scholarly journals Assessment of the Preparedness and Planning of Academic Emergency Departments in India during the COVID-19 Pandemic – A Multicentric Survey

2021 ◽  
pp. 1-13
Author(s):  
Vivek Gopinathan ◽  
Sanjan Asanar ◽  
Vimal Krishnan S ◽  
Freston Marc Sirur ◽  
Jayaraj Mymbilly Balakrishnan
Keyword(s):  
Emergency Medicine ◽  
Emergency Departments ◽  
Disaster Preparedness ◽  
Treatment Protocol ◽  
Descriptive Statistics ◽  
Emergency Physicians ◽  
Pandemic Preparedness ◽  
Cross Sectional ◽  
Planning Strategies ◽  
Training Exercises

ABSTRACT Objective: Emergency Medicine being a young specialty in India, we aimed to assess the level of disaster preparedness and planning strategies among various academic Emergency Departments (EDs) across India during the COVID-19 pandemic. Methods: A cross-sectional multicentric survey was developed and disseminated online to various academic EDs in India and followed up over a period of 8 weeks. All results were analysed using descriptive statistics. Results: 28 Academic Emergency Medicine Departments responded to the study. Compared to Pre-COVID period, COVID-19 pandemic has led to 90% of centres developing separate triage system with dedicated care areas for COVID suspect/infected in 78.6% centres with nearly 70% utilizing separate transportation pathways. Strategizing and executing the Institutional COVID-19 treatment protocol in 80% institutes were done by Emergency Physicians. Training exercises for airway management and PPE usage were seen in 93% and 80% centres respectively. Marked variation in recommended PPE usage were observed across EDs in India. Conclusions: Our study highlights the high variance in the level of preparedness response among various EDs across India during the pandemic. Preparedness for different EDs across India needs to be individually assessed and planned according to the needs and resources available.

scholarly journals P033: Procedural skills training in emergency medicine physicians within the Edmonton zone: a needs assessment

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S76-S76
Author(s):  
R. Schonnop ◽  
B. Stauffer ◽  
A. Gauri ◽  
D. Ha
Keyword(s):  
Emergency Medicine ◽  
Emergency Departments ◽  
Continuing Professional Development ◽  
Skills Training ◽  
Procedural Skill ◽  
Cross Sectional Survey ◽  
Procedural Skills ◽  
Cross Sectional ◽  
Health Region ◽  
Perceived Importance

Introduction: Procedural skills are a key component of an emergency physician's practice. The Edmonton Zone is a health region that comprises twelve tertiary, urban community and rural community emergency departments (EDs) and represents over three hundred emergency physicians. This study describes the current attitudes toward procedural skill competency, current procedural skill practices, and the role for educational skills training sessions among emergency medicine physicians within a geographical health region. Methods: Multicenter descriptive cross-sectional survey of all emergency medicine physicians working at 12 emergency departments within the Edmonton Zone in 2019 (n = 274). The survey underwent several phases of systematic review; including item generation and reduction, pilot testing, and clinical sensibility testing. Survey items addressed current procedural skill performance frequency, perceived importance and confidence, current methods to maintain competence, barriers and facilitating factors to participation in a curriculum, preferred teaching methods, and desired frequency of practice for each procedural skill. Results: Survey response rate was 53.6%. Variability in frequency of performed procedures was apparent across the type of hospital sites. For majority of skills, there was a significantly positive correlation between the frequency at which a skill was performed and the perceived confidence performing said skill. There was inconsistency and no significant correlation with perceived importance, perceived confidence, or frequency performing a given skill and the desired frequency of training for that skill. Course availability (76.2%) and time (72.8%) are the most common identified barriers to participation in procedural skills training. Conclusion: This study summarized the current emergency department procedural skill practices and attitudes toward procedural skill competency and an educational curriculum among emergency medicine physicians in Edmonton. This represents a step towards targeted continuing professional development in the growing realm of competency-based medical education.

scholarly journals Building and strengthening relationships between academic departments/divisions of emergency medicine and rural and regional emergency departments

CJEM ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 595-599 ◽  
Author(s):  
Aaron Johnston ◽  
Kylie Booth ◽  
Jim Christenson ◽  
David Fu ◽  
Shirley Lee ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Emergency Departments ◽  
Academic Departments ◽  
List Type ◽  
Emergency Physicians ◽  
Common Value ◽  
Rural And Urban ◽  
Canadian Association ◽  
Rural Physicians ◽  
Training Opportunities

ABSTRACTObjectivesMake recommendations on approaches to building and strengthening relationships between academic departments or divisions of Emergency Medicine and rural and regional emergency departments.MethodsA panel of leaders from both rural and urban/academic practice environments met over 8 months. Draft recommendations were developed from panel expertise as well as survey data and presented at the 2018 Canadian Association of Emergency Physicians (CAEP) Academic Symposium. Symposium feedback was incorporated into final recommendations.ResultsSeven recommendations emerged and are summarized below: 1)CAEP should ensure engagement with other rural stakeholder organizations such as the College of Family Physicians of Canada and the Society of Rural Physicians of Canada.2)Engagement efforts require adequate financial and manpower resources.3)Training opportunities should be promoted.4)The current operational interface between the academic department of Emergency Medicine and the emergency departments in the catchment area must be examined and gaps addressed as part of building and strengthening relationships.5)Initial engagement efforts should be around projects with common value.6)Academic Departments should partner with and support rural scholars.7)Academic departments seeking to build or strengthen relationships should consider successful examples from elsewhere in the country as well as considering local culture and challenges.ConclusionThese recommendations serve as guidance for building and strengthening mutually beneficial relationships between academic departments or divisions of Emergency Medicine and rural and regional emergency departments.

Emergency medicine registrar training in Africa: overview of programmes, faculty and sustainability

2020 ◽  
pp. emermed-2019-208668
Author(s):  
Abena Obenewaa Akomeah ◽  
Hendry Robert Sawe ◽  
Juma A Mfinanga ◽  
Michael S Runyon ◽  
Erin Elizabeth Noste
Keyword(s):  
Emergency Medicine ◽  
Training Programme ◽  
Descriptive Statistics ◽  
African Countries ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Career Options ◽  
Survey Responses ◽  
Collaborative Efforts ◽  
Registrar Training

BackgroundThe specialty of emergency medicine (EM) is new in most African countries, where emergency medicine registrar (residency) programmes (EMRPs) are at different stages of evolution and little is known about the programmes. Identifying and describing these EMRPs will facilitate planning for sustainability, collaborative efforts and curriculum development for existing and future programmes. Our objective was to identify and provide an overview of existing EMRPs in Africa and their applicant requirements, faculty characteristics and plans for sustainability.MethodsWe conducted a descriptive cross-sectional survey of Africa’s EMRPs between January and December 2017, identifying programmes through an online search supplemented by discussions with African EM leaders. Leaders of all identified African EMRPs were invited to participate. Data were collected prospectively using a structured survey and are summarised with descriptive statistics.ResultsWe identified 15 programmes in 12 countries and received survey responses from 11 programmes in 10 countries. Eight of the responding EMRPs began in 2010 or later. Only 36% of the EMRPs offer a 3-year programme. Women make up an average of 33% of faculty. Only 40% of EMRPs require faculty to be EM specialists. In smaller samples that reported the relevant data, 67% (4/6) of EMRPs have EM specialists who trained in that EMRP programme making up more than half of their faculty; 57% of Africa’s 288 EMRP graduates to date are men; and an average of 39% of EMRP graduates stay on as faculty for 78% (7/9) of EMRPs.ConclusionEMRPs currently produce most of their own EM faculty. Almost equal proportions of men and women have graduated from a predominantly >3-year training programme. Graduates have a variety of opportunities in academia and private practice. Future assessments may wish to focus on the evolution of these programme’ curricula, faculty composition and graduates’ career options.

Pandemic influenza and major disease outbreak preparedness in US emergency departments: A selected survey of emergency health professionals

2011 ◽  
Vol 6 (3) ◽  
pp. 187-195 ◽  
Author(s):  
Melinda J. Morton, MD, MPH ◽  
Edbert B. Hsu, MD, MPH ◽  
Sneha H. Shah, MD ◽  
Yu-Hsiang Hsieh, PhD ◽  
Thomas D. Kirsch, MD, MPH
Keyword(s):  
Infectious Disease ◽  
Pandemic Influenza ◽  
Health Professionals ◽  
Emergency Departments ◽  
Disaster Preparedness ◽  
The United States ◽  
Disease Outbreak ◽  
Free Text ◽  
Pandemic Preparedness ◽  
Personnel Staffing

Objective: To assess the level of pandemic preparedness at emergency departments (EDs) around the country and to better understand current barriers to preparedness in the United States represented by health professionals in the American College of Emergency Physician (ACEP) Disaster Medicine Section (DMS).Methods, design, and setting: A cross-sectional survey of ACEP DMS members was performed. A total of 300 members were surveyed both via e-mail and with paper surveys during the 2009 ACEP Scientific Assembly DMS Meeting. An optional comments section was included for section members’ perspectives on barriers to preparedness. A 15-item pandemic preparedness score was calculated for each respondent based on key preparedness indicators as defined by the authors. Results were analyzed with descriptive statistics, ᵪ2 analysis, Cochran-Armitage trend test, and analysis of variance. Free text comments were coded and subjected to frequency-based analysis.Results: A total of 92 DMS members completed the survey with a response rate of 31 percent. Although 85 percent of those surveyed indicated that their hospital had a plan for pandemic influenza response and other infectious disease threats, only 68 percent indicated that their ED had a plan, and 52 percent indicated that their hospital or ED had conducted disaster preparedness drills. Only 57 percent indicated that there was a plan to augment ED staff in the event of a staffing shortage, and 63 percent indicated that there were adequate supplies of personal protective equipment.While 63 percent of respondents indicated that their ED had a plan for distribution of vaccines and antivirals, only 32 percent of EDs had a plan for allocation of ventilators.A total of 42 percent of respondents felt that their ED was prepared in the event of a pandemic influenza or other disease outbreak, and only 35 percent felt that their hospital was prepared. The average pandemic preparedness score among respondents was 8.30 of a total of 15. Larger EDs were more likely to have a higher preparedness score (p = 0.03) and more likely to have a pandemic preparedness plan (p = 0.037). Some major barriers to preparedness cited by section members included lack of local administration support, challenges in funding, need for dedicated disaster preparedness personnel, staffing shortages, and a lack of communication among disaster response agencies, particularly at the federal level.Conclusions: There appear to be significant gaps in pandemic influenza and other infectious disease outbreak planning among the hospitals where ACEP DMS members work.This may reflect a broader underlying inadequacy of preparedness measures.

scholarly journals Evaluation of the Level of Safety and Disaster Preparedness of Comprehensive Healthcare Centers in Babol, Iran

2019 ◽  
pp. 287-293
Keyword(s):  
Disaster Preparedness ◽  
Safety Assessment ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Descriptive Statistics ◽  
Structural Safety ◽  
Average Score ◽  
Sectional Study ◽  
Safety Level ◽  
Cross Sectional

INTRODUCTION: Comprehensive healthcare centers should be able to provide primary healthcare services during disasters; therefore, it is necessary to assess their safety and preparedness to ensure that they can have acceptable functionality in critical situations. In this regard, the present study aimed to evaluate the level of safety and disaster preparedness of comprehensive healthcare centers in Babol, Iran. METHODS: The present descriptive cross-sectional study was conducted in 2016 to investigate the safety level and disaster preparedness of 232 comprehensive healthcare centers in Babol, using observation and checklists. The used checklist consisted of three parts, namely functional, structural, and non-structural safety assessment. Finally, the collected data were analyzed using descriptive statistics. FINDINGS: Based on the data analysis, the studied centers were more prone to weather hazards than other types of disasters. Moreover, the evaluation of the different aspects of the functionality of the centers showed that the best functionality was observed in firefighting, provision of the environmental health services, organization and structure, and provision of infectious disease management services, in that order. The non-structural safety obtained the highest average score (37.49) while the scores of functional and structural safety were 21.76 and 9.27, respectively. CONCLUSION: Based on the results, all the studied comprehensive healthcare centers had a moderate level of structure and functional safety, while no center had a completely desirable level. Therefore, it is recommended to develop proper plans and monitor the comprehensive healthcare centers to eliminate their defects and improve the level of their safety.

Pandemic influenza and major disease outbreak preparedness in US emergency departments: A selected survey of emergency health professionals

2019 ◽  
Vol 14 (4) ◽  
pp. 269-277
Author(s):  
Melinda J. Morton, MD, MPH ◽  
Edbert B. Hsu, MD, MPH ◽  
Sneha H. Shah, MD ◽  
Yu-Hsiang Hsieh, PhD ◽  
Thomas D. Kirsch, MD, MPH
Keyword(s):  
Infectious Disease ◽  
Pandemic Influenza ◽  
Health Professionals ◽  
Emergency Departments ◽  
Disaster Preparedness ◽  
The United States ◽  
Disease Outbreak ◽  
Free Text ◽  
Pandemic Preparedness ◽  
Personnel Staffing

Objective: To assess the level of pandemic preparedness at emergency departments (EDs) around the country and to better understand current barriers to preparedness in the United States represented by health professionals in the American College of Emergency Physician (ACEP) Disaster Medicine Section (DMS).Methods, design, and setting: A cross-sectional survey of ACEP DMS members was performed. A total of 300 members were surveyed both via e-mail and with paper surveys during the 2009 ACEP Scientific Assembly DMS Meeting. An optional comments section was included for section members’ perspectives on barriers to preparedness. A 15-item pandemic preparedness score was calculated for each respondent based on key preparedness indicators as defined by the authors. Results were analyzed with descriptive statistics, χ2 analysis, Cochran-Armitage trend test, and analysis of variance. Free text comments were coded and subjected to frequency-based analysis.Results: A total of 92 DMS members completed the survey with a response rate of 31 percent. Although 85 percent of those surveyed indicated that their hospital had a plan for pandemic influenza response and other infectious disease threats, only 68 percent indicated that their ED had a plan, and 52 percent indicated that their hospital or ED had conducted disaster preparedness drills. Only 57 percent indicated that there was a plan to augment ED staff in the event of a staffing shortage, and 63 percent indicated that there were adequate supplies of personal protective equipment. While 63 percent of respondents indicated that their ED had a plan for distribution of vaccines and antivirals, only 32 percent of EDs had a plan for allocation of ventilators. A total of 42 percent of respondents felt that their ED was prepared in the event of a pandemic influenza or other disease outbreak, and only 35 percent felt that their hospital was prepared. The average pandemic preparedness score among respondents was 8.30 of a total of 15. Larger EDs were more likely to have a higher preparedness score (p = 0.03) and more likely to have a pandemic preparedness plan (p = 0.037). Some major barriers to preparedness cited by section members included lack of local administration support, challenges in funding, need for dedicated disaster preparedness personnel, staffing shortages, and a lack of communication among disaster response agencies, particularly at the federal level.Conclusions: There appear to be significant gaps in pandemic influenza and other infectious disease outbreak planning among the hospitals where ACEP DMS members work. This may reflect a broader underlying inadequacy of preparedness measures. 

scholarly journals The Reliability of an Artificial Intelligence Tool, ‘Decision Trees’, in Emergency Medicine Triage

2020 ◽  
Author(s):  
Alp Giray AYDIN ◽  
Oktay Eray ◽  
Ali Vefa SAYRAC ◽  
Alten OSKAY ◽  
Umit Deniz ULUSAR
Keyword(s):  
Artificial Intelligence ◽  
Emergency Medicine ◽  
Decision Trees ◽  
Emergency Departments ◽  
Tertiary Care ◽  
Care Hospital ◽  
Cross Sectional ◽  
Support Tool ◽  
Triage Category ◽  
Kappa Value

Abstract Objective: Overcrowding is a challenge for emergency departments throughout the world. Triage systems categorize the patients based on medical emergencies in order to avoid the malpractices. The present study aimed to test the validity of an artificial intelligence tool, ‘Decision Trees’, in emergency medicine triage. Methods: This prospective, cross-sectional, clinical study was conducted in an emergency department of a tertiary care hospital. A total of 1999 patients over 18 years were included into the study. The triage stuff were trained before the study with the Australasian Triage Scale. Two independent observers rate the ultimate triage category of study patients. A new algorithym by ‘Decision Trees’ was constructed at the end of the study. Results: The mean age of the study patients were 41.1±17,2 and 49.1 % of them (n=981) were male. There were 867 patients (43.3%) with triage category of five and 14 (0.7%) patients with triage category one. The most common clinical descriptors of the patients were minimal pain with no high risk features 20.5% of them (n=409) and minor symptoms of low risk conditions 18.1% of them (n=362). There was an excellent consistency between two independent observers (kappa value: 0.997. The new algorithm by ‘Decision Trees’ rated wrong in only one patient. The accuracy rate was 99.9%. The consistency between ATS and ‘Decision Trees was excellent (kappa value: 0.999). There was average consistency between physicians and paramedics. (kappa value: 0.541).Conclusion: Decision trees as an artificial intelligence model should be used for producing practical triage algorithms as a decision support tool in emergency departments.

31. The birth of a new specialty: The history of emergency medicine in Canada

2007 ◽  
Vol 30 (4) ◽  
pp. 44 ◽  
Author(s):  
R. Elyas
Keyword(s):  
Emergency Medicine ◽  
Royal College ◽  
Emergency Departments ◽  
Clinical Medicine ◽  
Task Force ◽  
Family Physicians ◽  
Care Providers ◽  
Emergency Physicians ◽  
Canadian Association ◽  
History Of

Modern day emergency rooms across Canada have almost completely transformed over the past 30 years; perhaps more so than any other specialty. Before the 1970’s, it was primarily general practitioners working on a part-time basis who ran our emergency departments. Some hospitals used interns and residents as first-line emergency care providers, often under the direction of a surgeon or internist. Emergency Medicine has evolved into a highly sophisticated and respected medical specialty that extends beyond clinical medicine, into both research and academia. The appeal of Emergency Medicine is so great that it is now one of the most sought after specialties in the annual CaRMS match. The success story of Emergency Medicine is characterized by the tireless efforts and determination of its founders across the country. They fought for adequate and supervised care of the acutely ill or traumatized patient, believing in a special body of knowledge that should be available to physicians who spend most, if not all, their time in Emergency Departments. In 1977, these founders formally united and The Canadian Association of Emergency Physicians was born. A few years later, in 1980, Emergency Medicine was finally designated as a free-standing specialty by the Royal College of Physicians and Surgeons of Canada. Meanwhile, the College of Family Physicians of Canada also sought to establish a parallel route for Emergency Training of Family Physicians, feeling that Emergency Medicine lay within the realm of Family Medicine. The result was that both colleges established Emergency Medicine training programs that exist until this day. Using journals, archives, a survey, and interviews, the paper will trace the history of the professionalization of Emergency Medicine in Canada. Johnson R. The Canadian Association of Emergency Physicians. The Journal of Emergency Medicine 1993; 11:362-364. Reudy J, Seaton T, Walker D, Rowat B, Cassie J. Report of the Task Force on Emergency Medicine: RCPSC Accreditation Section, 1988. Walker DMC. History and Development of the Royal College Specialty of Emergency Medicine. Annals Royal College of Physicians and Surgeons of Canada 1987; 20:349-352.

scholarly journals P125: Faculty development in the age of competency-based medical education: a national, cross-sectional needs assessment for Canadian emergency medicine faculty

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S109
Author(s):  
A. Stefan ◽  
J. Hall ◽  
J. Sherbino ◽  
T. Chan
Keyword(s):  
Emergency Medicine ◽  
Faculty Development ◽  
Patient Care ◽  
Research Ethics ◽  
Direct Observation ◽  
Descriptive Statistics ◽  
Microsoft Excel ◽  
Cross Sectional ◽  
Integrated Research ◽  
Digital Survey

Introduction: In July 2018, Emergency Medicine (EM) transitioned to the Royal College of Physicians and Surgeons of Canada's (RCPSC) Competence by Design (CBD) training framework. In anticipation of CBD implementation, we conducted a nation-wide needs assessment of EM faculty and senior residents to understand their attitudes towards CBD, workplace-based assessments (WBA) and overall educational needs. Methods: A multi-site, cross-sectional digital survey was conducted in winter 2018 with a sample of EM faculty and senior residents across RCPSC EM programs in Canada. Recruitment was via program director nomination. Survey domains included baseline perceptions about CBD, attitudes toward implementation, perceived/prompted and unperceived faculty development needs. Microsoft Excel was used to calculate descriptive statistics. This study was reviewed by the Hamilton Integrated Research Ethics Board.A multi-site, cross-sectional digital survey was conducted in winter 2018 with a sample of EM faculty and senior residents across RCPSC EM programs in Canada. Recruitment was via program director nomination. Survey domains included baseline perceptions about CBD, attitudes toward implementation, perceived/prompted and unperceived faculty development needs. Microsoft Excel was used to calculate descriptive statistics. This study was reviewed by the Hamilton Integrated Research Ethics Board. Results: Between February-April 2018, 47 participants (40 faculty, 7 residents) completed the survey (58.8% response rate). Most respondents (89.4%) thought learner feedback should be provided on each shift; 55.3% believed they provided adequate feedback. Time constraints, learner disinterest and fear of assessment repercussions were the top three barriers to providing good feedback. A majority of respondents (78.7%) thought that the ED provided above average opportunities for direct observation and 91.5% were confident of incorporating WBAs into their practice. 44.7% reported that CBD will not impact patient care; 17.0% perceived it may have a negative impact. 55.3% felt that CBD will lead to improved feedback for trainees. The top areas for faculty development were: feedback delivery, completing WBAs, resident promotion decisions, and receiving feedback on teaching. Only 25.5% were interested in learning about CBD, although the average of correct responses on the CBD knowledge test was 44.6%. Conclusion: EM is well-situated to transition to CBD given clinicians’ positive attitudes towards feedback, direct observation, WBAs, and opportunities for direct observation. Threats to CBD implementation are concerns about effects on patient care and trainee education, and skepticism regarding effects on feedback quality. Faculty development should concentrate on further developing clinical teaching and supervision skills, focusing on feedback and WBAs.

scholarly journals Shift Work Disorder - Prevalence & Burden of Illness in Healthcare Providers of India

2019 ◽  
Vol 4 (6) ◽  
Keyword(s):  
Job Satisfaction ◽  
Emergency Medicine ◽  
Random Sample ◽  
Shift Work ◽  
Emergency Departments ◽  
Burden Of Illness ◽  
Sleep Hygiene ◽  
Emergency Physicians ◽  
Convenience Sample ◽  
Shift Work Disorder

Background: The proportion of shift workers in the society has taken a big leap in the last 2 decades or so. Thus, the epidemiological significance of shift work disorder (SWD) can no longer be ignored. Emergency Physicians & nurses almost always work in shifts and are an important subset of the population whose health and wellbeing directly and indirectly impacts the morbidity and mortality of the rest of the population. It is thus important to understand the magnitude of the problem in this population. Several studies describe a high incidence of SWD and psychosomatic complaints in EP. The main objective of this study is to examine the prevalence of symptoms of SWD; contribution of demographics, working hours, shift work, morningness/eveningness & sleep hygiene practices to occurrence of SWD, related health & occupational hazards and job satisfaction in a random sample of Emergency Physicians & nurses of India. Methods: A cross sectional survey of nurses and doctors working in emergency departments of at least 12 major urban hospitals across India was conducted during October 2016 – March 2017. Peer validated questionnaire with standard scales, descriptive & objective questions was emailed only to individuals who were known to be working in Emergency departments as nurses and doctors. This convenience-sample of email addresses was obtained through personal and professional contacts of the researcher. Those who volunteered responses were included in the study. No identifying information was collected. Those who reported diagnosed sleeping disorders were excluded from the analysis. For analysis, responses were divided into 2 groups – those who reported symptoms of SWD and those who did not. With aid of a professional biostatistician, these 2 groups were then compared for unique characteristics and statistically significant variables using t test, chi square test, odds ratio and logistic regression Results: Prevalence of symptoms indicative of SWD in a random sample of emergency medicine physicians and nurses in India ranges from 13-27% and was significantly (p=0.048) higher in those who did shift work and night shift work depending on the method of assessment. Women have 3 times higher risk than men. More than half (51%) the number of Emergency medicine physicians and nurses in the study suffer sleep disturbances due to work timings. This group may develop SWD in the future, pending due intervention. SWD is strongly (p<0.02) associated with bad sleep hygiene and excessive daytime sleepiness. The presence of symptoms of SWD also leads to poor job satisfaction. (p<0.05). Majority (60%) report preference for shifts that start later in the day

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