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Majuri, Minna, Maarit Malin, Asta Antila i Kari Reijula. "O-037 MENTAL HEALTH SKILLS AMONG MEDICAL SPECIALIST PHYSICIAN TRAINEES AND TRAINERS IN OCCUPATIONAL HEALTH IN FINLAND". Occupational Medicine 74, Supplement_1 (1.07.2024): 0. http://dx.doi.org/10.1093/occmed/kqae023.0514.
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Abstract Introduction Mental health problems are increasing in occupational health (OH) service visits, which might result from following transformations: 1) the loosening of the stigma related to mental health problems, 2) the changing character of employees and working life, and 3) decreasing medical dominance and increasing medicalization. We studied self-assessed mental health skills of specialist physician trainees and trainers in OH. Methods We conducted an online questionnaire among OH physician trainees and trainers in Finland during June to August 2022. We analyzed how OH physicians in specialist training programs assessed their own skills in mental health practice. We also analyzed the underlying assumptions about OH skills in general using an exploratory factor analysis. Results Among respondents (N=104), the trainer physicians replied more actively (N=58) than the trainees (N=42). Respondents’ perception of mental health skills was better among trainers than trainees. Individual mental health skills as work ability evaluation and return to work were more familiar than workplace level proactive processes. Discussion Self-assessed mental health skills of both trainees and trainers consisted of individual-based identification of illnesses, assessing risk of diseases and support of employees’ work ability. Based on our results, proactive measures between workplaces and OH services need more attention as a competence in mental health. Conclusion Typical OH approach based on the risk assessment of exposure isn’t enough to promote mental wellbeing at the workplace. OH services treats not only individuals, but the entire workplace. OH service must target services toward work life transformation, which requires new educational approaches and courses for OH physician curriculum.
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Castanov, Valera, Xiya Ma, Adam Pietrobon, Alan Blayney, Alexander Levit, Danielle Weber-Adrian, Nora Hutchinson, Tina Binesh Marvasti i Elina K. Cook. "Newsletter Fall 2019: Clinician Investigator Trainee Association of Canada (CITAC)". Clinical and Investigative Medicine 42, nr 3 (29.09.2019): E1—E5. http://dx.doi.org/10.25011/cim.v42i3.33086.
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A message from Elina Cook (President): Demystifying and promoting the MD-PhD/MSc world—our progress
Clinician Investigator Trainee Association of Canada (CITAC) seeks to promote, support and advocate for trainees whose goal is to become physician/ clinician/surgeon investigators. These include trainees of MD-PhD/MSc programs and Clinician Investigator Programs (CIP), who are preparing themselves to succeed in the overlapping world of medicine and research. Thanks to the wealth of talent, skill and motivation of the CITAC leadership this year, we are delivering new opportunities to these trainees in a number of ways: 1) developing international partnerships and initiatives; 2) revitalizing the Annual General Meeting (AGM); 3) advocating for clinician/physician/surgeon-scientist trainee support among influencers and policy makers; and 4) collecting data on the academic “health” of our training programs and trainees across Canada.
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Thangarasu, Sudhagar, Gowri Renganathan i Piruthiviraj Natarajan. "Empathy Can Be Taught, and Patients Teach it Best". Journal of Medical Education and Curricular Development 8 (styczeń 2021): 238212052110003. http://dx.doi.org/10.1177/23821205211000346.
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Empathy toward patients is an essential skill for a physician to deliver the best care for any patient. Empathy also protects the physician from moral injury and decreases the chances for malpractice litigations. The current graduate medical education curriculum allows trainees to graduate without getting focused training to develop empathy as a core competency domain. The tools to measure empathy inherently lack validity. The accurate measure of the provider’s empathy comes from the patient’s perspectives of their experience and their feedback, which is rarely reaching the trainee. The hidden curriculum in residency programs gives mixed messages to trainees due to inadequate role modeling by attending physicians. This narrative style manuscript portrays a teachable moment at the bedside vividly. The teaching team together reflected upon the lack of empathy, took steps to resolve the issue. The attending demonstrated role modeling as an authentic and impactful technique to teach empathy. The conclusion includes a proposal to include the patient’s real-time feedback to trainees as an essential domain under Graduate Medical Education core competencies of professionalism and patient care.
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Deemer, David A., John M. Byrne, Lawrence K. Loo, David Puder, Karina D. Torralba, Sonny C. Lee i T. Michael Kashner. "Calibration Bias and the Interpretation of Clinical Learning Environment Perceptions Surveys". Journal of Graduate Medical Education 12, nr 6 (1.12.2020): 727–36. http://dx.doi.org/10.4300/jgme-d-20-00237.1.
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ABSTRACT Background The clinical learning environment (CLE) is frequently assessed using perceptions surveys, such as the AAMC Graduation Questionnaire and ACGME Resident/Fellow Survey. However, these survey responses often capture subjective factors not directly related to the trainee's CLE experiences. Objective The authors aimed to assess these subjective factors as “calibration bias” and show how it varies by health professions education discipline, and co-varies by program, patient-mix, and trainee factors. Methods We measured calibration bias using 2011–2017 US Department of Veterans Affairs (VA) Learners' Perceptions Survey data to compare medical students and physician residents and fellows (n = 32 830) with nursing (n = 29 758) and allied and associated health (n = 27 092) trainees. Results Compared to their physician counterparts, nursing trainees (OR 1.31, 95% CI 1.22–1.40) and allied/associated health trainees (1.18, 1.12–1.24) tended to overrate their CLE experiences. Across disciplines, respondents tended to overrate CLEs when reporting 1 higher level (of 5) of psychological safety (3.62, 3.52–3.73), 1 SD more time in the CLE (1.05, 1.04–1.07), female gender (1.13, 1.10–1.16), 1 of 7 lower academic level (0.95, 1.04–1.07), and having seen the lowest tercile of patients for their respective discipline who lacked social support (1.16, 1.12–1.21) and had low income (1.05, 1.01–1.09), co-occurring addictions (1.06, 1.02–1.10), and mental illness (1.06, 1.02–1.10). Conclusions Accounting for calibration bias when using perception survey scores is important to better understand physician trainees and the complex clinical learning environments in which they train.
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Yoon, Hyun Bae, Jwa-Seop Shin, Ketsomsouk Bouphavanh i Yu Min Kang. "Evaluation of a continuing professional development training program for physicians and physician assistants in hospitals in Laos based on the Kirkpatrick model". Journal of Educational Evaluation for Health Professions 13 (31.05.2016): 21. http://dx.doi.org/10.3352/jeehp.2016.13.21.
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Purpose: Medical professionals from Korea and Laos have been working together to develop a continuing professional development training program covering the major clinical fields of primary care. This study aimed to evaluate the effectiveness of the program from 2013 to 2014 using the Kirkpatrick model. Methods: A questionnaire was used to evaluate the reaction of the trainees, and the trainers assessed the level of trainees’ performance at the beginning and the end of each clinical section. The transfer (behavioral change) of the trainees was evaluated through the review of medical records written by the trainees before and after the training program. Results: The trainees were satisfied with the training program, for which the average score was 4.48 out of 5.0. The average score of the trainees’ performance at the beginning was 2.39 out of 5.0, and rose to 3.88 at the end of each section. The average score of the medical records written before the training was 2.92 out of 5.0, and it rose to 3.34 after the training. The number of patient visits to the district hospitals increased. Conclusion: The continuing professional development training program, which was planned and implemented with the full engagement and responsibility of Lao health professionals, proved to be effective.
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Ghaith, Summer, Ronna L. Campbell, Jordan R. Pollock, Vanessa E. Torbenson i Rachel A. Lindor. "Medical Malpractice Lawsuits Involving Trainees in Obstetrics and Gynecology in the USA". Healthcare 10, nr 7 (17.07.2022): 1328. http://dx.doi.org/10.3390/healthcare10071328.
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Background: While the liability risks for obstetrics and gynecology (ob/gyn) physicians are widely recognized, little is known about how trainees have been involved in ob/gyn lawsuits. Objectives: To characterize involvement of trainees in malpractice lawsuits related to ob/gyn. Methods: The legal database Westlaw was utilized to collect ob/gyn-related malpractice lawsuits involving trainees reported from 1986 to 2020 in the USA. Outcome: Forty-six malpractice cases involving ob/gyn trainees were identified, including 34 cases related to obstetrics and 12 to gynecology. There were 11 cases alleging lack of informed consent, including 7 cases alleging lack of consent for trainee involvement. Of the 34 obstetrics cases, 27 related to procedural complications, 17 to treatment, 13 to diagnosis, and 4 to informed consent. Of these, 17 were decided in favor of the physician, 6 resulted in findings of negligence, 9 had unknown outcomes, and 3 ended in settlement. For the 6 cases ending in a finding of negligence, the mean award was $2,174,472 compared to $685,000 for those that were settled. Of the 12 gynecology cases, 8 related to procedural complications, 7 to informed consent, 3 to diagnosis, and 2 to treatment. Of these, 6 were decided in favor of the physician, 3 resulted in findings of negligence, and 3 had unknown outcomes. For the cases ending in a finding of negligence, the mean award was $465,000. Conclusions and Outlook: This review of malpractice cases highlights types of situations in which trainees are sued and reveals the importance of designing curriculum around faculty training and supervision regarding trainee involvement in patient care.
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Graham, Kelly L., Elizabeth Norian, Jonathan Li, Maelys Amat i Roger B. Davis. "An Analysis of Trainee Status of the Primary Care Physician and Ambulatory Care Outcomes". Academic Medicine 99, nr 7 (14.02.2024): 750–55. http://dx.doi.org/10.1097/acm.0000000000005663.
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Abstract Purpose Prior studies report disparities in outcomes for patients cared for by trainees versus faculty physicians at academic medical centers. This study examined the effect of having a trainee as the primary care physician versus a faculty member on routine population health outcomes after adjusting for differences in social determinants of health and primary care retention. Method This cohort study assessed 38,404 patients receiving primary care at an academic hospital–affiliated practice by 60 faculty and 110 internal medicine trainees during academic year 2019. The effect of primary care practitioner trainee status on routine ambulatory care metrics was modeled using log-binomial regression with generalized estimating equation methods to account for physician-level clustering. Risk estimates before and after adjusting for social determinants of health and loss to follow-up are presented. Results Trainee and faculty cohorts had similar distributions of acute illness burden; however, patients in the trainee cohort were significantly more likely to identify as a race other than White (2,476 [52.6%] vs 14,785 [38.5%], P < .001), live in a zip code associated with poverty (1,688 [35.9%] vs 9,122 [23.8%], P < .001), use public health insurance (1,021 [21.7%] vs 6,108 [15.9%], P < .001), and have limited English proficiency (1,415 [30.1%] vs 5,203 [13.6%], P < .001). In adjusted analyses, trainee status of primary care physician was not associated with lack of breast cancer screening but was associated with missed opportunities to screen for colorectal cancer (relative risk [RR], 0.77; 95% confidence interval [CI], 0.68–0.88), control type 2 diabetes mellitus (RR, 0.78; 95% CI, 0.64–0.94), and control hypertension (RR, 0.80; 95% CI, 0.69–0.94). Conclusions Primary care physician trainee status was associated with poorer quality of care in the ambulatory setting after adjusting for differences in socioeconomic factors and loss to follow-up, highlighting a potential ambulatory training gap.
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Ey, Sydney, Benjamin Ladd, Marie Soller i Mary Moffit. "Seeking Help in the “Perfect Storm”: Why Residents and Faculty Access an On-Site Wellness Program". Global Advances in Health and Medicine 10 (styczeń 2021): 216495612110174. http://dx.doi.org/10.1177/21649561211017471.
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Background In the face of significant distress among physicians, access to counseling is critical. Objective An on-site wellness program for physicians-in-training and faculty was assessed by examining (a) were participants representative of those eligible for services and (b) demographic and trainee vs. faculty differences in burnout, distress, suicide risk, and presenting concerns of participants who utilized services. Methods From 2013–2018, 73% (N = 468; 316 residents/fellows, 152 faculty) of individuals seeking services also consented to research. At intake, participants completed a distress measure (ACORN) and two items from the Maslach Burnout Inventory (MBI), and clinicians categorized presenting concerns and suicide risk. Using Chi-square analyses, participants’ characteristics were compared to physicians eligible for treatment. The association between demographics, faculty vs. trainee status, specialty, and distress, burnout, suicide risk, and presenting concerns was evaluated with ANOVAs and logistic regressions. Results Women, trainees, and primary care physicians were more likely to access services. On the ACORN, 63% were in the clinical range (M =1.7, SD =0.6). On the MBI, 36% scored in the clinical range. Clinicians rated 9% of participants with suicide risk. Neither gender, racial/ethnic minority status, nor specialty were associated with distress, burnout or suicide risk. Trainees reported greater distress than faculty ( F (1,447) = 8.42, P = .004, [Formula: see text] = .018). Participants reported multiple presenting concerns (M = 3.0, SD = 1.18) with faculty more commonly endorsing work-related issues. Trainees more commonly reported new or worsening psychological symptoms, performance and family concerns. Conclusions Two physician groups which often report higher levels of burnout and distress when surveyed, women physicians and residents/fellows, were the most likely to get professional help in an on-site wellness program. Physician wellness programs need to be prepared to address work and personal stressors and different levels of distress and risk.
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Chan, David C. "Influence and Information in Team Decisions: Evidence from Medical Residency". American Economic Journal: Economic Policy 13, nr 1 (1.02.2021): 106–37. http://dx.doi.org/10.1257/pol.20180501.
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I study team decisions among physician trainees. Exploiting a discontinuity in team roles across trainee tenure, I find evidence that teams alter decision-making, concentrating influence in the hands of senior trainees. I also demonstrate little convergence in variation of trainee effects despite intensive training. This general pattern of trainee effects on team decision-making exists in all types of decisions and settings that I examine. In analyses evaluating mechanisms behind this pattern, I find support for the idea that significant experiential learning occurs during training and that teams place more weight on judgments of senior trainees in order to aggregate information. (JEL D83, I11, J44, M53, M54)
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Phuong, Melissa S. Phuong, Valera Castanov, Claudia Turco, Robert X. Lao, Wenxuan Wang, Amelia T. Yuan i Heather T. Whittaker. "Spring 2022: Clinician Investigator Trainee Association Of Canada (CITAC)". Clinical and Investigative Medicine 45, nr 1 (23.03.2022): E1–4. http://dx.doi.org/10.25011/cim.v45i1.38101.
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Over the past two years, physician-scientist trainees have persevered in the face of evolving challenges presented by the ongoing coronavirus disease 2019 (COVID-19) pandemic. Research and healthcare institutions across the country continue to feel the impacts of the public health emergency. As scientists and physicians generate evidence to inform the prevention and treatment of COVID-19, physician-scientist trainees in all disciplines have adapted to the changing conditions of their education.
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Ballios, Brian G., i Norman D. Rosenblum. "Challenges Facing Physician Scientist Trainees: a Survey of Trainees in Canada’s Largest Undergraduate and Postgraduate Programs in a Single Centre". Clinical & Investigative Medicine 37, nr 5 (4.10.2014): 268. http://dx.doi.org/10.25011/cim.v37i5.22008.
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Purpose: A number of indicators suggest that the physician scientist career track is threatened. As such, it is an opportune time to evaluate current training models. Perspectives on physician scientist education and career path were surveyed in trainees at the University of Toronto, home to Canada’s longest standing physician scientist training programs. Methods: Trainees from the Clinician Investigator Program (CIP) and MD/PhD Program at the University of Toronto were surveyed. Liekert-style closed-ended questions were used to assess future career goals, present and future perspectives and concerns about and beliefs on training. Demographic information was collected regarding year of study, graduate degree program and focus of clinical and health research. Statistical analysis included non-parametric tests for sub-group comparisons. Results: Both groups of trainees were motivated to pursue a career as a physician scientist. While confident in their decision to begin and complete physician scientist training, they expressed concerns about the level of integration between clinical and research training in the current programs. They also expressed concerns about career outlook, including the ability to find stable and sustainable careers in academic medicine. Trainees highlighted a number of factors, including career mentorship, as essential for career success. Conclusion: These findings indicate that while trainees at different stages consistently express career motivation, they identified concerns that are program- and training stage-specific. These concerns mirror those highlighted in the medical education literature regarding threats to the physician scientist career path. Understanding these different and changing perspectives and exploring those differences could form an important basis for trainee program improvements both nationally and internationally.
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Garcia, Lawrence George P., Maria Minerva P. Calimag, Alejandro C. Baroque II i Ma Lourdes P. Corrales-Joson. "Betwixt and Between: Exploring the Liminal Space of the ‘First Generation’ Filipino Physician Through the Lens of the Rites of Passage". Journal of Medicine, University of Santo Tomas 5, nr 1 (31.07.2021): 564–71. http://dx.doi.org/10.35460/2546-1621.2020-0030.
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Introduction: The ‘first generation’ physician gathers a lot of strength to venture into a world unknown to him. Unlike a physician born to a family of physicians who has a family to guide him, the ‘first generation’ physician only has himself to survive this endeavor. Through the life worlds of a select group of ‘first generation’ physician-in-training, this study seeks to answer the following central question: How do ‘first generation’ Filipino physicians collectively characterize their liminal spaces in transition from medical school to clinical practice? Methodology: Anchored on the Theory of the Rites of Passage, this phenomenological inquiry, intends to surface the lebenswelt or essence of the experience of being the only physician in the family. Respondents comprised a purposive sample of physicians-in-training (residents and fellows), who are the only physicians in the family. Data were gathered using semi-structured interviews. Triangulation and member checking procedures were done to ensure the data reliability. Data were then subjected to cool (categorization) and warm analysis (thematization) using the Colaizzi's method. Findings and Discussion: With all the transcribed experiences summarized and those with the same meaning analyzed, the following categories and themes were generated: The Intending Facet / Purpose: From Uncertainty towards Redefinition; The Thinking Facet / Process: From Perplexity towards Self-efficacy; The Relating Facet / People: From Isolation towards Integration; and The Transforming Facet / Power: From Vulnerability towards Empowerment. It was shown that a ‘first generation’ physician in this liminal space undergoes challenges and struggles during his training in medicine. This served as his Rite of Passage to transition him to someone dreaming only to become a physician, to become redefined with conviction, supported and integrated into the health system, empowered and transformed to the physician he is meant to be. Recommendations: Physicians undergo a lot of challenges and mental stress and it means a lot for trainers to enter into the trainees’ life-world, especially that of a ‘first generation’ physician, so that they can build socio-emotional learning and mentoring programs and counselling services that address different facets of liminal space that the trainees go through.
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Coughlan, Timothy Edward. "Roadmap for physician trainees' Everest". Medical Journal of Australia 202, nr 1 (styczeń 2015): 55. http://dx.doi.org/10.5694/mja14.01214.
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Brahmania, Mayur, Madison Young, Chetty Muthiah, Alexandra Ilnyckyj, Donald Duerksen i Dana C. Moffatt. "Resident Trainees Do Not Affect Patient Satisfaction in an Outpatient Gastroenterology Clinic: A Prospective Study Conducted in a Canadian Gastroenterology Clinic". Canadian Journal of Gastroenterology and Hepatology 29, nr 7 (2015): 363–68. http://dx.doi.org/10.1155/2015/429405.
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BACKGROUND: There is little literature regarding how a gastroenterology trainee affects a patient’s interpretation of care during outpatient clinic visits. Improving patient satisfaction is desirable and benefits may include enhanced patient compliance as well as providing trainees with areas for improvement.OBJECTIVES: To evaluate patient satisfaction in an outpatient gastroenterology clinic when seen by a trainee and attending physician versus an attending physician alone. The secondary objective was to evaluate physician characteristics that play a role in creating a positive clinical experience.METHODS: A randomized prospective survey study was conducted over an 11-month period (July 2012 to June 2013) at St Boniface Hospital (Winnipeg, Manitoba). Two gastroenterology fellows (postgraduate year 4 and 5) and nine internal medicine residents (postgraduate year 1 to 3) comprised the ‘trainee’ role, while three academic clinicians comprised the ‘attending’ role. Patients included individuals seen for an initial consultation and were >18 years of age.RESULTS: A total of 211 patients comprised the final study group, with 118 in the attending group and 93 in the trainee group. In univariate analysis, patients more often had a very good experience when seen by an attending physician alone versus a trainee and attending physician (73% versus 56%; P=0.016); however, on multivariate analysis, there was no significant difference in patient satisfaction (OR 0.89; P=0.931). Physician factors found to be associated with high patient satisfaction on multivariate analysis included: addressing all patient concerns (OR 27.56; P=0.021); giving the patient a preliminary diagnosis (OR 78.02; P=0.006); and feeling the physician was thorough (OR 72.53; P=0.029).CONCLUSIONS: The present study did not reveal a difference in patient satisfaction if a patient sees an attending physician alone or with a trainee. Moreover, to improve patient satisfaction in a gastroenterology clinic, physicians should address all patient concerns, provide a preliminary diagnosis and appear to be thorough in their assessment. Further work to increase patient awareness on the role of residents in teaching hospitals is warranted to further promote careers in gastroenterology.
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Kwan, Jennifer M., Omar Toubat, Andrew M. Harrison, Megan Riddle, Brian Wu, Hajwa Kim, David W. Basta, Alexander J. Adami i Dania Daye. "A nationwide assessment of perceptions of research-intense academic careers among predoctoral MD and MD-PhD trainees". Journal of Clinical and Translational Science 4, nr 4 (4.03.2020): 307–16. http://dx.doi.org/10.1017/cts.2020.18.
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AbstractIntroduction:While previous studies have described career outcomes of physician-scientist trainees after graduation, trainee perceptions of research-intensive career pathways remain unclear. This study sought to identify the perceived interests, factors, and challenges associated with academic and research careers among predoctoral MD trainees, MD trainees with research-intense (>50%) career intentions (MD-RI), and MD-PhD trainees.Methods:A 70-question survey was administered to 16,418 trainees at 32 academic medical centers from September 2012 to December 2014. MD vs. MD-RI (>50% research intentions) vs. MD-PhD trainee responses were compared by chi-square tests. Multivariate logistic regression analyses were performed to identify variables associated with academic and research career intentions.Results:There were 4433 respondents (27% response rate), including 2625 MD (64%), 653 MD-RI (15%), and 856 MD-PhD (21%) trainees. MD-PhDs were most interested in pursuing academia (85.8%), followed by MD-RIs (57.3%) and MDs (31.2%). Translational research was the primary career intention for MD-PhD trainees (42.9%). Clinical duties were the primary career intention for MD-RIs (51.9%) and MDs (84.2%). While 39.8% of MD-PhD respondents identified opportunities for research as the most important career selection factor, only 12.9% of MD-RI and 0.5% of MD respondents shared this perspective. Interest in basic research, translational research, clinical research, education, and the ability to identify a mentor were each independently associated with academic career intentions by multivariate regression.Conclusions:Predoctoral MD, MD-RI, and MD-PhD trainees are unique cohorts with different perceptions and interests toward academic and research careers. Understanding these differences may help to guide efforts to mentor the next generation of physician-scientists.
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Mir, Hassan, Katheryne Downes, Antonia F. Chen, Ruby Grewal, Derek M. Kelly, Michael J. Lee, Philipp Leucht i Sukhdeep K. Dulai. "Physician wellness in orthopaedic surgery". Bone & Joint Open 2, nr 11 (1.11.2021): 932–39. http://dx.doi.org/10.1302/2633-1462.211.bjo-2021-0153.
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Aims Physician burnout and its consequences have been recognized as increasingly prevalent and important issues for both organizations and individuals involved in healthcare delivery. The purpose of this study was to describe and compare the patterns of self-reported wellness in orthopaedic surgeons and trainees from multiple nations with varying health systems. Methods A cross-sectional survey of 774 orthopaedic surgeons and trainees in five countries (Australia, Canada, New Zealand, UK, and USA) was conducted in 2019. Respondents were asked to complete the Mayo Clinic Well-Being Index and the Stanford Professional Fulfillment Index in addition to 31 personal/demographic questions and 27 employment-related questions via an anonymous online survey. Results A total of 684 participants from five countries (Australia (n = 74), Canada (n = 90), New Zealand (n = 69), UK (n = 105), and USA (n = 346)) completed both of the risk assessment questionnaires (Mayo and Stanford). Of these, 42.8% (n = 293) were trainees and 57.2% (n = 391) were attending surgeons. On the Mayo Clinic Well-Being Index, 58.6% of the overall sample reported feeling burned out (n = 401). Significant differences were found between nations with regards to the proportion categorized as being at risk for poor outcomes (27.5% for New Zealand (19/69) vs 54.4% for Canada (49/90) ; p = 0.001). On the Stanford Professional Fulfillment Index, 38.9% of the respondents were classified as being burned out (266/684). Prevalence of burnout ranged from 27% for Australia (20/74 up to 47.8% for Canadian respondents (43/90; p = 0.010). Younger age groups (20 to 29: RR 2.52 (95% confidence interval (CI) 1.39 to 4.58; p = 0.002); 30 to 39: RR 2.40 (95% CI 1.36 to 4.24; p = 0.003); 40 to 49: RR 2.30 (95% CI 1.35 to 3.9; p = 0.002)) and trainee status (RR 1.53 (95% CI 1.15 to 2.03 p = 0.004)) were independently associated with increased relative risk of having a ‘at-risk’ or ‘burnout’ score. Conclusions The rate of self-reported burnout and risk for poor outcomes among orthopaedic surgeons and trainees varies between countries but remains unacceptably high throughout. Both individual and health system characteristics contribute to physician wellness and should be considered in the development of strategies to improve surgeon wellbeing. Level of Evidence: III Cite this article: Bone Jt Open 2021;2(11):932–939.
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Holzer, Katherine J., Sunny S. Lou, Charles W. Goss, Jaime Strickland, Bradley A. Evanoff, Jennifer G. Duncan i Thomas Kannampallil. "Impact of Changes in EHR Use during COVID-19 on Physician Trainee Mental Health". Applied Clinical Informatics 12, nr 03 (maj 2021): 507–17. http://dx.doi.org/10.1055/s-0041-1731000.
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Abstract Objectives This article investigates the association between changes in electronic health record (EHR) use during the coronavirus disease 2019 (COVID-19) pandemic on the rate of burnout, stress, posttraumatic stress disorder (PTSD), depression, and anxiety among physician trainees (residents and fellows). Methods A total of 222 (of 1,375, 16.2%) physician trainees from an academic medical center responded to a Web-based survey. We compared the physician trainees who reported that their EHR use increased versus those whose EHR use stayed the same or decreased on outcomes related to depression, anxiety, stress, PTSD, and burnout using univariable and multivariable models. We examined whether self-reported exposure to COVID-19 patients moderated these relationships. Results Physician trainees who reported increased use of EHR had higher burnout (adjusted mean, 1.48 [95% confidence interval [CI] 1.24, 1.71] vs. 1.05 [95% CI 0.93, 1.17]; p = 0.001) and were more likely to exhibit symptoms of PTSD (adjusted mean = 15.09 [95% CI 9.12, 21.05] vs. 9.36 [95% CI 7.38, 11.28]; p = 0.035). Physician trainees reporting increased EHR use outside of work were more likely to experience depression (adjusted mean, 8.37 [95% CI 5.68, 11.05] vs. 5.50 [95% CI 4.28, 6.72]; p = 0.035). Among physician trainees with increased EHR use, those exposed to COVID-19 patients had significantly higher burnout (2.04, p < 0.001) and depression scores (14.13, p = 0.003). Conclusion Increased EHR use was associated with higher burnout, depression, and PTSD outcomes among physician trainees. Although preliminary, these findings have implications for creating systemic changes to manage the wellness and well-being of trainees.
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Hipp, Dustin M., Kristy L. Rialon, Kathryn Nevel, Anai N. Kothari i LCDR Dinchen A. Jardine. "“Back to Bedside”: Residents' and Fellows' Perspectives on Finding Meaning in Work". Journal of Graduate Medical Education 9, nr 2 (1.04.2017): 269–73. http://dx.doi.org/10.4300/jgme-d-17-00136.1.
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ABSTRACT Background Physician burnout is common and associated with significant consequences for physicians and patients. One mechanism to combat burnout is to enhance meaning in work. Objective To provide a trainee perspective on how meaning in work can be enhanced in the clinical learning environment through individual, program, and institutional efforts. Methods “Back to Bedside” resulted from an appreciative inquiry exercise by 37 resident and fellow members of the ACGME's Council of Review Committee Residents (CRCR), which was guided by the memoir When Breath Becomes Air by Paul Kalanithi. The exercise was designed to (1) discover current best practices in existing learning environments; (2) dream of ideal ways to enhance meaning in work; (3) design solutions that move toward this optimal environment; and (4) support trainees in operationalizing innovative solutions. Results Back to Bedside consists of 5 themes for how the learning environment can enhance meaning in daily work: (1) more time at the bedside, engaged in direct patient care, dialogue with patients and families, and bedside clinical teaching; (2) a shared sense of teamwork and respect among multidisciplinary health professionals and trainees; (3) decreasing the time spent on nonclinical and administrative responsibilities; (4) a supportive, collegial work environment; and (5) a learning environment conducive to developing clinical mastery and progressive autonomy. Participants identified actions to achieve these goals. Conclusions A national, multispecialty group of trainees developed actionable recommendations for how clinical learning environments can be improved to combat physician burnout by fostering meaning in work. These improvements can be championed by trainees.
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Mascaro, Jennifer S., Amanda Wallace, Brooke Hyman, Carla Haack, Cherie C. Hill, Miranda A. Moore, Maha B. Lund, Eric J. Nehl, Sharon H. Bergquist i Steve W. Cole. "Flourishing in Healthcare Trainees: Psychological Well-Being and the Conserved Transcriptional Response to Adversity". International Journal of Environmental Research and Public Health 19, nr 4 (16.02.2022): 2255. http://dx.doi.org/10.3390/ijerph19042255.
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While much attention has been paid to healthcare provider and trainee burnout, less is known about provider well-being (i.e., flourishing) or about the effects of well-being on immune function. This study examined the demographic and psycho-social correlates of well-being among healthcare trainees (resident physicians and physician assistant (PA) trainees) and evaluated the association of well-being with the “conserved transcriptional response to adversity” (CTRA) characterized by up-regulated expression of pro-inflammatory genes and down-regulated expression of innate antiviral genes. Participants (n = 58) completed self-reported assessments of sleep disturbance, loneliness, depressive symptoms, anxiety, stress, and well-being (flourishing). Blood sample RNA profiles were analyzed by RNA sequencing to assess the CTRA. Slightly over half (n = 32; 55.2%) of healthcare trainees were categorized as flourishing. Flourishing was less prevalent among primary caregivers, and more prevalent among trainees who exercised more frequently and those with fewest days sick. Loneliness (AOR = 0.75; 95% CI = 0.61, 0.91; p = 0.003) and stress (AOR = 0.65; 95% CI = 0.45, 0.94; p = 0.02) were associated with decreased odds of flourishing when controlling for other variables. Flourishing was associated with down-regulated CTRA gene expression, whereas loneliness was associated with up-regulated CTRA gene expression (both p < 0.05). Assessing these relationships in a larger, multi-site study is of critical importance to inform policy, curricula, and interventions to bolster sustainable trainee well-being.
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Kamra, Mihir, Shan Dhaliwal, Wenshan Li, Shrey Acharya, Adrian Wong, Andy Zhu, Jaydev Vemulakonda i in. "Physician Posttraumatic Stress Disorder During COVID-19". JAMA Network Open 7, nr 7 (24.07.2024): e2423316. http://dx.doi.org/10.1001/jamanetworkopen.2024.23316.
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ImportanceThe COVID-19 pandemic placed many physicians in situations of increased stress and challenging resource allocation decisions. Insight into the prevalence of posttraumatic stress disorder in physicians and its risk factors during the COVID-19 pandemic will guide interventions to prevent its development.ObjectiveTo determine the prevalence of posttraumatic stress disorder (PTSD) among physicians during the COVID-19 pandemic and examine variations based on factors, such as sex, age, medical specialty, and career stage.Data SourcesA Preferred Reporting Items for Systematic Reviews and Meta-analyses–compliant systematic review was conducted, searching MEDLINE, Embase, and PsychInfo, from December 2019 to November 2022. Search terms included MeSH (medical subject heading) terms and keywords associated with physicians as the population and PTSD.Study SelectionPeer-reviewed published studies reporting on PTSD as a probable diagnosis via validated questionnaires or clinician diagnosis were included. The studies were reviewed by 6 reviewers.Data Extraction and SynthesisA random-effects meta-analysis was used to pool estimates of PTSD prevalence and calculate odds ratios (ORs) for relevant physician characteristics.Main Outcomes and MeasuresThe primary outcome of interest was the prevalence of PTSD in physicians, identified by standardized questionnaires.ResultsFifty-seven studies with a total of 28 965 participants and 25 countries were included (of those that reported sex: 5917 of 11 239 [52.6%] were male and 5322 of 11 239 [47.4%] were female; of those that reported career stage: 4148 of 11 186 [37.1%] were medical trainees and 7038 of 11 186 [62.9%] were attending physicians). The estimated pooled prevalence of PTSD was 18.3% (95% CI, 15.2%-22.8%; I2 = 97%). Fourteen studies (22.8%) reported sex, and it was found that female physicians were more likely to develop PTSD (OR, 1.93; 95% CI, 1.56-2.39). Of the 10 studies (17.5%) reporting age, younger physicians reported less PTSD. Among the 13 studies (22.8%) reporting specialty, PTSD was most common among emergency department doctors. Among the 16 studies (28.1%) reporting career stage, trainees were more prone to developing PTSD than attendings (OR, 1.33; 95% CI, 1.12-1.57).Conclusions and RelevanceIn this meta-analysis examining PTSD during COVID-19, 18.3% of physicians reported symptoms consistent with PTSD, with a higher risk in female physicians, older physiciansy, and trainees, and with variation by specialty. Targeted interventions to support physician well-being during traumatic events like pandemics are required.
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Krouss, Mona, Jumana Alshaikh, Lindsay Croft i Daniel J. Morgan. "Improving Incident Reporting Among Physician Trainees". Journal of Patient Safety 15, nr 4 (grudzień 2019): 308–10. http://dx.doi.org/10.1097/pts.0000000000000325.
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Goldman, Matthew L., Ravi N. Shah i Carol A. Bernstein. "Depression and Suicide Among Physician Trainees". JAMA Psychiatry 72, nr 5 (1.05.2015): 411. http://dx.doi.org/10.1001/jamapsychiatry.2014.3050.
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Belfer, Joshua, Lance Feld, Sophia Jan, Joanna Fishbein, John Q. Young i Stephen Barone. "The Effect of the COVID-19 Pandemic on Pediatric Physician Wellness: A Cross-Sectional Study". International Journal of Environmental Research and Public Health 19, nr 6 (21.03.2022): 3745. http://dx.doi.org/10.3390/ijerph19063745.
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The COVID-19 pandemic has provided challenges to all healthcare workers. While the brunt of treating COVID-19 patients fell upon adult providers, pediatricians also experienced significant stressors and disruptions. Academic pediatricians and trainees (fellows and residents) were redeployed to manage adult patients in hospitalist and intensive care settings and/or had major changes to their clinical schedules. In this study, we aimed to describe levels of self-reported depression, anxiety, and burnout in pediatric physicians following the initial wave of the pandemic at the largest integrated health system in New York State. A cross-sectional study was conducted among pediatric physicians who cared for patients during the COVID-19 pandemic within the Northwell Health System as part of the Northwell Wellbeing Registry, a longitudinal registry assessing the psychological impact of COVID-19 on healthcare providers. A total of 99 pediatric physician respondents were included in this study; 72% of whom were attendings, 28% of whom were trainees. Compared to attendings, trainees reported significantly higher proportions of burnout–emotional exhaustion (p = 0.0007) and burnout–depersonalization (p = 0.0011) on the Abbreviated Maslach Burnout Inventory. There was not a similar trend in probable depression or probable anxiety using the Patient Health Questionnaire. In a multivariable logistic regression model, being a trainee was significantly associated with increased odds of burnout–emotional exhaustion (OR 5.94, 95% Confidence Interval: 1.85–19.02). These findings suggest that fellows and residents were a vulnerable population during the COVID-19 pandemic. Training programs should pay special attention to their trainees during times of crisis, and future studies can help to identify protective factors to reduce the risk of burnout during these times.
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Maksimenko, Yevgeniy, Kevin Ryan, Julianne Dugas i Laura Hahn. "Improving Hazardous Material Incident Preparedness for Emergency Medicine Physician Trainees: A Quality Improvement Project". Prehospital and Disaster Medicine 38, S1 (maj 2023): s150—s151. http://dx.doi.org/10.1017/s1049023x23003941.
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Introduction:Hazardous materials (HazMat) training is not a requirement for accreditation of US Emergency Medicine (EM) residencies, nor for EM board certification by the American Board of Emergency Medicine (ABEM). However, the US Occupational Safety and Health Administration (OSHA) requires hospitals train all personnel expected to deal with contaminated patients. This QI project aimed to develop an EM physician-specific HazMat course and evaluate the physician comfort level with HazMat personal protective equipment (PPE) donning and doffing, triage, procedural skills, and decontamination.Method:A four-hour “HazMat for Docs” course was designed at a large urban academic trauma center and offered to second-year EM residents. Additionally, we performed a quantitative survey of a cohort of 72 current and recently graduated EM residents (classes 2019-2024), some of whom had taken the course in person. Our primary outcome was to measure improvement in comfort level with essential HazMat tasks after completing the course. Our secondary outcome was to evaluate the current or recently graduated EM physician's overall comfort levels with managing a HazMat incident, as well as HazMat skills and knowledge retention.Results:A total of 53 responses (73.6%) were obtained. 45.3% of the respondents were male and 54.7% female. 37.8% of the respondents were recent EM graduates, with 20.8% PGY-4, 13.2% PGY-3, 15.1% PGY-2, 13.2% PGY-1. 16/53 (30.2%) had prior EMS experience. EM Physicians were most comfortable with donning and doffing PPE (4.92 on a 7-point scale) and least comfortable with decontamination procedures (2.98/7). After completing the HazMat course, EM physicians increased their comfort level with HazMat decontamination procedures by 8.6% and with organizing a multi-disciplinary ED HazMat response by 10.5%.Conclusion:EM Physician comfort levels with HazMat procedures are low. Increased training aimed at improving physician knowledge, preparedness, and comfort level for such events is necessary and can be accomplished through a short course.
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Ferrand, Amaryllis, Jelena Poleksic i Eric Racine. "Factors Influencing Physician Prognosis: A Scoping Review". MDM Policy & Practice 7, nr 2 (lipiec 2022): 238146832211451. http://dx.doi.org/10.1177/23814683221145158.
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Introduction. Prognosis is an essential component of informed consent for medical decision making. Research shows that physicians display discrepancies in their prognostication, leading to variable, inaccurate, optimistic, or pessimistic prognosis. Factors driving these discrepancies and the supporting evidence have not been reviewed systematically. Methods. We undertook a scoping review to explore the literature on the factors leading to discrepancies in medical prognosis. We searched Medline (Ovid) and Embase (Ovid) databases for peer-reviewed articles from 1970 to 2017. We included articles that discussed prognosis variation or discrepancy and where factors influencing prognosis were evaluated. We extracted data outlining the participants, methodology, and prognosis discrepancy information and measured factors influencing prognosis. Results. Of 4,723 articles, 73 were included in the final analysis. There was significant variability in research methodologies. Most articles showed that physicians were pessimistic regarding patient outcomes, particularly in early trainees and acute care specialties. Accuracy rates were similar across all time periods. Factors influencing prognosis were clustered in 4 categories: patient-related factors (such as age, gender, race, diagnosis), physician-related factors (such as age, race, gender, specialty, training and experience, attitudes and values), clinical situation-related factors (such as physician-patient relationship, patient location, and clinical context), and environmental-related factors (such as country or hospital size). Discussion. Obtaining accurate prognostic information is one of the highest priorities for seriously ill patients. The literature shows trends toward pessimism, especially in early trainees and acute care specialties. While some factors may prove difficult to change, the physician’s personality and psychology influence prognosis accuracy and could be tackled using debiasing strategies. Exposure to long-term patient outcomes and a multidisciplinary practice setting are environmental debiasing strategies that may warrant further research. Highlights Literature on discrepancies in physician’s prognostication is heterogeneous and sparse. Literature shows that physicians are mostly pessimistic regarding patient outcomes. Literature shows that a physician’s personality and psychology influence prognostic accuracy and could be improved with evidence-based debiasing strategies. Medical specialty strongly influences prognosis, with specialties exposed to acutely ill patients being more pessimistic, whereas specialties following patients longitudinally being more optimistic. Physicians early in their training were more pessimist than more experienced physicians.
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King, Ann, i Ruth B. Hoppe. "“Best Practice” for Patient-Centered Communication: A Narrative Review". Journal of Graduate Medical Education 5, nr 3 (1.09.2013): 385–93. http://dx.doi.org/10.4300/jgme-d-13-00072.1.
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Abstract Background Communicating with patients has long been identified as an important physician competency. More recently, there is a growing consensus regarding the components that define physician-patient communication. There continues to be emphasis on both the need to teach and to assess the communication skills of physicians. Objective This narrative review aims to summarize the work that has been conducted in physician-patient communication that supports the efficacy of good communications skills. This work may also help to define the physician-patient communication skills that need to be taught and assessed. Results A review of the literature shows it contains impressive evidence supporting positive associations between physician communication behaviors and positive patient outcomes, such as patient recall, patient understanding, and patient adherence to therapy. There is a consensus about what constitutes “best practice” for physician communication in medical encounters: (1) fostering the relationship, (2) gathering information, (3) providing information, (4) making decisions, (5) responding to emotions, and (6) enabling disease- and treatment-related behavior. Conclusions Evidence supports the importance of communication skills as a dimension of physician competence. Effort to enhance teaching of communication skills to medical trainees likely will require significant changes in instruction at undergraduate and graduate levels, as well as changes in assessing the developing communication skills of physicians. An added critical dimension is faculty understanding of the importance of communication skills, and their commitment to helping trainees develop those skills.
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Owusu-Ansah, Sylvia, Kyle A. Schmucker, Ashley Keilman, Christine Aspiotes i Natan Cramer. "Pilot study to teach residents about EMS scope of practice through reverse role simulations". Education for Health 37, nr 1 (22.05.2024): 86–94. http://dx.doi.org/10.62694/efh.2024.29.
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Objective: To improve emergency physician trainee understanding of Emergency Medical Services´ (EMS) scope of practice, and physician confidence in performing EMS skills by conducting a simulation role reversal workshop. Methods: EMS clinicians and physicians created and facilitated a role-reversal workshop for seven pediatric emergency medicine (PEM) fellows designed to emphasize scope of practice of EMS clinicians using basic life support (BLS) and advanced life support (ALS) skills. Fellows roleplayed using BLS or ALS skills in three different case scenarios. Medication preparation and delivery were assessed. Pre, post, and retention surveys (provided at 1 month post-intervention) were performed to assess scope of practice knowledge, and the EMS skill set confidence of the fellows. Results: Fellows reported the curriculum had an impact on their understanding of EMS scope of practice. Confidence in differentiating ALS and BLS scope of practice improved as did the subjective understanding of local EMS protocols. The confidence in preparing and administering multiple types of medications (i.e., intramuscular epinephrine administration, nebulized medication preparation) significantly improved as well (p<0.016 with Bonferroni adjustment). Conclusion: Given improved confidence scoring in understanding EMS scope of practice and medication administration, role reversal methodology may offer intangible affective and psychomotor benefits for emergency medicine trainees by generating a sense of a “lived-experience” when role-playing EMS skill sets. The workshop may serve as a model to use in teaching pre-hospital scope of practice and generating interprofessional understanding for physician trainees.
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Dubash, Faisal, Sareena Gajebasia, Sanaa Butt, Sibel Demirel, Marese O’Reilly, Robert Dawe i Andrew Affleck. "P046 The hidden generic curriculum: identifying and formalizing important soft skills for trainee dermatologists. A retrospective review of journal club experience (2022–2023)". British Journal of Dermatology 191, Supplement_1 (28.06.2024): i35—i36. http://dx.doi.org/10.1093/bjd/ljae090.073.
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Abstract We identified important soft skills not specifically highlighted within the dermatology trainee Joint Royal Colleges of Physicians Training Board (JRCPTB) curriculum, from our journal club experience. We propose a ‘hidden generic curriculum’: a rapidly expanding list of important soft skills to be honed for enhancing trainee learning and competency, while facilitating the transition into consultant dermatologist. Initiated by trainees during the COVID pandemic, trainee-led and consultant/professor-facilitated journal club sessions were developed for in-person, virtual and hybrid formats. Sessions were designated for 08.00–09.00 h on Wednesdays, with voluntary attendance. Topics were chosen randomly and were mapped to the existing dermatology curriculum as ‘subdomains’. Learning points from articles were used to reflect on real-world clinical practice. Articles were discussed with PowerPoint aids, trainee-generated quizzes and podcasts as adjuncts to sessions. Our journal club format was utilized as a tool and curriculum adjunct to enhance soft skills important for practising dermatologists, leading to discussion around clinical cases. Common but perhaps overlooked important competencies used in everyday practice were identified, and a continually expanding list of skills has been generated, leading to comprehensive discussion between trainees and consultants. Group reflection followed, on when to apply learned skills in outpatients or during on-call settings, for example motivational interviewing in patients with chronic disease. We highlight our list of ‘top 10’ articles, recommended for trainees to reflect on in their journal clubs, allowing them to build on soft skills. This includes articles titled ‘dermatological games’, ‘SPIKES – a six-step protocol for delivering bad news: application to the patient with cancer’, ‘writing to patients’, ‘motivational interviewing in dermatology’, ‘suicide in dermatological patients’, ‘the difficult patient – the hateful patient revisited: relevance for 21st-century medicine’, ‘achieving quality in clinical decision making: cognitive strategies and detection of bias’, ‘physician stress and burnout’, ‘compassionate care: enhancing physician–patient communication and education in dermatology’ and ‘how to train to discharge a dermatology outpatient: a review’. In a group, papers were summarized, learning points were noted, including why the article was important for trainees, and we proposed a hidden generic curriculum item or ‘subdomain’, later mapped to the JRCPTB curriculum. There are many other relevant articles beyond our top 10 list that have been used in subsequent journal club sessions. Exploring the ‘hidden generic curriculum’ may enhance the learning experience and trainee development. Our journal club format was utilized as a tool and curriculum adjunct to enhance soft skills important for practising dermatologists. It surely complements the existing JRCPTB curriculum for trainees and will likely lead to more well-rounded clinicians. Our local journal club format could be implemented by other centres, to enhance the UK dermatology trainee experience.
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Dubash, Faisal, Sareena Gajebasia, Sanaa Butt, Sibel Demirel, Marese O’Reilly, Robert Dawe i Andrew Affleck. "DE05 (P046) The hidden generic curriculum: identifying and formalizing important soft skills for trainee dermatologists. A retrospective review of journal club experience (2022–2023)". British Journal of Dermatology 191, Supplement_1 (28.06.2024): i160. http://dx.doi.org/10.1093/bjd/ljae090.337.
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Abstract We identified important soft skills not specifically highlighted within the dermatology trainee Joint Royal Colleges of Physicians Training Board (JRCPTB) curriculum, from our journal club experience. We propose a ‘hidden generic curriculum’: a rapidly expanding list of important soft skills to be honed for enhancing trainee learning and competency, while facilitating the transition into consultant dermatologist. Initiated by trainees during the COVID pandemic, trainee-led and consultant/professor-facilitated journal club sessions were developed for in-person, virtual and hybrid formats. Sessions were designated for 08.00–09.00 h on Wednesdays, with voluntary attendance. Topics were chosen randomly and were mapped to the existing dermatology curriculum as ‘subdomains’. Learning points from articles were used to reflect on real-world clinical practice. Articles were discussed with PowerPoint aids, trainee-generated quizzes and podcasts as adjuncts to sessions. Our journal club format was utilized as a tool and curriculum adjunct to enhance soft skills important for practising dermatologists, leading to discussion around clinical cases. Common but perhaps overlooked important competencies used in everyday practice were identified, and a continually expanding list of skills has been generated, leading to comprehensive discussion between trainees and consultants. Group reflection followed, on when to apply learned skills in outpatients or during on-call settings, for example motivational interviewing in patients with chronic disease. We highlight our list of ‘top 10’ articles, recommended for trainees to reflect on in their journal clubs, allowing them to build on soft skills. This includes articles titled ‘dermatological games’, ‘SPIKES – a six-step protocol for delivering bad news: application to the patient with cancer’, ‘writing to patients’, ‘motivational interviewing in dermatology’, ‘suicide in dermatological patients’, ‘the difficult patient – the hateful patient revisited: relevance for 21st century medicine’, ‘achieving quality in clinical decision making: cognitive strategies and detection of bias’, ‘physician stress and burnout’, ‘compassionate care: enhancing physician–patient communication and education in dermatology’ and ‘how to train to discharge a dermatology outpatient: a review’. In a group, papers were summarized, learning points were noted, including why the article was important for trainees, and we proposed a hidden generic curriculum item or ‘subdomain’, later mapped to the JRCPTB curriculum. There are many other relevant articles beyond our top 10 list that have been used in subsequent journal club sessions. Exploring the ‘hidden generic curriculum’ may enhance the learning experience and trainee development. Our journal club format was utilized as a tool and curriculum adjunct to enhance soft skills important for practising dermatologists. It surely complements the existing JRCPTB curriculum for trainees and will likely lead to more well-rounded clinicians. Our local journal club format could be implemented by other centres, to enhance the UK dermatology trainee experience.
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Rozen, Warren M., Elan D. Kaplan, Katharine J. Drummond i Robert J. Millar. "A tale of two colleges: do specialist trainees receive adequate hospital-based training?" Australian Health Review 31, nr 3 (2007): 362. http://dx.doi.org/10.1071/ah070362.
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Background: Both medical and surgical trainees have a dual reliance on their specialist training college and their respective teaching hospitals to maintain standards in teaching and training. Although guidelines are in place for the administration of this teaching, hospital-based teaching has been minimally regulated. A review of trainee satisfaction with current levels of hospital-based training was performed, both to reflect the thoughts of trainees themselves and to highlight specific areas requiring improvement. Methods: Sixty-four basic specialist trainees (44 surgical [BSTs] and 20 physician [BPTs]) from all of the major Melbourne metropolitan teaching hospitals completed an anonymous survey. Results: Surgical trainees considered all areas of hospital-based training to be deficient, with overall dissatisfaction significantly greater for BSTs compared with BPTs (P = 0.046). A requirement for increased hospital-based training was similarly greater for BSTs (P = 0.0072). Conclusion: The study confirms the need for a change in the regulation and administration of hospital-based teaching for surgical trainees.
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Sweet, Amalia R., Omar Sultan Haque i Michael Ashley Stein. "Ethical and Public Health Considerations for Integrating Physicians with Mental Disability into the Physician Workforce". Journal of Law, Medicine & Ethics 50, nr 4 (2022): 833–40. http://dx.doi.org/10.1017/jme.2023.24.
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AbstractStigma against mental disability within the medical field continues to impose significant barriers on physicians and trainees. Here, we examine several implications of this stigma and propose steps toward greater inclusion of persons with mental disabilities in the physician workforce.
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Maiorano, Alaina, Edwin van Wijngaarden, Alfred Vitale, Timothy De Ver Dye, Robert Gross i Kerry O’Banion. "4274 Thirteen Years of Pipeline Programming at the University of Rochester’s Clinical & Translational Science Institute to Train Physician-Scientists". Journal of Clinical and Translational Science 4, s1 (czerwiec 2020): 69. http://dx.doi.org/10.1017/cts.2020.228.
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OBJECTIVES/GOALS: Physician-scientists play a vital role in biomedical research but this chosen career path has many challenges, such as long training periods and funding. The University of Rochester (UR) CTSI pipeline programs address this by enabling medical trainees to partake in enriched research experiences. METHODS/STUDY POPULATION: The UR CTSI TL1 is a training grant from the National Center for Advancing Translational Science (NCATS), which funds predoctoral trainees. The TL1-funded physician-scientist pipeline includes the Academic Research Track (ART) year-out program and the Medical Science Training Program (MSTP). We describe the characteristics and training outcomes of TL1-funded trainees. We also obtained testimonials of current and former trainees regarding their career component decision-making, and their perception of programs, in order to identify how best to address the challenges of the physician-scientist workforce, and to facilitate the transition between the clinic and bench. RESULTS/ANTICIPATED RESULTS: From 2006-2019, the UR CTSI has had 56 ART trainees and 17 MSTP trainees complete training; six trainees have transitioned into the MSTP after completing the ART program. As of 2019, 63 of 67 graduated trainees (94%) have continued their engagement in CTS after graduation. Importantly, our programs have facilitated the careers of 31 women (39.7%) and 12 under-represented minorities (15.4%). We will present a breadth of qualitative data to inform which parts of the TL1-related programs have been successful, and which parts could use programmatic improvement to aid the transition into the physician-scientist workforce. DISCUSSION/SIGNIFICANCE OF IMPACT: Physician-scientist training barriers in the US have resulted in a shortage of these professionals in the clinical and translation workforce. Our data show the UR CTSI has been successful in addressing several of these challenges via the TL1-funded ART, MSTP, and ART/MSTP dual program pipeline.
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Portney, David S., Jenna Goldstein, Sean T. Berkowitz, Taylor S. Novice, Shriji Patel, Janice Law i Bradford Tannen. "Trainee Perspectives of Private Equity's Impact on Ophthalmology". Journal of Academic Ophthalmology 15, nr 01 (styczeń 2023): e56-e61. http://dx.doi.org/10.1055/s-0043-1761289.
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Abstract Objective The accelerated involvement of private equity (PE) in ophthalmology has many potential implications for the future of the field. The aim of this study was to evaluate trainee perspectives on PE's impact on ophthalmology. Methods An electronic survey was sent to trainees via an online ophthalmology research newsletter. The survey assessed for career goals and perspectives on the involvement of PE and its impact across a variety of attributes. Results A total of 41 United States-based respondents responded to the survey, 68% were medical students and 32% were residents or fellows. Seventy-eight percent of respondents reported they would not consider working for a PE-owned practice. There was a negative perceived impact of PE for physician autonomy, long-term physician income, career advancement, and quality of care. There was a positive perceived impact for the number of physician extenders, more referral sources, financial support, bargaining with insurance companies, starting physician salary, and administrative burden. All respondents agreed (76% strongly agree, 24% somewhat agree) that education about practice options and ownership structures is important to include in residency program education, with preferred modalities of small group discussions and on-site learning. Conclusions Trainees broadly perceive PE to negatively impact the practice of ophthalmology. While there were attributes perceived to be positively impacted by PE, these were not felt to be as important as those which may be negatively affected. New modalities for education about practice ownership options are necessary, and small group discussions and on-site learning may be of the highest yield for trainees.
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Kelly, Christina, Anastasia J. Coutinho, Natasha Bhuyan, Alexandra Gits, Mustafa Alavi, Tiffany Ho, Jean Shiraki, Kristina Dakis, Cecilia Jojola i Chandler Stisher. "Student and Resident Involvement in Family Medicine for America’s Health". Family Medicine 51, nr 2 (8.02.2019): 166–72. http://dx.doi.org/10.22454/fammed.2019.857539.
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Background and Objectives: Trainees—medical students and residents—are an important constituency of family medicine. The Family Medicine for America’s Health (FMAHealth) Workforce Education and Development (WED) Tactic Team attempted to engage trainees in FMAHealth objectives via a nationally accessible leadership development program. We discuss a how-to mechanism to develop similar models, while highlighting areas for improvement. Methods: The Student and Resident Collaborative recruited a diverse group of trainees to comprise five teams: student choice of family medicine, health policy and advocacy, burnout prevention, medical student education, and workforce diversity. An early-career physician mentored team leaders and a resident served as a liaison between the Collaborative and WED Team. Each team established its own goals and objectives. A total of 36 trainees were involved with the Collaborative for any given time. Results: Including trainees in a national initiative required special considerations, from recruitment to scheduling. Qualitative feedback indicated trainees valued the leadership development and networking opportunities. The experience could have been improved by clearly defining how trainees could impact the broader FMAHealth agenda. To date, the Collaborative has produced a total of 17 conference presentations and four manuscripts. Conclusions: Although trainees felt improvement in leadership skills, more robust trainee involvement in FMAHealth core teams would have made the leadership initiative stronger, while simultaneously improving sustainability among family medicine and primary care reform strategies. Nonetheless, the unique structure of the Collaborative facilitated involvement of diverse trainees, and some trainee involvement should be integrated into any future strategic planning.
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Williamson, Adam. "Letter to the editor: Acute Medicine Journal". Acute Medicine Journal 19, nr 1 (1.01.2020): 56. http://dx.doi.org/10.52964/amja.0800.
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Editor- I note with interest that the Joint Royal College of Physicians Training Board curriculum for Acute Internal Medicine (AIM) has been reviewed and circulated for comment and consideration of implementation in August 2022. The proposed curriculum hopes to produce doctors with generic professional and specialty specific capabilities needed to manage patients presenting with a wide range of medical symptoms and conditions. It aims to produce a workforce that reflects the current trends of increasing patient attendances to bothprimary care and emergency departments- one that has a high level of diagnostic reasoning, the ability to manage uncertainty, deal with comorbidities and recognise when specialty input is require in a variety of settings, including ambulatory and critical care. The new curriculum moves away from each trainee being required to develop a specialist skill, such as medical education, echocardiography or endoscopy throughout their training1, to trainees acquiring competencies in a specialist theme for their final 24 to 30 months of their training programme after they have completed their Point of Care Ultrasound certification. The current curriculum allows trainees to have regular dedicated time to develop interests inside or outside acute medicine to supplement their professional experience and training. This often allows trainees time away from the ‘front door’, can be welcomed break from high intensity acute care and uniquely offers trainee physicians flexibility in their training programmes and curriculum requirements. This sets acute medicine training apart from other physician training programmes and can attract trainees to apply to the specialty. It also addresses Shape of Training recommendations, which suggest more flexibility and choice in career structure for postgraduate doctors.2 Point of Care Ultrasound will undoubtedly be a welcome addition to the curriculum and will benefit patients, trainees and front door services up and down the country.3 However, concerns regarding supervision and maintenance of competency exist.4 More importantly, time spent gaining competency in this before pursuing an interest in an additional area or procedure will offer trainees less time to attain accreditation in some of the existing specialist skills currently available. With ongoing concerns regarding recruitment and retention in Acute Internal Medicine5 we should be careful that we do not lose a unique selling point that acute internal medicine training offers.
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Northcraft, Heather, Jia Bai, Anne R. Griffin, Sona Hovsepian i Aram Dobalian. "Association of the COVID-19 Pandemic on VA Resident and Fellow Training Satisfaction and Future VA Employment: A Mixed Methods Study". Journal of Graduate Medical Education 14, nr 5 (1.10.2022): 593–98. http://dx.doi.org/10.4300/jgme-d-22-00168.1.
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ABSTRACT Background The COVID-19 pandemic altered learning experiences of residents and fellows worldwide, including at the US Department of Veterans Affairs (VA). Because the VA is the largest training provider in the United States, understanding VA trainee experiences is vital to understanding the pandemic's impact on graduate medical education nationwide. Additionally, understanding the pandemic's potential impacts on future employment allows for a better understanding of any future disruptions in the supply of physicians. Objective To examine whether COVID-19 affected the satisfaction with VA training experiences and likelihood to consider future VA employment among residents and fellows. Methods Responses from the VA Trainee Satisfaction Survey were collected for 3 academic years (2018-2021). Quantitative analysis (bivariate logistic regression) and qualitative content analysis were conducted to determine COVID-19′s impact on satisfaction and likelihood of future VA employment. Results Across 3 academic years, 17 900 responses from a total of 140 933 physician trainees were analyzed (12.7%). Following COVID-19, respondents expressed decreased satisfaction (84.58% vs 86.01%, P=.008) and decreased likelihood to consider future VA employment compared to prior to the pandemic (53.42% vs 55.32%, P=.013). COVID-19-related causes of dissatisfaction included the onboarding process, which slowed due to the pandemic, limited workspace that precluded social distancing, and reduced learning opportunities. Conclusions Since the pandemic, physician trainees expressed decreased training satisfaction and decreased likelihood to seek future VA employment. Causes of dissatisfaction included increased difficulties with onboarding, further limitations to accessible workspaces, and the direct obstruction of learning opportunities including decreased patient volume or case mix.
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Ejnes, Yul D. "Empowering Trainees to Aim For Physician Wellness". Journal of Graduate Medical Education 8, nr 5 (1.12.2016): 775–76. http://dx.doi.org/10.4300/jgme-d-16-00546.1.
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Solá, Orlando Ivan, i John Paul Sánchez. "How to Turn Trainees Into Physician–Advocates". Academic Medicine 94, nr 9 (wrzesień 2019): 1262. http://dx.doi.org/10.1097/acm.0000000000002832.
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Austad, Kirsten E., Jerry Avorn, Jessica M. Franklin i Aaron S. Kesselheim. "Physician Trainees’ Interactions with the Pharmaceutical Industry". Journal of General Internal Medicine 28, nr 10 (25.06.2013): 1267. http://dx.doi.org/10.1007/s11606-013-2526-x.
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Ramachandran, Reshma, Marcia Hams i Jean Silver-Isenstadt. "Physician Trainees’ Interactions with the Pharmaceutical Industry". Journal of General Internal Medicine 28, nr 10 (9.07.2013): 1266. http://dx.doi.org/10.1007/s11606-013-2527-9.
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Spatz, Erica S., Darlene LeFrancois i Robert J. Ostfeld. "Developing cardiac auscultation skills among physician trainees". International Journal of Cardiology 152, nr 3 (listopad 2011): 391–92. http://dx.doi.org/10.1016/j.ijcard.2011.08.027.
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Khan, Rida, Jamie S. Lin i Douglas A. Mata. "Addressing Depression and Suicide Among Physician Trainees". JAMA Psychiatry 72, nr 8 (1.08.2015): 848. http://dx.doi.org/10.1001/jamapsychiatry.2015.0643.
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Schukow, Casey P., Meredith Herman i Kamran Mirza. "Osteopathic physician trainees and pathways to pathology". Academic Pathology 10, nr 2 (kwiecień 2023): 100071. http://dx.doi.org/10.1016/j.acpath.2023.100071.
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Klig, Jean E. "The legal implications of physician trainees and non-physician practitioners for the emergency physician". Clinical Pediatric Emergency Medicine 4, nr 4 (grudzień 2003): 243–48. http://dx.doi.org/10.1016/j.cpem.2003.09.001.
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Geelan-Hansen, Katie, Samantha Anne i Michael S. Benninger. "Burnout in Otolaryngology–Head and Neck Surgery: A Single Academic Center Experience". Otolaryngology–Head and Neck Surgery 159, nr 2 (15.05.2018): 254–57. http://dx.doi.org/10.1177/0194599818774740.
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Burnout in modern medicine is becoming more recognized and researched. The objective in this study is to evaluate burnout in a tertiary care academic institution and compare results among faculty, trainees, and advanced practice practitioners (APPs) in a cross-sectional survey using the Maslach Burnout Inventory. Fifty-two surveys were distributed; 44 participants completed the survey (85%): 25 staff physicians (57%), 14 resident physicians (32%), and 5 nurse practitioners (11%). Staff physicians had low emotional exhaustion, moderate depersonalization, and low result for reduced personal accomplishments; trainees reported low emotional exhaustion, high depersonalization, and moderate reduced personal accomplishment; and nurse practitioners reported moderate on all 3 dimensions. There is overall low burnout in this tertiary care academic center of otolaryngologist providers and no difference in rates among the different groups (trainees, APPs, staff). Measures addressing specific deficiencies among dimensions of burnout would be helpful to prevent disintegration of physician satisfaction into burnout.
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Koren, Gideon, Linoy Gabay i Joseph Kuchnir. "A Clinician-Researcher Training Program for Family Medicine Residents". Clinical and Investigative Medicine 42, nr 3 (29.09.2019): E35—E39. http://dx.doi.org/10.25011/cim.v42i3.33090.
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Purpose: Research training for clinicians is becoming relatively common for postdoctoral trainees in academic institutions. In contrast, there are relatively few such training programs for family physician residents. The purpose of this article is to describe a novel program for family medicine trainees in Maccabi Health Services, a large Israeli health fund.
Methods: Following organizational approval and budget allocation, a call for family residents resulted in 18 applications, 15 of whom were selected for a
two-year research training program. Each trainee submitted a research proposal, dealing with a community- based research question. Each protocol was allocated a budget. The Program, overseen by a steering committee of family physicians and scientists, has a designated clinical epidemiologist who coordinates all activities. The Project runs monthly face-to-face meetings where
trainees present their research proposals. The group reviewed the protocols ahead of time, commented on them and criticized them. In parallel, the trainees participate in a detailed discussion of their research proposals face-to-face with the program director and clinical epidemiologist, and the revised research proposal is submitted to the Institution Review Board.
Results: The Program received enthusiastic responses from the trainees and from Maccabi Health Services, which has already approved the budget for the
second year of the Program with a new stream of trainees. The approved research proposals dealt with original and important community-based clinical questions.
Conclusions: With the aim of developing clinician-researchers in the field of family medicine, this novel program will help change the research climate in a large organization, where community-based family practitioners were not typically involved in research.
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Jakes, Adam D., Ingrid Watt-Coote, Matthew Coleman i Catherine Nelson-Piercy. "Obstetric medical care and training in the United Kingdom". Obstetric Medicine 10, nr 1 (12.12.2016): 40–42. http://dx.doi.org/10.1177/1753495x16681201.
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The UK confidential enquiry into maternal deaths identified poor management of medical problems in pregnancy to be a contributory factor to a large proportion of indirect maternal deaths. Maternal (obstetric) medicine is an exciting subspecialty that encompasses caring for both women with pre-existing medical conditions who become pregnant, as well as those who develop medical conditions in pregnancy. Obstetrics and gynaecology trainees have some exposure to maternal medicine through their core curriculum and can then complete an advanced training skills module, subspecialise in maternal–fetal medicine or take time out to complete the Royal College of Physicians membership examination. Physician training has limited exposure to medical problems in pregnancy and has therefore prompted expansion of the obstetric physician role to ensure physicians with adequate expertise attend joint physician–obstetrician clinics. This article describes the role of an obstetric physician in the UK and the different career pathways available to physicians and obstetricians interested in maternal medicine.
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Cathcart, Jennifer, Kaitlin J. Mayne, Richard Hull, Michael Jones i Alastair Miller. "Less than full-time training (LTFT), is this the new norm? A cross-sectional study using a UK-wide online survey to evaluate trainees’ views and intentions for LTFT". BMJ Open 12, nr 11 (listopad 2022): e064518. http://dx.doi.org/10.1136/bmjopen-2022-064518.
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ObjectivesInterest in less than full-time training (LTFT) is growing among doctors in training. LTFT applications have previously been limited to fulfilment of specific criteria such as childcare or health reasons, but Health Education for England (HEE) has recently completed a pilot into LTFT for a third category: lifestyle choice. This was recognised as an opportunity to canvas trainee perspectives and intentions on LTFT and implications for workforce planning.DesignA cross-sectional study of UK trainees via an online questionnaire.Setting/participantsThe survey was distributed via email to trainees in all specialities and stages of training across the UK. The survey focused on three key themes: experiences of current LTFT trainees, perspectives of trainees considering LTFT in the future and experience of working with LTFT colleagues.ResultsResponses were received from 783 trainees across the UK, with most responses received from physician trainees (76%). Current LTFT trainees represented one-third of respondents. Of those not currently working LTFT, 75% expressed an intention to do so in future with lifestyle being the most common reason. Almost half of this group were concerned about the impact on their training. Stigma, reduced training opportunities, prolonged training and the application process were commonly cited barriers. These difficulties were experienced by several current LTFT trainees, 32% of whom described a negative impact on their training. Almost two-thirds (62%) of respondents stated they wish to work LTFT as a consultant.ConclusionSystems must adapt to increase access to LTFT training to promote trainee well-being and retention. Progress is being made and we suggest HEE’s category three pilot be rolled out across the UK as a priority. Workforce planning needs to consider the substantial rise in popularity of LTFT among trainees to offset any shortfalls in the present and future workforce.
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Trainer, Michael, Patricia O'Sullivan i Sam Brondfield. "Observing attending physician teaching behaviors during inpatient hematology/oncology consultation." Journal of Clinical Oncology 42, nr 16_suppl (1.06.2024): 9017. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.9017.
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9017 Background: Inpatient consultation is a primary responsibility of fellows and residents. Consults are complex tasks that impose significant cognitive load (CL) on trainees, potentially jeopardizing patient safety. We previously published strategies for attendings to optimize trainee CL during consults, and we also demonstrated that distractions are a prominent source of trainee CL during consults. Strategies to optimize CL have not been studied during inpatient consultation. Therefore, we aimed to observe and categorize attending behaviors that might affect trainee CL during consults using hematology/oncology as a model. Methods: After discussion with author SB (an oncologist who frequently performs and teaches inpatient oncology consultation), one author (MT, a neurology resident with experience performing consults outside of hematology/oncology) observed 10 new inpatient hematology and oncology consult discussions between attendings and fellows or residents at the University of California, San Francisco in 2023. The observer used our published set of strategies, divided into the three CL types (intrinsic load [IL] strategies to optimize the consult for the trainee, extraneous load [EL] strategies to reduce distractions, and germane load [GL] strategies to promote learning), as a checklist of attending behaviors and noted whether each behavior occurred during the discussions. Results: Discussions between four attendings and five trainees (three fellows and two residents) on inpatient hematology and oncology consult services were observed. Two attendings identified as female (one hematologist and one oncologist) and two male (one hematologist and one oncologist). Out of 18 attending behaviors on the checklist (six each of IL, EL, and GL), 13 (72%) were observed at least once. The median number of behaviors observed during one consult discussion was 3.5 (range 1-5, interquartile range 2-4.75). GL behaviors occurred most often (14 times across the 10 discussions), IL behaviors next most often (11 times), and EL behaviors least often (seven times). All four attendings exhibited at least one behavior from each CL type. The most commonly observed behavior was “teaching by sharing clinical reasoning” (GL). Conclusions: Hematology/oncology attendings exhibited observable behaviors related to optimizing trainee CL during inpatient consults and demonstrated behaviors intended to promote learning (GL) more frequently than behaviors intended to reduce trainee distractions (EL). Based on these data, hematology/oncology consult attendings may wish to augment their use of behaviors intended to reduce distractions, which are prominent during inpatient consults, to avoid trainee cognitive overload. Future research might correlate measured trainee CL with attending teaching behaviors to demonstrate the impact of these behaviors and optimize consult teaching interactions.
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Nelson, Brett D., Jennifer Kasper, Patricia L. Hibberd, Donald M. Thea i Julie M. Herlihy. "Developing a Career in Global Health: Considerations for Physicians-in-Training and Academic Mentors". Journal of Graduate Medical Education 4, nr 3 (1.09.2012): 301–6. http://dx.doi.org/10.4300/jgme-d-11-00299.1.
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Abstract Background Global health is an expansive field, and global health careers are as diverse as the practice of medicine, with new paths being forged every year. Interest in global health among medical students, residents, and fellows has never been higher. As a result, a greater number of these physicians-in-training are participating in global health electives during their training. However, there is a gap between the level of trainee interest and the breadth and depth of educational opportunities that prepare them for a career in global health. Objective Global health experiences can complement and enhance each step of traditional physician training, from medical school through residency and fellowship. Global health experiences can expose trainees to patients with diverse pathologies, improve physical exam skills by decreasing reliance on laboratory tests and imaging, enhance awareness of costs and resource allocation in resource-poor settings, and foster cultural sensitivity. The aim of this article is to describe issues faced by physicians-in-training and the faculty who mentor them as trainees pursue careers in global health. Methods We conducted a narrative review that addresses opportunities and challenges, competing demands on learners' educational schedules, and the need for professional development for faculty mentors. Conclusions A widening gap between trainee interest and the available educational opportunities in global health may result in many medical students and residents participating in global health experiences without adequate preparation and mentorship. Without this essential support, global health training experiences may have detrimental consequences on both trainees and the communities hosting them. We discuss considerations at each training level, options for additional training, current career models in global health, and challenges and potential solutions during training and early career development.