Symptoms of depression and anxiety and stress among postgraduate trainees in Sri Lanka: Risk factors and implications for practice.

High workload, long working hours, and the need to study and work simultaneously put postgraduate trainee doctors at a high risk of depression, anxiety, and stress. A cross-sectional descriptive study was conducted among all postgraduate trainees registered at the Postgraduate Institute of Medicine (PGIM), Sri Lanka, using the 21-item Depression Anxiety Stress Scale (DASS-21). Eleven-point two percent (11.2%) had depressive symptoms, 8.9% had anxiety symptoms, and 1.9% had high levels of stress. Being female, having a past or current mental illness, not being supported by the trainers, being unfairly treated by trainers, dissatisfaction with the work environment, difficulty in coping with long working hours, and poor peer support were significantly associated with symptoms of depression and anxiety, and stress (P < 0.01). Given the association between psychological distress and the characteristics of training and work environment, the postgraduate training programs should be reviewed to ensure the psychological well-being of trainees.

Analysing trends of Patient Safety Non-Technical Skills among postgraduate trainees through a modified survey tool.

Objective: To analyse practices of patient safety non-technical skills among postgraduate trainees to establish the utility of organised teaching programmes in this regard, and to determine the utilisation of different teaching modes. METHODS: The multicentre, two-phase, cross-sectional study was conducted from February to August 2020 at 27 teaching hospitals across Pakistan which were part of the Patient Safety Friendly Hospital Initiative by the World Health Organisation. The Hospital Survey on Patient Safety Culture was modified with validated additional survey items before using it to gather relevant data. Data was analysed using SPSS 21. RESULTS: In the first phase, 42 additional survey items were developed with content validity ratio >0.66 and item content validity index >0.83. Cronbach's alpha of the modified survey tool was 0.790. The second phase comprised 388 postgraduate trainees; 199(51.3%) males and 189(48.7%) females. Of them, 134(34.5%) were in the third year of training, 215(55.4%) fourth, and 39(10.1%) in the final year. Highest positive response was found for learning Teamwork 216(55.7%) and the lowest for Situational Awareness 62(15.9%). Leadership had highest good practice responses (subscales range: 77.6% to 76.6%) and Communication had the lowest (subscales range: 16.5% to 74.2%). Agreement on Informal Learning mode was the highest 268(69.1%) and the lowest was for Simulator Learning 63(16.2%). Besides, 274(70.6%) and 281(72.4%) subjects agreed on the supportive role of supervisors and hospital administrations. The correlation of the studied variables with the year of training was significant only for Teamwork (p=0.02) and Medication Safety skills (p=0.01). Conclusion: Modified Hospital Survey on Patient Safety Culture could be used as a benchmark for evaluating patient safety teachings and practices. Significance of patient safety non-technical skills was established with limited evidence for the utility of organised teaching programmes.

Burnout among surgeons; depression, anxiety and stress between consultant versus post-graduate trainee.

OBJECTIVE: To compare depression, anxiety and stress between consultant and post-graduate trainee (PG-trainee) surgeons and to find the difference of different factors i.e. gender, marital status, physical activity, BMI, comorbidity and Income per month between the two. METHODS: A descriptive cross-sectional study of eight months duration from March 2018 to August 2018 was conducted in Military Hospital and Combined Military Hospital, Rawalpindi, Pakistan. Convenient sampling technique was used. DASS 21 questionnaire was used for data collection. Data were entered and analysed by SPSS 22. A p-value of < 0.05 was considered statistically significant. RESULTS: The mean age of participants was 37.44±10.512 years. Out of 68 participants, 54 (79.4%) were males and 14 (20.6%) were females. There was a significant difference between the consultants and PG trainees in terms of gender, marital status and income per month (p= <0.005) PG-trainees were more depressed and anxious but not stressed as compared to consultants (p= 0.014, 0.012 and 0.280 respectively). CONCLUSIONS: There was a significant association in terms of gender, marital status and income per month between consultants and PG trainees. A statistically significant association was found between consultants and PG trainees concerning depression and anxiety showing PG trainees were more depressed and anxious.

Exploring the career maze: An investigation of career intentions of medical graduates in Pakistan: A qualitative study.

BACKGROUND & OBJECTIVES: Pakistan faces a number of challenges in medical education. While there is an increase in the number of medical schools across the country, there is a dearth of practicing doctors in rural areas as well as a shortage of specialists in various fields specially in surgical specialties. Similarly, the number of doctors migrating overseas is also increasing due to security concerns. This requires investigation of the factors that influence career intentions of medical graduates in Pakistan. As there is no validated instrument available within Pakistani context, this qualitative study was designed to examine medical graduates' reasons for their career intentions in light of Ajzen's Theory of Planned Behavior (TPB). METHODS: Five focus group discussions were conducted in two cities of Pakistan i.e. Karachi and Hyderabad during November - December 2012. These were then transcribed and were coded into the three primary attributes of TPB i.e. behavioral, normative and control beliefs by comparing similarities and differences. RESULTS: The results suggest that there is a variation in the factors that influence the career intentions of the medical students. In addition a number of new themes were identified which have not been reported earlier in studies elsewhere and are specific to this region. This needs further examination by stakeholders for intervention. CONCLUSION: The analysis of data from the focus groups confirms the theoretical framework and identifies a range of influencing factors, at different stages of education and practice. As the study was limited to a smaller number of graduates and all except one graduate wanted to continue practice, a larger sample may be required for the purpose of generalization of the findings reported in this study.

How postgraduate trainees from different health professions experience the learning climate within an operating theater: a mixed-methods study.

BACKGROUND: The learning climate within a learning environment is a key factor to determine the potential quality of learning. There are different groups of postgraduate trainees who study primarily in the operating theater (OT), which is a complex, high-stake environment. This study created and validated an interprofessional measure of the OT educational climate and explored how postgraduate trainees from different health professions experienced the learning climate within the operating theater. METHODS: An explanatory, sequential mixed-method design was used. The quantitative phase used and validated a newly developed questionnaire, the Operating Theater Educational Climate Test (OTECT), to evaluate the perceptions of anesthesia residents, surgical residents and student registered nurse anesthetists. In the qualitative phase, three mono-professional focus groups participants' opinions on the factors influencing their learning climate were explored. RESULTS: The OTECT questionnaire was found to be valid. The questionnaire response rate was 78.9% (142 respondents from 180). Questionnaire results indicated similar perceptions of the OT learning climate by learners from all disciplines. Focus groups revealed three major influencing factors on the experienced learning climate: 1) nature of work in the OT, 2) the role of the supervisor, and 3) the interprofessional dimension of work in the OT. CONCLUSIONS: The OT learning climate was perceived similarly by trainees from three health profession. The high stakes nature of the OT inhibited learning most as it impacted both trainees and supervisors. The results can be applied to improve the overall learning environment in the OT for all groups of learners.

Analysis Of Level Of Satisfaction Of Postgraduate Trainees On Surgical Floor.

BACKGROUND: Organizations flourish with a satisfied workforce. There is little known information on demographic characteristics and motivators for job satisfaction among Pakistani postgraduate trainees in surgery. Job satisfaction is predicted by intrinsic motivators (personal growth and perceived ability to work) and extrinsic motivators (perceived social support). Work family interference/enhancement and job stressors (workload and long working hours) also impacts job satisfaction; predicting overall life satisfaction. This study aims at examining life satisfaction predicted by personal and professional characteristics.. METHODS: The postgraduate trainees in the public and private hospitals of Rawalpindi and Islamabad were surveyed using validated measures of life satisfaction, personal growth, perceived social support, perceived ability to work, work family interference/enhancement, job stressors, co-workers support, supervisors support, and job satisfaction from September 15 to December 28, 2017. RESULTS: Personal growth, perceived ability to work, availability of social support, and work family enhancement positively correlate to job and life satisfaction. Work life interference and job stressors negatively relate to job and life satisfaction. Job satisfaction is also partially mediated by intrinsic and extrinsic motivators on life satisfaction, whereas job stressors weakened the relationship between job satisfaction and life satisfaction. Long working hours is negatively related to job satisfaction and life satisfaction. CONCLUSIONS: Life satisfaction is predicted by job satisfaction that is characterized intrinsic and extrinsic motivators. Healthcare organizations face challenge of providing reduced working hours, increased salaries, supportive working environment, and increased supervision to enhance the job satisfaction of employees and to improve the functioning of the healthcare environment.

Frequency of Workplace Burnout Among Postgraduate Trainees in a Teaching Hospital in Mirpur.

BACKGROUND: Work-related stress and burnout among medical practitioners has been a frequently studied phenomenon. It reduces work efficiency and productivity and also has negative impacts on patient care. This study assessed the extent of work-related stress and burnout and the reasons behind this burnout among the Internal Medicine and Pulmonology residents of Mirpur, Azad Kashmir. MATERIALS AND METHODS: This cross-sectional, observational study was conducted among the postgraduate trainees of Internal Medicine and Pulmonology in Mohi-uddin Islamic Medical College and Hospital, Mirpur, Azad Kahsmir. Out of the 70 trainees, 64 completed the study (response rate: 85.3%). The trainees recorded their sociodemographic profile including age, gender, marital status, name of the department, and year of training. Work-related stress and burnout were assessed using a 28-question-based Burnout Questionnaire adapted from the American Welfare Association. Reasons of burnout among the postgraduate trainees were recorded. Data were analyzed using SPSS v. 21. RESULTS: There were 45 men (70.3%) and 19 women (29.6%). The mean age of the trainees was 29.25 ± 2.87 years. No stress and professional burnout was reported in 20.3% residents; 29.6% residents had stress but no professional burnout; 23.4% residents had fair chances of burnout; 14% residents had early burnout; and 12.5% residents had advanced burnout. Higher grades of burnout are more common among male residents, those who are married, and those in early years of postgraduate training. Common reasons of work-related burnout were reported to be long work hours (68.75%), decreased job satisfaction (54.7%), and lack of workplace facilities (45.3%). CONCLUSION: Most of the residents in Mirpur have work-related stress and are at the verge of burning out. Large-scale studies, assessing more correlates, must be conducted in this region to give a better understanding of this phenomenon and help formulate plans to prevent and manage work-related stress and burnout among the postgraduate trainees.

Knowledge of female doctors about smoking risks and their attitude toward cessation in antenatal clinics - perspective from tertiary care hospitals in Karachi.

OBJECTIVE: To assess the knowledge and attitude of doctors with regard to smoking risks and cessation, and to identify factors associated with self- reported assessment of smoking. METHODS: This cross-sectional survey was performed in 5 hospitals of Karachi from February to April 2014, and comprised doctors providing antenatal care. Data was collected using a questionnaire. SPSS 21 was used for data analysis. RESULTS: Of the 164 respondents,150(91.5%) considered the assessment of smoking an integral part of their medical responsibilities, but only 53(32.4%) reported that they asked regarding smoking habit in 100% of patients and 77(47.3%) inquired about passive smoking. The mean knowledge score for risks and cessation was 2.57±0.278 and 2.12±0.457, respectively. A few misconceptions were also found, such as 94(57.3%) doctors were against the use of nicotine replacement therapy in pregnant females and 114(69.4%) falsely believed that smoking was associated with pre-eclampsia. Factors independently associated with good baseline knowledge were: formal training (p=0.01) and hospital's smoke-free policy (p=0.004). Doctors with formal training more frequently assessed smoking habit of their patients and were more confident while counselling patients for smoking cessation (p=0.05). CONCLUSIONS: Basic misconceptions showed inadequate knowledge among doctors working in antenatal clinics.

Personality differences among junior postgraduate trainees in the United Kingdom.

IMPORTANCE: An early understanding of the personality profiles of junior trainees may be valuable for supporting the professional and educational development of tomorrow's doctors. OBJECTIVE: This study aims to describe the personality profile of junior trainees and to explore whether the personality profiles differed according to the level of training, specialty choice, or gender. DESIGN: The Mental Muscle Diagram Indicator was distributed electronically. SETTING: South West London, Health Education England South London. PARTICIPANTS: A total of 157 junior trainees completed the personality questionnaire. Specifically, there were core surgical (n = 40), core medical (n = 24), and foundation trainees (n = 93). RESULTS: The preferential profile across all groups was Extroversion (E), Sensing (S), Feeling (F), and Perception (P). More foundation doctors favored an extrovert and sensing personality when compared with core trainees (72% vs 60.4% and 77.4% vs 57.5%, respectively). More core surgical trainees appeared to prefer Extroversion when compared with their medical counterparts (66.7% vs 54.2%). More core medical trainees favored an intuitive behavior when compared with their surgical colleagues (50% vs 35%). Significantly, more female trainees (83.3%) displayed an extrovert personality than male trainees (66.7%) did. CONCLUSIONS: According to the Mental Muscle Diagram Indicator analysis, this work shows that the more junior the trainees are in their career, the more they tend to enjoy human interaction and to favor acting before thinking. The most junior trainees tend to be slightly more interested in dealing with facts rather than ideas and favor a flexible approach of life. The reducing ratio of Extroversion and Sensing in the core trainees when compared with foundation doctors may suggest that clinical experience has an effect on personality. As trainees begin to progress, they may tend to reflect more on their practice and to start thinking about more long term. These results suggest that a greater understanding of their personality preferences and how they might change with experience may help trainees to develop a greater personal and professional insight.

Assessment of Surgical Training for First-Year Postgraduate Trainees; Analysis of Interrater Disagreements / 医学教育

We investigated causes of interrater disagreements in the observational assessment of clinical training for first-year postgraduate trainees. In 1998 25 first-year postgraduates rotated through the Second Department of Surgery for 3 months, including 1 month in cardiovascular surgery, thoracic surgery, and upper-gastrointestinal surgery. Each trainee cared for several patients at most with a senior resident under the supervision of senior staff members. Nine attending physicians (staff members), 3 doctor-course graduates, and 2 chief residents assessed the trainees at the end of the rotation with special reference to clinical, social, and supervisory abilities. Trainees were given scores of “Good, ” “Fair, ” “Pass, ” or “Fail” for each ability. Interrater disagreements often involved responsibility and activeness, which reflected social abilities, and rapid patient consultations, orderly arrangement of laboratory examinations and procedures, and avoiding ordering of unnecessary laboratory examinations and medications, which reflected supervisory abilities. Assessments of poorly performing trainees often disagreed. Some interrater disagreements were seen among 4 of 14 attending physicians, but disagreements were fewer among the 3 doctor-course graduates and 2 chief residents who were graduates of the college. Both the proper training of assessors and a good relationship between assessors and rotators are necessary to make appropriate evaluations that might affect the career of postgraduates trainees.

Development of a Format to Record Clinical Experiences of Trainees during the Initial Two-year Period of Postgraduate Clinical Training. A Study of the Validity and Reliability of Technical Items in the Self-reporting Questionnaire / 医学教育

A self-reporting questionnaire was designed and sent to our Jichi Medical School graduates each year since 1980, in order to investigate clinical competences attained in certain technical items. The responses from graduates of classes 1984 through 1987 were analysed, and the questionnaire was found to be highly reliable and moderately valid. The coefficient variable was 0.942, and the relevant variable was 0.934 using the half-split method. The content was clear, because items in the questionnaire were selected from published official reports. In the construction validity, 4 meaningful groups of items were found by factor-analysis. Yearly analysis using such a questionnaire may clarify some of the problems experienced by trainees and training hospitals, and would encourage the trainees to undergo a process of selfevaluation.

Development of a Format to Record Clinical Experiences of Trainees during the Initial Two-year Period of Postgraduate Clinical Training; A Study of Self-evaluation by Jichi Medical School Graduates / 医学教育

A self-reporting questionnaire was designed and sent to our Jichi Medical School graduates each year since 1980, in order to investigate clinical competence. The format was designed based on several major reports concerning postgraduate clinical training in primary medical care. We found that more than 70% of Jichi Medical School graduates trained in the multi-specialty rotation style in general hospitals that were certified by the Ministry of Health and Welfare. Our results also suggested that these graduates obtained a relatively high level of clinical competence in performing physical examinations, basic laboratory testing, clinical procedures, and various treatments.