BMJ Leader最新文献

Background: High burnout and low retention rates among trainee doctors threaten the future viability of the UK medical workforce. This study empirically examined factors that can sustain trainee doctors.

Method: A total of 323 trainee doctors from 25 National Health Service (NHS) Trusts in England and Wales completed an online survey on their training and employment experiences. A mixed method approach was employed.

Results: Structural equation modelling revealed that perceived compassionate leadership of hospital senior leaders (CLSL) (i.e., doctors in senior clinical and management positions, and senior managers) is directly and negatively associated with trainee doctors' burnout and intention to quit. We propose the associations may be indirectly strengthened through two mediating pathways: increased psychological contract fulfilment (PCF) of training/organisational support and reduced worry about the state of the NHS; however, only the former is supported. The model can explain a substantial 37% of the variance in reported burnout and 28% of intention to quit among trainee doctors. Being a Foundation Year (FY) trainee was significantly associated with poor PCF and burnout. Rich qualitative data further elaborated on their experiences in terms of senior leaders' awareness of their training/working experiences, listening to and acting on.

Conclusions: Active and demonstrable CLSL plays a vital role in trainee doctors' retention. It has both direct (through support) and indirect effects through improving trainee doctors' PCF to reduce burnout and intention to quit. This seems particularly valuable among FY doctors. Implications for the development and management of the medical workforce are discussed.

Objective: Achieving gender equity in academic medicine is not only a matter of social justice but also necessary in promoting an innovative and productive academic community. The purpose of this study was to assess gender distribution in dual MD/PhD academic programme faculty members across North America.

Methods: Academic metrics were analysed to quantify the relative career success of academic faculty members in MD/PhD programmes. Measured parameters included academic and leadership ranks along with nominal research factors such as peer-reviewed research publications, H-index, citation number and years of active research.

Results: Χ² analysis revealed a statistically significant (p<0.0001, χ²=114.5) difference in the gender distribution of faculty and leadership across North American MD/PhD programmes. Men held 74.2% of full professor positions, 64% of associate professor positions, 59.4% of assistant professor positions and 62.8% of lecturer positions. Moreover, men occupied a larger share of faculty leadership roles with a statistically significant disparity across all ranks (p<0.001, χ²=20.4). A higher proportion of men held positions as department chairs (79.6%), vice chairs (69.1%) and programme leads (69.4%).

Conclusion: Gender disparity was prevalent in the MD/PhD programmes throughout North America with women achieving a lower degree of professional stature than men. Ultimately, steps must be taken to support women faculty to afford them better opportunities for academic and professional advancement.

Background: Despite efforts to advance equity, diversity and inclusion, women face gender-based barriers in research, including in neurology. Compared with men, women are less likely to hold leadership positions and be senior authors. Gender disparities in grant funding within neurology have yet to be investigated. We examine gender disparities in Canadian Institutes of Health Research (CIHR) funding for Canadian neurology divisions and departments.

Methods: Data on CIHR grant recipients and metrics (grant contribution, duration and quantity) within Canadian neurology divisions and departments between 2008 and 2022 were acquired from the CIHR Funding Decisions Database. Gender identity was determined by a validated application programming interface. Gender-based differences in CIHR grant contribution amount, duration and prevalence within neurology were calculated. Subgroup analysis was conducted for Canadian-licensed neurologists and Project Grant awards.

Results: 1604 grants were awarded to Canadian neurology divisions and departments between 2008 and 2022. Compared with men, women received less funding (p<0.0001), shorter grant durations (p<0.0001) and fewer grants (41.5%) annually. Women comprised the minority of recipients (45.5%) and were less likely to be awarded grants (p<0.001) annually relative to men. Differences were consistent in subgroup analyses, except for equal grant durations observed across genders in Project Grant awards.

Conclusion: We report gender disparities in CIHR grant funding to Canadian neurology divisions and departments. Women receive lower contribution amounts, shorter grant durations and fewer grants than men. Future recommendations include addressing gender differences and continuing to evaluate CIHR funding to provide equal opportunities for women in research and funding.

Objectives: This study explores the evolving position of the health system chief information officer (CIO) by identifying new core roles for success.

Methods: An advisory board of industry executives and system leaders guided the study. Purposeful sampling was used to invite chief executive officer and CIOs from 65 not-for-profit US health systems to participate. Interviews were conducted with 51 executives from 33 different systems, using a comprehensive interview topic guide. Interview transcripts were analysed using NVivo software, focusing on themes related to the evolving role of the health system CIO.

Results: Analyses revealed three main themes, with the CIO as (1) enabler of strategic change and transformation, (2) strategic developer of technology and leadership talent and (3) driver of organisational culture.

Discussion: The role of CIO has undergone transformation from technology and information system management to strategic leadership within the broader health system context. It highlights the importance of comprehensive business knowledge for CIOs and the need for other C-suite executives to have a deeper understanding of information and technology.

Conclusion: As healthcare continues to evolve, the role of the CIO is expected to expand further, requiring a blend of technical and strategic business skills. This evolution presents opportunities for health systems to enhance their leadership development programmes, preparing leaders for the complexities of the contemporary health system sector.

Background: Since the outbreak of the COVID-19 pandemic, healthcare workers (HCWs) have faced multiple difficulties in their work and personal lives. However, most of the quantitative reviews have focused on the extent of the pandemic's impact on the HCWs and have thus failed to fully capture the HCWs' experiences and the complexity of the problems they encountered. Therefore, this qualitative systematic review elucidates the HCWs' challenges brought about by the pandemic, their perceptions of the existing support and the support that require further attention.

Methods: The literature search spanned five databases: Scopus, PubMed, Web of Science, CINAHL and PsycInfo, targeting qualitative studies of HCWs' pandemic experiences from December 2019 to December 2023. These studies underwent strict quality and relevance assessment, emphasising critical appraisal and selection. Findings were unified through meta-synthesis, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study was registered in PROSPERO.

Results: This study analysed 29 qualitative studies on HCWs' experiences during the pandemic and their perceptions of support, identifying four themes of HCWs' physical and mental well-being, the impact of the pandemic on their professional and personal lives, their work environments and the support they received. These themes encompassed 8 main categories and 25 codes. The research revealed that the pandemic and work conditions negatively influenced their health, affecting their professional and personal lives. Current support has lessened the pandemic's effects on HCWs but should also address future requirements like long-term psychological support.

Conclusion: The studies identified the challenges faced by HCWs during the pandemic, and the existing support. However, due to the complex interactions between the work and environmental factors, the effectiveness of the existing support remains challenging. To improve their effectiveness, the future support should target the interactions between the HCWs and the work system.

Prospero registration number: CRD42023426238.

Background: In 2021, Dr Kalra embraced an opportunity for a leadership role at a start-up healthcare organisation in India. This gave him an opportunity to adapt his National Health Service (NHS) leadership experience to the evolving Indian private healthcare landscape. This paper shares his lived experience as a National Medical Director and delves into the experiences and leadership insights he acquired during this.

Method: This account draws on Dr Kalra's reflections and learning from his experiences, including social and professional interactions with individuals and teams, and links these experiences with leadership and management literature.

Results: Dr Kalra's transition from the public NHS to a private healthcare start-up environment in India presented challenges characterised by unfamiliarity, uncertainty and self-doubt. Manoeuvring through these challenges required forming a well-integrated team. By harnessing a mix of democratic, visionary and adaptive leadership styles, Dr Kalra developed an environment that fosters collaboration among healthcare professionals. He learnt to focus on articulating the overarching organisational vision and promoting autonomy, which led to a deeper sense of ownership and purpose among the team. Furthermore, fostering a culture of co-production enriched patients' experiences and contributed to business growth.

Conclusion: Experiencing this leadership transition highlighted and reinforced the importance of a deep understanding of the context, taking an adaptable approach to leadership and recognising and accepting one's vulnerability and fallibility. Fundamentally, Dr Kalra concluded that empowering teams and cultivating a patient-centred approach are critical for success.