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Background Recent research has demonstrated that burnout is widespread among physicians, and impacts their wellbeing, and that of patients. Such data have prompted efforts to teach resilience among physicians, but efforts are hampered by a lack of understanding of how physicians experience resilience and stress. This study aimed to contribute to knowledge regarding how physicians define resilience, the challenges posed by workplace stressors, and strategies which enable physicians to cope with these stressors. Methods A qualitative approach was adopted, with 68 semi-structured interviews conducted with Irish physicians. Data were analysed using deductive content-analysis. Results Five themes emerged from the interviews. The first theme, ‘The Nature of Resilience’ captured participants’ understanding of resilience. Many of the participants considered resilience to be “coping”, rather than “thriving” in instances of adversity. The second theme was ‘Challenges of the Profession’, as participants described workplace stressors which threatened their wellbeing, including long shifts, lack of resources, and heavy workloads. The third theme, ‘Job-related Gratification’, captured aspects of the workplace that support resilience, such as gratification from medical efficacy. ‘Resilience Strategies (Protective Practices)’ summarised coping behaviours that participants considered to be beneficial to their wellbeing, including spending time with family and friends, and the final theme, ‘Resilience Strategies (Attitudes)’, captured attitudes which protected against stress and burnout. Conclusions This study emphasised the need for further research the mechanisms of physician coping in the workplace and how we can capitalise on insights into physicians’ experiences of coping with system-level stressors to develop interventions to improve resilience.

Background The financial burden on patients in terms of private out-of-pocket personal costs related to accessing healthcare services has become a growing concern internationally. While healthcare systems and access arrangements differ internationally, private cost to patients and their households remains an under-researched area. The private out-of-pocket costs of attending hospital outpatient consultations in Ireland has not been previously established. Methods We developed a data collection tool to measure the private costs to patients of attending hospital outpatient consultations. Resource items included travel time and expenses, missed work, need for accompanying carers, and care needs for dependents, in addition to demographic details. In the pilot study, the questionnaire was completed by 42 patients attending several hospital outpatient departments in a large teaching public hospital in the west of Ireland. Results The pilot study demonstrated the questionnaire’s feasibility and acceptability. Estimates of private costs per visit showed considerable variability, with a median cost per patient of €131 (Inter Quartile Range €142; range €22-€370). Participants reported attending on average 4 appointments per year (mean 4.26, range 1–20, SD 3.7), giving a mean annual cost of attending hospital clinics of €559 per person. On average, participants spent 1.2 h (range 0.1-3.0) travelling to their appointment. Fourteen participants (33%) reported missing work, while 18 (43%) required an accompanying carer, of whom four carers were paid. Conclusions Private costs related to attending outpatient clinics are not insignificant. Formal validation of the data collection tool is required, alongside further studies involving larger, more diverse participant samples to better quantify the financial implications for patients attending outpatient consultations. Registration The study protocol was pre-registered using the Center for Open Science registration portal (08 March 2024).

Background SAFMEDS (Say-All-Fast-Minute-Every-Day-Shuffled) is a flashcard-type behavioural instructional methodology, involving one-minute learning trials that function both as practice and assessment, used to facilitate the development of fluency in a behaviour. The primary research question was whether SAFMEDS engenders improvement in performance beyond that conferred by usual teaching. A secondary research question was whether SAFMEDS is an effective method of producing fluency in Electrocardiogram (ECG) interpretation. Methods A pilot study was conducted to determine sample size required to power the pragmatic randomised controlled trial (RCT). For the subsequent RCT, participants were randomly assigned to a “usual teaching” control group ( n  = 14) or the SAFMEDS intervention group ( n  = 13), with the recognition of 15 cardiac conditions on ECGs (e.g., atrial fibrillation, complete heart block) targeted. Intervention group participants’ performance was tracked over eight weeks as they worked towards achieving the fluency criterion. Percentage accuracy in ECG interpretation was assessed at baseline and post-test for both groups. An ANCOVA was conducted to assess for differences in the performance of the intervention and control group at post-test while controlling for the baseline performance of participants. At post-test, the numbers of participants achieving fluency within the intervention group was examined. Results A large effect size of SAFMEDS (partial η 2  = .67) was identified when controlling for the effects of baseline performance. At post-test, the intervention group significantly outperformed ( M  = 61.5%; SD  = 12.1%) the control group ( M  = 31.6%; SD  = 12.5%, p  < .001). In total, 7 of 13 intervention group participants achieved fluency. Participants required an average of 51.9 one-minute trials ( SD  = 18.8) to achieve fluency. Conclusions SAFMEDS offers a useful adjunct to usual teaching within medical education. Further research could assess whether learning retains, is stable, and transfers to clinical practice.

Metformin is used worldwide in the treatment of type 2 diabetes and has been used in the treatment of diabetes in pregnancy since the 1970s. It is highly acceptable to patients due to its ease of administration, cost and adverse effect profile. It is effective in reducing macrosomia, large-for-gestational-age infants and reduces maternal weight gain. Despite its many advantages, metformin has been associated with reductions in foetal size and has been associated with an increase in infants born small-for-gestational-age in certain cohorts. In this article, we review its efficacy, adverse effects and long-term follow-up before, during and after pregnancy for both mother and infant. We also evaluate the other forms of treatment for gestational diabetes, including oral therapies, insulin therapy and emerging treatments.

What are the fundamental mechanisms of decision making, processing speed, memory, and cognitive control? How do these give rise to individual differences, and how do they change as people age? How are these mechanisms implemented in neural functions, in particular the functions of the frontal lobe? How do they relate to the demands of everyday, ‘real-life’ behaviour? For over almost five decades, Professor Patrick Rabbitt has been among the most distinguished of British cognitive psychologists. His work has been widely influential in theories of mental speed, cognitive control, and ageing, influencing research in experimental psychology, neuropsychology, and individual differences. This book, dedicated to Professor Rabbitt, brings together a group of sixteen contributors who are actively pursuing research in the fields of speed, memory, and control, and the application of these fields to individual differences and ageing. It includes the latest work from senior figures in the field, and focuses on fundamental topics in both teaching and research.