Abstract Background and Purpose Fatigue, cognitive overload, and declining wellbeing remain pervasive threats to surgical performance. Existing interventions have focused on working-hour limits or reactive stress-management, with limited application of behaviour-change theory. This study tested the feasibility of a theoretically informed, two-phase intervention designed to enhance surgeons’ self-regulation and build sustainable performance. Methods A single-site feasibility and pilot study was conducted using the Medical Research Council Framework for Complex Interventions. Sixteen surgeons were invited; 10 participated. The intervention integrated an educational component on performance science and a coaching component using the GROW model. Behaviour Change Wheel and Theoretical Domains Framework principles guided design, with Self-Determination Theory underpinning motivational design. Feasibility outcomes included fidelity, dose, adaptation, and reach. Secondary outcomes assessed fatigue, thriving, psychological capital, and self-reported clinical performance using validated measures. Results Eighty percent of participants completed both phases. Fidelity and acceptability were high. Statistically significant changes were observed in fatigue (P = .046), recovery autonomy (P = .044), and sleep hours (P = .026). Thriving scores (learning subscale) increased (P = .014), alongside changes in hope and optimism within psychological capital. Participants valued the intervention’s professional relevance and identity-aligned framing. Conclusions A theoretically grounded behaviour-change intervention was feasible and acceptable for surgeons, showing preliminary signals in recovery and psychological resources. The study establishes proof-of-concept for embedding behavioural-science methods within surgical performance systems and provides a foundation for multi-site, multi-level evaluation.

Television (TV) has long influenced societal perceptions of professional roles, including those in medicine. Given the increasing emphasis on diversity and inclusion (D I) across healthcare, this study investigates whether these evolving societal values are reflected in the portrayal of medical doctors on TV. To assess trends in the depiction of doctors in English-speaking medical TV dramas (1950s–2020s), focusing on diversity across gender, race, and LGBTQ + representation, and to examine whether key social and professional issues are portrayed over time. A content analysis was conducted of 82 English-language medical TV dramas featuring physicians as central characters, spanning 1951–2020. Data were extracted from online databases and verified by researcher review. Demographic and thematic characteristics of main, core, and recurring physician characters were coded and analysed descriptively, with categorical comparisons via chi-squared testing. 618 seasons across 82 series were analysed. Main characters (MCs) were predominantly caucasian (95

BACKGROUND:Ireland's Olympian and Paralympian athletes are elite performers who possess skill, grit, and unrelenting drive. Parallels to the high performance required in healthcare can be drawn. Increasing recognition of human factors across the healthcare service in a pan-speciality interprofessional approach can improve patient outcomes. METHODS:We propose an analysis of Ireland's Olympian and Paralympian success in the context of sports psychology and human factors. Using DuPont's framework, we provide pragmatic, real-world examples in an easy-to-adapt fashion applicable to healthcare. RESULTS:The dirty dozen of human factors can be applied equally to the domains of sport and healthcare. Using clear examples of recent Irish sporting successes at the Olympics, a framework for how to conceptualise and apply the human factors which govern patient outcomes and organisational success can be achieved. These include lack of communication, complacency, lack of knowledge, distraction, lack of teamwork, fatigue, lack of resources, pressure, lack of assertiveness, stress, and lack of awareness. CONCLUSION:Novice healthcare professionals may use this introduction to become familiar with the area of human factors in an easy-to-conceptualise manner.

ImportanceSelection processes for surgical training should aim to identify candidates who will become competent independent practitioners and should aspire to high standards of reliability and validity.ObjectiveTo determine the association between measured candidate factors at the time of an Irish selection and assessment outcomes in surgical training, examined via rate of progression to Higher Specialist Training (HST), attrition rates, and performance as assessed through a multimodal framework of workplace-based and simulation-based assessments.Design, Setting, and ParticipantsThis retrospective observational cohort study included data from all successful applicants to the Royal College of Surgeons in Ireland (RCSI) national Core Surgical Training (CST) program. Participants included all trainees recruited to dedicated postgraduate surgical training from 2016 to 2020. These data were analyzed from July 11, 2016, through July 10, 2022.ExposuresSelection decisions were based on a composite score that was derived from technical aptitude assessments, undergraduate academic performance, and a 4-station multiple mini-interview.Main outcomes and measuresAssessment data, attrition rates, and rates of progression to HST were recorded for each trainee. CST performance was assessed using workplace-based and simulation-based technical and nontechnical skill assessments. Potential associations between selection and assessment measures were explored using Pearson correlation, logistic regression, and multiple linear-regression analyses.ResultsData were available for 303 trainees. Composite scores were positively associated with progression to HST (odds ratio [OR], 1.09; 95% CI, 1.05-1.13). There was a weak positive correlation, ranging from 0.23 to 0.34, between scores and performance across all CST assessments. Multivariable linear regression analysis showed technical aptitude scores at application were associated with future operative performance assessment scores, both in the workplace (β = 0.31; 95% CI, 0.14-0.48) and simulated environments (β = 0.57; 95% CI, 0.33-0.81). There was evidence that the interpersonal skills interview station was associated with future performance in simulated communication skill assessments (β = 0.55; 95% CI, 0.22-0.87).Conclusions and RelevanceIn this study, performance at the time of Irish national selection, measured across technical and nontechnical domains in a multimodal fashion, was associated with future performance in the workplace and in simulated environments. Future studies will be required to explore the consequential validity of selection, including potential unintended effects of selection and ranking on candidate performance.

PURPOSE:In simulation-based education (SBE), educators integrate their professional experiences to prepare learners for real world practice and may embed unproductive stereotypical biases. Although learning culture influences educational practices, the interactions between professional culture and SBE remain less clear. This study explores how professional learning culture informs simulation practices in healthcare, law, teacher training and paramedicine. METHODS:Using constructivist grounded theory, we interviewed 19 educators about their experiences in designing and delivering simulation-based communication training. Data collection and analysis occurred iteratively via constant comparison, memo-writing and reflexive analytical discussions to identify themes and explore their relationships. RESULTS:Varied conceptualizations and enactments of SBE contributed to distinct professional learning cultures. We identified a unique 'simulation culture' in each profession, which reflected a hyper-real representation of professional practice shaped by three interrelated elements: purpose and rationale for SBE, professional values and beliefs, and educational customs and techniques. Dynamic simulation cultures created tensions that may help or hinder learning for later interprofessional practice. CONCLUSION:The concept of simulation culture enhances our understanding of SBE. Simulation educators must be mindful of their uni-professional learning culture and its impacts. Sharing knowledge about simulation practices across professional boundaries may enhance interprofessional education and learners' professional practice.

Simulation training techniques for team communication skills are rarely shared across sectors. Lack of similar language and conceptualisations of what simulation entails creates barriers to shared learning. Cross sector dialogue is needed to remove barriers to curriculum development. The aim of this study is to identify how various professional sectors (healthcare, first responders, teacher training and law) can share learnings in experiential communication training. Grounded theory (GT) is a common qualitative methodology in health professions education research used to explore the “how”, “what”, and “why” of social processes” (Eppich et al. 2019). It is a flexible approach that allows researchers to interpret Findings: using an iterative process of coding and constant comparison of the data. Data collection and analysis occurred simultaneously, i.e. a small number of semi-structured interviews were conducted and then analysed, prior to conducting more interviews (Charmaz 2014; Watling and Lingard 2012). Sampling in GT is: purposeful, with non-random participants being selected based on their experiences with the phenomenon being explored and theoretical, meaning that as themes and constructs develop into theory, researchers can adjust the sampling strategy to include more relevant participants. For this study, our sample included educators spanning four professional sectors. GT methodology emphasizes the reflexivity of the researcher as a key element; the researchers aim to make sense of the participants experience from their own perspective, using their own backgrounds, experiences and preconceptions of the subject, in this case simulation training. Our indings indicate that learning culture influences participants' approach to experiential learning. Training encounters were categorised by how they are designed, implemented, and reflected upon. The language of experiential learning differed greatly between sectors. This research identifies the processes by which learning cultures are shaped within communication training across professional sectors, both within and external to healthcare.

Abstract Introduction Selection processes should conform to a ‘predictive paradigm’, identifying candidates who will become competent professionals. This study investigates the ability of a centralised, multi-modal national selection process to predict the future performance of surgical trainees. Methods A retrospective analysis of prospectively collected data from successful applicants to the Royal College of Surgeons in Ireland (RCSI) Core Surgical Training (CST) programme from 2016-2020 was conducted. Performance in subsequent assessments, attrition rates, and rates of progression to Higher Specialist Training (HST) were recorded. Selection decisions were based on a total score, composed of technical aptitude assessments, undergraduate academic performance, and a four-station multi-interview. CST performance was assessed using workplace-based and simulation-based assessments. Associations between selection and assessment measures were explored using Pearson correlation, binary logistic regression, and multiple linear regression analyses. Results Data was available for 303 trainees. Composite scores were positively associated with likelihood of progressing to HST (Exp(B) 1.09, 95% CI 1.05 – 1.13, p<0.001), and were significantly associated with performance across all CST assessments (r .23 - .34, P<0.001). On multivariate analysis, technical aptitude scores were the strongest predictor of future operative performance, both in the workplace (B 0.31, 95% CI .14 - .48, p<0.001) and simulated environments (B .57, 95% CI .33 - .81, p<0.001). The ‘interpersonal skills’ interview station was the strongest predictor of performance in simulated non-technical skill assessments (B .55, 95% CI .22 - .87, p<0.001). Conclusion Performance at the time of national selection, measured across technical and non-technical domains in a multi-modal fashion, is associated with future performance in the workplace and in simulation-based assessments.

Objective:This study sought to investigate the association between validated psychomotor ability tests and future in-theater and simulated operative performance. Background:Assessments of visuospatial ability, perceptual ability, and manual dexterity correlate with simulated operative performance. Data showing the predictive value of such assessments in relation to future performance in the workplace is lacking. Methods:Core surgical residents in Ireland recruited from 2016 to 2019 participated in assessments of baseline perceptual, visuospatial, and psychomotor ability; Pictorial Surface Orientation (PicSOr) testing, digital visuospatial ability testing, and manual dexterity testing. Operative performance was prospectively assessed using the in-theater Supervised Structured Assessment of Operative Performance (SSAOP) tool, and simulation-based Operative Surgical Skill (OSS) assessments performed over a 2-year core training period. SSAOP assessments were scored using a 15-point checklist and a global 5-point operative performance score. OSS assessments were scored using procedure-specific checklists. Univariate correlations and multiple linear regression analyses were used to explore the association between fundamental ability measures and operative performance. Results:A total of 242 residents completed baseline psychomotor ability assessments. Aggregated fundamental ability scores were associated with performance in submitted workplace-based SSAOP assessments using the Total Checklist score (P=0.002) and Overall Performance scores (P=0.002), independent of operative experience, and undergraduate centile scores. Aggregated ability scores were also positively associated with simulation-based OSS assessment scores on multivariable analysis (P=0.03). Conclusion:This study indicates that visuospatial, psychomotor, and perceptual ability testing scores are associated with the future operative performance of surgical residents.

Abstract Introduction Axillary surgery has been de-escalated in invasive breast carcinoma and may be omitted in certain age groups according to the Choosing Wisely initiative. Invasion can be found in 10-20% of patients with ductal carcinoma in-situ (DCIS). Therefore, Sentinel lymph node biopsy (SLNB) is indicated to rule out nodal metastasis. Our purpose was to study the risk factors and outcome of positive SLNB. Methods A retrospective analysis was performed on a series of 67 cases of patients who underwent mastectomy with SLNB for DCIS at Beaumont Hospital, Ireland, Royal College of Surgeons in Ireland, between 2015 and 2021. We evaluated their clinical, histopathological characteristics and regional recurrence. Results Only one invasive component was identified out of 67 cases (1.5%). Eight patients (11.9%) had positive SLN, six with isolated tumour cells, one micro-metastasis and one macro-metastasis. The three patients who proceeded for axillary lymph node dissection (ALND) presented with palpable lump, nipple discharge and through family history screening; however, all additional nodes retrieved were negative. All three patients had >5 cm high/intermediate grade disease. They were ER receptor positive and HER-2 negative. Regional recurrence was not reported in any. Conclusion This study identified a low rate of positive SLNB in DCIS and microinvasion on final histopathology. Factors which may increase the risk of positive SLNB are large tumours, palpable lump or nipple discharge. Our results indicate that ALND can be safely omitted in DCIS with positive SLNB but may be considered in high-risk patients.

In the Netherlands, patients with ovarian cancer are offered genetic testing. Pre-test preparation may help counseling patients. The aim of this study was to determine if use of a web-based intervention, leads to more effective genetic counseling of ovarian cancer patients.Between 2016 and 2018, 127 ovarian cancer patients referred for genetic counseling in our hospital participated in this trial. 104 Patients were analyzed. All patients filled out questionnaires pre- and post-counseling. The intervention group also completed a questionnaire after visiting an online tool. Length of consultation, patients’ satisfaction, knowledge, anxiety, depression and distress were compared before and after counselling.The intervention group had the same level of knowledge compared to the counseling group, but at an earlier point in time. They were satisfied with the intervention (86%) and better prepared for counseling (66%). The intervention did not lead to shorter consultations. No differences in levels of anxiety, depression, distress and satisfaction were observed.Although consultation length was unaffected, the improvements in knowledge after online education and patients satisfaction indicates that this tool can be an effective addition to genetic counseling.Use of an educational tool may lead to a more effective, personalized way of genetic counselling and enables shared decision making.

ISSUE:Health care management is faced with a basic conundrum about organizational behavior; why do professionals who are highly dedicated to their work choose to remain silent on critical issues that they recognize as being professionally and organizationally significant? Speaking-up interventions in health care achieve disappointing outcomes because of a professional and organizational culture that is not supportive.CRITICAL THEORETICAL ANALYSIS:Our understanding of the different types of employee silence is in its infancy, and more ethnographic and qualitative work is needed to reveal the complex nature of silence in health care. We use the sensemaking theory to elucidate how the difficulties to overcoming silence in health care are interwoven in health care culture.INSIGHT/ADVANCE:The relationship between withholding information and patient safety is complex, highlighting the need for differentiated conceptualizations of silence in health care. We present three Critical Challenge points to advance our understanding of silence and its roots by (1) challenging the predominance of psychological safety, (2) explaining how we operationalize sensemaking, and (3) transforming the role of clinical leaders as sensemakers who can recognize and reshape employee silence. These challenges also point to how employee silence can also result in a form of dysfunctional professionalism that supports maladaptive health care structures in practice.PRACTICE IMPLICATIONS:Delineating the contextual factors that prompt employee silence and encourage speaking up among health care workers is crucial to addressing this issue in health care organizations. For clinical leaders, the challenge is to valorize behaviors that enhance adaptive and deep psychological safety among teams and within professions while modeling the sharing of information that leads to improvements in patient safety and quality of care.

BACKGROUND: Conflict between healthcare professionals is a common feature of modern healthcare environments, contributing to more stressful working conditions and burnout in frontline staff. In the Royal College of Surgeons in Ireland we undertook to design and deliver a course called 'Professional Interactions' which would equip junior residents in surgery and other acute care specialties with the skills to better manage conflict and bullying. METHODS: The design of this course was based on a Transformative Learning Theory conceptual framework. Key teaching modalities included rational discourse, role-playing, simulations, case studies, reflection exercises and experience with critical incidents and feedback. This experiential learning session was followed with an online short course to reinforce the learning objectives. RESULTS: We in the National Surgical Training Programme have been delivering structured mandatory education to our residents on this topic for over a decade. Each iteration of this programme has been modified based on resident and faculty feedback as well as emerging evidence in the field of communication skills. Recent course evaluation data included feedback from 203 course participants, which represented a 66% response rate. Ninety-two percent of those respondents rated the course as 'Excellent' or 'Good' and that they would use the skills learned 'Daily or 'Weekly'. 85 percent reported a perceived improvement in conflict management skills. CONCLUSIONS: Conflicts and difficult interactions between colleagues in the workplace are a frequent feature of healthcare practice. Teaching residents skills to manage these interactions more successfully may help towards developing a culture of mutual respect in hospital-based practice. (C) 2021 The Authors. Published by Elsevier Inc. on behalf of Association of Program Directors in Surgery.

INTRODUCTION:GRIT, defined as passion and perseverance for long-term goals, is a personality trait that is key to academic success and career achievement. Doctors face significant challenges and exposure to stressful situations throughout their career and require high levels of grit and perseverance to achieve success and avoid burn-out. This study aimed to measure overall levels of grit among hospital doctors and medical students and to compare levels of Grit across specialties and career grades.METHOD:ology: A cross-sectional survey was used to measure GRIT levels using the validated Short Grit Scale (GRIT-S). Hospital doctors and medical students at University Hospital Galway were asked to complete the questionnaire. Gender, age, grade, education, and speciality were recorded. Analysis was conducted using STATA V12.1™ and SPSS 25™.RESULTS:378 questionnaires were completed with a participation rate of 75.6% eligible for analysis. The female: male ratio was 1.2:1, with a mean age of 29.6 ± 8.3 years. The mean Grit score of participants was 3.56 ± 0.55. Grit trait was independent of gender and increased with age and grade. Consultants had significantly higher mean Grit score (3.86 ± 0.59, p = 0.004). There was no difference between medical specialities, nor between graduate-entry and undergraduate medical students.CONCLUSION:our results show that medical students and NCHDs alike have high levels of Grit compared to the general population, and the levels increase with career advancement, with the highest scores observed in consultants. This suggests that Grit might be of benefit as an adjunct in the selection process of applicants for training schemes and jobs that require high levels of resilience, as well as an adjunct to monitoring progress in training from a personality and mental health perspective.

Abstract Introduction Assessments of visuospatial, psychomotor and perceptual ability correlate with simulated operative performance. This study investigates the association between fundamental technical ability and future operative performance as measured through both in-theatre and simulation-based assessments. Methods Core surgical trainees in the Republic of Ireland recruited from 2016–2019 participated in validated assessments of fundamental technical ability; Pictorial Surface Orientation (PicSOr) testing of perceptual ability, ‘paper-based’ visuospatial aptitude assessments, and psychomotor testing using a grooved pegboard. Operative performance was assessed using the in-theatre Supervised Structured Assessment of Operative Performance (SSAOP) tool, and Operative Surgical Skill (OSS) assessments (multi-station simulation-based assessments) performed over a 2-year core training period. SSAOP assessments were scored using a 15-point checklist and a global 5-point Operative Performance score. Univariate (Pearson) correlations and multiple linear regression were used to explore the association between fundamental ability and operative performance, controlled for both operative experience and centile scores from the trainee's undergraduate medical degree. Results Aggregated fundamental ability scores strongly correlated with performance in all submitted SSAOP assessments using the Total Checklist score (B = 0.75, t(168) = 3.17, p = 0.002) and weakly correlated with Overall Performance scores (B = 0.04, t(168) = 3.16, p = 0.002), independent of operative experience and centile scores. Fundamental ability scores were also predictive of OSS assessment scores on multivariate analysis (B = 0.219, t(168) = 2.22, p = 0.03). Conclusion Fundamental technical ability is predictive of future performance in both in-theatre workplace-based assessments of operative skill and simulation-based assessments of operative performance.

Ear, nose and throat (ENT) specialists are a high-risk group for COVID-19. Although the implications of SARS-CoV-2 infection on physical health are well-documented, the psychological impact is frequently overlooked. The aim of this study was to gauge the psychological impact of COVID-19 on ENT specialists in Ireland. A national, cross-sectional, web-based survey was distributed to ENT specialists during the peak of the COVID-19 pandemic (21st May 2020–21st June 2020). The questionnaire collected sociodemographic and COVID-19 related data. The GAD-7 was utilized to measure symptoms of clinically significant anxiety disorder. Thirty-eight ENT specialists (M/F:24/12, median age, 38.7 years (23–60 years)) completed the survey. About 34% (n = 13) of participants screened positive for an anxiety disorder, of which 2 (5%) had moderate symptoms. The majority of participants (n = 32, 84%) felt ENT specialists had increased exposure to SARS-CoV-2 compared with other medical specialties. Additionally, 32% (n = 12) felt incapable of protecting themselves from infection. An encouraging proportion of ENT specialists (n = 22, 58%) were aware of psychological support available from national and institutional organizations. The long-term psychological sequelae of COVID-19 will be felt as the physical burden eases. As we adjust to new normalities, ENT surgeons must be conscientious of the mental health issues that arise from the working environment. Sources of anxiety emanated from a lack of control over infection risk, increased vulnerability to COVID-19 relative to other specialties and the implications this has for ENT specialists and their families. Future interventions must focus on increasing awareness of the available psychological support services for our healthcare workers.

Objective: To collect experiences and to identify the main facilitators and barriers for the implementation process of large scale communication training programs. Methods: Using a multiple case study design, data was collected from leaders of the individual programs in Australia, Ireland, Austria and Denmark. The RE-AIM framework was used to evaluate the components: Reach, Effectiveness, Adoption, Implementation, and Maintenance of the programs. Results: The programs, all based on the Calgary-Cambridge Guide, succeeded in reaching the intended target groups corresponding to between 446 and 3000 healthcare workers. New courses are planned and so far the outcome of the intervention has been investigated in two countries. The fact that implementation, including educating trainers, relies on a few individuals was identified as the main challenge. Conclusion: Large scale communication training programs based on the Calgary-Cambridge Guide can be implemented and adopted in multiple different healthcare settings across a national health system culture. The importance of standardized trainer education and adaption of the programs to clinical practice was highlighted. Practice Implications: In order to address the sustainability of the programs and to allow the intervention to scale up, it is important to prioritise and allocate resources at the political and organizational level. (C) 2020 The Author(s). Published by Elsevier B.V.

Introduction: Surgeons regularly educate patients on health promoting behaviours including diet, sleep and exercise. No study thus far has explored surgeons' personal compliance with these health behaviours and their relationship with surgical performance. The primary outcomes of this study were self-reported health, health related behaviours, wellbeing, fatigue and surgical performance. Methods: A survey of validated themes on health related behaviours, workplace variables and performance was distributed to surgical trainees and consultants in the UK and Ireland through the Association for Surgeons in Training (ASiT). Non-parametric analysis was used to determine inferential associations. Results: Ninety five surgeons (51.5% female, 39.9% registrars) completed the survey. 94% and 74% reported "good" or better overall health and mental wellbeing respectively. The majority (54.7%) reported inconsistent sleep patterns. Less than a quarter engage in regular exercise. Sixty two and 64.2% reported being regularly fatigued and bothered by feelings of anxiety and/or depression respectively. Poor self-reported health and wellbeing were associated with poorer reported off-call performance (p < .01). Higher levels of fatigue negatively impacted self-reported surgical and non-surgical task proficiency (p < .01). Discussion and conclusion: Surgeons reported high levels of overall health. However, healthy behaviours around sleep, diet and exercise were not consistently reported. Fewer reported good mental health and emotional wellbeing. Self-reported health behaviours including sleep and physical activity were associated with surgical performance. Strategies to improve modifiable lifestyle factors which will optimise physical health, mental wellbeing and levels of fatigue may optimise surgical performance.