1
|
Lie JJ, Huynh C, Li J, Mak N, Wiseman SM. Psychological Impact of the COVID-19 Pandemic on Canadian Surgical Residents: A Province-Wide Study. J Surg Educ 2024; 81:486-494. [PMID: 38388311 DOI: 10.1016/j.jsurg.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/22/2023] [Accepted: 12/22/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVES The objective of this study was to evaluate the psychological impact of the COVID-19 pandemic on surgical residents. DESIGN An online survey was distributed evaluating multiple domains: demographics, health and socioeconomic factors, clinical experience, educational experience, and psychological outcomes. The Mayo Clinic Resident Well-Being Index (RWBI) was used as a validated measure of resident mental health. SETTING AND PARTICIPANTS Surgical residents from University of British Columbia's surgical residency programs. RESULTS A total of 31/86 surgical residents responded to the survey. Of which, 57% and 46% reported feeling burned out or depressed, respectively. Residents who were concerned about personal protective equipment supply and who lived with family members with comorbidities had a higher risk of depression (p = 0.03, p = 0.04). The median Mayo Clinic Resident Well-Being Index was 2.5, higher than the median of 2 observed in the United States national survey of residents. CONCLUSIONS The pandemic had a considerable negative impact on the psychological well-being of surgical residents.
Collapse
Affiliation(s)
- Jessica J Lie
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Caroline Huynh
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Li
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Mak
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
2
|
Abstract
Description According to theatrical superstition, saying "Macbeth" in the theater when you aren't actively performing or rehearsing foreshadows impending doom. In a similar way, in the hospital, its own production of sorts where medical staff is under pressure to perform, it's the "Q" word. We all dread the "Q" word and are vexed with anyone who dares say it. Yet sometimes wandering the hospital during night float, I often feel a profound sense of "Quiet." The word is typically associated with a lack of it, but I find there is a certain peace with being alone with one's thoughts. Residency can be an isolating endeavor, and this particular type of quiet reflection doesn't come around often in a busy hospital. When it does, I think about the other people in this shared space that we work in who may also be feeling the same way, which is bizarrely comforting. However, I probably wouldn't say so out loud, especially under a full moon.
Collapse
|
3
|
Seeland GR, Williams BM, Yadav M, Bowden E, Antoniewicz LW, Kilpatrick CC, Mastrobattista JM, Ratan BM. Implementation and Evaluation of a Comprehensive Resident Wellness Curriculum During the COVID-19 Pandemic. J Surg Educ 2024; 81:397-403. [PMID: 38135549 DOI: 10.1016/j.jsurg.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/27/2023] [Accepted: 11/09/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of resident-led and faculty-led initiatives for physician wellness after implementation of a resident wellness program. DESIGN We initiated a wellness curriculum with both resident and faculty-led components in a large academic OB/GYN residency program in October 2020. The curriculum was created and evaluated using the Logic model. Residents were surveyed pre and 8 months postintervention with the Maslach Burnout Inventory (MBI) and the Physician Well-Being Index (PWBI), with activity-related questions added to the second survey. Descriptive statistics, Mann-Whitney test, Chi-square test, and theme analysis were performed as appropriate. SETTING A large academic OB/GYN residency at Baylor College of Medicine in Houston, Texas PARTICIPANTS: All residents (n = 48) were invited to take part in the surveys. Response rate was 31/48 (65%) pre and 28/48 (58%) postintervention. RESULTS Residents scored moderate for emotional exhaustion and depersonalization and high for personal accomplishment on both pre and post-MBI surveys. All indices of the PWBI improved over time; however, no significant differences were found in pre and postmeasures. Resident-led activities, which were alternated between individualized time off and group resident socialization, were rated significantly higher than faculty-led activities; 93% (52/56) of respondents rated resident-led activities in their top 2 most helpful initiatives compared to 7% (4/56) who rated faculty-led activities in their top 2 most helpful (p < 0.01) initiatives. Open-ended comments revealed that continued focus on wellness, attention to personal health, and systematic change were the most important ways to improve resident wellness. CONCLUSION Decreases in burnout were not achieved over an 8-month period with program-level resident-led and faculty-led initiatives. Providing scheduled time for residents to use at their discretion and the continuation of events that encourage socialization are tools that are highest rated by residents to facilitate wellness.
Collapse
Affiliation(s)
- Gianna R Seeland
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Brinley M Williams
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Menaka Yadav
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Emily Bowden
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Leah W Antoniewicz
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Charlie C Kilpatrick
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | | | - Bani M Ratan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
4
|
Leraas HJ, Kang L, Chang D, Martz C, Mourad A, Cerullo M, Rhodin KE, Migaly J, Tracy ET. Who Benefits? An Assessment of Resident Benefits at Top 50 Academic Institutions. J Surg Educ 2024; 81:335-338. [PMID: 38158277 DOI: 10.1016/j.jsurg.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/15/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Residency serves as a crucial time in the professional and personal development of young physicians. Extensive effort is devoted to the clinical training of residents across the country. However, many residents report concerns with compensation, quality of life, and benefits during their clinical training. We sought to evaluate the benefits packages of resident physicians in comparison with other full-time employees at their institutions. SETTING "Top 50" Residency programs in Medicine, Surgery, and Pediatrics in the United States. DESIGN To accomplish this task we selected the, "Top-50," institutions for medicine, pediatrics, and surgery using Doximity's Residency Navigator and compared the benefits of residents at these institutions with full-time employees by accessing benefits offerings listed on institutional websites. RESULTS We found that residents were more likely to receive parking benefits and gym memberships, while full-time employees were more likely to be offered flexible spending accounts, retirement benefits, and tuition support. CONCLUSIONS Residents receive different benefits packages than their colleagues employed in full time positions at the same institutions. Further discussion regarding the benefits offered to physicians, and the role that benefits play in resident wellbeing is warranted in light of these findings.
Collapse
Affiliation(s)
- Harold J Leraas
- Department of Surgery, Duke University Medical Center, Durham, North Carolina.
| | - Lillian Kang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Doreen Chang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Colin Martz
- Department of Cardiology, Washington University, St. Louis, Missouri
| | - Ahmad Mourad
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Marcelo Cerullo
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kristen E Rhodin
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - John Migaly
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Elisabeth T Tracy
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
5
|
Abstract
BACKGROUND Burnout in pediatric residents is widespread. Certain factors are associated with decreased burnout, such as empathy, self-compassion, mindfulness, and resilience, while perceived stress is associated with increased burnout. Narrative medicine may reduce burnout by its impact on protective and exacerbating factors and can be an active tool to promote wellness. The objective of this pilot study was to evaluate immediate and delayed benefits of a longitudinal narrative medicine intervention for pediatric residents using qualitative and quantitative measures. MATERIALS AND METHODS We designed a voluntary longitudinal narrative medicine intervention implemented via Zoom teleconferencing software over five months for pediatric residents at Nationwide Children's Hospital. It consisted of six one-hour long sessions where residents engaged with literature, responded to a writing prompt, and shared their reflections. It was evaluated using open-ended survey questions and established quantitative assessment tools of well-being with validity evidence. Results were compared before the intervention, immediately after, and six months later using one-way ANOVA and multiple linear regression. Qualitative data was analyzed using thematic analysis. RESULTS Twenty-two (14% of eligible) residents participated in at least one session. After the intervention, the following themes emerged for benefits to resident well-being: the ability to Build Community, have an Outlet for Self-Expression, reap Emotional and Mental Health Benefits, and work on Personal Growth. Benefits were sustained even six months later, which has not been shown previously. While there were significant qualitative findings, between all three time points, there was no change in any quantitative well-being measures. CONCLUSION Our longitudinal narrative medicine pilot study showed meaningful sustained qualitative benefits, though no quantitative changes, in measured well-being outcomes that have been previously associated with lower resident burnout. While not a panacea, narrative medicine can be a useful strategy for residency programs to improve pediatric resident well-being even after completion of planned interventions.Key MessageWe used a mixed-methods approach to assess the effects of a longitudinal narrative medicine intervention on well-being in pediatric residents.Open-ended responses indicated that residents found utility in and appreciated the intervention and experienced sustained improvements in their mental and emotional health, though the sample size was likely too small to show quantitative changes in well-being measures.Narrative medicine is not a panacea, but it can be a useful tool to provide to pediatric residents to promote sustained improvements in their well-being through the framework of relationship-centered care.
Collapse
Affiliation(s)
- Nimisha Bajaj
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - James Phelan
- Department of English, The Ohio State University, Columbus, OH, USA
| | - Erin E McConnell
- Internal Medicine/Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Suzanne M Reed
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| |
Collapse
|
6
|
Bishop AG, Uhl TL, Zwischenberger JB, Meyerson SL. Prevalence and Impact of Musculoskeletal Pain Due to Operating Among Surgical Trainees. J Surg Educ 2023; 80:676-681. [PMID: 36841715 DOI: 10.1016/j.jsurg.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/18/2022] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Upwards of 79%-88% of practicing surgeons report musculoskeletal pain due to operating. However, little is known about when these issues begin to become clinically significant. This survey evaluates the prevalence and impact of musculoskeletal pain among surgical residents. DESIGN After IRB approval, an anonymous 19-question survey based on Cornell Musculoskeletal Discomfort Questionnaire was sent to current surgical residents measuring frequency and degree of pain at 5 sites (neck, shoulder, upper back, lower back, and elbow/wrist) as well as impact on activities both at work and outside of work. Chi square analysis was used to identify differences between groups. SETTING Single academic medical center. PARTICIPANTS Trainees in all surgical-based specialties. RESULTS Fifty-three residents responded from 8 different specialties (38% response rate). Respondents were a representative balance of male (53%)/female (47%) with a mean age of 30 ± 2 years. Residents in all specialties and all years of clinical training responded, with the greatest number from general surgery (the largest program with 48% of respondents), second year of clinical training (30%) and an overwhelming 96% of residents reported experiencing pain they felt was due to operating. The most common sites of pain were the neck (92%) and lower back (77%). This pain was a frequent issue for most with 74% reporting multiple times per month and 26% reporting pain nearly every day. Nearly half of residents reported that pain slightly to substantially interfered with their ability to work (44%) and with activities outside of work (47%). Most residents (75%) sought no treatment. No residents missed work despite reporting pain. CONCLUSIONS Musculoskeletal pain begins during training, occurs regularly, and affects function. Neck pain is the most frequent, severe, and disabling site. This provides a target for interventions to reduce the impact of chronic pain on patient care, surgeon wellness, and career longevity.
Collapse
Affiliation(s)
- Andrew G Bishop
- Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Timothy L Uhl
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| | | | - Shari L Meyerson
- Department of Surgery, University of Kentucky, Lexington, Kentucky.
| |
Collapse
|
7
|
Massenzio SS, Uhler TA, Massenzio EM, Sun E, Srikumaran D, Clifton MM, Green LK, Sun G, Wang J, Woreta FA. Navigating the Ophthalmology & Urology Match with a Significant Other. J Surg Educ 2023; 80:135-142. [PMID: 35965228 PMCID: PMC9792430 DOI: 10.1016/j.jsurg.2022.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/31/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Medical students with a significant other in medical school face challenges when applying for residency as they attempt to match in proximity to their partner. The National Resident Matching Program (NRMP) offers a Couples Match to aid such applicants. This system is not available for ophthalmology and urology because these specialties utilize match systems outside the NRMP and have an early match timeline. The purpose of this study is to analyze usage of the Couples Match and assess ophthalmology and urology applicant viewpoints on the Couples Match system. DESIGN & SETTING First, NRMP data on the Couples Match from 1987 to 2021 was reviewed. Second, an online survey was sent to 559 ophthalmology and 321 urology applicants to The Johns Hopkins University School of Medicine in the 2021 match cycle. PARTICIPANTS 342 ophthalmology and urology applicants (39% response rate). RESULTS There is increased usage of the Couples Match over time. In response to the survey, 89% of participants agreed that a Couples Match should be implemented in their specialty. 107 (31%) had a significant other in medicine. 78% of 68 respondents whose significant other also applied in 2021 reported that they would have used the Couples Match had it been available. 21% of those with a significant other considered not applying to ophthalmology or urology because there was no Couples Match. There are mixed responses regarding whether the early match timeline is beneficial to couples. Female applicants were more likely to report hesitancy about mentioning a significant other during the application process. CONCLUSIONS The Couples Match is highly desired by applicants to ophthalmology and urology, and the lack of such a system is a deterrent to pursuing these fields. Future studies will help elucidate how the match system can be leveraged to aid individuals applying with a significant other.
Collapse
Affiliation(s)
- Samantha S Massenzio
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tara A Uhler
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Erik M Massenzio
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Emily Sun
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marisa M Clifton
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura K Green
- LifeBridge Health Krieger Eye Institute at Sinai Hospital, Baltimore, Maryland
| | - Grace Sun
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York
| | - Jiangxia Wang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
8
|
Williams A, Schlueter D, Aprile J, Patterson K, Miller J, Shedlock AR. "Play How We Practice": A Residency Program's Snapshot of Pediatric Resident Perspectives on Education During the COVID-19 Pandemic. J Med Educ Curric Dev 2023; 10:23821205231219161. [PMID: 38106515 PMCID: PMC10722915 DOI: 10.1177/23821205231219161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Our objective was to understand the perspectives of current and recently graduated pediatric residents concerning the impact of the COVID-19 pandemic, and subsequent curriculum changes, to their education. INTRODUCTION Residency programs have experienced unprecedented alterations to education in the form of changing expectations, schedules, and opportunities during the COVID-19 pandemic. Little is known regarding resident perceptions of how these changes impact their education and ultimate career preparation. METHODS An anonymous and voluntary electronic IRB exempt survey was sent to pediatric residents at a mid-sized residency program in the mid-Atlantic in August of 2020. This cross-sectional study survey consisted of a series of multiple choice questions with optional short answer responses. RESULTS Twenty-two pediatric residents across all training years completed the survey for a response rate of 36%. The majority of residents, 59.1%, were interested in directly caring for COVID + patients; however, the minority (36%) felt prepared to care for COVID + patients. Most residents (63%) responded that graduate medical education programs should not have authority to exclude residents from taking care of patients with certain diagnoses and 95% of respondents indicated that they would prefer an opt out system instead. CONCLUSION The majority of resident respondents had a strong interest in caring for COVID + patients and report that they value frequent updates from program leadership to guide their patient care. Residents also overwhelmingly support an opt out system when caring for future patients with particular infectious diagnoses rather than a mandated exclusion approach.
Collapse
Affiliation(s)
| | | | - Justen Aprile
- Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Kelly Patterson
- Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Jennifer Miller
- Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Aaron R. Shedlock
- Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA
| |
Collapse
|
9
|
Joung RH, Amortegui D, Silver CM, Mackiewicz NI, Eng JS, Rosenkranz KM, Johnson J, Bilimoria KY, Hu YY. A National Mixed-Methods Evaluation of General Surgery Residency Program Responsiveness and the Association with Resident Wellness. J Surg Educ 2022; 79:e1-e11. [PMID: 35660306 DOI: 10.1016/j.jsurg.2022.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Resident burnout is highly prevalent in general surgery. Burnout is increasingly recognized as a symptom of an unsupportive workplace. The objectives of this study were to describe resident perceptions of program responsiveness and to identify associated factors. METHODS We used a convergent mixed-methods design. A cross-sectional survey was administered to all U.S. general surgery residents following the 2020 ABSITE, querying resident perceptions of their learning environment (including program responsiveness), burnout, thoughts of attrition and suicide, and career satisfaction. Multivariable logistic regression models adjusting for program/resident characteristics assessed associations of program responsiveness with aspects of the learning environment and resident wellness. 366 interviews and 27 focus groups with residents and faculty were conducted during in-person visits to 15 residency programs. Transcripts were analyzed thematically using inductive and deductive logics until thematic saturation was achieved. RESULTS Of the 7233 clinically active residents from 323 programs who completed the survey (85.5% response rate), 5256 had data available for all outcomes of interest. 72.1% (n = 3791) reported satisfaction with program responsiveness. These residents were significantly less likely to report 80-hour workweek violations (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.18-0.26), burnout (OR 0.47, 95% CI 0.41-0.53), thoughts of attrition (OR 0.32, 95% CI 0.27-0.38), and suicidality (OR 0.52, 95% CI 0.41-0.65). They were significantly more likely to report satisfaction with career choice, personal life, and work-life balance (all p < 0.001). Factors associated with improved perception of program responsiveness included larger program size (50+ vs. <23 residents; OR 1.48, 95% CI 1.01-2.19), having faculty mentorship (OR 2.64, 95% CI 2.22-3.14), having meaningful input into call and vacation schedules (OR 3.31, 95% CI 2.74-4.00), and feeling comfortable speaking up (OR 4.20, 95% CI 3.47-5.09). We conducted a qualitative analysis to identify the following components of program responsiveness: (1) core values reflecting a shared understanding of the importance of resident voice in shaping the training experience and the program, including mutual trust and respect between residents and faculty, transparency and communication, resident unity, and resident participation in and ownership of program improvement; (2) structural constructs that reflect and support responsiveness; (3) mechanisms for supporting resident agency, including resources and leadership support, faculty advocacy, and resident leadership opportunities. CONCLUSION Program responsiveness in surgical residency is associated with improved resident wellness. Programs should develop formal channels to elicit and concretely address resident concerns, provide opportunities for resident representation, and entrust residents with the flexibility and autonomy to make decisions that support their own education and wellness.
Collapse
Affiliation(s)
- Rachel H Joung
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniela Amortegui
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois
| | - Casey M Silver
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois
| | - Natalia I Mackiewicz
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois
| | - Kari M Rosenkranz
- Department of Surgery, Dartmouth University Geisel School of Medicine, New Hampshire, Lebanon
| | - Julie Johnson
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| |
Collapse
|
10
|
Ju TR, Mikrut EE, Spinelli A, Romain AM, Brondolo E, Sundaram V, Pan CX. Factors Associated with Burnout among Resident Physicians Responding to the COVID-19 Pandemic: A 2-Month Longitudinal Observation Study. Int J Environ Res Public Health 2022; 19:9714. [PMID: 35955071 PMCID: PMC9367700 DOI: 10.3390/ijerph19159714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 07/31/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Burnout during residency may be a function of intense professional demands and poor work/life balance. With the onset of the COVID-19 pandemic, NYC hospital systems were quickly overwhelmed, and trainees were required to perform beyond the usual clinical duties with less supervision and limited education. OBJECTIVE The present longitudinal study examined the effects of COVID-19 caseload over time on burnout experienced by resident physicians and explored the effects of demographic characteristics and organizational and personal factors as predictors of burnout severity. METHODS This study employed a prospective design with repeated measurements from April 2020 to June 2020. Participants were surveyed about their well-being every 5 days. Predictors included caseload, sociodemographic variables, self-efficacy, hospital support, perceived professional development, meaning in work, and postgraduate training level. RESULTS In total, 54 resident physicians were recruited, of whom 50% reported burnout on initial assessment. Periods of higher caseload were associated with higher burnout. PGY-3 residents reported more burnout initially but appeared to recover faster compared to PGY-1 residents. Examined individually, higher self-efficacy, professional development, meaningful work, and hospital support were associated with lower burnout. When all four predictors were entered simultaneously, only self-efficacy was associated with burnout. However, professional development, meaningful work, and hospital support were associated with self-efficacy. CONCLUSION Burnout among residency is prevalent and may have implications for burnout during later stages of a physician's career. Self-efficacy is associated with lower burnout and interventions to increase self-efficacy and the interpersonal factors that promote self-efficacy may improve physician physical and emotional well-being.
Collapse
Affiliation(s)
- Teressa R. Ju
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11354, USA
| | - Emilia E. Mikrut
- Department of Psychology, St. John’s University, 152-11 Union Turnpike, Jamaica, NY 11367, USA
| | - Alexandra Spinelli
- Department of Psychology, St. John’s University, 152-11 Union Turnpike, Jamaica, NY 11367, USA
| | - Anne-Marie Romain
- Department of Psychology, St. John’s University, 152-11 Union Turnpike, Jamaica, NY 11367, USA
| | - Elizabeth Brondolo
- Department of Psychology, St. John’s University, 152-11 Union Turnpike, Jamaica, NY 11367, USA
| | - Varuna Sundaram
- Department of Surgery, Division of Vascular and Endovascular Surgery, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
- Department of Surgery, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11354, USA
| | - Cynthia X. Pan
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11354, USA
- Department of Medicine, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
- Division of Geriatrics and Palliative Care, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11354, USA
| |
Collapse
|
11
|
Abstract
OBJECTIVE This cross-sectional study characterized associations between sex, role misidentification, and burnout among surgical and nonsurgical residents. SUMMARY BACKGROUND DATA Limited evidence suggests that female resident physicians are more likely to be misidentified as nonphysician team members, with potential negative implications for wellbeing. The prevalence and impact of role misidentification on the trainee experience in surgical as compared to nonsurgical specialties is unknown. METHODS An anonymous electronic survey was distributed to fourteen different residency programs at 2 academic medical centers in August 2018. The survey included questions about demographics, symptoms of burnout, the frequency of misidentification as another member of the care team, and the effect of misidentification on respondents' well-being. Results: Two-hundred sixty out of 419 (62.1% response rate) resident physicians completed the survey, of whom 184 (77.3%) reported being misidentified as a nonphysician at least weekly. Female sex was associated with a significantly increased odds of being misidentified at least weekly (adjusted OR 23.7, 95% CI 10.9-51.5; P < 0.001), as was training in a surgical program (adjusted OR 3.7, 95% CI 1.7-8.0; P = 0.001). Frequent role misidentification was associated with burnout (OR 2.6, 95% CI 1.2-5.5; P = 0.01). In free-text responses, residents reported that being misidentified invoked a sense of not belonging, caused emotional exhaustion, and interfered with patient communication. CONCLUSIONS Role misidentification is more prevalent among female residents and surgical residents, compared to male residents and nonsurgical residents, respectively. Physician role misidentification is associated with burnout and has negative implications for resident wellbeing; interventions to reduce role misidentification are needed.
Collapse
Affiliation(s)
- Nina Jain
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Benjamin N. Rome
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Ersilia M. DeFilippis
- Division of Cardiology, New York Presbyterian-Columbia University Medical Center, New York, NY
| | - Camille Powe
- Diabetes Unit, Division of Endocrinology, Massachusetts General Hospital, Boston, MA
| | - Maria A. Yialamas
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| |
Collapse
|
12
|
Abstract
PURPOSE Physician burnout is an issue that has come to the forefront in the past decade. While many factors contribute to burnout the impact of impostorism and self-doubt has largely been ignored. We investigated the relationship of anxiety and impostorism to burnout in postgraduate medical learners. MATERIALS AND METHODS Postgraduate learners in four diverse training programs: Family Medicine (FM), Paediatric Medicine (PM), Anesthesiology (AN), and General Surgery (GS) were surveyed to identify the incidence of impostorism (IP), anxiety, and burnout. IP, anxiety, and burnout were evaluated using the Clance Impostor Phenomenon Scale (CIPS), Maslach Burnout Inventory-Human Services Survey (MBI-HSS), and the General Anxiety Disorder-7 (GAD-7) questionnaires, respectively. Burnout was defined as meeting burnout criteria on all three domains. Relationships between IP, anxiety, and burnout were explored. RESULTS Two hundred and sixty-nine residents responded to the survey (response rate 18.8%). Respondents were distributed evenly between specialties (FM = 24.9%, PM = 33.1%, AN = 20.4%, GS = 21.6%). IP was identified in 62.7% of all participants. The average score on the CIPS was 66.4 (SD = 14.4), corresponding to 'frequent feelings of impostorism.' Female learners were at higher risk for IP (RR = 1.27, 95% CI: 1.03-1.57). Burnout, as defined by meeting burnout criteria on all three subscales, was detected in 23.3% of respondents. Significant differences were seen in burnout between specialties (p = 0.02). GS residents were more likely to experience burnout (31.7%) than PM and AN residents (26.7 and 10.0%, respectively, p = 0.02). IP was an independent risk factor for both anxiety (RR = 3.64, 95% CI:1.96-6.76) and burnout (RR = 1.82, 95% CI: 1.07-3.08). CONCLUSIONS Impostorism is commonly experienced by resident learners independent of specialty and contributes to learner anxiety and burnout. Supervisors and Program Directors must be aware of the prevalence of IP and the impact on burnout. Initiatives to mitigate IP may improve resident learner wellness and decrease burnout in postgraduate learners.
Collapse
Affiliation(s)
- Rachel Q Liu
- Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Jacob Davidson
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Tamara A Van Hooren
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Julie Ann M Van Koughnett
- Department of Surgery and Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Sarah Jones
- Department of Surgery and Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Michael C Ott
- Department of Surgery and Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| |
Collapse
|
13
|
Sedney CL, Dekeseredy P, Elmo R, Sofka S. Exploring Resident Physician Wellness at an Allopathic Medical School in West Virginia: A Qualitative Study. W V Med J 2022; 118:18-24. [PMID: 35600669 PMCID: PMC9119293 DOI: 10.21885/wvmj.2022.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Social support is key to wellness, especially during times of stress and uncertainty. The working climate, including the multidisciplinary medical community provides opportunities for both positive and negative wellness experiences. The purpose of this study is to explore residents' concepts of wellness and the influence of programs, faculty, peers, and nursing and ancillary staff. METHODS An email with a link to the REDCap survey was sent to each resident (n=450) in the school of medicine at West Virginia University asking them to give examples of ways their wellness has been supported (or not) by faculty members, their program, co-residents, and nursing and ancillary staff. The residents returned 51 completed surveys (11% response rate). Seven residents participated in a face to face interview. A content analysis using Hale's adaptation of resident wellness (based upon Maslow's Hierarchy of Needs) as the theoretical framework was conducted on the data. RESULTS Positive wellness elements frequently focused on time, supportive actions, and social connection. Negative examples impacting wellness included feeling disrespected, not being included in decision making, conflicts, and feeling unappreciated. Suggestions from the residents often described low cost interventions such as being" included" and feeling part of the team. CONCLUSION The participants described how all members of the healthcare team can support resident wellness in a variety of domains. Peers, support staff in the hospital environment, faculty supervisors, and the program overall can contribute to the basic physiologic needs, safety, belonging, esteem, and self-actualization of resident learners through social support.
Collapse
Affiliation(s)
- Cara L. Sedney
- Cara Sedney MD MA. Associate Professor Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Patricia Dekeseredy
- Patricia Dekeseredy MScN RN. Clinical Research Specialist in the Department of Neurosurgery, WVU Medicine, Morgantown, WV, USA
| | - Rebecca Elmo
- Rebecca Elmo Accreditation Specialist Department of Medical Education, West Virginia University School of Medicine
| | - Sarah Sofka
- Sarah Sofka MD. Associate Professor General Internal Medicine, West Virginia University School of Medicine
| |
Collapse
|
14
|
Niotis K, Saif N, Simonetto M, Wu X, Yan P, Lakis JP, Ariza IE, Buckholz AP, Sharma N, Fink ME, Isaacson RS. Feasibility of a wearable biosensor device to characterize exercise and sleep in neurology residents. Expert Rev Med Devices 2021; 18:1123-1131. [PMID: 34632903 DOI: 10.1080/17434440.2021.1990038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Research suggests optimizing sleep, exercise and work-life balance may improve resident physician burnout. Wearable biosensors may allow residents to detect and correct poor sleep and exercise habits before burnout develops. Our objectives were to evaluate the feasibility of a wearable biosensor to characterize exercise/sleep in neurology residents and examine its relationship to self-reported, validated survey measures. We also assessed the device's impact on well-being and barriers to use. METHODS This prospective cohort study evaluated the WHOOP Strap 2.0 in neurology residents. Participants completed regular online surveys, including self-reported hours of sleep/exercise, and validated sleep/exercise scales at 3-month intervals. Autonomic, exercise, and sleep measures were obtained from WHOOP. Changes were evaluated over time via linear regression. Survey and WHOOP metrics were compared using Pearson correlations. RESULTS Sixteen (72.7%) of 22 eligible participants enrolled. Eleven (68.8%) met the minimum usage requirement (6+ months) and were classified as 'consecutive wearers.' Significant increases were found in sleep duration and exercise intensity. Moderate-to-low correlations were found between survey responses and WHOOP measures. Most (73%) participants reported a positive impact on well-being. Barriers to use included 'Forgetting to wear' (20%) and 'not motivational' (23.3%). CONCLUSION Wearable biosensors may be a feasible tool to evaluate sleep/exercise in residents.
Collapse
Affiliation(s)
- Kellyann Niotis
- 2019-2020 McGraw Fellow in Neurology Research; Department of Neurology, Weill Cornell Medicine and New York-Presbyterian, New York, NY, USA
| | - Nabeel Saif
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Marialaura Simonetto
- Departments of Internal Medicine and Neurology, Weill Cornell Medicine and New York-Presbyterian, New York, NY, USA
| | - Xian Wu
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine and Department of Healthcare Policy & Research, New York-Presbyterian, New York, NY, USA
| | - Peter Yan
- Department of Neurology, Beth Israel Deaconess Hospital-Milton Center for Specialty Care, Milton, MA, USA
| | - Jessica P Lakis
- Office of Development, New York-Presbyterian, New York, NY, USA
| | | | - Adam P Buckholz
- Department of Internal Medicine, Weill Cornell Medicine and New York-Presbyterian, New York, NY, USA
| | | | - Matthew E Fink
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | | |
Collapse
|
15
|
Grewal US, Premnath N, Bhardwaj N, Sheth AR, Garikipati SC, Gaddam SJ, Shah PR, Paulk E. Analysis of the impact of COVID-19 pandemic on house-staff in the USA: addressing the ripple effects. J Community Hosp Intern Med Perspect 2021; 11:476-479. [PMID: 34211652 PMCID: PMC8221165 DOI: 10.1080/20009666.2021.1920663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: The novel corona virus has changed the way individuals interact with each other and society. In the medical sector, this has affected the residents and fellows who spend the majority of their time on the front lines. Methods: We conducted a cross-sectional survey to assess the impact of the COVID-19 pandemic on the lives and training of house-staff across the USA. Respondents in our survey reported feeling significantly overwhelmed by the ongoing pandemic. Results: The majority of house-staff were significantly concerned about the lack of protective equipment, inability to safeguard themselves from infection and inability to look after their families. Concerns regarding contracting the infection and transmitting it to their loved ones were reported as a cause of mental distress among resident physicians. Increasing patient load, lack of protective equipment, and disruption of educational and academic activities during the COVID-19 pandemic have all reportedly affected the training and overall well-being of resident physicians. Conslusion: Our study adds further support for measures to safeguard house-staff with proper protective equipment and ensure adequate support for both mental and physical well-being during these challenging times.
Collapse
Affiliation(s)
- Udhayvir S Grewal
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Naveen Premnath
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nakul Bhardwaj
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Aakash R Sheth
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Subhash C Garikipati
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Shiva J Gaddam
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Parth R Shah
- Department of Internal Medicine, Trumbull Memorial Hospital, Warren, OH, USA
| | - Elizabeth Paulk
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
16
|
Freedman-Weiss MR, Heller DR, White EM, Chiu AS, Jean RA, Yoo PS. Driving Safety Among Surgical Residents in the Era of Duty Hour Restrictions. J Surg Educ 2021; 78:770-776. [PMID: 32948507 DOI: 10.1016/j.jsurg.2020.08.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/18/2020] [Accepted: 08/23/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Fatigued driving is a known contributor to adverse motor vehicle events (AMVEs), defined as crashes and near misses. Surgical trainees work long and irregular hours; the safety of work-related driving since the introduction of work hour regulations has not yet been studied in this population. We aimed to assess the impact of fatigue on driving safety and explore perceptions of a funded rideshare program. DESIGN An electronic survey was delivered and inquired in retrospective fashion about fatigue and sleepiness while driving, occurrences of AMVEs, and projected use of a funded rideshare program as a potential solution to unsafe driving. Chi-square testing determined categorical differences between response choices. SETTING Yale University School of Medicine, Department of Surgery, New Haven, CT-a general surgery program with 4 urban clinical sites positioned along a roughly twenty mile stretch of interstate highway in Southeastern Connecticut. PARTICIPANTS General Surgery residents at the Yale University School of Medicine. RESULTS Of 58 respondents (81% response rate), 97% reported that fatigue compromised their safety while driving to or from work. Eighty-three percent reported falling nearly or completely asleep, and 22% reported AMVEs during work-related driving. Junior residents were more likely than Seniors to drive fatigued on a daily-to-weekly basis (69% vs 47%, p = 0.02) and twice as likely to fall asleep on a weekly-to-monthly basis (67% vs 33%, p = 0.02). Despite this, only 7% of residents had ever hired a ride service when fatigued, though 88%, would use a free rideshare service if provided. CONCLUSIONS Work-related fatigue impairs the driving safety of nearly all residents, contributing to frequent AMVEs. Currently, few residents hire rideshare services. Eliminating the cost barrier by funding a rideshare and encouraging its routine use may protect surgical trainees and other drivers.
Collapse
Affiliation(s)
| | - Danielle R Heller
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Erin M White
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Alexander S Chiu
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Raymond A Jean
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Peter S Yoo
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| |
Collapse
|
17
|
Dziadkowiec O, Durbin JS, Novak ML, Patt-Rappaport Z, Guldner G. A Two-Year Longitudinal, Cross-Sectional Evaluation of Resident Physician Burnout: An Exploration of the Effects of Stress, Satisfaction, Exercise and EMR. HCA Healthc J Med 2021; 2:123-132. [PMID: 37425643 PMCID: PMC10324758 DOI: 10.36518/2689-0216.1254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background There is a need for better understanding of trajectory of burnout in clinical training and what factors are associated with resident well-being and burnout overtime. This study examined medical resident burnout and physical activity throughout different times of the academic year, across several different medical specialties and postgraduate years (PGY), over two years. Methods A resident wellness survey was administered throughout five different waves from summer 2018 to winter 2020. A total of 493 survey responses from seven subspecialties completed the survey. We used 474 responses for quantitative statistical analysis and 138 for qualitative thematic analysis. Results The average response rate was 47%, and ranged between 40% (Wave 3) and 56% (Wave 1). Three analyses were conducted: the first demonstrated significantly higher Satisfaction in Wave 1 as opposed to Wave 2. The second analysis showed significant correlations between Overall, Satisfaction, and Stress scores and exercise-based questions for female, male, and primary care cohorts of residents. The third analysis showed that in 2018, interns and non-interns differed on Stress but did not differ on Satisfaction or Overall scores. Conclusions Similar levels of satisfaction, stress, and overall well-being were reported at different times in the academic year and from year to year. Exercise was not consistently related to resident well-being outcomes. These findings suggest a need for targeted interventions based on post-graduate year, time in the academic year and well-being drivers.
Collapse
Affiliation(s)
- Oliwier Dziadkowiec
- HCA Healthcare Graduate Medical Education, MidAmerica Division
- HCA Healthcare Graduate Medical Education, Continental Division
| | | | - Megan L. Novak
- HCA Healthcare Graduate Medical Education, Continental Division
| | - Ziva Patt-Rappaport
- HCA Healthcare Graduate Medical Education, MidAmerica Division
- Research Medical Center, Kansas City, MO
| | | |
Collapse
|
18
|
White EM, Shaughnessy MP, Esposito AC, Slade MD, Korah M, Yoo PS. Surgical Education in the Time of COVID: Understanding the Early Response of Surgical Training Programs to the Novel Coronavirus Pandemic. J Surg Educ 2021; 78:412-421. [PMID: 32768380 PMCID: PMC7381939 DOI: 10.1016/j.jsurg.2020.07.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/21/2020] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Describe the early impact of the COVID-19 pandemic on general surgery residency training nationwide. DESIGN A 31-question electronic survey was distributed to general surgery program directors. Qualitative data underwent iterative coding analysis. Quantitative data were evaluated with summary statistics and bivariate analyses. PARTICIPANTS Eighty-four residency programs (33.6% response rate) with representation across US geographic regions, program affiliations, and sizes. RESULTS Widespread changes were observed in the surgical training environment. One hundred percent of programs reduced the number of residents on rounds and 95.2% reduced the size of their in-hospital resident workforce; on average, daytime staffing decreased by nearly half. With telehealth clinics (90.5%) and remote inpatient consults (26.2%), both clinical care and resident didactics (86.9%) were increasingly virtual, with similar impact across all program demographics. Conversely, availability of some wellness initiatives was significantly higher among university programs than independent programs, including childcare (51.2% vs 6.7%), housing (41.9% vs 13.3%), and virtual mental health services (83.7% vs 53.3%). CONCLUSIONS Changes in clinical care delivery dramatically reduced in face-to-face learning opportunities for surgical trainees during the COVID-19 pandemic. While this effect had equal impact across all program types, sizes, and geographies, the same cannot be said for wellness initiatives. Though all programs initiated some strategies to protect resident health, the disparity between university programs and independent programs may be cause for action.
Collapse
Affiliation(s)
- Erin M White
- Department of Surgery, Yale University, New Haven, Connecticut
| | | | | | - Martin D Slade
- Occupational Health & Environmental Medicine, Yale University, New Haven, Connecticut
| | - Maria Korah
- School of Medicine, Yale University, New Haven, Connecticut; Department of Surgery, Stanford University, Stanford, California
| | - Peter S Yoo
- Department of Surgery, Yale University, New Haven, Connecticut.
| |
Collapse
|
19
|
Russell SW, Desai SV, O'Rourke P, Ahuja N, Patel A, Myers CG, Zulman D, Sateia HF, Berkenblit GV, Johnson EN, Garibaldi BT. The genealogy of teaching clinical reasoning and diagnostic skill: the GEL Study. ACTA ACUST UNITED AC 2020; 7:197-203. [PMID: 32146439 DOI: 10.1515/dx-2019-0107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/15/2020] [Indexed: 11/15/2022]
Abstract
The genealogy of graduate medical education in America begins at the bedside. However, today's graduate medical trainees work in a training environment that is vastly different from medical training a century ago. The goal of the Graduate Medical Education Laboratory (GEL) Study, supported by the American Medical Association's (AMA) "Reimagining Residency" initiative, is to determine the factors in the training environment that most contribute to resident well-being and developing diagnostic skills. We believe that increasing time at the bedside will improve clinical skill, increase professional fulfillment, and reduce workplace burnout. Our graduate medical education laboratory will test these ideas to understand which interventions can be shared among all training programs. Through the GEL Study, we aim to ensure resident readiness for practice as we understand, then optimize, the learning environment for trainees and staff.
Collapse
Affiliation(s)
- Stephen W Russell
- Associate Professor of Internal Medicine and Pediatrics, The University of Alabama at Birmingham, c/o UAB Medicine Leeds, 1141 Payton Way, Leeds, AL 35094, USA
| | - Sanjay V Desai
- Department of Internal Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - Paul O'Rourke
- Department of Internal Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - Neera Ahuja
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Anand Patel
- University of Chicago Hospital, Chicago, IL, USA
| | - Christopher G Myers
- Department of Internal Medicine, Johns Hopkins University Carey Business School - Baltimore Campus, Baltimore, MD, USA
| | - Donna Zulman
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Heather F Sateia
- Department of Internal Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - Gail V Berkenblit
- Department of Internal Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - Erica N Johnson
- Department of Internal Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - Brian T Garibaldi
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| |
Collapse
|
20
|
Weis HB, Clark AT, Scielzo SA, Weis JJ, Farr D, Abdelnaby A, Weigle DC, Kazi S, AbdelFattah KR. The Fuel Gauge: A Simple Tool for Assessing General Surgery Resident Well-Being. J Surg Educ 2020; 77:27-33. [PMID: 31399373 DOI: 10.1016/j.jsurg.2019.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/25/2019] [Accepted: 07/17/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Resident well-being is an increasingly relevant issue in medical education; however, there is no consensus on how to best measure well-being. The "fuel gauge," is a simple, easy-to-use tool developed to measure resident well-being and previously applied in an Internal Medicine Residency Program at our institution. The current study sought to evaluate its acceptability and usefulness in a surgery program. DESIGN Weekly fuel gauge data was retrospectively collected from August 2017 through December 2018 along with resident Postgraduate Year designations. SETTING This study was conducted at a single, large general surgery residency program that rotates through a variety of hospitals, including a University hospital, a large county hospital, a Veterans Affairs hospital, and a freestanding Children's hospital. PARTICIPANTS Categorical general surgery residents at every level of training as well as preliminary interns and off service intern rotators from urology, oral and maxillofacial surgery, and otolaryngology were eligible for the study. Fuel gauge submissions which did not denote a score were excluded from analysis. RESULTS Out of 130 residents, 103 (79.2%) completed at least 1 fuel gauge assessment with a weekly mean response rate of 41.5%. Low scores were submitted by 39.8% of resident participants. Narrative feedback was provided in 6.2% of submissions with increased length associated with decreased fuel gauge score. CONCLUSIONS The fuel gauge was well accepted by a large general surgery program with no decline in participation rates over the study period. The tool provided residents with a direct line of communication with their program's administration, and a feasible way for the program director's office to monitor and identify residents who were struggling with regard to their well-being.
Collapse
Affiliation(s)
- Holly B Weis
- Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | - Audra T Clark
- Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | - Shannon A Scielzo
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Joshua J Weis
- Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | - Deborah Farr
- Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | - Abier Abdelnaby
- Department of Surgery, University of Texas Southwestern, Dallas, Texas; Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas; Department of Graduate Medical Education, University of Texas Southwestern, Dallas, Texas
| | - David C Weigle
- Department of Graduate Medical Education, University of Texas Southwestern, Dallas, Texas
| | - Salahuddin Kazi
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | | |
Collapse
|
21
|
Webber S, Lauden SM, Fischer PR, Beyerlein L, Schubert C. Predeparture Activities Curricular Kit (PACK) for Wellness: A Model for Supporting Resident Well-Being During Global Child Health Experiences. Acad Pediatr 2020; 20:136-139. [PMID: 31150786 DOI: 10.1016/j.acap.2019.05.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/28/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Sarah Webber
- Department of Pediatrics (S Webber), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Stephanie M Lauden
- Department of Pediatrics (SM Lauden), Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Philip R Fischer
- Department of Pediatric and Adolescent Medicine (PR Fischer), Mayo Clinic, Rochester, Minn
| | - Larissa Beyerlein
- Department of Pediatrics (L Beyerlein), University of Minnesota, Masonic Children's Hospital, Minneapolis, Minn
| | - Charles Schubert
- Department of Pediatrics (C Schubert), Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | |
Collapse
|
22
|
Jun TW, Liebert CA, Esquivel M, Cox JA, Trockel M, Katznelson L. A protected time policy to improve dental health among resident physicians. J Am Dent Assoc 2019; 150:362-368.e6. [PMID: 31029211 DOI: 10.1016/j.adaj.2018.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/02/2018] [Accepted: 12/07/2018] [Indexed: 10/26/2022]
Abstract
BACKGROUND Resident physicians underuse preventive dental health services. The authors assessed the barriers to and need for oral health care among residents and piloted a program to enhance dental health care among house staff. METHODS Participants from 5 residency programs received 2 hours of protected time during business hours for visits to a nearby dental office. The authors surveyed participating residents before and after the visits about barriers to seeking oral health care and their experiences with the program. The authors recorded dental findings for each participant. RESULTS A total of 35 of 243 eligible residents (14.4%) participated in the study; 71.4% reported delaying or skipping preventive dental examinations during residency. Lack of time and norms and peer perceptions were important barriers; 28.6% of residents had dental findings requiring further management. CONCLUSIONS Residents neglect preventive oral health care because of work obligations. More than one-quarter of residents had clinically significant dental findings. Providing protected time addressed common barriers and was well received. PRACTICAL IMPLICATIONS Resident physicians have unmet oral health care needs. Collaborations between residency programs and dental practices to provide protected time for residents to seek oral health care could address common barriers to care.
Collapse
|
23
|
Lefebvre D, Dong KA, Dance E, Rosychuk RJ, Yarema M, Blouin D, Williams J, Rowe BH. Resident Physician Wellness Curriculum: A Study of Efficacy and Satisfaction. Cureus 2019; 11:e5314. [PMID: 31592369 PMCID: PMC6773458 DOI: 10.7759/cureus.5314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Recent literature highlights the alarming prevalence of burnout, depression, and illness during residency training; a trend that is also linked to suboptimal patient care. Dedicated wellness curricula may be one solution to this concerning issue. Purpose To determine the effect of a multi-faceted wellness curriculum during emergency medicine residency training on wellness scores and to assess resident satisfaction with the program. Methods This study was conducted via a longitudinal survey. In 2009, a faculty-derived resident wellness curriculum (F-RWC) was initiated. This program was then bolstered with a parallel resident-derived curriculum (R-RWC) one year later, in 2010. Emergency medicine residents were surveyed in 2009, 2010, and 2011 to assess wellness at baseline, after one year of the F-RWC, and after one year of combined RWCs, respectively. Surveys included two validated assessment instruments (the Brief Resident Wellness Profile (BRWP) and the SF-8TM Health Survey), a satisfaction Likert scale, and a demographics information sheet. Results The survey response rates were 89% (n=17), 100% (n=17), and 83% (n=24) from 2009, 2010, and 2011, respectively, for a total of 58 participants. From baseline in 2009, there was a significant improvement in resident wellness, with the addition of parallel RWC by 2011, as measured by the BRWP (p=0.024). The faces scale, a subset of the BRWP, showed a trend toward benefit but did not reach statistical significance (p=0.085). There was no evidence of a statistically significant change in SF-8TM scores over time. Participants consistently reported positive satisfaction scores with RWC initiatives. Conclusions Dedicated RWC, with input from both faculty and resident physicians, improved wellness during residency training with a high degree of participant satisfaction. Such programs are needed to support resident physicians during their training.
Collapse
Affiliation(s)
| | - Kathryn A Dong
- Emergency Medicine, Addiction Medicine, University of Alberta, Edmonton, CAN
| | - Erica Dance
- Emergency Medicine, University of Alberta, Edmonton, CAN
| | | | - Mark Yarema
- Emergency Medicine, University of Calgary, Calgary, CAN
| | - Danielle Blouin
- Emergency Medicine, Kingston Health Sciences Centre / Queen's University, Kingston, CAN
| | | | - Brian H Rowe
- Emergency Medicine, School of Community Based Medicine, University of Alberta, Edmonton, CAN
| |
Collapse
|
24
|
Abstract
Introduction Resident physician’s well-being has been postulated to worsen with longer shifts. At our institution, the admitting physician evening shift (known as short call) had been associated with higher levels of stress and reduced well-being among residents due to longer work hours and an excessive number of admissions. We introduced an intermediate swing shift to help mitigate those effects. This study sought to assess the outcomes of introducing the swing shift on the timeliness of leaving the hospital for the short call physician, and the median number of admissions done by the short call, swing shift, and night shift resident physicians. Method The swing shift was designed to cover admitting duties from 4:00 to 11:00 pm on weekdays, with support from both the short call and night shift resident physicians. Internal Medicine residents in their second or third year of training and combined Medicine/Psychiatry residents in their third, fourth or fifth year of training, were surveyed prior to the implementation of the swing shift and four-months post-implementation. Time of leaving the hospital and number of admissions before and after the introduction of the swing shift were compared. Data were recorded as frequencies and presented as medians. Results There were 27 surveys completed prior to swing shift implementation and 43 surveys completed post-implementation with a response rate of 52% and 83%, respectively. Surveys post-implementation were divided into 29 for the short call shift survey, six for the swing shift survey, and eight for the night shift survey. Residents who did not perform the short call physician duties were excluded, limiting the prior to implementation surveys from 27 to 25 and the post-implementation short call surveys from 29 to 19. Prior to swing shift implementation, the median time of leaving for the short call physician was 8:30 to 9:00 pm; the median number of admissions were four and eight, done by short call physician and night shift physician, respectively. Whereas post-swing shift implementation, the median time of leaving for short call physician was 7:00 to 7:30 pm, and for swing shift physician was 11:30 pm to midnight. The median number of admissions were two, five, and five done by the short call, swing shift, and night shift physicians, respectively. All residents reported the swing shift allowed them to take better care of patients and follow up on their tasks. Discussion and conclusion Delayed resident physicians departure at the end of their respective shift was associated with extended shifts. It is thought to be caused by an increased number of admissions, late shift admissions, and time of day shift with 4:00 to 9:00 pm being the busiest. The addition of the swing shift increased the ability of the short call resident physician to leave the hospital at the end of their shift and reduced the median number of admissions done by the short call and night shift resident physicians, hence likely improving resident’s well-being while preserving the total number of admissions.
Collapse
Affiliation(s)
- Mejalli Al-Kofahi
- Internal Medicine, University of Kansas Hospital & Medical Center, Kansas City, USA
| | | | - Melissa E Taylor
- Internal Medicine, University of Kansas Hospital & Medical Center, Kansas City, USA
| | - Leigh M Eck
- Internal Medicine, University of Kansas Hospital & Medical Center, Kansas City, USA
| |
Collapse
|
25
|
Affiliation(s)
| | - Amanda Jobe
- The University of Kansas Health System, Kansas City, KS USA
| | | | - Leigh Eck
- The University of Kansas Health System, Kansas City, KS USA
| |
Collapse
|
26
|
Abstract
Phenomenon: Fatigue is a significant risk factor for deterioration in performance, which may lead to medical errors and reduced well-being in resident physicians (residents). Sleep deprivation, which has been studied extensively, is only one contributor to fatigue. Given the complexity of fatigue and its relationship with resident performance, the National Steering Committee on Resident Duty Hours in Canada recommends that all residency education programs develop a fatigue risk management plan (FRMP) for their residents. The purpose of this study was to explore the impact of residents' experiences of fatigue and the strategies they use to manage it. Approach: This single-site study investigated the perceptions of resident physicians. Residents were recruited through purposive sampling to ensure representation from a variety of programs, postgraduate year level, and gender. Recruitment was managed with support from the residency programs; however, data collection and analysis were conducted by the Office of Postgraduate Medical Education to ensure participant anonymity. Program directors and administrators assisted in relaying the information about the study to the residents; however, they were not made aware if their residents participated in the study. Interview and focus group data were collected all at once, then transcribed, and then subsequent thematic analysis of these data was conducted using a quasi-constant comparison approach until thematic saturation was reached. Two researchers coded the data using thematic content analysis. Findings: Fifty-seven residents participated in a focus group or interview. There was representation from more than half of the 58 residency programs and from 15 of 16 departments. Overall, there was consensus that fatigue impacts residents' physical, cognitive, and emotional states. These impacts were reported as influencing resident performance including those related to patient care. Residents reported that fatigue led them to be less productive in their personal and professional lives. Three major themes were identified for which strategies could be developed for fatigue risk management: self, program, and system. Together with self-, program-, and system-level strategies that complement and enhance each other, specific targeted FRMPs could be developed. Insights: Fatigue is a multifaceted phenomenon experienced by residents that requires management beyond extended duty hours and adequate amounts of sleep. FRMPs that encompass strategies used by the resident, the residency-training program, and the healthcare system in which they work could assist with managing fatigue in residents and support enhanced resident well-being and patient care.
Collapse
Affiliation(s)
- Aliya Kassam
- a Office of Postgraduate Medical Education , University of Calgary Cumming School of Medicine , Calgary , Alberta , Canada
| | - Michèle Cowan
- a Office of Postgraduate Medical Education , University of Calgary Cumming School of Medicine , Calgary , Alberta , Canada
| | - Maureen Topps
- a Office of Postgraduate Medical Education , University of Calgary Cumming School of Medicine , Calgary , Alberta , Canada
| |
Collapse
|
27
|
Sagalowsky ST, Feraco AM, Baer TE, Litman HJ, Williams DN, Vinci RJ. Intimate Partner Relationships, Work-Life Factors, and Their Associations With Burnout Among Partnered Pediatric Residents. Acad Pediatr 2019; 19:263-268. [PMID: 30219493 DOI: 10.1016/j.acap.2018.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 08/16/2018] [Accepted: 09/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Burnout is prevalent among pediatric residents, and reducing burnout is a priority for pediatric residency programs. Understanding residents' personal circumstances, including relationship satisfaction and perceived work-life conflict, may identify novel determinants of burnout. OBJECTIVES To describe intimate partner relationships among pediatric residents and examine associations among relationship satisfaction, work-life factors, and burnout. METHODS We identified 203 partnered residents (married or in a self-identified committed, ongoing relationship) from a cross-sectional survey of 258 residents in 11 New England pediatric programs (response rate 54% of 486 surveys distributed), conducted from April through June of 2013. We analyzed associations among relationship satisfaction, work-life factors, and burnout using multivariable regression. Burnout was measured with the brief Maslach Burnout Inventory, and relationship satisfaction with the validated Relationship Assessment Scale. RESULTS Burnout was reported by 40.9% of partnered respondents. The vast majority of partnered residents (n = 167; 85.2%) reported high relationship satisfaction. Lower relationship satisfaction was not associated with burnout. Approximately half of the respondents (n = 102; 51.5%) reported being satisfied with life as a resident. When controlling for common stressors, such as sleep deprivation, work-life measures associated with burnout included frequent perceived conflicts between personal and professional life (adjusted odds ratio, 4.35; 95% confidence interval, 1.91-9.88) and dissatisfaction with life as a resident (adjusted odds ratio, 11.74; 95% confidence interval, 4.23-32.57). CONCLUSION Low relationship satisfaction and common work-life stressors were not associated with burnout among partnered pediatric residents. However, perceived work-life conflict and dissatisfaction with resident life were strongly associated with burnout and are targets for residency programs seeking to ameliorate burnout.
Collapse
Affiliation(s)
- Selin Tuysuzoglu Sagalowsky
- Boston Combined Residency Program (ST Sagalowsky, AM Feraco, and TE Baer), Boston Children's Hospital and Boston Medical Center.
| | - Angela M Feraco
- Boston Combined Residency Program (ST Sagalowsky, AM Feraco, and TE Baer), Boston Children's Hospital and Boston Medical Center
| | - Tamara E Baer
- Boston Combined Residency Program (ST Sagalowsky, AM Feraco, and TE Baer), Boston Children's Hospital and Boston Medical Center
| | - Heather J Litman
- Institutional Centers for Clinical and Translational Research (DN Williams), Boston Children's Hospital
| | - David N Williams
- Department of Pediatrics (RJ Vinci), Boston University School of Medicine, Boston, Mass
| | | |
Collapse
|
28
|
Abstract
Purpose Graduate medical education programs have a responsibility to monitor resident wellness. Residents are at risk of burnout, depression, and suicide. Burnout and depression are associated with poor patient care. Many existing tools measure burnout, depression, and general human well-being, but resident wellness is a distinct construct. We aimed to develop an instrument to measure resident wellness directly. Methods An expert panel from two purposefully different graduate medical education institutions generated a behavior- and experience-based model of resident wellness. The panel and resident leaders from both institutions generated 92 items, which were tested alongside anchor scales measuring burnout, depression, personality, optimism, life satisfaction, and social desirability in a convenience sample of 62 residents. Ten items were selected using a combination of factor analysis, a genetic algorithm, and purposeful selection. The 10-item scale was distributed to 5 institutions at which 376 residents completed it anonymously. Exploratory factor analysis was used to examine the factor structure of the scale. Results The model of resident wellness aligned with an accepted framework of well-being in the literature. The 10-item Resident Wellness Scale broadly covered the model and correlated meaningfully with anchor scales. The factor structure of the scale suggested sensitivity to meaningful work, life security, institutional support, and social support. Conclusions This novel Resident Wellness Scale is designed to track residents' wellness longitudinally. It is sensitive to aspects of resident wellness that have been shown to reduce burnout and depression and appears to be a psychometrically strong measure of resident wellness.
Collapse
Affiliation(s)
- R Brent Stansfield
- Graduate Medical Education, Wayne State University School of Medicine, Detroit, MI
| | - Dan Giang
- School of Medicine, Loma Linda University, Loma Linda, CA
| | - Tsveti Markova
- Graduate Medical Education, Wayne State University School of Medicine, Detroit, MI
| |
Collapse
|
29
|
Poonja Z, O'Brien P, Cross E, Bryce R, Dance E, Jaggi P, Krentz J, Thoma B. Sleep and Exercise in Emergency Medicine Residents: An Observational Pilot Study Exploring the Utility of Wearable Activity Monitors for Monitoring Wellness. Cureus 2018; 10:e2973. [PMID: 30237937 PMCID: PMC6141139 DOI: 10.7759/cureus.2973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Burnout is well-documented in residents and emergency physicians. Wellness initiatives are becoming increasingly prevalent, but there is a lack of data supporting their efficacy. In some populations, a relationship between sleep, exercise, and wellness has been documented; however, this relationship has not been established in emergency medicine (EM) residents or physicians. We aim to determine whether a wearable activity monitor is a feasible method of evaluating exercise and sleep quality and quantity in emergency medicine residents and if these assessments are associated with greater perceived wellness. Methods Twenty EM residents from two training sites wore a wearable activity monitor (Fitbit ChargeTM, Fitbit, Inc., San Francisco, CA, USA) during a four-week EM rotation. The Fitbit recorded data on sleep quantity (minutes sleeping) and quality (sleep disruptions), as well as exercise quantity and quality (daily step count, daily active minutes performing activity of 3 - 6, and > 6 metabolic equivalents). Participants completed an end-of-rotation Perceived Wellness Survey (PWS), which provided information on six domains of personal wellness (psychological, emotional, social, physical, spiritual, and intellectual). PWS levels were compared between groups of subjects with higher or lower levels of activity and sleep (i.e., above and below the median subject-averaged values) using the Mann-Whitney U test. Other subject characteristics were similarly assessed for their association with PWS. When a possible confounding effect was seen, the data was stratified and reviewed using a scatterplot. Results Of the 28 eligible residents, 23 agreed to participate. Of these, 20 and 16 wore the device for at least 50% of the respective days and nights during the observation period. Two devices were lost. One PWS was not completed. There was no statistically significant correlation between resident perceived wellness survey scores, sleep interruptions, average daily sleep minutes, daily step count, or average daily active minutes for the sample overall. However, first-year residents and residents from years two to five reported different median PWS scores of 13.9 and 17.1, respectively. Further exploration by the training group suggested that step counts may correlate with wellness in participants in their first year of residency, while the quantity of sleep may have an association with wellness in participants in years two through five of their residency. Conclusion Using wearable activity monitor devices to capture sleep and exercise data among residents does not seem to be an effective approach. Our data does not support our hypothesis that overall resident wellness was associated with exercise and sleep quality and quantity as measured by such a device. These results are counterintuitive and may be complicated by several measurement-related limitations and the possibility that benefits depend on the stage of training.
Collapse
Affiliation(s)
- Zafrina Poonja
- Emergency Medicine, University of Alberta, Edmonton, CAN
| | - Preston O'Brien
- College of Medicine, University of Saskatchewan, Saskatoon, CAN
| | - Elfriede Cross
- Emergency Medicine, University of Alberta, Edmonton, CAN
| | - Rhonda Bryce
- Clinical Research Support Unit, University of Saskatchewan, Saskatoon, CAN
| | - Erica Dance
- Emergency Medicine, University of Alberta, Edmonton, CAN
| | - Priya Jaggi
- Emergency Medicine, University of Alberta, Edmonton, CAN
| | - Joel Krentz
- Physical Education, Brandon University, Brandon, CAN
| | - Brent Thoma
- Emergency Medicine, College of Medicine/University of Saskatchewan, Saskatoon, CAN
| |
Collapse
|
30
|
McKillip R, Ernst M, Ahn J, Tekian A, Shappell E. Toward a Resident Personal Finance Curriculum: Quantifying Resident Financial Circumstances, Needs, and Interests. Cureus 2018; 10:e2540. [PMID: 29951347 PMCID: PMC6019332 DOI: 10.7759/cureus.2540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/26/2018] [Indexed: 11/05/2022] Open
Abstract
Introduction Resident financial health has been linked to wellness and resiliency, yet financial literacy among residents is highly variable. While some medical school curricula include budgeting and student loan education, content on managing finances as a resident is usually lacking. We sought to quantitatively assess residents' financial circumstances, needs, and interests to inform the design of a resident personal finance curriculum. Methods Surveys were sent to residents in eight specialties at an academic medical center. Likert-type responses allowed respondents to rate their level of comfort (1 = Very Uncomfortable, 7 = Very Comfortable) and interest (1 = Very Uninterested, 7 = Very Interested) in various personal finance topics including budgeting, loan repayment, disability insurance, life insurance, home buying, and retirement planning. Details regarding financial circumstances, including assets, liabilities, and insurance, were also collected. Results of questions that utilized a Likert-type scale are reported as median (interquartile range). Results Of 346 residents surveyed, 144 (41.6%) responded. Residents were from Internal Medicine (56, 38.9%), Pediatrics (34, 23.6%), Emergency Medicine (18, 12.5%), and other specialties (36, 25.0%). Ninety-one (63.2%) reported educational loans, with an average balance of $191,730. Credit card balances exceeding $3,000 were reported by 11 (7.6%) respondents. One-hundred-two (70.1%) reported emergency savings, but only 65 (45.1%) reported having a retirement account (average balance $27,608). Respondents rated highest comfort levels with budgeting (5[4-6]), and lowest level of comfort with disability insurance (2[2-4]) and home buying (2[2-5]). Interest in learning each topic was high (6[5-7]), with retirement planning (6[5-7]), investing (6[5-7]), and home buying (6[5-7]) the topics of highest interest. Conclusion These results highlight the deficits in personal finance literacy among residents. Future work should focus on development of a nationally scalable personal finance curriculum for residents.
Collapse
Affiliation(s)
| | - Michael Ernst
- Section of Emergency Medicine, University of Chicago
| | - James Ahn
- Section of Emergency Medicine, University of Chicago
| | - Ara Tekian
- Department of Medical Education, University of Illinois at Chicago College of Medicine
| | - Eric Shappell
- Section of Emergency Medicine, University of Chicago
| |
Collapse
|
31
|
Ambrose EC, Devare J, Truesdale CM, Ricker E, Firn J, Thorne MC, Shuman AG, Cabrera-Muffly C. Two Novel Approaches to Improve Otolaryngology Resident Wellness: The ACGME Back to Bedside Initiative. Otolaryngol Head Neck Surg 2018; 158:979-980. [PMID: 29436259 DOI: 10.1177/0194599818758272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rates of burnout, mental illness, and suicide are disproportionately elevated among physicians, and surgical specialists, including otolaryngologists, are at even higher risk for professional burnout. These trends have been identified at both the trainee and attending level. To combat resident burnout, the Accreditation Council for Graduate Medical Education (ACGME) Council of Review Committee Residents (CRCR) designed the Back to Bedside Initiative, the goals of which are to foster meaning in the learning environment and to help trainees to engage more deeply with patients. Two funded Back to Bedside proposals involve otolaryngology training programs. Herein, we discuss these 2 approaches in an effort to foster additional novel resident wellness initiatives and awareness thereof across our subspecialty.
Collapse
Affiliation(s)
- Emily C Ambrose
- 1 University of Colorado, Otolaryngology, Aurora, Colorado, USA
| | - Jenna Devare
- 2 University of Michigan, Otolaryngology-Head and Neck Surgery, Ann Arbor, Michigan, USA
| | - Carl M Truesdale
- 2 University of Michigan, Otolaryngology-Head and Neck Surgery, Ann Arbor, Michigan, USA
| | - Ellen Ricker
- 1 University of Colorado, Otolaryngology, Aurora, Colorado, USA
| | - Janice Firn
- 3 University of Michigan, Center for Bioethics and Social Sciences in Medicine, Ann Arbor, Michigan, USA
| | - Marc C Thorne
- 2 University of Michigan, Otolaryngology-Head and Neck Surgery, Ann Arbor, Michigan, USA
| | - Andrew G Shuman
- 2 University of Michigan, Otolaryngology-Head and Neck Surgery, Ann Arbor, Michigan, USA.,3 University of Michigan, Center for Bioethics and Social Sciences in Medicine, Ann Arbor, Michigan, USA
| | | |
Collapse
|
32
|
Abstract
Background Because of their arduous schedules, residents are susceptible to burnout, fatigue, and depression. In 2015, the Accreditation Council for Graduate Medical Education (ACGME) launched a campaign to foster physician wellness, in response to the suicides of three residents during the previous year. The campaign calls for strategies to developing resiliency, identify problems, and promote well-being. One of the suggested methods to promote well-being was a residency retreat. Objective To implement a novel retreat curriculum that emphasizes team building between residents and faculty, with which residents expressed high satisfaction. Methods We created an "Amazing Race" style retreat involving five activity stations set up in a neighborhood park in which 25 of our 34 residents participated. These stations implemented team building, faculty-resident bonding and resident-resident bonding. An anonymous survey was administered to the 25 participating emergency medicine (EM) residents after the retreat, of whom 21 returned the survey. The survey consisted of questions to assess the resident's perception of the team building activities, their satisfaction with each of the five activity stations and overall retreat satisfaction. Results Of the 25 residents who participated in the retreat, 21 (84%) returned the post-retreat survey (one participant returned a survey leaving the ranking questions incomplete). This low-cost event received high satisfaction ratings in regard to team-building, resident bonding, and faculty-resident bonding. Conclusions This novel retreat proved to be a low-cost and easily implemented activity with which the residents expressed high levels of satisfaction.
Collapse
Affiliation(s)
- Angela Cornelius
- Department of Emergency Medicine, Louisiana State University Health Science Center Shreveport
| | | | - Mary Ann Edens
- Department of Emergency Medicine, Louisiana State University Health Science Center Shreveport
| |
Collapse
|
33
|
|
34
|
Sussman D, Paul JE. The impact of transitioning from a 24-hour to a 16-hour call model amongst a cohort of Canadian anesthesia residents at McMaster University - a survey study. Adv Med Educ Pract 2015; 6:501-506. [PMID: 26300658 PMCID: PMC4535542 DOI: 10.2147/amep.s77389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE The primary objective of this study was to assess anesthesia residents' opinions and perceptions on wellness/burnout, fatigue, education, and patient safety after the initiation of a reduced call model (16-hour call). METHODS A prospective cohort study was conducted at three time points during the 2013-2014 academic year. A web-based questionnaire consisting of 23 questions was electronically distributed to all anesthesia residents from postgraduate years (PGY) 1 to 5 who were part of the active call roster (n=84) at McMaster University in Hamilton, Ontario. Descriptive summaries were calculated, counts and percentages were used for categorical variables, and answers to open text questions were reviewed for themes. RESULTS A response rate of 67% was obtained for this study. A majority of anesthesia residents (65%) approved of 16-hour call, felt that their overall quality of life as a senior resident (PGY3 or greater) or junior resident (PGY2 and below) had improved (73% and 55%, respectively), and reported overall feeling less fatigued. Most respondents indicated that the quality of education remained unchanged (47%), or had improved (31%). And most felt better prepared for the royal college exam (52%). Most felt patient safety had improved or was unchanged (both 48%). CONCLUSION The study demonstrates that 16-hour call improved resident wellness, reduced burnout and fostered an environment where residents are less fatigued and more satisfied with their educational experience promoting an environment of patient safety. Overall, the anesthesia residency group demonstrated that not only is 16-hour call preferred but beneficial.
Collapse
Affiliation(s)
- David Sussman
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - James E Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
35
|
Ahmed N, Devitt KS, Keshet I, Spicer J, Imrie K, Feldman L, Cools-Lartigue J, Kayssi A, Lipsman N, Elmi M, Kulkarni AV, Parshuram C, Mainprize T, Warren RJ, Fata P, Gorman MS, Feinberg S, Rutka J. A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg 2014; 259:1041-53. [PMID: 24662409 PMCID: PMC4047317 DOI: 10.1097/sla.0000000000000595] [Citation(s) in RCA: 372] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated 80-hour resident duty limits. In 2011 the ACGME mandated 16-hour duty maximums for PGY1 (post graduate year) residents. The stated goals were to improve patient safety, resident well-being, and education. A systematic review and meta-analysis were performed to evaluate the impact of resident duty hours (RDH) on clinical and educational outcomes in surgery. METHODS A systematic review (1980-2013) was executed on CINAHL, Cochrane Database, Embase, Medline, and Scopus. Quality of articles was assessed using the GRADE guidelines. Sixteen-hour shifts and night float systems were analyzed separately. Articles that examined mortality data were combined in a random-effects meta-analysis to evaluate the impact of RDH on patient mortality. RESULTS A total of 135 articles met the inclusion criteria. Among these, 42% (N = 57) were considered moderate-high quality. There was no overall improvement in patient outcomes as a result of RDH; however, some studies suggest increased complication rates in high-acuity patients. There was no improvement in education related to RDH restrictions, and performance on certification examinations has declined in some specialties. Survey studies revealed a perception of worsened education and patient safety. There were improvements in resident wellness after the 80-hour workweek, but there was little improvement or negative effects on wellness after 16-hour duty maximums were implemented. CONCLUSIONS Recent RDH changes are not consistently associated with improvements in resident well-being, and have negative impacts on patient outcomes and performance on certification examinations. Greater flexibility to accommodate resident training needs is required. Further erosion of training time should be considered with great caution.
Collapse
Affiliation(s)
- Najma Ahmed
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Itay Keshet
- Department of Internal Medicine, Mount Sinai Hospital, New York City, NY
| | - Jonathan Spicer
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Kevin Imrie
- Department of Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Liane Feldman
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Ahmed Kayssi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Maryam Elmi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Chris Parshuram
- Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Todd Mainprize
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Richard J. Warren
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paola Fata
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - M. Sean Gorman
- Department of Surgery, Royal Inland Hospital, Kamloops, British Columbia, Canada
| | - Stan Feinberg
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James Rutka
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
36
|
Gupta G, Schleinitz MD, Reinert SE, McGarry KA. Resident physician preventive health behaviors and perspectives on primary care. R I Med J (2013) 2013; 96:43-47. [PMID: 23641464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
UNLABELLED Little is known about lifestyle choices and preventive healthcare seeking behaviors among resident physicians. Residents function under unusual working conditions requiring extensive duty hours. This may significantly affect attentiveness to personal health and wellness. In this study, we surveyed residents across multiple training programs to compare lifestyle choices and access to preventive healthcare. METHODS Resident physicians affiliated with Brown University, Providence, Rhode Island, were surveyed between February and April 2009 regarding lifestyle habits and experiences with primary care. We evaluated the relationships between training program and established primary care on health behaviors. RESULTS Residents were in one of 5 programs: internal medicine, medicine/pediatrics, emergency medicine, surgery or pediatrics. Respondents slept an average of 6.7 hours per day and worked an average of 70 hours per week, with surgical residents sleeping the shortest and working the longest hours (p<0.001 for both). An average of 58.8% of residents indicated having a primary care physician. This rate was lowest among surgery residents at 37% (p=0.081). Rates of screening with regards to blood pressure, cholesterol and cervical cancer were significantly higher among residents maintaining primary care (p<0.001). A lack of time was the most common barrier to obtaining primary care. DISCUSSION Surgical residents may have unique barriers to healthcare seeking behaviors, such as longer work hours. Residents with established primary care had significantly higher rates of adherence to preventive screening. Residency programs should address barriers to accessing healthcare for trainees, particularly among surgical programs.
Collapse
Affiliation(s)
- Geetika Gupta
- Graduate of the general internal medicine residency program, Alpert Medical School at Brown University and works in the Division of Hospital Medicine, Rhode Island Hospital
| | | | | | | |
Collapse
|