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Hanna KF, Koo K. Professional Burnout and Career Choice Regret in Urology Residents. Curr Urol Rep 2024:10.1007/s11934-024-01226-4. [PMID: 39017800 DOI: 10.1007/s11934-024-01226-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE OF REVIEW High rates of professional burnout and career choice regret among urology residents may increase professional dissatisfaction, shorten career longevity, and exacerbate urology workforce shortages. Understanding the prevalence of and risk factors for burnout may help develop interventions. RECENT FINDINGS Up to 48% of contemporary U.S. urology residents experience burnout symptoms, including up to 70% of second-year residents. Among overlapping personal, professional, institutional, and lifestyle risk factors, barriers to accessing medical and mental health care are frequently cited as an important association in residents. Limited intervention studies suggest that providing basic needs, such as on-call meals, and facilitating physical wellness and social engagement among residents may result in sustained reductions in burnout. Urology residents continue to experience high rates of burnout and career choice regret among medical specialties. Evidence-based interventions and sustainable policies that address primary risk factors are urgently needed.
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Affiliation(s)
- Kevin F Hanna
- Department of Urology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Kevin Koo
- Department of Urology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Koljonen JL, Ruffolo AM, Neumeister MW, Sommer NZ. Strategies to Improve Resident Wellness in Plastic Surgery Training. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5858. [PMID: 38841530 PMCID: PMC11150031 DOI: 10.1097/gox.0000000000005858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/12/2024] [Indexed: 06/07/2024]
Abstract
Residency is known to be a challenging time in a surgeon's career. Surgical residents must learn the breadth of their field and develop technical skills while maintaining relationships and well-being outside their training. High burnout rates are well documented among all medical specialties, particularly during residency. Proven strategies in medical education that help decrease burnout and improve resident well-being, while maintaining quality patient care, have been reported in the medical education literature. However, little has been published specific to plastic surgery training programs. We discuss strategies that can be implemented into the curricula and workflow at plastic surgery residency programs to maximize resident well-being. We advocate for a multifaceted approach that includes a night float system, day call, integrating advanced practice providers to offload noneducational resident tasks, and establishing a wellness program. It is our hope that these strategies may serve as a guide for plastic surgery residency programs to promote general wellness and prevent burnout among trainees.
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Affiliation(s)
- Jessie L. Koljonen
- From the Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
| | - Alexis M. Ruffolo
- From the Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
| | - Michael W. Neumeister
- From the Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
| | - Nicole Z. Sommer
- From the Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
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Abdelmageed S, Horak VJ, Virtanen PS, Lam SK, Burchiel KJ, Raskin JS. A Well-Being Well-Check for Neurosurgery: Evidence-Based Suggestions for Our Specialty Based on a Systematic Review. World Neurosurg 2024; 185:351-358.e2. [PMID: 38403016 DOI: 10.1016/j.wneu.2024.02.093] [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: 12/23/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND The path through neurosurgery is rigorous. Many neurosurgeons may experience burnout, depression, or suicide throughout training and practice. We review the literature to help foster a culture of awareness and self-care and arm trainees with coping skills to reduce burnout and, thus, suicidality during all phases of their medical careers. METHODS A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using 4 databases. 7 studies were included. RESULTS Overlying themes of interventions were to increase balance, mindfulness, and physical fitness. The most common interventions included in programs were educational and physical activity. We suggest a comprehensive wellness program emphasizing interventions from 4 wellness dimensions-physical, spiritual, mental, and emotional. CONCLUSIONS Many neurosurgeons experience burnout, leading to a lack of satisfaction and early retirement; this necessitates a discipline-wide acknowledgment of endemic burnout among neurosurgeons. Systemic changes are needed to refine the training process and prioritize physician well-being- this cannot be left to chance.
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Affiliation(s)
- Sunny Abdelmageed
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Victoria Jane Horak
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA; Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Piiamaria S Virtanen
- Department of Neurological Surgery, Section of Pediatric Neurosurgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sandi K Lam
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kim J Burchiel
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeffrey S Raskin
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Mangham W, Parikh KA, Motiwala M, Gienapp AJ, Roach J, Barats M, Lillard J, Khan N, Arthur A, Michael LM. A Scoping Review of Professionalism in Neurosurgery. Neurosurgery 2024; 94:435-443. [PMID: 37819083 DOI: 10.1227/neu.0000000000002711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/10/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Accreditation Council for Graduate Medical Education's Milestones provides a foundation for professionalism in residency training. Specific professionalism concepts from neurosurgery could augment and expand milestones for the specialty. We reviewed the current literature and identified professionalism concepts within the context of neurosurgical practice and training. METHODS We used a scoping review methodology to search PubMed/MEDLINE and Scopus and identify English-language articles with the search terms "professionalism" and "neurosurgery." We excluded articles that were not in English, not relevant to professionalism within neurosurgery, or could not be accessed. Non-peer-reviewed and qualitative publications, such as commentaries, were included in the review. RESULTS A total of 193 articles were included in the review. We identified 6 professionalism themes among these results: professional identity (n = 53), burnout and wellness (n = 51), professional development (n = 34), ethics and conflicts of interest (n = 27), diversity and gender (n = 19), and misconduct (n = 9). CONCLUSION These 6 concepts illustrate concerns that neurosurgeons have concerning professionalism. Diversity and gender, professional identity, and misconduct are not specifically addressed in the Accreditation Council for Graduate Medical Education's Milestones. This review could be used to aid the development of organizational policy statements on professionalism.
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Affiliation(s)
- William Mangham
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Kara A Parikh
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Mustafa Motiwala
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Andrew J Gienapp
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis , Tennessee , USA
| | - Jordan Roach
- College of Medicine, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Michael Barats
- College of Medicine, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Jock Lillard
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Nickalus Khan
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Semmes Murphey, Memphis , Tennessee , USA
| | - Adam Arthur
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Semmes Murphey, Memphis , Tennessee , USA
| | - L Madison Michael
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Semmes Murphey, Memphis , Tennessee , USA
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Ng PR, Yearley AG, Eatz TA, Ajmera S, West T, Razak SS, Lazaro T, Urakov T, Jones PS, Coumans JV, Stapleton CJ, Shankar G, Chen HI, Komotar RJ, Patel AJ, Nahed BV. Neurological Surgery Residency Programs in the United States: A National Cross-Sectional Survey. Neurosurgery 2024; 94:529-537. [PMID: 37795983 DOI: 10.1227/neu.0000000000002703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/04/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Accreditation Council for Graduate Medical Education has approved 117 neurological surgery residency programs which develop and educate neurosurgical trainees. We present the current landscape of neurosurgical training in the United States by examining multiple aspects of neurological surgery residencies in the 2022-2023 academic year and investigate the impact of program structure on resident academic productivity. METHODS Demographic data were collected from publicly available websites and reports from the National Resident Match Program. A 34-question survey was circulated by e-mail to program directors to assess multiple features of neurological surgery residency programs, including curricular structure, fellowship availability, recent program changes, graduation requirements, and resources supporting career development. Mean resident productivity by program was collected from the literature. RESULTS Across all 117 programs, there was a median of 2.0 (range 1.0-4.0) resident positions per year and 1.0 (range 0.0-2.0) research/elective years. Programs offered a median of 1.0 (range 0.0-7.0) Committee on Advanced Subspecialty Training-accredited fellowships, with endovascular fellowships being most frequently offered (53.8%). The survey response rate was 75/117 (64.1%). Of survey respondents, the median number of clinical sites was 3.0 (range 1.0-6.0). Almost half of programs surveyed (46.7%) reported funding mechanisms for residents, including R25, T32, and other in-house grants. Residents received a median academic stipend of $1000 (range $0-$10 000) per year. Nearly all programs (93.3%) supported wellness activities for residents, which most frequently occurred quarterly (46.7%). Annual academic stipend size was the only significant predictor of resident academic productivity (R 2 = 0.17, P = .002). CONCLUSION Neurological surgery residency programs successfully train the next generation of neurosurgeons focusing on education, clinical training, case numbers, and milestones. These programs offer trainees the chance to tailor their career trajectories within residency, creating a rewarding and personalized experience that aligns with their career aspirations.
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Affiliation(s)
- Patrick R Ng
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Alexander G Yearley
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Tiffany A Eatz
- Department of Neurological Surgery, University of Miami, Miami , Florida , USA
| | - Sonia Ajmera
- Department of Neurological Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia , Pennsylvania , USA
| | - Timothy West
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Shahaan S Razak
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Tyler Lazaro
- Department of Neurological Surgery, Baylor College of Medicine, Houston , Texas , USA
| | - Timur Urakov
- Department of Neurological Surgery, University of Miami, Miami , Florida , USA
| | - Pamela S Jones
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Jean-Valery Coumans
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Christopher J Stapleton
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - Ganesh Shankar
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
| | - H Isaac Chen
- Department of Neurological Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia , Pennsylvania , USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami, Miami , Florida , USA
| | - Akash J Patel
- Department of Neurological Surgery, Baylor College of Medicine, Houston , Texas , USA
| | - Brian V Nahed
- Harvard Medical School, Boston , Massachusetts , USA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston , Massachusetts , USA
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Anand A, Jensen R, Korndorffer JR. We Need to Do Better: A Scoping Review of Wellness Programs In Surgery Residency. JOURNAL OF SURGICAL EDUCATION 2023; 80:1618-1640. [PMID: 37541937 DOI: 10.1016/j.jsurg.2023.07.009] [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: 02/25/2023] [Revised: 05/26/2023] [Accepted: 07/08/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE Burnout, depression, and fatigue are common among surgical residents. Most published wellness studies in surgery only focus on a cross-sectional view of attitudes and perceptions around wellness in training. While much of this literature calls for interventions and presents strategies for improving resident well-being, there is a paucity of published wellness initiatives, and even fewer with programmatic evaluation. DESIGN A scoping review was designed to address: (1) What wellness initiatives are used in surgery residency programs? (2) Which wellness domains do these programs address? and (3) How are program outcomes evaluated? A formal literature search was conducted using PubMed, Embase, and Scopus databases to identify English-language studies conducted in the United States that described wellness-focused initiatives for surgery residents. Two authors independently screened all abstracts and full texts for inclusion. Data were extracted including wellness domain(s) and outcomes evaluation methods with associated Kirkpatrick level(s) (1-reaction, 2-learning, 3-behavior, 4-results). Study quality was examined using the medical education research study quality index (MERSQI) score. RESULTS A total of 2237 abstracts were screened with 115 full texts reviewed for eligibility. Fifty-one studies were included in the final analysis, representing 39 distinct wellness programs. The most common domains of wellness addressed were emotional (19/39, 48.7%), occupational (17/39, 43.6%), and physical (16/39, 41.0%). Of the 51 studies reviewed, 8 (15.7%) did not conduct any program evaluation, 27 (52.9%) evaluated level 1, 30 (58.8%) evaluated level 2, 3 (5.9%) evaluated level 3, and none evaluated level 4 outcomes. The mean MERSQI score was 9.16 (SD 1.8). CONCLUSIONS Wellness is an established problem in surgical training. This review reveals a small number of published wellness interventions and even fewer that incorporate programmatic evaluation at the level of behavior and results change. Effective change will require rigorous and deliberate programming that addresses multiple domains and evaluation levels.
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Affiliation(s)
- Ananya Anand
- Department of Surgery, Stanford University, Stanford, California.
| | - Rachel Jensen
- Department of Surgery, Stanford University, Stanford, California
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Lawson McLean A, Lawson McLean AC. Resilience and recovery in neurosurgical residency: Unpacking lessons from video game mechanics. BRAIN & SPINE 2023; 3:101793. [PMID: 38020986 PMCID: PMC10668065 DOI: 10.1016/j.bas.2023.101793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/25/2023] [Accepted: 08/11/2023] [Indexed: 12/01/2023]
Abstract
Introduction Neurosurgical residency is a challenging journey demanding cognitive acuity and resilience, mirrored strikingly in the dynamics of video gaming. Gaming concepts of Down-But-Not-Out (DBNO), Heal-over-Time (HoT), and Damage-over-Time (DoT) can serve as compelling analogues to elements of neurosurgical training. Material and methods An innovative, cross-disciplinary methodology was implemented, blending elements of autoethnography, personal reflective narrative, and comprehensive literary review. The cornerstone of this approach was an experiential reflective analysis, where two neurosurgical residents critically examined the parallels between their residency experiences and video game mechanics, thereby applying a lens of heuristic introspection to their professional journey. Complementing this, a comprehensive narrative synthesis of existing literature on resilience, wellness, and stress in neurosurgical residency training was conducted. Results The DBNO concept parallels the resilience demonstrated by neurosurgical residents, emphasizing the importance of a supportive network. The HoT concept, analogous to wellness practices, underscores the incremental restoration of energy necessary for maintaining stamina in neurosurgery training. The DoT concept symbolizes the need to manage the often insidious and deleterious effects of chronic stress on residents' wellbeing. Discussion and conclusion These gaming concepts provide an integrative framework for understanding the challenges faced and strategies employed in neurosurgical residency. The interplay between resilience, wellness practices, and effective stress management, represented by DBNO, HoT, and DoT respectively, is critical for maintaining health and fostering professional excellence. By embedding these metaphors within the training paradigm, the neurosurgical residency journey can be navigated more effectively, promoting not only professional success but also personal growth and wellbeing.
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Affiliation(s)
- Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
| | - Anna C. Lawson McLean
- Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
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Lu FI, Ratnapalan S. Burnout Interventions for Resident Physicians: A Scoping Review of Their Content, Format, and Effectiveness. Arch Pathol Lab Med 2023; 147:227-235. [PMID: 35687790 DOI: 10.5858/arpa.2021-0115-ep] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Physicians face a high rate of burnout, especially during the residency training period when trainees often experience a rapid increase in professional responsibilities and expectations. Effective burnout prevention programs for resident physicians are needed to address this significant issue. OBJECTIVE.— To examine the content, format, and effectiveness of resident burnout interventions published in the last 10 years. DESIGN.— The literature search was conducted on the MEDLINE database with the following keywords: internship, residency, health promotion, wellness, occupational stress, burnout, program evaluation, and program. Only studies published in English between 2010 and 2020 were included. Exclusion criteria were studies on interventions related to the COVID-19 pandemic, studies on duty hour restrictions, and studies without assessment of resident well-being postintervention. RESULTS.— Thirty studies were included, with 2 randomized controlled trials, 3 case-control studies, 20 pretest and posttest studies, and 5 case reports. Of the 23 studies that used a validated well-being assessment tool, 10 reported improvements postintervention. These effective burnout interventions were longitudinal and included wellness training (7 of 10), physical activities (4 of 10), healthy dietary habits (2 of 10), social activities (1 of 10), formal mentorship programs (1 of 10), and health checkups (1 of 10). Combinations of burnout interventions, low numbers of program participants with high dropout rates, lack of a control group, and lack of standardized well-being assessment are the limitations identified. CONCLUSIONS.— Longitudinal wellness training and other interventions appear effective in reducing resident burnout. However, the validity and generalizability of the results are limited by the study designs.
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Affiliation(s)
- Fang-I Lu
- From the Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Lu).,From the Departments of Laboratory Medicine and Pathobiology (Lu), University of Toronto, Toronto, Ontario, Canada
| | - Savithiri Ratnapalan
- From the Department of Paediatrics (Ratnapalan), University of Toronto, Toronto, Ontario, Canada.,From the Dalla Lana School of Public Health (Ratnapalan), University of Toronto, Toronto, Ontario, Canada.,From the Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (Ratnapalan)
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Shah HP, Salehi PP, Ihnat J, Kim DD, Salehi P, Judson BL, Azizzadeh B, Lee YH. Resident Burnout and Well-being in Otolaryngology and Other Surgical Specialties: Strategies for Change. Otolaryngol Head Neck Surg 2023; 168:165-179. [PMID: 35133919 DOI: 10.1177/01945998221076482] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/07/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To perform a literature review on burnout prevalence, factors that affect burnout and well-being, and solutions to address burnout in otolaryngology-head and neck surgery (OTO-HNS) residents and residents in other surgical specialties. DATA SOURCES Ovid Medline, Embase, and article reference lists. REVIEW METHODS A literature search was performed to identify articles on resident burnout, distress, wellness, well-being, and quality of life. Articles deemed outside the scope of the current work were excluded. Search was limited to the past 5 years. CONCLUSIONS Moderate to high burnout has been reported in 35% to 86% of OTO-HNS residents. Among other surgical specialties, resident burnout ranges between 58% and 66% in plastics, 11% and 67% in neurosurgery, 38% and 68% in urology, and 31% and 56% in orthopedics. Highest burnout rates were seen in postgraduate year 2 residents. Factors significantly associated with burnout included hours worked (>80 h/wk), level of autonomy, exercise, and program support. Reported resident work hours have steadily increased: 8% of OTO-HNS residents in 2005 vs 26% in 2019 reported averaging >80 h/wk. Practical implications of resident burnout include decreased empathy, moral distress and injury, poor health, decreased quality of life, increased attrition, decreased desire to pursue fellowship, and increased likelihood of medical errors. Structured mentorship programs, wellness initiatives, and increased ancillary support have been associated with lower burnout rates and improvements in resident well-being across specialties. IMPLICATIONS FOR PRACTICE Addressing burnout, which is prevalent in OTO-HNS residents, is critical to improving patient care and physician well-being. Surgical specialties can share strategies to effectively address resident burnout through institutional interventions, which can be essential quality improvement initiatives, to promote well-being.
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Affiliation(s)
- Hemali P Shah
- Connecticut Department of Surgery, Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Parsa P Salehi
- Connecticut Department of Surgery, Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jacqueline Ihnat
- Connecticut Department of Surgery, Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - David D Kim
- Connecticut Department of Surgery, Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Pauniz Salehi
- College of Human Ecology, Department of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Benjamin L Judson
- Connecticut Department of Surgery, Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Babak Azizzadeh
- Center for Advanced Facial Plastic Surgery, Beverly Hills, California, USA.,Department of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Yan Ho Lee
- Connecticut Department of Surgery, Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Lee MJ, Nho WY, Jung H, Cho JW, Seo JS, Lee HM, Cho KH, Kim YJ, Kim JK. High prevalence of depression and sleep-wake disorders among female emergency medicine residents in South Korea. Ann Med 2022; 54:846-855. [PMID: 35348012 PMCID: PMC8967212 DOI: 10.1080/07853890.2022.2053568] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Depression and sleep-wake disorders are recognized as one of the major problems among emergency physicians. While depression is more common in females than in males, the associated factors linking depression and sleep-wake disorders in emergency physicians, particularly females, remain unknown. OBJECTIVE To analyze the prevalence of depression and sleep-wake problems among emergency medicine (EM) residents in South Korea and to identify the gender differences and situations that adversely predispose female residents to mental health problems. METHODS We conducted a cross-sectional analysis using the data collected from the 2019 National EM Residents Wellness Survey targeting all of 630 EM residents in South Korea. The survey included variables potentially influencing depression and sleep-wake problems, such as personal characteristics, work-related stress, and extrinsic environment. Information regarding medical conditions, depression, job stress, and sleep deprivation was obtained using the self-administered Patient Health Questionnaire (PHQ-9), the Apgar Wellness Score (AWS), and the Epworth Sleepiness Scale (ESS). We analyzed the data using IBM SPSS Statistics version 25 and MedCalc version 17. RESULTS A total of 384 residents participated in the survey. Overall, 27.5% of the EM residents met the criteria for at least moderate depression and 36.9% of the EM residents had sleep-related problems. We found that difficulty in trading the shift schedule and frequent night shifts was associated with depression (p = .001, p = .005; respectively). Female residents demonstrated an increased risk of depression and sleepiness compared to their male counterparts (odds ratio [OR] 1.95, OR 1.81; respectively). In addition, logistic regression analysis revealed significant differences by gender in depression with regards to flexibility of trading shifts (p = .005), level of training in the emergency medical centre (p = .035), and frequent night shifts (p = .010). CONCLUSIONS Approximately, one-third of EM residents report depression and sleep-wake problems, with female residents showing a higher risk than male residents. Several risk factors were identified, and future strategies should be aimed to address these issues to improve the training environment and overall wellbeing of EM residents.KEY MESSAGESThe prevalence of depression and sleep-related problems were, respectively, 1.95 and 1.81 times higher in female residents compared to their male colleagues.The associated risk factors for depression were flexibility of shift trade, level of training in the emergency medical centre, and frequency of night shifts.Improving the training environment and facilities, as well as offering more flexible duty trading options can provide potential opportunities to reduce the risk.
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Affiliation(s)
- Mi Jin Lee
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Woo Young Nho
- Department of Emergency Medicine, CHA Gumi Medical Center, CHA University, Gumi, South Korea
| | - Haewon Jung
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jae Wan Cho
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jun Seok Seo
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Seoul, South Korea
| | - Hyung Min Lee
- Department of Emergency Medicine, Kyung Hee Medical Center, Kyung Hee University, Seoul, South Korea
| | - Kwang Hyun Cho
- Department of Emergency Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Yun Jeong Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jong Kun Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
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Storm K, Kelly G, Kottapalli A, Kaissieh D, Osio V, Zoorob D. Published Support for Wellness, Diversity, Equity, and Inclusion Among Internal Medicine Residency Program Websites. Cureus 2022; 14:e29328. [PMID: 36277535 PMCID: PMC9580599 DOI: 10.7759/cureus.29328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: The objective of this study was to review internal medicine residency program websites in the United States based on their published support for wellness, diversity, equity, and inclusion concepts. Inclusion of wellness, diversity, equity, and inclusion on program websites can serve as critical student benchmarks, and it may be paramount to optimize residency program websites accordingly. Methods: This is a cross-sectional study of the websites of 597 internal medicine residency programs accredited by the Accreditation Council for Graduate Medical Education between March 25 and April 25, 2022. The websites were assessed based on 22 characteristics consisting of wellness verbiage, gender and underrepresented in medicine evaluation of faculty and residents, and diversity, equity, and inclusion-related semantics. Website photos were used to assess ethnic/sex representation. These attributes were devised by two sequentially set up focus groups consisting of 49 racially, ethnically, and gender-diverse medical students. Results: A total of 579 internal medicine programs were reviewed. Only 239 (41%) had a dedicated page for resident wellness activities and efforts, while 134 (19%) had no mention of the concept throughout their web pages. Similarly, only 136 (23%) had a dedicated wellness officer, whether faculty or resident, who was focused on departmental interests. Gender diversity could be determined in 445 (77%) and 459 (79%) websites for faculty and residents, respectively. Underrepresented in medicine faculty and residents was noted in 293 (51%) and 393 (68%) of websites, respectively. A diversity, equity, and inclusion section was present in 172 (30%) of programs, with 93 (16%) having an assigned faculty or resident. Chairpersons or program directors stressed diversity, equity, and inclusion in up to 456 (79%) of the websites, with 181 (31%) having program mission statements or goals that include diversity, equity, and inclusion verbiage. Conclusion: A deficit of various essential wellness, diversity, equity, and inclusion attributes persists across internal medicine residency websites. Residency programs would benefit from optimizing their websites to attract more diverse applicants.
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Ares WJ, Jankowitz BT, Kan P, Spiotta AM, Nakaji P, Wilson JD, Fargen KM, Ramos E, Leonardo J, Grandhi R. The neurosurgical marriage: evaluating the interplay of work life and home life from the perspective of partners of neurosurgical residents. J Neurosurg 2022; 138:1139-1146. [PMID: 36087329 DOI: 10.3171/2022.7.jns221493] [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: 06/24/2022] [Accepted: 07/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Burnout and work-life balance have been noted to be problems for residents across all fields of medicine, including neurosurgery. No studies to date have evaluated how these factors may contribute to issues outside of the hospital, specifically residents' home lives. This study aimed to evaluate the interplay between home life and work life of neurosurgical residents, specifically from the point of view of residents' significant others. METHODS Online surveys were distributed to the significant others of neurosurgical residents at 12 US neurosurgery residencies. Residents' partners were asked about relationship dynamics, their views on neurosurgery residency (work-life balance and burnout), and their views of neurosurgery as a career. RESULTS The majority of residents' significant others (84%) reported being satisfied with their relationship. Significant others who reported dissatisfaction with their relationship were more likely to report frustration with work-life balance and more likely to report their resident partner as having higher levels of burnout. CONCLUSIONS From the perspective of neurosurgery residents' significant others, higher perceived levels of burnout and lower satisfaction with work-life balance are correlated with lower levels of relationship satisfaction. These findings speak to the complex interplay of work life and home life and can be used to inform future interventions into improving the quality of life for both the resident and the significant other.
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Affiliation(s)
- William J Ares
- 1Department of Neurosurgery, Northshore University HealthSystem, Evanston, Illinois
| | - Brian T Jankowitz
- 2Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter Kan
- 3Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas
| | - Alejandro M Spiotta
- 4Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Peter Nakaji
- 5Department of Neurosurgery, Banner University Medical Center, Phoenix, Arizona
| | - Jason D Wilson
- 6Department of Neurosurgery, Louisiana State University Health, New Orleans, Louisiana
| | - Kyle M Fargen
- 7Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Edwin Ramos
- 8Division of Neurosurgery, University of Chicago Medicine, Chicago, Illinois
| | - Jody Leonardo
- 9Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania; and
| | - Ramesh Grandhi
- 10Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah
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Redinger J, Kabil E, Forkin KT, Kleiman AM, Dunn LK. Resting and Recharging: A Narrative Review of Strategies to Improve Sleep During Residency Training. J Grad Med Educ 2022; 14:420-430. [PMID: 35991104 PMCID: PMC9380640 DOI: 10.4300/jgme-d-21-01035.1] [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: 10/21/2021] [Revised: 01/21/2022] [Accepted: 05/31/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Residency involves demanding training with long hours that may cause fatigue and sleep deprivation and adversely impact residents and patients under their care. OBJECTIVE To identify, using a narrative review, evidence-based interventions to reduce the physiologic effects of fatigue and sleep deprivation from overnight and night shift work. METHODS A PubMed literature search was conducted through August 30, 2021, using the terms "resident" and "sleep" in the title or abstract and further narrowed using a third search term. Observational studies, randomized controlled trials, systematic reviews, and meta-analyses of human subjects written and published in English were included. Studies that were not specific to residents or medical interns or did not investigate an intervention were excluded. Additional studies were identified by bibliography review. Due to the heterogeneity of study design and intervention, a narrative review approach was chosen with results categorized into non-pharmacological and pharmacological interventions. RESULTS Initially, 271 articles were identified, which were narrowed to 28 articles with the use of a third search term related to sleep. Bibliography review yielded 4 additional articles. Data on interventions are limited by the heterogeneity of medical specialty, sample size, length of follow-up, and reliance on self-report. Non-pharmacological interventions including strategic scheduling and sleep hygiene may improve sleep and well-being. The available evidence, including randomized controlled trials, to support pharmacological interventions is limited. CONCLUSIONS Non-pharmacological approaches to mitigating fatigue and sleep deprivation have varying effectiveness to improve sleep for residents; however, data for pharmacological interventions is limited.
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Affiliation(s)
- Joyce Redinger
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Joyce Redinger, MD, is PGY-3 Resident
| | - Emmad Kabil
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Emmad Kabil, MD, is PGY-4 Resident
| | - Katherine T. Forkin
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Katherine T. Forkin, MD, is Associate Professor of Anesthesiology
| | - Amanda M. Kleiman
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Amanda M. Kleiman, MD, is Associate Professor of Anesthesiology
| | - Lauren K. Dunn
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Lauren K. Dunn, MD, PhD, is Associate Professor of Anesthesiology and Neurological Surgery
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Ahart ER, Gilmer L, Tenpenny K, Krase K. Improving resident well-being: a narrative review of wellness curricula. Postgrad Med J 2022:postgradmedj-2022-141541. [PMID: 35853712 DOI: 10.1136/postgradmedj-2022-141541] [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: 01/10/2022] [Accepted: 05/14/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND To improve wellness among residents, many graduate medical education programs have implemented formal wellness curricula. Curricular development has recently shifted focus from drivers of burnout to promotion of wellness. The specific components of successful wellness curricula, however, are not yet well defined. OBJECTIVE To review the published literature assessing core components of wellness curricula in graduate medical education programs. METHODS Searches were conducted through June 2020 in PubMed, Education Resources Information Center, Google Scholar and Web of Science using the search terms wellness curricula, wellness programs, well-being and graduate medical education. Additional articles were identified from reference lists. Curricula from primarily undergraduate medical education, singular interventions, non-peer-reviewed studies and non-English language studies were excluded. RESULTS Eighteen articles were selected and reviewed by three authors. Critical drivers of success included support from program leadership and opportunities for resident involvement in the curriculum implementation. Most curricula included interventions related to both physical and mental health. Curricula including challenging components of professionalisation, such as critical conversations, medical errors and boundary setting, seemed to foster increased resident buy-in. The most frequently used curricular assessment tools were the Maslach Burnout Inventory and resident satisfaction surveys. CONCLUSIONS Different specialties have different wellness needs. A resource or 'toolbox' that includes a variety of general as well as specialty-specific wellness components might allow institutions and programs to select interventions that best suit their individual needs. Assessment of wellness curricula is still in its infancy and is largely limited to single institution experiences.
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Affiliation(s)
- Erin R Ahart
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Lisa Gilmer
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kelsey Tenpenny
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kelli Krase
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas, USA
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15
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Rath CG, Lapetina PE, Reed J, Vogt E, Brown M. Roadmap to resilience: Incorporating a wellness program into the pharmacy residency curriculum. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:751-757. [PMID: 35809905 DOI: 10.1016/j.cptl.2022.06.006] [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: 09/19/2021] [Revised: 03/08/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND PURPOSE In recent years, wellness initiatives across various health professions have prompted national pharmacy organizations to prioritize pharmacist well-being. Pharmacy residency programs present ideal platforms to foster wellness practices among new pharmacy practitioners. By describing the components and implementation of the Resident Wellness Program at an academic medical center, we aim to guide other institutions in facilitating wellness activities for pharmacy trainees. EDUCATIONAL ACTIVITY AND SETTING The Resident Wellness Program was implemented in 2019 and provides pharmacy residents with a structured framework of wellness activities intended to promote mental and physical health and prevent burnout. Feedback surveys and written reflections have provided initial evidence of the program's value in enhancing resident well-being. FINDINGS A qualitative analysis of surveys and reflections highlights the program's positive impact, with more than 90% of participants indicating that the program met their needs and promoted self-development. Perspectives from residents and administrators identified key strengths, including the structured nature of sessions and diversity of wellness topics. Opportunities for improvement include teaching participants to apply practical wellness strategies and refining topics to align with residents' interests. As the program evolves, a formal analysis via standardized surveys and an assessment of longitudinal impact will support continued enhancement. SUMMARY The implementation of a pharmacy resident wellness program provides an opportunity to promote well-being and work performance. By engaging in similar initiatives, other institutions can mirror the commitment of national pharmacy organizations and contribute to a culture of wellness among pharmacy residents and the greater pharmacy workforce.
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Affiliation(s)
- Carolyn G Rath
- University of California, San Francisco Medical Center, 533 Parnassus Avenue, Box 0622, San Francisco, CA 94143, United States.
| | - Pablo E Lapetina
- University of California, San Francisco Medical Center, 533 Parnassus Avenue, Box 0622, San Francisco, CA 94143, United States.
| | - Julie Reed
- University of California, San Francisco School of Pharmacy, 513 Parnassus Avenue, Box 0150, San Francisco, CA 94143, United States.
| | - Eleanor Vogt
- University of California, San Francisco School of Pharmacy, 513 Parnassus Avenue, Box 0150, San Francisco, CA 94143, United States.
| | - Mandy Brown
- University of California, San Francisco Medical Center, 533 Parnassus Avenue, Box 0622, San Francisco, CA 94143, United States.
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Petrone S, Cofano F, Nicolosi F, Spena G, Moschino M, Di Perna G, Lavorato A, Lanotte MM, Garbossa D. Virtual-Augmented Reality and Life-Like Neurosurgical Simulator for Training: First Evaluation of a Hands-On Experience for Residents. Front Surg 2022; 9:862948. [PMID: 35662818 PMCID: PMC9160654 DOI: 10.3389/fsurg.2022.862948] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/04/2022] [Indexed: 12/01/2022] Open
Abstract
Background In the recent years, growing interest in simulation-based surgical education has led to various practical alternatives for medical training. More recently, courses based on virtual reality (VR) and three-dimensional (3D)-printed models are available. In this paper, a hybrid (virtual and physical) neurosurgical simulator has been validated, equipped with augmented reality (AR) capabilities that can be used repeatedly to increase familiarity and improve the technical skills in human brain anatomy and neurosurgical approaches. Methods The neurosurgical simulator used in this study (UpSurgeOn Box, UpSurgeOn Srl, Assago, Milan) combines a virtual component and a physical component with an intermediate step to provide a hybrid solution. A first reported and evaluated practical experience on the anatomical 3D-printed model has been conducted with a total of 30 residents in neurosurgery. The residents had the possibility to choose a specific approach, focus on the correct patient positioning, and go over the chosen approach step-by-step, interacting with the model through AR application. Next, each practical surgical step on the 3D model was timed and qualitatively evaluated by 3 senior neurosurgeons. Quality and usability-grade surveys were filled out by participants. Results More than 89% of the residents assessed that the application and the AR simulator were very helpful in improving the orientation skills during neurosurgical approaches. Indeed, 89.3% of participants found brain and skull anatomy highly realistic during their tasks. Moreover, workshop exercises were considered useful in increasing the competency and technical skills required in the operating room by 85.8 and 84.7% of residents, respectively. Data collected confirmed that the anatomical model and its application were intuitive, well-integrated, and easy to use. Conclusion The hybrid AR and 3D-printed neurosurgical simulator could be a valid tool for neurosurgical training, capable of enhancing personal technical skills and competence. In addition, it could be easy to imagine how patient safety would increase and healthcare costs would be reduced, even if more studies are needed to investigate these aspects. The integration of simulators for training in neurosurgery as preparatory steps for the operating room should be recommended and further investigated given their huge potential.
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Affiliation(s)
- Salvatore Petrone
- Department of Neuroscience “Rita Levi Montalcini”—Unit of Neurosurgery, University of Turin, Turin, Italy
| | - Fabio Cofano
- Department of Neuroscience “Rita Levi Montalcini”—Unit of Neurosurgery, University of Turin, Turin, Italy
- Humanitas Gradenigo, Turin, Italy
| | - Federico Nicolosi
- Dipartimento di Medicina e Chirurgia - Neurochirurgia, Università degli Studi di Milano Bicocca, Milan, Italy
| | - Giannantonio Spena
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | | | - Giuseppe Di Perna
- Department of Neuroscience “Rita Levi Montalcini”—Unit of Neurosurgery, University of Turin, Turin, Italy
- *Correspondence: Giuseppe Di Perna
| | - Andrea Lavorato
- Department of Neuroscience “Rita Levi Montalcini”—Unit of Neurosurgery, University of Turin, Turin, Italy
| | - Michele Maria Lanotte
- Department of Neuroscience “Rita Levi Montalcini”—Unit of Neurosurgery, University of Turin, Turin, Italy
| | - Diego Garbossa
- Department of Neuroscience “Rita Levi Montalcini”—Unit of Neurosurgery, University of Turin, Turin, Italy
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Maisner RS, Kapadia K, Keenan E, Ravikumar V, Ayyala HS, Lee ES. A Social Media Analysis of Wellness Culture in Plastic Surgery Residency. Ann Plast Surg 2022; 88:S250-S256. [PMID: 35513328 DOI: 10.1097/sap.0000000000003191] [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: 11/26/2022]
Abstract
BACKGROUND Burnout, "a psychological syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment", afflicts approximately one third of plastic surgery attending surgeons and residents. Burnout can be detrimental to resident training and patient outcomes. Therefore, cultivating wellness during residency is essential. In fact, the Accreditation Council for Graduate Medical Education requires residency programs to create learning and working environments that optimize faculty and resident wellness. With increasing social media use by plastic surgery residency programs, this study aimed to analyze their posts for wellness-related content. METHODS Integrated plastic surgery residency programs were obtained from the American Council of Academic Plastic Surgeons Web site, and their associated social media accounts were identified. The authors reviewed all post images, captions, and comments made by the program's account, until July 3, 2021. Any hashtags relating to wellness were also recorded. RESULTS Of 82 programs, 76 (92.7%) had active Instagram accounts, 31 (37.8%) had active Facebook accounts, and 30 (36.6%) had active Twitter accounts. Instagram had higher rates of engagement than Facebook and Twitter (P < 0.001). Across all platforms, the mean percent of total posts related to wellness was 18.87%. The most common wellness content showcased resident work-life balance (48.73%), followed by educational events incorporating wellness activities (27.61%), attention to physical health (17.71%), healthy work environments (5.29%), wellness-specific activities (3.25%), team building activities (2.40%), and images implying but not directly showing resident wellness (1.46%). Programs did not vary significantly in percentages of total posts related to wellness by geographic region, ranking, or accreditation length. In total, 1893 wellness-related hashtags were used on Instagram, 253 on Facebook, and 72 on Twitter. The most used wellness-related hashtag was #residentlife. Only 40.8% to 50.8% of posts using wellness hashtags met at least 1 wellness criterion. CONCLUSION Despite the importance of burnout prevention during plastic surgery residency, less than a quarter of residency program social media content promote wellness. Social media can demonstrate how residency programs are incorporating wellness into their curricula, but whether residencies lack sufficient wellness initiatives or are not advertising such programming on their social media accounts remains to be studied.
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Affiliation(s)
- Rose S Maisner
- From the Division of Plastic and Reconstructive Surgery, Rutgers-New Jersey Medical School, Newark, NJ
| | - Kailash Kapadia
- From the Division of Plastic and Reconstructive Surgery, Rutgers-New Jersey Medical School, Newark, NJ
| | - Emily Keenan
- From the Division of Plastic and Reconstructive Surgery, Rutgers-New Jersey Medical School, Newark, NJ
| | - Vaishali Ravikumar
- From the Division of Plastic and Reconstructive Surgery, Rutgers-New Jersey Medical School, Newark, NJ
| | - Haripriya S Ayyala
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edward S Lee
- From the Division of Plastic and Reconstructive Surgery, Rutgers-New Jersey Medical School, Newark, NJ
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Wellness in Graduate Surgical Medical Education. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schmeusser B, Gauthier Z, Nagy K. Assessment of Resident Burnout After Formalization of Wellness Program. Mil Med 2022; 188:usac004. [PMID: 35043956 DOI: 10.1093/milmed/usac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/01/2021] [Accepted: 01/10/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Burnout has reached epidemic levels among resident physicians. Characterized by emotional exhaustion (EE), depersonalization, and feelings of inefficacy, burnout negatively affects patient outcomes, increases costs, and decreases physician quality of life. These negative outcomes catalyze leaders in graduate medical education to address burnout and reverse its trends. The primary aim of this project is to design a residency Wellness Program utilizing the facets of physician wellness, assess levels of burnout among resident physicians, and determine the program's effects on burnout. MATERIALS AND METHODS A Wellness Program was formalized at a Midwestern, military-civilian Obstetrics and Gynecology residency program for the 2019-2020 academic year. Resident wellness and perceptions were assessed at three time points (0, 6, and 12 months) through surveys consisting of free response, yes-no questions, and the Maslach Burnout Inventory Scales. RESULTS On average, 17 of 24 residents completed all three survey assessments. Perception of the residency program prioritization of wellness increased significantly from 52.9% to 94.4% (P = .007). Residents consistently demonstrated burnout throughout the year with low levels of EE, high levels of depersonalization, and moderate levels of personal achievement. Residents were consistently satisfied with their personal wellness (80%-92.9%) during the program. Residents wanted to see physical activity incorporated into the program. CONCLUSIONS This study assessed burnout during a formalization of a Wellness Program and insight on resident perceptions and wellness requests. Military medicine, graduate medical education, and other residency programs can utilize this research to better develop and study the implementation of wellness initiatives aimed at reducing burn out.
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Hameed TK, Al Dubayee MS, Masuadi EM, Al-Anzi FG, Al Asmary NA. Prevalence of depressive symptoms and excessive daytime sleepiness in a cohort of Saudi doctors under training: A cross sectional study. J Taibah Univ Med Sci 2021; 16:695-699. [PMID: 34690649 PMCID: PMC8498694 DOI: 10.1016/j.jtumed.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives Recent studies have highlighted an increasing prevalence of depression and sleep problems among physicians during their residency training in the medical field. The study aims to explore the prevalence of depressive symptoms and sleepiness among the residents of different medical specialties in the two regions of KSA and describe the factors that potentially cause depression and sleepiness. Methods A survey was distributed to the residents of King Abdulaziz Medical City in the Riyadh province, and to the residents of King Fahad Specialist Hospital Buraidah and Maternity and Children's Hospital Buraidah in the Qassim province. The Patients' Health Questionnaire-2 was used to determine the prevalence of depression and the Epworth Sleepiness Scale was used to measure sleepiness. Results One hundred and eighty-one residents completed the survey. While depressive symptoms were prevalent among 93% of the residents, 49% of the residents reported excessive daytime sleepiness. Depressive symptoms were more common in the residents of King Abdulaziz Medical City, with the prevalence being 94.5%. There was a significant association between depressive symptoms and excessive sleepiness (p = 0.046). Conclusion Depressive symptoms and excessive sleepiness are highly prevalent in postgraduate trainees. Residents with depression were found to be sleepier during their work. Given the negative effect on patient safety, the high prevalence of both depressive symptoms and sleepiness is alarming. There is an urgent need to improve residents' wellness through well-structured well-being programs.
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Affiliation(s)
- Tahir K Hameed
- Department of Pediatrics, King Abdulaziz Medical City, Ministry of the National Guard - Health Affairs, King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA
| | - Mohammed S Al Dubayee
- Department of Pediatrics, King Abdulaziz Medical City, Ministry of the National Guard - Health Affairs, King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA
| | - Emad M Masuadi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA
| | | | - Nejoud A Al Asmary
- Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, KSA
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Kelly PD, Yengo-Kahn AM, Roth SG, Zuckerman SL, Chitale RV, Wellons JC, Chambless LB. Data-Driven Residency Training: A Scoping Review of Educational Interventions for Neurosurgery Residency Programs. Neurosurgery 2021; 89:750-759. [PMID: 34423828 DOI: 10.1093/neuros/nyab322] [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: 03/02/2021] [Accepted: 07/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neurosurgery residency programs are tasked with imparting large volumes of both clinical knowledge and technical skill to trainees in limited time. Many investigators have described local practices, which may offer evidence-based interventions in neurosurgical residency education, but this literature has not been systematically reviewed. OBJECTIVE To perform a scoping review of educational practices in neurosurgery, which are supported by quantitative, peer-reviewed research. METHODS A scoping review of the literature was performed. PubMed, Embase, and Web of Science databases were queried for articles describing educational interventions for neurosurgery residents, which included a quantitative assessment of the effect on resident performance. RESULTS From an initial set of 1785 unique articles, 29 studies were ultimately screened and included. Studies were into the following 6 topics: (1) didactics and curricula (n = 13), (2) nontechnical skills (n = 6), (3) wellness and burnout (n = 4), (4) assessment and feedback (n = 2), (5) mentorship and career development (n = 2), and (6) research (n = 2). Individual study results were described. CONCLUSION Several educational interventions in neurosurgical training are supported by quantitative evidence. Methodological shortcomings are prevalent among studies of education, particularly in the selection of meaningful outcome measures. A summary of evidence-based considerations is provided for current and future program directors.
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Affiliation(s)
- Patrick D Kelly
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aaron M Yengo-Kahn
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rohan V Chitale
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John C Wellons
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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22
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Team Sport Participation Protects Against Burnout During Neurosurgery Training: Cross-Sectional Survey Study. World Neurosurg 2021; 156:e104-e110. [PMID: 34506980 DOI: 10.1016/j.wneu.2021.08.146] [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: 07/10/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Burnout is experienced by up to two thirds of neurosurgery residents. Team sport participation as an adolescent protects against adverse mental health outcomes in adulthood. The objective of this study was to determine whether high school or collegiate team sport participation is associated with improved psychological well-being during neurosurgery residency. METHODS A cross-sectional survey study of U.S. neurosurgery residents was conducted between June 2020 and February 2021. Outcomes included self-ratings of sadness, anxiety, stress, burnout, optimism, and fulfillment, on 100-point scales, which were averaged into a "Burnout Composite Score" (BCS). Respondents were grouped and compared according to their prior self-reported participation in team sports (participants vs. nonparticipants). A 3-way analysis of variance tested the effects of resident level, exercise days, and team sport participation on BCS. RESULTS Of 229 submitted responses, 228 (99.5%) provided complete data and 185 (81.1%) residents participated in team sports. Days/week of exercise was similar across groups (2.5 ± 1.8 vs. 2.1 ± 1.8, P = 0.20). The team sport group reported lower mean BCS (37.1 vs. 43.6 P = 0.030, Cohen d = 0.369). There was a significant interaction between prior team sport participation and exercise regimen on BCS (F [3, 211] = 3.39, P = 0.019, n2 = 0.046), such that more exercise days per week was associated with decreased BCS for prior team sport athletes (F [3, 211] = 11.10, P < 0.0005), but not for nonparticipants (F [3, 211] = 0.476, P = 0.699). The positive impact of prior team sport participation was more pronounced for senior residents (-11.5 points, P = 0.016) than junior residents (-4.3 points, P = 0.29). CONCLUSIONS Prior team sport participation was associated with lower BCS among neurosurgery residents, an effect more pronounced during senior residency. Lessons imparted during early team sport experience may have profound impacts on reducing burnout throughout a 7-year neurosurgery residency.
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Rutka JT. Editorial. Neurosurgery training and the One Neurosurgery Summit: all for one, and one for all. J Neurosurg 2021. [PMID: 34359023 DOI: 10.3171/2020.12.jns203671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Grome LJ, Reul RM, Agrawal N, Abu-Ghname A, Winocour S, Buchanan EP, Maricevich RS, Reece EM. A Systematic Review of Wellness in Plastic Surgery Training. Aesthet Surg J 2021; 41:969-977. [PMID: 32596712 DOI: 10.1093/asj/sjaa185] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Physician and resident wellness has been increasingly emphasized as a means of improving patient outcomes and preventing physician burnout. Few studies have been performed with a focus on wellness in plastic surgery training. OBJECTIVES The aim of this study was to systematically review what literature exists on the topic of wellness in plastic surgery training and critically appraise it. METHODS A PubMed search was performed to identify journal articles related to wellness in plastic surgery residency. Seventeen studies (6 cohort and 11 cross-sectional) met inclusion criteria and were appraised with the Newcastle-Ottawa Quality Assessment Scale (NOQAS) to determine the quality of the studies based on selection, comparability, and outcome metrics. RESULTS Critical assessment showed that the studies were highly variable in focus. Overall, the quality of the data was low, with an average NOQAS score of 4.1. Only 2 studies focused on plastic surgery residents, examining work hours and social wellness, respectively; they were awarded NOQAS scores of 3 and 4 out of 10. CONCLUSIONS The results of this systematic review suggest that little research has been devoted to wellness in surgery training, especially in regard to plastic surgery residents, and what research that has been performed is of relatively low quality. The available research suggests a relatively high prevalence of burnout among plastic surgery residents. Evidence suggests some organization-level interventions to improve trainee wellness. Because outcomes-based data on the effects of such interventions are particularly lacking, further investigation is warranted.
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Affiliation(s)
- Luke J Grome
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Ross M Reul
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Nikhil Agrawal
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Amjed Abu-Ghname
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Sebastian Winocour
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Edward P Buchanan
- Division of Plastic Surgery, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - Renata S Maricevich
- Division of Plastic Surgery, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - Edward M Reece
- Division of Plastic Surgery, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
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Mackel CE, Nelton EB, Reynolds RM, Fox WC, Spiotta AM, Stippler M. A Scoping Review of Burnout in Neurosurgery. Neurosurgery 2021; 88:942-954. [PMID: 33471896 DOI: 10.1093/neuros/nyaa564] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/04/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Burnout is a negative workplace syndrome of emotional exhaustion, cynicism, and perceived professional inefficacy that risks the patient-provider relationship, patient care, and physician well-being. OBJECTIVE To assimilate the neurosurgical burnout literature in order to classify burnout among domestic and international neurosurgeons and trainees, identify contributory factors, and appraise the impact of wellness programs. METHODS A scoping review identified the available literature, which was reviewed for key factors related to burnout among neurosurgeons. Two researchers queried PubMed, Embase, Google Scholar, Cochrane, and Web of Science for articles on burnout in neurosurgery and reduced 1610 results to 32 articles. RESULTS A total of 32 studies examined burnout in neurosurgery. A total of 26 studies examined prevalence and 8 studies detailed impact of wellness programs. All were published after 2011. Burnout prevalence was measured mostly through the Maslach Burnout Inventory (n = 21). In 4 studies, participants defined their own understanding of "burnout." Domestically, burnout prevalence was 11.2% to 67% among residents and 15% to 57% among attendings. Among trainees, poor operative experience, poor faculty relationships, and social stressors were burnout risks but not age, sex, or marital status. Among attendings, the literature identified financial or legal concerns, lack of intellectual stimulation, and poor work-life balance as risks. The impact of wellness programs on trainees is unclear but group exercises may offer the most benefit. CONCLUSION Noticeable methodological differences in studies on trainee and attending burnout contribute to a wide range of neurosurgery burnout estimates and yield significant knowledge gaps. Environment may have greater impact on trainee burnout than demographics. Wellness programs should emphasize solidarity.
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Affiliation(s)
- Charles E Mackel
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Emmalin B Nelton
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Renée M Reynolds
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | | | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Martina Stippler
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Pascual JSG, Ignacio KHD, Khu KJO. Paving the Path to Wellness: A Systematic Review of Wellness Programs for Neurosurgery Trainees. World Neurosurg 2021; 152:206-213.e5. [PMID: 34146737 DOI: 10.1016/j.wneu.2021.06.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neurosurgical trainees have a heavy workload and poor quality of life, resulting in high rates of burnout and attrition. Consequently, wellness programs have been used by various training institutions to combat this situation. OBJECTIVE We aimed to identify and describe wellness programs available for neurosurgical trainees in their training institutions, the outcome measures used to assess them, and their efficacy. METHODS A systematic review of the literature was made following PRISMA guidelines. RESULTS Six studies were included in the review, describing wellness programs from 9 institutions. All programs except 1 used exercise as the core component. The other components included physical and mental well-being lectures, team-building activities, and cultural excursions. Most institutions used piloted satisfaction and perception questionnaires to assess efficacy. Trainee perceptions of wellness programs were generally positive, but the responses on validated questionnaires and surveys were mixed. Barriers to the program included lack of institutional support, time constraints, fatigue, and feelings of guilt in prioritizing wellness over patient care. CONCLUSIONS There is a paucity of literature regarding trainee wellness in neurosurgery. A few training programs have instituted wellness initiatives for trainees, and the feedback was generally positive. However, objective measures of efficacy such as validated questionnaires and scales yielded mixed results.
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Affiliation(s)
- Juan Silvestre G Pascual
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Katrina Hannah D Ignacio
- Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Kathleen Joy O Khu
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines.
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Beucler N, Sellier A, Desse N, Joubert C, Dagain A. Letter to the Editor. Rethinking the mentorship system in neurosurgery. J Neurosurg 2021; 135:659-660. [PMID: 33578382 DOI: 10.3171/2020.11.jns204050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nathan Beucler
- 1Sainte-Anne Military Teaching Hospital, Toulon, France
- 2Ecole du Val-de-Grâce, French Military Health Service Academy, Paris, France; and
| | | | - Nicolas Desse
- 1Sainte-Anne Military Teaching Hospital, Toulon, France
| | | | - Arnaud Dagain
- 1Sainte-Anne Military Teaching Hospital, Toulon, France
- 3Val-de-Grâce Military Academy, Paris, France
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Eskander J, Rajaguru PP, Greenberg PB. Evaluating Wellness Interventions for Resident Physicians: A Systematic Review. J Grad Med Educ 2021; 13:58-69. [PMID: 33680302 PMCID: PMC7901639 DOI: 10.4300/jgme-d-20-00359.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Wellness initiatives implemented by graduate medical education programs can help mitigate burnout in resident physicians. OBJECTIVE This systematic review seeks to identify factors that impact the effectiveness of resident wellness interventions and to provide a conceptual framework to guide future interventions. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 6 electronic databases were searched in November 2019 using variations of the keywords "resident physicians," "wellness," and "intervention." Peer-reviewed full-text English-language articles on controlled studies were considered for inclusion. The quality of the studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. RESULTS The initial search disclosed 1196 articles, of which 18 studies enrolling 666 resident physicians met inclusion criteria for qualitative review. Interventions using peer support and individual meditation enhanced well-being. Effective wellness interventions also used educational theory to guide program development, surveyed participants to guide intervention design, incorporated programming into existing didactic curricula, and recruited voluntary participants. The quality of most of the included studies was poor (13 of 18, 72%) and could be improved by using standardized wellness assessments supported by validity evidence. CONCLUSIONS This systematic review suggests that future resident wellness initiatives should focus on grounding interventions in educational theory, forging consensus on wellness instruments with validity evidence, and examining the impact of initiatives on patient outcomes. A logic model can provide a framework for designing and implementing effective wellness interventions.
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Diaz Baez Y, Chodakowski JD, Mycyk MB, Kontrick AV. Resident physician perception on how food choice affects wellness and professional development. Am J Emerg Med 2020; 45:602-603. [PMID: 33341324 DOI: 10.1016/j.ajem.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Yudith Diaz Baez
- Department of Emergency Medicine, Cook County Health, Chicago, IL, United States of America.
| | - Jason D Chodakowski
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Mark B Mycyk
- Department of Emergency Medicine, Cook County Health, Chicago, IL, United States of America.
| | - Amy V Kontrick
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
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Academics in the Pandemic: Early Impact of COVID-19 on Plastic Surgery Training Programs. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3320. [PMID: 33299728 PMCID: PMC7722607 DOI: 10.1097/gox.0000000000003320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/21/2020] [Indexed: 11/29/2022]
Abstract
Supplemental Digital Content is available in the text. Background: The COVID-19 global pandemic has impacted plastic surgery training in the United States, requiring unprecedented measures to prepare for potential surges in critically ill patients. This study investigates how plastic surgery programs responded to this crisis, as well as how successful these changes were, through a survey of program directors and of residents at academic training programs in the United States. Methods: Two separate anonymous online surveys were conducted via REDCap between April 16 and June 4, 2020. The first survey was distributed to program directors, and the second was distributed to plastic surgery residents. Resident responses were then subdivided for an analysis between geographic regions. Results: Of the 59 program director responses (43.7%), the majority of programs implemented a platoon approach for resident coverage. A minority did the same for attending coverage. In total, 92% transitioned to virtual didactics only. Plastic surgery residents covered alternative services at 25% of responding institutions, and an additional 68% had a plan in place for responding to personnel shortages. Overall, residents were satisfied with their program’s response in a variety of categories. When subdivided based on geographic region, respondents in the Northeast and Northwest were less satisfied with resident wellness, personal and loved ones’ safety, and program communication. Conclusions: With the possibility of a “second wave,” successful methods of academic programs adapting to the pandemic should be communicated to reduce the future impact. Increased frequency of communications between program directors and residents can improve mental health and wellness of the resident population.
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Ewen AM, Gittus N, Higgins MCSS, Palma S, Whitley K, Schneider JI. Program Administrator Burnout in Graduate Medical Education: a Longitudinal Study. J Gen Intern Med 2020; 35:3248-3253. [PMID: 32399913 PMCID: PMC7661571 DOI: 10.1007/s11606-020-05853-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Little is known about the level of burnout among program administrators (PAs) in medical education and its impact on the trainee environment. OBJECTIVE To investigate variations in burnout levels over a 1-year period among a national cohort of PAs and examine any associations between perceived support and isolation. DESIGN A 1-year longitudinal study conducted to assess burnout levels among PAs across the USA. The Copenhagen Burnout Inventory (score range, 0-100) was used to measure burnout over one academic year (July 2017-June 2018). The generalized estimating equations model was used to measure changes in burnout levels from the start of the academic year. To explore the differences in burnout scores across question response levels, a one-way ANOVA test was utilized and reported as least squares means ± SD. PARTICIPANTS Individuals who self-identified as PAs in a graduate medical education training program. Among the 1084 persons nationwide who expressed interest, 904 (83%) completed the baseline survey; 29 of the 42 (69%) local administrators completed the survey. "Clients" defined as interns, residents/fellows, and medical students. MAIN MEASURES Change in burnout score using the validated tool. Hypothesis formulated prior to data collection. KEY RESULTS Among the 931 participants, the 3rd quarter (March 2018) marked the lowest average personal burnout score (change from the start of academic year, - 3.67; p < 0.001, 95% CI - 5.77 to - 1.58) and work-related burnout score (change, - 3.03; p < 0.001, 95% CI - 5.01 to - 1.06). Client-related burnout was the lowest in September 2017 (change, - 1.46; p = 0.491; 95% CI - 3.54 to 0.62). June 2018: those who strongly agreed to feeling isolated in their current position had an increased personal (69.1 ± 18.4 SD), work-related (72.5 ± 20.8 SD), and client-related (42.3 ± 23.7 SD) burnout score. CONCLUSIONS PA burnout levels fluctuate over the academic year and are shown to increase as feelings of isolation grow.
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Affiliation(s)
- Alana M Ewen
- Graduate Medical Education, Boston Medical Center, Boston, MA, USA
| | - Natalie Gittus
- Medical Education, Baylor University Medical Center, Dallas, TX, USA
| | - Mikhail C S S Higgins
- Division of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Sandra Palma
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Kathryn Whitley
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Jeffrey I Schneider
- Graduate Medical Education, Boston Medical Center, Boston, MA, USA.
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA.
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Berardo L, Gerges C, Wright J, Stout A, Shah H, Papanastassiou A, Kimmell K. Assessment of burnout prevention and wellness programs for US-based neurosurgical faculty and residents: a systematic review of the literature. J Neurosurg 2020; 135:392-400. [PMID: 33126213 DOI: 10.3171/2020.6.jns201531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurosurgeon burnout is a serious and prevalent issue that has been shown to impact professionalism, physician health, and patient outcomes. Interventions targeting physician burnout primarily focus on improving physician wellness. Many academic neurosurgery programs have established wellness curricula to combat burnout and improve wellness. No official recommendations exist for establishing a wellness program that effectively targets sources of burnout. The aim of this review was to examine measures of burnout and report objective results of wellness interventions for neurosurgical faculty and residents. METHODS Two systematic literature reviews were performed in parallel, in accordance with PRISMA 2009 guidelines. Following removal of duplicates, a query of PubMed/MEDLINE, Scopus, Ovid, Cochrane, and EMBASE databases yielded 134 resident-related articles and 208 faculty-related articles for abstract screening. After abstract screening, 17 articles with a primary focus of resident wellness and 10 with a focus on faculty wellness met criteria for full-text screening. Of the total 27 screened articles, 9 (6 resident, 2 faculty, 1 both resident and faculty) met criteria and were included in the final analysis. Article quality was assessed using the Joanna Briggs Institute critical appraisal tools for cohort studies. RESULTS Included studies reported burnout rates for neurosurgery residents of 30%-67%. Work-life imbalance, imbalance of duties, inadequate operative exposure, and hostile faculty were contributors to burnout. The 2 included studies reported burnout rates for neurosurgery faculty members of 27% and 56.7%. Psychosocial stressors, relational stressors, and financial uncertainty were generally associated with increased feelings of burnout. Of the 4 studies reporting on outcomes of wellness initiatives included in this review, 3 reported a positive impact of the wellness interventions and 1 study reported no significant improvement after implementing a wellness initiative. CONCLUSIONS Burnout among neurosurgical faculty and residents is prevalent and permeates the daily lives of neurosurgeons, negatively affecting patient outcomes, career satisfaction, and quality of life. Many neurosurgery programs have instituted wellness programs to combat burnout, but few have published evidence of improvement after implementation. While studies have shown that residents and faculty recognize the importance of wellness and look favorably on such initiatives, very few studies have reported objective outcomes.
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Affiliation(s)
- Laura Berardo
- 1School of Medicine, University of Texas at San Antonio, Texas
| | - Christina Gerges
- 2School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - James Wright
- 2School of Medicine, Case Western Reserve University, Cleveland, Ohio
- 3Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Amber Stout
- 3Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Hamid Shah
- 4Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Kristopher Kimmell
- 6Department of Neurosurgery, Rochester Regional Health and University of Rochester Medical Center, Rochester, New York
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Williams-Karnesky RL, Greenbaum A, Paul JS. Surgery Resident Wellness Programs: The Current State of the Field and Recommendations for Creation and Implementation. Adv Surg 2020; 54:149-171. [PMID: 32713427 DOI: 10.1016/j.yasu.2020.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Alissa Greenbaum
- Department of Surgery, MSC10 5610, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Jasmeet S Paul
- Department of Surgery, MSC10 5610, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA; Division of Acute Care Surgery, Department of Surgery, University of New Mexico, Albuquerque, NM 87131-0001, USA.
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34
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Zaed I, Jaaiddane Y, Chibbaro S, Tinterri B. Burnout Among Neurosurgeons and Residents in Neurosurgery: A Systematic Review and Meta-Analysis of the Literature. World Neurosurg 2020; 143:e529-e534. [PMID: 32777406 PMCID: PMC7413160 DOI: 10.1016/j.wneu.2020.08.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 12/23/2022]
Abstract
Background Burnout syndrome (BS) is a common condition among medical professionals. It is composed of 3 different subdimensions: emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). In the last years, interest in BS in the neurosurgical community has increased. Here we investigated burnout among neurosurgeons and residents in neurosurgery. Methods A systematic review with meta-analysis was performed following PRISMA guidelines. A search of bibliographic databases was conducted from study inception to February 2020. A total of 16,377 studies were found. Six articles were included in our final analysis. Their references were checked for additional studies, but none were found. Results From the initial 16,377 studies identified, only 6 met our inclusion criteria. These studies included a total of 3310 physicians. The general prevalence of BS was 48%. The prevalence in neurosurgeons was 51.1%, higher than that recorded in neurosurgical residents (45.4%). Regarding subdimensions, personal accomplishment seemed to be the most influential factor for burnout development among neurosurgeons (42.57%) and residents (51.56%) alike. Conclusions Neurosurgery is a rewarding career choice, but numerous challenges and stressors can lead to lower levels of satisfaction and dangerously increased levels of burnout. We hope that our results will generate discussion, raise awareness, stimulate further studies, and lead to programs designed to mitigate excessive stress and burnout in neurosurgeons.
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Affiliation(s)
- Ismail Zaed
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - Youssef Jaaiddane
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Management Engineering, Polytechnic University of Milan, Milan, Italy
| | - Salvatore Chibbaro
- Department of Neurosurgery, Strasbourg University Hospitals, Strasbourg, France
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Pennington Z, Lubelski D, Khalafallah AM, Ehresman J, Sciubba DM, Witham TF, Huang J. Letter to the Editor "Changes to Neurosurgery Resident Education Since Onset of the COVID-19 Pandemic". World Neurosurg 2020; 139:734-740. [PMID: 32450312 PMCID: PMC7243785 DOI: 10.1016/j.wneu.2020.05.139] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adham M Khalafallah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Tang OY, Dunn KA, Yoon JS, Ponce FA, Sonntag VK, Lawton MT. Neurosurgery Resident Wellness and Recovery from Burnout: A 39-Year Single-Institution Experience. World Neurosurg 2020; 138:e72-e81. [DOI: 10.1016/j.wneu.2020.01.236] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 10/25/2022]
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Williamson K, Lank PM, Hartman N, Lu DW, Wheaton N, Cash J, Branzetti J, Lovell EO. The Implementation of a National Multifaceted Emergency Medicine Resident Wellness Curriculum Is Not Associated With Changes in Burnout. AEM EDUCATION AND TRAINING 2020; 4:103-110. [PMID: 32313856 PMCID: PMC7163197 DOI: 10.1002/aet2.10391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education Common Program Requirements effective 2017 state that programs and sponsoring institutions have the same responsibility to address well-being as they do other aspects of resident competence. OBJECTIVES The authors sought to determine if the implementation of a multifaceted wellness curriculum improved resident burnout as measured by the Maslach Burnout Inventory (MBI). METHODS We performed a multicenter educational interventional trial at 10 emergency medicine (EM) residencies. In February 2017, we administered the MBI at all sites. A year-long wellness curriculum was then introduced at five intervention sites while five control sites agreed not to introduce new wellness initiatives during the study period. The MBI was readministered in August 2017 and February 2018. RESULTS Of 523 potential respondents, 437 (83.5%) completed at least one MBI assessment. When burnout was assessed as a continuous variable, there was a statistically significant difference in the depersonalization component favoring the control sites at the baseline and final survey administrations. There was also a higher mean personal accomplishment score at the control sites at the second survey administration. However, when assessed as a dichotomous variable, there were no differences in global burnout between the groups at any survey administration and burnout scores did not change over time for either control or intervention sites. CONCLUSIONS In this national study of EM residents, MBI scores remained stable over time and the introduction of a multifaceted wellness curriculum was not associated with changes in global burnout scores.
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Affiliation(s)
- Kelly Williamson
- University of Illinois at ChicagoChicagoIL
- Department of Emergency MedicineAdvocate Christ Medical CenterOak LawnIL
| | - Patrick M. Lank
- Department of Emergency MedicineNorthwestern UniversityFeinberg School of MedicineChicagoIL
| | - Nicholas Hartman
- Department of Emergency Medicine Wake Forest University School of MedicineWinston‐SalemNC
| | - Dave W. Lu
- Tufts University School of MedicineBostonMA
- Department of Emergency MedicineMaine Medical CenterPortlandME
| | - Natasha Wheaton
- Ronald Reagan UCLA Medical CenterLos AngelesCA
- Department of Emergency MedicineUCLALos AngelesCA
| | - Jennifer Cash
- Department of Emergency MedicineSt. Louis UniversitySt. LouisMO
| | - Jeremy Branzetti
- New York University School of Medicine
- NYU Langone HealthNew YorkNY
| | - Elise O. Lovell
- University of Illinois at ChicagoChicagoIL
- Department of Emergency MedicineAdvocate Christ Medical CenterOak LawnIL
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Gaston-Hawkins LA, Solorio FA, Chao GF, Green CR. The Silent Epidemic: Causes and Consequences of Medical Learner Burnout. Curr Psychiatry Rep 2020; 22:86. [PMID: 33247376 PMCID: PMC7695582 DOI: 10.1007/s11920-020-01211-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Clinician burnout has significant socioeconomic, health, and quality of life implications. However, there has been little attention directed at medical students and house officers (i.e., medical learners). This review provides pertinent evidence regarding burnout as it relates to medical learners including risk factors and potential interventions. We conclude with recommendations on future research directions and potential approaches to address this epidemic of medical learner burnout. RECENT FINDINGS Burnout is a significant issue among medical learners that is impacted both by interpersonal and environmental factors. There are points of heightened vulnerability for medical learners throughout their training. However, studies are unable to reach consensus regarding effective interventions to mitigate the impact of burnout. Furthermore, some elements of burnout are not readily reversible even after removing risk factors. Burnout is a significant concern for medical learners with wide-ranging physical, emotional, and psychosocial consequences. However, the current body of literature is sparse and does not provide consistent guidance on how to address burnout in medical learners. It is clear additional attention is needed in understanding burnout among learners and establishing proactive approaches to minimize its negative impact.
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Affiliation(s)
| | - Francisco A Solorio
- Department of Anesthesiology, The University of Toledo College of Medicine & Life Sciences, Toledo, OH, USA
| | - Grace F Chao
- National Clinician Scholars Program (Veterans Affairs), Ann Arbor, MI, USA
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Carmen Renee' Green
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Program for Research on Black Americans, Resource Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Back and Pain Center, Michigan Medicine, Ann Arbor, MI, USA
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Kemper KJ, Schwartz A, Wilson PM, Mahan JD, Schubert CJ, Staples BB, McClafferty H, Serwint JR, Batra M. Burnout in Pediatric Residents: Three Years of National Survey Data. Pediatrics 2020; 145:peds.2019-1030. [PMID: 31843859 DOI: 10.1542/peds.2019-1030] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We aimed to describe the national epidemiology of burnout in pediatric residents. METHODS We conducted surveys of residents at 34 programs in 2016, 43 programs in 2017, and 49 programs in 2018. Survey items included the Maslach Burnout Inventory, demographics, program characteristics, personal qualities, experiences, and satisfaction with support, work-life balance, and learning environment. Analyses included cross-sectional comparisons and cross-sectional and longitudinal regression. RESULTS More than 60% of eligible residents participated; burnout rates were >50% in all years and not consistently associated with any demographic or residency characteristics. Cross-sectional associations were significant between burnout and stress, sleepiness, quality of life, mindfulness, self-compassion, empathy, confidence in providing compassionate care (CCC), being on a high-acuity rotation, recent major medical error, recent time off, satisfaction with support and career choice, and attitudes about residency. In cross-sectional logistic regression analyses, 4 factors were associated with an increased risk of burnout: stress, sleepiness, dissatisfaction with work-life balance, and recent medical error; 4 factors were associated with lower risk: empathy, self-compassion, quality of life, and CCC. Longitudinally, after controlling for 2017 burnout and 2018 risk factors (eg, recent error, sleepiness, rotation, and time off), 2017 quality of life was associated with 2018 burnout; 2017 self-compassion was associated with lower 2018 stress; and 2017 mindfulness, empathy, and satisfaction with learning environment and career choice were associated with 2018 CCC. CONCLUSIONS A majority of residents met burnout criteria. Several identified factors (eg, stress, sleepiness, medical errors, empathy, CCC, and self-compassion) suggest targets for interventions to reduce burnout in future studies.
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Affiliation(s)
- Kathi J Kemper
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio;
| | - Alan Schwartz
- Departments of Medical Education and Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Paria M Wilson
- Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John D Mahan
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | | | - Betty B Staples
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Hilary McClafferty
- Department of Medicine, College of Medicine, University of Arizona, Tucson, Arizona
| | - Janet R Serwint
- Depatrtment of Pediatrics, Johns Hopkins University, Baltimore, Maryland; and
| | - Maneesh Batra
- Division of Neonatology, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
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Hopkins L, Morgan H, Buery-Joyner SD, Craig LB, Everett EN, Forstein DA, Graziano SC, Hampton BS, McKenzie ML, Page-Ramsey SM, Pradhan A, Bliss S. To the Point: a prescription for well-being in medical education. Am J Obstet Gynecol 2019; 221:542-548. [PMID: 31181180 DOI: 10.1016/j.ajog.2019.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
This article is from the "To The Point" series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee. The purpose of this review was to provide an overview of the importance of well-being in medical education. A literature search was performed by a Reference Librarian who used Ovid/MEDLINE to identify scholarly articles published in English on learner well-being, using the search terms "burnout," "resilience," "wellness," and "physicians" between 1946 and January 11, 2019. The accreditation expectations and standards, available assessment tools for learner well-being, existing programs to teach well-being, and some key elements for curriculum development are presented. This is a resource for medical educators, learners, and practicing clinicians from any field of medicine.
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Mari S, Meyen R, Kim B. Resident-led organizational initiatives to reduce burnout and improve wellness. BMC MEDICAL EDUCATION 2019; 19:437. [PMID: 31775717 PMCID: PMC6880512 DOI: 10.1186/s12909-019-1756-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Professional burnout among medical trainees has been identified as a national concern in need of attention. A significant challenge for residency programs is designing and implementing effective strategies to promote resident wellness and reduce burnout. Emerging evidence highlights the importance of developing organizational changes targeting physician burnout. METHODS To address this critical need, Harvard South Shore (HSS) Psychiatry Residency Training Program aimed to assess burnout among residents, identify areas for wellness-related growth, and implement strategies for organizational change to reduce burnout and increase wellness. We aligned closely to the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines to systematically approach planning, conducting, and evaluating this quality improvement effort. We developed a wellness action team and assessed burnout using the Copenhagen Burnout Inventory (CBI). We also conducted a survey to investigate high opportunity areas for wellness-related growth and using this data we designed and implemented four organizational initiatives to (i) improve residents' on-call experience, (ii) increase social activities, (iii) support preventative care, and (iv) promote wellness education. We then re-assessed burnout 1 year after implementation and performed two-sample t-tests to compare CBI scores. We additionally gathered and analyzed feedback from residents on the implemented organizational initiatives' relevance to wellness and their well-being. RESULTS There was an overall clinically meaningful reduction in burnout averaged among all residents that participated. Participants indicated that fitness-oriented activities were most likely to lead to change in wellness habits. CONCLUSION Our implemented wellness program was resident-led and involved continuous feedback from both residents and leadership. Given that there may be multiple factors that affect resident burnout, future studies involving a control group could help reveal whether our intervention contributed to the change in burnout scores we observed.
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Affiliation(s)
- Sundus Mari
- Department of Psychiatry, Child and Adolescent Psychiatry Fellowship, Boston Children’s Hospital, Boston, MA USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Rachel Meyen
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
- Department of Psychiatry, Partners Geriatric Psychiatry Fellowship, Massachusetts General Hospital, Boston, MA USA
| | - Bo Kim
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA USA
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Khan NR, Derstine PL, Gienapp AJ, Klimo P, Barbaro NM. A Survey of Neurological Surgery Residency Program Mentorship Practices Compared to Accreditation Council for Graduate Medical Education Resident Outcome Data. Neurosurgery 2019; 87:E566-E572. [DOI: 10.1093/neuros/nyz479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/28/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Mentorship can be a powerful and life-altering experience during residency training, but there are few articles discussing mentorship models within neurosurgery. In this study, we surveyed US neurosurgical department mentorship practices and linked them to resident outcomes from the Accreditation Council for Graduate Medical Education (ACGME), including resident survey responses, board pass rates, and scholarly activity.
A 19-question survey was conducted from October to December 2017 with the assistance of the Society of Neurological Surgeons. De-identified data were then obtained from the ACGME and correlated to these results. Out of 110 programs, 80 (73%) responded to the survey and gave informed consent. The majority (65%) had a formal mentorship program and assigned mentor relationships based on subspecialty or research interest. Barriers to mentorship were identified as time and faculty/resident “buy-in.” Mentorship programs established for 5 or more years had superior resident ACGME outcomes, such as board pass rates, survey results, and scholarly activity. There was not a significant difference in ACGME outcomes among programs with formal or informal/no mentorship model (P = .17). Programs that self-identified as having an “unsuccessful” mentorship program had significant increases in overall negative resident evaluations (P = .02).
Programs with well-established mentorship programs were found to have superior ACGME resident survey results, board pass rates, and more scholarly activity. There was not a significant difference among outcomes and the different models of formal mentorship practices. Barriers to mentorship, such as time and faculty/resident “buy-in,” are identified.
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Affiliation(s)
- Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Review Committee for Neurological Surgery, Accreditation Council for Graduate Medical Education (ACGME)
| | - Pamela L Derstine
- Review Committee for Neurological Surgery, Accreditation Council for Graduate Medical Education (ACGME)
| | - Andrew J Gienapp
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
- Semmes-Murphey, Memphis, Tennessee
| | - Nicholas M Barbaro
- Review Committee for Neurological Surgery, Accreditation Council for Graduate Medical Education (ACGME)
- Department of Neurosurgery, Indiana University, Indianapolis, Indiana
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Current issues and future directions for vascular surgery training from the results of the 2016-2017 and 2017-2018 Association of Program Directors in Vascular Surgery annual training survey. J Vasc Surg 2019; 70:2014-2020. [PMID: 31147127 DOI: 10.1016/j.jvs.2019.02.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/25/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Surgical training is constantly adapting to better prepare trainees for an evolving landscape of surgical practice. Training in vascular surgery additionally underwent a paradigm shift with the introduction of the integrated training pathway now more than a decade ago. With this study, we sought to characterize the needs and goals of our current vascular surgery trainee population. METHODS The Association of Program Directors in Vascular Surgery Issues Committee compiled a survey to assess demographics, current needs, and goals of trainees and to evaluate trainee distress using a validated seven-item Physician Well-Being Index. The survey was distributed electronically to all current vascular surgery trainees and recent graduates in the academic years 2016-2017 and 2017-2018, and responses were recorded anonymously. RESULTS During the 2 years of the survey, the response rate was 30% (n = 367/1196). The respondents were 55% (n = 202) integrated vascular residents and 45% (n = 165) vascular surgery fellows. In each year of the survey, 60% (n = 102/170) and 58% (n = 86/148) of trainees expressed a desire to pursue academics in their careers, whereas 37% (n = 63/174) and 35% (n = 53/152) indicated their program had structured academic development time (2016-2017 and 2017-2018, respectively). Fifty-five percent (n = 96/174) and 52% (n = 79/152) stated that the overall impact of collaborative learners was positive. More than 60% of respondents in both years of the survey indicated experiencing one or more symptoms of distress on a weekly basis. The frequency of distress was associated with older age and with the presence of an advanced degree in both years of the survey. Sex, level of training, presence of collaborative learners, and having protected research time were not associated with frequency of distress in either year of the survey. CONCLUSIONS These results highlight an opportunity for programs to further evaluate the needs of their trainees for academic development during vascular surgery training to better accommodate trainees' career goals. Further investigation to identify modifiable risk factors for distress among vascular surgery trainees is warranted.
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