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Massar SAA, Chua XY, Leong R, Golkashani HA, Pu Z, Ng ASC, Ong JL, Soon CS, Ng NBH, Tan MY, Lin JB, Aw M, Chee MWL. Sleep, Well-Being, and Cognition in Medical Interns on a Float or Overnight Call Schedule. JAMA Netw Open 2024; 7:e2438350. [PMID: 39392631 DOI: 10.1001/jamanetworkopen.2024.38350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2024] Open
Abstract
Importance Extended work hours and night shifts are essential in health care, but negatively affect physician sleep, well-being, and patient care. Alternative schedules with shorter work hours and/or reduced irregularity might mitigate these issues. Objective To compare sleep, well-being, and cognition between interns working irregular, extended shifts (call schedule), and those working a more regular schedule with restricted hours (float schedule). Design, Setting, and Participants In this observational longitudinal cohort study, interns in a Singapore-based teaching hospital were studied for 8 weeks from January 2022 to July 2023. Data were analyzed from July 2023 to July 2024. Exposure Participants worked either regular approximately 10-hour workdays, interspersed with 24 hour or more overnight calls 4 to 5 times a month, or a float schedule, which included regular approximately 10-hour workdays, and 5 to 7 consecutive approximately 12-hour night shifts every 2 months. Exposure was based on departmental training and operational needs. Main Outcomes and Measures Sleep was measured with wearable sleep trackers and an electronic diary. Day-to-day well-being and cognitive assessments were collected through a smartphone application. Assessments included the Sleep Regularity Index (SRI; determines the probability of an individual being in the same state [sleep or wake] at any 2 time points 24 hours apart, with 0 indicating highly random sleep patterns and 100 denoting perfect regularity) and Pittsburgh Sleep Quality Inventory (PSQI; scores ranges from 0 to 21, with higher scores indicating poorer sleep; a score greater than 5 suggests significant sleep difficulties). Results Participants (mean [SD] age, 24.7 [1.1] years; 57 female participants [59.4%]; 41 on call schedule [42.7%]; 55 on float schedule [57.3%]) provided 4808 nights of sleep (84.2%) and 3390 days (59.3%) of well-being and cognition assessments. Participants on a float schedule had higher SRI scores (mean [SD] score, 69.4 [6.16]) and had better quality sleep (PSQI mean [SD] score, 5.4 [2.3]), than participants on call schedules (SRI mean [SD] score, 56.1 [11.3]; t91 = 6.81; mean difference, 13.3; 95% CI, 9.40 to 17.22; P < .001; PSQI mean [SD] score, 6.5 [2.3]; t79 = 2.16; 95% CI, 0.09 to 2.15; P = .03). Overnight call shifts, but not night float shifts, were associated with poorer mood (-13%; β = -6.79; 95% CI, -9.32 to -4.27; P < .001), motivation (-21%; β = -10.09; 95% CI, -12.55 to -7.63; P < .001), and sleepiness ratings (29%; β = 15.96; 95% CI, 13.01 to 18.90; P < .001) and impaired vigilance (21 ms slower; β = 20.68; 95% CI, 15.89 to 25.47; P < .001) compared with regular day shifts. Night shifts with naps were associated with better vigilance (16 ms faster; β = -15.72; 95% CI, -28.27 to -3.17; P = .01) than nights without naps. Conclusions and relevance In this cohort study, 24-hour call schedules were associated with poorer sleep, well-being, and cognition outcomes than float schedules. Naps during night shifts benefited vigilance in both schedules.
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Affiliation(s)
- Stijn A A Massar
- Sleep and Cognition Laboratory, Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xin Yu Chua
- Sleep and Cognition Laboratory, Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ruth Leong
- Sleep and Cognition Laboratory, Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hosein A Golkashani
- Sleep and Cognition Laboratory, Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhenghao Pu
- Sleep and Cognition Laboratory, Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alyssa S C Ng
- Sleep and Cognition Laboratory, Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ju Lynn Ong
- Sleep and Cognition Laboratory, Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chun Siong Soon
- Sleep and Cognition Laboratory, Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas B H Ng
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mae Yue Tan
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jeremy B Lin
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Marion Aw
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Michael W L Chee
- Sleep and Cognition Laboratory, Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Kim E, Sinco BR, Zhao J, Fang Y, Cunningham C, Frank E, Sen S, Bohnert A, Hughes TM. Duration of New-Onset Depressive Symptoms During Medical Residency. JAMA Netw Open 2024; 7:e2418082. [PMID: 38904957 PMCID: PMC11193122 DOI: 10.1001/jamanetworkopen.2024.18082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/20/2024] [Indexed: 06/22/2024] Open
Abstract
Importance The implications of new-onset depressive symptoms during residency, particularly for first-year physicians (ie, interns), on the long-term mental health of physicians are unknown. Objective To examine the association between and persistence of new-onset and long-term depressive symptoms among interns. Design, Setting, and Participants The ongoing Intern Health Study (IHS) is a prospective annual cohort study that assesses the mental health of incoming US-based resident physicians. The IHS began in 2007, and a total of 105 residency programs have been represented in this national study. Interns enrolled sequentially in annual cohorts and completed follow-up surveys to screen for depression using the 9-item Patient Health Questionnaire-9 (PHQ-9) throughout and after medical training. The data were analyzed from May 2023 to March 2024. Exposure A positive screening result for depression, defined as an elevated PHQ-9 score of 10 or greater (indicating moderate to severe depression) at 1 or more time points during the first postgraduate year of medical training (ie, the intern year). Main Outcomes and Measures The main outcomes assessed were mean PHQ-9 scores (continuous) and proportions of physicians with an elevated PHQ-9 score (≥10; categorical or binary) at the time of the annual follow-up survey. To account for repeated measures over time, a linear mixed model was used to analyze mean PHQ-9 scores and a generalized estimating equation (GEE) was used to analyze the binary indicator for a PHQ-9 score of 10 or greater. Results This study included 858 physicians with a PHQ-9 score of less than 10 before the start of their internship. Their mean (SD) age was 27.4 (9.0) years, and more than half (53.0% [95% CI, 48.5%-57.5%]) were women. Over the follow-up period, mean PHQ-9 scores did not return to the baseline level assessed before the start of the internship in either group (those with a positive depression screen as interns and those without). Among interns who screened positive for depression (PHQ-9 score ≥10) during their internship, mean PHQ-9 scores were significantly higher at both 5 years (4.7 [95% CI, 4.4-5.0] vs 2.8 [95% CI, 2.5-3.0]; P < .001) and 10 years (5.1 [95% CI, 4.5-5.7] vs 3.5 [95% CI, 3.0-4.0]; P < .001) of follow-up. Furthermore, interns with an elevated PHQ-9 score (≥10) demonstrated a higher likelihood of meeting this threshold during each year of follow-up. Conclusions and Relevance In this cohort study of IHS participants, a positive depression screening result during the intern year had long-term implications for physicians, including having persistently higher mean PHQ-9 scores and a higher likelihood of meeting this threshold again. These findings underscore the pressing need to address the mental health of physicians who experience depressive symptoms during their training and to emphasize the importance of interventions to sustain the health of physicians throughout their careers.
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Affiliation(s)
- Erin Kim
- University of Michigan Medical School, Ann Arbor
| | - Brandy R. Sinco
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor
| | - Joan Zhao
- University of Michigan Medical School, Ann Arbor
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor
| | - Yu Fang
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor
| | - Carrie Cunningham
- Department of Surgery, Massachusetts General Hospital, Boston
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
| | - Elena Frank
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor
| | - Srijan Sen
- University of Michigan Medical School, Ann Arbor
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Amy Bohnert
- University of Michigan Medical School, Ann Arbor
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
- Center for Clinical Management and Research, Ann Arbor Veterans Affairs Hospital, Ann Arbor, Michigan
- Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Tasha M. Hughes
- University of Michigan Medical School, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor
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Eu D, Daly MJ, Taboni S, Sahovaler A, Gilbank AN, Irish JC. Evaluation of a 3D Printed Silicone Oral Cavity Cancer Model for Surgical Simulations. J Pers Med 2024; 14:450. [PMID: 38793031 PMCID: PMC11121819 DOI: 10.3390/jpm14050450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/16/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024] Open
Abstract
Adequate surgical margins are essential in oral cancer treatment, this is, however, difficult to appreciate during training. With advances in training aids, we propose a silicone-based surgical simulator to improve training proficiency for the ablation of oral cavity cancers. A silicone-based tongue cancer model constructed via a 3D mold was compared to a porcine tongue model used as a training model. Participants of varying surgical experience were then asked to resect the tumors with clear margins, and thereafter asked to fill out a questionnaire to evaluate the face and content validity of the models as a training tool. Eleven participants from the Otolaryngology-Head and Neck Surgery unit were included in this pilot study. In comparison to the porcine model, the silicone model attained a higher face (4 vs. 3.6) and content validity (4.4 vs. 4.1). Tumor consistency was far superior in the silicone model compared to the porcine model (4.1 vs. 2.8, p = 0.0042). Fellows and staff demonstrated a better margin clearance compared to residents (median 3.5 mm vs. 1.0 mm), and unlike the resident group, there was no incidence of positive margins. The surgical simulation was overall useful for trainees to appreciate the nature of margin clearance in oral cavity cancer ablation.
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Affiliation(s)
- Donovan Eu
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
- Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Otolaryngology-Head and Neck Surgery, National University Health Systems, Singapore 119228, Singapore
| | - Michael J. Daly
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
| | - Stefano Taboni
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
- Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neuroscience, “Azienda Ospedale Università di Padova” University of Padua, 35122 Padua, Italy
| | - Axel Sahovaler
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
- Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Oral and Maxillofacial Surgery, University College London Hospitals, London NW1 2BU, UK
| | - Ashley N. Gilbank
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
| | - Jonathan C. Irish
- Guided Therapeutic (GTx) Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (M.J.D.); (A.S.); (A.N.G.)
- Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada
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Lazar LO, Kadar Sfarad H, Bar-Zakai B, Pines G. Effects of In-House Calls on Medical Students' Perspectives of Surgical Education and Future Career Opportunities. J Laparoendosc Adv Surg Tech A 2024; 34:318-322. [PMID: 38301124 DOI: 10.1089/lap.2023.0484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Background: It has been shown that surgical residents who took few or no in-house calls during medical school felt less prepared for the residency. In this study, our objective was to assess the impact of in-house calls carried out by medical students on their perceptions of medical training, including the influence on specialty choice. Methods: The students were asked to complete an anonymized questionnaire at the first and last day of their general surgery clerkship. Students were asked regarding importance for medical training and education, preparation for the internship, learning opportunities, skills acquisition; negative effects, including fatigue, negative effect over medical training, personal life, and physical and mental health derangements; and the student's perception of the residents' in-house calls and parameters affecting specialty selection: difficulty of the residency, prestige, and future career opportunities. Results: A total of 42 medical students responded to 84 questionnaires. There was a significant difference in the importance of calls among male students before the beginning of the clerkships compared with the end of the clerkship (4.53 versus 4.21, P = .034). At the end of general surgery clerkship, students indicated that the calls less impaired studying during the clerkship (2.5 versus 2.21, P < .05) compared with the beginning of the clerkship. Female students ranked the calls as less demanding at the end of the clerkship (2.53 versus 2.12, P < .05). The impact of the residency difficulty on the selection of their future specialty was rated higher by the students at the end of the clerkship compared with their expectations at the beginning (3.13 versus 2.85, P = .033). Conclusions: In conclusion, our study demonstrates that in-house calls performed by medical students during their general surgery clerkships have a significant influence on their perceptions of medical training and choice of specialty. The study also highlights the importance of gender differences in the students' perception of the importance and impact of calls on their well-being.
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Affiliation(s)
- Li Or Lazar
- Faculty of Medicine, Hebrew University of Jerusalem, Rehovot, Israel
- Department of Thoracic Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Hadas Kadar Sfarad
- Faculty of Medicine, Hebrew University of Jerusalem, Rehovot, Israel
- Department of Surgery B, Kaplan Medical Center, Rehovot, Israel
| | - Barak Bar-Zakai
- Faculty of Medicine, Hebrew University of Jerusalem, Rehovot, Israel
- Department of Surgery A, Kaplan Medical Center, Jerusalem, Israel
| | - Guy Pines
- Faculty of Medicine, Hebrew University of Jerusalem, Rehovot, Israel
- Department of Thoracic Surgery, Kaplan Medical Center, Rehovot, Israel
- Department of Surgery B, Kaplan Medical Center, Rehovot, Israel
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Ojute F, Gonzales PA, Berler M, Puente N, Johnston B, Singh D, Edwards A, Lin J, Lebares C. Investigating Workplace Support and the Importance of Psychological Safety in General Surgery Residency Training. JOURNAL OF SURGICAL EDUCATION 2024; 81:514-524. [PMID: 38388307 DOI: 10.1016/j.jsurg.2023.12.010] [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: 08/23/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVE Workplace interventions that increase support can mitigate burnout, improve workplace satisfaction, and increase well-being. Our aim is to provide evidence-based targets to inform future work for operationalizing support in general surgery residency. DESIGN This is a 2-part mixed-methods cross-sectional study. Part 1 analyzed qualitative data from focus groups (April 2021-May 2022). Part 2 comprised an online survey (informed by findings in Part 1) in May 2022 to assess the association between perceived psychological safety (PS) and flourishing, as well as PS and languishing. SETTING National multi-center study including 16 ACGME-accredited academic programs. PARTICIPANTS General surgery residents at various training levels, in both clinical and research. RESULTS A total of 28 residents participated in the focus groups which revealed both enhancers and inhibitors of support pertaining to PS in the workplace. Enhancers of support included those currently implemented (i.e., allyship of mentors) and those proposed by residents (i.e., nonpunitive analysis of mistakes). Inhibitors of support included both systems (i.e., wellness initiatives as a 'band-aid' for systems issues) and culture (i.e., indefatigability, stoicism). About 251 residents (31%) responded to the survey which revealed higher perception of PS was significantly associated with flourishing at the level of residency program and departmental leadership. Lower perception of PS was significantly associated with languishing at the level of residency program leadership only. CONCLUSION Our findings highlight the promotion of PS, such as expansion of mentorship to include advocacy (advocating on a resident's behalf, recognition when mistreated) and affirmation (i.e., soliciting opinions on controversial social matters/events, recognizing different life experiences), cultural acceptance of asking for help (without being perceived as weak), formal help navigating interpersonal dynamics (i.e., guidance from senior residents), and leadership presentations and modeling to destigmatize asking for help, as a means of operationalizing workplace support to increase flourishing and decrease languishing.
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Affiliation(s)
- Feyisayo Ojute
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Paul Adam Gonzales
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Michael Berler
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Nicole Puente
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Brianna Johnston
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Damin Singh
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Anya Edwards
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Joseph Lin
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Carter Lebares
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California.
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Dhillon J, Tanguilig G, Kraeutler MJ. Virtual and Augmented Reality Simulators Show Intraoperative, Surgical Training, and Athletic Training Applications: A Scoping Review. Arthroscopy 2024:S0749-8063(24)00146-4. [PMID: 38387769 DOI: 10.1016/j.arthro.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE To review published literature to identify and evaluate the effect of virtual reality (complete immersion) and augmented reality (overlay of digital information onto the physical world) simulators on intraoperative use for orthopaedic surgeons, orthopaedic surgical education, and athletic training. METHODS A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies, published since 2014, that evaluated the role of augmented/virtual reality on intraoperative use for orthopaedic surgeons, orthopaedic surgical education, and athletic training. RESULTS Virtual reality (VR) simulators provide 3-dimensional graphical simulation of the physical world, and augmented reality (AR) simulators overlay digital information onto the physical world. Simulators can include interactive features (i.e., replication of intraoperative bleeding), haptic feedback, and unrestricted task repetition, and they can record, compare, and analyze performance while being easily accessible and eliminating the need for the presence of a mentor or coach. Four studies reported on VR for intraoperative use, 47 studies on surgical education, and 10 studies on athletic training. Two studies revealed the advantages of using VR simulation during intraoperative procedures, specifically showcasing its benefits for elbow arthroscopy, while 2 studies demonstrated similar positive outcomes for hip arthroscopy. Seventeen studies demonstrated that a VR simulator could be a beneficial tool to assist in surgical education for the knee, while 12 studies found that VR simulation is a valuable tool for aiding in surgical education of shoulder arthroscopy. Ten studies demonstrated that VR simulation improves skills in the operating room. Three studies revealed that individuals with more experience exhibit superior performance on these simulators compared to those with less experience. In the realm of athletic training, 10 studies showcased the potential of VR simulation to play a significant role in athletic performance and injury rehabilitation. CONCLUSIONS VR simulation shows benefits in the operating room, is a valuable tool for surgical education resulting in improved skills, and can be used to enhance athletic performance and injury rehabilitation. CLINICAL RELEVANCE Understanding that VR simulators can improve surgical outcomes, surgical skill training, and athletic training and rehabilitation could facilitate development and adoption of this advanced technology.
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Affiliation(s)
- Jaydeep Dhillon
- Rocky Vista University College of Osteopathic Medicine, Greenwood Village, Colorado, U.S.A
| | - Grace Tanguilig
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Matthew J Kraeutler
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A..
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Nataraj N, Tome J, Ratelle JT. Teaming in Graduate Medical Education: Ward Rounds and Beyond. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205231225588. [PMID: 38304280 PMCID: PMC10832407 DOI: 10.1177/23821205231225588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/21/2023] [Indexed: 02/03/2024]
Abstract
Teamwork in graduate medical education (GME) is often hindered in clinical learning environments where discontinuity among residents, supervisors, and other health care professionals is typical. Teaming is a conceptual approach to teamwork in dynamic environments with constantly changing team members and goals. Teaming is built on principles of project management and team leadership, which together provide an attractive strategy for addressing teamwork challenges in GME. Indeed, teaming is now a requirement of the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review program. However, many clinician-educators and leaders may be unfamiliar with teaming and how to integrate it into their GME programs. In this article, the teaming framework is described with a specific example of how it can be applied to improve hospital ward rounds, a common setting of teamwork breakdown. The goal of this article is to educate and encourage GME leaders as they learn new ways to implement teaming to improve patient care and education in their programs.
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Affiliation(s)
- Neela Nataraj
- Division of Hospital Internal Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - June Tome
- Division of Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - John T. Ratelle
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Carr MM, Foreman AM, Friedel JE, O’Brien DC, Wirth O. Factors Affecting Medical Residents' Decisions to Work After Call. J Patient Saf 2024; 20:16-21. [PMID: 38116942 PMCID: PMC10753934 DOI: 10.1097/pts.0000000000001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Accreditation Council for Graduate Medical Education (ACGME) work-hour restrictions (WHRs) are intended to improve patient safety by reducing resident fatigue. Compliance with ACGME WHRs is not universal. PURPOSE The purpose of this study was to identify factors that influence residents' decisions to take a postcall day (PCD) off according to ACGME WHRs. METHODS Residents (N = 433) at one university were emailed a link to a survey in 2019. The survey included demographic details and a Discrete Choice Experiment examining influences on resident decisions to take a PCD off. RESULTS One hundred seventy-five residents (40.4%) responded to the survey; 113 residents (26%) completed the survey. Positive feedback from attending physicians about taking PCDs off in the past had the greatest impact on respondents' decisions to take a PCD off, increasing the probability by 27.3%, followed by chief resident comments about the resident looking tired (16.6% increase), and having never heard their attendings comment about PCDs off as either positive or negative (13.9% increase). Factors that had the largest effect on decreasing the probability of taking a PCD were negative feedback about taking PCDs off (14.3% decrease), continuity of care concerns (10.8% decrease), and whether the resident was looking forward to an assignment (7.9% decrease). CONCLUSIONS The most important influencer of residents' decisions to take a PCD off was related to feedback from their attending physicians, suggesting that compliance with WHRs can be improved by focusing on the residency program's safety culture.
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Affiliation(s)
- Michele M. Carr
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY
| | - Anne M. Foreman
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV
| | | | | | - Oliver Wirth
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV
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Walters SJ, Dizon J, Stern C, Stephenson M. The measurement of fatigue in clinicians within hospital settings: A systematic review of measurement properties. Nurs Health Sci 2023. [PMID: 38151888 DOI: 10.1111/nhs.13070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 09/19/2023] [Accepted: 11/08/2023] [Indexed: 12/29/2023]
Abstract
Medical staff fatigue leads to accidents and mistakes and puts patient safety at risk. A measure of fatigue in the workplace may help to quantify, predict, and manage fatigue. This review aimed to evaluate instruments used to measure fatigue in medical staff within hospitals. A systematic review following the JBI methodology was undertaken. A search for articles was conducted in 2021. Included articles (all validation studies) were assessed for methodological quality using the COSMIN checklist. Measurement property data was evaluated for Quality of Evidence using GRADE methodology. Ten studies representing five instruments were reviewed: Occupational Fatigue Exertion and Recovery scale (now superseded); Occupational Fatigue Exertion and Recovery scale (15-item); Multidimensional Fatigue Inventory; Need for Recovery Scale; and the Swedish Occupational Fatigue Inventory. Four instruments show promise for measuring fatigue in hospital medical staff, however, there is limited certainty in the measure property estimates. The Quality of Evidence for measurement properties for all instruments is insufficient. Further validation studies following the COSMIN standards are needed before recommendations for use can be made.
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Affiliation(s)
- Stephen John Walters
- Joanna Briggs Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Janine Dizon
- Joanna Briggs Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Cindy Stern
- Joanna Briggs Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Matthew Stephenson
- Joanna Briggs Institute, University of Adelaide, Adelaide, South Australia, Australia
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10
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Feng S, Davis JA, Chowdhary A, Lomazow W, Yi JS, Huang J, Ding L, Taravati P. The effect of mandatory post-call relief on sleep and wellness in ophthalmology residents. BMC MEDICAL EDUCATION 2023; 23:955. [PMID: 38093220 PMCID: PMC10720055 DOI: 10.1186/s12909-023-04947-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Multiple duty hour reforms have been implemented to optimize resident wellness through increasing opportunities for sleep recovery, but few studies have recorded objectively measured sleep or shown direct sleep and wellness benefits from such interventions. This study seeks to determine whether mandatory post-call relief policies with a partial night float system improved resident sleep, activity, and burnout among ophthalmology residents taking home call. METHODS We conducted a two group cohort study of ophthalmology residents at the University Washington comparing post graduate year-2 (PGY-2) resident sleep, activity, and burnout between the optional post-call relief group from July 1, 2017 to June 30, 2019 to the mandatory post-call relief group from July 1, 2019 to June 30, 2021. RESULTS Of twenty total residents participating in the survey portion, 18 residents participated in the sleep and activity tracking portion of the study, 9 in in the optional post-call relief cohort, and 9 in the mandatory post-call relief cohort. The mandatory post-call relief group recorded longer total sleep on call than the optional post-call relief group (p < 0.001). There was no difference in overnight sleep recorded on call (median 3.4 h), but residents recorded more time napping in the mandatory post-call relief cohort (p < 0.001). There was no significant difference between cohorts in amount of sleep while not on call. Residents in the mandatory post-call relief cohort recorded higher average daily steps, higher exercise time, and lower sedentary time than residents in the optional post-call relief cohort (p < 0.001). They also recorded lower median emotional exhaustion on the Maslach Burnout Inventory and lower stress in the Depression and Anxiety Stress Scale in the mandatory post-call relief cohort (p = 0.008). CONCLUSIONS Implementation of mandatory post-call relief policies with a partial night-float system among PGY-2 residents was associated with more post-call naps with more overall physical activity, lower emotional exhaustion scores, and lower stress scores, despite no changes to overnight sleep on call or total sleep. Although sample size limits interpretation of data, implementation of mandatory post call relief could be considered to improve post-call sleep in programs with home call.
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Affiliation(s)
- Shu Feng
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA.
| | - John A Davis
- Oregon Health and Sciences University, Casey Eye Institute, Portland, USA
| | - Apoorva Chowdhary
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Whitney Lomazow
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Jonathan S Yi
- University of Miami Health System, Bascom Palmer Eye Institute, Miami, USA
| | - Johnson Huang
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Leona Ding
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Parisa Taravati
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA
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11
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McAdams RM. Fatigue and fallibility: the perils of prolonged shifts for neonatologists. J Perinatol 2023; 43:1530-1534. [PMID: 37422587 DOI: 10.1038/s41372-023-01718-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
Sleep deprivation is a major challenge for neonatologists, who face increasing demands in the complex healthcare system. Current neonatal intensive care unit (NICU) schedule models often include extended shifts and overnight call, which can lead to sleep deprivation. This lack of sufficient sleep poses adverse health risks to neonatologists and can impair cognitive function, which increases the risk of medical errors and compromises patient safety. This paper proposes reducing shift durations and implementing policies and interventions to reduce fatigue among neonatologists and improve patient safety. The paper also offers policymakers, healthcare leaders, and NICU physicians valuable insights on potential ways to promote the health of the neonatologist workforce and safety in the NICU.
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Affiliation(s)
- Ryan M McAdams
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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12
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Mul Fedele ML, López Gabeiras MDP, Simonelli G, Diez JJ, Bellone GJ, Cagliani J, Larrateguy L, Eiguchi K, Golombek DA, Cardinali DP, Pérez-Chada D, Vigo DE. "Multivariate analysis of the impact of sleep and working hours on medical errors: a MICE approach". BMC Public Health 2023; 23:2317. [PMID: 37996804 PMCID: PMC10666331 DOI: 10.1186/s12889-023-17130-4] [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: 06/09/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The main objective of this study was to describe the relationship between working conditions, sleep and psycho-affective variables and medical errors. METHODS This was an observational, analytical and cross-sectional study in which 661 medical residents answered questionnaires about working conditions, sleep and psycho-affective variables. Actigraphic sleep parameters and peripheral temperature circadian rhythm were measured in a subgroup of 38 subjects. Bivariate and multivariate predictors of medical errors were assessed. RESULTS Medical residents reported working 66.2 ± 21.9 weekly hours. The longest continuous shift was of 28.4 ± 10.9 h. They reported sleeping 6.1 ± 1.6 h per day, with a sleep debt of 94 ± 129 min in workdays. A high percentage of them reported symptoms related to psycho-affective disorders. The longest continuous shift duration (OR = 1.03 [95% CI, 1.00-1.05], p = 0.01), working more than six monthly on-call shifts (OR = 1.87 [95% CI, 1.16-3.02], p = 0.01) and sleeping less than six hours per working day (OR = 1.66 [95% CI, 1.10-2.51], p = 0.02) were independently associated with self-reported medical errors. The report of medical errors was associated with an increase in the percentage of diurnal sleep (2.2% [95% CI, 0.1-4.3] vs 14.5% [95% CI, 5.9-23.0]; p = 0.01) in the actigraphic recording. CONCLUSIONS Medical residents have a high working hour load that affect their sleep opportunities, circadian rhythms and psycho-affective health, which are also related to the report of medical errors. These results highlight the importance of implementing multidimensional strategies to improve medical trainees' sleep and wellbeing, increasing in turn their own and patients' safety.
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Affiliation(s)
- Malena Lis Mul Fedele
- Chronophysiology Lab, Institute for Biomedical Research (UCA-CONICET), Buenos Aires, Argentina
| | | | - Guido Simonelli
- Centre d'études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord de L'Île-de-Montréal, Montreal, Canada
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Canada
- Department of Neuroscience, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Joaquín José Diez
- Pan-American Institute of Sleep Medicine and Chronobiology, Buenos Aires, Argentina
| | - Giannina Julieta Bellone
- Pontifical Catholic University of Argentina, Buenos Aires, Argentina
- Chronobiology Lab, Department of Science and Technology, National University of Quilmes, Bernal, Argentina
| | - Joaquín Cagliani
- Anesthesiology Department, North Shore University Hospital, Manhasset, NY, USA
| | - Luis Larrateguy
- Private Center of Respiratory Medicine of Paraná, Entre Ríos, Argentina
| | | | - Diego Andrés Golombek
- Chronobiology Lab, Department of Science and Technology, National University of Quilmes, Bernal, Argentina
- Interdisciplinary Time Lab, San Andrés University, Buenos Aires, Argentina
| | | | | | - Daniel Eduardo Vigo
- Chronophysiology Lab, Institute for Biomedical Research (UCA-CONICET), Buenos Aires, Argentina.
- Katholieke Universiteit Leuven, Leuven, Belgium.
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13
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Weaver MD, Sullivan JP, Landrigan CP, Barger LK. Systematic Review of the Impact of Physician Work Schedules on Patient Safety with Meta-Analyses of Mortality Risk. Jt Comm J Qual Patient Saf 2023; 49:634-647. [PMID: 37543449 DOI: 10.1016/j.jcjq.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 08/07/2023]
Abstract
Resident physician work hour limits continue to be controversial. Numerous trials have come to conflicting conclusions about the impact on patient safety of eliminating extended duration work shifts. We conducted meta-analyses to evaluate the impact of work hour policies and work schedules on patient safety. After identifying 8,362 potentially relevant studies and reviewing 688 full-text articles, 132 studies were retained and graded on quality of evidence. Of these, 68 studies provided enough information for consideration in meta-analyses. We found that patient safety improved following implementation of the Accreditation Council for Graduate Medical Education's 2003 and 2011 resident physicians work hour guidelines. Limiting all resident physicians to 80-hour work weeks and 28-hour shifts in 2003 was associated with an 11% reduction in mortality (p < 0.001). Limited shift durations and shorter work weeks were also associated with improved patient safety in clinical trials and observational studies not specifically tied to policy changes. Given the preponderance of evidence showing that patient and physician safety is negatively affected by long work hours, efforts to improve physician schedules should be prioritized. Policies that enable extended-duration shifts and long work weeks should be reexamined. Further research should expand beyond resident physicians to additional study populations, including attending physicians and other health care workers.
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14
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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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15
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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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16
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Mamourian A, Bagian J. Ax vs Scalpel: The Role of Quality in Optimizing Neuroradiologist's Workload. Acad Radiol 2023; 30:1228. [PMID: 37061450 DOI: 10.1016/j.acra.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/03/2023] [Indexed: 04/17/2023]
Affiliation(s)
- Alex Mamourian
- Professor of Radiology, Neurology and Neurosurgery, Pennsylvania State-Hershey Medical Center, 500 University Drive, Hershey, PA 17033; Professor of Anesthesiology, Operations and Industrial Engineering, Aerospace Engineering Executive Director Center for Risk Analysis Informed Decision Engineering, University of Michigan.
| | - James Bagian
- Professor of Radiology, Neurology and Neurosurgery, Pennsylvania State-Hershey Medical Center, 500 University Drive, Hershey, PA 17033; Professor of Anesthesiology, Operations and Industrial Engineering, Aerospace Engineering Executive Director Center for Risk Analysis Informed Decision Engineering, University of Michigan
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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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18
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Shi C, Luo JM, Xiao Y. The association of sleep quality and burnout among Chinese medical residents under standardized residency training in a tertiary hospital. Sleep Breath 2023; 27:379-386. [PMID: 35460049 PMCID: PMC9033310 DOI: 10.1007/s11325-022-02621-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/22/2022] [Accepted: 04/15/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the impact of sleep quality and chronotype on job burnout among medical residents under standardized residency training (SRT) in a tertiary hospital in Beijing, China. METHODS Medical residents in the Department of Internal Medicine of Peking Union Medical College Hospital were assessed by Morning and Evening Questionaire-5 (MEQ-5), Pittsburgh sleep quality index (PSQI), and Maslach Burnout Inventory-General Survey (MBI-GS). Factors associated with burnout were analyzed. RESULTS A total of 142 respondents returned completed questionnaires. Burnout was present in 85 (60%) residents. Prevalence of high emotional exhaustion, high depersonalization, and low personal accomplishment were 51%, 28%, and 18%, respectively. The global PSQI score of residents was 5.9 ± 2.4, and the self-reported sleep duration was 6.2 ± 0.8 h/day. The MEQ-5 distribution skewed towards morningness, with a median score of 14.5 [13.0, 16.3]. Poor daytime function significantly predicted emotional exhaustion and depersonalization. Chronotypes were not associated with any of the burnout components. CONCLUSION Sleep-related daytime dysfunction was strongly related to burnout. Strategies protecting the sleep of residents should be incorporated into the SRT programs for both efficiency and sustainability considerations.
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Affiliation(s)
- Chuan Shi
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China
| | - Jin-Mei Luo
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China.
| | - Yi Xiao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China
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19
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Guerrero DT, Asaad M, Rajesh A, Hassan A, Butler CE. Advancing Surgical Education: The Use of Artificial Intelligence in Surgical Training. Am Surg 2023; 89:49-54. [PMID: 35570822 DOI: 10.1177/00031348221101503] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The technology of artificial intelligence (AI) has made significant in-roads into the field of medicine over the last decade. With surgery being a discipline where repetition is the key to mastery, the scope of AI presents enormous potential for resident education through the analysis of technique and delivery of structured feedback for performance improvement. In an era marred by a raging pandemic that has decreased exposure and opportunity, AI offers an attractive solution towards improving operating room efficiency, safe patient care in the hands of supervised residents and can ultimately culminate in reduced health care costs. Through this article, we elucidate the current adoption of the artificial intelligence technology and its prospects for advancing surgical education.
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Affiliation(s)
- David T Guerrero
- 12317University of Pittsburgh Medical School, Pittsburgh, PA, USA
| | - Malke Asaad
- Department of Plastic Surgery, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Aashish Rajesh
- 14742University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Abbas Hassan
- Department of Plastic Surgery, 571198The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles E Butler
- Department of Plastic Surgery, 571198The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Krishnaswami S, Polites SF, Dekany G, Gaines BA, Nwomeh BC, Huang EY, Finck CM, Lopushinsky SR, Puligandla PS, Feliz A, Mak GZ, Anderson SA, Fairbanks T, Alaish SM. The First Two Years of the Association of Pediatric Surgery Training Program Directors (APSTPD) Transition to Fellowship Course: Lessons Learned and Future Directions. JOURNAL OF SURGICAL EDUCATION 2023; 80:62-71. [PMID: 36085115 DOI: 10.1016/j.jsurg.2022.08.006] [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: 07/07/2022] [Revised: 08/08/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The first transition to fellowship course for incoming pediatric surgery fellows was held in the US in 2018 and the second in 2019. The course aimed to facilitate a successful transition in to fellowship by introduction of the professional, patient care, and technical aspects unique to pediatric surgery training. The purpose of this study was to evaluate the feasibility and effectiveness of the first two years of this course in the US and discuss subsequent evolution of this endeavor. DESIGN This is a descriptive and qualitative analysis of two years' experience with the Association of Pediatric Surgery Training Program Directors' (APSTPD) Transition to Fellowship course. Course development and curriculum, including clinical knowledge, soft skills, and hands-on skills labs, are presented. Participating incoming fellows completed multiple choice, boards-style pre- and post-tests. Scores were compared to determine if knowledge was effectively transferred. Participants also completed post-course evaluations and subsequent 3- or 12-month surveys inquiring on the lasting impact of the course on their transition into fellowship. Standard univariate statistics were used to present results. SETTING The first APSTPD Transition to Fellowship course was held at the Johns Hopkins Hospital in Baltimore, Maryland in 2018, and the second course was held at the Oregon Health and Science University in Portland, Oregon in 2019. PARTICIPANTS All fellows entering ACGME-certified Pediatric Surgery fellowships in the United States were invited to participate. Twenty fellows accepted and attended in 2018, and fourteen fellows participated in 2019. RESULTS There were 34 incoming pediatric surgery fellow participants over 2 years. Faculty represented more than 10 institutions each year. Pre- and post-test scores were similar between years, with a significant improvement of scores after completion of the course (67±10% vs 79±8%, p < 0.001). Feedback from participants was overwhelmingly positive, with skills labs being attendees' favorite component. When asked about usefulness of individual course sessions, more attendees found clinical sessions more useful than soft skills (93% vs 73%, p = 0.011). Almost all (90%) of participants reported the course met its stated purpose and would recommend the course to future fellows. This was further reflected on 3 and 12 month follow up surveys wherein 85% stated they found the course helpful during the first few months of fellowship and 90% would still recommend it. CONCLUSIONS A transition to fellowship course in the US for incoming pediatric surgery fellows is logistically feasible, effective in transfer of knowledge, and highly regarded among attendees. Feedback from each course has been used to improve the subsequent courses, ensuring that it remains a valuable addition to pediatric surgical training in the US.
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Affiliation(s)
- Sanjay Krishnaswami
- Department of Surgery, Oregon Health and Sciences University, Portland, Oregon; APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | | | - Gabriela Dekany
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Barbara A Gaines
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | | | - Eunice Y Huang
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | | | | | | | - Alexander Feliz
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | - Grace Z Mak
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | - Scott A Anderson
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky
| | | | - Samuel M Alaish
- APSTPD Transition to Fellowship Task Force, Louisville, Kentucky; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Kaiser KA, Lench HC, Levine LJ. Medical residency match applicants undervalue factors that predict stress and burnout. MEDICAL EDUCATION ONLINE 2022; 27:2109243. [PMID: 35946069 PMCID: PMC9373742 DOI: 10.1080/10872981.2022.2109243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
In the medical residency match process, applicants' ranking decisions are influenced by multiple factors related to training, geography, and lifestyle expectations. Ranking decisions directly impact match results, with implications for emotional outcomes such as happiness and stress. The present study explored the decision factors considered most important by applicants when creating rank order lists (ROLs), and how match outcomes and program factors predicted happiness, enthusiasm, stress, and life satisfaction. Senior medical students (n = 182) at a large public university in California completed surveys at three timepoints, spanning from shortly before Match Day to several months into PGY-1. Study findings support that both program-related (e.g., training quality, program size) and non-program-related (e.g., geography, work life balance) factors are important to applicants when making ROL decisions. Applicants who matched with their top choice program initially experienced emotional benefits, but these emotional differences did not persist into PGY-1, where all matched applicants had similar levels of emotion and life satisfaction. The emotional cost and benefits of matching with programs of different ROL positions (e.g., matching with top-choice program or not) were most apparent shortly after matching but in the long-term, a stronger predictor of PGY-1 emotions was perceived person-program alignment. Person-program alignment (e.g., call schedule, patient caseload) also predicted burnout in the first few months of a residency program. These findings show that, when applicants are making ranking decisions, they undervalue factors that predict stress and burnout during residency.
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Affiliation(s)
- Kaitlyn A. Kaiser
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA
| | - Heather C. Lench
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA
| | - Linda J. Levine
- Department of Psychological Science, and fellow, Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine, California, USA
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22
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Sawangkum P, Lockwood C, Brown HL, Louis J, Hoffman MS. The Role of Gynecologic Surgical Training for the Practicing Obstetrician. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Peeraya Sawangkum
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Charles Lockwood
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Haywood L. Brown
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Judette Louis
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Mitchel S. Hoffman
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- MCC GYN Program, Moffitt Cancer Center, Tampa, Florida, USA
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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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Carr MM, Friedel J, O'Brien D, Foreman AM, Wirth O. Perceptions of Fatigue and Safety Climate Pertaining to Residency Duty-Hour Restrictions. Cureus 2022; 14:e28929. [PMID: 36237775 PMCID: PMC9547532 DOI: 10.7759/cureus.28929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: The Accreditation Council for Graduate Medical Education (ACGME), which sets the standards for residency training, instituted work-hour restrictions in 2003. Our purpose was to assess residents’ perceptions of fatigue and local safety climate specific to these duty-hour restrictions. Methods: All residents (N=433) at one university were emailed a link to a survey in 2019. The survey included demographic details, on-call descriptors, an 18-point climate survey (CS), and the 33-point Chalder Fatigue Questionnaire (CFQ). The CS was adapted from a commonly used safety climate scale and intended to measure the respondent’s perceptions of their program’s attitudes and practices around resident duty-hour compliance. A Pearson correlational analysis was used to determine if there were associations between the variables. Results: Mean CS score was 12.89 (95% confidence interval, CI 12.32-13.46, N=164, 48.5%). Respondents were most likely to disagree with “Residents are told when they are at risk of working beyond ACGME duty-hour restrictions,” where 57 (34.7%) disagreed or strongly disagreed. Mean CFQ score was 16.02 (95% CI 14.87-17.17, N=113, 26.1%). As the CS score improved, CFQ scores decreased indicating an inverse relationship between duty-hour climate and fatigue (r=-0.328, p<0.05). Having a protected post-call day off, and having either the Program Director, Chief Resident, or Senior Resident decide that a resident takes a post-call day off were all associated with higher CS scores. Conclusion: We found that the CS had good internal consistency and evidence of construct validity. An inverse relationship between CS score and fatigue suggests that the level of fatigue is higher among residents in programs where residents perceived that ACGME duty-hour compliance was less important.
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Mutter M, Kyle JR, Yecies E, Hamm M, DiNardo D. Use of Chart-Stimulated Recall to Explore Uncertainty in Medical Decision-Making Among Senior Internal Medicine Residents. J Gen Intern Med 2022; 37:3114-3120. [PMID: 35141852 PMCID: PMC9485402 DOI: 10.1007/s11606-022-07396-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uncertainty is common and impacts both patients and clinicians. The approach to uncertainty in medical trainees may be distinct from that of practicing clinicians and has important implications for medical education. OBJECTIVE Describe trainee approach to uncertainty with the use of chart-stimulated recall (CSR)-based interviews, as well as the utility of such interviews in promoting reflection about decision-making among senior internal medicine (IM) residents. DESIGN Qualitative analysis of CSR-based interviews with IM residents. PARTICIPANTS Senior IM residents rotating on inpatient night float at the University of Pittsburgh Medical Center from February to September 2019. INTERVENTION Each participant completed one, 20-min CSR session based on a self-selected case in which there was uncertainty in decision-making. Interviews explored the sources of, approaches to, and feelings about uncertainty. APPROACH Two independent coders developed a codebook and independently coded all transcripts. Transcripts were then analyzed using thematic analysis. KEY RESULTS The perceived acuity of the patient presentation was the main driver of the approach to and stress related to uncertainty. Perceived level of responsibility in resolving uncertainty during the overnight shift also varied among individual participants. Attending expression of uncertainty provided comfort to residents and alleviated stress related to uncertainty. Residents felt comfortable discussing their uncertainty and felt that the opportunity to think aloud during the exercise was valuable. CONCLUSIONS Our study demonstrated a novel approach to the exploration of uncertainty in medical decision-making, with the use of CSR. Variations in resident perceived level of responsibility in resolving uncertainty during the overnight shift suggest a need for curriculum development in approach to uncertainty during night shifts. Though residents often experienced stress related to uncertainty, attending expression of uncertainty was an important mitigator of that stress, emphasizing the important role that the trainee-attending interaction plays in the diagnostic process.
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Affiliation(s)
- Marina Mutter
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Jillian R Kyle
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Megan Hamm
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Deborah DiNardo
- Division of General Internal Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
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Hershkovitz Y, Rasco A, Tal O. Shortening shift’s length—Should we ask the residents if this is what they want? PLoS One 2022; 17:e0272548. [PMID: 35917323 PMCID: PMC9345332 DOI: 10.1371/journal.pone.0272548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/21/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Work overload in hospitals enforced reducing shifts length of physicians in many countries over the last decade. In Israel, the current shift standard is of 26 hours, however, there is a residents’ struggle alongside a governmental intent to short the shifts to 16 hour. We aim to evaluate residents and interns support and preferences regarding shortening shifts and their ramifications to quality of life and residency programs. Methods A structured questionnaire was distributed to all resident and interns in a single center. We evaluated their current quality of residency and life, their support in the shorter shifts model, offering alternative program components such as reduced pay, longer residency or replacement in order to allow rest. We compared those who support the new model to those who objected to identify common characteristics to draw a resident profile for acceptance of change. Results Overall, 151 physicians answer the questionnaire. 70.2% support the shorter shifts model. Residents above 35 years old and those reaching completion of residency, significantly less support the shortening shifts model. No other demographic nor professional parameters were different between the supporters and non-supporters. Option of reduced pay or longer residency dramatically reduced the support rate to less than 30% and 20%, respectively. Replacement by other physician (resident or senior physician) in order to allow rest was supported by only 40%. Conclusion Residents’ standpoints regarding a desirable change are crucial to plan a successful implementation. A national survey is required before a new model is introduced, to achieve an optimal transparent efficient process.
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Affiliation(s)
- Yehuda Hershkovitz
- Faculty of Medicine, Department of Surgery, Shamir Medical Center, Zeriffin, Tel Aviv University, Tel Aviv, Israel
- Department of Management, Medical Management program, Bar Ilan University, Ramat Gan, Israel
- * E-mail:
| | - Adi Rasco
- Department of Management, Medical Management program, Bar Ilan University, Ramat Gan, Israel
- Faculty of Medicine, Oncology Institute Shamir Medical Center, Zeriffin, Tel Aviv University, Tel Aviv, Israel
| | - Orna Tal
- Department of Management, Medical Management program, Bar Ilan University, Ramat Gan, Israel
- Faculty of Medicine, Shamir Medical Center, Zeriffin, Tel Aviv University, Tel Aviv, Israel
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Redinger J, Kabil E, Forkin KT, Kleiman AM, Dunn LK. Resting and Recharging: A Narrative Review of Strategies to Improve Sleep During Residency Training. J Grad Med Educ 2022; 14:420-430. [PMID: 35991104 PMCID: PMC9380640 DOI: 10.4300/jgme-d-21-01035.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/21/2022] [Accepted: 05/31/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Residency involves demanding training with long hours that may cause fatigue and sleep deprivation and adversely impact residents and patients under their care. OBJECTIVE To identify, using a narrative review, evidence-based interventions to reduce the physiologic effects of fatigue and sleep deprivation from overnight and night shift work. METHODS A PubMed literature search was conducted through August 30, 2021, using the terms "resident" and "sleep" in the title or abstract and further narrowed using a third search term. Observational studies, randomized controlled trials, systematic reviews, and meta-analyses of human subjects written and published in English were included. Studies that were not specific to residents or medical interns or did not investigate an intervention were excluded. Additional studies were identified by bibliography review. Due to the heterogeneity of study design and intervention, a narrative review approach was chosen with results categorized into non-pharmacological and pharmacological interventions. RESULTS Initially, 271 articles were identified, which were narrowed to 28 articles with the use of a third search term related to sleep. Bibliography review yielded 4 additional articles. Data on interventions are limited by the heterogeneity of medical specialty, sample size, length of follow-up, and reliance on self-report. Non-pharmacological interventions including strategic scheduling and sleep hygiene may improve sleep and well-being. The available evidence, including randomized controlled trials, to support pharmacological interventions is limited. CONCLUSIONS Non-pharmacological approaches to mitigating fatigue and sleep deprivation have varying effectiveness to improve sleep for residents; however, data for pharmacological interventions is limited.
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Affiliation(s)
- Joyce Redinger
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Joyce Redinger, MD, is PGY-3 Resident
| | - Emmad Kabil
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Emmad Kabil, MD, is PGY-4 Resident
| | - Katherine T. Forkin
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Katherine T. Forkin, MD, is Associate Professor of Anesthesiology
| | - Amanda M. Kleiman
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Amanda M. Kleiman, MD, is Associate Professor of Anesthesiology
| | - Lauren K. Dunn
- All authors are with the University of Virginia Health System, Department of Anesthesiology
- Lauren K. Dunn, MD, PhD, is Associate Professor of Anesthesiology and Neurological Surgery
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28
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Kaplan HM, Rana R, Kulkarni PA. Implementation of a Night-Float Curriculum: Impact on Intern Confidence over Time. South Med J 2022; 115:635-638. [PMID: 35922052 DOI: 10.14423/smj.0000000000001422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Formal nighttime education is becoming increasingly necessary as more internal medicine (IM) residency programs adopt night-float rotations (NFRs); however, the efficacy of an NFR curriculum throughout an academic year and which topics in an NFR curriculum increase trainee confidence are unknown. We implemented a 12-module, self-paced NFR curriculum for 76 postgraduate year-1 residents at an academic IM residency program. We evaluated the impact of this curriculum on postgraduate year-1 residents' clinical confidence, as well as longitudinal efficacy of the curriculum. METHODS Night-float interns' (NFIs) clinical confidence regarding specific curricular topics was evaluated overall and during specific timeframes within the academic year. Pre- and post-NFR surveys using Likert scales for each topic were administered to NFIs from June 24, 2020 to March 2, 2021, representing 32 week-long NFR cycles. RESULTS NFIs' pre- and postrotation confidence in managing clinical scenarios significantly improved for all 12 topics in the NFR curriculum. The NFR curriculum resulted most significantly in improved confidence during the first 4 months of the academic year, with 11 of 12 curricular topics reaching the threshold for statistical significance. Modules on altered mental status, hypotension, narrow-complex tachyarrhythmias, new fever, and sepsis and antibiotic escalation maintained their efficacy for the longest periods of time. CONCLUSIONS It may be especially important to emphasize an NFR curriculum at the beginning of the academic year. IM residency programs also may wish to carefully consider that certain topics may maintain their efficacy throughout the year, whereas other topics should potentially be replaced with more complex modules as the academic year progresses.
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Affiliation(s)
- Holland M Kaplan
- From the Department of Medicine, Baylor College of Medicine, and the Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Ruchit Rana
- From the Department of Medicine, Baylor College of Medicine, and the Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Prathit A Kulkarni
- From the Department of Medicine, Baylor College of Medicine, and the Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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29
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Nagasaki K, Nishizaki Y, Shinozaki T, Shimizu T, Yamamoto Y, Shikino K, Fukui S, Nishiguchi S, Kurihara M, Kataoka K, Tokuda Y, Kobayashi H. Association between mental health and duty hours of postgraduate residents in Japan: a nationwide cross-sectional study. Sci Rep 2022; 12:10626. [PMID: 35739229 PMCID: PMC9218701 DOI: 10.1038/s41598-022-14952-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/15/2022] [Indexed: 11/11/2022] Open
Abstract
The new duty hour (DH) limit for doctors in Japan will begin in 2024, setting the maximum DHs for postgraduate residents at approximately 80 h weekly. To set appropriate limits, understanding the association between DHs and psychological health is necessary. Thus, we assessed the relationship between residents' psychological health and DHs. We conducted a cross-sectional study involving examinees of the General Medicine In-training Examination 2020. Mental health outcomes were measured dichotomously using the Patient Health Questionnaire-2 for depression and Mini-Z 2.0, for burnout, stress, and satisfaction. Weekly DHs were measured in seven categories at 10-h intervals. The prevalence ratios (PRs) between the DH categories were estimated for each outcome. Of the 6045 residents who provided data on DHs and psychological outcomes, 37.3% showed signs of depression, 21.6% experienced burn out, and 39.2% were highly stressed. In contrast, 62.3% were highly satisfied with their training. Proportions of burnout were higher among residents in Category 6 (≥ 90 and < 100 h; PR 1.36; 95% CI 1.11-1.66) and Category 7 (≥ 100 h; PR 1.36; 95% CI 1.10-1.68) compared with residents in Category 3 (≥ 60 and < 70 h; reference). The results partially support the weekly 80-h DH limit in terms of resident well-being.
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Affiliation(s)
- Kazuya Nagasaki
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, 3-2-7, Miyamachi, Mito, Ibaraki, 310-0015, Japan
| | - Yuji Nishizaki
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Sho Fukui
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Sho Nishiguchi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Masaru Kurihara
- Department of Patient Safety, Nagoya University Hospital, Aichi, Japan
| | - Koshi Kataoka
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Hiroyuki Kobayashi
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, 3-2-7, Miyamachi, Mito, Ibaraki, 310-0015, Japan.
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Scharf VF, McPhetridge JB, Dickson R. Sleep patterns, fatigue, and working hours among veterinary house officers: a cross-sectional survey study. J Am Vet Med Assoc 2022; 260:1377-1385. [DOI: 10.2460/javma.21.05.0234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
OBJECTIVE
To describe the sleep patterns, working hours, and perceptions of fatigue among veterinary house officers and to identify potential areas for targeted intervention to improve well-being.
SAMPLE
303 house officers.
PROCEDURES
A 62-item questionnaire was generated by use of an online platform and sent to veterinary house officers at participating institutions via email. Responses were analyzed for trends and associations between variables of interest.
RESULTS
The mean age of respondents was 30 ± 3.7 years. Participants included 239 residents and 64 interns. House officers slept significantly less during times when they had clinical responsibilities compared to off-clinic time (6.0 hours vs 7.5 hours, respectively; P < 0.01). The majority of house officers reported working 11 to 13 hours on a typical weekday (58% [174/302]), and 32% reported clinical responsibilities 7 d/wk. Working hours were negatively related to sleep quantity (Pearson correlation coefficient, −0.54; P < 0.01), and perceived sleep quality was worse when on call (P < 0.01). The majority of house officers felt that fatigue negatively interfered with their technical skills, clinical judgment, and ability to empathize to some extent in the previous 4 weeks.
CLINICAL RELEVANCE
Most house officers fail to obtain sufficient sleep for optimal cognitive function and physical and mental health. Working hours and on call may be important factors contributing to the sleep patterns of veterinary house officers, and training program structure should be critically evaluated to promote protected time for sleep.
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Affiliation(s)
- Valery F. Scharf
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Jourdan B. McPhetridge
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Rachel Dickson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA
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Quality of sleep in a sample of Egyptian medical residency. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00192-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Sleep disturbances among medical staff are common serious entities with devastating consequences. Numerous studies have analyzed the effects of residency on the quality of sleep of the medical trainees in various specialties, but only few studies were conducted in Egypt.
Results
One hundred fifty medical residents from various medical and surgical specialties who work in the hospitals of Ain Shams University, Egypt, agreed to participate in our study. Sociodemographic and work-related data were collected by a semi-structured sheet. Sleep quality was assessed by self-administered questionnaire—Pittsburgh Sleep Quality Index (PSQI). According to the PSQI, 96.7% of the residents had poor sleep quality with mean PSQI score of 10.4 ± 2.5. No statistically significant difference was detected among the different specialties. Poorer sleep quality was more frequent among senior residents who spent longer duration in residency. The number of hours of sleep before residency and the number of days off during residency were the main predictors of total PSQI score and determinants of sleep quality
Conclusions
Poor sleep quality is highly prevalent among medical residents and is associated with work-related factors. It is necessary to consider residents’ sleep estate and conduct more analyses to diagnose, treat, and improve their sleep quality.
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Shahi S, Paudel DR, Bhandari TR. Burnout among resident doctors: An observational study. Ann Med Surg (Lond) 2022; 76:103437. [PMID: 35308433 PMCID: PMC8927790 DOI: 10.1016/j.amsu.2022.103437] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background Burnout is a syndrome of emotional exhaustion and depersonalization that reduces efficiency at work. No studies have been reported focusing only on residency burnout and risk factors from our country until now. This study aimed to find out the impact and the association of specific demographic and practice characteristics with burnout among resident doctors. Methods A prospective cross-sectional survey of all resident doctors under training at that point of time in 2019 in the National Academy of Medical Sciences, Nepal in different specialties was done. We evaluated demographic variables, practice characteristics, and assessed burnout through validated Maslach burnout inventory (MBI) tools, and data were analyzed. Results A total 347 among 410 resident doctors (227 male) responded to the survey. Median age was 30 years (range 25–44). Overall, 147 (42.4%) of responding residents were burned out with high emotional exhaustion in 58 (16.6%), high depersonalization in 55 (15.9%), and low personal achievement in 34 (9.8). In regression analysis, out of independent variables gender, marital status, having children, specialty, hours of work per week and year of residency, specialties (general surgery odds ratio [OR]; 12.595, confidence interval [CI],[ 1.037–152.9], P; 0.047), obstetrics, and gynecology (odds ratio [OR]; 13.977, confidence interval [CI]; [1.324–147.5], P; 0.028), and anesthesiology (odds ratio [OR]; 11.54, confidence interval [CI]; [1.014–131.4], P; 0.049)) and hours of work per week (≥80 h) (odds ratio [OR]; 2.511, confidence interval [CI]; [1.128–5.589], P; 0.024), were significantly associated with high burnout. Conclusions Burnout is common among trainee resident doctors which is possibly preventable. Thus, the concern should be to prepare strategies to identify and minimize burnout from the individual, institutional, and societal sides. It is essential to preserve and promote the mental health of trainee residents to prevent serious consequences in the personal lives of resident doctors and as well as on patient outcomes. Burnout amongst resident doctors is extremely predominant which may be caused due to various reasons. We describe the impact of burnout among resident doctors and focus on identifying different risk factors for burnout. Preservation of mental health of resident doctors is essential to prevent serious consequences in their lives as well as on patient care.
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Affiliation(s)
- Sudha Shahi
- Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
- Corresponding author.
| | - Dhundi Raj Paudel
- Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Tika Ram Bhandari
- General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
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Wellness in Graduate Surgical Medical Education. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mascaro JS, Wallace A, Hyman B, Haack C, Hill CC, Moore MA, Lund MB, Nehl EJ, Bergquist SH, Cole SW. Flourishing in Healthcare Trainees: Psychological Well-Being and the Conserved Transcriptional Response to Adversity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2255. [PMID: 35206440 PMCID: PMC8871849 DOI: 10.3390/ijerph19042255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 02/01/2023]
Abstract
While much attention has been paid to healthcare provider and trainee burnout, less is known about provider well-being (i.e., flourishing) or about the effects of well-being on immune function. This study examined the demographic and psycho-social correlates of well-being among healthcare trainees (resident physicians and physician assistant (PA) trainees) and evaluated the association of well-being with the "conserved transcriptional response to adversity" (CTRA) characterized by up-regulated expression of pro-inflammatory genes and down-regulated expression of innate antiviral genes. Participants (n = 58) completed self-reported assessments of sleep disturbance, loneliness, depressive symptoms, anxiety, stress, and well-being (flourishing). Blood sample RNA profiles were analyzed by RNA sequencing to assess the CTRA. Slightly over half (n = 32; 55.2%) of healthcare trainees were categorized as flourishing. Flourishing was less prevalent among primary caregivers, and more prevalent among trainees who exercised more frequently and those with fewest days sick. Loneliness (AOR = 0.75; 95% CI = 0.61, 0.91; p = 0.003) and stress (AOR = 0.65; 95% CI = 0.45, 0.94; p = 0.02) were associated with decreased odds of flourishing when controlling for other variables. Flourishing was associated with down-regulated CTRA gene expression, whereas loneliness was associated with up-regulated CTRA gene expression (both p < 0.05). Assessing these relationships in a larger, multi-site study is of critical importance to inform policy, curricula, and interventions to bolster sustainable trainee well-being.
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Affiliation(s)
- Jennifer S. Mascaro
- Department of Family and Preventive Medicine, Division of Preventive Medicine, Emory University, Atlanta, GA 30329, USA;
| | - Amanda Wallace
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (A.W.); (E.J.N.)
| | - Brooke Hyman
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA 30322, USA; (B.H.); (C.C.H.)
| | - Carla Haack
- Department of Surgery, Emory University, Atlanta, GA 30322, USA;
| | - Cherie C. Hill
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA 30322, USA; (B.H.); (C.C.H.)
| | - Miranda A. Moore
- Department of Family and Preventive Medicine, Division of Preventive Medicine, Emory University, Atlanta, GA 30329, USA;
- Department of Medicine, Emory University, Atlanta, GA 30322, USA;
| | - Maha B. Lund
- Department of Family and Preventive Medicine, Physician Assistant Program, Emory University, Atlanta, GA 30322, USA;
| | - Eric J. Nehl
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (A.W.); (E.J.N.)
| | | | - Steve W. Cole
- Department of Psychiatry & Biobehavioral Sciences, Department of Medicine, University of California, Los Angeles, CA 90095, USA;
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Apt E, Regev T, Shapira J, Haberfeld O, Duek OS, Bar-Yoseph R. Residents' perspective on duty hours at an Israeli tertiary hospital. Isr J Health Policy Res 2022; 11:11. [PMID: 35144693 PMCID: PMC8830127 DOI: 10.1186/s13584-022-00521-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Specialization in medical professions is considered a challenging and intensive period due to the number and sequence of duty hours. Considering the effect of duty hours on residents, both physically and mentally, several models have been created over the years to address this complexity. The two main model schools aim to decrease the duty hour length and night shift (i.e., night float, NF) frequency. In recent years, duty hours have become a source of disagreement and frustration among the medical community, both residents and attendings. A possible change in the duty hour structure may affect residents in terms of several parameters, such as patient safety, the well-being of the physician and the degree of training of the resident. PURPOSE (1) To investigate medical residents' perspectives on their duty hours utilizing online questionnaires on their effect on the work environment and (2) to assess residents' preferences in relation to the suggested shortened shift and NF models. METHODS Questionnaires were emailed to all residents (main residents and fellows) at an Israeli tertiary medical center between March 2020 and April 2020. Questions were scored from 1 (disagree) to 5 (fully agree). RESULTS Two hundred and sixty residents (227 main residents, 43 fellows) participated in the study (40% female). The score for the degree of balance between work and personal life was low (0.9±1.99). The shortened shift model was perceived by the residents as more compatible with a balanced lifestyle than the NF model (3.77 ± 1.20 and 3.14 ± 1.26, respectively, P < 0.0001). Neither model was considered to risk impairing professional training (2.33 ± 1.45 and 2.47 ± 1.25, respectively, P = 0.12). Overall, 74% of the residents were not willing to lower their income if the decision were made to change models, and 56% were not willing to increase the number of shifts. CONCLUSIONS There is agreement among residents that shortening shift hours to 16 h would have a positive effect on the balance between personal life and work. In the eyes of residents, the change would not impair their training during residency.
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Affiliation(s)
- Elad Apt
- Orthopedic Surgery Division, Rambam Health Care Campus, Haifa, Israel.
| | - Tslil Regev
- Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Jacob Shapira
- Orthopedic Surgery Division, Rambam Health Care Campus, Haifa, Israel
| | - Ori Haberfeld
- Department of Thoracic Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ori Samuel Duek
- Plastic and Reconstructive Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonology Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
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A Dual-Institutional Study on First Year Practice Outcomes of Pediatric Surgeons Who Trained in the Era of Work Hour Restrictions. Pediatr Surg Int 2022; 38:277-283. [PMID: 34709434 PMCID: PMC8742777 DOI: 10.1007/s00383-021-05037-3] [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] [Accepted: 10/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND In July 2003, an 80-h work week restriction for residencies was mandated. This was met with skepticism regarding its potential impact on operative training. We hypothesized no difference in outcomes for pediatric surgeons who trained under duty hour restrictions compared to historical complication rates. METHODS Dual-institutional review of pediatric patients who underwent five of the most common operations (2013-2018) by first-year pediatric surgeons who trained under duty hour restrictions was performed. Tests of proportions were used to compare complication rates to published rates on data collected prior to 2003. RESULTS Patient mean age was 10.1 years. No significant differences (p values > 0.05) were found in laparoscopic appendectomy rates of infection, bleeding or intra-abdominal abscess compared to previously published rates. Pyloromyotomy rates of infection or duodenal perforation were not different. No differences were detected in rates of infection, recurrence or testicular atrophy for inguinal hernia repair. Umbilical hernia rates of infection, bleeding, and recurrence were also not different. There was no difference in CVC rates of hemopneumothoraces; significantly more bleeding events were detected (1.2% vs. 0.1%; p value = 0.04). CONCLUSION In this study, first-year complication rates of pediatric surgeons who trained under duty hour restrictions were not significantly different when compared to published rates.
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Nkwerem S, Emejulu JK, Adimekwe M. Information communication technology in medical practice: Pattern of usage and knowledge among doctors in a tertiary health institution in Southeastern Nigeria. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_183_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wang HH, Lin YH. Assessing Physicians' Recall Bias of Work Hours With a Mobile App: Interview and App-Recorded Data Comparison. J Med Internet Res 2021; 23:e26763. [PMID: 34951600 PMCID: PMC8742215 DOI: 10.2196/26763] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/10/2021] [Accepted: 11/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background Previous studies have shown inconsistencies in the accuracy of self-reported work hours. However, accurate documentation of work hours is fundamental for the formation of labor policies. Strict work-hour policies decrease medical errors, improve patient safety, and promote physicians’ well-being. Objective The aim of this study was to estimate physicians’ recall bias of work hours with a mobile app, and to examine the association between the recall bias and physicians’ work hours. Methods We quantified recall bias by calculating the differences between the app-recorded and self-reported work hours of the previous week and the penultimate week. We recruited 18 physicians to install the “Staff Hours” app, which automatically recorded GPS-defined work hours for 2 months, contributing 1068 person-days. We examined the association between work hours and two recall bias indicators: (1) the difference between self-reported and app-recorded work hours and (2) the percentage of days for which work hours were not precisely recalled during interviews. Results App-recorded work hours highly correlated with self-reported counterparts (r=0.86-0.88, P<.001). Self-reported work hours were consistently significantly lower than app-recorded hours by –8.97 (SD 8.60) hours and –6.48 (SD 8.29) hours for the previous week and the penultimate week, respectively (both P<.001). The difference for the previous week was significantly correlated with work hours in the previous week (r=–0.410, P=.01), whereas the correlation of the difference with the hours in the penultimate week was not significant (r=–0.119, P=.48). The percentage of hours not recalled (38.6%) was significantly higher for the penultimate week (38.6%) than for the first week (16.0%), and the former was significantly correlated with work hours of the penultimate week (r=0.489, P=.002) Conclusions Our study identified the existence of recall bias of work hours, the extent to which the recall was biased, and the influence of work hours on recall bias.
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Affiliation(s)
- Hsiao-Han Wang
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Hsuan Lin
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.,Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
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Ashana DC, Chan VK, Vangala S, Bell DS. The Impact of Resident Holdover Admissions on Length of Hospital Stay and Risk of Transfer to an Intensive Care Unit. J Patient Saf 2021; 17:e1855-e1859. [PMID: 32217935 PMCID: PMC10188252 DOI: 10.1097/pts.0000000000000662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Implementation of residency duty hour standards has led to adoption of different staffing models, such as the "holdover" model, whereby nighttime teams admit patients and transfer their care to daytime teams who provide ongoing care. In contrast, nonholdover teams at our institution are responsible for both admitting patients and providing ongoing care. We sought to determine whether patients admitted by holdover teams experience worse outcomes than those admitted by nonholdover teams. METHODS This is a retrospective cohort study of patients admitted to the internal medicine hospital service at a quaternary care hospital from July 2013 to June 2015. Primary outcomes included hospital length of stay (LOS) and transfer to an intensive care unit within 72 hours of admission. Secondary outcomes were any transfer to an intensive care unit, in-hospital mortality, discharge to home (versus discharge to postacute care facility), and readmission to the health system within 30 days of discharge. RESULTS We analyzed 5518 encounters, 64% of which were admitted by a holdover team. Outcomes were similar between study groups, except the LOS, which was 5.5 hours longer for holdover encounters in unadjusted analyses (5.18 versus 4.95 days, P = 0.04) but not significantly different in adjusted analyses. The mean discharge time was 4:00 p.m. for both groups, whereas the mean admission times were 12:00 a.m. and 4:00 p.m. for holdover and nonholdover encounters, respectively. CONCLUSIONS Holdover encounters at our institution were not associated with worse patient safety outcomes. A small increase in LOS may have been attributable to holdover patients having earlier admission and identical discharge times.
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Affiliation(s)
- Deepshikha Charan Ashana
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Vincent K. Chan
- Division of Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Sitaram Vangala
- Division of General Internal Medicine, University of California, Los Angeles, Los Angeles, California
| | - Douglas S. Bell
- Division of General Internal Medicine, University of California, Los Angeles, Los Angeles, California
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Lorenzo IL, Tonelli CM, Bunn C, Kulshrestha S, Agnew SP, Cohn TD, Abdelsattar ZM, Baker MS, Luchette FA. Supervised independence in elective inguinal hernia repairs performed by surgical residents is not associated with compromised short clinical outcome or rates of reoperation for recurrence. Am J Surg 2021; 223:470-474. [PMID: 34815028 DOI: 10.1016/j.amjsurg.2021.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We evaluate the association between attending surgeon involvement and clinical outcome in elective inguinal hernia repairs performed by residents. METHODS Patients undergoing initial elective unilateral inguinal hernia repair between 2004 and 2019 were identified using the Veterans Administration Surgical Quality Improvement Program Database. The level of attending surgeon involvement was categorized as active (attending scrubbed [AS]) or passive (supervising the resident's performance but not scrubbed [ANS]). AS and ANS herniorrhaphies were 1:1 propensity matched for patient demographics, comorbidities, surgical approach, resident postgraduate level, and year of repair. Rates of complication and recurrence for matched cohorts were compared by standard methods. RESULTS 30,784 patients met inclusion criteria. 5136 (17%) repairs were performed without the attending scrubbed. On comparison of matched-cohorts, overall complication rates (1.7% vs 1.2%, p = 0.07) and rates of recurrence (1.9% vs 1.4%, p = 0.041) for patients undergoing herniorrhaphy AS were statistically similar to those performed ANS. CONCLUSION Supervised independence in elective inguinal hernia repair performed by surgical residents is not associated with inferior clinical outcomes.
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Affiliation(s)
- Isabela L Lorenzo
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
| | - Celsa M Tonelli
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Department of Surgery, Edward Hines, Jr. VA Medical Center, Hines, IL, USA
| | - Corinne Bunn
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Sujay Kulshrestha
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Sonya P Agnew
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Tyler D Cohn
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Zaid M Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Marshall S Baker
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Department of Surgery, Edward Hines, Jr. VA Medical Center, Hines, IL, USA
| | - Frederick A Luchette
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Department of Surgery, Edward Hines, Jr. VA Medical Center, Hines, IL, USA
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Schwartz LP, Devine JK, Hursh SR, Mosher E, Schumacher S, Boyle L, Davis JE, Smith M, Fitzgibbons SC. Biomathematical Modeling Predicts Fatigue Risk in General Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2021; 78:2094-2101. [PMID: 33994335 DOI: 10.1016/j.jsurg.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/08/2021] [Accepted: 04/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess resident fatigue risk using objective and predicted sleep data in a biomathematical model of fatigue. DESIGN 8-weeks of sleep data and shift schedules from 2019 for 24 surgical residents were assessed with a biomathematical model to predict performance ("effectiveness"). SETTING Greater Washington, DC area hospitals RESULTS: As shift lengths increased, effectiveness scores decreased and the time spent below criterion increased. Additionally, 11.13% of time on shift was below the effectiveness criterion and 42.7% of shifts carried excess sleep debt. Sleep prediction was similar to actual sleep, and both predicted similar performance (p ≤ 0.001). CONCLUSIONS Surgical resident sleep and shift patterns may create fatigue risk. Biomathematical modeling can aid the prediction of resident sleep patterns and performance. This approach provides an important tool to help educators in creating work-schedules that minimize fatigue risk.
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Affiliation(s)
| | | | - Steven R Hursh
- Institutes for Behavior Resources, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Lisa Boyle
- MedStar Georgetown University Hospital, Washington, DC
| | - Jonathan E Davis
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC
| | - Mark Smith
- MedStar Institute for Innovation, Washington, DC
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Grabow Moore K, Ketterer A, Wheaton N, Weygandt PL, Caretta-Weyer HA, Berberian J, Jordan J. Development, Implementation, and Evaluation of an Open Access, Level-Specific, Core Content Curriculum for Emergency Medicine Residents. J Grad Med Educ 2021; 13:699-710. [PMID: 34721800 PMCID: PMC8527934 DOI: 10.4300/jgme-d-21-00067.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Leaders in graduate medical education must provide robust clinical and didactic experiences to prepare residents for independent practice. Programs traditionally create didactic experiences individually, requiring tremendous resources with variable content exposure and quality. OBJECTIVE We sought to create and implement a free, open access, learner-centric, level-specific, emergency medicine (EM) residency curriculum. METHODS We developed Foundations of Emergency Medicine (FoEM) Foundations I and II courses using Kern's model of curriculum development. Fundamental topics were identified through content guidelines from the American Board of Emergency Medicine. We incorporated learner-centric strategies into 2 flipped classroom, case-based courses targeting postgraduate year (PGY) 1 and PGY-2 residents. The curriculum was made freely available online in 2016. Faculty and resident users were surveyed annually for feedback, which informed iterative refinement of the curriculum. RESULTS Between 2016 and 2020, registration for FoEM expanded from 2 sites with 36 learners to 154 sites and 4453 learners. In 2019, 98 of 102 (96%) site leaders and 1618 of 2996 (54%) learners completed the evaluative survey. One hundred percent of responding leaders and 93% of learners were "satisfied" or "very satisfied" with FoEM content. Faculty and residents valued FoEM's usability, large volume of content, quality, adaptability, organization, resident-faculty interaction, and resident-as-teacher opportunities. Challenges to implementation included resident attendance, conference structure, technology limitations, and faculty engagement. CONCLUSIONS We developed and implemented a learner-centric, level-specific, national EM curriculum that has been widely adopted in the United States.
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Affiliation(s)
- Kristen Grabow Moore
- Kristen Grabow Moore, MD, MEd, is Assistant Professor, Department of Emergency Medicine, Emory University
| | - Andrew Ketterer
- Andrew Ketterer, MD, MA, is Clinical Instructor and Assistant Residency Program Director, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Natasha Wheaton
- Natasha Wheaton, MD, is Associate Clinical Professor, Associate Program Director, and Medical Student Clerkship Director, Department of Emergency Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA)
| | - Paul Logan Weygandt
- Paul Logan Weygandt, MD, MPH, is Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine
| | - Holly A. Caretta-Weyer
- Holly A. Caretta-Weyer, MD, MHPE, is Assistant Professor and Associate Residency Program Director, Department of Emergency Medicine, Stanford University School of Medicine
| | - Jeremy Berberian
- Jeremy Berberian, MD, is Assistant Professor, Department of Emergency Medicine, Christiana Care Health System
| | - Jaime Jordan
- Jaime Jordan, MD, MAEd, is Associate Professor of Clinical Emergency Medicine, Associate Program Director, and Vice Chair, Acute Care College, Department of Emergency Medicine, David Geffen School of Medicine at UCLA
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Rux CE, Paloucek FP, Jarrett JB. Addressing stress and burnout in pharmacy residents, but at what cost? Am J Health Syst Pharm 2021; 79:126-127. [PMID: 34590121 DOI: 10.1093/ajhp/zxab369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Affiliation(s)
- Caleb E Rux
- University of Illinois at Chicago College of Pharmacy, Department of Pharmacy Practice
| | - Frank P Paloucek
- University of Illinois at Chicago College of Pharmacy, Department of Pharmacy Practice
| | - Jennie B Jarrett
- University of Illinois at Chicago College of Pharmacy, Department of Pharmacy Practice
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Abstract
In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Affiliation(s)
- Daniel Arendt
- Department of Pharmacy Practice University of Cincinnati James L. Winkle College of Pharmacy Cincinnati, OH, USA
| | - Jaclyn Boyle
- Department of Pharmacy Practice Northeast Ohio Medical University College of Pharmacy Rootstown, OH, USA
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Holmgren AJ, Lindeman B, Ford EW. Resident Physician Experience and Duration of Electronic Health Record Use. Appl Clin Inform 2021; 12:721-728. [PMID: 34348409 DOI: 10.1055/s-0041-1732403] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Electronic health records (EHRs) demand a significant amount of physician time for documentation, orders, and communication during care delivery. Resident physicians already work long hours as they gain experience and develop both clinical and socio-technical skills. OBJECTIVES Measure how much time resident physicians spend in the EHR during clinic hours and after-hours, and how EHR usage changes as they gain experience over a 12-month period. METHODS Longitudinal descriptive study where participants were 622 resident physicians across postgraduate year cohorts (of 948 resident physicians at the institution, 65.6%) working in an ambulatory setting from July 2017 to June 2018. Time spent in the EHR per patient, patients records documented per day, and proportion of EHR time spent after-hours were the outcome, while the number of months of ambulatory care experience was the predictor. RESULTS Resident physicians spent an average of 45.6 minutes in the EHR per patient, with 13.5% of that time spent after-hours. Over 12 months of ambulatory experience, resident physicians reduced their EHR time per patient and saw more patients per day, but the proportion of EHR time after-hours did not change. CONCLUSION Resident physicians spend a significant amount of time working in the EHR, both during and after clinic hours. While residents improve efficiency in reducing EHR time per patient, they do not reduce the proportion of EHR time spent after-hours. Concerns over the impact of EHRs on physician well-being should include recognition of the burden of EHR usage on early-career physicians.
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Affiliation(s)
- A Jay Holmgren
- Center for Clinical Informatics and Improvement Research, School of Medicine, University of California, California, United States
| | - Brenessa Lindeman
- Department of Surgery, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Eric W Ford
- School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, United States
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Gatz JD, Gingold DB, Lemkin DL, Wilkerson RG. Association of Resident Shift Length with Procedural Complications. J Emerg Med 2021; 61:189-197. [PMID: 34006422 DOI: 10.1016/j.jemermed.2021.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/02/2021] [Accepted: 02/19/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Training programs for resident physicians struggle to balance the need for clinical experience with the impact of fatigue on patient safety. The length of shifts worked by emergency medicine (EM) residents is likely an important determinant of resident fatigue. OBJECTIVE Assess the impact of a longer clinical shift on procedural competency. METHODS We conducted a retrospective chart review of arterial line placements, central venous catheterizations, tube thoracostomies, endotracheal intubations, and lumbar punctures performed by EM residents working 12-h shifts in the emergency department of an academic medical center over an academic year. We compared complication rates between procedures performed in the first 8 vs. the last 4 h of a 12-h shift. Procedures without complication were defined as successful on first-pass attempt and without a downstream mechanical or medical complication. Multivariable modified Poisson regression was used to simultaneously control for possible confounders affecting procedure success. RESULTS We identified 548 eligible procedures: 307 performed in the first 8 h of a 12-h shift and 241 in the last 4 h. The complication rate across all procedures was higher in the last 4 h of the shift (pooled risk ratio 1.41, 95% confidence interval 1.18-1.67). This effect persisted when adjusting for potential confounders (adjusted risk ratio 1.42, 95% confidence interval 1.19-1.69). CONCLUSION Overall, complication rates of included procedures performed by EM residents were higher during the last 4 vs. first 8 h of a 12-h shift. Training programs should consider the impact of resident fatigue on patient safety when making work schedules.
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Affiliation(s)
- J David Gatz
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Daniel B Gingold
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Daniel L Lemkin
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Gentry Wilkerson
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Carr MM, Friedel JE, Foreman AM, O'Brien DC, Wirth O. Perceptions of Safety Climate and Fatigue Related to ACGME Residency Duty Hour Restrictions in Otolaryngology Residents. Otolaryngol Head Neck Surg 2021; 166:86-92. [PMID: 33940962 DOI: 10.1177/01945998211010108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare otolaryngology residents' perceptions of safety climate with respect to duty hour compliance and self-perceived fatigue. STUDY DESIGN Cross-sectional study. SETTING Forty-one otolaryngology residencies distributed across the United States. METHODS A national sample of otolaryngology residents was surveyed electronically in 2019. The survey included demographic details, on-call descriptors, an 18-point Safety Climate Survey (SCS) modified to measure perceptions of program attitudes and practices around resident duty hour compliance, and the 33-point Chalder Fatigue Questionnaire (CFQ). RESULTS Of 397 surveyed residents, 205 (51.6%) responded. The mean modified SCS score was 11.29 out of 18 (95% CI, 10.76-11.81). Respondents were most likely to disagree with "Residents are told when they are at risk of working beyond ACGME [Accreditation Council for Graduate Medical Education] duty hour restrictions," where 100 (48.8%) disagreed or strongly disagreed. The mean CFQ score was 15.99 of 33 (95% CI, 15.17-16.81). As the modified SCS score improved, CFQ scores decreased, indicating an inverse relationship between duty hour safety climate and fatigue. Having a protected postcall day off and having the program director, chief resident, or senior resident decide that a resident should take a postcall day off were all associated with higher modified SCS scores. CONCLUSION Otolaryngology residents perceived a safety climate that is suboptimal with regard to duty hour restriction issues. Additionally, an inverse relationship between fatigue and modified SCS scores suggests that fatigue among residents may be lower in programs where residents perceive that ACGME duty hour compliance is more important.
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Affiliation(s)
- Michele M Carr
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Jonathan E Friedel
- Department of Psychology, Georgia Southern University, Statesboro, Georgia, USA
| | - Anne M Foreman
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Daniel C O'Brien
- Department of Otolaryngology, University of Alberta, Edmonton, Canada
| | - Oliver Wirth
- Bioanalytics Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
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Cygler J, Page AV, Ginsburg S. Life on Call: Perspectives of Junior and Senior Internal Medicine Residents. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:744-750. [PMID: 33060400 DOI: 10.1097/acm.0000000000003803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Models of daytime and nighttime on-call responsibilities for residents vary across internal medicine training programs, but there are few data regarding residents' perceptions of their on-call experiences. The authors sought to understand what residents perceive as the benefits and detriments of 24-hour, in-house call, a perspective instrumental to informing change. METHOD The authors conducted in-depth individual interviews and focus groups between December 2018 and March 2019 with 17 internal medicine residents from postgraduate years 1, 2, and 3 at the University of Toronto about their on-call experiences. Using constructivist grounded theory, the authors developed a framework to understand the residents' perceived benefits and drawbacks of 24-hour in-house call. RESULTS Residents' experiences on call were grouped into 7 themes regarding negative and positive aspects of call. Participants reported multidimensional fatigue related to call, including decision fatigue, emotional fragility and lability, and loss of empathy, and also reported that call adversely affected their personal lives. Residents expressed conflicting opinions as to whether prolonged duty hours affected patient outcomes. In contrast, residents also expressed benefits to call, including that overnight call led to increased autonomy and decision-making skills and provided preparation for future careers as independent internists. They described developing camaraderie and a sense of belonging to a team with coresidents overnight. Lastly, residents described occupying different roles during regular duty hours and while on call-daytime roles revolved around follow-up of previously admitted patients and administrative tasks, while overnight duties centered on initial workup and medical stabilization of referred patients. CONCLUSIONS Understanding the nuanced phenomenon of being on call from the perspective of those who live through it is a critical step in creating evidence-based educational policies. New call models should emphasize resident autonomy and decision making and should include a consideration of residents' perceived differences between daytime and on-call roles.
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Affiliation(s)
- Jeremy Cygler
- J. Cygler is a resident physician, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea V Page
- A.V. Page is assistant professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shiphra Ginsburg
- S. Ginsburg is professor, Department of Medicine, University of Toronto, scientist, Wilson Centre for Education, University of Toronto, Toronto, Ontario, Canada, and Canada Research Chair in Health Professions Education; ORCID: http://orcid.org/0000-0002-4595-6650
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Cantillon P, De Grave W, Dornan T. Uncovering the ecology of clinical education: a dramaturgical study of informal learning in clinical teams. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:417-435. [PMID: 32951128 PMCID: PMC8041675 DOI: 10.1007/s10459-020-09993-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 09/08/2020] [Indexed: 05/28/2023]
Abstract
Off-the-job faculty development for clinical teachers has been blighted by poor attendance, unsatisfactory sustainability, and weak impact. The faculty development literature has attributed these problems to the marginalisation of the clinical teacher role in host institutions. By focusing on macro-organisational factors, faculty development is ignoring the how clinical teachers are shaped by their everyday participation in micro-organisations such as clinical teams. We set out to explore how the roles of clinical teacher and graduate learner are co-constructed in the context of everyday work in clinical teams. Using an ethnographic study design we carried out marginal participant observation of four different hospital clinical teams. We assembled a dataset comprising field notes, participant interviews, images, and video, which captured day-to-day working and learning encounters between team members. We applied the dramaturgical sensitising concepts of impression management and face work to a thematic analysis of the dataset. We found that learning in clinical teams was largely informal. Clinical teachers modelled, but rarely articulated, an implicit curriculum of norms, standards and expectations. Trainees sought to establish legitimacy and credibility for themselves by creating impressions of being able to recognise and reproduce lead clinicians' standards. Teachers and trainees colluded in using face work strategies to sustain favourable impressions but, in so doing, diminished learning opportunities and undermined educational dialogue. These finding suggest that there is a complex interrelationship between membership of clinical teams and clinical learning. The implication for faculty development is that it needs to move beyond its current emphasis on the structuring effects of institutional context to a deeper consideration of how teacher and learner roles are co-constructed in clinical teams.
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Affiliation(s)
- Peter Cantillon
- Discipline of General Practice, National University of Ireland, Galway, Republic of Ireland.
| | - Willem De Grave
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Tim Dornan
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
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Zhang S, Ring J, Methot M, Zevin B. Medication Errors in Surgery: A Classification Taxonomy and a Pilot Study in Postcall Residents. J Surg Res 2021; 264:402-407. [PMID: 33848839 DOI: 10.1016/j.jss.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The post-call state in postgraduate medical trainees is associated with impaired decision-making and increased medical errors. An association between post-call state and medication prescription errors for surgery residents is yet to be established. Our objective was to determine whether post-call state is associated with increased proportion of medication prescription errors committed by surgery residents in an academic hospital without a computerized physician order entry (CPOE) system. METHODS This prospective observational study was conducted at a tertiary academic hospital between June 28 and August 31, 2017. It compared the proportion of medication prescription errors committed by surgery residents in their post-call (PC) and no-call (NC) states. A novel taxonomy was developed to classify medication prescription errors. RESULTS Sixteen of twenty-one eligible residents (76%) participated in this study. Self-reported hours of sleep per night was significantly higher in the NC group compared to the PC group (6(4-8) vs 2(0-4) hours, P < 0.01). PC residents committed a significantly higher proportion of medication prescription errors versus NC residents (9.2% vs 3.2%; p=0.04). Decision-making and prescription-writing errors comprised 33% and 67% of errors, respectively. CONCLUSIONS The post-call state in surgery residents is associated with a significantly higher proportion of medication prescription errors in a hospital without a CPOE system. Decision-making and prescription-writing errors could potentially be addressed by additional educational interventions.
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Affiliation(s)
- Shannon Zhang
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Justine Ring
- Division of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, Ontario, Canada.
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