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Time to revisit the skills and competencies required to work in rural general hospitals.

ABSTRACT: OBJECTIVES:To determine the structure and demographic of medical teams working in Rural General Hospitals (RGHs) in Scotland, and to gain insight into their experiences and determine their opinions on a remote and rural medical training pathway. DESIGN:Structured face-to-face interviews. Interviews were partially anonymised, and underwent thematic analysis. SETTING:Medical departments of the six RGHs in Scotland 2018-2019. PARTICIPANTS:14 medical consultants and 23 junior doctors working in RGHs in Scotland. Inclusion criteria: Present at time of site visit, medical consultant in an RGH or junior doctor working in an RGH who provides care for medical patients. Exclusion criteria: Doctors on leave or off shift. Medical consultants with less than one month of experience in post. Non-medical specialty consultants e.g. surgical or anaesthetic consultants. RESULTS:Of 21 consultant posts in the RGHs, only eight are filled with resident consultants, the remainder rely on locums. Consultants found working as generalists rewarding and challenging, and juniors found it to be a good training experience. Consultants feel little professional isolation due to modern connectivity. The majority of consultants (12/14) and all junior doctors favour a remote and rural medicine training pathway encompassing a mandatory paediatrics component, and feel this would help with consultant recruitment and retention. CONCLUSION:RGHs medical departments are reliant on locum consultants. The development of a remote and rural training medical training pathway is endorsed by the current medical teams of RGHs and has the potential to improve medical consultant staffing in RGHs.

SUBMITTER: Doyle C

PROVIDER: S-EPMC7544037 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Time to revisit the skills and competencies required to work in rural general hospitals.

Doyle Cormac C Isles Chris C Wilson Pauline P

PloS one 20201008 10

<h4>Objectives</h4>To determine the structure and demographic of medical teams working in Rural General Hospitals (RGHs) in Scotland, and to gain insight into their experiences and determine their opinions on a remote and rural medical training pathway.<h4>Design</h4>Structured face-to-face interviews. Interviews were partially anonymised, and underwent thematic analysis.<h4>Setting</h4>Medical departments of the six RGHs in Scotland 2018-2019.<h4>Participants</h4>14 medical consultants and 23 j ...[more]

PMID: 33031438

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Project description:ObjectivesAt minimum, safe patient outcomes are recognised as resulting from a combination of technical and non-technical skills. Flin and colleagues provide a practical framework of non-technical skills, cognitive, social and interpersonal, that complement technical skills, with categories identified as situational awareness, communication, team working, decision-making, leadership, coping with stress and managing fatigue. The aim of this research was to explore the alignment of categories and elements of non-technical skills with those in the published standards documents of several health professions in Australia.DesignA qualitative comparative analysis using document analysis and deductive coding examined, extracted and interpreted data from competency standards documents focusing on non-technical skills categories and elements.ParticipantsA purposive sample of 11 health professions competency standards documents required for registration in Australia.FindingsThe 11 competency standards documents contained 1616 statements. Although standards documents addressed all non-technical skills categories, there was limited reporting of managing stress and coping with fatigue. Of the 31 elements included in the non-technical skills framework, 22 were not common to all health professions and 3 elements were missing from the standards documents. Additionally, the documents were composed differently with no common taxonomy and multifaceted statements.ConclusionWhile commonalities identified in the standards documents related to non-technical skills categories are likely to support patient safety, gaps in associated elements may undermine their effectiveness. The notable lack of reference to stress and fatigue requires further attention for health professional well-being in Australia. A shared taxonomy with clear statements may offer the best support for collaborative practice and positive patient outcomes. Competency standards need to be flexible to respond to the emerging demands of current healthcare practice along with consumer and health service needs.

Project description:Background:Overseas studies suggest that 10-20% of doctors are depressed, 30-45% have burnout, and many report dissatisfaction with work-life balance. A local study on public doctors showed that 31.4% of the respondents satisfied the criteria for high burnout. Young, but moderately experienced doctors who need to work shifts appeared most vulnerable. This study aims to explore the experiences of those public doctors who have managed their work difficulties and maintained professional enthusiasm for references in medical education and continuing professional training. Method:Ten public doctors with reputation were invited respectively from three acute general hospitals for an in-depth interview. Interviews were audio recorded and transcribed. Content analysis was carried out to identify major themes in relation to the research questions. Results:Three themes emerging from difficulties encountered were (1) managing people, mostly are patients, followed by colleagues and then patients' relatives; (2) constraints at work, include time and resources; and (3) managing self with decision-making within a short time. Three themes generating from managing work difficulties included (1) self-adjustment with practicing problem solving and learning good communication appeared more frequently, followed by maintaining a professional attitude and accumulating clinical experiences; (2) seeking help from others; and (3) organizational support is also a theme though it is the least mentioned. Four themes emerging from maintaining work enthusiasm were (1) personal conviction and discipline: believing that they are helping the needy, having the sense of vocation and support from religion; disciplining oneself by continuing education, maintaining harmonious family relationship and volunteer work. (2) Challenging work: different challenging natures of their job. (3) Positive feedback from patients: positive encounters with patients keep a connectedness with their clients. (4) Organization support: working with good colleagues and opportunity for continuous training. Conclusion:Some implications for medical education include, developing good communication skill for medical students and junior doctors, preparing senior doctors to be mentors, and exploring the motivating force of spirituality/religion.

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Time to revisit the skills and competencies required to work in rural general hospitals.

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Time to revisit the skills and competencies required to work in rural general hospitals.

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