1
|
Graham ME, Aleksa E, Dzioba A, Madou E, Chen T, Strychowsky JE, Hu A, Chan Y, Seemann NM. Gender Differences in Domestic Responsibilities of Otolaryngologists-A Mixed-Methods Analysis. Laryngoscope 2024. [PMID: 38934344 DOI: 10.1002/lary.31605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/25/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES Female otolaryngologist-head and neck surgeons (OHNS) confront unique barriers. This study examines the influence of home life, especially gendered division of household labor, on leadership, productivity, and burnout. METHODS A survey was distributed through social media and national society list-serv. Demographics, responsibility for household roles, and Maslach Burnout Inventory for Medical Personnel were included. Participants were invited to participate in semi-structured interviews, employing purposive sampling, with qualitative thematic analysis. RESULTS Response rate was 26.4% (145 of 550 of eligible participants; 38.7% women, 60.7% men). Significantly fewer women were married (64.3% vs. 92% of men, p < 0.001), and significantly more were childless (21.4% of women vs. 9.1% of men, p = 0.037). More men reported exclusive/major responsibility for five duties, including yard work and home maintenance (all p < 0.03). More women reported exclusive/major responsibility for 15 duties, including meal planning and coordinating childcare (all p < 0.03). Women had higher Emotional Exhaustion on univariate analysis (p = 0.015). Across 27 interviews, two main themes were identified, each with three associated subthemes: Theme one, "division of duties," with subthemes (1) the way household duties were divided, (2) traditional gender norms, and 3. changing duties over time/unexpected circumstances. Theme two, "impact of domestic duties," with subthemes (1) professional, (2) financial, and (3) burnout/life satisfaction. CONCLUSIONS Women OHNS disproportionately manage domestic responsibilities, possibly altering career trajectory for some OHNS. Burnout, especially emotional exhaustion, may be elevated due to inequitable labor. Future research should focus on identifying ways to improve equity for this group. LEVEL OF EVIDENCE N/A Laryngoscope, 2024.
Collapse
Affiliation(s)
- M Elise Graham
- Victoria Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Emily Aleksa
- Victoria Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Agnieszka Dzioba
- Victoria Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Edward Madou
- Victoria Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Tanya Chen
- Victoria Hospital at London Health Sciences Centre, London, Ontario, Canada
| | | | - Amanda Hu
- Victoria Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Yvonne Chan
- Victoria Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Natashia M Seemann
- Victoria Hospital at London Health Sciences Centre, London, Ontario, Canada
| |
Collapse
|
2
|
Gouchoe DA, Ganapathi AM, Cui EY, Henn MC, Yim WY, Geng B, Whitson BA, Zhu H. Is Time Scheduling Important? An Analysis of Donor Heart Cross-clamp Times During Heart Transplantation. Transplant Direct 2024; 10:e1588. [PMID: 38529355 PMCID: PMC10962895 DOI: 10.1097/txd.0000000000001588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 03/27/2024] Open
Abstract
Background Outcomes in heart transplantation are affected by a variety of variables and patient factors. However, the impact of circadian rhythms, gene expression, and transcription remain underexplored. We thus evaluated the potential role of donor heart cross-clamp times on short-term and long-term outcomes after heart transplantation. Methods A total of 31 713 heart transplants were identified from the United Network for Organ Sharing Database. Patients were first stratified on the basis of time of donor procurement: 12 am to 12 pm or 12 pm to 12 am. To evaluate a possible effect of circadian rhythms, donor time was further divided into 5 groups based on preclinical data: 4 am to 8 am; 8 am to 11 am; 11 am to 5 pm; 5 pm to 10 pm; 10 pm to 4 am. Groups were assessed with comparative statistics. Long-term survival was evaluated using Kaplan-Meier methods and a multivariate Cox proportional hazard model. Results Patients who received hearts recovered between 12 am and 12 pm had significantly higher survival than those who received hearts recovered between 12 pm and 12 am. This survival difference was observed in both unadjusted (P = 0.002) and adjusted analyses (hazard ratio [HR]: 0.93; 95% confidence interval [CI], 0.89-0.97; P < 0.001). On unadjusted analysis, the survival difference among the 5 groups was insignificant (P = 0.07). Following adjustment, the periods of 11 am to 5 pm (HR: 1.09, 95% CI, 1.02-1.17; P = 0.012), 5 pm to 10 pm (HR: 1.11; 95% CI, 1.04-1.19; P = 0.002), and 10 pm to 4 am (HR: 1.07; 95% CI, 1.01-1.15; P = 0.034), were all independently associated with increased long-term mortality. Notably, the time of 8 am to 11 am was not associated with a change in survival (HR: 1.04; 95% CI, 0.96-1.14; P = 0.3). Conclusions Given the independent association of donor timing and survival after adjustment in a large national cohort, further investigation into the role of donor circadian rhythm and donor procurement time is warranted in preclinical and clinical studies. Understanding the underlying mechanisms of this observation could potentially lead to the development of effective treatments and donor procurement processes that prepare the organs for transplantation in a better condition.
Collapse
Affiliation(s)
- Doug A. Gouchoe
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Asvin M. Ganapathi
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ervin Y. Cui
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Matthew C. Henn
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Wai Yen Yim
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bingchuan Geng
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bryan A. Whitson
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, College of Medicine, Columbus, OH
| | - Hua Zhu
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, College of Medicine, Columbus, OH
| |
Collapse
|
3
|
Tai-Seale M, Baxter S, Millen M, Cheung M, Zisook S, Çelebi J, Polston G, Sun B, Gross E, Helsten T, Rosen R, Clay B, Sinsky C, Ziedonis DM, Longhurst CA, Savides TJ. Association of physician burnout with perceived EHR work stress and potentially actionable factors. J Am Med Inform Assoc 2023; 30:1665-1672. [PMID: 37475168 PMCID: PMC10531111 DOI: 10.1093/jamia/ocad136] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/27/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE Physicians of all specialties experienced unprecedented stressors during the COVID-19 pandemic, exacerbating preexisting burnout. We examine burnout's association with perceived and actionable electronic health record (EHR) workload factors and personal, professional, and organizational characteristics with the goal of identifying levers that can be targeted to address burnout. MATERIALS AND METHODS Survey of physicians of all specialties in an academic health center, using a standard measure of burnout, self-reported EHR work stress, and EHR-based work assessed by the number of messages regarding prescription reauthorization and use of a staff pool to triage messages. Descriptive and multivariable regression analyses examined the relationship among burnout, perceived EHR work stress, and actionable EHR work factors. RESULTS Of 1038 eligible physicians, 627 responded (60% response rate), 49.8% reported burnout symptoms. Logistic regression analysis suggests that higher odds of burnout are associated with physicians feeling higher level of EHR stress (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.07-1.25), having more prescription reauthorization messages (OR, 1.23; 95% CI, 1.04-1.47), not feeling valued (OR, 3.38; 95% CI, 1.69-7.22) or aligned in values with clinic leaders (OR, 2.81; 95% CI, 1.87-4.27), in medical practice for ≤15 years (OR, 2.57; 95% CI, 1.63-4.12), and sleeping for <6 h/night (OR, 1.73; 95% CI, 1.12-2.67). DISCUSSION Perceived EHR stress and prescription reauthorization messages are significantly associated with burnout, as are non-EHR factors such as not feeling valued or aligned in values with clinic leaders. Younger physicians need more support. CONCLUSION A multipronged approach targeting actionable levers and supporting young physicians is needed to implement sustainable improvements in physician well-being.
Collapse
Affiliation(s)
- Ming Tai-Seale
- Family Medicine, UC San Diego School of Medicine, La Jolla, California, USA
- Outcomes Analysis and Scholarship, Information Services, UC San Diego Health, La Jolla, California, USA
- Research and Learning, Population Health Services Organization, UC San Diego Health, La Jolla, California, USA
- Medicine, UC San Diego School of Medicine, La Jolla, California, USA
- UC San Diego Health, La Jolla, California, USA
| | - Sally Baxter
- Medicine, UC San Diego School of Medicine, La Jolla, California, USA
- UC San Diego Health, La Jolla, California, USA
- Ophthalmology, UC San Diego School of Medicine, La Jolla, California, USA
| | - Marlene Millen
- Medicine, UC San Diego School of Medicine, La Jolla, California, USA
- UC San Diego Health, La Jolla, California, USA
| | - Michael Cheung
- Family Medicine, UC San Diego School of Medicine, La Jolla, California, USA
| | - Sidney Zisook
- UC San Diego Health, La Jolla, California, USA
- Psychiatry, UC San Diego School of Medicine, La Jolla, California, USA
| | - Julie Çelebi
- Family Medicine, UC San Diego School of Medicine, La Jolla, California, USA
- UC San Diego Health, La Jolla, California, USA
| | - Gregory Polston
- UC San Diego Health, La Jolla, California, USA
- Anesthesiology, UC San Diego School of Medicine, La Jolla, California, USA
| | - Bryan Sun
- UC San Diego Health, La Jolla, California, USA
- Dermatology, UC San Diego School of Medicine, La Jolla, California, USA
| | - Erin Gross
- UC San Diego Health, La Jolla, California, USA
- Obstetrics and Gynecology, UC San Diego School of Medicine, La Jolla, California, USA
| | - Teresa Helsten
- Medicine, UC San Diego School of Medicine, La Jolla, California, USA
- UC San Diego Health, La Jolla, California, USA
| | - Rebecca Rosen
- Family Medicine, UC San Diego School of Medicine, La Jolla, California, USA
- UC San Diego Health, La Jolla, California, USA
| | - Brian Clay
- Medicine, UC San Diego School of Medicine, La Jolla, California, USA
- UC San Diego Health, La Jolla, California, USA
| | - Christine Sinsky
- Professional Satisfaction, American Medical Association, Chicago, Illinois, USA
| | - Douglas M Ziedonis
- Psychiatry, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
- University of New Mexico Health Sciences and Health System, Albuquerque, New Mexico, USA
| | - Christopher A Longhurst
- Medicine, UC San Diego School of Medicine, La Jolla, California, USA
- UC San Diego Health, La Jolla, California, USA
| | - Thomas J Savides
- Medicine, UC San Diego School of Medicine, La Jolla, California, USA
- UC San Diego Health, La Jolla, California, USA
| |
Collapse
|
4
|
Ninnoni JPK, Owoo B. Psychosocial experiences of caring by family caregivers of patients living with prostate cancer in a teaching hospital: A descriptive phenomenological study. Nurs Open 2023; 10:6268-6281. [PMID: 37269049 PMCID: PMC10416052 DOI: 10.1002/nop2.1869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 06/04/2023] Open
Abstract
AIM This study explored the psychosocial experience of caregiving on the family caregiver of patients with prostate cancer in the Cape Coast metropolis of Ghana. DESIGN A descriptive phenomenological study was conducted through in-depth face-to-face semi-structured interviews. Twelve family caregivers of prostate cancer patients were selected through purposive sampling. Interviews were conducted until data saturation. All interviews were taped, transcribed verbatim and analysed thematically. RESULTS The family caregiver's psychosocial experience associated with caregiving uncovered two significant themes with 13 sub-themes. 'Psychological impact' emerged as the first central theme, with anxiety, care as an obligation and feelings of inadequacy, hopelessness, uncertainty, denial and concealment as the sub-themes. The second central theme was 'Social impact' with sexual concerns, role adjustment, loss of livelihood, turmoil and reduced leisure activities emerging as sub-themes. CONCLUSION The findings demonstrated that caring significantly impacts the psychological and social well-being of the caregivers of prostate cancer patients. Therefore, there is a need for holistic assessment to include the psychosocial well-being of family caregivers to improve quality of life. Therefore, psychiatric nurses support family caregivers through education and psychosocial interventions to improve their quality of life and enable them to care for their loved ones more effectively.
Collapse
Affiliation(s)
- Jerry Paul K Ninnoni
- School of Nursing and Midwifery, Department of Mental Health, University of Cape Coast, Cape Coast, Ghana
| | - Benedicta Owoo
- School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| |
Collapse
|
5
|
Cansel N, Varol Fİ. Burnout, mental health symptoms, and empathy in healthcare workers who care for children treated in a liver transplant center. Pediatr Transplant 2023; 27:e14430. [PMID: 36380566 DOI: 10.1111/petr.14430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The healthcare workers in pediatric liver transplantation units are exposed to various stresses; however, their burnout has not been clarified yet. This study aimed to determine burnout, psychological symptoms and empathy levels in healthcare workers, to examine the relationship between these variables and to investigate the predictors of burnout. METHOD This cross-sectional study was conducted on healthcare workers in Turgut Özal Medical Center Pediatric Liver Transplant Institute. The participants filled out a questionnaire that investigating demographic and occupational characteristics, and including questions from Toronto Empathy Questionnaire, Maslach Burnout Inventory, and Brief Symptom Inventory. RESULTS Fifty healthcare workers participated in the study. Based on moderate and higher severity scores, 48% of the participants were emotionally exhausted, 22% of them were depersonalized. All of them had a high perception of personal accomplishment. There was a correlation between psychological symptoms level and emotional exhaustion and personal accomplishment as well as empathy and personal accomplishment. Not choosing the profession and the department willingly, age, education level, marital status, duration of profession, unit, not receiving in-service training, empathy, depressive symptoms and hostility scores predicted different aspects of burnout. CONCLUSION Considering that burnout and psychological stress lead to reduced professional abilities and the development of serious complications, the results obtained can guide managers on the measures to be taken.
Collapse
Affiliation(s)
- Neslihan Cansel
- Department of Psychiatry, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Fatma İlknur Varol
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Inonu University Faculty of Medicine, Malatya, Turkey
| |
Collapse
|
6
|
Trockel J, Bohman B, Wang H, Cooper W, Welle D, Shanafelt TD. Assessment of the Relationship Between an Adverse Impact of Work on Physicians' Personal Relationships and Unsolicited Patient Complaints. Mayo Clin Proc 2022; 97:1680-1691. [PMID: 36058580 DOI: 10.1016/j.mayocp.2022.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/12/2022] [Accepted: 03/04/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the relationship between an adverse impact of work on physicians' personal relationships and unsolicited patient complaints about physician behavior - a well-established indicator of patient care quality. PARTICIPANTS AND METHODS We paired data from a physician wellness survey collected in April and May 2013 with longitudinal unsolicited patient complaint data collected independently from January 1, 2013, to December 31, 2016. Unsolicited patient complaints were used to calculate the Patient Advocacy Reporting System (PARS) score, an established predictor of clinical outcomes and malpractice suits. The primary outcome was PARS score tercile. Ordinal logistic regression mixed effects models were used to assess the association between the impact of work on a physician's personal relationships and PARS scores. RESULTS Of 2384 physicians eligible to participate, 831 (34.9%) returned surveys including 429 (51.6%) who consented for their survey responses to be linked to independent data and had associated PARS scores. In a multivariate model adjusting for gender and specialty category, each 1-point higher impact of work on personal relationships score (0-10 scale; higher score unfavorable) was associated with a 19% greater odds of being in the next higher PARS score tercile of unsolicited patient complaints (odds ratio, 1.19; 95% CI, 1.07-1.33) during the subsequent 4-year study period. CONCLUSION An adverse impact of work on physicians' personal relationships is associated with independently assessed, unsolicited patient complaints. Organizational efforts to mitigate an adverse impact of work on physicians' personal relationships are warranted as part of efforts to improve the quality of patient experience and malpractice risk.
Collapse
Affiliation(s)
| | - Bryan Bohman
- Stanford University School of Medicine, Stanford, CA, USA
| | - Hanhan Wang
- Stanford University School of Medicine, Stanford, CA, USA
| | - William Cooper
- Vanderbilt Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dana Welle
- Tribeca Companies, San Francisco, CA, USA
| | - Tait D Shanafelt
- Stanford University School of Medicine, Stanford, CA, USA. https://twitter.com/StanfordWellMD
| |
Collapse
|
7
|
Abstract
OBJECTIVE One potential barrier to optimal healthcare may be provider burnout or occupational-related stress in the workplace. The objective of this study is to conduct a systematic review to identify the predictors of burnout among US. healthcare providers. DESIGN Systematic review using in-depth critical appraisal to assess risk of bias and present the quality of evidence in synthesised results from the prognostic studies. DATA SOURCES We searched 11 databases, registries, existing reviews and contacted experts through 4 October 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included all studies evaluating potential predictors and documenting the presence and absence of associations with burnout assessed as a multidimensional construct. We excluded studies that relied solely on a single continuous subscale of burnout. Data were abstracted from eligible studies and checked for accuracy by a content expert and a methodologist. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened citations and full-text publications using predetermined eligibility criteria. RESULTS The 141 identified studies evaluated a range of burnout predictors. Findings for demographic characteristics were conflicting or show no association. Workplace factors, such as workload, work/life balance, job autonomy and perceived support from leadership, had stronger associations with risk for burnout. Mental health factors, such as anxiety, and physical health risks may increase the risk, although the direction of these associations is unclear as few prospective studies exist to address this question. Factors such as social support appear to have a protective effect. CONCLUSION We found the most evidence for workplace, mental health and psychosocial factors in predicting burnout but limited evidence for other potential predictors. However, more prospective studies are needed to improve our understanding about how to prevent provider burnout. PROSPERO REGISTRATION NUMBER CRD4202014836.
Collapse
Affiliation(s)
| | | | - Joan Chang
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, California, USA
| | - Jody Larkin
- RAND Corporation, Santa Monica, California, USA
| | - Aneesa Motala
- RAND Corporation, Santa Monica, California, USA
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Susanne Hempel
- RAND Corporation, Santa Monica, California, USA
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
8
|
Treacy PJ, Barthe F, Bentellis I, Falagario UG, Prudhomme T, Imbert de La Phalecque L, Shaikh A, Albano L, Chevallier D, Durand M. Is night-time surgical procedure for renal graft at higher risk than during the day? A single center study cohort of 179 patients. Immun Inflamm Dis 2022; 10:225-234. [PMID: 34796677 PMCID: PMC8767511 DOI: 10.1002/iid3.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/11/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Various surgical centers tend to postpone a kidney transplantation (KT) to the following morning than to operate at night-time. The objective of our study was to assess whether there was any difference between daytime and night-time renal transplantation in our institution. METHOD This study is a retrospective monocentric study including all the KTs that were performed between 2012 and 2013 by transplant expert surgeons in our institution. Clavien-Dindo (CD) complications were classified according to 7 variables going from 1 to 5. Time before postgraft diuresis and delayed graft function (DGF) were also analyzed. Two groups of patients were formed according to threshold value of incision time (6.30 p.m.). Data comparison were performed using the Kruskal-Wallis nonparametric test. RESULTS A total of 179 patients were included. Median follow-up was 24 months. Cold ischemia time was longer in the night-time transplantation (1082 vs. 807 min, p < .001), but rewarming time was shorter (47.24 vs. 52.15 min, p = .628). No statistically significant differences were observed between the two groups using the Kruskal-Wallis method for CD complications (Qobs: 0.076; p = .735). CD complications proportion was similar, with a majority of grade II complications (72.7% daytime group vs. 75.4% night-time group (p = .735). DGF (19 patients for daytime group vs. 13 patients for night-time group, p = .359) and time before postgraft diuresis (4.65 days daytime group vs. 5.27 days night-time group, p = .422) were similar between both groups. Multivariate analysis did not show significant predictors of CD complications Grade 3 and more. CONCLUSION Night-time renal transplantation did not induce more postoperative CD complications than diurnal procedures in our cohort, challenging the false preconceptions that allow surgical teams to delay this surgery.
Collapse
Affiliation(s)
| | - Flora Barthe
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2CHU de NiceNiceFrance
| | - Imad Bentellis
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2CHU de NiceNiceFrance
| | | | - Thomas Prudhomme
- Department of Urology and Renal Transplantation, CHU RangueilToulouse University HospitalToulouseFrance
| | | | - Aysha Shaikh
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2CHU de NiceNiceFrance
| | - Laetitia Albano
- Department of Renal Transplantation, Hôpital Pasteur 2Nice Sophia‐Antipolis UniversityNiceFrance
| | - Daniel Chevallier
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2CHU de NiceNiceFrance
| | - Matthieu Durand
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2CHU de NiceNiceFrance
- Department of Renal Transplantation, Hôpital Pasteur 2Nice Sophia‐Antipolis UniversityNiceFrance
| |
Collapse
|
9
|
Valbuena VSM, Obayemi JE, Purnell TS, Scantlebury VP, Olthoff KM, Martins PN, Higgins RS, Blackstock DM, Dick AAS, Watkins AC, Englesbe MJ, Simpson DC. Gender and racial disparities in the transplant surgery workforce. Curr Opin Organ Transplant 2021; 26:560-566. [PMID: 34524181 PMCID: PMC8524746 DOI: 10.1097/mot.0000000000000915] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review explores trends in the United States (US) transplant surgery workforce with a focus on historical demographics, post-fellowship job market, and quality of life reported by transplant surgeons. Ongoing efforts to improve women and racial/ethnic minority representation in transplant surgery are highlighted. Future directions to create a transplant workforce that reflects the diversity of the US population are discussed. RECENT FINDINGS Representation of women and racial and ethnic minorities among transplant surgeons is minimal. Although recent data shows an improvement in the number of Black transplant surgeons from 2% to 5.5% and an increase in women to 12%, the White to Non-White transplant workforce ratio has increased 35% from 2000 to 2013. Transplant surgeons report an average of 4.3 call nights per week and less than five leisure days a month. Transplant ranks 1st among surgical sub-specialties in the prevalence of three well-studied facets of burnout. Concerns about lifestyle may contribute to the decreasing demand for advanced training in abdominal transplantation by US graduates. SUMMARY Minimal improvements have been made in transplant surgery workforce diversity. Sustained and intentional recruitment and promotion efforts are needed to improve the representation of women and minority physicians and advanced practice providers in the field.
Collapse
Affiliation(s)
- Valeria S. M. Valbuena
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA
| | - Joy E. Obayemi
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Tanjala S. Purnell
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Velma P. Scantlebury
- Texas Christian University and University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kim M. Olthoff
- Department of Surgery, Division of Transplant Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paulo N. Martins
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts, Worcester, MA, USA
| | - Robert S. Higgins
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - André A. S. Dick
- Department of Surgery, Division of Transplantation, University of Washington, Seattle, WA, USA
| | - Anthony C. Watkins
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Dinee C. Simpson
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
10
|
Cousino MK, Bogle C, Lim HM, McCormick AD, Sturza J, Fredericks EM, Magee JC, Blume ED. Burnout, professional fulfillment, and post-traumatic stress among pediatric solid organ transplant teams. Pediatr Transplant 2021; 25:e14020. [PMID: 33861499 PMCID: PMC9031412 DOI: 10.1111/petr.14020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/16/2020] [Accepted: 03/10/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adverse effects of clinician burnout have been studied across multiple specialties; however, there have been no studies examining rates of burnout among pediatric solid organ transplant teams. This study aimed to measure burnout, work exhaustion, professional fulfillment, and post-traumatic stress symptoms among clinicians and administrators practicing in this high-stress field. METHODS This cross-sectional study utilized a 50 item web-based survey that included the Personal Fulfillment Index and the IES-R. This survey was distributed across four pediatric solid organ transplant centers in North America. Basic demographics, clinician characteristics, and information regarding wellness and self-care activities were collected. Descriptive and correlational analyses were performed. RESULTS One hundred and thirty five participants completed the survey, 76% were female and 78% were Caucasian. One-third (34%) of participants endorsed burnout, while 43% reported professional fulfillment. Approximately 15% of respondents endorsed clinically significant levels of post-traumatic stress symptoms related to patient deaths, with female clinicians more likely to endorse symptoms (p = .01). Nearly 80% of participants reported engaging in self-care activities outside of work and only 10% of participants reported participation in hospital-sponsored wellness programs. CONCLUSIONS Pediatric solid organ transplant team members exhibited moderate levels of burnout, professional fulfillment, and post-traumatic stress. Female clinicians were the most likely to experience both work exhaustion and post-traumatic stress symptoms. Transplant centers are encouraged to consider interventions and programming to improve clinician wellness.
Collapse
Affiliation(s)
- Melissa K. Cousino
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI,University of Michigan Transplant Center, Ann Arbor, MI
| | - Carmel Bogle
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Heang M. Lim
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI
| | | | - Julie Sturza
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI
| | - Emily M. Fredericks
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI,University of Michigan Transplant Center, Ann Arbor, MI,Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI
| | - John C. Magee
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI,University of Michigan Transplant Center, Ann Arbor, MI,Department of Surgery, Michigan Medicine, Ann Arbor, MI
| | | |
Collapse
|
11
|
Ibáñez-López C, Méndez-Méndez MD, Concha-Gónzález V, Pereira-Lestayo MI. Aspectos psicosociales en pacientes candidatos a trasplante de órganos. DUAZARY 2021. [DOI: 10.21676/2389783x.3886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Este estudio analiza las variables psicosociales implicadas en el proceso de trasplante de órganos y plantea las posibles contribuciones de la psicología clínica en su abordaje. Se trata de un estudio descriptivo-transversal con muestra no probabilística intencional de N=64 (51 hombres y 13 mujeres), con edades comprendidas entre 37 y 66 años (Media=58,17; Desviación Típica=6,038). La evaluación se realiza mediante la entrevista clínica, la aplicación de la Escala de Ansiedad y Depresión Hospitalaria de Zimong y Shaith y del Mini-Examen del Estado Mental de Folstein y colaboradores. Se encuentra que entre el 56-68% de los pacientes tiene conciencia de la necesidad de mantener hábitos saludables. Un 37,5% del grupo de trasplante hepático no cumple abstinencia alcohólica superior a 6 meses. Más de la mitad de los candidatos tienen antecedentes en salud mental y aproximadamente el 20% presenta sintomatología clínica. Entre el 62-81% está motivado para la intervención. La influencia de los factores psicosociales en la evolución y el pronóstico de los trasplantes muestra la necesidad de fomentar la participación del psicólogo clínico en la evaluación y en el desarrollo de intervenciones adecuadas a las necesidades específicas de cada fase, favoreciendo la atención sanitaria integral durante todo el proceso.
Collapse
|
12
|
Kassam AF, Cortez AR, Winer LK, Conzen KD, El-Hinnawi A, Jones CM, Matsuoka L, Watkins AC, Collins KM, Bhati C, Selzner M, Sonnenday CJ, Englesbe MJ, Diwan TS, Dick AAS, Quillin RC. Extinguishing burnout: National analysis of predictors and effects of burnout in abdominal transplant surgery fellows. Am J Transplant 2021; 21:307-313. [PMID: 32463950 DOI: 10.1111/ajt.16075] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 01/25/2023]
Abstract
Burnout among surgeons has been attributed to increased workload and decreased autonomy. Although prior studies have examined burnout among transplant surgeons, no studies have evaluated burnout in abdominal transplant surgery fellows. The objective of our study was to identify predictors of burnout and understand its impact on personal and patient care during fellowship. A survey was sent to all abdominal transplant surgery fellows in an American Society of Transplant Surgeons-accredited fellowship. The response rate was 59.2% (n = 77) and 22.7% (n = 17) of fellows met criteria for burnout. Fellows with lower grit scores were more likely to exhibit burnout compared with fellows with higher scores (3.6 vs 4.0, P = .026). Those with burnout were more likely to work >100 hours per week (58.8% vs 27.6%, P = .023), have severe work-related stress (58.8% vs 22.4%, P = .010), consider quitting fellowship (94.1% vs 20.7%, P < .001), or make a medical error (35.3% vs 5.2%, P = .003). This national analysis of abdominal transplant fellows found that burnout rates are relatively low, but few fellows engage in self-care. Personal and program-related factors attribute to burnout and it has unacceptable effects on patient care. Transplant societies and fellowship programs should develop interventions to give fellows tools to prevent and combat burnout.
Collapse
Affiliation(s)
- Al-Faraaz Kassam
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Leah K Winer
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kendra D Conzen
- Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Ashraf El-Hinnawi
- Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | | | - Lea Matsuoka
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anthony C Watkins
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Kelly M Collins
- Department of Transplantation and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Chandra Bhati
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Markus Selzner
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | - Tayyab S Diwan
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - André A S Dick
- Department of Surgery, University of Washington, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Ralph C Quillin
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| |
Collapse
|
13
|
Neuberger J, Callaghan C. Organ utilization - the next hurdle in transplantation? Transpl Int 2020; 33:1597-1609. [PMID: 32935386 DOI: 10.1111/tri.13744] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022]
Abstract
Nonutilization of organs from consented deceased donors remains a significant factor in limiting patient access to transplantation. Critical to reducing waste is a clear understanding of why organs are not used: accurate metrics are essential to identify the extent and causes of waste but use of these measures as targets or comparators between units/jurisdictions must be done with caution as focus on any one measure may result in unintended adverse consequences. Comparison between centres or countries may be misleading because of variation in definitions, patient or graft characteristics. Two of the most challenging areas to improve appropriate deceased donor organ utilization are appetite for risk and lack of validated tools to help identify an organ that will function appropriately. Currently, the implanting surgeon is widely considered to be accountable for the use of a donated organ so guidelines must be clear to allow and support sensible decisions and recognition that graft failure or inadvertent disease transmission are not necessarily attributable to poor decision-making. Accepting an organ involves balancing risk and benefit for the potential recipient. Novel technologies such as machine perfusion may allow for more robust guidance as to the functioning of the organ.
Collapse
Affiliation(s)
| | - Chris Callaghan
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital and the Evelina London Children's Hospital, London, UK
| |
Collapse
|
14
|
Lerut J. Restructuring training in transplantation surgery …and medicine: a necessity on both sides of the Atlantic. Transpl Int 2018; 31:570-572. [PMID: 29453886 DOI: 10.1111/tri.13139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jan Lerut
- Université catholique Louvain, Brussels, Belgium
| |
Collapse
|