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Fernández-Villa de Rey-Salgado J, Curiel-Montes A, Abarca-Olivas J, González-López P, Borrás-Rocher F, González-Sánchez L, Nieto-Navarro JA. Burnout in Neurosurgery. World Neurosurg 2024; 184:e586-e592. [PMID: 38336209 DOI: 10.1016/j.wneu.2024.01.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Burnout is a pervasive psychosocial syndrome that manifests as a chronic response to interpersonal stressors encountered in the occupational setting. Neurosurgeons exhibit a high prevalence rate of burnout, ranging from 33% to 67%. The primary objective of this study is to examine the prevalence of Burnout syndrome within the neurosurgical community and identify the contributing factors. METHODS A prospective observational study was conducted utilizing an anonymous survey format, incorporating the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) questionnaire. Additional inquiries were made regarding demographic characteristics, occupational factors, lifestyle choices, and the Hospital Anxiety and Depression Scale (HADS) questionnaire. The survey was disseminated between March 23rd, 2023, and April 4th, 2023, utilizing the email registries of the Spanish Society of Neurosurgery (SENEC) and the Latin American Federation of Neurosurgical Societies (FLANC). Descriptive analysis was performed, comparing responses between participants with and without burnout syndrome using cross-tabulation and the Chi-square test to assess the presence of dependency. RESULTS A total of 282 neurosurgeons completed the survey. The sample comprised 30.1% females and 69.9% males, with a median age within the 30-40 range. Among the surveyed neurosurgeons, 66.7% exhibited a prevalence of burnout, while 23.4% met the criteria for defined burnout. Significantly higher rates of burnout syndrome were observed among residents, specifically those in their fifth year of residency, as well as those whose departments perform a moderate range of surgeries (500-1000), participating in on-call duties, lacking regular physical exercise (at least twice a week), engaging infrequently in social activities with friends, lacking extracurricular hobbies, and obtaining scores exceeding 10 points in any of the HADS subscales. CONCLUSIONS Burnout syndrome affects nearly a quarter of the neurosurgical specialists included in this study. Moreover, a distinct profile associated with defined burnout among neurosurgeons emerges, encompassing characteristics such as being a fifth-year resident, belongs to departments with a moderate number of surgeries, with few extra-occupational distractions and exhibiting symptoms of depression or anxiety.
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Affiliation(s)
| | - Alberto Curiel-Montes
- Department of Neurosurgery, Hospital General Universitario Dr Balmis, Alicante, Spain
| | - Javier Abarca-Olivas
- Department of Neurosurgery, Hospital General Universitario Dr Balmis, Alicante, Spain
| | - Pablo González-López
- Department of Neurosurgery, Hospital General Universitario Dr Balmis, Alicante, Spain
| | | | - Luz González-Sánchez
- Department of Neurosurgery, Hospital General Universitario Dr Balmis, Alicante, Spain
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Strobel S. Effects of extending residencies on the supply and quality of family medicine practitioners; difference-in-differences evidence from the implementation of mandatory family medicine residencies in Canada. HEALTH ECONOMICS 2024; 33:393-409. [PMID: 38043129 DOI: 10.1002/hec.4782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023]
Abstract
I examine the impacts of extending residency training programs on the supply and quality of physicians practicing primary care. I leverage mandated extended residency lengths for primary care practitioners that were rolled out over 20 years in Canada on a province-by-province basis. I compare these primary care specialties to other specialties that did not change residency length (first difference) before and after the policy implementation (second difference) to assess how physician supply evolved in response. To examine quality outcomes, I use a set of scraped data and repeat this difference-in-differences identification strategy for complaints resulting in censure against physicians in Ontario. I find declines in the number of primary care providers by 5% for up to 9 years after the policy change. These changes are particularly pronounced in new graduates and younger physicians, suggesting that the policy change dissuaded these physicians from entering primary care residencies. I find no impacts on quality of physicians as measured by public censure of physicians. This suggests that extending primary care training caused declines in physician supply without improvement in the quality of these physicians. This has implications for current plans to extend residency training programs.
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Affiliation(s)
- Stephenson Strobel
- Division of Health Policy and Economics, Population Health Sciences, Weill Cornell Medical College, New York, New York, USA
- Department of Family Medicine- Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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3
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Weaver MD, Barger LK, Sullivan JP, Quan SF, Robbins R, Landrigan CP, Czeisler CA. Public opinion of resident physician work hours in 2022. Sleep Health 2024; 10:S194-S200. [PMID: 37940477 DOI: 10.1016/j.sleh.2023.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE The purpose of this study was to characterize public awareness and opinion regarding resident physician work hours in the United States. METHODS We conducted a nationally representative cross-sectional survey among adults in the United States. Demographic quota-based sampling was conducted by Qualtrics to match 2020 United States Census estimates of age, sex, race, and ethnicity. Descriptive statistics are presented. Hypothesis testing was conducted to identify characteristics associated with agreement with current resident physician work-hour policies. RESULTS 4763 adults in the United States participated in the study. 97.1% of the public believes that resident physicians should not work 24-hour shifts and 95.6% believe the current 80 hours resident work week is too long. 66.4% of the participants reported that the maximum shift duration should be 12 consecutive hours or fewer, including 22.9% who recommended a maximum shift length of 8 hours. Similarly, 66.4% reported that maximum weekly work hours should be 59 or fewer, including 24.9% who recommended a maximum of 40 weekly work hours. CONCLUSIONS Nearly all US adults disagree with current work-hour policies for resident physicians. Public opinion supports limiting shifts to no more than 12 consecutive hours and weekly work to no more than 60 hours, which is in sharp contrast to current regulations that permit of 28 hours shifts and 80 hours of work per week.
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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, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA.
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason P Sullivan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stuart F Quan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher P Landrigan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA; Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
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4
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Sprajcer M, Robinson A, Thomas MJW, Dawson D. Advancing fatigue management in healthcare: risk-based approaches that enhance health service delivery. Occup Med (Lond) 2023; 73:459-463. [PMID: 38157486 DOI: 10.1093/occmed/kqad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Given the need for 24/7 healthcare services, fatigue is an inevitable consequence of work in this industry. A significant body of regulatory advice and hospital services have focused primarily on restricting work hours as the primary method of mitigating fatigue-related risk. Given the inevitability of fatigue, and the limited capacity of labour agreements to control risk, this commentary explores how the principles of fatigue risk management might be applied in a healthcare setting.
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Affiliation(s)
- M Sprajcer
- Appleton Institute for Behavioural Sciences, Central Queensland University, Wayville, South Australia, 5034, Australia
| | - A Robinson
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, K1H 8L1, Canada
| | - M J W Thomas
- Appleton Institute for Behavioural Sciences, Central Queensland University, Wayville, South Australia, 5034, Australia
| | - D Dawson
- Appleton Institute for Behavioural Sciences, Central Queensland University, Wayville, South Australia, 5034, Australia
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5
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Haymaker C, Berry SD, Cadick A, Bane C, VanDerKolk K. The relationship between a single-item measure of burnout and the Copenhagen Burnout Inventory in family medicine residents. Int J Psychiatry Med 2023; 58:637-642. [PMID: 37060242 DOI: 10.1177/00912174231171791] [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: 04/16/2023]
Abstract
OBJECTIVE Burnout during residency education is a phenomenon which requires careful study. A single item for measuring burnout shows promise for its brevity and concordance with the most commonly used measure of burnout, the Maslach Burnout Inventory, but has not been compared to the Copenhagen Burnout Inventory. We compared the single-item measure of burnout question to the Copenhagen Burnout Inventory to assess the convergence between these two measures of burnout. METHOD Family Medicine residents (n = 32) from three residency programs completed the single-item measure of burnout question and the Copenhagen Burnout Inventory. We compared the single-item measure of burnout measure to the three scales of the Copenhagen Burnout Inventory. RESULTS Our analyses indicated that the single item measure is highly correlated with personal burnout (r = .76), moderately correlated with patient burnout (r = .58), and not correlated with work burnout (r = .18). CONCLUSIONS Because the single-item measure of burnout is particularly useful for identifying personal burnout, it may help to identify early signs of burnout amount physicians in training.
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Affiliation(s)
| | | | - Amber Cadick
- Union Hospital Family Medicine Residency, Terre Haute, IN, USA
| | - Cynthia Bane
- Western Michigan Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Kristi VanDerKolk
- Western Michigan Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
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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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Yuan JH, Huang Y, Rosgen BK, Donnelly S, Lan X, Katz SJ. Burnout and fatigue amongst internal medicine residents: A cross-sectional study on the impact of alternative scheduling models on resident wellness. PLoS One 2023; 18:e0291457. [PMID: 37708198 PMCID: PMC10501672 DOI: 10.1371/journal.pone.0291457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Fatigue and burnout are prevalent among resident physicians across Canada. Shifts exceeding 24 hours are commonly purported as detrimental to resident health and performance. Residency training programs have employed strategies towards understanding and intervening upon the complex issue of resident fatigue, where alternative resident scheduling models have been an area of active investigation. This study sought to characterize drivers and outcomes of fatigue and burnout amongst internal medicine residents across different scheduling models. METHODS We conducted cross-sectional surveys were among internal medicine resident physicians at the University of Alberta. We collected anonymized socioeconomic demographics and medical education background, and estimated associations between demographic or work characteristics and fatigue and burnout outcomes. RESULTS Sixty-nine participants competed burnout questionnaires, and 165 fatigue questionnaires were completed (response rate of 48%). The overall prevalence of burnout was 58%. Lower burnout prevalence was noted among respondents with dependent(s) (p = 0.048), who identified as a racial minority (p = 0.018), or completed their medical degree internationally (p = 0.006). The 1-in-4 model was associated with the highest levels of fatigue, reported increased risk towards personal health (OR 4.98, 95%CI 1.77-13.99) and occupational or household harm (OR 5.69, 95%CI 1.87-17.3). Alternative scheduling models were not associated with these hazards. CONCLUSIONS The 1-in-4 scheduling model was associated with high rates of resident physician fatigue, and alternative scheduling models were associated with less fatigue. Protective factors against fatigue are best characterized as strong social supports outside the workplace. Further studies are needed to characterize the impacts of alternative scheduling models on resident education and patient safety.
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Affiliation(s)
- Jack H. Yuan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Yiming Huang
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Brianna K. Rosgen
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Donnelly
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Xiaoyang Lan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Steven J. Katz
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Jawad S, Thomas M, Hecker K, Kassam A. Exploring the construct of anticipatory stress in finding a job after residency training through cognitive interviewing: Implications for learner well-being and health workforce planning. MEDEDPUBLISH 2023; 13:25. [PMID: 37881509 PMCID: PMC10594048 DOI: 10.12688/mep.19559.1] [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: 10/27/2023] Open
Abstract
Background: Anticipatory stress (AS) is denoted by concern about future events for which there is little control. Most AS research has been physiological studies such as measuring salivary cortisol levels. Medical learners may experience AS regarding employment after residency, however AS a psychological construct across career stages has not previously been studied. The objective of this study is to explore the psychological construct of employment AS in medical students, residents, and former Program Directors (PDs). Methods: Participants were recruited from a large Canadian medical school via purposive sampling. Semi-structured interviews with n=21 participants (six medical students, nine residents, and six PDs) were transcribed verbatim, and coded by two independent reviewers using thematic analysis. Results: Participants agreed that financial, family, and geographical factors exacerbate AS, and it is mitigated by flexibility, social support, and being proactive. External support, job market saturation, and differences between medical specialities also influence AS. Perspectives unique to participant groups included: medical students reflecting on a hidden curriculum and preoccupation with proximal issues over distal concerns of employment; residents experiencing competing residency program demands; former PDs finding that resident competency, yearly hiring fluctuations, and existing stress impact AS. Consequences of AS include physical and psychological manifestations, performance anxiety, and pursuing additional training. Conclusions: Perceptions of AS vary by medical career stage. Individual, program and systems-level changes can help manage and address the underlying cause of AS: an unreliable job market for physicians. Correcting the mismatch between residency positions and job openings may be a proactive, preventative approach.
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Affiliation(s)
- Sana Jawad
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Megan Thomas
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, BC V6T 1Z3, Canada
| | - Kent Hecker
- Department of Veterinary Clinical and Diagnostic Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Aliya Kassam
- Community Health Sciences Cumming School of Medicine, Health Sciences Centre Foothills campus, 3330 Hospital Drive NW, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
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Maoz Breuer R, Waitzberg R, Breuer A, Cram P, Bryndova L, Williams GA, Kasekamp K, Keskimaki I, Tynkkynen LK, van Ginneken V, Kovács E, Burke S, McGlacken-Byrne D, Norton C, Whiston B, Behmane D, Grike I, Batenburg R, Albreh T, Pribakovic R, Bernal-Delgado E, Estupiñan-Romero F, Angulo-Pueyo E, Rose AJ. Work like a Doc: A comparison of regulations on residents' working hours in 14 high-income countries. Health Policy 2023; 130:104753. [PMID: 36827717 DOI: 10.1016/j.healthpol.2023.104753] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Medical residents work long, continuous hours. Working in conditions of extreme fatigue has adverse effects on the quality and safety of care, and on residents' quality of life. Many countries have attempted to regulate residents' work hours. OBJECTIVES We aimed to review residents' work hours regulations in different countries with an emphasis on night shifts. METHODS Standardized qualitative data on residents' working hours were collected with the assistance of experts from 14 high-income countries through a questionnaire. An international comparative analysis was performed. RESULTS All countries reviewed limit the weekly working hours; North-American countries limit to 60-80 h, European countries limit to 48 h. In most countries, residents work 24 or 26 consecutive hours, but the number of long overnight shifts varies, ranging from two to ten. Many European countries face difficulties in complying with the weekly hour limit and allow opt-out contracts to exceed it. CONCLUSIONS In the countries analyzed, residents still work long hours. Attempts to limit the shift length or the weekly working hours resulted in modest improvements in residents' quality of life with mixed effects on quality of care and residents' education.
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Affiliation(s)
- Rina Maoz Breuer
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel
| | - Ruth Waitzberg
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel; Department of Health Care Management, Faculty of Economics & Management, Technical University Berlin, Germany.
| | - Adin Breuer
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Peter Cram
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Lucie Bryndova
- Center for Social and Economic Strategies, Faculty of Social Sciences, Charles University, Czechia
| | - Gemma A Williams
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, Houghton Street, London United Kingdom
| | | | | | - Liina-Kaisa Tynkkynen
- Faculty of Social Sciences, Tampere University, Finland; Welfare State Research and Reform, Finnish Institute for Health and Welfare, Finland
| | - Verena van Ginneken
- Department of Psychiatry, Campus Benjamin Franklin, Charité - Universitätsmedizin, Germany
| | - Eszter Kovács
- Health Workforce Planning Knowledge Centre, Semmelweis University, Hungary
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, Ireland
| | | | | | | | - Daiga Behmane
- Faculty of Public Health and Social Welfare, Riga Stradins University, Latvia
| | - Ieva Grike
- Faculty of Residency Manager of Residency study process Riga Stradins University, Latvia
| | - Ronald Batenburg
- Netherlands institute for Health Services Research (Nivel), Radboud University Nijmegen, Faculty of Social Sciences, the Netherlands
| | - Tit Albreh
- Centre for Health Care National Institute of Public Health Trubarjeva, Slovenia
| | - Rade Pribakovic
- Centre for Health Care at the National Institute of Public Health of Slovenia, Slovenia
| | | | | | | | - Adam J Rose
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel; School of Public Health, Hebrew University, Jerusalem, Israel
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Samuel N, McQueen SA, Barnett RR, Everson MC, Fiala C, Lau R, Zadeh G. Parenting and Childbearing in Neurosurgical Residency: Perspectives from the United States and Canada. JOURNAL OF SURGICAL EDUCATION 2023; 80:572-580. [PMID: 36737307 DOI: 10.1016/j.jsurg.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/27/2022] [Accepted: 01/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Despite growing interest in family planning alongside surgical training, significant barriers exist including time constraints, stigma, and lack of paid leave and formal policies. We currently lack a deep understanding of the challenges residents face and how practice cultures may prohibit successful policy enactment. OBJECTIVE To investigate residents' perspectives surrounding parenting and childbearing during neurosurgical residency in the United States and Canada. METHODS A cross-sectional, qualitative study methodology was used, including focus groups with neurosurgical residents. Purposive sampling was employed to capture a broad range of perspectives including stage of training, geographical location, and gender. Data collection and analysis occurred in parallel, using a thematic analysis approach. Data collection continued until no new themes relating to the research questions were identified. RESULTS Notable challenges included lack of formal family leave policies, time constraints, insufficient clinical human resources, physical health concerns, lack of lactation accommodations, and lack of mentorship. A subset of barriers were uncovered that stem specifically from workplace cultures, including gender norms, difficulty in asking for help, concerns for inconveniencing others, and pressures to time parental leave during research blocks. Several positive changes were identified including growing awareness and female representation, and benefits of the dual surgeon-parent identity. CONCLUSION While parenting during neurosurgery residency is becoming increasingly common, significant practical and cultural barriers persist including a marked absence of formal policies. Culture shifts are essential in ensuring opportunities for life outside of medicine for all residents, irrespective of family status.
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Affiliation(s)
- Nardin Samuel
- Department of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Sydney A McQueen
- Department of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Megan C Everson
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Clare Fiala
- Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ruth Lau
- Department of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Department of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
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Fadle AA, Khalifa AA, Mahran DG, Khidr SS, Said HG, Farouk O. Burnout syndrome (BOS) among resident doctors in an Egyptian tertiary care university hospital: Prevalence and determinants during the COVID-19 pandemic. Int J Soc Psychiatry 2023; 69:396-405. [PMID: 35695719 PMCID: PMC10076172 DOI: 10.1177/00207640221104698] [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: 11/16/2022]
Abstract
OBJECTIVES The current study aimed to detect the BOS prevalence and determinants among residents working during the second wave of the COVID-19 pandemic in an Egyptian tertiary university referral hospital. METHODS A cross-sectional study evaluating the working period from June to November 2020 during the COVID-19 pandemic second wave, through a five sections questionnaire evaluating: 1 - sociodemographic characteristics, 2 - job characteristics, 3 - negative thoughts related to their job, 4 - resident's health problems, and 5 - evaluating BOS through Maslach Burnout Inventory (MBI) scale (including emotional exhaustion [EE], depersonalization [DP], and personal accomplishment [PA] as subscales). RESULTS We included 230 residents with a median age of 27 years. The median MBI sub-scales (IQ Range) values were 30.0 (20, 39), 21.0 (15, 30), and 29.5 (22, 36) for EE, DP, and PA, respectively. About 51.0% and 83.0% of the residents were high in EE and DP, while 8.7% were low in PA. The median EE and DP were higher in younger age (⩽27 years; p = .002 and .024), males (p = .001 and <.001), working >90 hours weekly (p = .016 and <.001), exposure to harassment (p < .001), and having COVID-19 infection (p = .002 and .001). Residents working in surgical departments reported higher DP scores than those in non-surgical departments (p = .03). There was a mild positive correlation between working hours per week and the total scores in EE and DP, r = .24 (p < .001) and r = .23 (p = .001) respectively, while it was found to have a negative correlation with the PA (r = -.133 and p = .044). CONCLUSIONS The BOS is evident and considerably high among the residents working during the COVID-19 pandemic. Younger age, males, working in surgical departments, and those who got COVID-19 infection were most vulnerable.
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Affiliation(s)
- Amr A Fadle
- Orthopaedic Department, Assiut University Hospital, Egypt
| | - Ahmed A Khalifa
- Orthopaedic Department, Assiut University Hospital, Egypt.,Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt
| | - Dalia G Mahran
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Egypt
| | | | - Hatem G Said
- Orthopaedic Department, Assiut University Hospital, Egypt
| | - Osama Farouk
- Orthopaedic Department, Assiut University Hospital, Egypt
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12
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Weaver MD, Landrigan CP, Sullivan JP, O'Brien CS, Qadri S, Viyaran N, Czeisler CA, Barger LK. National improvements in resident physician-reported patient safety after limiting first-year resident physicians' extended duration work shifts: a pooled analysis of prospective cohort studies. BMJ Qual Saf 2023; 32:81-89. [PMID: 35537821 PMCID: PMC9887355 DOI: 10.1136/bmjqs-2021-014375] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/13/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) enacted a policy in 2011 that restricted first-year resident physicians in the USA to work no more than 16 consecutive hours. This was rescinded in 2017. METHODS We conducted a nationwide prospective cohort study of resident physicians for 5 academic years (2002-2007) before and for 3 academic years (2014-2017) after implementation of the 16 hours 2011 ACGME work-hour limit. Our analyses compare trends in resident physician-reported medical errors between the two cohorts to evaluate the impact of this policy change. RESULTS 14 796 residents provided data describing 78 101 months of direct patient care. After adjustment for potential confounders, the work-hour policy was associated with a 32% reduced risk of resident physician-reported significant medical errors (rate ratio (RR) 0.68; 95% CI 0.64 to 0.72), a 34% reduced risk of reported preventable adverse events (RR 0.66; 95% CI 0.59 to 0.74) and a 63% reduced risk of reported medical errors resulting in patient death (RR 0.37; 95% CI 0.28 to 0.49). CONCLUSIONS These findings have broad relevance for those who work in and receive care from academic hospitals in the USA. The decision to lift this work hour policy in 2017 may expose patients to preventable harm.
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Affiliation(s)
- Matthew D Weaver
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher P Landrigan
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Departments of Pediatrics and Medicine, and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason P Sullivan
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
| | - Conor S O'Brien
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
| | - Salim Qadri
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
| | - Natalie Viyaran
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
| | - Charles A Czeisler
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura K Barger
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
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13
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Li Z, Liu D, Liu X, Su H, Bai S. The Association of Experienced Long Working Hours and Depression, Anxiety, and Suicidal Ideation Among Chinese Medical Residents During the COVID-19 Pandemic: A Multi-Center Cross-Sectional Study. Psychol Res Behav Manag 2023; 16:1459-1470. [PMID: 37131958 PMCID: PMC10149078 DOI: 10.2147/prbm.s408792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/14/2023] [Indexed: 05/04/2023] Open
Abstract
Background Long working hours are common among medical residents and may increase the risk of mental disorders. We aimed to investigate the association between experienced long working hours and depression, anxiety, and suicidal ideation among Chinese medical residents during the COVID-19 pandemic. Methods This study was conducted in September 2022; 1343 residents from three center in Northeastern China were included in the final analysis (effective response rate: 87.61%). The data were collected from participants via online self-administered questionnaires. Depression and anxiety were measured by the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder (GAD-7) scale, respectively. Adjusted odds ratios and 95% confidence intervals were determined after adjusting for potential confounders by binary unconditional logistic regression. Results The effective response rate was 87.61%. Among the 1343 participants, 12.88% (173), 9.90% (133), and 9.68% (130) had experienced major depression, major anxiety, and suicidal ideation, respectively. We found that longer weekly worktime increased the risk of major depression, particularly in those who worked for more than 60 hours per week (≥ 61 hours vs ≤ 40 hours, OR=1.87, P for trend = 0.003). However, this trend was not observed for either major anxiety or suicidal ideation (P for trend > 0.05 for both). Conclusion This study revealed that there was a considerable incidence of poor mental health among medical residents; furthermore, the longer weekly worktime was associated with a higher risk of major depression, especially for those who worked more than 60 hours per week, but this association was not observed in either major anxiety or suicidal ideation. This may help policymakers to develop targeted interventions.
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Affiliation(s)
- Zhiyuan Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Dongmei Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Xiuping Liu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Hui Su
- Department of Sleep Medical Center, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
- Correspondence: Song Bai, Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People’s Republic of China, Tel +86-18940255568, Fax +86-024-83955092, Email
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14
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Yoo SJ, Hussein N, Barron DJ. Congenital Heart Surgery Skill Training Using Simulation Models: Not an Option but a Necessity. J Korean Med Sci 2022; 37:e293. [PMID: 36193641 PMCID: PMC9530313 DOI: 10.3346/jkms.2022.37.e293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/20/2022] Open
Abstract
Congenital heart surgery (CHS) is technically demanding, and its training is extremely complex and challenging. Training of the surgeon's technical skills has relied on a preceptorship format in which the trainees are gradually exposed to patients in the operating room under the close tutelage of senior staff surgeons. Training in the operating room is an inefficient process and the concept of a learning curve is no longer acceptable in terms of patient outcomes. The benefits of surgical simulation in training of congenital heart surgeons are well known and appreciated. However, adequate surgical simulation models and equipment for training have been scarce until the recent development of three-dimensionally (3D) printed models. Using comprehensive 3D printing and silicone-molding techniques, realistic simulation training models for most congenital heart surgical procedures have been produced. Newly developed silicone-molded models allow efficient CHS training in a stress-free environment with instantaneous feedback from the proctors and avoids risk to patients. The time has arrived when all congenital heart surgeons should consider surgical simulation training before progressing to real-life operating in a similar fashion to the aviation industry where all pilots are required to complete simulation training before flying a real aircraft. It is argued here that simulation training is not an option anymore but should be a mandatory component of CHS training.
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Affiliation(s)
- Shi-Joon Yoo
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada
- Division of Cardiology, Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Nabil Hussein
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, England, UK
| | - David J Barron
- Division of Cardiovascular Surgery, Department of Surgery, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Canada
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15
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Dehmoobad Sharifabadi A, Clarkin C, Doja A. Trainee perceptions of resident duty hour restrictions: a qualitative study of online discussion forums. BMJ Open 2022; 12:e063104. [PMID: 36167374 PMCID: PMC9516167 DOI: 10.1136/bmjopen-2022-063104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Resident duty hour (RDH) restrictions in postgraduate medical education is a controversial yet important topic for study. There is limited literature on authentic trainee perceptions surrounding RDH restrictions to inform evaluation and future planning. Online forums are a widely accessible, yet underused resource, for insight into trainee perceptions. Our objective was to qualitatively assess trainee perceptions of RDH restrictions on online discussion forums. SETTING Online discussion forums; Premed101 (Canadian forum) and Student Doctor Network (SDN) (American forum). PARTICIPANTS 6630 posts from 161 discussion threads; comprising 429 posts in 14 threads from Premed101 and 6201 posts in 147 threads from SDN. Posters included medical students, residents and attending physicians. DESIGN Data were analysed inductively and iteratively to create themes and subthemes. Cocoding, consensus-based decision making and an audit trail were used to ensure trustworthiness. RESULTS Key findings distilled across both forums include: the relationship between hours worked and competence, the inapplicability of blanket RDH restrictions to all specialties and the inter-relationship between fatigue and patient safety. Discussions of RDH restriction compliance and perceived consequence for the reporting of violations were also featured on the American SDN forum. CONCLUSIONS The findings of this study reveal multiple themes pertinent to the implementation and revision of RDH restrictions. The most prominent theme was the inapplicability of blanket restrictions on duty hours theme due to the diversity of training needs across specialties and the environmental context of training programmes. Other discussions included the inter-relationship of patient safety and resident competence with duty hours. Lastly, concerns regarding the lack of transparency and psychological safety surrounding RDH violations, were discussed.
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Affiliation(s)
| | - Chantalle Clarkin
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Asif Doja
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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16
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Zeytinoglu IU, Sayin FK, Neiterman E, HakemZadeh F, Geraci J, Plenderleith J, Lobb D. Hours of work and on-call weeks preferences of Canadian midwives: relationships with intention to stay in the profession. BMC Health Serv Res 2022; 22:950. [PMID: 35883071 PMCID: PMC9316842 DOI: 10.1186/s12913-022-08287-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Midwives have long workdays and work many weeks on call. There is a concern that these extended work schedules can negatively affect their intention to stay in the profession. Purpose This study provides evidence on Canadian midwives’ preferences for and experiences with policies and guidelines which limit the hours of work and weeks per year preferred to be on call, and examines the relationship between preferences and midwives’ intention to stay in the profession. Methods Data come from our 2018 pan-Canadian survey of midwives. Descriptive statistics of 720 midwives’ preferences and experiences are provided. In the correlations followed by the OLS regressions, 596 midwives’ data are used to test the associations between preferences and intention to stay in the profession. STATA (version 15) is used. A thematic analysis of 274 midwives’ responses to the open-ended survey question is conducted to give voice to midwives on what can be done for retention. Results Three quarters of the 720 respondents prefer policies and guidelines to limit hours of work in a 24-hour period, though less than half have policies and guidelines on hours of work. More than half prefer to have fewer on-call weeks or never to be on call, less than a third prefer same number of on-call weeks, and only 2% prefer more weeks to be on call. Midwives are currently working on average 33 weeks per year on call. OLS regression analysis shows that ‘met preference’ for hours of work and on-call weeks are positively associated with intention to stay. In responding to the open-ended survey question, midwives recommend limiting the consecutive hours of work and on-call weeks to manageable hours and weeks to retain them in the profession. Conclusion Midwives whose preferences are met are the ones intending to stay in the profession. There is, however, a large number of midwives with ‘unmet needs’ preferring to have policies and guidelines to limit the hours but do not have that currently, and would like to work fewer weeks on call than currently. These are the midwives who are not intending to stay in the profession. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08287-6.
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Affiliation(s)
- Isik U Zeytinoglu
- DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4M4, Canada.
| | - Firat K Sayin
- Sobey School of Business, Saint Mary's University, 923 Robie Street, Halifax, Nova Scotia, B3H 3C3, Canada
| | - Elena Neiterman
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Farimah HakemZadeh
- School of Human Resource Management, Faculty of Liberal Arts and Professional Studies, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
| | - Johanna Geraci
- College of Midwives of Ontario, 21 St Clair Ave E #303, Toronto, Ontario, M4T 1L9, Canada
| | - Jennifer Plenderleith
- DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4M4, Canada
| | - Derek Lobb
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4K1, Canada
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17
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Mendelsohn D. Self in medicine: Determinants of physician well-being and future directions in improving wellness. MEDICAL EDUCATION 2022; 56:48-55. [PMID: 34559421 DOI: 10.1111/medu.14671] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Medicine, a profession dedicated to the wellness of patients, is struggling with a crisis of physician and trainee wellness. Physicians and trainees are burning out at alarming rates. Historically, medicine has been characterised by challenging working conditions and inattention to physician wellness and self-care. Healthy physicians are better at promoting wellness to their patients, and physicians who are suffering from burnout can deliver compromised patient care. DISCUSSION In recent years, research has increasingly focused on the causes of unwellness among doctors, and a broad range of health determinants have been identified. Studies of interventions for improving trainee and physician wellness have identified individual-focused and organisational approaches that can address the root causes of burnout. Insights from the corporate workplace may help guide interventions. Strategies for addressing physician burnout and improving wellness will involve innovative and multifaceted approaches. Despite a growing emphasis of physician wellness in the literature, implementation of wellness interventions is lagging, and quality improvement methods can address these challenges. CONCLUSION Physician wellness is a shared responsibility among doctors, health care organisations and governing bodies. Addressing burnout and improving physician wellness will require transformational change and the embracement of a culture of wellness in medicine. Quality improvement methods are the next step in identifying effective wellness interventions and the targeted groups of physicians and trainees who will most benefit.
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Affiliation(s)
- Daniel Mendelsohn
- Lions Gate Hospital, Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
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18
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McGuire C, Crawley E, Tang D. The Role of Senior Resident Clinics in Plastic Surgery Education in Canada. Plast Surg (Oakv) 2021; 29:169-177. [PMID: 34568232 DOI: 10.1177/2292550320967401] [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: 11/15/2022] Open
Abstract
Background Senior resident clinics are a means to encourage independent practice and problem solving and enhance surgical skills. The objective of this study is to investigate senior resident clinics across Canada and their utility in providing comprehensive plastic surgery training. Methods A web-based survey was sent to all plastic surgery program directors (PDs) and senior residents (SRs; postgraduate years 3, 4, and 5) across Canada. The surveys focused on demographics, clinic structure, procedures commonly performed, perceived autonomy, educational benefit, competency-based design considerations, and areas for improvement. Chi-square tests were used to compare responses between PDs and SRs. Results A total of 10 PDs (100% response rate) and 26 SRs (41% response rate) responded. Half of the training programs across Canada currently have senior clinics, and the format varies between institutions. Clinics generally focus on hand trauma and aesthetics. Both PDs and SRs felt that there is considerable autonomy for resident care in both the pre/post-operative and operative setting. Common barriers to implementing a senior clinic include not enough staff, not enough time, and the medicolegal risk. Most core competencies are felt to be addressed through the use of senior clinics. Methods to improve senior clinics could include more regular and higher volume clinics, enhanced equipment, and separation of hand and aesthetics clinics. Conclusions Senior clinics are a useful method to improve plastic surgery education and address many core aspects of plastic surgery training. Implementation of supported clinics focused on hand and aesthetics surgery separately may be useful for training programs that currently lack a senior clinic.
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Affiliation(s)
- Connor McGuire
- Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emma Crawley
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Tang
- Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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19
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Cassidy LF, Croft EL, Erdelyi S, Brubacher JR. Motor vehicle incidents in postgraduate trainees in British Columbia. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:27-38. [PMID: 34567303 PMCID: PMC8463221 DOI: 10.36834/cmej.71604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Postgraduate medical trainees frequently work ≥ 24- hour shifts causing fatigue and adverse consequences such as motor vehicle incidents (MVIs). We aim to determine the incidence of MVIs during the commutes of trainees in British Columbia (BC) in the preceding year. METHODS We completed a retrospective, cross-sectional survey of trainees regarding work hours, shifts, and MVIs in the previous year. MVIs included falling asleep while driving, sudden braking or swerving to avoid a collision, unintentionally running a red light or stop sign, or collisions. RESULTS Of 273 respondents, over half (54.6%) reported ≥1 MVI, one in 14 were in a collision (7.0%), and two thirds (66.3%) reported that the safety of their commute had been impacted by fatigue in the past year. After adjustment for road exposure and shift-related factors, every ten km increase in commute length was associated with an increased risk of MVI (aOR=1.54;95%CI:1.15-2.12). Reported attentional failures, such as unintentionally running a red light and/or stop sign, increased for every ten hours on-call (aOR=1.44;95%CI:1.03-2.04) and for every additional past-midnight shift worked (aOR=1.13;95%CI:1.01-1.26). DISCUSSION Trainees with longer and more frequent commutes had an increased risk of MVIs. Trainees who worked more hours on-call and more past-midnight shifts reported significantly more attentional failures while commuting. This study helps us understand factors affecting trainee commuter safety and supports calls for the provision of safe alternatives to commuting for postgraduate trainees.
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Affiliation(s)
- Louise F Cassidy
- Department of Emergency Medicine, Diamond Health Care Centre, British Columbia, Canada
| | - Emma L Croft
- University of British Columbia Medical School, British Columbia, Canada
| | - Shannon Erdelyi
- Department of Emergency Medicine, Diamond Health Care Centre, British Columbia, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, Diamond Health Care Centre, British Columbia, Canada
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20
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In-House, Overnight Physician Staffing: A Cross-Sectional Survey of Canadian Adult ICUs. Crit Care Med 2021; 48:e1203-e1210. [PMID: 33031147 DOI: 10.1097/ccm.0000000000004598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Overnight physician staffing in the ICU has been recommended by the Society of Critical Care Medicine and the Leapfrog Consortium. We conducted a survey to review practice in the current era and to compare this with results from a 2006 survey. DESIGN Cross-sectional survey. SETTING Canadian adult ICUs. PARTICIPANTS ICU directors. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS A 29-question survey was sent to ICU directors describing overnight staffing by residents, fellows, nurse practitioners, and staff physicians, as well as duty duration, clinical responsibilities, and unit characteristics. We established contact with 122 ICU directors, of whom 107 (88%) responded. Of the 107 units, 60 (56%) had overnight in-house physicians. Compared with ICUs without overnight in-house physician coverage, ICUs with in-house physicians were in larger hospitals (p < 0.0001), had more beds (p < 0.0001), had more ventilated patients (p < 0.0001), and had more admissions (p < 0.0001). Overnight in-house physicians were first year residents (R1) in 20 of 60 (33%), second to fifth year residents (R2-R5) in 46 of 60 (77%), and Critical Care Medicine trainees in 19 of 60 (32%). Advanced practice nurses provided overnight coverage in four of 107 ICUs (4%). The most senior in-house physician was a staff physician in 12 of 60 ICUs (20%), a Critical Care Medicine trainee in 14 of 60 (23%), and a resident (R2-R5) in 20 of 60 (33%). The duration of overnight duty was on average 20-24 hours in 22 of 46 units (48%) with R2-R5 residents and 14 of 19 units (74%) covered by Critical Care Medicine trainees. CONCLUSIONS Variability of in-house overnight physician presence in Canadian adult ICUs is linked to therapeutic complexity and unit characteristics and has not changed significantly over the decade since our 2006 survey. Additional evidence about patient and resident outcomes would better inform decisions to revise physician scheduling in Canadian ICUs.
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21
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Copeland AE, Mackinnon V, Axelrod DE, Farrokhyar F, Avram R, Coroneos CJ. Job Satisfaction Among Plastic Surgery Residents in Canada. Plast Surg (Oakv) 2021; 30:151-158. [PMID: 35572079 PMCID: PMC9096853 DOI: 10.1177/22925503211007237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Resident wellness is a focus of medical training and is prioritized in both
Canadian and American accreditation processes. Job satisfaction is an
important component of wellness that is not examined in the literature. The
purpose of this study was to analyze job satisfaction in a national sample
of plastic surgery residents, and identify factors that influence
satisfaction. Methods: We designed a cross-sectional survey adapted from existing instruments, with
attention to thorough item generation and reduction as well as pilot and
clinical sensibility testing. All plastic surgery residents at Canadian
institutions were surveyed regarding overall job satisfaction as well as
personal- and program-specific factors that may affect satisfaction.
Predictors of satisfaction were identified using multivariable regression
models. Results: The response rate was 40%. Median overall job satisfaction was 4.0 on a
5-point Likert scale. Operative experience was considered both the most
important element of a training program, and the area in most need of
improvement. Senior training year (P < .01), shorter
commute time (P = .04), fewer duty hours
(P = .02), fewer residents (P <
.01), and more fellows (P < .01) were associated with
significantly greater job satisfaction. Conclusions: This is the first study to gather cross-sectional data on job satisfaction
from a national sample of plastic surgery residents. The results from this
study can inform programs in making tangible changes tailored to their
trainees’ needs. Moreover, our findings may be used to inform a
prospectively studied targeted intervention to increase job satisfaction and
resident wellness to address North American accreditation standards.
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Affiliation(s)
- Andrea E. Copeland
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Victoria Mackinnon
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daniel E. Axelrod
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Health, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ronen Avram
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christopher J. Coroneos
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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22
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Chartrand G, Soucisse M, Dubé P, Trépanier JS, Drolet P, Sideris L. Self-directed learning by video as a means to improve technical skills in surgery residents: a randomized controlled trial. BMC MEDICAL EDUCATION 2021; 21:91. [PMID: 33546679 PMCID: PMC7863545 DOI: 10.1186/s12909-021-02524-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND With their demanding schedules, surgical residents have limited time to practice techniques. The aim is to evaluate the pedagogic model of self-directed learning using video in surgery residents. METHODS Informed consent was obtained from all the participants. A randomized controlled trial was conducted in 2018 at Hôpital Maisonneuve-Rosemont (University of Montreal). Participants were general surgery residents. There were 27 eligible residents; 22 completed the study. They were filmed performing an intestinal anastomosis on cadaveric pig bowel. The self-directed learning by video (SDL-V) group was given an expert video, which demonstrated the technique performed by an experienced surgeon. The control group continued with their regular duties. Three weeks later, participants performed a second filmed anastomosis. Two attending surgeons evaluated the residents' filmed anastomosis using the Objective Structured Assessment of Technical Skills scale. After their second anastomosis, all participants had access to the expert video and completed a survey. RESULTS Score did not differ significantly between groups during the first (control: 23.6 (4.5) vs. SDL-V: 23.9 (4.5), p = 0.99, presented as mean (SD)) or second filmed anastomosis procedure (control: 27.1 (3.9) vs. SDL-V: 29.6 (3.4) p = 0.28). Both groups improved significantly from pre- to post-intervention (mean difference between the two anastomosis procedure with 95% CI for control: 3.5, [1.1; 5.9] and for SDL-V: 5.8, [3.4: 8.2]). Correlation between the evaluators for score was moderate (r = 0.6, 95% CI: [0.3: 0.8]). The pass/fail global evaluation exhibited poor inter-rater reliability (Kappa: 0.105, 95% CI: [- 0.2:0.4]). On the survey, all participants wanted more expert-made videos of specific surgical techniques. CONCLUSIONS Despite a higher final OSATS score for the intervention group, self-directed learning by video failed to produce a statistically significant difference on the overall OSATS scores between the two groups in this small cohort.
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Affiliation(s)
- Geneviève Chartrand
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada.
| | - Mikael Soucisse
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Pierre Dubé
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Jean-Sébastien Trépanier
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Pierre Drolet
- Centre d'acquisition des attitudes et habiletés cliniques, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Lucas Sideris
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
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23
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Vosshenrich J, Brantner P, Cyriac J, Boll DT, Merkle EM, Heye T. Quantifying Radiology Resident Fatigue: Analysis of Preliminary Reports. Radiology 2021; 298:632-639. [PMID: 33497316 DOI: 10.1148/radiol.2021203486] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Workloads in radiology departments have constantly increased over the past decades. The resulting radiologist fatigue is considered a rising problem that affects diagnostic accuracy. Purpose To investigate whether data mining of quantitative parameters from the report proofreading process can reveal daytime and shift-dependent trends in report similarity as a surrogate marker for resident fatigue. Materials and Methods Data from 117 402 radiology reports written by residents between September 2017 and March 2020 were extracted from a report comparison tool and retrospectively analyzed. Through calculation of the Jaccard similarity coefficient between residents' preliminary and staff-reviewed final reports, the amount of edits performed by staff radiologists during proofreading was quantified on a scale of 0 to 1 (1: perfect similarity, no edits). Following aggregation per weekday and shift, data were statistically analyzed by using simple linear regression or one-way analysis of variance (significance level, P < .05) to determine relationships between report similarity and time of day and/or weekday reports were dictated. Results Decreasing report similarity with increasing work hours was observed for day shifts (r = -0.93 [95% CI: -0.73, -0.98]; P < .001) and weekend shifts (r = -0.72 [95% CI: -0.31, -0.91]; P = .004). For day shifts, negative linear correlation was strongest on Fridays (r = -0.95 [95% CI: -0.80, -0.99]; P < .001), with a 16% lower mean report similarity at the end of shifts (0.85 ± 0.24 at 8 am vs 0.69 ± 0.32 at 5 pm). Furthermore, mean similarity of reports dictated on Fridays (0.79 ± 0.35) was lower than that on all other weekdays (range, 0.84 ± 0.30 to 0.86 ± 0.27; P < .001). For late shifts, report similarity showed a negative correlation with the course of workweeks, showing a continuous decrease from Monday to Friday (r = -0.98 [95% CI: -0.70, -0.99]; P = .007). Temporary increases in report similarity were observed after lunch breaks (day and weekend shifts) and with the arrival of a rested resident during overlapping on-call shifts. Conclusion Decreases in report similarity over the course of workdays and workweeks suggest aggravating effects of fatigue on residents' report writing performances. Periodic breaks within shifts potentially foster recovery. © RSNA, 2021.
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Affiliation(s)
- Jan Vosshenrich
- From the Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Philipp Brantner
- From the Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Joshy Cyriac
- From the Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Daniel T Boll
- From the Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Elmar M Merkle
- From the Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Tobias Heye
- From the Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
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Dagnone JD, Chan MK, Meschino D, Bandiera G, den Rooyen C, Matlow A, McEwen L, Scheele F, St Croix R. Living in a World of Change: Bridging the Gap From Competency-Based Medical Education Theory to Practice in Canada. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1643-1646. [PMID: 32079931 DOI: 10.1097/acm.0000000000003216] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Within graduate medical education, many educators are experiencing a climate of significant change. One transformation, competency-based medical education (CBME), is occurring simultaneously across much of the world, and implementation will require navigating numerous tensions and paradoxes. Successful transformation requires many types of power and is most likely to happen when the medical education community of professionals is engaged in designing, experimenting, acting, and sensemaking together.In this complex climate, the craft of change facilitators and community leaders is needed more than ever. National top-down policies and structures, while important, are not sufficient. The operationalization of new advances is best done when local leaders are afforded room to shape their local context. An evidence-based approach to thinking about the transformative change associated with CBME needs to be adopted. In this age of entrustment, 3 priorities are paramount: (1) engage, entrust, and empower professionals with increasing shared ownership of the innovation; (2) better prepare education professionals in leadership and transformational change techniques in the complex system of medical education; and (3) leverage the wider community of practice to maximize local CBME customization. These recommendations, although based largely on the Canadian experience, are intended to inform CBME transformation in any context.
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Affiliation(s)
- Jeffrey Damon Dagnone
- J.D. Dagnone is associate professor of emergency medicine and competency-based medical education faculty lead, Queen's University, Kingston, Ontario, Canada; ORCID: http://orcid.org/0000-0001-6963-7948
| | - Ming-Ka Chan
- M.-K. Chan is associate professor and clinician educator of pediatrics and child health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Diane Meschino
- D. Meschino is assistant professor, Department of Psychiatry, University of Toronto (Women's College Hospital), Toronto, Ontario, Canada
| | - Glen Bandiera
- G. Bandiera is professor of emergency medicine and associate dean of postgraduate medical education, University of Toronto, Toronto, Ontario, Canada
| | - Corry den Rooyen
- C. den Rooyen is an educationalist and change manager, Utrecht, the Netherlands
| | - Anne Matlow
- A. Matlow is faculty lead, strategic initiatives, postgraduate medical education, University of Toronto, Toronto, Ontario, Canada
| | - Laura McEwen
- L. McEwen is director of assessment and evaluation for postgraduate medical education, Queen's University, Kingston, Ontario, Canada
| | - Fedde Scheele
- F. Scheele is professor of health systems innovation and education, Athena Institute, VU University and Amsterdam UMC, and a practicing clinician, obstetrics and gynecology, OLVG Hospital, Amsterdam, the Netherlands
| | - Rhonda St Croix
- R. St. Croix is change advisor, The Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
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Norris S, Papillon-Smith J, Gagnon LH, Jacobson M, Sobel M, Shore EM. Effect of a Surgical Teaching Video on Resident Performance of a Laparoscopic Salpingo-oophorectomy: A Randomized Controlled Trial. J Minim Invasive Gynecol 2020; 27:1545-1551. [DOI: 10.1016/j.jmig.2020.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
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Hu J, Yang Y, Li X, Yu L, Zhou Y, Fallacaro MD, Wright S. Adverse Outcomes Associated With Intraoperative Anesthesia Handovers: A Systematic Review and Meta-analysis. J Perianesth Nurs 2020; 35:525-532.e1. [DOI: 10.1016/j.jopan.2020.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/27/2019] [Accepted: 01/09/2020] [Indexed: 12/27/2022]
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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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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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Mak NT, Li J, Wiseman SM. Resident Physicians are at Increased Risk for Dangerous Driving after Extended-duration Work Shifts: A Systematic Review. Cureus 2019; 11:e4843. [PMID: 31410326 PMCID: PMC6684113 DOI: 10.7759/cureus.4843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Resident physicians often work longer than 24 consecutive hours with little or no sleep. A systematic review of the literature was conducted to investigate the risk of resident physician motor vehicle collisions (MVC), and dangerous driving, after extended-duration work shifts (EDWS). MATERIAL AND METHODS A keyword search was performed for original research articles evaluating any aspect of driving safety following EDWS for the resident physician population. Two authors independently reviewed articles for inclusion. Subsequent independent data abstraction and quality appraisal were carried out. Five articles met the study inclusion criteria. RESULTS The quality of the evidence was low to very low. Results were not pooled due to study heterogeneity. Residents reported between 2.3 to 3.8 hours of sleep during EDWS. Three survey-based studies identified an increased risk of MVCs and falling asleep at the wheel after EDWS. One study associated weekly cumulative sleep hours lost with the risk of falling asleep while driving. Both driving simulation and survey studies linked EDWS with MVCs. Notably, a driving simulation study found an increase in crash frequency in male residents post-EDWS. Additionally, a survey reported that the risk of an MVC post-EDWS increased by 16.2% per shift worked in a month. CONCLUSION The period following EDWS is associated with an increased risk of potentially life-threatening driving safety risks for resident physicians. These observations warrant careful consideration. They suggest that there is a need for greater awareness and action in order to avoid the occupational and public health risks of driving after EDWS.
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Affiliation(s)
- Nicole T Mak
- Surgery, University of British Columbia, Vancouver, CAN
| | - Jennifer Li
- Surgery, University of British Columbia, Vancouver, CAN
| | - Sam M Wiseman
- Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, CAN
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Sy S, Sall K, Dempsey E, Tedder G, Madden KM. The metabolic demands of internal medicine residency. J Occup Med Toxicol 2019; 14:14. [PMID: 31080492 PMCID: PMC6501377 DOI: 10.1186/s12995-019-0234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/25/2019] [Indexed: 11/29/2022] Open
Abstract
Background North American and European accreditation bodies have legislated progressively more strict work hour restrictions for residents in light of evidence that sleep deprivation leads to increased medical errors and decreased wellbeing. The purpose of the study is to determine the physiologic demands of internal medicine training during residency as well as document average sleep (on- and off-call) and physical activity performed using accelerometers. Methods A total of 40 internal medicine residents working on the clinical teaching unit at a single center were enrolled in the study from November 2011 to March 2016. There were 22 subjects that completed the study and were included in the analysis. SenseWear PRO 2 armband monitors were worn for 5 consecutive days including one call day. The primary outcomes of the study were to quantify and compare the calories per day, steps per day, METs per hour, hours of activity, hours of sleep, and sleep efficiency for on call versus post-call and non-call days. Results The average activity per day, calories per day, steps per day and METs per hour for the call day were 7.6 ± 7.6 h, 2647.0 ± 541.1, 11,261.1 ± 2355.9, and 1.7 ± 0.2 respectively. Each of these parameters had a statistically significant F statistic compared to post-call and non-call days. The subjects had a mean of 1.8 ± 2.0 h of sleep per day with a sleep efficiency of 77.3 ± 23.8% for the call day. The F statistic for sleep per day was significant with a p value < 0.001. Conclusion This study shows that overnight call has a substantial impact on multiple metabolic parameters. These findings have potentially important implications on future resident working hour restrictions.
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Affiliation(s)
- Sarah Sy
- Department of Geriatric Medicine, 2775 Laurel Street, 7th Floor, Vancouver, BC V6H 0A5 Canada
| | - Karanvir Sall
- Department of Geriatric Medicine, 2775 Laurel Street, 7th Floor, Vancouver, BC V6H 0A5 Canada
| | - Erika Dempsey
- Department of Geriatric Medicine, Bridgeland Seniors Health Clinic, 1070 McDougall Road NE, Calgary, Alberta T2E 8B8 Canada
| | - Gale Tedder
- Department of Geriatric Medicine, 2775 Laurel Street, 7th Floor, Vancouver, BC V6H 0A5 Canada
| | - Kenneth Michael Madden
- Department of Geriatric Medicine, 2775 Laurel Street, 7th Floor, Vancouver, BC V6H 0A5 Canada
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Kassam A, Cowan M, Topps M. Lessons Learned to Aid in Developing Fatigue Risk Management Plans for Resident Physicians. TEACHING AND LEARNING IN MEDICINE 2019; 31:136-145. [PMID: 30596293 DOI: 10.1080/10401334.2018.1542307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Phenomenon: Fatigue is a significant risk factor for deterioration in performance, which may lead to medical errors and reduced well-being in resident physicians (residents). Sleep deprivation, which has been studied extensively, is only one contributor to fatigue. Given the complexity of fatigue and its relationship with resident performance, the National Steering Committee on Resident Duty Hours in Canada recommends that all residency education programs develop a fatigue risk management plan (FRMP) for their residents. The purpose of this study was to explore the impact of residents' experiences of fatigue and the strategies they use to manage it. Approach: This single-site study investigated the perceptions of resident physicians. Residents were recruited through purposive sampling to ensure representation from a variety of programs, postgraduate year level, and gender. Recruitment was managed with support from the residency programs; however, data collection and analysis were conducted by the Office of Postgraduate Medical Education to ensure participant anonymity. Program directors and administrators assisted in relaying the information about the study to the residents; however, they were not made aware if their residents participated in the study. Interview and focus group data were collected all at once, then transcribed, and then subsequent thematic analysis of these data was conducted using a quasi-constant comparison approach until thematic saturation was reached. Two researchers coded the data using thematic content analysis. Findings: Fifty-seven residents participated in a focus group or interview. There was representation from more than half of the 58 residency programs and from 15 of 16 departments. Overall, there was consensus that fatigue impacts residents' physical, cognitive, and emotional states. These impacts were reported as influencing resident performance including those related to patient care. Residents reported that fatigue led them to be less productive in their personal and professional lives. Three major themes were identified for which strategies could be developed for fatigue risk management: self, program, and system. Together with self-, program-, and system-level strategies that complement and enhance each other, specific targeted FRMPs could be developed. Insights: Fatigue is a multifaceted phenomenon experienced by residents that requires management beyond extended duty hours and adequate amounts of sleep. FRMPs that encompass strategies used by the resident, the residency-training program, and the healthcare system in which they work could assist with managing fatigue in residents and support enhanced resident well-being and patient care.
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Affiliation(s)
- Aliya Kassam
- a Office of Postgraduate Medical Education , University of Calgary Cumming School of Medicine , Calgary , Alberta , Canada
| | - Michèle Cowan
- a Office of Postgraduate Medical Education , University of Calgary Cumming School of Medicine , Calgary , Alberta , Canada
| | - Maureen Topps
- a Office of Postgraduate Medical Education , University of Calgary Cumming School of Medicine , Calgary , Alberta , Canada
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Lafleur A, Harvey A, Simard C. Adjusting to duty hour reforms: residents' perception of the safety climate in interdisciplinary night-float rotations. CANADIAN MEDICAL EDUCATION JOURNAL 2018; 9:e111-e119. [PMID: 30498549 PMCID: PMC6260506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND New scheduling models were needed to adjust to residents' duty hour reforms while maintaining safe patient care. In interdisciplinary night-float rotations, four to six residents from most residency programs collaborated for after-hours cross-coverage of most adult hospitalised patients as part of a Faculty-led rotation. Residents worked sixteen 12-hour night shifts over a month. METHODS We measured residents' perception of the patient safety climate during implementation of night-float rotations in five tertiary hospitals. We surveyed 267 residents who had completed the rotation in 2015-2016 with an online version of the Safety Attitudes Questionnaire. First year residents came from most residency programs, second- and third-year residents came from internal medicine. RESULTS One-hundred-and-thirty residents completed the questionnaire. Scores did not differ across hospitals and residents' years of training for all six safety-related climate factors: teamwork climate, job satisfaction, perceptions of management, safety climate, working conditions, and stress recognition. CONCLUSION Simultaneous implementation in five hospitals of a Faculty-led interdisciplinary night-float rotation for most junior residents proved to be logistically feasible and showed similar and reassuring patient safety climate scores.
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Affiliation(s)
- Alexandre Lafleur
- Département de médecine, Faculté de médecine, Université Laval, Québec, Canada
- QMA-CMA-MD Educational Leadership Chair in Health Professions Education, Vice-décanat à la pédagogie et au développement professionnel continu, Faculté de medicine, Université Laval, Québec, Canada
| | - Adrien Harvey
- Département de médecine, Faculté de médecine, Université Laval, Québec, Canada
| | - Caroline Simard
- QMA-CMA-MD Educational Leadership Chair in Health Professions Education, Vice-décanat à la pédagogie et au développement professionnel continu, Faculté de medicine, Université Laval, Québec, Canada
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Gates M, Wingert A, Featherstone R, Samuels C, Simon C, Dyson MP. Impact of fatigue and insufficient sleep on physician and patient outcomes: a systematic review. BMJ Open 2018; 8:e021967. [PMID: 30244211 PMCID: PMC6157562 DOI: 10.1136/bmjopen-2018-021967] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES For physicians in independent practice, we synthesised evidence on the (1) impacts of insufficient sleep and fatigue on health and performance, and patient safety and (2) effectiveness of interventions targeting insufficient sleep and fatigue. DESIGN We systematically reviewed online literature. After piloting, one reviewer selected studies by title and abstract; full texts were then reviewed in duplicate. One reviewer extracted data; another verified a random 10% sample. Two reviewers assessed risk of bias. We pooled findings via meta-analysis when appropriate or narratively. DATA SOURCES We searched Medline, Embase, PsycINFO, CINAHL and PubMed for published studies in April 2016; Medline was updated in November 2017. We searched Embase for conference proceedings, and hand-searched meeting abstracts, association and foundation websites. ELIGIBILITY CRITERIA FOR SELECTING STUDIES English or French language primary research studies published from 2000 to 2017 examining the effect of fatigue-related or sleep-related exposures or interventions on any outcome among physicians in independent practice and their patients. RESULTS Of 16 154 records identified, we included 47 quantitative studies of variable quality. 28 studies showed associations between fatigue or insufficient sleep and physician health and well-being outcomes. 21 studies showed no association with surgical performance, and mixed findings for psychomotor performance, work performance and medical errors. We pooled data from six cohort studies for patient outcomes. For sleep deprived versus non-sleep deprived surgeons, we found no difference in patient mortality (n=60 436, relative risk (RR) 0.98, 95% CI 0.84 to 1.15, I2=0% (p=0.87)) nor postoperative complications (n=60 201, RR 0.99, 95% CI 0.95 to 1.03, I2=0% (p=0.45)). The findings for intraoperative complications and length of stay were considerably heterogeneous. CONCLUSIONS Fatigue and insufficient sleep may be associated with negative physician health outcomes. Current evidence is inadequate to inform practice recommendations.
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Affiliation(s)
- Michelle Gates
- Alberta Research Centre for Health Evidence (ARCHE), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Aireen Wingert
- Alberta Research Centre for Health Evidence (ARCHE), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence (ARCHE), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Charles Samuels
- Centre for Sleep and Human Performance, Calgary, Alberta, Canada
| | | | - Michele P Dyson
- Alberta Research Centre for Health Evidence (ARCHE), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
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Chan M, van Manen MA. Exploring the transition into practice of general paediatricians from a Canadian residency program. Paediatr Child Health 2018; 23:314-318. [PMID: 30046269 DOI: 10.1093/pch/pxx188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Paediatric training programs are committed to graduating paediatricians able to function independently in professional practice. The focus of this study was to gain understanding of a training program's strengths and deficiencies, while also exploring new methods to aid in transitioning trainees into practice. Method Using the CanMEDS framework, semi-structured focus groups were conducted with recently graduated paediatricians. Data were analyzed using qualitative content analysis. Results Three focus groups were completed, including a total of nine participants. Key themes were identified pertaining to CanMEDS roles. Particular strengths were found in medical expert for managing acute illnesses, communicator for engaging in difficult conversations, and health advocate in responding to diverse patient populations. Relative deficits were recognized in collaborator for connecting patients with community services, leader related to practice development and management, and scholar for cultivating critical appraisal. Opportunities for training program growth included ensuring community exposures were timely and varied, engaging additional community preceptors in training and giving appropriate expectations and mentoring to trainees to develop as scholars. Conclusions Educators need to be mindful of the exposures that trainees receive in residency. New graduates may also ultimately benefit from mentorship in the community or ongoing contact with their past training program.
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Affiliation(s)
- Melissa Chan
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
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Tam P, Nijjar AP, Fok M, Little C, Shingina A, Bittman J, Raghavan R, Khan NA. Structured patient handoff on an internal medicine ward: A cluster randomized control trial. PLoS One 2018; 13:e0195216. [PMID: 29672526 PMCID: PMC5908079 DOI: 10.1371/journal.pone.0195216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 03/08/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The effect of a multi-faceted handoff strategy in a high volume internal medicine inpatient setting on process and patient outcomes has not been clearly established. We set out to determine if a multi-faceted handoff intervention consisting of education, standardized handoff procedures, including fixed time and location for face-to-face handoff would result in improved rates of handoff compared with usual practice. We also evaluated resident satisfaction, health resource utilization and clinical outcomes. METHODS This was a cluster randomized controlled trial in a large academic tertiary care center with 18 inpatient internal medicine ward teams from January-April 2013. We randomized nine inpatient teams to an intervention where they received an education session standardizing who and how to handoff patients, with practice and feedback from facilitators. The control group of 9 teams continued usual non-standardized handoffs. The primary process outcome was the rate of patients handed over per 1000 patient nights. Other process outcomes included perceptions of inadequate handoff by overnight physicians, resource utilization overnight and hospital length of stay. Clinical outcomes included medical errors, frequency of patients requiring higher level of care overnight, and in-hospital mortality. RESULTS The intervention group demonstrated a significant increase in the rate of patients handed over to the overnight physician (62.90/1000 person-nights vs. 46.86/1000 person-nights, p = 0.002). There was no significant difference in other process outcomes except resource utilization was increased in the intervention group (26.35/1000 person-days vs. 17.57/1000 person-days, p-value = 0.01). There was no significant difference between groups in medical errors (4.8% vs. 4.1%), need for higher level of care or in hospital mortality. Limitations include a dependence of accurate record keeping by the overnight physician, the possibility of cross-contamination in the handoff process, analysis at the cluster level and an overall low number of clinical events. CONCLUSIONS Implementation of a multi-faceted resident handoff intervention did not result in a significant improvement in patient safety although did improve number of patients handed off. Novel methods to improve handoff need to be explored. TRIAL REGISTRATION Registered at ClinicalTrials.gov: NCT01796756.
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Affiliation(s)
- Penny Tam
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aman P. Nijjar
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Fok
- Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chris Little
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jesse Bittman
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rashmi Raghavan
- Division of Family Practice, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nadia A. Khan
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Devitt KS, Kim MJ, Gotlib Conn L, Wright FC, Moulton CA, Keshet I, Ahmed N. Understanding the Multidimensional Effects of Resident Duty Hours Restrictions: A Thematic Analysis of Published Viewpoints in Surgery. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:324-333. [PMID: 28746074 DOI: 10.1097/acm.0000000000001849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Individuals representing various surgical disciplines have expressed concerns with the impact of resident duty hours (RDH) restrictions on resident education and patient outcomes. This thematic review of published viewpoints aimed to describe the effects of these restrictions in surgery. METHOD The authors conducted a qualitative systematic review of non-research-based literature published between 2003 and 2015. Articles were included if they focused on the RDH restrictions in surgery and resident wellness, health promotion, resident safety, resident education and/or training, patient safety, medical errors, and/or heterogeneity regarding training or disciplines. A thematic analysis approach guided data extraction. Contextual data were abstracted from the included articles to aid in framing the identified themes. RESULTS Of 1,482 identified articles, 214 were included in the review. Most were from authors in the United States (144; 67%) and focused on the 80-hour workweek (164; 77%). The emerging themes were organized into three overarching categories: (1) impact of the RDH restrictions, (2) surgery has its own unique culture, and (3) strategies going forward. Published opinions suggested that RDH restrictions alone are insufficient to achieve the desired outcomes and that careful consideration of the surgical training model is needed to maintain the integrity of educational outcomes. CONCLUSIONS Opinions from the surgical community highlight the complexity of issues surrounding the RDH restrictions and suggest that recent changes are not achieving all the desired outcomes and have resulted in unintended outcomes. From the perceptions of the various stakeholders in surgical education studied, areas for new policies were identified.
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Affiliation(s)
- Katharine S Devitt
- K.S. Devitt is research associate, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. M.J. Kim is a PhD student in medical education and research fellow, Wilson Centre, University of Toronto, Toronto, Ontario, Canada. L. Gotlib Conn is associate scientist, Sunnybrook Research Institute, Toronto, Ontario, Canada. F.C. Wright is professor, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. C.-A. Moulton is associate professor, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. I. Keshet is clinical fellow, Neurocritical Care, Department of Neurosurgery, North Shore University Hospital, Manhasset, New York. N. Ahmed is residency training program director, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Repp AB, Bartsch JC, Pasanen ME. What the "Nonteaching" Service Can Teach Us. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:41-44. [PMID: 28746070 DOI: 10.1097/acm.0000000000001833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
"Teaching" services usually incorporate a cadre of learners such as resident physicians and medical students as part of the care team, led by a faculty physician. "Nonteaching" services, in contrast, are usually defined by the absence of resident physicians on the care team. The care for patients on a nonteaching service is frequently managed directly by a faculty or nonfaculty physician. Nonteaching services have grown in number and size at academic medical centers (AMCs) in response to regulatory requirements, operational demands, and efforts to improve clinical education. The allocation of patients to teaching and nonteaching services is frequently based on perceived teaching value of hospitalized patients, which can potentially lead to a number of unintended consequences for medical education, professional satisfaction, and patient care. Through a series of four lessons, the authors describe how the structure of nonteaching services can result in curricular gaps, devalue attending physicians, and undermine the educational and clinical missions of AMCs. Anticipating the continued expansion and evolution of nonteaching services, the authors propose seven design principles for nonteaching services to ensure robust education for students and resident physicians, advance quality of care, and enhance attending physician and patient experience.
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Affiliation(s)
- Allen B Repp
- A.B. Repp is associate professor and vice chair for quality, Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont; ORCID: http://orcid.org/0000-0001-7513-532X. J.C. Bartsch is assistant professor, Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont. M.E. Pasanen is associate professor, internal medicine residency program director, and chief, Division of Hospital Medicine, Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont
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Leafloor CW, Liu EY, Code CC, Lochnan HA, Keely E, Rothwell DM, Forster AJ, Huang AR. Time is of the essence: an observational time-motion study of internal medicine residents while they are on duty. CANADIAN MEDICAL EDUCATION JOURNAL 2017; 8:e49-e70. [PMID: 29098048 PMCID: PMC5661738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The effects of changes to resident physician duty hours need to be measureable. This time-motion study was done to record internal medicine residents' workflow while on duty and to determine the feasibility of capturing detailed data using a mobile electronic tool. METHODS Junior and senior residents were shadowed by a single observer during six-hour blocks of time, covering all seven days. Activities were recorded in real-time. Eighty-nine activities grouped into nine categories were determined a priori. RESULTS A total of 17,714 events were recorded, encompassing 516 hours of observation. Time was apportioned in the following categories: Direct Patient Care (22%), Communication (19%), Personal tasks (15%), Documentation (14%), Education (13%), Indirect care (11%), Transit (6%), Administration (0.6%), and Non-physician tasks (0.4%). Nineteen percent of the education time was spent in self-directed learning activities. Only 9% of the total on duty time was spent in the presence of patients. Sixty-five percent of communication time was devoted to information transfer. A total of 968 interruptions were recorded which took on average 93.5 seconds each to service. CONCLUSION Detailed recording of residents' workflow is feasible and can now lead to the measurement of the effects of future changes to residency training. Education activities accounted for 13% of on-duty time.
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Affiliation(s)
| | - Erin Yiran Liu
- Quality and Performance Measurement, Ottawa Hospital, Ontario, Canada
| | - Catherine C. Code
- Faculty of Medicine, University of Ottawa, Ontario, Canada
- Division of General Internal Medicine, The Ottawa Hospital, Ontario, Canada
| | - Heather A. Lochnan
- Faculty of Medicine, University of Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, The Ottawa Hospital, Ontario, Canada
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ontario, Canada
| | - Erin Keely
- Faculty of Medicine, University of Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, The Ottawa Hospital, Ontario, Canada
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ontario, Canada
| | | | - Alan J. Forster
- Faculty of Medicine, University of Ottawa, Ontario, Canada
- Quality and Performance Measurement, Ottawa Hospital, Ontario, Canada
- Division of General Internal Medicine, The Ottawa Hospital, Ontario, Canada
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ontario, Canada
| | - Allen R. Huang
- Faculty of Medicine, University of Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ontario, Canada
- Division of Geriatric Medicine, The Ottawa Hospital, Ontario, Canada
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Allen L, Vogt K, Mele T, Ott M, Leslie K, Colquhoun P. Evaluating the impact of a resident research program in general surgery. CANADIAN MEDICAL EDUCATION JOURNAL 2017; 8:e13-e20. [PMID: 29098044 PMCID: PMC5661734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Programs of resident research have been found to improve research productivity. However, evidence of the success of these programs is lacking in a Canadian context. The objective of this study was to evaluate the impact of the introduction of a formal program of resident research at a single Canadian academic centre. METHODS Resident research activities were tracked over a 10-year period (Resident Research Day (RRD) presentations, abstract presentations, published articles). Activities were divided into pre (2002-2007) and post (2007-2012) resident research program implementation time frames. Differences in research productivity were compared between time frames. Surveys of resident attitudes towards research were administered prior to the program's implementation in 2007, and following introduction of the resident research program in 2009 and 2015. RESULTS Overall, research productivity (abstracts, publications, and RRD presentations) increased between pre and post resident research program time periods, with a statistically significant increase in mean number of published abstracts. Resident attitudes towards research changed somewhat over time, with fewer residents supporting mandatory research in recent years. CONCLUSION Implementation of a resident program of research resulted in a significant increase in research productivity. The setting of clear, modifiable, and achievable goals, as well as providing tools for research success, have contributed to the success of this program.
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Affiliation(s)
- Laura Allen
- London Health Sciences Centre, Division of General Surgery, Ontario, Canada
| | - Kelly Vogt
- London Health Sciences Centre, Division of General Surgery, Ontario, Canada
| | - Tina Mele
- London Health Sciences Centre, Division of General Surgery, Ontario, Canada
| | - Michael Ott
- London Health Sciences Centre, Division of General Surgery, Ontario, Canada
| | - Ken Leslie
- London Health Sciences Centre, Division of General Surgery, Ontario, Canada
| | - Patrick Colquhoun
- London Health Sciences Centre, Division of General Surgery, Ontario, Canada
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Ens A, Janzen K, Palmert MR. Development of an Online Learning Module to Improve Pediatric Residents' Confidence and Knowledge of the Pubertal Examination. J Adolesc Health 2017; 60:292-298. [PMID: 27986457 DOI: 10.1016/j.jadohealth.2016.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/30/2016] [Accepted: 10/11/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE Pediatric residents must know how to perform pubertal examinations. The initial objective of this study was to evaluate pediatric resident knowledge and comfort related to the pubertal examination and to determine whether and why these examinations are avoided. The subsequent objective was to develop and assess a learning module (LM) addressing identified education gaps. METHODS A learning needs assessment (LNA) was administered to residents in four Canadian pediatric training programs. Identified themes and knowledge gaps were used to develop an online, case-based LM. A randomized assessment of the LM was conducted among residents from nine training programs across Canada. RESULTS Sixty-four residents completed the LNA. About 52% reported discomfort introducing the pubertal examination, 50% reported a lack of confidence related to the examination, and 56% reported having avoided a warranted examination. Ninety-seven residents participated in the LM assessment. The baseline results were similar to those from the LNA in terms of discomfort, lack of confidence, and avoidance related to pubertal examinations. However, the intervention group showed improvement on a knowledge assessment compared with control group (p < .001). Confidence levels also improved in the intervention group LM (p < .01). Most residents (95%) stated they found the LM to be useful. CONCLUSIONS Residents report being uncomfortable with and avoiding the pubertal examination and have significant knowledge gaps. The online, case-based LM used in this study improved the knowledge and confidence related to this aspect of pediatric care and may be an effective adjunct to pediatric training.
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Affiliation(s)
- Andrea Ens
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada; Department of Leadership, Higher and Adult Education, Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada; Department of Pediatrics, Markham Stouffville Hospital, Markham, Canada.
| | - Katharine Janzen
- Department of Leadership, Higher and Adult Education, Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada
| | - Mark R Palmert
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada; Department of Physiology, University of Toronto, Toronto, Canada
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Development of a Night Float Call Model for Obstetrics and Gynaecology Residency: The Process and Residents' Perceptions. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:1061-1064.e1. [DOI: 10.1016/j.jogc.2016.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/24/2016] [Indexed: 11/18/2022]
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Taylor TS, Watling CJ, Teunissen PW, Dornan T, Lingard L. Principles of fatigue in residency education: a qualitative study. CMAJ Open 2016; 4:E200-4. [PMID: 27398364 PMCID: PMC4933638 DOI: 10.9778/cmajo.20150086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Proposals to implement fatigue-management strategies in residency education assume that medicine shares the view of other risk-adverse industries that fatigue is hazardous. This view is an essential underpinning of fatigue-management strategies that other industries have embedded as part of their workplace occupational health and safety programs. We sought to explore how residents understand fatigue in the context of their training environment. METHODS We interviewed 21 residents in 7 surgical and nonsurgical programs at Western University in 2014. All participants met the inclusion criteria of routinely working 24-hour call shifts while enrolled in their training program. Data collection and analysis occurred iteratively in keeping with constructivist grounded theory methodology and informed theoretical sampling to sufficiency. RESULTS Four predominant principles of fatigue captured how the social learning environment shaped residents' perceptions of fatigue. These included the conceptualization of fatigue as (a) inescapable and therefore accepted, (b) manageable through experience, (c) necessary for future practice and (d) surmountable when required. INTERPRETATION This study elaborates our understanding of how principles of fatigue are constructed and reinforced by the training environment. Whereas fatigue is seen as a collective hazard in other industries, our data showed that, in residency training, fatigue may be seen as a personal challenge. Consequently, fatigue-management strategies that conceptualize fatigue as an occupational threat may have a limited impact on resident behaviour and patient safety.
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Affiliation(s)
- Taryn S Taylor
- Department of Obstetrics & Gynaecology, and Centre for Education Research & Innovation (Taylor); Departments of Clinical Neurological Sciences and Oncology (Watling), and Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ont.; School of Health Professions Education (Teunissen), Maastricht University, Maastricht; Department of Obstetrics & Gynaecology (Teunissen), VU University Medical Center, Amsterdam, the Netherlands; Centre for Medical Education (Dornan), Queen's University Belfast, Belfast, Northern Ireland; School of Health Professions Education (Dornan), Maastricht University, Maastricht, the Netherlands; Centre for Education Research & Innovation (Lingard), Schulich School of Medicine & Dentistry; Faculty of Education (Lingard), Western University, London, Ont
| | - Christopher J Watling
- Department of Obstetrics & Gynaecology, and Centre for Education Research & Innovation (Taylor); Departments of Clinical Neurological Sciences and Oncology (Watling), and Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ont.; School of Health Professions Education (Teunissen), Maastricht University, Maastricht; Department of Obstetrics & Gynaecology (Teunissen), VU University Medical Center, Amsterdam, the Netherlands; Centre for Medical Education (Dornan), Queen's University Belfast, Belfast, Northern Ireland; School of Health Professions Education (Dornan), Maastricht University, Maastricht, the Netherlands; Centre for Education Research & Innovation (Lingard), Schulich School of Medicine & Dentistry; Faculty of Education (Lingard), Western University, London, Ont
| | - Pim W Teunissen
- Department of Obstetrics & Gynaecology, and Centre for Education Research & Innovation (Taylor); Departments of Clinical Neurological Sciences and Oncology (Watling), and Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ont.; School of Health Professions Education (Teunissen), Maastricht University, Maastricht; Department of Obstetrics & Gynaecology (Teunissen), VU University Medical Center, Amsterdam, the Netherlands; Centre for Medical Education (Dornan), Queen's University Belfast, Belfast, Northern Ireland; School of Health Professions Education (Dornan), Maastricht University, Maastricht, the Netherlands; Centre for Education Research & Innovation (Lingard), Schulich School of Medicine & Dentistry; Faculty of Education (Lingard), Western University, London, Ont
| | - Tim Dornan
- Department of Obstetrics & Gynaecology, and Centre for Education Research & Innovation (Taylor); Departments of Clinical Neurological Sciences and Oncology (Watling), and Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ont.; School of Health Professions Education (Teunissen), Maastricht University, Maastricht; Department of Obstetrics & Gynaecology (Teunissen), VU University Medical Center, Amsterdam, the Netherlands; Centre for Medical Education (Dornan), Queen's University Belfast, Belfast, Northern Ireland; School of Health Professions Education (Dornan), Maastricht University, Maastricht, the Netherlands; Centre for Education Research & Innovation (Lingard), Schulich School of Medicine & Dentistry; Faculty of Education (Lingard), Western University, London, Ont
| | - Lorelei Lingard
- Department of Obstetrics & Gynaecology, and Centre for Education Research & Innovation (Taylor); Departments of Clinical Neurological Sciences and Oncology (Watling), and Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ont.; School of Health Professions Education (Teunissen), Maastricht University, Maastricht; Department of Obstetrics & Gynaecology (Teunissen), VU University Medical Center, Amsterdam, the Netherlands; Centre for Medical Education (Dornan), Queen's University Belfast, Belfast, Northern Ireland; School of Health Professions Education (Dornan), Maastricht University, Maastricht, the Netherlands; Centre for Education Research & Innovation (Lingard), Schulich School of Medicine & Dentistry; Faculty of Education (Lingard), Western University, London, Ont
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Pattani R, Wu PE, Dhalla IA. Other consequences of reduced duty hours. The authors respond. CMAJ 2015; 187:207. [PMID: 25691795 PMCID: PMC4330147 DOI: 10.1503/cmaj.115-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Reena Pattani
- Department of Medicine (Pattani, Dhalla), St. Michael's Hospital; Department of Medicine, (Pattani, Wu, Dhalla), University of Toronto; Department of Medicine (Wu), Toronto General Hospital; Institute of Health Policy, Management and Evaluation (Dhalla), University of Toronto, Toronto, Ont
| | - Peter E Wu
- Department of Medicine (Pattani, Dhalla), St. Michael's Hospital; Department of Medicine, (Pattani, Wu, Dhalla), University of Toronto; Department of Medicine (Wu), Toronto General Hospital; Institute of Health Policy, Management and Evaluation (Dhalla), University of Toronto, Toronto, Ont
| | - Irfan A Dhalla
- Department of Medicine (Pattani, Dhalla), St. Michael's Hospital; Department of Medicine, (Pattani, Wu, Dhalla), University of Toronto; Department of Medicine (Wu), Toronto General Hospital; Institute of Health Policy, Management and Evaluation (Dhalla), University of Toronto, Toronto, Ont
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Affiliation(s)
- Shlok Gupta
- Institute of Health Policy Management and Evaluation, Department of Medicine, University of Toronto, Toronto, Ont
| | - Allan S Detsky
- Institute of Health Policy Management and Evaluation, Department of Medicine, University of Toronto, Toronto, Ont
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