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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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Migdanis A, Tsolis K, Migdanis I, Kaltsa AG, Fytsilis FA, Manouras A, Androutsos O, Kapsoritakis A. The Effect of Shift Working on Dietary Patterns of Healthcare Practitioners during the COVID-19 Pandemic: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:627. [PMID: 38674273 PMCID: PMC11051816 DOI: 10.3390/medicina60040627] [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: 03/05/2024] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Health professionals' working schedules often do not allow them to follow a balanced way of life, and the nature of their work can affect their weight and eating habits. The aim of the present study is to shed some light on the impact of night shift working on the dietary practices of healthcare practitioners in Greece. Materials and Methods: This was a cross-sectional study. With the use of an administered questionnaire several parameters were assessed, including anthropometric characteristics, weight history, as well as nutritional habits of the same group of participants during night shifts and when at regular working hours. Moreover, nutritional beliefs of the subjects were recorded, as well as the level of adherence to the Mediterranean diet. Results: It was observed that in all food groups, including water, used to compare the nutritional patterns of the participants during night shifts and when working regular hours, statistical differences were noted (p = 0.001). Furthermore, the participants who reported a higher adherence to the Mediterranean diet and self-reported healthier nutritional habits, had a statistically lower weight compared to the participants that rarely followed the specific model or reported unhealthier eating routine (p = 0.010 and p = 0.015, respectively). Conclusions: We conclude that shift-working healthcare professionals are associated with disturbed eating behaviours leading to the high consumption of unhealthy food. The implementation of interventions that will concentrate on educating health workers on balanced nutrition and improving physical environment (i.e., food availability, healthier food choices) seems to be of great importance.
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Affiliation(s)
- Athanasios Migdanis
- Nutrition and Dietetics Department, University of Thessaly, Argonafton 1C, 42132 Trikala, Greece; (I.M.); (A.M.)
- Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece; (K.T.); (A.K.)
| | - Konstantinos Tsolis
- Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece; (K.T.); (A.K.)
| | - Ioannis Migdanis
- Nutrition and Dietetics Department, University of Thessaly, Argonafton 1C, 42132 Trikala, Greece; (I.M.); (A.M.)
- Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece; (K.T.); (A.K.)
| | - Agoritsa G. Kaltsa
- Department of Gastroenterology, General University Hospital of Larissa, Viopolis Mezourlo, 41110 Larissa, Greece (F.A.F.)
| | - Fotios A. Fytsilis
- Department of Gastroenterology, General University Hospital of Larissa, Viopolis Mezourlo, 41110 Larissa, Greece (F.A.F.)
| | - Athanasios Manouras
- Nutrition and Dietetics Department, University of Thessaly, Argonafton 1C, 42132 Trikala, Greece; (I.M.); (A.M.)
| | - Odysseas Androutsos
- Laboratory of Clinical Nutrition and Dietetics (CND-Lab), Department of Nutrition and Dietetics, University of Thessaly, Argonafton 1C, 42132 Trikala, Greece;
| | - Andreas Kapsoritakis
- Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece; (K.T.); (A.K.)
- Department of Gastroenterology, General University Hospital of Larissa, Viopolis Mezourlo, 41110 Larissa, Greece (F.A.F.)
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Dove JH, Kutschke MJ, Fadale PD, Akelman E. Resilience in Residency and Beyond. JBJS Rev 2023; 11:01874474-202306000-00012. [PMID: 37315162 DOI: 10.2106/jbjs.rvw.22.00242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
» Distinct from the burnout and wellness continuum, resilience is a developed and refined characteristic that propels an individual toward personal and professional success.» We propose a clinical resilience triangle consisting of 3 components that define resilience: grit, competence, and hope.» Resilience is a dynamic trait that should be built during residency and constantly fortified in independent practice so that orthopaedic surgeons may acquire and hone the skills and mental fortitude required to take on the overwhelming challenges that we all inevitably face.
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Affiliation(s)
- James H Dove
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Kosoko AA, Walia S, Huebinger R. Emergency Department Virtual Happy Hour: A Novel Approach to Peer Group Support During a Pandemic. Cureus 2023; 15:e35321. [PMID: 36968906 PMCID: PMC10038650 DOI: 10.7759/cureus.35321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction Communities responded to the coronavirus disease 2019 (COVID-19) pandemic with mandatory social-distancing regulations. Pandemic and disaster research shows that social isolation can often cause negative emotions and medical provider burnout. The primary objective of this study was to create and evaluate a novel wellness program, the Happy Hour Wellness Initiative (HHWI), based on peer support group concepts to foster resilience for emergency healthcare providers in response to a novel disaster. Methods The study was performed at a large emergency department with physicians, advanced practice providers, and staff invited to attend weekly "virtual happy hour" sessions. Participants individually opted into each of the six weekly sessions, with no obligation to attend. The program was designed based on the tenets of a peer support group and implemented by video conferencing. Participants completed a demographic questionnaire and answered open-ended questions after the six-session HHWI ended. Results Of the 40 survey respondents, 30% reported feeling stressed and 40% felt isolated at the early declaration of the pandemic. Regarding the HHWI, 90% of participants had no expectations from the HHWI, but 90% reported that their favorite part of the initiative was the feeling of togetherness. Most participants (95%) requested a continuation of the HHWI, even if not by a video-conferencing platform, and 90% reported feeling sad after the HHWI ended. Conclusion The emergency department HHWI was a welcome opportunity for employees to combat stress and anxiety brought on by the COVID-19 pandemic and social distancing. The initiative fostered team building, comradery, group advocacy, stress relief, and cheerfulness. The initiative was so greatly welcomed as a tool for wellness that almost all participants recommended that the HHWI should be available, not just in times of hardship, but year-round. The HHWI has provided a new approach to promote wellness in emergency care providers using a peer support group.
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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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Nagasaki K, Nishizaki Y, Shinozaki T, Shimizu T, Yamamoto Y, Shikino K, Fukui S, Nishiguchi S, Kurihara M, Kataoka K, Tokuda Y, Kobayashi H. Association between mental health and duty hours of postgraduate residents in Japan: a nationwide cross-sectional study. Sci Rep 2022; 12:10626. [PMID: 35739229 PMCID: PMC9218701 DOI: 10.1038/s41598-022-14952-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/15/2022] [Indexed: 11/11/2022] Open
Abstract
The new duty hour (DH) limit for doctors in Japan will begin in 2024, setting the maximum DHs for postgraduate residents at approximately 80 h weekly. To set appropriate limits, understanding the association between DHs and psychological health is necessary. Thus, we assessed the relationship between residents' psychological health and DHs. We conducted a cross-sectional study involving examinees of the General Medicine In-training Examination 2020. Mental health outcomes were measured dichotomously using the Patient Health Questionnaire-2 for depression and Mini-Z 2.0, for burnout, stress, and satisfaction. Weekly DHs were measured in seven categories at 10-h intervals. The prevalence ratios (PRs) between the DH categories were estimated for each outcome. Of the 6045 residents who provided data on DHs and psychological outcomes, 37.3% showed signs of depression, 21.6% experienced burn out, and 39.2% were highly stressed. In contrast, 62.3% were highly satisfied with their training. Proportions of burnout were higher among residents in Category 6 (≥ 90 and < 100 h; PR 1.36; 95% CI 1.11-1.66) and Category 7 (≥ 100 h; PR 1.36; 95% CI 1.10-1.68) compared with residents in Category 3 (≥ 60 and < 70 h; reference). The results partially support the weekly 80-h DH limit in terms of resident well-being.
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Affiliation(s)
- Kazuya Nagasaki
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, 3-2-7, Miyamachi, Mito, Ibaraki, 310-0015, Japan
| | - Yuji Nishizaki
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Sho Fukui
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Sho Nishiguchi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Masaru Kurihara
- Department of Patient Safety, Nagoya University Hospital, Aichi, Japan
| | - Koshi Kataoka
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Hiroyuki Kobayashi
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, 3-2-7, Miyamachi, Mito, Ibaraki, 310-0015, Japan.
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Brown KB, Cook A, Chen F, Martinelli SM. A Perspective on Wellness in Anesthesiology Residency Programs: A Multi-Strategy Approach. Anesthesiol Clin 2022; 40:257-274. [PMID: 35659399 DOI: 10.1016/j.anclin.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Addressing resident wellness is an important topic given the high risk for burnout and depression in resident physicians compared with the general U.S. population. This article provides an overview of various approaches to help conceptualize and intervene on resident wellness, based on the 9-strategies framework to improve wellness laid out by Shanafelt and colleagues. This article outlines the most relevant literature in each strategy followed by the authors' experience within their anesthesiology residency program.
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Affiliation(s)
- Kenneth B Brown
- Department of Anesthesiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, USA.
| | - Arianna Cook
- Department of Anesthesiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Fei Chen
- Department of Anesthesiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Susan M Martinelli
- Department of Anesthesiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, USA
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Shahi S, Paudel DR, Bhandari TR. Burnout among resident doctors: An observational study. Ann Med Surg (Lond) 2022; 76:103437. [PMID: 35308433 PMCID: PMC8927790 DOI: 10.1016/j.amsu.2022.103437] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background Burnout is a syndrome of emotional exhaustion and depersonalization that reduces efficiency at work. No studies have been reported focusing only on residency burnout and risk factors from our country until now. This study aimed to find out the impact and the association of specific demographic and practice characteristics with burnout among resident doctors. Methods A prospective cross-sectional survey of all resident doctors under training at that point of time in 2019 in the National Academy of Medical Sciences, Nepal in different specialties was done. We evaluated demographic variables, practice characteristics, and assessed burnout through validated Maslach burnout inventory (MBI) tools, and data were analyzed. Results A total 347 among 410 resident doctors (227 male) responded to the survey. Median age was 30 years (range 25–44). Overall, 147 (42.4%) of responding residents were burned out with high emotional exhaustion in 58 (16.6%), high depersonalization in 55 (15.9%), and low personal achievement in 34 (9.8). In regression analysis, out of independent variables gender, marital status, having children, specialty, hours of work per week and year of residency, specialties (general surgery odds ratio [OR]; 12.595, confidence interval [CI],[ 1.037–152.9], P; 0.047), obstetrics, and gynecology (odds ratio [OR]; 13.977, confidence interval [CI]; [1.324–147.5], P; 0.028), and anesthesiology (odds ratio [OR]; 11.54, confidence interval [CI]; [1.014–131.4], P; 0.049)) and hours of work per week (≥80 h) (odds ratio [OR]; 2.511, confidence interval [CI]; [1.128–5.589], P; 0.024), were significantly associated with high burnout. Conclusions Burnout is common among trainee resident doctors which is possibly preventable. Thus, the concern should be to prepare strategies to identify and minimize burnout from the individual, institutional, and societal sides. It is essential to preserve and promote the mental health of trainee residents to prevent serious consequences in the personal lives of resident doctors and as well as on patient outcomes. Burnout amongst resident doctors is extremely predominant which may be caused due to various reasons. We describe the impact of burnout among resident doctors and focus on identifying different risk factors for burnout. Preservation of mental health of resident doctors is essential to prevent serious consequences in their lives as well as on patient care.
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Affiliation(s)
- Sudha Shahi
- Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
- Corresponding author.
| | - Dhundi Raj Paudel
- Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Tika Ram Bhandari
- General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
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Abstract
Although a dermatology residency is associated with a favorable lifestyle, nearly one in three budding dermatologists meet the criteria for burnout. The competitive nature of dermatology residency selection may confer a predisposition to burnout. Contributing factors during residency include a high-volume clinical experience and frequent use of electronic health records. Women may face particular pressures in managing work-life balance when starting a family during dermatology residency. In addition to preventing burnout before residency, fears of professional repercussions should be alleviated to ensure resident well-being. We have focusedW focus on the causes of burnout among dermatology residents and suggest solutions to promote wellness.
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Nasir AA, Ameh EA, Ojo EO. A Survey of Perceptions of Surgical Trainees on Feedback During Training in West Africa. World J Surg 2021; 44:2542-2549. [PMID: 32318791 DOI: 10.1007/s00268-020-05535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Feedback has become an integral part of learning within the medical profession, particularly as training becomes more trainees'-centered. Feedback from the trainees about their training and trainers is essential for effective and high-quality training. The purpose of this survey was to evaluate trainees' perceptions on feedback on their postgraduate training and trainers in West Africa. METHODS Cross-sectional self-administered written survey of junior and senior registrar attending the annual revision and update course of the West African College of Surgeons. Information sought included sociodemographic variables, perception on feedback, opportunity to give feedback, trainee-trainers relationship and their opinion on different aspects of the postgraduate program where they would like to give feedback. RESULTS The response rate was 81.5% (66/81). Median age was 33 years. Sixty trainees (90.9%) were junior registrars. Sixty-four (97%) trainees would like to give feedback about their training and trainers. Only 18 (27.3%) trainees have had opportunity of giving feedback about their training. Most trainees (90.9%) would like to give feedback on patient care and learning environment; 89.4% would like to give feedback on their training curriculum and 87.9% would like to give feedback on their operating room experiences. Most trainees (81.8%) believed trainee feedback is of critical importance to training. With regard to trainees-trainer relationship, 39 (59.1%) trainees were either unsatisfied or reported just a fair relationship. CONCLUSIONS This study has shown that many of the trainees lack opportunity of giving feedback on their training but considered feedback critical to their training. Trainees would like to give feedback on patient care, curriculum, learning environment and operative room experience. Trainee feedback should be encouraged in surgical training in West Africa.
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Affiliation(s)
- Abdulrasheed A Nasir
- Division of Pediatric Surgery, Department of Surgery, University of Ilorin Teaching Hospital/University of Ilorin, PMB 1459, Ilorin, Nigeria.
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Emmanuel O Ojo
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
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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: 18] [Impact Index Per Article: 4.5] [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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Kohan L, Moeschler S, Spektor B, Przkora R, Sobey C, Brancolini S, Wahezi S, Anitescu M. Maintaining High-Quality Multidisciplinary Pain Medicine Fellowship Programs: Part I: Innovations in Pain Fellows' Education, Research, Applicant Selection Process, Wellness, and ACGME Implementation During the COVID-19 Pandemic. PAIN MEDICINE 2020; 21:1708-1717. [PMID: 32632454 PMCID: PMC7197561 DOI: 10.1093/pm/pnaa168] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Pain fellowship programs are facing unique challenges during the COVID-19 pandemic. Restrictions from state governments and the Centers for Disease Control and Prevention have resulted in a rapidly changing and evolving learning environment for todays’ fellows. Innovative solutions must be sought to guarantee proper education is maintained and ensure the well-being of our trainees. Methods We assembled a panel of pain program directors who serve as officers/board members of the Association of Pain Program Directors to provide guidance and formulate recommendations to pain fellowship directors nationally. This guidance is based on reviewing current changes to Accreditation Council Graduate Medical Education (ACGME) and American Board Anesthesiology policies and best available evidence and expert opinion on use of remote educational activities, research endeavors, and trainee wellness. Conclusions The country is in the midst of an unprecedented pandemic. The impact on pain management fellowships has been severe and will likely last for months, resulting in extraordinary challenges to the administration of pain fellowship programs and the education of our fellows. Understanding revisions in ACGME policies, use of technology to promote remote learning opportunities, and providing trainees with opportunities to alleviate their anxieties and encourage mental health are beneficial strategies to implement. Together, we can implement innovative solutions to help overcome these challenges.
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Affiliation(s)
- Lynn Kohan
- Division of Pain Medicine, Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Susan Moeschler
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Boris Spektor
- Department of Anesthesiology, Emory School of Medicine, Atlanta, Georgia
| | - Rene Przkora
- Pain Medicine Division, Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, Florida
| | - Christopher Sobey
- Clinical Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott Brancolini
- Department of Anesthesia, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sayed Wahezi
- Physical Medicine and Rehabilitation, Anesthesiology, and Orthopedic, Montefiore Medical Center, New York, New York
| | - Magdalena Anitescu
- Pain Management Department of Anesthesia and Critical Care Medicine, University of Chicago, Chicago, Illinois, USA
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Carrieri D, Pearson M, Mattick K, Papoutsi C, Briscoe S, Wong G, Jackson M. Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The growing incidence of mental ill-health in health professionals, including doctors, is a global concern. Although a large body of literature exists on interventions that offer support, advice and/or treatment to sick doctors, it has not yet been synthesised in a way that takes account of the complexity and heterogeneity of the interventions, and the many dimensions (e.g. individual, organisational, sociocultural) of the problem.
Objectives
Our aim was to improve understanding of how, why and in what contexts mental health services and support interventions can be designed to minimise the incidence of doctors’ mental ill-health. The objectives were to review interventions to tackle doctors’ mental ill-health and its impact on the clinical workforce and patient care, drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives to produce actionable theory; and recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts.
Design
Realist literature review consistent with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.
Data sources
Bibliographic database searches were developed and conducted using MEDLINE (1946 to November week 4 2017), MEDLINE In-Process and Other Non-indexed Citations (1946 to 6 December 2017) and PsycINFO (1806 to November week 2 2017) (all via Ovid) and Applied Social Sciences Index and Abstracts (1987 to 6 December 2017) (via ProQuest) on 6 December 2017. Further UK-based studies were identified by forwards and author citation searches, manual backwards citation searching and hand-searching relevant journal websites.
Review methods
We included all studies that focused on mental ill-health; all study designs; all health-care settings; all studies that included medical doctors/medical students; descriptions of interventions or resources that focus on improving mental ill-health and minimising its impacts; all mental health outcome measures, including absenteeism (doctors taking short-/long-term sick leave); presenteeism (doctors working despite being unwell); and workforce retention (doctors leaving the profession temporarily/permanently). Data were extracted from included articles and the data set was subjected to realist analysis to identify context–mechanism–outcome configurations.
Results
A total of 179 out of 3069 records were included. Most were from the USA (45%) and had been published since 2009 (74%). More included articles focused on structural-level interventions (33%) than individual-level interventions (21%), but most articles (46%) considered both levels. Most interventions focused on prevention, rather than treatment/screening, and most studies referred to doctors/physicians in general, rather than to specific specialties or career stages. Nineteen per cent of the included sources provided cost information and none reported a health economic analysis. The 19 context–mechanism–outcome configurations demonstrated that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job, and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote well-being. Interventions creating a people-focused working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors needed to have confidence in an intervention for the intervention to be effective.
Limitations
Variable quality of included literature; limited UK-based studies.
Future work
Use this evidence synthesis to refine, implement and evaluate interventions.
Study registration
This study is registered as PROSPERO CRD42017069870.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 19. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Daniele Carrieri
- College of Medicine and Health, University of Exeter, Exeter, UK
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, UK
| | - Karen Mattick
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon Briscoe
- Exeter HSDR Evidence Synthesis Centre, Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Jackson
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
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14
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Lee D, Choi D, Lee Y. Clustering with varying risks of false assignments in discrete latent variable model. Stat Methods Med Res 2020; 29:2932-2944. [PMID: 32216581 DOI: 10.1177/0962280220913067] [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] [Indexed: 11/17/2022]
Abstract
In clustering problems, to model the intrinsic structure of unlabeled data, the latent variable models are frequently used. These model-based clustering methods often provide a clustering rule minimizing the total false assignment error. However, in many clustering applications, it is desirable to treat false assignment errors for a certain cluster differently. In this paper, we introduce the false assignment rate for clustering and estimate it by using the extended likelihood approach. We propose VRclust, a novel clustering rule that controls various errors differently across clusters. Real data examples illustrate the usage of estimation of false assignment rate and a simulation study shows that error controls are consistent as the sample size increases.
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Affiliation(s)
- Donghwan Lee
- Department of Statistics, Ewha Womans University, Seoul, Republic of Korea
| | - Dongseok Choi
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA.,Graduate School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Youngjo Lee
- Department of Statistics, Seoul National University, Seoul, Republic of Korea
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15
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Parsons M, Bailitz J, Chung AS, Mannix A, Battaglioli N, Clinton M, Gottlieb M. Evidence-Based Interventions that Promote Resident Wellness from the Council of Emergency Residency Directors. West J Emerg Med 2020; 21:412-422. [PMID: 32191199 PMCID: PMC7081870 DOI: 10.5811/westjem.2019.11.42961] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 11/19/2019] [Indexed: 12/15/2022] Open
Abstract
Initiatives for addressing resident wellness are a recent requirement of the Accreditation Council for Graduate Medical Education in response to high rates of resident burnout nationally. We review the literature on wellness and burnout in residency education with a focus on assessment, individual-level interventions, and systemic or organizational interventions.
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Affiliation(s)
- Melissa Parsons
- University of Florida College of Medicine, Department of Emergency Medicine, Jacksonville, Florida
| | - John Bailitz
- Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Arlene S Chung
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Alexandra Mannix
- University of Florida College of Medicine, Department of Emergency Medicine, Jacksonville, Florida
| | - Nicole Battaglioli
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Michelle Clinton
- Carilion Clinic, Department of Emergency Medicine, Roanoke, Virginia
| | - Michael Gottlieb
- Rush Medical Center, Department of Emergency Medicine, Chicago, Illinois
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16
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Baiu I, Titan A, Kin C, Spain DA. Caring for Caregivers - Resident Physician Health and Wellbeing. JOURNAL OF SURGICAL EDUCATION 2020; 77:13-17. [PMID: 31494061 DOI: 10.1016/j.jsurg.2019.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/12/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE There is a national epidemic of physician burnout and serious concerns exist regarding the well-being of future physicians. This project seeks to address resident physician health, by creating a sense of support and community during training, as a method to target one of the many facets of burnout. DESIGN We created a program that allows residents who fall ill to receive a health package, delivered to work or home, consisting of essential medications, vitamins, nutrition, and hydration. The recipients were asked to answer a short survey regarding their experience. SETTING Stanford Health Care, Department of Surgery, Division of General Surgery, Palo Alto California. RESULTS Eighteen packages have been delivered since the start of the project. One hundred percent of residents agree that this program fulfills an otherwise unmet need in residency. Similarly, all felt that the supplies they received helped them recover faster. The majority (83%) of the packages were requested by colleagues of the ill residents. CONCLUSIONS We present an innovative project aimed at improving resident physician health, fostering a feeling of support, and helping to reduce resident burnout. This is the first report of a program of this kind and we hope that it incentivizes a broader discussion and implementation of similar initiatives in other residency programs across the country.
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Affiliation(s)
- Ioana Baiu
- Department of Surgery, Stanford University School of Medicine, Stanford, California.
| | - Ashley Titan
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Cindy Kin
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - David A Spain
- Department of Surgery, Stanford University School of Medicine, Stanford, California
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17
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Abstract
PURPOSE The objective of this study is to quantitatively evaluate the well-being of residents doing casino shifts compared with those doing standard overnight shifts while working in an academic pediatric emergency department. METHODS A randomized prospective survey study was performed over a period of 1 year on all residents who were scheduled to complete a 28-day block. Each block (28-day period) within the year was designated as either a "standard" or "casino" block. The standard overnight shifts were scheduled from midnight to 0800 hours, and casino shifts occurred from either 2000 to 0400 hours (casino A) and 0400 to 1200 hours (casino B). Participating residents were asked to complete both a preblock and postblock survey. The primary outcome was defined as differences in resident well-being as assessed by the brief resident wellness profile (BRWP). A mood faces graphical rating item to assess overall mood was used as a secondary outcome measures as well as a 10-item survey based on World Health Organization domains for quality of life and adapted to reflect completion of shiftwork. RESULTS A total of 124 (90%) of 138 residents completed the study and were included in the analysis. No significant difference in resident well-being measured by BRWP between those in the standard and casino shift groups (17 ± 2.5 for preblock standard and 16.9 ± 2.8 for casino, P = 0.904; 17.1 ± 2.7 for postblock standard and 17.2 ± 3.1 for casino, P = 0.817), or in the relative change of the BRWP preblock and postblock between the 2 groups (standard, 0.35 ± 2.7; casino, 0.29 ± 3.0; P = 0.926). No significant difference in the mood faces rating scale scores or the 10-item postblock survey was found. CONCLUSIONS In the first study examining the effects of casino shifts on trainees, we found no effect of standard overnight versus casino shifts on their well-being. This counters the benefits previously seen in emergency department consultant staff and highlights the need for more studies specifically in trainees.
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18
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Deng G, Zhao D, Lio J, Chen X, Ma X, Liang L, Feng C. Strategic elements of residency training in China: transactional leadership, self-efficacy, and employee-orientation culture. BMC MEDICAL EDUCATION 2019; 19:355. [PMID: 31521148 PMCID: PMC6744663 DOI: 10.1186/s12909-019-1792-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The standardized training of resident physicians in China is significant and robust. During the training, clinical teachers act as leaders. The training taking place in public hospitals requires a transactional leadership style (TLS), but existing research studies seldom analyze how to promote residents' performance from this perspective. METHODS Two hundred and ninety six new residents undertaking standardized training were recruited from five tertiary hospitals in two provinces of China. Hierarchical moderated and mediated regression analyses were used to test the hypotheses. The hypotheses include that TLS is positively related to the training performance; mediating effect of self-efficacy and moderating effect of employee-orientation organizational culture (EOC) are significant. RESULTS (1) Two kinds of teachers' TLS, punishment and reward, have significant positive influence on residents' performance. (2) Self-efficacy of residents partly mediates the positive relationship. (3) EOC moderates the relationship between the punitive behavior of clinical teachers with TLS and the self-efficacy of the residents. CONCLUSIONS Empirical evidence has shown the positive relationship between teachers' TLS and residents' performance outcomes in China. Teachers can enhance training performance by promoting self-efficacy of residents. This study also advances our understanding of EOC by examining the demonstrated moderating effects of cultural background in the relationship between teachers' TLS and the self-efficacy of residents.
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Affiliation(s)
- Guangwei Deng
- School of Management, Hefei University of Technology, Hefei, 230009 Anhui China
| | - Di Zhao
- School of Management, University of Science and Technology of China, Hefei, 230026 Anhui China
| | - Jonathan Lio
- Department of Medicine, University of Chicago, Chicago, IL 60637 USA
| | - Xinyu Chen
- National Health Commission of the People’s Republic of China, Beijing, 100044 China
| | - Xiaopeng Ma
- Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001 Anhui China
| | - Liang Liang
- School of Management, Hefei University of Technology, Hefei, 230009 Anhui China
| | - Chenpeng Feng
- School of Management, Hefei University of Technology, Hefei, 230009 Anhui China
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Pluhar E, Power S, Freizinger M, Altman W. Medical Education: Guidelines for Effective Teaching of Managing Challenging Patient Encounters. MEDICAL SCIENCE EDUCATOR 2019; 29:855-861. [PMID: 34457551 PMCID: PMC8368418 DOI: 10.1007/s40670-019-00729-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Health care providers require strong communication skills to effectively interact with and assist patients on a daily basis. However, medical professionals and trainees are often not equipped with the tools necessary to conduct productive exchanges, especially with challenging patient encounters. Communicating thoughtfully can become extremely challenging when patients exhibit problematic behaviors or attitudes. The following guidelines-inspired by a workshop for medical students at Tufts University School of Medicine (TUSM) and further developed by the authors' interdisciplinary experiences and research-offer comprehensive criteria for medical instructors to lead an experiential seminar on how students can succeed in challenging patient encounters.
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Affiliation(s)
- Emily Pluhar
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, 333 Longwood Avenue, Boston, MA 02115 USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Stephanie Power
- Department of Family Medicine, Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111 USA
| | - Melissa Freizinger
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, 333 Longwood Avenue, Boston, MA 02115 USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Wayne Altman
- Department of Family Medicine, Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111 USA
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20
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Lefebvre D, Dong KA, Dance E, Rosychuk RJ, Yarema M, Blouin D, Williams J, Rowe BH. Resident Physician Wellness Curriculum: A Study of Efficacy and Satisfaction. Cureus 2019; 11:e5314. [PMID: 31592369 PMCID: PMC6773458 DOI: 10.7759/cureus.5314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Recent literature highlights the alarming prevalence of burnout, depression, and illness during residency training; a trend that is also linked to suboptimal patient care. Dedicated wellness curricula may be one solution to this concerning issue. Purpose To determine the effect of a multi-faceted wellness curriculum during emergency medicine residency training on wellness scores and to assess resident satisfaction with the program. Methods This study was conducted via a longitudinal survey. In 2009, a faculty-derived resident wellness curriculum (F-RWC) was initiated. This program was then bolstered with a parallel resident-derived curriculum (R-RWC) one year later, in 2010. Emergency medicine residents were surveyed in 2009, 2010, and 2011 to assess wellness at baseline, after one year of the F-RWC, and after one year of combined RWCs, respectively. Surveys included two validated assessment instruments (the Brief Resident Wellness Profile (BRWP) and the SF-8TM Health Survey), a satisfaction Likert scale, and a demographics information sheet. Results The survey response rates were 89% (n=17), 100% (n=17), and 83% (n=24) from 2009, 2010, and 2011, respectively, for a total of 58 participants. From baseline in 2009, there was a significant improvement in resident wellness, with the addition of parallel RWC by 2011, as measured by the BRWP (p=0.024). The faces scale, a subset of the BRWP, showed a trend toward benefit but did not reach statistical significance (p=0.085). There was no evidence of a statistically significant change in SF-8TM scores over time. Participants consistently reported positive satisfaction scores with RWC initiatives. Conclusions Dedicated RWC, with input from both faculty and resident physicians, improved wellness during residency training with a high degree of participant satisfaction. Such programs are needed to support resident physicians during their training.
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Affiliation(s)
| | - Kathryn A Dong
- Emergency Medicine, Addiction Medicine, University of Alberta, Edmonton, CAN
| | - Erica Dance
- Emergency Medicine, University of Alberta, Edmonton, CAN
| | | | - Mark Yarema
- Emergency Medicine, University of Calgary, Calgary, CAN
| | - Danielle Blouin
- Emergency Medicine, Kingston Health Sciences Centre / Queen's University, Kingston, CAN
| | | | - Brian H Rowe
- Emergency Medicine, School of Community Based Medicine, University of Alberta, Edmonton, CAN
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21
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Smith C, Rao A, Tompach PC, Petersen A, Lyu D, Nadeau RA. Factors Associated With the Mental Health and Satisfaction of Oral and Maxillofacial Surgery Residents in the United States: A Cross-Sectional Study and Analysis. J Oral Maxillofac Surg 2019; 77:2196-2204. [PMID: 31422015 DOI: 10.1016/j.joms.2019.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Residents in training have reported high levels of stress and anxiety and have a greater risk of mental health problems compared with the general population. Mental health problems among residents have been correlated with decreased professional effectiveness, increased medical errors, emotional exhaustion, and depersonalization and could have significant negative effects on future practitioners. The purpose of the present study was to identify the factors that might be associated with the mental health and satisfaction of oral and maxillofacial surgery (OMS) residents and to determine the associations between these factors and OMS resident satisfaction as a surrogate of resident well-being. MATERIALS AND METHODS We designed and implemented an online survey, which was e-mailed to all OMS residents in the 101 accredited training programs in the United States. The survey was designed to determine and assess the factors associated with OMS resident satisfaction. Differences between groups were tested using 1-way analysis of variance for continuous variables and χ2 tests for categorical variables. For each factor, we fit a logistic regression model to estimate the odds ratio of resident satisfaction for the factor, adjusting for gender, year in residency, and years of advanced training. RESULTS Of the 1181 resident surveys sent out, 300 were completed (25.4% response rate). The satisfied OMS residents tended to be men, further along in their training program, and to have access to mental health resources. Dissatisfaction was associated with greater self-reported stress levels, working a greater number of hours per week, and believing one would be viewed differently for speaking to faculty about mental health. CONCLUSIONS OMS resident satisfaction was associated with identifiable and potentially modifiable factors. These factors included workload characteristics, stress and coping ability, and mental health impact and resource availability. Evidence-based strategies for OMS resident well-being could lead to the development of best practice guidelines for promoting and optimizing resident mental health.
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Affiliation(s)
- Charlie Smith
- Dental Student, Division of Oral and Maxillofacial Surgery, University of Minnesota School of Dentistry, Saint Paul, MN
| | - Aarathi Rao
- Resident, Division of Oral and Maxillofacial Surgery, University of Minnesota School of Dentistry, Saint Paul, MN
| | - Paul C Tompach
- Assistant Clinical Professor, Division of Oral and Maxillofacial Surgery, University of Minnesota School of Dentistry, Saint Paul, MN.
| | - Ashley Petersen
- Assistant Professor, Division of Biostatistics, University of Minnesota School of Public Health, Saint Paul, MN
| | - Diana Lyu
- Resident, Division of Oral and Maxillofacial Surgery, University of Minnesota School of Dentistry, Saint Paul, MN
| | - Robert A Nadeau
- Clinical Associate Professor and Clinic and Graduate Training Program Director, Division of Oral and Maxillofacial Surgery, University of Minnesota School of Dentistry, Saint Paul, MN
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Jordan J, Watcha D, Cassella C, Kaji AH, Trivedi S. Impact of a Mentorship Program on Medical Student Burnout. AEM EDUCATION AND TRAINING 2019; 3:218-225. [PMID: 31360814 PMCID: PMC6637010 DOI: 10.1002/aet2.10354] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 05/13/2023]
Abstract
BACKGROUND Burnout can have negative consequences for providers' health and patient care. Mentorship has positive effects including stress mitigation. We sought to evaluate the impact of a mentorship program on burnout in fourth-year medical students during their 4-week emergency medicine subinternship. METHODS This was a prospective, quasi-experimental, mixed-methods study at two institutions. We assessed burnout using the Maslach Burnout Inventory, comprising three subscales: Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA). We compared changes in burnout scores before and after implementation of a resident-student mentorship program. We compared categorical variables using risk ratios and continuous variables using Wilcoxon rank-sum test. To account for potential confounders, we performed multivariable analysis. Students and mentors completed an evaluative survey. We reported descriptive statistics and performed thematic qualitative analysis on free-response data. RESULTS A total of 135 students (intervention = 51; control = 84) and 59 mentors participated. Intervention students demonstrated decreased EE and DP and increased PA scores, medians of -2 (-4 to 4), -1 (-3 to 2), and 1 (-1 to 4), respectively, compared to controls, median difference of 0 for all subscales. After adjusting for potential confounders, there was no significant difference in EE (mean difference = -0.2 [-0.5 to 0.2], p = 0.4) or DP scores (mean difference = -0.2 [-1.8 to 1.5], p = 0.9). There was a significant difference in PA scores (mean difference = 2.2 [0.1 to 4.3], p = 0.04). Most students felt the program positively impacted their rotation (39/48) and decreased stress (28/48). Students felt that the program provided career guidance and positively impacted their personal and professional development. The majority (34/37) of mentors enjoyed participating. Qualitative analysis revealed five major themes: relationship building, different perspective, knowledge sharing, personal fulfillment, and self-reflection. CONCLUSION We found an increased sense of personal accomplishment after implementation of a mentorship program. Both mentors and mentees viewed the program positively and perceived multiple benefits.
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Affiliation(s)
- Jaime Jordan
- Department of Emergency MedicineRonald Reagan UCLA Medical CenterLos AngelesCA
- David Geffen School of Medicine at UCLALos AngelesCA
- Department of Emergency MedicineHarbor‐UCLA Medical CenterTorranceCA
| | - Daena Watcha
- Department of Emergency MedicineRegional Medical CenterSan JoseCA
- Department of Emergency MedicineHarbor‐UCLA Medical CenterTorranceCA
| | - Courtney Cassella
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
- Mount Sinai HospitalIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Amy H. Kaji
- David Geffen School of Medicine at UCLALos AngelesCA
- Department of Emergency MedicineHarbor‐UCLA Medical CenterTorranceCA
| | - Shefali Trivedi
- Mount Sinai HospitalIcahn School of Medicine at Mount SinaiNew YorkNY
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23
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Jackson T, Morgan J, Jackson D, Cook T, McLean K, Agrawal V, Taubman K, Kumar G, Truitt MS. Trends in Surgeon Wellness (Take a Sad Song and Make it Better): A Comparison of Surgical Residents, Fellows, and Attendings. Am Surg 2019. [DOI: 10.1177/000313481908500620] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We aim to investigate the prevalence of posttraumatic stress disorder (PTSD), physician burnout (PBO), and work–life balance (WLB) among surgical residents, fellows, and attendings to illustrate the trends in surgeon wellness. A cross-sectional national survey of surgical residents, fellows, and attendings was conducted screening for PTSD, PBO, and WLB. The prevalence of screening positive for PTSD was more than two times that of the general population at all levels of experience, and more than half have an unhealthy WLB. The prevalence of PTSD, PBO, and unhealthy WLB declined with increasing level of experience ( P < 0.001). One deviation in this trend was a lower prevalence of PBO among surgical fellows compared with residents and attendings ( P < 0.001). Surgeon wellness improved with increasing level of experience. The incorporation of wellness programs into surgical residencies is essential to the professional development of young surgeons to cultivate healthy lasting habits for a well-balanced career and life.
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Affiliation(s)
- Theresa Jackson
- Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma
| | - Jake Morgan
- Department of Graduate Medical Education, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Diane Jackson
- Department of Graduate Medical Education, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Taylor Cook
- Department of Graduate Medical Education, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Kevin McLean
- Department of Graduate Medical Education, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | | | - Kevin Taubman
- Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma
| | - Gajal Kumar
- Saint John Medical Center, Tulsa, Oklahoma; and
| | - Michael S. Truitt
- Department of Graduate Medical Education, Methodist Dallas Medical Center, Dallas, Texas
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24
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Pérez-Álvarez C, Gallego-Royo A, Marco-Gómez B, Martínez-Boyero T, Altisent R, Delgado-Marroquín MT, Astier-Peña MP. Resident Physicians as Patients: Perceptions of Residents and Their Teaching Physicians. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:67-70. [PMID: 30264275 DOI: 10.1007/s40596-018-0981-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This study aims to broaden understanding into the process by which resident physicians deal with illness and to identify areas for improvement regarding healthcare of residents and teaching physicians training to support them adequately. METHODS A qualitative study of ten semi-structured interviews with residents who had suffered a serious illness and a focus group of teaching physicians were conducted. Analysis of the interview transcripts was performed using the grounded theory approach, with information divided into five categories: Differences between residents as patients and general patients; confidentiality; feelings and attitudes; learning from illness; and impact on work and training. RESULTS There are differences between residents and the general population: In the initial stage, diagnosis is made promptly with preferential treatment shown by colleagues. Subsequently, the lack of clear guidelines can lead to poor follow-up. They accept a loss of confidentiality in the process. One of the most serious concerns felt by residents is the impact of their illness on their training as specialists, meaning that teaching physicians are charged with the important role of guaranteeing the resident's proper recovery, return to work, and readaptation to the training program. Teaching physicians demand their own training be reinforced in these aspects. CONCLUSION There is a need to assess the great diversity observed in training-related decisions made by teaching physicians when residents fall ill. Given the differences observed, more research is required to improve the care provided to sick residents and particularly the teaching physicians training to handle them.
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Affiliation(s)
- Candela Pérez-Álvarez
- Professionalism and Clinical Ethics Department, University of Zaragoza (Spain), IIS Aragón, Zaragoza, Spain
| | - Alba Gallego-Royo
- Professionalism and Clinical Ethics Department, University of Zaragoza (Spain), IIS Aragón, Zaragoza, Spain
| | - Bárbara Marco-Gómez
- Professionalism and Clinical Ethics Department, University of Zaragoza (Spain), IIS Aragón, Zaragoza, Spain
| | - Teresa Martínez-Boyero
- Professionalism and Clinical Ethics Department, University of Zaragoza (Spain), IIS Aragón, Zaragoza, Spain
| | - Rogelio Altisent
- Professionalism and Clinical Ethics Department, University of Zaragoza (Spain), IIS Aragón, Zaragoza, Spain
| | | | - María Pilar Astier-Peña
- Professionalism and Clinical Ethics Department, University of Zaragoza (Spain), IIS Aragón, Zaragoza, Spain.
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25
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Hale AJ, Ricotta DN, Freed J, Smith CC, Huang GC. Adapting Maslow's Hierarchy of Needs as a Framework for Resident Wellness. TEACHING AND LEARNING IN MEDICINE 2019; 31:109-118. [PMID: 29708437 DOI: 10.1080/10401334.2018.1456928] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
ISSUE Burnout in graduate medical education is pervasive and has a deleterious impact on career satisfaction, personal well-being, and patient outcomes. Interventions in residency programs have often addressed isolated contributors to burnout; however, a more comprehensive framework for conceptualizing wellness is needed. EVIDENCE In this article the authors propose Maslow's hierarchy of human needs (physiologic, safety, love/belonging, esteem, and self-actualization) as a potential framework for addressing wellness initiatives. There are numerous contributors to burnout among physician-trainees, and programs to combat burnout must be equally multifaceted. A holistic approach, considering both the trainees personal and professional needs, is recommended. Maslow's Needs can be adapted to create such a framework in graduate medical education. The authors review current evidence to support this model. IMPLICATIONS This work surveys current interventions to mitigate burnout and organizes them into a scaffold that can be used by residency programs interested in a complete framework to supporting wellness.
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Affiliation(s)
- Andrew J Hale
- a Infectious Diseases, University of Vermont Medical Center , Burlington , Vermont , USA
| | - Daniel N Ricotta
- b Department of Medicine , Harvard Medical School , Boston , Massachusetts , USA
| | - Jason Freed
- b Department of Medicine , Harvard Medical School , Boston , Massachusetts , USA
| | - C Christopher Smith
- b Department of Medicine , Harvard Medical School , Boston , Massachusetts , USA
| | - Grace C Huang
- b Department of Medicine , Harvard Medical School , Boston , Massachusetts , USA
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26
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Hsu DP, Hansen SL, Roberts TA, Murray CK, Mysliwiec V. Predictors of Wellness Behaviors in U.S. Army Physicians. Mil Med 2018; 183:e641-e648. [DOI: 10.1093/milmed/usy059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/20/2018] [Indexed: 01/11/2023] Open
Affiliation(s)
- Daniel P Hsu
- Department of Pediatrics, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX
- Department of Sleep Medicine, Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Dr. Ste 1, JBSA Lackland AFB, TX
| | - Shana L Hansen
- Department of Pediatrics, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX
- Department of Sleep Medicine, Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Dr. Ste 1, JBSA Lackland AFB, TX
| | - Timothy A Roberts
- Department of Pediatrics, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX
| | - Clinton K Murray
- 1st Area Medical Laboratory, 44th Medical Bde, 5116 Bel Air St, Aberdeen Proving Grounds, MD
| | - Vincent Mysliwiec
- Department of Sleep Medicine, Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Dr. Ste 1, JBSA Lackland AFB, TX
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Luk AL, Yau AFT. Experiences of Public Doctors on Managing Work Difficulties and Maintaining Professional Enthusiasm in Acute General Hospitals: A Qualitative Study. Front Public Health 2018; 6:19. [PMID: 29552549 PMCID: PMC5840166 DOI: 10.3389/fpubh.2018.00019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/18/2018] [Indexed: 11/15/2022] Open
Abstract
Background Overseas studies suggest that 10–20% of doctors are depressed, 30–45% have burnout, and many report dissatisfaction with work-life balance. A local study on public doctors showed that 31.4% of the respondents satisfied the criteria for high burnout. Young, but moderately experienced doctors who need to work shifts appeared most vulnerable. This study aims to explore the experiences of those public doctors who have managed their work difficulties and maintained professional enthusiasm for references in medical education and continuing professional training. Method Ten public doctors with reputation were invited respectively from three acute general hospitals for an in-depth interview. Interviews were audio recorded and transcribed. Content analysis was carried out to identify major themes in relation to the research questions. Results Three themes emerging from difficulties encountered were (1) managing people, mostly are patients, followed by colleagues and then patients’ relatives; (2) constraints at work, include time and resources; and (3) managing self with decision-making within a short time. Three themes generating from managing work difficulties included (1) self-adjustment with practicing problem solving and learning good communication appeared more frequently, followed by maintaining a professional attitude and accumulating clinical experiences; (2) seeking help from others; and (3) organizational support is also a theme though it is the least mentioned. Four themes emerging from maintaining work enthusiasm were (1) personal conviction and discipline: believing that they are helping the needy, having the sense of vocation and support from religion; disciplining oneself by continuing education, maintaining harmonious family relationship and volunteer work. (2) Challenging work: different challenging natures of their job. (3) Positive feedback from patients: positive encounters with patients keep a connectedness with their clients. (4) Organization support: working with good colleagues and opportunity for continuous training. Conclusion Some implications for medical education include, developing good communication skill for medical students and junior doctors, preparing senior doctors to be mentors, and exploring the motivating force of spirituality/religion.
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Affiliation(s)
- Andrew Leung Luk
- Nethersole Institute of Continuing Holistic Health Education, Alice Ho Miu Ling Nethersole Charity Foundation, Tai Po, Hong Kong
| | - Adrian Fai To Yau
- Nethersole Institute of Continuing Holistic Health Education, Alice Ho Miu Ling Nethersole Charity Foundation, Tai Po, Hong Kong
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Abedini NC, Stack SW, Goodman JL, Steinberg KP. "It's Not Just Time Off": A Framework for Understanding Factors Promoting Recovery From Burnout Among Internal Medicine Residents. J Grad Med Educ 2018; 10:26-32. [PMID: 29467969 PMCID: PMC5821021 DOI: 10.4300/jgme-d-17-00440.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/19/2017] [Accepted: 10/11/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Burnout rates for internal medicine residents are among the highest of all specialties, yet little is known about how residents recover from burnout. OBJECTIVE We identified factors promoting recovery from burnout and factors that assist with the subsequent avoidance of burnout among internal medicine residents. METHODS A purposive sample of postgraduate year 2 (PGY-2), PGY-3, and recent graduates who experienced and recovered from burnout during residency participated in semistructured, 60-minute interviews from June to August 2016. Using qualitative methods derived from grounded theory, saturation of themes occurred after 25 interviews. Coding was performed in an iterative fashion and consensus was reached on major themes. RESULTS Coding revealed 2 different categories of resident burnout-circumstantial and existential-with differing recovery and avoidance methods. Circumstantial burnout stemmed from self-limited circumstances and environmental triggers. Recovery from, and subsequent avoidance of, circumstantial burnout arose from (1) resolving workplace challenges; (2) nurturing personal lives; and (3) taking time off. In contrast, existential burnout stemmed from a loss of meaning in medicine and an uncertain professional role. These themes were identified around recovery: (1) recognizing burnout and feeling validated; (2) connecting with patients and colleagues; (3) finding meaning in medicine; and (4) redefining a professional identity and role. CONCLUSIONS Our study suggests that residents experience different types of burnout and have variable methods by which they recover from and avoid further burnout. Categorizing residents' burnout into circumstantial versus existential experiences may serve as a helpful framework for formulating interventions.
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Tabibian JH, Bertram AK, Yeh HC, Cofrancesco J, Codori N, Block L, Miller ER, Ranasinghe PD, Marinopoulos SS. Health and wellness among incoming resident physicians: A multi-domain survey. ACTA ACUST UNITED AC 2018; 1. [PMID: 31897450 PMCID: PMC6939760 DOI: 10.33582/2637-4900/1003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Burnout and depression are well-described in medical students and physicians and can lead to adverse personal and patient outcomes; however, their time course and risk factors remain understudied. Here, we measured multiple domains of mental and physical health and wellness and assessed gender differences among incoming physician trainees beginning residency at an academic medical center. Methods Using a cross-sectional study design, all incoming trainees (i.e. housestaff) at Johns Hopkins Hospital received a questionnaire assessing depression, burnout, sleep, exercise, and alcohol consumption, among other domains. Standardized instruments were utilized for questionnaire development. Tests of significance were two-tailed. Results 196 of 229 incoming housestaff (86%) completed the survey, and 49% were female. A history of depression was reported in 8%, and 5.4% met criteria for at least moderate depression by Patient Health Questionnaire (PHQ-9). Females were more likely to report a history of depression than males (13% vs. 3%, p=0.02) but had similar PHQ-9 scores. Four percent of participants reported feeling they were in the wrong profession. Goal and mean sleep were 7 and 6.7 hours/night, respectively. Forty-seven percent reported exercising once/week or not at all. While mean reported weekly alcohol consumption was three drinks, participants reported consuming ≥5 drinks in one sitting on average 1.6 times in the prior 6 months, and 4% used alcohol to sleep. Conclusions Incoming housestaff reported generally favorable mental and physical health at the beginning of residency training. However, exercise rates were low, and ill-suited alcohol consumption was noted, though infrequent. The few areas of possible improvement were largely similar between males and females. Wellness interventions might capitalize on the relatively high morale and health at the completion of medical school by helping to promote healthy habits, including regular exercise and avoidance of excess alcohol consumption, throughout future training and practice.
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Affiliation(s)
- James H Tabibian
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Amanda K Bertram
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hsin-Chieh Yeh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Health Policy and Management, Bloomberg School of Public Health, Baltimore, MD
| | - Joseph Cofrancesco
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nancy Codori
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,University Health Services, Johns Hopkins University, Baltimore, MD
| | - Lauren Block
- Department of Health Policy and Management, Bloomberg School of Public Health, Baltimore, MD.,Department of Medicine, North Shore-LIJ Health System, New Hyde Park, NY
| | - Edgar R Miller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Bloomberg School of Public Health, Baltimore, MD
| | - Padmini D Ranasinghe
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Spyridon S Marinopoulos
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,University Health Services, Johns Hopkins University, Baltimore, MD
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Spiotta AM, Fargen KM, Denham SL, Fulton ME, Kellogg R, Young E, Patel S, Turner RD. Incorporation of a Physical Education and Nutrition Program Into Neurosurgery: A Proof of Concept Pilot Program. Neurosurgery 2017; 79:613-9. [PMID: 27465847 DOI: 10.1227/neu.0000000000001358] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Balancing the demands of a busy medical career with personal wellness can be daunting, and there is little education on these principles available to physicians in training. OBJECTIVE To implement a voluntary wellness initiative in our neurosurgery department to promote healthy lifestyle choices. This report details the baseline data collected as part of this quality improvement initiative. METHODS The wellness initiative was implemented in July 2015 and available to all faculty and resident physicians in the Department of Neurological Surgery in collaboration with the Medical University of South Carolina Wellness Center. All participants were provided a Fitbit Surge HR wrist monitor (Fitbit, Boston, Massachusetts) and underwent baseline physical and psychological testing. RESULTS Six faculty physicians and 9 residents participated. Overall physical fitness levels varied widely between subjects. Health screening demonstrated abnormalities in 80% of participants (elevated systolic blood pressure in 60%, elevated diastolic in 47%, elevated serum low-density lipoprotein in 53%). Body composition analysis demonstrated body weight higher than ideal in 69% (47% overweight; 13% obese). Recommended average body fat mass reduction was 25.4 pounds. Seventy-nine percent reported below-average quality of life compared with the average healthy adult. All subjects reported wanting more time for personal health. CONCLUSION Baseline health and psychological screenings in our department demonstrated alarmingly prevalent, previously undiagnosed abnormalities on cardiovascular and body weight screenings. Obstacles to leading a healthier lifestyle have been identified and solutions have been incorporated into the program. This quality improvement initiative may serve as a template for other programs seeking to improve physician physical and mental well-being. ABBREVIATIONS BMI, body mass indexESS, Epworth Sleepiness ScaleHR, heart rate.
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Affiliation(s)
- Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
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Wilson PM, Kemper KJ, Schubert CJ, Batra M, Staples BB, Serwint JR, McClafferty H, Mahan JD. National Landscape of Interventions to Improve Pediatric Resident Wellness and Reduce Burnout. Acad Pediatr 2017; 17:801-804. [PMID: 28919483 DOI: 10.1016/j.acap.2017.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 10/24/2022]
Affiliation(s)
- Paria M Wilson
- Department of Pediatrics, Division of Emergency Medicine, University of Pittsburgh, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa.
| | - Kathi J Kemper
- Department of Pediatrics and Center for Integrative Health and Wellness, Nationwide Children's Hospital, Columbus, Ohio
| | - Charles J Schubert
- Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maneesh Batra
- Department of Neonatology and Pediatrics, University of Washington, Seattle Children's Hospital
| | - Betty B Staples
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Janet R Serwint
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Hilary McClafferty
- Department of Medicine, University of Arizona College of Medicine, Tucson, Ariz
| | - John D Mahan
- Department of Pediatrics and Nephrology, Nationwide Children's Hospital, Columbus, Ohio
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Nomura O, Mishina H, Jasti H, Sakai H, Ishiguro A. Pediatric resident perceptions of shift work in ward rotations. Pediatr Int 2017; 59:1119-1122. [PMID: 29081080 DOI: 10.1111/ped.13370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/13/2017] [Accepted: 07/13/2017] [Indexed: 11/26/2022]
Abstract
Although the long working hours of physicians are considered to be a social issue, no effective policies such as duty hour regulations have so far been proposed in Japan. We implemented an overnight call shift (OCS) system for ward rotations to improve the working environment for residents in a pediatric residency program. We later conducted a cross-sectional questionnaire asking the residents to compare this system with the traditional overnight call system. Forty-one pediatric residents participated in this survey. The residents felt that the quality of patient care improved (80.4% agreed). Most felt that there was less emphasis on education (26.8%) and more emphasis on service (31.7%). Overall, the residents reported that the OCS was beneficial (90.2%). In conclusion, the pediatric residents considered the OCS system during ward rotations as beneficial. Alternative solutions are vital to balance improvements in resident work conditions with the requirement for a high quality of education.
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Affiliation(s)
- Osamu Nomura
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.,Department of Integrated Medical Education, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Hiroki Mishina
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Harish Jasti
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hirokazu Sakai
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishiguro
- Department of Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
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DeCaporale-Ryan L, Sakran JV, Grant SB, Alseidi A, Rosenberg T, Goldberg RF, Sanfey H, Dubose J, Stawicki S, Ricca R, Derrick ET, Bernstein CA, Jardine DA, Stefanou AJ, Aziz B, He E, Dissanaike S, Fortuna COLGR, Oviedo RJ, Shapiro J, Galowitz P, Moalem J. The undiagnosed pandemic: Burnout and depression within the surgical community. Curr Probl Surg 2017; 54:453-502. [DOI: 10.1067/j.cpsurg.2017.07.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Glover Takahashi S, Nayer M, St. Amant LMM. Epidemiology of competence: a scoping review to understand the risks and supports to competence of four health professions. BMJ Open 2017; 7:e014823. [PMID: 28864686 PMCID: PMC5588989 DOI: 10.1136/bmjopen-2016-014823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This study examined the risks and supports to competence discussed in the literature related to occupational therapists, pharmacists, physical therapists and physicians, using epidemiology as a conceptual model. DESIGN Articles from a scoping literature review, published from 1975 to 2014 inclusive, were included if they were about a risk or support to the professional or clinical competence of one of four health professions. Descriptive and regression analyses identified potential associations between risks and supports to competence and the location of study, type of health profession, competence life-cycle and the domain(s) of competence (organised around the CanMEDS framework). RESULTS A total of 3572 abstracts were reviewed and 943 articles analysed. Most focused on physicians (n=810, 86.0%) and 'practice' (n=642, 68.0%). Fewer articles discussed risks to competence (n=418, 44.3%) than supports (n=750, 79.5%). The top four risks, each discussed in over 15% of articles, were: transitions in practice, being an international graduate, lack of clinical exposure/experience (ie, insufficient volume of procedures or patients) and age. The top two supports (over 35%) were continuing education participation and educational information/programme features. About 60% of all the articles discussed medical expert and about 25% applied to all roles. Articles focusing on residents had a greater probability of reporting on risks. CONCLUSIONS Articles about physicians were dominant. The majority of articles were written in the last decade and more discussed supports than risks to competence. An epidemiology-based conceptual model offers a helpful organising framework for exploring and explaining the competence of health professions.
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Affiliation(s)
- Susan Glover Takahashi
- Department of Postgraduate Medical Education, University of Toronto, Toronto, Ontario, Canada
| | - Marla Nayer
- Department of Postgraduate Medical Education, University of Toronto, Toronto, Ontario, Canada
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McKinley TF, Boland KA, Mahan JD. Burnout and interventions in pediatric residency: A literature review. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.burn.2017.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Koo K. Addressing Digital Wellness in Contemporary Training and Practice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:897-898. [PMID: 28654518 DOI: 10.1097/acm.0000000000001737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Kevin Koo
- Resident physician, Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire;
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Packirisamy P, Meenakshy M, Jagannathan S. Burnout during early career: lived experiences of the knowledge workers in India. JOURNAL OF ENTERPRISE INFORMATION MANAGEMENT 2017. [DOI: 10.1108/jeim-01-2016-0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to explore the phenomenon of burnout during early career among knowledge workers in information technology (IT) services industry in India.Design/methodology/approachThe grounded theory research design was used to explore the research phenomenon. The study was based on the analysis of 43 in-depth interviews from the employees, managers and human resource professionals in IT services industry in India. Purposeful and theoretical sampling designs were used to locate the participants for the study. Grounded theory analytical procedures – open, axial and selective coding – were used to analyze and interpret the interview narratives. Atlas ti version 5.0. was used for qualitative data analysis.FindingsThe analysis of the interviews with the young knowledge workers reveal the following as the reasons for their burnout during early career: poor integration with the job and the organization at large, underemployment, stressful job and exhausting work environment, fear and insecurity of replacement of talent and downsizing. Strategies are discussed to deal with burnout situations among the young knowledge workers for individual and organizational well-being.Research limitations/implicationsThe findings of the study are applicable to organizations such as the IT services industry and thus the research outcome cannot be generalized. The study includes lived experiences of employees only during their early career.Practical implicationsThe findings are relevant and useful in the practice domain as they are grounded in field reality. It provides directions for managerial and organizational practices in preventing burnout in early career among knowledge workers.Originality/valueThe paper is original and the present study is among the first attempts to investigate the nature of burnout through qualitative inquiry.
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Anesthesiology Resident Wellness Program at the University of Saskatchewan: concept and development. Can J Anaesth 2016; 64:185-198. [DOI: 10.1007/s12630-016-0772-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/11/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022] Open
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Anesthesiology Resident Wellness Program at the University of Saskatchewan: curriculum content and delivery. Can J Anaesth 2016; 64:199-210. [DOI: 10.1007/s12630-016-0773-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/24/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022] Open
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Malaquin S, Mahjoub Y, Musi A, Zogheib E, Salomon A, Guilbart M, Dupont H. Burnout syndrome in critical care team members: A monocentric cross sectional survey. Anaesth Crit Care Pain Med 2016; 36:223-228. [PMID: 27671976 DOI: 10.1016/j.accpm.2016.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/23/2016] [Accepted: 06/02/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION There has been a growing interest in evaluating the occurrence of burnout syndrome (BOS) among intensive care units (ICU) team over recent years. The aims of this study were to determine the prevalence of BOS among staff working in the Amiens University Hospital and to assess associated factors. PATIENTS AND METHODS Prospective observational study based on self-administered questionnaires filled in by physicians and non-physicians working in 3 ICUs. Demographic data, well-being assessment, work relationships, level of BOS and depressive symptoms were investigated. Logistic regression analysis was performed to identify variables independently associated with BOS. RESULTS One hundred and sixty-one questionnaires were analysed. Participation rate was 90%. Thirty-two respondents were physicians and 129 were non-physicians. The prevalence of BOS was 51% and was not significantly different between physicians and non-physicians (56% versus 50%; P=0.501). Respondents who reported BOS less frequently had regular leisure activities (54 [66%] versus 70 [87%], P=0.001). In the BOS group, well-being was significantly lower (4.8±2.5/10 versus 6±2/10, P=0.001), a desire to leave the job was more frequently expressed (50 [61%] versus 32 [40%], P=0.009) and depressive symptoms were significantly more frequent (41 [50%] versus 21 [27%], P=0.002). Factors independently associated with BOS were regular leisure activities (OR 0.24 [0.1-0.59]; P=0.002), the presence of depressive symptoms (OR 2.71 [1.26-5.84]; P=0.011) and a well-being visual analogue scale≥5 (OR 0.40 [0.18-0.89]; P=0.024). CONCLUSIONS BOS affects all ICU workers and is determined by multiple factors. Leisure activities and measures designed to improve well-being should be promoted.
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Affiliation(s)
- Stéphanie Malaquin
- Surgical Intensive Care Unit, Amiens University Hospital, 80000 Amiens, France.
| | - Yazine Mahjoub
- Surgical Intensive Care Unit, Amiens University Hospital, 80000 Amiens, France; Inserm U1088, University of Picardy-Jules-Verne, 80000 Amiens, France.
| | - Arianna Musi
- Surgical Intensive Care Unit, Amiens University Hospital, 80000 Amiens, France.
| | - Elie Zogheib
- Cardiac, Thoracic and Vascular Intensive Care Unit, Amiens University Hospital, 80000 Amiens, France; Inserm U1088, University of Picardy-Jules-Verne, 80000 Amiens, France.
| | - Alexis Salomon
- Neurological Intensive Care Unit, Amiens University Hospital, 80000 Amiens, France; Inserm U1088, University of Picardy-Jules-Verne, 80000 Amiens, France.
| | - Mathieu Guilbart
- Cardiac, Thoracic and Vascular Intensive Care Unit, Amiens University Hospital, 80000 Amiens, France.
| | - Hervé Dupont
- Surgical Intensive Care Unit, Amiens University Hospital, 80000 Amiens, France; Cardiac, Thoracic and Vascular Intensive Care Unit, Amiens University Hospital, 80000 Amiens, France; Neurological Intensive Care Unit, Amiens University Hospital, 80000 Amiens, France; Inserm U1088, University of Picardy-Jules-Verne, 80000 Amiens, France.
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Nomura O, Mishina H, Kobayashi Y, Ishiguro A, Sakai H, Kato H. Limitation of duty hour regulations for pediatric resident wellness: A mixed methods study in Japan. Medicine (Baltimore) 2016; 95:e4867. [PMID: 27631253 PMCID: PMC5402596 DOI: 10.1097/md.0000000000004867] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Duty hour regulations have been placed in residency programs to address mental health concerns and to improve wellness. Here, we elucidate the prevalence of depressive symptoms after implementing an overnight call shift system and the factors associated with burnout or depression among residents.A sequential exploratory mixed methods study was conducted in a tertiary care pediatric and perinatal hospital in Tokyo, Japan. A total of 41 pediatric residents participated in the cross-sectional survey. We determined and compared the prevalence of depressive symptoms and the number of actual working hours before and after implementing the shift system. A follow-up focus-group interview with 4 residents was conducted to explore the factors that may trigger or prevent depression and burnout.Mean working hours significantly decreased from 75.2 hours to 64.9 hours per week. Prevalence of depressive symptoms remained similar before and after implementation of the shift system. Emotional exhaustion and depersonalization from the burnout scale were markedly associated with depression. High workload, stress intolerance, interpersonal difficulties, and generation gaps regarding work-life balance could cause burnout. Stress tolerance, workload monitoring and balancing, appropriate supervision, and peer support could prevent burnout.Although the overnight call shift system was effective in reducing working hours, its effectiveness in managing mental health issues among pediatric residents remains unclear. Resident wellness programs represent an additional strategy and they should be aimed at fostering peer support and improvement of resident-faculty interactions. Such an approach could be beneficial to the relationship between physicians of different generations with conflicting belief structures.
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Affiliation(s)
- Osamu Nomura
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo
- Department of Integrated Medical Education, Graduate School of Medicine, Hirosaki University, 1 Zaifu-cho, Hirosaki City, Aomori, Japan
- Correspondence: Osamu Nomura, Department of Integrated Medical Education, Graduate School of Medicine, Hirosaki University, 1 Zaifu-cho, Hirosaki City, Aomori, Japan (e-mail: )
| | - Hiroki Mishina
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo
| | - Yoshinori Kobayashi
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo
| | - Akira Ishiguro
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo
| | - Hirokazu Sakai
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo
| | - Hiroyuki Kato
- Department of Integrated Medical Education, Graduate School of Medicine, Hirosaki University, 1 Zaifu-cho, Hirosaki City, Aomori, Japan
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Soares DS, Chan L. Stress and wellbeing of junior doctors in Australia: a comparison with American doctors and population norms. BMC MEDICAL EDUCATION 2016; 16:183. [PMID: 27435724 PMCID: PMC4949893 DOI: 10.1186/s12909-016-0693-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 06/21/2016] [Indexed: 05/24/2023]
Abstract
BACKGROUND Stress in doctors adversely affects decision-making, memory, information-recall and attention, thereby negatively impacting upon the provision of safe and high quality patient care. As such, stress in doctors has been subject to increasing scientific scrutiny and has amassed greater public awareness in recent years. The aims of this study are to describe stress levels and the psychological wellbeing of current junior medical officers (JMOs), and to compare this to their predecessors, American surgical residents and population norms. METHODS Post graduate years 1 & 2 doctors at a single metropolitan tertiary referral center were surveyed in 2009 and 2014 using two reliable and validated psychometric questionnaires, the Short Form-36 (SF36) and Perceived Stress Scale-14 (PSS14), with additional questions pertaining to demographics and training. The results were compared with published data from American general surgical residents and Australian age-matched population norms. RESULTS Mean stress levels were lower in 2014 (23 ± 7.2) than in 2009 (27.2 ± 7.6) (p = 0.017). The mean PSS-14 score was lower than that of American surgical residents, both before (26.8 ± 7.3, p = 0.003) and after (26.7 ± 8.2, p = 0.004) implementation of the safe working hour policies but higher than societal controls (p < 0.0001). Whilst JMOs in 2014 reported better overall mental health compared to those in 2009 (p = 0.02), they were significantly worse than the general population (p = 0.009). Multivariate analysis showed that JMOs were more likely to have a high PSS-14 score or to have a low mental health score if they reported higher career anxiety (p < 0.05). CONCLUSIONS Doctors are still at risk despite an improvement in their stress levels and overall mental health. They are less likely to be stressed and to have better mental health if they have less career-related anxiety. This has implications for the medical education and training of our junior doctors.
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Affiliation(s)
- Deanne S. Soares
- Department of Urology, Concord Repatriation General Hospital, Sydney, Australia
| | - Lewis Chan
- Department of Urology, Concord Repatriation General Hospital, Sydney, Australia
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Runyan C, Savageau JA, Potts S, Weinreb L. Impact of a family medicine resident wellness curriculum: a feasibility study. MEDICAL EDUCATION ONLINE 2016; 21:30648. [PMID: 27282276 PMCID: PMC4901506 DOI: 10.3402/meo.v21.30648] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 03/20/2016] [Accepted: 03/23/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND Up to 60% of practicing physicians report symptoms of burnout, which often peak during residency. Residency is also a relevant time for habits of self-care and resiliency to be emphasized. A growing literature underscores the importance of this; however, evidence about effective burnout prevention curriculum during residency remains limited. OBJECTIVES The purpose of this project is to evaluate the impact of a new, 1-month wellness curriculum for 12 second-year family medicine residents on burnout, empathy, stress, and self-compassion. METHODS The pilot program, introduced during a new rotation emphasizing competencies around leadership, focused on teaching skills to cultivate mindfulness and self-compassion in order to enhance empathy and reduce stress. Pre-assessments and 3-month follow-up assessments on measures of burnout, empathy, self-compassion, and perceived stress were collected to evaluate the impact of the curriculum. It was hypothesized that this curriculum would enhance empathy and self-compassion as well as reduce stress and burnout among family medicine residents. RESULTS Descriptive statistics revealed positive trends on the mean scores of all the measures, particularly the Mindfulness Scale of the Self-Compassion Inventory and the Jefferson Empathy Scale. However, the small sample size and lack of sufficient power to detect meaningful differences limited the use of inferential statistics. CONCLUSIONS This feasibility study demonstrates how a residency wellness curriculum can be developed, implemented, and evaluated with promising results, including high participant satisfaction.
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Affiliation(s)
- Christine Runyan
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA;
| | - Judith A Savageau
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA
| | - Stacy Potts
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA
| | - Linda Weinreb
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA
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Tabatabai RR. Responding to the Call for Improving Resident Wellness. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:750. [PMID: 27218899 DOI: 10.1097/acm.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Ramin R Tabatabai
- Assistant professor of clinical emergency medicine, Keck School of Medicine of USC, and assistant program director, LAC+USC Emergency Medicine Residency, Los Angeles, California;
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Regan L, Hexom B, Nazario S, Chinai SA, Visconti A, Sullivan C. Remediation Methods for Milestones Related to Interpersonal and Communication Skills and Professionalism. J Grad Med Educ 2016; 8:18-23. [PMID: 26913097 PMCID: PMC4762325 DOI: 10.4300/jgme-d-15-00060.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Linda Regan
- Corresponding author: Linda Regan, MD, Johns Hopkins Medical Institutions, Department of Emergency Medicine, 1830 East Monument Street, Suite 6-100, Baltimore, MD 21287,
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Watson EM. The importance of leisure reading to health sciences students: results of a survey. Health Info Libr J 2015; 33:33-48. [DOI: 10.1111/hir.12129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 10/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Erin M. Watson
- Leslie and Irene Dubé Health Sciences Library; University of Saskatchewan; Saskatoon Canada
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Evaluating Mind Fitness Training and Its Potential Effects on Surgical Residents’ Well-Being: A Mixed Methods Pilot Study. World J Surg 2015; 40:29-37. [DOI: 10.1007/s00268-015-3278-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Siedsma M, Emlet L. Physician burnout: can we make a difference together? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:273. [PMID: 26134266 PMCID: PMC4489124 DOI: 10.1186/s13054-015-0990-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Citation West CP, Dyrbye LN, Rabatin JT, Call TG, Davidson JH, Multari A, Romanski SA, Hellyer JMH, Sloan JA, Shanafelt TF. Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA Intern Med. 2014;174:527–33. Background Despite the documented prevalence and clinical ramifications of physician distress, few rigorous studies have tested interventions to address the problem. Methods Objective: To test the hypothesis that an intervention involving a facilitated physician small-group curriculum would result in improvement in well-being. Design: A randomized clinical trial of practicing physicians. Additional data were collected on nontrial participants responding to annual surveys timed to coincide with the trial surveys. Setting: Department of Medicine at the Mayo Clinic in Rochester, Minnesota between September 2010 and June 2012. Participants: The study involved 74 practicing physicians in the Department of Medicine and 350 nontrial participants responding to annual surveys. Interventions: The intervention involved 19 biweekly facilitated physician discussion groups incorporating elements of mindfulness, reflection, shared experience, and small-group learning for 9 months. Protected time (1 hour of paid time every other week) for participants was provided by the institution. Outcomes: Meaning in work, empowerment and engagement in work, burnout, symptoms of depression, quality of life, and job satisfaction were assessed using validated metrics. Results Empowerment and engagement at work increased by 5.3 points in the intervention arm vs. a 0.5-point decline in the control arm by 3 months after the study (P = .04), an improvement sustained at 12 months (+5.5 vs. +1.3 points; P = .03). Rates of high depersonalization at 3 months had decreased by 15.5 % in the intervention arm vs. a 0.8 % increase in the control arm (P = .004). This difference was also sustained at 12 months (9.6 % vs. 1.5 % decrease; P = .02). No statistically significant differences in stress, symptoms of depression, overall quality of life, or job satisfaction were seen. In additional comparisons including the nontrial physician cohort, the proportion of participants strongly agreeing that their work was meaningful increased 6.3 % in the study intervention arm but decreased 6.3 % in the study control arm and 13.4 % in the nonstudy cohort (P = .04). Rates of depersonalization, emotional exhaustion, and overall burnout decreased substantially in the trial intervention arm, decreased slightly in the trial control arm, and increased in the nontrial cohort (P = .03, P = .007, and P = .002 for each outcome, respectively). Conclusions An intervention for physicians based on a facilitated small-group curriculum improved meaning and engagement in work and reduced depersonalization, with sustained results 12 months after the study.
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Affiliation(s)
- Matthew Siedsma
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, 3471 Fifth Avenue, 1215 Kaufmann Building, Pittsburgh, PA, 15213, USA.
| | - Lillian Emlet
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, 3471 Fifth Avenue, 1215 Kaufmann Building, Pittsburgh, PA, 15213, USA.
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Cedfeldt AS, Bower E, Flores C, Brunett P, Choi D, Girard DE. Promoting resident wellness: evaluation of a time-off policy to increase residents' utilization of health care services. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:678-683. [PMID: 25354073 DOI: 10.1097/acm.0000000000000541] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To evaluate awareness and utilization of a new institutional policy to grant residents time off to access personal and family health care. METHOD In 2012, two years after policy implementation, an electronic survey was sent to all 546 residents and fellows at a tertiary care academic medical center in the United States. Residents were asked questions regarding awareness of the time-off policy, use of the policy, health care status, reasons for policy use, and barriers to use. RESULTS A total of 490 (90%) residents responded. Eighty-nine percent of those surveyed were aware of the policy. Of those who were aware, 49.7% used the policy to access health care. Top reasons for policy use were for personal routine or preventive health care, dental care, and urgent health care needs. The most commonly reported barrier to policy use was concern about the impact the resident's absence would have on colleagues. CONCLUSIONS Implementation of policies to prospectively schedule residents' time off during business hours to address health care needs is an important means to promote resident wellness. Such policies remove one commonly cited barrier to residents' access to health care. However, residents still reported concerns about impact on peers and patients as the main reason they were reluctant to take the time off to address their health care needs. More work is needed on both wellness policy implementation practices and on refining the systems that will allow seamless and guiltless transitions of care.
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Affiliation(s)
- Andrea S Cedfeldt
- A.S. Cedfeldt is education consultant, Division of Graduate Medical Education, and associate professor, Department of Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon. E. Bower is associate professor, Department of Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon. C. Flores is associate director, Division of Graduate Medical Education, School of Medicine, Oregon Health & Science University, Portland, Oregon. P. Brunett is associate dean, Division of Graduate Medical Education, and associate professor, Department of Emergency Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon. D. Choi is professor, Department of Public Health and Preventive Medicine, Department of Ophthalmology, School of Medicine, and Department of Community Dentistry, School of Dentistry, Oregon Health & Science University, Portland, Oregon. D.E. Girard is senior consultant, Divisions of Graduate Medical Education and Continuing Medical Education, J.S. Reinschmidt Professor of Medical Education, and professor, Department of Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
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