Association of Burnout and Other Factors Within Physicians and Advanced Practice Providers in an Academic Surgery Department.

BACKGROUND: Provider burnout is a work-related syndrome that is under-recognized, under-reported, and has negative repercussions on the individual, system, and patients. This study investigated burnout incidence and its association with wellness characteristics such as resilience, psychological safety, and perceptions of the workplace to inform future work in improving well-being. METHODS: Electronic surveys were sent to 153 physicians and advanced practice providers (APPs) in the department of surgery at a single institution. Survey topics included demographics, intention to stay, engagement, and items from validated measures for workplace perceptions including work pace/stress (Mini Z), burnout, psychological safety, and resilience. Descriptive statistics, bivariate associations, and logistic regression were used to evaluate responses. RESULTS: Overall response rate was 47%. The majority of providers reported feeling burned out (56%), and 48% indicated they would probably leave the organization within three years. Additionally, 61% reported being satisfied with their job and 55% felt that they contributed professionally in the ways they value most (meaningful work/engagement). Significant predictors for burnout included negative work environment perceptions (work pace/stress), low resilience, low meaningful work, and professional role (physician vs APP). DISCUSSION: Maintaining a healthy workforce requires investigation into the factors that support workplace well-being. The strongest predictors of burnout were work pace/stress. Protective factors against burnout were psychological safety and resilience. An organizational culture that promotes psychological safety, as well as workplace improvements to enhance providers' sense of meaning in work, and decreasing work pace and stress may contribute to the prevention of burnout and the retention.

Redesigning nurse practitioner clinical education with a Dyad/POD model: A feasibility study.

ABSTRACT: Clinical education for nurse practitioner (NP) students is increasingly challenging. With fewer preceptors, lack of resources and time burden, finding clinical placements is a burdensome responsibility. Also, when students have multiple preceptors, there may be inconsistencies when evaluating students. With the change to competency-based education, consistency is crucial when evaluating NP students. Typical preceptorship with students is a 1:1:1 ratio: one student with one preceptor for one semester. The Dyad/Precepting to Optimize Development (POD) model has potential to improve clinical precepting. Precepting to optimize development refers to a consistent team of students, preceptors, and faculty over the course of the students' education. Dyad refers to two students with one preceptor. Students rotate in dyad pairs every 4-8 weeks with a consistent group of preceptors, and see these same preceptors again over the course of their educational journey. Preceptors met monthly to collaborate, discuss, and learn. This article reports on the outcomes of a mixed-methods feasibility study that occurred over a year. The students, preceptors, and faculty report satisfaction with the model. Several themes arose during analysis of focus group sessions. Those themes were as follows: safe learning environment; everyone teaches, everyone learns; growth mindset; teaming culture and the POD structure is essential to the dyad. In conclusion, developing a different approach to precepting is essential to meet national provider needs. The Dyad/POD model provides consistency for development and evaluation of the NP student.

Defining Types of Leadership Within an Academic Surgery Department to Promote Change for Decreasing Rates of Burnout.

OBJECTIVES: Successful leaders influence the group they represent. Effective surgical care is tied to its leadership climate. However, most surgical providers are not attuned to their individual strengths which if known they could leverage them within their teams. This study identifies leadership types within a department of surgery which may be used to better understand and cultivate their strengths. METHODS: In 2022, 172 providers in an academic surgery department were offered the GallupTM CliftonStrengths assessment, a proprietary instrument that maps 34 strengths across 4 domains of leadership. The assessment provides a respondent with their top 5 strengths and the domain in which they naturally "lead". RESULTS: Of 172 providers, 127 (74%) completed the assessment. While providers have strengths in multiple domains, they "lead with" a specific domain. Mapped from the providers' top 10 strengths, the most common "lead with" domain for surgical providers was Executing: the ability to implement ideas and produce results. Strategic Thinking: those who are analytical and push teams forward and Relationship Building: the ability to create strong and effective teams were followed by the least common domain. Influencing: the ability to communicate ideas and lead others. Formal leaders were significantly more likely to lead with Strategic Thinking. There were no significant differences between APPs and physicians. CONCLUSION: A majority of surgical providers "lead with" the GallupTM Executing domain. Those who lead with executing skills work tirelessly to produce outcomes. Learning to leverage the strengths of our teams to create cohesion and efficiency may improve engagement and retention.

Using insulin pump for glycemic control in patients with severe insulin resistance.

BACKGROUND: Patients with type 2 diabetes using a continuous subcutaneous insulin infusion (CSII) often require large doses of insulin and need to change their insulin administration sets frequently. A proposed solution to this problem is to use concentrated insulin in their insulin pump; however, insulin pumps are programmed to administer U-100 insulin. Therefore, these patients are at greater risk of hypoglycemia and are responsible for adjusting daily doses. CASE SUMMARY: The solution for our patient encountering this problem was to administer half of his daily basal insulin via subcutaneous injection and allow the CSII to administer the remainder through automated insulin delivery (AID). When this strategy was initiated, the patient's A1C was > 14%. After 5 months of follow-up, the patient's A1C was 8.3% and he reported improved quality of life. PRACTICE IMPLICATIONS: This technique allows patients with high insulin requirements to benefit from AID without the safety risks associated with using concentrated insulin.

Introductory patient communication training for medical physics graduate students: Pilot experience.

Despite medical physics becoming a more patient-facing part of the radiation oncology team, medical physics graduate students have no training in patient communication. An introductory patient communication training for medical physics graduate students is presented here. This training exposes participants to foundational concepts and effective communication skills through a lecture and it allows them to apply these concepts through realistic simulated patient interactions. The training was conducted virtually, and eight students participated. The impact of the training was evaluated based on changes in both confidence and competence of the participants' patient communication skills. Participants were asked to fill out a survey to assess their confidence on communicating with patients before and after the training. They also underwent a simulated patient interaction pre- and postlecture. Their performance during these was evaluated by both the simulated patient actors and the participants themselves using a rubric. Each data set was paired and analyzed for significance using a Wilcoxon rank-sum test with an alpha of 0.05. Participants reported significantly higher confidence in their feeling of preparedness to interact with patients (mean = 2.38 vs. 3.88, p = 0.008), comfort interacting independently (mean = 2.00 vs. 4.00, p = 0.002), comfort showing patients they are actively listening (mean = 3.50 vs. 4.50, p = 0.005), and confidence handling challenging patient interactions (mean = 1.88 vs. 3.38, p = 0.01), after the training. Their encounter scores, as evaluated by the simulated patient actors, significantly increased (mean = 77% vs. 91%, p = 0.022). Self-evaluation scores increased, but not significantly (mean = 62% vs. 68%, p = 0.184). The difference between the simulated patient and self-evaluation scores for the postinstruction encounter was statistically significant (p = 0.0014). This patient communication training for medical physics graduate students is effective at increasing both the confidence and the competence of the participants in the subject. We propose that similar trainings be incorporated into medical physics graduate training programs prior to students entering into residency.

The use of motivational interviewing to overcome COVID-19 vaccine hesitancy in primary care settings.

Vaccine hesitancy is not a new phenomenon. However, the COVID-19 pandemic has highlighted the impact of political, racial, and health disparities on vaccine hesitancy at a global level. With the creation of the COVID-19 vaccine, a resurgence of vaccine hesitancy has emerged and many are reluctant to receive the vaccination. The reluctance varies from concerns about government interference in vaccine development, to the speed of vaccine development, to long-term health outcomes and potential side effects. Health care professionals need to consider evidence-based approaches that are effective in assisting patients with health care decision-making regarding vaccine uptake. Motivational Interviewing (MI) is an effective technique to positively impact behavior change. Definitions and examples of MI techniques are provided to illustrate how MI can be used to support patient autonomy and provide a safe and trusting environment, with the goal of increasing COVID-19 vaccination uptake.