Looking beyond duty hours: Offering a balanced quantitative-qualitative approach to resident burnout.

Burnout, stress and overwork are highly prevalent amongst junior training physicians worldwide, which explains the widespread phenomenon of physicians leaving the field and organised protests/strikes for better working conditions. Back in 2003, the mandatory duty hour restriction was a landmark intervention rolled out by the Accreditation Council for Graduate Medical Education that formally mandated limiting working hours of trainee residents to no more than 80 h per week, and not exceeding 24-h shifts with 6 added hours for education and handover. Nonetheless, 20 years later, this measure continues to be subject to multiple debates on its purported efficacy in achieving its intended objectives and fails to adequately prevent physician burnout and exodus. In our view, the current duty hour restriction model is, in and of itself, inadequate for combating burnout amongst medical residents for several reasons, including insignificant reduction in duty hours with suboptimal adherence/reporting, failure to account for off-site clinical and non-clinical duties, as well as nature of clinical work which typically involves high work intensity in less-than-optimal/unconducive work environments and significant psychoemotional stress. In this article, we offer our perspectives on pursuing a balanced approach towards both meaningful quantitative reduction in working hours as well as practical qualitative improvement in nature of clinical and non-clinical work that could collectively address resident burnout and improve work and training outcomes.

Clinical reasoning in real-world practice: a primer for medical trainees and practitioners.

Clinical reasoning is a crucial skill and defining characteristic of the medical profession, which relates to intricate cognitive and decision-making processes that are needed to solve real-world clinical problems. However, much of our current competency-based medical education systems have focused on imparting swathes of content knowledge and skills to our medical trainees, without an adequate emphasis on strengthening the cognitive schema and psychological processes that govern actual decision-making in clinical environments. Nonetheless, flawed clinical reasoning has serious repercussions on patient care, as it is associated with diagnostic errors, inappropriate investigations, and incongruent or suboptimal management plans that can result in significant morbidity and even mortality. In this article, we discuss the psychological constructs of clinical reasoning in the form of cognitive 'thought processing' models and real-world contextual or emotional influences on clinical decision-making. In addition, we propose practical strategies, including pedagogical development of a personal cognitive schema, mitigating strategies to combat cognitive bias and flawed reasoning, and emotional regulation and self-care techniques, which can be adopted in medical training to optimize physicians' clinical reasoning in real-world practice that effectively translates learnt knowledge and skill sets into good decisions and outcomes.

The rise of medical influencers: The pros and the cons.

In the past few years, the online influencer industry has exponentially expanded, fuelled by the COVID pandemic lockdown, increased social media platforms and lifestyle appeal of influencership. This phenomenon has likewise infiltrated the medical field, where many healthcare practitioners have taken to social media platforms for content creation and influencer marketing. There are many reasons that underlie medical influencership - some may use it to improve public health literacy and correct medical misinformation, engage in medical advocacy or use the platform simply as a means of humanistic expression of the medical career, while others may seek to advertise private practice/medical products, boost personal reputation, and gain popularity and monetary benefits. Regardless of the underlying motivations of the medical influencers, some have fallen afoul of professionally accepted practices and ethical boundaries in their use of social media platforms, leading to serious consequences such as professional sanctioning or termination of employment. In this article, we hope to provide a comprehensive review of the 'good' (positive practices), the 'bad' (practices with possible unintended negative consequences) and the outright unprofessional or unethical behaviours aspects of social media use by medical influencers and offer practical strategies to ensure responsible and meaningful use of influencer platforms at both the physician and health systems level.

When I say Socratic questioning.

In this article, Ng et al. define the core concepts of Socratic questioning and how it can be appropriately applied in clinical education.

Providing family updates: a primer for the medical trainee.

Providing family updates is a common clinical task for medical trainees and practitioners working in hospital settings. Good clinical communication skills are essential in clinical care as it is associated with improved patient satisfaction, understanding of condition, treatment adherence, and better overall clinical outcomes. Moreover, poor communications are often the source of medical complaints. However, while patient-centred communication skills training has generally been incorporated into clinical education, there hitherto remains inadequate training on clinical communications with patients' families, which carry different nuances. In recent years, it is increasingly recognized that familial involvement in the care of hospitalized patients leads to better clinical and psychological outcomes. In fact, in Asian populations with more collectivistic cultures, families are generally highly involved in patient care and decision-making. Therefore, effective clinical communications and regular provision of family updates are essential to build therapeutic rapport, facilitate familial involvement in patient care, and also provide a more holistic understanding of the patient's background and psychosocial set-up. In this article, we herein describe a seven-step understand the clinical context, gather perspectives, deliver medical information, address questions, concerns and expectations, provide tentative plans, demonstrate empathy, postcommunication reflections model as a practical guide for medical trainees and practitioners in provision of structured and effective family updates in their clinical practice.

'Insight' in medical training: what, why, and how?

The term 'insight' is generically defined in English language as the ability to perceive deeper truths about people and situations. In clinical practice, patient insight is known to have important implications in treatment compliance and clinical outcomes, and can be assessed clinically by looking for the presence of illness awareness, correct attribution of symptoms to underlying condition, and acceptance of treatment. In this article, we suggest that cultivating insight is actually a highly important, yet often overlooked, component of medical training, which may explain why some consistently learn well, communicate effectively, and quickly attain clinical competency, while others struggle throughout their clinical training and may even be difficult to remediate. We herein define 'insight' in the context of medical training as having an astute perception of personal cognitive processes, motivations, emotions, and ability (strengths, weaknesses, and limitations) that should drive self-improvement and effective behavioural regulation. We then describe the utility of cultivating 'insight' in medical training through three lenses of (i) promoting self-regulated, lifelong clinical learning, (ii) improving clinical competencies and person-centred care, and (iii) enhancing physician mental health and well-being. In addition, we review educational pedagogies that are helpful to create a medical eco-system that promotes the cultivation of insight among its trainees and practitioners. Finally, we highlight several tell-tale signs of poor insight and discuss psychological and non-psychological interventions that may help those severely lacking in insight to become more amenable to change and remediation.

Spotlighting 'Medical Collegiality'.

'Collegiality' comes from the Latin term 'Collegium', which essentially refers to a community of individuals bounded by their collective pursuit of a common goal. The concept has historical roots in both organised religion and academia, with its use subsequently extended to various industrial and corporate settings including healthcare. Nowadays, 'collegiality' has become a common buzzword adopted by the medical fraternity - often deemed as having a polite and respectful demeanour, maintaining cordial work relationships and being a team player who demonstrates willingness to help others and avoid speaking ill of fellow colleagues. While it is true that workplace incivility, aggression, bullying and verbal abuse are not uncommonly reported in highly stressful healthcare settings, which are concerning phenomena that should be addressed and prevented, the concept of 'medical collegiality' is, in reality, a rich and multi-faceted concept that is not limited to behavioural attributes, but extends to larger cultural principles and organisational constructs. In this article, we herein define 'medical collegiality' as 'a collective manifestation of respect, empathy and solidarity within the medical fraternity, driven by a common pursuit of clinical excellence in patient care, demonstrated through interpersonal/work relationships and organisational culture', by referencing historical origins of 'collegiality' in organised religion and academia. We further review the concept of 'medical collegiality' through three core lenses of cultural, behavioural and structural collegiality. Finally, we discuss the importance of medical collegiality for physician mental health and well-being, and quality of clinical care.

The impact of Chat Generative Pre-trained Transformer (ChatGPT) on medical education.

Artificial intelligence (AI) in medicine is developing rapidly. The advent of Chat Generative Pre-trained Transformer (ChatGPT) has taken the world by storm with its potential uses and efficiencies. However, technology leaders, researchers, educators, and policy makers have also sounded the alarm on its potential harms and unintended consequences. AI will increasingly find its way into medicine and is a force of both disruption and innovation. We discuss the potential benefits and limitations of this new league of technology and how medical educators have to develop skills and curricula to best harness this innovative power.

Development and validation of a new self-assessment tool to measure professionalism among medical students.

Introduction: Professionalism is a key quality that medical students should possess, but it is difficult to define and assess. Current assess-ment tools have room for improvement. This study aimed to design and validate a self-assessment tool to assess professionalism among medical students. Method: A questionnaire was created based on 10 tenets of professionalism from the Charter on Medical Professionalism jointly published by the American Board of Internal Medicine Foundation, American College of Physicians Foundation and European Federation of Internal Medicine, along with input from Singapore guides. The self-administered questionnaire was administered to Year 2 to 5 students from Yong Loo Lin School of Medicine, National University of Singapore in a voluntary, anonymised manner in the academic year of 2019/2020. Construct validity and internal reliability were evaluated using Principal Component Analysis (PCA) and Cronbach's alpha, respectively. Results: There was a total of 541 respondents. After removing incomplete responses, 504 responses were included. Following PCA, a 17-item questionnaire titled "Medical Professionalism: A Self-assessment Tool" (MPAST) with a 5-component solution was obtained. The 5 components were commit-ment to: (1) patient's best interest, (2) honesty and integrity, (3) professional competency, (4) patient safety and care, and (5) educational responsibilities. Their Cronbach's alpha value ranged from 0.540 to 0.714, with an overall Cronbach's alpha value of 0.777. Conclusion: MPAST is valid, reliable, practical, and is the first validated self-assessment tool to assess professional attributes and behaviours among medical students, to our knowledge.