The Hardest Weeks of My Life: A Qualitative Study of Experiences, Practice Changes, and Emotional Burden of New York City Oncology Physicians During the COVID-19 Surge in 2020

PURPOSE: The COVID-19 pandemic surge in New York City in Spring 2020 resulted in an unprecedented constraint on health care resources. This study aimed to explore the experiences of doctors providing care to oncology patients during this time. METHODS: Hospitalists and medical oncologists from two large inpatient services at a dedicated cancer center participated in virtual in-depth interviews exploring how the pandemic affected their practice and to what extent it may have affected decisions for urgent evaluation or hospital admission, interventions, or goals-of-care discussions. Interviews also explored how the pandemic affected each individual physician's psychologic well-being. Transcripts were analyzed by three independent coders in Atlas.ti v. 7.5, using a thematic analysis approach. RESULTS: Eighteen physicians were interviewed (n = 6 GI medical oncologists, n = 6 gynecologic medical oncologists, and n = 6 hospitalists). Analysis identified five major themes related to fear and distress: (1) perceived patient fears of the hospital during COVID-19, leading to avoidance and delay of acute care needs before admission, (2) physicians' fear and distress delivering oncology care during COVID-19, (3) physician distress resulting from ambiguity in decision making, (4) distress and anxiety balancing the need for patient contact with the need to minimize infection risk, and (5) distress regarding impact of uncertainty and acuity of COVID-19 on goals-of-care discussions. CONCLUSION: Insight into the experiences of physicians providing cancer care during a COVID-19 surge underscores the need for strategies mitigate short-term distress and long-term psychologic impacts. Findings can also inform practitioner training and preparedness for future pandemics in the oncology setting.

A Sociocultural Framework to Analyse M-Learning Options for Early Childhood Development (ECD) Practitioner Training

This article, a contribution to m-learning (mobile learning) research, centres on the motivation for, and development of, a suitable framework to analyse m-learning options for early childhood development (ECD) practitioners. Grounded in a sociocultural learning perspective, the framework was developed as part of a larger study into the feasibility of m-learning for ECD practitioners in the Penreach professional development programme in Mpumalanga Province, South Africa. Analysis of existing frameworks enabled the development of a new, modified framework to suit the Penreach context. Here we unpack the framework and explain its development. The new, modified framework aims to assist researchers, developers, and implementers by prompting consideration of five sociocultural learning features associated with m-learning in ECD, namely: device access, data affordability, authenticity, collaboration, and personalisation.

How Lawyers Search When No-One Is Looking: A Transaction Log Analysis to Evaluate the Educational Needs of the Legal Profession

<p>Lawyers are increasingly responsible for conducting research using legal databases and are looking to law librarians for training. As there is little information regarding law practitioner training, and even less which provides information about the actual search behaviour of the legal profession, much of this training has had to be based upon experience and best guesses of individual librarians. This study was undertaken to investigate the actual search behaviour of practitioners using the Auckland District Law Society Library. Its purpose is to provide the training personnel in that library with information about the search habits of their potential trainees to improve current training initiatives. It is based on data from transaction logs gathered from the public terminals in the Auckland District Law Society Library which are used by practitioners. An analysis of the logs collected revealed that: (1) the case summary databases, LINX and BRIEFCASE, were the databases most commonly used by practitioners; (2) the most common type of search conducted during the study was for commentary or case law on a particular subject; (3) the majority of search sessions comprised only a single query, but there were some instances where practitioner sessions would involve more than 10 queries; and (4) there was limited use of any of the advanced search features offered on FolioVIEWS. Based upon these findings the following recommendations were made in relation to the existing training programme offered by the Library: 1. All training sessions include information regarding database concepts; 2. The library initiate additional lunch-time training sessions to inform practitioners of the databases currently available in the library and their content; 3. The library continue to teach advanced search techniques, particularly search construction, the use of synonyms and truncation, to help increase the levels of recall and therefore search success in practitioner searches; 4. The library continue to include information on Field and Phrase searching in both the beginners and advanced courses. Although the purpose of the study was not to investigate the level of search 'failure' or 'success' attained by practitioners, this paper contains a discussion of the different measurement techniques which could be used to measure search effectiveness. It is argued that recall would be the most appropriate measure of search success and that, based upon a visual examination of the transaction logs, this is not being achieved in the majority of cases. Given this alarming observation it is argued that more attention should be paid to issues surrounding database and interface design and that the library become involved in a general education programme to help users recognise situations in which end-user searches may be inappropriate.</p>

How Lawyers Search When No-One Is Looking: A Transaction Log Analysis to Evaluate the Educational Needs of the Legal Profession

<p>Lawyers are increasingly responsible for conducting research using legal databases and are looking to law librarians for training. As there is little information regarding law practitioner training, and even less which provides information about the actual search behaviour of the legal profession, much of this training has had to be based upon experience and best guesses of individual librarians. This study was undertaken to investigate the actual search behaviour of practitioners using the Auckland District Law Society Library. Its purpose is to provide the training personnel in that library with information about the search habits of their potential trainees to improve current training initiatives. It is based on data from transaction logs gathered from the public terminals in the Auckland District Law Society Library which are used by practitioners. An analysis of the logs collected revealed that: (1) the case summary databases, LINX and BRIEFCASE, were the databases most commonly used by practitioners; (2) the most common type of search conducted during the study was for commentary or case law on a particular subject; (3) the majority of search sessions comprised only a single query, but there were some instances where practitioner sessions would involve more than 10 queries; and (4) there was limited use of any of the advanced search features offered on FolioVIEWS. Based upon these findings the following recommendations were made in relation to the existing training programme offered by the Library: 1. All training sessions include information regarding database concepts; 2. The library initiate additional lunch-time training sessions to inform practitioners of the databases currently available in the library and their content; 3. The library continue to teach advanced search techniques, particularly search construction, the use of synonyms and truncation, to help increase the levels of recall and therefore search success in practitioner searches; 4. The library continue to include information on Field and Phrase searching in both the beginners and advanced courses. Although the purpose of the study was not to investigate the level of search 'failure' or 'success' attained by practitioners, this paper contains a discussion of the different measurement techniques which could be used to measure search effectiveness. It is argued that recall would be the most appropriate measure of search success and that, based upon a visual examination of the transaction logs, this is not being achieved in the majority of cases. Given this alarming observation it is argued that more attention should be paid to issues surrounding database and interface design and that the library become involved in a general education programme to help users recognise situations in which end-user searches may be inappropriate.</p>

Translating Qualitative Data into Intervention Content Using the Theoretical Domains Framework and Stakeholder Co-Design: A Worked Example from a Study of Cervical Screening Attendance in Older Women

Background: Previous screening interventions have demonstrated a series of features related to social determinants which have increased uptake in targeted populations, including the assessment of health beliefs and barriers to screening attendance as part of intervention development. Many studies cite the use of theory to identify methods of behaviour change, but fail to describe in detail how theoretical constructs are transformed into intervention content. The aim of this study was to use data from qualitative exploration of cervical screening in women over fifty in the UK as the basis of intervention co-design with stakeholders using behavioural change frameworks. We describe the identification of behavioural mechanisms from qualitative data, and how these were used to develop content for a service user leaflet and a short video animation for practitioner training. The interventions aimed to encourage sustained commitment to cervical screening among women over fifty, and to increase sensitivity to age-related problems in cervical screening among primary care practitioners.Methods: We translated qualitative data into barriers and facilitators by recoding a primary data set, and subsequently applied the Theoretical Domains Framework (TDF) to identify relevant behaviour change techniques (BCTs) based on the data set. Key TDF domains and associated BCTs were presented in stakeholder focus groups to guide intervention content and mode of delivery.Results: Behavioural determinants relating to attendance clustered under three domains: beliefs about consequences, emotion and social influences, which mapped to three BCTs respectively: (1) persuasive communication/information provision; (2) stress management; (3) role modelling and encouragement. Service-user stakeholders translated these into three pragmatic intervention components: (i) addressing unanswered questions, (ii) problem-solving practitioner challenges and (iii) peer group communication. Based on (ii), practitioner stakeholders developed a call to action in three areas – clinical networking, history-taking, and flexibility in screening processes. APEASE informed modes of delivery (a service-user leaflet and a cartoon animation for practitioners).Conclusion: The application of the TDF to qualitative data can provide an auditable protocol for the translation of qualitative data into intervention content.

Witness Statements for Employment Tribunals in England and Wales: What are the ‘Issues’?

In England and Wales, Employment Tribunals (ETs) hear claims from persons who believe that an employer, or potential employer, has treated them unlawfully. Witness statements form part of the evidence considered by ETs, but research is lacking with regard to the methods used to produce ET witness statements. This study presents the findings from 40 semi-structured interviews with ET judges, panel members, employment lawyers (solicitors, barristers, advisers) and litigants. Our data revealed six themes: professional processes, enabling through case management, presentation preferences, challenges for litigants in person, availability and quality of resources, and lack of training. Participants felt that the quality of witness statements varied amongst those prepared by professional advisors and by litigants in person. Our interviews revealed almost no evidence of practitioner training on how best to prepare a witness statement. We make recommendations about guidance and training for those tasked with drafting witness statements.

The ‘medically unexplained symptoms’ syndrome concept and the cognitive-behavioural treatment model

The American Psychiatric Association’s, 2013 DSM-5 abandoned the use of the term ‘medically unexplained symptoms’ for non-neurological disorders. In the UK, treatments for various medical illnesses with unexplained aetiology, such as chronic fatigue syndrome, irritable bowel syndrome and fibromyalgia, continue to fall under an MUS umbrella with cognitive behavioural therapy promoted as a primary therapeutic approach. In this editorial, we comment on whether the MUS concept is a viable diagnostic term, the credibility of the cognitive-behavioural MUS treatment model, the necessity of practitioner training and the validity of evidence of effectiveness in routine practice.

Development of a blended learning system for nurses to learn the basics of psychoeducation for patients with mental disorders

Background Psychoeducation should be practiced by various professionals. However, many Japanese psychiatric nurses recognize that psychoeducation should be practiced by other professionals, and show passive attitudes toward learning about evidence-based practices (EBPs), including psychoeducation. We developed a psychoeducation practitioner training program (PPTP) to nurture nurses. However, the PPTP was shown to be ineffective to help nurses achieve psychoeducation skills, although it improved their knowledge of psychoeducation and views on EBP. We developed and evaluated a revised version of the PPTP, integrating blended learning that combines e-learning and group education (BL-PPTP), to nurture nurses’ competencies to practice psychoeducation for patients with mental disorders. Method We trained nurses working on acute psychiatric care wards of Japanese hospitals using BL-PPTP, and compared their attitudes for evidence-based practices (EBP attitudes), preparedness for psychoeducational practice, and self-efficacy at 4 points to clarify time-course changes in each participant. Results Sixty-nine nurses participated, 31 withdrew, and 38 were analyzed. The time needed to complete BL-PPTP ranged from 31 to 259 days, revealing a marked individual difference. There were significant improvements in most participants’ EBP attitudes and preparedness for psychoeducational practice at the end of the program compared with the baseline. Conclusions BL-PPTP may be useful to nurture nurses’ competencies to practice psychoeducation. BL-PPTP developed in the present study may also help disseminate psychoeducation among nurses, and increase the quality of nursing care.

Development of a competency model for general practitioners after standardized residency training in China by a modified Delphi method

Background The “5 + 3” residency training is the main stream general practitioner training program in China. However, a competency model is absent for evaluating the clinical competence attained by general practitioners after training. This study was conducted to develop a consensus set of competencies for general practitioners after standardized residency training in China. Methods A modified Delphi process was deployed to develop the competency model, including two stages: (1) generation of an initial set of competencies derived from literature review, behavioral observation of GP–patient consultations, and critical incidents interview of GPs; (2) a 2-round, web-based Delphi survey of experts in general practice, selected using purposive sampling, to prioritize and gain consensus on the essential competencies of GPs. Results From literature review, behavioral observation, and critical incidents interview, 46 competencies in 7 domains were identified. After two rounds of Delphi survey of 28 participants (the mean age was 47.9 [9.3] years and 64.3% were women) representing a range of health professionals (GPs, managers, and researchers), a consensus was reached on 50 competencies categorized into 7 domains. Conclusion A consensus-based competency model for general practitioners in China has been identified which may be used to evaluate the general practitioners’ clinical competence after standardized training.