INTRODUCTION: Despite efforts to improve junior doctors' working conditions, burnout, distress and disillusionment persist, with implications for patient outcomes. This qualitative study analysed factors shaping the lived experiences of junior doctors in Singapore and their changes over time, thereby seeking to inform improvements to working conditions. METHOD: Thirty purposively sampled respondents who were junior doctors in Singapore between 1975 and 2022 were interviewed. Respondents were grouped into 3 cohorts: (1) junior, (2) middle and (3) senior. Employing the framework method of qualitative analysis, open coding was performed with reference to the individual, interpersonal, institutional, community and policy levels of the socioecological model (SEM). Four themes emerged: (1) inherent challenges of junior doctorship, (2) exacerbating factors, (3) alleviating factors and (4) responses of junior doctors to their experiences. Codes were reconstructed into a modified SEM, demonstrating trickle-down effects of interpersonal or structural forces on the individual doctor and pertinent factors evolving with time. RESULTS: Across cohorts, respondents echoed mental and physical challenges. While senior cohort doctors recounted higher patient-to-doctor ratios and longer working hours, junior cohort doctors cited new difficulties. These include a hostile medicolegal landscape, patients' increasingly complex needs and expectations, and higher administrative loads. Amid these difficulties, alleviating factors included good workplace relationships alongside institutional interventions. Doctors responded differently to their challenges. Some externalised difficulties through expression and advocacy; others internalised them, whether into fulfilment or distress. CONCLUSION While some facets of junior doctorship have improved with time, new challenges that warrant consideration are emerging. Junior doctors should be centred, listened to and empowered in shaping improvements to working conditions.
Singapore ; Humans ; Qualitative Research ; Medical Staff, Hospital/psychology* ; Male ; Female ; Adult ; Burnout, Professional/psychology* ; Workload/psychology* ; Attitude of Health Personnel ; Interviews as Topic ; Job Satisfaction

PURPOSE: To evaluate superiority of a night float (NF) system in comparison to a traditional night on-call (NO) system for surgical residents at a single institution in terms of efficacy, safety, and satisfaction. METHODS: A NF system was implemented from March to September 2017 and big data analysis from electronic medical records was performed for all patients admitted for surgery or contacted from the emergency room (ER). Parameters including vital signs, mortality, and morbidity rates, as well as promptness of response to ER calls, were compared against a comparable period (March to September 2016) during which a NO system was in effect. A survey was also performed for physicians and nurses who had experienced both systems. RESULTS: A total of 150,000 clinical data were analyzed. Under the NO and NF systems, a total of 3,900 and 3,726 patients were admitted for surgery. Mortality rates were similar but postoperative bleeding was significantly higher in the NO system (0.5% vs. 0.2%, P = 0.031). From the 1,462 and 1,354 patients under the NO and NF systems respectively, that required surgical consultation from the ER, the time to response was significantly shorter in the NF system (54.5 ± 70.7 minutes vs. 66.8 ± 83.8 minutes, P < 0.001). Both physicians (90.4%) and nurses (91.4%) agreed that the NF system was more beneficial. CONCLUSION: This is the first report of a NF system using big data analysis in Korea, and potential benefits of this new system were observed in both ward and ER patient management.
Electronic Health Records ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Internship and Residency ; Korea ; Medical Staff ; Mortality ; Statistics as Topic ; Vital Signs

BACKGROUND AND PURPOSE: Thrombectomy within 24 hours can improve outcomes in selected patients with a clinical-infarct mismatch. We devised an easy-to-use visual estimation tool that allows infarct volume estimation in centers with limited resources. METHODS: We identified 1,031 patients with cardioembolic or large-artery atherosclerosis infarction on diffusion-weighted images (DWIs) obtained before recanalization therapy and within 24 hours of onset, and occlusion of the internal carotid or middle cerebral artery. Acute DWIs were mapped onto a standard template and used to create visual reference maps with known lesion volumes, which were then used in a validation study (with 130 cases) against software estimates of infarct volume. RESULTS: The DWI reference map chart comprises 144 maps corresponding to 12 different infarct volumes (0.5, 1, 2, 3, 5, 7, 9, 11, 13, 15, 17, and 19 mL) in each of 12 template slices (Montreal Neurological Institute z-axis –15 to 51 mm). Infarct volume in a patient is estimated by selecting a slice with a similar infarct size at the corresponding z-axis level on the reference maps and then adding up over all slices. The method yielded good correlations to software volumetrics and was easily learned by both experienced and junior physicians, with approximately 1 to 2 minutes spent per case. The sensitivity, specificity, and accuracy for detecting threshold infarct volumes ( < 21, < 31, and < 51 mL) were very high (all about >90%). CONCLUSIONS: We developed easy-to-use reference maps that allow prompt and reliable visual estimation of infarct volumes for triaging patients to thrombectomy in acute stroke.
Atherosclerosis ; Cerebral Infarction ; Decision Making ; Diffusion Magnetic Resonance Imaging ; Humans ; Infarction ; Medical Staff, Hospital ; Methods ; Middle Cerebral Artery ; Sensitivity and Specificity ; Stroke ; Thrombectomy

BACKGROUND/AIMS: We evaluated the management and educational status of adult anaphylaxis patients at emergency departments (EDs). METHODS: Anaphylaxis patients who visited ED from 2011 to 2013 were enrolled from three hospitals. We analyzed clinical features, prior history of anaphylaxis, management and provided education for etiology and/or prevention. For analyzing associated factors with epinephrine injection, Pearson chi-square test was used by SPSS version 21 (IBM Co.). RESULTS: A total of 194 anaphylaxis patients were enrolled. Ninety-nine patients (51%) visited ED by themselves. Time interval from symptom onset to ED visit was 62 ± 70.5 minutes. Drug (56.2%) was the most frequent cause of anaphylaxis. Forty-seven patients (24.2%) had prior history of anaphylaxis and 33 patients had same suspicious cause with current anaphylaxis. Cutaneous (88.7%) and respiratory (72.7%) symptoms were frequent. Hypotension was presented in 114 patients (58.8%). Mean observation time in ED was 12 ± 25.7 hours and epinephrine was injected in 114 patients (62%). In 68 patients, epinephrine was injected intramuscularly with mean dose of 0.3 ± 0.10 mg. Associated factor with epinephrine injection was hypotension (p = 0.000). Twenty-three patients (13%) were educated about avoidance of suspicious agent. Epinephrine auto-injectors were prescribed only in five patients. Only 34 (19%) and 72 (40%) patients were consulted to allergist at ED and outpatient allergy department respectively. CONCLUSIONS: We suggested that management and education of anaphylaxis were not fully carried out in ED. An education and promotion program on anaphylaxis is needed for medical staff.
Adult* ; Anaphylaxis* ; Education ; Educational Status* ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Epinephrine ; Humans ; Hypersensitivity ; Hypotension ; Medical Staff ; Outpatients ; Patient Care Management

BACKGROUND: This retrospective study analyzed the causes of failure in the management process from the identification of brain-dead potential organ donors to actual donation in Korea over the past 5 years. METHODS: Data of 8,120 potential brain deaths reported to the Korea Organ Donation Agency were used, including information received at the time of reporting, donation suitability evaluation performed by the coordinator after the report, and data obtained from interviews of hospital medical staff and the donor's family. RESULTS: From January 2012 to December 2016, the total number of brain-dead potential organ donors in Korea was 8,120, of which 2,348 (28.9%) underwent organ procurement surgery with designated recipients. While the number of transplant donors has increased over time, the ratio of transplant donors to medically suitable brain-dead donors has decreased. The common causes of donation failure included donation refusal (27.6%), non-brain death (15.5%), and incompatible donation (11.6%); 104 potential donors (7.8%) were unable to donate their organs because they were not pronounced brain dead. CONCLUSION: The rate of successful organ donation may be increased by analyzing the major causes of failure in the brain-dead organ donation management process and engaging in various efforts to prevent such failures.
Brain Death ; Humans ; Korea* ; Medical Staff, Hospital ; Retrospective Studies ; Statistics as Topic* ; Tissue and Organ Procurement ; Tissue Donors* ; Transplantation

OBJECTIVE: This study was designed to report on the progress of the fire at Jecheon sports complex and to assess the adequacy of Disaster Medical Assistant Team (DMAT)'s activities in response to the fire disaster. METHODS: We conducted a retrospective review based on camera recordings and medical records that were recorded at the disaster site for assessment of activities. We cooperated with firefighters, police officers, local hospital medical staffs and public health personnel in Jecheon in order to classify patients in the disaster field and to understand the patients' progress. RESULTS: At 15:53, the first request for emergency rescue came to the 119 general emergency call center, and a request for DMAT activation came at 16:28. DMAT arrived at the site at 17:04 and remained active until the following day at 00:43. The total number of casualties was 60, including 27 minimal (Green) patients, 29 expectant (Black) patients, three delayed (Yellow) patients, and one immediate (Red) patient. There were 32 patients who received on-site care by DMAT. Two patients were transferred from a local hospital to Wonju Severance Christian Hospital for hyperbaric oxygen therapy. CONCLUSION: Twenty-nine victims were found in the sports complex building, and there were 31 mildly to moderately injured patients in this fire disaster. The main cause of death was thought to be smoke suffocation. Although DMAT was activated relatively quickly, it was not able to provide effective activity due to the late rescue and difficulty with fire suppression.
Asphyxia ; Cause of Death ; Chungcheongbuk-do* ; Disasters* ; Emergencies ; Firefighters ; Fires* ; Gangwon-do ; Humans ; Hyperbaric Oxygenation ; Medical Assistance ; Medical Records ; Medical Staff, Hospital ; Police ; Public Health ; Retrospective Studies ; Smoke ; Sports*

To construct a competency model for junior caregivers for the elderly and to provide a reference for the selection, evaluation and training for the junior caregivers for the elderly.
 Methods: Firstly, we drafted the primary competency model for junior caregivers for the elderly through literature review. Then, we used Delphi method to carry out 2 rounds of questionnaire survey for 20 experts to optimize the indicators for primary model. The weight of each indicator is determined by analytic hierarchy process (AHP) and expert sequencing method.
 Results: The effective recovery rates of the two-round questionnaire were 87% and 100%, respectively. The expert authority coefficient was 0.70-0.93, and the average authority coefficient was 0.80. The final version of the competency model for junior caregivers for the elderly included 4 first-grade indexes, 11 second-grade indexes and 37 third-grade indexes.
 Conclusion: The competency model for the junior caregivers for the elderly is reliable and can be used as the reference standard for the selection, evaluation and training for the junior caregivers for the elderly.
Aged ; Caregivers ; standards ; Clinical Competence ; Delphi Technique ; Health Services for the Aged ; standards ; Humans ; Medical Staff, Hospital ; standards ; Reference Standards ; Surveys and Questionnaires

BACKGROUND: With the rising patients dissatisfying experiences and poor patient satisfaction rate accounted in the Emergency Department (ED) of Manila Doctors Hospital, the researcher was determined to alleviate these upsetting experiences without making huge and costly renovation on the part of the hospital management by educating the patients and guardians of pediatric patients of the ED processes and scenarios while at the triage.

METHODS: This study was randomized,controlled trial in which 70 acute care adult patients and guardians of pediatric patients that came in the afternoon shift (2-10pm) were enrolled and randomized to experimental and control groups, where the experimental group was educated of the ED processes and scenarios at the triage area and the control group was given no information. At the end of ED visit, participants were asked to give a patient satisfaction rating using a scale where 6 domains are rated (triage, patient safety, security, non-medical and medical staffs, facility and payments). 

RESULTS: The results showed no statistically significant differences between the experimental and the control groups. There was not enough power to detect a statistically significant difference between the two groups as to the level of satisfaction.

CONCLUSION: The experimental and control groups were comparable as to the level of patient satisfaction. Patient education in the triage is not an effective strategy in improving the patient satisfaction in the ED of Manila Doctors Hospital.

Human ; Male ; Female ; Triage ; Patient Satisfaction ; Patient Safety ; Personal Satisfaction ; Emergency Service, Hospital ; Hospitals ; Medical Staff ; Health Facilities

OBJECTIVE: This study aims to assess broadly the attitudes ad perceptions of consultant doctors, fellows, residents, medical interns, nurses and orderlies toward mental illness.

METHODOLOGY: A representative sample of 326 medical hospital staff 18 years old and above in the Medical City was surveyed from March 15, 2010 to June 19, 2010. Attitudes and perceptions of the respondents were measured by using the two scales: Community Attitudes Toward the Mentality III Scale (CAMI) and Empathy Toward the Mentally III Scale. CAMI was divided into 4 subcategories: authoritarianism, benevolence, restrictiveness and Community Mental Health Ideology (CMHI). Empathy Toward the Mentally III Scale represented the eight concepts with a positive and negative counterpart for each concept. Data was encoded and tallied in SPSS Version 10 for windows.

RESULTS: Results indicated that orderlies/nurse aides were more authoritative than the residents/fellows as well as medical interns and lowest among orderlies/nurse assistants. Scores with social restrictiveness decreased with increasing age of the respondents. Although there was no significant difference with regard to positive and negative empathy with age, a trend of increasing positive scores with increasing age was noted. According to sex, no significant difference in the attitudes and perceptions of the respondents was found. With regards to previous experience/ contact with mentally ill, higher scores on benevolence and CMHI were seen. Furthermore, higher scores for positive empathy were noted among those with experience on the mentally ill and have the lowest negative score.  On the other hand, among those without previous experience /contact with the mentally ill, higher scores were noted for authoritarianism and social restrictiveness. Highest scores for positive attitude were noted among consultants, residents, fellows, and medical interns and lowest among orderlies/nurse assistants.

CONCLUSION: The level of care and service to psychiatric patients can be compromised by stigmatizing attitudes from the medical hospital staff. It is therefore imperative that further education on mental health is promoted in hospital institutions and anti-stigma initiatives established in our society.

Attitude ; Mental Disorders ; Medical Staff, Hospital

PURPOSE: Activated charcoal (AC) has been widely used as a universal antidote. Currently, emergency medical centers in Korea cannot administer AC due to discontinuation of the supply of commercial ready-mixed AC suspension. This study was conducted to investigate the proportion of emergency medical centers that administer AC to poisoning patients and provide basic information for emergency physicians and toxicologists. METHODS: A prospective telephone survey of all of the included emergency medical institutions was conducted. The type of emergency medical institution, average annual number of patients admitted to the emergency department, annual average number of patients who were poisoned and whether the hospital currently utilizes gastric lavage and administration of AC were determined. RESULTS: AC was administered to poisoning patients in 40% of regional emergency medical centers, 59.3% of local emergency medical centers, and 45.9% of local emergency medical rooms. Overall, 37% of total emergency medical institutions did not administer AC due to discontinuation of the commercial ready-mixed AC suspension. Additionally, 77% of emergency physicians in institutions without AC knew AC is necessary for poisoning patients. The rate of vomiting experienced by the medical staff according to types of charcoal showed that the average rate of vomiting was 33% for commercial ready-mixed activated charcoal suspension and 51% for self-prepared charcoal powder (p=0.02). CONCLUSION: AC should be secured promptly in emergency medical institutions. Before the supply of commercial ready-mixed AC suspension becomes again it is essential to develop a standardized regimen for self-preparation of charcoal powder and to educate emergency physicians and toxicologists to its use.
Charcoal* ; Emergencies* ; Emergency Service, Hospital ; Gastric Lavage ; Humans ; Korea* ; Medical Staff ; Poisoning* ; Prospective Studies ; Telephone ; Vomiting