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Clinical Workload (clinical + workload)

Distribution by Scientific Domains
Medical Sciences100%

Selected Abstracts

The Effects of Clinical Workload on Teaching in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 6 2007
Sean P. Kelly MD
Background:Academic emergency physicians have expressed concern that increased clinical workload and overcrowding adversely affect clinical teaching. Objectives:To evaluate the influence of clinical workload and attending physicians' teaching characteristics on clinical teaching in the emergency department (ED). Methods:This was a prospective observational study using learner satisfaction assessment tools to evaluate bedside teaching. On days when a research assistant was available, all ED residents and attending physicians were queried. A total of 335 resident surveys were administered over nine months (89% response). Clinical workload was measured by perception and patient volume. Teaching quality and characteristics were rated on ten-point scales. A linear mixed-effects model was used to obtain adjusted impact estimates of clinical workload and teaching attributes on teaching scores while controlling for individual attending physicians' teaching ability and residents' grading tendencies. Results:No clinical workload parameter had a significant effect on teaching scores: residents' workload perception (, estimate, 0.024; p = 0.55), attending physicians' workload perception (, estimate, ,0.05; p = 0.28), patient volume in patients per hour (, estimate, ,0.010; p = 0.36), and shift type (, estimate, ,0.19; p = 0.28). The individual attending physician effect was significant (p < 0.001) and adjusted in each case. In another model, the attending physicians' learning environment established (, estimate, 0.12; p = 0.005), clinical teaching skills (, estimate, 0.36; p < 0.001), willingness to teach (, estimate, 0.25; p < 0.001), and interpersonal skills (, estimate, 0.19; p < 0.001) affected teaching scores, but the attending physicians' availability to teach had no significant effect (, estimate, 0.007; p = 0.35). Conclusions:Clinical workload and attending physicians' availability had little effect on teaching scores. Attending physicians' clinical teaching skills, willingness to teach, interpersonal skills, and learning environment established were the important determinants of overall scores. Skilled instructors received higher scores, regardless of how busy they were. [source]

Benefits and limitations of nurses taking on aspects of the clinical role of doctors in primary care: integrative literature review

JOURNAL OF ADVANCED NURSING, Issue 8 2010
Claire RashidArticle first published online: 2 JUL 2010
rashid c. (2010) Benefits and limitations of nurses taking on aspects of the clinical role of doctors in primary care: integrative literature review. Journal of Advanced Nursing,66(8), 1658,1670. Abstract Aim., This paper presents an integrative literature review of studies exploring the benefits and limitations of the recent expansion of the clinical role of nurses working in general practice in the United Kingdom. Background., Similar clinical outcomes and high levels of satisfaction with consultations undertaken by nurse practitioners compared to general practitioners in primary care have been reported in a Cochrane review [Cochrane Database of Systematic Reviews (2004) vol. 5, p. CD001271]. Since then, nurse consultations have increased considerably as general practitioners have delegated part of their clinical workload to other general practice nurses. However, whether all general practice nurses can fulfil this extended role remains open to question. Method., An integrative review was performed. Nine electronic databases were searched. UK studies were included if they were published after the previous Cochrane review, i.e. between 2004 and 2009. Results., Eight studies were identified, most using qualitative methodology. The evidence suggested that the changes in nurses' role have been predominantly driven by the perceived increase in workload arising from the new general practitioner contract. Delegating work to nurses provided a means of organizing workload within a practice without necessarily allowing patient choice. Patients generally thought that all general practice nurses would be able to deal with simple conditions, but they would prefer to consult with a general practitioner if they thought it necessary. There were concerns about nurses' knowledge base, particularly in diagnostics and therapeutics, and their levels of training and competence in roles formerly undertaken by general practitioners. Conclusion., There have been few studies in this key area of healthcare policy. There is a need for better training and support for nurses undertaking roles in consultation and for patients' views to be better represented. [source]

The Effects of Clinical Workload on Teaching in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 6 2007
Sean P. Kelly MD
Background:Academic emergency physicians have expressed concern that increased clinical workload and overcrowding adversely affect clinical teaching. Objectives:To evaluate the influence of clinical workload and attending physicians' teaching characteristics on clinical teaching in the emergency department (ED). Methods:This was a prospective observational study using learner satisfaction assessment tools to evaluate bedside teaching. On days when a research assistant was available, all ED residents and attending physicians were queried. A total of 335 resident surveys were administered over nine months (89% response). Clinical workload was measured by perception and patient volume. Teaching quality and characteristics were rated on ten-point scales. A linear mixed-effects model was used to obtain adjusted impact estimates of clinical workload and teaching attributes on teaching scores while controlling for individual attending physicians' teaching ability and residents' grading tendencies. Results:No clinical workload parameter had a significant effect on teaching scores: residents' workload perception (, estimate, 0.024; p = 0.55), attending physicians' workload perception (, estimate, ,0.05; p = 0.28), patient volume in patients per hour (, estimate, ,0.010; p = 0.36), and shift type (, estimate, ,0.19; p = 0.28). The individual attending physician effect was significant (p < 0.001) and adjusted in each case. In another model, the attending physicians' learning environment established (, estimate, 0.12; p = 0.005), clinical teaching skills (, estimate, 0.36; p < 0.001), willingness to teach (, estimate, 0.25; p < 0.001), and interpersonal skills (, estimate, 0.19; p < 0.001) affected teaching scores, but the attending physicians' availability to teach had no significant effect (, estimate, 0.007; p = 0.35). Conclusions:Clinical workload and attending physicians' availability had little effect on teaching scores. Attending physicians' clinical teaching skills, willingness to teach, interpersonal skills, and learning environment established were the important determinants of overall scores. Skilled instructors received higher scores, regardless of how busy they were. [source]