Becoming a neurosurgeon in France: A qualitative study from the trainees’ perspective
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SUBMITTER: Debono B
PROVIDER: S-EPMC10668099 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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Project description:IntroductionGlobal interest has increased in improving the quality and increasing the number of graduates from surgical training programmes in countries with limited resources. Needs assessment of stakeholders in the training programmes represent the backbone of such process. The aim of this study was to assess the surgical training in Sudan from trainees' perspective in order to inform training delivery.MethodsWe adopted mixed methods design using focus group discussion for qualitative data collection and questionnaire survey for quantitative data. NVivo 20 Pro was used to organize qualitative data and SPSS 24.0 was used for quantitative data analysis.ResultsThematic analysis of qualitative data identified three themes. Trainees were overall satisfied that they will make good surgeons after completion of the programme. They identified case volume and collaborations with colleagues as the main strengths of the programme and lacking clear objectives for each year of training and academic activities as the main weaknesses. They suggested motivation of trainers and utilization of online resources and meeting platforms as solutions to improve supervision and academic activities during training.ConclusionThe gaps in training and their suggested solutions highlighted by trainees in this study should form the base for reforming the surgical training in Sudan and countries with similar circumstances.
| S-EPMC10553270 | biostudies-literature
Project description:ObjectivesExploration of influencing factors and promotion strategies for self-directed learning (SDL) is a current research hotspot. However, there is a dearth of relevant research among medical trainees. The objective of the present study was to explore the perceptions of SDL among medical trainees, while also identifying the multidimensional factors associated with SDL and potential facilitating strategies from the perspective of medical trainees.DesignThis multicentre qualitative study used focus group discussions to gather insights into SDL, analysed through thematic analysis. NVivo V.12 was used for efficient data management and processing.SettingFour focus group discussions were held at three large tertiary hospitals in mainland China from December 2022 to July 2023.ParticipantsThis study used purposive sampling to recruit eligible participants from the selected hospitals, primarily through instructor recommendations. Recruitment was further supported by snowball sampling, where trainees who completed the interviews referred additional participants. Medical trainees from three major tertiary hospitals in mainland China were ultimately invited to participate in the study.ResultsA total of four focus group discussions were conducted involving 17 medical trainees. Thirteen themes were summarised and assigned into three categories: (1) perceptions of SDL among medical trainees, (2) multidimensional factors affecting SDL among medical trainees and (3) potential improvement strategies.ConclusionThis qualitative study investigated the perspectives of medical trainees regarding SDL across various grades and hospitals in mainland China. The participants universally acknowledged the significance of SDL and expressed a strong aspiration to enhance their competence in this area. The study identified that the factors influencing SDL abilities are multifaceted, highlighting the need for tailored intervention strategies to address these challenges effectively.
| S-EPMC11843009 | biostudies-literature
Project description:ObjectiveThis study aimed to explore the positive factors related to working in general practice in France, from a student studying medicine, trainee general practitioner (GP) and GP point of view.SettingPrimary care, France.DesignNine different qualitative studies involving medical students, trainees and GPs.ParticipantsSixty-seven medical students, 22 trainees in general practice and 71 GPs.ResultsThe final codebook contained 66 interpretative codes and 8 positive themes. The themes were general practice as a commitment, doctor-patient care and relationships, skills and competencies in general practice, practice organisation and work-life balance, relationship with the professional community, GPs and university, GPs in the social community and private life, relatives and family. Positive feelings about being a GP are similar throughout the different age groups, from young students to older professionals.Discussion and conclusionThis study provided a comprehensive picture of the satisfied GP across different ages. This picture describes GPs as patient-centred professionals who need to have the freedom to choose an efficient working environment, organise their practice, have opportunities for professional development and acquire specific competencies. Both younger and older GPs believe in the future of general practice.
| S-EPMC8808418 | biostudies-literature
Project description:Objectives: Co-constructive patient simulation (CCPS) is a novel medical education approach that provides a participatory and emotionally supportive alternative to traditional supervision and training. CCPS can adapt iteratively and in real time to emergent vicissitudes and challenges faced by clinicians. We describe the first implementation of CCPS in psychiatry. Methods: We co-developed clinical scripts together with child and adolescent psychiatry senior fellows and professional actors with experience performing as simulated patients (SPs). We conducted the simulation sessions with interviewers blind to the content of case scenarios enacted by the SPs. Each hour-long simulation was followed by an hour-long debriefing session with all participants. We recorded and transcribed case preparation, simulation interactions, and debriefing sessions, and analyzed anonymized transcripts through qualitative analysis within a constructivist framework, aided by NVivo software. Results: Each of six CCPS sessions was attended by a median of 13 participants (range, 11-14). The first three sessions were conducted in person; the last three, which took place during the COVID-19 pandemic, via synchronized videoconferencing. Each of the sessions centered on clinically challenging and affectively charged situations informed by trainees' prior experiences. Through iterative thematic analysis we derived an alliterating "9R" model centered on three types of Reflection: (a) in action/"while doing" (Regulate, Relate, and Reason); (b) on action/"having done" (Realities, Restraints, and Relationships); and (c) for action/"will be doing" (with opportunities for Repair and Reaffirmation). Conclusions: CCPS is an experiential approach that fosters autonomous, meaningful, and individually tailored learning opportunities. CCPS and the 9R model for reflective practice can be effectively applied to psychiatry and have the potential to contribute uniquely to the educational needs of its trainees and practitioners.
| S-EPMC7820173 | biostudies-literature
Project description:BACKGROUND:Switzerland, like many other countries, has a shortage of General Practitioners (GPs). Optional GP training modules in GP practices were offered during the at least 5-year GP training program to increase student and trainee interest in becoming a GP. The training modules had not yet been evaluated. We determined how many Swiss GP trainees became practicing GPs after they completed optional training modules, and if longer modules were associated with higher rates of GP specialization. METHODS:In this population-based cohort study, we included GP trainees who chose an optional GP training module in GP practice, provided by the Foundation to Promote Training in General Practice (WHM) between 2006 and 2015. GP trainees were invited to complete an online survey to assess the primary outcome (becoming a practicing GP by 2016). Data on non-responders was collected via an internet search. We calculated univariate time-to-event curves to become a practicing GP, stratified by trainee's gender, length, part-time training, and number of years after graduation until training modules were completed. We used a multivariate model to adjust for characteristics of participants, training, and satisfaction with training modules. RESULTS:We assessed primary outcome for 351 (92.1%) of 381 former GP trainees who participated in a WHM program between 2006 and 2015. Of these 218 (57%) were practicing GPs by 2016. When focusing on the trainees who had completed training between 2006 and 2010, the rate of practicing GPs was even 73%. Longer (p = 0.018) and part-time training modules (p = 0.003) were associated with higher rates of being a practicing GP. Most (81%) practicing GPs thought their optional GP training module was (very) important in their choice of specialty. CONCLUSION:GP trainees who spent more time training in a GP practice, or who trained part-time were more likely to become practicing GPs. Most (80%) rated their training module as (very) important in their choice of career, highlighting that these modules effectively encourage the interests of those already inclined towards the GP specialty. Longer GP training modules and more opportunities for part-time training may attract and retain more interested trainees, and possibly increase the number of practicing GPs.
| S-EPMC5756440 | biostudies-literature
Project description: Not available
| S-EPMC8785777 | biostudies-literature
Project description:Stroke Care Pathways (SCPs) aim to improve quality of care by providing better access to stroke units, rehabilitation centres, and home care for dependent patients. The objective of this study was to identify the main barriers to effective implementation of SCPs in France.We selected 4 types of SCPs currently implemented in France that differed in terms of geographical location, population size, socio-economic conditions, and available health care facilities. We carried out 51 semi-structured interviews of 44 key health professionals involved in these SCPs and used the interview data to (i) create a typology of the organisational barriers to effective SCP implementation by axial coding, (ii) define barrier contents by vertical coding. The typology was validated by a panel of 15 stroke care professionals.Four main barriers to effective SCP implementation were identified: lack of resources (31/44 interviewees), coordination problems among staff (14/44) and among facilities (27/44), suboptimal professional and organisational practices (16/44), and inadequate public education about stroke (13/44). Transposition of the findings onto a generic SCP highlighted alternative care options and identified 10 to 17 barriers that could disrupt continuity of care.Lack of resources was considered to be the chief obstacle to effective SCP implementation. However, the main weakness of existing SCPs was poor communication and cooperation among health professionals and among facilities. We intend to use this knowledge to construct a robust set of quality indicators for use in SCP quality improvement initiatives, in comparisons between SCPs, and in the assessment of the effective implementation of clinical practice guidelines.
| S-EPMC3943407 | biostudies-other
Project description:PurposeAlthough research has explored burnout risk factors among medical trainees, there has been little exploration of the personal experiences and perceptions of this phenomenon. Similarly, there has been little theoretical consideration of trainee wellbeing and how this relates to burnout. Our study aimed to conceptualise both constructs.MethodWe situated this study within a post-positivist epistemology using grounded theory to guide the research process. Participants were recruited from one Australian General Practice training organisation. Fourteen trainees completed interviews, while a further five focus groups explored the views of 33 supervisors, educators and training coordinators. Data collection and analysis occurred concurrently, drawing upon constant comparison and triangulation. Template analysis, using an iterative process of coding, was employed to generate conceptual models of the phenomena of interest.ResultsParticipants described burnout as an insidious syndrome lying on a spectrum, with descriptions coalescing under seven themes: altered emotion, compromised performance, disengagement, dissatisfaction, exhaustion, overexertion and feeling overwhelmed. Wellbeing was perceived to comprise personal and professional domains that interacted and were fuelled by an underlying 'reservoir'. Both constructs were linked by the degree of a trainee's value fulfilment, with burnout occurring when a trainee's wellbeing reservoir was depleted.ConclusionsParticipants in this study characterised burnout and wellbeing as multifaceted, connected constructs. Given the complexity of these constructs, preventive interventions should target both person and workplace-focused factors, with value fulfilment proposed as the basic change mechanism. A novel model that synthesises and advances previous research is offered based on these findings.
| S-EPMC10086955 | biostudies-literature
Project description:BackgroundThe challenge of graduate medical education is to prepare physicians for unsupervised practice while ensuring patient safety. Current approaches may inadequately prepare physicians due to limited opportunities for autonomy. Recent work on how trainees gain autonomy shows that they actively influence their supervisors' entrustment decisions. If program directors more clearly understand how trainees experience increasing independence, they may better sensitize trainees to the deliberations they will face during patient care.ObjectiveThe authors sought to explore how trainees experience lessening supervision as their clinical training advances.MethodsUsing constructivist grounded theory, the authors recruited trainees from various specialties and training levels via email and conducted 17 semi-structured interviews from 2019 to 2020 to solicit clinical experiences during which their perceived autonomy changed. Through constant comparison and iterative analysis, key themes and conceptual relationships were identified.ResultsSeventeen trainees from 4 specialties described novel clinical situations that required "overextending," or going beyond their perceived edge of evolving expertise. This move represented a spectrum based on perceived locus of control, from deliberate overextending driven by trainees, to forced overextending driven by external factors. Trainee judgments about whether or not to overextend were distilled into key questions: (1) Can I do it? (2) Must I do it? (3) Do I want to do it? and (4) Is it safe to do it? More advanced trainees posed a fifth question: (5) Am I missing something?ConclusionsDecisions to move into the realm of uncertainty about capabilities carried weight for trainees. In making deliberative judgments about overextending, they attempted to balance training needs, capability, urgency, and patient safety.
| S-EPMC9200247 | biostudies-literature
Project description:BackgroundNarrative medicine (NM) is an approach involving narrative skills and is regarded as a model for medical humanism and effective medical practice. This study aims to explore how NM impacts medical trainees' learning of professionalism during a clerkship in a Taiwanese clinical setting.MethodsA qualitative interview study adopting a purposive sampling method was undertaken. Thirty medical trainees participated in this study, including five fifth-year medical students (MSs), ten sixth-year MSs, nine seventh-year MSs, and six postgraduate year (PGY) trainees. Thematic framework analysis was applied, and a modified realist evaluation approach was further used to analyse the interview data.ResultsWe identified self-exploration, reflection, and awareness of professional identity as mechanisms explaining how NM impacted professionalism learning in our participants. Furthermore, empathy, communication, doctor-patient relationship and understanding patients were identified as the outcomes of the NM intervention for trainees' learning of professionalism.ConclusionsNM facilitates medical trainees' self-exploration, reflection, and awareness of professional identity, thereby affecting their learning of professionalism in clinical settings. Adopting NM as an educational intervention in undergraduate medical education could play an important role in professionalism learning, as trainees can thereby be supported to gradually develop self-exploration and reflection capabilities and heightened awareness of professional identity reflectively through a narrative process.
| S-EPMC8296619 | biostudies-literature