Strategies for mitigating burnout among early career doctors in Nigeria: lessons learnt from the qualitative CHARTING study

BackgroundEarly career doctors (ECDs) are faced with many challenges due to their transition from undergraduate medical/dental studentship to being postgraduate doctors and being in an early phase of their career. The specific factors that affect ECDs in their careers and endeavors at the workplace range from poor remuneration, particularly in developing countries, to psychosocial problems (such as burnout [BO] syndrome). There is a dearth of information on BO among ECDs in Nigeria. This qualitative study aims to explore the opinions of ECDs in Nigeria on the causal/predisposing factors of BO, effects of BO, and strategies for mitigating BO among ECDs in Nigeria.MethodUsing purposive sampling method, two sessions of focus group discussions (FGDs) involving 14 ECDs (key informants) holding key leadership positions and who were delegates of other ECDs in Nigeria were conducted to explore their experiences on psychological issues among ECDs. Data collected were transcribed and analyzed thematically.ResultsBO is an issue of serious concern among ECDs in Nigeria. The causes of BO are diverse, some of which include low staff strength, prolonged work hours, wrong counseling, lack of job description and specification, and abuse of powers by trainers. In order to mitigate the issue of BO among ECDs, the respondents recommended that work policy review, medical workforce strengthening, stakeholder dialog on ECDs’ welfare, regular psychological review of ECDs, and provision of free yearly medicals need to be looked into. Conclusion: Our findings revealed that the participants considered BO issues among ECDs to be common, and it affected their performance and the overall quality of care in Nigeria health system. Based on our findings, there is an urgent need to mitigate the problem of emotional exhaustion among ECDs in Nigeria.

Strategies and measures directed towards overtourism: a perspective of European DMOs

Purpose Due to both the new quality and intensity overtourism discussions have received, it is time to examine the question concerning the consequences this development has on destination level and how destinations can adjust their strategies for future development. This is especially important to consider, since overtourism can be seen as a fundamental issue for tourism development. First measures taken within destinations show that reactions are taking place, e.g. through access restrictions of frequently visited places. The purpose of this paper is to identify future-oriented strategies and to derive concrete measures in order to deal with overtourism on a destination level. Design/methodology/approach In total, 19 qualitative interviews with European destination managers were conducted and evaluated via the qualitative analysis method GABEK® with WinRelan® software. Findings The results show that various stakeholders are involved in overtourism, with the destination management organization being the central actor to deal with issues. It is challenging to choose between different strategies and measures, which always have to be considered in relation to the specific conditions of a destination and the perception level of overtourism. In order to face current developments, the initiation of a stakeholder dialog can be seen as a promising factor, but also as a challenging task. Originality/value Currently, a “wait-and-see-attitude” exists, where well-known destinations are cited as negative examples, but a serious examination related to one’s own destination has not yet been developed. This consideration should be seen as a prerequisite for future-oriented destination development, which takes the local population into account.

Innovation in Outcomes-Based Water Quality Policy: A Case Study from the Yahara Watershed, Wisconsin, USA

This case examines the risks and opportunities for stakeholders involved in an experimental water quality management program in Wisconsin, USA. This program pays for pounds of pollution reduced through soil conservation practices on farm fields and other high-runoff areas across the landscape—nonpoint sources of pollution—by redirecting funds from the sewerage plant and municipal point sources of pollution. Uncertain monitoring and modeling of pollution sources used for program payments and accountability create perceived and real risks to program participants and the environment, including the threat of regulatory enforcement, lost revenue, and failure to achieve environmental outcomes. On the other hand, in this case study, regulatory flexibility also opened a space for stakeholder dialog and programmatic cooperation that could lead to more adaptive and locally acceptable watershed pollution control in the future.