Moral Injury during the COVID-19 pandemic: A delphi model survey of family medicine residents

Objectives The objective is to investigate the primary factors that created experiences leading to moral injury in family medicine residents during the COVID-19 pandemic and also to identify any barriers keeping these residents from seeking or receiving help when they experienced moral injury. Method A DELPHI model study utilizing three rounds of surveys was conducted at four family medicine residency programs in the United States. Resident responses to Survey 1 generated factors perceived to be causing them moral injury or constituting barriers to their seeking help. Thematic analysis identified common themes which were presented to residents in Survey 2 for rating and justification. Results and feedback from Survey 2 were shared with residents in Survey 3, where residents were prompted to reevaluate their ratings for factors and barriers for the purpose of generating consensus among themselves. A ranked list of factors and barriers was thereby created for the participating sites. Results Residents shared several stories about the factors that most pressured them to violate their moral values. The most severe and frequent factors contributing to moral injury involved disruptions to doctor–patient relationships, patient–family relationships, and relationships with other healthcare professionals. Time was the major barrier to residents seeking help. Conclusion During times of crisis, moral injury among residents may be minimized by protecting and promoting important clinical and professional relationships with patients, colleagues, and other medical professionals. While residents report that lack of time was the most significant barrier to seeking help, it is unclear how this complicated and ubiquitous problem would be resolved or mitigated.

Learning by Comparison: The Benefits of Co-Teaching for University Professors’ Professional Development

There is an abundance of studies that suggest that the use of co-teaching strategies in higher education courses can enhance instructors’ professional development, mainly by providing a space for transfer of methodologies and tools, as well as critical reflection on one’s teaching practice. However, little has been said about the actual processes through which co-teachers learn from each other. This study analyzes the opportunities of professional growth afforded to seven professors by eight co-taught courses, over two academic years, in the fields of Education and Translation and Interpreting. Specifically, it examines how professional relationships between co-teachers fuel teacher learning, the specific learning processes generated, and the areas of professional development impacted. To do so, 11 reflective teacher diaries were coded and analyzed, and further evidence was collected through focus groups interviews with students of some of the co-taught courses. Results suggest that comparison with the co-teacher is the main force behind participants’ learning on co-teaching; furthermore, such comparisons enable three main learning processes: reflection, negotiation and transfer, bearing mainly on teaching methods and materials and use of technology. Finally, there is evidence that occasional or ongoing team teaching (two instructors simultaneously in class) can enhance the effectiveness of co-teacher comparisons.

A Qualitative Exploratory Study of the Effects of Simulation on Nursing Students’ Self-Efficacy Beliefs for Using English for Professional Purposes

Background The health sector has become more international than ever because of patients’ increased mobility and access to healthcare services. As a result, the ability to communicate in English has become critical for nursing students in countries where English is used as a foreign language. Aim This study aimed to highlight and understand the experiences of nursing students regarding the effect of simulation-based learning on their self-efficacy beliefs for using English for professional purposes. Methods The study was conducted with 28 third-year university nursing students enrolled in a required English course and participating in two nursing simulations conducted in English. Focus groups were conducted using semi-structured interview questions to elicit and understand the self-efficacy beliefs of nursing students for using English for professional purposes. The collected data were analyzed by using content analysis. Results The result of the study emerged under three themes: carrying out nursing duties by using professional discourse, building professional relationships with patients, and maintaining spontaneous conversations with patients. The overall results showed that while the students’ self-efficacy beliefs increased for performing standard nursing duties and establishing rapport with patients, no increase was observed in their self-efficacy beliefs for holding a prolonged conversation with the patient. Conclusion This study’s findings have implications for nursing programs in which English proficiency is considered an important program outcome for nurses who may be expected to work in both their own language and English.

Improving the Quality of Patient Care and Healthcare Staff Well-Being through an Empathy Immersion Educational Programme in New Zealand: Protocol of a Feasibility and Pilot Study

Empathy is positively related to healthcare workers and patients’ wellbeing. There is, however, limited research on the effects of empathy education delivered in acute clinical settings and its impact on healthcare consumers. This research tests the feasibility and the potential efficacy outcomes of an immersive education programme developed by the research team in collaboration with clinical partners and a multidisciplinary advisory group. Healthcare worker participants in the intervention ward will receive an 8-week immersive empathy education. The primary outcome (feasibility) will be assessed by evaluating the acceptability of the intervention and the estimated resources. The secondary outcome (efficacy) will be assessed using a quasi-experimental study design. Non-parametric tests will be used to test healthcare worker participants’ empathy, burnout, and organisational satisfaction (within-group and across groups), and healthcare consumer participants’ satisfaction (between-group) over time. Despite growing interest in the importance of empathy in professional relationships, to our knowledge, the present pilot study is the first to explore the feasibility and efficacy of an immersive empathy education in New Zealand. Our findings will provide critical evidence to support the development of a randomised cluster trial and potentially provide preliminary evidence for the effectiveness of this type of empathy education.

Understanding the barriers and enablers of pharmacogenomic testing in primary care: a qualitative systematic review with meta-aggregation synthesis

Introduction: Pharmacogenomic testing can indicate which drugs may have limited therapeutic action or lead to adverse effects, hence guiding rational and safe prescribing. However, in the UK and other countries, there are still significant barriers to implementation of testing in primary care. Objective: This systematic review presents the barriers and enablers to the implementation of pharmacogenomics in primary care setting. Materials & methods: MEDLINE, EMBASE, PsycINFO and CINAHL databases were searched through to July 2020 for studies that reported primary qualitative data of primary care professionals and patient views. Following screening, data extraction and quality assessment, data synthesis was undertaken using meta-aggregation based on the theoretical domain’s framework (TDF). Confidence in the synthesized findings relating to credibility and dependability was established using CONQual. Eligible papers were categorized into six TDF domains – knowledge; social and professional roles; behavioral regulation; beliefs and consequences; environmental context and resources; and social influences. Results: From 1669 citations, eighteen eligible studies were identified across seven countries, with a sample size of 504 participants including both primary care professionals and patients. From the data, 15 synthesized statements, all with moderate CONQual rating emerged. These categories range from knowledge, awareness among Primary Care Physicians and patients, professional relationships, negative impact of PGx, belief that PGx can reduce adverse drug reactions, clinical evidence, cost–effectiveness, informatics, reporting issues and social issues. Conclusion: Through use of TDF, fifteen synthesized statements provide policymakers with valuable recommendations for the implementation of pharmacogenomics in primary care. In preparation, policymakers need to consider the introduction of effective educational strategies for both PCPs and patients to raise knowledge, awareness, and engagement. The actual introduction of PGx will require reorganization with decision support tools to aid use of PGx in primary care, with a clear delegation of roles and responsibilities between general professionals and pharmacists supplemented by a local pool of experts. Further policy makers need to address the cost effectiveness of pharmacogenomics and having appropriate infrastructure supporting testing and interpretation including informatic solutions for utilizing pharmacogenomic results.

Differentiated Embedding and Social Relationships Among Russian Migrant Physicians in Finland: A Narrative Socio‐Analysis

Migrants’ processes of (dis)embedding in local and transnational social networks have received growing attention in recent years, but most research focuses on low‐skilled migration. This study explores the affordances and challenges that Russian physicians, as a high‐skilled migrant group in Finland, experience in these processes in work and non‐work domains. Based on semi‐structured biographical interviews with 26 Russian physicians, the study employs Bourdieu’s socio‐analysis to analyze their narratives. The results reveal that Russian migrant physicians negotiate and experience differentiated embedding across work–life domains in local and transnational contexts. They mostly develop collegial relationships with Finnish colleagues and benefit from fulfilling professional relationships in the work domain. However, alongside time and efforts needed for building social ties, various factors often impede friendship making and socialization with locals beyond the work domain. These physicians cope with individual life circumstances through their enduring and supportive relationships with their Russian relatives and colleagues–friends. These results indicate that high‐skilled migrants have a greater opportunity to connect professionally with locals than low‐skilled migrants, but experience similar challenges to the latter in building close personal relationships.

Empowerment: A Book Review About Fulfilling Your Destiny Using Eight Personal Steps

Many of us want to improve, grow, and succeed in life. Although we cannot change our circumstances, our circumstances should not stop us from reaching our destiny (Hall, 2020). Everything we want out of life is within our reach. We just cannot give up. These topics are the essence of what Hall discusses as she takes us on a journey through eight steps of personal empowerment. We have to go through trials to come out on the other side. Based on these eight steps of empowerment, Hall discusses how these steps will guide us to our next chapter in life. We have the power: the power to choose how personal experiences can ultimately impact our personal, work, and professional relationships.

Review of social networks of professionals in healthcare settings—where are we and what else is needed?

Background Social Network Analysis (SNA) demonstrates great potential in exploring health professional relationships and improving care delivery, but there is no comprehensive overview of its utilization in healthcare settings. This review aims to provide an overview of the current state of knowledge regarding the use of SNA in understanding health professional relationships in different countries. Methods We conducted an umbrella review by searching eight academic databases and grey literature up to April 30, 2021, enhanced by citation searches. We completed study selection, data extraction and quality assessment using predetermined criteria. The information abstracted from the reviews was synthesized quantitatively, qualitatively and narratively. Results Thirteen reviews were included in this review, yielding 330 empirical studies. The degree of overlaps of empirical studies across included reviews was low (4.3 %), indicating a high diversity of included reviews and the necessity of this umbrella review. Evidence from low- and middle-income countries (LMIC), particularly Asian countries, was limited. The earliest review was published in 2010 and the latest in 2019. Six reviews focused on the construction or description of professional networks and seven reviews reported factors or influences of professional networks. We synthesized existing literature on social networks of health care professionals in the light of (i) theoretical frameworks, (ii) study design and data collection, (iii) network nodes, measures and analysis, and (iv) factors of professional networks and related outcomes. From the perspective of methodology, evidence lies mainly in cross-sectional study design and electronic data, especially administrative data showing “patient-sharing” relationships, which has become the dominant data collection method. The results about the impact of health professional networks on health-related consequences were often contradicting and not truly comparable. Conclusions Methodological limitations, inconsistent findings, and lack of evidence from LMIC imply an urgent need for further investigations. The potential for broader utilization of SNA among providers remains largely untapped and the findings of this review may contain important value for building optimal healthcare delivery networks. PROSPERO registration number The protocol was published and registered with PROSPERO, the International Prospective Register of Systematic Reviews (CRD42020205996).

CONSTRUCTION DISPUTE AND CONTRACT DOCUMENT DEFECTIVENESS: TESTING MODERATING EFFECT OF BIM

Construction dispute is the result of contract incompleteness caused by bounded rationality and uncertainty. These disputes are prevalent and have a detrimental effect on project success in terms of increased cost, low quality of work, loss of profit, time extension, and damaged business and professional relationships. Using Structural Equation Modelling (SEM), this study examines the relationship between contract defectiveness (one of the bounded rationality classes) and dispute occurrence and the moderating effect of BIM on the causal relationship. The result shows that contract document defectiveness has a significant effect on dispute occurrence. Likewise, the multigroup moderation test revealed a significant, positive, and more substantial impact on the BIM user group. Therefore, it can be posited based on this study's findings that BIM has a significant effect on reducing contract document defectiveness, which is one of the potential benefits of its adoption on construction projects.