Funded mini-projects

 

(602) Evaluation of stress, well-being and clinical performance in recently graduated veterinary surgeons

N.B. The information below is authored by the mini-project applicants, not by staff of the subject centre. This text represents the views and opinions of the mini-project team only, not those of the subject centre or its affiliates.

Principal investigator

Richard Mellanby, Royal (Dick) School of Veterinary Studies

Full list of project partners

Dr Richard Mellanby (Small Animal Medicine Clinician, University of Edinburgh)
Dr Neil Hudson (Director of Admissions/Veterinary Clinical Lecturer, University of Edinburgh)
Professor Susan Rhind (Chair of Veterinary Education, University of Edinburgh)
Professor Ian Ricketts (Chair of Assistive Systems and Healthcare Computing, University of Dundee)
Mr Kenny Morrison (PhD student, University of Dundee)
Dr Martyn Jones (Reader in Nursing, University of Dundee)

Topic

This is a MINI-PROJECT proposal

Background

Smoothing the transition to employment is a crucial aspect of any vocational training programme and is key to the ‘employability’ agenda. However, this remains a considerable challenge for the healthcare professions where the undergraduate curriculum may not adequately prepare recent graduates for the rapidly evolving demands placed on junior professionals. The medical and dental professions have risen to this challenge by developing structured training programmes which ensure that junior colleagues are well supported during their initial months as professional health care providers. In contrast, employers of new veterinary graduates have no obligation to provide equivalent structured training programmes or supervision for their new employees. Consequently the standard of support provided is determined by the facilities and attitudes of colleagues in the practice. The lack of a more formal post graduate support structure is particularly surprising given that a recent survey of the incidence of clinical mistakes in recent graduates found that 82% of recent graduates worked frequently or always unsupervised and only 43% could always rely on support from other veterinarians in the practice.1 Furthermore, 78% stated that they had made a clinical mistake, defined as an erroneous act or omission resulting in a less than optimal or potentially adverse outcome for a patient and in many cases these mistakes had a considerable emotional impact on the veterinarians involved. Crucially, lack of time and lack of supervision was implicated in 35% and 26%, respectively, of all mistakes which are issues that would be easily rectified in a more structured new graduate support programme.1 These concerns have, in part, led to initiatives such as the British Veterinary Association (BVA) Young Vet Network and the Royal Veterinary College (RCVS) Professional Development Phase (PDP) programme yet these schemes still offer recent veterinary graduates very little formal support. It is particularly important that the veterinary profession tackles these given the widely acknowledged problems of mental distress which have already been well documented in the profession.2

There is an urgent need to understand the challenges that new graduates meet in their transition from student to practising vet, how this transition impacts on their well-being and performance in clinical practice and ultimately, based on this knowledge, to develop strategies to optimise the transition from training to employment. However, until recently, the accurate and reliable measurement of stress (measured as perceptions of the work environment, including demand, control and effort/reward imbalance3-5), well being (measured by positive and negative affect) and clinical error has suffered from ‘recall bias’ caused by the delay between the occurrence and subsequent recording of the event. Now, appropriately adapted Personal Digital Assistant (PDA) have been developed which can provide rapid and reliable assessment of stress, well being together with a time-stamped record of clinical activity and performance in the form of computerised ambulatory diaries. This approach, ecological momentary assessment,5 provides repeated measurement of data of interest in the respondents’ natural environment. It allows analysis of both between and within-person effects, and allows signal, event and time based recording. The approach has been validated in the assessment of work related stress in other healthcare professions.6 We propose to investigate affect, perceptions of the working environment and the incidence of clinical mistakes in a cohort of recent graduates in the initial weeks of their first job. This high quality data will enable us to quantify the incidence of stress and its relationship to clinical performance in recent graduates and to assess, more accurately than has previously possible, the well being of veterinarians at the start of their professional career. This data will also define the nature of the critical skills gap so that we can then seek to optimise the transition to professional life as a practising veterinarian.

Proposed activities

This programme of work will be delivered through two summer undergraduate projects (July to September 2009/2010). The general approach will be the same as the studies undertaken by Dr Jones and colleagues on stress in the nursing profession. In short, recent graduates will be invited to carry a personal digital assistant (PDA) for a randomly selected three day period during the second and third months of their first job as a practising veterinarian. During this three day period, the PDA will request information about stress and clinical performance by a discrete audible alert on six random occasions during the working day. The PDA will present questions on current feelings of positive and negative affect, current perceptions of the working environment and then at the end of each of the three days the PDA will automatically ask for more detailed questions on affect, perceptions of the working environment, including support receipt, and detail the impact on clinical performance. Participants will also have the opportunity to provide details of personally significant clinical incidents, i.e. those situations that have a significant effect on the vets thoughts, feelings and behaviour. Participants will have the opportunity to provide up to a 30 word account of the situation. This will provide crucial, real time data on the challenges faced by recent graduates as they make the transition from student to practising vet. In addition, the graduates will be asked to complete a written questionnaire to allow the efficacy of the two data capture systems to be compared. The initial part of the first undergraduate project will be to develop and refine the interview format and during the second part, the interview will then be made available via PDA and the system will be piloted. The second undergraduate project, the following year, will then distribute the PDAs to recent graduates and will collate and analyse the results. It is envisaged that 20 new graduates will be recruited in this study.

Proposed outcomes

A wide range of outcomes are anticipated from this project including :
• Presentation of findings to the veterinary community at a specific workshop/conference in session 09-10 and to a wider conference focused on the assessment of stress within the workplace
• Presentations/ workshops at relevant BVA, RCVS and Society of Practising Veterinary Surgeons (SPVS) events. This will add much needed objective data to the on-going debate about new graduate mentorship within the veterinary profession.
• It is anticipated that this project will yield at least one research paper which will be published in a peer-reviewed journal explaining the approach to a wide audience and allow dissemination of our findings to a large number of higher education bodies.
• The results of this study will feed back to the veterinary curriculum which may result in alterations with the aim that graduates are better prepared for life as practising vets. It is anticipated that the course modifications resulting from this study will be taken up by other veterinary schools which will further increase the number of students who will benefit from this study.
• It is expected that this pilot study will lead to the more widespread use of this technology to assess stress and well being in students in other disciplines as well as allowing the applicants to develop additional studies to examine stress and well as being more widely within the veterinary profession.

Expertise of grant holder and project team

The co-applicants are in an extremely strong position to effectively deliver this important study. Dr Mellanby’s study on incidence of clinical mistakes by recent veterinary graduates was one of the first studies to highlight the difficulties of the transition from student to practising veterinarian and he also completed the initial study on the incidence of suicide within the veterinary profession.1,2 In addition, Dr Mellanby and Professor Rhind are collaborating with Professor Platt, Director of Research Unit in Health, Behaviour and Change, University of Edinburgh in a questionnaire based survey evaluating veterinary student well being. Therefore, this programme of work fits in extremely well with previous and on-going studies by extending the assessment of stress and well-being as students make the transition to practising veterinarians. Furthermore, Professor Rhind is the first Professor of Veterinary Education in the UK and has considerable experience and expertise in the development and evaluation of novel learning and teaching strategies within the veterinary curriculum. Professor Rhind, Dr Hudson and Dr Mellanby are actively involved in teaching and mentoring veterinary graduates and are well placed to undertake this study and implement changes based on the findings of the study. The development of the technology and approach to real time measurement of stress has been pioneered by Dr Jones who has successfully undertaken a number of studies of stress evaluation in other healthcare professions in conjunction with his colleagues Professor Ricketts and Mr Morrison.

Similar work

This technology has been developed and validated by Dr Jones and colleagues in other professions, most notably nursing, and we are therefore very confident that this approach will allow us to evaluate affect and performance in real time in new veterinary graduates. Currently, there is only limited information available on the stressors involved in the transition from student to practising veterinarians and we are unaware of any studies which have evaluated stress and well being in real time in either veterinary students or new graduates.

References
1. Mellanby RJ, Herrtage ME. Survey of mistakes made by recent veterinary graduates. Vet Rec 2004;155:761-765.
2. Mellanby RJ. Incidence of suicide in the veterinary profession in England and Wales. Vet Rec 2005;157:415-417.
3. Siegrist J. Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1996;1:27-41.
4. Karasek, R. A. Job Demands, Job Decision Latitude and Mental Strain: Implications for Job Redesign. Administrative Science Quarterly 1979; 24, 285-308.
5. Shiffman, S., & Stone, A. Introduction to the Special Section: Ecological Momentary Assessment in Health Psychology. Health Psychology 1998; 17(1), 3-5.
6. Johnston, DW, Beedie, A. & Jones, MC. Using computerized ambulatory diaries for the assessment of job characteristics and work-related stress in nurses. Work & Stress 2006; 20, 163-172

Contact details

Grant holder: Richard Mellanby, Royal (Dick) School of Veterinary Studies
Amount awarded: £4,900
Subject centre project contact: Gillian Brown

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