Author: Brian S McGowan, PhD

Abstract
OBJECTIVE:To identify key stressors for emergency department (ED) staff, investigate positive and negative behaviours associated with working under pressure and consider interventions that may improve how the ED team functions.METHODS:This was a qualitative study involving semistructured interviews. Data were collected from staff working in the ED of a London teaching hospital. A purposive sampling method was employed to recruit staff from a variety of grades and included both doctors and nurses.RESULTS:22 staff members took part in the study. The most frequently mentioned stressors included the ‘4-hour’ target, excess workload, staff shortages and lack of teamwork, both within the ED and with inpatient staff. Leadership and teamwork were found to be mediating factors between objective stress (eg, workload and staffing) and the subjective experience. Participants described the impact of high pressure on communication practices, departmental overview and the management of staff and patients. The study also revealed high levels of misunderstanding between senior and junior staff. Suggested interventions related to leadership and teamwork training, advertising staff breaks, efforts to help staff remain calm under pressure and addressing team motivation.CONCLUSIONS:This study highlights the variety of stressors that ED staff are subject to and considers a number of cost-efficient interventions. Medical education needs to expand to include training in leadership and other ‘non-technical’ skills in addition to traditional clinical skills.

via Teams under pressure in the emergency department… [Emerg Med J. 2012] – PubMed – NCBI.

AbstractOBJECTIVE:Professional capabilities, such as empathy and patient-centeredness, decline during medical education. Reflective practice is advocated for teaching these capabilities. The Clinical Reflection Training (CRT) is a reflective practice intervention using the professional dilemmas faced by medical students during clinical practice. The aim of this study was to evaluate students’ perceptions of the helpfulness of the CRT and its effects on their medical education.METHODS:Eighteen semi-structured interviews were conducted with medical students who had participated in the CRT. Content analysis was used to analyze the interview data.RESULTS:Medical students did not feel adequately prepared to manage the difficult personal and interpersonal problems frequently encountered in clinical practice. They reported that the CRT reduces stress, improves patient care and serves as a tool for professional development.CONCLUSION:The CRT may be a useful tool for developing professionalism during medical education, reducing stress and enhancing the quality of patient care.PRACTICE IMPLICATIONS:Providing students with reflective practice training that draws on their current personal clinical problems in order to improve their clinical work may be a productive investment in personal professional development, physician health, and quality improvement.

via A reflective practice intervention for pr… [Patient Educ Couns. 2013] – PubMed – NCBI.