed questionnaires prior to the learning activity, right after the learning session and two weeks and three months after the learning activity. RESULTS: Our findings show that there are differences in the preferences of instruction methods in relation to the medical profession and seniority. E-learning was preferred by senior doctors and was the most effective in knowledge gain and the fastest in knowledge loss. CONCLUSIONS: The risk management learning method should be "tailor-made" to the learner's preferences and adjusted in accordance to their medical profession and seniority. DISCUSSION: Instruction is an important part of risk management in medicine and has to do with adult learning. In order to achieve effective learning the teaching should be adjusted to the learner's profession and seniority.

Cultivating Psychological Resilience of Israeli Medical Directors of COVID-19 Divisions: The Dynamic Spheres of Salutogenics.

Purpose: There are a few qualitative studies on the psychological resilience of COVID-19 medical directors upon outbreaks of pandemics. Psychological resilience is essential to providing quality care through the pandemic. Materials and Methods: We conducted narrative interviews with 14 out of 21 medical directors of COVID-19 divisions in Israeli public hospitals upon the outbreak of the pandemic and through its first wave. We adopted the Salutogenic paradigm to identify personal and organizational resources that both deterred and promoted resilience of front-line medical directors. Thematic analysis was performed based on the Sense of coherence construct, an anchor of Salutogenics. Results: Low comprehensibility was compensated by ethical boundaries and managerial experience. A few organizational and personal resources promoted manageability. The hospital management both deterred and promoted resilience. In contrast to Salutogenics theory, meaningfulness was driven by the occupational calling rather than by comprehensibility and manageability. Gaps in personal resources inhibited resilience. Conclusions: Our study adds to the scant qualitative research performed upon the outbreak of the pandemic and extends the Salutogenic paradigm suggesting that the three axes of sense of coherence are multi-layered, intertwined, and evolving. We introduce the dynamic spheres model that we adopted from Physics to illustrate the findings. We propose interventions to build resilience in front-line medical directors.

Are doctors risk takers?

OBJECTIVE: Risk taking affects human behavior in general and decisions in medicine in particular. We used game theory to assess physicians' risk-taking tendencies. METHODS: Physicians were recruited to the study by advertisement. It was explained that they would receive a sum of money for correct prediction of the flipping of a coin. They could try to sell their opportunity to flip the coin for an amount of money they determined. The sum offered by the participants was considered an indicator of risk taking. A demographic questionnaire assessed age, sex, seniority, and area of specialization of the participants. A multivariate analysis assessed associations between risk-taking behavior and, seniority, and specialization. RESULTS: Sixty-two physicians participated, 36 males and 26 females, seniority 1-34 years. Of a possible range of 0-10, the mean score for risk taking was 5.5 - just slightly more than indifference. Negative correlations were found between risk taking and seniority, and between risk taking and age (ß =-0.45, P<0.001 for both). Surgeons and anesthesiologists showed greater risk taking than did other physicians (ß =0.69, P<0.05); and females less than males, though the latter correlation was not statistically significant. CONCLUSION: Understanding the tendency of physicians to risk taking may elucidate their decision-making processes and contribute to understanding of causes of adverse events and to the education of physicians.

The importance of side marking in preventing surgical site errors.

BACKGROUND: Wrong site confusions are among the most common mistakes in operations of twosome organs. PURPOSE: To examine the frequency of wrong sided confusions that could theoretically occur in various surgeries in the absence of preoperative verification. METHODS: Ten cataract surgeons, twelve orthopedic surgeons and 6 ENT surgeons participated in the study. The surgeons were asked to fill a questionnaire that included their demographic data, occupational habits and their approach to and handling of patients preoperatively. On the day of operation the surgeons were asked to recognize the side of the operation from the patient's name only. At the second stage of the study, surgeons were asked to recognize the side of the operation while standing a two meter distance from the patient's face. Surgeons' answers were compared to the actual operation side. Patients then underwent a full "time out" procedure, which included side marking before the operation. RESULTS: Of a total of 67 ophthalmic patients, 52 orthopedic patients and 26 ENT patients the surgeons correctly identified the operated side in 111 (76.5%) by name and in 126 (87%) by looking at patients' faces. Wrong side identification correlated with the time lapsed from the last preoperative examination (p = 0.034). The number of cataract surgeries performed by the same surgeon (on the same day) also correlated to the number of wrong identifications (p = 0.001) in ophthalmology. Orthopedic surgeons were more accurate in identifying the operated site Surgeon seniority or age did not correlate to the number of wrong identifications. CONCLUSIONS: This study illustrates the high error that can result in the absence of side marking prior to cataract surgery, as well as in operations on other twosome organs.

"It is the left eye, right?".

OBJECTIVE: Because wrong-site confusion is among the most common mistakes in the operations of paired organs, we have examined the frequency of wrong-sided confusions that could theoretically occur in cataract surgeries in the absence of preoperative verification. METHODS: Ten cataract surgeons participated in the study. The surgeons were asked to complete a questionnaire that included their demographic data, occupational habits, and their approach to and the handling of patients preoperatively. On the day of operation, the surgeons were asked to recognize the side of the operation from the patient's name only. At the second stage of the study, surgeons were asked to recognize the side of the operation while standing a 2-meter distance from the patient's face. The surgeons' answers were compared to the actual operation side. Patients then underwent a full time-out procedure, which included side marking before the operation. RESULTS: Of the total 67 patients, the surgeons correctly identified the operated side of the eye in 49 (73%) by name and in 56 (83%) by looking at patients' faces. Wrong-side identification correlated with the time lapsed from the last preoperative examination (P=0.034). The number of cataract surgeries performed by the same surgeon (on the same day) also correlated to the number of wrong identifications (P=0.000). Surgeon seniority or age did not correlate to the number of wrong identifications. CONCLUSION: This study illustrates the high error rate that can result in the absence of side marking prior to cataract surgery, as well as in operations on other paired organs.