Why our doctors are leaving Irish emergency medicine training

BMC Emergency Medicine, 2013

Background As in other countries, the Irish Regulator for Pre-Hospital practitioners, the Pre-Hospital Emergency Care Council (PHECC), will introduce a Continuous Professional Competence (CPC) framework for all Emergency Medical Technicians (EMTs), Paramedics and Advanced Paramedics (APs). This framework involves EMTs participating in regular and structured training to maintain professional competence and enable continuous professional developments. To inform the development of this framework, this study aimed to identify what EMTs consider the optimum educational outcomes and activity and their attitude towards CPC. Methods All EMTs registered in Ireland (n = 925) were invited via email to complete an anonymous online survey. Survey questions were designed based on Continuous Professional Development (CPD) questionnaires used by other healthcare professions. Quantitative and qualitative analyses were performed. Results Response rate was 43% (n = 399). 84% of participants had been r...

Emergency Medicine Australasia, 2020

Objective: Demand for global health (GH) training and experiences among emergency medicine trainees is unknown. The primary objective of the Trainee Interest in Global Health Training (TIGHT) study was to quantify the number of trainees interested in completing a rotation in a resource-limited environment within a low-or middle-income country during their specialty training. Methods: A cross-sectional study of trainees in seven specialty training programmes was conducted between August and October 2018. Data were collected using a voluntary, anonymous , self-reporting, web-based survey. This study describes the results of a planned subgroup analysis of ACEM trainees. Results: There were 203 respondents among 2525 ACEM trainees. Although only a small number (36/198, 18.2%) had undertaken a GH experience as a specialty trainee, 85.6% (167/195) were keen to do so. The vast majority of respondents (179/194, 87.1%) were interested or very interested in having their GH experience accredited for training, but 68.9% (133/193) reported that accessing a suitable placement was a barrier. More than 79% (147/186) expressed interest in undertaking an integrated GH training or fellowship programme as an adjunct to specialty training. Conclusions: Notwithstanding the limitations of a self-reporting survey with a sub-optimal response rate, there is significant demand for GH training and experiences among ACEM trainees. These findings should inform the development of safe and effective global emergency care training pathways, underpinned by mutually beneficial, international partnerships with educational and development objectives.

Rural and Remote Health, 2007

Introduction: Australia is a country with a relatively small rural population dispersed over an enormous area. Issues similar to how best to deliver health services and recruit health professionals to rural areas exist in other countries. For professional and lifestyle reasons, most specialist doctors (including emergency medicine specialists), choose to live and work in major metropolitan centres. Outside the major Australian cities, most presentations to emergency departments are dealt with by 'nonspecialist' doctors, often with limited specialist back up. Recruitment of suitably trained medical staff is increasingly difficult. There is increasing reliance on overseas trained doctors from widely varying backgrounds. In Canada and New Zealand, family medicine trained emergency medicine doctors are a significant proportion of the workforce in rural and regional emergency departments. Aim: To undertake a detailed investigation of the non-specialist emergency medicine doctors in Australia, and examine strategies to secure a more highly trained emergency medicine workforce for rural and regional Australia.

Emergency Medicine Journal, 2013

Background The intensive physical and psychological stress of emergency medicine has evoked concerns about whether emergency physicians could work in the emergency department for their entire careers. Results of previous studies of the attrition rates of emergency physicians are conflicting, but the study samples and designs were limited. Objective To use National Health Insurance claims data to track the work status and work places of emergency physicians compared with other specialists. To examine the hypothesis that emergency physicians leave their specialty more frequently than other hospital-based specialists. Methods Three types of specialists who work in hospitals were enrolled: emergency physicians, surgeons and radiologists/pathologists. Every physician was followed up until they left the hospital, did not work anymore or were censored. A KaplaneMeier curve was plotted to show the trend. A multivariate Cox regression model was then applied to evaluate the adjusted HRs of emergency physicians compared with other specialists. Results A total of 16 666 physicians (1584 emergency physicians, 12 103 surgeons and 2979 radiologists/ pathologists) were identified between 1997 and 2010. For emergency physicians, the KaplaneMeier curve showed a significantly decreased survival after 10 years. The log-rank test was statistically significant (p value <0.001). In the Cox regression model, after adjusting for age and sex, the HRs of emergency physicians compared with surgeons and radiologists/pathologists were 5.84 (95% CI 2.98 to 11.47) and 21.34 (95% CI 8.00 to 56.89), respectively. Conclusion Emergency physicians have a higher probability of leaving their specialties than surgeons and radiologists/pathologists, possibly owing to the high stress of emergency medicine. Further strategies should be planned to retain experienced emergency physicians in their specialties.

BMJ Open

ObjectiveTo gain insight into factors involved in attrition from hospital-based medical specialty training and future career plans of trainees who prematurely left their specialty training programme.DesignNationwide online survey study.SettingPostgraduate education of all hospital-based specialties in the Netherlands.Participants174 trainees who prematurely left hospital-based medical specialty training between January 2014 and September 2017.Main outcome measuresFactors involved in trainees’ decisions to leave specialty training and their subsequent career plans.ResultsThe response rate was 38%. Of the responders, 25% left their programme in the first training year, 50% in year 2–3 and 25% in year 4–6. The most frequently reported factors involved in attrition were: work-life balance, job content, workload and specialty culture. Of the leaving trainees, 66% switched to another specialty training programme, of whom two-thirds chose a non-hospital-based training programme. Twelve per...

Background: PGY program was initiated in 2003 for undifferentiated physicians in Taiwan, the program aimed to improve physicians’ general competency gap exposed during the SARS epidemic breakout. Many published studies discussed the effectiveness of the program. We were interested in the learning impacts gained from the physicians' perspectives during EM rotation in the PGY program, and little was known regarding this subject. Methods: This retrospective study used grounded theory data analysis methods. 201 PGY physicians rotated in the emergency department from August 2014 to July 2017 answered three open-ended post-rotation survey questions resulting in a dataset of 603 comments. A three-member team for code develop-ment reviewed all comments and established the code themes with the consensus of the team members. A four-member coding team coded applicable comm-ents accordingly. Results: We coded 563 (96%) comments and sorted 32 themes essential to characterize the clinical exper-iences into two categories. Twenty-six codes were relevant to professional development; 6 were related to the emotional issue. In the professional develop-ment category, patient care (33%) was the most frequently coded domain in the sub-level of six core competencies, followed by system-based practice (25%) and interpersonal and communication skills (19%). Senses of growth and improvement were the most frequently coded themes in the emotional issue category, followed by pressure at the workplace and on-the-spot-feedback. The top 3 lessons learned by physicians' perception were decision-making, team and patient communication, and prioritizing tasks. Conclusions: EM rotation had a productive role in professional development for undifferentiated physic-ians before receiving specialty discipline training. Gaining experiences in clinical judgment and comm-unication were the strengths of the EM PGY program. This analysis model might be used as a novel way of assessing the achievement of learning objectives from the trainee's perspective. However, a prospective standardized study protocol is needed for a further affirmative conclusion.

BMJ Open, 2020

ObjectivesTo compare the contribution of physician associates to the processes and outcomes of emergency medicine consultations with that of foundation year two doctors-in-training.DesignMixed-methods study: retrospective chart review using 4 months’ anonymised clinical record data of all patients seen by physician associates or foundation year two doctors-in-training in 2016; review of a subsample of 40 records for clinical adequacy; semi-structured interviews with staff and patients; observations of physician associates.SettingThree emergency departments in England.ParticipantsThe records of 8816 patients attended by 6 physician associates and 40 foundation year two doctors-in-training; of these n=3197 had the primary outcome recorded (n=1129 physician associates, n=2068 doctor); 14 clinicians and managers and 6 patients or relatives for interview; 5 physician associates for observation.Primary and secondary outcome measuresThe primary outcome was unplanned re-attendance at the sa...

Prehospital Emergency Care, 2017

Objective: Inadequate staffing of agencies, increasing attrition rates, and frequent turnover of personnel make employee retention an ongoing concern for Emergency Medical Services (EMS). Faced with increasing demand for EMS, understanding the causes underlying turnover is critical. The objectives of this study were to describe the proportion of individuals that left EMS, likelihood of returning to the profession, and key factors contributing to the decision to leave EMS. Methods: This was a cross-sectional study of nationally-certified EMS professionals who left EMS. Respondents to a census survey who reported not practicing EMS were directed to a subsection of items regarding their choice to leave EMS. Demographic and employment characteristics, likelihood of returning to EMS, and factors influencing the decision to leave EMS were assessed. Descriptive and comparative statistics (Chi-square and nonparametric test of trend [p-trend]) and univariable odds ratios were calculated. Results: The overall response rate for the full survey was 10% (n = 32,114). A total of 1247 (4%) respondents reported leaving the profession and completed the exit survey. The

Revista da Associação Médica Brasileira, 2017

costa sarno nEvEs 2 , bruna mElo coElho lourEiro 3 , victor auGusto camarinha dE castro lima 2 , raFaEl marquEs calaZans 2 , camila KruschEWsKY Falcão 3 , rEnata trindadE El Fahl 3 , bianca rEcarEY barrEto 3

Annals of Emergency Medicine, 1998

A Study of the Workforce in Emergency Medicine Study objective: Emergency medicine has progressed significantly since its initial recognition as a medical specialty. Relatively little factual information is known, however, regarding who or how many physicians practice emergency medicine. The purpose of this study is to determine the total number of physicians practicing clinical emergency medicine during a specified period, to describe certain characteristics of those individuals, and to estimate the total number of full-time equivalents (FTEs), as well as the total number of individuals needed to staff those FTEs. Methods: Data were gathered from a survey of a random sample of 2,062 hospitals drawn from a population of 5,220 hospitals reported by the American Hospital Association as having, or potentially having, an emergency department. The survey instrument addressed items such as descriptive data on the institution, enumeration of physicians in the ED, as well as the total number working during the period June 1, 1997, through June 14, 1997. Demographic data on the individuals were also collected. Results: A total of 942 hospitals responded (a 45.7% return rate). These hospitals reported a total of 5,872 physicians were working during the specified period, or an average of 7.48 persons scheduled per institution. The physicians were scheduled for a total of 297,062 hours. The average standard for FTE was 40 clinical hours per week. This equates to 3,713 FTEs or 4.96 FTEs per institution. The ratio of persons to FTEs was 1.51:1. With regard to demographics, 83% of the physicians were men and 81% were white. Their average age was 42 years. As to professional credentials, 58% were emergency medicine-residency trained and 53% were board certified in emergency medicine; 46% were certified by the American Board of Emergency Medicine. Conclusion: Given that there are 4,945 hospitals with EDs and given that the data indicate there are 4.96 FTEs per ED, the total number of FTEs is projected to be 24,548 (standard error=437). Given further that the data indicate a physician/FTE ratio of 1.51:1, we conclude that there are 36,990 persons (standard error=683)

Emergency Medicine Journal, 2008

Background and aims: How far is too far? Recent government policy and demographic growth have led to role changes within the professions in emergency care. Healthcare professionals have extended and expanded their scopes of practice to include duties outside their traditional role boundary. Nurses in particular are able to see and treat patients more independently. These expanded roles mean there is growing overlap between professional roles and responsibilities and one wondershow far is too far? Where should role expansion cease? The aim of this research was to explore the perceptions of the professions on their current and future roles in emergency care. Methods: A qualitative design, utilising semistructured interviews was employed. Eight respondents, including doctors and nurses of all grades, were purposefully sampled from an emergency department within a large UK teaching hospital. Results: Content analysis revealed five key themes: role boundaries; driving forces; managing risk; training and future professional roles. Conclusions: Of genuine concern to the respondents was the lack of standardisation within the expansion of healthcare roles. In terms of ''how far is too far'', the respondents believed that greater clarification of training and scope of practice is required, enabling clinical roles to develop more consistently.

BMJ Open, 2020

Objectives To determine the need for recovery (NFR) among emergency physicians and to identify demographic and occupational characteristics associated with higher NFR scores. Design Cross-sectional electronic survey. Setting Emergency departments (EDs) (n=112) in the UK and Ireland. Participants Emergency physicians, defined as any registered physician working principally within the ED, responding between June and July 2019. Main outcome measure NFR Scale, an 11-item selfadministered questionnaire that assesses how work demands affect intershift recovery. Results The median NFR Score for all 4247 eligible, consented participants with a valid NFR Score was 70.0 (95% CI: 65.5 to 74.5), with an IQR of 45.5-90.0. A linear regression model indicated statistically significant associations between gender, health conditions, type of ED, clinical grade, access to annual and study leave, and time spent working out-of-hours. Groups including male physicians, consultants, general practitioners (GPs) within the ED, those working in paediatric EDs and those with no long-term health condition or disability had a lower NFR Score. After adjusting for these characteristics, the NFR Score increased by 3.7 (95% CI: 0.3 to 7.1) and 6.43 (95% CI: 2.0 to 10.8) for those with difficulty accessing annual and study leave, respectively. Increased percentage of out-of-hours work increased NFR Score almost linearly: 26%-50% out-of-hours work=5.7 (95% CI: 3.1 to 8.4); 51%-75% out-of-hours work=10.3 (95% CI: 7.6 to 13.0); 76%-100% out-of-hours work=14.5 (95% CI: 11.0 to 17.9). Conclusion Higher NFR scores were observed among emergency physicians than reported in any other profession or population to date. While out-ofhours working is unavoidable, the linear relationship observed suggests that any reduction may result in NFR improvement. Evidence-based strategies to improve well-being such as proportional out-of-hours working and improved access to annual and study leave should be carefully considered and implemented where feasible.

Irish journal of medical science, 2018

Healthcare professionals are exposed to high levels of stress in the course of their profession and are particularly susceptible to experiencing burnout. In the USA, burnout among physicians is highly prevalent, exceeding that of other workers. Little literature has been published describing burnout prevalence in the context of the Irish emergency healthcare population. We conducted a survey to determine burnout in the Emergency Department hospital staff at Cork University Hospital (CUH). This is a prospective inclusive cross-sectional study assessing burnout with the Oldenburg Burnout Inventory (OLBI). Over 90 staff (physicians, nurses, administrators, radiographers, care assistants, and porters) participated. Provider demographic differences were documented and comparisons of burnout were made between this study population and previous international studies. Sixty-three percent of administrators (8), 100% of care assistants (3), 78% of nurses (50), 70% of physicians (23), 67% of p...

Journal of Academic Emergency Medicine, 2014

Objective: Emergency medicine (EM) was established as a specialty in Finland at the beginning of 2013. The training period of six years conforms to the principles of the European Curriculum for EM. In this study, we evaluated the first-year experience of training in the Kanta-Häme Central Hospital, Finland.. Material and Methods: We studied both qualitatively and quantitatively the typical structure of the working week of EM residents. A qualitative analysis of a weekly learning day was carried out with regards to the programme, learning methods and themes. A quantitative analysis was carried out by pre/post setting of the topics offered in weekly clinical lectures and the numbers of attending physicians. Results: Since the initiation of EM specialty, the lectures became more comprehensive (p<0.001). The proportion of topics of conservative specialties decreased from 77.0% to 46.7% while those of operative specialties increased from 5.9% to 36.7%. The mean (±standard error of mean) number of attending doctors increased from 14.0±0.4 to 22.7±0.9 (p<0.001). The working group sessions, lectures and ultrasound training increased after establishment of EM specialty. Conclusion: According to these preliminary results, a successful training programme of EM is achievable by systematic planning of practical training.

To act with professionalism is to act within a set of moral norms, principles and standards of conduct and competency  Problems arise when paramedics do not understand what it means to be a professional, and this is largely due to gaps in education.  Regulation should not be seen as a threat, but rather as a positive way of advancing the profession, and focussing on doing the best for patients.  Education plays a key role in creating a culture of professionalism, a solid foundation of professionalism and a professional identity. This education must be consistent.  Paramedics should be supported in their professional development with a greater emphasis on applied ethics to facilitate professional problem solving and a more comprehensive understanding of the regulatory system.