Otolaryngology residency program websites in a socially distanced application cycle

Objective To provide an updated evaluation of otolaryngology residency program websites during a socially distanced application cycle. Criteria were selected to evaluate for level of comprehensiveness, new content accommodating a virtual interview cycle, and stated commitment to diversity and inclusion. Study design Review of otolaryngology residency program websites. Setting Online websites between December 2020 and January 2021. Methods Otolaryngology residency program websites were evaluated for selected criteria. Programs were categorized by geographic location, size, and Doximity rankings. Differences between groups were analyzed using Student’s t-test and analysis of variance with a significance level of P < .05. Results 118 otolaryngology residency program websites contained a mean (SD) of 16.3 (4.7) of 31 criteria (52.6%). Fewer than one third included virtual/video tours of facilities or the surrounding area. Only 33% had a stated commitment to diversity and inclusion. There was no difference in number of criteria included when categorized by geographic location ( P = .22). Larger programs (17.9 vs 14.5, P < .001) and programs ranked in the top 50 by Doximity (17.7 vs 15.2, P = .003) included a significantly greater number of criteria. Conclusion While the comprehensiveness of otolaryngology residency program websites has improved, considerable room for improvement remains. Programs should strive to maintain updated websites that highlight training opportunities, program culture, and commitment to diversity and inclusion. Programs also should consider prioritizing the development of new online resources that may be especially useful to applicants during a virtual interview cycle.

The Impact of Overseas Training on the Performance of Bangladesh Civil Service: The Case of AIT Extension Training, Thailand

Public administration has to compete with private sectors in terms of quality service delivery to citizens. In this context, civil service training, especially overseas training, has been considered the most significant requirement to increase the performance of the Bangladesh Civil Service. This article tries to explore the impact of overseas training on the performance of the Bangladesh Civil Service. To achieve this objective, this study interviewed Bangladesh Civil Servants who participated Asian Institute Training (AIT) Extension training programme from 2016 to 2018. A mixed-method was applied to analyse the collected data. It found that Bangladesh Civil Servants, who have received AIT Extension training, were satisfied with the training management of AIT. Participants believed that such overseas training positively contributes to enhancing the performance of the Bangladesh Civil Service. However, this study also disclosed that fewer overseas training opportunities for young civil servants, lack of need-based training, and poor management of overseas training policy are the main obstacles in Bangladesh Civil service management. This article strongly recommends that there must be a detailed overseas training policy management and more collaboration with international training institutes to get better performance from the government officers in Bangladesh.

UK-wide study of the opinions of gastroenterology trainees: COVID-19, Shape of Training and the future workforce

IntroductionThe COVID-19 pandemic has disrupted training. Gastroenterology higher specialty training is soon to be reduced from 5 years to 4. The British Society of Gastroenterology Trainees Section biennial survey aims to delineate the impact of COVID-19 on training and the opinions on changes to training.MethodsAn electronic survey allowing for anonymised responses at the point of completion was distributed to all gastroenterology trainees from September to November 2020.ResultsDuring the first wave of the COVID-19 pandemic, 71.0% of the respondents stated that more than 50% of their clinical time was mostly within general internal medicine. Trainees reported a significant impact on all aspects of their gastroenterology training due to lost training opportunities and increasing service commitments. During the first wave, 88.5% of the respondents reported no access to endoscopy training lists. Since this time, 66.2% of the respondents stated that their endoscopy training lists had restarted. This has resulted in fewer respondents achieving endoscopy accreditation. The COVID-19 pandemic has caused 42.2% of the respondents to consider extending their training to obtain the skills required to complete training. Furthermore, 10.0% of the respondents reported concerns of a delay to completion of training. The majority of respondents (84.2%) reported that they would not feel ready to be a consultant after 4 years of training.ConclusionsReductions in all aspects of gastroenterology training were reported. This is mirrored in anticipated concerns about completion of training in a shorter training programme as proposed in the new curriculum. Work is now required to ensure training is restored following the pandemic.

What do codes of ethics tell us about impartiality, and what is preferred at the hospital?

The impartiality of the interpreter has long been an important aspect of and an indispensable quality in healthcare interpreting. Official documents on professional ethics created by professional associations around the world refer to impartiality among the fundamental ethical principles to be adhered to. However, the conditions in the workplace and the background of the interpreter might pose significant risks to ensuring the implementation and adoption of ethics in the field. Furthermore, specific conditions of immigration and the quality (or the existence) of interpreter training in the required language combinations may play a role in either facilitating or impeding the implementation of ethical principles. As a country that has been receiving migrants for a relatively short time, Turkey lacks a code of ethics specifically drawn up for healthcare (or community) interpreters and this may well lead to problems in the field. Therefore, the primary objective of this study is to compare healthcare interpreters’ understanding of, preference for and exercise of impartiality with the prescripts of the codes applicable in other countries and to demonstrate how the principle of impartiality unfolds in healthcare contexts. The results of the study demonstrate that helping the patient was the main motivation of the interpreters in the field rather than being guided purely by impartiality. They reported being deliberately on the patient’s side to support them and to ensure that they obtained the required treatment, an approach which contradicts the codes of the associations in the countries that prefer “interpreting” rather than “mediation”. The analysis pointed to the fact that the meaning of impartiality is shaped by the system in which it is laid down. These results suggest that the codes and the attitudes of healthcare interpreters do not coincide as regards impartiality in a country where healthcare interpreting research and practice are emerging and training opportunities are scarce. They can serve as a useful reference point for policymaking and the professionalization of healthcare interpreters.

State Incentives and Sustainable Motivation System in the Health Sector

Now that the pandemic has entered the second phase, in which countries are adapting to the crisis, governments need to determine incentives that will contribute to the sustainability of the health system and human health. Regarding this, human resources are a significant factor, which affects the sustainability of any system, and it is important to establish a relevant motivation system that will withstand the challenges that society will face in the coming period. The aim of this paper is to analyse three dimensions of state incentives (employment program, COVID-19 bonus, training opportunities) and to examine their influence on healthcare workers’ motivation and the sustainability of the health system in the Republic of Serbia. The empirical research was conducted on a sample of 207 respondents employed in the tertiary level of healthcare. Data analysis included exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and structural equation modelling (SEM). The research results confirmed the existence of all three incentives and indicated that state incentive “training opportunities” has the strongest effect on the motivation of health workers and the sustainability of the healthcare system.

Barriers to increase surgical productivity in Sierra Leone: a qualitative study

ObjectiveTo explore factors influencing surgical provider productivity and identify barriers against and opportunities to increase individual surgical productivity in Sierra Leone, in order to explain the observed increase in unmet surgical need from 92.2% to 92.7% and the decrease in surgical productivity to 1.7 surgical procedures per provider per week between 2012 and 2017.Design and methodsThis explanatory qualitative study consisted of in-depth interviews about factors influencing surgical productivity in Sierra Leone. Interviews were analysed with a thematic network analysis and used to develop a conceptual framework.Participants and setting21 surgical providers and hospital managers working in 12 public and private non-profit hospitals in all regions in Sierra Leone.ResultsSurgical providers in Sierra Leone experience a broad range of factors within and outside the health system that influence their productivity. The main barriers involve both patient and facility financial constraints, lack of equipment and supplies, weak regulation of providers and facilities and a small surgical workforce, which experiences a lack of recognition. Initiation of a Free Health Care Initiative for obstetric and paediatric care, collaborations with partners or non-governmental organisations, and increased training opportunities for highly motivated surgical providers are identified as opportunities to increase productivity.DiscussionBroader nationwide health system strengthening is required to facilitate an increase in surgical productivity and meet surgical needs in Sierra Leone. Development of a national strategy for surgery, obstetrics and anaesthesia, including methods to reduce financial barriers for patients, improve supply-mechanisms and expand training opportunities for new and established surgical providers can increase surgical capacity. Establishment of legal frameworks and appropriate remuneration are crucial for sustainability and retention of surgical health workers.

Learning needs assessment for multi-stakeholder implementation science training in LMIC settings: findings and recommendations

Background Despite significant progress in the field of implementation science (IS), current training programs are inadequate to meet the global need, especially in low-and middle-income countries (LMICs). Even when training opportunities exist, there is a “knowledge-practice gap,” where implementation research findings are not useful to practitioners in a field designed to bridge that gap. This is a critical challenge in LMICs where complex public health issues must be addressed. This paper describes results from a formal assessment of learning needs, priority topics, and delivery methods for LMIC stakeholders. Methods We first reviewed a sample of articles published recently in Implementation Science to identify IS stakeholders and assigned labels and definitions for groups with similar roles. We then employed a multi-step sampling approach and a random sampling strategy to recruit participants (n = 39) for a semi-structured interview that lasted 30–60 min. Stakeholders with inputs critical to developing training curricula were prioritized and selected for interviews. We created memos from audio-recorded interviews and used a deductively created codebook to conduct thematic analysis. We calculated kappa coefficients for each memo and used validation techniques to establish rigor including incorporating feedback from reviewers and member checking. Results Participants included program managers, researchers, and physicians working in over 20 countries, primarily LMICs. The majority had over 10 years of implementation experience but fewer than 5 years of IS experience. Three main themes emerged from the data, pertaining to past experience with IS, future IS training needs, and contextual issues. Most respondents (even with formal training) described their IS knowledge as basic or minimal. Preferences for future training were heterogeneous, but findings suggest that curricula must encompass a broader set of competencies than just IS, include mentorship/apprenticeship, and center the LMIC context. Conclusion While this work is the first systematic assessment of IS learning needs among LMIC stakeholders, findings reflect existing research in that current training opportunities may not meet the demand, trainings are too narrowly focused to meet the heterogeneous needs of stakeholders, and there is a need for a broader set of competencies that moves beyond only IS. Our research also demonstrates the timely and unique needs of developing appropriately scoped, accessible training and mentorship support within LMIC settings. Therefore, we propose the novel approach of intelligent swarming as a solution to help build IS capacity in LMICs through the lens of sustainability and equity.

P-O05 Deconstructing Operations to Improve Recording of Surgical Training Experience

Background A new outcomes-based curriculum is soon to be implemented for UK surgical trainees. Performance will be evaluated against the standard expected of a new consultant. Accurate recording of operative experience and performance will therefore be crucial to demonstrate achievement of this standard. The current eLogbook system for recording surgical experience has many benefits including simplicity and accessibility, but may misrepresent actual experience because most operations are considered as a whole; unlike some colorectal operations, involvement in steps within many upper gastrointestinal (UGI) operations cannot be recorded. Methods Impact on training by the COVID-19 pandemic led to discussion and identification of cultural and logistical barriers to accurate recording of experience. To address these, a modification to enhance the current eLogbook system was developed by trainees and trainers at a university teaching hospital. An existing typology was used to deconstruct common UGI operations into their component steps, which can be recorded at this more detailed level. Results The modified deconstructed logbook concept is described using a worked example, which can be applied to any operation. We also describe the integration of a component-based training discussion into the surgical team brief and debrief; this complements the deconstructed logbook by promoting a training culture. Conclusions Using the described techniques, trainees of all levels can comprehensively and accurately describe their surgical experience. Senior trainees will benefit from recording complex operations which they are not expected to complete in their entirety, whilst less experienced trainees will benefit from the ability to record their involvement in more basic parts of operations. The suggested approach will reduce misrepresentation of experience, encourage proactive planning of training opportunities, and reduce the impact of crises such as pandemics on surgical training.

Employers' Support of Older Adults Facing Ageism in the Workplace: A Scoping Review of the Literature

As the Canadian population continues to age rapidly, addressing the social structures that negatively impact older adults is of increasing importance. The most prominent of these social structures is the workplace, which can be a potential source of age discrimination. The goal of this scoping review was to analyze the literature that addresses strategies for employers to support older workers experiencing ageism, in order to answer the research question: How can employers support older adults (50+) facing ageism in the workplace? Following Arksey and O’Malley’s five-step framework, an electronic database and grey literature search was conducted between September and December 2020. Thematic content analysis was performed to establish key themes. The search revealed 3,635 peer-reviewed and grey literature sources that were evaluated by three investigators. Thirty-six articles, published between 2006 and 2020, met inclusion criteria and examined various support strategies for employers. Five major emerging themes were identified from the literature: (1) Recruitment practices, (2) Training opportunities, (3) Education for managers, leaders, and employees in the workplace, (4) Flexible employment opportunities, and (5) Methods to change the psycho-social environment of the workplace. Implementation of these interventions is required to support older adults who may be experiencing workplace ageism. Longitudinal research of these interventions is required to determine the lasting effects of these strategies; however, the existing literature supports the implementation of these supportive actions, which is vital to ensuring that older adults are able to attain and maintain valuable work, in healthy environments, now and into the future.