Doris Østergaard

Background: Healthcare professionals working in anaesthesiology are exposed to frequent emotionally challenging situations. Many well‐being initiatives focus on individual coping or support after major events, whereas less attention has been given to organisationally embedded support for everyday work‐related challenges. We aimed to describe the development, implementation, uptake and staff experience of a department‐wide peer‐support programme. Methods: We conducted a single‐centre, uncontrolled pre–post mixed‐methods implementation and evaluation study in a university hospital anaesthesiology department. Kern's six‐step approach guided development and implementation of a multicomponent programme comprising education about well‐being and psychological safety, leadership modelling, local change champions, structured collegial conversations and brief team defusing. Evaluation combined pre‐ and post‐intervention surveys, implementation/process data and post‐intervention group interviews. Survey outcomes across five dimensions—well‐being, coping, teamwork, psychological safety and patient safety culture—were exploratory. Results: Approximately 80% of staff were trained in structured collegial conversations; 55% of post‐intervention respondents reported participating in at least one structured collegial conversation and 35% in at least one defusing. Across the five survey dimensions there was no consistent pattern of change. In exploratory analyses, the proportion of respondents with coping scores in the highest quartile increased from 31.3% to 42.0% (OR 1.59, 95% CI 1.08–2.34), while the proportion reporting ‘being new’ as a source of emotional burden decreased from 14.0% to 6.8% (OR 0.45, 95% CI 0.23–0.86). Group interview participants described a shared language for discussing challenging experiences, increased attention to colleagues' support needs and value in the structured listening approach. These findings should be interpreted cautiously because of the uncontrolled design and multiple exploratory outcomes. Conclusion: A multicomponent peer‐support programme was implemented with substantial staff participation in an anaesthesiology department. The study provides evidence about implementation, uptake and staff experience, but does not establish that the programme caused improvements in well‐being or organisational culture. Leadership engagement, local champions and integration into existing departmental structures appeared important to implementation. Editorial Comment: The present study describes the implementation of a departmental peer‐support programme addressing everyday emotional challenges in anaesthesiology. Substantial participation and positive qualitative accounts suggest that structured conversations can be integrated into clinical practice. However, inconsistent survey findings and the uncontrolled design preclude strong conclusions about effectiveness.

Background: Mental health issues among healthcare professionals (HCPs) are rising, impacting individual wellbeing, healthcare systems, and patient safety. This exploratory study aimed to analyse the association between anaesthesia teams' perception of their mental wellbeing, psychosocial work environment, and patient safety culture in a university hospital's anaesthesiology department. Second, to identify types of stressors and strategies to overcome them. Third, to explore differences in perception by profession, gender, and years of experience. Finally, to evaluate the psychometric properties of the questionnaire.Methods: A questionnaire covering mental wellbeing, teamwork, psychosocial work environment, and patient safety culture was sent to all HCPs in the department in May 2021 via e‐mail. The questionnaire consisted of 35 questions, 4 demographic questions, and 2 open text fields.Results: 293 HCPs responded (73% response rate); 60% agreed their work is emotionally challenging, and 30% experienced weekly emotional strain. Significant differences were seen between professions in terms of stressors. Clinical situations contributed most to doctors' emotional strain, while nurses scored higher on making compromises and being busy. A strong relationship was seen between weekly/daily emotional strain and making compromises in standards, clinical situations, and busyness.Conclusion: In conclusion, all HCPs experienced emotional strain, with different causes and coping strategies across professions. Support was primarily found among colleagues and networks. Interestingly, low emotional strain correlated positively with coping, teamwork, psychological safety, and patient safety culture, suggesting an interrelation between these dimensions and HCPs' mental health. These findings may inform future conceptualisations of mental health, psychological safety, and safety culture.

Background: Team reflexivity and peer feedback in daily clinical work can improve patient safety. However, teams do not always engage in reflection after patient care. A reason could be that team members may lack skills in engaging in team reflection. This study explores the use of interprofessional team-based simulations to encourage and equip teams for reflective conversations in the real-world clinical practice. Methods: This was a prospective, explorative study of team members’ perceptions of the use of in situ simulation-based scenarios with critically ill patient cases to train team-based reflections and peer feedback. The study took place in two neurological wards. Prior to the intervention, a 1-day observation in each ward and semi-structured short interviews with physicians and nurses were conducted. Results: A total of 94 staff members, 57 nurses, 8 nurse assistants and 29 physicians participated in the in situ simulation scenarios. All team members showed appreciation of the safe learning environment. The authors found that the simulations and the debriefing structure provided an opportunity for training of team reflexivity and feedback. The team members evaluated the simulation-based training very positively, and their initial reaction indicated that they found peer feedback useful for the individual and the team. This approach allowed them to reflect on their own clinical practice. Conclusion: The simulation-based training scenarios and the debriefing structure promoted team members’ team reflexivity and peer feedback skills. The method is feasible and could be used in other specialties and situations. The team members’ reactions to feedback were positive, and based on their reflections, there is a potential to increase both individual and team skills as well as improve patient treatment.

Objectives: Little is known about medical students’ speak-up barriers upon recognizing or becoming aware of risky or deficient actions of others. Improving our knowledge on these helps in preparing student to function in actual health care organizations. The aim was to examine medical students' perceived reasons for silence in respect to different speak-up situations (i.e., vignette content) and to test if vignette difficulty had an effect on reasons indicated. Methods: This study was a randomized, controlled, single-blind trial, with text-based vignettes to investigate speak-up barriers. Vignette contents described speak-up situations that varied systematically with respect to speak-up barrier (i.e., environmental norm, uncertainty, hierarchy) and difficulty (i.e., easy, difficult). For each vignette, participants indicated which speak-up barriers they regarded as important. Descriptive analysis was performed for the study population, the numbers of barriers perceived and rating of vignette difficulty. Logistic regression analysis was used to examine the association between barriers perceived and vignette contents, designed vignette difficulty and subjectively rated vignette difficulty. Results: A total of 265 students were included. The response rate was 100%. Different barriers were relevant for the different vignettes and varied in a consistent way with the theme of the vignette. Significantly more speak-up barriers were indicated for participants with the difficult version for vignette 1 (not an environmental norm) and vignette 3 (hierarchy) with odds ratio (OR) = 1.52 and 95% confidence interval (95% CI: 1.33–1.73) and OR = 1.25 (95% CI: 1.09–1.44). For (OR) estimates, confidence intervals were rather large. Conclusions: Perceived barriers for speak-up vary consistently with the characteristics of the situation and more barriers preventing speak-up were related to the difficult versions of the vignettes.

BackgroundAn Utstein style meeting of key stakeholders from the existing collaboration surrounding post-graduate training was arranged to set a direction for continuing professional development (CPD) of anesthesiologists in Denmark. A 2-day meeting was planned to guide discussions about competencies in anesthesiology, facilitate the development of a blueprint for a portfolio-based CPD program and provide examples of how a portfolio can be used in practice.MethodsThe meeting agenda was based on an adaptation of Kern's six-step approach to curriculum development. Twenty-four participants from the university hospitals in Denmark were invited. Prior to the meeting participants were informed of the objectives and the Utstein style process.ResultsParticipants acknowledged a need for a more structured approach to CPD, preferably within the current organizational set up at the departmental level, and with a portfolio-based, individualized curriculum. It was recognized that CPD should contain an array of possibilities to accommodate needs and wants of both the individual and the department. It was emphasized that, while anesthesiologists are used to give feedback to trainees, many are less familiar in providing the same to peers, and psychological safety was identified as a prerequisite to support a culture where specialists can reflect openly on each other's performance.ConclusionThe results provide an insight into the attitudes, opportunities, and challenges of anesthesiologists in relation to continuing professional development in Denmark. Generally, participant suggestions are in line with the shift in medical education toward workplace-based learning, feedback and lifelong learning.

A significant factor of clinicians' learning is based on their ability to effectively transfer acquired knowledge, skills, and attitudes from specialty-specific clinical courses to their working environment. We conducted semi-structured interviews with 20 anaesthesiologist trainees (i.e. residents) in four group and five individual interviews using SRL principles as sensitizing concepts. Data were collected and analyzed iteratively using thematic analysis. Advanced trainees are highly motivated to explore what they have learned in specialty-specific courses, but they often face several barriers in implementing their learning in the workplace environment. Four themes emerged from the interview data: 'Be ready to learn', "Take the 'take-home-messages' home', "Be ready to create your own opportunities', and "Face it, it's not entirely up to you'. Understanding the challenges regarding transferring knowledge from courses to the working environment is an important lesson for assisting trainees set their learning goals, monitor their progress, and re-evaluate their SRL processes. Even for advanced trainees, successfully transferring knowledge from specialty-specific courses often requires adequate commitment and support. Medical supervisors and other relevant stakeholders must be aware of their shared responsibility for creating individual environments that support opportunities for trainees to self-regulate their learning.

Background: In accordance with the focus on patient safety and quality in healthcare, continuing professional development (CPD) has received increasing levels of attention as a means to ensure physicians maintain their clinical competencies and are fit to practice. There is some evidence of a beneficial effect of CPD, though few studies have evaluated its effect within anesthesia. The primary aim of this systematic review was to establish which CPD activities anesthetists are engaged in and their effectiveness. The secondary aim was to explore which methods are employed to evaluate anesthetists’ clinical performance.Methods: Databases searched: Medline, Embase and Web of Science, in May 2023. Additional papers were identified through searching the references of included studies. Eligible studies included anesthetists, either exclusively or combined with other healthcare professionals, who underwent a learning activity or assessment method as part of a formalized CPD program or a stand‐alone activity. Non‐English language studies, non‐peer reviewed studies and studies published prior to 2000 were excluded. Eligible studies were quality assessed and narratively synthesized, with results presented as descriptive summaries.Results: A total of 2112 studies were identified, of which 63 were eligible for inclusion, encompassing more than 137,518 participants. Studies were primarily of quantitative design and medium quality. Forty‐one studies reported outcomes of single learning activities, whilst 12 studies investigated different roles of assessment methods in CPD and ten studies evaluated CPD programs or combined CPD activities. A 36 of the 41 studies reported positive effects of single learning activities. Investigations of assessment methods revealed evidence of inadequate performance amongst anesthetists and a mixed effect of feedback. Positive attitudes and high levels of engagement were identified for CPD programs, with some evidence of a positive impact on patient/organizational outcomes.Discussion: Anesthetists are engaged in a variety of CPD activities, with evidence of high levels of satisfaction and a positive learning effect. However, the impact on clinical practice and patient outcomes remains unclear and the role of assessment is less well‐defined. There is a need for further, high‐quality studies, evaluating a broader range of outcomes, in order to identify which methods are most effective to train and assess specialists in anesthesia.

Healthcare professionals (HCP) are an important resource, but the shortage of staff and an increased volume of patients with comorbidities might put a pressure on them. We speculated if mental strain was a challenge for HCP working in a department of Anaesthesiology. The purpose of the study was to explore HCP's perception of their psychosocial work environment and how they handle the mental strain in a department of Anaesthesiology in a university hospital. In addition, to identify types of strategies to handle the mental strain. This was an exploratory study based on semi‐structured, individual interview with anaesthesiologists, nurses and nurse assistants employed in the Department of Anaesthesiology. The interviews were conducted online and were recorded in Teams, transcribed, and analysed using systematic text condensation. A total of 21 interviews were conducted with HCP from the different sections of the department. The interviewees described that they had experienced mental strain at work, with the unforeseen situation as the most challenging. High workflow is mentioned as an important contributing factor to mental strain. Most of the interviewees found that their traumatising experiences were met with support. Overall, everyone had someone to talk to either at work or privately, but they still found it difficult to talk about collegial conflicts or own vulnerabilities. Teamwork is described as strong in some sections. All HCP had experienced mental strain. Differences were found in how they perceived the experience of mental strain, their reactions and needs of support as well as their coping strategies.

Background We aimed to explore (1) the influence of healthcare professionals' (HCPs’) specialty, profession, gender and length of employment on their perception of six dimensions of patient safety culture (PSC) and (2) the relation between these characteristics and the two dimensions of safety climate and perception of management. Methods In a cross-sectional study, a Danish version of the Safety Attitudes Questionnaire was sent to all HCPs at a large regional hospital organisation. This included hospitals, the Emergency Services, the Regional Pharmacy and the Centre for Diabetes corporations. A total of 30 230 HCPs received the survey. Differences between specialties, professions, gender and years of employment were tested for each dimension of PSC. Differences in mean attitude scores were tested using analysis of variance and differences in having a positive attitude were tested using logistic regression. Results In total, 15 119 (50%) HCPs returned the survey. Significant differences are seen across hospitals and corporations for all dimensions of PSC. The proportion of HCPs with a positive attitude was largest regarding job satisfaction (74.8%) and lowest regarding perception of management (43.9%). Significant differences are seen in physicians' and nurses' perception of PSC in the different specialties within all dimensions of PSC except for the dimension of recognition of stress. Significant differences in positive perception of teamwork climate are seen between anaesthesiologists' (69.4%) and surgeons' (41.7%). No significant gender differences were found between physicians' and nurses' perception of safety climate and of management. In addition, we found an influence of years of employment on PSC. Discussion Significant differences were found in HCPs' perception of PSC between corporations, specialties and professions. The lowest proportion of HCPs with a positive perception of PSC was found within the dimensions of safety climate and perception of management. These differences may have implications for teamwork and patient safety.