HCA healthcare journal of medicine最新文献

Background: The Accreditation Council for Graduate Medical Education (ACGME) has called for self-study within residency programs. Post-graduate surveys allow the graduate to reflect upon their residency experience after years of autonomous practice. Despite their potential utility, a standardized assessment of residency training from the perspective of orthopaedic alumni does not exist. In this study, we aimed to create, analyze, and share with our alumni a post-graduate survey based on ACGME core competencies.

Methods: The survey was developed by full-time orthopaedic faculty and reviewed by a survey methodologist to ensure clarity and an ideal survey format. In May 2020, the survey was emailed to all 90 graduates from 2000 to 2019. Respondents were polled on current clinical practice and satisfaction with program-specific initiatives, residency requirements, and learning environment issues based on a 7-point Likert scale. Respondents were also given the opportunity to provide open-ended responses. Data were collected within the survey platform and subdivided into 3 cohorts based on years since graduation.

Results: The response rate was 71% (64/90). The likelihood of fellowship training increased with recency since graduation. Most respondents are in either private or health-system-owned practice but 23% work in an academic center.The oldest cohort had greater variability in clinical practice. Most program-specific initiatives received high satisfaction scores, but graduates within the past 5 years had the lowest satisfaction scores. Instruction of skills included in ACGME competencies received generally favorable reviews, but professional development skills, such as starting a practice and evaluating job opportunities, received low marks.The overall satisfaction with the program was high (86%) but was lowest among most recent graduates.

Conclusion: The post-graduate survey demonstrates areas of strength and weakness and highlights dissatisfaction among recent graduates. The data will drive specific curricular changes within our program. The survey will be shared to promote self-study within other programs.

Description Atraumatic ball thrower's humerus fracture is an uncommon, and poorly understood injury pattern. The majority of these cases are seen in untrained and younger individuals. A missed diagnosis could severely impact a patient's quality of life, as management is operative in most cases. Here, we present the case of a young patient, suffering an atraumatic "ball thrower's" fracture. We present images of this exceedingly rare injury pattern and showcase original artwork with a proposed mechanism of injury.

Background: Immunoglobulin A (IgA) vasculitis is common in children and typically resolves spontaneously. However, when presenting in adults, it is more likely to be severe and recurrent.

Case presentation: We present the case of a 19-year-old female patient with recurrent steroid-dependent IgA vasculitis. She had a history of a prolonged episode of IgA vasculitis in childhood. She presented to our hospital with proteinuria and a painful, palpable purpuric rash on her bilateral lower extremities. She was treated with high-dose intravenous steroids. When steroids were tapered, the patient had a recurrence of her painful rash. Over several months, she developed steroid-induced hyperglycemia and worsening proteinuria.

Conclusion: Recent studies have shown that corticosteroids have limited effect on long-term outcomes in IgA vasculitis, but steroid-sparing agents have potential for the treatment of recurrent steroid-dependent IgA vasculitis.

Background: This study evaluated wellness programs in a large hospital network to determine residency program directors' (PDs) perspectives on their wellness programs' state, including wellness prioritization, frequency of wellness activities, and wellness' influence on decision-making across organizational levels.

Methods: In 2021, 211 PDs were sent surveys on program policies, program implementation frequency, perceptions of the administration's ability to prioritize wellness, funding sources, and perceptions of resident wellness' impact on decision-making.

Results: Among 211 contacted programs, 148 surveys were completed (70.1%). The majority reported having wellness programs, committees, and funding. Fewer than 25% reported having a chief wellness officer. PDs perceived that fellow colleagues in their institution linked wellness to markers of institutional success to a greater extent than other available options (ie, Accreditation Council for Graduate Medical Education [ACGME] requirements, budgetary concerns, resident input, core faculty priorities, and education quality). Financial well-being was perceived as least connected to wellness. Perceptions of wellness were rated across 3 organizational levels: program, institution, and organization. Across all levels, ACGME requirements (31.0%-32.8%) and budgetary/financial concerns (21.9%-37.0%) were perceived as having the most significant influence on overall decision-making, whereas resident wellness was rated lower in influence (8.0%-12.2%). Most programs allowed residents to attend mental health appointments without using paid time off (87.9%) and while on duty (83.1%).

Conclusion: The frequency of wellness activities varied greatly across programs. PDs reported challenges making resident self-care and personal development a priority and perceived resident wellness as having limited importance to decision-making at higher levels.

Description There are many studies, some discussed in this article, that recognize the numerous issues faced by women in medicine and the health care field. In response to the prevalence of these challenges, Riverside Community Hospital's General Medical Education department organized the second Women in Medicine & Healthcare Symposium on November 17, 2023. The symposium featured a panel of women leaders addressing challenges, such as work-life balance, maternity leave, fertility concerns, and family planning. Personal stories and studies on gender bias and infertility shed light on the shared experiences of women physicians. The positive response prompted Riverside Community Hospital to view the event as the first step in creating a supportive community.

Description Burnout is a complex organizational phenomenon that diminishes employee well-being and overall organizational productivity. Researchers propose that leadership style contributes to employees' well-being, which impacts employee productivity. Organizations and leaders must address the causes of burnout and promote techniques employees can use to mitigate burnout, such as employee participation in recovery experiences. Recovery experiences are non-work activities that create positive outlooks and restore the energy needed to focus on one's work. This literature review examines current research in employee recovery experiences, conservation of resource theory (COR), burnout, and transformational leadership theory. Studying burnout through the lens of COR shows how important resource gain and recovery activities are to healthy employees and their job performance within the organization. The research reviewed suggests that transformational and transactional leadership styles have higher probabilities of promoting employee participation in recovery experiences than passive avoidant leadership style. The literature consistently showed burnout as a significant organizational phenomenon negatively affecting productivity, employee well-being, and turnover rates. The literature revealed that mitigating burnout happens through participation in recovery experiences. The literature on leadership styles supports the assumption that leaders play a significant role in employee well-being, group identity, and organizational climate. Leaders who desire to mitigate employee burnout will benefit from research that links transformational leadership style behaviors and employee participation in recovery activities.

Description As part of wellness activities in 2023, our family medicine residents produced individual paintings. Samantha coalesced these 4 × 4 canvases to create this heart. The following quote is also poignant for those of us in family medicine.

Background: With long hours, significant responsibilities, and a heavy workload, residency can be an incredibly stressful experience. The aim of our study was to assess the impact of residency on mental health and wellness. A secondary aim was to determine if the post-graduate year (PGY) of the different residents impacted their mental health or ability to cope with the stressors of residency.

Methods: Residents in anesthesiology, family medicine, internal medicine, and surgery were invited to complete a survey. The first portion of the survey had residents rank their mental health on a scale from 1 to 5. There was also a short-form answer portion, which collected suggestions on how to improve wellness. An analysis of variance was used to compare the means of 2 continuous outcome variables-Patient Health Questionnaire (PHQ) and burnout scores compared across specialties and post-graduate years. Burnout scores were measured using the Oldenburg Burnout Inventory. This survey was created and validated by psychology researchers to assess burnout based on the strongest indicators of burnout-emotional exhaustion and disengagement from work. The PHQ9 survey was chosen as it has a specificity of 91-94% and is a reliable method to screen for depression, a common companion to burnout.

Results: PHQ9 scores were highest among surgery residents (7.2 ± 7.07), followed by anesthesia (6.59 ± 6.64), emergency medicine (5.57 ± 4.09), and internal medicine (4.82 ± 3.68). Scoring was also higher among PGY4-6 residents. Burnout scores were highest among surgery (37.8 ± 8.69) and anesthesia (38.17 ± 7.09) residents and among PGY4-6 residents. PGY4-6 residents had a mean burnout score of 38.55 ± 7.67 compared to 36.17 ± 8.69 among first-year residents. Similarly, the P value noted no significant difference among burnout scores across either specialty or year: .5930 and .8061.

Conclusion: There was no significant difference among specialties or years in training among their subjective ratings of depression.

Description Burnout is a prevalent and expensive problem in the US, and the National Plan For Health Workforce Well-Being included a goal to institutionalize well-being as a long-term value. Lifestyle Medicine (LM), an evidence-based practice using behavioral interventions to treat, prevent, and reverse certain chronic conditions, can achieve this goal. Implementing small changes in the workplace that support lifestyle medicine has a butterfly effect on both workplace and community well-being. Furthermore, the health of health care workers (HCWs) and patients improves, and health care costs decrease. This can be done with LM wellness programs or LM training for HCWs. LM wellness programs help the individual HCWs' and patients' well-being through the implementation of the 6 pillars of lifestyle medicine (nutrition, diet, stress reduction, social connection, avoiding/reducing toxins, restorative sleep) on an institutional level. LM initiatives, like LM training, help HCWs and their patients embark on this journey of optimal well-being, disease prevention, treatment, or reversal. Aligning policies to support evidence-based lifestyle changes that improve mood and stress reduction would support restorative rest, leaving HCWs less drained and allowing for more energy to be spent devoted to other lifestyle pillars. The Lifestyle Medicine Residency Curriculum is an example of an LM training program that leads to successful lifestyle change in residents' lives, improving their ability to coach patients. Finally, health care delivery that supports lifestyle medicine, such as shared medical appointments, is in alignment with the trend towards a value-based system for the improvement of public health.

Description Burnout among academic physicians, who navigate multiple roles beyond the clinical environment, is a pressing issue. However, the factors driving burnout among academic physicians are not fully understood. Prior research has revealed differences in burnout dimensions between clinical and basic science faculty, but the impact of balancing research, education, and clinical demands on academic physicians is still unclear. This knowledge gap negatively affects the clinical, translational science, research, and medical education workforces and has particular implications for minoritized and marginalized groups working in academic medical centers. Creating a culture of well-being has been vital in addressing burnout. Further research is needed to explore the unique experiences and demands of academic physicians- particularly those from minoritized and marginalized backgrounds-and to develop effective strategies to promote well-being as they balance diverse roles and contexts. This commentary highlights gaps in understanding burnout among academic physicians and proposes guidelines for future research as well as strategies to improve well-being at academic medical centers.