ORCID Profile
0000-0003-4007-0989
Current Organisations
University of Newcastle Australia
,
The University of Newcastle
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Publisher: JMIR Publications Inc.
Date: 07-03-2022
Abstract: edical student burnout is a prevalent problem with adverse long-term outcomes. Incorporating psychological resource-building interventions into comprehensive burnout prevention approaches during medical training is an identified priority among educators. These interventions could reduce burnout risk by buffering students against nonmodifiable career stressors. However, there is a need for rigorous investigation into optimal intervention targets and methods. Psychological flexibility (PF) is an adaptive behavioral skill set that has demonstrated relationships with medical student burnout and well-being. More broadly, there is evidence that PF mediates burnout and well-being outcomes and may be a protective factor. Efficacy studies assessing the benefits of interventions targeting PF among medical students are needed. Research also supports the need to establish optimal methods for increasing intervention efficacy in the context of in idual differences in burnout and PF by using in idualized approaches. his study aims to assess whether an app-delivered PF intervention (Acceptance and Commitment Training) reduces burnout and improves well-being among medical students. We will examine whether changes in burnout and well-being are mediated by changes in PF. The potential benefits of an in idualized version of the app versus those of a nonin idualized version will also be evaluated. n this 3-arm, parallel, randomized controlled study, a s le of medical students will be randomly allocated to 1 of 3 intervention arms (in idualized, nonin idualized, and waiting list) by using a 1:1:1 allocation ratio. Participants in the in idualized and nonin idualized intervention arms will have 8 weeks to access the app, which includes a PF concepts training session (stage 1) and access to short PF skill activities on demand (stage 2). Stage 2 will be either in idualized to meet participants’ identified PF training needs at each log-in or nonin idualized. urnout, well-being, and PF will be assessed at baseline and after the intervention. Quantitative analyses will include descriptive and inferential statistics. We hypothesize that the Acceptance and Commitment Training intervention app will be effective in improving burnout and well-being and that changes in these outcomes will be mediated by changes in PF. We further hypothesize that participants in the in idualized intervention group will demonstrate greater improvements in burnout and well-being outcomes than those in the nonin idualized group. he findings of this study could guide the development of burnout prevention and well-being initiatives for medical students. Identifying PF as a mediating process would provide support for the delivery of preventive intervention programs that train in iduals to strengthen this psychological resource before burnout symptoms emerge. This would be an important step in addressing and potentially offsetting the significant costs of burnout among medical students and physicians. Demonstrating the superiority of an in idualized version of the app over a nonin idualized version would have implications for enhancing intervention precision and efficacy by using scalable interventions. NZCTR 12621000911897
Publisher: Springer Science and Business Media LLC
Date: 06-2006
DOI: 10.3758/BF03193430
Abstract: Estes and Maddox (2002) suggested that the word frequency mirror effect in episodic recognition memory might be due to word likeness rather than to the frequency of experience with a word per se. We examined their suggestion using a factorial manipulation of frequency and neighborhood density, a measure used in lexical memory research to measure orthographic word likeness. For study with no specified task, main effects of density and frequency were in the mirror order, confirming the hypothesized mirror effect of word likeness but not its role in producing the frequency mirror effect. Lexical decision study increased the size of both mirror effects, even though the density manipulation had a negligible effect on lexical decision performance for words. Post hoc analyses showed that neither mirror effect could be explained by differences in lower order measures of word likeness (letter and bigram frequency). The joint orders of frequency and density results were mirrored across new and old conditions in accordance with attention likelihood theory (ALT), but density effects on z-ROC slope suggest that ALT may require extension to accommodate the effect of word likeness on response confidence.
Publisher: JMIR Publications Inc.
Date: 10-01-2023
DOI: 10.2196/43263
Abstract: Medical students are at higher risk of burnout than the general population. Interventions that facilitate adaptive coping behaviors (eg, Psychological Flexibility) in the context of inherent stressors associated with medical training could mitigate burnout risk and improve well-being. Delivering these interventions using smartphone apps offers advantages such as accessibility, scalability, mitigation of time and stigma barriers, and facilitation of in idual tailoring (in idualization). There is a need for feasibility trials with medical students in this emerging field. Formal evaluations of user experiences of app-based psychological skill training are required to identify barriers to and facilitators of engagement and optimize intervention development before implementation in efficacy trials and real-world settings. This study aimed to assess the feasibility of delivering an in idualized Psychological Flexibility skill training intervention (Acceptance and Commitment Training [ACTraining]) to medical students using an app-based delivery format. We further aimed to explore how formal evaluation of user experiences might inform and guide the development of this app before implementation in an efficacy trial and future research involving app-delivered psychological skill training for medical students. This single-arm study was an early-phase feasibility trial of a stand-alone ACTraining app conducted with a s le of Australian medical students (n=11). We collected app usability and user experience data across a broad range of domains (eg, perceived helpfulness and relevance, learning experiences, and self-efficacy) using self-report questionnaires (quantitative and qualitative) and behavioral engagement outcomes. Behavioral engagement data demonstrated that the app delivered the assessment procedures and in idualized ACTraining intervention to medical students as intended. The subjective feedback provided by students who actively engaged with the app was generally positive across several indicators, including usability, perceived relevance and helpfulness, accessibility, maintenance of privacy, and opportunity for self-reflection. Disengagement from the app was an identified challenge throughout the trial. Participant feedback identified several factors that may have affected engagement, such as time, expectations regarding app interface functioning, and in idual differences in confidence and self-efficacy when implementing skills. This study reports user experience data that have been largely absent from the literature on digital psychological interventions for medical students. Our findings demonstrate the preliminary feasibility of an app-delivered ACTraining intervention for medical student well-being and burnout and support the value of future assessment of the efficacy of this approach with larger s les. We consider subjective feedback from medical students in relation to observed engagement and propose how this information might be used to inform the development of this app and future research in this nascent field.
Publisher: Springer Science and Business Media LLC
Date: 31-01-2022
DOI: 10.1186/S12961-022-00817-2
Abstract: Greater use of knowledge translation (KT) strategies is recommended to improve the research impact of public health trials. The purpose of this study was to describe (1) the research impact of setting-based public health intervention trials on public health policy and practice (2) the association between characteristics of trials and their research impact on public health policy and practice and (3) the association between the use of KT strategies and research impacts on public health policy and practice. We conducted a survey of authors of intervention trials targeting nutrition, physical activity, sexual health, tobacco, alcohol or substance use. We assessed the use of KT strategies aligned to domains of the Knowledge-To-Action Framework. We defined “research impact” on health policy and practice as any one or more of the following: citation in policy documents or announcements, government reports, training materials, guidelines, textbooks or court rulings or endorsement by a (non)governmental organization use in policy or practice decision-making or use in the development of a commercial resource or service. Of the included trials, the authors reported that 65% had one or more research impacts. The most frequently reported research impact was citation in a policy document or announcement (46%). There were no significant associations between the effectiveness of the intervention, trial risk of bias, setting or health risk and trial impact. However, for every one unit increase in the total KT score (range 0–8), reflecting greater total KT activity, the odds of a health policy or practice research impact increased by approximately 30% (OR = 1.30, 95% CI: 1.02, 1.66 p = 0.031). Post hoc examination of KT domain scores suggests that KT actions focused on providing tailored support to facilitate program implementation and greater use of research products and tools to disseminate findings to end-users may be most influential in achieving impact. Trials of public health interventions frequently have public health impacts, and the use of more comprehensive KT strategies may facilitate greater research impact.
Publisher: JMIR Publications Inc.
Date: 18-08-2021
Abstract: edical student burnout is a prevalent problem with adverse long-term outcomes. Incorporating psychological resource-building interventions into comprehensive burnout prevention approaches during medical training is an identified priority among educators. These interventions could reduce burnout risk by buffering students against nonmodifiable career stressors. However, there is a need for rigorous investigation into optimal intervention targets and methods. Psychological flexibility (PF) is an adaptive behavioral skill set that has demonstrated relationships with medical student burnout and well-being. More broadly, there is evidence that PF mediates burnout and well-being outcomes and may be a protective factor. Efficacy studies assessing the benefits of interventions targeting PF among medical students are needed. Research also supports the need to establish optimal methods for increasing intervention efficacy in the context of in idual differences in burnout and PF by using in idualized approaches. his study aims to assess whether an app-delivered PF intervention (Acceptance and Commitment Training) reduces burnout and improves well-being among medical students. We will examine whether changes in burnout and well-being are mediated by changes in PF. The potential benefits of an in idualized version of the app versus those of a nonin idualized version will also be evaluated. n this 3-arm, parallel, randomized controlled study, a s le of medical students will be randomly allocated to 1 of 3 intervention arms (in idualized, nonin idualized, and waiting list) by using a 1:1:1 allocation ratio. Participants in the in idualized and nonin idualized intervention arms will have 5 weeks to access the app, which includes a PF concepts training session (stage 1) and access to short PF skill activities i on demand /i (stage 2). Stage 2 will be either in idualized to meet participants’ identified PF training needs at each log-in or nonin idualized. urnout, well-being, and PF will be assessed at baseline and after the intervention. Quantitative analyses will include descriptive and inferential statistics. We hypothesize that the Acceptance and Commitment Training intervention app will be effective in improving burnout and well-being and that changes in these outcomes will be mediated by changes in PF. We further hypothesize that participants in the in idualized intervention group will demonstrate greater improvements in burnout and well-being outcomes than those in the nonin idualized group. he findings of this study could guide the development of burnout prevention and well-being initiatives for medical students. Identifying PF as a mediating process would provide support for the delivery of preventive intervention programs that train in iduals to strengthen this psychological resource before burnout symptoms emerge. This would be an important step in addressing and potentially offsetting the significant costs of burnout among medical students and physicians. Demonstrating the superiority of an in idualized version of the app over a nonin idualized version would have implications for enhancing intervention precision and efficacy by using scalable interventions. ustralian New Zealand Clinical Trials Registry ANZCTR 12621000911897 www.anzctr.org.au/ACTRN12621000911897.aspx RR1-10.2196/32992
Publisher: JMIR Publications Inc.
Date: 16-03-2022
DOI: 10.2196/37798
Publisher: JMIR Publications Inc.
Date: 07-05-2023
Abstract: ollowing total knee arthroplasty (TKA), 10% to 20% of patients report dissatisfaction with procedural outcomes. There is growing recognition that postsurgical satisfaction is shaped not only by the quality of surgery but also by psychological and social factors. Surprisingly, information on the psychological and social determinants of surgical outcomes is rarely collected before surgery. A comprehensive collection of biopsychosocial information could assist clinicians in making recommendations in relation to rehabilitation, particularly if there is robust evidence to support the ability of presurgical constructs to predict postsurgical outcomes. Clinical decision support tools can help identify factors influencing patient outcomes and support the provision of interventions or services that can be tailored to meet in iduals’ needs. However, despite their potential clinical benefit, the application of such tools remains limited. his study aims to develop a clinical decision tool that will assist with patient stratification and more precisely targeted clinical decision-making regarding prehabilitation and rehabilitation for TKA, based on the identified in idual biopsychosocial needs. n this prospective observational study, all participants provided written or electronic consent before study commencement. Patient-completed questionnaires captured information related to a broad range of biopsychosocial parameters during the month preceding TKA. These included demographic factors (sex, age, and rurality), psychological factors (mood status, pain catastrophizing, resilience, and committed action), quality of life, social support, lifestyle factors, and knee symptoms. Physical measures assessing mobility, balance, and functional lower body strength were performed via video calls with patients in their home. Information related to preexisting health issues and concomitant medications was derived from hospital medical records. Patient recovery outcomes were assessed 3 months after the surgical procedure and included quality of life, patient-reported knee symptoms, satisfaction with the surgical procedure, and mood status. Machine learning data analysis techniques will be applied to determine which presurgery parameters have the strongest power for predicting patient recovery following total knee replacement. On the basis of these analyses, a predictive model will be developed. Predictive models will undergo internal validation, and Bayesian analysis will be applied to provide additional metrics regarding prediction accuracy. atient recruitment and data collection commenced in November 2019 and was completed in June 2022. A total of 1050 patients who underwent TKA were enrolled in this study. ur findings will facilitate the development of the first comprehensive biopsychosocial prediction tool, which has the potential to objectively predict a patient’s in idual recovery outcomes following TKA once selected by an orthopedic surgeon to undergo TKA. If successful, the tool could also inform the evolution rehabilitation services, such that factors in addition to physical performance can be addressed and have the potential to further enhance patient recovery and satisfaction. ERR1-10.2196/48801
Publisher: JMIR Publications Inc.
Date: 11-07-2022
DOI: 10.2196/40684
Publisher: Frontiers Media SA
Date: 29-05-2020
Publisher: JMIR Publications Inc.
Date: 04-02-2022
DOI: 10.2196/32992
Abstract: Medical student burnout is a prevalent problem with adverse long-term outcomes. Incorporating psychological resource-building interventions into comprehensive burnout prevention approaches during medical training is an identified priority among educators. These interventions could reduce burnout risk by buffering students against nonmodifiable career stressors. However, there is a need for rigorous investigation into optimal intervention targets and methods. Psychological flexibility (PF) is an adaptive behavioral skill set that has demonstrated relationships with medical student burnout and well-being. More broadly, there is evidence that PF mediates burnout and well-being outcomes and may be a protective factor. Efficacy studies assessing the benefits of interventions targeting PF among medical students are needed. Research also supports the need to establish optimal methods for increasing intervention efficacy in the context of in idual differences in burnout and PF by using in idualized approaches. This study aims to assess whether an app-delivered PF intervention (Acceptance and Commitment Training) reduces burnout and improves well-being among medical students. We will examine whether changes in burnout and well-being are mediated by changes in PF. The potential benefits of an in idualized version of the app versus those of a nonin idualized version will also be evaluated. In this 3-arm, parallel, randomized controlled study, a s le of medical students will be randomly allocated to 1 of 3 intervention arms (in idualized, nonin idualized, and waiting list) by using a 1:1:1 allocation ratio. Participants in the in idualized and nonin idualized intervention arms will have 5 weeks to access the app, which includes a PF concepts training session (stage 1) and access to short PF skill activities on demand (stage 2). Stage 2 will be either in idualized to meet participants’ identified PF training needs at each log-in or nonin idualized. Burnout, well-being, and PF will be assessed at baseline and after the intervention. Quantitative analyses will include descriptive and inferential statistics. We hypothesize that the Acceptance and Commitment Training intervention app will be effective in improving burnout and well-being and that changes in these outcomes will be mediated by changes in PF. We further hypothesize that participants in the in idualized intervention group will demonstrate greater improvements in burnout and well-being outcomes than those in the nonin idualized group. The findings of this study could guide the development of burnout prevention and well-being initiatives for medical students. Identifying PF as a mediating process would provide support for the delivery of preventive intervention programs that train in iduals to strengthen this psychological resource before burnout symptoms emerge. This would be an important step in addressing and potentially offsetting the significant costs of burnout among medical students and physicians. Demonstrating the superiority of an in idualized version of the app over a nonin idualized version would have implications for enhancing intervention precision and efficacy by using scalable interventions. Australian New Zealand Clinical Trials Registry ANZCTR 12621000911897 www.anzctr.org.au/ACTRN12621000911897.aspx PRR1-10.2196/32992
Publisher: JMIR Publications Inc.
Date: 30-06-2022
Abstract: his is a corrigendum for MS 32992.
Publisher: JMIR Publications Inc.
Date: 09-08-2023
DOI: 10.2196/48801
Abstract: Following total knee arthroplasty (TKA), 10% to 20% of patients report dissatisfaction with procedural outcomes. There is growing recognition that postsurgical satisfaction is shaped not only by the quality of surgery but also by psychological and social factors. Surprisingly, information on the psychological and social determinants of surgical outcomes is rarely collected before surgery. A comprehensive collection of biopsychosocial information could assist clinicians in making recommendations in relation to rehabilitation, particularly if there is robust evidence to support the ability of presurgical constructs to predict postsurgical outcomes. Clinical decision support tools can help identify factors influencing patient outcomes and support the provision of interventions or services that can be tailored to meet in iduals’ needs. However, despite their potential clinical benefit, the application of such tools remains limited. This study aims to develop a clinical decision tool that will assist with patient stratification and more precisely targeted clinical decision-making regarding prehabilitation and rehabilitation for TKA, based on the identified in idual biopsychosocial needs. In this prospective observational study, all participants provided written or electronic consent before study commencement. Patient-completed questionnaires captured information related to a broad range of biopsychosocial parameters during the month preceding TKA. These included demographic factors (sex, age, and rurality), psychological factors (mood status, pain catastrophizing, resilience, and committed action), quality of life, social support, lifestyle factors, and knee symptoms. Physical measures assessing mobility, balance, and functional lower body strength were performed via video calls with patients in their home. Information related to preexisting health issues and concomitant medications was derived from hospital medical records. Patient recovery outcomes were assessed 3 months after the surgical procedure and included quality of life, patient-reported knee symptoms, satisfaction with the surgical procedure, and mood status. Machine learning data analysis techniques will be applied to determine which presurgery parameters have the strongest power for predicting patient recovery following total knee replacement. On the basis of these analyses, a predictive model will be developed. Predictive models will undergo internal validation, and Bayesian analysis will be applied to provide additional metrics regarding prediction accuracy. Patient recruitment and data collection commenced in November 2019 and was completed in June 2022. A total of 1050 patients who underwent TKA were enrolled in this study. Our findings will facilitate the development of the first comprehensive biopsychosocial prediction tool, which has the potential to objectively predict a patient’s in idual recovery outcomes following TKA once selected by an orthopedic surgeon to undergo TKA. If successful, the tool could also inform the evolution rehabilitation services, such that factors in addition to physical performance can be addressed and have the potential to further enhance patient recovery and satisfaction. DERR1-10.2196/48801
Publisher: Public Library of Science (PLoS)
Date: 18-08-2021
DOI: 10.1371/JOURNAL.PONE.0255704
Abstract: Governments commonly fund research with specific applications in mind. Such mechanisms may facilitate ‘research translation’ but funders may employ strategies that can also undermine the integrity of both science and government. We estimated the prevalence and investigated correlates of funder efforts to suppress health behaviour intervention trial findings. Our s ling frame was lead or corresponding authors of papers (published 2007–2017) included in a Cochrane review, reporting findings from trials of interventions to improve nutrition, physical activity, sexual health, smoking, and substance use. Suppression events were based on a previous survey of public health academics. Participants answered questions concerning seven suppression events in their efforts to report the trial, e.g., [I was…] “asked to suppress certain findings as they were viewed as being unfavourable.” We also examined the association between information on study funder, geographical location, targeted health behaviour, country democracy rating and age of publication with reported suppression. We received responses from 104 authors (50%) of 208 eligible trials, from North America (34%), Europe (33%), Oceania (17%), and other countries (16%). Eighteen percent reported at least one of the seven suppression events relating to the trial in question. The most commonly reported suppression event was funder(s) expressing reluctance to publish because they considered the results ‘unfavourable’ (9% reported). We found no strong associations with the subject of research, funding source, democracy, region, or year of publication. One in five researchers in this global s le reported being pressured to delay, alter, or not publish the findings of health behaviour intervention trials. Regulation of funder and university practices, establishing study registries, and compulsory disclosure of funding conditions in scientific journals, are needed to protect the integrity of public-good research.
Publisher: JMIR Publications Inc.
Date: 06-02-2023
DOI: 10.2196/42566
Abstract: Physician burnout is a common problem, with onset frequently occurring during undergraduate education. Early intervention strategies that train medical students in psychological flexibility skills could support well-being and mitigate burnout risks associated with unmodifiable career stressors. There is a need for randomized controlled trials to assess effectiveness. As psychological flexibility varies contextually and among in iduals, tailoring interventions may improve outcomes. Smartphone apps can facilitate in idualization and accessibility, and the evaluation of this approach is an identified research priority. This study aimed to evaluate the effectiveness of a stand-alone app–delivered Acceptance and Commitment Training intervention for improving medical students’ self-reported burnout, well-being, psychological flexibility, and psychological distress outcomes. We aimed to explore whether an in idualized app would demonstrate benefits over a nonin idualized version. This parallel randomized controlled trial was conducted with a s le of medical students from 2 Australian universities (N=143). Participants were randomly allocated to 1 of 3 intervention arms (in idualized, nonin idualized, and waitlist) using a 1:1:1 allocation ratio. In idualized and nonin idualized participants were blinded to group allocation. The 5-week intervention included an introductory module (stage 1) and on-demand access to short skill training activities (stage 2), which students accessed at their own pace. Stage 2 was either nonin idualized or in idualized to meet students’ identified psychological flexibility training needs. The mean differences in change from baseline between the intervention groups and the waitlist group were not statistically significant for burnout outcomes: exhaustion (primary in idualized: −0.52, 95% CI −3.70 to 2.65, P=.75 nonin idualized: 1.60, 95% CI −1.84 to 5.03, P=.37), cynicism (in idualized: −1.26, 95% CI −4.46 to 1.94, P=.44 nonin idualized: 1.00, 95% CI −2.45 to 4.46, P=.57), and academic efficacy (in idualized: 0.94, 95% CI −0.90 to 2.79, P=.32 nonin idualized: 2.02, 95% CI 0.02-4.03, P=.05). Following the intervention, the in idualized group demonstrated improved psychological flexibility (0.50, 95% CI 0.12-0.89 P=.01), reduced inflexibility (0.48, 95% CI −0.92 to −0.04 P=.04), and reduced stress (−6.89, 95% CI −12.01 to 5.99 P=.01), and the nonin idualized group demonstrated improved well-being (6.46, 95% CI 0.49-12.42 P=.04) and stress (−6.36, 95% CI −11.90 to −0.83 P=.03) compared with waitlist participants. Between-group differences for the in idualized and nonin idualized arms were not statistically significant. High attrition (75/143, 52.4%) was observed. This trial provides early support for the potential benefits of Acceptance and Commitment Training for medical student well-being and psychological outcomes and demonstrates that psychological flexibility and inflexibility can be trained using a smartphone app. Although postintervention burnout outcomes were not statistically significant, improvements in secondary outcomes could indicate early risk mitigation. Replication studies with larger s les and longer-term follow-up are required, and future research should focus on improving implementation frameworks to increase engagement and optimize in idualization methods. Australian New Zealand Clinical Trials Registry 12621000911897 p92cwrw RR2-10.2196/32992
No related grants have been discovered for Elizabeth Ditton.