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Fresán A, Robles-García R, Yoldi-Negrete M, Guízar-Sánchez D, Tovilla-Zárate CA. To the bone: Prevalence and correlates of depression and anxiety among orthopedic residents in Mexico. Int J Psychiatry Med 2024; 59:455-468. [PMID: 37653426 DOI: 10.1177/00912174231199216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Examining orthopedic residents in Mexico, researchers explore the relationship between the presence of depressive or anxious symptoms and the degree of perfectionism, perceived work-related distress, and involvement in the care of patient(s) who died. METHODS This was a cross-sectional online survey of 642 orthopedic residents from October 2019 to April 2021. RESULTS Of orthopedic residents contacted, 50.6% responded rate (70.9% male, average age 29.8 years). A total of 12.5% reported significant depressive symptoms and 18.4% reported significant anxious symptoms. On a scale from 0-100, the mean score of perceived work-related distress was 51.9. One-third (33.6%) reported being involved in the care of patient(s) who had died. Higher levels of work-related distress and higher scores on perfectionism were associated with depressive and anxiety symptoms. In particular, being involved in the care of patient(s) who had died was associated with anxious symptoms (OR = 1.79; 95%CI = 1.18-2.72). CONCLUSIONS These results highlight the need for systematic monitoring of the mental health of orthopedic residents in Mexico, particularly those who report a high level of work-related distress or perfectionism or who have recently experienced the death of a patient.
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Affiliation(s)
- Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Rebeca Robles-García
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - María Yoldi-Negrete
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Diana Guízar-Sánchez
- Departamento de Fisiología de la Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico
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Antony P, Kalkum E, Muller MK, Hager L, Probst P. The introduction of a 42 + 4 h work week for surgical residents in Switzerland - a stakeholder analysis. Langenbecks Arch Surg 2024; 409:197. [PMID: 38913126 DOI: 10.1007/s00423-024-03385-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/16/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND The Swiss national union of residents and attendings (VSAO) has voiced its desire for a transition from the current 48 h work week to a 42 + 4 h work week, in which 42 h be focused on patient care with the remaining 4 h be dedicated solely to training purposes. This could potentially result in a significant decrease in surgical education time. The current study seeks to address the issues involved in its implementation as well as possible compensatory mechanisms. METHODS This mixed methods study seeks to clearly underline the challenges associated with the implementation of a 42 + 4 h work week. First, the major stakeholders were identified and analysed via umbrella review. Thereafter, a classic stakeholder analysis was performed. Via morphological matrix, possible models for the implementation of a 42 + 4 h work week were developed and evaluated. Finally, representatives from the identified stakeholder groups were interviewed and given the opportunity to provide feedback. RESULTS A total of 26 articles were identified by the literature search and were used to identify the major stakeholders and issues involved in the implementation of the desired work hour regulation. Overall, these showed conflicting results with regard to the effect decreased working hours would have on surgical training and patient outcomes. In the end, the morphological matrix produced three feasible and desirable models for the implementation of a 42 + 4 h work week. Each included compensatory mechanisms like auxiliary staff, reduction in administrative tasks, and a switch to EPAs. In their interviews, the stakeholders generally supported these solutions. CONCLUSION Given the increasing emphasis on the importance of a positive work-life balance, it seems inevitable that the next few years will see the introduction of a 42 + 4 h work week in Switzerland. However, it is imperative that every effort be made to preserve the quality of training and patient care for the next generations. This will require the cooperation of all stakeholders in order to find workable solutions.
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Affiliation(s)
- P Antony
- Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, Münsterlingen, 8501, Switzerland
| | - Eva Kalkum
- The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Heidelberg, Germany
| | - M K Muller
- Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, Münsterlingen, 8501, Switzerland
| | | | - Pascal Probst
- Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, Münsterlingen, 8501, Switzerland.
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Khalil MA, Khalifa D, Allam RM, Abdalgeleel SA, Khalaf OO. Suicide and depressive symptoms possible correlates among a sample of Egyptian physicians: observational cross-sectional study (online survey). BMC Psychiatry 2024; 24:408. [PMID: 38816711 PMCID: PMC11137965 DOI: 10.1186/s12888-024-05825-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Compared to other occupations, physicians are more susceptible to depression and suicide. Suicide among physicians in some countries reached up to 1.5- to threefold higher than the general population. However, this rate was not homogenous in all countries. Most of the Egyptian studies were related to the stressful pandemic event, but the actual prevalence of depression among physicians is still under research. To the best of the researcher's knowledge, no other study has been conducted to evaluate the risk of suicide among Egyptian physicians. AIM The study aimed to screen for depressive symptoms and suicide among Egyptian physicians and to investigate the correlates associated with suicide ideations. METHODS This cross-sectional survey included Egyptian physicians recruited online by Google Forms. Depressive symptoms were screened using the Beck Depression Scale (BDI-II), while suicidal ideas were assessed using the Suicidal Ideation Attributes Scale (SIDAS). RESULTS Six hundred sixty Egyptian physicians completed the survey following a two-week pilot study between January 10 and July 16, 2023. The average age was 39.1 years, and 71.4% were married. 49.1% were medical specialists. The median daily working hours were eight, and 27.7% of the physicians attended night shifts. 22.3% had a psychiatric illness, and 34.3% had a chronic disease. Younger and single physicians of both sexes were more prone to suicide risk (p-value = 0.019 and 0.021, respectively). Those with psychiatric or chronic medical disorders had a higher suicidal risk (p-values < 0.001 and 0.004, respectively). Physicians with fewer academic degrees and those who work longer hours or night shifts had more depressive symptoms (p-values < 0.001 and 0.009, respectively). The risk of depression and suicide is almost the same in all medical specialties. The SIDAS suicide score and the Beck depression score revealed a statistically significant association (r = 0.288, p-value < 0.001). CONCLUSION Suicide risk is higher among younger, single physicians of both sexes, as well as those with psychiatric or chronic medical disorders. More depressive symptoms are seen in physicians who have more extended hours or night shifts and who have fewer academic degrees. Almost all medical specialties carry the same risk of depression and suicide. Longitudinal research is recommended for regular follow-up of suicidal thoughts and depressive symptoms.
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Affiliation(s)
- Mohamed A Khalil
- Psychiatry Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Khalifa
- Psychiatry Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rasha Mahmoud Allam
- Cancer Epidemiology and Biostatistics Department, National Cancer Institute, Cairo University, Egypt
| | - Shaimaa Abdalaleem Abdalgeleel
- Cancer Epidemiology and Biostatistics Department, National Cancer Institute, Cairo University, Egypt
- Department of Public Health, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
| | - Ola Osama Khalaf
- Psychiatry Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Fu K, Walmsley J, Abdelrahman M, Chan DSY. How much time do surgeons spend operating? Surgeon 2024; 22:1-5. [PMID: 37793946 DOI: 10.1016/j.surge.2023.09.001] [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: 07/19/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Worldwide, there is significant variation in the amount of time surgeons spend performing elective surgery. The degree of variation is unknown. The aim of this study was to assess the variation in amount of time that surgeons spend operating worldwide. METHODS An anonymised electronic survey was sent via email to members of The Upper Gastrointestinal Surgeons (TUGS) and shared via social media. The questionnaire consisted of demographic details (age, gender, country of practice), scope of practice (full time/less than full time; private/public sector), experience and average number of days the surgeon spends performing elective surgery. RESULTS A total of 225 predominantly general/upper GI surgeons from 47 countries responded. Worldwide, the median number of days that surgeons spend performing elective surgery is 2 days a week. There was significant variation across countries/continents: UK 1 day; North America 2.5 days; Europe 3 days; Asia 2 days; Africa 2 days; South America 1 day; Oceania 1 day (p < 0.0001). All surgeons worldwide preferred to spend 3 days a week performing elective surgery except UK surgeons who desired 2 days a week. CONCLUSION There is significant variation in the amount of time that surgeons spend performing elective surgery worldwide. Results of this study could inform public expectations and trainee surgeons on ideal opportunities for training. Reasons for the wide variation could be explored.
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Affiliation(s)
- Kathryn Fu
- Department of Oesophago-gastric Surgery, Derriford Hospital, Plymouth, PL6 8DH, United Kingdom.
| | - James Walmsley
- Department of Oesophago-gastric Surgery, Derriford Hospital, Plymouth, PL6 8DH, United Kingdom
| | - Mohamed Abdelrahman
- Department of Oesophago-gastric Surgery, Derriford Hospital, Plymouth, PL6 8DH, United Kingdom
| | - David S Y Chan
- Department of Oesophago-gastric Surgery, Derriford Hospital, Plymouth, PL6 8DH, United Kingdom
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Koike S, Wada H, Ohde S, Ide H, Taneda K, Tanigawa T. Working hours of full-time hospital physicians in Japan: a cross-sectional nationwide survey. BMC Public Health 2024; 24:164. [PMID: 38216962 PMCID: PMC10785398 DOI: 10.1186/s12889-023-17531-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND The culture of excessively long overtime work in Japan has not been recently addressed. New legislation on working hours, including a limitation on maximum overtime work for physicians, will be enforced in 2024. This study was performed to elucidate the working conditions of full-time hospital physicians and discuss various policy implications. METHODS A facility survey and a physician survey regarding physicians' working conditions were conducted in July 2022. The facility survey was sent to all hospitals in Japan, and the physician survey was sent to all physicians working at half of the hospitals. The physicians were asked to report their working hours from 11 to 17 July 2022. In addition to descriptive statistics, a multivariate logistic regression analysis on the factors that lead to long working hours was conducted. RESULTS In total, 11,466 full-time hospital physicians were included in the analysis. Full-time hospital physicians worked 50.1 h per week. They spent 45.6 h (90.9%) at the main hospital and 4.6 h (9.1%) performing side work. They spent 43.8 h (87.5%) on clinical work and 6.3 h (12.5%) on activities outside clinical work, such as research, teaching, and other activities. Neurosurgeons worked the longest hours, followed by surgeons and emergency medicine physicians. In total, 20.4% of physicians were estimated to exceed the annual overtime limit of 960 h, and 3.9% were estimated to exceed the limit of 1860 h. A total of 13.3% and 2.0% exceeded this level only at their primary hospital, after excluding hours performing side work. Logistic regression analysis showed that male, younger age, working at a university hospital, working in clinical areas of practice with long working hours, and undergoing specialty training were associated with long working hours after controlling for other factors. CONCLUSIONS With the approaching application of overtime regulations to physicians, a certain reduction in working hours has been observed. However, many physicians still work longer hours than the designated upper limit of overtime. Work reform must be further promoted by streamlining work and task-shifting while securing the functions of university hospitals such as research, education, and supporting healthcare in communities.
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Affiliation(s)
- Soichi Koike
- Division of Health Policy and Management, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Hiroo Wada
- Department of Public Health, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Sachiko Ohde
- Graduate School of Public Health, St. Luke's International University, 3-6-2 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Hiroo Ide
- Institute for Future Initiatives, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Kenichiro Taneda
- Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
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Chen-Xu J, Miranda Castilho B, Moura Fernandes B, Silva Gonçalves D, Ferreira A, Gonçalves AC, Ferreira Vieira M, Silva AM, Borges F, Paes Mamede M. Medical residency in Portugal: a cross-sectional study on the working conditions. FRONTIERS IN HEALTH SERVICES 2023; 3:1190357. [PMID: 38116534 PMCID: PMC10728646 DOI: 10.3389/frhs.2023.1190357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/07/2023] [Indexed: 12/21/2023]
Abstract
Objectives The current European crisis in human resources in health has opened the debate about working conditions and fair wages. This is the case with Resident doctors, which have faced challenges throughout Europe. In Portugal, they account for about a third of the doctors in the Portuguese National Health Service. No studies to date objectively demonstrate the working conditions and responsibilities undertaken. This study aims to quantify the residents' workload and working conditions. Methods Observational, retrospective cross-sectional study which involved a survey on the clinical and training activity of Portuguese residents, actively working in September 2020. The survey was distributed through e-mail to residents' representatives and directly to those affiliated with the Independent Union of Portuguese Doctors. The descriptive analysis assessed current workload, and logistic regression models analyzed associations with geographical location and residency seniority. Results There were a total of 2,012 participants (19.6% of invited residents). Of the residents giving consultations, 85.3% do so with full autonomy. In the emergency department, 32.1% of the residents work 24 h shifts and 25.1% work shifts without a specialist doctor present. Regarding medical training, 40.8% invest over EUR 1,500 annually. Autonomy in consultations was associated with being a Family Medicine resident (OR 4.219, p < 0.001), being a senior resident (OR 5.143, p < 0.001), and working in the Center (OR 1.685, p = 0.009) and South regions (OR 2.172, p < 0.001). Seniority was also associated with investing over EUR 1,500 in training annually (OR 1.235, p = 0.021). Conclusion Residents work far more than the contracted 40 h week, often on an unpaid basis. They present a high degree of autonomy in their practice, make a very significant personal and financial investment in medical training, with almost no time dedicated to studying during working hours. There is a need to provide better working conditions for health professionals, including residents, for the sake of the sustainability of health systems across Europe.
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Affiliation(s)
- José Chen-Xu
- Unidade de Saúde Pública, Agrupamento de Centros de Saúde Baixo Mondego, Coimbra, Portugal
- Comprehensive Health Research Centre, National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | | | - Bruno Moura Fernandes
- Radiology Oncology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Diana Silva Gonçalves
- Unidade de Saúde Familiar ARS Médica, Agrupamento de Centros de Saúde Loures-Odivelas, Loures, Portugal
| | - André Ferreira
- Medical Oncology Department, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Ana Catarina Gonçalves
- Infectious Diseases Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Maycoll Ferreira Vieira
- Centros de Saúde de Santana e do Caniçal, Serviço de Saúde da Região Autónoma da Madeira, EPERAM, Madeira, Portugal
| | - Andreia M. Silva
- General Surgery Department, Hospital da Horta, EPER, Açores, Portugal
| | - Fábio Borges
- Unidade de Saúde Familiar S. Miguel-O-Anjo, Agrupamento de Centros de Saúde Ave-Famalicão, Famalicão, Portugal
| | - Mónica Paes Mamede
- Anaesthesiology Department, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
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Nagasaki K, Kobayashi H. The effects of resident work hours on well-being, performance, and education: A review from a Japanese perspective. J Gen Fam Med 2023; 24:323-331. [PMID: 38025934 PMCID: PMC10646297 DOI: 10.1002/jgf2.649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/20/2023] [Accepted: 08/31/2023] [Indexed: 12/01/2023] Open
Abstract
This article examines the impact of working-hour restrictions on the well-being, performance, and education of medical residents in Japan. Despite Japan's plan to introduce new regulations for resident working hours by 2024, there is still an ongoing debate regarding their appropriateness. This review provides a comprehensive overview of the current regulations of resident working hours worldwide, with a specific focus on weekly hours. The varying regulations are highlighted, including the 80-hour-per-week regulation in the United States and the 48-h-per-week regulation in the European Union influencing other regions. The article also discusses the effectiveness of working-hour restrictions on residents' mental health, with shorter working hours having potentially greater benefits. However, the impacts on medical safety and resident education are mixed, and further reduction in working hours must be carefully considered to avoid adverse effects. The planned changes to working-hour limits for residents in Japan offer a unique opportunity to gain new evidence on the impact of such regulations, which will be of interest to policymakers and researchers worldwide.
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Affiliation(s)
- Kazuya Nagasaki
- Department of Internal Medicine, Mito Kyodo General HospitalUniversity of TsukubaIbarakiJapan
| | - Hiroyuki Kobayashi
- Department of Internal Medicine, Mito Kyodo General HospitalUniversity of TsukubaIbarakiJapan
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Shah AP, Walker KA, Walker KG, Cleland J. Context matters in curriculum reform: An analysis of change in surgical training. MEDICAL EDUCATION 2023; 57:741-752. [PMID: 36869257 DOI: 10.1111/medu.15071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Education and training reforms are typically devised by accreditation bodies and rolled out nationally. This top-down approach is positioned as contextually independent, yet context is highly influential in shaping the impact of change. Given this, it is critical to consider how curriculum reform plays out as it meets local settings. We have therefore used a national-level curriculum reform process of surgical training, Improving Surgical Training (IST), to examine the influence of context in IST implementation across two UK countries. METHODS Adopting a case study approach, we used document data for contextualisation purposes and semi-structured interviews with key stakeholders across multiple organisations (n = 17, plus four follow-up interviews) as our main source of data. Initial data coding and analysis were inductive. We followed this with a secondary analysis using Engeström's second-generation activity theory nested within an overarching framework of complexity theory to help tease out some key elements of IST development and implementation. RESULTS The introduction of IST into the surgical training system was historically situated within a landscape of previous reforms. IST's aims collided with existing practices and rules, thus creating tensions. In one country, the systems of IST and surgical training came together to some extent, mostly due to processes of social networks, negotiation and leverage nested in a relatively cohesive setting. These processes were not apparent in the other country, and instead of transformative change, the system contracted. Change was not integrated, and the reform was halted. CONCLUSIONS Our use of a case study approach and complexity theory deepens understanding of how history, systems and contexts interact to facilitate or inhibit change within one area of medical education. Our study paves the way for further empirical work examining the influence of context in curriculum reform, and thus determining how best to bring about change in practice.
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Affiliation(s)
- Adarsh P Shah
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kim A Walker
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kenneth G Walker
- NHS Education for Scotland, Centre for Health Science, Inverness, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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Fresán A, Guízar-Sánchez D, Yoldi-Negrete M, Robles-García R, Tovilla-Zárate CA, Saracco-Álvarez R. Gender Differences in Professional Adversities and Mental Health Among Surgical and Nonsurgical Medical Trainees: An Internet-Based Survey. JOURNAL OF SURGICAL EDUCATION 2023; 80:666-675. [PMID: 36801202 DOI: 10.1016/j.jsurg.2023.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/05/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Physicians in training face a variety of stressors throughout their professional development and according to their gender. Among them, surgical trainees appear to be especially at risk for mental health problems. OBJECTIVE The aim of the present study was to compare demographic features, professional activities and adversities, depression, anxiety, and distress among men and women trainees of surgical and nonsurgical medical specialties. DESIGN AND PARTICIPANTS A cross-sectional, retrospective, comparative study was conducted on a total of 12,424 trainees (68.7% nonsurgical and 31.3% surgical) from Mexico through an online survey. Demographic features, variables related to professional activities and adversities, depression, anxiety, and distress were evaluated through self-administered measures. Comparative analyses using the Cochran-Mantel-Haenszel test for categorical variables and multivariate analysis of variance including medical residency program and gender as fixed factors to test their interaction effect for continuous variables were used. RESULTS An important interaction between medical specialty and gender was found. Women trainees from surgical specialties report more frequent psychological and physical aggressions. Women from both specialties had higher distress, significant anxiety, and depression than men. Men from surgical specialties worked more hours per day. CONCLUSIONS Gender differences are evident in trainees for medical specialties, with a larger impact in surgical fields. Mistreatment of students is a pervasive behavior that affects society as a whole, and actions to improve learning and working environments in all medical specialties, but mostly in surgical fields, are urgently needed.
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Affiliation(s)
- Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico.
| | - Diana Guízar-Sánchez
- Departamento de Fisiología de la Facultad de Medicina, Universidad Nacional Autónoma de México, UNAM, Copilco Universidad, Mexico City, Mexico
| | - María Yoldi-Negrete
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Rebeca Robles-García
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Carlos-Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Ranchería Sur, Cuarta sección, Comalcalco, Tabasco, Mexico
| | - Ricardo Saracco-Álvarez
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
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Czeisler CA, Weaver MD, Landrigan CP, Berenberg W, Barger LK. Extended work hours increase risk of harm, regardless of resident physicians' experience levels. BMJ 2023; 381:838. [PMID: 37055060 DOI: 10.1136/bmj.p838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
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Che H, Wu H, Qiao Y, Luan B, Zhao Q, Wang H. Association between long working hours and mental health among nurses in China under COVID-19 pandemic: based on a large cross-sectional study. BMC Psychiatry 2023; 23:234. [PMID: 37029359 PMCID: PMC10080503 DOI: 10.1186/s12888-023-04722-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/27/2023] [Indexed: 04/09/2023] Open
Abstract
OBJECTIVE Nurses were more likely to experience mental disorders due to long working hours and irregular schedules. However, studies addressing this issue are scarce; therefore, we aimed to investigate the association between long working hours and mental health in Chinese nurses during the coronavirus disease pandemic. METHODS A cross-sectional study was conducted with 2,811 nurses at a tertiary hospital in China from March to April 2022. We collected data on demographic, psychological characteristics, dietary habits, life, and work-related factors using a self-reported questionnaire and measured mental health using Patient Health Questionnaire-9 and General Anxiety Disorder-7. Binary logistic regression to determine adjusted odds ratios and 95% confidence intervals. RESULTS The effective response rates were 81.48%, 7.80% (219), and 6.70% (189) of the respondents who reported depression and anxiety, respectively. We categorized the weekly working hours by quartiles. Compared with the lowest quartile, the odds ratios and 95% confidence intervals across the quartiles for depression after adjustment were 0.98 (0.69, 1.40), 10.58 (2.78, 40.32), and 1.79 (0.81, 3.97) respectively, the P for trend was 0.002. The odds ratios across the quartiles for anxiety after adjustment were 0.87 (0.59, 1.30), 8.69 (2.13, 35.46), and 2.67 (1.26, 5.62), respectively, and the P for trend was 0.008. CONCLUSIONS This study demonstrated that extended working hours increased the risk of mental disorders among nurses during the coronavirus disease pandemic, particularly in those who worked more than 60 h per week. These findings enrich the literature on mental disorders and demonstrate a critical need for additional studies investigating intervention strategies.
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Affiliation(s)
- Hongwei Che
- Department of Operating Room, Shengjing Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Huiying Wu
- Department of Operating Room, Shengjing Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Yu Qiao
- Department of Operating Room, Shengjing Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Bonan Luan
- Department of Operating Room, Shengjing Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Qingyun Zhao
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Hongyan Wang
- Department of Thoracic Surgery, Shengjing Hospital of China Medical University, 36 Sanhao Street, 110004, Shenyang, Liaoning, P. R. China.
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Barger LK, Weaver MD, Sullivan JP, Qadri S, Landrigan CP, Czeisler CA. Impact of work schedules of senior resident physicians on patient and resident physician safety: nationwide, prospective cohort study. BMJ MEDICINE 2023; 2:e000320. [PMID: 37303489 PMCID: PMC10254593 DOI: 10.1136/bmjmed-2022-000320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 02/15/2023] [Indexed: 06/13/2023]
Abstract
Objective To determine whether long weekly work hours and shifts of extended duration (≥24 hours) are associated with adverse patient and physician safety outcomes in more senior resident physicians (postgraduate year 2 and above; PGY2+). Design Nationwide, prospective cohort study. Setting United States, conducted over eight academic years (2002-07, 2014-17). Participants 4826 PGY2+ resident physicians who completed 38 702 monthly web based reports of their work hours and patient and resident safety outcomes. Main outcome measures Patient safety outcomes included medical errors, preventable adverse events, and fatal preventable adverse events. Resident physician health and safety outcomes included motor vehicle crashes, near miss crashes, occupational exposures to potentially contaminated blood or other bodily fluids, percutaneous injuries, and attentional failures. Data were analysed with mixed effects regression models that accounted for dependence of repeated measures and controlled for potential confounders. Results Working more than 48 hours per week was associated with an increased risk of self-reported medical errors, preventable adverse events, and fatal preventable adverse events as well as near miss crashes, occupational exposures, percutaneous injuries, and attentional failures (all P<0.001). Working between 60 and 70 hours per week was associated with a more than twice the risk of a medical error (odds ratio 2.36, 95% confidence interval 2.01 to 2.78) and almost three times the risk of preventable adverse events (2.93, 2.04 to 4.23) and fatal preventable adverse events (2.75, 1.23 to 6.12). Working one or more shifts of extended duration in a month while averaging no more than 80 weekly work hours was associated with an 84% increased risk of medical errors (1.84, 1.66 to 2.03), a 51% increased risk of preventable adverse events (1.51, 1.20 to 1.90), and an 85% increased risk of fatal preventable adverse events (1.85, 1.05 to 3.26). Similarly, working one or more shifts of extended duration in a month while averaging no more than 80 weekly work hours also increased the risk of near miss crashes (1.47, 1.32 to 1.63) and occupational exposures (1.17, 1.02 to 1.33). Conclusions These results indicate that exceeding 48 weekly work hours or working shifts of extended duration endangers even experienced (ie, PGY2+) resident physicians and their patients. These data suggest that regulatory bodies in the US and elsewhere should consider lowering weekly work hour limits, as the European Union has done, and eliminating shifts of extended duration to protect the more than 150 000 physicians training in the US and their patients.
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Affiliation(s)
- Laura K Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Matthew D Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Jason P Sullivan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Salim Qadri
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher P Landrigan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
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Sivakumar J, Chen Q, Hii MW, Cullinan M, Choi J, Steven M, Crosthwaite G. Learning curve of laparoscopic inguinal hernia repair: systematic review, meta-analysis, and meta-regression. Surg Endosc 2022; 37:2453-2475. [PMID: 36416945 DOI: 10.1007/s00464-022-09760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laparoscopic inguinal hernia repair has a long learning curve. It can be a technically challenging procedure and initially presents an unfamiliar view of inguinal anatomy. The aim of this review was to evaluate published literature relating to the learning curve of laparoscopic inguinal hernia repair and identify the number of cases required for proficiency. The secondary aim was to compare outcomes between surgeons before and after this learning curve threshold had been attained. METHODS A systematic literature search was conducted in databases of PubMed, Medline, Embase, Web of Science, and Cochrane Library, to identify studies that evaluated the learning curve of laparoscopic inguinal hernia repair. A meta-regression analysis was undertaken to identify the number of cases to achieve surgical proficiency, and a meta-analysis was performed to compare outcomes between cases that were undertaken during a surgeon's learning phase and experienced phase of the curve. RESULTS Twenty-two studies were included in this review, with 19 studies included in the meta-regression analysis, and 11 studies included in the meta-analysis. Mixed-effects Poisson regression demonstrated that there was a non-linear trend in the number of cases required to achieve surgical proficiency, with a 2.7% year-on-year decrease. The predicted number of cases to achieve surgical proficiency in 2020 was 32.5 (p < 0.01). The meta-analysis determined that surgeons in their learning phase may experience a higher rate of conversions to open (OR 4.43, 95% CI 1.65, 11.88), postoperative complications (OR 1.61, 95% CI 1.07, 2.42), and recurrences (OR 1.32, 95% CI 0.40, 4.30). CONCLUSION Laparoscopic inguinal hernia repair has a well-defined learning curve. While learning surgeons demonstrated reasonable outcomes, supervision during this period may be appropriate given the increased risk of conversion to open surgery. These data may benefit learning surgeons in the skill development of minimally invasive inguinal hernia repairs.
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Affiliation(s)
- Jonathan Sivakumar
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia.
- Department of General Surgery, Royal Melbourne Hospital, Melbourne, Australia.
- Department of Surgery, The University of Melbourne, Melbourne, Australia.
| | - Qianyu Chen
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Michael W Hii
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Mark Cullinan
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
- Department of Surgery, Monash University, Clayton, VIC, Australia
| | - Julian Choi
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Western Health, Melbourne, Australia
| | - Mark Steven
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
| | - Gary Crosthwaite
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
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14
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Shimazu Y, Kobashi Y, Imoto S, Tsubokura M. A retrospective observational study analyzing work and study motivation based on the work environment of 15,677 Japanese clinicians in 2016. Sci Rep 2022; 12:14806. [PMID: 36045145 PMCID: PMC9428877 DOI: 10.1038/s41598-022-19007-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/23/2022] [Indexed: 11/09/2022] Open
Abstract
Physicians play an active role in public health. However, there is a limit to the knowledge and experience that can be gained through hospital work alone. This was a secondary data analysis from 100,000 doctors in Japan (15,677 respondents). The results of the analysis showed that 898 (8.4%) male and 190 (6.0%) female doctors worked 60 h or more in a week. The percentage of physicians whose spouse was a physician was found to be 31.4% (male) and 61.7% (female) (p < 0.001), and the rate of full-time working clinicians was 85.7% (male) and 30.0% (female) (p < 0.001). In the univariate analysis, female’s working hours were affected by childbirth and childcare experience (p < 0.001, 95% CI − 10.3 to − 8.4, with “none” as reference) and specialty certification (p < 0.001, 95% CI − 3.5 to − 1.4, with “none” as reference). In the multivariate analysis, physician’s working hours were associated with sex (coefficient, − 7.4; 95% CI − 8.3 to − 6.5, with “male as reference), childbirth/childcare (coefficient, − 2.2; 95% CI − 2.9 to − 1.4, with “possession” as reference), and specialty qualification (coefficient − 4.0, 95% CI − 5.0 to − 3.0, with “possession” as reference). To summarize the results of the analysis, work/study motivation of physicians will be facilitated by ensuring adequate learning opportunities and by developing support systems and environments.
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Affiliation(s)
- Yuzo Shimazu
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima, 960-1295, Japan.
| | - Yurie Kobashi
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima, 960-1295, Japan
| | - Seiya Imoto
- Division of Health Medical Intelligence, Human Genome Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima, 960-1295, Japan
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15
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Castedo JS, Carvalho VH. The anesthesiologist thoughts on medical residency in anesthesiology in Brazil. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2022; 73:115-116. [PMID: 35917845 PMCID: PMC9366517 DOI: 10.1016/j.bjane.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023]
Affiliation(s)
- João S. Castedo
- Unidade Local de Saúde de Matosinhos (ULSM), Departamento de Anestesia, Matosinhos, Portugal,Corresponding author.
| | - Vanessa Henriques Carvalho
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Departamento de Anestesiologia, Campinas, SP, Brazil
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16
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Swed S, Shoib S, Almoshantaf MB, Bohsas H, Hassan ASEM, Motawea KR, Hassan NAIF, Ahmad EMS, Sheet L, Khairy LT, Bakkour A, Muwaili AHH, Muwaili DHH, Abdelmajid FAA, Ahmad S, Hasan MM, Elkalagi NKH. A National Cross-Sectional Survey of Bullying in Syrian Graduate Medical Education. Front Public Health 2022; 10:916385. [PMID: 35875042 PMCID: PMC9301191 DOI: 10.3389/fpubh.2022.916385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Bullying is defined as unpleasant behavior that causes someone to feel disturbed or embarrassed, affecting their self-esteem. Based on this premise, we set out to investigate bullying among Syrian graduate medical education residents and fellows, estimate its prevalence among specific subgroups, and give recommendations to help validate the findings and enhance the graduate medical education training experience. A sample of 278 residents and fellows in Syrian graduate medical school were recruited for the study in a national cross-sectional survey, with 276 participants completing a Bullying survey in 2021 and two people refusing to participate. Participants in the survey were asked to provide basic demographic and programming information and three general Bullying and 20 specific bullying behavior items. Differences across groups were compared for demographic and programmatic stratifications. About 51% of participants had experienced one or more bullying behaviors, 69% said they had been bullied, and 87% said they had witnessed Bullying. Residents and supervisor-attendings were the most common sources of perceived Bullying (~67 and 62%, respectively), followed by patients (58%), nurses (46%), and pharmacists (46%) (33%). More specific bullying behaviors have been recorded by female Arabic Syrians who are shorter than 5'8, have a body mass index (BMI) of 25, and are 30 years old or younger who were -compared to males- more likely to report attempts to minimize and devalue work (55 vs. 34%, P ≤ 0.01) and criticism and work monitoring (56 vs. 33%, P ≤ 0.01). In addition, general medical graduates and PGY-2-PGY-6 respondents reported more specific bullying behaviors than private medical graduates and post-graduate participants in the first year (PGY 1), respectively. For example, a significant difference is noticed when reporting unreasonable pressure to perform work (83 vs. 6%, P ≤ 0.01). Except for physical violence, which does not differ statistically between groups, most bullying behaviors were reported by participants with statistically significant differences between study groups—many residents and fellows in Syria's graduate medical school system report being bullied. Anti-bullying rules and a multidisciplinary strategy including all players in the medical system are essential to eradicating these pervasive practices in healthcare.
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Affiliation(s)
- Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
- *Correspondence: Sarya Swed
| | - Sheikh Shoib
- Department of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Srinagar, India
| | | | | | | | | | | | | | - Lana Sheet
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Lina Taha Khairy
- Faculty of Medicine, The National Ribat University, Al-Ribat, Sudan
| | - Agyad Bakkour
- Faculty of Medicine, Albaath University, Homs, Syria
| | - Ali Hadi Hussein Muwaili
- Faculty of Medicine, Ivano-Frankivsk National Medical University, Ivano-Frankivsk Oblast, Ukraine
| | | | | | - Shoaib Ahmad
- District Head Quarters Teaching Hospital, Faisalabad, Pakistan
- Faculty of Medicine, Punjab Medical College, Faisalabad, Pakistan
| | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
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17
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Irigoyen-Otiñano M, Castro-Herranz S, Romero-Agüit S, Mingote-Adán JC, Garrote-Díaz JM, Matas-Aguilera V, López-Ordoño GJ, Puigdevall-Ruestes M, Alberich S, González-Pinto A. Suicide among physicians: Major risk for women physicians. Psychiatry Res 2022; 310:114441. [PMID: 35183987 DOI: 10.1016/j.psychres.2022.114441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The risk of suicide is related to professional activity. Preliminary data suggest that being in the medical profession increases the risk of suicide in women. The objective of this nationwide study is to compare the death rate of physicians due to suicide with that of the general population and to assess the differences based on gender. MATERIALS AND METHODS All physicians and the general population who died by suicide in Spain between 2005 and 2014, both inclusive, were studied. Between these years, the Spanish population grew from 43,662,613 to 46,455,123 persons and from 199,123 to 238,240 number of doctors. The data relating to the deaths of physicians were extracted from the databases of the General Council of Official Medical Associations (CGCOM) and data related to the general population were obtained from the National Institute of Statistics (INE). The variables included in the analyses are gender, age, specialty, place of residence and death, and causes of death according to the ICD-10. RESULTS The annual mean of physician deaths was 918, with an annual crude rate of 4.8 per 1,000 registered physicians. It is confirmed that physicians have a significantly higher suicide rate (average of 1.3%) than the general population (average of 0.8%) (p = 0.003). The comparison of suicide between men and women doctors is significantly higher in women (X2= 53.068, p<0.001). In addition, if we separate by gender, female physicians have a suicide rate 7.5% higher than women from the general population, although the difference is not significant (X2 = 2.614, p = 0.107). CONCLUSIONS . Suicide is higher among physicians than the general population and affects female physicians significantly more.
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Affiliation(s)
- M Irigoyen-Otiñano
- Psychiatrist, former Secretary General of the Medical Association Lérida. University Hospital Santa Maria, Lérida. Spain.
| | - S Castro-Herranz
- Forensic Doctor, national representative of physicians in Public Administrations at CGCOM. Spain
| | - S Romero-Agüit
- Family Doctor, former President General Council of Medical Associations of Spain (CGCOM). Spain
| | | | - J M Garrote-Díaz
- Family Doctor, former Secretary General of the General Council of Medical Associations of Spain (CGCOM). Spain
| | - V Matas-Aguilera
- Family Doctor, national representative of Urban Primary Health Care at CGCOM. Spain
| | - G J López-Ordoño
- General Surgeon, National representative of Hospitals at CGCOM. Spain
| | | | - S Alberich
- Mathematician, Araba Univesity Hospital-Santiago. Bioaraba. CIBERSAM. UNED. Spain
| | - A González-Pinto
- Psychiatrist. Professor of Psychiatry University of the Basque Country. President of the Spanish Foundation of Mental Health. CIBERSAM. Spain
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18
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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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19
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Milas GP, Issaris V, Zareifopoulos N. Burnout for medical professionals during the COVID-19 pandemic in Greece; the role of primary care. Hosp Pract (1995) 2022; 50:102-103. [PMID: 35188054 DOI: 10.1080/21548331.2022.2045133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hospital physicians in Greece were assigned care of numerous COVID-19 patients in addition to their usual caseload, resulting in excess morbidity and mortality for both COVID and non-COVID patients. In this article we focus on the challenges faced by resident physicians during the pandemic, emphasizing a critical view of the hospital-centric healthcare system of Greece and the necessity of reforms to strengthen primary care and reduce the burden placed on hospitals.
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20
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Apt E, Regev T, Shapira J, Haberfeld O, Duek OS, Bar-Yoseph R. Residents' perspective on duty hours at an Israeli tertiary hospital. Isr J Health Policy Res 2022; 11:11. [PMID: 35144693 PMCID: PMC8830127 DOI: 10.1186/s13584-022-00521-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Specialization in medical professions is considered a challenging and intensive period due to the number and sequence of duty hours. Considering the effect of duty hours on residents, both physically and mentally, several models have been created over the years to address this complexity. The two main model schools aim to decrease the duty hour length and night shift (i.e., night float, NF) frequency. In recent years, duty hours have become a source of disagreement and frustration among the medical community, both residents and attendings. A possible change in the duty hour structure may affect residents in terms of several parameters, such as patient safety, the well-being of the physician and the degree of training of the resident. PURPOSE (1) To investigate medical residents' perspectives on their duty hours utilizing online questionnaires on their effect on the work environment and (2) to assess residents' preferences in relation to the suggested shortened shift and NF models. METHODS Questionnaires were emailed to all residents (main residents and fellows) at an Israeli tertiary medical center between March 2020 and April 2020. Questions were scored from 1 (disagree) to 5 (fully agree). RESULTS Two hundred and sixty residents (227 main residents, 43 fellows) participated in the study (40% female). The score for the degree of balance between work and personal life was low (0.9±1.99). The shortened shift model was perceived by the residents as more compatible with a balanced lifestyle than the NF model (3.77 ± 1.20 and 3.14 ± 1.26, respectively, P < 0.0001). Neither model was considered to risk impairing professional training (2.33 ± 1.45 and 2.47 ± 1.25, respectively, P = 0.12). Overall, 74% of the residents were not willing to lower their income if the decision were made to change models, and 56% were not willing to increase the number of shifts. CONCLUSIONS There is agreement among residents that shortening shift hours to 16 h would have a positive effect on the balance between personal life and work. In the eyes of residents, the change would not impair their training during residency.
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Affiliation(s)
- Elad Apt
- Orthopedic Surgery Division, Rambam Health Care Campus, Haifa, Israel.
| | - Tslil Regev
- Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Jacob Shapira
- Orthopedic Surgery Division, Rambam Health Care Campus, Haifa, Israel
| | - Ori Haberfeld
- Department of Thoracic Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ori Samuel Duek
- Plastic and Reconstructive Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonology Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
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21
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Kakarala SE, Prigerson HG. Covid-19 and Increased Risk of Physician Suicide: A Call to Detoxify the U.S. Medical System. Front Psychiatry 2022; 13:791752. [PMID: 35222114 PMCID: PMC8864162 DOI: 10.3389/fpsyt.2022.791752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/14/2022] [Indexed: 11/21/2022] Open
Abstract
Suicide among physicians is a longstanding problem, with risk factors exacerbated by the coronavirus disease 2019 (COVID-19) pandemic. In this article, we explore suicidal thoughts and behaviors among physicians and risk factors created or intensified by the work environment, such as overwork and loss of autonomy. We discuss the ways in which the COVID-19 pandemic has made the medical work environment more stressful (e.g. greater exposure to traumatic experiences and employment insecurity) and, consequently, elevated physician suicide risk. We also review evidence that the medical system in the United States has not adequately protected physicians' mental health. Lack of confidentiality, stigma, cost, and time, as well as intrusive medical licensing applications, remain barriers to physicians seeking help. Work pressures imposed by insurance companies and financial incentives to increase revenue while cutting costs compound physicians' work stress. We conclude that system-wide changes to the practice of medicine and policies regarding healthcare delivery are needed to improve physicians' work environments, as is research addressing the impact of the interventions to reduce their suicidal risk. The proposed changes, and greater access to timely and confidential mental health services amid and in the aftermath of the pandemic, may prove promising approaches to reduce physicians' suicide risk.
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Affiliation(s)
- Sophia E Kakarala
- Cornell Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medicine, New York, NY, United States.,Department of Medicine, Weill Cornell Medicine, New York, NY, United States
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22
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Okawara M, Ishimaru T, Yoshikawa T, Kido M, Nakashima Y, Nakayasu A, Kimori K, Imamura S, Matsumoto K. Working hours, side work, and depressive symptoms in physicians: A nationwide cross‐sectional study in Japan. J Occup Health 2022; 64:e12377. [DOI: 10.1002/1348-9585.12377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Makoto Okawara
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences University of Occupational and Environmental Health, Japan Kitakyushu Japan
| | - Tomohiro Ishimaru
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences University of Occupational and Environmental Health, Japan Kitakyushu Japan
| | - Toru Yoshikawa
- Research Center for the Overwork‐Related Disorders National Institute of Occupational Safety and Health, Japan Kawasaki Japan
| | - Michiko Kido
- Department of Obstetrics & Gynecology Japanese Red Cross Medical Center Tokyo Japan
| | | | - Anna Nakayasu
- Department of Obstetrics & Gynecology Japanese Red Cross Medical Center Tokyo Japan
| | - Kokuto Kimori
- Executive Boards Japan Medical Association Tokyo Japan
| | - Satoshi Imamura
- Executive Boards Japan Medical Association Tokyo Japan
- Imamura Clinic Tokyo Japan
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23
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Delgado E, Meza Mori G, Barboza E, Rojas Briceño NB, Torres Guzmán C, Oliva-Cruz M, Chavez-Quintana SG, Salas López R, López de la Lama R, Sevillano-Ríos CS, Sarmiento F. Efectividad de áreas de conservación privada comunal en bosques montanos nublados del norte de Perú. PIRINEOS 2021. [DOI: 10.3989/pirineos.2021.176006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Las Áreas de Conservación Privada (ACP) son uno de los mecanismos de conservación, gestionadas por ciudadanos privados que más protagonismo han adquirido en los escenarios de conservación local en los últimos años. En este estudio evaluamos la efectividad de cuatro ACP gestionadas por comunidades locales (CC). Se aplicó el Índice de Efectividad Compuesto (IEC) para determinar la efectividad del diseño, la integridad ecológica y la gestión. Los resultados muestran sistemas de gestión con una efectividad media, tres de las cuatro ACP evaluados (Copallín, Huaylla Belén-Colcamar y Tilacancha) reportan un diseño efectivo. Los rangos altitudinales protegidos están entre 2500 y 3500 m.s.n.m., con un índice de representatividad de la superficie promedio de 4,55% con respecto al área conservada en la categoría ACP para el departamento de Amazonas. La evaluación de la integridad ecológica indica que las ACP presentan menor superficie transformada (TS) (0-10%) y mayor TS en sus áreas circundantes, especialmente en el ACP Tilacancha (13,37% de TS en un buffer de 1,5 km). La suma ponderada de los índices individuales resulta en índices de efectividad compuestos de mayor a menor para el ACP Copallín (2,22), Hierba Buena Allpayacku (1,82), Huaylla Belen Colcamar (1,81) y Tilacancha (1,56).
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Thomson A, McDermott B. Psychiatry after-hours: factors impacting workload and workflow. Australas Psychiatry 2021; 29:349-351. [PMID: 33434051 DOI: 10.1177/1039856220984034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The study evaluated the workload and workflow of registrars engaged in a psychiatry after-hours roster, quantified their perceptions of this experience and provided recommendations for system redesign. METHOD Multiple sources of information, including medical student observers and telephone logs, quantified the tasks performed during shifts. Registrars completed a satisfaction questionnaire. RESULTS After-hours shifts often started with a lack of attendance of key clinicians at handover. Tasks handed over and completed during shifts varied; there was very little difference between evening, weekends and night shifts except for the higher likelihood of seclusion reviews on weekends. Registrars experienced a significant and complex workload including emergency department and ward reviews, and admissions. Workflow interruptions were frequent; the high number of phone calls and critical incidence warrant further investigation. Registrars were confident in their own ability, but had less confidence in other key clinicians. Many registrars did not discuss after-hours work during supervision. CONCLUSIONS The after-hours experience of psychiatry registrars at a university hospital is arduous and includes a wide range of clinical tasks. This activity is an essential service provision undertaking as well as a training activity. This must be weighed against the impact of after-hours work on registrar well-being.
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Affiliation(s)
- Alisha Thomson
- Mental Health Service Group, The Townsville Hospital and Health Service, Queensland Health, QLD, Australia
| | - Brett McDermott
- College of Medicine and Dentistry, James Cook University, QLD, Australia
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Ubom AE, Adesunkanmi AO, Ndegbu CU, Balogun SA, Ajekwu SC, Sowemimo SO, Olugbami AM, Ekhaiyeme PA, Olasehinde O, Awowole IO, Ijarotimi OA. Nigerian Surgical Trainees' Work Schedule: It is Time for a Change! World J Surg 2021; 45:2653-2660. [PMID: 34046691 DOI: 10.1007/s00268-021-06182-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Unregulated work schedules have deleterious effects on trainees' productivity and patients' safety. For these reasons, duty hours have been capped in many developed countries. Such regulations, however, appear to be lacking in many parts of Africa, and the effects of unregulated work hours in this part of the world have only been scantily documented. This study evaluated the work schedule of Nigerian surgical trainees, and its impact on their wellbeing, as well as assessed the perception of trainees towards capped duty hours. METHODS A cross-sectional survey of 650 Nigerian Resident Doctors in surgical specialties was conducted in November 2020. Enquiries were made about their work schedules using a purpose-designed questionnaire, developed using Google Forms®. The data were analysed using the IBM SPSS version 23. RESULTS The mean weekly work hours of surgical residents was 122.72 ± 34.17 h. Majority (228, 40.4%) of the residents had cumulative call hours of ≥ 72 h per week. One-half (283, 50.1%) of them worked continuously for up to 48-72 h during calls, with mean daily sleep hours of 3.53 ± 1.42 h during calls. The majority (558, 98.8%) of respondents had post-call clinical responsibilities. Seventy-five percent of the respondents reported hazards from prolonged work hours, and an overwhelming majority (530, 93.8%) desire official limits on work hours. CONCLUSION Prolonged, unregulated work schedules appear to be the norm among Nigerian surgical trainees. This trend calls for urgent measures, to avoid potentially catastrophic consequences on both physicians and patients.
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Affiliation(s)
- Akaninyene Eseme Ubom
- Department of Obstetrics, Gynaecology, and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | | | - Chinedu Udochukwu Ndegbu
- Colorectal Surgery Unit, Department of Surgery, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Simon Adewale Balogun
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Samuel Chibuzo Ajekwu
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | | | - Adebayo Moses Olugbami
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | | | - Olalekan Olasehinde
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Department of Surgery, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Ibraheem Olayemi Awowole
- Department of Obstetrics, Gynaecology, and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Faculty of Clinical Sciences, Department of Obstetrics, Gynaecology, and Perinatology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun state, Nigeria
| | - Omotade Adebimpe Ijarotimi
- Department of Obstetrics, Gynaecology, and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Faculty of Clinical Sciences, Department of Obstetrics, Gynaecology, and Perinatology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun state, Nigeria
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Samsudin EZ, Isahak M, Rampal S, Rosnah I, Zakaria MI. Workplace Bullying Among Junior Doctors in Malaysia: A Multicentre Cross-Sectional Study. Malays J Med Sci 2021; 28:142-156. [PMID: 33958968 PMCID: PMC8075595 DOI: 10.21315/mjms2021.28.2.13] [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] [Received: 09/07/2020] [Accepted: 01/12/2021] [Indexed: 12/04/2022] Open
Abstract
Background Research suggests that junior doctors often experience workplace bullying, which may have adverse impacts on medical training and delivery of quality healthcare. However, evidence among local population has not been established. The present study aims to examine the prevalence of workplace bullying among Malaysian junior doctors and explore its associated sociodemographic and employment factors. Methods A multicentre cross-sectional study was conducted in 12 government hospitals accredited for housemanship training within the central zone of Malaysia. The study included a total of 1,074 house officers who had been working for at least 6 months in various housemanship rotations. The Negative Acts Questionnaire-Revised (NAQ-R) was used to examine workplace bullying. Results The 6-month prevalence of workplace bullying among study participants was 13%. Work-related bullying such as ‘being ordered to do work below your level of competence’, person-related bullying such as ‘being humiliated or ridiculed in connection with your work’, and physically intimidating bullying such as ‘being shouted at or being the target of spontaneous anger’ were commonly reported by study participants. Medical officers were reported to be the commonest perpetrators of negative actions at the workplace. Study participants who graduated from Eastern European medical schools (adjusted odds ratio [AOR] 2.27; 95% confidence interval [CI]: 1.27, 4.07) and worked in surgical-based rotation (AOR 1.83; 95% CI: 1.13, 2.97) had higher odds of bullying compared to those who graduated from local medical schools and worked in medical-based rotation, whereas study participants with good English proficiency (AOR 0.14; 95% CI: 0.02, 0.94) had lower odds of bullying compared to those with poor English proficiency. Conclusion The present study shows that workplace bullying is prevalent among Malaysian junior doctors. Considering the gravity of its consequences, impactful strategies should be developed and implemented promptly in order to tackle this serious occupational hazard.
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Affiliation(s)
- Ely Zarina Samsudin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Marzuki Isahak
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjay Rampal
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ismail Rosnah
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Mohd Idzwan Zakaria
- Dean's Office, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Grueschow M, Stenz N, Thörn H, Ehlert U, Breckwoldt J, Brodmann Maeder M, Exadaktylos AK, Bingisser R, Ruff CC, Kleim B. Real-world stress resilience is associated with the responsivity of the locus coeruleus. Nat Commun 2021; 12:2275. [PMID: 33859187 PMCID: PMC8050280 DOI: 10.1038/s41467-021-22509-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/04/2021] [Indexed: 02/02/2023] Open
Abstract
Individuals may show different responses to stressful events. Here, we investigate the neurobiological basis of stress resilience, by showing that neural responsitivity of the noradrenergic locus coeruleus (LC-NE) and associated pupil responses are related to the subsequent change in measures of anxiety and depression in response to prolonged real-life stress. We acquired fMRI and pupillometry data during an emotional-conflict task in medical residents before they underwent stressful emergency-room internships known to be a risk factor for anxiety and depression. The LC-NE conflict response and its functional coupling with the amygdala was associated with stress-related symptom changes in response to the internship. A similar relationship was found for pupil-dilation, a potential marker of LC-NE firing. Our results provide insights into the noradrenergic basis of conflict generation, adaptation and stress resilience.
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Affiliation(s)
- Marcus Grueschow
- Zurich Center for Neuroeconomics (ZNE), Department of Economics, University of Zurich, Zurich, Switzerland.
| | - Nico Stenz
- Division of Experimental Psychopathology and Psychotherapy, Dept of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Hanna Thörn
- Division of Experimental Psychopathology and Psychotherapy, Dept of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- Division of Clinical Psychology and Psychotherapy, Dept of Psychology, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Division of Clinical Psychology and Psychotherapy, Dept of Psychology, University of Zurich, Zurich, Switzerland
| | - Jan Breckwoldt
- Medical School, Deanery, University of Zurich, Zurich, Switzerland
| | | | | | - Roland Bingisser
- Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Christian C Ruff
- Zurich Center for Neuroeconomics (ZNE), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Birgit Kleim
- Division of Experimental Psychopathology and Psychotherapy, Dept of Psychology, University of Zurich, Zurich, Switzerland.
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.
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Dunbar-Yaffe R, Wu RC, Oza A, Lee-Kim V, Cram P. Impact of an internal medicine nocturnist service on care of patients with cancer at a large Canadian teaching hospital: a quality-improvement study. CMAJ Open 2021; 9:E667-E672. [PMID: 34145049 PMCID: PMC8248558 DOI: 10.9778/cmajo.20200167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Nocturnists (overnight hospitalists) are commonly implemented in US teaching hospitals to adhere to per-resident patient caps and improve care but are rare in Canada, where patient caps and duty hours are comparatively flexible. Our objective was to assess the impact of a newly implemented nocturnist program on perceived quality of care, code status documentation and patient outcomes. METHODS Nocturnists were phased in between June 2018 and December 2019 at Toronto General Hospital, a large academic teaching hospital in Toronto, Ontario. We performed a quality-improvement study comparing rates of code status entry into the electronic health record at admission, in-hospital mortality, the 30-day readmission rate and hospital length of stay for patients with cancer admitted by nocturnists and by residents. Surveys were administered in June 2019 to general internal medicine faculty and residents to assess their perceptions of the impact of the nocturnist program. RESULTS From July 2018 to June 2019, 30 nocturnists were on duty for 241/364 nights (66.5%), reducing the mean maximum overnight per-resident patient census from 40 (standard deviation [SD] 4) to 25 (SD 5) (p < 0.001). The rate of admission code status entry was 35.3% among patients admitted by residents (n = 133) and 54.9% among those admitted by nocturnists (n = 339) (p < 0.001). The mortality rate was 10.5% among patients admitted by residents and 5.6% among those admitted by nocturnists (p = 0.06), the 30-day readmission rate was 8.3% and 5.9%, respectively (p = 0.4), and the mean acute length of stay was 7.2 (SD 7.0) days and 6.4 (SD 7.8) days, respectively (p = 0.3). Surveys were completed by 15/24 faculty (response rate 62%), who perceived improvements in patient safety, efficiency and trainee education; however, only 30/102 residents (response rate 29.4%) completed the survey. INTERPRETATION Although implementation of a nocturnist program did not affect patient outcomes, it reduced residents' overnight patient census, and improved faculty perceptions of quality of care and education, as well as documentation of code status. Our results support nocturnist implementation in Canadian teaching hospitals.
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Affiliation(s)
- Richard Dunbar-Yaffe
- Division of General Internal Medicine and Geriatrics (Dunbar-Yaffe, Wu, Cram), Sinai Health System and University Health Network; Division of General Internal Medicine (Dunbar-Yaffe, Wu, Cram), Department of Medicine, University of Toronto; Division of Medical Oncology and Hematology (Oza), University Health Network, Toronto, Ont.; School of Medicine (Lee-Kim), Queen's University, Kingston, Ont.
| | - Robert C Wu
- Division of General Internal Medicine and Geriatrics (Dunbar-Yaffe, Wu, Cram), Sinai Health System and University Health Network; Division of General Internal Medicine (Dunbar-Yaffe, Wu, Cram), Department of Medicine, University of Toronto; Division of Medical Oncology and Hematology (Oza), University Health Network, Toronto, Ont.; School of Medicine (Lee-Kim), Queen's University, Kingston, Ont
| | - Amit Oza
- Division of General Internal Medicine and Geriatrics (Dunbar-Yaffe, Wu, Cram), Sinai Health System and University Health Network; Division of General Internal Medicine (Dunbar-Yaffe, Wu, Cram), Department of Medicine, University of Toronto; Division of Medical Oncology and Hematology (Oza), University Health Network, Toronto, Ont.; School of Medicine (Lee-Kim), Queen's University, Kingston, Ont
| | - Victoria Lee-Kim
- Division of General Internal Medicine and Geriatrics (Dunbar-Yaffe, Wu, Cram), Sinai Health System and University Health Network; Division of General Internal Medicine (Dunbar-Yaffe, Wu, Cram), Department of Medicine, University of Toronto; Division of Medical Oncology and Hematology (Oza), University Health Network, Toronto, Ont.; School of Medicine (Lee-Kim), Queen's University, Kingston, Ont
| | - Peter Cram
- Division of General Internal Medicine and Geriatrics (Dunbar-Yaffe, Wu, Cram), Sinai Health System and University Health Network; Division of General Internal Medicine (Dunbar-Yaffe, Wu, Cram), Department of Medicine, University of Toronto; Division of Medical Oncology and Hematology (Oza), University Health Network, Toronto, Ont.; School of Medicine (Lee-Kim), Queen's University, Kingston, Ont
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Loewenthal J, Dyer NL, Lipsyc-Sharf M, Borden S, Mehta DH, Dusek JA, Khalsa SBS. Evaluation of a Yoga-Based Mind-Body Intervention for Resident Physicians: A Randomized Clinical Trial. Glob Adv Health Med 2021; 10:21649561211001038. [PMID: 33786209 PMCID: PMC7961714 DOI: 10.1177/21649561211001038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/03/2021] [Accepted: 02/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Objective Mind-body interventions (MBIs) have been shown to be effective individual-level interventions for mitigating physician burnout, but there are no controlled studies of yoga-based MBIs in resident physicians. We assessed the feasibility of a yoga-based MBI called RISE (resilience, integration, self-awareness, engagement) for residents among multiple specialties and academic medical centers. Methods We conducted a waitlist controlled randomized clinical trial of the RISE program with residents from multiple specialty departments at three academic medical centers. The RISE program consisted of six weekly sessions with suggested home practice. Feasibility was assessed across six domains: demand, implementation, practicality, acceptability, adaptation, and integration. Self-reported measures of psychological health were collected at baseline, post-program, and two-month follow-up. Results Among 2,000 residents contacted, 75 were assessed for eligibility and 56 were enrolled. Forty-four participants completed the study and were included in analysis. On average, participants attended two of six sessions. Feasibility of in-person attendance was rated as 28.9 (SD 25.6) on a 100-point visual analogue scale. Participants rated feasibility as 69.2 (SD 26.0) if the program was offered virtually. Those who received RISE reported improvements in mindfulness, stress, burnout, and physician well-being from baseline to post-program, which were sustained at two-month follow-up. Conclusion This is the first controlled study of a yoga-based MBI in residents. While the program was not feasible as delivered in this pilot study, initial analyses showed improvement in multiple measures of psychological health. Residents reported that virtual delivery would increase feasibility.
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Affiliation(s)
- Julia Loewenthal
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Natalie L Dyer
- Department of Research, Kripalu Center for Yoga & Health, Stockbridge, Massachusetts
| | - Marla Lipsyc-Sharf
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sara Borden
- Department of Research, Kripalu Center for Yoga & Health, Stockbridge, Massachusetts
| | - Darshan H Mehta
- Harvard Medical School, Boston, Massachusetts.,Benson-Henry Institute for Mind-Body Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Osher Center for Integrative Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffery A Dusek
- Department of Research, Kripalu Center for Yoga & Health, Stockbridge, Massachusetts
| | - Sat Bir S Khalsa
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Bazan D, Nowicki M, Rzymski P. Medical students as the volunteer workforce during the COVID-19 pandemic: Polish experience. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2021. [PMID: 33585172 DOI: 10.1016/j.ijdrr.2021.102103] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In response to the COVID-19 pandemic medical students in different countries were mobilized to support healthcare systems during the emergency. This study presents the experience of 580 students of a single medical university in Poland who served as volunteers at different healthcare units during the first six months of the first case being recorded in the country (March-September 2020). The mean ± SD hours and days spent on volunteering in the studied group were 52 ± 36 h and 144 ± 126 d, respectively, the collective number of worked hours amounted to 83,460 h. Compared to other fields of study students of medicine engaged in volunteering for more hours and for more days. The main tasks performed by the surveyed group included triage, servicing call-centers for patients and working at the admission ward, hospital clinics, emergency departments and diagnostic labs. The level of fear at the beginning of volunteering was relatively low in the studied group and did not increase over the course. The majority of students received positive feedback from families, friends, patients and healthcare workers, revealed a high level of satisfaction from volunteering (also when experiencing COVID-19-related prejudice), while gaining professional experience and a sense of giving real aid were among the most frequently indicated benefits. The results of the present study demonstrate that although medical students are not essential workers in response to the COVID-19 pandemic, they can be of real assistance to healthcare systems during times of emergency, and should be considered as such in the future in case such a need arises again.
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Affiliation(s)
- Dominika Bazan
- Department of Promotion and Careers, Poznan University of Medical Sciences, 61-701, Poznań, Poland
| | - Michał Nowicki
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-781, Poznań, Poland
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806, Poznań, Poland
- Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), 60-806, Poznań, Poland
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Bazan D, Nowicki M, Rzymski P. Medical students as the volunteer workforce during the COVID-19 pandemic: Polish experience. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2021; 55:102109. [PMID: 33585172 PMCID: PMC7871109 DOI: 10.1016/j.ijdrr.2021.102109] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 05/24/2023]
Abstract
In response to the COVID-19 pandemic medical students in different countries were mobilized to support healthcare systems during the emergency. This study presents the experience of 580 students of a single medical university in Poland who served as volunteers at different healthcare units during the first six months of the first case being recorded in the country (March-September 2020). The mean ± SD hours and days spent on volunteering in the studied group were 52 ± 36 h and 144 ± 126 d, respectively, the collective number of worked hours amounted to 83,460 h. Compared to other fields of study students of medicine engaged in volunteering for more hours and for more days. The main tasks performed by the surveyed group included triage, servicing call-centers for patients and working at the admission ward, hospital clinics, emergency departments and diagnostic labs. The level of fear at the beginning of volunteering was relatively low in the studied group and did not increase over the course. The majority of students received positive feedback from families, friends, patients and healthcare workers, revealed a high level of satisfaction from volunteering (also when experiencing COVID-19-related prejudice), while gaining professional experience and a sense of giving real aid were among the most frequently indicated benefits. The results of the present study demonstrate that although medical students are not essential workers in response to the COVID-19 pandemic, they can be of real assistance to healthcare systems during times of emergency, and should be considered as such in the future in case such a need arises again.
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Affiliation(s)
- Dominika Bazan
- Department of Promotion and Careers, Poznan University of Medical Sciences, 61-701, Poznań, Poland
| | - Michał Nowicki
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-781, Poznań, Poland
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806, Poznań, Poland
- Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), 60-806, Poznań, Poland
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Alsohime F, Alkhalaf H, Almuzini H, Alyahya M, Allhidan R, Assiry G, AlSalman M, Alshuaibi W, Temsah MH, Alakeel A, Aleyadhy A. Pediatric resident's perception of night float system compared to 24 hours system, a prospective study. BMC MEDICAL EDUCATION 2021; 21:23. [PMID: 33407360 PMCID: PMC7789422 DOI: 10.1186/s12909-020-02474-x] [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: 05/27/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The study aims to evaluate the perceptions of pediatric residents under the night float (NF) on-call system and its impact on well-being, education, and patient safety compared with the traditional 24-h on-call system. METHODS The study is prospective in nature and conducted on two pediatric resident training centers who apply the NF on-call system as a pilot project. Senior residents (PGY-3 and PGY-4) enrolled in the two training centers were invited to participate before and 6 months after the implementation of the change in the on-call system. A self-administered online questionnaire was distributed. Responses were rated using a five-point Likert-type scale (1 = strongly disagree; 5 = strongly agree). The items covered three main domains, namely, residents' well-being, ability to deliver healthcare, and medical education experience. Pre- and post-intervention scores were presented as means and compared by t-test for paired samples. RESULTS A total of 42 residents participated in the survey (female = 24; 57.1%). All participants were senior residents; 25 (59.6%) were third-year residents (PGY-3), whereas 17 (40.4%) were fourth-year residents (PGY-4). The participants reported that many aspects of the three domains were improved with the introduction of the NF system. The system was perceived to exert less adverse health effect on the residents (mean: 2.37 ± 1.01) compared with the 24-h on-call system (mean: 4.19 ± 0.60; P < 0.001). In addition, the NF system was perceived to lead to less exposure to personal harm and result in less negative impact on quality of care, better work efficiency, reduced potential for medical errors, more successful teaching, and less disruptions to other rotations compared with the 24 h on-call system (P < 0.001). CONCLUSION The perception of senior residents toward the 24-h on-call system pertains to negative impacts on well-being, education, and patient safety compared with on-call systems with restrictive duty hours, such as the NF system, which is perceived to be less harmful, to exert positive impacts on the quality of delivered healthcare services, and more useful from pedagogic aspect.
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Affiliation(s)
- Fahad Alsohime
- College of Medicine, King Saud University, P.O. 231418, Riyadh, Riyadh, 11321, Saudi Arabia.
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia.
| | - Hamad Alkhalaf
- General Pediatrics and Complex Care, King Abdullah Specialized Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hissah Almuzini
- College of Medicine, King Saud University, P.O. 231418, Riyadh, Riyadh, 11321, Saudi Arabia
| | - Malak Alyahya
- College of Medicine, King Saud University, P.O. 231418, Riyadh, Riyadh, 11321, Saudi Arabia
| | - Reema Allhidan
- College of Medicine, King Saud University, P.O. 231418, Riyadh, Riyadh, 11321, Saudi Arabia
| | - Ghadeer Assiry
- College of Medicine, King Saud University, P.O. 231418, Riyadh, Riyadh, 11321, Saudi Arabia
| | - Munirah AlSalman
- College of Medicine, King Saud University, P.O. 231418, Riyadh, Riyadh, 11321, Saudi Arabia
| | - Walaa Alshuaibi
- College of Medicine, King Saud University, P.O. 231418, Riyadh, Riyadh, 11321, Saudi Arabia
- Department of Pediatrics, Medical Generics Division, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamad-Hani Temsah
- College of Medicine, King Saud University, P.O. 231418, Riyadh, Riyadh, 11321, Saudi Arabia
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alakeel
- College of Medicine, King Saud University, P.O. 231418, Riyadh, Riyadh, 11321, Saudi Arabia
| | - Ayman Aleyadhy
- College of Medicine, King Saud University, P.O. 231418, Riyadh, Riyadh, 11321, Saudi Arabia
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
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Naji L, Singh B, Shah A, Naji F, Dennis B, Kavanagh O, Banfield L, Alyass A, Razak F, Samaan Z, Profetto J, Thabane L, Sohani ZN. Global prevalence of burnout among postgraduate medical trainees: a systematic review and meta-regression. CMAJ Open 2021; 9:E189-E200. [PMID: 33688027 PMCID: PMC8034324 DOI: 10.9778/cmajo.20200068] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Burnout among postgraduate medical trainees (PMTs) is increasingly being recognized as a crisis in the medical profession. We aimed to establish the prevalence of burnout among PMTs, identify risk and protective factors, and assess whether burnout varied by country of training, year of study and specialty of practice. METHODS We systematically searched MEDLINE, Embase, PsycINFO, the Cochrane Database of Systematic Reviews, Web of Science and Education Resources Information Center from their inception to Aug. 21, 2018, for studies of burnout among PMTs. The primary objective was to identify the global prevalence of burnout among PMTs. Our secondary objective was to evaluate the association between burnout and country of training, year of study, specialty of training and other sociodemographic factors commonly thought to be related to burnout. We employed random-effects meta-analysis and meta-regression techniques to estimate a pooled prevalence and conduct secondary analyses. RESULTS In total, 8505 published studies were screened, 196 met eligibility and 114 were included in the meta-analysis. The pooled prevalence of burnout was 47.3% (95% confidence interval 43.1% to 51.5%), based on studies published over 20 years involving 31 210 PMTs from 47 countries. The prevalence of burnout remained unchanged over the past 2 decades. Burnout varied by region, with PMTs of European countries experiencing the lowest level. Burnout rates among medical and surgical PMTs were similar. INTERPRETATION Current wellness efforts and policies have not changed the prevalence of burnout worldwide. Future research should focus on understanding systemic factors and leveraging these findings to design interventions to combat burnout. STUDY REGISTRATION PROSPERO no. CRD42018108774.
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Affiliation(s)
- Leen Naji
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
| | - Brendan Singh
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Ajay Shah
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Faysal Naji
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Brittany Dennis
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Owen Kavanagh
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Laura Banfield
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Akram Alyass
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Fahad Razak
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Zainab Samaan
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Jason Profetto
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Lehana Thabane
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Zahra N Sohani
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
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Loo BKG, Ng CL, Chin RT, Davies LJ, Yong J, Ang AEL, Chong YW, Tambyah PA. Nationwide survey comparing residents' perceptions of overnight duty systems in Singapore: night float versus full overnight call. Singapore Med J 2020; 61:559-562. [PMID: 33225371 DOI: 10.11622/smedj.2020149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Benny Kai Guo Loo
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Chew Lip Ng
- Department of Ear, Nose & Throat - Head & Neck Surgery, Ng Teng Fong General Hospital, Singapore
| | - Run Ting Chin
- Department of Endocrine, National University Hospital, Singapore
| | | | - Jin Yong
- Department of Urology, Singapore General Hospital, Singapore
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Philibert I, Blouin D. Responsiveness to societal needs in postgraduate medical education: the role of accreditation. BMC MEDICAL EDUCATION 2020; 20:309. [PMID: 32981520 PMCID: PMC7520978 DOI: 10.1186/s12909-020-02125-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Social accountability in medical education has been defined as an obligation to direct education, research, and service activities toward the most important health concerns of communities, regions, and nations. Drawing from the results of a summit of international experts on postgraduate medical education and accreditation, we highlight the importance of local contexts in meeting societal aims and present different approaches to ensuring societal input into medical education systems around the globe. MAIN TEXT We describe four priorities for social responsiveness that postgraduate medical education needs to address in local and regional contexts: (1) optimizing the size, specialty mix, and geographic distribution of the physician workforce; (2) ensuring graduates' competence in meeting societal goals for health care, population health, and sustainability; (3) promoting a diverse physician workforce and equitable access to graduate medical education; and (4) ensuring a safe and supportive learning environment that promotes the professional development of physicians along with safe and effective patient care in settings where trainees participate in care. We relate these priorities to the values proposed by the World Health Organization for social accountability: relevance, quality, cost-effectiveness, and equity; discuss accreditation as a lever for change; and describe existing and evolving efforts to make postgraduate medical education socially responsive. CONCLUSION Achieving social responsiveness in a competency-based postgraduate medical education system requires accrediting organizations to ensure that learning emphasizes relevant competencies in postgraduate curricula and educational experiences, and that graduates possess desired attributes. At the same time, institutions sponsoring graduate medical education need to provide safe and effective patient care, along with a supportive learning and working environment.
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Affiliation(s)
- Ingrid Philibert
- Department of Medical Education, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT USA
| | - Danielle Blouin
- Faculty of Health Sciences (Department of Emergency Medicine) and Faculty of Education, Queen’s University, Kingston, Ontario Canada
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Ogunsuji O, Adebayo O, Olaopa O, Amoo A, Igbokwe M, Babalola R, Sokomba A, Atilola O, Ilesanmi O, Durowade K. Evaluating the Relationship between Duty Hours and Quality of Life of Nigerian Early Career Doctors. Hosp Top 2020; 98:118-126. [PMID: 32794436 DOI: 10.1080/00185868.2020.1789521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study explored association between early career doctors (ECDs) duty hours and their quality of life (QoL). Information was collected on socio-demographics, duty hours and QoL of 391 Nigerian ECDs. Results showed median of 70 duty-hours weekly, 10 call-days monthly and 6 sleep-hours daily. Weekly duty-hours and daily sleep-hours were significantly negatively and positively correlated respectively with all four domains of WHOQoL. QoL potentially affects health of ECDs especially mental health. Policies targeted at improving ECDs workforce, working conditions should improve QoL and curtail the potential impact of brain drain and attrition among ECDs in Nigeria.
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Affiliation(s)
- Oluwaseyi Ogunsuji
- Department of Periodontology and Community Dentistry, University College Hospital, Ibadan, Nigeria
| | - Oladimeji Adebayo
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Olusegun Olaopa
- Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria
| | - Abimbola Amoo
- Department of Medical Microbiology, University College Hospital, Ibadan, Nigeria
| | - Martin Igbokwe
- Department of Surgery, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Rereloluwa Babalola
- Department of Surgery, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Aliyu Sokomba
- Department of Community Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Olayinka Atilola
- Department of Psychiatry, Lagos State University/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Olayinka Ilesanmi
- Department of Community Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Kabir Durowade
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria.,Department of Community Medicine, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
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Weaver MD, Landrigan CP, Sullivan JP, O'Brien CS, Qadri S, Viyaran N, Wang W, Vetter C, Czeisler CA, Barger LK. The Association Between Resident Physician Work-Hour Regulations and Physician Safety and Health. Am J Med 2020; 133:e343-e354. [PMID: 32061733 PMCID: PMC7469904 DOI: 10.1016/j.amjmed.2019.12.053] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/24/2019] [Accepted: 12/28/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND In 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted a 16-h limit on consecutive hours for first-year resident physicians. We sought to examine the effect of these work-hour regulations on physician safety. METHODS All medical students matched to a US residency program from 2002 to 2007 and 2014 to 2017 were invited to participate in prospective cohort studies. Each month participants reported hours of work, extended duration shifts, and adverse safety outcomes, including motor vehicle crashes, percutaneous injuries, and attentional failures. The incidence of each outcome was compared before and after the 2011 ACGME work-hour limit. Hypotheses were tested using generalized linear models adjusted for potential confounders. RESULTS Of all first-year resident physicians nationwide, 13% participated in the study, with 80,266 monthly reports completed by 15,276 first-year resident physicians. Following implementation of the 16-h 2011 ACGME work-hour limit, the mean number of extended duration (≥24-h) shifts per month decreased from 3.9 to 0.2. The risk of motor vehicle crash decreased 24% (relative risk [RR] 0.76; 0.67-0.85), percutaneous injury risk decreased more than 40% (relative risk 0.54; 0.48-0.61), and the rate of attentional failures was reduced 18% (incidence rate ratio [IRR] 0.82; 0.78-0.86). Extended duration shifts and prolonged weekly work hours were associated with an increased risk of adverse safety outcomes independent of cohort. CONCLUSIONS The 2011 ACGME work-hour limit was associated with meaningful improvements in physician safety and health. Surveillance is needed to monitor the ongoing impact of work hours on physician safety, health, and well-being.
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Affiliation(s)
- Matthew D Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass.
| | - Christopher P Landrigan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass; Department of Medicine, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass
| | - Jason P Sullivan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Conor S O'Brien
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Salim Qadri
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Natalie Viyaran
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Wei Wang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass
| | - Céline Vetter
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Department of Integrative Physiology, University of Colorado, Boulder
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass
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Pokhrel NB, Khadayat R, Tulachan P. Depression, anxiety, and burnout among medical students and residents of a medical school in Nepal: a cross-sectional study. BMC Psychiatry 2020; 20:298. [PMID: 32539732 PMCID: PMC7294639 DOI: 10.1186/s12888-020-02645-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 05/01/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Medical students and residents were found to have suffered from depression, anxiety, and burnout in various studies. However, these entities have not been adequately explored in the context of Nepal. We proposed to determine the prevalence of depression, anxiety, burnout, their associated factors, and identify their predictors in a sample of medical students and residents in a Nepalese medical school. METHODS It was a cross-sectional study with 651 medical students and residents chosen at random between December 2018 and February 2019. The validated Nepali version of Hospital Anxiety and Depression Scale, the Copenhagen Burnout Inventory, and Medical Students' Stressor Questionnaire were used to assess depression, anxiety, burnout, and stressors respectively. We used univariate and multivariable logistic regression analyses to identify the correlation of predictor variables with depression, anxiety, and burnout. RESULTS The overall prevalence of burnout (48.8%; 95% CI 44.9-52.7) and anxiety (45.3%; 95% CI 41.4-49.2) was more than that of depression (31%; 95% CI 27.5-34.7). Burnout and depression were more prevalent in residents than in medical students (burnout: 64.5% vs 37.6%, P-value < 0.0001; depression: 33.7% vs 29.1%, P-value 0.21). Whereas, medical students were found more anxious than residents (46.3% versus 43.96%, P-value 0.55). Academic related stressors caused high-grade stress to participants. Multivariable model for depression significantly showed anxiety, personal burnout, and work-related burnout as risk enhancing correlates; satisfaction with academic performance as a protective correlate. Similarly, the multivariate model for anxiety significantly identified female gender, depression, personal burnout, teaching and learning related stressors, and past history of mental illness as risk enhancing correlates; being satisfied with academic performance, getting adequate sleep, and being a second-year resident as protective correlates. The logistic model for burnout significantly showed being a first-year resident, depression, anxiety, and drive and desire related stressors as positive predictors. None of the variables were identified as significant negative predictors of burnout. CONCLUSIONS A high prevalence of depression, anxiety, and burnout was seen among medical students and residents. Most of them were stressed with academic-related factors. A strong correlation between teaching and learning-related stressors with depression and anxiety may be a call for an efficient and more student-friendly curriculum.
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Affiliation(s)
| | - Ramesh Khadayat
- grid.80817.360000 0001 2114 6728Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Pratikchya Tulachan
- grid.80817.360000 0001 2114 6728Department of Psychiatry and Mental Health, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
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Lambert T, Blessberger H, Fellner A, Steinwender C, Tekian A. Self-assessment of medical students and young physicians in training : Self-confidence of clinical competencies and working or learning environment. Wien Klin Wochenschr 2020; 132:155-160. [PMID: 32130522 DOI: 10.1007/s00508-020-01623-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In 2015 medical training regulations have been restructured for postgraduate medical training in Austria resulting in a significant shortening of the training period. Furthermore, a restriction of working hours for physicians to 48 h per week was implemented affecting the framework of postgraduate medical training. The aim of this study was to obtain a self-assessment of students and young physicians in Austria regarding their self-confidence in clinical skills and their working and learning environment. METHODS In this study 6th year medical students, physicians in their basic training (common trunk), physicians in family medicine training, and residents in their first 18 months of training were asked to participate in a survey. Self-reported data were collected for five different prespecified domains (communication, motor skills, knowledge, documentation, and emergency). RESULTS In all domains, self-confidence increased significantly during medical training. Analysis further revealed better results of residents compared with all other groups in all domains, whereas physicians in family medicine training only rated themselves better in the documentation domain (p = 0.010); however, the interest in family medicine was low, even among physicians in family medicine training. The workload significantly increased during medical education, with the highest stress levels for physicians in family medicine training and residents (p = 0.001). CONCLUSIONS Self-confidence of young physicians but also their stress levels increased during the medical training. Further studies are needed to answer the question why the interest in family medicine was so unexpectedly low in this cohort.
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Affiliation(s)
- Thomas Lambert
- University Hospital, Medical Faculty, Med Campus III, Department of Cardiology, Johannes Kepler University Linz, Krankenhausstraße 9, 4020, Linz, Austria.
| | - Hermann Blessberger
- University Hospital, Medical Faculty, Med Campus III, Department of Cardiology, Johannes Kepler University Linz, Krankenhausstraße 9, 4020, Linz, Austria
| | - Alexander Fellner
- University Hospital, Medical Faculty, Med Campus III, Department of Cardiology, Johannes Kepler University Linz, Krankenhausstraße 9, 4020, Linz, Austria
| | - Clemens Steinwender
- University Hospital, Medical Faculty, Med Campus III, Department of Cardiology, Johannes Kepler University Linz, Krankenhausstraße 9, 4020, Linz, Austria
| | - Ara Tekian
- Department of Medical Education, University of Illinois at Chicago, Chicago, USA
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Urwin JW. Vacation as a Duty Hour Policy Lever. Am J Med 2020; 133:e79-e80. [PMID: 31449771 DOI: 10.1016/j.amjmed.2019.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Affiliation(s)
- John W Urwin
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Penn.
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Alsohime FM. Pediatric residents' perceptions of the impact of the 24-hour on-call system on their well-being and education and patient safety. A national survey. Saudi Med J 2020; 40:1040-1044. [PMID: 31588484 PMCID: PMC6887876 DOI: 10.15537/smj.2019.10.24548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: To examine pediatric residents’ perceptions of the 24-hour in-hospital shift and its impact on their well-being and education and patient safety. Methods: A cross-sectional survey conducted with residents enrolled in pediatric residency programs across Saudi Arabia in February 2017 at the Saudi Commission For Health Specialties, Riyadh Saudi Arabia. We designed a self-administered questionnaire that was distributed using the Saudi Commission for Health Specialties E-mail groups. A 4-point Likert-type scale was used to rank the residents’ responses; and the relative importance index (RII) approach was used to analyze the relative contribution of each indicator to its main theme. Results: A total of 314 residents participated in the survey (response rate, 30%). Of these, 168 (53.6%) were females. When asked about their preferences regarding the 24-hour on-call system, 286 residents (91.1%) preferred not to continue with this system. Residents ranked several indicators that they perceived as a negative impact due to the 24-hour on-call system. The first ranked indicator was missing academic activities and elective rotations post-call (mean 3.10 [standard deviation 1.25], RII 90.94%), and the second was decreased performance and decision-making skills during night duty (mean 3.51 [standard deviation 1.0], RII 88.11%). Conclusion: We found that the 24-hour on-call system negatively impacts residents’ well-being and education and patient care. Pediatric residency training programs in Saudi Arabia should consider resident duty hour reform and evaluate new on-call models to improve resident well-being and training, as well as patient care.
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Affiliation(s)
- Fahad M Alsohime
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Petrie K, Crawford J, LaMontagne AD, Milner A, Dean J, Veness BG, Christensen H, Harvey SB. Working hours, common mental disorder and suicidal ideation among junior doctors in Australia: a cross-sectional survey. BMJ Open 2020; 10:e033525. [PMID: 31964674 PMCID: PMC7045753 DOI: 10.1136/bmjopen-2019-033525] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/14/2019] [Accepted: 11/26/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Despite concern regarding high rates of mental illness and suicide amongst the medical profession, the link between working hours and doctors' mental health remains unclear. This study examines the relationship between average weekly working hours and junior doctors' (JDs') mental health in Australia. DESIGN AND PARTICIPANTS A randomly selected sample of 42 942 Australian doctors were invited to take part in an anonymous Beyondblue National Mental Health Survey in 2013, of whom 12 252 doctors provided valid data (response rate approximately 27%). The sample of interest comprised 2706 full-time graduate medical trainees in various specialties, at either intern, prevocational or vocational training stage. Consultants and retired doctors were excluded. OUTCOME MEASURES Main outcomes of interest were caseness of common mental disorder (CMD) (assessed using a cut-off of 4 as a threshold on total General Health Questionnaire-28 score), presence of suicidal ideation (SI) (assessed with a single item) and average weekly working hours. Logistic regression modelling was used to account for the impact of age, gender, stage of training, location of work, specialty, marital status and whether JDs had trained outside Australia. RESULTS JDs reported working an average of 50.1 hours per week (SD=13.4). JDs who worked over 55 hours a week were more than twice as likely to report CMD (adjusted OR=2.05; 95% CI 1.62 to 2.59, p<0.001) and SI (adjusted OR=2.00; 95% CI 1.42 to 2.81, p<0.001) compared to those working 40-44 hours per week. CONCLUSIONS Our results show that around one in four JDs are currently working hours that are associated with a doubling of their risk of common mental health problems and SI. These findings suggest that management of working hours represents an important focus for workplaces to improve the mental health of medical trainees.
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Affiliation(s)
- Katherine Petrie
- Black Dog Institute, Randwick, New South Wales, Australia
- Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Anthony D LaMontagne
- School of Health & Social Development, Deakin University, Melbourne, Victoria, Australia
- The McCaughey Centre: VicHealth Centre for the Promotion of Mental Health & Community Wellbeing, Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Allison Milner
- The McCaughey Centre: VicHealth Centre for the Promotion of Mental Health & Community Wellbeing, Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jessica Dean
- St Vincents Hospital Melbourne, Fitzroy, Victoria, Australia
- Beyond Blue, Hawthorn, Victoria, Australia
| | - Benjamin G Veness
- Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia
| | - Helen Christensen
- Black Dog Institute, Randwick, New South Wales, Australia
- Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Sfez M, Salaün JP, Villevieille T, Baghdadi H, Raucoules-Aimé M. How far can we go with resident duty hours? Anaesth Crit Care Pain Med 2020; 39:5-6. [PMID: 31911142 DOI: 10.1016/j.accpm.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michel Sfez
- Clinique Oudinot, 2, rue Rousselet, 75007 Paris, France; Professional Practice Committee of the French Society of Anaesthesia & Intensive Care Medicine, 74, rue Raynouard, 75016 Paris, France.
| | - Jean-Philippe Salaün
- CHU de Caen, Department of Anaesthesiology and Critical Care Medicine, Caen University Hospital, avenue de la Côte de Nacre, 14033 Caen, France; Juniors group (Groupe Jeunes) of the French Society of Anaesthesia and Intensive Care Medicine (SFAR), 74, rue Raynouard, 75016 Paris, France
| | - Thierry Villevieille
- Professional Practice Committee of the French Society of Anaesthesia & Intensive Care Medicine, 74, rue Raynouard, 75016 Paris, France; Franco-British Hospital, 4, rue Kléber, 92300 Levallois-Perret, France
| | - Houtin Baghdadi
- Professional Practice Committee of the French Society of Anaesthesia & Intensive Care Medicine, 74, rue Raynouard, 75016 Paris, France; Anaesthesia service, Aix-en-Provence Hospital, avenue des Tamaris, 13616 Aix-en-Provence, France
| | - Marc Raucoules-Aimé
- Professional Practice Committee of the French Society of Anaesthesia & Intensive Care Medicine, 74, rue Raynouard, 75016 Paris, France; Department of Anaesthesiology, Intensive care and Emergency Medicine, Pasteur 2 Hospital, 30, voie Romaine, CS 51069, 06001, Nice cedex 1, France
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44
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Dutheil F, Aubert C, Pereira B, Dambrun M, Moustafa F, Mermillod M, Baker JS, Trousselard M, Lesage FX, Navel V. Suicide among physicians and health-care workers: A systematic review and meta-analysis. PLoS One 2019; 14:e0226361. [PMID: 31830138 PMCID: PMC6907772 DOI: 10.1371/journal.pone.0226361] [Citation(s) in RCA: 228] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/24/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Medical-related professions are at high suicide risk. However, data are contradictory and comparisons were not made between gender, occupation and specialties, epochs of times. Thus, we conducted a systematic review and meta-analysis on suicide risk among health-care workers. METHOD The PubMed, Cochrane Library, Science Direct and Embase databases were searched without language restriction on April 2019, with the following keywords: suicide* AND (« health care worker* » OR physician* OR nurse*). When possible, we stratified results by gender, countries, time, and specialties. Estimates were pooled using random-effect meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Suicides, suicidal attempts, and suicidal ideation were retrieved from national or local specific registers or case records. In addition, suicide attempts and suicidal ideation were also retrieved from questionnaires (paper or internet). RESULTS The overall SMR for suicide in physicians was 1.44 (95CI 1.16, 1.72) with an important heterogeneity (I2 = 93.9%, p<0.001). Female were at higher risk (SMR = 1.9; 95CI 1.49, 2.58; and ES = 0.67; 95CI 0.19, 1.14; p<0.001 compared to male). US physicians were at higher risk (ES = 1.34; 95CI 1.28, 1.55; p <0.001 vs Rest of the world). Suicide decreased over time, especially in Europe (ES = -0.18; 95CI -0.37, -0.01; p = 0.044). Some specialties might be at higher risk such as anesthesiologists, psychiatrists, general practitioners and general surgeons. There were 1.0% (95CI 1.0, 2.0; p<0.001) of suicide attempts and 17% (95CI 12, 21; p<0.001) of suicidal ideation in physicians. Insufficient data precluded meta-analysis on other health-care workers. CONCLUSION Physicians are an at-risk profession of suicide, with women particularly at risk. The rate of suicide in physicians decreased over time, especially in Europe. The high prevalence of physicians who committed suicide attempt as well as those with suicidal ideation should benefits for preventive strategies at the workplace. Finally, the lack of data on other health-care workers suggest to implement studies investigating those occupations.
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Affiliation(s)
- Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Occupational and Preventive Medicine, WittyFit, Clermont-Ferrand, France
- Australian Catholic University, Faculty of Health, School of Exercise Science, Melbourne, Victoria, Australia
| | - Claire Aubert
- Université de Versailles Saint-Quentin-en-Yvelines, Faculty of Health Science Simone Veil, Versailles, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Biostatistics Unit, the Clinical Research and Innovation Direction, Clermont-Ferrand, France
| | - Michael Dambrun
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, Clermont-Ferrand, France
| | - Fares Moustafa
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Emergency, Clermont-Ferrand, France
| | - Martial Mermillod
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
- Institut Universitaire de France, Paris, France
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Marion Trousselard
- French Armed Forces Biomedical Research Institute-IRBA, Neurophysiology of Stress, Neuroscience and Operational Constraint Department, Brétigny-sur-Orge, France
| | - François-Xavier Lesage
- University of Montpellier, Laboratory Epsylon EA, Dynamic of Human Abilities & Health Behaviors, CHU Montpellier, University Hospital of Montpellier, Occupational and Preventive Medicine, Montpellier, France
| | - Valentin Navel
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France
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45
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46
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Gupta R, Eady K, Moreau K, Frank JR, Writer HK. Resident duty hours: Families' knowledge and perceptions in the paediatric intensive care unit. Paediatr Child Health 2019; 25:467-472. [PMID: 33173558 DOI: 10.1093/pch/pxz092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/03/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Resident duty hours remain a controversial topic in the literature. Competing interests include patient safety, resident education, and resident well-being. No studies, however, have sought family members' perspectives on duty hours in the paediatric context. This study aimed to explore family members' knowledge of trainee duty hours, and their perspectives on the balance between shift duration and hand-off frequency. METHODS We surveyed family members of patients admitted ≥ 24 hours in the paediatric intensive care unit at an academic center. We simultaneously collected daily logs of hours worked by trainees. Descriptive statistics were used to analyze survey responses and trainee duty hours. RESULTS One-hundred and one family members responded (75%). Respondents demonstrated knowledge of trainees working long duty hours but reported lower averages than the trainee logs (55 versus 66 hours per week and 16 versus 24 hours per shift). Elements related to both potential trainee fatigue and hand-offs raised concern in more than half of respondents. When asked to choose between a familiar trainee working a prolonged shift, or an unfamiliar trainee at the start of their shift, respondents were divided (52% versus 48%, respectively). CONCLUSIONS Family members of critically ill paediatric patients are aware that trainees provide patient care while working long duty hours with minimal sleep. Despite this awareness, long shifts retain value with some families, possibly due to continuity. Changes to duty hours and hand-off frequency may pose an unrealized harm on family-centered care, as well as patient-provider relationships, and further study is warranted.
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Affiliation(s)
- Ronish Gupta
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Kaylee Eady
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | | | - Jason R Frank
- Office of Specialty Education, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario
| | - Hilary K Writer
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
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Houchens N, Meddings J, Gupta A. Quality and safety in the literature: September 2019. BMJ Qual Saf 2019; 28:769-774. [PMID: 31253735 DOI: 10.1136/bmjqs-2019-009918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/12/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Nathan Houchens
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States .,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Jennifer Meddings
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States.,Departmentof Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Ashwin Gupta
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States
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Mughal Z, Al-Jazieh I, Zaidi H. Development of a proforma to improve quality of handover of surgical patients at the weekend. J Eval Clin Pract 2019; 25:456-462. [PMID: 30411446 DOI: 10.1111/jep.13063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/06/2018] [Accepted: 10/09/2018] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The introduction of shift pattern of working in the medical profession has led to an increase in reliance on effective handover of patient information. We evaluated the use of a weekend handover proforma in General Surgical patients at a University Teaching Hospital. METHODS A standardized weekend handover proforma was implemented. A pre-post survey of medical staff and prospective observational study on the use of the proforma was carried out. The impact of three strategies to reinforce change in clinical practice was investigated at random time-points. These were (1) presentation at a clinical governance meeting; (2) email; and (3) induction training on handover combined with one-to-one interactive training. The two outcome measures were compliance with the proforma, and "handover score," which was the amount of data transferred per patient. RESULTS The survey highlighted inadequate provision for handover at the weekend. National guidelines were used to design the weekend handover proforma. There was 70% compliance with the new standardized proforma with a median handover score of 83% (IQR = 0-100). The results were presented at a clinical governance meeting, and the proforma was refined. After this change, the proforma was used in 71% of patients, and the median score was 65% (IQR = 0-80, P = 0.0516). Compliance after an email reminder was 69%, and median handover score was 80% (IQR = 0-90, P = 0.1037). After induction training, there was a significant improvement in proforma compliance (94%) and median score (90%, IQR = 80-90, P = 0.013). CONCLUSION Effective transfer of handover information can be achieved over the weekend with the use of a standardized proforma. Use of the proforma was greatest after providing junior doctors with didactic training on handover combined with interactive guidance on completing the proforma.
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Affiliation(s)
- Zahir Mughal
- Department of Otorhinolaryngology, University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, CV2 2DX, UK
| | - Iyad Al-Jazieh
- Department of General Surgery, University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, CV2 2DX, UK
| | - Hammad Zaidi
- Department of General Surgery, University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, CV2 2DX, UK
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Roy M, Dip F, Rosales A, Roche M, Hutchins RR. Smartphone Application as an Education Platform in Hepato-Pancreato-Biliary Surgery. Surg Innov 2019; 26:613-620. [PMID: 31092141 DOI: 10.1177/1553350619848210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. There are no data to assess the need for smartphone applications (SA) as an educational tool in hepato-pancreato-biliary (HPB) surgery. The primary objective of this study was to assess if SA can be used as an educational tool in HPB surgery. The secondary objective was to assess if SA can help as a decision-making tool for fellowship applicants in HPB surgery. Methods. A preapproved questionnaire was e-mailed by International Hepato-Pancreato-Biliary Association to all its 2350 members. Results. Two hundred seventy-one surgeons responded to the survey. Eight were excluded for incomplete data. A total of 48.7% of responders were between 28 and 43 years old (generation X) and 45.2% between 44 and 62 years old (baby boomers). A total of 37.6% of the responders considered SA as an effective method to teach future trainees, and there were slightly higher odds of choosing SA as a teaching tool if the responder considered themselves as an innovator (odds ratio: 2.24). A total of 87.8% of the responders believe that SA in HPB surgery can be directed toward surgical trainees' education, and 91.6% believed SA can be directed toward a fellow. Ninety-five percent of the responders believed that SA in HPB surgery can possibly help a future applicant to choose an HPB fellowship program. Conclusion. SA can complement other teaching techniques and educational tools in HPB surgery. In addition, it can potentially be used as a platform for HPB surgery fellowship by helping in making a decision regarding appropriate fellowship programs.
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Affiliation(s)
- Mayank Roy
- 1 Royal London Hospital, Barts and the London NHS Trust, London, UK
| | | | | | - Matthew Roche
- 1 Royal London Hospital, Barts and the London NHS Trust, London, UK
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Low ZX, Yeo KA, Sharma VK, Leung GK, McIntyre RS, Guerrero A, Lu B, Sin Fai Lam CC, Tran BX, Nguyen LH, Ho CS, Tam WW, Ho RC. Prevalence of Burnout in Medical and Surgical Residents: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091479. [PMID: 31027333 PMCID: PMC6539366 DOI: 10.3390/ijerph16091479] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Abstract
The burnout syndrome is characterized by emotional exhaustion, depersonalization, and reduced personal achievement. Uncertainty exists about the prevalence of burnout among medical and surgical residents. Associations between burnout and gender, age, specialty, and geographical location of training are unclear. In this meta-analysis, we aimed to quantitatively summarize the global prevalence rates of burnout among residents, by specialty and its contributing factors. We searched PubMed, PsycINFO, Embase, and Web of Science to identify studies that examined the prevalence of burnout among residents from various specialties and countries. The primary outcome assessed was the aggregate prevalence of burnout among all residents. The random effects model was used to calculate the aggregate prevalence, and heterogeneity was assessed by I2 statistic and Cochran's Q statistic. We also performed meta-regression and subgroup analysis. The aggregate prevalence of burnout was 51.0% (95% CI: 45.0-57.0%, I2 = 97%) in 22,778 residents. Meta-regression found that the mean age (β = 0.34, 95% CI: 0.28-0.40, p < 0.001) and the proportion of males (β = 0.4, 95% CI = 0.10-0.69, p = 0.009) were significant moderators. Subgroup analysis by specialty showed that radiology (77.16%, 95% CI: 5.99-99.45), neurology (71.93%, 95% CI: 65.78-77.39), and general surgery (58.39%, 95% CI: 45.72-70.04) were the top three specialties with the highest prevalence of burnout. In contrast, psychiatry (42.05%, 95% CI: 33.09-51.58), oncology (38.36%, 95% CI: 32.69-44.37), and family medicine (35.97%, 95% CI: 13.89-66.18) had the lowest prevalence of burnout. Subgroup analysis also found that the prevalence of burnout in several Asian countries was 57.18% (95% CI: 45.8-67.85); in several European countries it was 27.72% (95% CI: 17.4-41.11) and in North America it was 51.64% (46.96-56.28). Our findings suggest a high prevalence of burnout among medical and surgical residents. Older and male residents suffered more than their respective counterparts.
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Affiliation(s)
- Zhi Xuan Low
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Keith A Yeo
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Vijay K Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Gilberto K Leung
- Department of Surgery, The University of Hong Kong, Hong Kong, China.
| | - Roger S McIntyre
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada.
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5G 2C4, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada.
- Department of Toxicology and Pharmacology, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Anthony Guerrero
- Department of Psychiatry, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA.
| | - Brett Lu
- Department of Psychiatry, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA.
| | | | - Bach X Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
- Vietnam Young Physicians' Association, Hanoi 100000, Vietnam.
| | - Long H Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam.
| | - Cyrus S Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119228, Singapore.
| | - Wilson W Tam
- Alice Lee School of Nursing, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore.
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
- Biomedical Institute for Global Health Research and Technology, National University of Singapore, Singapore 119228, Singapore.
- Centre of Excellence in Behavioral Medicine, Nguyen Tat Thanh University (NTTU), Ho Chi Minh City 70000, Vietnam.
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