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Witt EE, Jogerst K, Wojcik BM, Mansur A, Mullen JT, Petrusa ER, Phitayakorn R, McKinley SK. Patient satisfaction with women vs men surgical interns and senior residents. Am J Surg 2024; 235:115813. [PMID: 38991253 DOI: 10.1016/j.amjsurg.2024.115813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Patient satisfaction is critical for referrals and reimbursement of surgical faculty but remains poorly characterized for residents. We investigated whether patient evaluations of surgical trainees vary by resident gender. METHODS Surgical inpatients evaluated surgical resident care postoperatively after positively identifying trainees. Evaluations (Consumer Assessment of Healthcare Providers and Systems Surgical Care Surveys (S-CAHPS)) were scored by the "top-box" method, stratified by training level, and compared between women and men residents. RESULTS Ninety-one percent of patients participated (n = 324/357). Patients recognized women interns less than men (75.0 % vs 87.2 %, p = 0.01). S-CAHPS scores for women vs men interns were equivalent except for spending sufficient time with patients (75.6 % vs 88.0 %, p = 0.02). For senior residents, there was no difference in patient recognition of women vs men (83.9 % vs 85.2 %, p = 0.91) or in any S-CAHPS scores (p > 0.05). CONCLUSIONS Gendered differences in patient evaluations of surgical trainees exist for interns but resolve by senior years. Future work should explore how patient evaluations can support trainee development while ensuring patients recognize the role of surgical residents regardless of gender.
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Affiliation(s)
- Emily E Witt
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Kristen Jogerst
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Brandon M Wojcik
- Division of Cardiothoracic Surgery, Department of Surgery, Munson Medical Center, 1105 Sixth St, Traverse City, MI, 49684, USA
| | - Arian Mansur
- Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
| | - John T Mullen
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
| | - Emil R Petrusa
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
| | - Roy Phitayakorn
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
| | - Sophia K McKinley
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
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Jones JH, Fleming N. Quality Improvement Projects and Anesthesiology Graduate Medical Education: A Systematic Review. Cureus 2024; 16:e57908. [PMID: 38725749 PMCID: PMC11079850 DOI: 10.7759/cureus.57908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Quality improvement (QI) projects are essential components of graduate medical education and healthcare organizations to improve patient outcomes. We systematically reviewed the literature on QI projects in anesthesiology graduate medical education programs to assess whether these projects are leading to publications. A literature search was conducted in July 2023, using PubMed, Embase, and the Central Register of Controlled Trials (CENTRAL) for articles describing QI initiatives originating within the United States and applicable to anesthesiology residency training programs. The following data were collected: intervention(s), sample size (number of participants or events), outcome metric(s), result(s), and conclusion(s). One hundred and fifty publications were identified, and 31 articles met the inclusion criteria. A total of 2,259 residents and 72,889 events were included in this review. Educational modalities, such as simulation, training sessions, or online curricula, were the most prevalent interventions in the included studies. Pre-intervention and post-intervention assessments were the most common outcome metrics reported. Our review of the literature demonstrates that few QI projects performed within anesthesiology training programs lead to published manuscripts. Further research should aim at increasing the impact of required QI projects within the sponsoring institution and specialty.
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Affiliation(s)
- James H Jones
- Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Neal Fleming
- Anesthesia, UC Davis Medical Center, Sacramento, USA
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Tischendorf JS, Krecko LK, Filipiak R, Osman F, Zelenski AB. Gender influences resident physicians' perception of an employee-to-employee recognition program: a mixed methods study. BMC MEDICAL EDUCATION 2024; 24:109. [PMID: 38302913 PMCID: PMC10835820 DOI: 10.1186/s12909-024-05083-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Burnout is prevalent in medical training. While some institutions have implemented employee-to-employee recognition programs to promote wellness, it is not known how such programs are perceived by resident physicians, or if the experience differs among residents of different genders. METHODS We used convergent mixed methods to characterize how residents in internal medicine (IM), pediatrics, and general surgery programs experience our employee-to-employee recognition ("Hi-5″) program. We collected Hi-5s received by residents in these programs from January 1, 2021-December 31, 2021 and coded them for recipient discipline, sex, and PGY level and sender discipline and professional role. We conducted virtual focus groups with residents in each training program. MAIN MEASURES AND APPROACH We compared Hi-5 receipt between male and female residents; overall and from individual professions. We submitted focus group transcripts to content analysis with codes generated iteratively and emergent themes identified through consensus coding. RESULTS Over a 12-month period, residents received 382 Hi-5s. There was no significant difference in receipt of Hi-5s by male and female residents. Five IM, 3 surgery, and 12 pediatric residents participated in focus groups. Residents felt Hi-5s were useful for interprofessional feedback and to mitigate burnout. Residents who identified as women shared concerns about differing expectations of professional behavior and communication based on gender, a fear of backlash when behavior does not align with gender stereotypes, and professional misidentification. CONCLUSIONS The "Hi-5" program is valuable for interprofessional feedback and promotion of well-being but is experienced differently by men and women residents. This limitation of employee-to-employee recognition should be considered when designing equitable programming to promote well-being and recognition.
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Affiliation(s)
- Jessica S Tischendorf
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Medical Foundation Centennial Building Room 5263, 1685 Highland Avenue, Madison, WI, 53705, USA.
| | - Laura K Krecko
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Rachel Filipiak
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Medical Foundation Centennial Building Room 5263, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Fauzia Osman
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Amy B Zelenski
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705, USA
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Sawatsky AP, Matchett CL, Hafferty FW, Cristancho S, Ilgen JS, Bynum WE, Varpio L. Professional identity struggle and ideology: A qualitative study of residents' experiences. MEDICAL EDUCATION 2023; 57:1092-1101. [PMID: 37269251 PMCID: PMC10592531 DOI: 10.1111/medu.15142] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/26/2023] [Accepted: 05/15/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION To enter a profession is to take on a new identity. Professional identity formation can be difficult, with medical learners struggling to adopt professional norms. The role of ideology in medical socialisation may offer insight into these tensions experienced by medical learners. Ideology is the system of ideas and representations that dominates the minds of individuals or social groups and calls individuals into certain ways of being and acting in the world. In this study, we use the concept of ideology to explore residents' experiences with identity struggle during residency. METHODS We conducted a qualitative exploration of residents in three specialties at three academic institutions in the United States. Participants engaged in a 1.5-hour session involving a rich picture drawing and one-on-one interview. Interview transcripts were coded and analysed iteratively, with developing themes compared concurrently to newly collected data. We met regularly to develop a theoretical framework to explain findings. RESULTS We identified three ways that ideology contributed to residents' identity struggle. First was the intensity of work and perceived expectations of perfectionism. Second were tensions between the developing professional identity and pre-existing personal identities. Many residents perceived messages regarding the subjugation of personal identities, including the feeling that being more than physicians was impossible. Third were instances where the imagined professional identity clashed with the reality of medical practice. Many residents described how their ideals misaligned with normative professional ideals, constraining their ability to align their practice and ideals. CONCLUSION This study uncovers an ideology that shapes residents' developing professional identity-an ideology that creates struggle as it calls them in impossible, competing or even contradictory ways. As we uncover the hidden ideology of medicine, learners, educators and institutions can play a meaningful role in supporting identity development in medical learners through dismantling and rebuilding its damaging elements.
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Affiliation(s)
- Adam P Sawatsky
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Frederic W Hafferty
- Program in Professionalism and Values, Mayo Clinic, Rochester, Minnesota, USA
| | - Sayra Cristancho
- Department of Surgery and Faculty of Education and scientist, Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jonathan S Ilgen
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - William E Bynum
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lara Varpio
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Wong BJ, Nassar AK, Earley M, Chen L, Roman-Micek T, Wald SH, Shanafelt TD, Goldhaber-Fiebert SN. Perceptions of Use of Names, Recognition of Roles, and Teamwork After Labeling Surgical Caps. JAMA Netw Open 2023; 6:e2341182. [PMID: 37976068 PMCID: PMC10656635 DOI: 10.1001/jamanetworkopen.2023.41182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/22/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Communication failures in perioperative areas are common and have negative outcomes for both patients and clinicians. Names and roles of teammates are difficult to remember or discern contributing to suboptimal communication, yet the utility of labeled surgical caps with names and roles for enhancing perceived teamwork and connection is not well studied. Objective To evaluate the use of labeled surgical caps in name use and role recognition, as well as teamwork and connection, among interprofessional perioperative teammates. Design, Setting, and Participants In this quality improvement study, caps labeled with names and roles were distributed to 967 interprofessional perioperative clinicians, along with preimplementation and 6-month postimplementation surveys. Conducted between July 8, 2021, and June 25, 2022, at a single large, academic, quaternary health care center in the US, the study comprised surgeons, anesthesiologists, trainees, and all interprofessional hospital staff who work in adult general surgery perioperative areas. Intervention Labeled surgical caps were offered cost-free, although not mandatory, to each interested clinician. Main Outcome and Measure Quantitative survey of self-reported frequency for name use and role recognition as well as postimplementation sense of teamwork and connection. The surveys also elicited free response comments. Results Of the 1483 eligible perioperative clinicians, 967 (65%; 387 physicians and 580 nonphysician staff; 58% female) completed preimplementation surveys and received labeled caps, and 243 of these individuals (51% of physicians and 8% of staff) completed postimplementation surveys. Pre-post results were limited to physicians, due to the low postsurvey staff response rate. The odds of participants reporting that they were often called by their name increased after receiving a labeled cap (adjusted odds ratio [AOR], 13.37; 95% CI, 8.18-21.86). On postsurveys, participants reported that caps with names and roles substantially improved teamwork (80%) and connection (79%) with teammates. Participants who reported an increased frequency of being called by their name had higher odds for reporting improved teamwork (AOR, 3.46; 95% CI, 1.91-6.26) and connection with teammates (AOR, 3.21; 95% CI, 1.76-5.84). Free response comments supported the quantitative data that labeled caps facilitated knowing teammates' names and roles and fostered a climate of wellness, teamwork, inclusion, and patient safety. Conclusions and Relevance The findings of this quality improvement study performed with interprofessional teammates suggest that organizationally sponsored labeled surgical caps was associated with improved teamwork, indicated by increased name use and role recognition in perioperative areas.
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Affiliation(s)
- Becky J. Wong
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Aussama K. Nassar
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Michelle Earley
- Department of Surgery, Division of General Surgery, Stanford School of Medicine, Stanford, California
| | - Ling Chen
- Interventional Platform Education, Stanford, California
| | | | - Samuel H. Wald
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Tait D. Shanafelt
- Division of Hematology, Department of Medicine, Stanford School of Medicine, Stanford, California
| | - Sara N. Goldhaber-Fiebert
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Harvey JA, Butterfield RJ, Ochoa SA, Yang YW. Patient Use of Physicians' First (Given) Name in Direct Patient Electronic Messaging. JAMA Netw Open 2022; 5:e2234880. [PMID: 36197668 PMCID: PMC9535496 DOI: 10.1001/jamanetworkopen.2022.34880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cohort study examines factors that may contribute to whether patients address physicians differently through electronic messaging
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Affiliation(s)
| | | | - Shari A. Ochoa
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Yul W. Yang
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
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7
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Brenner AM. Staying Focused on Diversity, Equity, and Inclusion: a Marathon, Not a Sprint. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:591-592. [PMID: 36123517 DOI: 10.1007/s40596-022-01706-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Adam M Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Foote MB, Jain N, Rome BN, DeFilippis EM, Powe CE, Yialamas MA. Association of Perceived Role Misidentification With Use of Role Identity Badges Among Resident Physicians. JAMA Netw Open 2022; 5:e2224236. [PMID: 35900759 PMCID: PMC9335144 DOI: 10.1001/jamanetworkopen.2022.24236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Role misidentification of resident physicians occurs frequently and is associated with decreased well-being. OBJECTIVE To evaluate the role misidentification and burnout rates among resident physicians after disbursement of role identity badges. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study was conducted during the 2018 to 2019 academic year. Residents in 13 surgical and nonsurgical residency programs at 2 large academic medical centers (Massachusetts General Hospital and Brigham and Women's Hospital) were eligible to receive the intervention and complete 2 surveys (before and after the intervention). Data were analyzed from December 4, 2021, to February 7, 2022. INTERVENTION Role identity badges that displayed "Doctor" and could be attached to mandatory hospital identification badges were distributed to residents in August 2018 at Massachusetts General Hospital and in March 2019 at Brigham and Women's Hospital. Residents were not required to wear the badge. MAIN OUTCOMES AND MEASURES The primary outcome was self-reported role misidentification at least once per week during the previous 3 months. The change from pre- to post-badge distribution surveys was assessed with McNemar's test. A secondary outcome was any reduction in the frequency of role misidentification after badge distribution. Multivariable logistic regression was used to assess the association between reduced frequency of role misidentification and demographic characteristics. A separate analysis evaluated the change in self-reported burnout after badge distribution. RESULTS A total of 161 residents (39%) completed both surveys, which included 79 men (49%), 72 (45%) who were younger than 30 years, 20 (12%) with an underrepresented in medicine status, and 74 (46%) who were in surgical specialties. The proportion of residents reporting at least weekly role misidentification decreased from 50% (n = 81 of 161) before badge distribution to 35% (n = 57 of 161; P < .001) after badge distribution. Female residents were more likely to report reduced role misidentification frequency after receiving a badge compared with male residents (adjusted odds ratio, 2.32; 95% CI, 1.18-4.63; P = .01). Residents who wore badges demonstrated no change in burnout before vs after badge distribution (39% [n = 33 of 85] vs 34% [29 of 85]; P = .87) compared with an increase among residents who did not wear a badge (27% [n = 15 of 55] vs 45% [n = 25 of 55]; P = .03). CONCLUSIONS AND RELEVANCE This study found that the distribution of role identity badges was associated with less frequent perception of role misidentification among resident physicians across specialties, particularly among female residents. Role identity badges were a well-received, low-cost intervention that could be used to reduce role misidentification and address burnout among residents.
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Affiliation(s)
- Michael B. Foote
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nina Jain
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Benjamin N. Rome
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Camille E. Powe
- Diabetes Unit, Division of Endocrinology, Massachusetts General Hospital, Boston
| | - Maria A. Yialamas
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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9
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West CP, Files JA, Friedrich P, Rihal CS. Language, Respect, and the Medical Profession. Mayo Clin Proc 2022; 97:642-644. [PMID: 35379415 DOI: 10.1016/j.mayocp.2022.02.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Colin P West
- Division of General Internal Medicine, Department of Medicine, Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.
| | - Julia A Files
- Division of Women's Health, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Patricia Friedrich
- School of Social and Behavioral Sciences, Arizona State University, Phoenix, AZ
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