scholarly journals Implementation of small-group reflection rounds at an emergency medicine residency program

CJEM ◽  
2013 ◽  
Vol 15 (03) ◽  
pp. 175-178 ◽  
Author(s):  
Leana S. Wen ◽  
Justin T. Baca ◽  
Patricia O'Malley ◽  
Kriti Bhatia ◽  
David Peak ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Small Group ◽  
Reflective Practice ◽  
Well Being ◽  
Ethical Challenges ◽  
Clinical Experiences ◽  
Safe Environment ◽  
Wellness Curriculum ◽  
Curricular Interventions ◽  
Question Survey

Few residency curricular interventions have focused on improving well-being and promoting humanism. We describe the implementation of a novel curriculum based on small-group reflection rounds—the Emergency Medicine Reflection Rounds (EMRR)—at a 4-year US emergency medicine (EM) residency. During the inaugural year (2010–2011), nine residents volunteered to take part in 1-hour monthly sessions with faculty facilitators. Residents were provided with a confidential environment to discuss difficult ethical and interpersonal encounters from their clinical experiences. Ongoing feedback from participants was solicited, culminating with a four-question survey in which all respondents remarked that the EMRR contributed to improving their own well-being and agreed that it provided an important forum for residents to discuss difficult issues in a safe environment. In this article, we describe our innovation as an example of a wellness initiative that has promoted reflective practice and fostered cooperative learning around the communication, professional, and ethical challenges inherent in EM practice. Our EMRR model may be useful to other EM residences looking to supplement their wellness curriculum.

scholarly journals Using Blended and Virtual Schwartz Center Rounds® to Support Maternity Staff in Ireland During the Covid-19 Pandemic

2021 ◽  
Vol 5 (1) ◽  
pp. 108-119
Author(s):  
Jean Doherty ◽  
Clara K Devine ◽  
Sarah Cullen
Keyword(s):  
Public Health ◽  
Well Being ◽  
Control Measures ◽  
Free Text ◽  
Ethical Challenges ◽  
Staff Support ◽  
Social Distancing ◽  
Safe Environment ◽  
Health Measures ◽  
Infection Control Measures

Background: Many staff supports, such as the internationally accredited Schwartz Center Rounds were suspended worldwide during the Covid-19 restrictions, at a time when they were most needed. Schwartz Rounds are multi-disciplinary forums where staff can discuss the emotional, social and ethical challenges of care in a confidential and safe environment, intending to improve staff well-being and patient care. In a bid to improve staff support after the suspension of full Schwartz Rounds, virtual, then blended (limited spaces for socially distanced in-person attendance and virtual access) Rounds were initiated.Purpose: This study aimed to evaluate Schwartz Rounds in a maternity setting in Ireland and compare full-in person Rounds with virtual and blended Rounds.Methods: Standard Schwartz Rounds evaluation forms were completed by Rounds attendees. Data were analysed using SPSS (Version 24). Respondents were invited to include a comment at the end of the form, and these free-text comments were analysed thematically.Results: Six Rounds were evaluated (2 full in-person Rounds attended before the pandemic, 1 virtual, 3 blended) and a total of 115 evaluation forms were completed. The Rounds were rated extremely high. Some, but not all aspects of the Rounds were rated more positively from the full in-person Rounds. Some technical difficulties were a barrier to fully experiencing the Round when attending remotely.Conclusion: Schwartz Rounds are attended by staff in over 560 healthcare organisations, internationally and have been reported to improve staff well-being and teamwork. The pandemic saw Schwartz Rounds being suspended in most organisations due to social distancing guidelines. Virtual and blended Rounds are recommended as an effective replacement for full Schwartz Rounds while social distancing and infection control measures are in place. However, in order to improve post-panellist discussion and gain the full Schwartz Round experience, recommencement of full, in-person Rounds are recommended as soon as public health measures allow

scholarly journals Dyads in Dementia Care: An International Perspective on Research Challenges and Opportunities

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 757-757
Author(s):  
Marie Boltz ◽  
Karin Wolf-Ostermann ◽  
Katie Maslow
Keyword(s):  
Daily Practice ◽  
Well Being ◽  
International Perspective ◽  
Dementia Care ◽  
Research Approach ◽  
Ethical Challenges ◽  
Research Strategies ◽  
Policy And Practice ◽  
Challenges And Opportunities ◽  
Informal Carers

Abstract Dementia poses a societal challenge that is life-changing not only for persons with dementia (PWD) but also for family members and friends (informal carers) directly involved in the care arrangement. Informal carers (IC) have typically poorer outcomes in terms of well-being, quality of life (QoL), health status, and use of health care resources. Dyads of PWD and IC living with dementia are characterized by strong reciprocal relationships and complex living contexts. Therefore, research should investigate home based dementia caregiving from a dyadic perspective to yield interventions that support the PWD, the IC, and the unit as a whole. However, it is an ongoing challenge to investigate dyadic needs and preferences in daily practice and develop effective interventions. Challenges are related to incomplete understanding of dyadic characteristics, attitudes and beliefs within the dyad, as well as how to adapt research approach to engage and retain the dyad in research. This international symposium will therefore address these issues. The first presentation will describe a typology of dementia care dyad characteristics and needs in Germany. The second presentation will examine the challenges and opportunities associated with recruiting and retaining dementia dyads. The third presentation will explore ethical challenges posed in communication with dyads and possible solutions for the researcher. The final presentation reports on the Meeting Centre Support Program as an example of an effective psychosocial intervention employing research strategies that transcend cultural barriers. Our discussant, Katie Maslow, will synthesize the presentations and lead a discussion of future directions for policy and practice.

scholarly journals Reflecting on the contemporary relevance of the forgotten management pioneers: A creative auto/biography

2019 ◽  
Vol 12 (2) ◽  
pp. 205979911986328
Author(s):  
Hester Nienaber
Keyword(s):  
Reflective Practice ◽  
Well Being ◽  
Base Change ◽  
Theory And Practice ◽  
Organisational Performance ◽  
Relevant Today ◽  
Practice Gap ◽  
Theory Practice Gap ◽  
And Control

Management theory and practice are characterised by the ‘theory–practice gap’. A way of addressing this divide is to engage in reflective practice, in this instance, a creative auto/biography. This different way of presenting an old issue demonstrates how the original teachings of the management pioneers remain relevant today. The central issues are the purpose of the organisation and the role of both leadership and employees in unlocking human competence in pursuit of organisational performance. The concepts ‘autonomy’ and ‘control’ transpired as crucial, which could easily be misunderstood or misapplied. This personal reflection presents evidence on which to base change, enhancing the well-being of employees, societies and the profit of organisations. This article contributes to knowledge by making inaccessible knowledge, accessible and inclusive, and the expectation that the meaning emanating from this reflection will result in the management audience to reconsider management, advancing management science and benefitting society at large.

scholarly journals Increasing Medical Student Exposure to Pathology by Creating an Integrated Rotation During Surgery Clerkship

2021 ◽  
Vol 8 ◽  
pp. 237428952110153
Author(s):  
Madelyn Lew
Keyword(s):  
Small Group ◽  
Healthcare Delivery ◽  
University Of Michigan ◽  
Clinical Experiences ◽  
Michigan Medical School ◽  
Fast Pace ◽  
Contact Hours ◽  
Group Sessions ◽  
Preclinical Curriculum ◽  
The University

Following a nationwide trend, the University of Michigan Medical School has restructured its curriculum to facilitate integration of basic science curricula and early inclusion of clinical experiences, resulting in a truncation of a 19-month didactic-based preclinical curriculum to 13 months. Because preclinical didactic and lab sessions formed the bulk of pathology contact hours, the curriculum overhaul significantly reduced student exposure to pathologists. This reduction in exposure may decrease student understanding of how pathology integrates into the larger picture of healthcare delivery and could also decrease the pipeline of students interested in pursuing pathology as a career choice. To ameliorate these concerns, a mandatory 1-week rotation through the Pathology Department was integrated into the surgery clerkship. This brief report outlines the process of creating a new, unique pathology rotation for surgery clerkship students that includes observation in autopsy and surgical pathology sign-out, small group sessions focused on foundational concepts in microbiology, chemistry, and transfusion medicine, and access to online case-based modules. Available qualitative student feedback indicates that students appreciate how this rotation granted them a “behind the scenes” look at pathology but also noted that the fast pace of clinical sign-out sessions and length of small group sessions were suboptimal for student learning. This feedback and future survey data will serve as a platform on which curricular improvements can be made to enhance the learning environment for both learners and educators.

scholarly journals Should my robot know what's best for me? Human–robot interaction between user experience and ethical design

AI & Society ◽  
2021 ◽  
Author(s):  
Nora Fronemann ◽  
Kathrin Pollmann ◽  
Wulf Loh
Keyword(s):  
User Experience ◽  
Interaction Design ◽  
Real Life ◽  
Well Being ◽  
Design Principles ◽  
Human Robot Interaction ◽  
Ethical Challenges ◽  
Original Design ◽  
Robot Interaction ◽  
Ethical Design

AbstractTo integrate social robots in real-life contexts, it is crucial that they are accepted by the users. Acceptance is not only related to the functionality of the robot but also strongly depends on how the user experiences the interaction. Established design principles from usability and user experience research can be applied to the realm of human–robot interaction, to design robot behavior for the comfort and well-being of the user. Focusing the design on these aspects alone, however, comes with certain ethical challenges, especially regarding the user’s privacy and autonomy. Based on an example scenario of human–robot interaction in elder care, this paper discusses how established design principles can be used in social robotic design. It then juxtaposes these with ethical considerations such as privacy and user autonomy. Combining user experience and ethical perspectives, we propose adjustments to the original design principles and canvass our own design recommendations for a positive and ethically acceptable social human–robot interaction design. In doing so, we show that positive user experience and ethical design may be sometimes at odds, but can be reconciled in many cases, if designers are willing to adjust and amend time-tested design principles.

What gets resident physicians stressed and how would they prefer to be supported? A best–worst scaling study

2021 ◽  
pp. postgradmedj-2021-140719
Author(s):  
Andrew Wu ◽  
Ritika S Parris ◽  
Timothy M Scarella ◽  
Carrie D Tibbles ◽  
John Torous ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Emergency Medicine ◽  
Peer Support ◽  
Well Being ◽  
Specific Information ◽  
Choice Modelling ◽  
Work Stressors ◽  
Cross Sectional ◽  
Academic Medical Centre ◽  
Best Worst Scaling

IntroductionPhysician burnout has severe consequences on clinician well-being. Residents face numerous work-stressors that can contribute to burnout; however, given specialty variation in work-stress, it is difficult to identify systemic stressors and implement effective burnout interventions on an institutional level. Assessing resident preferences by specialty for common wellness interventions could also contribute to improved efficacy.MethodsThis cross-sectional study used best–worst scaling (BWS), a type of discrete choice modelling, to explore how 267 residents across nine specialties (anaesthesiology, emergency medicine, internal medicine, neurology, obstetrics and gynaecology, pathology, psychiatry, radiology and surgery) prioritised 16 work-stressors and 4 wellness interventions at a large academic medical centre during the COVID-19 pandemic (December 2020).ResultsTop-ranked stressors were work-life integration and electronic health record documentation. Therapy (63%, selected as ‘would realistically consider intervention’) and coaching (58%) were the most preferred wellness supports in comparison to group-based peer support (20%) and individual peer support (22%). Pathology, psychiatry and OBGYN specialties were most willing to consider all intervention options, with emergency medicine and internal medicine specialties least willing to consider intervention options.ConclusionBWS can identify relative differences in surveyed stressors, allowing for the generation of specialty-specific stressor rankings and preferences for specific wellness interventions that can be used to drive institution-wide changes to improve clinician wellness. BWS surveys are a potential methodology for clinician wellness programmes to gather specific information on preferences to determine best practices for resident wellness.

Ethical impact of suboptimal referrals on delivery of care in radiology department

2021 ◽  
pp. medethics-2021-107335
Author(s):  
Catherine Chilute Chilanga ◽  
Kristin Bakke Lysdahl
Keyword(s):  
Imaging Modality ◽  
Well Being ◽  
Good Health ◽  
Correct Choice ◽  
Radiology Department ◽  
Ethical Challenges ◽  
Patient Anxiety ◽  
Missed Opportunities ◽  
Delivery Of Care ◽  
Lack Of Information

The referral is the key source of information that enables radiologists and radiographers to provide quality services. However, the frequency of suboptimal referrals is widely reported. This research reviews the literature to illuminate the challenges suboptimal referrals present to the delivery of care in radiology departments. The concept of suboptimal referral includes information, that is; missing, insufficient, inconsistent, misleading, hard to interpret or wrong. The research uses the four ethical principles of non-maleficence, beneficence, Autonomy and Justice as an analytic framework.Suboptimal referrals can cause harm by hindering safe contrast-media administration, proper radiation protection by justification of procedures, and compassionate patient care. Suboptimal referrals also hinder promoting patient benefits from the correct choice of imaging modality and protocol, an optimal performed examination, and an accurate radiology report. Additionally, patient autonomy is compromised from the lack of information needed to facilitate benefit–risk communication. Finally, suboptimal referrals challenge justice based on lack of reasonable patient prioritising and the unfairness caused by unnecessary examinations.These findings illuminate how suboptimal referrals can inhibit good health and well-being for patients in relation to safety, missed opportunities, patient anxiety and dissatisfaction. The ethical challenges identified calls for solutions. Referral-decision support tools and artificial intelligence may improve referral quality, when implemented. Strategies addressing efforts of radiology professionals are inevitable, including gatekeeping, shared decision-making and inter-professional communication; thereby raising awareness of the importance of good referral quality and promoting commitment to ethical professional conduct.

scholarly journals Reflective Practice for Professional Development Among Nursing Instructors

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Boniface Harerimana
Keyword(s):  
Nursing Students ◽  
Reflective Practice ◽  
Health Professionals ◽  
Action Plan ◽  
Self Awareness ◽  
Work Experiences ◽  
Clinical Experiences ◽  
Clinical Scenarios ◽  
Reflection In Action ◽  
Reflection On Action

Reflective practice among health professionals involves considering and questioning clinical experiences. The process of learning through work involves “reflection-in-action” (the skills of self-awareness, critical analysis, synthesis, and evaluation while executing clinical activities),  and “reflection-on-action” which involves retrospective reviews of the clinical scenarios  experienced by  health professionals (Clouder, 2000; Duffy, 2009). Johns (1995)  suggests that reflective practice is the professional’s ability to understand and learn from work experiences to achieve more effective and satisfying followup work experiences. Nursing instructors play a crucial role in helping nursing students consolidate taught theories and practice through guided and regular reflection on professional experiences (Duffy, 2009). To be effective guides, nursing instructors require the knowledge and skills necessary to implement reflective practice techniques into their teaching. This workshop actively engages participants in examining reflective practice by building on Gibbs’ (1998) six-step reflective cycle (i.e., description, feelings/thoughts, evaluation, analysis, conclusion, and action plan). The goal is to help instructors develop the necessary abilities to guide reflective practice among their students.

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