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Prentice S, Mullner H, Benson J, Kay M. Family medicine and general practitioner supervisor wellbeing: a literature review. BJGP Open 2024:BJGPO.2023.0230. [PMID: 38479758 DOI: 10.3399/bjgpo.2023.0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Research examining general practice supervisor wellbeing has often been conducted within the context of trainee wellbeing and educational outcomes. AIM To consolidate the current literature regarding the wellbeing of GP supervisors through a 'supervisor-wellbeing' lens. DESIGN & SETTING Literature review of original research studies on Embase, Ovid MEDLINE, and Ovid PsycINFO from inception to December 2022. METHOD The Embase, Ovid MEDLINE, and Ovid PsycINFO databases were systematically searched from inception to December 2022. Original research studies were eligible if they explored any aspect of wellbeing or burnout (that is, construct conceptualisations, risk and protective factors, implications, or interventions) among GPs involved in educating GP trainees. Reporting quality of included studies was assessed using the QualSyst tool. Results from included studies were narratively synthesised. RESULTS Data from 26 independent samples were reviewed. Burnout was generally conceptualised using the Leiter and Maslach model. Wellbeing was poorly defined in the literature, largely being conceptualised in personal psychological terms and, to a lesser extent, professional satisfaction. Risk and protective factors were identified and grouped as individual (for example, satisfaction with capacity to teach) and external (for example, autonomy, collegial relationships, resource availability) factors. GP supervisors' wellbeing appeared to affect their job performance and retention. This review identified only two studies evaluating interventions to support GP supervisors' wellbeing. CONCLUSION The present review highlights a lack of conceptual clarity and research examining interventions for GP supervisor wellbeing. It provides guidance for future research designed to maximise the wellbeing of GP supervisors and support the wellbeing of trainees.
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Affiliation(s)
- Shaun Prentice
- School of Psychology, The University of Adelaide, Adelaide, South Australia
- General Practice Training Research Department, Royal Australian College of General Practitioners, Adelaide, South Australia
| | - Helen Mullner
- General Practice Training, Royal Australian College of General Practitioners, Adelaide, South Australia
| | - Jill Benson
- General Practice Training, Royal Australian College of General Practitioners, Adelaide, South Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Margaret Kay
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland
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Wang T, O'Neill TR, Peterson LE, Newton WP. COVID-19 Impact on Family Medicine Residents Exam Performance. Fam Med 2024; 56:163-168. [PMID: 38467034 PMCID: PMC11136621 DOI: 10.22454/fammed.2024.719362] [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] [Indexed: 03/13/2024]
Abstract
BACKGROUND AND OBJECTIVES The COVID-19 pandemic began interrupting family medicine residency training in spring 2020. While a decline in scores on the American Board of Family Medicine In-Training Examination (ITE) has been observed, whether this decline has translated into the high-stakes Family Medicine Certification Examination (FMCE) is unclear. The goal of this study was to systematically assess the magnitude of COVID-19 impact on medical knowledge acquisition during residency, as measured by the ITE and FMCE. METHODS A total of 19,101 initial certification candidates from 2017 to 2022 were included in this study. Annual ITE scores and FMCE scores were reported on the same scale (200-800) and served as the outcome measure. We conducted multilevel regression analysis to determine ITE score growth and FMCE scores compared to cohorts prior to COVID-19. RESULTS During COVID-19, the increase in ITE scores from postgraduate year 2 (PGY-2) to PGY-3 was 25.5 points less, representing a 57.6% relative decrease; and from PGY-3 ITE to FMCE, it was 8.6 points less, a 12.7% relative decrease, compared with cohorts prior to COVID-19. FMCE scores were 6.6 points less during COVID-19, representing a 1.2% relative decline from the average FMCE score prior to COVID-19. CONCLUSIONS This study found nonsubstantive COVID-19 impact on FMCE scores, but a considerable knowledge acquisition decline during residency, especially during the PGY-2 to PGY-3 period. While COVID-19 impacted learning, our findings indicated that residencies were largely able to remediate knowledge deficits before residents took the FMCE.
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Affiliation(s)
- Ting Wang
- American Board of Family MedicineLexington, KY
| | | | - Lars E. Peterson
- American Board of Family MedicineLexington, KY
- Department of Family and Community Medicine, College of Medicine, University of KentuckyLexington, KY
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O'Connor TM, Guaman MC, Randell KA, Keenan HT, Snowden J, Mack JW, Camp EA, Perez O, Chang ML, Myers AL, Nigrovic LE, O'Toole J, Reed JL, Reese J, Rosenberg AR, Slater AC, Wootton SH, Ziniel SI, Yost HJ, Murray KO, Shekerdemian L, Chumpitazi CE. Impact of the COVID-19 pandemic on pediatric faculty: a report from nine academic institutions. Pediatr Res 2024; 95:775-784. [PMID: 37454186 DOI: 10.1038/s41390-023-02726-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The COVID-19 pandemic affected home and work routines, which may exacerbate existing academic professional disparities. Objectives were to describe the impact of the pandemic on pediatric faculty's work productivity, identify groups at risk for widening inequities, and explore mitigation strategies. METHODS A cross-sectional study of faculty members was conducted at nine U.S. pediatric departments. Responses were analyzed by demographics, academic rank, and change in home caregiving responsibility. RESULTS Of 5791 pediatric faculty members eligible, 1504 (26%) completed the survey. The majority were female (64%), over 40 years old (60%), and assistant professors (47%). Only 7% faculty identified as underrepresented in medicine. Overall 41% reported an increase in caregiving during the pandemic. When comparing clinical, administrative, research, and teaching activities, faculty reported worse 1-year outlook for research activities. Faculty with increased caregiving responsibilities were more likely to report concerns over delayed promotion and less likely to have a favorable outlook regarding clinical and research efforts. Participants identified preferred strategies to mitigate challenges. CONCLUSIONS The COVID-19 pandemic negatively impacted pediatric faculty productivity with the greatest effects on those with increased caregiving responsibilities. COVID-19 was particularly disruptive to research outlook. Mitigation strategies are needed to minimize the long-term impacts on academic pediatric careers. IMPACT The COVID-19 pandemic most negatively impacted work productivity of academic pediatric faculty with caregiving responsibilities. COVID-19 was particularly disruptive to short-term (1-year) research outlook among pediatric faculty. Faculty identified mitigation strategies to minimize the long-term impacts of the pandemic on academic pediatric career pathways.
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Affiliation(s)
- Teresia M O'Connor
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
- Division of Academic General Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
| | - Milenka Cuevas Guaman
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Kimberly A Randell
- Division of Emergency Medicine, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Heather T Keenan
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jessica Snowden
- Section of Infectious Disease, Department of Pediatrics, University of Arkansas Medical School, Little Rock, AR, USA
| | - Jennifer W Mack
- Division of Hematology and Oncology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Camp
- Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Oriana Perez
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Michael L Chang
- Division of Infectious Diseases, Department of Pediatrics, UT Health Houston McGovern Medical School and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Angela L Myers
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- University of Kansas School of Medicine, Kansas City, KS, USA
- Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Lise E Nigrovic
- Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer O'Toole
- Department of Pediatrics and Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Cincinnati, OH, USA
- UC Health, Department of Internal Medicine, Cincinnati, OH, USA
| | - Jennifer L Reed
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Cincinnati Children's Hospital Medical Center, Division of Emergency Medicine, Cincinnati, OH, USA
| | - Jennifer Reese
- Division of Hospital Medicine, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Abby R Rosenberg
- Division of Hematology and Oncology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Psychosocial Oncology & Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Anne C Slater
- Division of Emergency Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Susan H Wootton
- Division of Infectious Diseases, Department of Pediatrics, UT Health Houston McGovern Medical School and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Sonja I Ziniel
- Division of Hospital Medicine, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - H Joseph Yost
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kristy O Murray
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Lara Shekerdemian
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Corrie E Chumpitazi
- Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Chua IS, Khinkar RM, Wien M, Kerrissey M, Lipsitz S, Cheung YY, Mort EA, Desai S, Morris CA, Pearson M, Eappen S, Rozenblum R, Mendu M. What Went Right? A Mixed-Methods Study of Positive Feedback Data in a Hospital-Wide Mortality Review Survey. J Gen Intern Med 2024; 39:263-271. [PMID: 37725228 PMCID: PMC10853134 DOI: 10.1007/s11606-023-08393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Toxic work culture contributes to healthcare worker burnout and attrition, but little is known about how healthcare organizations can systematically create and promote a culture of civility and collegiality. OBJECTIVE To analyze peer-to-peer positive feedback collected as part of a systematized mortality review survey to identify themes and recognition dynamics that can inform positive organizational culture change. DESIGN Convergent mixed-methods study design. PARTICIPANTS A total of 388 physicians, 212 registered nurses, 64 advanced practice providers, and 1 respiratory therapist at four non-profit hospitals (2 academic and 2 community). INTERVENTION Providing optional positive feedback in the mortality review survey. MAIN MEASURES Key themes and subthemes that emerged from positive feedback data, associations between key themes and positive feedback respondent characteristics, and recognition dynamics between positive feedback respondents and recipients. KEY RESULTS Approximately 20% of healthcare workers provided positive feedback. Three key themes emerged among responses with free text comments: (1) providing extraordinary patient and family-centered care; (2) demonstrating self-possession and mastery; and (3) exhibiting empathic peer support and effective team collaboration. Compared to other specialties, most positive feedback from medicine (70.2%), neurology (65.2%), hospice and palliative medicine (64.3%), and surgery (58.8%) focused on providing extraordinary patient and family-centered care (p = 0.02), whereas emergency medicine (59.1%) comments predominantly focused on demonstrating self-possession and mastery (p = 0.06). Registered nurses (40.2%) provided multidirectional positive feedback more often than other clinician types in the hospital hierarchy (p < 0.001). CONCLUSIONS Analysis of positive feedback from a mortality review survey provided meaningful insights into a health system's culture of teamwork and values related to civility and collegiality when providing end-of-life care. Systematic collection and sharing of positive feedback is feasible and has the potential to promote positive culture change and improve healthcare worker well-being.
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Affiliation(s)
- Isaac S Chua
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Roaa M Khinkar
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Matthew Wien
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Stuart Lipsitz
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Yvonne Y Cheung
- Department of Quality and Safety, Newton Wellesley Hospital, Newton, MA, USA
- Department of Anesthesia, Newton Wellesley Hospital, Newton, MA, USA
| | - Elizabeth A Mort
- Harvard Medical School, Boston, MA, USA
- Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Sonali Desai
- Harvard Medical School, Boston, MA, USA
- Office of the Chief Quality Officer, Brigham and Women's Hospital, Boston, MA, USA
| | - Charles A Morris
- Harvard Medical School, Boston, MA, USA
- Office of the Chief Medical Officer, Brigham and Women's Hospital, Boston, MA, USA
| | - Madelyn Pearson
- Office of the Chief Nursing Officer, Brigham and Women's Hospital, Boston, MA, USA
| | - Sunil Eappen
- University of Vermont Health Network, Burlington, VA, USA
| | - Ronen Rozenblum
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mallika Mendu
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Office of the Chief Medical Officer, Brigham and Women's Hospital, Boston, MA, USA
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Hoff T, Trovato K, Kitsakos A. Burnout Among Family Physicians in the United States: A Review of the Literature. Qual Manag Health Care 2024; 33:1-11. [PMID: 37817317 DOI: 10.1097/qmh.0000000000000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Burnout among physicians who work in primary care is an important problem that impacts health care quality, local communities, and the public's health. It can degrade the quality of primary care services in an area and exacerbate workforce shortages. This study conducted a review of the published research on burnout among family physicians working in the United States. METHODS We used a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided approach and several article databases to identify, filter, and analyze published research on US family physician burnout that uses data collected from 2015 onward. RESULTS Thirty-three empirical studies were identified with findings that included US family physician burnout prevalence and/or associations between burnout and specific personal and contextual drivers. Mean family physician burnout prevalence across studies that measured it was 35%. Almost half of the studies classified one-third or more of their family physician samples as burned out. Physician gender (being female), age (being younger), and job/work-related factors (workload, time pressures) were the most commonly identified correlates of family physician burnout. The vast majority of studies were cross-sectional and used secondary data. CONCLUSIONS The extant research literature on family physician burnout in the United States shows that burnout is currently a meaningful problem. Several important correlates of the problem can be identified, some of which managers and health care organizations can proactively address. Other correlates require managers and health care organizations also viewing family physicians in differentiated ways. The collective literature can be improved through a more consistent focus on similar burnout correlates across studies; inclusion of interventions aimed at lessening the effects of key burnout correlates; employment of more robust longitudinal and quasi-experimental research designs; and additional pandemic-era data collection on burnout.
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Affiliation(s)
- Timothy Hoff
- D'Amore-McKim School of Business, Northeastern University, Boston, Massachusetts (Dr Hoff); School of Public Policy and Urban Affairs, Northeastern University, Boston, Massachusetts (Dr Hoff); Green-Templeton College, University of Oxford, Oxford, England, United Kingdom (Dr Hoff); Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts (Ms Trovato); and School of Public Policy and Urban Affairs, Northeastern University, Boston, Massachusetts (Ms Kitsakos)
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Mickey W. Critical care medicine training in the age of COVID-19. J Osteopath Med 2023; 123:427-434. [PMID: 37307290 DOI: 10.1515/jom-2022-0244] [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: 12/19/2022] [Accepted: 05/15/2023] [Indexed: 06/14/2023]
Abstract
CONTEXT The COVID-19 pandemic caused the largest disruption to graduate medical education in modern history. The danger associated with SARS-CoV-2 necessitated a paradigm shift regarding the fundamental approach to the education of medical residents and fellows. Whereas prior work has examined the effect of the pandemic on residents' experiences during training, the effect of the pandemic on academic performance of critical care medicine (CCM) fellows is not well understood. OBJECTIVES This study examined the relationship between CCM fellow's lived experiences during the COVID-19 pandemic and performance on in-training examinations. METHODS This mixed-methods study consisted of a quantitative retrospective analysis of critical care fellows' in-training examination scores and a qualitative, interview-based phenomenological examination of fellows' experiences during the pandemic while training in a single large academic hospital in the American Midwest. Quantitative: Prepandemic (2019 and 2020) and intrapandemic (2021 and 2022) in-training examination scores were analyzed utilizing an independent samples t test to determine whether a significant change occurred during the pandemic. Qualitative: Individual semi-structured interviews were conducted with CCM fellows exploring their lived experiences during the pandemic and their perception of the effect on their academic performance. Transcribed interviews were analyzed for thematic patterns. These themes were coded and categorized, and subcategories were developed as indicated during the analysis. The identified codes were then analyzed for thematic connections and apparent patterns. Relationships between themes and categories were analyzed. This process was continued until a coherent picture could be assembled from the data to answer the research questions. Analysis was performed from a phenomenological perspective with an emphasis on interpretation of the data from the participants' perspectives. RESULTS Quantitative: Fifty-one in-training examination scores from 2019 to 2022 were obtained for analysis. Scores from 2019 to 2020 were grouped as prepandemic scores, while scores from 2021 to 2022 were grouped as intrapandemic scores. Twenty-four prepandemic and 27 intrapandemic scores were included in the final analysis. A significant difference was found between mean total prepandemic and intrapandemic in-service examination scores (t 49=2.64, p=0.01), with mean intrapandemic scores being 4.5 points lower than prepandemic scores (95 % CI, 1.08-7.92). Qualitative: Interviews were conducted with eight CCM fellows. Thematic analysis of the qualitative interviews revealed three main themes: psychosocial/emotional effects, effects on training, and effects on health. The factors that most effected participants' perceptions of their training were burnout, isolation, increased workload, decreased bedside teaching, decreased formal academic training opportunities, decreased procedural experience, a lack of an external reference point for normal training in CCM, fear of spreading COVID-19, and neglect of personal health during the pandemic. CONCLUSIONS In-training examination scores decreased significantly during the COVID-19 pandemic for CCM fellows in this study. The fellows in this study reported perceived effects of the pandemic on their psychosocial/emotional well-being, medical training, and health.
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Upadhyay S, Flora R, Rajaee A, Ugiliweneza B, Iles AM. Training of Family Medicine residents in the first year of the COVID-19 pandemic. J Family Med Prim Care 2023; 12:996-1002. [PMID: 37448918 PMCID: PMC10336927 DOI: 10.4103/jfmpc.jfmpc_1777_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/29/2023] [Accepted: 02/06/2023] [Indexed: 07/18/2023] Open
Abstract
Background The immediate impact of the pandemic on resident training has been well documented. As the pandemic and its effects persisted beyond what was initially predicted, this study aimed to assess the impact of the pandemic on the training of family medicine (FM) residents a year after it began and to assess the burnout residents experienced during this period. Methods The survey was conducted between January 18 and February 18, 2021. Participation was solicited via an email sent to the program directors throughout the US, who were asked to circulate the survey among their residents. The questionnaire was divided into sections to assess the impact of the pandemic on clinical training, didactics, and preparedness for the next phase in the career. In addition, the burnout experienced was assessed using the Copenhagen Burnout Inventory. Results 227 responses were analyzed. 83% (n = 186) of respondents felt that the pandemic had a negative impact on their training and 63% (n = 141) felt that the pandemic had a negative impact on didactics. 50% (n = 44) of the third-year residents thought that they would be able to meet the graduation requirement for outpatient encounters. 41% (n = 36) of the third-year residents felt less prepared for the next step in their careers. 119 respondents met the cutoff threshold for personal burnout, 134 for work-related burnout, and 65 for client-related burnout. Conclusion Residency training is difficult with high reported rates of burnout before the COVID-19 pandemic. This study reinforces the evidence that the pandemic made both mental well-being and adequate training more difficult for FM residents across the country.
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Affiliation(s)
- Smita Upadhyay
- Department of Family and Geriatric Medicine, University of Louisville, Louisville, KY, USA
| | - Rebecca Flora
- Department of Family and Geriatric Medicine, University of Louisville, Louisville, KY, USA
| | - Arezoo Rajaee
- Department of Family and Geriatric Medicine, University of Louisville, Louisville, KY, USA
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
- Department of Health Management and Systems Sciences, University of Louisville, Louisville, KY, USA
| | - Ashley M. Iles
- Department of Family and Geriatric Medicine, University of Louisville, Louisville, KY, USA
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Roth LT, Mogilner L, Talib H, Silver EJ, Friedman S. Where Do We Go from here? Post-pandemic Planning and the Future of Graduate Medical Education. MEDICAL SCIENCE EDUCATOR 2023; 33:375-384. [PMID: 36778672 PMCID: PMC9900559 DOI: 10.1007/s40670-023-01737-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 05/31/2023]
Abstract
Background As the pandemic wanes, there is an opportunity to reevaluate resultant changes in graduate medical education (GME), particularly from the viewpoints of those affected most. We aimed to assess both trainee and faculty perceptions on the educational changes and innovations resulting from the pandemic to inform future educational planning. Methods We surveyed trainees and core education faculty at three New York City children's hospitals. Surveys assessed perceived changes to educational activities, skills, scholarship, effectiveness of virtual teaching, future desirability, and qualitative themes. Results The survey was completed by 194 participants, including 88 (45.4%) faculty and 106 (54.6%) trainees. Trainees were more likely to report a negative impact of the pandemic compared with faculty (75.5% vs. 50%, p < 0.01). Most respondents reported a decrease in formal educational activities (69.8%), inpatient (77.7%) and outpatient (77.8%) clinical teaching. Despite this, most perceived clinical and teaching skills to have stayed the same. Most (93.4%) participated in virtual education; however, only 36.5% of faculty taught virtually. Only 4.2% of faculty had extensive training in virtual teaching and 28.9% felt very comfortable teaching virtually. In the future, most (87.5%) prefer a hybrid approach, particularly virtual didactic conferences and virtual grand rounds. Faculty themes included challenges to workflows and increased empathy for trainees, while trainee themes included increased work/life balance and support, but increased burnout. Conclusion Many changes and innovations resulted from the pandemic. Hospital systems and GME programs should consider this data and incorporate viewpoints from trainees and faculty when adapting educational strategies in the future. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-023-01737-8.
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Affiliation(s)
- Lauren T. Roth
- Children’s Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Ave, Bronx, NY 10467 USA
| | - Leora Mogilner
- Icahn School of Medicine at Mount Sinai, 1184 5th Ave, New York, NY 10029 USA
| | - Hina Talib
- Children’s Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Ave, Bronx, NY 10467 USA
| | - Ellen J. Silver
- Children’s Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Ave, Bronx, NY 10467 USA
| | - Suzanne Friedman
- Columbia University Vagelos College of Physicians & Surgeons, 622 West 168th Street, NY New York, 10032 USA
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Smith N, Newton C, Barbacuta D, Tseng OLI. An unexpected transition to virtual care: family medicine residents’ experience during the COVID-19 pandemic. BMC PRIMARY CARE 2022; 23:127. [PMID: 35614415 PMCID: PMC9130052 DOI: 10.1186/s12875-022-01728-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/05/2022] [Indexed: 11/19/2022]
Abstract
Background The global COVID-19 pandemic led to rapid changes in both medical care and medical education, particularly involving the rapid substitution of virtual solutions for traditional face-to-face appointments. There is a need for research into the effects and impacts of such changes. The objective of this article investigates the perspectives of Family Medicine Residents in one university program in order to understand the impact of this transition to virtual care and learning. Methods This is a qualitative focus group study. Four focus groups, stratified by site type (Rural = 1; Semi-Urban = 1; Urban = 2) were conducted, with a total of 25 participants. Participants were either first or second-year Residents in Family Medicine. Focus group recordings were analyzed thematically, based upon a five-level socio-ecological model (individual, family, organization, community, environment and policy context). Results Two main themes were identified: (1) Residents’ experiences of Virtual Learning and Virtual Care, and (2) Living and Learning in Pandemic Times. In the first theme, Residents reported challenges both individually, in their family context, and in their training organizations. Of particular concern was the loss of hands-on experience with clinical skills such as conducting physical examinations. In the second theme, Residents reported disruption of self-care routines and family life. These Residents were unable to engage in the relationships outside of the workplace with their preceptors and peers which they had expected, and which play key roles in social support as well as in future decisions about practice location. Conclusions While many patients appreciated virtual care, in the eyes of these Residents it is not the ideal modality for learning the practice of Family Medicine, and they awaited a return to normal times. Despite this, the pandemic has pointed out important ways in which residency training needs to adapt to an evolving world. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01728-5.
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Silva B, Ožvačić Adžić Z, Vanden Bussche P, Van Poel E, Seifert B, Heaster C, Collins C, Tuz Yilmaz C, Knights F, de la Cruz Gomez Pellin M, Astier Peña MP, Stylianou N, Gomez Bravo R, Cerovečki V, Klemenc Ketis Z, Willems S. Safety Culture and the Positive Association of Being a Primary Care Training Practice during COVID-19: The Results of the Multi-Country European PRICOV-19 Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10515. [PMID: 36078230 PMCID: PMC9518383 DOI: 10.3390/ijerph191710515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
The day-to-day work of primary care (PC) was substantially changed by the COVID-19 pandemic. Teaching practices needed to adapt both clinical work and teaching in a way that enabled the teaching process to continue, while maintaining safe and high-quality care. Our study aims to investigate the effect of being a training practice on a number of different outcomes related to the safety culture of PC practices. PRICOV-19 is a multi-country cross-sectional study that researches how PC practices were organized in 38 countries during the pandemic. Data was collected from November 2020 to December 2021. We categorized practices into training and non-training and selected outcomes relating to safety culture: safe practice management, community outreach, professional well-being and adherence to protocols. Mixed-effects regression models were built to analyze the effect of being a training practice for each of the outcomes, while controlling for relevant confounders. Of the participating practices, 2886 (56%) were non-training practices and 2272 (44%) were training practices. Being a training practice was significantly associated with a lower risk for adverse mental health events (OR: 0.83; CI: 0.70-0.99), a higher number of safety measures related to patient flow (Beta: 0.17; CI: 0.07-0.28), a higher number of safety incidents reported (RR: 1.12; CI: 1.06-1.19) and more protected time for meetings (Beta: 0.08; CI: 0.01-0.15). No significant associations were found for outreach initiatives, availability of triage information, use of a phone protocol or infection prevention measures and equipment availability. Training practices were found to have a stronger safety culture than non-training practices. These results have important policy implications, since involving more PC practices in education may be an effective way to improve quality and safety in general practice.
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Affiliation(s)
- Bianca Silva
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Zlata Ožvačić Adžić
- Department of Family Medicine, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Health Centre Zagreb-Centar, 10000 Zagreb, Croatia
| | | | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Bohumil Seifert
- Institute of General Practice, First Medical Faculty, Charles University, CZ-121 08 Prague, Czech Republic
| | - Cindy Heaster
- Department of Family Medicine, Faculty of Medicine, Riga Stradiņš University, LV-1007 Riga, Latvia
| | - Claire Collins
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
| | - Canan Tuz Yilmaz
- Family Medicine Department, Bursa Uludag University, 16130 Bursa, Turkey
| | - Felicity Knights
- Population Health Research Institute, St George’s University of London, London SW17 0RE, UK
| | | | - Maria Pilar Astier Peña
- Primary Health Centre Universitas, Aragon Health Services, 50009 Zaragoza, Spain
- Medical School, Universidad de Zaragoza, GIBA-ISS-Aragón, 50009 Zaragoza, Spain
| | - Neophytos Stylianou
- RTD Talos, 2404 Nicosia, Cyprus
- International Institute for Compassionate Care, 2415 Nicosia, Cyprus
| | - Raquel Gomez Bravo
- CHNP, Rehaklinik, L-9002 Ettelbruck, Luxembourg
- Research Group Self-Regulation and Health, Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, Faculty of Humanities, Education and Social Sciences, University of Luxembourg, L-4366 Esch-sur-Alzette, Luxembourg
| | - Venija Cerovečki
- Department of Family Medicine, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Health Centre Zagreb-Centar, 10000 Zagreb, Croatia
| | - Zalika Klemenc Ketis
- Ljubljana Community Health Centre, 1000 Ljubljana, Slovenia
- Department of Family Medicine, Medical Faculty, University of Maribor, 2000 Maribor, Slovenia
- Department of Family Medicine, Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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